Mid National Finance Specialist

E4H KP TA: Development of District Action Plans for Six NHSP Priority Districts in Khyber Pakhtunkhwa

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 (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.

Position Summary

The overall goal of this TA is to develop costed, implementable, and results-oriented DAPs for six additional NHSP priority districts in KP, leveraging FLB to strengthen district planning, improve service delivery, and support achievement of NHSP DLIs. We will achieve this by pursuing five objectives:

•  Objective 1: Translate provincial priorities and NHSP requirements into district-specific, evidence-based plans that address local service delivery gaps, equity, and quality at the PHC level.

•  Objective 2: Strengthen and institutionalise a participatory, evidence-based, and government-led district planning process by integrating FLB, facility readiness assessments, routine information systems, and district performance reviews into district planning and decision-making processes.

•  Objective 3: Build district capacity in integrated planning, costing, and performance management to ensure DAPs are realistic, implementable, and results oriented.

•  Objective 4: Embed clear implementation, monitoring, and accountability mechanisms within DAPs to support effective execution and progress towards NHSP DLIs.

•  Objective 5: Support districts and provincial stakeholders to prioritise and sequence interventions based on implementation feasibility, service delivery needs, available capacities, and resource considerations to enable progressive strengthening of PHC systems

Strategic Approach

Contributions to health systems strengthening

This TA support strengthens the governance and stewardship functions of the health system in KP by addressing a core bottleneck: weak, fragmented, and top-down district planning. By building the capacity of District Health Management Teams (DHMTs) to undertake evidence-based, participatory, and costed planning, anchored in FLB. The TA improves the alignment between local needs, resource allocation, and service delivery priorities. The resulting DAPs provide a practical mechanism to enhance accountability, guide efficient use of limited resources, and link planning with financing and performance, thereby contributing to more equitable, responsive, and resilient primary health care systems.

Alignment with other E4H TAs/Investments

This TA builds directly on earlier support from E4H KP, including the initial development of DAPs and the rollout of FLB, representing a next phase to scale and institutionalise these approaches in additional districts. It is closely aligned with ongoing E4H support to District Health Office (DHO) reforms, ensuring that strengthened planning processes are matched by improved district management and governance capacity. The DAPs will operationalise priorities set out in the NHSP, the KP Health Sector Policy, the EPHS, and the Quality-of-Care strategy, while also drawing on the UHC roadmap and Climate Health Adaptation Plan (CHAP) to inform context-specific district actions. In doing so, this TA provides a critical bridge between strategic policy frameworks and their practical implementation at district level.

Alignment with other donors (if relevant)

No direct co-financing from other development partners is anticipated; however, partners will be consulted during DAP development to ensure complementarity and avoid duplication. The TA will align closely with Disbursement-Linked Indicators (DLIs) under the World Bank-supported National Health Support Programme (NHSP), ensuring coherence with results-based financing requirements. It will also consider priorities and investments supported by Gavi, the Vaccine Alliance, particularly in relation to immunisation and PHC strengthening, to maximise synergies at district level.

Scope of Work and Methodology

This TA will support the DOH KP to develop six costed, implementable, and results-oriented DAPs for additional NHSP priority districts by building on earlier E4H-supported facility readiness and gap assessments conducted in ten NHSP-prioritised districts. The assignment will integrate facility-level evidence, routine information systems, programme performance reviews, and district management assessments to generate both facility-level requirements for Facility-Level Budgeting (FLB) and broader district system priorities for DAP development. The process will support development of evidence-based, operationally feasible, and phased district plans aligned with EPHS, NHSP priorities, and DLIs.

District Portfolio Assessment and Evidence Generation

Review existing facility readiness and gap assessments previously supported by E4H in NHSP priority districts, including:

Facility Readiness to Deliver Essential Health Services (IMU standards)

Facility Readiness to Deliver RMNCH interventions as per EPHS

Gap Analysis Summary presented to the Department of Health.

Analyse additional evidence sources including DHIS2, HRMIS, IMU scorecards, supervisory findings, programme performance reviews, quality of care assessments, and relevant district and provincial planning documents.

Conduct facility-level assessments to identify infrastructure, human resource, equipment, service delivery, and quality of care gaps to inform facility-level planning and FLB requirements.

Assess district management, coordination, supervision, monitoring, and programme support systems to identify district-level operational and implementation gaps affecting PHC and EPHS delivery.

Develop district portfolio assessments consolidating facility-level needs, service delivery gaps, management constraints, and system strengthening priorities to guide DAP development and prioritisation.

Validation and prioritisation of needs

Findings will be validated through engagement with facility staff, district teams, and key stakeholders to ensure accuracy and ownership.

Facility-level priorities will then be consolidated into district-wide analyses, alongside identification of cross-cutting system bottlenecks such as supply chain, human resources, governance, monitoring and evaluation, and quality of care.

Prioritise interventions based on service delivery needs, implementation feasibility, district capacities, and available support systems to ensure realistic and phased implementation planning.

District-Level Consolidation and Systems Analysis

Aggregate and synthesise facility-level needs into a district-wide perspective.

