TA Title: Technical Assistance For Conducting Simulation Exercise For Public Health Emergencies In Selected Districts

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 made important strides toward strengthening health system resilience and emergency preparedness, particularly through reforms in primary healthcare (PHC) and alignment with the Universal Health Coverage (UHC) Roadmap. However, recurrent public health emergencies—including COVID-19, dengue outbreaks, and climate-related shocks—have exposed persistent gaps in district-level response systems and institutional coordination. These challenges are especially acute in vulnerable and underserved districts such as Rajanpur, DG Khan, Jhang, and Muzaffargarh.
•           While simulation exercises were piloted during COVID-19 and subsequent vector-borne disease responses, the absence of a standardised, system-integrated simulation package has limited institutional memory, undermined consistency in emergency protocols, and hindered the use of digital learning tools like the Learning Management System (LMS). In many districts, parallel systems, outdated SOPs, and insufficient training cycles further reduce the effectiveness of response mechanisms.
•           National evaluations, including the Joint External Evaluation (JEE) and the National Action Plan for Health Security (NAPHS), have emphasised the need for sustainable emergency preparedness models aligned with the International Health Regulations (IHR 2005). These assessments underscore the importance of integrated simulation drills, routine preparedness reviews, and local ownership of emergency response capacities. Yet, these mechanisms remain fragmented and underutilised at the district level.
•           At the global and national levels, Pakistan’s commitments to health system resilience are reflected in its adherence to SDG 3.8 on UHC, the Astana Declaration on Primary Health Care, and WHO benchmarks for IHR core capacities. The Evidence for Health (E4H) Programme aims to translate these commitments into sub-national action through targeted Technical Assistance (TA) focused on embedding simulation-based preparedness frameworks into provincial and district training systems.
•           This TA is situated within the broader reform agenda of the Health and Population Department (H&PD) and leverages the Sustainable Training System and digital infrastructure (e.g., LMS) to institutionalise simulation exercises as a core component of public health emergency readiness. It also seeks to promote equity and inclusion by ensuring that simulation content is accessible, linguistically appropriate, and adaptable to low-connectivity contexts.
By embedding simulation exercises into routine health system operations, this TA provides a scalable, replicable, and equity-oriented model for strengthening preparedness and response capacity at the district level—aligned with both national priorities and international health security standards.

Strategic Approach
Punjab’s Universal Health Coverage (UHC) Roadmap (2021) and the National Action Plan for Health Security (NAPHS) serve as foundational frameworks for strengthening the province’s emergency preparedness and health system resilience. While notable progress has been achieved in primary healthcare (PHC) service delivery and digital health innovation, recurring public health emergencies—such as COVID-19 and seasonal dengue outbreaks—have exposed persistent gaps in simulation-based preparedness at the district level.
•           In response, the H&PD, with support from the E4H Programme, has prioritised the integration of simulation exercises into the Sustainable Training System (STS) to improve institutional memory, coordination across tiers, and frontline emergency response capacity.
•           National and provincial evaluations—including the Joint External Evaluation (JEE)—have highlighted the absence of routine simulation drills, outdated or inconsistent SOPs, and a lack of scalable training models as critical gaps in achieving WHO’s International Health Regulations core capacities.
•           The strategic objective of this technical assistance is to embed a standardised, LMS-integrated simulation package within existing district-level health systems, ensuring accessibility, continuity, and equity—particularly in underserved and climate-vulnerable regions.
•           By aligning with both national policies and global health security commitments, the intervention will directly contribute to IHR compliance, strengthen sub-national ownership of emergency preparedness, and institutionalise simulation-based learning within routine training and governance mechanisms.
Grounded in these priorities, this TA offers a scalable, equity-focused, and digitally enabled model for operationalising district-level resilience, contributing to the broader objective of sustainable public health emergency preparedness in Punjab.

