Assessment of external perceptions of NHIF Sudan

Start date: January 2022

End date: April 2022

1. Context

The National Health Policy (2017-30) in Sudan enshrines Universal Health Coverage (UHC) as an overarching goal to be achieved by 2030. As per the National Health Insurance Law 2016, registration with national health insurance in Sudan is mandatory for all residents, including citizens, foreigners, and refugees. In 2020, the National Health Insurance Fund (NHIF) had already achieved 81.7% of population coverage guaranteeing access to a network of 3,123 facilities and 2,712 pharmacies. However, out of the total covered population, almost 12.1 % are from the formal sector, only 11% from the informal sector, 65.4% are subsidised members and the remaining 11.5% include pensioners; students; children under-five; and the private sector (NHIF, 2019).

Looking forward, the six goals of the recently adopted NHIF strategic Plan 2021-2024 are as follows:

1. Strengthen institutional capacity of the NHIF;
2. Improve population coverage from 80% to 90%, by expanding access to informal sector and enhancing private sector compliance;
3. Improve the quality of the existing network of health services to boost health services utilization;
4. Provide adequate and sustainable resources for national health insurance to meet the needs of beneficiaries and utilize resources efficiently;
5. Increase insurance awareness of the population; and
6. Strengthen communication and partnerships with stakeholders.

According to NHIF top management, priorities include:

1. Expand the coverage to the informal sector and private sector and include refugees and internally displaced persons in the scheme;
2. Fully digitalize (through electronic programs and applications) the NHIF scheme;
3. Build capacity of NHIF in the following areas: procurement & claims management; and
4. Improve the health insurance package adequacy.

ILO was requested by NHIF to support with an institutional diagnosis, which will support the identification of key areas for institutional strengthening. As different areas are currently targeted by the NHIF, from costing to purchasing and quality control, financial management, claims management and channelling funds, but also from procurement to systematically producing evidence, the ILO proposes to support the NHIF in identifying strength and areas of improvement through an analysis of institutional frameworks and administrative processes (internal perception). In addition, an assessment of beneficiary perspectives and provider views on NHIF will inform the external perception of the NHIF and potential areas for improvement. In parallel, an actuarial valuation will inform the team about the sustainability of the fund and design options.

2. Objectives and approach

The objective of this assignment is to conduct an assessment of the perceived strength and weaknesses of the NHIF from the perspective of protected persons on the one hand and service providers on the other hand. This study will inform NHIF of areas of improvement and feed into the institutional assessment that is conducted in parallel.

This work will be done through a survey of protected persons and health service providers to assess the quality, relevance and performance of services provided under the Sudanese NHIF:

• The survey with protected persons will be designed to benchmark the system along the key principles that health services should meet as per relevant International Labour Standards (ILS), and provide the NHIF with an overview of the satisfaction of beneficiaries and key perceived strength and weaknesses. The design of the survey should consider existing guidelines and international practices on health insurance beneficiary satisfaction. The survey shall include but not be limited to the following topics:
  • Level of information beneficiaries and employers have about health insurance benefits/entitlements/awareness of NHIF existence.
  • Level of worker and employers satisfaction with NHIF’s health insurance services.
  • Level of satisfaction on benefits received as compared to entitlements / Level of satisfaction on medical treatments covered by NHIF.
  • Review the benefits provided and all aspects of their administration, including planning, process flows for all functionalities, decision-making on enforcement and benefit approval, efficiency of processes, and productivity at different levels, human resource capacity and ICT.
  • The survey with service providers will be designed to assess the perception of service providers in relation with the Social Health Insurance (SHI), in particular administrative processes, adequacy of the benefit package, issues related to exclusion, evasion and fraud, as well as overall satisfaction vis-à-vis performance on key functions (financial flows from the SHI, linkages with medicine and equipment purchasing, etc.
  • Perception of the Health Service Providers regarding the performance of the NHIF in implementing the SHI. It should include their perception on the relevance and operability of the claim procedures, the level of the benefit package and other elements that might be of relevance for the review of the scheme.

The provider will work under the general supervision of the of the PROSPECTS-SUD Programme Manager and under direct supervision of the Technical Officer - Social Health Protection for Refugees and Host Communities for PROSPECTS in coordination with the Social Protection National Programme Officer assigned to PROSPECTS-SUD. The provider will also collaborate closely with the team of experts in charge of the overall institutional assessment and strategy development exercise with NHIF.

3. Timelines and deliverables

4. Payment schedule

• 20% of the total fees against deliverable 1 (inception report) to the satisfaction of the ILO.
• 20% of the total fees against deliverable 2 (preliminary report) to the satisfaction of the ILO
• 60% of the total fees against deliverable 3 (final report) to the satisfaction of the ILO

5. Profile of service provider

• Extensive experiences with qualitative and quantitative data collection and analysis
• Experience working with UN institutions, ideally with ILO
• Experience working in Sudan
• Fluency in both English and Arabic

6. Evaluation criteria

The evaluation of applicants will be made against the following evaluation criteria. Those that are qualified during this technical evaluation will proceed to the financial evaluation, at which stage the most competitive offer will be selected.

7. How to apply

Interested candidates should submit the following documents to Shana Hoehler, Technical Officer – Social Health Protection for Refugees and Host Communities, hoehler@ilo.org by 31 October 2021 at the latest:

• Technical proposal including the proposed methodology and timeline of work
• Financial proposal based on deliverables

Requests for documents as well as questions related to this assignment can be submitted to the above email until 22 October 2021. Interested consultants are requested to provide a financial offer that is deliverable based AND includes ONLY professional fees and associated costs (e.g. missions etc.) related to the activity.