Nigeria State Health Investment Programme (Nship)

Section 5 –Terms of Reference 1

Section 5: Terms of Reference

NIGERIA STATE HEALTH INVESTMENT PROGRAMME (NSHIP) TERMS OF REFERENCE FOR RESULTS BASED FINANCING TECHNICAL ASSISTANCE (RBFTA)

A. BACKGROUND

The Federal Government of Nigeria has received a credit from the International Development Association (IDA) towards the cost of implementation of the Nigeria State Health Investment Project (NSHIP), The National Primary Health Care Development Agency (NPHCDA) an Agency of Government responsible for managing some aspects of the credit, intends to apply part of the proceeds for payments for services including appointment of Consultants for the Results Based Financing Technical Assistance (RBFTA). The overall objective of the project is to introduce payment for outputs as opposed to input financing into the Nigerian health system as means of attaining the health MDGs The following Terms of Reference (TOR) is therefore developed for a consultancy firm or firms that will be required to perform the service.

Despite several decades of financial and human capital investments, Nigeria has made only limited progress in delivering key health interventions and the country still lags behind on meeting the MDG targets. Bold innovations and reforms that increase the focus on results and address ineffective incentive structures are required to improve health in Nigeria.

The Nigeria State Health Investment Project (NSHIP) aims to address two key challenges encountered in the current Nigeria portfolio (i) How to enhance the focus on results; and (ii) How to shift the Bank’s strategic focus to a few states in order to demonstrate improved health outcomes. The project will: (i) test the effectiveness of results based management tools through programmatic financing linked to a set of disbursement linked indicators (DLIs) at state and local government level and Performance-Based Financing (PBF) for health facilities; (ii) build social accountability through community management of health facilities and performance measurement of health outputs and (iii) invest in strengthening monitoring and evaluation (M&E) mechanisms. These pilot innovations will be carefully evaluated using rigorous methodologies and implemented at a sustainable level of expenditure. Lessons learned from these large scale pilots will provide the basis for quickly scaling up successful interventions. The project will be implemented in three states (Adamawa, Nasarawa and Ondo).

The proposed project is a performance-based loan in the amount of US$ 170 million aimed at improving delivery of high impact primary health care services. Key features of the project include: (i) Agreement on a series of Disbursement Linked Indicators (DLIs); (ii) Disbursement to Local Government Authorities (LGAs) against clear performance criteria; (iii) A facility based Performance Based Financing (PBF) pilot in half of the LGAs; (iv) A Decentralized Financing Facility (DFF) which provides facilities operational funds, strengthened supervision and will serve as counterfactuals for the PBF. (v) Disbursement conditioned on each states spending money according to an Eligible Expenditure Program (EEP), and (v) Traditional project inputs for technical assistance to states. (vi) Validation of results through annual health facility assessments and rapid household surveys by a third party Monitoring & Evaluation (M&E) firm (vi) . Facility- level outputs and quality will be verified independently on a monthly (quantity) and quarterly (quality) basis and will be the basis for performance-based payments to PBF facilities and their staff.

This Terms of Reference is for a Results Based Financing Technical Agency/ Firm to support the National Primary Health Care Development Agency (NPHCDA) and the Project States (Adamawa, Section 5 –Terms of Reference 2

Nasarawa and Ondo) to introduce Results Based Financing approaches. The NPHCDA will enter into a contract with a Results Based Financing Technical Agency (RBF-TA) to support development and implementation of the RBF elements and roll out. Details of the project implementation framework and phasing are laid out in the Project Appraisal Document.

B. OBJECTIVES OF THE CONSULTANCY

This consultancy aims to provide technical assistance to operationalize the RBF project at the NPHCDA and in the states of Ondo, Nasarawa and Adamawa. To help the states implement the project, the RBF-TA will design and define operational procedures for the results based financing components (the DLIs; DFF and PBF) and build institutional capacity of the NPHCDA/SPHCDA to carry out purchasing, verification and oversight functions, and assist the States and the LGAs to make operational its DLIs/scorecards through an advisory function.

