E4H Punjab TA: Revision of Punjab Infectious Disease Act (2020) as Punjab Public Health Act 2025

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 (2023–2027) provides technical assistance (TA) to Punjab, Federal, and KP governments, implemented by Palladium in partnership with Oxford Policy Management (OPM).

Through its flexible, embedded, and demand-driven model, E4H supports governments to achieve a resilient health system that is prepared for emergencies, responsive to 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

• Worldwide, public health systems are confronted with an increasing burden of disease, including emerging and re-emerging infectious diseases and potential hazards, including chemical, radio-nuclear, and food safety aspects. These factors have led to a considerable rise in preventable morbidity and mortality, particularly in low- and lower-middle-income countries.
• Over the past two decades, Pakistan has experienced frequent disease outbreaks and public health emergencies, including the COVID-19 pandemic, which have exposed gaps and highlighted the urgent need for health systems towards better preparedness and effective response. This requires a robust legal and institutional framework to effectively manage emerging and re-emerging disease threats and hazards in Punjab. The Joint External Evaluation (JEE) Report (2023) has reported low scores for legal instruments both at the national and provincial levels, underscoring the need for in-depth analysis and development/revision of a comprehensive legal framework. The proposed framework must address critical health security challenges, including surveillance and response for outbreak-prone emerging and re-emerging infectious diseases, as well as health emergencies.
• While the Punjab Infectious Diseases Act 2020 provides effective institutional mandates for enforcement in relation to disease control, its scope remains limited to the management aspects of the epidemic only. Notable gaps include a lack of routine disease surveillance structures, a one health approach, multisector coordination, human resources for health, public health laboratories, antimicrobial resistance, and insufficient provisions for data sharing with the IHR focal point.
• After the analysis of nationwide public health laws, conducted by the Evidence for Health (E4H) Programme at the federal level, there is a further need to have an in-depth analysis of the Punjab Prevention and Control of Dengue Regulations 2011  and the Punjab Hepatitis Act 2018 to merge them within the overarching Punjab Infectious Disease Act 2025/26. The Punjab Prevention and Control of Dengue Regulations 2011, framed under the Epidemic Diseases Act 1958, set a precedent for operationalizing disease control through multi-sectoral coordination. Similarly, the Punjab Hepatitis Act 2018 establishes a legal framework for surveillance, diagnosis, treatment, and prevention of Hepatitis through regulatory oversight. 
• Recognizing these challenges, the Health and Population Department (H&PD) of the Government of Punjab has prioritized legislative reforms to strengthen its core health security capacities. The E4H Program is supporting the H&PD with technical assistance (TA) to enhance Punjab’s legislative and institutional framework by revising various laws and drafting a comprehensive, single legal framework focused on improving provincial health security.

Problem Statement

Public health legislation in Punjab is fragmented across vertical programmes, Universal Health Coverage (UHC) and emergency management like control of dengue, blood borne hepatitis, among others. No single act exists to provide legal backing for the comprehensive prevention and control of communicable diseases, health emergencies, and the implementation of the IHR. There are significant legislative gaps to address in order to comply with relevant IHR core capacities and strengthen provincial health security standards.

Objectives

The overall objective of this TA is to strengthen the legal and institutional framework for provincial health security in compliance with IHR core capacities relevant to the provincial level.

Specific Objectives

• To analyse and identify legal and operational gaps in existing health sector legislation encompassing health security.
• To draft an updated, comprehensive legislative framework that strengthens integrated, one-health-based surveillance, preparedness, and efficient multisector emergency response across the province.
• To provide a legal basis and statutory support for implementing the NAPHS (Punjab operational plan) in the relevant IHR technical areas, thereby strengthening the preparedness and response of health systems.

Strategic Approach

Contributions to health systems strengthening

At the national level, this TA complements the NAPHS vision, including a five-year operational plan for Punjab, ensuring that Punjab’s legal and institutional structures are harmonised with federal emergency preparedness and response protocols. IHR is an integral part of the WHO General Program of Work 14 (2018 -27) agenda endorsed by the World Health Assembly and national standards aimed at providing a consolidated legal framework to strengthen public health systems, evidence-based decision-making, and health security preparedness.

Alignment with other E4H TAs/investments

The Evidence for Health (E4H) Programme supports Output 1 by advancing key governance reforms and institutionalising multisector IHR coordination mechanisms at the provincial level. The TA aligns with concurrent and ongoing support for simulation exercises, capacity building of senior managers on IHR as well as with the meeting of the technical working group (TWG) on IHR in Punjab. It is also closely linked to the strategic goals outlined in the broader Punjab Universal Health Coverage (UHC) Roadmap, particularly those relating to public accountability, system interoperability, and legal oversight of epidemic surveillance and response.

