Consultant to Strengthen Ebonyi State Health Insurance Agency’s (EBSHIA) Capacity at Palladium Group



Palladium is a global leader in the design, development and delivery of Positive Impact – the intentional creation of enduring social and economic value. We work with foundations, investors, governments, corporations, communities and civil society to formulate strategies and implement solutions that generate lasting social, environmental and financial benefits.

Applications are invited for:

Title: Consultant to Strengthen Ebonyi State Health Insurance Agency’s (EBSHIA) Capacity to Manage Claims Reimbursements and Establish a Sustainable Quality Assurance System

Subject RFP #: TO2/217727/Subcontract-2023-003-Ebonyi
Location: Ebonyi

Purpose

  • IHP seeks the engagement of a qualified health insurance expert for a period of 90 working days to strengthen EBSHIA’s capacity to manage claims reimbursements and establish a sustainable quality assurance system.
  • He/she will also build the capacity of EBSHIA to develop and implement business process manuals for the agency and providers standard treatment protocols to guide the effective and efficient provision of quality health services under the EBSHIS and support the agency to introduce flexible payment options to ease financial burden of high premium rate on residents which would in turn, attract resident’s interest to enrol into the EBSHIS.
  • The consultant must be embedded in the EBSHIA state office for the consultancy period.

Type of Contract:

  • This is a firm fixed price deliverable-based contract.
  • The consultant is expected to satisfactorily accomplish the deliverables before he/she gets paid for that deliverable.
  • The IHP Chief of Party reserves the right to confirm if a deliverable is delivered adequately or otherwise.
  • No price change is expected after contract is signed. IHP will not pay for cost of any deliverable that is not complete, of quality and delivered on time.

Anticipated Contract Term:

  • The anticipated performance period for the consultancy is May 1, 2023, to July 31, 2023.
  • As a firm fixed price consultancy based on deliverables, Palladium will only pay for deliverables that have met the standards and expectations of the program and which is also delivered within assigned timelines.

Project

  • The USAID Integrated Health Program (IHP) is a five-year program of the United States Agency for International Development (USAID) with the Government of Nigeria (GON) to provide technical support for rapid scale-up of proven interventions, improvement of service delivery and strengthening of health systems. The activity facilitates seven core intervention areas: health system strengthening (HSS), reproductive health/family planning, maternal, new-born, adolescent, and child health, and nutrition (RMNCAH +N).
  • IHP supports the rapid scale-up of proven high impact interventions appropriate to each stage of life through improvements in the delivery of quality primary health care services, the strengthening of health systems, the reduction in supply side barriers to service access and optimizing each contact with a client.
  • IHP works closely with state and local government in Bauchi, Kebbi, Sokoto, Ebonyi states and the FCT to support established health and development plans, build capacity and ensure ownership of interventions, systems, and results.
  • The project promotes integrated packages of services in the seven core intervention areas of HSS and RMNCH+NM, ensuring that priority is given to mainstream gender and social inclusion and foster sustainability and country ownership.

Timeline

  • Applications are expected to be submitted on or before the due date as specified at the first page of this RFP.
  • Bidders are expected to submit both technical and financial bids and in two separate emails to [email protected] stating as part of the subject matter of the email whether “Technical bid” or “Financial bid” and also quoting the RFP number as it appears on the cover page.
  • Applications received will have a validity period of six months. Palladium will set up an evaluation committee who will meet to review all applications received within two weeks after the application period has closed.
  • Top candidates may further be invited for an interview by the evaluation committee which will be conducted a week after the first evaluation.
  • Depending on availability of the members of the evaluation committee and the exigences of the program, evaluation may be conducted at times which may be shorter or longer than stated here.
  • Palladium will most likely issue the contract to the successful consultant from this process within 30 to 60 days after submission.
  • Palladium’s ability to issue such contracts may be contingent upon USAID approval and when donor approval is required, timelines for contract award may be longer than stated.
  • Palladium hopes that the services to be rendered on this contract will commence on May 1, 2023.

Scope of Work and Standards
Background:

  • USAID IHP has been providing technical assistance (TA) to Ebonyi in implementation of the Ebonyi State Health Insurance Scheme (ESBHIS).
  • The implementation of the scheme is an essential mechanism for the attainment of Universal Health Coverage (UHC) by improving access to quality, equitable care, especially for reproductive health, family planning, maternal, new-born, child, nutrition, and malaria services.
  • The scheme will ensure a stable, predictable, and sustainable source of funding for health. The EBSHIS is fully operational with 58 and over 30,000 persons enrolled and accessing services through the SHIS and the Basic Health Care Provision Fund, respectively. In addition, a web-based Information Communication Technology (ICT) application has been developed for the management of key aspects of the Scheme’s operations.
  • The Ebonyi State Health Insurance Agency (EBSHIA) also has 169 accredited 169 public primary health facilities, 13 general hospitals and 4 private owned facilities with a functional referral system for service provision.
  • The program is currently supporting the agency to develop necessary systems, processes, and tools for EBSHIA to execute their role effectively.

