Jordan: Health Care Cost Study at MoH

Organization: UN Children’s Fund
Country: Jordan
Closing date: 27 Nov 2016


To support Ministry of Health to conduct a detailed health care cost study at MoH facilities analysis for both Jordanians and Syrians with an aim to inform policy decision makers on health care cost, and provide options for financing arrangement and modalities for including vulnerable populations in national health and social protection scheme.

To support Ministry of Health/ Health economy Directorate to build their capacities in conducting various health economics and financing studies (costing, economic modelling for simulating various financing arrangements options) and educate them about Universal Health coverage Schemes.


Home and Jordan (may include travel to camps and host community)

Estimate number of working days

up to 19 week (95working days) over 6 months contract duration period

Reporting to

Primary supervision by Chief Health and Nutrition with technical support from Chief Social Policy


Jordan is an upper middle-income country that has made considerable progress in improving the health of its population. The Government of Jordan (GoJ) is committed to sustaining these improvements going forward even as the country copes with the ramifications of the global economic downturn, the influx of refugees as a result of instability in the region, and epidemiological shifts such as an increase in the burden of non-communicable diseases (DAI 2015). In 2015, GoJ adopted the Sustainable Development Goals, which includes the goal of achieving universal health coverage (UHC) by 2030 (United Nations 2015). The UHC vision is to ensure that everyone has access to needed healthcare services regardless of their place in society and without getting into financial ruin (WHO 2015). Improving health equity is therefore a critical priority for GoJ and its development partners (GoJ 2015). Several policy reform options for modernizing health sector were suggested such as PHC strengthening, review of cost and assess barrier to access to services by those receiving no financial protection, harmonization of benefit package (and its costing) across main public health insurance programmes.

UNICEF commissioned an equity and health financing study which applied the health equity lens to four topics: (1) trends in household health spending and catastrophic health spending, (2) the distribution of healthcare services delivered by government facilities across wealth quintiles, (3) inequality in utilization of maternal and child health services (MCH) across socio-economic groups, and (4) healthcare utilization and health spending patterns among Syrian refugees. One of the main recommendations of the study was to increase health insurance coverage which will reduce out-of-pocket (OOP) health spending, ensuring financial risk protection for all.

Furthermore, it proposed that GoJ needs to articulate a clear plan for how the country will bring more people into financial risk pooling arrangements, increase the percentage of services covered by the benefit package, and reduce the amount of co-payment. Overall, the UNICEF study and other recent health financing reviews provide a wealth of ideas and data to guide this discussion (World Bank 2014, DAI 2015).

Attracting those who are uninsured from the bottom two quintiles (Jordanian) and other vulnerable segments (other nationalities) into the Ministry of Health (MoH) scheme through partial subsidies seems like a promising way to increase coverage and reduce fragmentation of risk pools. The study also suggests that the 2014 policy change, which increased the cost of health services at MoH facilities for refugees, has reduced access and increased catastrophic health expenditure for refugee households. Bringing these households into the main health system, including the MoH insurance scheme, through full or partial subsidies to cover their insurance premiums will go a long way in reducing financial barriers to access for this vulnerable segment of the population and provide a sustainable approach to catering for their health needs. Evidence gap identified during the above study was to obtain appropriate cost data and conduct detailed simulation of cost and cost analysis.


UNICEF Jordan is increasingly engaged in supporting health financing and policy related in Jordan to address inequitable health service access by the most vulnerable children and women. UNICEF will support the Government of Jordan to achieve its goal of achieving Universal Health Care (UHC) by 2025. In this context, UNICEF Jordan seeks consultant support in order to support Ministry of Health to conduct detailed costing analysis on how to integrate refugees into existing schemes (CIF) which contributes to UHC in Jordan.


The core objectives of this consultancy are the following:

  1. To conduct & assess current cost of health care services at MoH facilities for Jordanian and Syrian refugees[1] and estimate the cost of providing health care (through CIF or any other modalities),
  2. To provide projections (simulation model) for various options for financing arrangements and modalities to include

  3. those who are uninsured from the bottom two quintiles (Jordanian) into the Ministry of Health (MoH)/RMS scheme through partial subsidies

  4. those other vulnerable segments (Syrians in particular) into existing scheme through full subsidies from donors

  5. To support Ministry of Health/ Health economy Directorate to build their capacities in the following subjects:

  6. Conducting costing and financing studies in the health care sector

  7. How to develop simulation models /schemes for financing arrangement and modalities

  8. Educate MoH about Universal Health coverage Schemes in similar countries


Specific tasks (scope of the work) to be undertaken

The specific tasks for the consultants in collaboration with MoH technical team include the following:

