TORs: National Senior STTA – Health System Expert
Development of a Coordination Mechanism for Donors and Development Partners 

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

• Following the 18th amendment in Pakistan, provinces have gained significant autonomy through devolution. Consequently, the role of the federal government—including ministries such as the Ministry of National Health Services, Coordination & Regulation (M/o NHSR&C)—has eroded over time from having operational control to having a responsibility limited to coordination and strategic oversight.
• The Primary & Secondary Healthcare Department (P&SHD) in Punjab now interacts directly with international development partners.
• Punjab receives significant international donor funding, accounting for 41.6% of total donor health expenditures in Pakistan (National Health Accounts 2021-2022). Key international partners include the World Bank and the Asian Development Bank; United Nations Agencies (UNICEF, WHO, UNDP, etc.); the United States Agency for International Development (USAID); the Foreign Commonwealth Development Office (FCDO); and several others.
• These partners provide financial and technical support across healthcare reform initiatives, including the six Health System Strengthening (HSS) building blocks.
• Bilateral Aid Agencies (USA, UK, Canada): Financial assistance, technical expertise, and resources.
• In Punjab, the Director General Health Services (DGHS) Office coordinates with donors but lacks the capacity for effective engagement.
• The Secretary P&SHD is the donors' key point of contact; however, interactions depend on availability and willingness, leading to irregular meetings, fragmentation, overlapping mandates, and differing priorities among donor partners and government agencies. This results in duplication of efforts and inefficient resource use.
• Harmonising donor activities and aligning them with national health strategies is essential for maximising impact and avoiding fragmentation. This risk can be mitigated through one unified coordination mechanism designed to align and synchronise all health efforts of donors and development partners with the government's sectoral reform objectives. There can be alignment with existing coordination mechanisms, including the Universal Health Coverage (UHC) Technical Committee and other structures that aim to engage donors and partners.
• In the FCDO-funded Improved Health Service Delivery in Pakistan (IHSDP) project, the P&SHD extended support for developing a web portal. This was housed in P&SHD's Health Information and Service Delivery Unit (HISDU) of P&SHD. The digital dashboard was designed to serve as a central repository for development partners to upload their current projects, focus areas, priority interventions and funding strategies. The web portal, however, could not be made sustainably functional due to the programme's closure immediately after its development. Following the conclusion of the TA, the following recommendations were proposed as next steps:
• The department must ensure that all development partners are aware of the portal and given their respective user credentials so they can enter data into the portal.
• Once the portal is populated, it should serve as a centralised repository of donor support provided. It can evolve into a more complex platform for two-way communication between the Government and development partners. 

Objective

To establish a unified and efficient health system in Punjab by optimising the allocation and utilisation of resources, encouraging cohesive collaboration among donors and stakeholders, aligning with national and global health priorities, and enhancing the capacity of the P&SHD to independently manage health programmes and respond effectively to emergencies, thereby promoting a sustainable, where possible innovative and integrated approach to healthcare delivery. 

Scope of Work and Methodology

1. Assess best practices to collect insights and create a better understanding from peer-reviewed academic research relevant to donor and/or partner coordination mechanisms.

• The team is expected to conduct a quick, structured literature review with a clear protocol, including research questions, inclusion/exclusion criteria, and a consistent method for extracting and presenting findings. This review should cover donor coordination mechanisms and extend to public institutions' coordination structures and best practices.

Checkpoint 1: An inception slide deck was sent to the E4H project team, with the methodology and relevant findings clearly explained and priority areas identified for stakeholder consultations. Proposed key information interview schedule and prompts. Consult with the relevant officials in the P&SHD and the M/o NHSR&C to identify key stakeholders to be included in the consultations to develop the donor coordination group.

• The team is expected to conduct initial meetings with key focal points within the Department and rapidly assess donors, international agencies, implementing partners, and government institutions in the province. Consulting the federal ministry will help map relevant stakeholders at both federal and provincial levels. The team is expected to ensure a wide range of consultations to nurture buy-in from the various wings and implementation arms of the P&SHD, including, at a minimum, the DG’s office, the HISDU, the UHC Delivery Unit, and the Additional Secretary Technical office. This will identify actors working towards similar goals who could benefit from a central coordination platform.

