LHSS Afghanistan Consultancy – Designing and Conducting Operations Research Studies and Providing Technical Assistance in Afghanistan

Consultancy for Designing and Conducting Operations Research Studies and Providing Technical Assistance in Afghanistan

Background

The Local Health System Sustainability Project (LHSS) Activity in Afghanistan is working with local stakeholders to strategically expand the scale, quality, availability, and affordability of health products and services through the private sector in the U.S. Agency for International Development (USAID) priority large urban provinces of Kabul, Herat, Kandahar, Balkh, and Nangahar. Led by Abt Global, the three-year Afghanistan Activity uses a combination of financial and technical support to strengthen the capacity of local private sector actors, including for-profit and not-for-profit organizations, to increase access to critical health commodities and services, particularly among low-income population groups and women in vulnerable situations. In addition the Activity deploys promising provider aggregation models for the private health sector to offer priority health provisions at greater scale, more affordably, and with improved quality. The interconnected network of provider organizations are able to sustainably scale up or adopt new, improved business models and practices. LHSS integrates gender equality and social inclusion (GESI) into all interventions, recognizing it as a cross-cutting priority to meet the needs of both men and women at all levels.

Specific objectives include:

• Provide financial and technical support to the Afghan Social Marketing Organization (ASMO) aimed at expanding its role and improving its organizational capabilities to deliver sustained health impact.
• Increase product coverage and support establishment of franchising and provider networking models to improve service provision, by partnering with additional social marketing/franchising organizations.

Under objective 1, the LHSS supports ASMO, the leading social marketer at national scale and has a direct impact on MCH and family planning outcomes across Afghanistan with Afghanistan Demographic Health Survey (AfDHS) 2015 data indicating more than 22 percent of women who use modern contraceptives rely on products marketed by ASMO. Similarly ASMO contributes 16 percent of total household water treatment use, 11 percent of oral rehydration salt use, and 5 percent of iron folic acid use in Afghanistan through its socially marketed products[1]. ASMO actively promotes family planning, diarrhea prevention and management, newborn health, and nutrition through the national distribution of affordable products, and by using social and behavior change (SBC) to motivate Afghans to proactively address health issues. The COVID 19 pandemic followed by the Taliban takeover adversely impacted ASMO’s operations, forcing the organization to scale down sales and marketing activities. LHSS responded to those challenges in its first two years and further strengthened ASMO’s role and impact by expanding its retail sales and distribution network to urban slums and district markets, scaling up a new distribution channel through a network of private midwifery clinics and small/mid-sized health facilities located in low-income areas of the urban provinces. ASMO has strengthened its technical, institutional and financial capacities to increase equitable coverage, access, and demand for its priority health products. ASMO has not only reversed the decline in sales and revenue faced immediately following Taliban takeover, but improve its health impact, operational efficiency, financial performance and organizational sustainability. Furthermore, ASMO has decided to diversify from product social marketing to include franchising of priority health services through its standalone network of midwifery clinics, solo doctors and specialists, small hospitals and pharmacies located in urban slums of five large provinces. ASMO has also extended its strategic diversification plan to aggregate standalone networks of large private sector hospitals and service provider organizations. 

Under objective 2, LHSS supports five other private service provider organizations, who had major setback due to the economic collapse that followed the Taliban takeover. These organizations with LHSS support, strengthened their respective business models now to include a variety of strategies including community mobilization, outreach, supply- and demand-side capacity and resource strengthening, targeting low income, and women patients aimed at increasing patient uptake for preventive and primary care. Moreover, the private organizations see the promise of effectively expanding the scale of preventive and primary care practice through the private provider network of health service providers under ASMO and significantly contributing to organizational, network and national objectives with efficiencies in training, capacity development, procurement, and promotion. 

Building on the achievements of the past two years, LHSS will undertake a few initiatives in FY25 to assist its grantees to further expand and strengthen coverage, availability, affordability and sustainability of priority health products and services among the low-income population and women with specific emphasis on underserved areas and population. These include as follows: –

• ASMO’s targeted distribution channels: LHSS works in close collaboration with ASMO to increase the availability of priority health products among urban and peri-urban poor populations. Specifically, LHSS works with ASMO to further expand geographic coverage of ASMO’s sales operations to peri-urban areas across the five priority provinces, add or scale up new distribution channels that improve access and affordability for poor populations. To increase the availability of high-priority health products among low-income populations in the past two years, LHSS worked closely with ASMO to expand coverage of retail outlets in over 100 low-income urban and peri-urban market areas— urban slums and extension areas of main cities and district headquarter towns—of the five large provinces through ASMO’s direct sales team and third-party distributors. LHSS will continue to support ASMO to deploy adequate salespersons and facilitate engagement of third-party distributors and direct sales team to develop strategy and plan to service additional markets regularly.

