Health Economist – Cost and Efficiency Analysis

1. Background

As part of the pediatric pneumonia continuum of care intervention in Zanzibar, D-tree seeks to demonstrate that strengthening the care pathway between community and facility levels can reduce costs to the health system while improving outcomes. A health economist is needed to provide cost-related expertise during the intervention design phase, ensuring D-tree has the economic evidence and methodological guidance needed to design an intervention that is positioned to demonstrate cost-effectiveness and efficiency gains.

2. Objective

To provide health economics expertise that equips D-tree with the evidence, benchmarks, and methodological guidance needed to design an intervention that incorporates cost-reduction strategies and is positioned to demonstrate measurable health system cost savings, cost-effectiveness, and efficiency improvements. D-tree will lead the translation of these economic inputs into intervention design decisions.

3. What We Need From the Health Economist

The health economist provides specialized economic knowledge and methodology guidance. 

A. Understanding Current Cost Drivers

• What are the primary cost drivers in the current pediatric pneumonia care pathway in Zanzibar (e.g., late presentation leading to hospitalization, inefficient referral systems, drug stockouts, unnecessary facility visits)?
• Where are the greatest inefficiencies or cost leakages in the current system that an intervention of this type could realistically address?

B. Economic Evidence for Intervention Design

The economist provides the cost evidence and analysis that will inform design decisions.

• What intervention design features are most likely to reduce costs to the health system, based on evidence from comparable settings? For example:
  • Earlier identification and treatment at community level (reducing severe cases)
  • Improved referral completion (reducing repeat visits or delayed care)
  • Digital tools that reduce time spent gathering redundant information or context
• What evidence exists from comparable settings about cost savings from strengthening community-to-facility pneumonia care pathways?
• What are realistic expectations for cost reduction within a 1-year timeframe, and what assumptions underpin those estimates?
• How should we think about the investment costs of the intervention itself (training, tools, supervision) relative to the expected savings?

C. Anticipating Cost-Effectiveness Measurement and Designing for Evaluability

The health economist is not expected to design the evaluation methodology. A separate evaluation partner will be engaged to lead that work. The purpose of this section is to ensure the intervention is designed with likely cost-effectiveness measures in mind, so that the program is positioned to demonstrate impact when evaluated. The health economist should also be available to advise and align with the evaluation team as the evaluation framework is developed.

• What cost-effectiveness measures are most likely to be used in an evaluation of this type of intervention (e.g., cost per DALY averted, cost per life saved, cost per case appropriately managed)? Given that these are the likely measures, what does the intervention need to demonstrate—and what should D-tree be paying attention to in its design choices?
• What averted-cost metrics are evaluators likely to focus on (e.g., hospitalizations prevented, reduced length of stay, cases managed at community vs. facility level)? For each, what intervention design features would most directly drive those savings?
• What cost data will an evaluation likely need to capture at community, facility, and health system levels? Collaborate with D-tree to assess whether routine monitoring systems and digital tools are generating data in the right format and frequency, or if modifications are needed.
• How should we think about government costs vs. program/donor costs from an intervention design perspective? Are there design choices that shift costs toward government-funded inputs, making the program more sustainable and the cost argument more compelling for RGoZ?
• What are the most common methodological limitations in cost-effectiveness evaluations of community health programs in LMICs, and what should D-tree be aware of when designing the intervention and its data systems?

D. Building the Investment Case

• What economic evidence would be most compelling for the RGoZ and potential funders to justify continued investment and scale-up of this model?
• How should we frame the return on investment for a government-integrated community health program versus the counterfactual (no intervention)?
• What benchmarks from comparable programs or countries should we reference to contextualize our findings?

4. Deliverables

1. Analysis of current cost drivers in the Zanzibar pediatric pneumonia care pathway, identifying where the greatest inefficiencies exist and which are most amenable to intervention
2. Summary of economic evidence on cost-reduction strategies from comparable settings, with guidance on which design features are most likely to generate savings
3. Joint memo with clinical expert linking priority health outcome indicators to their cost implications and quantifiable savings potential
4. Summary of likely cost-effectiveness measures and averted-cost metrics that an evaluation would use, with recommendations for how the intervention’s monitoring systems and digital tools could be configured to generate the data an evaluation will need
5. Brief investment case framing document outlining the economic argument for RGoZ and funders, including relevant benchmarks from comparable programs

5. Expert Profile

• Advanced degree in health economics, public health economics, or related field
• Demonstrated experience conducting cost-effectiveness analyses of health interventions in low- and middle-income countries
• Experience with costing studies in primary health care or community health systems
• Familiarity with economic evaluation methods used in global health (e.g., CEA, cost-benefit analysis, budget impact analysis)
• Experience in East Africa or similar LMIC contexts preferred
• Track record of producing evidence used for policy advocacy or investment cases

6. Level of Effort and Timeline

Estimated 4-6 days from April-June 2026. Unless the consultant is based in Zanzibar, engagement will include remote consultations and document review. Potential for one-trip to Zanzibar if the consultant is based nearby and budgetarily feasible. 

7. Budget Requirements

The consultant will submit a proposed budget which will be reviewed and approved by D-tree. The consultant's proposed budget and costs will be subject to applicable taxes as stipulated by Tanzania law. The total cost submitted by the consultant should be inclusive of VAT. All budget amounts must be quoted in Tanzanian Shillings (TZS). For the successful offeror, all invoices submitted by the consultant must also be quoted in Tanzanian Shillings (TZS), and all payments will be made in Tanzanian Shillings (TZS).

8. Application

To apply for this role, please click the link <Here> and submit your resume and a cover letter. Please note that by applying to this position, you consent to your name being checked against a terrorist watch list prior to an offer of employment.  Deadline for submitting applications  is April 1, 2026