TA Title: E4H Punjab TA: Technical Assistance to Support Development of a Governance Framework for the Punjab Nursing Centres of Excellence (COEs)

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 quality, effectiveness, and sustainability of health workforce education institutions depend fundamentally on the governance systems within which they operate. In Punjab, nursing workforce development is delivered through a combination of public sector nursing colleges and a growing private training sector. Governance arrangements are currently fragmented across Specialized Healthcare and Medical Education Department (SHC&MED), affiliated institutions (medical universities), and regulatory bodies such as the Pakistan Nursing and Midwifery Council (PNMC), with limited standardisation of decision-making, accountability, and institutional autonomy.

International experience indicates that high-performing health professional education institutions require clear governance arrangements, defined accountability structures, transparent decision-making, effective leadership, and appropriate institutional autonomy supported by robust oversight.

The World Health Organization (WHO) Global Strategic Directions for Nursing and Midwifery 2021–2025 emphasises leadership, governance, and institutional capacity as key enablers of nursing workforce development. Similarly, the WHO State of the World's Nursing Report 2020 highlights the importance of strengthening governance and leadership within nursing education institutions to support workforce quality and sustainability. Experience from comparable countries, including Malaysia, Thailand, Sri Lanka, and Bangladesh, demonstrates that Nursing Centres of Excellence achieve improved educational, research, and workforce outcomes when underpinned by well-defined governance frameworks. In Malaysia, for example, governance frameworks for nursing education institutions have been embedded within national accreditation systems, providing a practical and transferable model.

ADB has been a development partner to SHC&MED over several years. In December 2020, The Asian Development Bank (ADB) and the Government of Punjab signed a Memorandum of Understanding to jointly promote public-private partnership (PPP) projects in Punjab's hospital sector, with SHC&MED and the Punjab Health Initiative Management Company (PHIMC) as primary counterparts. This was complemented by ADB's broader Human and Social Development Technical Assistance from around 2022, which provided needs and systems assessments and project preparation support to Punjab's health sector.

Presently the Government of Punjab, through the SHC&MED, is implementing a broader Health Workforce Reform Agenda, including the Punjab Nursing and Health Workforce Reform Program. The Program emphasises strengthening governance, institutional capacity, and quality of nursing education, including the establishment of Nursing Centres of Excellence (COEs) in Lahore, Multan, and Rawalpindi. This initiative is supported through the ADB Results-Based Lending (RBL) Program (2026–2030), which includes Disbursement Linked Indicator (DLI) 8 requiring the development, formal approval, and notification of a comprehensive governance framework for the COEs by an independent Board of Governors, including gender-responsive provisions.

According to the ADB Programme Implementation document DLI 8 will be achieved through three milestones: 

1. Board of Governors notified in 2025;
2. Draft Governance Framework developed by 2026
3. Formal Governance Framework notified in 2027.

The assignment should ensure that all governance outputs are prepared with clear documentary evidence required for DLI verification, including approval records, notification drafts, BoG endorsement minutes, and implementation roadmap.

Currently, governance arrangements for the COEs remain interim and undefined, with no formally approved institutional framework guiding their operations. The Program Implementation Unit (PIU) is responsible for coordination, implementation, and monitoring of program-supported interventions, including professional development, faculty development, and clinical training for the nursing workforce in Punjab.

Within this context, the establishment and operationalisation of Nursing Centres of Excellence represents an important opportunity to strengthen nursing education, leadership development, faculty capacity, and professional advancement within the province. Without such arrangements, there is a risk that institutional effectiveness and sustainability may not be fully realised. 

Building on E4H’s experience in governance reform and institutional strengthening, this Technical Assistance (TA) will support development of a context-appropriate governance framework for the Punjab Nursing Centres of Excellence. The assignment will contribute to relevant governance strengthening actions under the Program, with deliverables designed to support institutional adoption, formal approval processes where applicable, and independent verification requirements consistent with the RBL modality.

