1. Background
Amref Health Africa (Amref), head-quartered in Kenya, is the largest Africa-based international health and development organisation delivering health services and training to over 20 million people annually in at least 35 countries in Africa. Founded in 1957 as the Flying Doctors of East Africa to bring critical health services to remote communities, Amref Health Africa continues to evolve and innovate approaches to increase sustainable health access in communities. Amref Health Africa in Zambia traces its roots to the late 1970s, when it first entered Zambia as the then Flying Doctors of East Africa. The organisation received support from the Zambian government to establish the Zambia Flying Doctor Service (ZFDS). In the 1980s, Amref Health Africa entered another partnership with the government, this time, to conduct nationwide training of Clinical Officers through the then Chainama Hills Hospital Training School. In the 1990s and the first decade of the new millennium, technical support was organised through regional outreach programmes. Since the dawn of the 2000s, Amref in Zambia has been implementing interventions in different thematic areas while working closely with Ministry of Health to attain Universal Health Coverage (UHC) by 2030.

The Strategic Purchasing Africa Resource Center (SPARC) is a resource hub incubated by Results
for Development (R4D) and hosted by Amref Health Africa. SPARC aims to generate evidence and
strengthen strategic health purchasing in Africa to enable better use of health resources. As the
core technical partner, R4D facilitated eleven technical partners affiliated with SPARC to create a
framework to understand strategic purchasing, and track progress in strategic health purchasing. The
Framework was applied in ten African countries to facilitate dialogue on what drives progress and
to promote regional learning. In-addition, Amref HQ through SPARC has targeted to build capacities of the Amref Country offices on health financing and strategic health purchasing including the Zambia Country office.

Following a scoping mission done in March 2023 one of the key areas of support raised by the Ministry of Health (MoH) was the application of the Strategic Health Purchasing (SHP). The Zambia Amref Country office is planning to conduct a study to assess the level of application of SHP in the Country. This will be done using a mixed method approach to include document review of policy, legal and research papers done on the subject, key informant interviews (KIIs) and the use of external reviewers. The study will look at two key areas namely:

1. Assessment of the application of strategic health purchasing in Zambia
2. Examining of the implication of the reforms on decentralization to the financing of primary health care in Zambia
To advocate for reforms aimed at strengthening health financing and strategic health purchasing , it is imperative to conduct a comprehensive assessment working closely with key purchasers of health services i.e Ministry of Health (MoH) and NHIMA establish information for better understanding of the countrys’ purchasing landscape. This will serve as a crucial benchmark for measuring progress and impact in the future.

2. Objectives
The objectives of the assessment are as follows:
General Objective
To assess the strategic health purchasing mechanisms in primary health care in Zambia for universal health coverage

Specific Objectives
1. To assess the level of strategic health purchasing mechanisms and the influence on universal health coverage
2. To identify existing gaps in strategic health purchasing mechanisms and the influence on universal health coverage
3. To identify the opportunities for strengthening the application of strategic health purchasing mechanisms towards universal health coverage
4. To Assess the implications of the devolution policy on the financing of primary healthcare in Zambia

3. Methodology
This will be a cross-sectional study design employing a qualitative approach. Qualitative methods are particularly vital in capturing important contextual information that is critical in meaningful interpretation of study findings.

3.1 Data collection
This study will employ a qualitative approach to collect data through the following ways; i) review of literature, and document reviews of available documents ii) KIIs. The study will seek to assess the level of SHP in PHC by exploring the following questions a) What is the level of strategic health purchasing in PHC in Zambia? b) What gaps exist in SHP? c) How can SHP for PHC be improved?

i. Review of literature, and document reviews of available policy documents
Policy documents that outline health sector inputs/investments and objectives will be reviewed. These include but are not limited to: National health policy documents and reports. These documents will be supplemented by published and grey literature on strategic health purchasing. Where there is disparity between data sources, the research team will between data sources, the research team will conduct a thorough analysis to reconcile differences, ensuring a comprehensive understanding of the topic. They will also document the reasons for any discrepancies and outline the implications for policy and practice.
ii. Key Informant Interviews
KIIs with a range of health system actors will be conducted. Approximately 10 KIIs will be conducted. Participants for interviews will be selected by a mix of purposive sampling and snow-balling. Participants will be drawn from departments within the MoH, NHIMA and development partner organizations supporting health initiatives in the country. Interviews are the preferred data collection method because of the respondents’ unique grasp of the topic of interest. Interviews will be conducted using a semi-structured interview guide and will be conducted at private locations that the participants may deem suitable and confidential. Interviews will take around 45 to 60 minutes. A topic guide will be developed for use to guide the KIIs. These topic guides will be developed based on our thematic framework.
A Microsoft Excel data collection tool designed by SPARC will be used to collect and collate information from document and literature reviews describing the existing purchasing arrangements. Document review will include national and sector-level strategic documents, national guidelines on financing and recent evaluations of key sector interventions, published literature on health financing and public finance management as well as grey literature. The documents will be assessed mainly from the public domain, including the Ministry of Health (MOH) website and other relevant resource sites/ banks.

