TORs: National Mid-Level STTA – Public Health Training Expert
Technical Assistance to the Primary and Secondary Healthcare Department (P&SHD) Punjab in Smog-Related Health Crisis Response

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

Punjab, particularly Lahore, faces severe smog levels due to pollution from various sources, including crop burning, vehicle emissions, and industrial activities. These conditions have worsened air quality, leading to increased respiratory, cardiovascular, and other health issues. In response, the Government of Punjab has started taking measures to mitigate the adverse health impacts, emphasizing the need for research, awareness, and logistical support to tackle this public health emergency.

The Primary and Secondary Healthcare Department (P&SHD), with support from E4H, aims to improve its capacity for monitoring, mitigating, and responding to health issues linked to smog through two key areas of support:

1. Training for Smog-Related Health Crisis Response
2. Designing Awareness Campaigns and IEC Material on Smog Mitigation 

Objective

The technical assistance aims to enhance the capacity of healthcare workers across Lahore Division by:

1. Training healthcare personnel on the identification, case definitions, and reporting of smog-related illnesses following Integrated Disease Surveillance and Response (IDSR) standards.
2. Providing advanced clinical training to doctors on respiratory illnesses caused or worsened due to smog.
3. Designing a strategic public awareness campaign to educate communities about the health risks associated with smog and the importance of adopting preventative measures.
4. Creating culturally appropriate and easily understandable educational materials, such as pamphlets, posters, SOPs, and IEC content, to reach a diverse audience, including children, the elderly, school and workplace communities, and high-risk groups.  

Scope of Work and Methodology

The two types of trainings envisioned are as follows:

Public Health Training on Smog-Related Disease Identification and Case Definitions

• This component of the training programme aims to equip 100 healthcare professionals—comprising DHIS2 focal persons, nurses, paramedics, and doctors—with essential knowledge on smog-related diseases. The content will cover the history, composition, and adverse health effects of smog, providing a foundational understanding of the environmental factors contributing to respiratory conditions. Participants will learn about specific case definitions, including Acute Upper Respiratory Infection (AURI), Influenza-like Illness (ILI), Pneumonia/Acute Lower Respiratory Infection (ALRI), and Severe Acute Respiratory Infection (SARI). Additionally, the training will emphasize the proper reporting protocols as outlined in the Integrated Disease Surveillance and Response (IDSR) framework to ensure consistent and effective disease tracking.
• Five one-day sessions will be delivered by experienced public health professionals specializing in IDSR to cohorts of 20 participants. To accommodate participants from across Lahore, Sheikhupura, Nankana Sahib, and Kasur, sessions will be held in government facilities where available. Alternative venues and online/in-person hybrid training delivery options will be explored although in-person training will be encouraged to ensure maximum uptake. 

Specialized Training for Respiratory Management

• This advanced training will focus on 100 healthcare professionals, including Medical Officers (MOs), Women Medical Officers (WMOs), postgraduate trainees, and General Practitioners (GPs) from P&SHD. The training material will be designed to provide in-depth instruction on managing Severe Acute Respiratory Infection (SARI) and Hospital-Acquired Acute Disease (HAAD)/Asthma. The sessions will be led by renowned pulmonologists and internal medicine professionals.
• Five one-day training sessions will be conducted for 20-person cohorts, with options for on-site sessions at hospitals equipped with large halls or a hybrid delivery model that combines in-person and online participation if more participants are to be included.
  

1. Training Material Development

   • Curriculum Design: Develop a detailed curriculum for both training modules:
     • Public Health Training: Covering smog history, composition, health impacts, case definitions (AURI, ILI, ALRI, SARI), and IDSR reporting protocols.
     • Specialized Respiratory Management: Detailed management strategies for SARI and HAAD/Asthma, incorporating case studies and clinical simulations.

• • Content Creation: Prepare comprehensive training materials, including:
    • Presentations
    • Case study examples
    • Clinical management guides and algorithms
    • Handouts summarizing key points for quick reference.
  • Visual Aids and Tools: Develop visual aids like posters, infographics, and flowcharts to simplify complex information.
  • Pre- and post-test quizzes

2. Stakeholder Engagement and Coordination

• • Engage with Key Stakeholders: Collaborate with both Health Departments and other relevant government bodies to align training content with current health policies and surveillance protocols.
  • Methodology Discussions: Organize planning meetings with stakeholders to discuss and finalize the training methodologies and formats. Ensure alignment with national and international best practices for smog-related health management.

3. Participant Nominations and Management

• • Gathering Nominations: Coordinate with Health departments and District Health Authorities (DHAs) to gather nominations for the training participants. Ensure an equitable selection process that includes a mix of healthcare professionals from rural and urban areas.
  • Participant Communication: Prepare and disseminate invitation letters, training schedules, and pre-training information packs to all nominated attendees. Follow up to confirm attendance and address any questions or concerns participants may have.

4. Logistical Arrangements

• • Coordination for Venue Booking Setup, printing Materials and Supplies: Coordinate with E4H Programme team to arrange logistics and provide necessary details for booking and other arrangements.

5. Training Delivery

• • Session Facilitation: Conduct interactive training sessions over the planned duration:
    • Public Health Training: Five one-day sessions, with a focus on disease identification, case definitions, and reporting protocols.
    • Specialized Respiratory Management: Five one-day sessions, emphasizing practical management skills through clinical simulations and case studies.
  • Participant Engagement: Use interactive teaching methods, including Q&A sessions, group discussions, and real-life clinical scenarios, to maximize learning retention. Ensure active participation and address questions effectively.

6. Monitoring and Evaluation

• • Pre- and Post-Training Assessments: Develop and administer assessments to gauge participants' knowledge before and after the training. Analyze results to measure knowledge gains and identify areas needing further emphasis.
  • Feedback Collection: Distribute evaluation forms at the end of each training session to collect participant feedback on the content, delivery, and overall training experience. Use feedback to make continuous improvements.
  • Reporting: Compile a comprehensive report summarizing training outcomes, including participant feedback, assessment results, and any recommendations for future training sessions.

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 in public health, Environmental Health, or a related field.

Technical expertise

• Knowledge of smog-related health crises and experience in public health emergency response.
• Proficient in developing case definitions for respiratory illnesses and training healthcare staff in disease recognition and reporting.
• Understanding of health data collection and surveillance systems, particularly in the context of environmental health. 

Competencies

• Strong interpersonal and facilitation skills for delivering engaging and interactive training sessions.
• Ability to design content that meets the needs of healthcare professionals at different levels.
• Problem-solving skills to address training challenges and adapt to various delivery formats.
• Proficient in using modern training tools and platforms for effective content dissemination.

Deliverables/KPIs

• Well-structured, easy-to-understand training materials, including presentations and clinical guides
• Successful delivery of interactive sessions, measured through participant feedback and knowledge assessment results.
• Post-training report outlining lessons learned, key outcomes, and potential areas for improvement.