TERMS OF REFERENCE FOR INDIVIDUAL CONSULTANT CONSULTANT, MIDWIFERY INVESTMENT CASE

TERMS OF REFERENCE (to be completed by Hiring Office)

Hiring Office:

Ethiopian Midwives Association

Background

Global attention and investment in midwifery are increasing as an effective strategy to achieve Sustainable Development Goal 3 (SDG3). To advance this agenda, the Midwifery Accelerator was launched in April 2025 by a global coalition including WHO, UNICEF, and ICM, offering a unified, evidence-driven approach to catalyzing collective efforts for maternal and newborn health and well-being. This initiative aims to expand access to care provided by midwives, aligning with the "Transitioning to Midwifery Models of Care: Global Position Paper."

A key part of this initiative is encouraging increased domestic and international funding for midwifery through evidence-based advocacy.

In this context, UNFPA has developed a comprehensive "Investing in Midwifery Models of Care" handbook to guide the creation of national investment cases. UNFPA will support the rollout of this framework in several countries, with Ethiopia selected for implementation in 2026. This consultancy is crucial for adapting the global framework to the Ethiopian context, generating country-specific evidence to drive sustainable improvements in midwifery services.

Midwifery models of care are a proven, cost-effective, and sustainable solution. This approach directly addresses the root causes of adverse maternal and newborn health outcomes, strengthens health systems, advances public health, supports healthier future generations, and accelerates progress towards SDG 3 (health and well-being) and SDG 5 (gender equality).

The Ministry of Health of Ethiopia is currently developing the Midwifery Model of Care protocol and implementation guideline and has commenced piloting the model in 2026 in selected regions.

Building on this momentum, UNFPA  in collaboration with MoH Ethiopia and the Ethiopian Midwifery Association(EMA) will develop an Ethiopia specific Midwifery Investment Case. This case will guide strategic investments, policy formulation, alignment with the existing National Human Resource for Health strategic plan (2024–2030) and Nursing and Midwifery roadmap (2025–2034), and resource mobilization, with the goal of improving maternal and neonatal health outcomes in the country.

This TOR is for a Health Economist who will work in close collaboration with the MOH team, Ethiopian Midwives Association and any relevant stakeholders under close supervision and collaboration UNFPA team and international experts to develop the Midwifery Investment Case for Ethiopia.

Objective of the Consultancy

The primary objectives of the consultant are to:

• Lead the technical, health, economic, and financial analyses required for the development of the midwifery investment case in Ethiopia.

• To Conduct a detailed funding and financial analysis of the SRMNCAH and midwifery landscape, identifying resource allocation, donor flows, and critical financing gaps.

• Conduct economic modeling and costing analysis to estimate resource requirements, health impacts, long-term economic benefits, and the Return on Investment (ROI) for scaling up midwifery models of care under various scenarios.

• Assess fiscal space for health and collaborate with the public health consultant to integrate broader situation analysis findings and workforce development strategies into a compelling, evidence-based economic case.

Scope of Work and Responsibilities

The consultant will be responsible for the following tasks:

 1.Inception and Stakeholder Engagement

• Plan and facilitate an inception workshop with government officials, UN agencies, midwifery associations, NGOs, academia, and development partners.

• Develop a stakeholder engagement plan to ensure broad participation and buy-in.

• Work in close collaboration with the public health consultant to ensure health analyses and workforce strategies inform the economic modelling, and vice versa.

2. Situation Analysis: Lead a comprehensive  analysis of the national and subnational SRMNCAH landscape in Ethiopia This includes conducting desk review and key informant interviews focusing  on maternal and neonatal mortality rates, primary drivers of preventable mortality, health system architecture , existing policies framework, and the current operational status  of the midwifery workforce and model of care.

1. Funding and Financial Analysis:

• Conduct desk reviews and key informant interviews to analyze the current financing  landscape for SRMNCAH and midwifery in Ethiopia, including government allocations , external donor flows, and out-of-pocket expenditures.

• Identify critical financing gaps, assess opportunities for strategic resource reallocation (E.g,  addressing underspent budgets), and explore potential innovative financing mechanisms to  ensure sustainable funding.

4.Define Midwifery Intervention Package: In line with the investment case framework and national priorities, define and select a comprehensive package  of evidence-based interventions delivered by midwives within the Ethiopian

 context.

5. Model Health Impacts: Utilizing validated analytical tools, such as the Lives Saved Tool (LiST), to model the health impacts associated with different scaling up scenarios of  the defined midwifery intervention package. Key deliverables  will include quantifying maternal and neonatal lives saved, stillbirths averted, unintended pregnancies averted and morbidity reductions.

1. Costing Analysis:

• Employ an ingredients-based approach and validated analytical instruments, such as the OneHealth Tool and LiST, estimate the total costs of scaling up the defined midwifery intervention package under different scenarios. This includes costs of pharmaceuticals , medical supplies, labor, logistics, and programmatic expenses.

