Consultant (#VN035) (WHO)

Job title: Agreement for Performance of Work (APW) holder (firm/institution/agency) to support the process of revising the Circular 36 on medical examination, treatment, and payment covered by health insurance for tuberculosis-related costs in Viet Nam.
Vacancy notice number: VN035
Start date: 25 July 2023
End date: 31 Dec 2023
Place of assignment: Hanoi
Cost: All bids will be evaluated based on the submitted proposals with detailed budget breakdown in term of the technical requirements, timeline, and value for money.
Travel: The service provider will work in Hanoi and travel to some provinces which are identified by the APW holder.

1. Background

The transition from the state budget to social health insurance (SHI) for first-line drugs (FLD) in tuberculosis (TB) treatment reimbursement is a significant step taken by the government. Circular No. 36/2021/TT-BYT, issued on December 31, 2021, by the Ministry of Health (MoH), provided regulations on medical examination, treatment, and payment covered by health insurance for tuberculosis-related costs. Before Circular No36, the MoH issued the Decision No. 2050/QD-BYT, dated April 28, 2021, assigning the National Lung hospital responsible for organizing national-level centralized bidding for TB medication which is a requirement for reimbursement under the health insurance scheme. The implementation of the transition process has proven to be challenging and constantly changing. Firstly, TB patient who doesn’t have HI card may face catastrophic cost related TB as previously, all TB patients had been provided with TB drug free of charge - TB hospital will use state budget to cover cost related to diagnosis and treatment. However, since the Circular 36 has taken effect, those expenditures will not be fully covered, resulting in high risk of late treatment admission and loss to follow up – one of the causes for increasing TB transmission in the community.

Secondly, regarding TB drug supply chain, the shift from the state budget to social health insurance for financing first-line drugs in TB treatment is a multifaceted process involving numerous stakeholders and intricate coordination. Although there is a framework for bidding of TB drug conducted by the National TB Program (NTP), individual TB facilities at lower levels are responsible for preparing plan and implementing the drug procurement process, as well as managing the use, reimbursement, and reporting. These additional tasks are causing many challenges, and an increased workload for lower TB units.

Thirdly, regarding NTP system: Before the transition many TB services were provided by preventive health facilities rather than hospital and without a contract with health insurance. Since the implementation of the new health insurance mechanism, these preventive medicine facilities no longer meet the standard of the health insurance regulation. As a result, TB services have been shifted to hospitals to ensure compliance with the health insurance regulations. This change has made it challenging for the NTP to manage and monitor TB services.

Besides challenges to TB system mentioned above, the current circular No. 36 also has some disadvantages for TB services. Some costs indicated in TB services are not easily applicable in practice; Cost for screening TB, cost for Gene Xpert test for Active case finding are not covered by HI; There is no ICD-10 code for latent TB infection and suspected TB case for coding on SHI code platform, which supports HI reimbursement. Furthermore, the requirement of medical practitioner who can prescribe TB services related to diagnosis and treatment is not clear creating misunderstandings between MOH and Vietnam Social Security (VSS), leading to difficulties in obtaining reimbursement for TB diagnosis and treatment in some provinces. Since issues mentioned above, the National TB program and Health Insurance Department of MOH are requesting to undertake a thorough revision of Circular 36. The primary goal of this revision is to ensure that the circular encompasses all the practical requirements and complexities involved in the management and coordination of TB diagnosis and treatment under the Social Health Insurance (SHI) system. The revised circular aims to provide clear guidelines and procedures that healthcare providers and stakeholders can follow to navigate the transition smoothly. It will consider the diverse stakeholders involved in TB care, such as healthcare facilities, health professionals, insurance providers, and patients. By addressing these practical requirements and intricacies, the revised circular will contribute maintaining the efficiency and effectiveness of the National Tuberculosis control system in Vietnam with changes that fit SHI scheme. It acknowledges the need for a comprehensive approach that considers the dynamic nature of the transition process. The revision process will focus on ensuring the widest coverage of TB care for the population, especially the vulnerable, while maintaining the achievements made in TB management by the Vietnamese health system.

2. Work to be performed

Method(s) to carry out the activity:

The APW holder, with technical support from WHO Viet Nam, will work with the Department of Health Insurance/ MoH, the National TB program (NTP) and VSS to revise the Circular 36. The revision of the circular would only be practical with strong involvement from NTP. The revision will cover not just HI scheme, but also technical information related to diagnosis, treatment, and follow-up as well as current NTP system. Therefore, it is crucial for the NTP to take on the role as co-lead in the revision process, starting from the start to the draft revision that will be submitted to MOH for approval regarding medical examination, treatment, and payment covered by health insurance for tuberculosis-related costs. The APW holder will be under guidance from the WHO representative office in Viet Nam with the following activities:

Activity 1: Conduct a desk-review of the tuberculosis (TB) situation in the country, including an assessment of the current health insurance coverage for TB patients
Activity 2: Conduct a situational analysis of the transition/decentralisation of TB programme to identify all the challenges and propose some policy options/solutions, including updating the Circular 36
Activity 3: Facilitate discussion among with MoH, Health Insurance Department, NTP and VSS to develop a draft of the revised Circular 36, which will outline additional information on medical examination, treatment, TB prescription, referral, ICD code for LTBI, suspected TB case follow up and health insurance coverage for costs related to tuberculosis.

Output/s:

An assessment report of the implementation results of Circular 36, which focuses on medical examination, treatment, and payment covered by health insurance for tuberculosis-related costs. This review should include gathering opinions and comments from all levels, service provider and service receiver.
Draft version of a revised Circular 36 on medical examination, treatment, and payment covered by health insurance for tuberculosis-related costs.

3. Specific requirements

The selected service provider (APW holder) must have:

Team Leader’s requirements: holds a PhD degree and/or a post graduate qualification of related areas; has at least 10 years working experiences regarding Tuberculosis management; has been involved in management, coordination and use of drugs using health insurance funds, as well as legal procedure related to drug management using health insurance funds.
Preference is given to expert(s) who have experience participating in the WHO supported activity.

4. How to apply

The agencies/institutions that are interested can submit your proposals indicating vacancy notice number and job title by 13 July 2023 and should be addressed to: