GBLCAREERS

1. CA’s health programme aims to improve health for target households and communities, particularly women, children and people with HIV and persons with disabilities in Nigeria. The programme aims to increase basic knowledge and information for marginalised groups to improve their health seeking and adoption behaviours and encourages better healthy community practices. It also seeks to improve government accountability of healthcare resources and involve target communities in policy formulation and oversight management of the Primary Health centres in line with the National Policy.

   As in most health systems, Nigeria is characterized by mixed public and private financing and delivery of care. Greater quality and access calls for further thinking on the role of the private sector into health systems and a broader systems perspective on how public and private sectors can work together to address the challenges of affordability, quality, and availability of care. Many formal sector employees currently have employee financed or subsidised private health insurance, but this access rarely reaches the poorest and most marginalised communities and populations, who tend to work in the informal sector.

   According to the World Health Organization (WHO), every year 100 million people worldwide are pushed into poverty because they have to pay in cash for medicines and treatment. Many companies are providing elements of health insurance programs to their staff, and insurance companies offer them to customers, but both avenues exclude most people and leave the poor behind due to affordability of premiums. Lowering the cost of private health insurance, as well as regulating the sector to create quality standards becomes an important objective in terms of achieving the health SDG goal 3, and especially target 3.8 on universal health coverage.

   Private providers of health care have a visible role to play in health care delivery in Nigeria. Some of these actors are more motivated by service to the public good, while others have a short-term profit and efficiency firmly in their sights, which if taken as the only objective may undermine affordability, quality and access. Though these issues are not necessarily mutually exclusive, they strongly affect the types of products and services provided, the target populations for them, and their quality.

   The private sector contribution to health care in Nigeria is often mired with weak oversight management, where roles and responsibilities are not well stated and the underlying benefit to the poor has not been effectively actualised.^[1] Our involvement in community health work has always included an element of advocacy in improving health systems, included also in Christian Aid’s corporate strategy, Partnership for Change, which states that “We believe business interventions must be effectively regulated and form part of an integrated national strategy in the provision of quality and equitable services.”

   Christian Aid seeks to harness the power of the private sector, balancing its significant power with that of other stakeholders and influencing business practices to meet the development challenges we face.

   2. OBJECTIVE

   The overall objective of this research is to provide a well-documented analysis of the role the private sector plays in Nigeria’s health care system looking at access, affordability, quality and standards and make a set of clear recommendations on how Christian Aid could strategically engage the private sector to expand health access to the base of the pyramid.^[2] These should include short term recommendations to inform Christian Aid’s current health strategy and long term recommendations to grow CA’s health programme portfolio in Nigeria.

   3. SCOPE OF WORK

   The geographical scope of this study is the following states: Abuja FCT and Lagos State.

   Activity 1: Provide analysis on the role the private sector plays in providing and funding healthcare in Nigeria. Conduct a short literature review on what research already exists on this subject. Look at national statistics in achieving SDG goal 3, and indicator 3.8 on universal health coverage as a top line goal. Look, specifically at four types of private sector actors, 1) private hospitals/clinics, 2) private health insurance providers, 3) companies, including corporate foundations who fund health care programmes and 4). Identify approximately 3 key actors for each group^[3].

   For each key player, please refer to:

   Group 1: private hospitals / clinics / surgeries:

2. Size, nature and location of business.
3. What type of a business are they: single provider, national chain, international company?
4. What is their core business activity, opportunities / challenges to their business?
5. Number of patients treated by gender, age, other socioeconomic factors.
6. Was the patient covered by health insurance, or paying out of pocket, other means?
7. Average payment out of pocket, or out of pocket supplement for those covered.

Group 2: private health insurance providers, social health insurance (SHI) providers:

• Size, nature and location of business.
• What type of a business are they: single provider, national chain, international company?
• What is their core business activity, opportunities / challenges to their business?
• Number of individuals who are covered in their health care plans, by gender, age, other socioeconomic factors.
• Are they covered via their employer, or has the person sought health coverage individually, or is insurance partly paid by government / donor grants?
• Average payment on a health insurance plan per month, any supplements that person needs to pay out of pocket when accessing health care facilities.

Group 3: companies, including corporate foundations, who fund health care programmes:

• Size, nature and location of business.
• What type of a business are they: SME, national, international company?
• What is their core business activity?
• What are their drivers for funding healthcare programmes e.g. CSR? Strategic interest e.g. need for healthy workforce?
• What type of healthcare projects have they funded and where?
• Identify operating modalities for implementing their health interventions.

Activity 2: Provide a list of common (supply and demand) private sector health interventions in Nigeria. Include both best and poor practice examples and an analysis of lessons learned. Provide a list of collaborative interventions between the non-profit sector, the private sector and/or government. Analyse what worked well and why. Are there opportunities to develop models that leverage formal and informal private sector innovation in the financing and provision of health services for the poor? Are there opportunities to assist the most promising businesses and models, either directly or by enabling increased technical assistance and funding flows. Provide a set of clear recommendations that could inform CA’s health programmatic work beyond 2017.

