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1. Purpose of the Consultancy
The purpose of this consultancy is to generate baseline estimates of out-of-pocket (OOP) health expenditures per capita in Syria by assessing household spending on key health services and goods, including consultations, medicines, diagnostics, hospitalizations and informal payments. The focus is exclusively on quantifying the level and distribution of OOP spending to provide a credible picture of OOP expenditures as contribution to the estimation of private spending as a foundation for Syria’s National Health Accounts.
2. Background
More and more countries around the world are producing and using national health accounts (NHA) as the system to track and monitor health expenditure. SHA guidelines 2011 is the most up to date globally accepted tool to assess this. In addition, the Health Accounts Production Tool (HAPT) has been developed to facilitate the process.
In the context of the ongoing efforts for post conflict health system recovery and to get a clear picture of the health financing situation, the Syrian MoH has decided, in collaboration with the World Health Organization to assess health expenditure using National Health Accounts (NHA). The study will not only assess the overall health expenditure but will also allow for internal comparability among different subnational units (e.g. Governorates) which will help in assessing equity in the use of resources. This assessment will also contribute to the development of realistic budgets. As part of this, and to fulfil priority urgent needs for information, Ministry of Health has requested WHO support to estimate the OOP expenditure using rapid assessment methods.
3. Objectives
• Collect and analyse OOP data built on previous studies and Global Health Expenditure database set
• Measure the magnitude of OOP health expenditure among households in Syria
• Identify the main expenditure drivers (e.g. consultations, medicines, diagnostics, hospitalizations, informal payments, transport, etc.).
• Provide policy recommendations to reduce OOP burden and strengthen financial protection in the Syrian health system.
4. Main activities and scope
Overall, the activities foreseen are expected to contribute to a better understanding of private spending on health in Syria. The Consultant will also facilitate transfer of skills to local counterparts by maximizing time spent at MoH working together with MoH staff in each step of the process. He will also provide remote mentoring while away.
It is agreed that the WHO health financing expert should address the following:
• Step 1: inception
o Inception report including expected number of local travels, workshops and timeline.
• Step 2. Preparation
o Document review: review existing reports and data.
o Define sampling strategy including target groups representing the main different strata (e.g. urban/ rural, IDPs / host, etc.)
o Define needed rapid surveys sampled selectively
o Design and test survey tools (e.g. household questionnaire, key informant guide, etc.)
• Step 3. Data Collection
o Training data collection teams
o Conduct assessment of health service expenditure using rapid methods such as providers survey, exit interviews, health survey and donors/NGOs survey
o Carry out a few focus groups or KI interviews for qualitative insights.
o Gather secondary data (e.g. prices, subsidies) from NGOs/UN agencies, private providers, etc.
• Step 4. Analysis
o Analyse data calculating average per capita OOP spending and main cost categories
o Triangulate with existing data
• Step 5. Reporting & Policy Dialogue
o Produce a report and a policy brief
5. Expected outputs
• Household survey dataset on OOP health expenditures.
• Analytical report with findings
6. Deliverables:
• Inception report (after first week)
• Data collection tools (end of work)
• Dataset (end of work)
• Analytical report (end of work)
• Policy brief (end of work)
• Mentoring of MoH staff (in-person and remotely) for the duration of the consultancy.
7. Fees: based on national staff salary scale - NOD
8. Payment terms: based on deliverables or monthly.
9. Planned timelines: 50 days consultancy work
10. Technical Supervision
The selected Consultant will work under the supervision of:
Responsible Officer: Dr Alvaro Alonso-Garbayo
Manager: Ms. Christina Bethke
11. Specific requirements
Educational Qualifications:
Essential: Advanced university degree (MSc) in Economics, public health or related discipline
Desirable: Doctorate degree in health economics
Experience required:
Essential: at least 7 years of experience in health economics at senior level including work related to health expenditure assessments such as national health accounts
Skills / Technical skills and knowledge:
- Good knowledge of the setup in Syria’s health system with particular attention to healthcare financing
- Good communication, research, analytical and writing skills
Language requirements:
English & Arabic proficiency required
12. Place of assignment
Hybrid - Remote/Damascus, Syria (with eventual local travel)
13. Medical clearance
The selected Consultant will be expected to provide a medical certificate of fitness for work.