LIB – Consultancy call for ECHO costing exercise consultant

CONTEXT

For the past three years, Lebanon has faced a triple crisis that has led to severe repercussions across most sectors. One sector in particular that has been significantly impacted is the health sector; the ongoing economic crisis has significantly reduced the purchasing power of citizens. According to a Reuters’ report which was published in January 2022, as a result of the currency devaluing by 90% of its original value and has pushed approximately 80% of the population below the poverty line. As a result, according to a 2021 UNESCWA report on multi-dimensional poverty in Lebanon about a third of the population, equivalent to 430,000 households, were deprived of healthcare services as of 2021, with the figure increasing to 83% of households that include a PWD reporting barriers to access most often linked to lack of affordable services and the cost of transportation (Lebanon MSNA 2021). Furthermore, an April 2022 UNICEF report on healthcare in Lebanon highlights the shortage of medical and human resources as being the direct result of the worsening economic crisis affecting local purchasing power, with the greatest impact ensuing from the reduction of services being felt by the most vulnerable households.

The grim reality of reduced accessibility and availability of health services has had a deep impact on people in need of sexual and reproductive health (SRH) services such as pregnant and lactating women (PLW), women, and girls, According to the latest studies on the effectiveness of sexual and reproductive health services during humanitarian crises, poor access to SRH services is known to generate (1) a high risk of mortality or morbidity due to pregnancy-related complications; (2) unintended or unwanted pregnancies; (3) complications related to unsafe abortions; (4) sexual and gender-based violence (SGBV); and (5) an increased incidence of sexually transmitted infections (STIs), including HIV.  According to the latest data shared by the Lebanese statistics department at MoPH, ever since 2017, tremendous efforts have been put into to reducing maternal and neonatal mortality. In 2018, the maternal mortality rate dropped significantly and remained almost the same (13.7) in 2019. This trend was halted in 2020, with the maternal mortality rate increasing to 16.9, a phenomenon ascribed to COVID-19. During December 2021, there has been a remarkable increase in the total number of cases with 37 Maternal deaths for 2021 compared 22 maternal deaths in 2020 and out of the 37 cases, 17 were COVID-19 related.

As of 2021, the Health Utilization and Access Survey (HAUS), annually conducted by the UNCHR, showed regression or stagnation across most services. With regards to delivery patterns, 84% of participants (239) had delivered in a hospital, a 3% reduction from the figures of 2020. On the other hand, a 3% increase was observed in terms of those who had delivered in medical facilities other than hospitals amounting to a total of 11% (31).  In terms of antenatal care services, there has been a 16% reduction from 2020 with 70% of women who have delivered reporting receiving ANC services9. In addition, of all the women that delivered only 49% went for 4 or more ANC visits, a significant decrease from 12% from the previous year. With regards to post-natal care (PNC) services, only 32% (90) of the 289 women who had delivered had sought PNC services as reported by a 2021 UNHCR survey on health service utilization of Syrian refugees in Lebanon. Among those who did not receive ANC services, the most common barrier to not accessing ANC service was reported to be the inability to pay off clinic fees (44%) followed by the belief that ANC was unnecessary (30%). In terms of costs, the study further elaborated that only 24–36% of Syrian refugee women indicated that SRH services were affordable and accessible, despite the re-enforced subsidies to access PHC services. In addition, the study highlighted that transportation fees and medications are often not covered, which add up to an additional cost of 20–30 USD per visit. In addition to this in conservative and rural communities, access to SRHR and sexual health education is limited and, as such, women’s vulnerability to unwanted pregnancies, unsafe abortions, and STIs is increased.

This further compounded by the significant challenges Lebanon is facing in delivering quality and accessible secondary healthcare services. There are several coverage mechanisms in place, including the Ministry of Public Health (MOPH), National Social Security Fund (NSSF), Army, private insurance, and out-of-pocket payments. However, these mechanisms are fragmented, leading to coverage gaps for many beneficiaries. As an NGO that subsidizes healthcare services, we aim to identify the best coverage scheme to cover these gaps and improve health outcomes for high-risk pregnancies.

   OVERALL OBJECTIVE

The overall objective of this consultancy is to conduct a costing exercise for secondary healthcare delivery services in Lebanon and identify the best coverage scheme to improve access and health outcomes for high-risk pregnancies.

  SPECIFIC OBJECTIVES

• Identify the coverage mechanisms currently in place for secondary healthcare delivery services in Lebanon, including the Ministry of Public Health (MOPH), National Social Security Fund (NSSF), Army, private insurance, and out-of-pocket payments.
• Determine the strengths and weaknesses of each coverage mechanism, including the extent of coverage, the financial protection provided, and the accessibility and quality of healthcare services.
• Identify the coverage gap for beneficiaries, particularly for high-risk pregnancies, and assess the financial burden associated with accessing secondary healthcare delivery services.
• Identify best practices and lessons learned from the current ECHO project, in addition to, bench marking with other similar programs implemented in Lebanon or in other countries.
• Analyze the cost-effectiveness of different coverage mechanisms and explore potential financing options to support the coverage gap for beneficiaries.
• Develop recommendations for the best coverage scheme to follow to efficiently closer the coverage gap for beneficiaries, including the roles and responsibilities of different stakeholders and potential policy and regulatory changes required.

  DURATION OF THE STUDY

The assigned activities have to be conducted in maximum 3 Months. The timeframe to implement the following activities will be defined by the consultant.

   Languages

• Fluency in English and Arabic, French is an asset.

For more information, go to Term of Reference

Deadline for submission:

17/10/2023

Application to be addressed to:

[email protected]  &  [email protected] &,[email protected] with Reference: LIB/MD/23/COO/047 ECHO CONSULTANCY EXCERISE

Only applications including the full list of requested documents will be considered.