Consultant Terms of Reference: Domestic Resource Mobilization (DRM) Case Study - Nepal

Consultant Terms of Reference: Domestic Resource Mobilization (DRM) Case Study - Nepal
Results for Development , Fiji

1 Year
0 - 0
Job Type
Job Shift
Job Category
Requires Traveling
Career Level
As mentioned in job details
Total Vacancies
1 Job
Posted on
Nov 16, 2021
Last Date
Feb 16, 2022

Job Description

Results for Development (R4D) is a leading non-profit global development partner. We collaborate with change agents around the world government officials, civil society leaders and social innovators to create strong systems that support healthy, educated people. We help our partners move from knowing their goal to knowing how to reach it. We combine global expertise in health, education and nutrition with analytic rigor, practical support for decision-making and implementation and access to peer problem-solving networks. Together with our partners, we build self-sustaining systems that serve everyone and deliver lasting results. Then we share what we learn so others can achieve results for development, too.
We have a unique and vibrant culture at R4D. Diversity, equity and inclusion are at the heart of our work environment and help advance our mission. Diversityof ideas, identities, perspectives and backgroundsis vital to who we are and what we do. We seek people who embrace these values and will help reinforce them. Our work culture is collaborative, creative and entrepreneurial. We operate based on trust and respect. Teams across the organization frequently collaborate on programmatic work and support each other in continuously building a better R4D.

