Senior STTA - IT Expert

KP TA - Strategic Support for NHSP

Programme Overview

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 overall goal of this technical assistance (TA) is to address critical operational gaps in training quality, referral mechanisms, and district-level planning, enabling the NHSP to achieve its DLIs and ensure fund flows for implementing prioritised RMNCH interventions under the EPHS, thereby delivering measurable improvements in primary healthcare services. TA will be focused on following specific objectives:

1. Develop and integrate competency-based assessment tools to measure provider performance across practical skills, clinical decisionmaking, and professional behaviours, along with their implementation mechanism, integrated with the Sustainable Training System (STS).
2. Design and operationalise a functional referral mechanism in five districts that can serve as a model for replication in other districts.
3. Conduct district-level evidence-informed  financial gap analysis and resource mapping using available Independent Monitoring Unit (IMU), District Health Information System (DHIS) 2 and other relevant data to enable the DOH to request optimal funding for NHSP implementation and service delivery in 10 districts from the finance department.

Strategic Approach 

Contributions to health systems strengthening

The TA will address key bottlenecks in KP’s health system by implementing competency-based workforce assessments, establishing functional referral pathways, and conducting evidence-based district planning through financial gap analyses. These interventions will institutionalise training, referral, and planning functions, ensuring the sustainability of EPHS delivery and UHC goals beyond the NHSP. Delivery of the TA will also focus on capacity building and skills transfer and as such, embedment of TA will be considered.

Alignment with other E4H TAs/investments

This TA builds on E4H’s support to the DOH in operationalising the STS, developing Continuous Professional Development (CPD) frameworks, and strengthening Monitoring and Evaluation (M&E). Competency-based assessment tools will link training quality to service outcomes, while the referral mechanism and district-level costing will reinforce health system integration and evidence-based planning. Overall, this catalytic NHSP collaboration builds on the E4H district-level TA focus.

Alignment with other donors (if relevant)

The NHSP will train master trainers to ensure routine use of the competency-based assessment tools developed under this TA. The referral mechanism will align with patient flow and service integration initiatives supported by the Global Alliance for Vaccines and Immunization (Gavi), the United Nations Children’s Emergency Fund (UNICEF), the World Health Organization (WHO), and immunisation programmes. Findings from the Financial Gap Assessment will inform district planning by NHSP, E4H, and partners, ensuring coherent provincial planning and consistent implementation of the EPHS at the district level.

Scope of Work and Methodology 

The TA will address three priority areas critical to achieving NHSP’s DLIs. The work will be implemented in close collaboration with the DOH, NHSP, and relevant partners.

1. Competency-Based Assessment Tools

The DOH in KP has established STS to address persistent skill gaps in healthcare workforce development. While progress has been made in standardising curricula and CPD frameworks, there is no robust system to assess practical skills, professional behaviours, and clinical decision-making. 

To address this gap, this TA will:

• Develop assessment tools for five NHSP-RMNCH training modules, including integrated management of newborn and childhood illness (IMNCI), family planning (FP), pregnancy, childbirth, postpartum and newborn care (PCPNC), and kangaroo mother care (KMC) and labour care. These tools will comprise cognitive (knowledge tests, case-based multiple-choice questions), psychomotor (objective structured clinical examinations, skills, simulation-based stations), and affective (structured behavioural observation) domains, aligned with CPD standards.
• Develop standardised scoring criteria, trainers’ instructions, trainee feedback templates, and complete mapping to training competencies, adaptable for both in-person and digital use.
• Integration with an M&E framework, including the development of performance indicators for each competency domain, templates, and tools for ongoing monitoring, feedback, and review.
• Digital integration of tools into the Provincial Health Services Academy’s (PHSA) STS training database. 
• Build capacity through training of master trainers and programme assessment coordinators on training assessment tools.
• Pilot testing in selected training programmes, incorporating structured feedback from trainers and trainees to refine and finalise the tools for full implementation.

2. Establishing a Functional Referral Mechanism (5 Districts)

The referral system in KP remains fragmented, with unclear pathways between primary, secondary, and tertiary facilities, limited coordination among providers, and no standardised tools to track patient referrals. These gaps contribute to delays in care, congestion at higher-level facilities, and disruptions in continuity of care—limiting the effectiveness of the NHSP’s service delivery objectives. 

