E4H Punjab TOR - TA for Developing e-Certification Programme on MSDS Capacity Building for Healthcare Providers

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

Under Sections 13–20 of the Punjab Healthcare Commission (PHCC) Act of 2010, PHCC is mandated to regulate healthcare establishments (HCEs) across Punjab through registration, licensing, and quality assurance functions. Over the past decade, PHCC has implemented a range of capacity-building initiatives to support HCEs in effective Minimum Service Delivery Standards (MSDS) implementation, including online learning modalities and specific certification programmes.

Since 2010, PHCC has implemented multiple physician engagement initiatives to drive MSDS uptake. These include: 1) Free of cost orientation sessions; 2) on-site MSDS orientation sessions for HCEs; 3) Desk review and coaching through implementation cell; 4) The 2024 Hospital Infection Prevention & Control e-certification module, which saw 68% completion rates among targeted Cat-II/III hospital staff; and 5) District-level Continuing Medical Education sessions on quality standards, with emphasis on PHC. These approaches have increased physician familiarity with MSDS requirements and created demand for structured learning, as evidenced by HIPC module uptake. The proposed e-certification expands this model to remaining nine MSDS functional areas.

PHCC’s current digital learning platform hosts the HIPC e-certification module and supports:

1. User self-registration and profile management for physicians/administrators
2. Bilingual content delivery with video, PDFs, and quizzes
3. Automated tracking of completion and certification issuance
4. Basic analytics dashboard for PHCC administrators.

The platform is web-based and mobile-responsive, with negligible licensing cost to end-users. Utilisation data from HIPC shows >5800 registered users and

While MSDS implementation remains variable, the constraints extend beyond regulatory requirements and include limited awareness, managerial challenges, and competing operational priorities. In this context, there is a need to strengthen structured and accessible learning pathways that can support consistent understanding and application of MSDS.

Globally, healthcare regulators are increasingly complementing oversight functions with structured digital learning approaches to support continuous professional development (CPD) and quality improvement. While such models provide useful reference points, PHCC’s experience indicates that incremental adaptation of existing approaches, rather than the introduction of fully new systems, is both appropriate and feasible.

Building on the experience of the HIPC module, and emerging global healthcare regulatory trends, the PHCC has identified an opportunity to expand its existing e-certification programme to cover the remaining nine MSDS functional areas. The proposed Technical Assistance (TA) is therefore intended to support progressive expansion and refinement of this approach, in alignment with PHCC’s regulatory mandate. The MSDS functional areas to be covered under this TA include:

1. Access, Assessment and Continuity of Care (AAC)
2. Care of Patients (COP)
3. Patients’ Rights and Education (PRE)
4. Management of Medication (MOM)
5. Continuous Quality Improvement (CQI)
6. Facility Management and Safety (FMS)
7. Responsibilities of Management (ROM)
8. Human Resource Management (HRM)
9. Information Management Systems (IMS)

Problem Statement

Despite the availability of a comprehensive MSDS framework, its effective implementation across the HCEs remains uneven. While PHCC has undertaken focused capacity-building initiatives to address this challenge, the efforts have not been successful for system-wide competency development. These gaps are particularly evident in primary healthcare facilities, where variability in provider competencies and limited access to structured training mechanisms affect standardisation, continuity of care, and quality outcomes.

In this context, expanding e-certification to the 9 additional MSDS functional areas can contribute to:

• improved understanding of MSDS
• consistent application of quality requirements
• strengthened CPD pathways

The TA is therefore intended to support the structured expansion and refinement of PHCC’s existing e-certification approach, ensuring that learning content, delivery mechanisms, and certification processes remain practical and scalable in principle.

Goal and Objective(s)

Goal

To support PHCC in strengthening implementation of MSDS and improving quality of healthcare including primary healthcare delivery in Punjab by building provider competencies through a scalable e-certification approach across all functional areas, using its current digital learning systems.

Objectives

1. To develop and integrate structured e-certification modules for the remaining nine MSDS functional areas.
2. To strengthen utilisation of existing PHCC digital learning platform for course delivery, assessment, and certification processes.
3. To support institutionalisation of the e-certification approach through iterative user feedback, and development of basic governance and content management processes.

