Agreement For Performance of Work – Universal Health Coverage (UHC) Country Evaluations

1. BACKGROUND

The Sustainable Development Goal (SDG) 3 is about ensuring "Good Health and Wellbeing for all, at all ages" by 2030. Target 3.8 is considered as the overarching target for Health SDG and aims to achieve Universal Health Coverage (UHC) – which means that “all people have access to quality health services they need without financial hardship”. The country progress on UHC is monitored by two composite indicators.

 

• The SDG indicator 3.8.1 (UHC Service Coverage Index) is measured by the average coverage of essential services based on tracer indicators under 4 sub-indices that include 1) reproductive, maternal, newborn and child health (RMNCH), 2) infectious diseases (ID), 3) non-communicable diseases (NCD), and 4) service capacity and access (Capacity) (More details on SDG 3.8.1 available here).
• The SDG indicator 3.8.2 (Financial protection Indicator) is measured by the proportion of population with large household expenditure on health as a share of total household expenditure or income. The lower the population with large household expenditure, the better it is. Two thresholds are used to define “large household expenditure on health”: greater than 10%, and greater than 25% of total household expenditure or income (More details on SDG 3.8.2 available here).

Leaving no one behind: The 2023 UHC Global Monitoring Report was released in September 2023, portrayed an alarming picture. Despite considerable variation across regions, globally there is a stagnating service coverage and worsening financial protection against catastrophic health expenditures since 2015 when the SDGs were adopted. The causes of this lack of progress vary by region and country, and addressing them requires evidence informed context-specific actions.

Regional trends: The UHC Service Coverage Index in the Western Pacific Region shows significant progress – improving from 49 in 2000 to 79 in 2021 – one of the highest amongst six WHO regions. However, the catastrophic health expenditures (measured at a 10% threshold) significantly increased from 9.9% in 2000 to 19.8% in 2019 – highest amongst all six WHO regions. Whilst the regional averages are population-weighted and are therefore driven by populous countries such as China, this trend is not encouraging.

Variation within the Sub-indices and countries of the region: Overall, progress in UHC service coverage (SDG 3.8.1) has slowed across all four sub-indices (RMNCH, ID, NCD and Capacity). However, the big concern is that despite growing burden of NCDs in the region, the progress in the NCD sub-index has been slow and has remained largely static over the past 20 years. Only six countries in the region have managed to achieve both service coverage above global averages and catastrophic health expenditures lower – Australia, Malaysia, Vietnam, Singapore, Japan and Republic of Korea. Indeed, there remain inter- and intra-county variations, inequities are rising, and the lack of adequate and up-to-date reliable data remain key challenges.

 

Country Impact and UHC: Building on the WHO’s thirteenth general programme of work (GPW- 13), GPW 14 Is focused on country impact.’ Given that, UHC is the overarching target for Health SDG (SDG-3), is the foundation for the Regional ‘For the Future Vision’, and is incorporated in nearly all Country Cooperation Strategies, there is a clear need to accelerate countries’ UHC progress in order to achieve health SDG by 2030.

Call for UHC Country Evaluations (diagnostics): The global, regional and country level progress was discussed during the meeting of Technical Advisory Group on UHC in WPRO (UHC TAG) during September 2023. One of the key priorities identified by Acting Regional Director for UHC TAG was ‘Country Focus and Impact’. In keeping this priority, UHC TAG has now recommended the WHO Secretariat to look beyond numbers, evaluate country progress and unravel the story behind the UHC trends at country level. This would enable WHO-WPRO technical divisions, Country Offices and the UHC TAG in providing more tailored and impactful country support for advancing UHC. This evidence will also feed into the discussions of Seventh UHC TAG Meeting planned for 25-26 April 2024.

 

1. PURPOSE/SPECIFIC OBJECTIVE OF THE ACTIVITY

The Objective of the UHC Country Evaluations is to inform and guide prioritization and implementation of country and regional level actions for advancing UHC.

The UHC evaluations entail in-depth analysis of country-level progress towards UHC. The analysis will focus on the diagnostics of UHC – identifying the key factors contributing to differential progress on the two UHC indicators [3.8.1 (Service Coverage index) and 3.8.2 (financial Protection Index)] including health systems, legislative and policy frameworks and financing as well as relevant public policies and broader socio-economic determinants amongst others. The evaluation will take into account both commonalities across countries as well as country-specific contexts and priorities in answering what and why of the numerical presentation of UHC performance in the region.