Furthermore, in last two years, LHSS expanded an ASMO initiative to improve product availability among women in low-income areas through private, independent midwives and health facilities. With LHSS support, ASMO provided the selected midwives and health facilities with routine support (through training, provider detailing, and in-clinic client sensitization), and they now stock and sell ASMO’s products at agreed prices. In addition, the LHSS Activity helped ASMO connect nearby pharmacies to the trained midwives and health facilities for client referrals on counseling, including clarifying myths and misconceptions on the use of family planning and MCH products.

Furthermore, LHSS and ASMO assessed the feasibility, cost-effectiveness, and acceptance of a community-based distribution (CBD) model for Afghanistan to serve communities where women have limited access to essential health commodities because of low availability of pharmacies in isolated neighborhoods. The initiative aims to improve health outcomes in underserved communities and reduce dependence on free commodity distribution, often suffering from unreliable supply, high cost and lack of sustainability. This will be achieved by increasing door-step access to and use of high quality, affordable priority health products, information and referrals for family planning, maternal, newborn and child health, nutrition TB, and NCDs, in the underserved areas of five priority urban provinces. To start with ASMO would pilot the initiative in Kabul and Nangarhar provinces before finetuning and scaling up to other provinces. In FY25 LHSS will assist ASMO in implementing the proposed CBD model in Kabul and Nangarhar. LHSS and ASMO will collaborate with ongoing community health initiatives in these areas, led by the UHI and Agha Khan Foundation in Nangarhar and Kabul, respectively.

ASMO’s product price revisions 

LHSS established a process for revising the price of ASMO’s products to increase their efficiency and financial sustainability and to mitigate the risk of subsidized social marketed brands crowding out the private for-profit sector. The process includes an annual assessment of macro-environment factors (e.g., inflation, exchange rate, gross national income), market factors (e.g., estimated affordability of the product, price of and margins offered by other brands available in the market), organizational factors (e.g., product’s contribution to ASMO’s operating profit/loss, and finally demand elasticity factors (i.e., the brand’s ability to withstand a price increase without adversely affecting its demand). In the past two years, given the challenges of including demand elasticity factors in the market assessments, the Activity supported ASMO in completing this assessment partially using macro-environment, market and organizational factors. ASMO’s sales suggested a robust demand despite the economic downslide following Taliban takeover. In fact, there is some indication that demand increased in the last year too, but ASMO was unable to fully capitalize on it as a result of stiff competition from cheaper commodities, largely smuggled through porous borders across the country. LHSS and ASMO remain committed to following an annual process of marginal price increases so that ASMO brands are eventually sold at a price higher than procurement costs. As such, ASMO will revise the prices of select contraceptives and other health products in FY25. LHSS will support ASMO analyzing sales trends and market feedback before finalization, by product, to either retain current price levels or increase them by a nominal amount in line with inflation and currency depreciation levels. 

• Private Provider Networking: LHSS implements the first-of-its-kind network of private health providers grouped together under an umbrella structure, aimed at effectively expanding the scale of private practice and significantly contributing to national public health objectives. The market-based two-tier network is led by the aggregator, Afghan Social Marketing Organization (ASMO), with technical assistance from Greenstar Social Marketing, Pakistan. It offers comprehensive promotive, preventive, primary healthcare services including referrals to tertiary care and ancillary support and welfare services, through a network of qualified and specially trained cadres of private health and support services providers. ASMO integrates the standalone networks and offers cross-cutting support services including provider selection and onboarding, training and quality assurance, network branding, promotion and social behavior change for demand generation, patient referral and welfare using demand-side financing strategies to cater to low income and vulnerable patients with special emphasis on women.
• Pooled Procurement: Limited access to critical health commodities, medicines and other medical supplies and equipment, with frequent stock-outs across public and private facilities, continue to nag Afghanistan’s health system given the weak supply chain and heavy reliance on imports. Pooled procurement is a highly effective driver of affordable access to quality commodities. LHSS will develop a business and sustainability roadmap including a pilot demonstration of the model to implement pooled procurement through a formal arrangement where financial and other resources of its grantees and the network providers are combined to task the network manager ASMO for procuring health commodities, medicines and other medical supplies on behalf of a group of purchasing authorities. It will enable collaboration among buyers that can offer cost efficiency and sustainability through economies of scale.

