Senior National - Monitoring & Evaluation Expert

KP TA - Strengthening Provincial and District Systems to Deliver Quality Primary Health Care 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 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.

Position Summary

The goal of this technical assistance is to strengthen institutional capacity and promote a system-strengthening culture within the DOH to improve PHC services in the district health system. By enhancing governance, planning, and monitoring systems and leveraging the NHSP platform, the technical assistance will enable effective EPHS rollout, achievement of DLIs, and progress toward Universal Health Coverage (UHC) in KP. We will achieve this by pursuing three objectives:

Objective 1: Strengthen provincial-level governance, planning, and coordination to provide leadership and technical backstopping to district teams for EPHS and NHSP implementation.

Objective 2: Enhance monitoring, evaluation, and learning systems across provincial and district levels to institutionalize data-driven decision-making, ensure effective data flows and analysis, and sustain improvements beyond NHSP.

Objective 3: Build district-level capacity to design, implement, and monitor integrated resource plans, supported by structured provincial guidance and quality assurance to improve PHC service delivery.

Objective 4: Institutionalize district health system strengthening through functional District Health Planning and Management Teams (DHPMTs), integrated governance and coordination mechanisms, strengthened Monitoring and Evaluation (M&E), and resource planning linked with provincial systems.

Strategic Approach

Contributions to health systems strengthening

This technical assistance will strengthen the health system by supporting the Government of KP to integrate and scale up its flagship PHC strengthening initiatives, the HCIP, NHSP, and the PHC Revamp. While the Good Governance Reform Roadmap is under implementation and policy revision has just begun, the technical assistance will harmonize these three major investments to ensure coherence, avoid duplication, and maximize impact at provincial and district levels. By embedding technical support within DOH structures, provincial teams will provide leadership and backstopping, while district teams will operationalize district plans based on prioritised Reproductive, Maternal, Newborn and Child Health (RMNCH) interventions of the EPHS rollout. In doing so, the technical assistance will institutionalize reforms beyond the temporary NHSP platform, reinforce PHC as the foundation of UHC, and accelerate measurable progress toward improved access, quality, and equity of essential services.

Alignment with other E4H TAs/investments

This techincial assistance builds directly on the UHC Implementation Roadmap developed by Evidence for Health (E4H) KP Programme in 2024, which identified systemic bottlenecks and proposed a phased strategy for EPHS rollout in KP. It complements ongoing E4H support to health financing reforms, facility-level budgeting, and strengthening of training systems, by providing the operational backbone at provincial and district levels. The technical assistance will also integrate specific actions from the Quality of Care (QOC) Strategic Plan, the Multisectoral Health Workforce Strategy (MSHWFS), and the Climate Health Adaptation Plan (CHAP) into district resource planning, ensuring that provincial strategies are effectively translated into district-level implementation. Critically, it supports the implementation of the approved KP Health Information and Service Delivery Unit (HISDU) PC-I, particularly through Human Resource Management Information System (HRMIS) strengthening and piloting of an Electronic Medical Records (EMR) system in one district. Together, these efforts create a coherent package of E4H support that strengthens primary health care (PHC) systems and accelerates measurable progress toward UHC in KP.

Alignment with other donors

The technical assistance embeds donor-funded activities into a unified provincial and district planning framework, helping reduce duplication and creating stronger synergies for PHC reform and EPHS rollout. It will incorporate recommendations from the Evidence for Health (E4H) Review of Global Health Initiatives’ Supported Interventions and Programmes in Pakistan into district resource planning, ensuring partner-supported interventions are integrated and aligned. This includes leveraging World Bank–financed NHSP investments to strengthen provincial and district capacities for strengthening PHC; improving monitoring and health information systems that support immunization and communicable disease control with support from Gavi and the Global Fund; and aligning with United Nations Children’s Fund (UNICEF) community health programming and World Health Organization (WHO) initiatives on quality of care and service readiness.

Scope of Work and Methodology

This technical assistance will support the DOH to strengthen district action plans as the primary vehicle for improving the coverage and quality of essential health services, operationalising the EPHS, and achieving NHSP DLIs.

The technical assistance will adopt a phased approach, beginning with four priority districts (including Peshawar) and expanding quickly to four additional districts, while providing continuous provincial backstopping. This ensures reforms are embedded systematically, expanded rapidly, and aligned with the Good Governance Reform Roadmap.

Phase I: Technical Assistance for Evidence-Informed District Health Action Plans

The technical assistance will strengthen the link between provincial reforms and district-level execution

to deliver quality PHC, aligned with the Good Governance Reform Roadmap. As part of the broader technical assistance, resource planning — including the development of district action plans — will be introduced in eight districts, starting with four priority districts (Peshawar, Swat, Mardan, and Kohat) and later expanding to Abbottabad, Haripur, Malakand, and D.I. Khan. Specifically, the team will:

• Conduct rapid situational analyses in four priority districts, building on the E4H-supported financial gap analysis, to identify service delivery gaps, financing bottlenecks, workforce needs, M&E challenges, and governance constraints.
• Facilitate provincial–district consultations to co-develop costed DAPs focused on the DOH’s prioritised interventions such as RMNCH and ensure they are aligned with the EPHS, NHSP DLIs, and provincial reform priorities.
• Integrate specific actions from policies and strategies such as the Quality of Care (QOC) Strategic Plan, the Multisectoral Health Workforce Strategy, and the Climate Health Adaptation Plan (CHAP) into District Action Plans (DAPs), ensuring that district implementation is closely aligned with provincial priorities. Institutionalise a PHC quality assurance mechanism, aligned with the QOC Strategic Plan
• Provide technical support to DHPMTs and District Technical Review Committees (DTRCs) to roll out DAPs, track progress, and address implementation challenges across all eight districts.
• Document and apply lessons learned from the first four districts to guide expansion to the next four districts, ensuring a phased, evidence-informed, and scalable approach to DAP development and implementation.

