Scope of Work for Consultancy Service on Health Financing Support to Strengthen Woreda’s Capacity on Planning and Budgeting

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.

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Act to End NTDs I East (Act I East) Program

I. Background

Neglected tropical diseases (NTDs) impose a devastating human, social and economic burden on more than 1.7 billion people worldwide, predominantly in tropical and subtropical areas, who are among the most vulnerable and marginalized populations. NTDs are significant cause of morbidity, disability, and lead to death of more than 170,000 people per year. The estimated global burden attributed to NTDs is 47.9 million Disability-Adjusted Life Years (DALYs). Over 40% of the global NTD burden is concentrated in Africa. Ethiopia is one of the world’s burdened countries with the highest NTDs burden, with more than 75 million people at risk of at least one NTD.

Ethiopia has completed the implementation of two phases of NTD strategic plans in the past decade, and has made remarkable progress in the prevention, control, and elimination of NTDs in the country. Ethiopia is currently implementing the 3rd national NTD strategic plan (2021-2025) which is aligned with the country health sector transformation plan (HSTP II) and the WHO road map (2021-2030). One of the pillars of the 3rd national NTD strategic plan aims to strengthen resource mobilization, coordination, and communication by improving the capacity of the health system to raise sufficient domestic resources for NTDs. The MoH also developed the NTD sustainability plan (2021-2025) which advocates for domestic resource mobilization efforts at federal, regional and woreda level with government, private sectors, and Ethiopia health insurance system.

As a key NTD partner in Ethiopia, USAID’s Act to End Neglected Tropical Diseases jobs-near-me.org East (Act jobs-near-me.org East) program (2018-2026) supports the Ministry of Health (MOH) in reaching the NTD control and elimination goals through proven, cost-effective public health interventions. Results for Development (R4D), as one of the Act I East consortium partners, provides technical assistance to strengthens local capacity for NTD program financing, planning, budgeting, and budget execution so that NTD programs develop capacity and systems toward sustainable domestic financing and sustainable NTD response and services. In Tanzania, Uganda, and Ethiopia, the program works with ministries of health and other relevant stakeholders such as ministries of finance and budget decision makers to identify potential options for sustainable financing of NTD program activities in line with broader health financing strategies for domestic resource mobilization (DRM), Primary Health Care (PHC) and/or Universal Health Coverage (UHC). As such, Act jobs-near-me.org East supports government institutions at the national and sub-national levels to assume greater programmatic and financial responsibility for their NTDs response.

In 2020, Act I East provided technical support to the national NTD control program to develop the NTD program sustainability plan and the costing and development of the 3rd NTD strategic plan. In FY22 and FY23, R4D conducted an NTD financing assessment at Federal Ministry of Health (MOH), Ministry of Finance (MoF), Oromia Regional (Health and Finance) Bureaus, seven woredas in the Oromia region and key NTD stakeholders.

Evidence from the FY23 NTD financial assessment revealed that the government did not allocate sufficient resources for NTD elimination and control, and that NTDs are not included and prioritized in the woreda planning and budgeting process. The main reasons for this are (i) inadequate regional budget allocation for woredas; (ii) low prioritization of NTDs by budget decision makers because of a lack of data and awareness of the magnitude and impact of NTDs on social, health and economic status of the community; and (iii) high dependency on donors/partners with the assumption that the health sector has several partners who allocate adequate funds for program implementation, and (iv) limited capacity of the health sector staff on planning and budget preparation.

