Technical Expert Health Finance: National Health Insurance (NHI)

at  Panagora Group

BACKGROUND TO THIS SOW

The National Department of Health is seeking a Technical Expert Health Finance (NHI) to support the Deputy Director General within the National Health Insurance Directorate. The technical expert will focus on designing and implementing a capitated payment mechanism for primary healthcare providers in selected proof-of-concept Contracting Units for Primary Health Care (CUP) sites.
The National Health Insurance (NHI) bill, enacted in May 2024, aims to achieve universal health coverage and improve access to quality healthcare services through the establishment of around 250 CUPs for strategic purchasing of primary health care.

REQUIREMENTS

• Master’s degree in Health Economics, Economics, Public Health Administration, Accounting, Finance, or a related field, with at least six years of relevant experience in direct financial planning, health fund planning and collection of revenue, and administrative management with international organizations
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  6- 10 years of experience in health finance capacity building approaches., stakeholder engagement, policy development, health finance, or implementation of capitation/payment systems.
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  Demonstrated expertise in National Health Insurance (NHI) policies and frameworks, with a strong ability to analyze and navigate complex regulatory environments and contribute to effective implementation strategies.
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  Excellent analytical and communication skills, capable of presenting complex financial and health-related data to diverse audiences.
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  Strong organizational and project management skills.
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  Exceptional writing and oral presentation skills, with the ability to adapt messaging for various audiences in English.
  Panagora Group LLC is an Equal Opportunity Employer and does not discriminate on the basis of race or ethnicity, religion, sex, national origin, age, veteran disability or genetic information or any other reason prohibited by law in employment.

POSITION RESPONSIBILITIES

The I-CUPs program provides a unique opportunity to apply existing international and local research on capitation design, including insights from the 2018 GTAC capitation project, to develop a tailored approach for South Africa. The framework for designing an outcomes-based capitation model for primary care reimbursement in proof-of-concept CUP areas is outlined below.

KEY TASKS AND DELIVERABLES:

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  Literature Review: Examine existing research on capitation and risk adjustment.
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  Progress Report: Provide oversight, guidance, and support for the I-CUPs program.
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  Internal Consultation Report: Assist the Deputy Director General (DDG) in consultations regarding the primary care capitation contract.
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  External Stakeholder Presentation: Support the NDOH team in consultations with external stakeholders on the primary care capitation contract.
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  Methodology Development: Create a detailed methodology for calculating the risk-adjusted capitated fee and facilitate decision-making processes.
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  Scenario Planning Document: Aid in discussions with providers and stakeholders regarding the proposed risk-adjusted capitated fee.
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  Facilitation of Consultations: Lead discussions on outcomes-based payment design, including HIV/TB-related outcome measures.
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  Data Collection Specifications: Develop detailed requirements for data collection and reporting.
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  Capitation Manual Refinement: Update and refine the capitation manual.
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  Pilot Report: Prepare a report on the NHI and CUPs pilot.