Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1698832699752.pdf (Saint Vincent and the Grenadines)
Government of Saint Lucia Department of Health and Wellness Terms of Reference Review of public sector health expenditures, including recommendations for efficiency gains and improvements in equity, and development of National Health Accounts 006/CS/HSSP/18 March 2019 April 16, 2019 1.0 Background Saint Lucia is an upper-middle income country in the Caribbean with a population of 180,000, nearly 30 percent of which reside in Castries Quarter, where the capital (also called Castries) is located.
The country is a mountainous island with a tropical, humid climate and ranks high on the United Nations Development Programme’s (UNDP) Human Development Index (HDI).

Gross National Income (GNI) per capita is US$7,350, life expectancy at birth is 75 years, and the Under-Five Mortality Rate is 14 per 1,000 live births; health outcomes are slightly better than the Caribbean small states average.
Total and public sector expenditures on health as a share of GDP (6.7 and 3.6 percent, respectively) in Saint Lucia are comparable to regional averages (2014), but public sector expenditure in health is still below the 5 percent threshold recommended by the World Health Organization (WHO).

At the same time, the share of total health expenditures in the form of out-of-pocket payments are higher than the regional average.
The country is interested in identifying efficiency gains and understanding the impact of current health expenditures on equity to inform the design and subsequent rollout of the National Health Insurance Scheme.
In order to do so, the country is interested in conducting a Public Expenditure Review (PER) of the health sector, including recommendations for efficiency gains and improvements in equity, and development of National Health Accounts PERs are diagnostic instruments used to evaluate the effectiveness of public finances.

PERs typically analyze government expenditures over a period of years to assess their consistency with policy priorities, and what results were achieved.
The focus of the current PER is on the health sector, hence the goal of the PER is to examine the allocation, management and efficiency of public expenditure in the health sector.

The objective is to establish a baseline understanding of key fiscal management and policy challenges and highlight priority reform areas for policy makers.
2.0 Objectives of this Assignment The Objective of the this assignment is to engage a firm to conduct a review of the Public sector health expenditures during the period of five years (2013 to 2018) and make recommendations for efficiency gains and improvements in equity and development of national health accounts.
Such information and recommendations will be used to guide the Government of Saint Lucia on how to make healthcare expenditure more economical, efficient or effective in its current use or redirect the expenditure to better uses as indicated by the strategic plans of Government.
The consultancy will entail an independent assessment of the adequacy, appropriateness and effectiveness of public sector spending in health, how it is used and how resource utilisation could be improved in the interest of sustainable financing.

Also, the PER will inform the subsequent development of National Health Accounts which look to measure where health sector financing comes from, how it is managed and distributed , where money is spent and what type of treatments or services are delivered.
3.0 Scope of Services The Consultant shall undertake the following: 1.

Establish baseline data and framework for analyzing healthcare expenditure 2.

Analyze how healthcare expenditure conformed to budgets and the medium term strategies of government in the context of current account and budget deficits.

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Evaluate the economy, efficiency and effectiveness of healthcare expenditure and any related potential for savings.

4.
4.

To monitor the allocation expenditure to deliver needed healthcare services to the vulnerable population 5.

To address the availability of revenues to meet the resource requirements of the health sector.

4.0 Specific Tasks I.

Establish Baseline data and framework for analyzing healthcare expenditure A.

Literature Review The Consultant should critically study the existing relevant documents and reports relating to the assignment.
The review of the documents will provide a clear context of the activities in the sectors, the involvement and relationships among various stakeholders.

The Consultant is expected to do the following but not limited to:  An assessment of current policy priorities and strategies as these relate to health  A review of the integration of health sector objectives within the budgeting process, including the part of budget planning, implementation, expenditure management and financing.
 A review of institutional arrangements for promoting the integration of health sector priorities into budgeting and expenditure management  Budgetary allocation and tracking actual expenditure: The consultant will review the financial management systems for allocating and spending health-related expenditures with an aim to attempt to understand a trends analysis on both budgeted and actual expenditure.
 Define the boundaries of the PER – the consultant in consultation with relevant stakeholders should identify the specific health expenditures to which the assignment refers, in the absence of a definition on health related expenditure This should be carefully determined as this will inform the National Health Accounts.

