ASSESSMENT STUDY ON THE IMPACT OF WTO ACCESSION ON HEALTH AND HEALTH-RELATED SERVICES IN ETHIOPIA

RFP/013/2010

 

TERMS OF REFERENCE

 ASSESSMENT STUDY ON THE IMPACT OF WTO ACCESSION ON HEALTH AND HEALTH-RELATED SERVICES IN ETHIOPIA

 

I. Background

 

Ethiopia applied for WTO membership in January 2003 and submitted a memorandum on its foreign trade regime in December 2006. A number of Impact Assessment Studies have been conducted so far aimed at assessing the impact of WTO accession on the country's economy. The current study on health and health related services is one of these endeavours. The purpose of the study is to assist Ethiopia make informed decisions about the upcoming accession negotiations with respect to the type of commitments it may wish to make in health and health related services sectors.

 

Trade in the health services is minimal, particularly when compared to other services. Although the level of trade in health services is modest at present, given the rapidly growing global health care industry and the likely removal of some of the regulatory barriers to such trade at the regional, multilateral, and the national levels, trade in health services is likely to take on greater importance in the future.  International trade in health services is opening many possibilities for increasing the contribution of the health sector to the national economy of many countries. Governments from both developed and developing countries are exploring different options to enable them to benefit from the expected growth in this section, including the implementation of export strategies for health services and the liberalization of business ownership to maximize resource endowment and other competitive advantages.

 

Within the WTO (GATS Agreement) framework, trade in health services is understood as the provision of specialized and general health personnel, nursing services, hospital services, ambulance services, and physiotherapeutic and paramedical services provided by medical and dental laboratories. While health services are not amongst the highest committed sectors in WTO schedules, there is ample evidence that many recently acceding countries have agreed to make some type of commitment in the health sector. Importantly, countries have made commitments in health related sub-sectors, classified as sectors other than health, e.g., dentists, midwives and nurses (professional services) or health and social insurance (financial services).

 

 

II. Objective of the Study

 

The overall objective of the study is to assess the economic and social implications of WTO accession on the health and health-related services sector of Ethiopia. Specifically, the study will examine the implications of responding to requests for commitments in the sector during accession negotiations. The study will also assess the potential impacts of opening the economy to trade in health and health-related services under GATS and similarly identify different measures that may help prepare the sector for those reforms likely to emerge from negotiations. The study shall also examine these issues from a universal access and development-oriented perspectives.

 

 

 

 

 

III. Scope of the Study

 

The study will include the following elements:

 

3.1       Assess the economic background and importance of Ethiopia's health and health-related services.  

 

·         Assess the importance of the country’s health sector for the overall social and economic development;

·         Assess Ethiopia's health care sector with respect to:  access to health services (e.g., nurses, hospitals, clinics, dentists, midwives, laboratories, etc.); across different regions (e.g., particularly urban and rural areas); and across different segments of society (e.g., the more affluent vis-à-vis the poor and marginalized; female vis-à-vis male; old vis-à-vis young); -

·         Assess areas where Ethiopia might have a comparative advantage in health related services (e.g., natural health services).

 

3.2       Structure of Ethiopia's health system

 

·         Identify the main operators and actors providing health and health-related services in Ethiopia (public, private non for profit, private for profit, domestic or foreign).

·         Identify the type of health and health-related services offered by above operators and which segments of the population (both socio-economic and geographical areas) they target.

·         Identify how health and health-related services are provided and financed (e.g., on a profit or not for profit basis); indicate funding sources for the latter and level of sustainability.

 

3.3       Trade in health-related services and possible implications

 

·         Indicate essential facts about the GATS and Trade in health and health-related services.  Show the different forms of trade in health and health-related services (“the 4 Modes”).

·         Assess the extent to which Ethiopia is already trading in health and health-related services.

·         Indicate what benefits can be accrued from trade in health and health-related services. (e.g., access to better quality and a broader range of health services, enhanced skills etc.) Show adverse/attendant costs to Ethiopia (i.e. brain drain, cream skimming).

·         Examine potential challenges and threats from various degrees of liberalizing health services to foreign health service providers.

 

3.4       Review the Policy and Regulatory Framework, including trade-related policies

 

·         Assess the regulatory and institutional framework governing Ethiopia's health system, including, inter alia:

o   The Government's universal access goals.

o   The legal/regulatory framework

o   The health policies and reforms outlined by the government to enhance access (e.g., focusing on public or private provision).

o   The sources of available finance (private sector, donations, user fees, government revenues).

