TORs: National Senior STTA – M&E Expert

Universal Health Coverage Implementation Roadmap in Khyber Pakhtunkhwa

Programme 

Evidence for Health (E4H) is a new 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 the Federal and Khyber Pakhtunkhwa (KP) governments and will subsequently operate in Punjab. The KP and Federal component is being implemented by Palladium along with Oxford Policy Management (OPM).

Through its flexible, embedded, and demand-driven model, E4H KP & Federal will support 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 will deliver TA across three outputs:

Output 1: Strengthened integrated health security, with a focus on preparing and responding to health emergencies, including pandemics.

Output 2: Enhanced capacity for 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.

E4H works in partnership with the Ministry of National Health Services, Regulations & Coordination (M/o NHSR&C) at the Federal level, and the Health Department in KP.

Background and Problem Statement

The Khyber Pakhtunkhwa (KP) Health Sector Strategic Plan (HSSP 2019-25) provides prioritised health strategies and proposes programmes to address the issues related to health status of the population and health system operations, achieving health related Sustainable Development Goals (DGs) and Universal Health Coverage (UHC), national priorities in health (as envisaged in National Health Vision 2016- 25), and international/regional commitments.

To advance in achieving UHC in KP, the Department of Health (DOH), KP started the Sehat Card Plus programme that gradually covered all people in the province. Furthermore, the UHC Benefit Package / Essential Package of Health Services (EPHS) was finalised in 2021, as a policy framework for UHC. EPHS implementation gaps at community and primary health care (PHC) level are being filled through the government financing and partners' support, mainly through World Bank (WB)'s National Health Support Programme (NHSP) and Human Capital Investment Project (HCIP). Additionally, the KP Health Foundation has rolled out public private partnership interventions to promote PHC services. Other small projects on UHC from development partners are also under implementation in KP. 

As a baseline, the UHC Service Coverage Index (SDG 3.8.1) was 36.2 in 2015, which has gradually improved to 51.1 In 2022, indicating 41.2% change In the Index since 2015 (the highest change observed among provinces). Though progress towards achieving UHC service coverage index is positive, the global target of 80+ is unlikely to be achieved in the province by 2023. The DOH KP wants to intensify its efforts and aims not only to enhance investment for UHC but also use available resources more effectively and efficiently, while ensuring effective monitoring.      

Despite multiple reforms and collaboration for UHC in the province, there is lack of cohesive alignment toward a comprehensive UHC implementation. Addressing this gap necessitates a unified approach that integrates these reforms cohesively, providing a consolidated and strategic direction for UHC reforms in the province. To address this gap, a UHC roadmap is crucial—a comprehensive, integrated approach that centralises and prioritises these reforms to offer a holistic and strategic direction for improving implementation across the province.

Specific Objectives

The main objectives of the development of UHC roadmap are:

• To quickly review the status of UHC in the province for a brief situation analysis for the roadmap, along with issues and challenges; 
• To engage key stakeholders both in public sector and partners to develop understanding on the strategic and programmatic priorities along with mapping for UHC investments and plans;
• To hold consultations/ workshop with stakeholders to define specific, measurable, achievable, relevant, and time-bound (SMART) objectives for UHC progress in the province along with strategic priorities and actions along with monitoring mechanism and budgeting (required and available);
• To prioritise actions related to the delivery of an essential package of health services, with availability of essential health workforce, strengthening of supply side systems, access to essential medicines and strengthening of the governance mechanism;
• To prioritise the implementation of UHC reforms while considering availability of financial resources and expected new resources. 

Scope of Work

• The consultants are anticipated to be embedded within the DOH to both minimise implementation risks and strengthen the capacity of selected DOH staff. Efforts will be made to actively enhance the capabilities of selected DOH staff, with the goal of empowering them to independently manage the TA post-handover and completion. They will be tasked to deliver the following scope of work:
• The team will start with reviewing local and international evidence on UHC-linked reforms, analyses, and assessments, including but not limited to UHC strategies and roadmaps from other lower-middle income countries, to develop a theoretical underpinning for the roadmap;
• The team is expected to review the documents which include but are not limited to reforms being undertaken, KP EPHS, UHC monitoring report 2023, and the Pakistan Status of Health Financing Report, UHC Index to gain a deeper understanding of the current situation, initiatives contributing to UHC, status of health financing, and review institutional functions, mechanisms and structure.
• Guided by the literature review, proceed with a thorough review of current initiatives. Align these investments with different service delivery platforms, clusters , and prioritised interventions in the KP EPHS.  Map these initiatives to the public sector (development and current) and partners supporting these interventions and ensure their alignment within these domains (this may include phasing of districts for additional financing for UHC interventions);
• Collaborate with development partners, donors, global health Initiatives, and government stakeholders including the KP Health Foundation and KP Health Care Commission etc., during the process. It is crucial to interact with the Planning and Development (P&D) and Finance departments to gain more clarity and understanding;
• Develop a draft UHC roadmap with a clear approach and framework and develop consensus with stakeholders;
• Drawing from the review and consultations, the team will highlight challenges across service delivery, financial management, monitoring and evaluation, policy, and governance. The effort will result in a UHC roadmap based on existing /anticipated resources including a prioritised phased plan of implementation, which will be presented and revised based on feedback from government partners, finance, P&D, donors, and development partners. The UHC roadmap strategic plan will be linked clearly with annual recurrent and developmental planning of the Department of Health;
• Suggest the way forward including the development and implementation of district action plans for the phased implementation of UHC, in the case of financial constraints. Embed adaptability in the roadmap to respond to new developments and mitigate risks effectively;
• Create a robust monitoring and evaluation framework encompassing specific indicators and benchmarks;
• Detail the resource requirements and potential partnerships necessary for the implementation of the UHC roadmap;
• Guide short, medium, and long-term UHC planning for the DOH, with the HSRU as a focal point.
• Create a robust monitoring and evaluation framework encompassing specific indicators and benchmarks;
• Detail the resource requirements and potential partnerships necessary for the implementation of the UHC roadmap;

Guide short, medium, and long-term UHC planning for the DOH, with the HSRU as a focal point.

Deliverables:

The team of consultants responsible for this assignment is expected to diligently work towards the completion of the deliverables outlined in the project scope.

Timeline and LOE

The level of effort for the role is 15 working days, from February 2024 to July 31, 2024

Requirement

• Understanding of results-based M&E systems, encompassing indicators, data collection, analysis, and reporting for informed decisions.
• Expertise in data handling, validation, and analysis using statistical tools, ensuring accurate insights for programme assessment.
• Familiarity with diverse evaluation methods such as impact assessments, process evaluations, and cost-effectiveness analyses.
• Capacity to collaborate with stakeholders to enhance programme design using M&E insights, driving evidence-based improvements.
• Strong analytical skills for data interpretation, pattern recognition, and performance assessment.
• Effective communication to convey key findings, insights, and recommendations to diverse stakeholders.
• Ability to design and implement data collection systems, ensuring accuracy and reliability.
• Skilled in translating M&E results into actionable strategies for programme improvement.