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Programme

Evidence for Health (E4H) is a Foreign, Commonwealth & Development Office (FCDO)-funded programme aimed at strengthening Pakistan's healthcare system, thereby decreasing the burden of illness and saving lives. E4H (2023-2027) provides technical assistance (TA) to Punjab and also to the Federal and Khyber Pakhtunkhwa (KP) governments. The Punjab component is being implemented by Palladium along with Oxford Policy Management (OPM).

Through its flexible, embedded, and demand-driven model, E4H Punjab will support the government to achieve a resilient health system that is prepared for health emergencies, responsive to the latest evidence, and delivers equitable, quality, and efficient healthcare services. Specifically, E4H will deliver TA across three outputs:

Output 1: Strengthened integrated health security, with a focus on preparing and responding to health emergencies, including pandemics.

Output 2: Strengthened evidence-based decision-making to drive health sector performance and accountability.

Output 3: Improved implementation of Universal Health Coverage, with a focus on ending preventable deaths.

E4H-Punjab works in partnership with the Punjab Department of Health (DOH).

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Terms of reference

Background

• The Punjab Prisons Department operates 45 health facilities providing medical services to inmates. In December 2024, the Punjab government transferred oversight of these hospitals to the Health & Population Department (H&PD). Prior to handover, health Department’s role was only limited to seconding medical staff to prison hospitals, whereas all paramedical and other staff as well as procurement of medical supplies and day-to-day administrative management was the responsibility of the Prison Department. Following the transfer, H&PD is now responsible for staffing, procurement, infrastructure oversight and service delivery improvement, with an expressed intent to upgrade selected prison hospitals to secondary-level status where feasible. This governance shift presents an opportunity to reform custodial healthcare, particularly given the unique systemic challenges and resource limitations in prison settings compared to routine public facilities.

• Historically, prison health facilities in Punjab have remained poorly mainstreamed, with intermittent support from vertical programmes (e.g. TB, HIV/AIDS, Hepatitis) but limited strengthening of routine systems. A recent H&PD-led assessment indicates very low readiness against Minimum Service Delivery Standards (MSDS) across all prison hospitals, with preliminary findings pointing to major gaps in documentation, IPC practices, and oversight mechanisms.

• International evidence, including UNODC/WHO Prisons and Health, the ICRC Healthcare in Detention guidance, and HRCP’s Access to Healthcare in Pakistan’s Prisons (2023), highlights that custodial healthcare systems face distinct challenges compared to routine public facilities, including constrained governance arrangements, HRH limitations, overcrowding, high burdens of communicable disease and mental health conditions, and weak continuity of care. These realities highlight the need for MSDS readiness to be pursued within a broader, prison-specific health systems strengthening framework.

• For licensing purposes, the PHCC has classified the 45 prison hospitals as follows: Category I (7), Category II-A (4), Category II-B (11), and Category II-C (23). In response, H&PD has requested targeted technical assistance to strengthen MSDS compliance and prepare prison hospitals for PHCC licensing. This TA will support MSDS readiness while also assessing and addressing key enabling factors—particularly governance arrangements, HRH capacity, financing and supply constraints, IPC feasibility, and documentation practices—to ensure that improvements in quality of care are realistic, sequenced, and sustainable within custodial settings.

Problem Statement

The transition of prison health facilities from the Prisons Department to the H&PD has revealed longstanding systemic weaknesses, including limited staff capacity, poor IPC and documentation practices, overcrowding-related operational pressures, and low familiarity with MSDS requirements. Without targeted support that strengthens MSDS readiness alongside the enabling conditions required for sustained compliance, particularly governance, HRH, financing, and oversight, prison hospitals risk continued non-compliance with service delivery standards and compromised quality of care for a highly vulnerable population.

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Goal and Objective(s)

To support the Health & Population Department (H&PD) in strengthening the quality and governance of healthcare services in Punjab’s prison hospitals by improving MSDS readiness and PHCC licensing preparedness, while ensuring that interventions are feasible, informed by best practice, and responsive to the enabling conditions required for sustainable quality of care in custodial settings.

Specific objectives include:

1. Validate enabling conditions for quality of care in prison hospitals using the H&PD assessment and targeted facility-level assessment to determine realistic, sequenced pathways for MSDS compliance.
2. Build the institutional and staff capacity of prison hospitals and relevant H&PD counterparts to understand, apply, and operationalise MSDS requirements, and support PHCC licensing preparedness through facility-specific compliance improvement plans and preparatory actions.
3. Improve coordination and role clarity between H&PD, the Prisons Department, and PHCC, and generate practical recommendations (drawing on model or phased implementation approaches) to guide sustainable scaling of quality-of-care improvements across the prison health system.