Roles and Responsibilities
Services description:

The expected outputs and deliverables for this consultancy include:

  • Introduce flexible premium payment options to ease the financial burden of high premium on Ebonyi state residents and catalyse interest to enrol into the EBSHIS.
  • Collaborate with the EBSHIA-hired ICT firm and provide technical guidance (non-ICT) to the adjustments of the enrolment database and ensure that the database tracks premium contributions and analyses and reports enrolment data from various enrolment points.
  • Support EBSHIA in automation of paper-based operations – claims management, monitoring and evaluation tools and finance/accounting processes and mentor EBSHIA to transition to new digital processes.
  • Build the capacity of EBSHIA staff to use enrolment data for decision making.
  • Develop Business process manual, Claims manual, Quality assurance manual and Standard Treatment Protocols (STPs) for EBSHIS accredited public and private primary health facilities and secondary health facilities and conduct series of capacity building trainings to facilitate understanding and implementation of the documents.
  • Close mentoring of program staff on incoming claims review, adjudication, and payment process.

Eligibility Requirements

  • Candidates should possess a First Degree or its equivalent in Medicine or Medical sciences for example, Pharmacy, Medical Laboratory, Biochemistry, anatomy etc.
  • Post graduate qualification in Management, Public Health, Health Management, Health Economics, Insurance, or other related fields.
  • Certification in and/or professional membership of Health, Management and Health Insurance related bodies shall be an added advantage.
  • Minimum of 7 years’ experience implementing health insurance in Nigeria or related settings.
  • Expertise in health insurance enrolment processes, quality assurance, claims management and reimbursement best practices.
  • Experience in developing and delivering capacity building workshops particularly on health insurance implementation.
  • Experience in contributing to the development of health insurance strategic plans and managing teams to implement health insurance strategic plans.
  • Good understanding of current health financing reform initiatives in Nigeria, especially the subnational level.
  • Experience carrying out similar assignments in Nigeria particularly at the sub-national level.

Required Technical Competencies:

  • Expert in insurance management and operations.
  • Familiar with results-based management.
  • Knowledgeable about ICT systems for insurance management.
  • Knowledgeable about change theories and health system approaches.
  • Expert in knowledge management and skills development.

Deliverables Table

S/NO Deliverables Means of Verification
1 A flexible premium payment system designed and capacity of EBSHIA marketing staff built for implementation and enrollment.
  • A Copy of Premium payment Method approved by the Executive Secretary, ESBHIA.
  • Soft copies of proof of premium payment template – Registers, Receipt booklet etc.
  • Documented evidence of implementation of the new premium payment method.
  • One Capacity building session for the Marketers.
    • Attendance, PowerPoint presentation and compendium of pictures for the capacity building sessions on the new premium payment methods.
    • Pretest and post test scores
    • Agenda approved by IHP.
2 Digital Automation of EBSHIS operations from paper to digital format – premium payment, claims management, monitoring and evaluation tools and finance and accounting processes. • Revised enrollment database that tracks premium contributions and analyses and reports enrolment data from various enrolment points. • Capacity of EBSHIA staff built to use enrolment data for decision making.
  • Documented evidence of automation of EBSHIS operations from paper to digital format – premium payment, claims management, monitoring and evaluation tools and finance and accounting processes. Evidence includes:
  • Detailed report verified by the Executive Secretary, EBSHIA.
  • System extract.
  • The informal sector enrollment database is operationalized to capture and report on the informal sector enrollees. Evidence of updated informal sector enrolment database.
    • Detailed report approved by the Executive Secretary, EBSHIA.
    • System extract
  • Evidence of two mentoring sessions with EBSHIA to translate, evaluate and strategize on marketing measures using enrolment and premium payment data. –
    • Report
    • Signed Attendance
    • Compendium of pictures
3 Approved business process manual, claims manual, quality assurance manual and Standard Treatment Protocol (STP) for accredited public and private primary health facilities and secondary health facilities. • Capacity of EBSHIA staff and selected health care providers built to facilitate understanding and implementation of the documents.
  • Signed soft copies of an EBSHIA claims manual, Business Process Manual, quality assurance manual and standard treatment protocol by the Executive Secretary of EBSHIA.
  • Report, Signed Attendance, PowerPoint presentations and action pictures from two capacity building sessions with EBSHIA staff and one session with healthcare providers on the business process manual, claims manual, quality assurance manual and standard treatment protocol.
4 Close mentoring of program staff on incoming claims review, adjudication, and payment process.
  • At least 6 approved copies of properly vetted and reimbursed claims from 3 cycles of claims reimbursements.
5 Submission of Final consultancy report.
  • Final consultancy report including barriers with implementation, lessons learnt, compendium of pictures.

