JUNIOR NATIONAL STTA – RESEARCH ASSOCIATE

E4H KPTA: Implementation of Facility-Level Budget and Expenditure Management Policy (Health Sector) – Expansion to 10 Additional Districts.

Programme 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

E4H initially supported the Department of Health (DoH), Khyber Pakhtunkhwa, to introduce Facility-Level Budgeting (FLB) in one district. The initial implementation demonstrated that facility-level needs assessment, planning and budget preparation could be undertaken through government structures and processes and provided the practical basis for subsequent scale-up.

Building on this experience, E4H supported expansion to nine additional districts, bringing total coverage to 10 districts. Across these 10 districts, the FLB approach has now been substantially institutionalised through standardised tools and processes, DHO engagement, facility-level needs assessment and budget preparation, and integration with government budgeting arrangements. The experience has demonstrated both the feasibility and value of institutionalising needs-based budgeting closer to the point of service delivery.

The successful implementation and institutionalisation of FLB in these 10 districts has generated strong recognition and demand within the Department of Health, including among its senior leadership and the Financial Management Cell (FMC), for further expansion of the approach. The Department of Health/FMC has therefore requested E4H support to extend and institutionalise FLB in another 10 districts, bringing total FLB coverage to 20 districts across Khyber Pakhtunkhwa.

The proposed expansion represents an important transition in the implementation model. Whereas E4H played a more active technical and facilitation role during the earlier phases, the next phase will be led and owned by FMC. FMC will lead the planning, coordination, mobilisation, oversight and institutionalisation of FLB in the additional 10 districts, drawing on the systems and experience established in the first 10 districts.

E4H will deliberately assume a more passive and enabling role during this phase, providing technical backstopping, mentoring and quality assurance where required rather than directly leading implementation. The expansion will therefore function as a transition phase through which FMC strengthens its practical capacity to independently manage FLB and subsequently scale the approach to the remaining districts of the province.

Goal and Objectives

The overall goal of this TA is to support an FMC-led expansion and institutionalisation of FLB in 10 additional districts, bringing total coverage to 20 districts, while transitioning responsibility for FLB implementation, oversight and future scale-up from E4H to FMC.

We will achieve this by pursuing three objectives:

Objective I: FMC-led expansion of FLB to 10 additional districts, applying the established FLB model and lessons from the existing 10 districts, with target districts oriented and operationalised for the standard FLB planning and budgeting process.

Objective 2: Strengthened FMC and district capacity to manage and sustain FLB implementation, including a pool of 40 trained focal persons/master trainers (two per district across 20 districts) to support district mobilisation, Annual District Budget Seminars, implementation oversight and quality assurance.

Objective 3: FMC-led model for continued FLB scale-up institutionalised and tested, with facility-level Annual Action Plans and budget estimates consolidated into district submissions for the FY 2027–28 Demand for Grant, enabling further expansion with reduced reliance on external technical assistance.

Strategic Approach

• Contributions to health systems strengthening: The central principle of this TA will be government ownership and transition. The additional 10-district expansion will be led by FMC rather than E4H and will serve as a practical transition from externally supported implementation to government-led implementation. FMC will be positioned at the centre of the implementation model and will lead provincial coordination, district mobilisation, implementation planning, oversight of the DHO master-trainer system, progress monitoring and quality assurance. DHO offices and their trained focal persons/master trainers will lead implementation at district level. E4H's role will intentionally shift from direct implementation to a passive enabling role. E4H will remain available for mentoring, technical backstopping, troubleshooting and quality assurance but will not substitute for FMC or DHO leadership. Wherever feasible, activities will be led and delivered by FMC and district government counterparts, with E4H intervening only where additional technical support is required. This approach will allow FMC to learn through leading the expansion itself and will progressively transfer the institutional knowledge, implementation responsibility and accountability required for future province-wide scale-up.
• Alignment with other E4H TAs/investments: Implementation will be coordinated with E4H support on RHC DDO functions and budget execution, as well as the proposed FLB E-App. The DDO support addresses the post-approval side of FLB, including financial authority, DDO capacity and expenditure management, while this assignment focuses on the planning and budget-formulation cycle in the 10 target districts. Where the FLB E-App is sufficiently ready during the budget preparation cycle, the TA will support its use for facility-level planning and budgeting without making application development a deliverable of this assignment.
• Alignment with other donors (if relevant): The TA will coordinate with NHSP-supported district planning and EPHS work so that facility Annual Action Plans and budget demands align with district priorities and can feed into the Integrated DAP Financial and Operational Plan where relevant. Coordination will also be maintained with the Health Department, Finance Department and IFMIS stakeholders to ensure that facility-level budget and HR configuration requirements are incorporated within routine government processes and do not create parallel arrangements.