3.1 Data storage
All written consent forms will be stored securely in locked cabinets. Data from KIIs will be captured using digital voice recorders and handwritten notebooks. The audio recordings, transcripts and NVivo files will be kept in secure password-protected computers and backed up on online servers in line with the Amref Health Africa. Data will be made accessible to the research team only. De-identification of all respondents will be done to ensure anonymization.

3.2 Data Analysis and Reporting
Qualitative data collected through KIIs will be subjected to a framework (thematic) analysis as described by Ritchie and Spencer. Audio recordings of KIIs will be transcribed verbatim into MS Word. The transcripts will be cross-checked against the audio recordings as a quality assurance measure. The transcribed data will be imported into NVIVO 10 software (QSR International, Australia) for coding and to aid with the analysis. Each transcript will have a unique identifier comprising of a code, date, and participant identifier to enhance anonymity and facilitate informed analysis. A thematic framework approach using the strategic health purchasing progress tracking framework will be employed. All transcripts will then be coded using the analytical framework while allowing for the emergence of new themes. Coded data and detailed summaries will then be drawn upon to fill charts based on our research/ interview questions, and emerging learning themes (thereby combining deductive and inductive elements). Data from document reviews will also added into charts and will provide wider contextual information.

4. Responsibilities
As mentioned in the objectives, the primary purpose of the assessment is to establish data related to Health Financing, by the definitions and methodologies outlined in the respective IGS (Indicator Guidance Sheets). The specific responsibilities of each entity involved are as follows:

4.1 Amref Health Africa
• Amref Health Africa will map iindicators and tools to be tracked
• Provide funds and logistical support for the entire exercise.
• Provide technical oversight, quality assurance, as well as quality control as necessary.
• Mobilise local partners to participate in the assessment
• Provide the venue and equipment for the presentation and dissemination of the findings.
• Provide the relevant project documents for review.
• Provide feedback on drafts of the inception reports and Assessment report.
4.2 Consultant Deliverables
The consultant will be recruited to provide the following:
(i) Understand the assessment requirements as proposed by the Amref team
(ii) Conduct an introductory/courtesy visit to MoH and NHIMA before commencing data collection, with support from the Amref Health Africa in Zambia
(iii) Oversee and coordinate data collection activities in adherence to the provided methodologies, ensuring effective surveys are conducted. This coordination will also involve collaboration with the Amref
(iv) Undertake the progressive transcription of audio recordings, submitting both audio recordings and transcripts to the Amref team at end of exercise
(v) Adhere to established data quality assurance checks and ethical procedures,
(vi) Analyze information at the country office level and collaborate with the Amref to generate the necessary information and reports as per the country office’s requirements.

Specific deliverables include:
(i) Inception Report detailing the understanding of the ToR and the scope of work.
(ii) Draft versions and final report according to the provided template (consultant may improve on it) and with additional analyses attached as required.
(iii) Manuscript developed and submitted to relevant journal
(iv) 2 Policy briefs (SHP and Devolution briefs)
(v) Final presentation to internal audiences.

5. Expected Profile of the Consultant
The Assessment will be contracted to an independent consultant to lead and execute. The lead consultant should have the following expertise:
(i) Demonstrated experience in conducting studies that cover an organization, with similar experience in coordination and analysis across multiple thematic and operational areas. It will be required that consultants submit work in the recent past, with a preference for having undertaken studies with a similar or greater scope within the programming areas.
(ii) Good understanding of the Zambia health financing sector and context
(iii) Demonstrated experience in health system strengthening;
(iv) Sound statistical background with working expertise in relevant software; Experience working with tools development, sampling and surveys is required.
(v) Excellent in-depth analytical and report-writing skills; experience in developing reports and presentations with easy-to-read graphics is highly preferred

6. Time Frame
The period of performance for exercise is 4 months, data collection starting in end of September, 2024. Data analysis and reporting writing will begin in October 2024 and end no later than no later than early November, 2024. The indicative timeline is as shown below;

Item July August September October November December
Development of protocal
Ethical Review
Data collection
Stakeholder engagement
Report writing
Manuscript writting
Validation
Dissemination

7. Proposed Cost
Interested consultants must include in their application a detailed technical and financial proposal with the following components:

Technical
● Understanding and interpretation of the TOR in their terms
● Methodology to be used in undertaking the assignment
● Time and activity schedule.
● Profile of the Consultant
● Samples of two most recent related works (not more than 3 years) including the contacts of the organizations where the survey/ evaluation was done.
● Curriculum vitae of key personnel
Financial
The consultant will invoice Amref Health Africa against agreed-upon milestones. Provide a detailed cost proposal in Zambia Kwacha for the consultancy.
A. Submission of proposal

The financial and technical proposals must be received electronically on or before the closing date and time stipulated i.e. 14:00pm on 26th September 2024. Proposals must be sent via email to procurement.zambia@amref.org. Further clarifications or request for more information on technical issues related to the application can be sent to: Levy.Mkandawire@amref.org or Sechelanji.nambela@amref.org
Please indicate Strategic Health Purchasing for Primary Health Care in Zambia as the subject heading.
B. Evaluation and award of Consultancy
Amref Health Africa in Zambia will evaluate the proposals and award the assignment based on technical and financial feasibility. Amref Health Africa in Zambia reserves the right to accept or reject any proposal received without giving reasons and is not bound to accept the lowest or the highest bidder.