Senior National - Health System Expert

FED TA: Exploratory Study on Innovative Financing in the Health Sector of Pakistan

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 objective of this technical assistance is to identify, evaluate, and prioritise innovative financing mechanisms that can generate sustainable and equitable resources to bridge Pakistan’s health financing gap and accelerate progress toward UHC.

Specific objectives are to:

• Undertake a succinct review of Pakistan’s macroeconomic and policy environment and health financing architecture, systematically mapping critical gaps across resource generation, pooling, purchasing, governance, and PFM.
• Develop and evaluate a menu of feasible, evidence-based, and contextually relevant innovative financing mechanisms tailored to Pakistan’s health sector needs and priorities.
• Design a strategic, phased implementation roadmap outlining policy actions, institutional arrangements, and capacity requirements for integrating and scaling up the prioritised innovative financing mechanisms.

Strategic Approach

Contributions to Health Systems Strengthening: This scoping study is primarily aimed at enhancing the core building blocks of Pakistan's health system, specifically health financing, leadership, and governance functions. By identifying viable mechanisms to increase and improve the flow of financial resources, the study will directly contribute to a more resilient, equitable, and efficient health system. 

Alignment with other E4H TAs/Investments/National Standards:  The study’s foundation will be Pakistan’s key strategic documents, including the draft National Health Population Policy (NHPP) 2025-34, and the draft National Health Financing Framework. 

Alignment with other donors (if relevant): No direct financing from different development partners is foreseen in this TA. Key stakeholders, including the WHO, UNICEF, Global Health Initiatives, World Bank, Asian Development Partners, US State Department, and others, will be consulted throughout the process to ensure ownership and sustainability.

Scope of Work and Methodology

The development of the specialised course will be evidence-based, collaborative, and practical. The technical approach will include:

Desk Review: Examine global and regional literature on innovative health financing models, Pakistan’s macroeconomic and fiscal reports (Economic Survey, Budget documents), national health policies (draft NHPP 2025-34, draft National Health Financing Framework), climate policies (Carbon Markets Guidelines), and relevant laws and regulations. The review will include an assessment of existing policies, incentives, and barriers including those related to effective private sector participation.

•  Consider various health financing Innovations, including but not limited to:
•  Sin Taxes/ Health Levy’ and robust Earmark Enforcement mechanisms
• Domestic resource mobilisation (Federal, Provincial, and District)
• Sovereign Healthcare Sukuk bonds for sustainable health financing
• Multilateral Climate Financing
• PFM efficiencies and real-time expenditure tracking, along with ‘Pooling’ of financing reforms for integrated health financing 
• Aggregate corporate social responsibility (CSR) contributions into a central pooled health fund managed jointly by Zakat & Waqf institutions and/or other Ministries/Departments working on health initiatives
• Ethical health financing mechanisms, including Islamic endowment funding (Waqf), Zakat-based health funds, Shariah-compliant microfinance, and impact investing, are aligned with Environmental, Social, and Governance (ESG) principles
• Partnerships with philanthropists for the provision of essential health services provision
• Health trade (goods, services, and workforce) at the bilateral level, and exploring opportunities for medical tourism 
• Evidence-informed ‘best buy’ interventions from the private sector
• Enabling regulatory frameworks to facilitate private sector resource generation through stock exchange listings for hospitals.
• Innovative engagement with donors and lending agencies, including debt swaps for health investments.
• Performance-based donor co-financing models
• Strategic purchasing of PHC services with result-based co-financing modalities
• Financing reforms in the health insurance / SSP
• Diaspora-Government matching grant schemes
• Municipal Health Service Contracts
• Community-Based Health Savings Groups
• Public Land Lease models of health facilities
• Digital Health Innovations, including the telehealth revenue cross-subsidy through documentation
• Other emerging innovative financing options were identified during the process.

• Stakeholder Mapping and Consultations: Conduct extensive consultations with key stakeholders including the Mo/ NHSR&C, Ministry of Finance, Federal and Provincial Boards of Revenue, Ministry of Climate Change, Provincial Health and Finance Departments, State Bank of Pakistan (SBP), Securities and Exchange Commission of Pakistan (SECP), selected Local governments leading health economists, Islamic finance institutions, development partners, private sector representatives, and civil society organisations.
• Multi-Criteria Analysis: Analyse the options based on the following (but not limited to) options:
  • Revenue Potential: Scale and sustainability of funds generated.
  • Feasibility: Preliminary assessment of financial, operational, and political feasibility of options/ models under review.
    • Equity: Impact on financial protection for the poor, women, and vulnerable groups.
    • Efficiency: Potential to reduce waste and improve resource utilisation.
    • Speed of Implementation: Time required to launch and see results.
    • Ethics: Alignment with ethical, social, and religious principles to ensure legitimacy and public acceptability
    • UHC: Consistency with national and provincial UHC strategies to ensure policy coherence
  • Final Consultation: Present the draft findings, prioritised options, and strategic pathways to a broad group of stakeholders for validation and feedback.

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

Focal Point: Nominated by the Director General (Health) and the Director Programmes, along with other relevant staff of the Ministry of NHSR&C, DOHs will be actively engaged, where possible, in the activity for capacity development.  

Capacity Building: The study process itself will be a capacity-building exercise for key government counterparts. This will not be an extractive consultancy but an engaged, collaborative process.

Institutionalisation: The goal is to embed the findings and recommendations within the government's own policy and planning cycles.

Transition Planning: The final report will be a practical, user-friendly report and will be formally handed over to the Mo/ NHSR&C.

Responsibilities

The Health System Expert will work to achieve the following:

1. Inception Report
2. Draft Report on Scoping Study
3. Final Scoping Study Report with strategic pathways of prioritised options

Timeline and Days

The level of effort (LOE) for the role is Maximum 72 days from Nov 2025 – Apr 30, 2026.

Requirement

Technical Expertise

• Postgraduate in Public Health or relevant field.
• 15+ years in Health service delivery and health systems.

Competencies

• Analysis and use of data, Teamwork and Communication Skills, ability to engage with diverse sectors.