Scope of Work and Methodology

The TA will use an FMC-led, DHO-delivered and E4H-supported implementation model. This represents a deliberate transition from the comparatively active role played by E4H during the establishment and initial expansion of FLB to a government-owned model in which FMC assumes leadership and E4H progressively steps back. The guiding principle throughout implementation will be "FMC leads, DHOs deliver, and E4H supports." E4H support will be demand-driven and progressively reduced as FMC and district teams demonstrate the capacity to undertake the functions independently.

Implementation period: November 2026 to August 2027.

Phase 1 – Orientation and institutional mobilisation

During November 2026, FMC will lead, with technical backstopping from E4H, the orientation and institutional mobilisation of the 10 additional districts. Participants will include DHOs, relevant district budgeting/planning and accounts staff, and provincial stakeholders. The sessions will establish a common understanding of FLB-EMP, implementation roles and responsibilities, the Annual District Budget Seminar methodology, standard formats and templates, and the implementation calendar.

The orientation will draw explicitly on the experience and lessons from the 10 districts where FLB has already been institutionalised, enabling the additional districts to adopt an established government model rather than initiating a new or parallel approach.

Each of the 10 additional districts will nominate two relevant budget/accounts staff as prospective focal persons/master trainers. In addition, two focal persons/master trainers from each of the 10 existing FLB districts will participate in the capacity-strengthening arrangements, resulting in a pool of 40 DHO-based focal persons/master trainers across the 20 districts. This broader pool will strengthen peer learning, standardisation and the government resource base available to FMC for continued FLB implementation and future expansion.

FMC will lead coordination of district nominations, participation arrangements and implementation scheduling, while E4H will provide mentoring and technical support where required.

Phase 2 – Planning and facility-level budget preparation

Two focal persons/master trainers per district—20 from the 10 additional districts and 20 from the 10 districts where FLB has already been institutionalised, making 40 in total—selected from relevant budget and accounts staff of DHO offices, will undergo competency-based Training-of-Trainers (ToT) conducted through PHSA using the standard FLB modules and materials.

FMC will lead the coordination and oversight of the ToT in collaboration with PHSA, with E4H providing technical inputs, mentoring and quality assurance as required. Combining focal persons/master trainers from the existing and additional districts will establish a common government-owned facilitation model across all 20 districts and strengthen the pool of district-level expertise that FMC can draw upon for future expansion.

Following the ToT, the trained DHO focal persons/master trainers will lead and facilitate five-day Annual District Budget Seminars in their respective DHO offices. Days 1–2 will focus on facility needs assessment and prioritisation; Day 3 on costing, Annual Action Plans and facility budget demands; Day 4 on DHO review, consolidation and prioritisation; and Day 5 on finalisation of facility-level budgets and the submission package.

The seminars will be budget-production exercises rather than classroom training. DHO focal persons/master trainers will have primary responsibility for facilitation and production of the required budget outputs, while FMC will oversee implementation and provide coordination and problem-solving support across districts. E4H will not routinely lead district delivery; its role will be limited to mentoring, technical troubleshooting and selective quality assurance, with support provided where gaps or complex technical issues arise.

