TA Title: Development of Comprehensive Implementation Plan for CHI Initiative in Selected Districts

Program 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 and Problem Statement

Over the past several years, the Government of Punjab has accelerated efforts to strengthen the province’s primary healthcare (PHC) system, guided by national and provincial reform agendas. The Punjab Health Sector Strategy 2019-28 (PHSS) outlines the government’s commitment to building equitable, resilient, and people-centred healthcare systems, emphasising decentralised service delivery, integrated care, and community-level oversight. However, despite vertical programme expansions and digital investments, critical implementation and accountability gaps persist at the community level, particularly in districts with limited Lady Health Worker (LHW) coverage.

• To address these gaps, the Community Health Inspector (CHI) initiative was introduced by the Health & Population Department (H&PD). CHIs are expected to strengthen PHC service delivery and promote better alignment between frontline efforts and provincial health priorities. Yet, the implementation of the CHI cadre across Punjab remains inconsistent and under-resourced.
• While CHIs were envisioned to fill crucial service delivery and coordination gaps in underserved areas, many districts lack formalised operational guidelines and referral protocols aligned with the Essential Package of Health Services (EPHS) . Inadequate role clarity, limited capacity-building opportunities, and lack of institutionalised performance management mechanisms have hindered the potential impact of this cadre.
• At the national level, the National Health Vision (2016–25)  and the Astana Declaration on Primary Health Care (2018) emphasise stronger community-level integration as key to achieving Universal Health Coverage (UHC) . The National Health Support Programme (NHSP), supported by the World Bank, has introduced Disbursement Linked Indicators (DLIs) to incentivise provincial progress.  Under DLI-11, Punjab is tasked with expanding community-based engagement mechanisms in lagging districts not served by LHWs—providing a direct policy impetus for scaling the CHI model.
• Despite the presence of digital platforms and various donor-supported dashboards, systemic fragmentation continues due to poor interoperability and underutilisation. Similarly, capacity-building mechanisms like the Provincial Health Development Centre (PHDC)’s Learning Management System (LMS) remain underused/underdeveloped, limiting CHIs’ ability to deliver on their intended mandates.

In response to these gaps, the Evidence for Health (E4H) Programme is supporting the development of a comprehensive implementation plan for the CHI initiative in selected districts under Output 3. This Technical Assistance aims to standardise the CHI cadre, define its role in the PHC ecosystem, and operationalise supportive systems to ensure scalability, accountability, and alignment with broader PHSS and NHSP objectives. The implementation plan will serve as an actionable strategic instrument to institutionalise CHIs as an effective community-based extension of the health system, thereby contributing to improved service quality, reach, and sustainability in Punjab’s PHC landscape.

Strategic Approach

This TA is designed to support the H&PD in strengthening the role of CHIs as part of broader PHC reforms. The TA aligns with national and global commitments to UHC, integrated PHC, and community-level accountability mechanisms for improved service delivery.   

• The PHSS 2019–2028 remains a central guiding document for provincial health reforms. While implementation progress has been made across vertical health programmes, persistent service fragmentation and limited community oversight continue to affect PHC outcomes. This TA aims to operationalise key PHSS priorities—particularly those related to decentralised service delivery, PHC governance, and quality assurance at the community level—through the institutionalisation of the CHI cadre.
• At the national level, the TA contributes directly to the implementation of the National Health Support Programme (NHSP), specifically under DLI 11, which incentivises provinces to expand community-based engagement in areas not covered by the LHW programme. The TA thus responds to systemic challenges in underserved districts by building accountability structures that complement and extend existing PHC efforts.
• The TA is also consistent with the overarching direction of the National Health Vision (2016–2025), which emphasises health system strengthening, equity in service access, and active community participation. The CHI implementation plan supports these goals by enabling local monitoring, improving feedback loops, and reinforcing service quality standards.
• Globally, the TA draws on Sustainable Development Goal (SDG) 3, particularly Target 3.8, which calls for achieving UHC, including financial risk protection and access to quality essential healthcare services. It also aligns with the WHO Framework on Integrated, People-Centred Health Services, supporting the shift from vertical, facility-based programming to holistic, community-anchored health systems.
• Under the E4H Programme, this TA will contribute to Output 3, which focuses on improving practices for high-quality PHC delivery in Punjab. By developing a standardised, scalable approach for CHI implementation, the TA seeks to institutionalise a critical governance layer that enhances both community trust and system accountability.