·         Assess specific trade related policies currently in place, including a review of:

o   The extent to which current policies aim to expand Ethiopia's trade in health and health-related services with a view of reaping potential benefits (e.g., to maximize benefits and minimize negative impacts).

o   Policies which provide incentives to health workers to return to Ethiopia.

o   Possible universal service obligations.

o   Other policies which might help harness the benefits of private sector participation from abroad?

·         Analyse Ethiopia’s health policies impact on the four modes of trade in health services. In relation to this, examining the compatibility of existing legislations, regulatory and supervision frameworks (including key policies) with those rules, standards and norms detailed in GATS;

  

3.5       Commitments undertaken by other WTO Members (in particular LDCs WTO member countries) and possible lessons to be learned by Ethiopia

 

·         Assess typical commitments undertaken by WTO member countries (both original WTO Members and accession countries) in health and health-related sectors

·         Types of GATS commitments which Ethiopia could undertake to facilitate and strengthen its health system, including universal access to health and health-related services.

·         Indicate conditions and limitations which Ethiopia could attach to its commitments (e.g., carve out for subsidies; limited commitments only for private health and health related services, etc.) with a view to maximize benefits from trade in health and health-related services.

 

The consultant may wish to refer to or discuss briefly the linkages between health and  other services sectors and discuss for example:

 

• Assess how the country's insurance system impacts on universal access to health services (e.g., brief description of the country's health insurance, the coverage, and the main players).
• Assess what government policies are in place that may enhance universal access to health services (including policies related to insurance services).
• Assess the situation regarding access to drugs (short summary).

 

3.6   Develop reform scenarios 

 

·         Based on an understanding of GATS and a comparative assessment of the  liberalization reforms negotiated by other Members in the health sector, the consultant shall propose a reform framework on which Ethiopian officials can begin to do more comprehensive, detailed impact assessments;

·         The consultant shall provide relative ranking to each of the recommended reforms and suggest whether each should be addressed in the short, medium and longer-term.  Similarly the consultant should provide realistic scenarios relating to the degree, form and timeframe for market liberalization, while remaining consistent with recent GATS Action Plans and negotiated positions of recently acceding countries. 

·         The proposed market access/reform scenarios shall include liberalization of trade in all four Modes;

·         Lastly, the proposed reform scenarios shall consider the regulatory changes and/or policies necessary to ensure that market liberalization engenders broad benefits.

 

3.7.     Impact Assessment: Risks, Costs and Benefits 

 

·         The consultant shall assess the impact of GATS on the potential impact of liberalization on the structure, conduct and performance of the existing health services;

·         Due concern shall be given to the risk that liberalization may pose to the health system of the country; in particular, the risk it may pose to the social development goals of health, and on access, quality and efficiency of these services ;

·         The consultants shall identify the key implementation challenges, including those associated with legislative policy, regulatory and capacity building requirements.

·         The Consultants shall identify the key benefits likely to be achieved through implementation of the scenarios defined in 3.6 for market opening in, including inter alia market access (i.e. in providing a wide range of opportunities to consumers or the need to protect consumers by assuring appropriate levels of access to and quality of health services), technology upgrade, improved techniques, reduced cost of health treatment, and improved reliability of the health sector.

·         The consultants shall also examine the economic rationale of opening this sector in generating trade revenue by exporting or attracting additional investment for this sector.

 

3.7. Flexibility Provisions of GATS: 

 

The Consultants shall thoroughly examine the extent to which Ethiopia could benefit from the flexibility provisions of GATS. 

 

IV. Methodology

 

The Methodology shall be as proposed by the consultant and agreed with MoTI. At a minimum, it will include:

 

4.1       In-Depth Interviews. The Consultants shall perform in-depth interviews with key policymakers to gain a better understanding of the goals and objectives of the health sector reform, as well as an understanding of the perceived risks in liberalizing. The Consultant will conduct in-depth interviews with, inter alia, the Federal Ministry of Health (FMH), Drug Administration and Control Agency (DACA), Regional Health Bureaus, international and local non-government organizations engaged in health related activities, medical associations, and academia.

 

4.2       Focus Groups. The Consultants shall draw upon focus groups with policy makers and health professionals to assess the health sector’s performance in service delivery.

 

4.3       Data Analysis. The Consultants shall collect data from the Ministry of Health, Drug Administration and Control Agency, and donors working in the sector, analyze the data to assess key vulnerabilities and risks as defined.  

 

4.4       Quantitative scenario testing. The consultant shall deploy quantitative testing.

 

4.5       Experiences of other LDCs on opening up the health services during accession  

 

The experience of recently acceded LDC WTO members shall be assessed.