Phase 3 – Consolidation

DHO offices will lead the consolidation of facility-level Annual Action Plans and budget estimates into unified district budget submissions. These consolidated submissions will be taken forward for inclusion in the FY 2027-28 Demand for Grant and will also serve as inputs to the Integrated DAP Financial and Operational Plan.

FMC will lead provincial-level oversight of the consolidation process, including monitoring district progress, supporting resolution of bottlenecks and ensuring consistency with the standard FLB approach. This will provide FMC with practical experience in managing the full cycle of multi-district FLB implementation and consolidation.

E4H will provide selective technical review and quality assurance, rather than undertaking routine consolidation functions on behalf of DHOs or FMC. Attention will be given to mentoring FMC and district teams to independently assess whether facility-level needs, district priorities and budget estimates are appropriately reflected in consolidated submissions.

Phase 4 – Execution and transition to sustained government ownership

Following budget finalisation, facilities will begin the transition into expenditure routines and financial reporting against their respective facility-level cost centres.

FMC and the relevant government counterparts will lead coordination of the initial execution arrangements. This will include configuration of position codes in the HR Module of IFMIS against the respective cost centres of BHUs and RHCs, in coordination with the relevant Health Department, Finance Department and accounting authorities. This will help align sanctioned positions and payroll structures with facility-level cost centres and support operationalisation of facility-level financial management.

E4H will provide technical backstopping on execution-readiness issues where required, while responsibility for coordination and follow-up will remain with FMC and the relevant government authorities.

This phase will also consolidate the transition from E4H-supported implementation to FMC-led management of FLB. Drawing on the institutionalised experience of the first 10 districts and the FMC-led expansion to the additional 10 districts, standard tools, implementation processes, training arrangements, monitoring mechanisms, lessons and quality-assurance procedures will be consolidated into a government-owned model for future scale-up. By the end of the TA, FMC is expected to be positioned to lead subsequent expansion of FLB to the remaining districts, with E4H or other external technical assistance limited to specialised or on-demand support rather than routine implementation.

Sustainability: Capacity Building, Institutionalisation, and/or Transition Planning

• Ownership of FLB will rest with FMC at provincial level and DHOs at district level. The TA will not establish parallel E4H-led implementation arrangements. Instead, existing government structures will lead planning, capacity development, implementation, monitoring, consolidation and institutionalisation. The additional 10-district expansion will serve as a structured transition phase. FMC will "learn by leading": it will undertake the functions required for multi-district expansion while E4H provides mentoring and technical backstopping. This will enable institutional capacity to be developed through actual implementation rather than through stand-alone training alone.
• E4H's involvement will follow a deliberate step-back approach: from technical accompaniment during initial mobilisation, to on-demand backstopping during district implementation, and ultimately to selective quality assurance as FMC assumes full responsibility. Functions demonstrated to be within FMC/DHO capacity will not continue to be performed by E4H.
• By the completion of the TA, FMC is expected to own the FLB implementation model, standard tools, capacity-building arrangements, monitoring mechanisms and quality-assurance processes, supported by a network of trained DHO focal persons/master trainers across 20 districts. This institutional platform will enable FMC to lead subsequent expansion to the remaining districts with limited or no routine implementation support from E4H.

Timeline and Days

The proposed LOE is 110 days from November 2026 – August 2027, subject to final confirmation from client.

Requirement

Technical Expertise

• Degree in finance, economics, public administration, data/health management or related field with at least 5 years’ experience;
• Experience in data collection/analysis, documentation, training logistics and government coordination.
• Experience in Facility-Level Budgeting FLB/ DDO functions, and/or public-sector budgeting and expenditure processes is highly desirable.

Competencies

• Strong organisation, field coordination, data quality, communication, problem solving and ability to support parallel district activities, consolidation exercises and evidence tracking.