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.

Position Summary

The purpose of the TA is to assist HSRU and DGHS in implementing the Policy and the associated guidelines to establish the budgeting and expenditure management function at the primary healthcare facility level. Given the complexity and enormous support required in implementing the Policy and the guidelines, this implementation support will be provided in a select district.  The specific objectives of this TA are as follows:

• Build capacities of the facility managers, PCMCs, and district level officials in facility level budget and expenditure management.
• Support the facility managers, PCMCs, and district level officials in developing budgets for primary healthcare facilities including preparation of facility level annual action plans and district health plan;
• Build capacities of the in-charges of Rural Health Centres (RHCs) and Category-D Hospitals with the necessary skills, knowledge, and resources to effectively perform their roles as Drawing and Disbursing Officers (DDOs).
• Support the DHOs in preparing financial statements and undertaking budget execution reviews; and
• Support DGHS and HSRU in undertaking budget execution reviews of the primary healthcare facilities. 

The TA will be instrumental in supporting DOH to effectively implement the Policy and guidelines, establish various routines and protocols associated with the implementation of the Policy, build requisite capacities, and adequately learn lessons and build foundations for further rollout.

The TA will support the DGHS and HSRU and in implementing the policy and guidelines for facility level budget and expenditure management in district Swat.  The TA Team will build upon the approved policy and guidelines and will support in operationalising the systems and conducting the activities as outlined in the subject policy and guidelines; i.e., budget planning and preparation, formulation of facility level budgets, establishing routines and protocols for expenditure management especially where the DDO powers are assigned i.e., the RHCs and Cat-D hospitals, formulating financial statements, and conducting budget execution reviews at various levels.  This will mainly be achieved through capacity building activities at various levels along with handhold support especially at the facility and DHO office levels. The team is also expected to work closely with the relevant development partners, especially the KP Spending Effectively for Enhanced Development (KP SPEED) to ally to facilitate the successful implementation of this TA. The scope of work is detailed below:

• Conduct an orientation session at the provincial level by engaging the officials of HSRU, FMC, DGHS, and the DHO and relevant officials of DHO office of district Swat.
• Develop a detailed implementation plan along with various milestones and notification of the same to all relevant authorities.

Checkpoint 1: Submission of an inception report summarising the outputs from the initial activities along with methodology, responsibilities, and timelines. This shall include a detailed implementation plan which shall be notified by DOH along with instructions for various officials at provincial and district level to smoothen the process of implementation of the policy and guidelines in the pilot district. Due Date: 02 weeks from the award of the TA.

• Conduct orientation sessions (03 session) at District Swat with officials of DHO office, BHUs, RHC and Cat-D hospitals and respective PCMCs on facility level budgeting and expenditure management policy and guidelines.   

Checkpoint 2: Report of the orientation sessions. Due Date: 06 weeks from the award of TA.

• Undertake a comprehensive HR reconciliation process to distribute the pooled HR within the existing budget codes (i.e., pooled budgets for BHUs, RHCs, and Cat-D hospitals respectively. It shall be noted that separate cost centres for each BHU, RHC, and Cat-D hospital have been created in the Integrated Financial Management Information System (IFMIS), however, these remain notional only and no expenditure transactions are carried out within any of these cost centres).
• The HR reconciliation process will include:
  • Acquire Sanctioned Posts for FY 2024-25 for respective district from Budget Officer VI of Finance Department
  • Obtain latest standard posts criteria for each health facility from DG Health 
  • Distribute BPS and Designation wise posts among concerned facilities (BHUs, RHCs & Cat-D Hospitals)
  • Collect Payroll data from District Accounts Officer (DAO)
  • Assign each individual employee to respective Facility based on Sanctioned Strength
• Conduct session at provincial level for identifying key performance indicators for the primary healthcare facilities which shall guide budget preparation at those levels.
• Conduct sessions with the facility managers to support in undertaking the needs assessment process, preparation of annual action plans, and preparation of budgets for their respective health facilities.
• Conduct sessions with the DHO office in undertaking district level needs assessment exercise and developing District Health Plan.

Checkpoint 3: Draft budgets submitted by respective health facilities to DOH for inclusion in the annual budget. Due Date: 16 weeks from the award of TA.

• Develop capacity building materials for the DDOs (RHCs and Cat-D hospitals) focusing on Delegation of Financial Power Rules 2018 and General Financial Rules 2019.
• Undertake capacity building sessions with the officials of the RHCs and Cat-D hospitals.

Checkpoint 4: Report of the Capacity building of the official’s pf RHCs and Cat-D hospitals.  Due date: 36 weeks from the award of TA.

• Support configuration of position codes in HR Module of IFMIS in respect of cost centres of BHUs, RHCs, and Cat-D hospitals.
• Support RHCs and Cat-D hospitals in developing customised books of accounts and other templates for sanctioning and incurring expenditures out of their designated cost centres.
• Provide handhold support to RHCs and Cat-D in exercising routines and protocols for incurring expenditures.
• Support the DHO office, RHCs and Cat-D hospitals in generating various financial statements as per the Policy and Guidelines.
• Support the DHO office, DGHS, and HRSU in undertaking budget execution reviews.

Checkpoint 5: Financial statements and budget execution review reports of District Swat. Due Date: 51 weeks from the award of TA.

• Develop a concept note on rolling out the facility level budget and expenditure management policy and guidelines across KP based on lessons learnt and capacities build during this TA.

Checkpoint 6: Concept note on strategic approach and methodology with detailed plan to rollout the policy and guidelines across KP. Due Date: 52 weeks from the award of TA.

Responsibilities

The Capacity Building Expert will work to achieve the following:

1. Inception Report with a detailed implementation plan
2. Capacity building materials focusing of delegation of power roles and general financial rules.
3. Report on facility level budgets extracted from IFMIS
4. Financial statements and budget execution review reports.
5. Concept note on rolling out the facility level budget and expenditure management policy across KP.

Timeline and Days

The level of effort (LOE) for the role is 40 working days, from Dec ’24 – Dec ‘25.

Requirement

Technical Expertise

• Knowledge of primary healthcare systems, facility-level operations, and budgetary processes to strengthen service delivery.
• Experience in preparing customized, context-specific training materials and tools for facility managers, PCMCs, and district-level officials.
• Proficiency in guiding health facilities on expenditure tracking, financial reporting, and compliance with financial rules.
• Skilled in translating policies and guidelines into actionable capacity-building initiatives for decentralized financial management.
• Experience working with government departments, health facility managers, and donors to ensure smooth implementation and buy-in.

Competencies

• Ability to lead capacity-building initiatives and mentor staff to enhance their financial and operational skills.
• Strong verbal and written communication skills to engage effectively with diverse stakeholders.
• Capability to assess training needs and design targeted capacity-building programs.
• Skills in evaluating outcomes and recommending improvements.
• Demonstrated ability to work collaboratively with cross-functional teams, including government officials, facility managers, and development partners.
• Focused on achieving tangible improvements in the financial management capabilities of healthcare facilities.