Conduct district-level consultations with DHOs and key stakeholders to prioritise interventions.

Analyse cross-cutting system requirements, including supply chain, human resources, monitoring and evaluation, quality of care, and governance.

Identify district-level system strengthening priorities required to support effective service delivery.

Analyse provincial support mechanisms and district-programme coordination arrangements to identify operational gaps, implementation dependencies, and opportunities for strengthening district performance management and service delivery oversight.

Participatory District Planning Process

Facilitate structured district-level planning workshops using a bottom-up approach informed by FLB outputs.

Support stakeholders to define strategic priorities, interventions, and performance indicators.

Ensure alignment of proposed interventions with EPHS standards, NHSP priorities, and DLIs.

Facilitate agreement on district implementation priorities, sequencing of interventions, institutional responsibilities, and monitoring arrangements through structured consultations with district and provincial stakeholders.

Drafting of District Action Plans

Prepare draft DAPs for each district, incorporating prioritised interventions, implementation arrangements, timelines, responsibilities, and cost estimates.

Ensure plans are realistic, resource-informed, and aligned with public financial management processes and NHSP financing requirements.

Validation and Finalization

Present draft DAPs to provincial and district stakeholders for review and feedback.

Incorporate inputs and finalise DAPs with clear results frameworks, monitoring mechanisms, and accountability structures.

Governance and Coordination Mechanism

A Provincial Working Group (PTWG), chaired by the DGHS and comprising representatives from DGHS, HSRU, FMC, NHSP, DHOs, and relevant technical units and partners, will provide strategic oversight and technical guidance throughout the DAP development and implementation planning process. This mechanism is intended to strengthen coordination, ensure continuity, and support the long-term institutionalisation of district-level planning systems.

In addition, a District-Level Working Group will be established to operationalise and reinforce implementation at the sub-provincial level. This group will work in close coordination with the E4H team and will include representatives from NHSP, DHPMTs, IMU, and relevant implementation partners. It will serve as a dedicated platform for local coordination, data review, and planning support, ensuring that district priorities are effectively reflected in the DAP process and aligned with provincial direction.

Together, these two complementary structures will institutionalise a coherent governance and feedback loop between provincial and district levels, thereby enhancing sustainability, ownership, and the effectiveness of planning and implementation mechanisms over time.

Throughout the assignment, the team will work closely with provincial stakeholders, particularly the NHSP team, to ensure alignment with ongoing reforms and financing requirements. Regular coordination will be maintained with relevant provincial reform units, and the team will undertake frequent field visits to the target districts to ensure strong engagement, real-time problem solving, and effective capacity building.

Focal points nominated by the Director General Health Services (DGHS), HSRU, and district authorities will be actively engaged throughout to strengthen institutional capacity in integrated planning, costing, and performance monitoring, supporting sustainability and future scale-up.

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

District Health Management Teams (DHMTs) will be strengthened through structured mentoring, planning workshops, and standardised tools and templates. Capacity building will focus on the use of facility-level data, including FLB outputs, for evidence-based planning, costing, and performance monitoring, to support districts in updating and implementing DAPs. The NHSP PMU will closely collaborate in this process to ensure alignment with NHSP requirements and district planning priorities.

The DAP development process will be embedded within routine district planning and budgeting cycles, with explicit integration of FLB as a core input into district-level decision-making. This will support a shift towards more consistent use of data-driven planning tools and ensure that DAPs function as a standard instrument for aligning district priorities with provincial and national frameworks. Over time, this will strengthen coherence between planning, budgeting, and implementation processes at district level.

The DAP development process will be progressively embedded within routine government planning, review, and budgeting mechanisms through active leadership of DGHS and participation of provincial technical units and district management teams. Joint review processes, implementation monitoring forums, and iterative planning cycles will support gradual institutionalisation and sustained ownership beyond the TA period.

The approach will prioritise gradual handover of planning functions through iterative engagement, on-the-job support, and periodic joint reviews with district and provincial counterparts. Refresher sessions and structured knowledge-sharing forums will help maintain continuity beyond the TA period, while reinforcing local ownership of tools and processes. This will ensure that planning capacities and systems are progressively internalised within government structures, supporting continuity of reforms and sustained use of improved planning practices over time.

Responsibilities

The Finance Specialist will be responsible for:

• Work and inception plan

• Facility-Level Needs Assessment and District Situational Analysis

• District Planning Workshops (report)

• Draft District Action Plans (One per priority district)

• Final District Action Plans (One per priority district)

Timeline and Days

The level of effort (LOE) for the role is 60 days from May 2026 – September 2026.

Requirement

Technical Expertise

• Postgraduate qualification in Public Finance, Health Economics, Public Health, or a related field.

• Minimum 10 years of experience in public sector budgeting, costing, and financial planning.

• Demonstrated expertise in costing health interventions, linking plans with budget frameworks, and working with government financial systems.

• Experience in FLB, resource allocation, and aligning plans with NHSP financing and DLI requirements.

Competencies

• Costing and financial modelling;
• budget alignment;
• resource optimisation;
• data-driven financial analysis;
• problem-solving;
• communication with technical and non-technical stakeholders;