Rationale and Scope for Consultancy

LHSS plans to assess the effectiveness of the above-mentioned initiatives using a combination of desk review, qualitative and quantitative operations research methods. LHSS thus seeks to employ a part-time consultant to assist the project to accomplish the following tasks: –

• Assist LHSS and ASMO in conducting the distribution and coverage monitoring (DISCOM) survey, product pricing research, post launch effectiveness assessments of community-based distribution and private provider network initiatives by –
• Co-developing, reviewing and finalizing research design and research instruments
• Co-selecting local field and tabulation agency and overseeing the data collector and tabulator training, fieldwork and data tabulation done the field and tab agency
• Conducting desk review a s appropriate and KIIs to get a first-hand impression and debrief LHSS team
• Co-finalizing data analysis and reports
• Assist LHSS and ASMO to design and institutionalize performance monitoring, evaluation and learning framework with list of indicators, targets and performance tracking plan for the pooled procured initiative by –
• Acting as the MEL and data analysis lead in coordination with a Pharmaceutical Procurement Specialist and business and Sustainability Specialist.
• Working closely with procurement specialist in designing and managing the technical feasibility assessment covering demand and reorder estimation and forecast for list priority commodities, medicines and other medical supplies, and cost benefit analysis of standalone and pooled procurement.
• Working closely with the procurement specialist, and the business and sustainability specialist in assessing staff and capacity strengthening need gaps, developing appropriate training materials and training ASMO team.
• Attending meetings and collaborating with ASMO, Greenstar, the private provider network secretariat, and other LHSS grantees and relevant stakeholders in undertaking the exercise, develop and submit technical feasibility plan.

Required Consultant Qualifications

• Master’s degree from a reputed university, preferably a PhD
• Expertise and at least 7 years’ experience of conducting quantitative and qualitative analysis, demand estimation and forecasting, desk and field research
• Female applicants are encouraged to apply
• Has expertise and experience of developing training materials and providing training to Afghan grassroots staff
• Other skills and expertise:
• Excellent writing and oral English communication skills
• High familiarity with Afghanistan and its fragile context
• Ability to understand Dari and/or Pashtu languages – preferable
• Willing to travel and undertake field visits to relevant provinces and districts, as necessary.

Time Estimate

The consultant will be expected to complete the assignments in no more than 125 person days spread over nine months of starting, the breakup of which by assignments are as follows: 

(# of person days)

• AssignmentsKey responsibilitiesEstimated LOECBD assessmentCo-developing, reviewing and finalizing research design and research instruments
• Co-selecting local field and tabulation agency and overseeing the data collector and tabulator training, fieldwork and data tabulation done the field and tab agency
• Conducting desk review a s appropriate and KIIs to get a first-hand impression and debrief LHSS team
• Co-finalizing data analysis and reports
• 15Network assessment30DISCOM survey30Pricing research5Pooled procurement MEL framework and planDesign and institutionalize performance monitoring, evaluation and learning framework with list of indicators, targets and performance tracking plan
• Working closely with procurement specialist in designing and managing the technical feasibility assessment covering demand and reorder estimation and forecast for list priority commodities, medicines and other medical supplies, and cost benefit analysis of standalone and pooled procurement.
• Working closely with the procurement specialist, and the business and sustainability specialist in assessing staff and capacity strengthening need gaps, developing appropriate training materials and training ASMO team.
• Attending meetings and collaborating with ASMO, Greenstar, the private provider network secretariat, and other LHSS grantees and relevant stakeholders in undertaking the exercise, develop and submit technical feasibility plan.

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Monitoring and Reporting of Work

The consultants will be overseen by LHSS for the duration of their work. 

For consideration, please submit the following to Anastasia Letaw (Anastasia.Letaw@abtglobal.com) by September 10, 2024, 12:00 PM US EST:

Qualified and experienced candidates are encouraged to apply for appropriate positions, submitting curriculum Vitae highlighting the position applied for and relevant experience for the role with a brief 2-3-page cover letter with information on the most pertinent experiences, which will allow for a successful completion of the outlined statement of work. Selected consultants will sign an undertaking to work as a team. 

[1] SHOPS Plus. Private Sector Contribution to Improving Health Outcomes in Fragile States: The Case of the Afghan Social Marketing Organization, SHOPS Plus, July 2019. https://marketbookshelf.com/wp-content/uploads/2020/08/Private-Sector-Contribution-to-Improving-Health-Outcomes-in-Fragile-States.pdf

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