TORs: National Senior STTA – Health System Expert
Technical Assistance for Assessment of the Implementation of Punjab Healthcare Commission’s Minimum Service Delivery Standards (MSDS) in Selected Healthcare Establishments 

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 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

Established through the promulgation of the Punjab Healthcare Commission Act 2010 (PHC Act 2010), the Punjab Healthcare Commission (PHC) is the regulatory body for healthcare facilities in Punjab. PHC’s mandate is to improve the quality of healthcare in the public and private sectors and take measures against all forms of quackery in Punjab. Under Section 13 of the PHC Act 2010, the Commission has the mandate to register all types and categories of Healthcare Establishments (HCEs).

The Minimum Service Delivery Standards (MSDS) define a set of the benchmarks for minimum level of mandatory services that a HCE is responsible to achieve and patients have a right to expect. It entails a package of yardsticks essential for all types and Categories of the Healthcare Establishments i.e. Category I, Category II and Category III and encompasses all the disciplines of healthcare and focuses on ensuring Quality Healthcare Services.

The PHC uses the as a regulatory and quality assurance framework to ensure that healthcare establishments across Punjab provide a baseline level of healthcare services. These standards are comprehensive and cover multiple functional areas that are essential for safe, effective, and patient-centered healthcare delivery. The MSDS are applied to both public and private healthcare facilities, serving as a benchmark for evaluating and improving healthcare services. The PHC requires healthcare establishments to comply with MSDS as a condition for obtaining and maintaining their licenses. The standards help define the quality and safety requirements that healthcare facilities must meet to be legally recognized and operational.

Conducting an evaluation of the implementation of the MSDS in HCEs is of immense value to the PHC. This assessment will provide a comprehensive and objective analysis of how effectively healthcare facilities are adhering to the established standards. By identifying areas where hospitals meet or fall short of MSDS, the evaluation can highlight critical gaps in service delivery and operational inefficiencies that need to be addressed.

The insights gained from this evaluation will not only enable the PHC to enforce compliance more effectively but also inform strategic revisions and improvements to the MSDS themselves. If the audit reveals recurring challenges faced by healthcare establishments—such as difficulties in infection control, medication management, or patient education—these findings can serve as a basis for refining the standards. This process ensures that the MSDS remain relevant, practical, and capable of driving meaningful improvements in healthcare quality.

Objective

The primary aim of this assessment is to evaluate the effectiveness and practicality of the MSDS as a regulatory framework for HCEs. By identifying implementation challenges and assessing the feasibility of the standards, the study seeks to provide evidence-based recommendations for revising and improving the MSDS. Additionally, the assessment will explore new approaches to enhance the standards' implementation methodology, ensuring that the MSDS can better support continuous quality improvement and efficient healthcare delivery across Punjab. 

1. Evaluate the Effectiveness of MSDS as a Regulatory Tool
2. Identify Implementation Challenges and Gaps
3. Inform the Revision and Enhancement of MSDS
4. Facilitate Continuous Quality Improvement

Scope of Work and Methodology

Phase 1: Planning and Preparation

The initial phase will focus on preparing for a systematic assessment by engaging with relevant stakeholders and reviewing existing documentation. Key activities will include:

• Stakeholder Engagement: Organize introductory meetings with PHC officials to understand expectations and refine the scope of work.
• Literature and Document Review: Conduct a structured review of essential documents, including the Punjab Healthcare Act 2010, MSDS guidelines, strategic business plans, and prior assessment reports. This review will inform the design of the assessment methodology and highlight critical performance indicators.
• Inception Slide Deck: Develop and present an Inception slide deck that outlines the assignment's objectives, proposed methodology, key performance indicators, data collection instruments, and a detailed work plan with timelines.

Phase 2: Tool Development and Training

• Adaptation and Development of Assessment Tools: Design and adapt comprehensive assessment tools tailored to the MSDS, covering all ten functional areas such as patient care, infection control, and facility management. These tools will be informed by best practices and pre-tested to ensure effectiveness and reliability.
• Training of Data Collectors: Organize a structured training programme for the six Health Facility Surveyors and supporting RAs. The training will cover data collection techniques, the use of digital tools (if any), and ethical guidelines for fieldwork. A hands-on orientation session will be conducted to ensure that the field staff are well-prepared and aligned with the assessment’s objectives.

Phase 3: Field Data Collection

• On-Site Assessments: Implement the assessment across selected hospitals in Lahore Division covering all categories in both public and private HCEs. The assessments will focus on evaluating compliance with the MSDS and identifying opportunities for improvement.
• Facility Engagement: Engage with hospital management and staff to facilitate the assessment process, gather qualitative and quantitative insights, and address any operational challenges encountered.

Timeline and LOE

The level of effort for the role is 36 working days, from January 2025 - April 2025. 

Requirements:

Technical expertise

• In-depth knowledge and understanding of the MSDS Punjab
• Proven track record of leading such assignments during the last ten years
• Ability to analyse the healthcare establishments comprehensively, assessing their strengths and weaknesses.
• Collaboration with multidisciplinary teams to foster partnerships and promote stakeholder engagement to achieve shared health system goals and outcomes.
• Experience developing and implementing strategic plans to assess the performance of healthcare establishments.

Competencies 

• Ability to communicate effectively with all levels in an organisation
• Strong influencing and facilitation skills
• Ability to work effectively within a multi-disciplinary team
• Ability to analyse data and evaluate risks
• Ability to manage diversity and respond on time

Deliverables/KPIs

• Inception Slide Deck 
• Assessment Tool(s) Development & Training
• Data Collection 
• Final Report