The Ministry of Health /Ghana Health Service has received funds from the World Bank to support Maternal Child Health and Nutrition Service delivery in all regions and to undertake the piloting of community Performance Based Financing (cPBF) system in eight (8) selected districts under the Maternal Child Health and Nutrition Improvement Project(MCHNP).

The Maternal Child Health and Nutrition Improvement Project (MCHNP) seeks to improve the utilization of community-based health and nutrition services by women of reproductive age, especially pregnant women, and children under the age of two years. The Project Development Objectives will be achieved by:

• Increasing availability of high impact health and nutrition interventions.
• Addressing access barriers using existing community-based health service delivery strategies and communications channels to inform, sensitize and motivate care-givers, community leaders and other key audiences.

The project will address key disparities in access to high-impact maternal, neonatal and child health services focused on remote and underserved areas.

The "MCHNP Base" funding component involves the provision of financial support to Community Health Planning and Services (CHPS) in all districts to conduct their operational work; including funds for critical equipment and supplies, outreaches, home visits, the organization of community durbars as well as Community Health Committee meetings. Funds for supportive supervision and monitoring are also provided to the sub district, district and regional levels

Community Performance-Based financing Pilot

A sub-component of the World-Bank supported MCHNP seeks to pilot a community performance-based financing (cPBF) system. The cPBF is to be piloted in two districts each in four targeted regions namely Northern, Upper East, Upper West and Volta. The pilot selected districts are North Gonja, West Gonja, Bawku West, Talensi, Lawra, Nandom, Agortime Ziope, and Kadjebi.

Performance-Based Financing (PBF) is a system approach which seeks to create demand and strengthen focus on results, both quantity and quality; and to address equity by increasing coverage of high impact interventions. This approach entails making facilities autonomous agencies that work for the benefit of health-related goals and their staff.

Objective

This Terms of Reference (ToR) outlines the main responsibilities and activities for a PBF Technical Advisor to be contracted by the Ghana Health Service.

Ghana cPBF

The four target regions of the cPBF pilot were selected based on their high burden of maternal and child health conditions, especially among the lowest wealth quintile. The selection of the 8 districts was based on a ranking performed by the Impact Evaluation (IE) team, using maternal and child health and nutrition indicators from the District Health Information Management System (DHIMS2). The selection of the intervention and control sub-districts for the pilot was based on a scientific randomization.

The Ghana cPBF model is a pilot implemented within the national health system, which will be targeted at the Community-based Health Planning and Services (CHPS) zone level. The cPBF pays for results based on the achievement and verification of maternal, child health and nutrition indicators achieved through outreaches, static clinics, home visits, and community durbars amongst others.

This cPBF introduces incentives targeting the Community Health Officers (CHOs) and a team of active Community Health Volunteers (CHVs)-coliectively referred to as Community Health Teams, to improve health behaviors and health service utilization. Community Health Teams (CHTs) will be rewarded with incentives for performance, based on agreed quantity and quality target indicators achieved on a quarterly basis. Additionally, midwives associated with the CHPS zones would be rewarded based on pre-defined indicators.

The incentivized Quantity and Quality indicators will be verified on a monthly and quarterly basis by the Internal Verification Team, composed of the District Assembly and the District Health Team. In initial phases, the cPBF indicators will be reported manually in paper forms, however within the subsequent quarters of cPBF implementation it is expected that an electronic mechanism will be introduced, also known as the "Dashboard." The Dashboard will be and Operations Management Portal which will be an easy-to-use and flexible data capture and management tool with data entered electronically directly at the CHPS level. The Dashboard will be a real-time mechanism to view indicators and trends at each level of the health system- it will constitute a supervision and management tool for the CHPS level, and will enable the automatic calculation ofthe CPBF payout per CH PS Zone,

The Ghana Health Service is leading in the design and implementation of the cPBF. The World Bank with a PBF Technical Advisor would provide technical support and assistance to the cPBF Secretariat.

A PBF Consultant contracted by the World Bank, has been working with the GHS team to help finalize the Ghana cPBF design and to prepare for the launch of the pilot. GHS is now seeking a longer-term Technical Advisor to provide longer term support on the cPBF pilot implementation and monitoring.

