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TERMS OF REFERENCE

Agreement for Performance of Work

Purpose

The purpose of this assignment is to support Ministry of Health in its one year pilot initiative on health insurance scheme known as the “Sehat Sahulat” by acting as an independent third party to carry out monitoring and evaluation of each stage of implementation of the pilot study including pre-pilot baseline study and post intervention survey to ensure that the pilot study is conducted as per detailed proposal submitted to and approved by the Ministry.

Background

The SRHR Project/Initiative and the Sehat Sahulat Program (SSP)

In January 2019, World Health Organisation (WHO), signed a four-year donor agreement to implement the Initiative “Supporting country strategies to reduce maternal mortality and achieve Sustainable Development Goal (SDG) targets through a health systems approach” which is known as the Sexual Reproductive Health and Rights (SRHR) Initiative. The SRHR Initiative supports countries to make progress toward achieving universal health coverage (UHC) and meeting their SDG targets, particularly with reference to reduction of maternal mortality (SDG 3.1), universal access to sexual and reproductive health care services (SDG 3.7) and sexual and reproductive health and reproductive rights (SDG 5.6).

One of the activities in the Initiative’s 2020 workplan in Pakistan is to support the Ministry of National Health Services Regulation and Coordination (MoNHSR&C) to initiate pilot test of an Outpatient Health Insurance programme to provide access of SRHR services to poor families through private practitioners. MoNHSR&C in Pakistan has established a Health Insurance Programme known as Sehat Sahulat.

Sehat Sahulat Program (SSP) is a social health protection initiative of Federal government in Pakistan working to provide financial protection to poor and vulnerable families against catastrophic health expenditure. Through this program free of cost health insurance is provided to families to access cash less indoor health care services (only), both secondary and tertiary, from any empaneled hospitals across Pakistan. Currently, 9 million families in 93 districts of Pakistan have been enrolled in both Federal and Provincial programs and it is expected that a total of 15 million poor and under privileged families in all districts will be enrolled in the program during next two years.

The existing Sehat Sahulat Program scheme is and continues to play a vital role in Pakistan, providing invaluable coverage and financial protection to millions of poor households through the provision of inpatient services at secondary and tertiary (priority treatment) level and can be considered as a key building block as the country moves towards UHC[1]. However, Out-Patient services (OP) / or outdoor services at Primary Health Care (PHC) level which mainly includes sexual and reproductive health, maternal child health, family planning, neonatal care, nutrition, adolescent health, non-communicable diseases (NCDs), communicable diseases, palliative care etc. are not part of the existing model and this is a gap in the existing coverage and financial health protection scheme implemented by the government of Pakistan. Implementation of UHC in ICT provides an opportunity to address this gap.

Through innovation in management of a private sector network of service providers (general practitioners) in an area where no public sector PHC facility exists through a contracting out mechanisms, the proposed project for the first time in Pakistan intends to integrate Out-Patient services (OP) including reproductive and family planning services to the already existing Sehat Sahulat Program (a national health insurance program) at PHC level, thus envisioning to expand coverage and access to the poorest of communities and ensure equitable health service delivery in fragile settings in the country through the provision of financial protection. Through this initiative a system of referral-upward and referral-downward (gatekeeping) will also be developed and strengthened through which follow-up of the patients are to be ensured. The private sector in Pakistan is accessible and well trusted by people and must be a partner to play its role for effective delivery of essential healthcare services, where feasible. The private sector can be a major provider of essential services where public sector has capacity (human resources/coverage) constraints.

For this purpose, the Ministry of National Health Services Regulation and Coordination SSP has partnered with a private sector service provider on SRHR in the implementation of this pilot project.

However, the services of the implementing partner and the impact of the interventions need to be closely monitored by an independent third party who will assess and document baseline situation and impact of the initiative at the end of the designated implementation period.