LASHMA Consultant at Palladium Group

Project Overview and Role

• The Social Health Insurance plan known as the Lagos State Health Scheme (LSHS) is in line with the Lagos State Health Scheme Law (Law No.4 of 2015), which makes Lagos State Health Scheme mandatory for all residents of Lagos State, including employees in the public and private sectors, self-employed and the unemployed.
• The Lagos State Health Management Agency (LASHMA) was established as a public-private partnership to promote, regulate and supervise the activities of the LSHS. Thus, LSHS is a system of advance financing of healthcare expenditure through contributions and premiums paid into a common pool, called the Lagos State Health Fund (LASHEF). It was created to provide a social security system that guarantees needed health services to people paying annual premium contributions. It is primarily a risk-sharing arrangement that can improve resource mobilization and equity in the healthcare sector.

The regulatory functions of LASHMA are:

• Registration of Lagos State Residents, Employers and Employees. Subject to the guidelines made under the Law, all residents should be registered under the Scheme. The LASRRA registration number is a pre-requisite for registration into the Scheme and itself grants eligibility and access to all benefits available under the Scheme. All employers from public and private sector are expected to register with LASHMA to obtain a Corporate Identification Number (CIN) and shall register their employees with the Health Maintenance Organization (HMOs) of their choice.
• Registration of HMOS, Mutual Health Association (MHAs) and Allied Association
• The Agency is also expected to register NHIS accredited HMOs, MHAs, and Allied Associations. The Law recognizes the existence of the contributory Health Insurance Organizations (including HMOs) and prepaid health plans before the commencement of Lagos State Health Scheme. Such organization operating in the state shall be registered, licensed, and monitored by the Agency.
• The operationalization of the regulations unit of the Agency would enable many Lagosians who require the benefits of the health scheme but lack the necessary awareness and opportunities to get healthcare insurance for themselves and their families to onboard unto the scheme through domestication of the LASHMA regulatory functions. More so, monitoring and sanctioning of erring HMOs and healthcare facilities would further strengthen the health scheme and increased accountability and advocacy to encourage more Lagosians to utilize the LSHS.
• To this end, HP+ wishes to engage a Consultant to undertake the development of a framework of operations for implementing the Regulatory role established by the Law in line with relevant stakeholders and policy framework of the Lagos State Health Scheme.
• HP+ is a global USAID-funded project with a mandate across global, country, and sub-national levels to strengthen and advance health policy priorities in the areas of TB and HIV. HP+ aims to improve the enabling environment for equitable and sustainable financing of health services, supplies, and delivery systems through policy development, and implementation.

 Primary Duties and Responsibilities

• The objective is to develop and formalize a framework and Standard Operating Protocol that would inform the framework for Registration, Monitoring, Licensing, Sanctioning and Customer Relations of the Agency.

The consultant will work and collaborate with LASHMA under supervision of HP+. The Consultant’s scope of work and responsibilities include:

• Engage the Ministry of Justice and interpret the LSHS Law in line with the proposed Regulatory Functions for the Agency.
• Carry out stakeholder analysis to highlight the roles and responsibilities of relevant organizations in Lagos State
• In consultation with the Regulations Team, prepare a comprehensive list of contents that should be included in the framework and SOPs
• Draft specific, detailed, and practical steps for Registration, Monitoring, Licensing, Sanctioning and Customer Relations
• Facilitate working group consultations with Lagos State House of Assembly (LAHA), Lagos State Residents Registration Agency (LASRRA), HMOs, Corporate Organizations, Healthcare Providers
• Present the draft SOP to LASHMA; finalize the SOP incorporating all inputs and feedback
• Produce a well-written and comprehensive Framework of Operation highlighting:
  • Standard Operating Procedures for Registration, Monitoring & Compliance, Licensing, Sanctioning, Customer Relations activities
  • Recommendations on the SOPs to strengthen linkages between organizations involved in the process
  • Resource Directory of all the relevant stakeholders with focal points
• Coordinate and conduct a detailed presentation before completion of the project

Duration and Expected Deliverables
The duration of the contract will be August 17 - September 30, and the Consultant will be responsible for two deliverables:

• Written documentation on the interpretation of the LSHS Law, outlining LASHMA’s regulatory roles, responsibilities, and rights.
• Written framework of the implementation of the LSHS Law and LASHMA’s regulatory functions, including SOPs for each identified function and how linkages between organizations will be ensured

Methodology:

• The consultant will strictly follow a workplan and timeline to be proposed by HP+ before signing of the contract. An appropriate methodology will be discussed between the consultant and the HP+ team.
• The consultant will work closely with the LASHMA Regulations Team and HP+ and will share progress on activities when requested.
• The consultant will be responsible for undertaking collection of all the required data/information from various sources, including Government departments, Ministries, and other relevant sources. LASHMA will be expected to facilitate data and information whenever necessary.
• The Consultant will also be expected to facilitate presentations and coordinate stakeholder workshops or consultations as per agreed on HP+ workplan.

Required Qualifications

• A post-graduate or equivalent qualification/ degree in Public Health, Law, Political Science, Development Study, Humanities, or any other relevant discipline, or with bachelor’s degree with a minimum of 15 years of professional relevant experience in the HMO industry is required.
• At least 10-15 years of prior work experience in dealing with social health insurance regulations setup and operations, especially in the subnational context. Knowledge of HMO practices in Nigeria is strongly preferred.
• Demonstrated knowledge and experience doing research in the area of Social health Insurance.
• Demonstrated experience and skills in facilitating stakeholder/working group consultations.
• Knowledge and experience developing SOPs, especially in the area of Health Insurance.
• Solid knowledge of LASHMA’s mandate and goals.