TA Title: E4H Punjab TA: Technical Assistance to Support Development of a Governance Framework for the Punjab Nursing Centres of Excellence (COEs)

Programme

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 and also to the Federal and Khyber Pakhtunkhwa (KP) governments. The Punjab component is being implemented by Palladium along with Oxford Policy Management (OPM).

Through its flexible, embedded, and demand-driven model, E4H Punjab 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: 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.

E4H-Punjab works in partnership with the Punjab Department of Health (DOH).

Terms of reference

Background

The Government of Punjab, through the Specialized Healthcare and Medical Education Department (SHC&MED), is implementing the Punjab Nursing and Health Workforce Reform Program 2026–2030, supported by the Asian Development Bank (ADB) through a Results-Based Lending arrangement. The programme includes the establishment of Nursing Centres of Excellence (CoEs) in Lahore, Multan and Rawalpindi to strengthen nursing education, faculty development, continuing professional development, curriculum innovation, research, digital learning and quality improvement across Punjab.

The CoEs are envisaged as provincial resource institutions linked to SHC&MED, the Directorate General of Nursing Services, the Program Implementation Unit (PIU), the Human Resources for Health Management Unit, affiliated universities, the Pakistan Nursing and Midwifery Council (PNMC), and the wider nursing education system. Their precise functions, service model and institutional relationships will need to be validated to ensure that the governance arrangements are designed around an agreed mandate.

The Board of Governors has been notified in 2025, the draft framework to be developed in 2026, and the final framework formally notified in 2027.
Under ADB Disbursement-Linked Indicator 8, the programme requires the development, formal approval and notification of a gender-responsive governance framework for the CoEs. The programme milestones include notification of the Boards of Governors, development of the draft framework and formal notification of the final framework.

The PIU is responsible for coordinating and monitoring programme implementation. Building on E4H’s experience in governance reform and institutional strengthening, this Technical Assistance will support SHC&MED and the PIU to validate the CoEs’ functional mandate and develop an approval-ready governance and institutional framework, together with the instruments, implementation arrangements and evidence required for institutional adoption and ADB results verification.

Problem Statement

Although substantial investment is being made in the three Nursing CoEs, the institutional arrangements required for their effective operation and sustainability are not yet in place. Specifically:

• The CoEs’ functions, service model and respective mandates have not been formally agreed.
• Governance structures, institutional roles, reporting lines, decision rights and accountability arrangements remain unclear.
• Core governance and operational instruments (including Board and committee TORs, Rules of Business, delegation frameworks, SOPs and an operational manual) have not been developed.
• Academic governance, accreditation, quality-assurance and institutional-partnership arrangements require definition.
• Financial, human-resource and administrative responsibilities, including recurrent financing and long-term sustainability arrangements, are unclear.
• Performance-management, data-reporting and accountability systems, including HRMIS/LMS and ADB verification linkages, are not established.
• The pathway for validation, formal approval, notification, leadership orientation and initial operationalisation has not been agreed.

Without these arrangements, the CoEs risk fragmented decision-making, overlapping responsibilities, weak accountability and delayed operationalisation. The TA will address these gaps by defining the CoEs’ functions and developing a practical, approval-ready governance, operational and institutionalisation framework aligned with Government of Punjab and ADB programme requirements.

Goal and Objectives

To support the establishment and operationalisation of the Punjab Nursing Centres of Excellence, aligned with the Punjab Nursing Education Reform and Capacity Building Policy 2026–2030, by defining their functional mandate and developing an approval-ready governance and institutional framework that strengthens accountability, academic quality, gender-responsive leadership, operational effectiveness and long-term sustainability. 

Objectives

• Define and validate the functional mandates and operating model of the three CoEs, including their services, institutional relationships and any other responsibilities.
• Assess existing governance, legal, regulatory and institutional arrangements and develop a comprehensive governance framework with clear structures, roles, reporting lines, decision rights and accountability mechanisms.
• Develop the governance and operational instruments required for effective and sustainable functioning, including BoG and committee TORs, Rules of Business, delegation frameworks, SOPs, academic quality and accreditation arrangements, performance systems, partnership models and financial sustainability framework.
• Support institutional adoption and initial operationalisation of the framework through stakeholder validation, an agreed approval and notification pathway, leadership orientation, implementation planning and handover to the responsible government and CoE institutions.

Strategic Approach

The TA will use a function-led and system-strengthening approach. It will first validate the mandates, services and operating model of the three CoEs, and then design governance, accountability, academic, administrative and financial arrangements around those agreed functions.

