17.3.1 In consultation with the senior management within the Ministry of Health and Social Services (MOHSS) as well as the Ministry of Finance and Economic Development (MOFEM), the Health Economist will undertake the following tasks: (1) Design and develop the process for the health economic and fiscal analysis and any other analyses required to inform health financing reform not previously conducted. This will require working closely with the MOFEM to determine the parameters and methodology for the analysis. The consultants should review already completed work on this, especially by Mott MacDonald, to ensure existing work is complemented and extended where necessary, rather than replicated. The work should be guided by existing frameworks for the development of a health financing strategies in a UHC context, such as the WHO’s. (2) Based on available analysis of referrals – conducted by MOHSS – and in consultation with the Chief Medical Officer, Healthcare Development Manager and service providers in the region, explore and identify opportunities for improvement in the efficiency, timeliness and effectiveness of overseas referrals, including through preferred provider agreements for high-volume tertiary care; a revised visiting specialist scheme, where safe and feasible; and third party administration/care coordination of referrals. Quantify and model potential efficiencies arising from these strategies. 13 (3) Undertake the relevant analysis, as per agreed process, and develop options for a minimum package of essential Health Services for Montserrat – taking into consideration fiscal space constraints, alternative domestic resource mobilisation scenarios, viable opportunities for provision of off island care, e.g. through partnerships with other institutions, or islands, or medical referrals brokers, and their resulting costs (4) Design and facilitate agreement on the consultation process to be followed to appraise health financing options, including different Health Benefit Package options. (5) Facilitate consultation: (a) prepare materials for consultation / meeting (MOHSS will support the actual coordination of the consultation). (b) present results and key trade-offs at key high-level stakeholders. (c) assist in bettering the knowledge and understanding of relevant GoM staff members in this field and its issues for Montserrat, through seminar and/or training session. (6) Once consultation has ended, refine a final report with recommendations and guidance on next steps/phases.