TORs: National Governance Expert

KP TA – 17 - Addendum to the Mid-Term Review of the Health Policy Revision and Health Sector Strategic Plan – Revision of Health Policy and Health Sector Strategic Plan for Khyber Pakhtunkhwa

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.

Problem Statement

• Policy and Governance: Policy and governance in KP lack clear stewardship from the DOH, contributing to inconsistent implementation and enforcement of healthcare policies. This inconsistency results in gaps in service delivery and accountability, highlighting the need for enhanced clarity and oversight in healthcare governance.
• Unequal Healthcare Access: Despite significant investments in healthcare by the DOH, donors, and the development partners, improvements in health indicators in KP remain limited. The focus primarily on tertiary care over primary healthcare (PHC) has led to systemic inefficiencies and barriers within the healthcare delivery system, hindering progress towards achieving UHC and meeting global health commitments.
• Quality of Healthcare Services: The inconsistencies in quality of care and variable standards across both public and private healthcare facilities present significant challenges in achieving standardised and high-quality healthcare service delivery under the current health policy.
• Financial Constraints: Financial constraints, including limited healthcare budget allocations and reduced fiscal space, are hindering the implementation of provincial strategies. This situation underscores the need for more rationalised, prioritised interventions, and efficient resource allocation to ensure adequate service delivery and infrastructure development in KP.
• Health Information Systems:  The Health Information Systems (HIS) in KP are inefficiently managed across multiple platforms, impeding effective data utilisation for decision-making and resource allocation, thereby hindering the promotion of evidence-based decision-making.
• Public Health Emergencies: Vulnerability to public health emergencies and outbreaks due to inadequate preparedness and response systems.
• Healthcare Infrastructure: Despite significant investments in healthcare infrastructure, desired improvements have not been adequately demonstrated, highlighting ongoing challenges in maintaining sufficient and effective healthcare facilities, equipment, and infrastructure in KP.
• Health Workforce Shortages: Shortages of skilled healthcare professionals, particularly in remote and underserved areas.

Objectives

The specific objectives of this TA are:

• Refine strategies and reallocate resources effectively based on specific findings from the mid-term review of the health policy and HSSP.
• Enhance governance and decision-making frameworks to effectively address identified current health challenges and emerging needs.
• Optimise healthcare delivery and measurable health outcomes through targeted revisions of the health policy and sector strategic plan.
• Achieve sustainable health system development by leveraging successful strategies and lessons learned from the mid-term review process.

Scope of Work and Methodology

• Conduct initial consultations with the E4H team, Health Minister, Secretary of Health, Director General of Health Services (DGHS), and Health Sector Reform Unit (HSRU), or any other authority recommended by HSRU, to ensure a clear understanding of the Terms of Reference (TOR), the assignment's scope, deliverables, and expected outcomes.
• Establish clearly defined TOR for a Policy and Strategic Technical Working Group (TWG) and assist HSRU in notifying the TWG to support the assignment's execution. The TWG should include senior leadership from the DOH, academia, regulatory bodies, and other relevant stakeholders.
• Submit an inception plan within the first two weeks of the consultancy, detailing the proposed methodology, work plan, and key milestones for the project.
• Collect and review all relevant materials (both printed and online), including the Health Policy (2019 -2025), Health Sector Strategic Plan (2019 -2025), National Health Vision (2016-2025), Mid-term review of national health Vision (NHV) and Health Policy and Health Sector Strategic Plan KP, UHC roadmap, HIS Strengthening Roadmap 2024-2028, Survey Reports (KP Health Survey, MICS, and PDHS), DOH Yearbook, DHIS Annual Report, DOH review and progress reports, key presentations from DOH and HSRU, and other relevant documents.
• Plan and conduct consultations with stakeholders through meetings, structured interviews, and key informant interviews, ensuring proper documentation. Stakeholders will be identified by the team and agreed upon with the HSRU and E4H team.
• Conduct a rapid analysis of the current health sector situation, drawing on available reports, stakeholder consultations, and a review of health-related data from various health surveys.
• Based on the analysis, identify key issues and propose revisions to the health policy, addressing aspects such as the population's health status, health system operations, intersectoral coordination for population health improvement, current government priorities in the health sector, progress towards health-related SDGs and Universal Health Coverage, national health priorities outlined in the National Health Vision 2016-2025, and international/regional commitments to address identified gaps and capitalise on opportunities, considering the findings of the mid-term review and the financial constraints faced by the province.
• Collaborate closely with the newly established Policy and Strategic Technical Working Group (TWG) to develop the policy, incorporating their feedback and actively supporting in organising meetings and keeping them updated throughout the process.
• Develop and submit a draft policy.
• Present the draft policy to Policy and Strategic Technical Working Group (TWG) and/or other forums suggested by DOH.
• Prepare and submit an updated draft policy after incorporating feedback and comments from TWG and other stakeholders.
• Develop a detailed strategic plan that supports the revised health policy objectives. Outline clear objectives, strategies, activities, timelines, responsibilities, and performance indicators.
• Conduct a comprehensive costing exercise to estimate financial requirements for implementing the strategic plan.
• Allocate resources effectively to prioritise key interventions and achieve sustainable health outcomes.
• Engage stakeholders, including DOH officials, healthcare providers, NGOs, and community representatives, to validate findings and proposed revisions.
• Incorporate stakeholder inputs into the strategic plan development and costing process.
• Establish a robust framework for monitoring and evaluating the implementation of the revised policy and strategic plan.
• Include mechanisms for feedback and adaptation to ensure continuous improvement and alignment with national and provincial health priorities.
• Document the entire process, findings, recommendations, and strategic plan in a comprehensive report.
• Present evidence-based recommendations and a costed strategic plan to guide policymakers in decision-making and resource allocation.

Timeline and LOE

The level of effort for the role is 30 working days, from August 24 – December 24.

Requirement

Technical Expertise

1. Minimum 10-15 years’ experience.
2. Advanced degree in Public Health, Public Administration, Health Policy, Governance, or a related field.
3. Experience in strategic planning processes for governance reforms and institutional strengthening.
4. Knowledge of risk management practices and compliance frameworks to ensure adherence to governance standards.
5. Understanding of legal and regulatory requirements impacting governance frameworks and operations.

Competencies

1. Familiarity with health systems strengthening approaches and health governance reforms.
2. Experience working in Pakistan or similar contexts, particularly in Khyber Pakhtunkhwa.
3. Knowledge and experience in designing, implementing, and evaluating governance frameworks within the health sector.
4. Ability to analyse complex issues, identify root causes of governance challenges, and propose practical solutions.

Deliverables

1. Inception report outlining methodology, timelines, and tools for consultative meetings.
2. Developing TOR for Policy and Strategic TWG defining roles and responsibilities.
3. Draft policy with concise reports on stakeholder consultations.
4. Finalised health policy document.
5. Support in developing costed strategic plan detailing strategies and financial allocations for policy objectives.