C. GENERAL APPROACH i. The RBF-TA will support the implementation of Results Based Financing within the 3 NSHIP states (Adamawa, Nasarawa, and Ondo) by working closely with the National Primary Health Care Development Agency (NPHDCA) and the 3 States. The implementation design will be guided by the experience gained during the pre-pilot phase ( December 2011 onwards). ii. The RBF-TA will establish technical support units within the States (in the SPHCDA). iii. The RBF-TA will support the SPHCDA to function as a purchaser of services from individual health facilities. It will support the SPHCDA to verify the validity of these services based on results from independent monthly quantity and quarterly quality assessments prior to payment. It will support the SPHCDA in carrying out the coordination and capacity building tasks, which are part and parcel of such scaled up Performance-Based Financing (PBF) systems; iv. The State RBF technical support units will organize independent verification mechanisms to ensure careful and independent monitoring of the outputs claimed by the facilities and as certified by the ex-ante verification mechanisms. (These are the ex-post verification mechanisms: the so- called counter-verification of reported results; (a) community client satisfaction surveys and (b) independent or transparent counter-verification of reported quality performance); v. The RBF-TA will provide support and provide guidelines for supervision of the DFF LGAs; vi. The RBF-TA will ensure that the administrative set-up, and the institutional arrangements as designed by the States, and guided by the experience of the pre-pilot LGAs are implemented, including its cloud-computing solution; vii. The RBF-TA will collaborate intensively with the overall impact evaluation design; its planning; its household surveys and the various qualitative surveys. The IE will be conducted through a separate TA contracted by the FMOH. viii. The RBF-TA will provide technical assistance to the states and local government on the disbursement linked indicators (DLIs) and support them to achieve the DLIs

D. KEY PRINCIPLES: Section 5 –Terms of Reference 3

The aim of the RBF Pilot is to: i. Pay for results as opposed to the traditional input financing; ii. Introduce a minimum package of services and a complementary package of services with an emphasis on MDGs 4 and 5, whilst increasing the population coverage of these packages; iii. Improve the quality of care provided in select project facilities (Health Centers and General Hospitals) whether public, private non-for profit or private for profit facilities; iv. Reach the poorest members of the community with effective health services and to increase equity in access and use of both preventive and clinical services; v. Collect evidence based information on the impact of Performance-Based Financing in the Nigerian context and in case PBF shows results, to collect actionable information for scaling-up such systems throughout the country.

E. MANAGEMENT i. The RBF-TA will have the opportunity to assist the NPHCDA and the States to implement the RBF project with sufficient managerial autonomy so they can flexibly respond to local conditions, introduce innovations aimed at achieving the stated objectives, and be held accountable for the results. ii. The RBF-TA will be paid for its technical and management services. Management of the RBF funds for outputs will be managed by the Project Financial Management Unit (and other future fund holders). The RBF-TA will support the PBF purchaser role (which includes the contract management, the strategic purchasing, the verification and counter-verification of results and the capacity building and coaching roles). iii. The RBF-TA will report to the National Project Steering Committee, the Executive Director of the NPHCDA and the Executive Director/Chairmen of the SPHCDAs at the state level.

F. SCOPE OF SERVICES

The firm/organization will need to partner with appropriate local organizations (civil society; university, or research institute, etc) in each of the three States to carry out the scope of services as defined below. Knowledge and Capacity transfer of Performance-Based Financing purchasing, verification and coaching tasks will be an important evaluation criterion.

