Download Outsourcing Outpatient Drug Benefit Scheme

Request for Expression of Interest
Country: Kosovo
Project ID: P147402
Contract Identification No.: KHP/A.1.1.2/2017
World Bank Loan/Credit Name: Kosovo Health Project
Outsourcing Outpatient Drug Benefit Scheme
Background:
On March 26, 2015 the Assembly of Republic of Kosovo has approved the Financial
Agreement between the Kosovo Government and International Association for Development.
The agreement supports a US$25.5 million for Kosovo Health Project (KHP). The project will
support improvement of financial protection from health spending for the poor, and quality of
care for priority maternal and child health (MCH) and non-communicable disease (NCD)
services in Kosovo.
The project consists of three components:
COMPONENT 1: Improving financial protection and quality of care;
Sub-component 1.1 - Improving financial protection,
Sub-component 1.2 - Improving Quality of Care
COMPONENT 2: Strengthening primary care
COMPONENT 3: Project Management
The introduction of the Outpatient Drug Benefit Scheme (OPDBS) is planned and implemented
as a component of Kosovo’s mandatory health insurance reform. It is a policy priority for the
MoH in view of the fact that medicines account for 85 percent of Out of Pocket (OOP) spending
in Kosovo, as a sustained benefit for the population at large, and a visible ‘quick win’ for health
sector reforms.
The OPDBS will be introduced in a phased manner to ensure that the HIF is able to manage
the OPDBS effectively and to match the revenues available. The first phase of implementation
will be a proof-of-concept pilot. This benefit will cover a very restricted list of medicines that
will be prescribed by one family medicine centre and available for free in several contracted
private pharmacies. The pilot will offer an opportunity to test the claims processing and
monitoring scheme, build trust with private pharmacies to ensure their participation and offer
some ‘quick wins’ for the health sector reforms to the public.
The second phase of the project will focus on extending the benefit package to cover a wider
range of essential medicines bearing in mind public health benefits and financial protection as
key concerns. The expansion will keep pace with the increase in revenues and HIF capacity to
manage the OP drug benefit and will be gradually implemented in the entire territory of
Kosovo.
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Objective of the Assignment:
The overall objective of the assignment is to provide the Ministry of Health (MoH) and the
Health Insurance Fund (HIF) with technical assistance that will enable them to efficiently
establish, sustain and implement the Kosovo Outpatient Drug Benefit Scheme
Specific objectives of the assignment are:
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To assist the MoH and HIF in developing an institutional framework that will operate
and manage the OPDBS;
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To develop capacity of the MoH and HIF in managing the OPDBS;
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To assist the MoH and HIF with external reference pricing (international price
comparisons);
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To assist the MoH and HIF with internal reference pricing;
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To assist the MoH and HIF with analysing data on prescribed and dispensed medicines;
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To assist the MoH and HIF in developing and implementing protocols to prevent fraud;
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To assist the MoH and HIF in developing pharmacy contract inspection protocols;
Scope of work:
1) Institutional Framework
2) Capacity Development
3) External Reference Pricing
4) Internal Reference Pricing
5) Data Analysis
6) Fraud prevention and detection protocols
7) Pharmacy Contract Inspections
Required expertise:
The Ministry of Health would like to contract an Consulting firm with:
Demonstrated experience and record of accomplishment in technical assistance in the
management of outpatient lists of reimbursed medicines;
Expertise in pricing, reimbursement and pharmaceutical management in an EU country;
Experience in training and working with public administration staff and health care
workers at the health facility level;
Eligible consulting firms will be valued and shortlisted according to the above mentioned.
Members of the Consulting team should have substantial demonstrated experience in
pharmaceutical policy, pharmaceutical economics, pricing and reimbursement of medicines
and contracting and inspecting pharmacies. Profound knowledge of English language is
compulsory.
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Duration and level of effort:
The foreseen contract duration: 18 months.
The total time duration of consultant work shall be not less than 11.5 man-months.
Selection process:
The Consulting firm will be selected in accordance with the procedures set out in the World Bank’s
Guidelines: Selection and Employment of Consultants under IBRD Loans and IDA Credits &
Grants by World Bank Borrowers published in January 2011 (Consultants Guidelines), according
to selection based on Quality and Cost Based Selection (QCBS) method.
Interested Consulting firms may obtain further information for this assignment at the e-addresses
during office hours: 08:00 - 16:00 hrs (Monday to Friday):
Expression of interest may be submitted to the below stated address until February 27, 2017
Ministry of Health,
Afrim Bajrami, Procurement Specialist
Address: Ministry of Health Rr. Zagrebit p.n.
10 000 Prishtinë, Republic of Kosovo
E-mail: To : [email protected]
E-mail: Cc : [email protected]
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