Expected outcome:

The e-certification programme is expected to contribute to healthcare strengthening including PHC through:

1. Improved provider competency in core MSDS areas
2. Increased adherence to MSDS during PHCC inspections
3. Enhanced patient safety culture in primary care settings.

For PHC facilities, key outcomes include better triage, referral, and infection control. For Cat-I/II/hospitals, outcomes include improved clinical governance and medication safety. The programme applies equally to public and private HCEs, supporting uniform quality standards across Punjab’s mixed health system. Impact will be tracked via pilot pre/post assessments and LMS completion analytics.

Strategic Approach

The TA supports PHCC’s ongoing efforts to complement its regulatory functions with practical learning approaches, aimed at improving understanding and application of MSDS across HCEs. The programme will explicitly support primary healthcare strengthening by targeting first-contact care providers. Course content will incorporate principles of people-centred care, continuity of care, referral linkages, patient rights, safety, and equitable access, particularly for underserved populations. Building on PHCC’s existing experience with the HIPC e-certification module, the TA focuses on translating MSDS requirements into structured and accessible learning formats, enabling professionals to more effectively interpret and apply standards within routine service delivery.

The approach is designed to incrementally strengthen healthcare worker capacity and support more consistent implementation of quality standards.

In addition, the use of existing digital platforms provides an opportunity to improve accessibility of learning resources across different types and locations of healthcare establishments, while supporting PHCC in establishing practical, scalable mechanisms for continuous professional development.

Scope of Work and Delivery Methodology

Phase 1 - Inception, Scoping and Content Adaptation

• Review existing MSDS for all levels of care (Cat-I, II, III), PHCC regulations, HIPC e-certification content and learning platform functionality.
• Undertake a rapid need assessment to identify sequencing of priority MSDS areas.
• Agree with PHCC on:
  • module sequencing and phased rollout
  • indicative learning objectives and structure
  • certification approach aligned with existing practices
• Following agreement on sequencing and module structure, adapt MSDS reference materials into initial structured e-certification modules, building on the HIPC model.
• Develop bilingual (English and Urdu) learning content, based on feasibility.
• Prepare supporting materials (presentations, job aids, simplified guidance, basic multimedia)
• Develop practical assessment tools (e.g., quizzes, short exercises)
• Conduct iterative content review and validation with PHCC

Phase 2: Integration and Pilot Testing

• Upload and integrate MSDS modules within the existing learning system.
• Support course setup, navigation, and learner registration.
• Enable basic learner tracking, completion monitoring, and certification issuance.
• Address practical usability and accessibility improvements.
• Develop simple learning system administration and course management guidance.
• Conduct pilot implementation across each healthcare category.

Pilot Design: The pilot will run across 2 districts (duration decided upon inception), selected to represent Punjab’s geographic and sectoral diversity. Proposed selection criteria include;

1. Mix of urban/rural districts;
2. Inclusion of at least 2 districts with high density of facilities;
3. Mix of public and private HCEs;
4. Existing PHCC regional presence for monitoring.

Target scale: 200–250 healthcare professionals across Cat-I, II, and III, covering all nine modules. Rationale: This sample enables testing usability across user types and settings before full rollout. Learning modality: The pilot will be fully digital via PHCC’s LMS, with optional facility-based group sessions using downloaded content for low-connectivity areas. This blended approach maximises accessibility while testing the scalability of the pure digital model. Pilot findings will directly inform module refinement and LMS setup.