To address this, the technical assistance will:

• Building on NHSP support in assessment, map the existing referral systems in the five prioritised districts, documenting patient flows, facility linkages, and bottlenecks, and consolidate the findings.
• Facilitate agreement on simple referral pathways between facilities—within districts and, where applicable, with neighbouring districts—based on time required to reach services.
• Provide support to the DOH in identifying and assigning referral focal persons at each facility and outlining their roles and responsibilities.
• Compile and circulate updated contact information for all referral focal points to strengthen communication between facilities.
• Provide technical inputs to adopt and implement a standardized referral form for all cases, ensuring completeness and consistency of patient information.
• Provide technical guidance on establishing a basic system (e.g., shared spreadsheet or DHIS dashboard) to record, track, and follow up on referrals.
• Utilizing existing efforts, such as the NHSP referral guidelines and the Primary Revamp Project, work with DOH, RMNCH, and NHSP to update referral guidelines and Standard Operating Procedures (SOPs) for Basic Health Units (BHUs) and Rural Health Centres (RHCs), and support their dissemination and orientation.
• Support DHPMTs in reviewing referral data, identifying gaps and challenges, and proposing solutions to address bottlenecks.

3. District-Level Financial Gap Assessment (10 districts)

District-level planning for the implementation of the EPHS in 10 priority districts under the NHSP is currently hampered by fragmented data on human resources, infrastructure, medicines, supplies, and financing. TA will support financial gap assessments to determine funding shortfalls for implementing the prioritized EPHS by:

• Using existing data from the IMU, District Health Information System (DHIS), Human Resource Management Information System (HRMIS), Health Facility Readiness Assessment by NHSP, and other MIS platforms to estimate the funds needed for implementing the prioritised RMNCH interventions of the EPHS.
• Developing district-level costing sheets to determine funding requirements, informing the implementation of prioritised EPHS. 
• Identifying and mapping fund flow streams from different sources for these prioritised interventions, including HCIP, NHSP, Primary Revamp, UN agencies, and others.
• Identifying financing gaps for the prioritised RMNCH interventions of the EPHS.
• Engaging district and provincial stakeholders to validate costing results and prioritise interventions.
• Developing final costing reports to guide the NHSP in planning. 
• Supporting NHSP in building a case for submission to the finance department for allocation of required funds.

Sustainability: Capacity Building, Institutionalisation, and/or Transition Planning 

• Capacity will be built within the NHSP PMU and MNCH sections of the DOH to manage and oversee the referral mechanism, including training of district referral focal points and orientation of facility staff.
• The PHSA will be equipped to manage and update the competency-based assessment tools through training of master trainers and assessment coordinators, ensuring integration into its training database.
• District-level financial costing methodologies will be institutionalised with the planning and budgeting processes.

Requests to World Bank

• The World Bank is requested to ensure that referral data is regularly captured in DHIS-2.
• One significant aspect of the referral process is the availability of transport to ensure timely transfers. While the current plan is to sign a MoU and utilize Rescue 1122 services, is there a plan by the DOH to provide subsidies, engage with private partners, or allocate funds for areas where Rescue 1122 services may not be fully available?
• Following the financial gap analysis, what is the DOH’s plan for utilizing the funds, and how can E4H support in ensuring their effective and efficient use?
• Ensure that the competency-based assessment tools are effectively utilized under the E4H sustainable training system technical assistance to DOH.
• The NHSP team should ensure access to information and resources, including all modules for which the competency-based assessment tool is to be developed. The NHSP team should also facilitate the E4H team in securing timely inputs from different stakeholders and ensure that the necessary information resources are available for the funding gap analysis.

Responsibilities

The IT Expert will work to achieve the following: 

1. Digitise competency-based assessment tools and integrate them into the NHSP/PHSA IT dashboard.
2. Ensure real-time monitoring functionality and compatibility with existing provincial health information systems.
3. Prepare technical documentation and user manuals for the digital module.

Timeline and Days

The level of effort (LOE) for the role is 15 days from August 25- October 25. 

Requirement 

Technical Expertise

• Bachelor’s or master’s degree in information technology, Computer Science, Health Informatics, or related field.
• Custom software and dashboard development for health sector applications.
• Data integration and interoperability standards
• User experience (UX) design for digital health tools.
• Cybersecurity and health data privacy compliance.

Competencies

• Translating user needs into functional digital tools.
• Clear technical documentation and training for end-users.
• Analytical troubleshooting under time constraints.
• Balancing innovation with stability and security in systems.