The UHC evaluations aim to uncover the underlying narratives and success factors, and provide actionable insights to accelerate progress towards UHC. The findings will be used to map and prioritize WHO WPRO and UHC TAG support areas, discuss with key regional and country stakeholders, develop plans and enhance implementation of actions for supporting UHC at regional and country level.

1. DESCRIPTION OF ACTIVITIES TO BE CARRIED OUT

Scope of Work

The work will be performed under supervision and guidance of the UHC team Coordinator in the WPRO’s DSI Group; and consulted by WHO County Offices. The evaluation aims to cover 37 Members States in the WHO’s Western Pacific Region, although targeted Member States can be adjusted in case key relevant, data or information is not available for certain countries or areas. This will require further discussions and agreement of WPRO.

Outputs

Output 1. Regional level overview of underlying reasons for UHC performance

• Comprehensive overview of the regional trend of UHC performance based on the regional and country-level analysis – potentially describing both commonalities across countries and explain success factors behind the countries performing well on both UHC dimensions
• Regional-level recommendations (prioritized based on impact and feasibility) for accelerating UHC progress by 2030, which are actionable for WHO WPRO and Country Offices from both short- medium and long-term perspectives

 

Output 2. Country specific evaluation on enabling factors and barriers to advancing UHC

• One Common- ‘UHC Country Matrix’ including:
• Guidance on how to comprehend country-level analyses
• Member States’ data availability and performance of UHC indicators (SDG 3.8.1 & 3.8.2) and other key indicators
• Key findings and implications from literature review and data analysis
• For Each Country- (What and why) Country evaluation of barriers as well as enabling and contextual factors to the UHC progress reported via SDG 3.8.1 and 3.8.2 indicators including:
• Quantitative data analyses and narratives
• Key factors contributing to differential progress, including health systems, legislative and policy frameworks and financing as well as relevant public policies and broader socio-economic determinants amongst others which have direct/potential impact on UHC
• Key findings and recommendations for WHO WPRO, Country Offices and Ministries of Health
• A tool for guiding ‘UHC Country Dialogues’ to discuss and identify solutions for addressing the findings from this analysis

 

Output 3. Case studies of a subset of 6-10 countries showing good progress

• Case studies with narratives of their practice in advancing UHC which can provide lessons and implications for other countries that share similar characteristics
• This part differentiates from the Country Chapter by focusing on the narratives to help deepen understanding of the country’s work and context behind the good performance in achieving UHC

 

Deliverables

Deliverable 1. Inception report max 20 pages- including:

• Proposed structure and outline of each Chapter (based on the proposed key guiding questions)
• Methodology and approach including potential sources of literature for review, mechanisms for sourcing qualitative and quantitative data, data collection, collation and analysis, as well as potential limitations
• Detailed workplan with timeline (suggested to include potential roles and responsibilities of various team members)

Deliverable 2. Evaluation Framework (with sample country chapters with three countries)

• Framework that will guide the evaluation to answer the key questions using proposed methodologies
• Country analyses of three countries as sample to confirm direction of analyses, the structure, flow and content
• Proposal for updated key questions and updated workplan with timeline based on the experiences till this stage

Deliverable 3. A final report that contains visual summaries, graphs, tables and charts with following chapters:

• Chapter 1. Summary of evaluation methodologies (1-3 pages) - including objectives, evaluation framework and methodologies; considerations and limitations for the evaluation; and usefulness of the evaluation outcomes and potential future actions
• Chapter 2. Overarching regional overview and evaluation (2-5 pages) - covering Output 1
• Chapter 3. Country evaluation (2-3 pages for ‘country matrix’ and 1-3 pages per country) - Covering Output 2
• Chapter 4. Case studies (1-2 page per case of 6-10 countries) - Covering Output 3
• Annexures

Deliverable 4. PowerPoint Slides of the final report

• Visualized summary of the final report for dissemination
• To include all four chapters of the final report

 

1. METHODS TO CARRY OUT THE ACTIVITY

Methodology

The Contractor will conduct desk research/literature review of WHO publications, government/NGO reports, scientific journal articles, database and grey literature, with objectives to review and analyse country and regional level data relevant to advancing UHC – beyond UHC monitoring data – and to identify and delve into health systems and policy issues in the countries that directly or potentially impact UHC progress.

