Project Overview and Role
- The Integrated Health Program (IHP) is a USAID-funded five-year project with a mandate to improve health systems, improve access to and increase quality of primary health care in designated states (Sokoto, Bauchi, Kebbi and 2 other states to be determined). IHP is working with state governments to strengthen and advance the operationalization of State Health Insurance Schemes toward the attainment of universal health coverage.
- IHP aims to improve the enabling environment for equitable and sustainable health services, supplies, and delivery systems through policy development and implementation, with an emphasis on voluntary, rights-based health programs. IHP will help public health and policy leaders attach higher priority to their national and sub-national health needs, secure sustainable financing, advance health equity, and monitor policy implementation to ensure gains stay on track.
- IHP aims to secure long-term enduring change by working with coalitions both inside and outside of health and showing common cause with neglected populations and other development actors. Central elements of IHP revolve around building in country capacity, institutionalizing achievements of past investments, and promoting country ownership of programs and initiatives.
- The Decentralization of the National Health Insurance Scheme (NHIS) and consequent establishment of State Health Insurance/Contributory Schemes (SHIS) across the country is one of the key policy thrusts of the Government of Nigeria aimed at reforming the health financing landscape for a stronger health system and improved health outcomes. To realize this laudable reform effort, IHP shall be supporting the Bauchi, Kebbi and Sokoto states to put in place necessary design elements for the effective roll-out and implementation of the various State contributory health schemes (SCHS).
- In Sokoto State, the law establishing the Sokoto State Contributory Health Scheme (SOCHEMA) has been passed and a Director General has been appointed to head the Sokoto State Contributory Health Care Management Agency (SOCHEMA). With support from erstwhile USAID projects, the state has developed several technical documents including the operational guidelines, establishment plan, funds management guidelines, and conducted health financing analytics (Fiscal Space Analysis, Actuarial analysis) to guide evidence-based and context appropriate pre-payment design. It is anticipated that the State Contributory Health Scheme will take off by January 2020.
- The IHP project which aims to partner the State Government and other stakeholders to sustainably improve health outcomes has identified the establishment of a prepayment health mechanism as an important approach for achieving sustainable financing for health, increasing access to critical health services and improving financial risk protection for the populace. Based on this, IHP further recognizes the need for organizational and technical capacity to effectively implement the SOCHES, hence health insurance operations and technical assistance.
- This consultancy aims to provide technical assistance to roll out and operationalize the Sokoto State Health Contributory Management Scheme by embedding an experienced health insurance expert within SOCHEMA to guide health insurance technical operations and to build the capacity of the team.
- To support the agency to implement an effective health insurance scheme, the Technical Assistance consultancy will provide technical support towards development and effective execution of technical processes, especially processes contained in the SHIS laws, operational manuals, and other documents as may be required and provide capacity building and hands-on support to the staff of the agency throughout the consultancy period. The IHP work plan contains specific deliverables related to developing an enrolment plan and providing capacity development on claims management and reimbursement functions.
Roles and Responsibilities
- The consultant is expected to contribute to the successful roll out and operations of the SOCHEMA Schemes by working with agency and the Sokoto State Ministry of Health leadership to put in place necessary structures that will guarantee delivery of services to enrolees, ensure continuous quality improvement and capacity building for staff of the agency to implement the scheme. See deliverables tables for more details.
- The consultant is required to be embedded in Sokoto State functioning directly in the SOCHEMA office for the period of consultancy.
The major products and outcomes of this assignment are;
- SOCHEMA policy review report detailing goals, objectives, status, challenges, opportunities and recommendations.
- SOCHES roll-out plan/roadmap
A complete package of Operational Guidelines, SOPs and Tools covering core insurance processes including but not limited to:
- Guidelines and Standard Operational Procedures:
- Claims management guidelines
- Key performance indicators
- Integration of vertical programs into health insurance programs
- Reporting requirements
- Resource mobilization document
- Enrolment plan
- Equity fund use
- TPA/HIA engagement
- Facility selection and accreditation
- Service level agreements
- Operational Tools:
- Accreditation tool
- Quality Assurance Tool
- Encounter/ Utilization Tool
- Claims forms
- Recommendations for ICT design, scope and requirements
- Staff capacity building plan and completed skills development training to SOCHEMA covering but not limited to accreditation, enrolment, empanelment, provider management, claims management and reimbursement processes
- Availability of a quality management framework for the Scheme
- Performance management system for SHIS operations established
- Enrolment plan for prioritized state sub-population groups
- Monthly update reports
- Final consultancy report.
- This is a firm fixed price deliverable-based contract. The consultant is expected to satisfactorily accomplish the deliverables before he/she gets paid for that deliverable. Interested individuals and companies should email: to request a copy of the full Request for Proposal for this consultancy. Applications submitted through the link on this page will not be accepted.
- A good first degree or its equivalent from a reputable University in Medicine, Sciences, Social Sciences, or numerate disciplines such as Actuarial Science, Statistics, Insurance, etc.
- Post graduate qualification in Management, Public Health, Health Management, Health Economics, Insurance or other related fields
- Certification in and/or professional membership of Health, Management and Health Insurance related bodies shall be an added advantage
- Minimum of 7 years’ experience implementing health insurance in Nigeria or related settings.
- Experience working with an HMO that implements a health insurance scheme (preferred).
- Expertise in claims management and reimbursement best practices
- Experience in developing and delivering capacity building workshops on Health insurance implementation
- Experience in developing and executing insurance enrolment plans
- Good understanding of current health financing reform initiatives in Nigeria especially the subnational level;
- Expertise in Health insurance operations
- Experience carrying out similar assignments in Nigeria particularly at the sub-national level.
Required Technical Competencies:
- Familiar with results-based management.
- ICT for Health Insurance operations.
- Knowledgeable of change theories and health system approaches
- Proven success in capacity building through coaching and mentoring.
- Strong and proven English writing skills with experience writing government policy documents, guidelines, etc.)
- Expert in capacity development for Universal Health Coverage (UHC) and social health insurance.
- Analytical skills
- Leadership and coaching skills
- Good interpersonal skills
- Good communication skills (negotiation, moderation, representation, presentation of results)
- Strong oral and writing skills in English
How to Apply
Interested and qualified candidates should:
Application Deadline: 7th November 2019.