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Middle East and North Africa


Programme and Policy

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Primary Health Care in the Middle East and North Africa: Access, coverage and quality

Apply now Job no: 522072
Work type: Consultancy
Location: Jordan
Categories: Health

Duration: The duration of the contract is for 7 months starting from date of signature of the contract


Location: From home with expected mission to few countries (county for travel are in MENA region and will be identified by the consultant based on the assessment done in the study)

Off-site working days: 60


Start Date: 1st, June 2019

End Date:  31st, December 2019





Improving the health status of children and women and ensuring their survival is central for prosperous societies and sustained economic growth. Healthy children become healthy adults: people who create better lives for themselves, their communities and their countries.  The first global commitment to ensure health for all emerged in 1978. This commitment was furthermore operationalized in the United Nation’s Millennium Development Framework through the Millennium Development Goals (MDGs) 1, 4, 5, 6 and 7.

Primary health care (PHC) plays a great contributing factor to universal health coverage by ensuring that health services are available, accessible and affordable – including services that prevent illness, cure disease and promote good health. It is not “poor care for the poor”, as it is unfortunately perceived in some countries as a result of a history of inadequate resourcing and limited implementation.

For the purpose of this study, the services provided at the primary health care level which will be considered are: Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition Services, School Health Services, Prevention and Control of Communicable Diseases, Prevention and Treatment of Non-Communicable Diseases (NCDs), Emergency Health Services and Mental Health Services.

Many countries in MENA have undertaken initiatives to generate evidence on health in the last 15 years, especially through using the different relevant modules included in the Multiple Indicator Cluster Survey (MICS)  which has modules to illustrate Access to PHC. Demographic Health Surveys (DHS) also illustrate similar modules.

As of today, many countries in the region have collected data on Primary Health Care using the MICS methodology (either through MICS or DHS). This wealth of data at regional level provides the opportunity to conduct cross-country and regional analysis and a cross country comparative equity analysis through identifying disparities among different groups based on wealth, area, sex or ethnicity and how practice changes with age, as feasible.



The purpose of the assignment is to provide a broad evidence base on the degree and frequency of access of primary health care services and the Governance, Policy, and Finance levers that are known to be essential for delivery of primary health care in the countries of the MENA region. The evidence generated would contribute to regional advocacy efforts on improving the situation of children, and highlighting aspects that would be key features of effective programming in MENA that would promote increased access and reduced inequalities to primary health care.




The specific objectives of the analytical exercise are to draw out an in-depth understanding of the supply of and demand for PHC services and their quality in MENA including the country level policy, financial and organizational setup. More specifically:


  1. Provide a broad overview of how PHC services are organized and administered – type, content and administering affiliation of the services - in the region
  2. Provide a broad overview of the health system levers - governance policy and finance, which facilitate or inhibit the delivery of primary health care in the region.
  3. Conduct a comparative cross-country equity analysis of PHC services in MENA.
  4. Conduct multivariate analysis with available household datasets to profile household and caregivers who have access to and use primary health care services in MENA; identify similarities and differences across countries and with other regions (similar in GNI, emergency setting, HDI).
  5. Profile households and families who do not have access to or use primary health care services in MENA by typology of countries.



The study will cover all 20 countries in MENA region, and include various quantitative data sources, including but not limited to household surveys, facility data, Health information management systems, Civil registration and vital statistics, financial and budget data and others. Additional data on health system levers will be obtained through review of documents and key informant interviews and focus groups. The time frame of the analysis should include data from recent years (2010 onwards) but also be accommodating to the situation of some of the emergency effected countries in the region, such as Syria and Djibouti which might not have very recent data (2006). Furthermore, available surveys targeting refugee population should also be included (Palestinians and Syrians in Lebanon and Jordan, Palestinians in Syria) which have comparable data.




The study will be primarily based on secondary analysis of primary data available in the public domain. The tasks to be completed by the consultant(s) or firms include, but are not necessarily limited to the following:

  1. Conduct a focused literature review on the organization of and utilization of primary health care services, health system levers and relevant program interventions and other relevant information available to situate the analysis in solid theoretical field in the region and globally;  
  2. Conduct key informant interviews with experts knowledgeable about health system levers essential for primary health care which gives a broad overview of particularly governance, policy and finance levers that facilitate or inhibit the delivery of primary health care in the region; and FGDs with the users of the services to have their perspective.
  3. Conduct a cross-country Qualitative Comparative analysis (QCA) on quality PHC service delivery and use.
  4. Identify, organize and analyze datasets of surveys and other relevant data sources in MENA region from 2010 onwards that will be used for the above objectives. This will include nationally representative household surveys such as MICS, DHS and other national surveys in the region which include the required topics, also other relevant admin sources where survey data is not available[1]. The exploration should also identify data gaps in the region on the specific topic and be incorporated as a section in the final report.
  5. Produce an inception report, for approval, that describes the approach of the study on answering the objectives of this study with details on the qualitative and quantitative approaches, methods, tools, analysis plans, ethical considerations, workplan detailing the various country consultations and other supporting documentation as needed.
  6. Conduct the fieldwork (mostly envisaged over skype though would be possible to provide scenarios on including in-country field missions to conduct face-to-face interviews and FGDS) and qualitative (qualitative comparative study) analysis.
  7. Conduct relevant statistical analysis including multilevel modeling, bivariate and correlation analysis and produce tabulations.
  8. Produce a draft report and final report covering main analysis and findings. Also, a PowerPoint covering main findings.




  1. An inception report, detailing the:
    • Understanding of the objectives and summary of the literature review
    • Detailed methodology including design specifications and criteria for judgment
    • Analysis plan, and
    • Detailed work plan and timeline
  2. Draft analytical report
  3. A final Report, which should include
    • Executive summary
    • Methodology:  and limitations (including identified data gaps)
    • Findings
    • Conclusions and Recommendations (if any)
    • Annexes


The final report should be provided in electronic version in English in MS word document format.

The final report will also be formatted in UNICEF style publication (see examples here).

A PowerPoint summary of key findings is also required.


For further details on the assignment please click here

[1] Admin data will be explored for countries where no comparable survey data is available (mainly Gulf countries) primarily for Objective 1

Advertised: Jordan Daylight Time
Applications close: Jordan Daylight Time

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