• Estimate the financial requirements for proposed workforce development strategies, including pre-service training, salaries, and retention incentives.

7. Workforce Analysis and Strategy:

• quantify the workforce requirements needed to deliver the modeled scale-up scenarios.

• Conduct a gap analysis comparing the current midwifery workforce supply, distribution, and skill mix against the projected demand.

• Develop evidence-based workforce development strategies, evaluating  options such as expanding training programs, introducing new cards and enhancing retention mechanisms.

8. Economic Benefit Analysis:

• Quantify the long-term economic benefits resulting from improved health outcomes (lives saved and morbidity averted). Including, increased workforce participation and productivity, and social benefits, calculated using a human capital approach.

• Estimate the economic benefits from averting unintended pregnancies, such as increased educational attainment for adolescent girls and reduced time out of the workforce for women.

• Estimate the cost savings associated with    reduction innon-medically indicated interventions such as cesarean sections.

1. Return on Investment (ROI): Calculate the benefit-cost ratio and overall return on investment(ROI)for investing in midwifery care by comparing total estimated costs against total monetized benefits for the defined scale-up scenarios.

10. Stakeholder Engagement and Collaboration:

• Work in close collaboration with any relevant stakeholders under close supervision and collaboration with the UNFPA team, EMA and international experts, using their health impact and workforce models as the foundation for the economic analysis.

• Act as the primary technical liaison with counterparts at the Ministry of Finance and other key economic and financial stakeholders.

11.Stakeholder Workshops: Plan and facilitate national workshops to support the midwifery investment case, including  consultative, validation and a final dissemination workshop with MOH and relevant stakeholders. While the  consultant is responsible for the workshop facilitation, all associated costs will be covered by the Ethiopian Midwives Association.

12. Reporting: Draft comprehensive reports and key deliverables, ensuring a cohesive,rigorously integrated  and final investment case document.

Key Deliverables

All deliverables will be submitted in electronic format. and written in English.

1. An inception report detailing the methodology, workplan, and data availability.  

2. A comprehensive report on the SRMNCAH,  midwifery and financing landscape, including funding gaps, and detailed costing analysis for midwifery in Ethiopia.

3. Draft and final reports detailing  the modeled health impacts, workforce development scenarios, estimated economic benefits and the Return on Investment (ROI) analysis.

4. Substantial written contributions to the final, integrated Investment Case document, a financing roadmap, and the monitoring and evaluation framework.

Duration and start date

The consultancy is for a duration of two and half months.

 The consultancy will commence on the day following the contract's signature.

Monitoring and progress control, including reporting requirements, periodicity format and deadline:

A clear milestone-based payment is outlined for this consultancy, with each payment tranche released upon the successful submission and approval of specific deliverables.

The payment is made upon receiving a confirmation email for the final approval from the technical committee composed of Ethiopian Midwives Association, UNFPA and MOH on the deliverables.

Payment Schedule

Lump Sum value for each deliverable will be paid to the consultant upon successful submission and approval  by the Ethiopian Midwives association and UNFPA Ethiopia CO in accordance the ToR

Supervisory arrangements:

The consultant will work under the overall leadership of the MOH and supervision of the Ethiopian Midwives Association and UNFPA Ethiopia Country office, SRH program Specialist, with direct technical guidance from the designated team from UNFPA’s Regional and Headquarters offices.

Place where services are to be delivered:

Addis Ababa, Ethiopia- Remote work

Expected travel:

The consultant is required to attend any meetings specifically requested by the Ministry of Health (MOH) and Ethiopian midwives’ association.

Any domestic travel costs for activities such as stakeholder consultations and validation workshops outside Addis Ababa will be covered by the Ethiopian Midwives Association, in accordance with their  policy documents. This includes transportation and per diem.,

Job Requirements

The Consultant will meet the following criteria:

• Advanced university degree in Economics, Health Economics, Public Finance, or a related field.

• A minimum of 7-10 years of professional experience in health economics and financing, evaluation of health programs, or cost-benefit analysis.

• Strong skills in health costing and economic modeling such as the OneHealth Tool and LiST, or equivalent tools.

• Demonstrated expertise in developing investment cases or health financing strategies.

• Demonstrated expertise in conducting return-on-investment (ROI) analysis for social sector programs

• Strong understanding of innovative health financing mechanisms.

• Experience working in Ethiopia or the East and Southern Africa region is highly desirable.

• Excellent analytical, quantitative, writing, and communication skills in English.

How To Apply

Other relevant information or special conditions, if any: All interested applicants should submit the following:

Letter of interest

CV with evidence of qualifications and experience

Detailed technical and financial proposal

How To Apply Email: recruit@emwa.org.et

Subject: Consultant – Midwifery Investment Case economics

Deadline: October 2, 2026, at 5:30 PM

Qualified professionals are encouraged to apply and share!