Problem Statement

While significant investments are being made to establish and operationalise Nursing Centres of Excellence (COEs) in Punjab, the required governance arrangements are not yet in place. Critical system-level governance gaps remain, including:

• Absence of formally approved governance framework
• Unclear institutional roles and reporting lines
• Lack of standardised governance instruments;
  • Rules of Business
  • SOPs
  • Delegation frameworks
• Weak accountability and performance management systems
• Unclear legal basis for BoG decision-making;
• Limited clarity on financial, HR and administrative delegation;
• Weak linkage between academic governance, regulatory standards and institutional autonomy; and
• Absence of a clear approval and notification pathway

In the absence of structured and approved governance arrangements, there is a risk of unclear decision-making, overlapping responsibilities, weak accountability, and inconsistent management practices, which may affect institutional performance, sustainability and limit the ability to demonstrate formalised governance systems consistent with program requirements.

A practical and implementable governance framework is therefore required to support operationalisation of these COEs, clarify institutional roles, and establish accountable and transparent governance practices.

Goal and Objectives

To support the establishment and operationalisation of the Punjab Nursing Centres of Excellence through the development of a comprehensive governance framework that strengthens institutional effectiveness, accountability, leadership, gender-responsive governance, and sustainability. 

Objectives

1. Review current governance, management, and operational requirements for COEs
2. Develop a governance framework defining oversight, decision-making, accountability, and institutional responsibilities.
3. Prepare core governance instruments, including BoG TORs, committee structures, rules of business, delegation of authority frameworks, SOPs and governance procedures, in formats suitable for government review and approval.
4. Establish performance management and accountability systems and outline a practical roadmap for operationalisation and institutionalisation of the COEs.

Map and define the formal approval, endorsement and notification pathway for adoption of the governance framework, including institutional responsibilities of SHC&MED, PIU, BoG, DG Nursing, affiliated universities and relevant regulatory bodies. 

Strategic Approach

The TA will support institutional foundations for nursing workforce development by strengthening governance, accountability, and organisational performance.  The approach will adopt a system-strengthening lens focused on institutionalisation rather than creation of parallel structures. It will build on existing SHC&MED systems and legal frameworks, align governance arrangements with the BoG and HRH Unit, integrate governance mechanisms into existing systems, and ensure outputs are developed in suitable formats for government approval and notification.

The approach will identify key decision-makers, likely approval challenges, and actions needed to secure government ownership and adoption of the governance framework.

It complements ongoing support to health workforce strengthening, nursing sector reform, institutional development, and governance systems, and is aligned with the Faculty Development TA and broader Government of Punjab efforts to strengthen nursing education and workforce systems.

This TA contributes to the FCDO Health Big Changes as follows:

• Stronger Health Care Systems — strengthens governance, accountability and institutional management of nursing education institutions that support PHC, MNCH and service quality.
• Sustainable Population Growth through Family Planning — supports the female health workforce pipeline and improves governance of institutions producing nurses, LHVs and midwives who deliver RMNCH and family planning services.
• Improved Health Financing — helps protect and optimise government and ADB investment in Nursing COEs by defining ownership, oversight, decision rights, accountability mechanisms and sustainability arrangements.

Given that nursing and midwifery education institutions have a predominantly female student and workforce base, the governance framework will include gender-responsive provisions that strengthen safe, inclusive and supportive institutional environments. This will include, where applicable, governance arrangements for student support, grievance redress, safeguarding, prevention and response to harassment, safe clinical placements, equitable participation in decision-making, and leadership pathways for female faculty, students and administrators.

The governance framework should explain how COEs will ensure a safe and inclusive environment, who will be responsible, how concerns will be reported and escalated, and how progress will be monitored.

Scope of Work and Methodology

Phase 1: Inception and Governance Assessment

• Review documentation related to establishment and operationalisation of the COEs.
• Assess existing governance, legal, and operational arrangements.
• Map applicable laws, rules, notifications, PNMC standards, university affiliation requirements, and SHC&MED administrative procedures relevant to COE governance.
• Assess the institutional readiness of Lahore, Multan, and Rawalpindi COEs to implement the proposed governance arrangements.
• Review relevant international practices for nursing education governance, with a focus on guidance for low- and middle-income countries (LMICs)
• Conduct consultations with SHC&MED, PIU, and key stakeholders including senior management at SH&ME, DG Nursing, PNMC representatives, public and private nursing education leaders and ADB programme stakeholders including Finance Department, Law Department, P&D Board, HR/administration wings, affiliated universities, student/faculty representatives, and relevant gender/safeguarding bodies.
• Identify governance priorities, risks, and institutional requirements.
• Prepare and submit inception report and agreed workplan with timelines.

