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Job Details: Operational Support for Health Insurance Implementation of Abia SHIS

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Operational Support for Health Insurance Implementation of Abia SHIS
Palladium is a global leader in the design, development and delivery of Positive Impact - the intentional creation of enduring social and economic value. We work with foundations, investors, governments, corporations, communities and civil society to formulate strategies and implement solutions that generate lasting social, environmental and financial benefits.

For the past 50 years, we have been making Positive Impact possible. With a team of more than 2,500 employees operating in 90 plus countries and a global network of more than 35,000 technical experts, Palladium has improved - and is committed to continuing to improve - economies, societies and most importantly, people's lives.

Palladium is a child-safe organisation, and screens applicants for suitability to work with children. We also provide equal employment to all participants and employees without regard to race, color, religion, gender, age, disability, sexual orientation, veteran or marital status.
Program Activity: Consultancy to provide technical support to the Abia, Osun State and FCT State Health Insurance Scheme Agencies (SHIA) to ensure effective implementation of the State Health Insurance Schemes.

Health Policy Plus (HP+) is a global USAID-funded five-year project with a mandate across global, country and sub-national levels to strengthen and advance health policy priorities in the areas of family planning and reproductive health (FP/RH), HIV, and maternal health.  HP+ aims to improve the enabling environment for equitable and sustainable health services, supplies, and delivery systems through policy development and implementation, with an emphasis on voluntary, rights-based health programs. HP+ will help public health and policy leaders attach higher priority to their national and sub-national health needs, secure sustainable financing, advance health equity, and monitor policy implementation to ensure gains stay on track.  HP+ aims to secure long-term enduring change by working with coalitions both inside and outside of health and showing common cause with neglected populations and other development actors. Central elements of HP+ revolve around building in country capacity, institutionalizing achievements of past investments, and promoting country ownership of programs and initiatives.
The Osun and Abia state Governments has signed into law, a bill that establishes the State Health Insurance Scheme with the overall goal of ensuring all residents of the state have access to quality and affordable health care services with financial and social risk protection. Subsequently the states have developed operational guidelines and benefit packages in readiness for implementation of the SHIS. The FCT is also in its process of implementing the FCT HIS, with its SHIS bill at advanced stages.

The implementation of the SHIS in states is an essential mechanism for ensuring improvement in attaining Universal Health Coverage (UHC) in the country. These schemes will ensure a stable, predictable and sustainable source of funding for the schemes. Additionally, the successful implementation of the schemes will ensure universal access to quality, equitable care especially to RMNCH services. There is considerably low technical capacity to implement and manage these schemes at the state level and therefore, it is essential to strengthen operational and technical capacity of the Abia, Osun states and FCT SHIS to implement efficient and effective health insurance operations that will ensure coverage and protection to the entire populace.
This consultancy aims to provide technical assistance to roll out and operationalize the Abia, Osun and FCT States’ Health Contributory Management Scheme by embedding an experienced health insurance expert within the SHIS agencies of the three states to guide health insurance technical operations. To support the agency to implement an effective health insurance scheme, the Technical Assistance consultancy will provide technical support towards development and effective execution of technical processes, especially processes contained in the SHIS laws, operational manuals, and other documents as may be required and provide capacity building and hands-on support to the staff of the agency throughout the consultancy period. The HP+ work plan contains specific deliverables related to developing and enrolment plan and providing capacity development on claims management and reimbursement functions.
Roles and Responsibilities
The consultant is expected to contribute to the successful roll out and operations of the Abia, Osun and FCT State Contributory Health Management Schemes by working with agency and SMOH leadership to put in place necessary structures that will guarantee delivery of services to enrollees, ensure continuous quality improvement and capacity building for staffs of the agency to implement the scheme.
Specific Role of the Consultant includes:
  1. Technical review of all available SHIS policy documents – The SHIS Laws, Operational guidelines, benefit package, and health financing diagnostic reports, Provider Payment Mechanisms, claims management, business process manuals and work flows, among other documents with the aim of identifying immediate processes and structures that need urgent attention;
  2. Development of a plan for roll out of the scheme that fits the state’s context and in keeping with best practice.
  3. Development of documents, technical processes and tools that are needed for the operations of SHIS agency and implementation of the SHIS
  4. Facilitate the set-up of necessary structures for the implementation of the SHIS, in keeping with the operational guidelines and business process manual.
  5. Support for the institution of a quality assurance system for the SHIS and support for ICT linkages across the different departments in the SHIS
  6. Support for the development and implementation of a performance management system for the health insurance operations and facilitating regular performance reviews with a view to achieving continuous quality improvement.
  7. Development and implementation of the enrolment plan targeting prioritized population groups in the state, including marketing strategy and demand creation
  8. Supporting advocacy for resource mobilization for the scheme.
  9. Capacity building for staff on the technical operations of the State Health Insurance Scheme, including on claims management and reimbursement processes
  10. Provide mentoring and technical support for the various departments to develop and translate organizational manuals and business process manuals into practice.
  11. Provide monthly progress update report to the SHIS, SMOH management, HF TWG and HP+ on status of the operations and technical assistance.
Three Consultants are required; each to be resident in each of the two states and FCT for the period of consultancy.
The major products and outcomes of this assignment are;
  • Enrolment plan for prioritized state sub-population groups
  • Completed skills development training to SHIS on claims management and reimbursement processes
  • SHIS policy documents review report detailing alignment or otherwise with intended SHIS objectives and clear roll out plan developed
  • Necessary operational documents, tools and technical processes for the operations of SHIS developed
  • Key structures for SHIS implementation established in the supported state
  • Performance management system for SHIS operations established and functional
  • Quality assurance system for SHIS operations established and functional
  • Brief Weekly and monthly update reports
  • Final consultancy report.
Period of performance of the consultancy
April 1– August 30, 2018, 75 days per consultant, 15 days a month. There will be weekly virtual meetings among the three consultants to share lessons and standardize approaches.
Skills and Expertise Required
The consultant should possess the following;

Qualifications and required experience
  • A good first degree or its equivalent from a reputable University in Medicine, Sciences, or numerate disciplines such as Actuarial Science, Statistics, Insurance, etc.
  • Post graduate qualification in Management, Public Health, Health Management, Health Economics, Insurance or other related fields
  • Certification in and/or professional membership of Health, Management and Health Insurance related bodies shall be an added advantage
  • Minimum of 7 years’ experience implementing health insurance in Nigeria or related settings.
  • Experience working with an HMO that implements a health insurance scheme.
  • Expertise in claims management and reimbursement best practices
  • Experience in developing and delivering capacity building workshops; including on Health insurance implementation
  • Experience in developing and executing insurance enrolment plans
  • Good understanding of current health financing reform initiatives in Nigeria especially the subnational level;
  • Expertise in health insurance operations
  • Experience carrying out similar assignments in Nigeria particularly at the sub-national level.
Required technical competences
  • Expert in insurance management and operations
  • Familiar with results-based management
  • Knowledgeable about ICT systems for insurance management
  • Knowledgeable about change theories and health system approaches
  • Expert in knowledge management and skills development
02 Apr 2019
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