81314023-Technical advisory services on the development of the National Health Insurance scheme in Nepal

Kurze Beschreibung

The German Federal Ministry for Economic Cooperation and Development (BMZ) has been supporting the development of the Nepalese health sector since 1994. There has been a steady improvement in the health of Nepal"s population since the end of the civil war in 2006, including a substantial reduction in maternal and infant mortality. Despite this progress there are still major regional disparities in levels of public service provision.

In September 2015, the Constitution of Nepal was promulgated, and it transferred many administrative and political functions to seven provinces and 753 municipalities as local governments. Although decentralization and devolution offer the prospect of creating health sector management systems with a greater focus on local needs, it also presents major challenges in terms of clarifying specific roles, getting used to new functions and building the capacity of subnational governments. The newly empowered local governments are now progressively prioritizing health. Nonetheless, challenges remain in meeting the Sustainable Development Goals (SDGs), particularly in reducing the financial risks of major health expenditures; especially for poor households, and marginalized and vulnerable people is another challenge. The Government of Nepal has also formulated and adopted a health financing strategy to ensure the availability and efficient management of funding for the health sector.

Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) was commissioned by the German government to support the Ministry of Health and Population (MoHP) for implementation of the Nepal Health Sector Strategic Plan (NHSSP 2023-2030) through the Support to the Health Sector Strategy (S2HSS II) project (2024-2027). The overall goal of S2HSS II is to strengthen the institutional capacities of state actors in the health system, in particular the Ministry of Health and Population (MoHP), the Health Insurance Board (HIB) and the municipal health authorities, to enhance implementation of NHSSP.

Building on past achievements, it focuses on three main areas:

a) strengthening organizational management and improving the financial sustainability of national health insurance program, that involves supporting HIB to develop strategies for sustainable financing and efficient claims management, as a foundation to increase insurance coverage among poor and vulnerable populations,

b) promoting evidence-based health management through data-driven decision-making and citizen participation, leading to efficient sectoral planning at sub-national level,

c) strengthening digital health information systems by establishing standards, ensuring interoperability and allowing efficient data exchange leading to better data-driven decision-making, reduced costs, and enhanced public health outcomes.

In the thematic area of social health protection, S2HSS II is advising the MoHP and the HIB on organizational development activities and measures to strengthen the core processes of these institutions and promote the strategic competence development of their experts and managers. In addition, the support will also be extended to key social protection actors in the country like Social Security Fund (SSF), Employee"s Provident Fund (EPF), etc. Thematically, the work focuses on the key social health protection concepts, organisational development, the administration of national health insurance (gender responsive benefit packages, beneficiary management and financial management), the uses of information systems and operational research findings in social health insurance and evidence-based management.

Beschreibung der Beschaffung

Nepal has made significant progress in improving the overall health status of the population, with huge improvements in life expectancy and reductions in maternal and child mortality rates. However, access to quality healthcare remains unequal, as many citizens face barriers due to geography, socio-economic status, and economic constraints. Nepal National Health Accounts (NHA) report indicates that out-of-pocket (OOP) healthcare expenses accounted for 54.2% of total health spending in 2019/20, exceeding the South Asian average of 48.2% (WHO 2023). Government contributions to health expenditure are only 30%, which is lower than the regional average of 42% (WHO GHED 2023). A 2018 study found that 10.3% of households faced catastrophic health expenditures monthly (Ghimire et al. 2018). Furthermore, the report found that 10.7% of households spent 10% of their total household expenditure on health and 2.4% even spent 25%, implying that Nepalese households face increased vulnerability to catastrophic health expenditures risking impoverishment (ADB 2024).

To achieve Universal Health Coverage (UHC), Nepal seeks to reduce OOP spending through the National Health Insurance (NHI), launched in 2016. This initiative, overseen by the Health Insurance Board (HIB), aims to provide universal access to quality health services, primarily for the informal sector. Currently, the NHI is operational in all 753 local structures across 77 districts. Though the Health Insurance Act 2017 has clearly mentioned the health insurance to be mandatory, in practice this is not yet enforced; highlighted by the fact that out of 8.1 million ever-enrolled, currently only 4.4 are actively insured as of June 2024. The increasing coverage and expansion of the NHI is a priority to the Government of Nepal (GoN) and strengthening the institution has been identified as an important action area within the strategies in both the National Health Financing Strategy (NHFS) 2022-2032 and in the National Health Sector Strategic Plan (NHSSP) 2022-2030.

