TORs: National Senior STTA – Monitoring and Evaluation Expert

Midterm Review of HSS (2019–2028) & Development of the Punjab Health Sector Strategy (2025-2035)
to ensure alignment with NHV 

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 provides technical assistance (TA) to the Federal, Khyber Pakhtunkhwa (KP), and Punjab governments, and is being implemented by Palladium along with Oxford Policy Management (OPM).

Through its flexible, embedded, and demand-driven model, E4H supports 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 delivers 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.

Background and Problem Statement

After the 18th constitutional amendment, the Punjab Government decided to steer the Health Sector by formulating a strategy. The Punjab Health Sector Strategy (PHSS) (2012-2020) was developed in response to challenges such as a lack of quality-of-service delivery and coverage, a competent health workforce, governance, and regulation of the health sector to ensure that the poor and vulnerable were shielded from catastrophic health expenditure.

• Midway through the Strategy's duration in 2015, the Department of Health in Punjab was bifurcated into two separate entities: The Primary and Secondary Healthcare Department (P&SHD) and the Specialised Health and Medical Education Department (SH&MED). In the initial years, the P&SHD pursued a reform agenda approved by the then Chief Minister Punjab but was not aligned with PHSS as it had lost its relevance due to the administrative and functional division of the Health Department.
• In 2019, the Policy and Strategic Planning Unit (PSPU) in the P&SHD endeavoured to develop a PHSS for the next ten years. The PHSS 2019-2028 aimed to define the priorities of the political leadership in the health sector, which included "patient safety and quality of care, infection control, hospital waste management, environmental/one health, and health financing & public-private partnership in the backdrop of three paradigms—biomedical, socio-environmental, and lifestyle & behavioural contexts.
• However, before this Strategy could be implemented, the global health landscape underwent a significant transformation due to COVID-19. In Pakistan, the healthcare setup experienced immense strain. Internationally, there was a heightened emphasis on enhancing healthcare sector resilience and security, with growing recognition that preparedness and response to epidemics are indispensable for the health safety of the population and a country's economic survival. Again, in 2022, owing to climate change, Pakistan was buffeted by unprecedented floods, costing the national exchequer an estimated USD 15.9 billion in damages and USD 15.2 billion in economic losses.
• These challenges appeared to be much wider in scope than what the PHSS 2019-2028 envisioned tackling during its development. Also, as of today, in 2024, the PHSS, which is halfway through its stipulated duration, has a new political government sworn in the province with a vigorous healthcare reform agenda and an approach to delivering services effectively. This, therefore, is the most appropriate time to carry out a third-party Mid-Term Review (MTR) of the PHSS 2019-28 with the following objectives:
  • To assess progress against the Strategy to date and identify the challenges, especially those which have risen in the wake of the COVID-19 pandemic and climate change and the renewed agenda of primary healthcare to ensure meeting the Universal Health Care (UHC) implementation.
  • To evaluate future common health strategic priorities in the lead-up to its revision/generation of a new version, particularly considering the new political government and Sustainable Development Goals (SDG) commitments.
  • Build the capacity of the P&SHD to conduct holistic policy reviews.
  • To develop the next PHSS 2025-2035 in a highly consultative process with the political and bureaucratic leadership in consonance with the National Health and Population Policy being developed at the Federal Level and a strategy that is in line with the thematic areas of International Health Regulations (IHR), UHC and climate-change agenda. 

Scope of Work and Methodology

As with all E4H TA engagements, the team is expected to work with a roadmap approach, with clearly defined checkpoints and markers of success at each milestone, ensuring progress measurement and space for course correction. The scope of work outlined below sets out a general sequence of activities that fulfil the team's minimum expectations.

Step: 1 (September October)

Adapting the analytical framework (Figure 1) will result in a rapid process and improvement analysis. This will involve gathering stakeholder feedback, evaluating cost-efficiency, ensuring alignment with health sector goals, reviewing monitoring and evaluation mechanisms, and providing recommendations for the next iteration of the PHSS.

Build understanding of HSPP (2019-2028)

1. Understand the HSPP's strategic direction, objectives, and priority actions through desk research, Key Informant Interviews (KIIs), and political economy analysis.
2. Analyse PHSS implementation and impact, focusing on health outcomes and cost efficiency.
3. Identify practical challenges and opportunities for improvement.

