BENAZIR INCOME SUPPORT PROGRAM TERMS OF REFERENCE FOR DIRECTOR (HEALTH PRODUCT) A. Background The Government of Pakistan has launched the Benazir Income Support Program (BISP) as its main social safety net program. The objective of this nation-wide program is to provide Income Support to the poorest families to cushion the negative effects of the food crisis and inflation. The program will provide cash transfers of Rs. 1000 per month to eligible families. BISP demonstrates the Government’s intention to increase social assistance spending significantly. The current BISP budget allocation for 2009/10 is Rs 70 billion, which is intended to cover over 5 million families. or 13.6 million people. The Government intends to expand the BISP budget in the coming fiscal year to cover around 7 million families. The BISP program, instituted as a consumption led cash transfer program, is evolving into a long term engagement that will also invest in human capital to enable its beneficiaries graduate out of the ultra poor segment and into a stratum with improved economic prospects. The graduation and exit strategy for the BISP beneficiaries will provide employment, vocational training, and credit facilities to connect beneficiaries exiting out of the cash transfer program to government’s human development initiatives. Moving ahead on this agenda, the GoP has announced dispensation of health insurance to the poor under BISP. The budget speech 2009-10 states that "the BISP will also serve as a platform for complementary social assistance program, the main being health insurance for the poor and vulnerable. This will cover full hospitalization, pregnancy, day-care treatment, diagnostic tests, and accident compensation for earning members of the family to a maximum limit of Rupees 25,000/- per family per year." The objective of providing health insurance is to “support the ultra poor in managing the catastrophic health shocks besides improving their general health condition". The coverage of the program will be limited to target population (ultra poor being identified through poverty scorecard) only. However, the specifics of the health insurance program pertaining to the business model, benefit package, compensation modalities, and delivery systems are yet to be worked out. In order to translate the federal Government’s objective on health insurance into a workable model that suitably integrates into the BISP program, BISP Secretariat seeks services of a qualified and experienced practitioner to lead the health insurance product. Objective of the Consultancy Director Health Insurance Product will be engaged to take charge of and guide the design, development, and delivery of the BISP health insurance program. The prospective candidate will also ensure that the health insurance product synchronizes with BISP’s core mandate of income cash transfers, and complementary graduation programs directed at human capital development. Specific objectives are: i. Provide regular counsel to BISP on the health insurance and lead the development of the Health Insurance Product. ii. Engage all relevant stakeholders (public and private) in the development and management of a health insurance program that capitalizes on the available health service infrastructure and expertise (local and international) to generate innovative and efficient mechanisms to deliver health insurance to the poor. iii. Coordinate the development of the health insurance model with Ministry of Health, Provincial Departments of Health, Local level health facilities, technical advisors on health insurance, and relevant donors. iv. Lead the program strategy planning and will be accountable to BISP senior management in terms program quality and performance. B. Responsibilities of the Consultant The Director Health Insurance Product will report to the Director General Special Projects on product development, delivery, and progress. Specific responsibilities of the subject position are listed as follows: Lead the design of the health insurance model for BISP, process flows, and implementation plans to execute health insurance to the BISP beneficiaries. Furnish expertise on health sector and health insurance from a local context, which will feed into the information requirements of the technical advisors in the design of the health insurance model for BISP. Supervise consultants and program team in developing detailed guidelines for responsibilities at federal, provincial and state level in dispensing health insurance. Also define roles and responsibilities of the insurance companies in the health insurance model. Ensure the design of the health insurance product integrates and is complementary to other programs of BISP. Produce briefing materials for use with the BISP board, Federal and Provincial governments and agencies, to assist the relevant officials understand the scheme of activities and the interaction between the state, health insurers (if in the model), intermediaries, and hospitals in the health insurance model. Liaise and coordinate with relevant stakeholders (Ministry of Health, Provincial Health Departments, insurance companies, actuarial experts, etc.) to facilitate dialogue and garner specialist input for the health insurance model, implementation design, and plan. Extend timely advisory services to the BISP management and facilitate their understanding of health insurance technicalities as and when required. This will also entail presentations, documented submissions, concept briefs, and reports. Engage with actuarial experts to ascertain details and the type of insurance cover that can be provided with an annual premium of Rs. 25000. Using this information, also facilitate BISP discussions with the insurance companies. Update BISP and other relevant entities on the progress of the health insurance model and program. Select the BISP team on health insurance products, based on purely merit and credentials. Supervise and manage the health insurance team in attaining the program targets by inculcating a practice of regular planning and performance assessment at program and individual level. Stipulate specific targets for the program in lieu of the health insurance product design and implementation plans, and take ownership of the performance and outputs. Follow and implement operational and financial guidelines of BISP and ensure compliance on every aspect of it. C. Deliverables Timely delivery of a health insurance model for BISP complete with process flows, and implementation plans. Unit structure established and functional. Also ensure that the selected team is an efficient mix of expertise, experience, credentials, and best suited to attain the BISP goals on health insurance. Unit work-plans complete with periodic targets and verifiable indicators for program progress and performance. Concept notes on various models of health insurance (e.g. RSBY-the health insurance program in India), along with detailed analysis of their suitability to the local context. Also provide recommendations on the health insurance model (or a mix of various models) best suited to the local conditions. Detailed guidelines for institutional roles and responsibilities at federal, provincial and state level, including those of the private sector (insurance companies, hospitals, NGOs etc.). Briefing material on health insurance for the consumption of various clients, which may be the BISP management, BISP Board, relevant government agencies, and the World Bank. Conduct stakeholder dialogues at federal and provincial levels for input into the design of the health insurance model and also to cultivate ownership of the BISP health insurance program among relevant public agencies and provincial governments. Presentations, documented submissions, concept briefs, and reports to develop understanding of BISP on various aspects of health insurance. Actuarial assessment of the costs involved in the provision of health insurance, and work out details of the medical package to be provided under BISP. Bimonthly reports to BISP management on the progress of the health insurance model and program. D. Qualifications & Experience The selected candidate must have the following qualifications: Masters Degree in Public Health, Public Administration, Development Planning or similar fields. At least 5-7 years experience in the area of public health insurance, Health sector development and policy. Demonstrated experience of coordination with a range of stakeholders in health sector in pursuit of project delivery. Should have an in-depth understanding of program and project designing. Practical knowledge of tools for developing design frameworks would be an added advantage. A thorough practical knowledge of the Project Management Knowledge Areas and project lifecycle concepts and approaches. Demonstrated expertise in team management and large scale projects. Should have excellent command on MS Office, complementary knowledge of project management soft wares would be an added advantage. Good understanding of Government of Pakistan systems and procedures, specifically with reference to the federal and provincial health structures and service delivery systems. Proficiency in English and Urdu language. Good communication, people management, and writing skills.
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