UNICEF – Egypt Country Office

Terms of Reference (TOR) for Individual & Institutional Contract

PROJECT AND SUB - PROJECTS: Health Policy; Costing Analysis Study of Perinatal Care Program of Excellence (PCPE)
1. BACKGROUND:

Egypt, which is a large population low- middle income country, has made good progress in child survival and is on track
to achieving Millennium Development Goals (MDGs) 4 and 5. The Egypt Demographic & Health Survey (DHS) 2008
shows that the Under 5 Mortality Rate (U5MR) is 28.3 per 1000, and Infant Mortality Rate (IMR) is 24.5 per 1000. Egypt
has also made significant reduction in MMR. However, Upper Egypt data does not show the same pace of reduction. As
the DHS data also shows that about 87 per cent of childhood mortality occurs in the first year of life, and 58 per cent of
deaths during first month of life (neonatal period), it is critical that the momentum is maintained with special focus on
Upper Egypt specifically for reduction of perinatal1 deaths as the key challenges to achieving the last stretch of national
targets, as neonatal mortalities represent about 46.6 % in Upper Egypt. The pattern is the same for Maternal Mortality
Ratio (MMR), especially in Upper Egypt. In brief, available data indicate that MDGs national targets can be achieved by
2015 only if: existing regional disparities are reduced; and, focus is made on perinatal period to reduce perinatal mortality

In response to this, and as part of the Country Program Action Plan (CPAP) of UNICEF with GoE (2007-2011), UNICEF
and MoH have collaborated in developing an innovative model, the "Perinatal Care Program of Excellence in Upper-
Egypt" (PCPE), under the Young Child Survival and Development Program (YCSD). PCPE is designed to be piloted as a
model that could have the potential to be the centre of the government’s strategy for further reduction of Neonatal
Mortality Ration (NMR) in Upper Egypt in line with the Health Sector Reform of the MoH.

The program ultimate goal is to contribute to the national efforts to achieve MDGs related to child and maternal health,
with specific objectives to upgrade quality of perinatal and neonatal health care services in deprived areas of Upper Egypt
(namely governorates of Qena, Sohag, Assiut); along with improving community and family practices. The program key
strategies are: strengthening institutional capacity, response and systems at central and sub-national levels; providing
essential commodities and services to improve health services in deprived localities in rural Upper Egypt; social and
community mobilization to promote healthy behavior; and, expanding partnerships under the leadership of the MoH.

The model envisages five key components for integrated perinatal care that can fulfill standards of excellence in terms of
service quality, access, and coverage. The five components include: perinatal care service packages provided at primary
level (PHC/FHUs)2, secondary level (District Hospitals), and tertiary level (specialized hospitals), with built-in referral
systems, and a behavioral change communication component that promotes key practices of health, nutrition and
hygiene at the household and community levels. Elements of the service packages at the various levels are defined by
the MoH standard protocols. It is worth mentioning that the national advisory committee of the MoH established for this
Model, has decided to focus application only on three components out of the five: Primary perinatal care,
family/community support, and referral system. The fourth and fifth components (secondary and tertiary care) are not
addressed by UNICEF intervention given that the government is allocating intensive investments in the clinical care.

The PCPE is a joint program between UNICEF and the government. The 1st phase of the model is being implemented by
MoH since mid 2007 in four districts of three Upper Egypt Governorates (Sohag, Qena and Assiut where about 70% of
the poorest villages exist), with a targeted population of about 4 million. In these districts 12 FHUs have been identified by
a structured process to test the PCPE and are now at various stages of program implementation (two FHUs have more
than 12 months implementation; 4 between 6-12 months, and 6 less than 6 months).

Evidence created to date is promising: a program of excellence is featured in locations with longer duration of
implementation where improved elements of service supply and community demand were synergistically reflected on
performance indicators of the FHUs involved in the program. The program has identified 16 indictors to measure the
progress against baselines at the beginning of implementation.

