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. Diversity—of ideas, identities, perspectives and backgrounds—is 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.
I. Background
USAID’s Act to End Neglected Tropical Diseases (Act | East) program, led by RTI International, supports national governments to reach their NTD control and elimination goals through proven, cost-effective public health interventions. The Act | East program works with the government of Haiti and partners to eliminate lymphatic filariasis (LF) and seeks to promote and build capacity towards sustainable NTD programming with a key focus on national planning and financing processes. Since 2008, USAID has supported the Haiti Ministry of Health’s LF program to make progress towards elimination goals. Currently, 122 of the 140 communes endemic for LF have achieved the criteria to stop treatment and started surveillance. The remaining 18 communes require additional rounds of annual treatment; domestic and donor funding are currently inadequate to reach all 18 communes. In addition, security concerns, particularly around the Port-au-Prince metropolitan area, present a challenge to achieving the national elimination goal.
Act | East aims to assess and strengthen the capacity of the Ministry of Health to properly manage future financing for continued LF treatment and surveillance. Act | East is exploring the use of a fixed amount award (FAA) mechanism, an approach that channels donor funding through existing public finance structures, to attempt a revitalization of funding flow with a view to proving if this could strengthen government financial systems and ownership, thereby positively impacting long term sustainability of the NTD program.
In FY20 and FY21, Act | East issued FAAs to the Northwest and North Departmental Directorates of the Ministry of Public Health and Population of Haiti (MSPP) through its sub-partner at the time. These FAAs were not wholly successful, with funds getting delayed at various points in Haiti’s departmental finance system. Act | East would like to try issuing FAAs again in FY23, this time through prime partner RTI International, but before doing so seeks to better understand how the health financing systems work at national, departmental, and communal levels to ensure that USAID/Act | East funding moves smoothly and in a coordinated way with domestic NTD and health financing.
Results for Development (R4D), one of the Act I East consortium implementing partners, is planning to carry out an assessment of the health financing landscape in Haiti and conduct a fund flow analysis of the Haiti Ministry of Health, with a goal to evaluate how FAAS could support implementation of Haiti’s LF program and strengthen Haiti’s MSPP financial systems. The analysis employs a mixed-methods approach and will include a review of the current fiscal context for health financing to understand the implications for NTDs resource mobilization, analyses of how health and NTD funding is managed and flows through the system, as well as examine local planning and budgeting processes for their incorporation of NTD services.
II. Objectives
The objective of this analysis is to conduct a health financing landscape and fund flow analysis of Haiti’s health sector that will inform the prospects for strengthening government ownership and financial management of the NTD Program by using FAAs to support NTD activities at the MSPP Central, departmental and/or commune levels through the following sub-objectives:
- To understand the fiscal context for health financing and health expenditure trends in Haiti and the feasibility of mobilizing domestic financing for NTDs.
- To understand how funding flows from national to department level to know how FAA funding would need to flow to support activities at the commune level.
- To understand the main sources of funding for health and NTDs at the National/department/commune level and particularly how external donor funding is managed by the various government levels.
- To understand the capacity of each level of government to properly manage external donor funding.
III. Scope of Work
The Consultant will undertake all activities necessary to fulfill the objectives outlined above, including but not limited to the following:
- Support facilitation of the stakeholder engagement meetings
- Develop and pilot data collection instruments
- Conduct a comprehensive review of policy documents, health financial data, and reports as well as relevant websites/databases from the national government and relevant literature (peer-reviewed and grey)
- Conduct qualitative data collection activities across the different levels- national, department, and commune
- Analyze data retrieved from both the review and interview process
- Produce a high-quality report on the result of the assessment and a presentation on findings and recommendations, including as they relate to the feasibility of the FAA mechanism
- Facilitate validation and dissemination of findings.
- Attend regular meetings with R4D and the Act | East country team to report on the progress made in the project.
IV. Project Deliverables
Deliverable 1: Upon signing of contract, the consultant is expected to produce a detailed workplan of the activities to be undertaken and timelines, in line with the Scope of Work. This will include a concept note for the first stakeholder engagement meeting, identifying primary and secondary data sources.
Deliverable 2: Final version of data collection instruments and the list of interviewees. This will include a detailed list of secondary data analyzed and documents gathered.
Deliverable 3: A 12-page report in English and French addressing all the proposed questions including references, annex, footnotes, and figures. Once reviewed by R4D and Act | East, a copy of the report will also be submitted to the MSPP/UCMIT.
The report will include a review of the current fiscal context for health financing to understand the implications for NTDs resource mobilization, analyses of how health and NTD funding (both internal and external) is managed and flows through the system and examine local planning and budgeting processes for their incorporation of NTD services. The health financing landscape and fund flow analysis will seek to address the following questions:
- Describe the fiscal context for health financing and health expenditure trends. Describe the latest available health budget allocations for Haiti and selected departments and extent of alignment to health priorities, including NTDs. Are some/all NTDs captured within the health budget?
- Describe the main sources of funding for health and NTDs at the National/Department/commune level. How are these resources allocated and managed at the various levels of the system? Are there issues with fund flows to local governments from the different financing mechanisms? In the case of off-budget donor funds, how are NTD resources used/planned/accounted for within the government system? Is NTD service provision integrated within existing funding pools and purchasing arrangements?
- Discuss the implications of the above for Act | East’s response. More specifically, how could Act | East funding have to flow in order to reach activities at the commune? What are the pros and cons of each funding flow option? Are there departments or communes where there is evidence of stronger financial capacity that Act | East should consider? Are there other donor transitions that have happened/are happening in Haiti and what has their experience been?
- What are the prospects for mobilizing public domestic financing for NTDs given current fiscal challenges? Are private sector initiatives an opportunity for NTDs?
- Report on good practices and lessons learned from the previous implementation of FAA mechanism in the North West and North departments.
R4D will provide the consultant with a template for the 12-page report.
Deliverable 4: A slide deck with findings and options or recommendations to be shared with R4D/RTI.
V. Qualification/Requirement
- Master’s degree in health economics, health policy and management, or public health with a health financing focus.
- At least 3 to 5 years of field-based experience working on health financing and/or health economics evaluation and analytics, health policy, planning, public financial management (PFM), and/or financing.
- Experience in workshop facilitation and collaboration with government and non-government stakeholders.
- Familiarity with the Haiti health financing mechanisms and health system, Haiti Ministry of Health (MSPP), NTD or vertical programs including HIV/AIDS, FP/RH, Malaria, EPI, MCH, TB, among others is necessary
- Full professional fluency in French and 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 detail.
- Must be based in Haiti and willing to travel to select departments/communes
VI. Implementation arrangements
The consultant will report to the R4D’s program officer. The consultant will also be expected to routinely engage with the Act | East country team. RTI serves as the implementing partner in Haiti and the consultant should coordinate efforts and engagement with RTI, MSPP, and government stakeholders. The consultant will provide regular updates on the progress of the activities to the R4D program officer. The consultant will be based in Haiti.
VII. Timeline & Output
The timeline of the deliverables are as follows:
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Deliverable1: Within two weeks after signing the contract (August 2022)
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Deliverable2: August 2022
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Deliverable 3: September 2022
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Deliverable 4: September 2022
The consultancy must be completed by September 25, 2022.
Please submit applications by July 25, 2022.
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