Key Guiding Questions (but not limited to)

1. What are the trends and patterns of countries that are making progress or falling behind in achieving UHC?
2. Why are some countries making more progress and others are regressing?
3. What are commonalities between the countries who performed better or worse than the regional average?
4. Why more progress is being made in some sub-indices, and not in others?
5. Who is being left behind and why?
6. What are the reasons for trends in catastrophic expenditures?
7. What are the status and reasons for unavailability of up-to-date UHC data in some countries?
8. What are the recommendations (prioritized by impact and feasibility) actionable for WPRO and WHO Country Offices to provide more tailed and impactful country support in advancing UHC?

Consultation with the WHO

An inception meeting and bi-weekly progress review meetings with the WHO team must be organized to ensure quality of the deliverable and alignment with the work objectives. Detailed format of the meeting can be further agreed.

This work will be collaboratively undertaken by WHO WPRO technical divisions led by Data, Strategy and Innovation (DSI) Group, Division of Health Systems and Services (DHS), Division of Programmes for Disease Control (DDC), and other technical divisions, country offices, and partners may be involved as needed.

Timeline

Once the contract is signed, the inception meeting must be organized within one week. Final report will be delivered in Week 12, followed by the final version of PowerPoint Slides in Week 13. Modification of the proposed timeline needs discussion with and confirmation by the WHO team.

Activity

Timeline

Inception meeting

Week 1

Submission of the inception report (Feedback to be provided within a week after submission)

Week 2

Submission of the final inception report & Progress review meeting

Week 3

Submission of the evaluation framework (Feedback to be provided within a week after submission) & Progress review meeting

Week 5

Progress review meeting

Week 7 & 9

Submission of the draft final report (Feedback to be provided within a week after submission)

Week 11

Submission of the final report

Week 12

Submission of the draft PowerPoint slides (Feedback to be provided within a week after submission)

Week 12

Submission of the final version PowerPoint slides

Week 13

 

1. QUALIFICATIONS & EXPERIENCE

Experience

• Strong track record in conducting complex health evaluations including health systems and policy analysis and research using qualitative and quantitative methods – particularly in supporting advancement of UHC in the Western Pacific Region.

Technical Skills & Knowledge

• In-depth knowledge of UHC, health systems and policy, and social determinants of health in the Western Pacific Region
• Proven expertise in research methodology, quantitative and qualitative data collection, and analysis.
• Excellent skills in synthesizing findings and analytical writing using numerical and contextual data/information
• Good understanding of WHO and ministry of Health mandates and ability to make prioritized and actionable recommendations
• Technical and institutional capacity to deliver a comprehensive final report with actionable recommendations.

Languages

• Advanced knowledge of spoken and written English is essential
• Working knowledge of other UN languages is an advantage.

Competencies

• Analytical capacity
• Proactive and effective communication
• Effective time and task management
• Teamwork

 

Additional Information

The team must have personnel with following experiences and skills:

• Project manager (At least 15 years solid experiences in public health, health systems/policy, health research including international and/or country level)
• Biostatistician (At least 5 years experiences, in particular handling country level UHC related data)
• Project officer (At least 2-3 years M&E or research experiences in public health, health systems, health research in the Western Pacific Region)

 

Key references include followings:

1. Tracking universal health coverage: 2023 global monitoring report. Geneva: World Health Organization and International Bank for Reconstruction and Development / The World Bank; 2023.
2. Universal Health Coverage: Moving Towards Better Health – Action Framework for the Western Pacific Region. World Health Organization Regional Office for the Western Pacific. 2016.
3. Universal Health Coverage Country Profile 2023. World Health Organization Regional Office for the Western Pacific. 2023.
4. Country Health Systems Reviews, Policy Briefs, Comparative Country Studies, and HiT Policy Notes by Asia Pacific Observatory on Health Systems and Policies (APO)

Applications

Qualified and interested agencies or institutions are invited to submit their Expressions of Interest to the Supply Officer through WPRO UNGM at wproungm@who.int by 1 November 2023.

The Expression of Interest should include the following:

• Cover letter outlining their interest, experience and institutional capacity that make them suitable to deliver this work.
• A detailed proposal outlining the approach and methodology for conducting the Evaluation, including a budget and timelines. Key focus on the methodology and approach
• Curriculum Vitaes of key team members
• Two references from previous clients or partners

Please use Tender Notice No. 217094 as subject to all submission. Shortlisted applicants may be invited for further discussions or presentations. Only successful candidates will be contacted.