Consultant

Objective of the programme

Bangladesh government has embarked on the 4th Health Population and Nutrition Sector Program (HPNSP) aiming at improving inequity, quality and efficiency in the health sector for gradually moving towards universal health coverage (UHC) and achieving health-related Sustainable Development Goals by 2030. Health financing system will play a major role to increase equitable access to quality health care services through effective utilization of resources for health care. Health financing reforms require effective budget execution practices to ensure money flows to identified priorities and ultimately deliver the needed health services which are directly impacted by budget execution rules and practices.

Government’s health expenditure in relation to GDP is only 0.69% placing Bangladesh among the countries that least spends on health globally. The government of Bangladesh pools the revenues for health from budget and donors’ contributions and allocate largely to Ministry of Health and Family Welfare (MOHFW) to finance the health sector. The line-item based budgets are transferred to the MOHFW from government’s non-development and development budgets. MOHFW development budget funds the implementation of 29 operational plans (OPs). The MOHFW development budget is characterized by the Sector-wide Approach (SWAp). The Health SWAp is implemented through different OPs. The SWAp’s advantage is that, as resources are pooled in a common fund, and services are divided by line items under different OP fund flows, accounting and accountability of individual OPs are better ensured.

A World Bank’s study on public financial management showed the budget utilization of lead operational plans for essential services are much lower than that of capital-intensive operational plans. Annual Program Implementation Report of 4th HPNPS shows that government has allocated BDT 22,457.3 core from July 2016 to June 2020, of which 14 OPs related to improving health services and 10 OPs on Health System Strengthening received 59.02% and 40.1 % of total allocation respectively. However, in total BDT 3,247,2 core of total allocated budget for OPs remained unspent during last four fiscal years, which equals to 14.5% of the total allocation. On average, 77%-80% (2017-2019) of the development budget has been executed. This level of underspending not only further shrunk the scope of maximizing the health outcome but also weakens the stance of MOHFW for demanding higher share of national budget for health from the Ministry of Finance. There are previous studies identified challenges and barriers of budget implementation or utilization in general. For instance, major PFM barriers in service delivery include delays in fund availability and procurement and the lack of operational funds at the facility level. However, to date, efforts are limited to systematically and clearly assess the root causes of poor budget execution practices by OPs, document the measures introduced to tackle this issue and, accordingly, inform evidence-based policy changes in Bangladesh.

In addition, the Strategic Plan for the fourth HPNSP (2017–2022) includes several priorities in governance, including PFM. The HNP Sector Investment Plan (SIP) 2016–2021 rightly adopted capacity strengthening of MOHFW’s core systems, encompassing financial management, procurement, and institutional development as strategic objectives for the five-year period between 2017 and 2022 (MOHFW 2016). Therefore, the World Health Organization plans to support the MOHFW to address this important knowledge gap by jointly undertaking a research program.

Purpose of the Activity:

The purpose of this consultancy is to diagnose and deepen the understanding of root causes of underspending and poor budget execution of allocated budget for key operational plans related to improving health services under 4^th HPNSP. The study will also aim to explore policy options and advocacy interventions to address those challenges in order to gain efficiency in resource utilization.

Specific objectives:

• To understand the process of budget preparation and budget formulation of the following selected OPs;

1. Hospital Service Management (HSM)
2. Maternal Neonatal, Child and Adolescent Health (MNACH),
3. Community Based Health care (CBHC),
4. Clinical Contraception Services Delivery Programme (CCSDP),
5. Non-Communicable Disease Control (NCDC),

• To understand the funding flows of the mentioned OPs in health^[1] and assess how they relate to the health budget execution system;
• To understand how the budget formulation process of the selected OPs may create duplication with budgetary allocation for other OPs or revenue budget and identify the areas of duplication;
• To understand and clarify budget execution rules and practices (variance in budget execution rates) of selected operational plans;
• To understand and clarify the depth and breadth of budget execution issues in health in general, in selected operational plans, and at facility level;
• To identify root causes, factors, weaknesses and challenges (including non-compliance of PFM system, bottlenecks in line-item based budgeting approaches etc.,) that hinder budget execution of selected operational plans;
• To identify the barriers in the public procurement system and how it affects budget spending by the selected operational plans;
• To identify other barriers in the current Public Financial Management system that obstructed or delayed the budget execution process, including
  • The gaps in accounting, reporting and monitoring mechanisms;
  • To identify the institutional capacity gaps, including weaknesses and challenges with OPs implementing units;
• To understand and document how budgetary practices (budget formulation, spending and reporting) vary between health financing schemes and sources;
• To understand and document how the budget spending is monitored and reported;
• To identify corrective actions and interventions to address these root causes and barriers, thereby improving the budget execution and enhancing budgetary space for health;
• Identify the ways to mobilize health and budgetary leaderships to prioritize evidence-based policy change.

