Technical Assistance to strengthen the actuarial processes and capacity of the Philippine Health Insurance Corporation (PhilHealth)

Item Description:

The World Health Organization (WHO) was established in 1948 as a specialized agency of the United Nations. The objective of WHO (www.who.int) is the attainment by all peoples of the highest possible level of health. “Health”, as defined in the WHO Constitution, is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity. WHO’s main function is to act as the directing and coordinating authority on international health work.

The WHO Secretariat consists of some 8,400 staff at the Organization’s headquarters in Geneva, in the six regional offices and in countries. The Secretariat is headed by the Director-General, who is appointed by the WHA on the nomination of the Executive Board. The head of each regional office is a Regional Director. Regional directors are appointed by the Executive Board in agreement with the relevant regional committee.

BACKGROUND

The National Health Insurance Programme (NHIP) was established to provide health insurance coverage and ensure affordable, acceptable, available and accessible health care services for all Filipinos.  To ensure effective administration of the NHIP, RA 7875 (as amended by RAs 9241, 10606 and 11223 (Universal Health Care Law) ) has mandated that the Philippine Health Insurance Corporation (PhilHealth) to provide effective stewardship and management of the National Health Insurance Fund in order to obtain the objectives of the NHIP and this includes its sustainability and effective fund management to better serve its members.

The governance of PhilHealth is carried out in a transparent, responsible and accountable manner and with the utmost degree of professionalism and effectiveness.  As the Office of the Actuary plays an important role in ensuring the sustainability of the NHIP by providing recommendations that are evidence-based, timely and relevant as well as compliance with local and international standards.  The current capacity of the Office of the Actuary is very limited, although there is intention to expand capacity; however, at the current time there is an overall need to provide additional capacity to assist the PhilHealth Actuary to not only review current actuarial processes and identify possible improvements but also to assist in carrying out updated actuarial analysis to inform key policy and budget decisions of PhilHealth, as well as a number of specific projects, including such matters as projections, actuarial studies, and preparatory measures to ensure compliance with the new Philippine Financial Reporting Standards (PFRS 17).

PURPOSE/SPECIFIC OBJECTIVE OF THE ACTIVITY

The purpose of this work is to provide technical assistance to strengthen the actuarial processes and capacity of the Philippine Health Insurance Corporation (PhilHealth).

The objectives of this technical assistance are:

1. To review, validate and improve on the processes, methodologies and assumptions used in actuarial valuation reports (AVR)
2. To develop/refine the processes, methodologies and models to come up with the actuarial studies in support of the assumptions being used by the Office of the Actuary for the AVR, for product development, that are in compliance to Philippine Financial Reporting Standards:  expense analysis, asset-liability matching, mortality study, morbidity study, persistency study, salary increase study, and inflation study.
3. To formulate and implement a training programme for PhilHealth actuarial staff to strengthen their capacity to undertake actuarial analysis that is anchored on applying social health insurance principles and functions such as adequate revenue collection, risk pooling and fund management purchasing
4. To develop and conduct a course for PhilHealth offices and selected staff that aims to ensure that they develop an appreciation/understanding of social health insurance principles and functions including the role of actuarial analysis and methodologies
5. To develop a manual for conducting PhilHealth’s actuarial analyses and AVRs
6. To identify and implement solutions to improve the current methodology on actuarial valuation to ensure compliance with the Philippine Financial Reporting Standards (PFRS) 4 and working towards future compliance with PFRS 17.

DESCRIPTION OF ACTIVITIES TO BE CARRIED OUT

The work will be divided into two phases:

Phase 1: 20 October to 31 December 2021, and

Phase 2: 1 January 2022 onwards.

As a minimum, under Phase 1 it is expected that the following deliverables will be achieved: 1.1 and 2.1, and as relevant 1.2 and 1.3.

Output 1: Management deliverables

Deliverable 1.1: Develop an inception report that includes a work plan with a Gantt chart of activities, and a budget (broken down by main deliverables 2.1, 2.2, 2.3, 3.1, 3.2)

Deliverable 1.2: Provide monthly progress reports, summarising progress to date and highlighting any challenges to the deliverables and timelines required by this TOR or as proposed in the inception report. The final monthly report will summarise overall achievements and progress for the duration of the contract and identify any recommendations for the future.

Deliverable 1.3: Submit any required documentation to support processing of payments according to deliverables in the contract and provide a final financial report together with any final technical reports and other required documentation at the end of the contract.

Output 2: Support PhilHealth to strengthen its actuarial processes and methodologies and to undertake Actuarial Valuation Reports (AVR) and related analyses

Deliverable 2.1: Provide a report that assesses the validity of the current processes, methodologies/models and assumptions being used by PhilHealth to produce their Actuarial Valuation Reports (AVRs) and, where relevant, identify improvements/options for improvements that may be considered for these processes, methodologies/models and assumptions including ensuring compliance with Philippine Financial Reporting Standards (PFRS) 4 and working towards future compliance with PFRS 17.

