Operational Support for Health Insurance Implementation of Abia SHIS
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:
* 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;
* Development of a plan for roll out of the scheme that fits the state’s context and in keeping with best practice.
* Development of documents, technical processes and tools that are needed for the operations of SHIS agency and implementation of the SHIS
* Facilitate the set-up of necessary structures for the implementation of the SHIS, in keeping with the operational guidelines and business process manual.
* Support for the institution of a quality assurance system for the SHIS and support for ICT linkages across the different departments in the SHIS
* 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.
* Development and implementation of the enrolment plan targeting prioritized population groups in the state, including marketing strategy and demand creation
* Supporting advocacy for resource mobilization for the scheme.
* Capacity building for staff on the technical operations of the State Health Insurance Scheme, including on claims management and reimbursement processes
* Provide mentoring and technical support for the various departments to develop and translate organizational manuals and business process manuals into practice.
* 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