Overview:
The Promoting Results and Outcomes through Policy and Economic Levers (PROPEL) Health project aims to improve the enabling environment for equitable and sustainable health services, supplies, and delivery systems. Results will be achieved through (1) policy development and implementation, (2) adequate, predictable, and sustainable health financing, (3) enhanced government stewardship, transparency, and accountability, and (4) the use of evidence-based approaches at global, national, and subnational levels. Areas of focus are family planning, primary healthcare, and the integration of family planning with HIV and maternal and child health (MCH).

Zambia has demonstrated a commitment to improving its healthcare sector. The National Health Strategic Plan (NHSP) 2022-2026 and the 2024 National Decentralization Plan both specifically identify primary healthcare (PHC) as the prime modality for implementation through district decentralized structures. PHC and decentralized health service delivery are also viewed as essential vehicles to achieve Universal Health Coverage (UHC) by 2030. Zambia made significant progress in key PHC indicators and major progress towards HIV epidemic control during the period of the NHSP 2017–2021. As per on the Ministry of Health (MOH), the country faces persistent challenges in the PHC system which will complicate achievement of the ambitious goals of the NHSP, including reducing the maternal mortality ratio. These challenges include inadequate and inequitably distributed human resources for health, inadequate equipment, and lack of dedicated infrastructure for implementation of robust PHC services. 

Given the context of ongoing decentralization and a shifting burden of disease in the country, there is a need to update the overall PHC guidelines to inform district-level health authorities on their responsibilities and set a direction for resource allocation. The community health service package was updated in 2022. The overall PHC guidelines were last updated in 1996, and specifically, the essential package of PHC facility-level interventions with a defined list of supportive diagnostics, required to set the vision for highest attainable quality of PHC, is in urgent need of updating. Additionally, the list of essential medicines and commodities, as well as systems for their procurement and distribution within the PHC setting, are in need of review and recommendation for revision.

The USAID- and PEPFAR-supported PROPEL Health project is supporting the MOH to update the PHC facility-based service package (PFSP) alongside recommendations on improving supportive diagnostic services at the health center level as well as the list of and systems for key pharmaceuticals and commodities needed for PHC services.

Purpose and Description of Consultancy:
PROPEL Health is recruiting a local consultant to support the activity on PHC reform, specifically to assist in the process leading to the update of the PFSP and improve diagnostic services as well as systems for key pharmaceuticals and commodities for PHC. The local consultant will work in collaboration with the existing PROPEL Health Zambia National Consultant, who is providing senior-level support, including coordination with MOH and partners, across all aspects of the activity, which also covers a workstream on HIV integration into PHC.

The consultant will engage in tasks to fulfil the planned deliverables under the activity’s Phase 2, which began in November 2024 and will continue till end of Q2, 2025. In Phase 1 (August-October 2024), PROPEL Health conducted scoping tasks and confirmed details on how the support would be provided, and coordinated with other technical partners of the MOH, including UNICEF, which is funding a larger activity to develop the next National PHC Strategic Framework (2024-2030). 
The PHC Reform Consultant will work with the National Consultant and further liaise with a three-person PROPEL Health team based in the US, including one international consultant and two full-time Palladium senior associates. The PHC Reform Consultant will coordinate directly with the National Consultant as well as PROPEL Health staff as needed. 

For Phase Two, this consultancy assignment will focus on (a) engaging with MOH structures, including technical working groups, to gain or share inputs related to the update of the PFSP, based on a predefined process; (b) collecting quantitative and qualitative information from local sources, especially through key informant interviews to inform the update of the PFSP as well as the design of changes to supportive diagnostic services and systems for key pharmaceuticals and commodities for PHC; and (c) conducting quick analyses and writing to ensure the activity’s tasks are progressed at the national level, including responding to MOH requests for updates and inputs related to the revision of the PFSP; and (d) along with the National Consultant, coordinate with the National PHC Strategic Framework development activity (supported by UNICEF).  

Specific tasks for the consultancy may include:

Obtain key informant views and support review of outputs and lessons learned from a previous attempt to update the health benefit package in Zambia (2020).Obtain disaggregated HIS and other routine health systems data which will serve the review and analysis of indicators that help to determine PHC service delivery trends over the last five years, including facility level service load, quality audits, health workforce availability, and others.Support the analysis of key trends in PHC in Zambia especially to identify changing trends in utilization, patterns in health center service use and shifts based on a changing disease burden.Support the development of a methodology and its socialization with MOH stakeholders, that will yield locally acceptable recommendations on updating the interventions in the PFSP. Facilitate consultation with key leaders in the PHC service delivery ecosystem in Zambia, such as district-level leaders, managers of public and faith-based health facility networks, etc.; in order to develop and refine the methodology and thereafter to share initial findings and recommendations around the PFSP as well as diagnostic services and pharmaceutical/commodity supplies. Conduct rapid review, such as through convenience sample of PHC facilities (including laboratories) to gain provider views and assess feasibility around the activity’s findings and recommendations and to identify appropriate changes to be made in the recommendations. Support dissemination of the activity's findings and recommendations, especially to MOH leaderships and through its technical working groups, working closely with PROPEL Health staff and the National Consultant.

Required Qualifications:

Consultant MUST be a full-time resident of Zambia and/or Zambian country national.Advanced degree in Public Health, Health Policy, Medicine, or a related field.Extensive experience (minimum 7-10 years) in public health, especially PHC.Extensive knowledge of Zambian health systems and key public and private stakeholders.In-depth knowledge of health systems strengthening, PHC reform and PHC service delivery.Familiarity with current global and regional guidelines on PHC package design and update.Excellent oral communication (both written and spoken) in English.Experience working on USAID-funded or donor-funded projects strongly preferred and knowledge of USAID’s priorities related to PHC services.

Anticipated Period of Performance and Level of Effort
This scope of work is estimated at 25 person days. The work is expected to be performed between March 2025 and September 2025. Based on performance and needs of the activity, additional effort may be contracted from the consultant for Phase Two.

Application Instructions:
Interested applicants are invited to submit their CVs by February 7, 2025 5:00 PM U.S. Washington DC time. Any questions or clarifications should be sent to Cindi.Cisek@thepalladiumgroup.com no later than February 1, 2025.