Responsibilities of the contractor

The contractor is responsible for providing the following services:

Work Package 1: Upgrade the existing IT system to Align with informal sector business process
- Assess the status of the existing IT systems in NHIF and ZHSF for management of informal sector enrolment,
- Upgrade and enhance existing IT systems with modern technologies to align with business processes ensuring all features and functionality for health insurance management are working properly.
- Organizing a review workshop of technical documents required to develop new features with partners’ institutions to understand the requirements for the upgrade
- Develop and integrate new features into existing IT systems based on the feedback collected from partners institution team.

Work Package 2: Design /develop Artificial Intelligence (AI) and Machine Learning (ML) algorithms for claims Management
− Review the existing claiming and reimbursement systems in NHIF and ZHSF,
− Develop AI and ML algorithms for healthcare claims processing systems to reduce the manpower and time required for claims review and reimbursement. These algorithms should also detect fraud and identify patterns or anomalies commonly associated with fraudulent claims.
− Configure medical rules and medical coding features on existing IT systems and solutions to ZHSF and NHIF
− Design and develop ML algorithms which feature intelligent analysis with predictive algorithms to easily determine trends and patterns of patient’s medical records, analyze disease patterns, control and minimize documentation error from medical practicians on diagnostics and treatment of the patient.
− Conduct on-the-job training in AI and big data analytics to facilitate the effective management of health insurance information systems. This includes developing scenario-based cases and best practices for problem-solving, with the development team collaborating closely with ICT teams from partner institutions.
− Organizing workshop to test the algorithms and integrate feedback received during workshop.

Work Package 3: Integration and Interoperability and implementation of FHIR standards
− Conduct an assessment to identify systems that need to be linked with the NHIF insurance management systems for mainland and ZHSF for Zanzibar as well as systems to be linked with TIRA
− Lead the team from partner institutions on integration and Interoperability of existing IT systems with other digital systems
− Lead the team on implementing Fast Health Interoperability Resources (FHIR) standards to facilitate data health exchange among the digital health systems. The interoperability specification for FHIR by the Health Level Seven International Organization (HL7)

Work Package 4: Test and Deploy modules/new features and knowledge transfer.
− Test features in corresponding modules and based on test results, fix bugs if there are any. Deploy the newly developed modules /features on the live server.
− The developed features will be tested by technical experts from both the contractor and the technical teams of partner institutions.
1. Based on the User Acceptance Test (UAT) workshops, discussions during technical testing provide expert views on feature requests, questions, bug reports that are reported and ensure proper documentation.
2. Organize a training program for knowledge transfer to technical and non-technical users from partners institution for sustainability

Work package 5: Documentation
− Detail documentation of the functionalities and features developed including the source code. The documentation must include the following items in particular:
• Software stack and dependencies
• System requirements, system specifications and system architecture
• Diagrams and outlines (e.g. use case, ERD, process outlines, mock‑ups)
• Other technical documentation (e.g. interfaces, (clearance of) faults)