Area of TA
National PEFA Assessment including Gender, Climate and Health components / deep dives
Level of Effort
50 Days
Commencement Date
15 October 2024
Completion Date
31 May 2025
Context and Introduction
Overview of LHSS:
The Local Health Systems Sustainability (LHSS) project is USAID’s flagship initiative in strengthening integrated health systems, intending to help low- and middle-income countries move to sustainable, self-funded health systems to support universal health coverage. Led by Abt Global, this five-year, $209 million project works with partner countries and local stakeholders to reduce financial barriers to care and treatment, ensure equitable access to essential health services for all, and improve the quality of health services.
Background:
The Local Health System Sustainability (LHSS) Namibia Activity supports the Ministry of Health and Social Services (MoHSS) and other Government of the Republic of Namibia (GRN) stakeholders as well as non-governmental entities in advancing long-term sustainability planning for health. LHSS will focus its efforts on the journey towards universal health coverage (UHC), improved health financing, and strengthened private-sector engagement (PSE). Specifically, LHSS Namibia will: Support the MoHSS’s efforts towards UHC and sustainable health financing. LHSS will support the continued engagement of UHC governance structures for strengthened stakeholder coordination and participatory decision-making, strengthening the MoHSS’s capacity to strategically engage with multisectoral stakeholders and facilitate health financing reforms, and support the Ministry’s sustainability planning efforts for more equitable and adequate resource mobilization and allocation.
Improve the efficient use of resources through evidence-based decision-making and improved accountability. Through improved public financial management, budgeting, and contract management practices, LHSS will work with the MoHSS to strengthen its capacity for effective, efficient, and equitable resource allocation and management. Further, LHSS will strengthen the resource-tracking capacity of the MoHSS in facilitating the routine generation and use of critical data for health financing and programmatic decision-making.
The GRN has demonstrated its commitment to health 1) through its achievement of the Abuja target in the most recent expenditure estimates, when health spending was 15 per cent of total government spending in comparison to 13 per cent in prior years, and 2) with the increase of GRN funding for health from 56 per cent to 62 per cent of total health expenditures in three years (2015/16-2017/18) (Ministry of Health and Social Service 2020). In line with these investments, Namibia’s health system has been able to achieve notable progress in improving key health indicators such as the increase in life expectancy, combating critical communicable diseases, making substantial progress towards HIV epidemic control, and achieving one of the highest UHC service coverage index rates in Africa. While HIV prevalence has decreased from 12.6 per cent in 2018 to 11.6 per cent in 2020, and deaths have decreased from 3,300 per annum to 3,000 over the same period (Ministry of Health and Social Service 2022), HIV continued to be the leading cause of death in 2019 (IHME 2021). Namibia is one of the first high-burden countries to approach HIV epidemic control, having achieved 92-99-94 towards the Joint United Nations Program on HIV/AIDS (UNAIDS) 95-95-95 treatment cascade by the end of 2022 (Ministry of Health and Social Service 2023). Given this progress, donors focus more on ensuring that epidemic control can be sustained through improved domestic ownership of the HIV response by integrating its management, financing, and strategic oversight into the broader health system.
Despite the considerable investment and progress in certain areas, Namibia has made mediocre achievements in non-HIV health areas such as life expectancy adjusted for health status (64 years in 2020 versus 67 years for well-performing peers), maternal mortality (195 per 100,000 live births versus an average of 65 among emerging market economies) and infant mortality (31 per 1,000 live births compared to 15 for emerging market economies and 9 among high performing income-level peer countries) (International Monetary Fund 2022), despite comparatively high levels of health spending per capita. An assessment of sub-Saharan African countries’ abilities to finance their own essential needs shows that Namibia already has sufficient financial resources to pay for a cost-effective basic package of health services without donor support (Eozenou et al. 2017), which implies that inefficiencies and inequities in health spending and allocation are contributing to the misalignment of health outcomes.
Given the ongoing economic constraints, it is imperative that resources are used more effectively, efficiently, and equitably and that the wastage of resources is limited.
