To provide services for A Study tour on ‘Experience Sharing of the Primary Healthcare System of Sri Lanka' focusing on the primary healthcare system.

TERMS OF REFERENCE FOR INSTITUTIONAL CONTRACT

(above US$ 2,500)

 

Title of the assignment

A Study tour on ‘Experience Sharing of the Primary Healthcare System of Sri Lanka' focusing on the primary healthcare system

Purpose

The purpose of the Study Tour is “To enhance the technical capacity and understanding of the officials of MOHFW by sharing Sri Lanka’s experience and best practices regarding the primary health care system for better influencing the health systems transformation of Bangladesh towards building a resilient and people-centric integrated health system at primary healthcare level

Location

The Study tour is planned to be held in Sri Lanka. The contents of the tour will be comprised of the lecture/presentation on the primary health care system preferably in Colombo for two days and three days of field visits at the rural level of Sri Lanka to gather learnings on the public health programme on the primary health care system at the community level.

Estimated Duration

It will be five days of training will tentatively start from 12 August 2024.

Reporting to the Technical Supervisor of this assignment

Health Specialist, Health Section

1. Background

The primary healthcare approach has been recognized most cost-effective approach to bring services for health and well-being closer to people. Since independence, successive health strategies and plans of Bangladesh emphasized primary health care as the key approach to improving the health status of Bangladesh. Bangladesh was one of the signatories of the Alma-Ata Declaration of 1978, which adopted a broader vision of expanding primary health care to the grassroots level of the nation. Enormous efforts have been made to establish public facilities across the country at the primary healthcare level since then. The government further committed to achieving Universal health coverage by 2030 through a primary healthcare approach and reinforced its commitment at different UN platforms, and global and local meetings.

Despite the considerable progress in improving the delivery of primary health care over the last decades, the government is struggling to advance the progress to the desired level for achieving universal health coverage. The country has reached halfway of the UHC service coverage target in reaching out to all people with essential health coverage with 56 scores out of 100 in the UHC service coverage index in 2022. Household Income and Expenditure Survey 2022 discloses that the population coverage of health services by the public delivery channels at the primary healthcare level has declined significantly over the last five years. This is also reflected in the higher out-of-pocket expenditure of the country, which accounts for 68.5% of the total spending as the citizens are deprived of affordable health services at public facilities. This leads to 24.7% of the population incurring catastrophic expenditure, i.e. spending over 10% of their household income on health.

Building a resilient and people-centric integrated health system supported by sufficient and sustainable funding, a competent health workforce, and enabling legislative and regulatory frameworks is key to advancing UHC. On the contrary, public finance on health is very low, accounting for 0.46% of GDP, while financing for primary health care is declining. This low-level financing translates into low-level health facility readiness regarding availability of health workforce, medical supply, medicine and other logistics, resulting in the poor performance of the public health facilities particularly at the primary health care level. Although the country has a large network of community clinics at the grassroots level, an appropriate primary healthcare approach has not been developed to provide preventive, promotive and demand-generating services at the community level. The governance and stewardship role of the government is another crucial factor in the given context of the country’s health system, which is hardly emphasized in the health sector program planning and implementation process. 

Recently, greater momentum has been created in the country to transform the health systems as a part of the country’s efforts towards achieving universal health coverage. However, the process requires strong political buy-in in the first place. As well, there are critical gaps in knowledge and ‘technically-know how’ among the key stakeholders for planning and transforming the health systems.

To fill the critical gaps in knowledge and capacity, UNICEF Bangladesh intends to provide technical assistance to the government through sharing global knowledge and experience and building institutional capacity to strengthen the primary health care system. Sri Lanka has been recognized as one of the successful low-middle-income countries, proving its competence in establishing a strong primary health care system. Even both Bangladesh and Sri Lanka have similar health financing and health system approaches towards achieving Universal Health Coverage. On this ground, UNICEF Bangladesh has identified Sri Lanka as the most suitable country, where a few high-level government officials may visit and learn from Sri Lanka’s experiences and best practices in strengthening the primary health care system. In this regard, UNICEF would like to engage a competent academic/ research/ policy institute, which will be able to facilitate learning sessions in Sri Lanka.

