Supporting Cost Efficiency and Sustainability Transformation Program in Egypt’s Healthcare System for EHA — Supporting Egypt’s Universal Health Insurance System

REQUEST FOR EXPRESSIONS OF INTEREST (CONSULTING SERVICES – FIRMS SELECTION) Egypt Supporting Egypt’s Universal Health Insurance System Project Loan No.: IBRD-91320 Assignment Title: Cost Efficiency and Sustainability Transformation Technical Assistance for Egypt Healthcare Authority Reference No: EG-MOF-520197-CS-CQS The Ministry of Finance has received a loan of $400M from the World Bank toward the cost of the Supporting Egypt’s Universal Health Insurance System Project, and intends to apply part of the proceeds for consulting services. The consulting services (“the Services”) include consultancy aimed for Cost Efficiency and Sustainability Transformation Technical Assistance for Egypt Healthcare Authority. The detailed Terms of Reference (TOR) for the assignment are attached to this request for expressions of interest. The “Supporting Egypt’s Universal Health Insurance System Project” now invites eligible consulting firms (“Consultants”) to indicate their interest in providing the Services. Interested Consultants should provide information demonstrating that they have the required qualifications and relevant experience to perform the Services (company profile, brochures, experience in similar assignments, availability of appropriate skills and resources, ... etc.). The shortlisting criteria are: The consultancy should demonstrate experience in healthcare cost optimization, operational transformation, revenue cycle management, managerial costing, workforce productivity analysis, administrative efficiency, sustainable finance, utilities optimization, and support-function improvement, preferably in public healthcare systems. Where a consortium is proposed, one lead firm shall assume overall contractual accountability and shall clearly demonstrate how the expertise required across both pillars will be integrated through a unified project-management and quality-assurance approach. The consulting team should include expertise in: Hospital management and healthcare operations improvement. Clinical operations and hospital administration. Hospital finance, managerial costing, budgeting, and cost optimization. Revenue cycle management and process control. Costing and analytics, including review of cost sheets, cost-allocation structures, data architecture, and managerial reporting systems. Workforce productivity and performance management. Data analytics, KPI development, dashboard specification, and management information architecture. Sustainability, energy, water, waste, utilities optimization, and sustainable supply chains. Procurement, inventory, logistics, and support-function improvement. Change management, capacity building, and institutional adoption support. The attention of interested Consultants is drawn to Section III, paragraphs, 3.14, 3.16, and 3.17 of the World Bank’s “Procurement Regulations for IPF Borrowers” November 2020 (“Procurement Regulations”), setting forth the World Bank’s policy on conflict of interest. Consultants may associate with other firms to enhance their qualifications, but should indicate clearly whether the association is in the form of a joint venture and/or a sub-consultancy. In the case of a joint venture, all the partners in the joint venture shall be jointly and severally liable for the entire contract, if selected. A Consultant will be selected in accordance with the CQS method set out in the Procurement Regulations. Further information can be obtained at the address below during office hours 10.00 am to 4.00 pm – Sunday to Thursday. Expressions of interest must be delivered in a written form to the address below by e-mail by 30th June, 2026 Supporting Egypt’s Universal Health Insurance System Project. Attn: Yara Gamal – Procurement Specialist. Ministry of Finance. Cairo – Egypt. Tel: +2011141221444 E-mail: yara_gamal13@hotmail.com Cost Efficiency and Sustainability Transformation Technical Assistance Egypt Healthcare Authority (EHA) Terms of Reference for a Cost Efficiency and Sustainability Transformation Technical Assistance Assignment Index Executive Summary Introduction and Program Overview Background and Strategic Context Work Requirements Scope of Work Key Deliverables Project Governance and Timeline Required Competencies and Qualifications of the Consultancy Evaluation and Selection Criteria Executive Summary Egypt Healthcare Authority (EHA), the national public healthcare provider under the Universal Health Insurance System (UHIS), is leading a major transformation in Egypt’s health sector. Since its establishment, EHA has developed a network of 328 healthcare facilities, including 42 hospitals and 286 primary healthcare centers and units, delivered over 83 million cumulative health services, and reached nearly 6 million citizens. The second phase of the UHIS is being rolled out across Minya, Matrouh, Damietta, Kafr El-Sheikh, and North Sinai, with total coverage expected to exceed 18 million citizens upon completion. Nationwide rollout