BLENDED PROVIDER PAYMENT MECHANISM (CAPITATION-PBF) BASELINE ASSESSMENT.

JSI is a US-based public health nonprofit organization dedicated to providing high-quality technical and managerial assistance programs throughout the world. In Ethiopia, JSI has been working to improve health outcomes for more than 30 years, implementing more than 60 projects and working in every region. JSI has historically managed a large portfolio of projects focusing on the quality, and equity in access of RMNCAH services, primary health care (PHC) including community health program, digital health, health information systems (HIS), supply chain management, public health emergency responses, and social and behavior change.

USAID Quality Healthcare Activity (QHA) aims at improving health outcomes through improved readiness of health facilities to deliver quality reproductive, maternal, newborn, child, and adolescent health (RMNCAH) services, increased management and accountability for quality service delivery, and restoration of services in health facilities in conflict-affected areas. QHA’s strategies and implementation approaches will help the government of Ethiopia build public and private health care systems that are responsive, resilient, and sustainable. QHA will cover urban and peri-urban primary health care units (PHCU) and referral health facilities in select regions and woredas. The Activity, through funding support from USAID, will be implemented by JSI in collaboration with Institute for Healthcare Improvement (IHI), MSI Reproductive Choices (MSI), Project HOPE, and Network of Ethiopian Women’s Associations (NEWA) for five years (May 01, 2023 – April 30, 2028). The ultimate goal of this Activity is to improve health outcomes and sustain quality improvement efforts. With this overarching goal, the Activity aims to achieve the following three results. 

             Result 1: Readiness for, and Delivery of, Quality RMNCAH Services Improved          

             Result 2: Management and Accountability for Quality Service Delivery Strengthened

             Result 3: Health Services Restored in Health Facilities in Conflict-Affected Areas

The Ethiopian health system has been implementing a fragmented mix of provider-payment mechanisms which have not been designed purposely. The core provider payment mechanisms that are used at primary health care level are line-item budgeting and fee for service. In recent years, performance-based financing and capitation (for community-based health insurance) has been piloted in selected woredas independently. 

Blended provider payment mechanism (Capitation-PBF) combines two financing approaches in healthcare to leverage the strengths of both models while minimizing their individual limitations. The rationale behind this blended approach is to improve quality of service provision and patient satisfaction, help manage unnecessary referral, enhance data management and reporting, and strengthen the M&E framework, and address equity issues among health facilities, and contribute towards achieving Universal Health Coverage (UHC) goals. 

In collaboration with Ministry of Health (MoH) and Ethiopian Health Insurance service (EHIS), QHA has finalized contextual design for blended provider payment mechanism (capitation-PBF) to be piloted in two woredas from Oromia and South Ethiopia regions. Baseline assessment ToR is prepared to outline the scope, objectives, expectations of a project, task, or engagement and acts as a guide for everyone involved, clarifying roles, deliverables, timelines, and procedures. 

Objective 

The general objective of blended provider payment mechanism (capitation-PBF) baseline assessment is to collect and analyze data on the current status of healthcare delivery in terms of quality and quantitative data, financial resource allocation and utilization, and human resource, understand the different perspectives of key informants and the overall provider payment mechanism within the selected regions and other elements in order to establish benchmarks that will guide the implementation, monitoring and evaluation. This will create baseline from which the pilot out puts, outcomes and impact can be measured, enhancing accountability by providing concrete data for comparing expected outcomes against actual results. 

Specific objectives include: –

1. To gather data that reflects the current status of key performance indicators before the blended provider payment (capitation PBF) pilot begins and create baseline for comparing outcomes against baseline results at end of the pilot.
2. To establish the foundation for ongoing monitoring and evaluation by identifying key performance indicators and outcomes that will be tracked throughout the project
3. To analyze quantitative and qualitative data, and identify areas that require immediate attention or focus.
4.  To prepare summary report of the baseline assessment

Scope of the work 

The base line assessment will be conducted in two regions: Oromia and South Ethiopia in four woredas and all health centers in each woreda using base line assessment tool. The baseline assessment data will be collected from MoH, EHIS, regional health bureaus, woreda health office, CBHI schemes and health centers. One-year performance quantitative baseline data will be collected based on Ethiopian fiscal year (January 09, 2024 to January 08, 2025) from DHIS2, CBHI data sources, and other financial data sources. In addition to that, status of quality service provision at health centers will be collected using quality verification guide from July 08, 2024 to January 08, 2025. Key informant interview from stakeholders will be part of the data collection using structured checklist. 

Study Population

The baseline assessment will cover clients at all health centers, woreda health offices, zonal health department, CBHI schemes and regional health bureaus in the selected pilot areas, MoH and EHIS. 

Methodology

The baseline assessment will employ both qualitative and quantitative data collection methods to generate baseline data. Multiple data collection and analysis tools, instruments, and processes such as document review, clinical audit, client interview and key informant interview will be applied. 

• Structured checklist and data collection tool will be used for quantitative and qualitative data collection from all study population.
• Secondary data will be collected from the health facility registration books, regular service delivery reports, financial reports and patient chart reviews. 
• Structured questionnaire will be used to collect patient satisfaction
• Structured quality and quantity checklist within the project implementation manual will be used to assess the initial status of the health facilities in the intervention and control sites.
• All the data will be collected digitally by using data collection applications. 

Required key deliverables 

• Inception report including activity time plan
• Structured data collection checklists and electronic data collection tools.
• Cleaned baseline data before the analysis
• First draft evaluation report
• Final version of soft copy and hard copy source documents based on inputs provided
• Final report of the baseline assessment with power point

Qualifications 

The Consultant is expected to have the following skills: 

• Proven experience in conducting program evaluation and baseline assessment in areas of health financing, health system and other program areas in Ethiopia and/or international level 

• The consultant should have multidisciplinary team with advanced degree in public health, health economics and other related field, and proven experience in health system/health financing/healthcare quality improvement.  
• Background and adequate experience in research methodologies, data analysis, and report writing
• Effective verbal and written communication and presentation skills, and planning tasks. 
• Adaptability to change and problem-solving abilities.
• Proficiency in Microsoft office applications and other soft wares  

Contract details

The duration of the consultancy is a maximum of 45 days from the date of signature of the consultancy contract with JSI.

Tentative starting date:  5th February 2024

The expected level of effort (tentative):  60days

Application procedure 

Interested and qualified (individual or institution) consultants are invited to submit their proposal (s) comprising the following: separate technical and financial proposals. The technical proposal should be in single document of Word or PDF format including but not limited to:

• Consultants’ understanding of the assignment and context 

• Approach to the assignment Methodology and work plan for performing the assignment 

• Deliverables and their work plan 

• A detail of the experience of previously conducted similar assignments and capacity to undertake the assignment. 

• Recent CV including experience in baseline assessment/program evaluation in health system/ health financing/other program areas and the lead person plus three professional references including previous clients. 

The financial proposal should clearly show the budgeted cost for the work to be conducted by the consultant under the scope of work (e.g., per diem, transportation, equipment, and professional fee). 

NB: The aforementioned documents should be submitted as part of the application. Incomplete applications will not be considered. Please make sure you have provided all requested materials. 

Evaluation of applicants

Candidates will be evaluated using a cumulative analysis method taking into consideration the combination of the applicant’s technical and financial proposals. A contract will be awarded to the individual consultant/institution whose offer receives the highest score out of the below-defined technical and financial criteria. Only candidates obtaining a minimum of 50 points in the technical evaluation will be considered for financial evaluation. Therefore, financial documents will be opened once the technical part is rated above 50%.

Technical Evaluation (70%) – max. 70 point

Financial Evaluation (30%)-Max. 30 points

How To Apply

Applications Procedure:

Interested and qualified applicants should follow the below instruction and apply through the online application form no later than January 30, 2025.

1. Submit your resume and proposal to – recruitment@et.jsi.com

2. You must include the name of the position you are applying for in the subject line of the email. 

3. Any application received after the closing date will not be considered.

Application deadline: January 30, 2025