National Consultancy (HSD)

Background

Many low- and middle-income (LMIC) governments have attempted to address health system information requirements through the collection of more, better, and different types of data on the private health sector; increasingly, this is collected in a routine manner, through national health information systems (HIS). Alongside these efforts, other sources of information may exist, such as programmatic, financial, geospatial, survey and other structured or unstructured data sets. Despite these advances, data and information may not be used to govern the private health sector or build understanding with component entities.

Through a combination of desk review and qualitative research, the proposed case study seeks to identify what data and information is currently being collected by governments and how this is used for governance of the private sector in health, with a specific focus on primary healthcare providers. This study responds to recommendations from the private sector landscaping undertaken as part of the development of the WHO strategy report “Engaging the private health service delivery sector through governance in mixed health systems”. Launched in 2020, this strategy contributes a specific focus on the private sector as part of health systems governance and systems strengthening. The strategy report conceptualized six governance behaviours (i.e., build understanding, deliver strategy, foster relations, align structures, nurture trust, enable stakeholders), to foster effective public-private engagement, as part of more resilient and responsive health systems.

Purpose and focus of the study

Purpose: identify what data and information is currently being collected by governments and how this is used for governance of the private sector in health.

Key questions that will be addressed through the case study are outlined below.

• [structural] How do private sector entities report into national health systems? Are there concerns with the quality of reporting? Has this changed over time?
• [technical] What are the minimum information requirements to generate/demonstrate situational awareness and perform specific governance behaviours and functions?
• [procedural] What are the incentives and disincentives for private sector reporting in national health systems? Have these changed over time?
• What are the potential approaches for overcoming the challenges / barriers for the inclusion of private health sector in the data reporting and the improvement of private health sector data reporting particularly at primary care level?
• [performance] How do national health entities use information to govern the health system? What sources are used? Do these capture the private sector in health at different service delivery platforms and service delivery levels? If yes, what kind of data is reported particularly at primary care level?
• If private sector data is captured, how it is used in analysis, use and visualization of data for enhanced readiness?
• [innovations] How do technology solutions address fragmentation across sectors, sources, and systems?

The case study will predominantly focus on private primary healthcare provider inclusion in national HIS and less on regulatory systems. A HIS is broadly defined as a system that integrates data collection, processing, reporting, and use of the information necessary for improving health service delivery. HIS may include data from different sources, including routine service statistics, population-based surveys, vital statistics, and surveillance systems. The purpose of a HIS is to produce high-quality information that can be used at all levels of a health system for program monitoring and improvement, to inform strategy and policy development, planning and implementation.

Overview of the consultancy

The national consultant will provide technical input and support to the development of the data for governance case study under the direction of a taskforce led by the WHO Pakistan country office, the Federal Ministry of Health and the WHO Systems Governance and Stewardship (SGS) Unit under the WHO Headquarters Primary Healthcare Special Programme.

Case study development will entail an initial introductory workshop with 5-10 individuals at national level representing key constituencies across the public and private sectors. During this workshop we will outline the concept and map data and information sources, systems and sectors of relevance to the case study. Additional grey literature will be identified, and tools will be reviewed and refined. A second confirmatory validation workshop will be held once the case studies are drafted (this may also be a combined exercise across countries to generate peer learning and exchange).

As part of the case studies, semi-structured, in-depth interviews will be conducted with identified key informants. These will be drawn from private sector, academia, government, and intermediary/partner organisations. Targeted sampling will be employed based on feedback from the participants in the introductory workshop. Analysis and writing of the case study will be undertaken by the national consultant with support from the WHO SGS Unit.

A. Planned timelines: 60 working days over a period of 4 months

Tentative Start date: 10 July 2024

Tentative End date: 10 November 2024

Output 1: Conduct initial assessment of private sector entities in guidance and in coordination with WHO.

Deliverables 1.1: Provide technical input to support the country office in securing national IRB approval/exemption for the case study (if needed)

Deliverable 1.2: Conduct technical review and analysis of the Pakistan grey and published literature related to data for governance of the private sector in health and develop a report summarizing findings.

Output 2:

Deliverable 1.3: Refine approach and tailor tools to the national context (draft tools and adapt already developed) and support the country office in the organization of an in-person kick-off meeting/ small group consultation.

Output 2: Draft study on the potential approaches for overcoming the challenges / barriers for the inclusion of private health sector in the data reporting and the improvement of private health sector data reporting particularly at primary care level?

Deliverable 2.1: Conduct online or in-person key informant interviews with identified stakeholders (up to 20 KIIs anticipated) with support from SGS, WHO/HQ.

Deliverable 2.2: Conduct qualitative analysis of the data gathered as part of deliverable 1.4. with support from the SGS, WHO/HQ.

Deliverable 2.3: Draft country case study in English, with support from SGS, WHO/HQ.

Deliverable 2.4: Provide technical support to the convening of a country validation workshop to present findings, generate insights and recommendations

Deliverable 2.5: Participate in taskforce meetings as required

Deliverable 2.6: Submission of comprehensive consultancy report.

B. Technical Supervision

The selected Consultant will work on the supervision of:

Responsible Officer & WR

C. Specific requirements

Qualifications required:

University degree in international health, or global health policy & management.

Experience required:

5 years of relevant experience working on health systems/global health and a minimum of 3-year experience working in Pakistan’s health system governance. Proven experience in conducting qualitative research, including in-depth interviews with diverse stakeholders is required.

Desirable:

Experience working with health information systems (HIS).

Language requirements:

Expert knowledge in English and Urdu

Place of assignment

The consultant will perform the work remotely (from his/her home) and will be required to attend online meetings in addition to the workshops (kick-off and validation). TBD if KIIs are remote or in-person.

Medical clearance

The selected consultant will be expected to provide a medical certificate of fitness for work.

Travel

No international travel is anticipated given the scope of the assignment. However, travel within Pakistan to the province of focus might be needed.