Checkpoint 2: A succinct three/four-page report presenting distilled findings from all consultative meetings, including individual KIIs.

1. Develop a coordination mechanism incorporating all development partners supporting the P&SHD.

• The team is expected to develop detailed Terms of Reference (TORs), including the functions at each level (provincial and district). The frequency of convening, membership, roles, responsibilities, Standard Operating Procedures (SOPs), standard administrative templates, and other guidelines for establishment, operationalisation and continued engagement. The team is expected to identify focal points at both the provincial and district levels to ensure the sustainability of the coordination mechanism. Additionally, focal points within donor organisations should be identified to form a core group responsible for leading the coordination efforts. This core group may include the E4H project team, FCDO, the World Bank or the World Health Organisation, and any other implementing partners nominated by the P&SHD. The core group's primary task will be to ensure maximum participation from all donor agencies and implementing partners by leading coordination meetings.
• Furthermore, the team is expected to develop an exit plan for the E4H programme, which concludes in 2027. This plan should include innovative strategies to ensure the continuity and sustainability of the coordination group and mechanism beyond the programme's duration.

1. Develop a comprehensive Monitoring and Evaluation (M&E) framework for assessing the effectiveness and impact of the donor coordination mechanism and establish a data dashboard to provide progress reporting metrics to the donor coordination group.

• Identify and define KPIs aligned with the donor coordination mechanism's objectives, covering financial metrics, programmatic outcomes, and process efficiency indicators.
• Develop periodic review and evaluation protocols, including a detailed M&E plan with methodology, data sources, collection frequency, and responsible parties.
• Explore collaboration with HISDU on a Health Data Information Framework and the UHC Delivery Unit to analyse the progress of UHC implementation.
• Develop a real-time dashboard for tracking donor contributions, expenditures, and health outcomes, integrated with HISDU and UHC Delivery Unit data capabilities.

Checkpoints 3 & 4: A report presenting the details of the governance structure linking it with the findings of the consultations and the desk research. Development of a comprehensive M&E framework, with well-reasoned and thoroughly researched linkages drawn to the initial literature review, the consultative sessions, and the expectations developed regarding a functional coordination group. Provide embedded support in the operationalisation and capacity transfer of the coordination mechanism. 

• Provide hands-on support for planning and conducting the first two coordination group meetings.
• Collaborate with DGHS staff to prepare the agenda, send invites, define presentation formats, and identify presenters.
• Support the government in leading sessions, recording minutes, and sharing action points and commitments.

Checkpoint 5: Coordination sessions held. 

Timeline and LOE

The level of effort for the role is 56 working days, from Ocotber 2024 to - February 2025.

Requirements: 

Educational Background

Master's degree in Public Health, Health Policy or related field.

Technical expertise

• The consultant should have a sound understanding of the health reforms in the province, health service delivery models, quality improvement approaches, and strategies for enhancing service accessibility, coverage, and effectiveness.
• The consultant should engage at policy and strategic levels, coordinating with government departments, policymakers, and key stakeholders to navigate health system reforms and policy development.
• The consultant should possess strong project management and leadership skills and the ability to lead and coordinate complex assignments.
• The consultant should be skilled in researching health systems, developing evidence, and effectively translating research findings into practical recommendations to inform decision-making and policy development. 

Competencies

• The consultant should have proven expertise in understanding the components and functions of health systems, including governance, financing, health workforce, health information systems, and service delivery.
• The consultant should be able to analyse the health system comprehensively, assessing its strengths and weaknesses.
• The consultant should collaborate with multidisciplinary teams to foster partnerships and promote stakeholder engagement to achieve shared health system goals and outcomes.
• The consultant should have experience developing and implementing strategic plans to address health system challenges and achieve expected outcomes.

Deliverables/KPIs

• A comprehensive spreadsheet detailing international development partners and selected national organisations in Punjab, including organisation names, donors, level of support, thematic areas, districts, budget, and government focal points for coordination.
• Concise document outlining the agreed coordination mechanism with HSRU, including well-defined TOR encompassing functions, linkages with other structures, frequency of meetings, membership details, plan, and specific roles and responsibilities.
• Develop the meeting agenda in collaboration with HSRU, finalise the presentation format, conduct the session, document meeting minutes, and endorse from HSRU.