E4H Punjab TA: Training of Trainers for Smog-Related Health Crisis Response

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 (2023–2027) provides technical assistance (TA) to Punjab, Federal, and KP governments, implemented by Palladium in partnership with Oxford Policy Management (OPM).

Through its flexible, embedded, and demand-driven model, E4H supports governments to achieve a resilient health system that is prepared for emergencies, responsive to evidence, and delivers equitable, quality, and efficient healthcare services. Specifically, E4H delivers TA across three outputs:

• Output 1: Strengthened integrated health security and preparedness.

• Output 2: Strengthened evidence-based decision-making for accountability and performance.

• Output 3: Improved implementation of Universal Health Coverage (UHC).

Background and Problem Statement

Background

• E4H supported the Health and Population Department in addressing the smog issue. A TA was initiated at the request of the H&PD to design a public awareness campaign addressing the health risks associated with smog. E4H played a central role in developing the campaign strategy, tailoring messaging and IEC materials for diverse population groups. 
• Against this backdrop, the proposed Technical Assistance aims to support the Health & Population Department (H&PD) in strengthening preparedness for smog-related health crises by developing a cadre of district-level master trainers through structured Training of Trainers (ToT) workshops. This initiative seeks to strengthen the capacity of health workforce in Punjab and ensure continuity, efficiency, and quality in the management of seasonal respiratory health risks linked to smog.
• By focusing on workforce capacity-building and linking content to the LMS/PHDC/DHDCs, the intervention contributes to key health system building blocks: Health Workforce, Service Delivery, and Health Information Systems.

Problem Statement

Punjab lacks a sustainable pool of certified trainers within P&SHD/DGHS to cascade smog-related health crisis response training. Reliance on ad-hoc workshops limits scale, quality, and continuity, leaving frontline health workers underprepared for annual smog surges.

Goal and Objective(s)

The overall goal of this TA is to establish a cadre of master trainers capable of institutionalising and cascading smog-related health crisis response training across Punjab.

We will achieve this by pursuing 3 objectives:

• Objective 1: Develop an advanced Training of Trainers (ToT) curriculum integrating IDSR protocols and respiratory crisis management.

• Objective 2: Train 50 master trainers selected from previously trained participants, equipping them with facilitation and simulation-based skills.

• Objective 3: Standardise training materials, SOPs, and IEC content for provincial rollout, and strengthen DHAs’ capacity to independently deliver refresher and cascade trainings beyond the TA lifecycle.

Strategic Approach

Contributions to health systems strengthening

This Technical Assistance will strengthen Punjab’s capacity to manage smog-related health crises by embedding ToT modules within the provincial training ecosystem. By equipping district-level master trainers with both technical expertise and facilitation skills, the intervention creates a sustainable cascade model for frontline health worker preparedness. Embedding the curriculum and materials within the Learning Management System (LMS), the Provincial Health Development Centre (PHDC), and District Health Development Centres (DHDCs) will ensure institutional ownership, reduce reliance on ad-hoc training, and promote continuity and quality in training delivery year after year.

Alignment with other E4H TAs/investments

The TA directly builds on previous E4H phases: Phase I (smog crisis response training for 200 professionals) and Phase II (embedded communications campaign for public awareness). It operationalises the Sustainable Training System Framework by linking smog-specific modules with the LMS, PHDC, and DHDCs. This complements broader E4H workstreams on climate-sensitive health security, PHC workforce strengthening, and the digitisation of training resources.

Alignment with other donors

The TA aligns with the Government of Punjab’s climate adaptation and health resilience agenda, particularly under the Punjab Green Development Programme and commitments to improve air quality. It is consistent with WHO’s IDSR framework for surveillance and case management, UNICEF’s focus on child health and air pollution, and World Bank investments in environmental and health system resilience. By institutionalising digital content and enabling provincial and district-level hubs to lead, this TA ensures complementarity with other donor-supported reforms while avoiding duplication.

Scope of Work and Methodology

This Technical Assistance will operationalise the ToT model by strengthening training content, equipping a selected pool of master trainers, and embedding tools and systems for sustainable cascade delivery across Punjab. The approach combines curriculum enhancement, adult learning methodologies, and hands-on clinical simulations to ensure trainers are both technically proficient and capable of facilitating high-quality trainings at the district level.

The TA will conduct the following activities:

• Curriculum Enhancement: Upgrade Phase I training modules into ToT manuals (trainer guides, facilitation notes, simulation packs).

• Trainer Selection: Develop criteria and shortlist 50 trainers in consultation with H&PD/DHAs.

• ToT Delivery:Conduct 2× four-day ToT workshops, covering:

  • Public Health/IDSR protocols (AURI, ILI, ALRI, SARI).
  • Clinical management (SARI, asthma, hospital-acquired acute disease).
  • Adult learning methodologies, facilitation, and clinical simulation skills.
  • Toolkit Development: Produce a “Trainer Toolkit” (decks, SOPs, pre/post-tests, IEC templates).
  • M&E and Reporting: Assess trainer competencies, collect feedback, and produce a final report with recommendations for cascade rollout.

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

• Moreover, this TA will institutionalise and link the ToT modules with the Learning Management System (LMS), the Provincial Health Development Centre (PHDC), and District Health Development Centres (DHDCs) in line with the Sustainable Training System Framework developed in the previous year of E4H. By embedding the content digitally and at institutional training hubs, this TA ensures long-term sustainability and accessibility for refresher trainings and cascade rollouts.
• This technical assistance aligns with the Government of Punjab’s broader health systems strengthening goals. It directly supports Output Indicator 3.2 of the E4H Programme: Strengthened health workforce as a means to PHC for Universal Health Coverage (UHC).
• Capacity will be built through ToT workshops, ensuring participants can independently conduct trainings.
• Training materials, SOPs, and IEC content will be embedded within PHDC LMS and Health Education Wing repositories.
• Cascade training plans will be handed over to DHAs, enabling district-level replication each smog season.
• A transition roadmap will recommend long-term institutional anchoring within P&SHD. 

 Deliverables

1. Inception Report & Training Design Slide Deck.

2. Trainer Toolkit (manuals, SOPs, IEC materials, digital content).

3. ToT Delivery Report (trainer assessments).

4. Final ToT Report (with slide deck) & Cascade Plan. 

STTA Senior National - Lead ToT Advisor

LOE: 27 days

Period: Sep – Nov 2025

Role Requirements
Provide leadership in curriculum enhancement, oversee ToT design, ensure alignment with IDSR protocols, and guide quality assurance.

Technical Expertise
Postgraduate degree in Public Health, Health Systems, or related field. Minimum 15 years of overall experience. Demonstrated expertise in curriculum design, IDSR implementation, and emergency health training. Proven experience in leading large-scale ToT initiatives and institutionalising training systems within government structures.

Core Competencies
Strategic leadership; Curriculum design; Stakeholder engagement; Policy alignment; Decision-making.

Deliverables/KPIs
Same as overall TA deliverables.