 

V. DELIVERABLES

 

5.1       Inception Report and Presentation

 

Within three weeks of commencing the assignment, the Consultants shall prepare and deliver an inception report detailing the consultants’ understanding of the assignment, the final time-bound work plan, identify available information, program for obtaining information, tentative final report structure, data base structure and any issues to be raised for the assignment.  The consultants shall present the Inception report to Trade Relation and Negotiations Directorate of the Ministry of Trade and Industry (MoTI).

 

5.2       Mid-Term Report and Presentation 

 

Within five weeks of inception report review the consultants shall produce a Mid-Term report indicating way progress of the study.  The consultants shall present the mid-term Report to Trade Relation and Negotiations Directorate of   MoTI and the latter will call relevant stakeholders to assess the report.

 

5.3 Final Draft Report and Presentation 

 

Within four weeks of the mid-term review, the Consultant shall submit a draft final Report, covering all aspects of the Terms of Reference.   The final draft report shall be  submitted to  Trade Relation and Negotiations Directorate of the Ministry of Trade and Industry (MoTI) for comments, and such comments duly incorporated/ reflected as appropriate, following which it will be presented to a broad audience of stakeholders during a workshop. The workshop will allow for the presentation of the primarily results and recommendations of the study.  This will directly inform the key stakeholders of the study’s preliminary findings; allow collecting their comments, and making the consultants aware of view of key stakeholders. The presentation will also offer a final opportunity to make exhaustive comments that might be incorporated into the final report. The Consultant shall organize and deliver a public presentation of the findings of the study.

 

5.4    Final Report and Presentation 

 

Within two weeks of receiving comments on the final draft report, or at such time specified by the Trade Relation and Negotiations Directorate  the Consultants shall produce a final report, including a 20-page summary, translated into Amharic.  The Consultants shall produce 20 bound copies of the final report, 50 bound copies of the summary, and 50 electronic copies in CD-ROMs.  After receiving  the final report, MoTI will have 30 days to accept, reject or request modification to the report, and should request modification, the consultants shall produce a revised version within 30 days. The final report will become definitive upon acceptance of MoTI.

 

The Consultants shall report to and be directly supervised by the Trade Relation and Negotiations Directorate of MoTI.

 

Timing: estimated time for the study including the submission of final report will be four (4) months.

 

VI. Skills Required:

 

The Consultants shall hold an advanced university degree in Economics, Law, International Relations or the like; substantive knowledge of WTO issues (and in particular the General Agreement on Trade in Services - GATS) and comprehensive understanding of the social and economic situation of Ethiopia. The consultants shall also have a sound knowledge of the health sector and health-related social policies as they are implemented in developed and developing countries as well as good analytical, research and English drafting skills.

 

VII. Ownership and Confidentiality

 

The materials produced by the Consultant will become the intellectual property of the Ministry of Trade and Industry of Ethiopia and shall not be distributed beyond the fora described above without the specific written permission of the Ministry of Trade and Industry.

 

Evaluation Criteria

 

Technical proposals will be rated as per the following matrix. A firm will have to score a minimum of 70% to be considered for the next step. Financial evaluation will be conducted for the qualified and responsive technical proposals (i.e 70% and above). Financial Proposal and Technical proposal will constitute 30% and 70% respectively. The responsive and qualified firm with the highest combined rate will be issued a contract.

 

1.	Expertise of Firm / Organization submitting Proposal (relevance of experience, reputation of firm, general organization)	30%	30 points
2.	Proposed Work Plan and Approach (understanding of TOR, scope of task, clear presentation,	50%	50 points
3.	Personnel (General qualification, specialized trainings, professional experience, knowledge of region)	20%	20 points

 

 

Submission of Technical & Financial proposals

 

The technical proposal should have as annexes: (i) CVs of the Consultants expected to undertake the work; (ii) A list of related consultancies/ contracts carried out satisfactorily, supported by credentials; (iii) A confirmation of the capacity to deliver the completed work by the set timeframe; ( iv)  Detailed list of capacity in terms of human and material resources of the organization is needed; (v) Proposed methodology of the study, and (vi) Copies of professional and trade licenses of the consultancy firm.

The financial proposal - cross-referenced to the sealed technical bid should be a financial bid, giving the overall cost (fees & expenses)  but with as much breakdown of costs as possible to allow analysis of reasonableness of the offer.

 

Interested Firms should submit their Technical and Financial proposals in separate sealed Envelopes to the following address no later than 2 April 2010:

 

UNDP Ethiopia

Procurement Specialist

ECA Compound Old Bld.

Vacancy No: RFP/013/ 2010

Fax: 251 11 5514599 / 5515147

P. O. Box 5580, Addis Ababa

Ethiopia