TORs: National Senior STTA – Public Health Systems Training Advisor
Training of Lady Health Supervisors (LHSs), Medical Officers (MOs/WMOs) and Lady Health Workers (LHWs) on Integrated Management of Neonatal and Childhood Illness (IMNCI) in District Muzaffargarh

Programme

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 and Problem Statement

Pakistan is one of the main contributors to the global burden of maternal, neonatal and child morbidity and mortality. The neonatal Mortality Rate stands at 42 per 1,000 live births and the stillbirth rate at 31 per 1,000 live births. Declines in the maternal, infant and child mortality rates have been slower in Pakistan than its neighbouring countries.

In Punjab specifically, Multiple Indicator Cluster Survey (MICS 2018) shows that the status of Infant Mortality Rate (IMR) was 60/1,000 live births that are still very high. The Under 5 mortality rate is 64 which is still far from the SDG 2030 target of 49. A total of 25,208 deaths of under 5 children were reported to IRMNCH Programme in Punjab during 2021. These deaths included, 13,706 Neonatal, 8,045 Infant and 3,457 under 5 children’s deaths. In addition to these deaths, a total of 62,813 still births were also reported in Punjab in 2021. Altogether, a total of 88,021 deaths (25,208 U5 children’s deaths + 62, 813 still births) were reported in Punjab during 2021.[1]The Lady Health Worker (LHW) programme, launched in the early 1990s, is a key component of community-based primary healthcare in Pakistan, focusing on underserved rural and urban populations. LHWs provide essential services in maternal and child health, nutrition, and family planning, especially for pregnant and lactating women, children under five, and eligible couples. Their duties include household visits for health education, basic treatments, referrals, antenatal and postnatal care, immunization support, malnutrition screening, and basic childhood illness management. LHWs also participate in public health campaigns, promoting preventive health measures.

With over 42,000 LHWs and 1,757 Lady Health Supervisors (LHSs) deployed across Punjab, the Programme has made significant strides in improving access to primary healthcare, particularly in rural areas, covering 73% of rural and 30% of urban populations. Despite this, service coverage and quality have declined in recent years. SWOT analysis done during the development of the LHW Strategic Plan (2022-2028): “highlights: Inadequate on job/refresher training sessions mainly due to overlapping of field campaigns (for LHWs)”.

To advance Universal Health Coverage (UHC) in Punjab, the Provincial Health and Services Department (P&SHD) aims to strengthen the Essential Packages of Health Services (EPHS) through LHWs, who play a critical role in providing preventive, promotive, and curative healthcare. However, gaps in primary healthcare and inadequate LHW training have hindered progress. Training LHWs in Integrated Management of Neonatal and Childhood Illnesses (IMNCI) is key to improving child health services, reducing mortality, and enhancing early identification and referral of severe cases. This Technical Assistance (TA) will provide embedded support within the IRMNCH&N Programme office, coordinating training and ensuring seamless implementation.

The scoping study conducted by E4H in January 2024 highlights Pakistan’s commitment to Ending Preventable Deaths (EPD) of mothers, newborns, and children, a key element within the national and provincial health agendas, including UHC and the SDGs. With neonatal mortality rates remaining high, particularly in Punjab, by training LHWs to manage and refer life-threatening childhood illnesses, IMNCI strengthens primary care and reduces preventable deaths. The importance of empowering frontline health workers is also emphasized in the Ending Preventable Deaths Approach Paper (December 2021). Given the significant role of LHWs in Punjab, training on IMNCI will strengthen primary healthcare at the community level, ensuring early intervention and care continuity for infants and young children—two critical factors in reducing preventable child deaths.

Objective:

The primary objective of this TA is to train at least one Master Trainers LHS/MO from each Tehsil in Muzaffargarh on IMNCI protocols who can then impart training to LHWs through a series of model cohort trainings in a phased manner.

Scope of Work and Methodology:

• Engage stakeholders including P&SHD, District Coordinator IRMNCH, DHDC staff, MOs. LHSs, LHWs and UNICEF to develop shared understanding of training needs, capacity gaps, and establish collaborative objectives.
• Assess DHDC Muzaffargarh’s training infrastructure and capacity, evaluating accessibility and available resources to support high-quality training sessions.
• Adopt UNICEF’s IMNCI curriculum to cater to the needs of LHWs in Muzaffargarh.
• Develop additional training materials (if needed) such as IMNCI Scoring Cards, visual guides, checklists, and quick-reference booklets to enhance understanding.
• Step 1: Training of the 5 New Trainers - Organise Training of Trainer sessions for LHSs/MOs from each Muzaffargarh Tehsil, conducted at a suitable venue, preferably DHDC Muzaffargarh
• Step 2: Model Trainings for 200 Lady Health Workers - Trainings will be organised for 200 LHWs from all three tehsils of Muzaffargarh district in cohorts of 20 LHWs each. Each cohort will be trained by 2 Master Trainers, one originally trained by UNICEF and the other trained at Step 1 of this TA.
• Implement a quality assurance process, collecting real-time feedback from trainers and participants to continuously improve the training sessions and ensure adherence to IMNCI standards.
• Conduct pre and post-training assessments to gauge improvements in knowledge and skills, with results guiding any adjustments needed for subsequent sessions.
• Prepare regular progress reports for the IRMNCH&N Programme, documenting training outcomes, challenges, adjustments made, and insights gained for continuous improvement.
• Provide embedded support to P&SHD and IRMNCH&N staff throughout the TA to ensure knowledge transfer and sustainable integration of practices within the Department.
• Develop a follow-up plan, including refresher training schedules that can be supported during the life cycle of E4H

Timeline and LOE

The level of effort for the role is 18 working days, from January 2025- February 2025.

Requirements:

Educational Background

Master’s degree or higher in Public Health, Health Education or a related field.

Technical expertise

• Experience (15+ years) in designing, implementing, and evaluating public health training programmes at a provincial or national level, ideally in Pakistan or similar contexts.
• Proven experience in the development and delivery of training programmes at provincial level in Pakistan.
• Experience in developing and implementing training programmes that align with national health priorities.

Competencies 

• Ability to collaborative with other team members to maintain high standards of internal communications and professional working standards.
• Capable of providing leadership and mentorship to the Public Health Training & Capacity Building Specialist.

Deliverables/KPIs

• Lead the team to prepare inception report with political economy analysis, methodology and workplan.
• Guide the team to review and adapt/adopt the existing training materials designed by UNICEF and develop a training plan to deliver the trainings.
• Provide oversight on the training plan developed by the Public Health Training and Capacity Building Specialist.