Objectives
The overall objectives of the technical support will be:
•           To adapt and institutionalise a standardised simulation package for public health emergency preparedness tailored to the needs of selected vulnerable districts.
•           To conduct simulation exercises that strengthen district health teams’ capacity for coordinated emergency response, while embedding these exercises into the Sustainable Training System (STS) and Learning Management System (LMS) to enable routine preparedness and long-term knowledge retention.
•           To generate lessons learned and policy recommendations to inform the scale-up of simulation-based training across other districts in Punjab.
By anchoring these objectives within ongoing health system reforms and digital transformation efforts, this TA will deliver a technically sound, operationally feasible, and contextually grounded model for public health emergency preparedness across Punjab.

Scope of Work and Methodology
This technical assistance will support the adaptation, piloting, and institutionalisation of a district-level simulation package for health emergency preparedness. A multidisciplinary team of consultants will work closely with the H&PD, district health offices, and relevant stakeholders to ensure the intervention is context-sensitive, technically sound, and embedded into existing systems.
The assignment will follow a phased, consultative, and data-driven approach structured as follows:
Phase 1: Inception and Planning
•           Conduct a desk review of existing simulation exercises conducted in Punjab (e.g., COVID-19, dengue), SOPs, and international models (e.g., WHO simulation packages).
•           Map relevant stakeholders across provincial and district levels, including health, disaster management, and regulatory institutions.
•           Hold an inception meeting with H&PD, district focal persons, and partners to validate the scope, geographic focus, and technical approach.
•           Finalise a work plan, tools, and outputs; submit an inception report and presentation.
Phase 2: Package Development and Tool Design
•           Develop a standardised simulation exercise package, including objectives, roles, formats (tabletop, functional, full-scale), and protocols.
•           Adapt training materials, scenario templates, debriefing tools, and monitoring checklists suitable for the LMS.
•           Align simulation tools with IHR core capacities, JEE recommendations, and SDG/UHC priorities.
Phase 3: Pilot Rollout in Selected Districts
•           Roll out the standardised simulation package in Muzaffargarh and DG Khan, engaging district emergency response teams, health facility staff, and relevant inter-sectoral actors.
•           Implement simulation scenarios designed to test coordination, communication, and emergency protocols in real-time settings.
•           Monitor the rollout using predefined tools to capture data on participant engagement, procedural adherence, and operational gaps.
•           Document key observations and lessons learned to inform refinement of the simulation framework in subsequent phases.
Phase 4: Review, Refinement, and Institutionalisation
•           Conduct after-action reviews (AARs) with participants and local authorities.
•           Refine the simulation package and tools based on field feedback, learning outcomes, and observed challenges.
•           Provide recommendations for integrating the final package into the LMS and routine training cycles under H&PD’s Sustainable Training System.
Phase 5: Finalisation and Dissemination
•           Prepare a final Simulation Package including SOPs, training guides, LMS-compatible modules, and monitoring templates.
•           Develop a policy brief and dissemination deck for use by H&PD, district governments, and development partners.
•           Submit final TA deliverables including the simulation package, documentation, AAR report, and endorsement-ready package.
This methodology ensures the TA is participatory, actionable, and aligned with both technical requirements and institutional expectations. Emphasis will be placed on flexibility to accommodate evolving needs during the assignment period.

Timeline and LOE

The level of effort for the role is 90 days working days, from Aug 2025 – Dec 2025

Role Specific Requirements

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Technical Expertise

Graduate or postgraduate degree in Public Health, Social Sciences, or a related field.

Overall, 5 years of experience.

With experience in qualitative and quantitative research, documentation, and field coordination.

Experience supporting implementation research or emergency simulation exercises is desirable.

Strong skills in stakeholder consultations, field note-taking, and drafting technical content.

Competencies

Data collection and synthesis

Communicating with others

Working with others

Documentation and reporting

Organisational skills

Deliverables/KPIs

1.         Inception Report & Slide Deck
2.         Simulation Package and Tool Package (Draft)
3.         Simulation Rollout, Review, and Final Package