Senior National - Monitoring, Evaluation, and Learning (MEL) Expert

KP TA: District Health Office Reform for Improved Governance

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 goal of this technical assistance is to strengthen and restructure DHOs to ensure they are adequately equipped, governed, and capacitated to implement provincial health reforms and deliver on commitments to PHC, UHC, and IHR. By addressing governance and institutional gaps, the technical assistance will enable DHOs to effectively translate provincial policies and investments into improved health outcomes at the provincial level.

We will achieve this by pursuing four objectives:

Objective 1: Review and analyse the current structures, functions, and financing arrangements of DHOs to identify governance, accountability, and capacity gaps, as well as opportunities to optimise existing resources.

Objective 2: Design and propose a restructured DHO model that strengthens governance, clarifies roles, and aligns with provincial, national, and international health commitments (PHC, UHC, IHR).

Objective 3: Build the capacity of DHOs to implement reforms effectively, with a focus on service delivery, public health functions, data management, M&E, planning, coordination, financial management, and accountability.

Objective 4: Support institutionalisation and sustainability of the restructured model within the health system to ensure long-term impact and efficient use of public investments.

Strategic Approach

Contributions to health systems strengthening

In KP, a critical bottleneck has been the limited capacity of districts to operationalise provincial health policies and reforms. Despite significant investments in PHC, digitalisation, and health policy revision, weak governance structures at the district level constrain implementation and accountability. This TA directly addresses that challenge by restructuring DHOs to strengthen governance, clarify mandates, and optimise the use of existing resources. By doing so, it equips KP’s districts to more effectively deliver on provincial reforms and commitments to PHC, UHC, and IHR, thereby moving the province toward a more accountable, resilient, and citizen-responsive health system.

Alignment with other E4H TAs/investments

This technical assistannce is closely aligned with E4H’s wider portfolio in KP, including support for District Action Plan (DAP) development, the Facility-Level Budgeting (FLB) pilot and its expansion, and ongoing assistance for district-level health system strengthening. Each of these technical assistances depends on adequate and well-structured DHOs to sustain results and institutionalise reforms. The technical assistance also responds directly to the recommendations of the Universal Health Coverage (UHC) Roadmap, which call for stronger district governance to operationalise PHC and UHC reforms. By providing the structural foundation, this technical assistance ensures that E4H’s existing and future investments — including embedded support to Health Sector Reform Unit (HSRU) — are effectively implemented and sustained at the district level.

Alignment with other donors (if relevant)

This technical assistance will align with the work of other development partners, particularly around the strengthening of DHOs. By strengthening district health governance and structures, it will also pave the path for donor-supported reforms and implementation in districts, ensuring investments are coherent and sustainable.

Scope of Work and Methodology

This technical assistance will focus on restructuring DHOs to ensure they are adequately governed, resourced, and capacitated to implement provincial health reforms and commitments to PHC, UHC, and IHR. The work will build on existing provincial investments and E4H support, addressing institutional gaps that currently constrain district-level planning, accountability, and service delivery. The technical assistance will be delivered through a systematic and phased approach, combining technical analysis, stakeholder engagement, and capacity-building:

Diagnostic Review – Assess the current structure, functions, and financing of DHOs, including reporting lines, accountability mechanisms, and resource utilisation.

Situational Analysis & Stakeholder Consultations – Engage HSRU, Director General Health Services (DGHS), provincial, and district stakeholders to validate findings, identify reform priorities, and ensure alignment with provincial strategies and donor initiatives.

Design of Restructured Model – Develop options for an evidence-based DHO structure that strengthens governance, clarifies mandates, and integrates financing and accountability measures; ensure proposals are aligned with UHC Roadmap recommendations.

Validation & Consensus-Building – Present the proposed model to provincial and district stakeholders through consultative workshops and refine based on feedback.

Capacity Building & Change Management – Provide tailored support and training to DHOs to operationalise the new structure, with an emphasis on governance, planning, and financial management.

Sustainability & Institutionalisation – Support integration of the restructured model into provincial frameworks to ensure long-term adoption and pave the way for donor-supported reforms at the district level.

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

1. As outlined in the methodology, this technical assistance includes training and mentoring of DHO staff to strengthen governance, planning, and financial management functions. Capacity-building activities will be embedded within the reform process to ensure DHOs can independently sustain new roles and responsibilities.
2. The restructured DHO model will be validated and formally endorsed through provincial channels (DGHS/HSRU), ensuring reforms are embedded within government systems rather than external parallel structures. This institutionalization will safeguard continuity and ownership beyond the life of the TA.
3. To promote sustainability, the TA will include a transition plan that clearly sets out how responsibilities will shift fully to government counterparts, including phased handover of tools, guidelines, and processes. This will enable DHOs and provincial oversight bodies to maintain momentum after E4H support concludes.

Responsibilities

The Monitoring, Evaluation, and Learning (MEL) Expert will work to achieve the following:

1. Inception Report
2. Diagnostic Assessment Report
3. Proposed Restructured DHO Model
4. Validation & Final Report

Timeline and Days

The level of effort (LOE) for the role is Maximum 30 days from October 2025 – June 2026.

Requirement

Technical Expertise

• Master’s degree in public health, Development Studies, or related field.
• 15+ years of experience in developing monitoring and evaluation frameworks, institutional performance measurement, and health systems strengthening.
• Managed and implemented donor-funded health and development projects, contributing to district-level health service delivery and governance strengthening.

Competencies

• Strong data analysis and interpretation.
• Adaptive learning and continuous improvement.
• Excellent reporting and documentation skills.