E4H Punjab TA: Facility Readiness for Registration and Licensing of Government and Outsourced Rural Health Centres (Mariam Nawaz Hospitals) in Selected Districts

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 (2023-2027) provides technical assistance (TA) to Punjab and also to the Federal and Khyber Pakhtunkhwa (KP) governments. The Punjab component is being implemented by Palladium along with Oxford Policy Management (OPM).

Through its flexible, embedded, and demand-driven model, E4H Punjab will support 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 will deliver 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.

E4H-Punjab works in partnership with the Punjab Department of Health (DOH).

Terms of reference

Background

The Health & Population Department, Government of Punjab, is expanding and reforming primary and secondary healthcare delivery through government-managed and outsourced service-delivery arrangements. Under the Mariam Nawaz Hospital initiative, Rural Health Centres are gradually being transformed into enhanced facilities with defined service-delivery, staffing, monitoring and accountability requirements and renamed as Maryam Nawaz Hospitals.

Healthcare establishments are required to progress through the applicable registration and licensing processes of the Punjab Healthcare Commission (PHCC). Licensing is linked to compliance with the relevant Minimum Service Delivery Standards (MSDS) and other prescribed regulatory requirements. Considerable work has already been undertaken by E4H on MSDS and healthcare quality improvement, providing a basis for more focused support to prepare Mariam Nawaz Hospital facilities for registration and licensing.

This Technical Assistance will build on the existing MSDS work by adapting relevant assessment tools and applying them in a selected government and outsourced Mariam Nawaz Hospital facilities in two districts (Gujranwala & Multan). The assignment will assess facility-level readiness, support prioritised improvement planning, strengthen compliance monitoring and develop a phased roadmap to inform possible future scale-up.

Problem Statement

Government and outsourced Mariam Nawaz Hospital facilities may be at different stages of readiness for PHCC registration and licensing. Potential gaps may relate to documentation, staffing, infrastructure, equipment functionality, service delivery, clinical governance, infection prevention and control, patient records, referral arrangements and internal compliance monitoring. However, these gaps have not yet been assessed consistently across the selected facilities against an adapted and practical readiness framework based on applicable PHCC and MSDS requirements.

Without a structured facility-level assessment and follow-up approach, responsible government, district and facility teams may have limited visibility of specific compliance gaps, required corrective actions, responsible owners and issues requiring higher-level decisions or resources. There is therefore a need to test and refine a practical readiness approach in a limited number of facilities, prepare prioritised facility improvement plans, establish a simple compliance-monitoring mechanism and prepare them for PHCC licensing.

Goal and Objective(s)

Goal

The overall goal is to support the Government of Punjab to assess and strengthen the readiness of selected government and outsourced Mariam Nawaz Hospital facilities, formerly Rural Health Centres, for PHCC registration and licensing through a practical, government-owned approach.

Specific Objectives

• Review and adapt existing MSDS work and applicable PHCC requirements into a practical facility-readiness assessment framework/tools.
• Assess selected facilities in the two selected districts to identify and prioritise gaps affecting regulatory compliance, quality, safety and service continuity.
• Prepare realistic facility-level improvement plans with clearly assigned responsibilities for addressing prioritised gaps.
• Establish a concise compliance-monitoring mechanism, document lessons from the pilot and develop a phased roadmap to inform continued readiness support, and possible future scale-up.

Strategic Approach 

The TA will adopt a government-led, PHCC-aligned, evidence-based and improvement-oriented approach. It will build on existing Minimum Service Delivery Standards (MSDS) work, assessment tools and institutional processes and focus on a limited number of government and outsourced Mariam Nawaz Hospital facilities in two districts, one in Central Punjab and one in South Punjab (approximately 25 facilities in total). The approach will be designed for practical application and possible future scale-up without duplicating the statutory role of the PHCC. 

• Work through H&PD, the designated MNH programme or implementation unit, district authorities, facility teams and agreed PHCC interfaces. 
• Review, adapt and consolidate existing MSDS and readiness resources before proposing additional tools or requirements.  This will explicitly include the earlier FCDO-supported PHCC-MSDS Health Facility Assessment materials and findings; new instruments will be developed only where a documented gap cannot be addressed through adaptation of existing resources.
• Use applicable PHCC registration, licensing and MSDS requirements as the controlling reference and maintain traceability between each assessment item, evidence source and requirement. 
• Apply desk review, observation, authorised staff consultation and document verification to establish factual facility-level findings.
• Distinguish immediate management actions from gaps requiring budgets, procurement, staffing, infrastructure, contractual or regulatory decisions. 
• Validate factual findings and action ownership with designated government, district, facility and outsourced-operator counterparts. 
• Prioritise patient safety, infection prevention and control, emergency readiness and continuity of essential services. 
• Establish a concise compliance-monitoring mechanism using existing government structures and proportionate reporting arrangements. 
• Keep all formal registration, inspection and licensing determinations with PHCC

