Expression of Interest are invited for Understanding Health Workers Motivational Preferences and Accountability Modalities Using DCE-SS South Sudan is one of the most fragile, conflict-impacted countries in the world with less than 20 years of interspersed peace since 1955. Two almost consecutive civil wars, from 1955-1972 and 1983-2005, between what was then Southern Sudan and the Sudanese Government, left the Southern region systemically underdeveloped. South Sudan became independent from Sudan in 2011, to much optimism for the future of the fledgling nation. In 2013, civil war broke out in the country, leading to widespread violence between ethnic groups and raising questions about the future of the country. South Sudans health system faces enormous challenges, leading to some of the worst health outcomes in the world: underfive mortality is 91 per 1,000 live births; neonatal mortality is 39 per 1,000 births; and maternal mortality is estimated at 789 per 100,000 births. The countrys health system is challenged by ongoing intercommunal violence, a virtual absence of road infrastructure, limited communications infrastructure, access challenges due to seasonal flooding, highly dispersed populations, and substantial population movements. Human resource gaps are one of the single biggest challenges facing South Sudans health system and are further complicated by South Sudans challenging context with respect to limited budget, fragile security environment, and organizational fragmentation. There is a severe shortage of skilled human resources to respond to South Sudans health needs, constraining achievement of Universal Health Coverage (UHC). The country has 0.15 doctors and 0.2 midwives for every 10,000 people. Skilled health workers are concentrated in the countrys few urban areas, with almost no skilled health workers based in rural areas, where 80% of South Sudans population resides.[1] The shortage of health workers is underlined by low educational levels: net primary school enrolment was 35% in 2015 and the 15-24 years old literacy rate was 48% in 2018.[2] Health workers are hired on Government contracts but work in facilities run by NGOs. Health worker salaries are constrained as there is limited fiscal space for health and health service delivery is currently almost entirely donor financed: Government health expenditure as a percentage of overall health expenditure was only 2% in 2015. Low salaries complicate retention, particularly in rural areas, and there are no formal mechanisms to ensure staff retention or to supervise and manage staff. Government payment of salaries is inconsistent due to low health expenditures and governance issues including the absence of established PFM systems in the MoH. Extremely remote locations, flood and conflict-impacted conditions, along with gaps in communication and road infrastructure further complicate retention. On top of health worker availability, support and supervision of health workers is complicated by these extremely remote locations, conflict impacted conditions, with many facilities accessible only by foot over distances well above five kilometers. Supervision gaps further erode health worker quality and retention, leaving health workers with little support. As a result, most of South Sudans few qualified health workers choose to either leave the country, practice in Juba, or join the countrys private sector, which is concentrated in South Sudans limited urban areas. The lack of qualified health workers in South Sudan means that very few people have access to even the most basic level of healthcare providers, making UHC difficult. Human resource shortages and capacity gaps have been exacerbated by the COVID-19 pandemic. First, COVID-19 has disproportionately impacted health workers in South Sudan who have become sick while treating patients. Second, the country lacks adequate human resources to fill the treatment and case detection needed to contain the pandemic while maintaining essential health services. Third, COVID-19 related movement restrictions have made it difficult to implement oversight and quality improvement activities of clinical staff at health facilities in South Sudans extremely capacity constrained context. There is a need for additional information to support the South Sudanese Government and partners to develop policies and take actions in support of human resource improvements. Recent analytics on health service delivery in South Sudan identified the need for further information to support: (i) rapid training and deployment of qualified health workers; and (ii) harmonizing the health worker payment scheme. These issues challenge the ability to deliver basic services and ultimately, to achieve UHC in the country. In light of these challenges, the Japan Policy and Human Resource Development (PHRD) Trust Fund offers an opportunity to finance analytics to support the Government to strengthen Human Resources for Health (HRH) towards UHC. The World Bank is looking to hire a consulting Firm to conduct a study on motivational preferences and accountability modalities. The study should use Discrete Choice Experiment (DCE) to better understand how health workers prefer to be motivated and options for improving accountability with close attention to which form of motivation would improve rural retention of health workers in South Sudan. 2. Objective of the assignment The objective of the study is to evaluate health workers incentive preferences to improve performance and retention. 3. Scope of work The consultant will be responsible for designing and conducting the DCE: i. Develop tools for discrete choice experiment to better understand health workers motivational preferences and effective means to generate accountability. Tools should be based on best practice along with contextual information to ensure they are appropriate for the South Sudan context. ii. Develop a research protocol for the work that provides as detailed methodology (see deliverables section below for more detail) as well as a timeline. iii. Conduct background research to develop tools as needed, drawing upon best practices in LMICs and FCV settings. iv. Conduct discrete choice experiment in South Sudan, focusing primarily on health workers in rural areas and using multiple rural sites. v. Analyze data from research, developing a concise report and PowerPoint presentation inclusive of data visualizations and recommendations. vi. Develop policy brief(s) based on findings vii. Present findings to stakeholders in platforms organized by the task team. Multiple presentations are expected. Tender Link : https://wbgeprocure-rfxnow.worldbank.org/rfxnow/public/advertisement/4665/view.html
