Consulting Services to Scope Options for Public Health Insurance in Oman

Terms of Reference
Consulting Services to Scope Options for Public Health Insurance in Oman
I.
Background
The Sultanate of Oman is undergoing a series of significant reforms to accelerate progress with delivering its Vision 2040. Among these initiatives is the country’s plan to establish a universal social security system. Recent measures include the introduction of cash benefits for children under 18, universal pensions for seniors and disability benefits. Additionally, the extension of maternity, paternity, sickness and injury benefits to both Omani and non-Omani workers is meant to enhance social protection and foster inclusivity of migrant workers. The consolidation of multiple pension funds into a single national social protection scheme managed by a single entity, the Social Protection Fund (SPF), further aims at improving efficiency, aligning with international social security standards, and marking a significant step toward universal social protection.
Investment in social protection, including social health protection, is critical to ensure ongoing economic and social transformation remains human-centred. Not only a more comprehensive, adequate, and efficient social health protection system will cushion the most vulnerable and curb rising inequalities. It will also better equip individuals and firms to reap the opportunities that future economic and technological transitions will offer.
The Sultanate of Oman is considering to reform the way access to health care services is managed, and particularly arrangements for financial protection against health care costs, and bearing in consideration health financing needs for both national and migrant population. A Unified Health Insurance proposal aims at transitioning the current national health service system, where care is affordable or fully free-of-charge at the point of care in public facilities under the Ministry of Health, to a mandatory health insurance model.
In the recent past consideration has been given to the establishment of a mandatory private health insurance model under the auspices of the Capital Market Authority. A benefit package, financing mechanism and draft legislation have been developed to this effect but the implementation of such a scheme has been put on hold. Since the creation and establishment of the Social Protection Fund as an integrated agency for the administration of social protection in the Sultanate, further consideration has been given to the establishment of a mandatory public health insurance model to be better linked with the new social protection system. Reference to social health insurance was included within the Social Protection Law, as established by Royal Decree No. (52/2023)
In October 2024 the Cabinet instructed the Social Protection Fund to conduct a comprehensive study on health insurance focussing on an analysis of the overall frameworks, implementation mechanisms, and the roles of the relevant entities in their execution, to guide further policy deliberation on the matter. The Social Protection Fund has expressed its intention to engage the International Labour Organization to undertake a scoping study on Supporting social health protection reforms in Oman: assessing options for a public health insurance model.
II.
Project scope
Specifically, the Omani government aims to develop an integrated, efficient, and sustainable health system including health insurance coverage. This initiative seeks to ensure that all citizens, residents and visitors of Oman have access to health services without barriers.
It is understood the reforms should address multiple concerns as follows:
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Extend financial protection against healthcare costs to those currently uncovered or provide greater levels of protection to those already with coverage (e.g. replacing out-of-pocket spending with some form of prepayment, at least for a basic package of health services). In particular, putting in place a sustainable and equitable system to extend quality social health protection for the migrant population.
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Mobilize additional domestic resources to foster access to health services without financial barriers. Diversify the financing base for the public health budget, in the context of the overall macro and fiscal reforms.
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Fit into broader reforms aimed at organizational changes for improved health system efficiency and quality of services, working specifically on the provider purchaser split.
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Addressing existing inequalities in access to healthcare and provide avenues for segments of the population who are inadequately covered.
To achieve this goal, as a first step, the government intends to assess different possible models for public health insurance coverage to identify the most optimal model. The ILO assists the Government of Oman in this project. The project will support a preparatory phase to this process by taking stock of the available evidence, identifying the key design parameters of a public national health insurance scheme, assessing its relationship with complementary commercial insurance and comparing the advantages and disadvantages of public and private approaches, and laying out a roadmap for a detailed financial and operational feasibility and preparatory work once a model has been selected.
The project will develop three outputs in a phased approach to support the Government of Oman in selecting an option for health insurance coverage, as follows:
Output 1: Stock-taking and collection of available data and analysis
A comprehensive stock-taking exercise will be conducted with a two-fold objective, with a comprehensive focus on both Omani and non-Omani population:
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Understanding the strengths and opportunities for improvement of the existing system to access healthcare and financial protection thereof in Oman, which will support the development of tailored options for reform that are adapted to the country context and make the best use of existing mechanisms.
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Assess data availability to inform detailed design parameters of the proposed models, with a view to immediately use the available data for the purpose of this project but also to be able to identify data gaps for a fully fledge feasibility study, including actuarial feasibility, of the option that will be selected by the Government, as part of a subsequent assignment in a second phase.
Social acceptability is the cornerstone of sound reforms in social policies. The project will facilitate consultations with key stakeholders with a view to capture their vision, ideas and perspectives on the establishment of a public health insurance. This will be a central component of supporting the Government of Oman to choose design parameters that effectively respond to the perceived needs of key stakeholders and to propose an institutional architecture that is fit for purpose and can be integrated smoothly within the current framework.
Output 2: Options for public health insurance design parameters and institutional arrangements, and comparison with commercial insurance model
Based on the data, analysis and stakeholders’ perspectives gathered though output 1, the project will support the Government of Oman to design options for both the key parameters of the public health insurance and the possible institutional set-up for its administration. A limited number of options will be developed and consolidated in a package for decision-making purpose by the Government. International experience will be reviewed and presented for illustrative purposes throughout on different national health insurance scheme architectures.
The project will:
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Support the definition of core parameters for 2-3 scenarios for the design of a public health insurance.
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Provide a comparison of public health insurance model with the existing commercial insurance model.
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Identify options for institutional arrangements to administer the public health insurance scheme under different scenarios.
Those options for both scheme design and institutional arrangements will support the national counterparts to determine core features of the new public health insurance scheme. Advantages and disadvantages of alternative options will be presented, in light of international social security standards, national strategic objectives and relevant international experiences. The project will support the development of a comprehensive report summarizing the options that can be used as a basis for dialogue and a framework with criteria to enable further decision making.
Output 3: Road map
A road map will be developed with the Government of Oman laying out the following elements:
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Overall process and milestones for the selection of a general option and then for assessing further the feasibility and operationalization of said option;
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Timelines and detailed activities to conduct a comprehensive assessment of the operational and actuarial feasibility of the selected option and produce a full design document.
The proposed roadmap will be discussed to reflect the views of stakeholders and implementers.
Expected Timeline
Track Jan Feb Mar Apr May Jun
Stock-taking and collection of available data and analysis: Jan-Feb 2025
Options for public health insurance design parameters and institutional arrangements: Mar-May 2025
Road map: May-Jun

III. Objectives, tasks and deliverables
Objectives
The ILO is seeking senior expertise in health insurance to support the project and act as team lead. The assignment encompasses overseeing the delivery of the main outputs of the project, steering and coordinating inputs across all members of the ILO team. Engagement in strategic conversations with Oman counterparts is expected to understand the objectives of the assignment, and substantially engage to ensure the deliverables meet such objectives. Direct engagement in the production and quality assurance of the main deliverables is expected.
Close collaboration with the ILO team of experts set-up for the project is expected. In particular, the social health protection officer responsible for the project within the Universal Social Protection department of the ILO will be working jointly with the supporting consultancy, in addition, the assignment encompasses seeking and integrating the inputs of a range of ILO experts, including the quantitatives analysts responsible for actuarial modelling in healthcare and the Social Health Protection Specialist within the social protection Global Technical Team of the ILO, the Social Protection Specialist responsible for the Arab States region, who will provide direct supervision and will be in charge of the institutional liaison with Omani cunterparts.
The timeframe and sequence of tasks might be subject to revision upon inception of assignment, in consultation with the ILO team and subject to agreement with the supervisor.
Tasks
The consulting services to Scope Options for Public Health Insurance in Oman will be tasked with the following:
1.
Information Consolidation
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Integrate and analyse data gathered by the ILO team (Social Health Protection Technical Officer and Social Security Quantitative Analyst) from desk reviews of published and unpublished materials against the proposed framework.
2.
Interviews and on-site data collection
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Develop with the ILO team semi-structured questionnaires for key informant interviews with government officials from relevant line ministries and stakeholders. Input into the list of KI prepared by the ILO team.
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Conduct interviews and discussions during a 5-day mission, compile and code summary notes, and draft a brief analysing the collected data in a mission report.
3.
Comprehensive Analysis
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Draft a report analysing the current situation, strengths and weaknesses relevant to the design of a public health insurance model and integrating the results of the data availability assessment for modelling purpose with the ILO team.
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Integrate ILO review and feedback to finalize the report.
4.
Scenario Development
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Develop an evidence-based alternative scenarios for a public health insurance model tailored to Oman, detailing key design features. Definition of core parameters for the design of a public health insurance along the following parameters: scope of personal coverage (population groups, eligibility and access modalities as applicable), benefit package (range of services covered and financial protection levels), network of service
providers (contractual/institutionalized relationships with providers (public, private
or both) abilitated to deliver the services defined under the benefits package to the persons covered with financial protection), and financing architecture (main sources of revenues envisaged and interplay with the government budget).
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Develop options for institutional arrangements thereof alongside the following dimensions: legal frameworks and governance; responsibilities for key health financing functions (including raising revenues, pooling risks, purchasing services) but also service provision, and; institutional set-up for public health insurance administration (registration, access modalities and eligibility, contribution collection, provider contractual arrangements, claims management, complaints and appeals) and main processes (monitoring, risk management, financial management).
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Draft a rapid comparative analysis of alternative models, and recommendations based on international practices and standards with the ILO team.