Phase 2: Governance Framework and Instrument Development

Develop an integrated governance framework and instruments package, including:

• Board of Governors structures and TORs
• Institutional governance architecture and reporting lines
• Rules of Business and governance procedures
• Delegation of authority frameworks
• Committee structures and TORs
• SOPs and governance manuals
• Performance scorecard/KPI framework; risk register; financial and procurement delegation matrix; HR delegation matrix; academic quality assurance mechanism; complaints and safeguarding protocol; and implementation roadmap.

Phase 3: Validation, Finalisation and Institutionalisation

Conduct stakeholder consultations and validation sessions. These include formal validation and endorsement processes:

• Multi-stakeholder validation workshops
• Technical review by SHC&MED and PIU
• Submission to Board of Governors
• Formal endorsement and government notification
• Finalise governance package in approval-ready formats, including all supporting documents
• Conduct orientation and handover of governance instruments.
• Support preparation of approval/notification package;
• Develop a handover and capacity-building plan for BoG/COE leadership; and
• Conduct orientation sessions for BoG members, COE principals and relevant SHC&MED/PIU officials.

Sustainability and Institutionalisation

Sustainability is built into the assignment from the outset by anchoring governance arrangements within existing Government of Punjab systems and implementation processes.

• Governance frameworks and instruments will be developed in coordination with SHC&MED and the PIU to ensure ownership and alignment.
• All outputs will be prepared to support formal approval and institutional adoption.
• Clear roles, reporting lines, and accountability mechanisms will be defined.
• Performance and reporting arrangements will align with broader program monitoring systems.
• A practical roadmap will guide phased implementation, handover, and ongoing refinement of governance arrangements.
• Sustainability will be tracked through practical milestones, including
  • nomination of government focal points,
  • formal adoption of governance tools,
  • use of agreed reporting templates,
  • orientation of relevant officials and COE leadership, and
  • integration of governance responsibilities into routine COE and SHC&MED processes.

Deliverables

1. Inception Slide Deck, Workplan and Governance Assessment: Governance gap analysis, stakeholder map, legal/regulatory review plan, approval pathway, risk matrix, and detailed workplan endorsed by SHC&MED.
2. Draft Governance Framework and Instrument package: Complete draft package includes governance architecture, BoG/committee TORs, delegation matrices, rules of business, SOPs, gender/safeguarding provisions, performance framework, risk register and implementation roadmap
3. Final Governance Framework and Institutionalisation Package: Governance framework and instruments finalised and submitted for formal approval/adoption, with agreed roadmap outlining implementation milestones, roles, and accountability arrangements validated through stakeholder consultations, revised based on comments, accompanied by approval/notification package, handover plan, orientation materials and DLI verification evidence checklist

Position Title:
Legal & Regulatory Specialist (Mid National)

Duty Station: Lahore (with travel as required)

Duration / LOE: Mid-August 2026 – March 2027 (LOE 50 days – subject to change until the start of the TA)

Reporting To: E4H Punjab Programme Team (Team Lead & Designated Provincial Coordinator) & Health Systems Adviser

Role Purpose

Provide legal and regulatory expertise to develop governance instruments, ensuring compliance with Government of Punjab legislation, administrative procedures, and regulatory requirements for Nursing Centres of Excellence.

Key Roles & Responsibilities

• Develop governance instruments including Rules of Business, delegation frameworks, committee TORs, and SOPs.
• Support design of Boards of Governors and institutional governance arrangements.
• Ensure governance framework complies with applicable legislation and administrative procedures.
• Prepare notification drafts, approval documentation, and legal guidance for institutional adoption.
• Support stakeholder consultations and review processes.

Requirements

Technical Expertise

• Degree in Law, Governance, Public Administration, or related discipline.
• Minimum 10 years of overall professional experience.
• Experience in legal drafting, governance frameworks, regulatory systems, and public sector administration preferred.
• Experience with Government of Punjab rules, notification procedures, and health or education sector governance preferred.

Core Competencies

• Legal drafting
• Regulatory compliance
• Governance instrument development
• Policy interpretation
• Analytical thinking
• Stakeholder coordination