Consultant to Conduct a Regional Scan on Barriers to Universal Health Coverage in East and Southern Africa At AIDS and Rights Alliance for Southern Africa

Background and introduction

Universal Health Coverage (UHC) is a popular global health policy agenda and particularly in East and Southern Africa, the health ambition is not yet aligned to the UHC target. In 2015, Member States of the United Nations adopted the 2030 Agenda for Sustainable Development and its accompanying Sustainable Development Goals (SDGs), with the third goal of the agenda focusing on health – good health and well-being. Most countries in this region have weak public health systems and receive considerable external support. The African Union countries are signatories of the Abuja Declaration and committed to having 15 percent of the annual budgets covering health financing. In 2019, at a high-level UN meeting on UHC, further commitments were made on increasing the health workforce, public spending on health, resource mobilisation and improving access and financial risk protection. Urgent action is required to improve access to the national minimum healthcare packages of countries – that is a basic package of essential healthcare services; shielding healthcare service consumers from catastrophic health spending; and ensuring equity in access to healthcare services. There still exists gaps in HIV, TB and malaria prevention, treatment, and care. In the regions, many countries still contend with high levels of child and maternal mortality, malnutrition, and most health systems are not able to deal effectively with epidemics and the growing burden of chronic diseases, such as diabetes. Many countries in the region are far from attaining UHC – the principle that everyone receives needs health services without financial hardship. Additionally, the three SRHR bundles of services (modern contraception; pregnancy, delivery and post-delivery care including fistula; and HIV/STI/RTI are part of UHC benefit packages, which are not fully covered under UHC financing and financial risk protection mechanisms in most countries.

The United Nations Sustainable Development Goals Report (2023) noted a decrease in progress towards achievements in HIV, TB, malaria, an increase in the population with out-of-pocket expenditure on health of more than 10 percent of income; persistence in low health worker to patient ratios in Sub-Saharan Africa and doubling of official development assistant (ODA) for basic health from all donors since 2015 implying increased dependence on external support. The report further emphasises on insufficient progress on reducing maternal mortality and on expanding universal health coverage and an overall negative impact of the COVID-19 pandemic and ongoing crises. This has immensely impeded progress towards Goal 3 with childhood vaccinations experiencing the largest decline in three decades, and tuberculosis and malaria deaths increasing compared with pre-pandemic levels.

ARASA’s recent engagement with the SADC PF revealed that besides the budget gaps, there are various challenges including policies and legal frameworks that need to be looked at and aligned. It was noted that there is need to invest in continuous capacity building, gender responsive laws and repealing of restrictive laws.

Organisational profile

Established in 2003, the AIDS and Rights Alliance for Southern Africa (ARASA) is a regional partnership of over 100 non-governmental organisations working together to promote a human rights-based response to HIV and TB in 18 countries in Southern and East Africa through capacity strengthening and advocacy. The Regional Office of ARASA is in Windhoek, Namibia.

ARASA’s experience in this sector spans over 20 years. In this period ARASA has proved itself to be a strategic influencer and a health and human rights expert. It, therefore, looks to utilise this comparative advantage, to strengthen its BAI work using lessons gained through the “My Body is Not a Democracy” programme and enhance its intervention on the issues through the “Every Body Counts: Building a resilient CSO movement in the Southern and East Africa (SEA) region” Programme (BAI 2.0).

1. Description of the Project

The “Every Body Counts: Building a resilient CSO movement in the East and Southern Africa (ESA) region” Programme (BAI 2.0) is a multi-pronged, integrated, human rights-centred approach to addressing the SRHR challenges on the sub-continent. It emphasises the role that should be played by civil society organisations (CSOs) in addressing challenges faced by adolescent girls, young women and key and marginalised vulnerable populations in their diversities, in attaining their rights. The programme will build on the “My Body is Not a Democracy” initiative implemented by ARASA from 1 August 2019 to 28 March 2023. The BAI 2.0 programme draws from these lessons learnt to carefully sequence activities to contribute towards the establishment of a resilient regional movement with a shared understanding and amplified voice. The programme is being implemented in Zimbabwe, Malawi, Botswana, Uganda, Namibia, Mozambique, Democratic Republic of Congo, Zambia, Seychelles, and Kenya.