Objectives

The overall objectives of the technical support will be:

• To design a standardised operational framework for the CHI initiative, aligned with the UHC EPHS, PHSS 2019–28, and the NHSP targets under DLI-11.
• To develop district-level implementation plans that include service delivery mapping, referral linkages, supervisory protocols, and equity-focused strategies targeting LHW-uncovered and high-need areas.
• To establish an accountability and performance monitoring framework for CHI deployment, incorporating indicators aligned with provincial UHC priorities and ensuring alignment with broader digital governance and health system reforms.

These objectives will collectively ensure that the strategy is not only policy-compliant and technically sound but also operationally feasible and institutionally endorsed.

Scope of Work and Methodology

A team of four national consultants will be deployed from August 2025 to January 2026 to support the Government of Punjab in developing and implementing a comprehensive, operational framework for the CHI initiative in selected districts.

The team will work under the strategic guidance of the H&PD and in coordination with DGHS, PHDC, and District Health Authorities (DHAs). The TA will follow a phased, systems-oriented, and participatory approach, ensuring operational feasibility and institutional ownership.

The scope of work is structured across five main phases:

Phase 1: Inception and Diagnostic Planning

•           Conduct inception meetings with H&PD, DGHS, PHDC and district stakeholders to finalise expectations, roles, and timelines

•           Validate selected districts for CHI support and finalise the work plan

•           Undertake a desk review and rapid diagnostic assessment of existing CHI structures, workforce deployment, referral mechanisms, and digital health systems

•           Prepare an Inception Report and Slide deck outlining methodology, stakeholder mapping, diagnostic tools, and timeline

Phase 2: Framework Development and Tool Development

•           Co-develop a provincial CHI operational framework including SOPs, quality assurance protocols, supervisory pathways, and service packages

•           Define standardised referral and counter-referral protocols integrated into PHC service delivery

•           Identify and draft key CHI performance indicators for integration into district-level M&E tools (e.g., scorecards, supervision templates)

•           Design implementation tools and templates to support framework rollout and monitoring

Phase 3: District-Level Planning and Stakeholder Validation

•           Develop tailored, district-level CHI implementation plans, incorporating service mapping, workforce strategy, and costed rollout

•           Ensure the plans prioritise LHW-uncovered and underserved areas, consistent with DLI-11 targets

•           Facilitate structured consultations with district managers, PHC facility leads, and community stakeholders to validate and localise plans

•           Incorporate feedback into final district plans, ensuring equity, ownership, and feasibility

Phase 4: Mid-Term Review, Finalisation, and Knowledge Products

•           Conduct a mid-term review (December 2025) to document progress, challenges, and lessons

•           Make iterative adjustments to tools, frameworks, and district plans based on review findings

•           Compile and submit the Final Technical Report, summarising the CHI framework, implementation experiences, and scale-up roadmap

•           Prepare a presentation deck for high-level review and knowledge dissemination

This methodology ensures the TA is participatory, actionable, and aligned with both technical requirements and institutional expectations. Emphasis will be placed on flexibility to accommodate evolving needs during the assignment period.

Timeline and LOE

The level of effort for the role is 72 days working days, from Aug 2025 – Feb 2026

Role Specific Requirements

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Technical Expertise

• Postgraduate in public health, health policy, health systems, or relevant degree.
• Minimum of 15 years over all experience.
• With demonstrated experience in leadership in designing and implementing primary healthcare reforms.
• Experience in community health system strengthening, policy development, and multisectoral coordination.
• Familiarity with UHC, EHSP, and DLI-based programmes preferred.

Competencies

• Strategic planning;
• Stakeholder engagement and influencing;
• Analysis and use of information;
• Decision-making;
• Convening and facilitation.

Deliverables/KPIs

1. Inception Report and Slide Deck
2. CHI Operational Framework
3. District-Level Implementation Plans               
4. Final Technical Report and Presentation Deck