Consultations with the Ministry of Finance and Public Enterprises (MOFPE) have identified concerns about efficiency in spending and possible wastage of resources as a critical concern regarding health spending. Inadequate public financial management (PFM) systems have often been identified as a crucial cause of these inefficiencies. It is against this background that the MOFPE is interested in conducting a public expenditure and financial accountability (PEFA) assessment, including the added modules related to Gender, Climate and Health Sector to understand better the strengths and weaknesses of Namibia’s PFM system and processes and to inform recommendations for policy reforms . A PEFA assessment concept note with a detailed implementation plan was developed in August and September 2024, which will be shared with the consultant. It will guide the implementation of the PEFA assessment and will serve as reference throughout the process.
Scope of Work
The consultant will have the following duties and responsibilities concerning the implementation of the PEFA assessment, under direction of the PEFA Team Lead and in collaboration with the PEFA assessment team: Preparatory Work:
Review, adjust and agree on methodological details (indicators and dimensions and all related details) with the GRN – MOFPE, MoHSS, Ministry of Education and Ministry of Gender Equality.
Review list of evidence, documentation, data, information collected by PEFA team per Indicator / Dimension / Key Informants.
Provide input into and deliver key segments of a 4.5-day in depth PEFA methodology (all modules) training workshop (supporting in participants selection as well and related preparatory work).
Provide input into and deliver key segments of a half day high level workshop or assessment launch (supporting in participants selection as well and related preparatory work).
Prepare any other inception related work and issue an inception report as directed by PEFA Team Lead.
Support Secretariat / Focal Point team at MOFPE as needed.
Facilitate effective coordination and communication with key PFM stakeholders, including USAID, ensuring alignment on critical issues relating to the assessment planning and delivery.
Field Work:
Conduct – remote and in-person – one-on-one or smaller group key informant interviews to consult with relevant key informants (as prepared for in the Preparatory Work stage).
Work closely with the MOFPE and remaining ministries to establish the oversight team by identifying suitable stakeholders to be represented and run the respective regular validation meetings.
In collaboration with the MOFPE and remaining ministries draft the indicators (first and revised) assessment using the template and instructions provided by the PEFA framework.
Compile all information into the draft report using the template and instructions provided by the PEFA framework.
Provide input into and review any draft indicator and/or report presentations as requested by PEFA Team Lead.
Conduct in-country visits for fieldwork and report presentations – details to be agreed and scheduled during inception.
Period of Performance, Expected Level of Effort (LOE), deliverables, reporting, and travel
Assumptions: This work is contingent on approval of funding.
This contract depends on the ability of government and development partner stakeholders to engage with the Activity, given any COVID-19-related restrictions and the ability of USAID to obtain concurrence from the MoHSS and MOFPE to work with the Activity.
PEFA Assessment Concept Note finalized and approved by GRN.
Reporting: The consultant will report to the PEFA team lead and Claire Jones, Chief of Party for LHSS Namibia, and is expected to lead this work described above and be responsible for final deliverables.
Location: The consultant will work remotely, but travel to Namibia for parts of the consultancy may be required and will be detailed during inception.
Period of Performance: The consultant’s performance period begins on 15 October 2024 to 31 May 2025.
LOE: Up to 50 days.
Expected Deliverables and Due Dates: Deliverables
Anticipated
Due date
Estimated LOE
Preparatory Work and Inception Report
30 November 2024
10
Field Work – Part I and Draft Assessment Report
31 March 2025
20
Field Work – Part II and Final Assessment Report
30 May 2025
19.75
Short-term technical assistance report
30 May 2025
0.25
MAXIMUM LOE DAYS
50
Consultant Profile
A senior Public Financial Management expert with experience conducting PEFA assessments.
At least 8-12 years of experience in the field, focusing on PFM reforms in Africa – Public Accounting, External Audit or any other relevant to the PEFA scope of work.
Will be an active assessor for a selection of indicators, ensuring that the methodologies are applied correctly and that the final reports meet international standards.
Consultant specializing in climate, gender or sector PFM and financing, budgeting and public financial management.
Strong background in environmental economics and climate-related public expenditure.
Experience in conducting sector PFM assessments in several countries inc Namibia and will be responsible for performing the climate and gender assessments.
The Assessors will support the Assessment Lead on all the assessment implementation plan.
The team will maintain close communication with the Lead Assessor to align the assessment process with planned priorities and ensure that all work is delivered as agreed to.
More Information
- Job City Windhoek, Namibia
