TORs: National Midlevel STTA – Research Associate

Technical Assistance Name: Universal Health Coverage Implementation Roadmap in Punjab

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

Pakistan is committed to the Sustainable Development Goals Agenda 2030, and the Universal Health Coverage (UHC) initiative is the key element to ensure progress on health-related Sustainable Development Goal 3. Pakistan is one of the first countries to use a global review of evidence by Disease Control Priorities (DCP 3) to guide the definition of its generic UHC benefit package/Essential Health Services Package. Subsequently, the province of Punjab developed its own Essential Package of Health Services EPHS/UHC benefit package in 2021 as a guiding framework for extending UHC for the public and improving the sub-national and, consequently, national ranking of UHC’s Service Coverage Index (SCI).

The Government of Punjab has been striving to improve UHC SCI on four prioritised clusters for health services through 5 service delivery platforms identified during the development of EPHS. The funding opportunities of the indigenous and development partners can be utilised to improve UHC coverage. Government funding must mainly fill EPHS implementation gaps at the community and Primary Health Care levels. Some programmes like the World Bank (WB) funded, such as the National Health Support Programme (NHSP), can contribute if appropriately leveraged.

As a baseline, nationally, the UHC SCI (SDG 3.8.1) was 40.6 in 2015, gradually improving to 53.8 in 2022, indicating a 32.4% change since then. Though progress towards achieving the SCI is positive, Punjab is among the slowest-progressing federating provinces/areas during this period. The Primary & Secondary Healthcare Department (P&SHD) wants to intensify its efforts and enhance investment in UHC. It also aims to use available resources more effectively and efficiently while ensuring effective monitoring.

Despite multiple reforms and collaboration for UHC in the province, there is a lack of cohesive alignment towards a comprehensive UHC implementation. Addressing this gap necessitates a unified approach, based upon the institutional capacity of P&SHD, that integrates these efforts cohesively, providing a consolidated and strategic direction for the UHC agenda in the province. To address this gap, a UHC roadmap is crucial - a comprehensive, integrated framework approach that centralises and prioritises these reforms to offer a holistic and strategic direction for improving implementation across the province while allowing necessary flexibility to field formations for implementation.

Objectives

The main objectives of the development of the UHC roadmap are:

• To quickly review issues and challenges that are afflicting the progress of UHC-SCI in the province for a brief situation analysis for the roadmap 
• To engage key stakeholders both in the public sector and partners to develop an understanding of the strategic and programmatic priorities along with mapping for UHC investments and plans
• To hold consultations with stakeholders to define SMART objectives for UHC progress in the province along with strategic priorities and actions along with circumscribing monitoring mechanisms, and for ascertaining available and required budget
• To prioritise actions that can be taken simultaneously or consequently (determining a critical path) related to the delivery of EPHS, with the availability of essential health workforce, strengthening of supply-side systems, access to essential medicines and strengthening of governance mechanism(s)
• To prioritise the implementation of UHC reforms while considering the availability of existing and forecasted financial resources and keeping a view of options for innovative financing

Scope of Work and Methodology

A team of consultants will be tasked to deliver the following scope of work:

