Hospital Autonomy Expert
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Project Overview and RoleThe Jordan Health Finance and Governance Activity (HFG), a five-year USAID funded activity begun in November 2016, aims to improve health sector sustainability and resilience in Jordan, both highly dependent on sound health sector financing and governance. The HFG workplan contains diverse tasks across diverse technical areas. One of the top priority among them is management autonomy for the hospitals of the Ministry of Health.Both UHC and decentralization task areas are long lived objectives in Jordans health sector, with efforts going back well over a decade.
The Ministry of Health (MOH) with support from USAID and on its own has been experimenting with various pilots in hospital management autonomy. In 1998/99 the MOH with technical assistance from the USAID funded PHR Plus project started a hospital management decentralization pilot at the El Karak (Karak) and Princes Raya (Irbid) regional hospitals. The pilot aimed at granting the hospitals partial management autonomy, pursued strengthening the ways in which articles of the law were executed to increase efficiency in such areas as personnel management, hiring and firing, employee transfers and performance evaluation, staff training, increasing hospital directors discretion in purchasing supplies or services above a threshold amount of 200 JD.
In 2004/5 the USAID PHR Plus project and the MOH started the execution of an ambitious plan for skills and systems building for management autonomy at all MOH hospitals. The plan included areas of quality management, financial and operations management, information systems etc. While the direction and intent of the program were well aimed, it is unclear why it was discontinued. Some anecdotal views point to aversion to decision-making and criticism from high-level policy makers that such steps were pursuing privatization of providers.
Prince Hamza, a 440+ bed hospital in Amman built in 2006, was granted special legal status (and the privilege) to operate with some management autonomy. The special status is grounded in bylaw No.90 of 2008 issued by the Cabinet of Ministers on the basis of art.114 of the constitution and law No.0 of 1952. The hospital is a juridical entity with its own bank account and the right to collect payments from patients and use them for internal needs. It is subordinated administratively to the MOH but has its own budget approved by the Cabinet of Ministers and allocated directly to the hospital by the Ministry of Finance. Hospital management is supervised by a Board of Directors chaired by the Minister of Health.
In contrast, other MOH hospitals have no budgets, no legal status and no management autonomy. All inputs / supplies are paid for directly by the MOH. Decisions related to hiring and firing of staff, financing and financial management, opening and closing services, equipment purchases, renovation, investments etc. are centralized at the MOH. Decisions related to hiring and firing have to be further coordinated with the Civil Service Bureau which serves the function of the Human Resources department of the state.
The health delivery and finance system managed by the MOH may be at a threshold influenced by a recent drive toward decentralization of government under new laws and regulations and interest in expanding health insurance on the way to achieving Universal Health Coverage. The coverage of more people with insurance requires additional resources, some of which may come from more efficient and effective use of public resources at health care facility/provider/delivery level. Improving the efficient use of resources is linked to provider performance measuring and rewarding (paying) providers according to their performance. A major prerequisite to this is for hospitals of the MOH to be granted freedom of decision-making (management autonomy). The Government of Jordan seems increasingly interested in looking for ways to increase the efficiency of government as a way of operating more economically, yet effectively at times of economic hardship.
ResponsibilitiesThe HFG team invites expression of interest from qualified individual experts for an anticipated SOW related to hospital management autonomy under HFGs new workplan for October 1 2017 to September 30, 2018. The services of a short-term technical expert in hospital management autonomy will be needed to plan and execute activities through a highly participatory process involving employees of various government institutions. The consultant will work closely with HFG staff to deliver the following tasks (level of effort per task is indicated):
- Review background materials and conduct meetings with various executives and experts from MOH central institution and hospitals in and outside of Amman. 7 days
- Provide technical support to the formation of a working group on hospital autonomy at the MOH - developing the terms of reference and determining appropriate group composition/membership. 5 days
- Assess the capacity building needs of the working group and develop a capacity building plan. 3 days
- Execute the capacity building plan - deliver workshops, trainings, presentations and other capacity building approaches and measure capacity improvement. 10 days
- Guide the working group in developing multi-year workplan. 4 days
- Serve as technical lead in the development of a strategy for expansion of hospital management autonomy including the development of appropriate hospital payment system detailed enough to enable implementation. 30 days
- Participate in meetings and prepare and deliver presentations to policy makers in the country on issues of hospital management autonomy and the development of a strategy and roll out plan. 5 days
- Prepare readiness criteria for including hospitals into hospital autonomy pool. 8 days
- Develop a policy paper on hospital management autonomy for the needs of HFGs small group dialogue forum From Talk to Action and take part in the forum. 3 days
- Lead the working group to develop a model bylaw for a hospital with management autonomy. 10 days
- Provide technical advice on the dialogues of MOH with the Ministry of Finance on the financing of hospitals with management autonomy. 5 days
- Lead the development of a detailed hospital management autonomy and payment system implementation / roll out plan. 20 days
- Work closely with the HFG technical staff and other short and long-term technical assistants in designing and delivering the tasks of the SoW.
The level of effort (LOE) is estimated at up to 120 days of onsite and offsite work, including time in travel. The assignment envisions up to four trips to Amman, Jordan between October 2017 and September 2018. All assignment deliverables must be completed in English.
- Minimum 10 years of work experience in the management of hospitals / hospital systems
- International experience in advising governments how to transition to healthcare providers with management autonomy
- Experience working on hospital management strengthening
- Experience with developing and/or implementing different types of hospital payment systems
- Experience with establishing working groups and leading diverse teams of professionals toward achieving common goals
- Experience developing strategies and implementation plans in developed and developing country contexts
- Strong analytical and report writing skills
- Fluent in English
- Knowledge of Arabic is a plus