In FY24, Act East supported the MOH and ORHB to prepare the NTD planning and budgeting operational guide, strengthen the capacity of government staff on NTD planning and budgeting and facilitating the NTD budget allocation workshop with woreda steering committees in seven woredas (three zones) of Oromia region. In the first quarter of FY25, Act I East has completed the field data collection (key informant interviews and secondary data) of the NTD budget assessment in these piloted woredas. The findings from this assessment will inform the Health Financing Pause and Reflect meeting that will be conducted in the Q2 of FY25. The Act I Eastwill also continue providing technical and financial support to MOH, Oromia and Benishangul-Gumuz regional health bureaus to strengthen the capacity of woredas on planning and budgeting and resource mobilization for NTD program as detailed below: –

II. Objective of the consultancy

The objective of the consultancy is to provide technical support to in the implementation of the health financing activities prioritized and approved for support in the Act jobs-near-me.org East FY25 Ethiopia Country Work Plan. Under the Act East program, the consultancy assignment mainly focuses on providing technical support to strengthen Woreda’s capacity on planning and budgeting and domestic resource mobilization for NTD Program in Oromia Region (7 woredas) and Benishangul-Gumuz Region (8 woredas).

The consultant will conduct the following specific activities:

1) Finalize the Analysis of NTD Budget Allocation Assessment in Seven Selected Woredas of Oromia Region: The Act I East completed the translation and transcription of the field data including the key informant interviews and the secondary data (NTD financial data) from the seven woredas in the Oromia region. The consultant will conduct a detail analysis of the NTD budget allocation assessment report using the data collected from these woredas.

2) Conduct Health Financing Pause and Reflect (P&R) Meeting; The consultant in collaboration with MOH, ORHB, R4D and RTI team will organize a 2-day Pause and Reflect meeting with seven woredas in Oromia region to understand the key drivers and barriers to NTD domestic resource mobilization at the woreda level. The objective of the P&R is to assess the impact of the operational guide development, capacity-building efforts, and the NTD budget allocation advocacy workshop conducted with seven pilot woredas in FY24. This meeting will also serve as a platform to collect feedback from the seven woredas, review lessons learned, and identify effective strategies, as well as areas that need improvement on domestic resource mobilization for NTDs. The consultant will support presenting the findings from the pause and reflect meeting and NTD budget assessment to senior-level government officials of the Oromia Region.

As outcome of this session, the consultant will share the NTD budget assessment conducted in the seven woredas and document the key drivers and barriers for sustainable mobilization and allocation of domestic resources for NTDs at the woreda level.Act jobs-near-me.org East aims to understand the entry points that can help the MOH and RHBs to strategically identify opportunities for mobilizing domestic resources at subnational level. The Pause and Reflect will be the last opportunity to identify key enablers and tweaks needed prior to the Operational Guide Validation Workshop. By documenting these insights and the learnings, Act jobs-near-me.org East aims to contribute to the overall improvement of NTD resource mobilization efforts in the region and in Ethiopia.

3) NTD Operational Guide Validation Workshop: Following the pause and reflect meeting, the consultant in collaboration with R4D SPO, RTI HSS country lead, ORHB and MOH will organize a 1-day workshop to validate and disseminate the NTD Planning and Budgeting Operational Guide with Act jobs-near-me.org East-supported regions. The purpose of this task is to review the guide to improve its content, methodologies, and strategies proposed in the guide to ensure they are reliable and effective in addressing the specific needs and challenges related to NTD planning and budgeting. Alongside the validation and dissemination, participants will gain an understanding of how to develop evidence-based NTD plans and budgets and effectively demonstrate the need for NTD resource allocation during their respective planning and budgeting cycles. Act jobs-near-me.org East anticipates that the Guide will be endorsed by the MOH and Oromia RHB for implementation at the national level in FY25. Following the approval of the Operational Guide by the MOH and Oromia Regional Health Bureau, the Guide will be translated into Afaan Oromo.

4) Benishangul-Gumuz Operational Guide Introduction Workshop (Capacity Building and Budget Allocation Advocacy): Based on learnings from FY24 health financing activity implementation in Oromia region, in collaboration with the MOH and Benishangul-Gumuz regional health bureau (BGHB), in FY25 Act jobs-near-me.org East will expand health financing support to eight new woredas in Benishangul-Gumuz region. The consultant in collaboration with MOH, RTI and R4D team will provide support to build the woreda-level capacity to use the Operational Guide that emphasizes the inclusion of all NTDs in the planning and budgeting cycle and facilitate budget advocacy efforts in the region. This activity aims to ensure that the woredas and regional officials have the necessary knowledge and skills to effectively develop a woreda-specific comprehensive NTD plan and budget targeting all prevalent NTDs, including estimating and mobilizing resources for funding gaps for NTD interventions. Through ensuring the mainstreaming of comprehensive NTD plans as part of government health sector plan, the activity also aims to link the planned NTD interventions with health insurance and service exemption schemes at the health facility level. The delegate from the MOH will share the on-going efforts on inclusion of NTDs into EHS and HIBP to the regional and woreda staff as well as open dialogue how the region is handling the case management of NTDs at health facility level.