 

 

1. Purpose and Expected Results

The primary purpose of the study tour is to enhance the technical capacity and understanding of the officials of MOHFW by sharing Sri Lanka’s experience and best practices regarding the primary health care system. It is expected that learning from the tour will help the participants of the MOHF to contribute to strengthening and transforming the primary healthcare system as part of building a resilient and people-centric integrated health system at the primary healthcare level at primary health care for advancing UHC progress of the country, with clear accountability system.

 

1. Description of Assignment:

 

Study Tour Design:

The leanings on Sri Lanka’s primary health care system will be delivered below methods and meeting expectations.

1. Classroom sessions (Two days):

 

Expectations from the classroom sessions:

• Knowledge and experience shared on the structure of the primary healthcare system of Sri Lanka
• Experience shared on the planning and budgeting for primary healthcare.
• Knowledge and experience shared on governance mechanisms of the PHC system including the structure of the management body, and decision-making process.
• Knowledge and experience shared on the monitoring mechanism based on the health information system on PHC, support supervision and accountability of the key players in the system.
• Experience shared on the major reforms of the primary health care system over the five decades.
• Learning shared about the Essential Service Package (Primary health care package) provided through the Primary health care system in Sri Lanka (services, HR, medicines, diagnostics, equipment, infrastructure).
• Shared critical lessons learnt operating the primary health care programme

 

 

1. Field visit (Three days)

 

Expectations from the field visits:

• Demonstrated how the PHC is managed from the central level to the filed level and how the filed level activities are reported to the upward
• Be acquainted with the responsibilities of the PHC managers and how they ensure accountability at every tier of the primary healthcare system
• Get oriented on the details job description and qualifications of the PHC workers and community health workers and demonstrate the mechanism of ensuring their adherence to the job description.
•  Demonstrated community health programme at the field level and demonstrated how the community health workers systematically implement the community health programme
• Get experienced in how different program elements, like EPI, maternal health, NCD etc. are integrated into the community health program and connected seamlessly to the national level
• Demonstrated how  the data flow from the community level to subdistrict, district, and national levels, and observed program review meetings at various levels (for data for decision making)—PHM areas (community level catchment population), Medical Officer of Health areas, districts, and national—to evaluate different program performances Observe how Sri Lanka gathers primary healthcare data at the community level, including services provided by the private sector (ANC, Immunization, etc.)
• Demonstrated how the maternal and perinatal death review, NCD data review and EPI review and use that data to improve the programme.
• Explored the mechanisms of supportive supervision in Sri Lanka at the primary healthcare level, including planning, monitoring, and utilizing supervision data for program enhancement.
• Explored strategies aimed at improving underperforming areas served by midwives, Medical Officers of Health (Subdistrict), or districts, considering both challenges and opportunities.
• Sri Lankan counterparts engaged in discussions to identify and exchange best practices and lessons learned relevant to Bangladesh, emphasizing the primary healthcare system.
• community health workers, especially community midwives and public health inspectors engaged, to discuss their experiences and learn how they manage, maintain, and monitor primary healthcare within their catchment populations while observing Sri Lanka's methods for monitoring primary healthcare performance at various administrative levels

 

1. Participants:

The study tour will be designed for high-level government officials from the Ministry of Health, DGHS, DGFP, and health managers at the district and sub-district levels. The estimated number of participants for this tour is about 10-15.

