TORs: National Senior STTA – Team Lead / Legal Expert

Technical Assistance Name: IN-DEPTH LEGAL ASSESSMENT OF INTERNATIONAL HEALTH REGULATIONS-RELATED LEGISLTAION (Phase I) IN PAKISTAN

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’s National Health Vision (2016-25) - Pillar VIII (Global Health Responsibilities) highlighted international public health security as one of the main challenges arising from the new and complex landscape of public health, requiring core capacities at federal or provincial levels.

·       As a member of the International Health Regulations (IHR) 2005, Pakistan is committed to strengthening its core capacities across 19 technical areas, from the continuum of prevention, detection and response

·       Despite ongoing efforts, the country has not fulfilled the required core capacities. This inadequacy poses potential threats to trade, travel, and the well-being of its population, particularly in the face of health crises originating both globally and domestically

·       In 2016, Pakistan underwent a Joint External Evaluation (JEE), assessing its core capacities with a score of 48% from 48 indicators, leading to the identification of gaps and key recommendations for each technical area. Consequently, a five-year costed National Action Plan for Health Security (NAPHS) was established in response (2017-21)

·       However, the recent COVID-19 pandemic further highlighted gaps in Pakistan's health security despite the implementation of initial JEE recommendations

·       A second JEE using a revised WHO tool was performed in May 2023, with an IHR index of 43% from 56 indicators. The 2023 JEE report has identified gaps and provides recommendations for all 19 technical areas tabulated below:

·       One of the critical technical areas related to the IHR ‘Prevent’ thematic area is P1.1 Legal Instruments, where the score in 2023 was 2/5 (level 2). This score indicates  that ‘’the country has conducted a legal mapping of relevant legal instruments for IHR implementation at the national and intermediate levels and documented them where applicable’’.

·       As per the JEE tool recommendations, to progress to the next Level 3, the milestone to be achieved is that ‘The country has conducted a legal analysis (legal mapping and legal assessment) and identified and reviewed gaps in the health sector and developed and /or revised the necessary legal instruments for IHR implementation at the national and intermediate levels, where applicable.’’ 

·       One of the critical technical areas related to the IHR ‘Prevent’ thematic area is P1.1 Legal Instruments, where the score in 2023 was 2/5 (level 2). This score indicates  that ‘’the country has conducted a legal mapping of relevant legal instruments for IHR implementation at the national and intermediate levels and documented them where applicable’’.

·       As per the JEE tool recommendations, to progress to the next Level 3, the milestone to be achieved is that ‘The country has conducted a legal analysis (legal mapping and legal assessment) and identified and reviewed gaps in the health sector and developed and /or revised the necessary legal instruments for IHR implementation at the national and intermediate levels, where applicable.’’ 

·       The Ministry of National Health Services, Regulations and Coordination (NHSR&C) has already started a scoping review of IHR-related health legislation, with descriptions to pinpoint legislations requiring detailed assessment.

·       Given the considerable number of approximately 200 national and provincial laws, the next recommended step is an in-depth legal assessment of public health laws related to IHR through a phased approach. Therefore, in phase I, only priority health-related IHR legislations have been identified for in-depth legal analysis, whereas in the follow-up phases, other sectoral IHR-related laws will need to be analysed for any revision or new legislation to move to level 4.

Objectives

The overall objectives of the technical support will be:

A.     To conduct an in-depth legal analysis of IHR-related public health laws, employing a phased approach

o   To conduct and evaluate the effectiveness of legal instruments.

o   To analyse gaps with the country's legal system and national/ provincial context in mind;

o   To Inform the refinement and revision of existing Instruments or development of new legal Instruments or to recommend unwanted.

B.     To share the findings of the detailed legal analysis of public health laws among the relevant IHR Technical Working Group (IHR/Prevent) and stakeholders to develop a better understanding and initiate recommended actions.

Scope of Work and Methodology

• A team of consultants will conduct the legal analysis while considering global and national best practices through literature review, examining the constitution & rules of business and prioritised IHR-related public health laws at national and provincial levels. Key stakeholders at both the national and provincial levels will also be consulted for gap analysis.

• 
  

The analysis will include, but not be limited to, the following elements:

• Perform a desk review of global literature on IHR related legislations, review reports, the WHO guidance reports, etc. to understand the context, identify best practices and comparative analysis.  
• Review the Constitution of Pakistan (1973) along with rules of business to understand the context, position and responsibilities related to IHR
• Consultrelevant stakeholders and experts, including the Ministry/ Departments of Law, Ministry of NHSR&C and DOHs, NIH, and ‘One Health’ stakeholders, to gather deeper insights, perspectives, and feedback on the prioritised legal laws
• Analyse in detail the prioritised laws and frameworks to assess their alignment with the core requirements at national & provincial levels against the obligations outlined in the IHR
• Identify gaps, inconsistencies, or deficiencies within the legal framework; identify needs for amendments, new IHR-related legislation, e.g. climate change or recommendations unwanted in the current scenario
• Prepare a comprehensive report documenting the findings, analysis, and recommendations of the legal analysis.
• Structure of the report:
• Provide a brief background, findings from the global literature review, and an overview of constitutional positions and responsibilities related to the IHR at national and provincial levels
• Briefly describe the process and annex the stakeholders consulted
• Offer an in-depth legal analysis of each prioritised law, along with recommendations/ actions in a systematic way
  • Deliver a presentation with the recommendations for amendments/revision or new laws for IHR Implementation based on their significance, relevance, and potential impact on public health outcomes
  • Incorporate comments and suggestions to finalise the in-depth legal analysis report (phase I) with clear recommendations/ actions. This will inform decision-makers on how to continue in the future, ensuring evidence-informed reforms in IHR-related legislation for the health sector. The evaluation may employ a mixed methods approach using quantitative and qualitative methods.

Focal points nominated by the Director General (Health) and the Chief Executive of NIH will be actively engaged, where possible, in the activity for capacity development related to IHR legislation.

Timeline and LOE

The level of effort for the role is 55 working days, from May - July 2024.

Requirements

 Technical Expertise

• Postgraduate degree in Law.
• More than fifteen years of experience in law practice and critical legal analysis.
• Strong convening, report writing, and analytics skills with the following expertise:
• Literature review, reviewing relevant legislations and documents, policies, and procedures
• Conducting interviews with key stakeholders, including healthcare professionals and regulatory bodies
• Identifying best practices and lessons learned on IHR-related legislation from other countries that have implemented similar reforms
• Writing report and dissemination

Competencies

• Planning and delivering work; analysing and using information;
• Decision making; and Influencing.

Deliverables / KPIs

• Draft in-depth analysis report with recommendations / future actions for amendments/new laws of IHR and presentation.
• Final report after inclusion of comments and suggestions; Final presentation.