In FY25 Q3, the consultant will prepare training materials for the capacity building, and budget allocation workshops and facilitate a 3-day workshop in Benishangul-Gumuz, to sensitize NTD budget allocation to decision makers, including the woreda steering committees, woreda health, finance, education, and water heads, NTD focal person, woreda health and finance planning and M&E experts, primary health care unit director, zonal health and finance department heads, and zonal NTD focal person and M&E experts. The workshop will dedicate 2 days to capacity-building activities with technical staff and 1-day for NTD budget allocation workshop with woreda steering committees. During these workshops, the consultant, will prepare and present actionable evidence and tailor messages for increasing NTD funding and greater prioritization of NTDs during the woreda-based planning and budgeting process. In these workshops, the woreda steering committee will actively participate in discussions and decision-making related to budget allocation for NTD interventions. Through this collaborative effort, Act I East endeavors to strengthen the healthcare system, improve resource allocation, and ultimately contribute to more effective NTD interventions in the supported woredas.

5) Conduct Supportive Supervision in Benishangul-Gumuz Region: As a follow-up activity, the consultant, in collaboration with the MOH, the Benishangul-Gumuz Health Bureau (BGHB), RTI, and the R4D team, will visit eight selected woredas in the Benishangul-Gumuz region. This visit will take place after capacity-building and advocacy efforts, but prior to the government’s budget submission and approval. The purpose of this travel is to engage with the staff of the woreda health and finance offices, as well as the woreda steering committees, to review preparations for incorporating NTDs into the woreda’s health sector planning and budgeting. As part of supportive supervision, comprehensive feedback will be provided to all visited woredas regarding their status and plans for mobilizing domestic resources for NTDs.

III. Expected Deliverables

Activity 1: Finalize Analysis of NTD Budget Allocation in Seven Selected Woredas of Oromia Region:

Deliverable 1.1: Submit Draft and Final Assessment Report: After the transcription of the KIIs, the consultant will prepare and submit the draft assessment report to R4D. The consultant will revise the draft report and submit the final version of the assessment report based on the feedback from ORHB, RTI and R4D HQ and country team.

Activity 2: Conduct Health Financing Pause and Reflect (P&R) Meeting:

Deliverable 2.1: Prepare and Submit Inception Report (IR): The consultant will prepare the draft inception report including thepurpose, objective, methods, and tools for pause and reflect meeting. The consultant will revise the draft IR and submit the final IR based on the feedback from ORHB, RTI and R4D HQ and country team.

Deliverable 2.2: Facilitate 2 days’ workshop and submit workshop report: After the workshop, the consultant will prepare the draft report including summarizing the woredas’ feedback, the key lessons learned and effective strategies and further adaptation for allocating domestic resources for NTDs. The consultant will revise the draft report and submit the final version of the pause and reflect session report based on the feedback from ORHB, RTI and R4D HQ and country team.

Activity 3: NTD Operational Guide Validation Workshop:

Deliverable 3.1: Prepare concept note and training material and facilitate 1-day workshop: A concept note specifying the purpose, content, methods, expected outcomes and agenda of the workshop including workshop materials required for the session (PowerPoint presentation). After the workshop, the consultant will submit the draft and final report of the validation workshop to R4D.

Deliverable 3.2: Submit the final NTD Planning and Budgeting Guide in English and Afan Oromo language: The consultant will incorporate the feedback from the validation workshop, MOH, ORHB, Act East team, and USAID and submit the final version of the guide both in English and Afan Oromo.