In 2015, Nepal shifted from a unitary government to a federal system of government after the declaration of a new constitution. The Constitution of Nepal 2015 establishes a federal government structure with three tiers of government (federal, provincial, and local) with a strong emphasis on local governments (LGs) having greater authority. The intent for decentralization was to reduce inequalities by bringing services closer to the community, ensure cost containment by moving from vertical disease to more integrated approach in pursuit of UHC, promote greater local financing, and involve local communities in decision making.
The country is now divided into 7 provinces and 77 districts. The districts are divided into 753 local levels: 6 metropolitan cities, 11 sub-metropolises, 278 urban municipalities, and 458 rural municipalities. Each municipality is now responsible for implementing government programs and delivering services through local health facilities. The Nepal Health Policy 2019 has put Universal Health coverage as a center priority and has mandated subnational governments to deliver basic health services to the people that includes preventive and promotive care. [2] This new decentralized system of local governance presents both challenges as well as opportunities for improving health service delivery. The local government can allocate resources more efficiently and equitably based on the community’s needs. However, there is a lack of clarity on the delegation of responsibilities between federal and subnational government, inadequate human resources for health, and limited capacity at the local level which could impact health service delivery especially for programs such as NTDs that have been making considerable progress towards reaching disease control and elimination.
Results for Development (R4D), one of the Act I East consortium implementing partners, will lead the development of a case study that will describe the progress and challenges of financing NTD programs under Nepal’s decentralized system of government and the implications for domestic resource mobilization. The case study will inform discussions on NTD program sustainability and identify needs and opportunities to strengthen local capacity for planning, budgeting, and financial management of available health resources, inclusive of NTDs specifically lymphatic filariasis (LF), Soil-transmitted helminths (STH), and Trachoma. II.ObjectiveThe case study will seek to:1. Describe current challenges to allocating, disbursing, and spending funds for NTDs under Nepal’s federal system of government, including obstacles to domestic resource mobilization and sustainable financing of the NTD response.2.Identify opportunities for improving planning and resource allocation as well as overall management of financial resources for NTDs considering current fiscal constraints and other competing health needs in Nepal.III.MethodologyIn the first phase of the work the consultant will prepare descriptive analyses of the health financing landscape and fund flow as it relates to NTDs. The second phase of the analysis will focus on the experience of four to six municipalities to allow for deeper analyses of the relevant issues under decentralization. Selection of the municipalities will be based on input from the GON, Act | East country team, and technical experts.
Analytic components·Qualitative review of peer reviewed and grey literature on the current context for health financing given ongoing UHC and public financial management reforms that have implications for the financing of NTDs·Analysis of current NTD financing mechanisms and sources of funding, including fund flow analysis of NTD program expenditures under the federal system·Analysis across four to six selected municipalities on the extent to which NTD program cost components are fully, partially or not well integrated within local health sector planning and budgeting processes.Information Sources1.Literature/database reviews: The consultant will review and utilize relevant policy documents, country health financial data and reports as well as relevant websites/databases from government, WHO, World Bank among others2.Interviews: The consultant will interview key informants from public institutions such as the Ministry of Health and Population of Nepal, Ministry of Finance, municipality, district and/or provincial offices, among others. Interviews with NTD donors and implementation partners working in the country would also be necessary. The consultant is expected to work closely with the R4D, Act | East HQ and country team to create the survey instruments, collect data, and produce reports.3.Review of available financial data. i.e., analysis of national and municipal health budgetsScope of data collectionThe following questions should be answered using the data and information collected from the interviews and literature/database reviews. Questions should be addressed in a coherent narrative; the responses can also include additional relevant information. When possible, data from 2015 to the present should be collected.Note: Act | East will be responsible for obtaining USAID Nepal concurrence with case study activities and will facilitate any required ethical clearance. The consultant will work with Act | East to understand and incorporate timelines for these approvals.
1.Decentralization process and implications·Summarize the current structure of the national NTD program and what authorities are retained at what level under the decentralized system·Describe key aspects of transition to a decentralized health system that has impacted the financing and delivery of health and NTD services including LF/STH MDA, school-based deworming, trachoma and LF post- MDA/validation surveillance. Include changes in governance, resource mobilization across different levels of governance, financial management as per any laws, policies, and decrees.·Describe the transition of authority. What roles and responsibilities for funding, health service delivery, and financial management were assigned to different levels of government? Highlighting any changes in roles, responsibilities, and accountabilities, as well as status of timelines for this transition. To what extent are these roles and responsibilities being fulfilled and/or what are challenges to carrying out these functions·Did the local government incur additional costs associated with health service (for example, human resource and community health education needs) and programming implementation because of decentralization? Are there any additional challenges and considerations?2.Status of domestic mobilization and current financing for NTDs·What are/have been the main sources and composition of financing, i.e.: Domestic public funds (government, earmarked, insurance), External funds (donors, philanthropic donations); Out of pocket payments for NTD programming at national/subnational levels prior to and since the transfer of decentralized functions?Present a historical table with this information.·What are existing funding pools and purchasing arrangements that include NTD services (I.e., benefit packages, payment mechanisms etc.)? Which NTD services and cost components are included? I.e., lymphedema morbidity management, hydrocele surgery, and trichiasis surgery, etc.·Describe the current flow of funds associated with NTDs from the federal to local government to service delivery points. What are major bottlenecks to allocating, disbursing and spending these funds for NTD service delivery and/or for cost components for clinical care, MDA, or surveillance etc.?·Describe the extent to which some/all NTD program cost components are captured within the current health budget and/or other non-health sector budgets such as WASH or education? What can be said about the relative prioritization of NTDs compared to other health priorities reflected in the health budgets?·Is the most recent version of the strategic plans for LF, STH, and trachoma costed plans? If so, how were NTD-related resource needs estimated?How are these used to inform, or are otherwise reflected in, national or local priority setting and resource allocation processes? How frequently are resource needs estimates updated?Are these estimates based on historical allocations or do they reflect changes in the program’s response to NTD control and elimination (I.e., reduced number of MDAs, etc.)?·What reporting mechanisms and adjustments (e.g., inclusion of program code in the Integrated Financial Management Information System, or IFMIS) have been set up to account for spending on NTD programming?·What have been the main instruments/avenues to achieve DRM for LF MDA and clinical care, school-based deworming and trachoma surveillance prior to shift to federalism? Are there any financing/DRM strategies to increase domestic resources allocation to the health sector and NTDs? If so, please list and describe them.·How has financing of the COVID-19 response impacted the financing of the NTD program? Have NTD programs faced a reprioritization of national funding or delays in receiving funds at decentralized levels due to COVID-19? How are NTD programs dealing with this changing environment?3.Advocacy strategies·Has the Ministry of Health/District Offices implemented an advocacy strategy/plan for domestic resources mobilization for NTD programming or for health inclusive of NTD services? If so, describe this strategy/plan and the key stakeholders involved. Does this strategy/plan include the generation and use of evidence to inform advocacy for increased budget allocation to NTD? Please explain.·Who are some of the champions advocating for increases in government funding for NTDs?·What role have municipalities played (if any) in advocating for funding for NTD programs?·Explain key success factors that influence the decisions of policymakers at the national and district level to prioritize NTD programming.IV.Deliverable·A 1015-page report addressing all the proposed questions including references, annex, footnotes, and figures. R4D will provide a template for the final report·An Excel file with relevant data and analysis including graphs, figures, tables, and computations done.·A shared folder containing all the collected documents·A shared folder including the survey instrument used in all the interviews·Responses to comments from reviewers of the draft report and/or edits to the draft report based on comments received.V.Qualifications·A minimum of first degree in International Development, Public health, Statistics, Economics, Health Economics, Public/Social/Health Policy, Health Systems, Health Planning or related qualification with extensive training on quantitative and quantitative analysis; Master's degree in related fields will be an added advantage·(7+) years of experience working on research, health economics, health policy, planning, and/or financing in low- and middle-income countries. Experience working in/with public or private sector health financing organizations is desirable·Significant experience with qualitative and quantitative data collection and analysis, as well as the ability to translate complex technical analysis into policy.·Familiarity with Nepal’s health financing mechanisms and health system (in context of the recent decentralization), The Ministry of Health and Population of Nepal, NTD or vertical programs including HIV/AIDS, FP/RH, Malaria, EPI, MCH, TB, etc.·Full professional fluency in English, including excellent written communication skills; language abilities relevant to the project countries also valuable·Ability to work independently and collaboratively as part of a team and deliver high-quality results within tight timeframes·Excellent organizational skills and attention to detailHow to apply: Please submit all required application materials directly to Jose Gonzalez () by no later than 13th December 2021.
Results for Development is anEOE/M/F/Vet/Disabled/Affirmative Action Employer committed tofosteringand nurturing an energetic, collaborative and diverse workforce.R4D provides market-competitivesalaries and comprehensive employee benefits.

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