Activity 3: Analyse the policies, regulations and laws that impact on the role the private sector plays in the Nigerian health eco-system. Identify core policy and advocacy concerns related to private healthcare provision. Use political economy analysis to understand the relationship between the government and the private sector in the health eco-system. Who are the influential decision makers and who do their decisions benefit? What networks or regulatory agencies exists and how do they interact with one another? Conduct a brief power analysis to identify the most efficient entry points for in-country advocacy work. Analyse which private providers are particularly influential in relation to government policy. Are there opportunities for CA to facilitate dialogue or foster collaboration between the private and public sector to deliver improved health outcomes? Are there ways in which CA could harness the power of the private sector by supporting awareness of the extent and neglect of health systems? Provide a set of clear recommendations that could inform CA’s next health strategy beyond 2017.

Activity 4: Drawing from the analysis conducted in Activities 1, 2, and 3, identify suitable funding, programme and/or advocacy private sector partners (national and international) for 1) Christian Aid’s current health work in Nigeria and 2) CA’s health strategy beyond 2017. Provide a set of clear recommendations, based on sound evidence, to inform CA’s private sector partnership strategy.

4. METHODOLOGY

In the proposal, the Consultant(s) should clearly explain the methodology to be used. However, as a minimum the consultant should:

• Conduct a detailed desk review of key documents such as relevant national policies and laws, government development strategies, NGO reports on universal health coverage, and plans and UN Sustainable Development Goals, and World Health Organization documentation on Universal Health Coverage and Access to Medicines.
• Familiarise themselves with CA policies and guidelines on relevant topics, such as CA’s Community Health and HIV Framework, country and programme strategies, project progress reports, project completion reports, annual reports and other relevant publications (to be provided by CA).
• Consult with target groups and other relevant stakeholders (e.g. key private sector players, relevant ministries, local government, other national and international development agencies) at various stages.
• Conduct visits to the possible geographical areas of operation, and with actors from the three groups, outlined above, in the private health care ecosystem
• Provide a list of potential private sector partners (fundraising, programmatic and advocacy) and suggest how they might strategically contribute to the programme
• Provide a list of people (with contact details) met during the study

The Consultant(s) will be expected to engage with CA staff throughout the assignment. Several meetings with relevant CA staff during the research and a debriefing should be considered as an important part of the methodology, including for example, a briefing on the ToR, frequency of progress meetings to review emerging issues, trends and priorities and a debriefing, etc. The Consultant(s) should also be open to being accompanied by CA staff to meetings with key external stakeholders and should expect to present and discuss the findings of the research to an external and internal audience.

The Consultant(s) is/are expected to provide a detailed methodology for conducting a context analysis based on the TOR. The methodology/the proposal of the Consultant(s) should cover all the services described in the TOR.

5. OUTPUT

A final report should be submitted no later than 12 April, 2017. The report should be no more than 40 pages and should be in English, with an executive summary and a set of clear and detailed recommendations. The report should be broken into 4 chapters, reflecting the four activities outlined above. The content should be well structured and clearly written. The document should provide statistical information and refer to reliable materials/reports/documentation developed by local and international organizations, state agencies, private sector and others sources to make evidence to statements and conclusions in the report.

The Consultant(s) will be expected to present and discuss the findings of the research with key external stakeholders in a workshop, upon completion of the final report. The Consultant(s) will also be expected to attend an internal strategy development workshop with CA staff.

6. DURATION AND LOCATION

Location: Based in Abuja but be willing to travel to other states, particularly Lagos state.

Start Date: 14 March 2017

No. of days: 30-32 days.

7. CANDIDATE SPECIFICATION

• Minimum of a postgraduate degree in Public Health, Health Economics, International Development, Business Administration, or equivalent level of work experience.
• Significant experience and knowledge of the healthcare system in Nigeria, with particular expertise in the private health sector.
• Sound knowledge of international development and the role civil society plays in the health sector in Nigeria
• Demonstrable experience and knowledge in research, including critical analysis, political economy analysis and policy and power analysis. Must also possess strong report-writing skills (Candidates will be required to provide samples of previous studies including reports).
• Excellent communication skills – verbally and in writing. Confidence and ability to represent/ present to senior stakeholders across multiple sectors e.g. government, private sector, civil society
• Ability to work collaboratively with other stakeholders e.g. with CA programmes and policy teams.

[1] International Finance Corporation (IFC), The Role of the Private Sector in Expanding Health Access to the Base of the Pyramid. (Health Team: Washington DC, 2012).

[2] According to the World Bank, the ‘Base of the Pyramid’ refers to those living on less than US$8 PPP per day or those who lack access to basic goods and services.

[3] A key actor is a business which is highly relevant to the functioning of the health system, and/or has a high degree of power or influence to bring about change in the health system.