• The P&SHD has recently unveiled the Health Sector Reform Programme (using a roadmap approach) for the next five years. The UHC implementation roadmap will contribute to advancing the UHC SCI scores across all Punjab Districts by being an integral arm of this reform programme. Furthermore, it will align the reform agenda with the Chief Minister’s roadmap, which is structured around the manifesto of the current political regime. This TA Is envisaged to ensure effective monitoring and political ownership at the chief executive level for sustainable outcomes
• The team will be reviewing local and international evidence on UHC-linked reforms, analyses, and assessments, including but not limited to UHC strategies and roadmaps from other lower-middle-income countries. The review will develop an understanding of the roadmap's theoretical underpinnings. The documents to be reviewed include but are not limited to UHC reforms being undertaken, Punjab EPHS, UHC monitoring report 2023, Pakistan status of health financing report, UHC-SCI index to gain a deeper understanding of the current situation, initiatives contributing to UHC, and status of health financing. This review aims to gain deeper insights into the status, ongoing initiatives contributing to UHC and the status of health financing
• Guided by the literature review, the team will thoroughly review current initiatives ( Including SSP approach , WB NHSP UHC support) align these investments with different service delivery platforms, and prioritise interventions in Punjab's EPHS.  The TA will also map these initiatives to the public sector (development and current) and partners supporting these interventions and ensure their alignment within these domains (this may include phasing of districts for additional financing for UHC interventions)
• The TA will entail collaboration with development partners, donors, global health Initiatives, and government stakeholders, including Punjab Health Foundation and Punjab Healthcare Commission and with the Departments of Planning and Development (P&D) and Finance (FD) etc., to gain more clarity and understanding;
• Develop a draft UHC roadmap with a clear approach and framework and develop consensus with stakeholders in view  of current opportunities within existing systems and  various funding mechanisms
• Create a cohesive framework to monitor and evaluate the implementation progress and impacts of the UHC initiatives and the Delivery Unit’s activities. To that end, the team is expected to:

1. Establish an M&E Working Group: Include M&E specialists from the Delivery Unit and the UHC planning team.
2. b.     Set Up Real-Time Data Reporting Systems: Implement and channel digital solutions for real-time data collection and reporting, facilitating timely decision-making and adjustments. The team is expected to coordinate closely with the data governance and decision-making support provided through embedded TA at HISDU.
3. Regular Review and Feedback Mechanisms: Schedule monthly and quarterly review meetings between three TA workstreams to discuss M&E findings, allowing for ongoing adjustments to strategies and interventions.

• Drawing from the review and consultations, the team will highlight challenges across service delivery, financial management, monitoring and evaluation, policy, and governance. The effort will result in a UHC roadmap, which will be presented and revised based on feedback from stakeholders identified during this TA
• Suggest the way forward, including developing district action plans for the phased implementation of UHC in case of financial constraints. Embed adaptability in the roadmap to respond to new developments and mitigate risks effectively. The team is also expected to develop guidelines that allow district health officers to adapt the UHC implementation strategies to local demographics, health challenges, and resource availability. The idea is to have a flexible implementation strategy considering the various needs of districts across the province. This may be important when considering the differences in key policy actions between South Punjab districts and Northern and Central Punjab districts.
  • The team is also expected to consider incorporating in the roadmap a plan to pilot district-specific and flexible implementation plans in selected districts to evaluate progress and flexible implementation approaches.
• Estimate and reflect the resource requirements and potential partnerships necessary for the implementation of the UHC roadmap
• Guide -, medium-, and long-term UHC planning for the P&SHD, with the complementing UHC Delivery Unit as a focal point. The team is also expected to collaborate and coordinate with the Delivery Unit team to assess their capacity to implement the UHC roadmap, identify any capability gaps, and provide capacity-building support and continued embedded guidance.

Timeline and LOE

The level of effort for the role is 40 working days, from Jun 2024-Dec 2024.

Requirements

Technical Expertise

• Expertise in thorough literature review and synthesis, consolidating information from diverse sources to prepare scientific summaries to inform research and identify knowledge gaps.
• Strong writing skills to prepare clear and concise reports, documents, and findings that effectively present research results and recommendations.
• The ability to generate meaningful insights from collected data.
• Proficiency in managing research projects, including planning, organising, and coordinating research activities and meeting project timelines and objectives.

Competencies

• Ability to advocate for policy changes or improvements based on research findings, translating research outcomes into actionable policy recommendations.
• Competence in collaborating across disciplines, connecting health security and climate change expertise to address complex issues effectively.
• Skill in developing and implementing health communication strategies to convey research findings.

Deliverables/KPIs

• Support to Inception report
• Support to Situation analysis
• Support to Draft UHC framework and strategic plan
• Support the M&E framework
• Support to Final UHC roadmap
• Capacity building and embedded support