Scope of Work

The PBF Technical Advisor will provide ongoing support tothe Ghana Health Service (GHS) on the implementation of the cPBF pilot in the 8 districts. The Technical Advisor will be based in Accra but will spend at least 80% of his/her time traveling to the eight (8) cPBF pilot districts to provide hands-on support to the districts, sub-districts and implementing CHPS zones. The 8 cPBF pilot districts in the four regions are as follows:

• Northern: North Gonja and West Gonja
• Upper East: Bawku West and Talensi
• Upper West: Lawra and Nandom
• Volta: Agortime Ziope, Kadjebi

Key Activities

National level

• Conduct consultations with the GHS national level to familiarize him/herself with the cPBF design and the health delivery system in Ghana
• Provide technical assistance to the national level to ensure that GHS, MOH staff and DP stakeholders have a firm understanding of the PBF principles and the cPBF model adapted to the Ghana context
• Provide technical assistance in the compilation of quantitative and qualitative data from the CHPS, sub-district and district levels and in organizing feedback sessions to stakeholders involved in the program.
• Supportthe national level in the oversight ofthe cPBF data management "Dashboard" at all levels and the proper integration of "Dashboard" with DHIMS2
• Work with GHS and the "Dashboard" firm to provide technical assistance in the use of the Dashboard to develop analytical reports, annual reports and other technical reports
• Propose incremental modifications to the cPBF manual, based on accumulated experience with implementation of the cPBF phased pilot implementation, through organizing regional and national consultative process with key stakeholders
• Contribute to the dissemination of best practices and lessons learned on the Ghana cPBF to other stakeholders within the country and other parts of the world,
• Assist GHS in the review of quantitative and qualitative indicators from the CHPS, Sub district and district on a quarterly basis and propose changes as needed.
• Assist the national level in setting up a system to ensure all requirements defined in the cPBF manual are met (including filing system, deadline, reporting, etc.)

Regional level

• Conduct field visits to the Regional Health Directorates to ensure that Regional representatives have a good understanding of the cPBF model. (The Fund holder responsibility will be managed by GHS Headquarters Finance Division but will be in part delegated to the Regional level; requiring comprehensive supervision & guidance by the PBF Technical Advisor).
• Conduct ongoing capacity building activities for the Regional Health Management team on the PBF
• Develop a mechanism for performance reviews for the performance of CHPS zones. Build the Regional Health Team's capacity to manage such reviews and produce reports for the national level
• Assist the regional level in setting up a system to ensure all requirements defined in the cPBF manual are met (including filing system, deadline, reporting etc.)

District level

• Conduct regular visits to the 8 cPBF districts, their sub-districts and CHPS zones (spend at least 80% of his/her time in the districts) to assist in the business planning, contracting, verification and feedback processes.
• Adapt the cPBF Operational manual to a user-friendly manual for use by the front-line health workers. The user manual should cover procedures and tools for record keeping by facilities, the contracts used, results verification and counter verification mechanisms, business plan and indices tools, funds disbursement and accounting procedures, the services with their fees and the quality checklist, etc.
• In the districts which have initiated cPBF, provide ongoing monitoring and supervisory assistance and guidance to ensure the cPBF principles are respected
• In the districts preparing to launch, provide guidance in the preparatory activities
• Refine and implement an appropriate training curriculum based on the lessons learnt in the initial 2 cPBF districts
• Work with District Assembly representatives to ensure they have a firm understanding of their roles and responsibilities as members of the Internal Verification Team
• Participate in the IVT Quarterly meetings at the district level and ensure that the internal verification processes are being followed
• Assist with implementation of cPBF M&E framework, i.e. the "Dashboard" system implemented in the 8 districts
• Conduct ongoing capacity building activities for the implementation sub-districts, CHPS zones and relevant NGOs
• Provide quality assurance support to ensure internal verification and payments for health providers follow the prescribed technical and operational methodology
• Oversight ofthe CHPS work plans, providing support to the DHT to ensure that CHPS targets are being met.
• Provide technical assistance to the hired NGOS for the implementation of the client satisfaction in the pilot district.
• Assist the District assembly, District, sub district and CHPS levels in setting up a system to ensure all requirements defined in the cPBF manual are met (including filing system, deadline, reporting, etc.)