Phase II: Strengthening Governance, Systems, and Accountability for PHC

Provincial Level Support

• Governance and coordination: Harmonise provincial-level governance forums by strengthening their functionality and ensuring they are effectively used for integrated decision-making to support PHC. Align steering committees, Technical Working Groups (TWGs), and data governance bodies so that their agendas are responsive to district-level priorities and EPHS rollout needs.
• M&E and MEAL backbone: Strengthen provincial M&E and Monitoring, Evaluation, Accountability and Learning (MEAL) systems, ensuring dashboards are fully utilised for analytics, performance tracking, and decision-making. Establish structured reporting and feedback loops so district progress informs provincial policy, and reforms are translated into district action. Support HSRU, IMU, and NHSP M&E units to produce regular analytics and progress briefs.
• HRMIS strengthening: Lead provincial-level Human Resource Management Information System (HRMIS) actions, validate and update HR records in collaboration with district teams, and align datasets with provincial requirements. Ensure HRMIS analysis is used for decision-making on staffing, linked with Sustainable Training System (STS) and HR management functions.
• EMR model and rollout oversight: Contextualise and agree on an interoperable Electronic Medical Records (EMR) model (building on FCDO’s investments), ensure interoperability with DHIS2 and HRMIS, and provide provincial oversight for phased rollout in districts.
• Analytics and performance reviews: Support the use of dashboards and analytics in forums such as DHO conferences, MS conferences, and DG Health reviews, ensuring district profiling and performance tracking are institutionalised.

District Level Support

• Governance mechanisms: Re-notify, harmonise, and functionalise DHPMTs and DTRCs as decision-making and performance review forums, directly linked to provincial oversight. Institutionalise these as core governance platforms for PHC and EPHS rollout.
• M&E and MEAL application: Implement the provincial M&E/MEAL framework using district action plans (DAPs) as the basis. Conduct regular reviews of progress at DHPMT and DTRC meetings, feed results into provincial dashboards and performance discussions.
• HRMIS validation and use: Work with HRMIS focal points to validate and update HR records, improve data quality, and ensure HRMIS is routinely used for workforce planning and decision-making at district level.
• EMR implementation: Roll out the contextualised and interoperable EMR model in districts, starting with Peshawar as a pilot, ensuring integration with service delivery and linking with provincial information systems.
• DAP implementation and monitoring: Support DAP implementation in the initial four districts (Peshawar, Swat, Mardan, Kohat), with DHPMTs monitoring progress, reviewing performance, and guiding corrective actions. Document lessons and apply them during expansion to the next four districts (Abbottabad, Haripur, Malakand, D.I. Khan).
• Capacity building: Embed ongoing training and mentoring within implementation by supporting DHPMTs to identify new needs, access targeted capacity-building, and institutionalise stronger governance and accountability practices.

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

• This technical assistance embeds continuous capacity strengthening by working directly with DOH units (HSRU, IMU, FMC, NHSP M&E, and DHPMTs) through hands-on mentoring, technical backstopping, and joint problem-solving. As outlined in the methodology, provincial experts will guide district teams, ensuring that skills in planning, monitoring, and decision-making are transferred and institutionalised.
• Functions supported by this technical assistance — such as DAP development, HRMIS validation, and EMR rollout — are anchored in existing government platforms (DHPMTs, DTRCs, HISDU, and IMU) to ensure they remain functional beyond external support. The TA deliberately avoids parallel systems, instead strengthening DOH structures and aligning with the Good Governance Reform Roadmap, NHSP, and HISDU PC-I.

By embedding TA within provincial and district structures, and ensuring all tools (MEAL framework, DAPs, dashboards, HRMIS, EMR) are fully owned by DOH staff, this support is designed for transition from day one. A phased approach (starting with 4 districts, expanding to 8) allows government ownership to deepen progressively, while capacity-building investments ensure continuity after E4H closure.

Responsibilities

The M&E Expert will work to achieve the following:

1. Gap analysis reports for 8 districts, endorsed by DOH.
2. M&E/MEAL sections in 8 DAPs with clear indicators and targets.
3. Approved provincial MEAL framework endorsed by DOH.
4. Support the use of data analytics at provincial and district levels to inform planning and decision-making.
5. Training reports from 2 M&E capacity-building workshops (provincial + district level).
6. 1 annual synthesis note on evidence use in planning and decision-making.

Timeline and Days

The level of effort (LOE) for the role is 125 days from September 2025 – September 2026.

Requirement

Technical Expertise

• Master’s in public health, Epidemiology, Biostatistics, or Social Sciences with strong quantitative background.
• Expertise in MEAL framework design, M&E systems, health data analysis, dashboards, and performance tracking.

Competencies

• Evidence-based decision-making, data visualization, facilitation of learning processes, capacity building of M&E units.