District Coordinators

KP TA: Piloting and System Strengthening for Primary Health Care Through a District-Level Approach Aligned with DOH Priorities

 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.

Background

The KP Good Governance Reform Roadmap prioritises accountable, evidence-based policy frameworks and stronger provincial institutions. In the health sector, the focus is on strengthening the health system to build resilient institutions and advance Primary Health Care (PHC).

However, investments such as Human Capital Investment Project (HCIP), National Health Support Programme (NHSP) and the PHC Revamp have followed a siloed approach and have limited system strengthening, thereby not generating value for money (VFM) or meaningful service delivery improvements.

To move towards a more integrated approach, the Department of Health (DOH) has identified strengthened district resource planning as a key mechanism to translate reforms into implementation and measurable results.

The Government of Khyber Pakhtunkhwa (KP) has launched the NHSP, with World Bank financing linked to Disbursement-Linked Indicators (DLIs). These DLIs focus on ensuring that PHC facilities meet essential service delivery norms, particularly in lagging areas, while also incorporating climate risk considerations. As part of this, the development of District Action Plans (DAPs) has been supported in four NHSP-prioritised districts.

Goal and Objective(s)

The goal of this technical assistance is to strengthen PHC at the district level to deliver quality PHC (qPHC) through system strengthening aligned with Department of Health (DOH) priorities, thereby accelerating progress toward UHC in KP. We will achieve this by pursuing three objectives:

Objective 1: Functionalize governance and coordination forums such as District Health Planning and Management Teams (DHPMTs) & District technical review Committee (DTRC) to institutionalize regular performance review, strengthen accountability, improve coordination, and support evidence-based decision making for the delivery of quality PHC.

Objective 2: Strengthen Monitoring and Evaluation (M&E) systems at district level to promote evidence-based decision making and timely tracking of PHC strengthening initiatives.

Objective 3: Support the contextualization and rollout of an Electronic Medical Record (EMR) system in Peshawar to strengthen service delivery and operationalize prioritized RMNCH interventions.

Strategic Approach

Contributions to health systems strengthening

This technical assistance aligns with the Government of KP’s priorities under the Good Governance Reform Roadmap and the revision of the provincial health policy, as well as with the Health Information Service Delivery Unit (HISDU) PC-I framework for digitization of health services. It advances these priorities by strengthening PHC at the district level through functionalizing governance and coordination forums to institutionalize performance review, improve accountability, and enhance coordination for delivery of qPHC. At the same time, it reinforces Monitoring and Evaluation (M&E) systems to embed evidence-based decision making and ensure reforms are tracked and adapted, while contextualizing and rolling out an EMR system in Peshawar to improve service delivery and information flows. Together, these efforts address systemic bottlenecks of weak accountability, fragmented data, and poor policy-to-implementation linkages, moving KP toward a more resilient, integrated, and equitable health system.

Alignment with Other E4H TAs/Investments

This technical assistance complements broader Evidence for Health (E4H) programme support by building on the UHC Implementation Roadmap and aligning with ongoing work on health financing reforms, facility-level budgeting, and strengthening of training systems. While other E4H investments focus on higher-level policy and planning, this technical assistance represents the operational arm anchoring reforms at the district level to strengthen systems and deliver qPHC. It also aligns with parallel E4H initiatives, including the Quality of Care (QoC) Strategic Plan, the Multisectoral Health Workforce Strategy (MSHWFS), and the Climate Health Adaptation Plan (CHAP), by embedding their priorities into district planning, monitoring, and service delivery. Moreover, it will work closely with facility-level budgeting teams and the Human Resource Management Information System (HRMIS) team to ensure better tracking of PHC expenditures, improved workforce planning, and stronger integration of financial and human resource systems with PHC delivery. In doing so, it ensures coherence across E4H’s portfolio and provides a practical foundation for more resilient and sustainable health system reforms in KP.

Alignment with other donors

This technical assistance aligns donor-funded activities within a unified district planning and coordination framework, reducing duplication and creating stronger synergies for PHC reform and delivery of qPHC. It builds on the E4H Review of Global Health Initiatives’ Supported Interventions and Programmes in Pakistan to ensure that partner-supported activities are embedded in district resource planning and implementation. This includes leveraging World Bank–financed NHSP investments to strengthen district capacity for PHC; working with Gavi and the Global Fund to improve monitoring and health information systems that sustain immunization and communicable disease control; and aligning with UNICEF’s community health programming and WHO’s quality of care and service readiness initiatives. In doing so, the technical assistance ensures donor contributions reinforce district-level system strengthening, rather than operating in silos, and collectively move KP closer to resilient and integrated health service delivery.