The interventions to which this improved performance is attributed now require costing and preparing a financial budget
for potential nationwide introduction by MoH. Results of the costing analysis exercise will feed into the coming phase of
the Pilot which will continue to operate till end of current program cycle (2011). It is worth-mentioning that a technical final
evaluation as well as cost-benefit analysis of the Model will be undertaken by end of the program (in 2011) in order to
explore links between the downstream to upstream policy dialogue and to advise on possible leveraging resources for
wider implementation.
2. PURPOSE OF ASSIGNMENT:

1
Perinatal deaths include deaths within the first seven days of life (early neonatal deaths) and pregnancy
losses occurring after seven months of gestation (stillbirths).
2
Under the Family Health Model, the government has established and accredited primary health care
(PHC) centers; Family Health Units (FHUs) at the rural level, to provide basic benefit packages
according to the Health Sector Reform Program;
1
The purpose of this exercise is to establish evidence-based knowledge on the costs and results of specific interventions
of the PCPE model, and to identify the information gaps to help a cost-benefit analysis at the end of the program cycle (by
2011). The outcome of this study will be used in policy advocacy for potential PCPE replication and scaling up in Upper
Egypt, as well as for leveraging the required government resources.

3. DUTY STATION: Cairo

4. DESCRIPTION OF ASSIGNMENT: (provide detail and in quantitative terms)

Key Tasks Expected Outputs

1. Undertake comprehensive financial/costing analysis as per the By end of the consultancy the consultant is
following guidelines: expected to provide a comprehensive report
that covers the following:
The PCPE interventions for costing and financial analysis consist of four
major areas; namely: a) capacity building/training, b) system
a) Calculation of the total cost of operating
strengthening, c) equipments/supplies; and d) community health
the model; marginal cost of PCPE
interventions. Specifically, interventions to be covered by the analysis are:
model specific interventions, and unit
a) capacity building/training costs at various levels of PCPE
interventions (namely : newborn,
• training of doctors (MCH, IMCI, PHC package) pregnant woman, mother, household,
• training of nurses (midwifery, IMCI, MCH) FHUs),
b) Documentation of the results at the
• training of community health workers (Raedat) output level attributable to PCPE
• training of FHUs board members interventions using available reported
data,
• training of school social workers c) Recommendations on PCPE
strategies/plans for acceleration,
• capacity building activities for local Community
expansion and resource leveraging,
Development Associations (CDAs)3
taking into account the expected impact
• on the job training by the central/directorate and district of economic crises on inflation rates
technical teams and increased prices at time of scaling
up
b) equipments/supplies d) Policy brief for advocacy
• delivery rooms equipment,
• incubators,
• IMCI equipments and supplies
c) system strengthening
• monitoring and supervision (at district and central levels)
• district technical and management support (namely in
Health Information System and Performance Indicators
(PIs)
• referral system (community referral; and, referral between
1ry and 2ry levels including the technical support provided
by specialists of the District Hospital)
• technical support by UNICEF,
• technical guidelines/protocols and manuals production
• IEC materials (for the national IMCI program)
d) community based interventions
• community-field activities which include: Health Education
classes, Nutrition education interventions, women
empowerment classes, community participation forums,
school health activities, FHUs’ Board members
empowerment and participation, capacity building of local
• Cost of umbrella NGO (Save the Children) for managing

3
CDAs/CBOs are types of national Egyptian NGOs community based organization which are registered
with the Ministry of Social Solidarity to provide community activities mainly in rural areas. Egypt has
about 20,000 local NGOs
2
 the community based interventions
2. Interventions that are NOT covered by the PCPE interventions, yet
to be considered in the analysis (as far as the data are available) are:
a) FHUs capital investment in construction and renovations (sunk
cost)
b) Training costs of non-PCPE related programs
c) Non-PCPE equipment
d) Savings of out-of-pocket expenditures as a result of interventions
e) Savings of rational use of health services at higher levels provided
by government facilities (district hospitals, general hospitals and
specialized institutions)

3. Team membership:
The assessment team will be composed of one international consultant
experienced in health economics and financial analysis, preferably with
special knowledge and expertise in health facilities operating costs in the
PHC setting. The consultant will be assisted by national public health
specialist who is familiar with PHC/FHM system in the context of the HSR
in Egypt. The team will be supported by a focal person from the MoH local
team implementing the PCPE in selected sites of the field