Sustainability and Institutionalisation

Sustainability will be supported by embedding the readiness approach within existing government and regulatory arrangements rather than establishing a consultant-dependent mechanism. The TA will: Identify accountable government owners for the readiness tools, facility findings, improvement plans, monitoring tracker and scale-up roadmap. Alig n assessment and monitoring arrangements with existing H&PD, MNH programme, district and facility review processes where feasible. Provide practical, editable tools and guidance that designated government teams can continue to use and adapt through approved processes. Orient nominated provincial, district and facility focal persons on evidence requirements, assessment interpretation, action tracking and escalation. 

• Orientation will cover PHCC-MSDS evidence requirements, use of the adapted tools, interpretation of findings, corrective-action management, evidence maintenance, follow-up monitoring and preparation for the applicable PHCC compliance/registration/licensing process.
• Define a proportionate review and validation cycle for monitoring unresolved gaps and evidence of corrective action. 
• Maintain clear version control so tools can be updated following approved changes to MSDS, facility categories or PHC procedures. 
• Document lessons and resource implications to inform government decisions on any future scale-up. 
• Hand over final materials through an indexed editable repository with an ownership and maintenance matrix.

Scope of Work and Methodology

Phase 1: Inception, Regulatory Mapping and Scope Confirmation

• End-to-end pathway: (1) review PHCC-MSDS requirements and the previous HFA and confirm tool fitness; (2) adapt and validate existing tools only where needed; (3) assess approximately 25 selected RHC/MNH facilities in Gujranwala and Multan and identify compliance gaps; (4) validate and share findings for corrective action; (5) develop and support implementation of facility improvement plans, including targeted capacity strengthening; (6) conduct follow-up monitoring and compliance assurance; and (7) facilitate facility progression towards the applicable PHCC certification, registration and licensing processes.
• Reconfirm the two districts (Gujranwala & Multan), the number of selected government and outsourced MNH facilities, facility categories, management arrangements, assessment sequence and focal persons.
• Review existing MSDS work, PHCC registration and licensing requirements, relevant forms, category-specific standards, available scoring or inspection guidance and related government materials.
• As a first step, obtain and review the previous FCDO-supported PHCC-MSDS HFA tools, checklists, methodologies, datasets/summary findings and lessons, confirm the year and coverage, and complete a documented fit-for-purpose and gap assessment for application to MNH/RHC settings.
• Confirm terminology and the distinction between registration, provisional licensing, inspection, licensing and internal readiness support.
• Map applicable requirements to facility categories, responsible levels and evidence sources and identify areas requiring clarification through agreed government channels.
• Agree the evidence hierarchy, readiness-rating method, validation arrangements, data-management approach, escalation route and quality-assurance protocol.
• Prepare an inception package containing the confirmed scope, methodology, workplan, consultation and facility-visit plan, data request, risk register, quality-assurance arrangements and review schedule.

Phase 2: Readiness Assessment Tool Adaptation and Initial Application

• Review and adapt existing MSDS and related readiness resources into a practical MNH facility-readiness assessment package.
• Adaptation, rather than de novo tool development, will be the default approach. Any new or substantially revised item must be justified by the Phase 1 gap assessment and mapped to an applicable PHCC-MSDS requirement.
• Refine the facility profile, document-review checklist, observation checklist, interview guide, evidence register, rating sheet and assessor instructions only where required.
• Cover relevant domains including governance, service availability, human resources, infrastructure and utilities, equipment, medicines and supplies, infection prevention and control, clinical quality and patient safety, records and digital systems, referral and emergency arrangements, waste management and patient rights.
• Define evidence requirements and consistent rules for compliant, partially compliant, non-compliant, not verified and not-applicable findings.
• Apply the draft package initially in selected facilities and refine it based on documented implementation experience and government feedback.
• Validate the adapted package with designated government counterparts.

Phase 3: Facility Gap Assessments and Improvement Planning

• Undertake desk review and on-site readiness assessments of selected facilities in the two selected districts, jointly with designated government or district representatives where feasible.
• Triangulate self-reported information through authorised documents, observation, system records and responsible staff consultation.
• Record findings by requirement and domain, including the evidence reviewed, limitations and any disputed or unresolved item.
• Provide each assessed facility with a factual findings sheet for review before finalisation.
• Findings will also be shared with H&PD, district authorities and relevant facility/outsourced-management teams through structured feedback sessions to agree corrective actions and ownership.
• Prepare prioritised facility improvement plans with clear actions, responsible owners, dependencies, indicative timing and evidence of completion.
• The TA will provide time-bound implementation support for agreed priority actions within its remit, including targeted orientation/coaching of responsible staff where capability gaps can be addressed through TA rather than additional resources.
• Separate quick management corrections from actions dependent on approved budgets, procurement, civil works, staffing, supplies, system access, contract decisions or regulatory clarification.
• Aggregate pilot findings to identify cross-cutting district or provincial constraints without masking facility-specific issues.
• Promptly escalate any immediate patient or staff safety concern through the agreed route.