The scope of services for this consultancy includes the following: i. Operationalize the RBF monitoring and evaluation and capacity building activities as described in the PBF manual and Project Implementation Manual (PIM); ii. Assist the States to set up a State/SPHCDA RBF Technical Support Unit that can support the State/SPHCDA to carry out purchasing, verification and oversight functions described above; iii. Develop a manual of procedures - based on the draft PBF user manual developed in the pre- pilot PBF LGA - acceptable to the Government and the World Bank that will govern the implementation of PBF. The manual of procedures should cover procedures and tools for record keeping by facilities, the contracts used, results verification and counter verification mechanisms, business plan and indice tools, funds disbursement and accounting procedures, the services with their fees and the quality checklist, etc; Section 5 –Terms of Reference 4 iv. Design the training of trainers for PBF, and carry out the snow ball training to roll out PBF and DFF in each State; v. Provide dedicated technical assistance to SPHCDA, LGA and health facility staff on PBF operational procedures, including training for staff and health workers in PBF and DFF facilities in the states, as described in the agreed manual of procedures; vi. Assist the SPHCDA in the states to design and enter into contracts with all participating health facilities describing the performance framework as well as the roles and responsibilities in relation to RBF; vii. Ensure that sufficient agency verification staff is hired to carry out the monthly quantity verification activities timely. These verification staff shall be qualified to carry out not only the quantity verification but also the coaching tasks. viii. Assist the SPHCDA in the states to establish formal LGA level RBF steering committees which meet at least quarterly to approve payment of performance invoices and oversee the decentralized governance and implementation of PBF. Each committee will be chaired by the LGA Authorities and will include relevant representatives of the SPHCDA, SMOH, local government and civil society in the LGA; ix. Assist the SPHCDA to carry out due diligence on the LGA RBF steering committee proceedings/and approved payments, and to ensure that payments to the health facilities bank accounts made by the fund holder(s) are based on verified services delivered in keeping with the agreed procedures; x. Assist the NPHCDA in maintaining a web-enabled database that tracks the quantity and quality of services provided, and also assist the NPHCDA in maintaining a web-portal that disseminates information on Nigeria PBF, including information on payments and performance, to the wider public; xi. Build the capacity of State Level Actors involved in PBF to provide technical assistance to the LGA PBF/DFF actors to conduct supervision to judge the quality of care provided in participating facilities using a standardized quantitative checklist; xii. Build a new implementation oriented coordination mechanism with interested development partners and other stakeholders at the State level, which will gather field based technical experts from public and private agencies involved in health care delivery, to set the agenda in close collaboration with the SPHCDA and the SMOH and to function as its secretariat; xiii. Create, using the implementation oriented coordination mechanism in each State, a system of ongoing intensified performance evaluations and data analysis capacities; xiv. In close collaboration with the NPHCDA and the SPHCDAs and the States, provide inputs for a pro-active communication strategy (using all appropriate communication routes -web; radio; television-) which will showcase early PBF successes; xv. Ensure that the PBF manual and the PIM are modified annually based on implementation experience and in close collaboration with PBF stakeholders; xvi. Set up systems for active contract management, and strategic purchasing using the web- enabled application, based on current best practice; xvii. Staff the State RBF technical support units with sufficient staff to carry out the core purchasing, verification, capacity building and contract management functions; adapt staffing according to local State/SPHCDA situations and staff availability; xviii. Provide guidelines for the states and the LGAs on supervision of the DFF LGAs; xix. Review and update NPHCDA, the World Bank and the States on the implementation of the DFF through regular quarterly reporting; xx. Provide technical assistance to the States and the LGAs on their DLIs and score cards.

G. LOCATION AND DURATION OF SERVICES Section 5 –Terms of Reference 5

The successful firm/organization will support the NPHDCA and the SPHCDAs in the implementation of the agreed RBF piloting in Ondo, Adamawa and Nasarawa states. At this stage the contracting will be for a five -year period subject to satisfactory annual performance.

