TERMS OF REFERENCE Market Assessment of the Health Sector in Liberia Background and justification The Ebola Virus Disease (EVD) outbreak in Liberia, Guinea and Sierra Leone now classified as an ‘epidemic’ has wreaked havoc on the health care system in all three affected countries. According to WHO, as of February 18, 2015 there are 9,007 cases and 3,900 deaths in Liberia, 11,103 cases and 3,408 deaths in Sierra Leone, and 3,108 cases and 2,057 deaths in Guinea. WHO projects that more than 20,000 people could be infected before the epidemic is brought under control. Needless to say, over the past nine months, the epidemic has severely weakened all aspects of the economy, while the health sectors in all 3 affected countries have not been able to cope. In these three countries, the government is the main driver and provider of health care services but unfortunately, historically under resourced like many other sub-Saharan countries. With the increase in number of Ebola infections, the public health care system became increasingly overwhelmed, while the private healthcare providers found themselves unprepared and unsupported. Hence, most private healthcare providers closed down their businesses, leaving the populations at the mercy of an over-burdened public health care system. Closure of the already limited number of private health care providers has further complicated the situation, rendering the populations even more vulnerable. Despite transmission rates in the three worst-affected countries showing significant signs of slowing, the World Bank expects around $1.6 billion of lost economic growth to be recorded in those States over the course of 2015, according to its report – The Economic Impact of Ebola on Sub-Saharan Africa: Updated Estimates for 2015 . With investors steering clear, economic growth estimates for 2015 have also been revised down, the report notes. Guinea and Sierra Leone are expected to see their economies contract – by 0.2 per cent and two percent respectively – while predicted growth for Liberia has been reduced to three percent. Pre-Ebola growth estimates for 2015 in Guinea were 4.3 per cent; in Sierra Leone were 8.9 per cent; and in Liberia were 6.8 per cent. The World Bank Group’s response to the Ebola crisis is to help stop the spread of infections, improve public health systems throughout West Africa, and assist countries in coping with the economic impact—including by enabling trade, investment and employment in the countries. The World Bank Group is supporting country responses in line with the World Health Organization (WHO) Roadmap, and is coordinating assistance closely with the United Nations (UN) and other international and country partners. This includes increasing private participation in rebuilding the health systems in the three countries and rapidly making access to basic quality health services available particularly in the deprived service areas. Hence, IFC is keenly interested in encouraging increased private sector participation in the health care sector and supporting governments in their initiatives to improve overall health systems. Objectives The main objective of this work is to develop a Market Assessment of the Health Sector in Liberia as a business case that can used to support initiatives to attract investment and capital inflow into the health sector. Under the supervision of the Task Team Lead of The World Bank Group Health, Nutrition and Population Health in Africa Initiative(Harnessing the Private Sector), a consulting firm with the relevant regional experience will be expected to undertake the following work and deliver the expected product within 30 working days per country. Scope of Work 1. General overview of the country, examining history, the political economy and key economic activities and issues impacting on economic growth over the past five years 2. Undertake an overview of the country’s health status covering the population and growth, fertility and family planning uptake, average life expectancy, crude death rate, maternal mortality ratio, neonatal, infant and child mortality rate and trends using the MDGs as a base measure 3. Review the burden of disease paying attention to the top ten causes of morbidity and mortality at out and inpatient levels and their trends over the past 10 years 4. Analyze the organization of public health care services throughout the country paying attention to distribution and clientele served covering services at community, primary, secondary and tertiary level outlining inputs, availability and quality of care for treatment, diagnostics and imaging, pharmaceutical services 5. Analyze the organization of private, faith-based and non-governmental organization (NGO) health care services throughout the country paying attention to ownership, distribution and clientele served covering services at community, primary, secondary and tertiary level outlining inputs, availability and quality of care for treatment, diagnostics and imaging, pharmaceutical services 6. Examine broadly the supply chain management system in both the public, NGO and private health sector 7. Review the human resource for health situation mainly for doctors, physician assistants, nurses and midwives, pharmacists and laboratory technicians paying attention to production, distribution, attrition, management and remuneration in the public, NGO sector 8. Review at the national level the governance, legislature and regulation of the health sector including establishment of public and non-public health facilities, training and management of human resource and service delivery 9. Analyze health financing including budget and expenditure paying attention to sources of funding: government, donor, commercial credit and loans and out-of-pocket expenditures noting per capita and proportions where appropriate over the last 5 years. Document any pooled funds or social health financing mechanisms in place and their contributions to health financing 10. Map opportunities for private public partnerships and validate the government interest in using private public partnerships to develop e.g medical and para-medical training college that could include training of lab technicians, radiology technicians, emergency medical technicians etc; National Ambulance Service and Diagnostic Centres – a national network of laboratory and limited radiology centres. 11. Develop a discussions chapter as a comparative analysis section highlighting lessons, challenges and opportunities in comparison with countries of similar developing country profiles in Africa Using the above: 12. Develop a conclusion and recommendations chapter that highlights the levels and areas of investment, partnerships, international collaboration and changes required to bring the country’s health sector to a desired level within the next five to ten years paying attention to: a. b. c. d. Issues in policy and legislation for health sector development Emerging trends in the public, NGO and private sector and their contribution Market opportunities for private sector growth (generally and for specific types of care). Government interest in PPPs including but not limited to National Health Institute – para-medical training college that could include training of lab technicians, radiology technicians, emergency medical technicians etc; National Ambulance Service – develop and run a national ambulance service for Liberia and Diagnostic Centres – a national network of laboratory and limited radiology centres.Short, medium and long term recommendations. Expected output A document entitled: Market Assessment of the Health Sector Liberia: a business case to attract investment and capital inflow Qualifications The candidate shall be a consulting firm with at least 5 years working experience in health sector analysis and advisory services with demonstrated ability to have undertaken similar work in developing countries for The World Bank Group. Duration: Maximum 30 working days in each country – May -June, 2015. Please send application and supporting documents to: [email protected]. No telephone calls, faxes, or hard copies of resumes will be accepted. Closing date/time for applications: May 8th, 2015 at 5:00 PM GMT. Please note that ONLY short listed candidates will be contacted. All applications will be treated in strictest confidence.