TORs: National STTA –Research Associate

Establish a functional governance mechanism to oversee the execution of National Action Plan for Health Security (NAPHS) recommendations in Khyber Pakhtunkhwa

Programme Overview

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 information systems and 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.

Introduction

The Evidence for Health (E4H) programme, funded by the Foreign Commonwealth and Development Office (FCDO), strives to enhance Pakistan's healthcare system, reducing the disease burden and saving lives. E4H employs a flexible and demand-driven approach, offering technical assistance to the Khyber Pakhtunkhwa (KP) and Federal governments. The programme's three output areas focus on building a resilient health system that is well-prepared for emergencies, grounded in the latest evidence, and capable of delivering equitable, high-quality healthcare services to improve the implementation of Universal Health Coverage (UHC).  The Technical Assistance (TA) areas are determined through collaborative discussions with the Department of Health (DOH) and subsequently endorsed by the project's steering committee for implementation. The assistance being proposed in this area aligns with the programme's output 1. 

Background

KP is prone to multiple natural and man-made disasters, including those triggered by climate change. The province has initiated efforts to comply with International Health Regulations (IHR), preparedness and response to natural disasters, epidemics, and health emergencies. KP has also developed and established an Integrated Disease Surveillance and Response System (IDSRS), as prioritised after the first Joint External Evaluation (JEE) report and National Action Plan on Health Security (NAPHS)- version 1. During the recent COVID-19 pandemic, the province developed and temporarily deployed governance mechanisms and information systems to respond effectively health security challenges. However, the DOH still faces many governance and coordination challenges due to verticality and system fragmentation. Additionally, intersectoral coordination for 'one health approach' is a significant challenge, particularly in complex issues that require policy and programmatic actions involving other relevant departments to address health.

Problem Statement

• KP is vulnerable to climate change impacts, epidemics, and pandemics and frequently experiences natural disasters such as earthquakes and floods.
• Inadequate inter-sectoral and intra-sectoral coordination hampers the health system's efficiency and responsiveness to natural and man-made disasters, epidemics, and pandemics and resilience in addressing health risks.
• Over the decades, different development initiatives have introduced verticality and fragmentations, leading to siloed actions and disconnects within different parts of the system, resulting in governance challenges. Additionally, several issues stem from disjointed International Health Regulations (IHR) coordination mechanism in the province.
• These challenges have resulted in inefficiencies, disjointed responses, a lack of adaptable management during emergencies and outbreaks, and insufficient proactive response measures.
• Furthermore, this has resulted in insufficient policy and planning actions within the health system and across sectors, ultimately compromising the resilience and efficiency of the response efforts

Specific Objectives

The TA aims to assess the existing KP health security arrangement at the provincial and district level. It will adopt governance recommendations from NAPHS and then operationalise a unified governance and coordination mechanism to address inefficiencies in the health system and enhance policy and programme planning, making it more efficient and responsive. The ultimate objective is to establish a resilient health system that can effectively and efficiently prepare for and respond to emergencies, epidemics, pandemics, and the health effects of climate change. 

Scope of Work and Methodology

As a part of this TA assignment, the team will cover the following scope of work:

1. As a part of the literature review, the team will look at all the relevant documents, including the latest JEE report (2023), the Framework of Action towards Climate Resilient Health Systems in Pakistan, Provincial Climate Change Policy, KP Essential Package of Health Services (EPHS), Public Health Act, PC-Is of IDSRS and other projects like Malaria, TB and HIV/AIDS control programmes and documents on COVID-19 preparedness and response, including other relevant documents that emerge during the TA.
2. The team will develop a clear understanding of the health security situation in KP to grasp its infrastructure, its notified and informal governance/ coordination mechanism, identify its challenges and recommend solutions.
3. The TA team will have consultations with the M/o NHSR&C, the NIH, and the KP DOH. These consultations will be informed by the assessment of the health security governance landscape, its associated challenges, and potential solutions. The aim is to collectively devise a governance mechanism, considering the situation in KP and the governance and coordination framework as being outlined in the NAPHS-II.
4. Additionally, the team will also hold consultations with the public sector stakeholders, donors and development partners working in health security.
5. Based on the consultation, the team will draft a governance mechanism that effectively and efficiently addresses the needs In KP to develop and implement policies and plans to achieve an integrated, resilient, and responsive health system for addressing the health risks arising from disasters, outbreaks, and climate change.
6. The draft governance mechanism will be finalised with the feedback of relevant stakeholders in a consultative workshop. Furthermore, the team will also support the DOH in approving the governance mechanism.  Building upon the provincial framework, the team will additionally establish a coordination mechanism for the districts and will seek approval from the relevant authorities.
7. Following the approval, the team will support the DOH in organising the first meeting of the governance mechanism at provincial and selected district level.
8. Furthermore, the team will also assess the funds requirements at KP level for the implementation of agreed actions and activities under NAPHS 2024-28. Additionally, they will conduct a thorough analysis of the current and anticipated domestic and external support to implement the NAPHS 2024-28.

Deliverables

• Support the team in drafting a comprehensive literature review and examining relevant sources to establish an understanding of the province's governance and health security system.
• Support the team to develop a crisp situation assessment that assesses the current health security infrastructure, challenges, and provides recommendations.
• Support the team to carry out consultative meeting with public sector stakeholders and development partners supporting the provincial government's objectives for health security in the province.
• Support the team to develop a governance mechanism for health security, finalised after consultations with relevant public sector stakeholders and donors/development partners.
• Support in SOPs, developing M&E linkages to ensure seamless governance mechanism operation at program and policy levels and support convening the proposed forums.
• Support the team in writing reports, preparing agendas, and meeting content, recording minutes, developing visuals for data illustration, interpreting graphs/charts, and maintaining project documentation. 

LOE

Research Associate for 20 working days.

Requirements

• Minimum of 10-15 years' experience.
• Expertise in thorough literature review and synthesis, consolidating information from diverse sources to inform research and identify knowledge gaps.
• Strong writing skills to prepare clear and concise reports, documents, and findings that effectively present research results and recommendations.
• The ability to generate meaningful insights from collected data.
• Proficiency in managing research projects, which includes planning, organising, and coordinating research activities, as well as meeting project timelines and objectives outlined.
• The ability to advocate for policy changes or improvements based on research findings, translating research outcomes into actionable policy recommendations.
• Competence in collaborating across disciplines, connecting health security and climate change expertise to address complex issues effectively.
• Familiarity with international agreements, such as the IHR, and regulations related to climate change and health security.
• Skill in developing and implementing health communication strategies to convey research findings and public health messages related to climate change and health security.