Review Strategy Document:

1. Use of the analytical framework.
2. Findings from literature reviews.
3. Learnings from initial stakeholder consultations, including a structured literature review with a clear protocol.
4. Evaluation of resource allocation.
5. Evaluation of key health indicators' improvements.

Checkpoint 1:

1. Present the MTR approach and methodology, proposed literature review, stakeholder list, and KII tool to the FCDO team.
2. Submit a 15-page quick report with findings from desk review, stakeholder mapping, methodology, KII findings, and a Gantt chart of the next steps.

Step 2 (November 2024 to March 2025)

The team will work closely with the Secretary Health and DG office and other stakeholders, including the public and private health sector, civil society organisations, development partners, academia, and community representatives. Below is a list of the sequence of activities that the consultants will be expected to undertake.

• Conduct a quick desk review and preliminary meetings with the Minister of P&SHD and Specialised and Medical Education, with the Secretary Health and key Programme Directors of the Programmes active in the province, with the Director General Health office along with in-depth analysis of the Health Sector Roadmap developed in the province and latest manifestoes of the political/ ruling parties and global commitments, while paying special attention to cross-cutting issues of equity and gender  
• Quick review of the governance and coordination mechanisms for building stronger and more resilient health systems at national and provincial/area levels
• Identify key bottlenecks, challenges and barriers to the implementation of resilient health systems in Punjab at the provincial and district level
• Develop a methodology as a part of the inception report/ presentation for the development of Punjab HSS (2025-35)
• Develop a clear vision, mission, principles and objectives for PHSS (2025-35) through an inclusive consultative process
• Identify health thematic pillars with key challenges, strategic vision/ actions for the remaining period of SDGs and align activities as the demand for and need of the Punjab Health Department and the Health Sector Reform Roadmap
• Produce an updated monitoring framework) for the PHSS (2025-35)

1. Draft PHSS, which is in line with the Punjab Health Department priorities, considers the international commitments, promoting climate resilience, is sensitive to the post-COVID-19 realities and is aligned with the manifesto and ideas of the political regime
2. Comprehensive feedback from all stakeholders on the draft PHSS, including but not limited to healthcare providers, policymakers, development partners, non-governmental organisations, private sectors and members of civil society

Checkpoint 2:

Completion of the first full draft of the PHSS. The draft is expected to include an analysis of the implementation and impact of the new strategy on health outcomes. This draft report will be shared with the project team for review and feedback before finalisation.

Consultative session with the development partners and public health experts to discuss and obtain feedback for the new PHSS.

Checkpoint 3:

Finalisation and approval of the new PHSS.
Dissemination event to be organised to officially launch the approved PHSS. 

Timeline and LOE
The level of effort for the role is 72 working days, from Sep 2024 to - March 2025. 

Requirements: 

Educational Background
Post-graduate degree in Public Health, Economics, Management Sciences or a related field.

Technical Expertise

• Understanding results-based M&E systems/frameworks, encompassing indicators, data collection, analysis, and reporting for informed decisions.
• Expertise in quantitative and qualitative data management and analyses, using statistical tools/software, ensuring accurate insights for programme assessment.
• Familiarity with diverse evaluation methods such as impact assessments, process evaluations, and cost-effectiveness analyses.
• Capacity to collaborate with stakeholders to enhance programme design using M&E insights, driving evidence-based improvements. 

Competencies

• Strong analytical skills for data interpretation, pattern recognition, and performance assessment.
• Effective communication to convey key findings, insights, and recommendations to diverse stakeholders.
• Ability to design and implement data collection systems, ensuring accuracy and reliability.
• Skilled in translating M&E results into actionable strategies for programme improvement. 

Deliverables/KPIs

• Support the team in developing a comprehensive inception slide deck that includes the MTR approach and methodology, proposed literature review, stakeholder list, and KII tool.
• Support the team prepare a 15-page report with findings from desk review, stakeholder mapping, methodology, KII findings, and a Gantt chart of the next steps.
• Contribute to the preparation of the draft of the MTRR document, providing valuable insights into public health perspectives.
• Collaboration with public sector stakeholders and development partners in developing recommendations and M&E linkages for seamless public health governance operations.