remains planned through 2032 in line with the phased implementation framework of the Universal Health Insurance Law. As the system expands, ensuring financial sustainability, operational efficiency, and optimal utilization of clinical and non-clinical resources has become a strategic priority. EHA therefore seeks technical assistance, through a competitive procurement process, to design and support the initial operationalization of a Cost Efficiency and Sustainability Transformation Model that strengthens operational performance, managerial control, and financial stewardship across the provider network. The assignment will deliver a comprehensive operational and financial gap assessment; identify major cost drivers, inefficiencies, productivity gaps, and resource leakages across healthcare facilities and central functions; review EHA’s current costing sheets and costing-data structure; develop practical workforce, performance, and cost management models; and transfer technical know-how and operational tools to EHA teams through structured capacity building. The assignment will be implemented through two integrated pillars. A. Enterprise Cost & Care Transformation Focus on optimising clinical service delivery to improve efficiency while enhancing quality of care. It will address the principal operational and cost drivers within clinical services through a structured assessment of clinical workflows, patient flow, service utilization, clinical productivity, and use of high-cost clinical resources. It will identify avoidable clinical expenditure, operational bottlenecks, non-value-added process steps, and resource leakage that affect throughput, productivity, and cost performance. It will also benchmark selected clinical performance domains against relevant good practice, strengthen managerial visibility of clinical cost drivers, review salary arrangements for the workforce in clinical areas in relation to performance, workload, productivity, and service delivery requirements, and assess revenue cycle management processes to improve financial control and reduce leakage. The expected output of Pillar A is a set of operational models, management tools, KPI frameworks, and phased implementation pathways to improve clinical workflow efficiency, service integration, patient throughput, workforce productivity, departmental accountability, and overall clinical cost efficiency. B. Sustainable Finance, Utilities Optimization. Focus on improving the efficiency of administrative and support functions across healthcare facilities. It will address the principal cost and performance drivers within non-clinical operations through structured review of procurement and supply chain, facility management, administrative operations, logistics, inventory management, workforce deployment, and support-service processes. It will identify inefficiencies, duplication, weak controls, avoidable overhead, and process constraints that undermine administrative efficiency and operational resilience. The pillar will assess workforce planning and performance management across non-clinical functions, develop process optimization measures, and cost reduction strategies, and define practical actions to strengthen procurement efficiency, supply chain performance, logistics control, and resource sharing across facilities. Where directly relevant to non-clinical cost control and long-term resilience, the pillar will also incorporate selected sustainable finance, utilities optimization, resource-efficiency, and sustainability-reporting measures. The expected output of Pillar B is a set of operationally actionable recommendations, management tools, KPI frameworks, and phased implementation pathways to strengthen administrative efficiency, support-function effectiveness, workforce productivity, non-clinical cost control, and broader operational sustainability across the EHA network. Across both pillars, the assignment shall combine structured gap assessment, root-cause analysis, evidence-based solution design, prioritized implementation planning, pilot support for selected interventions, integrated performance monitoring, and know-how transfer through capacity building of EHA teams. The intended result is a practical, scalable, and evidence-based transformation model that reduces avoidable cost, improves resource utilization, strengthens workforce and performance management, and sustains high-quality healthcare service delivery across the EHA network. Overview of Assignment The assignment shall be implemented over a total period of 3 months at EHA Headquarter and in one selected governorate. The assignment is intended to support EHA through diagnostics, benchmarking, analytical review, solution design, limited pilot support for selected interventions, and institutional capability transfer. Objective To support EHA in designing, testing, and initiating the implementation of a practical, evidence-based, and scalable Cost Efficiency and Sustainability Transformation Model that improves cost visibility, operational efficiency, workforce productivity, and institutional sustainability without