  1. Inception phase: Max 15 page

  2. A review of literature and reports and studies on (i) how other countries have approached the integration of vulnerable populations (refugees, non-insured, and those in informal sectors) into existing national scheme with a focus on the following countries: Turkey, Thailand, Philippines, Mexico, and other Middle Income and MENA (middle east, north Africa) countries, as well as Refugee settings/context, (2) simulation models that reflect differential financial and operational arrangements of a scheme that incorporate vulnerable populations,

  3. A methods paper development (the key analytical questions that are to be answered during costing, list of data to be collected and its sources (data framework and data list), the technical approach and methods of data analysis and analysis framework that will be employed, possible data collection challenges and methods of overcoming data challenges, simulation model framework and its component and simulation methods which will be used for the study, and a work plan detailing activities and timelines),

  4. Synthesize key elements of the costing studies (purpose of the study, agency that implemented it, time period, data sources used, key outputs/findings, key assumptions, etc.).

  5. Data Collection phase:

  6. Clearly articulate the services that comprise cost of care for Syrians by levels of care (community, primary, secondary and tertiary),

  7. Identify, collect and review published (grey, peer reviewed) costing studies that have been undertaken in Jordan in the past 10 years including but not limited to (i) the costing and expenditure study supported by the WHO/UNHCR/WB/USAID; (ii) the private sector costing exercise conducted by the USAID-funded project; (iii) insurance and costing analysis done by UNHCR and UNRWA for Syrians/Iraqi/Palestinian refugees; (iv) pricing and costing study of government services and functions,

  8. Identify, collect and review costing data to undertake a costing analysis of health/medical are services for Jordanians as well as refugees taking into accounts key inputs (human resources, infrastructure, supplies, operations and maintenance etc.) by levels of care,

  9. Identify key gaps in available costing data that need to be addressed in the future.

  10. Cost analysis, scenario building and simulation and Preliminary Report (max 30pages) writing:

  11. Undertake costing analysis of health/medical care services for Jordanians and Syrians,

  12. Develop methodology of average costing of health services at MoH facilities in collaboration with MOH team and get the methodology approved,

  13. Make assumptions to develop scenarios look for substitutes for the data gap, or use proxy data from similar country context (if needed). Also, Identify key gaps (if exciting )in available costing data that need to be addressed in the future ,

  14. Develop 3-4 options (scenario building and run a model to simulate a few scenarios for comparison) and per capita and overall cost for

  15. integrating non-insured Jordanians into MoH/RMS scheme,

  16. Integrating refugees into existing schemes and establishment and implementation/running of cross-subsidy equity health care fund scheme for Syrian refugee (as part of UHC/MOH reform).

  17. Conduct model alignment with full scale ex ante projections for a period in the past and adjustment of the model on the basis of it.

  18. Show how the proposed options add marginal costs compare to the existing approach (direct service provision model). This should include projections regarding refugee population growth and coverage, changes in epidemiological patterns, expressed population needs, cost of health system strengthening activities, and other macro-economic factors; develop projections for the costs of implementing the cross-subsidy equity health care fund scheme for Syrian refugees (provide 3-4 scenarios using different underlying assumptions about population dynamics, macroeconomic factors etc.)

  19. Validation of the findings: Coordinate, arrange stakeholder validation workshops, prepare and present preliminary findings to the MOH committees and stakeholders. Validate data/findings and collect inputs from MOH and stakeholders.

  20. Reanalysis and Final report writing phase: Reanalysis (based on inputs collected above) of models and costs, Report writing and submission of the Draft Report, Draft Final Report, and Final report with excel file with the cost models, and a revised PPT for high level partners to UNICEF after incorporating validation workshop results and inputs from stakeholders. Final presentation of the Final results to the stakeholder and high level MoH committee and submit final report.


End Product

Time frame (range)


Working teams

1.Review of existing literature on costing, health financing related studies submit draft Inception report (max 15 pages) ( data collection methods, data collection tools for costing analysis, work schedules)

  1. Review of literature and reports and studies on (see above Section 4 SCOPE OF WORK

  2. Methods paper development

  3. A draft inception report (proposal for costing study at the MoH facilities) and approval of the proposal/inception report including its methodology ((UNICEF in collaboration with MOH technical team )

  4. Synthesize key elements of the costing studies

2weeks (home-based)

By January 16

(UNICEF & MoH team (4 senior health economists and 4 junior health economics unit staffs)

2.Inception visits, technical committee and stakeholder consultation, and final Inception Report

  1. Inception visits, stakeholder consultation on methods,

  2. Conducting a capacity building workshop (A) costing and financing studies in the health care sector and how health care costing and financial analysis can benefit improvement of UHC schemes in other similar contexts

  3. Preliminary data collection on basic prices and costs from key facilities

  4. presentation of inception report, including agreed methodology in consultation with stakeholders

  5. finalization of inception report

3 weeks (Jordan In-country TA support in collaboration with MoH health economics unit )

Combined with below data collection phase

By end of February

(UNICEF & MoH team)

  1. Data collection visits phase

  2. Conduct capacity building workshop (B) for MOH teams to finalize data collection tools, data collection and validation methods.