Activity 4: Benishangul-Gumuz Operational Guide Introduction Workshop (Capacity Building and Budget Allocation Advocacy):

Deliverable 4.1: Prepare concept note and workshop materials for capacity building and advocacy) A concept note specifying the purpose, content, methods, expected outcomes, evaluation methods and agenda of the workshop including training and advocacy materials required for the sessions (PowerPoint presentation and the customized tools).

Deliverable 4.2: Facilitate 3 days’ workshop and submit workshop report: After the workshop, the consultant will submit the draft and final report of the capacity building and advocacy workshop to R4D.

Activity 5: Conduct Supportive Supervision in Benishangul-Gumuz Region

Deliverable 5.1: Prepare concept note and conduct supportive supervision and submit the filed report: The consultant will prepare the concept note along with tools for supportive supervision as well as conduct the supportive supervision in eight woredas in BG region. Additionally, the consultant will preparefield trip report along with actionable recommendations.

IV. Implementation arrangements

The consultant will work under the guidance and direct supervision of the R4D’s Senior Program Officer. The consultant will also be expected to routinely engage with the Act jobs-near-me.org East HSS country lead and the MOH, ORHB and BGHB NTD team leader. The consultant will be based in Ethiopia and may be required for regional travel in accordance with R4D travel and safety precautions.

V. Timeline and Output

The timeline of the deliverables are as follows:

Activity 1: Finalize Analysis of NTD Budget Allocation in Seven Selected Woredas of Oromia Region

Output: Deliverable 1.1

Timeline: January 2025

Activity 2: Conduct Health Financing Pause and Reflect (P&R) Meeting

Output: Deliverable 2.1

Timeline: February 2025

Output: Deliverable 2.2

Timeline: February 2025

Activity 3: NTD Operational Guide Validation Workshop

Output: Deliverable 3.1

Timeline: March 2025

Output: Deliverable 3.2

Timeline: March 2025

Activity 4: Benishangul-Gumuz Operational Guide Introduction Workshop (Capacity Building and Budget Allocation Advocacy)

Output: Deliverable 4.1

Timeline: April 2025

Output: Deliverable 4.2

Timeline: May 2025

Activity 5: Conduct Supportive Supervision in Benishangul-Gumuz Region

Output: Deliverable 5.1

Timeline: May-June 2025

The consultancy must be completed by September 30, 2025.

VI. Qualifications

• Master’s degree in health economics, health policy and management, or public health with a health financing focus.
• At least ten (10) 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 in Ethiopia.
• Extensive experience in supporting woreda-based health sector planning and budgeting process.
• Experience in advocacy workshop facilitation and collaboration with government and non-government stakeholders.
• Familiarity with the Ethiopia health financing mechanisms and health system, NTD or vertical programs including HIV/AIDS, FP/RH, Malaria, EPI, MCH, TB, among others is necessary.
• Previous experience working on USAID health financing programs (NTDs, WASH, HIV, Nutrition and TB etc.)
• Demonstrate experience in preparing strategies and guides.
• Full professional fluency in English including excellent communication skills in reading, speaking, writing, and listening is mandatory.
• Ability to work independently and collaboratively as part of a team and deliver high-quality results within tight periods.
• Strong qualitative and quantitative analysis skills
• Excellent organizational skills and attention to detail.
• Must be based in Ethiopia.

VII. Payment Modalities and Travel Related Costs

R4D will not make any advance payment to the consultant. Payment will be made to the consultant after the submission of the deliverables and the approval of the quality of the product by the client as indicated in the TOR. As well as R4D can reimburse for the preapproved domestic travel (including airfare, per diem, hotel accommodation, and transportation) to the consultant. This is intended for work being done (TBD with the MOH, R4D and RTI) to attend meetings/workshops, for technical support on health financing activities.

VIII. Application Submission.

To apply for this consultancy, please submit a cover letter and CV detailing relevant experiences and qualifications for this position along with your daily rate to achekole@r4d.org or agrider-reiff@r4d.orgby January 06, 2025.

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