compromising quality of care, patient safety, access, or continuity of service delivery. Specific Objectives Conduct a comprehensive operational and financial diagnostic across relevant clinical and non-clinical functions in the selected implementation areas. Cover EHA Headquarter and one selected governorate, including relevant branch structures, hospitals, and primary healthcare centers and units within the selected implementation area. Identify major cost drivers, inefficiencies, productivity gaps, duplication, bottlenecks, weak controls, avoidable expenditure, and resource leakages across healthcare facilities and central functions. Review EHA’s current costing sheets, cost-allocation logic, cost pools, reporting logic, and related data structures to determine whether the current costing architecture is fit for managerial costing, benchmarking, and operational decision-making, and provide recommendations for required adjustments. Benchmark central administrative costs at headquarters and branch level against hospital-level and primary care delivery costs to identify opportunities for administrative rationalization and stronger cost discipline. Review selected clinical and non-clinical workforce deployment, productivity, performance-management arrangements, and relevant salary and incentive structures in clinical settings, and provide practical recommendations to strengthen performance-oriented workforce management. Review revenue cycle management processes, including coding, billing, claims, collections, controls, and relevant data or system interfaces, and provide prioritized recommendations and practical tools to strengthen efficiency, discipline, and financial oversight. Assess opportunities for integrating sustainable finance, green budgeting, utilities optimization, resource-efficiency measures, and sustainable supply-chain practices where these directly support non-clinical cost control and operational resilience. Develop practical recommendations, KPI frameworks, dashboard specifications, prototype reporting templates, pilot support packages, and implementation roadmaps for agreed priority interventions across both pillars. Deliver structured capacity building, coaching, and knowledge transfer to relevant EHA teams to support adoption, institutionalization, replication, and scale-up. Capture implementation lessons and develop recommendations for broader replication and scale-up across EHA. Detailed Scope of Work Cross-Cutting / Inception Requirements Across the assignment, the consultancy shall: Prepare the assignment methodology, detailed workplan, governance arrangements, data requirements, and stakeholder engagement plan. Conduct an integrated diagnostic and gap assessment covering EHA Headquarters, relevant governorate branch structures, hospitals, and primary healthcare centers and units in the selected implementation areas. Review major cost drivers, operational bottlenecks, and system-level performance gaps across both pillars. Review EHA’s current costing sheets, cost-allocation practices, cost pools, reporting logic, and related costing-data structure. Benchmark central administrative costs against hospital-level and primary care delivery costs. Develop a prioritized opportunity matrix across Pillar A and Pillar B. Facilitate a validation and prioritization workshop with EHA to confirm the shortlist of priority interventions to be taken forward during implementation. Document implementation experience, operational constraints, validated practices, and lessons learned to inform broader EHA replication and scale-up. Only a limited number of priority interventions, as agreed with EHA following the baseline phase, shall be taken forward for detailed design, pilot support, and institutionalization during the assignment period. A. Clinical Operations Cost Efficiency This pillar focuses on optimizing clinical service delivery to improve efficiency while maintaining or enhancing quality of care. Clinical Operations and Patient Flow Assess current clinical workflows across hospitals and primary healthcare facilities. Analyze patient flow, service utilization , departmental performance, and operational bottlenecks affecting throughput, cost, and continuity of care. Identify inefficiencies and non-value-added activities affecting productivity, service delivery and waste of resources. Review care pathways, departmental performance, and operational bottlenecks affecting throughput, cost, and continuity of care. Resource Utilization Optimization Evaluate utilization of hospital beds, medical equipment, diagnostic services, pharmaceuticals, consumables, and other high-cost clinical inputs within service delivery Identify underutilization, duplication, leakage, weak scheduling, and inefficient consumption. Distinguish between clinically necessary cost and operationally avoidable cost and develop recommendations to improve efficiency and reduce waste. Clinical Workforce Productivity, Salary Review, and Performance Linkage Assess workforce deployment and productivity in clinical settings. Review workload alignment, staffing efficiency, clinical