  3. Field visit to Amman and collection of costing study data from stakeholders and sites in collaboration with MoH team.

  4. Data entry and validation of data simultaneously.

5 weeks (Jordan-in-country TA support, time for staying in Jordan will vary per each consultant) NOTE: Some data analysis will start during this phase.

By mid April

(UNICEF & MoH team)

4.Interpretation and analysis, cost analysis phase

  1. Costing data analysis in collaboration with MOH health economists

  2. Prepare a draft preliminary report which includes costing data analysis results and findings of costing study (without simulation) (30pages max)

4 weeks (Satellite TA support for data analysis jointly with MoH)

By mid May

(UNICEF & MoH team)

5.model/scenario building and validation of findings

  1. Design and conduct capacity building workshop(C) on how to develop simulation models/schemes for financing arragenemtns and modalities.

  2. Develop powerPoint presentation materials for the stakeholder consultation

  3. Prepare for at least three workshops (different levels of MOH facilities and with MOH officials and stakeholders) for scenario building and analysis/simulation excersize

  4. Prepare presentation of simulation /scenario analysis results and preliminary report findings at validation/ stakeholder consultation with MOH technical team and high level committee members.

  5. Coordinate and arrange validation and stakeholder workshops (D)at 2 levels (central high level decision authorities, mid/high-level managers)

  6. Conduct and participate in validation/stakeholder consultation workshops (D)(in-country)

  7. Validate data/findings of both costing analysis and model simulation results and collect inputs from MOH/HHC and stakeholders

2 weeks In-country TA support

By end May

(UNICEF & MoH team)

6.Re-analysis, Final report writing , final PPT (satellite presentation of the final report/results) and excel models

  1. Reanalysis of models and costs (based on inputs collected above)

  2. Draft Final Report writing and submission of the Draft Report

  3. Revise Draft Final report and produce 2nd DRAFT Final Report

  4. Revise 2nd DRAF Final report and make FINAL report, and excel file with the cost models, and a revised PPT for high level partners to UNICEF after incorporating validation workshop results and inputs from stakeholders

  5. Disseminate and make final presentation of the Final results to the stakeholder and high level MoH committee workshop (E)

3 weeks (home based)

By end June


19 working weeks over 6 months (contract period)

  1. EXPECTED DELIVERABLES (See details per each deliverables in Section 4 and 5)

  2. Draft Inception Report

  3. Final Inception Report (15 pages) after data collection

  4. Cost study at MoH facilities for the year 2015

  5. Draft and Final Preliminary Report: In English, (max 30 pages)

  6. A PowerPoint presentation (PPT) for validation workshop detailing the proposed scenario emerging from the study and expert committee, costing analysis results, and synthesis of available costing information

  7. Conduct series of workshops (A, B, C, D, E) at different stages for capacity building, validation, consultation and dissemination purposes.

  8. A Microsoft Excel file with the cost models, and a PPT of high-level consultation results

  9. Final Report (1st Draft Final, 2nd Draft Final report, and FINAL Final Report)


(19 working weeks) over 6 months during the contract period (See SCOPE OF WORK Section4, and EXPECTED DELIVERABLES Section 5).


  2. Multiple international travel to Jordan Amman for international consultants and home-based work during the non-travel contract period. Details of travel frequency will be discussed in detail in consultation with MoH health economics team. On average 4-5 visits per consultant is expected during the course of contract period.

  3. Study visit for the Planning Administration/Health Economy Directorate team to one of the countries that have integrated of uninsured &vulnerable populations into their existing national health insurance schemes will be pursued during this contract period. A separate arrangement will be sought for this learning study visit through partnership with MOH, WHO, JICA, KOICA and/or World Bank. The purpose of this visit is to extend the team’s perspectives of the existing systems, to learn from the experience of similar countries and to foster an understanding of the experiences made with integration of uninsured & vulnerable populations into their existing national health insurance and health care financing schemes, including the implementation, effectiveness and impact of this integration on the national health system.


