National Consultancy : Design a Global, adaptable, and user-oriented costing and analytical tool to estimate the health and economic impact of reducing medically unindicated cesarean sections

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 to scale up the Midwifery Model of Care (MMoC). 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. Increasing medicalization of pregnancy and childbirth has contributed to rising rates of obstetric interventions, including cesarean section (CS), labor induction, episiotomy, and other procedures that are not always medically indicated. In many countries, CS rates substantially exceed levels associated with improved maternal and neonatal outcomes, raising concerns about unnecessary interventions and their implications for health systems.

While obstetric interventions are essential when clinically indicated, unnecessary interventions can expose women and newborns to avoidable health risks, increase healthcare costs, and place additional pressure on limited health system resources. Cesarean birth, in particular, is associated with higher costs due to surgical care, longer hospital stays, management of complications, and implications for subsequent pregnancies. Strengthening evidence on the economic and health impacts of reducing medically unindicated obstetric interventions is increasingly recognized as a priority to inform policy, investment decisions, workforce planning, and quality improvement initiatives. To support this agenda, there is a need to develop adaptable economic models that can estimate the costs of current intervention practices and the potential savings and health benefits associated with evidence-based strategies to reduce unnecessary interventions across different health system contexts. The developed model will be added as an
annex to the Midwifery Investment Case Framework.

The developed model, by the end of 2026, will be initially piloted in Egypt in early 2027, where a national investment case for midwife-led care was recently developed in the country. This first pilot will provide key evidence and lessons learned on the applicability of the tool at the country level and provide a case study in a context where CS is a pressing public health priority. It is anticipated that the model will then be rolled out in additional countries in the Arab States
region, in Turkey and more widely.

The objective of the consultancy is to design a global, adaptable and user- oriented costing and analytical tool to estimate the health and economic impact of reducing medically unindicated cesarean sections and selected obstetric interventions, which will be an annex to the Midwifery Investment Case Framework incorporating evidence-based assumptions regarding the impact of midwifery autonomous care on reducing medically unindicated CS and interventions.
The tool will quantify associated costs, potential health outcomes, cost savings, and the cost of inaction, and will be accompanied by methodological guidance for adaptation and application across countries and settings. The tool, to be developed and finalized by the end of 2026, will be piloted in Egypt in early 2027, in collaboration with the UNFPA Egypt Country Office, the Senior Public Health Consultant, and relevant national stakeholders. The Egypt pilot will provide an opportunity to test and validate the tool using country-level data and assumptions, assess its applicability and usability, and inform its further refinement. Collaboration with counterparts in Turkey will also support
potential piloting of the tool in Turkey in 2027. The pilot will inform refinement of the model and demonstrate its applicability for estimating the potential health system and economic benefits of reducing unnecessary obstetric interventions.
The consultant will work in close collaboration with the consultant recruited by UNFPA Headquarters and the Senior Public Health Consultant in Egypt, with support from the UNFPA Country Office, Regional Office and Headquarters.
The consultants will coordinate the allocation of tasks and responsibilities throughout the assignment, and ensure the timely and effective implementation of tasks and delivery of the agreed outputs. The principal deliverable is a user-oriented analytical costing tool and accompanying methodological guidance on CS and obstetric interventions for inclusion as an annex to the Midwifery Investment Case Framework.

The consultant will be responsible for the following tasks, In collaboration with the Senior Public Health Consultant, UNFPA Egypt CO, ASRO, and the HQ consultant, and, as appropriate, with counterparts in Türkiye, to ensure that all deliverables are aligned with intended objective and responsive to the needs of its users:
1. Desk review of available and related resources relevant to the consultancy objective.
2. Design a global, adaptable tool to estimate unit cost and national cost at the current intervention rate;
a. The total cost of physician-delivered care in CS (medically indicated), unindicated cesarean sections, unindicated interventions, and complication management,
b. The costs associated with medically unindicated cesarean sections and selected obstetric interventions,
c. The costs of complication management,
d. The potential national cost savings associated with intervention reduction and associated complication reduction;
e. The health impacts of reduced intervention in terms of
i. Maternal and neonatal deaths/DALYs averted
ii. Cases of maternal and neonatal complications avoided
f. The cost of inaction and budgetary implications over time.

4. To participate in the stakeholder consultation and validation to review and approve the designed tool.
5. All coordination meetings are mandatory to be attended.
The designed tool will be shared for review, feedback and validation with an expert reference group, facilitated by UNFPA HQ.

All deliverables will be submitted in electronic copies. They must be written in English.
1. Design a global, adaptable, and user-oriented costing and analytical tool to estimate the health and economic impact of reducing medically unindicated cesarean sections and selected obstetric interventions.

2. The developed user-oriented guidance on the application and implementation of the tool,
The payment is made upon receiving a confirmation email for the final approval from UNFPA on the deliverables.

Payment Schedule
Lump Sum value for each deliverable will be paid to the consultant upon successful submission and approval from UNFPA Egypt CO side based on the below:
1. Draft designed tool and draft developed user-oriented guidance. 30%
2. Final approved designed tool and developed guidance. 70%

The Consultant must meet the following Criteria for selection:
● Advanced university degree in Health Economics, Public Health, or related field.
● A minimum of 10 years of professional experience in health economics, health systems, maternal and newborn health, or midwifery workforce planning.
● Strong skills in health costing and economic modeling.
● Demonstrated expertise in designing health economic modeling tools, developing investment cases or health financing strategies particularly related to maternal health or the health workforce.
● Experience working with Ministries of Health and Finance in Egypt and LMICs.
● Excellent written and oral communication skills in English and Arabic.

The consultancy is for a period of 3 months (End- September-December 2026).
The consultancy will commence on the day following the contract's signature.

All interested applicants should submit the following:
1. Letter of interest
2. CV with evidence of qualifications and experience