Deliverables

• Detailed activity plan to support implementation activities in the 8 cPBF districts
• User-friendly cPBF implementation documents for the District, Sub-district and CHPS zone levels
• Adaptations to all cPBF tools, as lessons are learnt from the pilot roll-out in all the initial districts; this includes contracts, incentive calibration tool, CHPS business plan, DHT Business Plan, Client Satisfaction Questionnaire, Quality Checklist, District Assembly TOR, DHT TOR, etc.
• Facilitate and review vetted Monthly Reports by the Internal Verification Team (IVT) of the Quantity and Quarterly Reports of Quality indicators, and lessons learnt on the cPBF pilot implementation
• Quarterly reports to the GHS cPBF team on challenges, best practices, lessons learnt and a detailed overview of the implementation cycle from the cPBF pilot implementation

Supervision and Reporting

The PBF Technical Advisor will submit deliverables to the GHS cPBF Secretariat, with a direct reporting channel to the MCHNP Project Coordinator at GHS. When requested, the PBF Technical Advisor wilt also be expected to provide information to the World Bank Task Team Leaders.

The PBF Technical Advisor will work closely with the Policy, Planning, Monitoring and Evaluation Division, the Family Health Division and the Finance Division of Ghana Health Service (GHS). Consultations will also be held with the Ministry of Health as needed .

Period

The contract is a time-based type of consultancy for a period of two years renewable every year on the availability of funds and satisfactory performance. GHS will conduct a performance assessment every 6 months to evaluate the Technical Advisor's performance. Consultants shall be selected based on the Individual Consultant Selection Method of the World Bank's Individual Consultant Selection guidelines: May 2004, and Revised October 2006 and May 2010. Main criteria for the selection will be relevant work experience, qualifications and interview.

Qualification Required & Experience

Academic & Professional Experience

• University degree in public health, health services management, health economics, and nutrition or development studies. A master's degree will be an added advantage
• Experience of 5 years in the field of health and or nutrition (and In particular reproductive health, nutrition, maternal and child health and community/primary health) and project management 2-3 years of direct field experience In designing and implementing Results Based Financing approaches, ideally with a community focus.
• Extensive experience with various forms of capacity building in public health and community driven development, specific experience in capacity building in Results Based Financing constitutes a distinct advantage
• Training management, diploma or a proven track record in facilitating training for public health workers.
• Having graduated from a TOT program In RBF is an added advantage

Qualifications & Skills

• Strong M&E skills
• Demonstrated experience with health data analysis for Results Based Financing Projects
• Strong communication skills and ability to simplify and explain the PBF concept and incentive scheme at different levels ofthe health sector
• Fluency in spoken and written English, excellent report writing skills
• Demonstrated ability to work respectfully and constructively with local partners, including community committees and governments agencies .
• Proven proficiency in the use of Microsoft Office applications, i.e., MS word, Excel, PowerPoint and Email software
• Proven ability to work effectively both Independently and In a team based environment
• Demonstrated willingness to be flexible and adaptable to changing priorities
• Discreet, honest, proactive, methodical, diplomatic, task-oriented, and proven managerial capacities
• Experience In working with the government and international (donor) organizations (Direct experience working on a World Bank funded project is a distinct advantage)

Location: Volta, Northern, Upper East & Upper West Region

How To Apply For The Job

Interested personnel may obtain further information at the address below during office hours 09:00 to 17:00 hours, Monday to Friday. Three hard copies ofthe copies of application letter with signed Curriculum Vitae (CV) must be submitted to the address below on or before 12:00 Noon on Friday, 17th August, 2018.

THE PROCUREMENT DEPARTMENT
GHANA HEALTH SERVICE
LIMB FITTING CENTRE, TEMA STATION
NEAR RENT CONTROL
P.M.B. MINISTRIES, ACCRA
ROOM 7

Tel: (233) 0302 3973320

Email: ssdmghgov@gmail.com

Closing Date: 19 August, 2018