Deliverable 2.2: Develop/refine the processes, methodology and models and produce the following actuarial studies in support of the Office of the Actuary for the AVR, for product development, and in compliance with Philippine Financial Reporting Standards:

(a)  Expense analysis

(b)  Asset-liability monitoring

(c)   Mortality study

(d)   Morbidity study

(e)   Persistency study

(f)    Salary increase study, and

(g)    Inflation study.

Deliverable 2.3: Develop manual(s) for conducting PhilHealth’s actuarial analyses and AVRs.

Output 3: Capacity-building programmes for PhilHealth staff

Deliverable 3.1: Formulate and implement a training and mentoring programme for the PhilHealth actuarial staff/team to strengthen their capacity to undertake actuarial analysis, anchored on applying social health insurance principles and functions such as adequate revenue collection, risk pooling and fund management purchasing. Where specific training is carried out, an after-training report should be completed.

Deliverable 3.2: Develop and conduct a course for PhilHealth offices and selected staff that aims to ensure that they develop an appreciation/understanding of social health insurance principles and functions including the role of actuarial analysis and methodologies

METHODS TO CARRY OUT THE ACTIVITY

• For an institutional contractor, form a team of qualified and competent individuals with defined roles and tasks as appropriate to fulfil the objectives and deliverables
• Provide an inception report including a workplan with an accompanying timeline
• Perform a review of current processes methodologies/models and processes through review of relevant documents and discussions with current PhilHealth staff
• Work with and coach PhilHealth staff to build their capacity and undertake the relevant analyses
• Schedule/attend meetings as may be necessary in order to have regular discussions on the progress of the project and submit periodic reports
• Write up the relevant reports, providing drafts for review before finalising
• Present final deliverables to WHO and PhilHealth management.

QUALIFICATIONS & EXPERIENCE

The team lead for an institutional contractor or the individual contractor must fulfil the following qualifications and experience:

Education and Certifications

•  Master’s degree in Actuarial science or a certified actuarial fellow.

Work Experience

•  At least ten years of relevant work experience gained in a national social security institution, or a national actuary office or a large health insurance company, gained in at least three developing countries including at least five years outside the Philippines.
•  At least 3 years working in a senior position as an actuary at the national level or providing technical assistance to a national actuary’s office
•  Leadership and coaching experience
•  Experience of having worked in this field in Asia would be an advantage, as would familiarity/knowledge with Philippine Financial Reporting Standards 4 and 17.

Team qualifications and experience for institutional contractor

•  The team proposed possess relevant qualifications and have demonstrable experience for this work.

Language 

•  The individual contractor or team leader and all team members for an institutional contractor must have excellent English communication skills (writing and speaking).

ADDITIONAL INFORMATION:

The contractor (in the case of an institutional contractor this includes both the institution and any individuals engaged on this work) shall have no direct or indirect involvement or interest, in any form, in arms dealing, drugs, alcohol industry, tobacco industry or human trafficking.  The contractor and personnel involved in this work shall have no conflicts of interest in relation to the work being undertaken.

Two contracts will be issued relating to the two phases of work.  Issuance of the second contract for the second phase will depend on satisfactory performance of the phase 1 contract and is subject to the availability of funding.

The work to be done under this Agreement for Performance of Work (APW) shall be completed as set out in the Terms of Reference. The contract will be completed in not more than 12 months from the commencement of the work, or otherwise as agreed in writing among the Owner and the Contractor. The work shall be done in strict compliance with the Contract, Specifications, Schedules, and all other Contract documents and all Instructions. Failure to do so shall be at the Contractor’s risk and account. Submission of bid by the Contractor shall constitute acknowledgement by the Contractor that it is aware of and concurs with all of the requirements or conditions incorporated in the Call for Proposal and the other documents.

As time is an essential element of this Contract, for failure to complete all work within the stipulated as set out in the Terms of Reference, the Owner shall charge the Contractor liquidated damages. This shall be in the amount the sum of 0.5% of the total contract amount per day (Saturdays, Sundays and holidays are included) but not to exceed on total 10% (ten percent) of the contract amount. These liquidated damages shall be for the added cost incurred by the Owner for such delay and also for the inconvenience caused to the users of the Work. It is understood that this is not a penalty but a fixed sum representing the liquidated damages for each calendar day of the delay. Delay shall be counted from the agreed completion date, considering further time extensions approved by the Owner, to the date of completion of work.

APPLICATIONS

Qualified and interested individual/institution should submit their proposals with financial details (including a breakdown by phase and deliverables) and proposed timeline and CV {for individual contractors} or Company Profile and qualifications of team members {for institutional applications} and Expression of Interest {cover letter} to the Supply Officer through WP RO UNGM at < wproungm@who.int > by  10 October 2021.

The cover letter should outline how their experience and qualifications make them a suitable candidate for this work.

Please use Tender Notice No. 146780 as subject to all submission. Only successful candidates will be contacted.

Contacts:

Thu Ha Le – wproungm@who.int
Email: wproungm@who.int
First name: Thu Ha
Surname: Le