Due Diligence requirements

  • Palladium conducts a due diligence search as part of our partner vetting and selection process. Please see Attachment A for a sample of the due diligence form.
  • Any individual or Company must complete Due Diligence Questionnaire if selected for Award within 5 days (See Attachment A for the Due Diligence Questionnaire)

Restrictions for debarred or otherwise prohibited companies:

  • As a USAID funded project, IHP does not partner with any debarred individuals or companies. Therefore, candidates and companies will be subjected to the approved systems of search which Palladium uses for vetting and certifying that potential contractors are not debarred.

Availability of Specific Registrations or Licenses to perform the Service:

  • For Companies Application, contractors are required to submit their certificates of incorporation and any other industry certificates which enables them to operate in Nigeria and in the industry of this SOW.
  • The Company must have a UEI number or obtain one within 5 days of being notified of selection (see Attachment C for instructions for obtaining UEI number).

Evaluation and Award Process
This is a Best Value Procurement. Palladium uses “Best value” to select the most advantageous offer by evaluating and comparing factors in addition to cost or price. Decision is taken by the evaluation team by considering the cost and non-cost evaluation factors with the intent of awarding to the consultant that will give Palladium the greatest or best value for its money. The evaluation committee shall review the proposal received using the following weights:

Technical and Management Approach – 30:

  • Quality and benefits of the solution.
  • Quality of the performance metrics and measurement approach.
  • Risks associated with the solution.
  • Management approach and controls.
  • Demonstrates strong understanding of the work required.
  • Demonstrates knowledge of the global and Nigeria best practices in Universal Health Coverage, operationalizing insurance schemes, risk pooling, enrolment, and payment processes.
  • Proposed activities are responsive to the RFP and are well thought out, organized and feasible.
  • List of deliverables with due dates/timelines

Qualifications – 20:

  • Educational background with evidence of degrees
  • Professional qualifications (relevant to the consultancy) with certificates, licenses and other documentation
  • Technical competencies relevant to this consultancy.

Past performance – 20:

  • Evidence of quality of past work (letters of reference/recommendations, performance reviews)
  • Samples of work done (reports, publications)
  • Other evidence of quality of work and timeliness of work.

Past Experience – 20:

  • Key relevant achievements and capabilities
  • Previous work experience (long and short term) relevant to this assignment
  • Number of years of demonstrated practical and progressive experience.
  • Past experience working or providing technical support and capacity building/mentoring to the government or non-governmental organizations.

Price – 10:

  • Financial proposal that includes cost per deliverable with total cost per deliverable broken down by: daily rate, travel, accommodation, per diem, material, communication (adherence to USAID cost principles – allowable, allocable and reasonable).

Total Possible – 100 points.

Procurement Integrity and Ethics

  • It is Palladium’s Policy that no gifts of any kind and of any value be exchanged between vendors/contractors and Palladium personnel.
  • Discovery of the same will be grounds for disqualification of the vendor / contractor from participation in any Palladium’s procurements and may result in disciplinary actions against Palladium personnel involved in such discovered transactions.

Application Closing Date
14th April, 2023: 5.00pm (WAT).

Method of Application
Interested and qualified bidders should submit both their Technical and Financial bids and in two separate emails to: [email protected] using “Technical bid” or “Financial bid” as the subject of the mail and also quoting the RFP number as it appears on the cover page.

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Instructions to the Offerors
The following items are required to be submitted as part of the proposal:

Technical Proposal & Management Approach including:

  • Personnel CV(s)
  • Past Experience Information / Capability Statement
  • Past Performance Information and Reference Information (Contact / Program Name etc)
  • Past Performance or Trade References; performance reviews

Financial Proposal detailing costs to be incurred with respect of the deliverables to be accomplished:

  • Details of costs should be provided: daily rate / LOE, travel, accommodation, per diem, material, communication (adherence to USAID cost principles – allowable, allocable and reasonable and supported with evidence past rates). No lumpsum cost will be accepted.
  • The costing should be done based on each deliverable to be accomplished. Provide detailed cost per deliverables and so it is requested that you budget based on deliverables to be accomplished.
  • Selected candidates will be required to sign certifications: Terrorism, Anti-Kick Back, Debarment, Foreign Corrupt Practices Act.

Note

  • Palladium conducts interviews for potential consultants who demonstrate technical competence in the written proposal to give assurance that the consultants that will be recommended can actually deliver on the tasks if assigned.
  • Palladium reserves the right to award under this solicitation without further negotiations. The offerors are encouraged to offer their best terms and prices with the original submission.
  • No late application will be received after the deadline.

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