TORs: National Mid-Senior STTA – Team Lead
Delivery Unit to Implement the Universal Health Coverage Roadmap

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). 

Background and Problem Statement

Accelerating the implementation of Universal Health Coverage (UHC) is one of the core objectives and key thematic areas of the Evidence for Health (E4H) Programme in Punjab. Under SDG 3.8, UHC is considered the best investment in human capital and a foundational driver of sustainable and inclusive economic growth and development.

Despite the National UHC Service Coverage Index (SCI) improving from 39.7 in 2015 to 52.7 in 2022, according to Pakistan's UHC Monitoring Report 2023, only half of the country has access to essential health services. Considering the pace of progress, it will be challenging for Pakistan to achieve its commitment to reach an SCI of 80+ by 2030, as stipulated by SDG 3.8.1.

 In Punjab, the SCI was 53.8 in 2022, slightly higher than the national average. Under the National Health Vision (2016-2025) and Punjab Health Sector Strategy (2019-2028), the provincial government finalized a UHC Benefit Package/Essential Package of Health Services (EPHS) in 2021.

Simultaneously, the Sehat Sahulat Programme was previously a pro-poor programme catering to people below specific markers of the proxy means test score, as determined by the survey conducted for the Benazir Income Support Programme (BISP).

However, in 2021, it was rolled out to 100% of the population in Punjab, contributing to the efforts of UHC. Later, the Government also tried to plug the EPHS implementation gaps at the community and Primary Health Care (PHC) level through government financing and partners' support, mainly through the World Bank (WB)'s National Health Support Programme (NHSP) and Human Capital Investment Project (HCIP). However, despite all these efforts, UHC implementation in the province has been grappling with serious challenges.

The Integrated Disease Surveillance and Response (IDSR) system reports weekly through DHIS2, and efforts are underway by the Punjab Information Technology Board (PITB) to integrate EMR systems in 53 specialised hospitals. District-level digitised data processes are being integrated into HISDU, although national-level linkage of DHIS or DHIS2 data is still in development. These ongoing improvements aim to achieve comprehensive data integration and interoperability across various levels and programmes.

Addressing socioeconomic and geographic disparities in healthcare access is critical for achieving UHC in Punjab, particularly in the southern regions where SCI scores remain low. The Primary & Secondary Healthcare Department (P&SHD) plans to enhance UHC investments and optimise existing resources while maintaining rigorous service delivery monitoring. The E4H Programme will provide Technical Assistance (TA) to develop a cohesive and comprehensive roadmap for UHC implementation.

Creating this roadmap must align with expanding the existing Family Planning Delivery Unit, which will centralise and prioritise reforms through an integrated approach, thereby strategically guiding UHC implementation improvements across the province. The previous Family Planning (FP) initiatives under DAFPAK PSSD established a robust Delivery Unit, which initially focused on improving Contraceptive Prevalence Rates. This Unit's capacity and analytical support capabilities will be leveraged and expanded within the new UHC Delivery Unit, continuing to upskill the existing team and drive strategic improvements in UHC implementation across Punjab.

Objectives

The unit's objective is to monitor data and build institutional capacities for evidence-based decision-making and accountability. It will define key performance indicators for the South, North, and Central districts in Punjab, monitor them regularly, and analyse data to report regularly in stock takes.

(The unit will be providing support to the Secretary Health and the CM to hold the department accountable through regular performance stock takes).

 Sub-objectives

1. To work on the UHC SCI in Punjab, focusing on Primary Health Care (PHC).

2. To coordinate and liaise with the STTA UHC implementation roadmap team to develop a roadmap aligned with the Department's 5-year HSRP and CM’s health sector priorities.

3. To liaise with the Data Governance embedded TA team (including DHIS II and EMR) to ensure the Delivery Unit can identify areas of data quality improvement.

4. To liaise with international development partners engaged in all UHC-related activities to create synergies and avoid duplication of efforts.To build the capacity of the Department to use data for evidence-based decision-making, performance and accountability.

