Introduction

The Fleming Fund (FF) is a U.K. Department of Health and Social Care programme to help low and middle-income countries fight Antimicrobial Resistance (AMR). AMR poses a severe global threat, expected to cause 10 million deaths annually by 2050. With potential costs reaching $100 trillion, its impact on the global economy is significant. Fleming Fund Grants aim to tackle the AMR challenge in developing countries including Pakistan. The grants are funded by the UK Department of Health and Social Care and managed by Mott MacDonald for the country, regional and fellowship grants. Pakistan has received Fleming Fund support since 2019 in the form of two Country Grants, 9 Fellowships, and central and local procurement of equipment, reagents, and consumables. Between 2017 and the end of phase-1 of the program in March 2023, the program has provided financial support to grantees to establish and support local development of national AMR surveillance systems.

In partnership with the Fleming Fund, DAI's programme in Pakistan collaborates with the Pakistani government to strengthen systems using a “One Health” (OH) approach – a multisectoral approach to complex health problems that reaches across human health, animal health, and environment sectors. As global leaders in One Health, the DAI team helps incorporate One Health across programme interventions. DAI is helping Pakistan become a leader in combating antimicrobial resistance, and a model for better management of antimicrobials in human and animal populations. DAI and its consortium partners have successfully secured an additional round, Phase 2, of the Fleming Fund Country Grant in Pakistan which spans from January 2024 to December 2025. The Phase 2 of the FFCG programme focuses on achieving four intermediate outcomes: 1) Production of quality AMR/U/C and burden of disease data; 2) Conducting quality data analysis; 3) Sharing quality data analysis with decision-makers; and 4) Contributing to sustainable investments at both the country and global levels to counter AMR.

Context

Antimicrobial Resistance (AMR) poses a severe global threat, expected to cause 10 million deaths annually by 2050. With potential costs reaching $100 trillion, its impact on the global economy is significant. In Pakistan, unchecked antibiotic use and institutional deficiencies contribute to drug-resistant bacteria.

In partnership with the relevant stakeholders from Government of Pakistan and development partners, the Fleming Fund Pakistan collaborates to strengthen AMR containment efforts using a “One Health” approach – a multisectoral approach to complex health problems that reaches across human health, animal health, and environment sectors.

Pakistan’s National Action Plan (NAP) for the containment of AMR 2017 – 2022 successfully guided the country’s efforts over the past five years. The 2023 Joint External Evaluation of IHR core capacities recommended to update the AMR NAP. Subsequently, a multi stakeholder Technical Working Group was established to oversee the process of NAP revision. Through a collaborative process, involving all stakeholders, Pakistan has finalized AMR NAP for the period of 2024-2028.

Purpose of the Assignment

As a next step to ensure proper implementation of the National Action Plan, the National Institute of Health (NIH) in its capacity as the One Health lead and focal point in Pakistan, in collaboration with other sectors require detailed costing of the entire NAP activities. Fleming Fund Country Grant Pakistan will provide support for the NAP costing process and seeks to engage a team of experts to work with the TWG to estimate the finances all the four sectors viz. humans, animals, food and environment. needed to execute the AMR-NAP at national and provincial levels.
The primary purpose of this assignment is to facilitate the development of a comprehensive and actionable NAP costing based on WHO costing and budgeting tool for NAPs on AMR and finalize readiness checklist which will support the government in estimating the required funding and map the gap between the existing support and the required costs. As such, we expect this technical assistance to be highly collaborative and the resultant costing to support the following in their role of ensuring successful implementation of the NAP:

1. Policy Level Actors: Understand AMR specific and AMR related fiscal arrangements in place, gaps in NAP funding, and advocate for additional financial resources,

2. Implementing Entities: Accurately plan and execute activities related to AMR surveillance and containment.

Assignment Scope

Pakistan’s AMR NAP for 2024-28 aims to achieve 6 priority objectives with intervention streams and specific activities for each of the OH sectors with broad allocation of responsibilities for federal and provincial levels. The NAP has a detailed Operational Plan and a framework for monitoring and evaluation. The consultant(s) will be required to determine cost estimates for each activity of the AMR NAP, including the costs required for implementing the M&E plan of the NAP using WHO costing and budgeting tool for NAP. The Ministry of National Health Services, Coordination and Regulation has also completed a National Action Plan for Health Security (NAPHS) with costing. Since AMR is part of the GHS technical areas, the AMR NAP will also align this costing with NAPHS.

The costing should be aligned to government funding cycle. Considering the basic requirement of employing collaborative and participatory methodologies, the consultant(s) will be expected to discuss and confirm the scope of the analyses, cost estimates, scheduling, and details of the actions with focal persons from the NIH, MoNFS&R and MoCC and WHO AMR teams at regional /country office. The consultant(s) will work closely with the Technical Working Group on AMR and the Multistakeholder AMR Steering Committee in MONHSR&C for the finalization of the costing document.
The Technical Working Group established for the review of AMR NAP will guide and oversee the costing process.

Assignment Approach and Methodology
Applicants are expected to suggest their preferred methodology in line with the following broad guidance:

1. The National Action Plan envisages significant involvement of the players from human health, animal health (including veterinary, poultry, and aquaculture sectors), and environment. In addition, players from agriculture, and other relevant sectors at the federal, provincial, and regional levels will contribute to successful implementation of the NAP.

2. Review the AMR NAP 2024-2028 document. Additional guidance for preparation of application for this assignment can be obtained from the costing of NAP 2017-2022.

3. The consultant(s) will also be expected to obtain and analyse existing government funding (PC-1s and Recurrent Budget) and support from various development partners specifically for AMR as well as well as funding allocated for closely linked initiatives like UHC, Global Fund, GHSA NAP, and EPI programmes etc.

4. The proposed methodology and the team of experts should demonstrate an in depth understanding of the multi-dimensional nature of OH and AMR NAPs and incorporate best practice related to costing for AMR action plans.

Timeframe / Duration

The final approved costing document should be available by end of March 2025.

Deliverables
The final product of the assignment will include 1) an inception report detailing agreed methodology along with a work plan 2) A validation workshop with stakeholders after the data gathering and analysis is completed, 3) A narrative report documenting the methodology, findings, analysis, and use of the information gathered during the exercise and 3) detailed draft of costed worksheets of unit costs and aggregate costs in a format that allows use of the information by sector, institution, administrative level, and theme.

Application Process
Interested consultant(s) should submit the following:

1. Technical proposal detailing their understanding of the task and proposed approach and methodology (4 pages max).

2. Team composition with CVs of the proposed experts highlighting relevant expertise. We envisage a total LoE of 90 man-days for this assignment over a period of 3 months. Considering the complexity of the assignment, we do not want to be prescriptive on the number of individuals in the team. Nonetheless, applicants are required to consider the scope of the assignment which can be viewed from the following broad perspectives: a) at the sector level - human health, animal health, environmental health, b) in accordance with 7 NAP objectives, c) implementation level – Federal, provincial, institutional, d) Thematic – AMR Surveillance vs AMR containment efforts. Applicants are encouraged to propose a team composition and LoE which can demonstrate the ability to deliver this assignment in a timely fashion and with quality.

3. Work plan with key tasks, deliverables, and anticipated timeframe(s).

4. Financial proposal outlining the consultancy fee for each of the proposed consultant. Please note that Fleming Fund Country Grant will cater the costs of travel and consultative workshops.

5. Contact details of three references.

6. Deadline for submission of the application is 30th November 2024.