H. DELIVERABLES

The firm/ organization selected will produce the following deliverables: i. One functioning and fully staffed RBF technical support units in each of the three states by November 2012; ii. Assessment of TA needs and TA work plan at start of consultancy iii. A training of trainers and snow ball training for the roll-out of PBF and DFF in all LGAs in each of the three States by March 2013; iv. One functioning implementation oriented coordination meeting in each of the three states, involving all key partners by December 2012; v. Functioning PBF systems in each of the three States by April 2013; using a web-enabled database for data reporting and invoicing vi. Operations Manual of Procedures based on the project implementation manual by December 2012; vii. An Inception report and six-monthly narrative project reports;

I. QUALIFICATION AND EXPERIENCE

The firm/organization should be legally incorporated to provide services in the areas of project management, financial management, procurement, monitoring and evaluation and consultancy services to clients. The firm/organization should have at least five years’ experience of providing Technical Assistance to health projects in sub-Saharan Africa on performance based financing, and have a track record in capacity building and South-South knowledge transfer. The firm/organization should be experienced in partnering with local organizations.

Proposed staff (per State SPHCDA RBF technical support unit):

1. Project Manager – key staff (1) 2. Health Economist/Health Specialist- Technical Advisor – key staff (1) 3. Contract Management Specialist (1) 4. Communication Specialist (1) 5. Data Management Specialist – which includes community client satisfaction survey management (1) 6. Verifiers (12-13) 7. Administrative Support Staff (3)

Key Personnel:

The minimum qualification & experience for the key positions is as given below: Section 5 –Terms of Reference 6

No Position Number of Minimum Qualification/Experience . positions 1. Technical Advisor (Health 1 1. MD or Economist with a Post-Graduate Sector Specialist/Health University degree, preferably in Public Economist) to the Health, MBA or Economics NPHCDA and RBF-TA team leader based in 2. At least 8 years of total post graduate Abuja with the NPHCDA qualification experience with the last 5 years in Health Sector projects

3. Demonstrable experience as team leader in similar high profile assignments preferably in developing countries. Demonstrable track record in success

4. Mandatory experience with designing and implementing Performance Based Financing approaches in sub Saharan Africa 2 Health Economist/ Health 3 1. MD with a post graduate qualification Specialist – Technical in Public Health, MBA, or Health Advisor Economics. [based in each of the three States] 2. At least 5 years of post qualification experience in projects involving Public Health management.

3. Experience with innovative models in the health sector – e.g. contracting out, results based financing

4. At least 5 years experience in public health in developing countries Section 5 –Terms of Reference 7

3 Project Manager 3 1. University Degree in an appropriate [based in each of the three field, with a post graduate degree in States] Public Health, MBA or Health Economics

2. At least 5 years of experience in project management

3. Experience with leading teams

4. Demonstrable track record of success

5. Innovative and flexible personality

7.0 REPORTING REQUIREMENT (SCHEDULE OF REQUIREMENT)

S/NO REPORT SCHEDULE REMARKS

1 Inception Report. One Month after takeoff 2 Progress Report and Every six months work plan 3. Consultative Workshop. Every six months after To discuss the submission of progress findings, lessons report and work plan learned and recommendations of the six-monthly reports 5 Final Report Year Five (5)

8.0 SCHEDULE OF PAYMENT

S/NO ITEM TIME PERCENTAGE REMARKS OF PAYMENT 1 Signing of contract 5 % 2 Submission of 10% The inception report is Inception Report expected three months Section 5 –Terms of Reference 8

after signing the contract 3 Acceptance of 1st July 2013 10% Based on satisfactory progress report and performance next six month work plan 4 Acceptance of 2nd January 10% Based on satisfactory progress report and 2014 performance next six month work plan 5 Acceptance of 3rd July 2014 10% Based on satisfactory progress report and performance next six month work plan. 6 Acceptance of 4th Jan 2015 10% Based on satisfactory progress report and performance next six month work plan 7 Acceptance of 5th July 2015 10% Based on satisfactory progress report and performance next six month work plan 8 Acceptance of 6th Jan 2016 10% Based on satisfactory progress report and performance next six month work plan 9 Acceptance of 7th July 2016 10% Based on satisfactory progress report and performance next six month work plan 10 Final Report Jan 2017 15% Based on satisfactory performance Section 5 –Terms of Reference 9