Senior National STTA – Health Systems Strengthening Expert / Team Lead with M&E Expertise

(E4H KPTA: Institutionalising District Health Systems for Sustainable 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.

Background

Khyber Pakhtunkhwa (KP) has prioritised governance and health-system reforms, recognising Primary Health Care (PHC) as the foundation for Universal Health Coverage (UHC). Investments including the National Health Support Programme (NHSP), Human Capital Investment Project (HCIP), PHC Revamp and other provincial initiatives provide an important platform for strengthening district health systems and improving PHC delivery.

Under the E4H technical assistance, district-level governance and management systems are being strengthened in four priority districts, Peshawar, Swat, Mardan and Kohat, through functionalisation of District Health Planning and Management Teams (DHPMTs) and District Technical Review Committees (DTRCs), strengthened monitoring and evidence use, and mechanisms for quality assurance and corrective action.

The TA has established the foundations for DHPMTs and DTRCs to serve as district platforms for planning, coordination, performance review and accountability. It has also introduced mechanisms for reviewing PHC performance and quality, documenting decisions and following up corrective actions. Quality Assurance (QA) mechanisms have been embedded within DHPMT/DTRC protocols, with structured QA reviews of PHC facilities formally incorporated into these forums for review and action.

The next phase therefore needs to move beyond functionalisation and externally supported implementation towards institutionalisation, government ownership and sustained use of these mechanisms. The emphasis will be on making DHPMTs, DTRCs and quality PHC (qPHC) approaches part of routine district health-system management, while strengthening the capacity of district leadership and teams to independently plan, review performance, identify bottlenecks, undertake quality improvement and follow through on agreed actions.

Goal and Objectives

The overall goal of this TA is to institutionalise effective district health-system management and quality Primary Health Care in Peshawar, Swat, Abbottabad and Kohat by strengthening government ownership, leadership and capacities to routinely plan, review, improve and account for PHC performance.

We will achieve this by pursuing three objectives:

Objective 1: Institutionalise DHPMTs as the principal district platform for integrated health planning, performance management, coordination, resource prioritisation and accountability.

Objective 2: Institutionalise DTRCs as routine technical platforms for reviewing service-delivery performance and quality, identifying systemic and facility-level bottlenecks, and ensuring implementation and follow-up of corrective actions.

Objective 3: Institutionalise qPHC within routine district management by strengthening district and facility capacities for quality assessment, quality improvement, supportive supervision, problem-solving and monitoring of improvement actions.

Objective 4: Strengthen the leadership, managerial and technical capacities of district health teams to independently use governance platforms, routine information and quality-improvement approaches for continuous district health-system strengthening.

Strategic Approach

Contributions to health systems strengthening

The TA will adopt a district health-system strengthening approach rather than a project or programme-specific approach. DHPMTs and DTRCs will be strengthened as permanent government mechanisms through which district leadership routinely brings together planning, service-delivery performance, quality, workforce, commodities, financing and other relevant health-system issues. The next phase will deliberately move from “doing for districts” to “districts doing with progressively lighter technical support.” Embedded technical assistance will therefore focus on coaching, mentoring, standardising processes and transferring practical competencies rather than establishing parallel implementation arrangements. qPHC will be positioned as an integral district management function. Quality assessment findings, facility performance, identified gaps and quality-improvement actions will routinely feed into DTRCs and DHPMTs, creating a continuous cycle of measurement → review → prioritisation → action → follow-up → improvement.

Alignment with Other E4H TAs/Investments

The TA will consolidate investments already made through E4H in district health planning, governance, data use, quality assurance, human resources, training and PHC strengthening. Rather than introduce additional standalone tools or structures, Phase II will support districts to use existing government and E4H-supported systems coherently through DHPMTs, DTRCs and qPHC processes. This is consistent with the first phase's approach of linking district governance platforms with other E4H-supported initiatives to strengthen district planning and monitoring. Emphasis will be placed on ensuring that learning, systems and capacities generated through previous technical assistance are absorbed into government functions and translated into routine district practices. Phase II will also establish strong operational linkages with the rollout of Facility-Level Budgeting (FLB) and DHO reforms, ensuring that DHPMTs, DTRCs and QPHC mechanisms complement and reinforce these reforms. DHPMTs will provide an important platform for connecting district priorities and identified PHC bottlenecks with planning and resource-allocation decisions, including those enabled through FLB and strengthened DHO functions. DTRC and QPHC reviews will, in turn, generate evidence on service-delivery and quality gaps that can inform facility and district-level prioritisation, management action and resource use.

Alignment with other donors

The TA will use DHPMTs and DTRCs as coordination and management mechanisms through which relevant government and partner-supported PHC interventions can be reviewed within an integrated district framework. This will help reduce fragmentation and ensure that partner investments contribute to common district priorities and PHC outcomes. The approach builds on the current TA's intention to provide a unified district planning and coordination framework and align investments from NHSP and other partners rather than create parallel implementation arrangements.

Scope of Work and Methodology

The TA will operate in the four districts Peshawar, Swat, Mardan and Kohat and focus exclusively on consolidating and institutionalising DHPMTs, DTRCs and QPHC as mutually reinforcing components of routine district health-system management. The methodology will combine institutional strengthening, competency-based capacity development, embedded mentoring, structured performance and quality reviews, action tracking and progressive transition of responsibilities to district teams.