Strategic Approach

Contributions to Health Systems Strengthening

This TA aims to strengthen the governance, oversight, and quality assurance functions of the H&PD by embedding MSDS readiness mechanisms, documentation practices, and internal quality controls within prison health facilities. The approach recognises the custodial context and focuses on building sustainable systems (rather than one-off compliance) by improving institutional processes, staff capacity, and accountability arrangements that underpin quality healthcare delivery for incarcerated populations.

Alignment with Other E4H Technical Assistance (TA) and Investments

This TA complements ongoing E4H initiatives, including the impact evaluation of the MSDS assessment of public and private HCEs across Punjab. The activity also supports the broader Universal Health Coverage (UHC) roadmap by ensuring equitable access to safe and compliant health services for vulnerable populations within the prison system.

Alignment with Departmental and Donor Priorities

The intervention directly supports the H&PD’s mandate to unify all public-sector healthcare facilities under PHCC’s regulatory system and to establish QA mechanisms. It also aligns with the PHCC’s licensing roadmap and strengthens donor-supported system enhancement efforts focused on regulation, standardisation, and performance management. A Joint Coordination Mechanism will be established, comprising the Home and Prison Departments (H&PD) and PHCC.

Scope of Work and Methodology

The assignment will be implemented in four phases. It will be conducted in close coordination with the H&PD throughout the TA, with the PHCC and the Prisons Department consulted as appropriate. Focal points will be nominated in all relevant departments to ensure effective coordination, while capacity-building activities will be embedded across all phases to support institutional ownership, continuity, and sustainability of the interventions. The scope of the TA will be refined and finalised during inception, following close consultations with the H&PD, to ensure the approach is realistic, appropriately sequenced, and adjusted based on findings from the enabling environment.

Phase 1: Inception, Diagnostic, and Planning

• Hold initial meetings with H&PD, PHCC, and the Prisons Department to discuss and finalise the scope, timeline, roles, and implementation arrangements.
• Establish a Joint Coordination Mechanism to provide oversight, handle constraints, and ensure alignment throughout the TA.
• Conduct a rapid desk review, including international best practice and relevant examples from low- and middle-income countries (LMICs), the H&PD assessment (and any supporting materials), and the relevant MSDS prescribed by PHCC applicable to prison health facilities to inform the approach.
• Conduct rapid validation visits to a small, representative sample of prison health facilities (across PHCC categories) to confirm baseline readiness and constraints.
• Based on the desk review and validation visits, conduct a structured situational analysis of enabling conditions for MSDS compliance and sustained quality of care, including governance/accountability arrangements, HRH availability and competencies, financing and recurrent cost constraints, procurement/supply chain reliability, IPC feasibility, documentation practices, referral linkages, and custodial operational constraints.
• Based on the findings, confirm with the H&PD a suitable implementation pathway, such as a model primary healthcare facility approach (if a model facility approach is agreed the development of an operational plan and guidelines can be explored) or a phased rollout, and a capacity-building approach for MSDS compliance and implementation in selected facilities.
• Develop and submit an Inception Report & Situation Analysis along with a Work Plan that details the TA strategy, milestones, and deliverables.

Phase 2: Development of Prison-specific MSDS Readiness Package

• Develop/adapt a practical and implementable MSDS readiness toolkit tailored to prison hospitals, including SOPs, checklists, documentation templates, internal audit tools, and job aids.
• Validate toolkit content with PHCC to ensure alignment with licensing expectations while addressing prison-specific operational realities.
• Develop or refine roles and responsibilities for prison healthcare and relevant administrative staff under H&PD oversight to support routine compliance (e.g., documentation focal points, IPC responsibilities, QA checks, referral coordination).
• Develop a tailored capacity building package including modules that integrate MSDS priorities with prison-specific health priorities (e.g communicable disease control, sexual and reproductive health needs, mental health and substance dependence, IPC in overcrowded settings, continuity of care and referral, and patient rights/safeguarding considerations).
• Submit the MSDS Readiness Toolkit + Capacity Building Package.

Phase 3: Capacity Building and Technical Support

• H&PD will nominate participants (facility-level and departmental) for capacity building.
• Deliver two Training of Trainers (ToT) sessions to enable master trainers to train prison hospital medical and administrative staff (on-site) on MSDS.
• Incorporate the training package into the HISDU LMS after discussion with H&PD.
• Submit a training report that includes session details, trainers’ feedback, pre- and post-evaluation scores, outcomes, learnings, and recommendations for scale-up.