 

1. Tasks to be performed:

 

1. Design a study tour based on the expectations provided in the ‘description of the assignment’ section.
2. Rent a suitable venue and ensure other logistics to organize classroom learning Facilitate the classroom learning session in an appropriate venue.
3. Develop and prepare the learning materials as required.
4. Contracted out appropriate resource persons for the classroom sessions.
5. Engage sufficient and appropriate resource persons to facilitate the field visits. 
6. Communicate and coordinate with the relevant govt officials, and health managers to be involved in the five days learning sessions.
7. Organize the field visits with the travel arrangement as per the design.
8. Arrange food and drinks for the participants during the classroom sessions and field visits.
9. Facilitate travel arrangements from hotel venue to classroom venues and field visits

 

1. Deliverables:

 

1. Inception report describing the design, methodology and approaches of the study tour
2. Knowledge management pack - Technical presentations and government resource materials (guidelines, circulars and job descriptions)
3. Facilitated classroom sessions and field visits
4. Final report of the study tour withdrawing key learnings of the visit

 

1.   Reporting requirements:

 

1. Inception report within one week of the signing contract
2. Progress report on the preparation of the study tour at least two weeks before the event.
3. Facilitated the technical and field-level sessions and submission of technical presentations within one week of the completion of the event.
4. Final report within two weeks of the event completion

 

6. Payment Schedule

 

• 30% of the total fee upon submission of the inception report.
• 30% on submission progress report report.
• 30% of the total fee for facilitating the five days event
• 10% of the total fee on submission and approval of the final report;

 

7. a. Qualification requirement of the company/institution/organization

• An academic/research/ capacity building institute/ think tank based in Sri Lanka that has at least ten years of experience in building capacity or conducting learning sessions on primary health care approaches/ Universal Health Coverage/ Health System Strengthening and policy for government officials of foreign countries
•  
• The Institute must have proven competency and experience of providing all academic, technical and administrative support in organising at least three similar types of events
•  
• This institute must have experience in supporting the government of Sri Lanka in health policy and health planning areas
•  

 

7b. Qualification requirement of the team (optional)

 

• One Team Leader having an education background in health policy/ health financing/ health planning or relevant areas and having at least 10 years of experience in capacity building, policy advocacy or conducting technical courses on health policy related to primary health care approach/ universal health coverage/health systems strengthening;
• One Deputy Team Leader and having at least seven years of experience in capacity building, policy advocacy or conducting technical courses on health policy related to primary health care approach/ universal health coverage/health systems strengthening;
• At least four resource persons having at least experience in delivering training or conducting courses in the area of primary health care system/ community health care
• One field facilitator having experience facilitating the field visit for similar types of event
• One coordinator having experience providing administrative and logistic support to the facilitators and participants during the preparation stage  and during the study tour

 

8. Evaluation Process and Method

 

 

EVALUATION CRITERIA FOR TECHNICAL PROPOSAL

 

 CATEGORY

POINTS

OVERALL RESPONSE

* Understanding of, and responsiveness to, UNICEF Bangladesh Office requirements;

* Understanding of scope, objectives and completeness of response;

* Overall concord between UNICEF requirements and the proposal

 

 

10

METHODOLOGY AND DETAILED TIMELINE

* Suitability of the approach: To what extent the study tour is designed in response to the needs of the TOR;

* Quality of proposed implementation plan, i.e. how the bidder will undertake each task and time-schedules;

*Risk assessment - recognition of the risks/peripheral problems and methods to prevent and manage risks/peripheral problems.

* Timelines proposed must be detailed and realistic;

(20)

10

10

 

5

 

5

 

 

ORGANISATIONAL CAPACITY and PROPOSED TEAM

* Professional expertise of the institute, knowledge and experience with similar types of assignments

* Team leader: Relevant experience, qualifications, and position with the institute;

* Team members - Relevant experience, skills & competencies.

* Organization of the team and roles & responsibilities;

 

(40)

10

 

10

5

5

    TOTAL MARKS

 

70

 

For this RFP, the Technical Proposal has a total score of 70 points. Bidders must score a minimum of 49 points to be considered technically compliant and in order, for the Financial Proposals to be opened. A financial proposal has a total score of 30 points.

The final selection of the bidder will be based on a quality and cost basis as specified in the RFP.