output patterns, salary arrangements, incentives, overtime, and shift-related payments in selected clinical settings. Assess alignment with workload, productivity, accountability, performance, and service-delivery requirements and provide practical recommendations to strengthen performance-oriented workforce management. Clinical Productivity and Quality Performance Benchmark selected clinical performance domains against relevant good practice, including physician productivity, nursing workforce allocation, operating room utilization, and diagnostic turnaround times. Review clinical KPIs and quality indicators relevant to operational efficiency. Define safeguards to ensure that efficiency measures do not compromise quality of care, patient safety, access, or continuity of service. Clinical Costing Review, and Cost Management Framework Review EHA’s current costing sheets, cost-allocation practices, cost pools, and cost architecture relevant to clinical operations. Assess whether the current costing approach is fit for managerial costing, benchmarking, and operational decision-making. Develop recommendations for a practical cost-management framework that improves cost visibility, accountability, and managerial decision support. Revenue Cycle Management Review revenue cycle management processes, including coding, billing, claims, collections, controls, and relevant data or system interfaces. Identify process gaps, control weaknesses, and revenue leakage risks. Provide recommendations and practical tools to strengthen efficiency, control, and financial discipline. Recommendations, Pilot Support, and Roadmap Develop practical operational models for selected clinical priorities. Support EHA in selecting and initiating limited pilot application of agreed Pillar A interventions. Prepare a phased implementation roadmap for broader replication across the EHA network. B. Non-Clinical Operations Cost Efficiency This pillar focuses on improving the efficiency, control, and sustainability of administrative and support functions across healthcare facilities. Administrative and Support-Function Assessment Review procurement and supply chain, warehousing, stock control, logistics, inventory management, facility management, administrative operations, and support-service arrangements. Identify inefficiencies, duplication, weak controls, avoidable overhead, and operational constraints affecting cost, responsiveness, continuity, and reliability. Non-Clinical Deployment and Performance Management Assess deployment and role allocation across non-clinical functions. Review staffing patterns, workload distribution, supervisory arrangements, and accountability mechanisms relevant to support functions. Identify practical opportunities to strengthen productivity, control, and effective use of non-clinical human resources. Process Optimization and Cost Reduction Review process flow, approvals, handoffs, internal controls, and coordination arrangements across non-clinical functions. Identify process inefficiencies and sources of delay, rework, or duplication. Provide practical recommendations for process improvement, cost reduction, centralized procurement, automation where appropriate, and resource sharing across facilities. Financial Stewardship and Resource Efficiency Review budgeting, expenditure monitoring, and planning practices relevant to non-clinical operations. Assess opportunities for stronger financial stewardship, green budgeting, and resource-efficiency measures where these directly strengthen non-clinical cost control. Provide recommendations to improve administrative cost discipline and operational resilience. Energy, Utilities, and Sustainable Supply Chains Assess energy, water, waste, medical gases, and other resource-intensive support functions. Review procurement, warehousing, stock control, logistics, and broader supply chain arrangements. Identify opportunities for utilities optimization, reduced waste, more efficient logistics, and sustainable supply-chain practices that also improve cost control. Non-Clinical KPI, Dashboard, Pilot Support, and Roadmap Develop relevant non-clinical operational, financial, utilities, supply-chain, and sustainability indicators. Define dashboard specifications, reporting templates, reporting frequency, indicator ownership, and management-review arrangements. Support EHA in selecting and initiating limited pilot application of agreed Pillar B interventions and prepare a phased roadmap for institutionalization and broader scale-up. Key Deliverables The consultancy shall deliver concise, action-oriented technical assistance outputs and support packages rather than stand-alone reports only. All deliverables shall be subject to EHA review and validation in accordance with the agreed scope, methodology, and comments-resolution process. All deliverables listed below shall apply to the 3-month assignment and shall be developed, validated, and operationalized at EHA Headquarters and in one selected governorate. The outputs shall also include practical recommendations and scale-up considerations for future replication