The framework will build on existing Government of Punjab systems rather than create parallel structures. It will define the roles and relationships of SHC&MED, the PIU, Boards of Governors, Directorate General of Nursing Services, HRH Management Unit, PNMC, affiliated universities and the wider nursing-college network. All governance instruments will be aligned with applicable legal, regulatory and administrative requirements and prepared in formats suitable for government review, approval and notification.

The framework will align with the Punjab Nursing Education Reform and Capacity Building Policy 2026–2030, particularly its priorities on institutional strengthening, leadership, education quality, research, digital transformation, inclusion and professional development. It will complement related nursing workforce, faculty-development and institutional-strengthening initiatives under the wider reform programme.

The assignment will draw on international best practice in CoE governance, management, accreditation, academic administration, partnership models and financial sustainability, adapting relevant approaches to Punjab’s legal, regulatory and institutional context. Outputs will be designed to meet ADB Disbursement-Linked Indicator requirements and support independent verification.

The TA contributes to FCDO’s Health Big Changes by:

• Strengthening health systems: improving governance, accountability and institutional performance across nursing education.
• Supporting population and family planning: strengthening institutions that develop the predominantly female nursing, midwifery and LHV workforce supporting RMNCH and family-planning services.
• Improving health financing: protecting Government of Punjab and ADB investment through clear ownership, financial accountability, resource responsibilities and sustainability arrangements.

Gender-responsive governance will be integrated across the framework, including clear responsibilities and procedures for safeguarding, grievance redress, prevention and response to harassment, safe clinical placements, student and faculty support, equitable participation in decision-making and leadership opportunities for women. The framework will specify how concerns are reported, escalated and monitored.

Scope of Work and Methodology

Phase 1: Inception and Governance Assessment

• Review programme, policy and institutional documentation relating to the establishment and operationalisation of the CoEs.
• Define and validate the functional mandate and operating model of the Lahore, Multan and Rawalpindi CoEs, including their core services, beneficiaries, institutional linkages and any common or differentiated functions.
• Map existing and proposed governance, legal, administrative, academic and financial business processes to inform the Institutional and Operational Manual.
• Map applicable laws, rules, notifications, PNMC accreditation requirements, university affiliation requirements and SHC&MED administrative procedures.
• Review the Punjab Nursing Education Reform and Capacity Building Policy 2026–2030 and map its relevant provisions against the proposed functions and governance requirements of the CoEs.
• Benchmark relevant international models for CoE governance, academic administration, accreditation, institutional partnerships and financial sustainability, adapting applicable lessons to Punjab’s context.
• Map and consult SHC&MED, the PIU, Directorate General of Nursing Services, PNMC, affiliated universities, Finance, Law and Planning and Development departments, HR and administration wings, nursing institutions, faculty and student representatives, ADB and relevant gender and safeguarding stakeholders.
• Identify governance priorities, institutional risks, key decision-makers and the required approval, endorsement and notification pathway.
• Submit an inception report and agreed work plan covering the validated CoE functions, assessment methodology, stakeholder map, risks, responsibilities, timelines and approval pathway.

Phase 2: Governance Framework and Instrument Development
Develop an integrated, function-led governance and institutional package covering:

• Governance architecture, reporting lines and institutional relationships.
• BoG and committee structures, mandates and TORs.
• Rules of Business, governance procedures and delegation-of-authority frameworks.
• An Institutional and Operational Manual, including key SOPs and business processes.
• Administrative, HR, procurement and financial-management arrangements, including delegation matrices and resource responsibilities.
• Academic governance, accreditation, affiliation, quality-assurance and continued-compliance arrangements.
• Process delineation of national and international partnerships for faculty development, CPD, simulation-based learning, research, digital learning and quality improvement.
• Performance and accountability arrangements, including KPIs, reporting templates, review mechanisms, audit requirements and a risk register.
• Gender-responsive governance, including safeguarding, grievance redress, harassment prevention and response, safe clinical placements and equitable participation in leadership and decision-making.
• Data-governance and reporting arrangements for academic, faculty, student, CPD and workforce information, including linkages with HRMIS, LMS, the HRH Management Unit and DLI verification requirements.
• A financial-sustainability framework; Performance and Accountability Framework; and Quality Assurance and Monitoring Framework.

