TA Title: Operational Review of Clinic on Wheels (And Field Hospitals) And Development of Deployment Plans

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
The Government of Punjab has made significant strides in enhancing primary healthcare (PHC) outreach through community-based models and mobile health solutions. One such innovation is the Clinic on Wheels (C-oW) initiative, introduced to address service delivery gaps in remote  and peri-urban areas. These mobile units have played a critical role in extending PHC services to the hard-to-reach populations. The C-oWs provide selective essential PHC services  with real-time data reporting to the Health & Population Department (H&PD). However, there is no systematic mechanism for strategic planning, performance analysis, or geographic optimization. Such capability will foster a sustainable systems approach to community-based PHC strengthening through C-oWs.

Since its launch in May 2024, the C-oW initiative has delivered essential PHC services to over 9.4 million clients across Punjab’s most underserved populations. Initially launched with 200 mobile units, the program has now entered Phase II, scaling operations through a total fleet of 911 vehicles, including new 555-passenger vans and 112 USG-equipped vehicles. The program’s next frontier is to embed these mobile services into broader health system strengthening efforts, making mobile healthcare an integral part of people-centered, decentralized service delivery in Punjab.

Preliminary evidence suggests that while C-oWs are active across all 36 districts, the deployment often lacks alignment with actual population needs, disease burden patterns, and PHC system priorities.  Service uptake varies significantly across sites, and existing outreach does not consistently integrate with static PHC facilities or referral pathways. Furthermore, there is limited use of spatial planning or real-time data systems to inform route design and service targeting. These gaps result in inefficient resource use, overlapping of coverage, uneven service access, and missed opportunities to improve the population’s health outcomes through more responsive deployment models.
The Department has initiated a daily provincial-level review mechanism, led by the Director General Health Services (DGHS) and his team, based on EMR data submissions. However, this mechanism needs to be strengthened and formalised. Currently, C-oWs have no linkages with the district-level disease surveillance teams or with nearby health facilities. In this context, there is a clear and urgent need to undertake an operational review of the C-oW initiative. This review should assess operational effectiveness, identify gaps in service delivery, and propose a geo-optimized deployment strategy based on health system needs and community demand.

To support this effort, technical assistance will be mobilized to lead a structured review and planning process across four priority districts, namely Lahore, Rajanpur, Muzaffargarh, and DG Khan. This includes mapping current C-oW routes against demographic and epidemiological indicators, conducting stakeholder consultations, and integrating field-based insights with digital reporting systems to inform decision-making. TA delivery will take into consideration the mapping of ward-based outreach teams’ concept from South Africa , to ensure that the proposed deployment model is aligned with international best practices, evidence-informed, and system-integrated.

Strategic Approach
This technical assistance aligns with the Punjab PHC Transformation vision. It draws on normative guidance such as the WHO PHC Operational Framework to enhance the coherence, coverage, and accountability of mobile PHC delivery. It seeks to reposition C-oWs as an agile, equitable, and results-driven mechanism integrated within the province’s broader healthcare delivery architecture. Moreover, it contributes to output 3 of the E4H Programme by addressing gaps in service equity and access. The overall strategic objectives of the TA, as per request from and consultation with the DOH, are as follows:
•           The assignment reinforces national and provincial priorities related to primary healthcare revitalization, mobile health innovation, and integrated service delivery.
•           It also advances key elements of the WHO Health System Building Blocks, particularly in Service Delivery, Health Workforce, and Health Information Systems, as guided by the WHO PHC Operational Framework. By embedding geographic targeting, digital integration, and performance accountability into mobile service planning, the TA ensures alignment with both system-level reform goals and real-time operational needs.
•           In this context, the inclusion of Field Hospitals offers additional infrastructure and service capacity that complements the C-oW model. Their rural deployment supports provincial equity goals and represents a scalable mechanism for integrating diagnostics, maternal care, and outreach support within mobile PHC frameworks.

Specific Objectives
The specific objectives are to:
•           To review current C-oW operations to assess service delivery, quality, coverage, utilization trends, and integration with primary healthcare and data reporting systems.
•           To map the current C-oW deployment scheme and draft a strategic deployment plan considering geographic, demographic, and epidemiological background, which includes optimized routing strategies, service packages, and workforce roles, aligned with PHC and community outreach goals.
•           To conduct a high-level financial feasibility analysis on C-oWs deployment to advise the strategic plan.
•           To obtain and prioritize the feedback from multi-level stakeholders, including local community beneficiaries.
•           To design a performance review and feedback system, including a C-oW monitoring dashboard, KPIs, and recommendations for real-time reporting integration to strengthen C-oW accountability and impact.

Scope of Work and Methodology
This technical assistance will be implemented over a six-month period (August 2025 – January 2026). The methodology combines desk review, spatial mapping, stakeholder input, and strategy development to strengthen the C-oW initiative.
Phase 1: Inception and Planning
•           Hold an inception meeting with H&PD key stakeholders to agree on the scope and timelines.
•           Develop a detailed work plan and coordination framework.
•           Review documentation and the daily dashboard, powered by HISDU data, on Field Hospitals and C-oWs.
•           Output: Inception Slide Deck elaborating all operational aspects of C-oWs, and the way forward.
Phase 2: Tool Development
•           Review C-oW service data and reports from HISDU, the health directorate, the Chief Minister’s Office, and other sources.
•           Use GIS tools to map current C-oW routes against population and health service gaps.
•           Stakeholders feedback assessment/survey using a mixed method approach (both quantitative surveys and in-depth qualitative insights)
•           Output: Deployment Gap Analysis Report (comprising of qualitative and quantitative aspects)
Phase 3: Field Data Collection
•           Stakeholder survey tool and client exit interviews will be piloted before administration.
•           Conduct field consultations with CEO Health, DC IRMNCH, CHIs, LHWs, and SH&NS in four districts.
•           Administer client exit interviews during visits to C-oWs.
•           Document on-ground challenges and coordination gaps.
•           Output: Field findings incorporated into Strategic Deployment Plan.
Phase 4: Preliminary Data Analysis
•           Draft a deployment plan with geo-optimized C-oW routes, service package, integration with PHC, and referral pathways.
•           Conduct a high-level financial feasibility analysis to assess the viability, sustainability, and cost implications of deploying C-oWs to inform strategic planning.
•           Validate the plan in a stakeholder workshop.
•           Output: Strategic Deployment Plan for C-oWs with high-level costing.
Phase 5: Comprehensive Data Analysis and Reporting
•           Define performance indicators and design a dashboard prototype for tracking C-oW performance.
•           Recommend integration with digital reporting systems and clear roles for oversight.
•           Output: Performance Dashboard Design and Monitoring Framework.

Timeline and LOE

The level of effort for the role is 60 days working days, from Aug 2025 to Jan 2026

Role Specific Requirements

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Technical Expertise

Master’s degree in public health, health systems - or relevant degree. Minimum 15 years of overall experience. Experience in PHC service design and implementation. Experience in managing mobile units and field hospitals. Familiarity with PHC integration in low-resource settings.

Competencies

Strategic planning; Working with others; Decision-making; Influencing.

Deliverables/KPIs

1.         Inception Slide Deck
2.         Deployment Gap Analysis Report
3.         Strategic Deployment Plan & Performance Dashboard Design
4.         Conclusion Slide Deck