Workstream 1: Institutionalisation of DHPMTs

The TA will consolidate DHPMTs as the district's overarching health planning and management platform. Support will include:

• Review and refine existing DHPMT TORs, membership, meeting protocols and operating procedures based on implementation experience from the first phase.
• Establish and institutionalise an annual calendar of DHPMT meetings aligned with district planning, budgeting and performance-review cycles.
• Strengthen DHPMT capacity to undertake integrated district health-system reviews covering PHC service delivery, quality, human resources, commodities, financing/resource use and other priority bottlenecks.
• Standardise meeting agendas, performance-review packs, action trackers and follow-up mechanisms.
• Strengthen the role of DHOs and relevant district managers in chairing, preparing and independently managing DHPMT processes.
• Support DHPMTs to translate performance findings into prioritised, time-bound actions and escalate issues requiring provincial action.
• Institutionalise review of implementation progress and unresolved actions at subsequent meetings.
• Establish stronger linkages between DHPMT decisions, district planning and resource prioritisation.
• Progressively transfer meeting preparation, analysis, facilitation, documentation and follow-up functions from TA personnel to designated district officials.

Workstream 2: Institutionalisation of DTRCs

The TA will consolidate DTRCs as the district's routine technical performance and problem-solving mechanism.

Support will include:

• Review DTRC experience from the first phase and refine TORs and operating procedures where necessary.
• Establish predictable DTRC review cycles linked to routine district performance and quality data.
• Strengthen DTRCs to undertake structured analysis of PHC service performance and quality.
• Enable DTRCs to identify underperforming services/facilities, undertake root-cause analysis and agree practical corrective measures.
• Establish clear pathways for issues to be resolved technically through the DTRC or escalated to the DHPMT where management, resource or policy decisions are required.
• Institutionalise action-tracking systems showing the responsible person, timeline, status and evidence of completion.
• Build the capacity of district technical staff to independently prepare analysis, facilitate reviews and document and monitor corrective actions.
• Link DTRC findings systematically with QPHC improvement processes and DHPMT management decisions.

Workstream 3: Institutionalising Quality Primary Health Care

• The TA will support districts to move from individual or periodic quality assessments toward a district-owned continuous quality-improvement system. Support will include:
• Review and consolidate the QPHC/QA processes and tools introduced or used during the first phase.
• Define a practical district QPHC cycle covering assessment, identification of gaps, prioritisation, improvement planning, implementation, supportive supervision and reassessment.
• Strengthen district teams to conduct structured QPHC reviews and supportive supervision without dependence on external technical personnel.
• Strengthen facility teams' capacity to identify quality gaps, undertake root-cause analysis and develop feasible quality-improvement actions.
• Establish facility-level Quality Improvement (QI) action plans for priority gaps and integrate their progress into DTRC reviews.
• Strengthen district capacity to mentor facilities and support implementation of improvement actions rather than relying solely on inspection/compliance approaches.
• Introduce peer learning and exchange between PHC facilities and across the four districts to spread workable quality-improvement practices.
• Ensure unresolved systemic quality bottlenecks identified through QPHC processes are escalated through DTRCs to DHPMTs for management action.
• Document improvement practices and practical lessons that can inform future provincial scale-up.
• This directly builds on the existing TA's requirement for structured QA reviews at PHC facilities and formal DHPMT/DTRC follow-up on corrective measures.

Workstream 4: District Leadership and Capacity Strengthening

Capacity development will be embedded across all three institutional mechanisms rather than delivered primarily through standalone training. The TA will:

• Conduct an initial capacity assessment of DHPMT/DTRC members and relevant district/facility teams.
• Develop district-specific capacity-strengthening plans based on identified competency gaps.
• Deliver targeted capacity development in district health-system management, leadership, planning, performance management, data interpretation, quality improvement, problem-solving, supportive supervision and action tracking.
• Use a training → application → mentoring → review → independent practice approach.
• Provide structured on-the-job coaching to DHOs, district managers, DTRC members and QPHC focal persons.
• Identify and develop district-level resource persons/champions capable of continuing coaching and orientation of staff.
• Introduce periodic competency assessments to measure whether capacity is translating into independent performance.
• Gradually reduce direct TA facilitation as district teams demonstrate competence.

Workstream 5: Institutionalisation, Learning and Transition

During implementation, the TA will progressively transfer responsibility for DHPMTs, DTRCs and QPHC processes to government counterparts. The TA will:

• Develop institutionalisation plans for each district with clear government ownership of key functions.
• Define responsibility matrices for DHPMT, DTRC and QPHC functions.
• Identify recurrent operational requirements and support districts to incorporate these within routine government planning and resources wherever feasible.
• Establish mechanisms for provincial oversight and periodic review of district institutional performance.
• Facilitate structured cross-district learning between Peshawar, Swat, Mardan and Kohat.
• Develop practical institutionalisation guidance/SOPs based on experience from the four districts.
• Undertake a final institutional maturity assessment to determine the extent to which DHPMTs, DTRCs and QPHC functions can operate independently of E4H support.
• Prepare and implement a phased transition and exit plan.

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

Capacity strengthening will focus on demonstrated competencies rather than participation in training alone. District teams will be coached while performing their routine functions, with TA support progressively reduced as competencies improve.

DHPMTs, DTRCs and QPHC will operate through government-approved mandates, membership, schedules, processes and reporting arrangements. Wherever possible, tools and procedures will be incorporated into existing district management processes rather than maintained as E4H-specific instruments.

Each district will have a time-bound transition plan identifying functions currently supported by the TA, responsible government counterparts, readiness criteria and dates for transfer. By the end of the TA, routine convening, performance review, QPHC oversight, action tracking and follow-up should be led by government counterparts, with provincial structures providing oversight and technical backstopping.

Timeline and Days

The proposed LOE is 90 days from November 2026 – May 2027, subject to final confirmation from client.

Requirement

Technical Expertise

Master’s or higher in Public Health, Health Systems/Policy, or related field. Expertise in health systems strengthening, PHC and EPHS rollout, governance, planning, and institutional reform.

Competencies

Strategic leadership, policy analysis, coordination across provincial/district teams, stakeholder engagement, and results-based management.