Phase 3: Validation, Finalisation and Institutionalisation

• Conduct structured stakeholder consultations and multi-stakeholder validation of the draft governance package.
• Facilitate technical, legal and administrative review by SHC&MED, the PIU and other relevant authorities.
• Develop a phased implementation roadmap setting out responsibilities, approval milestones and actions required to operationalise the governance arrangements.
• Revise and submit the package to the BoGs and competent government authorities for endorsement, approval and notification.
• Finalise all governance instruments in approval-ready formats, including supporting notification and endorsement documentation.
• Orient BoG members, CoE leadership and relevant SHC&MED, PIU and Directorate General of Nursing Services officials on their roles and the use of the governance instruments.
• Support limited initial operationalisation, including establishment of agreed committees, preparation of a governance calendar, introduction of reporting templates and initiation of selected governance procedures.
• Hand over the final framework, instruments, orientation materials and implementation roadmap to the responsible institutions.
• Ensure the final package reflects alignment with the Punjab Nursing Education Reform and Capacity Building Policy 2026–2030 and includes documentation required for DLI verification, institutional adoption and continuity of governance functions.

Sustainability and Institutionalisation

Sustainability will be secured by embedding the CoE governance arrangements within existing SHC&MED structures, budgets and routine management processes rather than creating parallel systems.

Key measures will include:

• Government focal points and responsible units (from the PIU Nursing Reform Programme) identified from inception for each stage of development, approval and implementation.
• Formal adoption of the governance framework and instruments through the agreed approval and notification pathway.
• Clear assignment of ongoing governance, academic, administrative, HR, financial and reporting responsibilities.
• Recurrent financing and resource responsibilities defined for the continued operation of the CoEs beyond programme-supported investment.
• Capacity transferred to BoG members, CoE leadership and relevant government officials through co-development, orientation and practical use of the instruments.
• Performance, financial-accountability and risk reporting incorporated into routine BoG, CoE and SHC&MED review processes.
• Data and reporting arrangements integrated with relevant HRH Management Unit, HRMIS, LMS and programme-monitoring systems.
• A phased implementation and handover roadmap, with measurable milestones for adoption and government uptake.

Deliverables

1. Inception Slide Deck, Workplan and Succinct Governance Assessment Report: PIU/SHC&MED-endorsed package.
   Draft 

2. Governance Framework and Instrument package: Governance architecture, BoG/committee TORs, Rules of Business, Roles and Responsibilities, Institutional and Operational Manual, SOPs, academic quality and accreditation arrangements, partnership and financial-sustainability framework, performance framework, risk register, gender/safeguarding provisions, and data/reporting arrangements.

3. Final Governance Framework and Institutionalisation Package: Final framework and instruments validated and submitted for approval/notification, with phased implementation roadmap, consultation records, handover and orientation materials, initial operationalisation evidence, and DLI verification checklist.

Position Title:

Financial Specialist – Punjab Nursing Centres of Excellence TA (Mid National)

Duty Station: Lahore (with travel as required)
Duration / LOE: Mid-August 2026 – March 2027 (LOE 30 days – subject to change until the start of the TA)
Reporting To: Institutional Governance & Health Systems Adviser / E4H Programme Team

Role Purpose

Provide financial and institutional sustainability expertise to ensure that the proposed governance and operating model for Punjab Nursing Centres of Excellence is financially realistic, aligned with Government of Punjab systems, and supported by clear budget, procurement, delegation, and resource-responsibility arrangements.

Key Roles & Responsibilities

• Assess the recurrent operating costs and resource requirements of the Nursing Centres of Excellence.
• Define budget ownership, financial responsibilities, and resource allocation arrangements across relevant institutions.
• Develop financial and procurement delegation provisions for inclusion in the governance and operational framework.
• Advise on feasible financing options, including government funding, grants, partnerships, and other permissible sources.
• Support development of the financial sustainability framework and related operating-cost projections.
• Ensure proposed financial arrangements align with Government of Punjab budgeting, procurement, and financial management systems.
• Contribute to the Institutional and Operational Manual, delegation matrices, implementation roadmap, and final governance package.
• Undertake other tasks related to the TA as assigned by the Institutional Governance & Health Systems Adviser or E4H Programme Team.

Requirements
Technical Expertise

• Master’s degree in Public Finance, Health Economics, Business Administration, Public Administration, or related field.
• Minimum 10 years of overall professional experience.
• Demonstrated experience in government budgeting, institutional operating models, financial delegation, recurrent-cost planning, and sustainability analysis.
• Experience in developing financial management, procurement, and resource-responsibility arrangements for public institutions.
• Experience with Government of Punjab financial and procurement systems preferred.

Core Competencies

• Financial management and sustainability analysis
• Operating-cost and resource assessment
• Government budgeting and financial planning
• Procurement and financial delegation
• Financing options and institutional operations
• Strong analytical and report-writing skills