Consultant Qualifications

We envision a team of consultants (both internationals) undertaking the tasks described here in close coordination, collaboration and partnership with Health Economics Team within the Ministry of Health Jordan. The required qualifications and experience for each are listed below.

Lead consultant: One Health Financing Expert (international)

  1. At least a master’s degree in Public Health, Health Economics, Health Systems or other relevant field
  2. At least 7 years of experience working on health economics, financing, costing of health programs in similar countries, and health policy
  3. In-depth knowledge of the Jordanian health financing system and key stakeholders
  4. Demonstrate excellent interpersonal skills required for high level engagement with government ministries, departments and agencies, development partners and other stakeholders
  5. Good writing and presentation and capacity building skills, and ability to communicate effectively to diverse audiences

Costing Expert(s) (one Local and/or one international, who will be closely working with economists/costing specialists of MoH):

  1. At least a master’s degree in Economics, Accounting, or other such relevant field
  2. In-depth understanding of Jordan’s health economics and financing issues/context, key principles and methods for costing health programs, policies and services
  3. At least five (5) years relevant experience working on costing studies in the health sector
  4. Prior experience conducting costing studies
  5. Demonstrate excellent interpersonal skills required for high-level engagement with government ministries, departments and agencies, development partners and other stakeholders.
  6. Good writing and presentation skills, capacity building skills, and ability to communicate effectively to diverse audiences


Proposed timelines for completion of activities are met and deliverables submitted on time with good quality.


    Performance reviews will be conducted after completion of each task activity. Interim progress reporting meetings will be held every two weeks by skype-conference (or face-to-face) between contracted agency, UNICEF and the High Health Council to update progress.


An applicant to this consultancy should submit at least two sample work reports for each consultant, publications in relevant field, cover letter, CVs, and a Proposal with a detailed description of the following and ate least two sample works (publication, consultancy report etc..):

Section A: Technical Component

This section will include all technical background information and methodologies that are proposed to carry out the desired activities.

Section B: Timetable (Schedule)

This section should include a proposed time schedule/delivery schedule. An action plan specifying the timeframe with various milestones and activities should be included under this section.

Section C: Technical Capability Statement

This section should include an experience statement describing the contractor’s relevant experience, qualifications and professional background of the staff (team) members that will have primary responsibility of the project

Section D: Financial Offer

A proposed daily rates of the consultant should be mentioned. The financial offer (this section) should be submitted on a separate page from the Technical Capability and Schedule information.


    (for consultants/individual contractors traveling with UNICEF or working in UNICEF Office)


    Standard UNICEF contractual penalties will apply.



  5. Cost of data collectors/analysts for eight (four senior and four junior) MOH health economists throughout 6 months period and workshop participation costs to be budgeted in financial proposal by the consultant team. Venue fees and meals for the workshops (A-E) will be covered by UNICEF directly.

  6. The contractor will work on its own computer(s) and use its own office resources and materials in the execution of this assignment. (a request will be made to MOH to allow UNICEF consultants to be based at MOH building) The contractor’s fee shall be inclusive of all office administrative costs

  7. International travel and airport transfers (where applicable) will be covered in accordance with UNICEF’s rules and tariffs, cost of all travels should be included in financial proposal, including terminal costs.

  8. Local travel arrangements should be made by consultants and necessary transportation costs should be included in financial proposal.

  9. Flight costs will be covered at economy class rate as per UNICEF policies.

  10. Please also see UNICEF’s Standard Terms and Conditions attached.

[1] Registered and non-registered refugees

How to apply:

In reference to the above mentioned subject, we are pleased to invite your kind to our Request for Proposal no. 2016-9128634 Health Care Cost Study at MoH (Re-Advertise). You are kindly requested to submit your best proposal “Technical & Financial” (**IN SEPARATE E-MAILS, ONE FOR TECHNICAL PROPOSAL, ONE FOR FINANCIAL PROPOSAL. IF THE TECHNICAL PROPOSAL INCLUDES ANY PRICING OR NUMBERING, YOUR PROPOSAL WILL BE INVALIDATED**) to JORDANBIDS@UNICEF.ORG ONLY no later than 11:59AM Amman Time on 27.NOVEMBER.2016, otherwise it will be considered as not valid.


  1. Please note that any inquiries related to this request for proposal will be acceptable through e-mail ONLY and will not be considered through phone calls.

  2. Please note that latest date to receive inquiries will be 15.NOVEMBER.2016.


P.S. Only proposals received through JORDANBIDS@UNICEF.ORG will be valid, any proposals received through any other e-mail will be INVALIDATED.

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