Phase 4: Compliance Monitoring, Scale-Up Roadmap and Handover

• Define a proportionate reporting, evidence-validation and follow-up cycle using existing government structures wherever feasible.
• Conduct scheduled follow-up reviews against facility improvement plans, verify evidence of corrective action, update readiness status and identify residual gaps requiring escalation.
• Prepare a phased roadmap setting out options and considerations for progression towards PHCC registration & licensing processes and possible future application to additional MNH facilities. The roadmap will set out the end-to-end pathway from assessment and gap closure through internal compliance assurance to facility progression towards PHCC certification/other applicable compliance recognition, registration and licensing, while clearly preserving PHCC's statutory authority for formal determinations.
• Document lessons, enabling factors, recurring constraints, unresolved dependencies and issues requiring decisions above facility or district level.
• Orient nominated provincial, district and facility focal persons on use of the assessment tools, improvement plans and monitoring mechanism.
• Conduct a final review and handover session and submit all approved editable tools, findings, plans, trackers, guidance and source files along with Final Report and Slide Deck.

 Deliverables

1. Inception Report, Slide Deck and MNH Facility Readiness Assessment Package: Confirmed scope, methodology, workplan, facility selection, regulatory and standards mapping, assessment framework, facility visit plan, data collection tools, assessment checklists, evidence requirements, rating methodology and assessor guidance. Includes a documented review of the previous FCDO-supported PHCC-MSDS HFA, a fit-for-purpose/gap analysis, and justification for any new or materially revised instruments.
2. MNH Facility Readiness Assessment Report and Facility Improvement Plans: Facility-wise readiness assessment findings, compliance gaps, evidence summary, readiness ratings, cross-cutting district/provincial issues, and prioritised facility improvement plans with actions, responsible parties, dependencies and indicative timelines. Includes structured feedback of findings, agreed corrective actions, targeted staff orientation/capacity strengthening, initial implementation support and a follow-up monitoring schedule.
3. Final Report and Presentation Deck: Consolidated summary of methodology, assessment results, key findings, improvement plans, monitoring arrangements, roadmap, lessons learnt, recommendations and TA achievements. Includes evidence of follow-up against improvement plans, updated compliance/readiness status, the end-to-end PHCC pathway, residual gaps and recommendations for progression through the applicable certification, registration and licensing processes.. 

Position Title:

Health Information, Monitoring & Assessment Specialist (Mid National)

Duty Station: Lahore (with travel to selected districts as required)

Duration / LOE: Mid-October 2026 – March 2027 (LOE 70 days – subject to change until the start of the TA)

Reporting To: Team Lead & Healthcare Regulation/Quality Specialist / E4H Programme Team

Role Purpose

Support the development and implementation of the MNH Facility Readiness Assessment by adapting assessment tools, strengthening evidence management, conducting data quality assurance and readiness analysis, and establishing practical monitoring mechanisms to support PHCC registration and licensing readiness.

Key Roles & Responsibilities

• Support adaptation and refinement of MSDS-based readiness assessment tools, evidence registers, and rating methodologies.
• Conduct data quality assurance, evidence verification, and readiness analysis across assessed facilities.
• Develop and maintain compliance monitoring trackers and reporting tools.
• Support readiness status updates and verification of corrective actions.
• Contribute to preparation of assessment reports, dashboards, and analytical summaries.
• Support orientation of government and facility teams on evidence management, monitoring processes, and assessment methodologies.
• Assist with repository management, version control, and handover of assessment tools and documentation.
• Contribute to preparation of final reports, presentations, and knowledge products.
• Undertake other TA-related assignments as requested by E4H or H&PD.

Requirements

Technical Expertise

• Master's degree in Public Health, Epidemiology, Health Information Systems, Statistics, Monitoring & Evaluation, or a related discipline.
• Minimum 10 years of overall professional experience.
• Demonstrated experience in assessment tool development or adaptation, monitoring systems, health information systems, data quality assurance, evidence management, compliance tracking, and analytical reporting.

• Experience supporting government health programmes, regulatory assessments, or donor-funded health system strengthening initiatives is preferred.

Core Competencies

• Health information management and monitoring systems
• Assessment methodology and evidence management
• Data quality assurance and validation
• Readiness analysis and compliance monitoring
• Dashboard and tracker development
• Analytical reporting and data synthesis
• Capacity building and technical documentation
• Repository management and version control