To achieve Universal Health Coverage it is critical for governments and bi- and multi-lateral donors to prioritize and invest more in community health. Living Goods is committed to providing the evidence and support necessary to enable this shift in budgets and priorities and are working closely with the Government of Kenya alongside key partners to build a country-specific investment case to demonstrate the precise value of investing in community healthcare and where savings can be made. Living Goods is supporting hiring of a consultant to carry out research, modelling, and costing out the investment case for funding community health in Kenya, which will help us:
- Prioritize community health: Ministry of Health (MoH) values the investment in community health and prioritizes budgeting and funding community health initiatives
- Shift in how community health is funded: Major donors such as USAID, World Bank and UNICEF designate higher proportion of funds to community health in Kenya, and donors embrace more innovative modes of financing to mobilize large-scale resources
- Better quality metrics, data collection and reporting: highlight the critical metrics that can be improved by community health which should prompt donors and governments to align their KPIs and invest in better data collection methods
- Increase Payment-by-Results financing for community health: Increasing the interest in Payment-by-Results by creating a more compelling value proposition for investors and donors to fund community health. This is intended to increase both the amount of funding available and direct funds into the most impactful initiatives increasing efficiency of resources deployed
The investment case is for the whole country and not for specific counties, so the consultant is expected to:
- Engage and manage stakeholder engagement to ensure relevant views are represented, and key stakeholders are brought into the process
- Work with the MoH and relevant stakeholders and experts to design the methodology for the investment case consistent with the model created by the Financing Alliance, investment cases done in other countries and the UNICEF Community Health Planning and Costing Tool.
- Collating data sets and information from interviews and secondary data sets to ensure a robust approach of determining ‘value’
- Analyse the data to show the return on investment for community health
- Develop deliverables to communicate and disseminate the findings
Developing an investment case that accurately incorporates the true costs and benefit of community healthcare requires a deep engagement with the relevant stakeholders in government, donor and broader healthcare providers, especially to understand the differing impacts in different contexts i.e. urban/ rural, coastal/ inland.
A steering committee and other key stakeholders must be engaged in the process of developing the investment case if it is to really shift perceptions of community health and catalyse a change in how it is funded and for the findings to be accepted by the wider health community.
- Data collection and analysis
Illustrative data and analysis required (not an exhaustive list):
Costing of CHW program
- Stipends and reimbursements (travel, lunches etc.)
- Supervisor time and costs
- Equipment, supply chain and logistics
Return on Investment (Value of CHW programs)
- Short-term value for money compared to facility-based care across the following services:
- Neonatal care
- Family planning
- Community Management of Acute Malnutrition (CMAM)
- Direct savings to the economy
- Saving of child and maternal lives – Impact of ICCM
- Reduction in cost of treating advanced stage diseases
- Savings related to lower total care needs and treatment infrastructure including associated services for the population
- Impact of education on basic hygiene and sanitation, education on childhood disease identification, immunisation nutrition, family planning on reducing disease
- Impact of demand creation for sanitation/ hygiene/ nutrition products which prevent disease?
- Effect on catastrophic cost for health care resulting from health crises e.g. Ebola/ cholera
- Economic impact of reduced stunting and better educated population (reduced childhood illness)/ economic impact of increased employment
- Increased productivity from a healthier adult population
- Disease elimination – eradication of diseases
- Greater female empowerment women
- Reducing patient costs
- Enabling data collection on civil registration and vital statistics (improved policy making, avoidance of disaster e.g. energy and water crises etc.)
- Enabling additional service delivery
- Differences in costs, savings, broader benefits of community healthcare in different regions, community healthcare delivery systems, urban/rural contexts and different regulations and policies in different counties.
Collate qualitative insights for key stakeholders including how to prioritize different types of data, how to best build the case and the impact of different contexts on different value levers. A qualitative narrative will be expected alongside the numbers to explain where things could not be costed but value still exists.
The investment case should not be an absolute number but needs to show how different coverage levels, suites of activities and slightly different staffing structures result in different return on investment. Therefore, it is expected that the analysis will provide different investment scenarios to show the investment case for example for, full CHW coverage such as in the current policy versus partial coverage in just the highest need areas.
- Report development and dissemination
The consultant will collate the data and insights from stakeholders and analysis into a user-friendly report that can be used by stakeholders to advocate for increased investment. There will be opportunities to engage key stakeholders to review draft documents and feedback into the final set of deliverables. The report will also need to include a literature review of relevant investment cases previously done and other relevant studies.
Deliverables and timeline
- Methodology – to be approved by internal panel and relevant credible external reviewers
- Report including but not limited to:
- Publishable and finalized Word document organized in a logical flow with necessary graphs and text addressing above questions, including executive summary, table of contents, sources/references, and appendices in a format that can easily be pulled into other documents
- A policy brief
- Condensed PowerPoint presentation with key slides summarizing the narrative from the publishable report
- Reusable investment case tool and raw data. Investment case tool
- Synthesis from key informant interviews describing motivations and constraints for community health (should be included in publishable report and PowerPoint slides)
- Attendance at a workshop with key stakeholders to disseminate and explain this research
Interim deliverables to include
- Draft report
- Draft Excel investment case tool
- Final Deliverables will be due end of November 2017
- Interim deliverables will be due in September
Please send all expressions of interest to firstname.lastname@example.org
Proposals can be as a group or as an individual and should include a
- Budget including cost breakdown
- Proposal for how you (and your team) will approach this project and timelines
- Outline of credentials and experience including relevant CVs
Proposals should be brief, no longer than five A4 pages or a short PowerPoint deck (not including CVs or budget).
Deadline for responses is 4th July