Background
Financing is central to progress toward the SDGs, within the very challenging country contexts while the costs of achieving the SDGs and demands on public spending have risen. At the same time, fiscal space has decreased, private sector investment has declined, debt has risen beyond sustainable levels and the outlook is characterised by heightened uncertainty and risk. There is a growing finance divide between countries. Getting back on track toward the 2030 Agenda will require concerted effort at the national and international levels and across public and private sector actors.
Investors play a pivotal role in shaping society, now arguably more than ever. By investing capital and resources in businesses likely to bring significant, sustainable economic gains to low- income communities, investors can positively impact those communities, in the process helping to determine how not just the current generation, but also future generations will live. At the same time, a number of new financing instruments and new mechanisms of working together across the public-private sector nexus towards better investments has emerged.
Furthermore, MAP has found that the necessary market pre-conditions to ensure readiness for more commercial financing that matches the criteria and terms of the private sector, is missing in LDCs. In other words, financial inclusion can play a much larger role in contributing to the domestic financing agenda if regulatory challenges can address the needs of the traditionally underserved low-income market, based on demand-side data, and by enabling greater integration and coordination between financial inclusion initiatives and the broader investment environment. In addition, the interaction between innovations in digital finance and the real economy creates new business models that make investment in sustainable sectors commercially viable. Ultimately, these enable the financial sector to interact more closely with the real economy and better align financial flows with the SDGs.
The market conundrum for healthcare in low-income countries with high levels of inequality:
Healthcare in low-income countries with high levels of inequality presents a complex challenge. Low employment rates and financial strain on households, coupled with an inadequate public healthcare system, result in limited access to quality, affordable healthcare for the low-income population. The prevalence of communicable diseases and their associated death and disability rates further emphasize the need for a shared financing model involving the public, NGOs, and private sectors to ensure accessible healthcare for all.
To address the overlapping usage of services between private and public healthcare and the affordability issues, it is crucial to develop a comprehensive mixed public-private healthcare solution. This approach is essential for creating a more integrated and effective healthcare system, particularly in countries with significant inequality.
Research indicates that there is a significant overlap in the utilization of shared spaces and social infrastructure across income groups, with relatively close distances to access these facilities in some cases, while segments of the low income are also excluded from specific services due to their lack of proximity. Therefore, it is important to establish systematic mechanisms and improve community mapping to create communicative ecologies for shared public infrastructure. This will enable the development of clearer and more transparent blended finance business models that consider the multifaceted risks associated with various stakeholders involved in healthcare provision.
The Problem:
Given the need for increased access to quality healthcare services at the community and regional level, as well as the need for sustainable provision of such services, there is a need for better cooperation or perhaps coordination, too, between existing and new community and regional healthcare facilities along the healthcare continuum across market segments, allowing for better access to specific (and more specialised) services at all levels of healthcare delivery and across a broader segment pf the income spectrum. To make such services more affordable (and the provision thereof more sustainable), there is also a need to explore alternative healthcare insurance products that can serve the low income, while enabling optimal usage of infrastructure, by expanding potential target markets, for better return on investments.
The problem at hand encompasses two key aspects: the lack of access to quality healthcare infrastructure and the absence of affordable medical aid to utilize such infrastructure. Currently, medical aid coverage in Eswatini primarily caters to higher-income individuals earning E18,000 or more per month. This demographic, along with a possible segment earning E11,000 per month or more, is the traditional target market for private sector healthcare.
However, according to data from health facility level, a significant number of clients who regularly utilize clinic facilities for healthcare fall below this income threshold. These individuals, earning less than E11,000 per month or significantly less, form a substantial portion of the clientele and often require services related to maternal health or communicable diseases, both falling under the public health category (and mostly provided at the regional level). Unfortunately, this income segment typically lacks access to medical aid and often falls within the social protection window.
To address this problem, this collaboration aims to enhance access to quality healthcare services that links provision at the community and regional levels while ensuring the sustainability of such services. Additionally, exploring alternative healthcare insurance products that cater to the low-income population is crucial. These products should enable optimal utilization of infrastructure by expanding the potential target markets, ultimately leading to better returns on investments and making healthcare services more affordable and sustainable.
Pilot concept and requirements:
The scoping work is meant to inform a potential medical aid/health insurance partnership in Eswatini to pilot business models for access to healthcare through an affordable medical aid product for communities living in the vicinity of a private sector hospital facility in Manzini. The concept seeks to test the blended finance potential of a complementary public-private partnership that can serve both the low-income and the high-end market within a shared infrastructure space.
This concept needs to work on two levels, namely at the stakeholder level which seeks to identify key stakeholders in the healthcare sector and engages to identify core pain points, opportunities and risks to the model. The focus of this ToR is on the stakeholder engagement and scoping the parameters of the pilot concept. Thus, it also needs to further flesh out the pilot concept, a potential healthcare product and list of exclusions and benefits for the low-income. Finally, it should also highlight the partnership model between the international NGO’s like IFRC, Salvation Army, etc that will work in concert with the private sector partner.
It is proposed that a partnership can result in referrals between community level clinics (provided by NGOs in more rural communities) and private sector hospital facilities (serving the regional level and mostly in urban areas), by making affordable medical aid linked to the private sector facility available to households in the vicinity of the community level clinics.
Thus, the current healthcare spend of these lower income patients will be further supplemented with a low-cost medical aid product for those currently utilising the services of a clinic. It is envisaged that services will be complementary and clinic patients will be referred to private sector regional facilities for more serious conditions that the clinics cannot provide.
Furthermore, as the community clinic patients are likely social protection recipients/vulnerable clients, there would need to be a conversation with Government around the potential pilot and discussion around a PPP on medical aid and shared infrastructure usage.
Objectives of the consultancy:
The overall objective of this consultancy is to provide scoping services for a collaborative public (NGO)-private partnership (PPP) to test solutions for shared social infrastructure in healthcare services.
Scope of work
To inform ongoing engagements with stakeholders, the Consultant is expected to undertake the following:
- Explore alternative healthcare insurance products that can serve the low income, while enabling optimal usage of infrastructure, by expanding potential target markets, for better return on investments;
- Understand current cooperation, coordination, or cross-usage/linkages between existing and new community and regional healthcare facilities along the healthcare continuum across market segments;
- Fine-tune the pilot concept including list of key products and services based on community-usage and engagement with NGO’s (benefits and exclusions list);
- Understand the interface between the private sector offering for the low-income market and the provision of Government healthcare services, within a financial inclusion lens;
- Conduct initial conversation with Government to understand the possible parameters around a PPP and blended finance for medical aid and shared infrastructure usage that can serve both the low-income and the high-end market within a shared infrastructure space;
- Draw on the above to scope the project requirements, and undertake preparatory work on the pilot concept that will feed into business model development and planning, including recommendations on business models and data analysis to be further explored/tested for the pilot.
- Also, provide recommendations, based on stakeholder consultation, on how to close the pilot should it not be successful.
Requirements:
Candidate need to have a master’s degree / post-graduate qualification or higher at an internationally recognized university in commerce.
Knowledge and Experience:
- Experience in healthcare with an in-depth knowledge of the insurance industry will be preferred.
- At least 5 years’ experience in working in insurance, experience or exposure to financial inclusion will be necessary;
- Experience in the SACU is essential;
- Experience or familiarity with the MAP Programme will be an advantage.
- Understanding of healthcare models will be an advantage
Languages:
English-speaking, report to be produced in English