GIZ has been supporting the national health insurance program since 2013, on policy advisory aspects as well as technical aspects. To strengthen HIB, GIZ supported a pool of experts through the Support to Health Sector Strategy (S2HSS) program in 2023. The pool of experts supported in defining roles and responsibilities of the policy, planning and monitoring department (PPMD) and developing job descriptions for those assigned to the departments, as envisioned in the Organisation and Management (O&M) survey. In addition, the support was extended for development of crucial policy documents, strategies, guidelines, and plans. On a technical front, GIZ supported HIB for improving the open-source insurance management information system (openIMIS) to streamline core business processes: from enrollment, member verification, policy activation to claims processing and reimbursement. Meanwhile, in the current context of HIB with constrained institutional capacity despite having developed numerous strategic documents in 2023, prioritizing its execution along with implementation of necessary reforms is now critical. Additionally, increasing population coverage, contextually redefining the benefit package, enhanced claims processing, strategic purchasing, actuarial analysis for decision modelling, using data analytics for enhancing quality of care and coordination with other actors like the Social Security Fund (SSF), Employee"s Provident Fund (EPF) etc. is vital to improve efficiency and avoid redundancy in successful implementation of the health insurance program.

In order to address these policy, strategy and operational level challenges, GIZ calls for a team of nine short-term and long-term experts with diverse expertise for building up the health insurance to strengthen the institutional capacities of the HIB and other social protection actors to implement the national health insurance program in Nepal. The team will consist of 2 international experts on organizational management and health insurance, 1 short-term national senior expert on health insurance, 4 national short-term experts (covering the topics insurance law, health economics, quality management and actuary analysis) and 2 national long-term experts (health economist and Monitoring & Evaluation specialist). The contract shall be managed and overseen by an international team leader and supported by a national team leader. The period of assignment of the contract will be 01 April 2025 to 31 March 2026.

The tasks to be performed by the contractor have been briefly listed in the following four work packages:

Work package 1: Support HIB in setting the normative and strategic structure and functions for refining the health insurance program, especially related to financial sustainability aspects.

Work package 2: Harmonization of procedures and service packages of national health insurance program and other programs offering benefits in the event of illness.

Work package 3: Organizational and institutional capacity development measures to improve core processes of the health insurance program.

Work package 4: Provide advice to HIB on various technical matters, focusing on use of data, data analysis, evidence-based planning, and quality management.

By the end of the contractual period, the experts need to develop five strategy papers relating to the financial sustainability of the national health insurance scheme, and adequately capacitate the health insurance board for major policy reforms as well as for efficiently enhanced operational functions of the program.

The contractor should conduct workshops, meetings, policy dialogues etc. for the purpose. For further details on the tender, including detailed specifications of the experts, work packages and other considerations, please refer to the Terms of reference.

Liste und kurze Beschreibung der Auswahlkriterien

Wirtschaftliche und finanzielle Leistungsfähigkeit: 1. Average annual turnover for the last three years (last-but-four financial year can be included in case of tenders held within 6 months of end of last financial year), at least: 700,000.00 EUR
2. Average number of employees and managers in the last three calendar years, at least 30 persons

Liste und kurze Beschreibung der Bedingungen

Eignung zur Berufsausübung: 1. Self-declaration: name of company and address, tax ID, registration and commercial register number or equivalent register in accordance with the legal provisions of the country of origin.
2. No grounds for exclusion pursuant to § 123, § 124 GWB, § 22 LkSG
3. Declaration of bidding consortium and/or declaration of subcontractors (if applicable)

Liste und kurze Beschreibung der Auswahlkriterien

Technische und berufliche Leistungsfähigkeit: 1. The technical assessment is only based on reference projects with a minimum commission value of 200,000.00 EUR.
2. At least 5 reference projects in the technical field of health insurance, of which at least 3 reference projects in the region of Asia in the last 3 years

Genaue Informationen über Fristen für Überprüfungsverfahren

According to Article 160, Section 3 of the German Act Against Restraint of Competition (GWB), application for review is not permissible insofar as

1. the applicant has identified the claimed infringement of the procurement rules before submitting the application for review and has not submitted a complaint to the contracting authority within a period of 10 calendar days; the expiry of the period pursuant to Article 134, Section 2 remains unaffected,

2. complaints of infringements of procurement rules that are evident in the tender notice are not submitted to the contracting authority at the latest by the expiry of the deadline for the application or by the deadline for the submission of bids, specified in the tender notice,

3. complaints of infringements of procurement rules that first become evident in the tender documents are not submitted to the contracting authority at the latest by the expiry of the deadline for application or by the deadline for the submission of bids,

4. more than 15 calendar days have expired since receipt of notification from the contracting authority that it is unwilling to redress the complaint.

Sentence 1 does not apply in the case of an application to determine the invalidity of the contract in accordance with Article 135, Section 1 (2). Article 134, Section 1, Sentence 2 remains unaffected.