Alignment with other donors

TA is clearly aligned with SDG 3, targets 3.3 (AIDS/TB/Malaria), 3.8 (UHC), and 3.d (early warning systems), drawing upon the WHO Benchmarks for IHR Core Capacities, particularly those related to legislation, coordination, and emergency response. It also contributes to ongoing efforts under the National Health Support Programme (NHSP-PforR), specifically Disbursement-Linked Indicators (DLIs) to improve vaccination (DLI-5) monitoring and accountability mechanisms across primary healthcare (DLI-10). The TA will support consultations with UKHSA as well as the Fleming Fund to achieve legal synergy on integrated surveillance and One Health avenues within the IHR monitoring and evaluation framework.

Scope of Work and Methodology

This TA will be implemented through five phases with flexibility to accommodate contextual developments.

Phase 1: Inception and Situational Analysis

• Conduct an inception meeting with H&PD, DGHS, CD&EPC, and stakeholders from relevant institutions to agree on scope, timelines, and coordination mechanisms.
• Review the Punjab Infectious Diseases (Prevention and Control) Act (2020), Calamities Act, Hepatitis Act, the Punjab Prevention and Control of Dengue Regulations, and the PHCC Act 2010, and other federal/provincial laws related to public health emergencies, such as the Sindh Epidemic Diseases Act 2014 and  Khyber Pakhtunkhwa Epidemic Control and Emergency Relief Act, 2020
• Review the results from the E4H E4H-supported scoping study of nationwide health sector legal frameworks.
• Map institutional roles, enforcement gaps, and reporting systems.
• Identify national and global best legislative practices to inform revisions.

Phase 2: Stakeholder Consultations and Gap Assessment

• Facilitate key informant interviews and focused group discussions with public health professionals, legal experts, district health managers, and CSOs
• Assess regulatory and procedural bottlenecks in the enforcement of communicable diseases prevention laws
• Align benchmarking with the IHR core capacities applicable at the provincial level.
• Analyse coordination challenges, SOP availability /adherence, and data governance issues.
• Engage stakeholders from various health intersecting departments, including animal, food, and environmental.

Phase 3: Drafting of Legislative Framework

• Prepare a comprehensive draft legal framework by merging the insights from the consultations mentioned above, with an improved legislative framework that focuses solely on including relevant areas from prevention, detection, and response, while meeting international standards under the IHR and JEE recommendations.
• Ensure provisions covering emergency declarations, clarity on roles and responsibilities, gender and equity safeguards, data sharing, and digital integration.
• Include all relevant provisions for various infections that have one or more modes of transmission, including zoonotic spillover.
• Conduct peer review and legal vetting with relevant competent authorities.

Phase 4: Validation and Consensus Building

• Organise a validation workshop to present, review, and refine the proposed legal framework.
• Capture stakeholder feedback and document areas of consensus or those requiring further discussion.
• Develop a succinct legal brief and institutional roadmap for final tabling and implementation of the Act.
• Validate the draft act through the IHR coordination forum.

Phase 5: Finalisation and Capacity Strengthening

• Finalise the legislation and prepare user-friendly implementation guidelines for field and legal teams.
• Recommend practical steps for operationalisation.
• Submit a final technical report, legal framework, and conclusion deck along with an operational roadmap to support policy endorsement and roll-out.

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

Revision and confluence of the existing public health legislation into a single comprehensive legislative framework is a significant initiative and support to the Government of Punjab in aligning its health security vision with IHR (2005). The draft act will address all the provincial-level core capacities under the thematic pillars of IHR. This will enable the health sector to better prevent and respond to emerging threats through strengthened routine, integrated disease surveillance, and effective management of untoward events.

Designated focal points from both health departments will be actively engaged in the process. Once the draft Punjab Public Health Act 2025 is handed over to H&PD, the department will proceed with the legislative process through the law department, the Punjab Assembly, and the provincial cabinet, post TA. After the provincial cabinet approves the act, the Governor of Punjab will notify it, which shall come into force immediately.

Deliverables

1. Succinct Inception Report & Slide deck
2. Report on Stakeholder Consultations
3. Draft Legislative Framework
4. Final Legislative Document and Succinct Legal Brief
5. Conclusion Report and Final Presentation

(Note: TORs subject to change)

One Health Expert (Senior National)

• LOE: 50 days 
• Period: 5 months

Role Requirements
Provide technical expertise during stakeholder consultations and legislative drafting. Support the integration of One Health-related core capacities—including zoonotic diseases, AMR, public health laboratories, food security, and IPC—into the revised legal framework.

Technical Expertise
Postgraduate degree in Public Health or relevant/equivalent degree. Background in veterinary sciences will be acceptable. Minimum of 15 years of overall experience – and experience working with veterinary, livestock, food, and environment sectors will be preferable. Experience with provincial-level advocacy and policy development will be preferred either at government or development sectors.

Core Competencies
Planning and delivering work; Analysis and use of information; Strategic thinking; Team working skills; Conflict management; and fluency in computer-adaptive working to produce efficient results.

Deliverables
Same as above.