across additional EHA facilities and governorates. Deliverable 1: Inception and Integrated Diagnostic Baseline Report A consolidated assessment report covering EHA Headquarters, relevant governorate branch structures, hospitals, and primary healthcare centers and units in the selected implementation areas. The report shall include: Assignment methodology, detailed workplan, governance arrangements, data requirements, and site coverage. Integrated gap assessment across EHA Headquarters, relevant branches, hospitals, and primary healthcare facilities in the selected implementation areas. Review of major cost drivers and operational bottlenecks across both pillars. Review of EHA’s current costing sheets and costing-data structure. Benchmarking of central administrative costs against provider-level delivery costs. Prioritized opportunity matrix across Pillar A and Pillar B. Validation and prioritization workshop summary and shortlist of priority interventions for the remainder of the assignment. A. Clinical Operations Cost Efficiency Deliverable 2: Clinical Operations Cost Efficiency Diagnostic Report Findings on clinical workflow, patient flow, departmental performance, service utilization, and cost visibility relevant to clinical operations. Review of clinical operations inefficiencies affecting cost, productivity, and service delivery. Review of workforce productivity in clinical settings. Identification of non-value-added activities and major clinical cost drivers. Assessment of clinical-use issues related to pharmaceuticals, consumables, and inventory availability affecting cost and service continuity. Identification of interface issues between clinical operations and revenue cycle processes affecting efficiency and financial control. Priority clinical efficiency opportunities for EHA consideration. Deliverable 3: Clinical KPI, Benchmarking, Dashboards, and Performance Monitoring Framework Selected financial, clinical, operational, and quality indicators against agreed benchmarks where applicable. KPI definitions, formulas, data sources, and calculation methodology. Target-setting approach, reporting frequency, indicator ownership, and accountability arrangements. Dashboard specifications, prototype reporting templates, and management-review formats. Safeguards to ensure efficiency measures do not compromise quality of care, patient safety, access, or continuity of service delivery. Deliverable 4: Clinical Operations Improvement and Pilot Support Package Pilot design note for selected facilities and services. Implementation prerequisites, sequencing, and monitoring checkpoints. Coaching and structured implementation support for agreed pilot teams. Short scale-up note for replication across additional EHA facilities. Deliverable 5: Revenue Cycle Management Review and Recommendations Report Review of coding, billing, claims, collections, and related controls. Review of selected data flows and system interfaces. Identification of process gaps, controlling weaknesses, and revenue leakage risks. Practical recommendations and tools for process improvement. Phased roadmap for EHA consideration. B. Non-Clinical Operations Cost Efficiency Deliverable 6: Non-Clinical Operations Cost Efficiency Diagnostic Report Assessment of non-clinical operational efficiency across procurement, logistics, facility management, administrative operations, and inventory management. Review of workforce planning and performance management in non-clinical functions. Assessment of sustainable finance, utilities, and supply chain efficiency opportunities where these directly support non-clinical cost control. Identification of key non-clinical efficiency gaps and priorities. Deliverable 7: Non-Clinical KPI, Dashboard, Institutionalization, and Scale-Up Package Monitoring indicators for administrative efficiency, workforce performance, utilities, supply chain, and selected sustainability measures. Dashboard specifications, reporting templates, indicator ownership, reporting frequency, and management-review arrangements. Pilot design note for selected non-clinical efficiency and support-service interventions. Institutionalization actions, governance arrangements, and phased scale-up roadmap for broader rollout across the EHA network. Consolidated summary of cross-cutting findings, implementation lessons, and recommendations for broader rollout. 