Maternal and Newborn Health Specialist Consultant TOR for the USAID Health Financing Activity
Maternal health is a high-priority health issue in Indonesia. Data from the 2017 Indonesia Demographic and Health Survey (DHS) show very good program coverage rates, including receipt of at least four antenatal care (ANC) visits (77%), births delivered with a skilled health worker (91%), and births in a health facility (74%). High rates of skilled birth attendance in Indonesia should correspond to low maternal mortality, but the maternal mortality ratio remains unexpectedly high at 305 deaths per 100,000 live births (2015) -- one of the highest in the ASEAN region. As a result, maternal health policymakers are focusing their attention on improving the quality of services, including adherence to standards and continuity of care from the time of pregnancy until the postpartum period.
Indonesia’s national health insurance scheme, Jaminan Kesehatan Nasional (JKN), covers more than 200 million people (>75% of the population). JKN is an important means of providing access to essential health services for pregnant women, but the increasing cost of JKN and ongoing budget deficits jeopardize the sustainability of the program. Deficits need to be managed by stabilizing the growth in health expenditure per member while maintaining access to necessary services and improving quality. The national health insurance agency (BPJS-K) can strengthen JKN’s financial sustainability while also improving quality and service delivery outcomes by adopting more strategic health purchasing approaches. To this end, the Government of Indonesia is considering a strategic purchasing pilot for maternal health services to better incentivize providers to provide improved quality care and work towards better value for money in health.
To design the proposed purchasing pilot, the Center for Financing and Health Insurance (PPJK) in the Ministry of Health convened a multi-stakeholder MNH Strategic Health Purchasing Technical Working Group (TWG) in 2018. The TWG identified service delivery challenges that could be improved through better health purchasing. These included earlier detection of risk in pregnancy, referral systems and procedures, and continuity of care during pregnancy and the post-partum period. In 2019, a technical team supporting the TWG (consisting of USAID, The World Bank, and consultants) conducted analysis, formulation, and validation of a set of strategic purchasing policy options to address these identified challenges. These options were presented to the TWG, assessed against a set of criteria, and refined into a final recommendation for a purchasing pilot to be implemented. The proposed pilot will test new ways of contracting and paying providers for maternal health services through JKN. Recently, the Family Health Directorate (Kesga) of the Ministry of Health selected two pilot districts for implementation of the pilot – Kota Serang and Kabupaten Serang in Banten Province, West Java.
The design and implementation of the SHP pilot is supported by the USAID Health Financing Activity (HFA). Results for Development (R4D) is a subcontractor on the project and is responsible for preparing the pilot design, facilitating national and district level coordination for pilot implementation, and developing capacity building modules to improve quality in maternal health service delivery.
Consultant Role and Responsibilities
R4D is looking to engage a consultant Maternal and Newborn Health Specialist for a 6-month consultancy, with the opportunity to extend up to one additional year based on performance. The consultant will coordinate ongoing engagement with government and nongovernment stakeholders, especially those involved in MNH policy and programming, at the national and district levels and facilitate the successful preparation of a strategic purchasing pilot for maternal health.
The consultant will work virtually with US-based and Jakarta-based R4D staff, and independently liaise with focal points and other contacts within government, civil society, and development partners. Specific responsibilities include:
- Review and propose revisions to the MNH Strategic Health Purchasing Pilot technical design document (interim draft already completed and available for review)
- Provide own expert opinion on key elements of pilot design
- Ensure alignment with current regulations and best clinical practice for MNH care; if regulations are likely to change in the coming 12 months, suggest options to align with these changes
- Conduct additional review of regulations as needed
- Propose changes to the design as needed
- Develop options to help complete unfinished sections of the pilot design
- Conduct interviews with other national-level experts, as necessary, to inform development of these options
- Identify areas of risk/weakness and suggest options for strengthening the design.
Advise on the approach to quality assurance under the pilot
- Assist HFA staff to finalize technical design of pilot elements on internal quality monitoring – provide suggestions on appropriate indicators and validation process
- Incorporate feedback from district stakeholders
- Lead training sessions at the district level during pilot preparation
Facilitate HFA Project’s engagement with Ikatan Bidan Indonesia (IBI)
- Advise the HFA project on how to engage IBI in the pilot process.
- Explore IBI’s willingness to provide competency trainings to providers and/or support quality assurance
- Seek IBI’s detailed input to and feedback on the pilot design; incorporate revisions as appropriate
- Provide suggestions on the approach to building networks of providers, including private midwives, and approach to quality assurance under the pilot
- Input on potential linkages between midwife certification process, including through Bidan Delima, and JKN empanelment
- Initiate efforts to build relationship with IBI for district-level pilot implementation
Facilitate HFA Project’s strong relationship with staff at MOH/Kesga
- Seek their detailed input to and feedback on the pilot design; incorporate revisions as appropriate
- Promote their official approval/endorsement of pilot design
- Facilitate preparation of official letters for proceeding with district-level engagement
Lead outreach to key stakeholders at district level in Kabupaten Serang
- Contribute to development of an approach to district stakeholder sensitization and engagement
- Identify information gaps in the technical design that would benefit from input from local health office team and MNH providers
- Lead development of interview guides for a district-level situational analysis
- Travel (if possible) or use virtual means (if travel not possible due to government restrictions) to conduct introductory meetings, interviews, and working feedback sessions with key district stakeholders
- District health officials
- Staff at puskesmas and private clinics
- Bidan mandiri
- BPJS-K staff
Assist HFA staff to finalize technical design of and implementation guidance for the MNH pilot, incorporating feedback from district stakeholders
- Draft and/or review sections of the pilot implementation manual
- Present revised, final design to Kesga and solicit final approval
Skills and Qualifications
- Relevant clinical background (physician, midwife, nurse or public health expert with expertise in maternal and newborn health)
- Expertise in maternal and newborn health policy and regulations in Indonesia
- 15+ years of experience
- Fluency in Bahasa Indonesia and English
The specific format, content, and timeline will be discussed and agreed, including:
- Brief inception report detailing an understanding of the assignment and a proposed approach and work plan with clear milestones and timeframe.
- Comments on and proposed revisions to the MNH Pilot Technical Design
- Brief description of proposed approach to district stakeholder sensitization and engagement of key stakeholders, including IBI
- Summary documents related to sub-national (district and sub district) capacity and needs for improving quality
- Training approach, plans and materials for pilot implementation
- Meeting/workshop agendas, minutes, synthesis of key decisions, and plans for incorporating feedback from district and national stakeholders
Deliverables should be submitted in English unless otherwise specified.
Management and Payment Schedule
This position will be located in or near Jakarta, Indonesia, with travel as needed to the pilot districts. The consultant will receive remuneration relevant to his/her qualifications and in line with R4D financial rules and regulations. The consultant will invoice R4D monthly and include expected deliverables with the invoices. The final invoice will be submitted on completion of the assignment, including all pending deliverables.
To apply for this consultancy, please include both a cover letter and your CV.
For more information please contact Meghan O’Connell at email@example.com.
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and nurturing an energetic, collaborative and diverse workforce. R4D provides market-competitive salaries and comprehensive employee benefits.