1. Purpose of the consultancy

The purpose of this consultancy is to conduct a comprehensive review of the existing Ministry of National Health Services Regulations and Coordination (NHSR&C) role, governance structure and mechanisms related to leading the national HIV, TB and Malaria responses. The review is intended to identify actionable recommendations and timeline for improving NHSR&C’s effectiveness in managing, executing and coordinating the national HIV, Malaria and TB responses; as well as engaging stakeholders and building sustainable and effective partnerships.

2. Background

In 2011, the National Ministry of Health was abolished as a result of the 18^th constitutional amendment, devolving health to the provincial governments including all its development projects and programmes. Subsequently, provincial HIV, TB and Malaria programmes were established including HIV, TB and Malaria programmes. In 2013, the Federal Cabinet established the Ministry of National Health Services, Regulations and Coordination (NHSR&C) to execute Federal functions including but not limited to:

– Provision of common strategic vision for health towards universal health coverage

– Coordinate public health and population welfare at national and international levels

– Fulfil international obligations and commitments

A Common Management Unit (CMU) for HIV, TB and Malaria was established under the NHSR&C and mandated to coordinate the HIV, TB and Malaria responses and donor funding. CMU is led by a national coordinator supported by a team of Deputy Coordinators who replaced the functions of programme managers for TB and HIV, while Director of Malaria Control continued as Programme Manager and Deputy Coordinator. Both TB and National AIDS Control Programmes were fully shifted to the CMU in 2020. However, the CMU was not fully resourced and capacitated to effectively lead and coordinate the nation HIV, TB and Malaria responses. There is a consistent lack of functional coordination among CMU and provincial programmes.

During this period, there have been significant changes in the epidemiological situation in Pakistan. For example, for HIV, the country continued to suffer a fast-growing HIV epidemic particularly among key populations, namely people who inject drugs, transgender people, men who have sex with men and sex workers, in addition to repeated outbreaks in different population groups at lower or high risk of HIV. It is estimated that there were 270000 PLHIV in Pakistan in 2022, of which 25000 were new infections during that year. Pakistan remains challenged by the very low coverage of HIV prevention, diagnosis, treatment and care services and a growing HIV epidemic despite significant investments from the Global Fund (over 200 million USD since 2003 of which over 65 million USD in the latest grant cycle of 2021-23). After the abolishment of the National AIDS Control Programme, UNDP and Nai Zindagi are the only principal recipients of the grant, with several sub-recipients implementing various activities.

For TB, according to WHO, 611,000 people developed a new episode of TB (including relapse) in Pakistan in 2021, which represented an estimated incidence rate of 264 new TB cases per 100,000 population. In 2021, of the estimated number of cases, 55% of TB cases and 18% of drug-resistant TB cases were diagnosed and treated. The number of deaths from TB is estimated, for the same year, at 50,100 with a mortality rate of 21.9 TB deaths per 100,000 population. Missed TB cases, TB preventive treatment, scaling up private sector engagement, sustainable domestic financing are key challenges faced by the programme. A more concerted, well defined, aligned multi-sectoral, health system-strengthening partnership approach would increase efficiency and effectiveness in the TB programme. WHO collaborative blueprint endorsed by NTP to improve governance, leadership, and partnership to end TB in Pakistan is a guiding document that aims is to delineate roles and responsibilities to optimize efforts to end TB from a health system and multi-sectoral perspective, but remains unimplemented.

For Malaria, weak programme technical capacities, dichotomy of leadership at DoMC and CMU and lack of governance and management structure affected the coverage and quality of malaria control interventions. Lack of access to quality diagnostic treatment and effective vector control services in the most peripheral health system resulted in gradual increase in transmission potential since 2016. The programme couldn’t achieve its target of 75% reduction of incidence by 2020; rather an upward trend has been observed in 60 districts. The 2022 devastating floods and unprecedented rains compounded the situation resulting in the country’s worst ever reported malaria outbreak in 2022 and 2023. A 10 times increase was recorded in reported incidence in only 4 months of the transmission season in public sector health facilities alone. During first nine months of 2023 1.8 million confirmed cases have been reported which may reach 3 million by end 2023. Between August and October 2022, 47 districts have remained in outbreak situation with heavy unreported death toll. Both the national and provincial programmes units were unprepared for this expected situation. According to expert estimates the situation may remain alarming in 2024 if concerted efforts are not made.