The Consultant will propose an inclusive methodology and coding system to define and track health related expenditure that is appropriate in the Saint Lucian Context.
The documents to be reviewed should include the following: a) Approved estimates of Expenditures on Recurrent and Capital Budget for the Relevant Financial Years b) Economic Reviews for the relevant years.

c) Laws guiding expenditure (finance and procurement) of the economy.

d) National Planning Frameworks e) Strategic Plan for Health f) Internal Audit Reports g) Budget Statements and guidelines h) Survey of living conditions.

i) Any other document as would be recommended by the client or the consultant.
Key Deliverable: Inception Report: based on the inception meeting and the review of the documents, the reviewer should produce an inception report which should provide an understanding of the assignment’s objectives, the methodology and the parameters for undertaking the study, the refined scope of work, revised work plan and deliverables.
The inception report should also highlight key challenges associated with the project including challenges related to data availability, and the proposals to address them.

Page 3 of 8 The appropriate methodology to be used will be suggested by the Consultant but should at minimum provide for adequate participation by key stakeholders.

It should ensure adequate consultation with the Department of Health and Wellness.
It should also include a significant element of quantitative analysis, evidence based findings and an emphasis on making clear recommendations based on thorough, objective analysis that have substantively relied on sector specific specialists.

B.

Development of Data Collection Tools and Data Collection Based on the literature review conducted and the gaps in information highlighted, the Consultant should develop a survey instrument for collecting data to inform the PER.
This questionnaire should be developed in such a manner that it should mainly capture both qualitative and quantitative data.

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Such data may include the following: a) Budgetary provisions for the fiscal years under review for respondent institution involved in health activities; b) The actual allocations for the years under review for each respondent institution; c) The actual expenditures on health by the targeted responded institution; d) The reasons for any differences between the approved budgets and actual results.
e) The different types of expenditure in terms of capital and recurrent and their proportions to total expenditure for the respondent organization, whole govt, GDP; f) The amounts and proportion of personnel costs within the recurrent costs; and g) The distribution between programme allocations (for service delivery) and management/administration allocations; h) The effectiveness of expenditure allocation, disbursement and execution; i) Allocation mechanisms and formulas for decentralized expenditures; j) The level of involvement of sectors key to these sectors such as those in the rural cluster in terms of how they have been monitoring budget allocation and execution for their activities and the extent to which this has impacted on the sector objectives; k) Uses to which funds have been put; and l) Trends and volatility/stability of expenditures.
m) Services provided by hospitals and health centers n) Outputs generated by the hospitals and wellness centers which is intended to compare the input/output relationship.

Once the Client approves the data collection tool, the Consultant will proceed to administer the survey instrument to collect the relevant data.

Deliverables: The Consultant is expected to produce a survey instrument to collect data from the relevant stakeholders.

II.
II.

Analyses a) Analyses and Synthesis of key trends in terms of inputs, outputs and outcomes in the health sector and analysis of the relationship between these.

b) Analysis the allocation of expenditures to the health sector, healthcare activities and programs by comparison with the allocations that reflect Government’s strategic priorities.

c) Analyses of the implications for this for future implementation of the National Health Insurance Scheme.
Page 4 of 8 d) Analyses for the following aspects of expenditure: Economy of the expenditures, efficiency of healthcare activities and institutions and effectiveness of healthcare programs and institutions.

Identification and highlighting of areas for savings from improvement in economy, efficiency and effectiveness.

e) III.

Recommendations a) Provide recommendations for savings from improvement in economy, efficiency and effectiveness.
b) Provision of recommendations on how PER could be institutionalized within the Department of Health to provide a more systematic input into policy, planning and budget preparation process.

Deliverable A Draft PER report which should be presented at the stakeholders’ workshop for discussion.

The report will include a conclusion on the findings of the PER as well as recommendations for addressing any gaps identified in the study.
The Final Report shall be submitted after stakeholder consultation and where all comments have been submitted to the Consultant for their consideration.

5.0 Duration of the Assignment The duration of the Consultancy is twenty-two weeks over a period of eight months 7.0 Reporting Requirements The Consulting Firm shall prepare and submit the following reports: 1.
Inception Report and Work Plan Within two weeks of contract signature, the consulting firm shall submit the Inception Report and a detailed work plan.

Comments in response by the Government of Saint Lucia, should reach the Consulting Firm no later than ten days after receipt of Report 1 (Inception Report and Work Plan).