Phase 4: Implementation Support, Monitoring, and Consolidation

• The master trainers from the above phase 3 will provide on-site trickle-down mentoring to prison medical staff (either through selected model facility approach or phased approach as decided by H&PD).
• Facilitate mock inspections of selected facilities (only hospitals with indoor (inpatient) facilities are proposed for support to prepare for PHCC licensing)
• Consolidate lessons, bottlenecks, and recommendations, particularly those relating to governance, HRH, financing, supply chain, and oversight required for sustainable compliance and quality of care.
• Prepare a Final Technical Report (and accompanying slide deck) including a sequenced roadmap for scale-up, recommended actions for H&PD/PHCC/Prisons, and practical next steps to institutionalise improvements across the prison health system.

Sustainability: Capacity Building, Institutionalisation, and Transition Planning

Embedded Capacity Building

The TA will deliver practical, hands-on capacity-building through ToTs and on-site hand-holding support tailored to prison hospitals. Standardised SOPs, compliance checklists, and documentation templates will be introduced to institutionalise MSDS practices across infection control, waste management, and patient safety. All capacity-building efforts will be anchored within H&PD systems to ensure sustainability.

Institutionalisation of Systems and Practices

Formal coordination between H&PD, PHCC, and the Prisons Department will sustain documentation standards and inspection readiness, aligning the initiative with broader quality-of-care reforms supported under E4H. The focal point of this TA will be confirmed during inception, as the Special Secretary for Development is about to go on an official leave.

Transition Planning and Handover

The TA team will formally transfer all training materials, SOPs, and checklists to the H&PD and PHCC training databases. The Final Report will outline institutional responsibilities for maintaining compliance, conducting refresher training, and integrating QA activities.

Deliverables

The TA duration will be 6 months.

1. Inception & Situational Analysis Report - Baseline evidence, governance mapping, stakeholder coordination framework, and detailed TA work plan endorsed by H&PD.
2. Training Package (Toolkit + Roles & Responsibilities) - MSDS toolkits, SOPs, compliance checklists, documentation templates, and TORs/JDs contextualised for prison health staff.
3. Training Report - Session details, participant feedback, pre/post evaluation scores, outcomes, and recommendations for scale-up.
4. Final Technical Report (with Capacity Building Plan & Slide Deck) - Mock inspection findings, lessons learned, sustainability plan, embedded capacity building strategy, and transition/handover package.

Position Title: Senior Quality & Compliance Expert (Health Systems)– Punjab Prison Health Facilities TA (Senior National)

Duty Station: Lahore with travel as required

Duration / LOE: February 2026 – August 2026 (LOE 60 days – subject to change until the start of the TA)

Reporting To: E4H Programme Team

Role Purpose

Serve as the overall technical lead for strengthening governance, quality of care, MSDS readiness, and PHCC licensing preparedness across Punjab prison health facilities through strategic oversight, coordination, and quality assurance.

Key Roles & Responsibilities

• Lead overall technical delivery of the TA and provide strategic direction on MSDS readiness and licensing preparedness.
• Coordinate with H&PD, PHCC, and the Prisons Department to ensure smooth implementation and stakeholder alignment.
• Oversee diagnostic assessments, governance reviews, and development of prison-specific compliance improvement pathways.
• Guide development of MSDS toolkits, SOPs, checklists, training materials, and institutional frameworks.
• Provide technical oversight for ToTs, mock inspections, and final scale-up recommendations.
• Ensure alignment with E4H quality frameworks, prison health realities, and sustainability objectives.
• Support preparation of key reports, presentations, and final handover documentation.

Requirements

Technical Expertise

• Postgraduate qualification in Public Health, Health Systems Management, Healthcare Quality, or related discipline (MBBS, MPH, MHM, MHA, MSc Quality Assurance or equivalent).
• Minimum 15 years of overall professional experience in health systems strengthening, healthcare quality assurance, regulation, or hospital management.
• Demonstrated experience in MSDS implementation, PHCC licensing readiness, facility audits, and institutional reform.
• Experience coordinating with government departments and multi-stakeholder programmes preferred.

Core Competencies

• Strategic leadership and results-based management
• Strong report writing and presentation skills
• Stakeholder engagement and interdepartmental coordination
• Ability to mentor multidisciplinary teams
• Strong understanding of QA systems, MSDS, and licensing processes