Introduction

The Fleming Fund (FF) is a U.K. Department of Health and Social Care programme to help low and middle-income countries fight Antimicrobial Resistance (AMR). AMR poses a severe global threat, expected to cause 10 million deaths annually by 2050. With potential costs reaching $100 trillion, its impact on the global economy is significant. Fleming Fund Grants aim to tackle the AMR challenge in developing countries including Pakistan. The grants are funded by the UK Department of Health and Social Care and managed by Mott MacDonald for the country, regional and fellowship grants. Pakistan has received Fleming Fund support since 2019 in the form of two Country Grants, 9 Fellowships, and central and local procurement of equipment, reagents, and consumables. Between 2017 and the end of phase-1 of the program in March 2023, the program has provided financial support to grantees to establish and support local development of national AMR surveillance systems.

In partnership with the Fleming Fund, DAI's programme in Pakistan collaborates with the Pakistani government to strengthen systems using a “One Health” (OH) approach – a multisectoral approach to complex health problems that reaches across human health, animal health, and environment sectors. As global leaders in One Health, the DAI team helps incorporate One Health across programme interventions. DAI is helping Pakistan become a leader in combating antimicrobial resistance, and a model for better management of antimicrobials in human and animal populations. DAI and its consortium partners have successfully secured an additional round, Phase 2, of the Fleming Fund Country Grant in Pakistan which spans from January 2024 to December 2025. The Phase 2 of the FFCG programme focuses on achieving four intermediate outcomes: 1) Production of quality AMR/U/C and burden of disease data; 2) Conducting quality data analysis; 3) Sharing quality data analysis with decision-makers; and 4) Contributing to sustainable investments at both the country and global levels to counter AMR.

Introduction

Antimicrobial Resistance (AMR) poses a severe global threat, expected to cause ten (10) million deaths annually by 2050. With potential costs reaching $100 trillion, its impact on the global economy is significant. In Pakistan, unchecked antibiotic use and institutional deficiencies contribute to drug-resistant bacteria.

In partnership with the relevant stakeholders from Government of Pakistan and development partners, the Fleming Fund Pakistan collaborates to strengthen AMR containment efforts using a “One Health” approach – a multisectoral approach to complex health problems that reaches across human health, animal health, and environment sectors.

Pakistan’s National Action Plan (NAP) for the containment of AMR 2017 – 2022 successfully guided the country’s efforts over the past five years. The 2023 Joint External Evaluation of IHR core capacities recommended to update the AMR NAP. Subsequently, a multi stakeholder Technical Working Group was established to oversee the process of NAP revision. Through a collaborative process, involving all stakeholders, Pakistan has finalized its AMR NAP for the period of 2024-2028.

Pakistan’s AMR NAP for 2024-28 aims to achieve 6 priority objectives with intervention streams and specific activities for each of the OH sectors with broad allocation of responsibilities for federal and provincial levels. The NAP has a detailed Operational Plan and a framework for monitoring and evaluation. The consultant(s) will be required to determine cost estimates for each activity of the AMR NAP, including the costs required for implementing the M&E plan of the NAP using WHO costing and budgeting tool for NAP. The Ministry of National Health Services, Coordination and Regulation has also completed a National Action Plan for Health Security (NAPHS) with costing. Since AMR is part of the GHS technical areas, the AMR NAP will also align this costing with NAPHS.

Purpose of the Assignment
As a next step to ensure proper implementation of the National Action Plan, the National Institute of Health (NIH) in its capacity as the One Health lead and focal point in Pakistan, in collaboration with other sectors require detailed costing of the entire NAP activities. Fleming Fund Country Grant Pakistan will provide support for the NAP costing process.

The primary purpose of this assignment is to facilitate the development of a comprehensive and actionable NAP costing based on WHO costing and budgeting tool for NAPs on AMR and finalize readiness checklist which will support the government in estimating the required funding and map the gap between the existing support and the required costs. As such, we expect this technical assistance to be highly collaborative and the resultant costing to support the following in their role of ensuring successful implementation of the NAP:

• Policy Level Actors: Understand AMR specific and AMR related fiscal arrangements in place, gaps in NAP funding, and advocate for additional financial resources,
• Implementing Entities: Accurately plan and execute activities related to AMR surveillance and containment.

Assignment Scope of Work (SoW)
Fleming Fund Country Grant will engage a team of experts who will work with the TWG to estimate the finances for the implementation of NAP 2024-28 across all the four sectors (human health, animal health, food, and environment).
The exercise will provide in-depth and accurate estimates of the financial resources needed to execute the AMR-NAP at the national and provincial levels. The costing will be aligned to government funding cycle.
Considering the basic requirement of employing collaborative and participatory methodologies, the team of consultants will be required to discuss and confirm the scope of the analyses, cost estimates, scheduling, and details of the actions with the Technical Working Group established for the review of AMR NAP, who will guide and oversee the costing process. The consultant(s) will also work closely with the Multistakeholder AMR Steering Committee in MONHSR&C, AMR focal persons from the NIH, MoNFS&R and MoCC/MoWR, Fleming fund Country Grant Pakistan, and WHO/FAO regional and in-country experts.

Applicants are expected to highlight their relevant experience and expertise for the assignment in alignment with the following broad guidance:

1. The AMR National Action Plan 2024-2028 envisages significant involvement of the players from human health, animal health (including veterinary, poultry, and aquaculture sectors), and environment.
2. Key actors who will play a pivotal role in providing the required support include NIH, Animal Husbandry Commissioner, PCRWR, DRAP, WHO, FAO, MoNHSR&C, and MOCC at the Federal level and their Provincial counterparts.
3. Besides the costing of NAP implementation, the consultants will also be expected to obtain and analyse existing government funding (PC-1s and Recurrent Budget) and support from various development partners for AMR. Moreover, a mapping of funding allocated for closely linked initiatives like UHC, Global Fund, GHSA NAP, and EPI programmes will be conducted to ascertain the current levels of investments and calculation of funding gaps.

Deliverables
The final products of this assignment will include:

1. An inception report detailing agreed methodology along with a work plan,
2. A validation workshop with stakeholders after the data gathering and analysis is completed,
3. A narrative report documenting the methodology, findings, analysis, and use of the information gathered during the exercise and
4. Detailed costing worksheets of unit costs and aggregate costs in a format that allows use of the information by sector, institution, administrative level, and theme.
5. Detailed narrative of the assumption used for the costing exercise.

During the inception phase of the assignment, the selected consultants will work together and with relevant stakeholders to finalize their respective responsibilities, methodologies, coordination plans, and timelines.

Required Qualifications:

1. Postgraduation in Human Health, Animal Health, Environmental Health, Public Financial Management, or other relevant fields.
2. Minimum 5 years of experience in One Health disciplines at a senior level.
3. Experience in developing strategic frameworks or guidelines or their costing.
4. Strong knowledge of OH, Global Health Security, and AMR approaches and financing mechanisms in Pakistan.
5. Data analysis, presentation and report writing skills.

Timeframe / Duration
The final approved costing document should be available by end of March 2025.
Application Process
Interested candidates should submit the following by 15th December 2024:

1. Cover letter highlighting a) relevant experience, achievements, and suitability for the role, b) Confirmation of availability for the consultancy duration, and c) Expected remuneration, clearly stated.
2. Updated CV with academic qualifications, professional experience, and references