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Terms of reference

Situational analysis: Service delivery models and purchasing arrangements for family planning services in Pakistan during and beyond COVID-19

Background and Rationale

The COVID-19 pandemic has contributed to family planning (FP) disruptions for millions of women and girls across the world (UNFPA, 2021). The situation in Pakistan is similar to other LMICs, where pre-COVID, existing unmet need for FP was high and the situation intensified with the onset of the pandemic, where access to FP and other essential services decreased.

In contexts of increasingly limited resource availability, there is an imperative to improve value for money and efficiency, while at the same improving access to SRH services without financial hardship. Moving towards more strategic purchasing (SP) is therefore higher than ever on the policy agenda, as it is increasingly recognized for its potential to improve performance of healthcare providers while incentivizing efficiency and quality in service provision.

SP arrangements have been key policy instruments that were leveraged to face evolving challenges since the start of the pandemic. Earlier in the pandemic, the primary policy objective was to primarily avoid potential disruptions in service provision for COVID-19 patients. There were and continue many potential underlying reasons. These include amongst others, gaps in entitlements to services, benefit design and specifications, potential funding and constraints in cashflow at health providers’ level arising from inappropriate provider payment and contracting modalities. Such modifications in purchasing arrangements have not been without consequences for the way FP services are financed, provided and accessed. Later in the pandemic, purchasing arrangements have been further adjusted to streamline / institutionalize COVID 19 service provision including integration in benefit package and successive adjustments in benefit design, provider selection, contracting modalities and payment rates. This was not only in response to aligning it with increasingly constrained budgets but also to some extent, to address the unintended consequences of the displacement of non-COVID 19 essential services (including FP services).

Purpose of situational analysis

The purpose of the situational analysis is to strengthen evidence of the pre-COVID and current status of FP programmes and services (both demand and supply), their purchasing arrangements and the enabling environment which include leadership and coordination of the different programmes as well as relevant policies and regulations.

The situational analysis will in turn inform an implementation research agenda, developed in collaboration with national stakeholders and local research partners to design, test and implement SP reforms for improving access to quality FP services during and beyond COVID-19.

Objectives of situational analysis

The team of APW Holders are expected to conduct a situational analysis (pre-and post- COVID-19) that will answer the following questions of the purchasing arrangements for FP in Pakistan over the past 10 years and make recommendations:

Pre- COVID-19:

1. What is the purchasing landscape for FP (i.e. detailed mapping of key purchasers, purchasing arrangements), how have these purchasing arrangements evolved ((both in terms of design and implementation) over time, what were the underlying drivers of changes and how effective have these changes been?

2. What are the service delivery models of care for FP, how they have evolved and their performance (i.e. access and utilisation) over time and what have been the factors (both supply-and demand-side) driving change?

Post- COVID-19

3. How has access and utilisation of FP services changed in response to COVID-19 and what have been the factors driving the change?

4. What have been the key timelines in the COVID-19 national response and in response the key changes in service delivery and purchasing arrangements for FP?

Recommendations

5. Against the backdrop of the pandemic which has resulted in new challenges, alongside pre-existing ones, what are the most appropriate models of care to improve access and uptake of FP services, paying attention to specifically creative approaches for aligning and ensuring services are responsive to the needs of local and especially hard to reach groups?

6. How should the existing purchasing arrangements be adapted to promote these models of care for FP?

Methodology

The methodology for the situation analysis involves primarily a desk review (i.e. secondary data analysis) and will be complemented with primary data from key informant interviews, which may require travel to the location of the key informants. Based on the initial desk review and interviews, there may be a need for more detailed mini-case studies that focus on specific changes in the purchasing arrangements or on a specific district (where several concomitant or successive interventions have been tried out)

The APW Holders are expected to establish an implementation plan to effectively carry out the data collection and preliminary analysis.

Scope of Work

The following serves to guide the minimum expectations and deliverables to the assignment. The APW Holders will provide the services and deliverables outlined below and are expected to propose the timelines and duration for each activity.

Activities

Deliverables

Activity-1: Draft an inception report that will reflect the methodology, conceptual framework, available data sources, schedule and timelines.

Deliverable: Inception report.

Activity-2: Draft protocol for technical and ethics review by WHO /HRP research project review panel (RP2) and WHO ERC respectively.

Deliverable: Protocol for technical and ethics review.

Activity-3: Collect relevant documents for desk review on country-specific literature on FP and SP.

Deliverable: Documents and literature for desk review.

Activity-4: Participate in periodic meetings to review progress of data collection activities with WHO staff in Headquarter and WHO Country office Pakistan, Transcribe all interviews.

Deliverable: Prepare and present final list of key informants and their roles, record, store, and share all interview raw data with WHO, including transcriptions

Activity-5: Present preliminary findings.

Deliverable: Responses to all requests for input on analysis, submit a detailed first draft report of results.

Activity-6: Participate in dissemination meeting sharing first draft report.

Deliverable: Presentation of first draft report of results.

Activity-7: Produce final report of the situation analysis, integrating feedback and comments received on the first draft.

Deliverable: Final report of the situation analysis.

Timelines

10 January- 30 April 2022

Payment Schedule

Payments will be made on received deliverables according to the following schedule:

Payment - Conditions

Inception report (30%) - Upon receipt of a satisfactory report

First draft report and presentation (30%) - Upon receipt of a satisfactory report and presentation

Final report and Presentation (40%) - Upon receipt of a satisfactory report and presentation

Project management

The APW Holders will work closely with WHO (Departments of Sexual and Reproductive Health and Research and Health Governance and Financing in HQ) and WHO Country Office, Pakistan who will serve as resource persons including facilitation of data and information gathering and making logistical arrangements for stakeholders’ consultations.

Location

Islamabad with travel to provinces/areas as required.

Team/institutional specification

The individuals in the team or institution should demonstrate combined qualifications, experience, knowledge and skills in the following areas.

Educational qualifications

• Essential: Advanced level university degree in health financing, sexual and reproductive health or another related field

• Desirable: Studies or specialization in public health, sexual and reproductive health or health systems with a focus on health financing.

Relevant experience

• Essential: At least 10 years of experience in sexual and reproductive health and health financing in Pakistan and global level.

• Desirable: Experience in health and development programmes at country or regional levels, as well as with WHO, other UN agencies or with an international organization.

Knowledge and skills

• Knowledge and understanding of key issues in sexual and reproductive health and health financing.
• Strong interpersonal skills and the ability to work and communicate effectively with a wide range of stakeholders.
• Work independently and coordinate collation of information from multiple stakeholders.
• Ability to produce high-quality outputs whilst working to short deadlines.
• Demonstrated experience in senior-level health working groups at the global and national levels

Language skills

Excellent spoken and written English and Urdu.

To Apply:

Interested applicants are required to submit a technical proposal with writing sample and work plan for the assignment deliverables along with updated CVs of team as well as financial proposal including realistic budget breakdown.

Do not apply online. The Proposals are required to be submitted in sealed envelopes on the following address with the title of assignment on envelope by 19th December 2021.

Address: c/o Team Lead HPLC, Promoting Health through the Life Course (Room No .6), WHO Country Office Pakistan, Park Road, Chak Shahzad, Islamabad-Pakistan