4. Methodology
The exercise intends to calculate the cost of the UNICEF sponsored
interventions that are specific to the PCPE model, as well as the resulting
benefits. It will therefore compare the cost and benefits of two major
components: 1) equipment and 2) other interventions.
Three types of FHU have been identified:
st
1 Typology: FHUs with all set of interventions (equipment, supplies,
technical support, system strengthening, and community based
interventions) (two FHUs)
2nd Typology: FHUs with all interventions but without equipments (4 FHUs)
rd
3 Typology: FHUs with no interventions but with similar population
characteristics as typology 1 and 2 (6 FHUs)

To estimate the cost and related results resulting from the equipment, a
comparison will be made between typology 1 and typology 2. To estimate
the cost and its related results from the other model specific interventions,
a comparison will be made between typology 2 and typology 3.

5. Data Collection
Methods of data collection
• Desk review of reported data and indicators
• Individual Interviews with key informants and resource persons
• Field visits to PCPE implementation sites
• Focus group discussions with beneficiaries of community level
interventions

5. Sources of information
a) Documents: Program documents, concept papers, TORs, records,
minutes of Advisory and technical committee meetings, PCPE
presentations, MTR report, PCPE validation report
b) Key informants: program Advisory and Technical Committees;
program implementation team at the central and governorate levels,
3
 FHUs staff, supervision team, sample of beneficiaries
c) Resources persons: MoH seniors at central levels, Save the children
NGO.

6. Data collection Tools

• Quantitative: Questionnaires
• Qualitative: Interview Questions lists (individual and group)
Financial/economic analysis tool/software package to be used as
necessary

6. DURATION OF ASSIGNMENT: Up to a total 4 weeks (total 28 working days) (could be spread over two calendar months),
tentatively divided as follows:
• 1st week: preparation: document review, interviews
• 2nd week: field visits, data collection data compilation,
rd
• 3 week: analysis and calculation, debriefing on key findings and submission of draft report and policy brief
paper (around 30 pages report; and 5 pages policy brief paper)
• 4th week: presentation of the report and policy brief, and getting feedback; submission of final Report and policy
brief paper
7. NATURE OF ASSIGNMENT: (Office or Field - Based , Frequency of travel, reporting mechanism etc.):

Assignment will include office-based Desk Review as well as field work (in Assiut, Sohag, and Qena governorates);
coordination with MoH centrally and at the field level will be required throughout the assignment.

8. QUALIFICATION AND/OR SPECIALIZED KNOWLEDGE/EXPERIENCE REQUIRED FOR THE ASSIGNMENT:

The consultant(s) should demonstrate the following qualifications:

At least five years’ experience in costing analysis and quantitative and qualitative research on health systems;

Proven experience in policy analysis and development

Advance degree in the social sciences, health economics, public health, etc.

Proven English writing skills; Arabic language is plus

9. SUGGESTED LEVEL OF THE CONSULTANCY (IF INDIVIDUAL): Team leader and main consultant at L4 level. Step to be
guided by previous similar consultancies.

10. PROPOSED PAYMENT SCHEDULE :

Payments will be made as per the following schedule:

1. 10% of total payment upon signing the contract
2. 40% of payment upon submission of drat report (as specified in this TOR)
3. 50% of payment upon submission of final report (as specified in this TOR)

11. ADVANCE REQUESTED: No. If Yes, give details.

12. OTHER COSTS: (equipment, printing, photocopy, any other arrangement expected from the Consultant):
Costs related to field travel will be covered by UNICEF as per policies and procedures (including DSA applicable for AS .
Relevant copies of project documents will be available to the consultant team. Consultant expected to use his/her laptop.
Office space will be availed to consultant for desk reviews and drafting reports if required. Costs of national team
members (described under point # 3 of tasks description above) will be covered by UNICEF under separate payment
arrangement.
14. REPORTING REQUIREMENTS: (if applicable, frequency of assignment reports and end assignment reports):
rd
a) Draft report is expected by 3 week of consultancy.
th
b) Final Report is expected by end of the consultancy (by end of 4 week)