Health Financing Consultant

The Aga Khan Health Service (AKHS) is a leading not-for-profit health care provider operating across South Asia, Central Asia, and East Africa.

AKHS is exploring the feasibility of a community-based health insurance product tailored to the populations it serves, with the goal of strengthening the continuum of care from PHC to hospital to PHC, reducing financial barriers to care, and strengthening primary health care utilization with Family Medicine in a gatekeeping role.

The consultant will:

• Lead ability and willingness-to-pay (WTP) research and market segmentation to understand what target communities can and will pay for a health insurance product, and what benefit packages they value most.
• Design a community-based insurance product - including benefit package, premium structure, eligibility criteria, and enrollment mechanics - grounded in WTP findings and the AKHS service delivery context.
• Draw on costing data, referral pathway analysis, and HMIS data gathered by dedicated support capacity with additional input from this consultancy, as needed, to ensure the product design is financially viable and operationally feasible.
• Coordinate with AKHS, HBL, Jubilee Insurance, and other relevant AKDN partners to align product design, distribution channels, and a phased implementation plan for the pilot.
• Scope of Work

A. Willingness-to-Pay and Market Assessment

• Design and lead a WTP study across defined pilot communities in Gilgit-Baltistan and Chitral, using appropriate methodologies (e.g., contingent valuation, discrete choice experiments).

• Conduct market segmentation to identify distinct population groups, their affordability thresholds, and behavioral drivers of and barriers to insurance uptake. Work with partner agencies (i.e. Aga Khan Rural Support Programme) to define the most vulnerable who will require subsidy. Define any additional criteria to define vulnerability.

• Synthesize findings into an assessment that directly informs product design decisions.

• B. Service Package and Product Design

• Understand community health needs, and define a benefit package aligned with WTP findings, and the AKHS continuum of care available.

• Develop product architecture including premium tiers, coverage scope, exclusions, enrollment mechanics, and claims processes.

• Incorporate costing data and referral pathway information to pressure-test financial assumptions and actuarial viability. The consultant will use existing data on service package and cost as well as referral pathway patterns and epidemiologic trends. The consultant is expected to request and analyze any additional data that may need to be collected to support the design of the community-based health insurance product.

• The consultant is also expected to advise on any cost adjustments for services to increase viability of and demand for the community-based health insurance product while still ensuring financial sustainability for AKHS services.

• Ensure the product design is gender-responsive and attentive to equity across income levels.

• Iterate the design based on community validation and partner feedback prior to finalization.

• C. Partner Coordination and Implementation Planning

• Collaborate with AKHS leadership to seek input from other AKDN agencies (e.g. HBL, Jubilee Insurance, and relevant AKDN entities) to review and validate the design and implement the product.

• Work with partners to define roles and responsibilities for product distribution, enrollment, claims management, and customer service.

• Develop a concise Pilot Implementation Plan covering launch sequencing, operational workflows, and partner agreements needed to move from product design to pilot rollout.

• Prepare mechanism and monitoring indicators, plans for midterm review, and end evaluation. Additional considerations include: communication strategy (for beneficiaries, providers, and professionals, and other key stakeholders); staff training needs.