TA: Political Economy Analysis of the Punjab Health & Population Department

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 governance and institutional capacity for integrated health and population services.

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

• Following the merger of the Primary & Secondary Healthcare Department (P&SHD) and Population Welfare Department (PWD), the newly constituted Health & Population Department (H&PD) is leading wide-ranging reforms including outsourcing of BHUs, revamping of infrastructure, digital governance, and expanded frontline workforce.
• The introduction of Maryam Nawaz Health Clinics, the induction of 20,000 Community Health Inspector (CHIs) by 2027, and scaling up of the Clinic on Wheels initiative, reflects a significant policy shift towards decentralised service delivery and performance-based management.
• To strengthen oversight, the H&PD, with E4H support, has established a Delivery Unit in June 2024 to monitor progress and track achievements. The focus is on improving Universal Health Coverage (UHC)through stronger monitoring systems, better use of data for decision-making, coordination with partners within the Department to ensure performance, accountability, and timely action.
• These initiatives require new modes of coordination between Health and Population Department (H&PD) and the agencies/organisations managing outsourced services, and a deeper understanding of institutional incentives, power relations, governance and decision-making dynamics.
• There is a need for robust governance structure to avoid the risk of fragmented reforms, weak implementation and ineffective monitoring of health service delivery, leading to challenges in achieving universal health coverage, and missed opportunities for FCDO-supported TA alignment.

Problem Statement

The merger of the Primary and Secondary Healthcare Department with the Popluation Welfare Department, coupled with rapid reforms in primary healthcare (PHC), has created a shifting political economy with new actors, incentives, and risks. However, there is limited evidence on how institutional power dynamics, political priorities, and bureaucratic incentives will influence reform uptake, coordination, achivement of universal health coverage and sustainability.

Goal and Objective(s)

The overall goal of this TA is to generate evidence on the political economy of the H&PD and its vision for achieving universal health coverage and to inform and align TA interventions with institutional realities, political priorities, and reform pathways.

We will achieve this by pursuing 4 objectives:

• Objective 1: Map institutional structures, decision-making processes, and key reforms by the H&PD Department.
• Objective 2: Identify formal and informal decision-making, risks, and power relations shaping reform implementation.
• Objective 3: Identify opportunities and constraints for integrated health and population service delivery—supported by strengthened coordination and performance monitoring mechanisms—towards achieving universal health coverage.
• Objective 4: Provide actionable recommendations for FCDO and E4H to position the TA for maximum traction and sustainability.

Strategic Approach

Contributions to health systems strengthening

This TA will unpack systemic bottlenecks in institutional coordination, power relations, and reform uptake within H&PD. By grounding recommendations in political economy realities, it will help E4H support reforms that are technically sound, politically feasible, and institutionally owned.

Alignment with other E4H TAs/investments

This analysis complements ongoing TAs on International Health Regulations (IHR), Universal Health Coverage (UHC), and primary health service delivery. It provides the contextual foundation to guide capacity-building, institutional restructuring, and policy alignment under these streams.

Alignment with other donors

The TA aligns with World Bank and other stakeholder investments in PHC infrastructure and HR optimisation, ensuring E4H’s support is complementary and avoids duplication.

Scope of Work and Methodology

Conduct a political economy analysis (PEA) of H&PD and associated entities using desk review, key informant interviews (KIIs), and stakeholder mapping.

• Phase 1: Scoping & Framework Development – Define analytical framework, map key actors, review the documents/ plans regarding new initiatives and identify priority reform areas.
• Phase 2: Field Inquiry – Conduct KIIs with government officials, development partners, and frontline implementers.
• Phase 3: Synthesis & Recommendations – Develop findings on institutional incentives, risks, and opportunities, and generate actionable policy recommendations.
• Methodology will ensure triangulation of sources and iterative validation with H&PD leadership.
• Institutionalise an actor-incentive mapping tool within H&PD for ongoing monitoring of reform dynamics.
• Provide recommendations to ensure political economy considerations are embedded in future planning beyond E4H.

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

• Institutionalise an actor-incentive mapping tool within H&PD for ongoing monitoring of reform dynamics.
• Provide recommendations to ensure political economy considerations are embedded in future planning beyond E4H.

Deliverables

1. Inception Report with literature review and PEA Framework.
2. Stakeholder Mapping & Interim Findings Brief.
3. Final Political Economy Analysis Report with recommendations.

Position: Political Economy Expert

Level: Senior National

LOE: 30 days

Period: Sep – Dec 2025

Role Requirements
Lead overall PEA design and execution, guide framework, oversee data collection and synthesis, ensure quality, and lead dissemination with H&PD leadership.

Technical Expertise

• Advanced degree in Political Science, Public Policy, Economics, or related.
• 15+ years’ overall experience. With experience in political economy analysis, governance reforms, institutional restructuring.
• Experience with ministries, donors, and preferably health sector reforms.

Core Competencies

• Strategic analysis
• Policy engagement
• High-level facilitation
• Report writing
• Navigating political sensitivities.

Deliverables/KPIs

Same as above.