Commented [REGS1]: For one consultant doing the work that may be short, especially if is about collecting data and other activities that do not quite depend on him.
I’d suggest at least 8-9 months 2.

Research/Survey Protocol (with relevant data collection instrument) The Research/Survey Protocol shall be submitted within six (6) weeks after acceptance of the Inception Report.

Comments in response by the Government of Saint Lucia should reach the Consulting Firm no later than ten days after receipt of The Research/Survey Protocol (with survey instrument).
Commented [REGS2]: I’d give a couple of weeks more, since there should be an initial time to revise the state of the art and available data and then develop the data collection tools 3.

The Draft Public Expenditure Review Report Page 5 of 8 The Draft PER report shall be submitted within eight (8) weeks of the after Acceptance of the Research/Survey Protocol.

This report shall contain the analysis of the information collected from the survey and the main findings.
Comments in response by the Government of Saint Lucia should reach the Consulting Firm no later than ten days after receipt of the Draft PER Report 4.

Final Report The final report shall be submitted within two (2) weeks of acceptance of Draft PER Report by the Client.

Comments in response by the Government of Saint Lucia should reach the Consulting Firm no later than ten days after receipt of the final report.
All reports shall be submitted in English All reports and documents relevant to the Consultant’s services, survey instruments, reports, etc.

shall become the property of the Government of Saint Lucia.

The Consulting Firm shall not during and after the term of contract, use or disclose any confidential information relating to the business or operations of the Government of Saint Lucia.

8.0 Working Arrangements Client’s Responsibility i.
The Client’s Coordinator is the Project Manager of the Project Implementation Unit located within the Department of Health and Wellness.

ii.

Make available to the consulting firm existing reports/studies/data including the existing Essential Package of Health Services and other relevant documents relevant to the work of the consulting firm.

iii.

iv.

Ensure that the review of reports is done in accordance with the Terms of Reference.
Initiate the consultation and cooperation of other agencies required to provide support to the Consulting Firm for realization of the relevant aspects of the assignment.

Consulting Firm’s Responsibility i. ii.

The Consulting Firm shall be responsible for the collection of all data and relevant information and survey required for the delivery of the assignment.

The Consulting Firm shall submit at the outset the expected outputs, as well as ensure their timely submission to the Project Manager for review.
The Technical Working Group will ensure the timely review and acceptance of the reports submitted by the Consulting Firm, not more than ten (10) days after receipt of reports from the Consulting Firm.

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iv.

v. The Consulting Firm shall be responsible for the supervision of its technical staff including providing all office space, equipment, materials, accommodation, office requirements and transportation.
Engagement of the appropriate qualified and experienced technical and administrative staff and other resources necessary to undertake the services.

The Consulting Firm shall execute the services in accordance with the laws, customs and practices in Saint Lucia and use of the appropriate international standards for preparation of technical information.
9.0 Qualifications and Skills of the Consulting Firm The firm should be registered; and the minimum required qualifications and experience of the consulting firm are: General Experience: At least ten (10) years’ experience in carrying out assignments which included the review and analysis of public sector expenditures Specific Experience: At least two (2) successfully completed contracts during the past ten (10) years which entailed review of health sector expenditures Key Experts required for the assignment Team leader –Expert in Public Finance The expected time input for the team leader is 4 man months a.
With at least a Master’s Degree in Economics, Public Finance or a related field from a recognized University.

b.

At least fifteen (15) years of relevant experience in public financial management, economics or a related area.

c. Demonstrated experience in Public Expenditure Review.

d. Proven understanding of ongoing processes such as national development strategies, public budgeting process.

e. Experience is supporting and analyzing institutional and public sector reform process.
f. Experience in health sector will be an asset.

g. Previous work experience in the Region would be an asset.

h. Demonstrated experience and ability to pro-actively lead and coordinate a team including strong interpersonal skills with ability to multi task and maintain effective work relationships.

Team Member – Expert in Public Health The expected time input for the team leader is 2.5 man months i.

With at least in Master’s Degree in Public Health or related health area from a recognized University.
j.

At least ten (10) years’ experience in one or more of the following areas: health financing, health systems monitoring and assessment, health system performance, health reform.

Page 7 of 8 k. Demonstrated expertise in public health l. m. Previous work experience in the Region will be an asset.

Experience in conducting evaluations and Public Expenditure Reviews in Health.

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