8: Capacity Building, Handover, and Replication Package Training plan and capacity-building completion summary. Workshop materials, user guidance, and handover tools for EHA teams. Coaching and mentoring outputs delivered during the assignment. Replication guidance to support continued institutional adoption and scale-up by EHA. At the end of the assignment, the consultancy shall provide consolidated lessons learned and scale-up notes, including: Validated approaches. Key implementation lessons. Required adaptations by governorate context. Success factors and risks. Recommendations for broader EHA scale-up. Project Governance and Timeline A designated overall coordination focal point shall be responsible for integration across both workstreams, including methodological alignment, quality assurance, and preparation of consolidated updates for EHA. The assignment shall be implemented over a total period of 3 months under unified governance arrangements. Coverage: EHA Headquarters and one selected governorate. Purpose: conduct diagnostics, validate priority interventions, develop tools and frameworks, support initial operationalization, and generate practical implementation lessons to inform broader scale-up across the EHA network. The consultancy shall deliver coordinated outputs through two workstreams under Pillar A and Pillar B, with selected diagnostic, design, implementation-support, and capacity-building activities undertaken in parallel where appropriate. All outputs shall be subject to unified governance, validation, and reporting arrangements led by the designated overall coordination focal point. The consultancy shall be expected to: Submit an inception report and detailed workplan with milestones, governance arrangements, data requirements, and site coverage. Conduct regular progress reviews with EHA. Present interim findings and draft recommendations for validation at key milestones. Document implementation lessons during the assignment; and Prepare a final roadmap for phased scale-up across additional EHA facilities and governorates. Contract Parameters and Payment Schedule Item Description Total Contract Duration 3 months Implementation Modality EHA Headquarters + one selected governorate Payments shall be made against submission and formal acceptance by EHA of the relevant milestone outputs, in accordance with the agreed workplan and contract terms. Each milestone shall be deemed achieved only upon EHA’s written confirmation that the corresponding outputs have been satisfactorily delivered and that comments raised by EHA have been appropriately addressed. Deliverable Description Timeframe % of Total Contract Deliverable 1 Inception and Integrated Diagnostic Baseline Report End of Month 1 20% Deliverable 2 Clinical Operations Cost Efficiency Diagnostic Report End of Month 2 15% Deliverable 3 Clinical KPI, Benchmarking, Dashboards, and Performance Monitoring Framework End of Month 2 15% Deliverable 5 Revenue Cycle Management Review and Recommendations Report End of Month 2 10% Deliverable 6 Non-Clinical Operations Cost Efficiency Diagnostic Report End of Month 2 10% Deliverable 4 Clinical Operations Improvement and Pilot Support Package End of Month 3 10% Deliverable 7 Non-Clinical KPI, Dashboard, Institutionalization, and Scale-Up Package End of Month 3 10% Deliverable 8 Capacity Building, Handover, and Replication Package End of Month 3 10% All deliverables set out in this ToR remain applicable throughout the assignment. For administrative and payment purposes, the deliverables are grouped into milestone-based payment tranches rather than repeated as separate payment lines for each deliverable. Potential Contract Expansion: In the event of expansion of the World Bank project, EHA may, subject to funding availability, internal approval, and applicable procurement and contracting procedures, extend the assignment to include an additional implementation period of 2 months in one additional governorate, with an estimated contract value of USD 30,000. Required Competencies and Qualifications of the Consultancy The consultancy should demonstrate experience in healthcare cost optimization, operational transformation, revenue cycle management, managerial costing, workforce productivity analysis, administrative efficiency, sustainable finance, utilities optimization, and support-function improvement, preferably in public healthcare systems. Where a consortium is proposed, one lead firm shall assume overall contractual accountability and shall clearly demonstrate how the expertise required across both pillars will be integrated through a unified project-management and quality-assurance approach. The consulting team should include expertise in: Hospital management and healthcare operations improvement. Clinical operations and hospital administration. Hospital finance, managerial costing, budgeting, and cost optimization. Revenue cycle management and process control. Costing and analytics, including review of cost sheets, cost-allocation structures, data architecture, and managerial reporting systems. Workforce productivity and performance management. Data analytics, KPI development, dashboard specification, and management information architecture. Sustainability, energy, water, waste, utilities optimization, and sustainable supply chains. Procurement, inventory, logistics, and support-function improvement. Change management, capacity building, and institutional adoption support. Evaluation and Selection Criteria Criterion Weight Technical expertise and references in healthcare transformation, cost optimization, and institutional efficiency improvement 30% Methodology and technical approach for delivery across Pillar A and Pillar B workstreams 30% Team qualifications and capacity-building / knowledge-transfer experience 20% Value for money and financial proposal 20%