TA Title: Strategic Alignment, Design Recommendations and Monitoring Framework For Telemedicine Initiative of H&PD

Program 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.

Terms of Reference

Background and Problem Statement
In recent years, the Government of Punjab has demonstrated a strong commitment to strengthening Universal Health Coverage (UHC) through structural reforms and digital innovations across the primary healthcare (PHC) system. As part of this transformation, the Health and Population Department (H&PD) is prioritising the scale-up of telemedicine services to address healthcare workforce shortages and close access gaps, particularly in underserved and remote areas. This digital push reflects broader national and global commitments to reduce health inequalities and improve service continuity through technology-enabled care models.
•           The COVID-19 pandemic underscored the critical role of telemedicine in mitigating facility overloads, supporting chronic disease management, and streamlining referrals. However, despite its potential, telemedicine uptake in Punjab has remained limited due to fragmented standards of practice, lack of interoperable systems, weak integration with Health Management Information Systems (HMIS), and inadequate technical and managerial capacities.
•           System-wide challenges also persist, including the absence of a unified telemedicine strategy, weak performance monitoring mechanisms, unaligned digital service pathways, and insufficient integration with Learning Management Systems (LMS). Moreover, key operational components—such as clinical SOPs, data privacy protocols, communication flows, and cadre readiness—remain underdeveloped, undermining long-term sustainability and quality assurance.
•           The Punjab UHC Roadmap (2021) identifies the strategic use of digital platforms as a critical enabler of PHC reform, while the World Bank-supported National Health Support Programme (NHSP) emphasises Disbursement Linked Indicator (DLI) 3, which focuses on strengthening referrals between primary and secondary health care levels in lagging districts. These frameworks collectively highlight the need for standardised, scalable, and equity-focused telemedicine models.
•           In response, the Health and Population Department, with support from the E4H Programme, is initiating a Technical Assistance (TA) intervention to provide strategic alignment, design inputs, and a monitoring framework for the province’s telemedicine initiative. This TA will ensure institutionalisation of high-quality digital service delivery models aligned with provincial reform priorities and national policy frameworks.
 
 
 The Punjab Universal Health Coverage (UHC) Roadmap (2021) and the Primary Healthcare (PHC) reform agenda serve as key strategic frameworks guiding digital innovation across the provincial health system. While the COVID-19 pandemic accelerated the uptake of telemedicine as a critical service delivery modality, implementation challenges have persisted due to fragmented systems, unstandardised protocols, and limited institutional readiness.

·         In line with the broader health system strengthening efforts, the H&PD has identified the need for a coherent and scalable telemedicine model that integrates with PHC, supports continuity of care, and improves access for underserved populations.

·         The Government of Punjab’s strategic commitment under the National Health Support Programme (NHSP), particularly Disbursement Linked Indicator (DLI) 3, necessitates improved referral systems and digital service delivery mechanisms at the PHC level.

·         The evolving digital health ecosystem, including recent investments in the Health Management Information System (HMIS), Learning Management Systems (LMS), and facility-level automation, underscores the need for interoperability, institutional alignment, and performance monitoring.

·         Based on these policy and system considerations, this TA will develop a strategic institutional design and monitoring framework for telemedicine that reflects the current digital health landscape, builds on past experiences, and aligns with both national and provincial reform milestones through 2030 and beyond.

The TA will serve as a foundational step toward institutionalising evidence-based, gender-responsive, and patient-centric telemedicine in Punjab and will contribute to the larger goal of achieving Universal Health Coverage.

Objectives

The overall objectives of the technical support will be:

• To provide strategic direction for the institutionalisation of a scalable, integrated, and equity-focused telemedicine model that aligns with Punjab’s UHC Roadmap, NHSP Results Framework, and PHC reform priorities
• To assess existing telemedicine platforms and referral pathways, identify operational and regulatory gaps, and harmonise service delivery standards including SOPs and clinical protocols
• To strengthen digital infrastructure readiness and interoperability with HMIS, LMS, and other provincial systems to ensure data-driven, patient-centred service delivery
• To design a robust monitoring and evaluation framework with clear indicators, verification protocols, and feedback mechanisms that promote transparency, quality, and accountability
• To recommend actionable next steps for phase-wise implementation, strategic costing, and long-term sustainability of telemedicine services within the public health system
• These objectives will ensure that telemedicine is not only technically sound and system-aligned, but also operationally feasible, equity-oriented, and embedded within institutional governance frameworks.

Scope of Work and Methodology

A multidisciplinary team of consultants will support the Health and Population Department (H&PD) in designing a strategic framework for scalable telemedicine services, aligned with provincial digital health reforms and national UHC targets. The TA will be grounded in evidence, systems thinking, and stakeholder engagement to ensure institutional ownership and operational feasibility. The approach will be implemented in four structured phases:

Phase 1: Inception and Alignment

• Conduct inception meetings with H&PD, Punjab Information Technology Board (PITB), DGHS, and other stakeholders to validate objectives and roles
• Finalise the TA workplan, stakeholder mapping, and technical approach
• Align scope with NHSP, UHC Roadmap, and ongoing digital health initiatives
• Submit an Inception Report and presentation summarising methodology and key milestones

Phase 2: Situational Analysis and Strategic Design

• Map existing telemedicine platforms, protocols, and referral pathways
• Assess interoperability with HMIS, LMS, and other relevant digital systems
• Identify infrastructural, regulatory, and human resource gaps across districts
• Analyse barriers to equitable access, particularly for women, marginalised groups, and persons with disabilities
• Develop a Strategic Design Paper outlining integration and scale-up recommendations

Phase 3: Development of Monitoring and Evaluation Framework

• Define telemedicine performance indicators aligned with NHSP DLI-3 and PHC metrics
• Recommend digital dashboard enhancements and integration pathways with DHIS2 and LMS
• Develop verification protocols, feedback loops, and accountability mechanisms
• Assign institutional roles and data flow structures to support quality assurance and supervision

Phase 4: Finalisation and Dissemination

• Incorporate stakeholder feedback into finalised deliverables
• Submit the Final Report and Implementation Roadmap including phased rollout recommendations and costing scenarios
• Prepare slide decks and policy briefs for strategic dissemination and decision-making
• Support stakeholder briefings and cross-departmental engagements for institutional buy-in

This participatory and phased methodology will ensure that the telemedicine framework is tailored to Punjab’s evolving needs, integrates with existing digital health systems, and supports long-term sustainability. Designated focal persons from H&PD and PITB will be closely engaged throughout the TA process to ensure alignment, relevance, and ownership.

Timeline and LOE

The level of effort for the role is 80 days working days, from Aug 2025 – Jan 2026

Role Specific Requirements

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Technical Expertise

Postgraduate degree in public health, biostatistics, or health information systems. Minimum of 15 years’ experience in M&E design, digital dashboards, and health data systems such as DHIS2. Experience with NHSP, UHC indicators, and DLI tracking.

Competencies

Planning and delivering work; Analysis and use of information; Results-based management; Communicating complex data

Deliverables/KPIs

1. Inception Report and Slide Deck
2. Situational Analysis and Strategic Design Paper
3. M&E Framework
4. Final Report and Implementation Roadmap
5. Strategic Briefing Slide Decks