5.
Implementation Planning
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Prepare a timeline plan with operational steps and technical support requirements for the detailed feasibility and institutional set up of the selected option in collaboration with the ILO team.
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Draft a roadmap for next steps in collaboration with the ILO team.
6.
Stakeholder Engagement & Presentation of Results
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Facilitate high-level discussions with key government officials in Oman and other key stakeholders throughout the assignment.
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Prepare with ILO team and deliver presentations to disseminate findings from the comprehensive analysis of current situation and scenarios for design and institutional arrangements for a public health insurance.
Modality of work
Desk based, with 2 missions to Muscat of 5 working days each
Deliverables
The primary objective of this assignment is to support the Government of Oman in advancing its social health protection (SHP) reform. In this phase, the assignment will focus on a comprehensive stocktaking exercise, with collection of data and in-depth analysis to deliver the following key outputs:
a.
Comprehensive analysis of the current situation. This in-depth analysis of the current mechanisms for accessing healthcare without financial hardship for nationals and non-nationals in the Sultanate of Oman will cover legal frameworks and policies governing SHP, population groups covered, existing benefit packages design, levels of financial protection, financing arrangements, network of contracted providers, provider payment mechanisms, utilization and institutional arrangements for managing the system in place. This will be complemented by a detailed assessment of data availability for the purpose of conducting actuarial modelling, for which assistance will be provided by the ILO quantitative team. The method will be based on:
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Desk review of published and official sources (annual reports from relevant ministries and social security institutions, national laws and regulation, research papers, reports from national and international organizations, among others).
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Stakeholder Interviews and, if needed, focus group discussions: engaging with key officials and informants from relevant ministries and social security institutions
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Data collection: including producing data requirements and collection templates, and actively supporting the Omani counterparts to feed them.
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Integration of ILO inputs: including on the data availability assessment.
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Presentation development of the final product for dissemination of results.
b.
Evidence- based scenarios for a public health insurance model in Oman that aligned with the country’s strategic objectives, socioeconomic context, and healthcare needs.
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Key design features of 2-3 scenarios (detailing the design parameters for each).
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Options for institutional arrangements essential for establishing a mandatory public health insurance system.
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Comparative analysis of this model against an alternative commercial private health insurance system, highlighting strengths, risks, and potential trade-offs.
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Examples of international practices and lessons learned from similar contexts and recommendations in line with international standards.
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Presentation development of the final product for dissemination of results
c.
Decision making package consolidating the above analysis from a and b as well as a roadmap developed with stakeholders to guide the selection of a specific scenario and option for institutional set up. This deliverable will include:
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Support to the organization of consultations with stakeholders.
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Development of a detailed roadmap for the selected reform option, including operational planning, milestones, and feasibility considerations.
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Drafting an implementation timeline to conduct a feasibility for the selected scenario.
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Final progress report summarizing the outputs of this phase will be prepared, outlining planned next steps for the second phase of the project.
IV.
Duration of Assignment
This assignment is expected to start on 15 January 2025 and will be finalized by 15th June 2025.
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Deliverable one:
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Inception report, including
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Mission report
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Finalized report on assessment on the current arrangement in place for SHP systems in place and data availability, including the results of stakeholder interviews and ILO inputs.
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Finalized presentation
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Deadline: 01/03/ 2025
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Deliverable two:
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First draft evidence-based proposal report with design parameters and institutional arrangements for public health insurance and a comparison with alternative models.
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First draft presentation.
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Deadline 15/04/ 2025
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Deliverable three
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First draft evidence-based proposal report with design parameters and institutional arrangements for public health insurance and a comparison with alternative models.
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Finalized roadmap for feasibility and institutional set up.
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Finalized report and presentations
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Deadline 15/06/ 2025
V.
Supervisory Arrangements
The senior expert in health insurance and team lead will work under the direct supervision Luca Pellerano, ILO Regional Social Security Specialist and under the technical supervision of Lou Tessier, Social Health Protection Specialist. Direct supervision will be handed over to the CTA for the STREAM project on Social Protection and Migration in the Gulf, once in place. The Senior Expert will work in close collaboration with other members of the ILO team working on the assignment as well as other external collaborators.
VI.
Requirements
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Relevant experience in the fields of health insurance, social health protection, health financing, health economics and social protection.
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Previous experience in conducting analytical work with practical implications on the extension of social protection.
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Knowledge of and previous work experience in the region would be a sizeable advantage.
VII.
Modalities for Application
A proposal including the following shall be submitted before 10 January 2024 mid night Geneva time:
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A succinct proposal outlining the understanding of the assignment, the proposed methodology for the work packages and the identified comparative advantage of the applicant;
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A budget proposal inclusive of all costs with a rationale;
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Curriculum vitae of the proposed team members
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Evidence of relevant previous assignments