• Collect feedback on usability, comprehension, and learner experience.
• Where feasible, apply simple pre/post assessments to gauge learning.
• Refine modules, assessments, and Learning System setup based on pilot findings

(Note: emphasis on structuring and usability rather than full curriculum re-development or complex competency frameworks)

Phase 3: Institutionalisation and Scale-Up Support

The TA will develop an operational SOP for linking individual physician e-certification to HCE licensing. Proposed mechanism will b;

• PHCC will define a minimum % of clinical staff per facility category that must complete relevant MSDS modules for licensing/renewal;
• Certification data from the LMS will be integrated into PHCC’s licensing database. This creates facility-level incentives because:
  • a) HCEs must demonstrate workforce competency to maintain licensure;
  • b) It shifts from one-time compliance to continuous professional development;
  • c) It allows smaller PHC facilities to meet standards without costly in-person training.
• Final policy will be determined by PHCC during institutionalisation, with TA providing technical options and global benchmarks.
• Develop practical SOPs for:
  • Module specific updates
  • Learning system administration
  • Certification management
• Orient designated PHCC focal persons on course delivery and system use.
• Complete handover of:
  • Module content and materials
  • Assessment tools
• Provide indicative recommendations for:
  • Future module expansion
  • Strengthening CPD pathways
• Recommend linking the e-certification programme results with licensing process.

The e-certification programme will be progressively linked to PHCC licensing and renewal processes. While certification is completed by individual healthcare providers, healthcare establishments may be required to demonstrate availability of certified personnel as part of compliance requirements. This mechanism will incentivise healthcare establishments, particularly primary healthcare facilities, to ensure staff participation in certification programmes, thereby strengthening facility-level compliance with MSDS

• Promote the programme across all categories of HCEs including primary healthcare.

Sustainability and Institutionalisation

• Designated PHCC focal persons and responsible units will be identified during inception to support content development, review, deployment, and ongoing management
• A progressive co-development approach will be adopted, enabling PHCC to gradually take on greater responsibility for content review, course management, and delivery.
• Content review processes will be light-touch and feasible, supporting periodic updates.
• All learning resources, source files, assessment materials, and guidance documents will be formally handed over to PHCC in editable formats
• The TA will provide indicative guidance on future expansion, including options for additional modules and continued use of e-certification to support professional development.
• The approach will support a repeatable and adaptable model for future module development, without requiring significant additional system development or external inputs.
• The approach supports long-term institutionalisation by embedding certification within regulatory processes, strengthening continuous professional development pathways, and ensuring scalability through existing digital infrastructure..

Deliverables

1. Inception Package (Slide Deck and Workplan): Scope, sequencing across nine MSDS areas, and overall implementation approach.
2. MSDS e-Certification Modules – Package 1: Initial set of (4-5) structured modules with content, assessments, and supporting materials.
3. MSDS e-Certification Modules – Package 2 (Completed Set with Integration): Full set of nine modules finalised, refined through pilot, and configured on digital learning platform.
4. Final e-Certification Package and Institutionalisation Note.

Position Title:

Clinical / Pharmacy & Patient Safety Specialist (Mid National)
Duty Station: Lahore (with travel as required)
Duration / LOE: Mid-August 2026 – March 2027 (LOE 70 days – subject to change until the start of the TA)
Reporting To: Team Lead – Health Systems & Regulatory Expert

Role Purpose

Provide clinical and quality-assurance expertise to ensure MSDS e-Certification content is technically accurate, practical, and aligned with patient safety, medication safety, infection prevention, clinical governance, and quality-of-care requirements.

Key Roles & Responsibilities

• Review and validate technical content across relevant MSDS functional areas.
• Ensure learning materials align with patient safety, medication safety, IPC, and quality-of-care requirements.
• Support development of practical clinical case studies, scenarios, exercises, and assessments.
• Provide technical input on clinical governance and healthcare standards implementation.
• Coordinate with PHCC technical focal persons where specialised domain expertise is required.
• Support pilot testing and refinement of clinical and cross-cutting learning content.
• Contribute to module validation, institutionalisation, and final handover.
• Undertake other TA-related tasks assigned by the Team Lead.

Requirements

Technical Expertise

• Relevant clinical qualification in Medicine, Pharmacy, Nursing, Public Health, or allied health discipline.
• Minimum 10 years of overall professional experience.
• Experience in patient safety, quality improvement, healthcare standards, and clinical governance.
• Experience supporting implementation or training related to healthcare quality standards preferred.

Core Competencies

• Clinical quality assurance
• Patient safety systems
• Healthcare standards implementation
• Technical content validation
• Training facilitation
• Mentoring and stakeholder engagement