Description of duties:

The consultant shall undertake the following duties;

1. Develop a proposal with methodology, study design following the guideline to meet the specific objectives, with the support of technical group and WHO (Country office, HQ and SEARO;

• The study will be informed and substantiated by existing published and unpublished reviews and assessments undertaken by other agencies including the World Bank, IMF and Global Fund etc. in recent years.
• This study will use qualitative and quantitative methods and analysis. The case study protocol will be administered through key informant interviews and focus groups discussion at national and sub-national levels, to form the qualitative approach to diagnose and identify the challenges and critical issues related to budget execution of operational plans. Budgeting practices and budget execution rates of selected facilities and operational plans will be analyzed to generate quantitative evidence.

2. Coordinate with WHO Bangladesh as well WHO HQ and SEARO to have overall guidance for conducting the study;
3. With guidance and supports by WHO Bangladesh, WHO HQ and SEARO, develop data collection tools for collecting the information;
4. Validate the proposal and data collection tools with the guidance of technical group and WHO Bangladesh and get endorsed by the technical group;
5. Train data collectors in districts, and lead the necessary data collection exercise, key-informant interviews, focus group discussion and administrative data collections process with the support of data collectors supported by Planning Wing and WHO with separate financial arrangement;

• Two districts will be purposively selected to inform the Case study protocols- one good performer district and one poor performer district. From each district, two Upazila Health Complexes will be purposively selected. From each Upazila, two Community Clinics will be selected for data collection.

Therefore, total number of facilities selected for data collection:

1. Two district hospitals;
2. Four Upazila Health Complexes;
3. Four community clinics

6. Validate the preliminary findings with the technical group, stakeholders, and WHO reviewers.
7. Prepare a report meeting the specific objectives of the study and get validated from Planning Wing, technical experts and WHO;
8. Develop a final report compiling the findings of the both studies on assessing the root causes of budget execution challenges for major OPs related to improved services delivery and health system strengthening with collaborating with another technical consultant. (A technical consultant will be assigned to diagnose and deepen the understanding of the root causes of budget execution challenges of major health system strengthening related OPs);
9. Develop a policy brief to address the budget execution challenges for major OPs related to service delivery and health system strengthening with support of a consultant ( A technical consultant will be recruited under a separate arrangement to diagnose and deepen the understanding of the root causes of budget execution challenges of major health system strengthening related OPs) by collaborating with WHO HQ and SEARO;

Required Qualifications:

Education:

Essential: Advanced university degree in economics / health economics/ health service management/ Health Administration/public finance/ or other relevant field from a recognized university.

Experience:

Essential:

- At least 10 years' direct or indirect experience of working of national health sector management/public budget planning/ national health expenditure tracking/public financial management
- Have demonstrated experience in producing or significantly contributing to at least 3 reports or publications on public expenditure tracking/ public financial management;
- Proven track-record of working in the Health sector as a consultant on health financing/budgeting/Public financial management;

Desirable:

- Have previous working experience with Ministry of Health, Ministry of Finance, local governments, WHO, other international organizations and/or major institutions

- Have demonstrated experience of formulating or executing or analysing operational budget under health sector programme;

Competencies:

• Teamwork
• Respecting and promoting individual and cultural differences
• Communication
• Building and promoting partnerships across the organization and beyond
• Producing Results

Languages:

• English language proficiency both in speaking and writing

Computer Literacy

• Excellent knowledge of MS office applications and computer skills including the ability to make high quality technical presentations and data analysis

Salary & others benefits:

BDT 32,044 per day

Limited Insurance Coverage as per WHO rules.

ADDITIONAL INFORMATION

• This vacancy notice may be used to identify candidates for other similar consultancies at the same level.

• Only candidates under serious consideration will be contacted.
• A written test and /or a presentation using computer followed by an interview will be held only for qualifying candidates.
• In the event that your candidature is retained for an interview, you will be required to provide, in advance, a scanned copy of the degree(s)/diploma(s)/certificate(s) required for this position. WHO only considers higher educational qualifications obtained from an institution accredited/recognized in the World Higher Education Database (WHED), a list updated by the International Association of Universities (IAU)/United Nations Educational, Scientific and Cultural Organization (UNESCO). The list can be accessed through the link: http://www.whed.net/. Some professional certificates may not appear in the WHED and will require individual review.
• Any appointment/extension of appointment is subject to availability of fund and performance.
• For information on WHO's operations please visit: http://www.who.int.
• WHO is committed to workforce diversity.
• WHO's workforce adheres to the WHO Values Charter and is committed to put the WHO Values into practice.
• WHO has a smoke-free environment and does not recruit smokers or users of any form of tobacco.

• This post is subject to local recruitment and will be filled by persons recruited in the local commuting area of the duty station.
• This vacancy is open to Bangladeshi Nationals (all genders) only.

• Qualified female candidates are encouraged to apply.

• Any attempt to unduly influence on WHO’s selection process will lead to automatic disqualification of the applicant