Scope of Work and Methodology

This technical assistance will support the DOH to strengthen district-level systems as the primary vehicle for delivering qPHC and advancing progress toward UHC in KP. The initiative will begin in NHSP-prioritised districts, starting with a pilot in Peshawar and subsequently expanding to Swat, Mardan, and Kohat, applying lessons learned to strengthen delivery and scalability across the province. The technical assistance adopts a district-level system strengthening approach centered on three areas of support:

Functionalizing governance and coordination forums

• Activate and strengthen forums such as DHPMTs and DTRCs to institutionalize regular performance review, strengthen accountability, and improve coordination for qPHC.
• Demonstrate improved district-level planning, monitoring, and decision-making capacity through evidence of DHPMT-led action points.
• Strengthening Monitoring, Evaluation, And Learning (MEAL) systems
• Develop and operationalize a district-level MEAL framework to embed data-driven decision making and ensure timely tracking of PHC reforms.
• Adapt and institutionalize a consolidated provincial performance monitoring dashboard integrating DHIS2, IMU, HRMIS, and EMR. Use the dashboard to generate quarterly analytics briefs for governance platforms (e.g., DHO and MS conferences, DG Health reviews), ensuring decisions and corrective actions are tracked and recorded.
• Integrate E4H and other donor-supported initiatives such as facility-level budgeting (FLB) and HRMIS within district planning and monitoring.
• Coordinate with technical assistance teams providing support on sustainable training system support to DOH, competency-based assessment tools training on RMNCH five modules, referral system training, facility-level budgeting in Peshawar, and simulation exercises for public health emergencies, ensuring integration of these efforts into district health planning and monitoring to support institutionalization.

Contextualizing and rolling out an Electronic Medical Record (EMR) system in district Peshawar

• Pilot the EMR system in Peshawar to strengthen service delivery and operationalize prioritised RMNCH interventions.
• Ensure interoperability with DHIS2 and HRMIS to strengthen information flows across levels.
• Document lessons learned and developed an endorsed guidance note/manual to support phased rollout to additional districts.

By embedding these reforms in district systems, while aligning with the Good Governance Reform Roadmap, the Health Information Systems Development Unit (HISDU) PC-I, and ongoing DoH initiatives, this TA ensures that PHC strengthening is institutionalized, evidence-driven, and responsive to both provincial priorities and community needs.

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

• The technical assistance directly supports district teams by providing mentoring, technical backstopping, and hands-on problem-solving through DHPMTs and DTRCs. This approach institutionalises skills in planning, monitoring, and evidence-based decision making at the district level.
• All technical assistance supported functions—such as governance and coordination forums, district-level MEAL framework application, and piloting of the EMR system—are embedded in existing district structures (DHPMTs, DTRCs, IMU linkages). By avoiding parallel systems, the TA reinforces government-owned platforms in line with the Good Governance Reform Roadmap, NHSP, and HISDU PC-I.
• Sustainability is embedded from the outset by ensuring that tools (dashboards, HRMIS, EMR) are applied and managed by district staff. The phased rollout deepens ownership progressively, while capacity-building investments prepare district teams to sustain reforms and continue implementation beyond E4H support.

Deliverables

The consultant will work to achieve the following deliverables:

Provide hands-on mentoring and technical backstopping to DHPMTs/DTRCs to ensure district-level PHC strengthening, regular data reviews, and corrective action.

• Provide technical leadership to strengthen provincial governance forums and district coordination platforms (DHPMTs/DTRCs) for effective district-level PHC strengthening.
• At least three sets of DHPMT/DTRC meeting minutes per district showing review of data and documented actions.
• Facilitate and document QA reviews at facility/district level
• District progress reports and implementation summaries signed off by DHOs/DHPMTs/DTRCs.
• Evidence of corrective actions taken by DHPMTs/DTRCs based on progress reviews.
• Lessons-learned briefs from district rollout experiences.

Timeline and Days

The level of effort for the role is 80, working days from October – March 2026.

Requirement

Technical Expertise

Master’s in public health, Health Policy, Business Administration, or related field with practical experience in M&E and PHC service delivery.

Competencies

Field-level coordination, facilitation of DHPMTs, mentoring of district staff, monitoring and reporting, adaptive problem-solving, and ensuring data use for decision-making.