It is believed that the absence of governmental stewardship and weak governance are among the root causes for the sluggish progress in the country’s response to HIV, TB and Malaria epidemics.

3. Planned timelines

1 April – 30 May 2024

4. Work to be performed

Output 1: Review documentation and conduct interviews with stakeholders to describe the current national governance of the HIV, TB and Malaria response

Deliverable 1.1: Review and validate the organogram of the CMU and identify the existing and vacant functions and gaps related to key functions.

Deliverable 1.2: Identify and map the functions of the CMU and the relationship to the functions of the provincial HIV, TB and Malaria programmes.

Deliverable 1.3: Determine the responsibilities of the CMU in relationship to other stakeholders including the higher levels and other departments of the NHSR&C, partners, CCM, Global Fund principal and sub-recipients using a logical framework model

Deliverable 1.4: Determine the decision-making process in the CMU and its channels of communication to internal and external stakeholders

Output 2: Lead a participatory assessment of the effectiveness of governance structure and mechanisms in place including oversight, accountability, and transparency

Deliverable 2.1: Lead a stakeholder engagement including a steering committee composed of CMU and key partners to steer the assessment and development of a plan to address governance issues in HIV, TB and Malaria, taking into account the role of partners and stakeholders.

Deliverable 2.2: Conduct interviews and collect case studies to demonstrate how and by whom governance functions are practiced including: (a) policy, regulation and standards setting; (b) strategic planning and prioritization; (c) stakeholder and community engagement and management; (d) accountability and performance monitoring; (e) partnership management; (f) contracting and (g) oversight of compliance.

Deliverable 2.3: Identify strengths and weaknesses in governance of the HIV, TB and Malaria responses.

Deliverable 2.4: Build consensus on the findings and identify actionable and time-bound recommendations for improvement in the governance of HIV, TB and Malaria responses.

Deliverable 2.5: Develop an accountability framework for monitoring progress in implementation of recommendations.

Deliverable 2.6: Submit to WHO a report comprising findings, summary of weaknesses and strengths and actionable recommendations.

5. Specific requirements

Qualifications required:

o Essential:Master’s degree in public health, public policy or related field.

o Desirable: University degree/advanced training in organization development or change management.

Experience required:

o At least 10years’ experience in health systems

Desirable: Experience in health systems governance and policy reviews.

Skills/Technical skills and knowledge:

1. Basic knowledge of programme management and evaluation
2. Excellent analytical writing skills
3. Excellent communication skills.
4. MS office and data analysis packages

Language requirements:

• Advanced knowledge on English.

6. Place of assignment

Islamabad, Pakistan, On-Site Consultant

Teleworking from Home Country may occur for preparatory work or for report development

Medical clearance : The selected Consultant will be expected to provide a medical certificate of fitness for work.

Travel (If travel is involved, a medical certificate of fitness for work will be required.) All travel arrangements will be made by WHO – WHO will not be responsible for tickets purchased by the Consultant without the express, prior authorization of WHO. While on mission under the terms of this consultancy, the Consultant will receive subsistence allowance. Visas requirements: it is the consultant’s responsibility to fulfil visa requirements and ask for visa support letter(s) if needed.

Additional Information section

· This vacancy notice may be used to identify candidates for other similar consultancies at the same level.

· Only candidates under serious consideration will be contacted.

· Remuneration is in line with WHO consultant established rates

· Successful candidates will be included in the roster for consideration for future contractual engagement via a consultancy, as they become available. Inclusion in the roster does not guarantee any future contractual relationship with WHO

· A written test may be used as a form of screening.

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(a) Your profile on Stellis is properly completed and updated;
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