Scope of Work

Phase 1: In the first phase, the Delivery Unit is expected to establish a solid foundational strategy aligned with the UHC roadmap and provincial health policies. This may include, among other tasks:

• Develop the TORs of the Delivery Unit
• Notify the Delivery Unit
• Conduct a kick-off workshop to align the Delivery Unit’s strategic objectives with the UHC roadmap
• Hold a workshop with development partners and technical experts to get feedback
• Establish an understanding of clear goals, responsibilities, and timelinesCreate specific, actionable and timed implementation plans for each of the four proxy areas of UHC implementation aligned with the UHC roadmap

Checkpoint(s)

• Conduct a kick-off workshop to align the Delivery Unit’s strategic objectives with the UHC roadmap
• Establish an understanding of clear goals, responsibilities, and timelines for the Delivery Unit
• Approval of TORs and action plan by the Secretary 

Phase 2: In the second phase, the Delivery Unit is expected to execute the action plan and ensure coordination among various stakeholders and decision-makers, which is essential for UHC implementation and decision-making.

• Implement a monitoring system to track progress against the UHC roadmap using indicators identified through a rigorous consultative process between the P&SHD and the CM office.
• Report the data to the CM’s health roadmap focal points and present data in quarterly stocktakes.
• Utilise data analytics to provide the Secretary with insightful, actionable feedback for Department’s internal monthly review (CEOs, Medical Superintendent, DC IRMNCH&N Conferences).
• Oversight on UHC implementation trends, challenges, and opportunities such as:
  • Set up an integrated data dashboard connected to data flowing into HISDU that collates real-time data.
  • Monitor the progress in relevant data indicators in the province and develop KPI to highlight equity gaps through disaggregation of data by region (North, Centre & South), districts, poverty and other possible equity indicators.
• Provide the Secretary with policy briefs, talking points, and advocacy briefs presenting the need for financial and non-financial resources. This will enable the Secretary to advocate for sustained investment in UHC implementation.
• Focal points within the Department, specifically from HISDU, will be identified for capacity building to carry out the Unit's functions, especially the capacity to analyse data to facilitate evidence-based decision-making.
• The analytics, policy briefs, reports etc developed by the Unit will be disseminated on regular basis on the Government forums such as CEOs, Medical Superintendent, DCs IRMNCH&N Conferences and any other learning events organised by Departments.
• The Unit will identify any possible areas where they can help cross validate data collected by the MERL component of this Programme such as Health Facility Assessment findings. Conversely, the Unit’s deliverables such as policy briefs and analytics can be reviewed by the Programme’s MERL team. This collaborative effort will further help identify areas for implementation research.

The UHC Delivery Unit will comprise a Team Manager (01), Associates (02), and Analysts (04) who will collectively work towards the successful implementation of the roadmap approach in UHC implementation. This Delivery Unit will work to improve the UHC SCI, a single indicator based on four proxy areas and their corresponding tracer indicators. The four proxy areas include Infectious Diseases (ID), Non-Communicable Diseases (NCD), Reproductive, Maternal, Newborn and Child Health (RMNCH) and Service Capacity and Access. Although the team knows that the UHC SCI Is currently calculated using data from demographic surveys, there will be an effort to map Input and outcome Indicators.

The team lead Oversee the overall functions and performance of the Delivery Unit. Contribute to strategic planning and operational execution of the roadmap approach. 

Timeline and LOE

The role is full-time for 5 months, from October 2024 to February 2025. The position will be based in Lahore and embedded in the Department of Health.

Roles and responsibilities:

• Oversee the overall functions and performance of the Delivery Unit
• Contribute to strategic planning and operational execution of the roadmap approach.
• Provide a bridging role in the adoption of the UHC roadmap by the Department
• Serve as a liaison and regularly report to government officials and the E4H Programme team.
• Maintain effective communication with all relevant stakeholders in close coordination with the E4H Punjab Team Leader.
• Continuously monitor and evaluate the team's performance and provide necessary feedback and support for improvement.
• Ensure adherence to timelines, quality standards, and project deliverables.
• Distribute work assignments among team members, ensuring effective task allocation.
• Provide leadership, guidance, and mentorship to Associates and Analysts. 

Educational Background & Competencies:

• MBA or MS/MSc / BS/ B.Sc. in Economics, Social Sciences, Management Sciences, Development Studies, Public Policy, Public Health and
• mid-level proven relevant experience in a national or international organisation OR(instead of educational qualification) mid-