This, it proposes to do through strengthening (using evidence-based training and information sharing) and harnessing CSOs’ collective voices in the region. ARASA has deliberately sought, with the proposed intervention, to align its work to regional priorities as these are articulated in the various standards and principles adopted on the continent. It has drawn inspiration from instruments such as the Maputo Plan of Action 2016 – 2030 (MPoA) and anchored its multi-pronged approach on the framework adopted as part of the Transforming our world: the 2030 Agenda for Sustainable Development. The BAI 2.0 Programme will continue to prioritise ARASA’s traditional themes of SRHR in Universal Health Coverage (UHC), HIV prevention, Sexual Orientation and Gender Identity and Expression (SOGIEE), and access to safe abortion. Given this background, ARASA seeks the services of a consultant to perform a baseline evaluation of the sexual reproductive health rights situation and context in the East and Southern Africa (ESA) region. Other frameworks guiding the purpose of the scan include the United Nations Declaration (2021) on HIV and AIDS: Ending inequalities and getting on track to end AIDS by 2030; the Sustainable Development Goal commitments and the Abuja Declaration of AU countries.

1. Purpose of the regional scan on barriers to Universal Health Coverage

As a part of this project**,** a consultant is expected to conduct a UHC regional scan in the ESA region, focussing on Botswana, Namibia, Malawi, Kenya, Zimbabwe, Mozambique, Democratic Republic of Congo, Seychelles, Zambia, and Uganda. The purpose of the regional scan is to assess the regional UHC context based on the sub-regional commitments pertaining to HIV, TB, Malaria, polio, and other relevant conditions. This will include a review of current UHC strategic documents and programmes pertaining, but not limited to: UHC health benefit packages; costing of the UHC benefit packages; financing instruments for UHC; financial risk protection mechanisms for UHC benefit package; delivery mechanisms for the UHC benefit package; and pathways to establish ways of progressively expanding the UHC benefit package to include comprehensive SRHR services. In this respect, the regional scan will assess the progress and barriers towards UHC, determine the health financing mechanisms in published literature and ascertain potential learnings and successful strategies for countries in the region.

1. Methodology

The regional scan methodology will be developed by the consultant and presented for approval to ARASA. The methodology should use a combination of quantitative and qualitative research methods and a desk review.

4.Scope of Work

The consultant will be required to undertake the following specific tasks:

• Undertake a review of current and proposed UHC key commitments, policies, roadmaps and programmes pertaining, but not limited to: UHC health benefit packages; costing of the UHC benefit package; financing instruments for UHC; financial risk protection mechanisms for UHC benefit package; delivery mechanisms for the UHC benefit package; and pathways for progressively expanding the UHC benefit package to include comprehensive SRHR services.
• Review barriers to Universal Health Coverage particularly pertaining to HIV, TB, malaria and SRH access.
• Conduct a desk review of secondary data available on the UHC context in the ESA region.
• Collect and analyse available secondary data related to Universal Health Coverage.
• Design data collection tools and methodology for the collection of quantitative and qualitative data for the regional scan, considering the outcomes of the project.
• Conduct primary data collection in targeted project locations.
• Analyse and interpret data to develop a comprehensive regional scan report.
• Develop monitoring tools to measure results and objectives.
• Share key findings and insights with relevant staff and stakeholders through consultations.
• Capture significant change stories of partners and community members in targeted locations.

1. Deliverables

The consultant is expected to produce:

• A draft inception report which responds to the scope of work with a clear detailed methodology, data collection instruments, and detailed work plan.
• A comprehensive draft regional scan report including a clear set of actionable recommendations.
• A final regional scan report incorporating feedback from ARASA and key stakeholders.

1. Timeframe

The consultant will be required to undertake the exercise within a period of 30 days upon signing of the contract. The tentative schedule of deliverables are as follows:

Activity Date

Submission of an inception report 9 October 2023

Sampling and field work 11 October 2023

Submission of draft report 03 November 2023

Validation meeting 6 November 2023

Final report and dissemination 10 November 2023

1. Required Skills and Experiences:

The consultant should have the following skills and experience:

• Master’s degree in relevant field of public health, health financing, economics
• Experience in similar studies such as review and/or formulation of health policies, costed health strategies and health financing strategies.
• A minimum of 10 years’ experience in relevant area
• Excellent analytical and writing skills.
• Knowledge of regional/country/ local context will be an asset.
• Proven experience and excellent networking and partnership skills with agencies, government and CSOs.
• Excellent communication skills, both verbal and written and strong presentation skills.
• Excellent spoken and written English (all deliverables to be in English). Working knowledge of other languages in the SEA region will be an asset.
• Capacity to work independently and use own equipment.