TORs: National Senior STTA – Public Health Expert
Developing a Human Resource for Health Strategic Plan for Primary & Secondary Healthcare Department

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 provides technical assistance (TA) to the Federal, Khyber Pakhtunkhwa (KP), and Punjab governments, and is being implemented by Palladium along with Oxford Policy Management (OPM).

Through its flexible, embedded, and demand-driven model, E4H supports 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 delivers 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.

Background and Problem Statement

• Human Resources for Health (HRH) plays a fundamental role in achieving the Sustainable Development Goals (SDGs). HRH is not only a specific target under SDG3 but is also included in the Universal Health Coverage (UHC) index (SDG3.8.1). It is also part of the thirteen core competencies for the International Health Regulations (IHR) index (SDG3. d.1). Moreover, the fact that the health workforce influences multiple other SDGs, including Goals 1, 2, 4, 5, 6, 8, 10, 11, and 17 shows that it has the potential to be the driver for inclusive economic growth and prosperity for a nation.
• After the 18th Amendment, the provinces have assumed greater independence and authority in managing provincial health workforce.
• The international benchmark for critical HRH is 4.45 per 1,000 population as per the WHO Global Strategy on HRH, for Pakistan this figure stands at 1.45 critical health workforce per 1,000 population. Punjab, with a population of over 110 million has 0.83 physicians and 0.56 nurses per 1,000 population.
• The demand for HRH in Punjab is forecasted to grow substantially due to population and economic growth, combined with epidemiologic and demographic transitions. However, the current workforce in Primary & Secondary Healthcare Department (P&SHD) is much less than the actual requirement and standards.
• The current patient-to-provider ratio is low, creating service capacity constraints with an overburdened healthcare workforce.
• There is geographical maldistribution with the majority of healthcare professionals preferring to stay in urban areas, leaving rural and remote regions with inadequate healthcare services. This disparity limits access to quality healthcare for a large segment of population particularly in South Punjab.
• There is a gender imbalance within the healthcare workforce of P&SHD, with fewer women in leadership roles and certain specialties which affects the overall dynamics and efficiency of the healthcare system.
• There is no continuous professional development of healthcare workers and most of them do not have access to updated training or modern medical practices, impacting the quality of care provided.
• Ineffective health policies and weak governance structures particularly at the district level contribute to low-performing HRH which is then aggravated by a lack of clear strategies and policies to address HRH challenges effectively at the provincial level.
• In view of the limitation outlined above, it is important to develop an HRH Strategic Plan which can help improve health, social and economic development outcomes by ensuring universal availability, accessibility, acceptability, coverage and quality of the health workforce. The plan may also highlight investments avenues to strengthen health systems, and the implementation of effective policies at provincial, and district levels.

Objective

To assess and review existing human resource for health to enhance human resource management, strengthen leadership and governance, align policy support with workforce reforms, promote multi-stakeholder partnerships, and build capacity for innovative resource mobilisation and efficient management, ultimately ensuring sustainable health workforce financing and self-reliance.

Scope of Work and Methodology

The TA team will conduct a rapid assessment of the current state of HRH. This assessment will involve a) structured literature review (policies and best practices) with a clear protocol, including research questions, inclusion/exclusion criteria, and a consistent method for extracting, synthesis and presenting; b) questionnaire/ interview schedule for the key information interviews (KIIs) and stakeholder mapping with power dynamics identified.

It will also involve a systematic evaluation of HRH goals, implementation progress, and overall effectiveness in addressing workforce needs in the health sector. The TA team will begin by assessing whether the current HRH align with the current and future demands of the health system, considering factors such as population health trends, disease burden, and technological advancements. It will also take stock of existing policies, or strategies if in place by examining whether resources, timelines, and activities are on track, and identify any bottlenecks or gaps in execution. Based on this evaluation, the TA team will put up an inception report highlighting areas for improvement for efficiency, and sustainability.

Expected Deliverables, Outputs, and Outcomes

The team of consultants responsible for this assignment is expected to diligently work towards the completion of the following deliverable outlined in the project scope, ensuring the attainment of the desired outputs and outcomes.

Outcome:

• Health workforce planning improved
• Recruitment and retention of the health workforce increased
• Equity in health workforce deployment ensured
• Skills mix improved to enhance the effectiveness of the health workforce
• Health workforce empowered for innovation and change management.
• The performance management of the health workforce strengthened 

Support the team in assessing the current HRH challenges, needs and gaps to be addressed through the strategic plan incorporating best practices and feedback from stakeholders.

Timeline and LOE
The level of effort for the role is 28 working days, from October 2024 to - November 2024.

Requirements:

Technical expertise

• Expertise in public health policy development and advocacy, enabling the influence of decision-makers, shaping health security policies, and soliciting the allocation of resources.
• Competence in conducting comprehensive literature reviews and synthesis, consolidating information from diverse sources to inform research and identify knowledge gaps.
• Strong writing skills, enabling the preparation of clear and concise reports, documents, and findings that effectively present research results and recommendations.
• Proficiency in managing research projects, encompassing planning, organising, and coordinating research activities while meeting project timelines and outlined objectives. 

Competencies

• Strong background experience in health systems and ability to conduct thorough reviews of policy documents and the ability to summarise the key insights into project reports and summary documents.
• Strong communication and advocacy skills to champion policy changes or improvements based on research findings, translating research outcomes into actionable policy recommendations.
• Collaboration skills to effectively work with diverse stakeholders in the public and private sectors, including health departments, and development partners.
• Strong analytical skills for assessing the current health sector infrastructure and identifying areas for improvement. 

Deliverables/KPIs

• Inception Report