TA: Scoping of Telemedicine Approaches in Pakistan & Model Design for Scalable Telemedicine Initiative for H&PD Punjab

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 integrated health security and preparedness.

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

• The Government of Punjab is considering to adopt telemedicine approach(es) under its Universal Health Coverage (UHC) and Primary Healthcare (PHC) reform agenda to improve access in underserved areas and address workforce shortages. This digital transformation supports national and global commitments to reduce health inequalities and ensure service continuity.
• The COVID-19 pandemic underscored telemedicine’s role in managing facility overloads, chronic diseases, and referrals.
• Aligned with the World Bank-supported National Health Support Programme (NHSP) DLI-3 on strengthening referrals in lagging districts, Evidence for Health Programme (E4H), will provide Technical Assistance (TA) to the Punjab Health and Population Department (H&PD), to review existing telemedicine models in various parts of Pakistan and recommend a model design aligned to provincial priorities of the Punjab Health and Population Department.

Problem Statement

• Despite Government's efforts to ensure accessibility of Universal Health Coverage to the whole population in the Country, ensuring availability of quality Primary Health Care to remote and rural areas have been a challenge due to several reasons; mainly non-availability of qualified medical staff in the remote areas.
• Telemedicine approach has been adopted in some parts of the country at a smaller scale to Improve access to health care, however, large-scale integration of telemedicine into the public health system faces significant barriers due to limited skills among frontline healthcare providers, poor internet connectivity, unreliable power, and a lack of digital equipment in peripheral areas.

Objectives

The overall objectives of the TA will be:

1. To conduct a comprehensive scoping review of telemedicine platforms, referral pathways, and digital health infrastructure in various regions of Pakistan, identifying successful approaches, operational, regulatory, and service delivery gaps to guide the design of a unified and scalable telemedicine model.
2. To develop a strategic framework for institutionalising an integrated, equity-focused telemedicine initiative in Punjab, with design recommendations, interoperability requirements, and a conceptual monitoring framework aligned with UHC and PHC reform priorities.

Strategic Approach

• The Punjab Primary and Secondary Healthcare Services Act 2025 makes digital transformation central to healthcare delivery, mandating a province-wide digital referral system to ensure smooth patient transfers between primary and secondary care, reduce delays, and improve outcomes.
• Under the NHSP, particularly DLI 3, Punjab is committed to strengthening referral systems and digital service delivery at the PHC level.
• H&PD is considering to adopt a scalable telemedicine model that integrates with PHC, ensures continuity of care, and expands access for underserved areas, drawing on best practices from university-affiliated teaching hospitals.
• Recent investments in Hospital management information system (HMIS), learning management system (LMS), and facility automation highlight the need for interoperability, institutional alignment, and strong performance monitoring. This TA will align telemedicine referral pathways with existing HMIS–EMR systems managed by HISDU, building upon E4H’s ongoing interoperability support.

Rationale:

Building on the Government of Punjab’s policy to outsource primary healthcare facilities, this TA will develop a strategic framework for a scalable telemedicine initiative, providing design recommendations and a robust monitoring system to strengthen digital referral pathways between primary and secondary care. Aligned with provincial and national health reform priorities, it will advance equitable, technology-enabled healthcare in Punjab. The TA will be a key step toward institutionalising evidence-based, gender-responsive, and patient-centred telemedicine, contributing to the goal of UHC.

Scope of Work and Methodology

A multidisciplinary team will conduct a nationwide scoping of various telemedicine approached and support H&PD in designing a scalable telemedicine framework aligned with provincial digital health reforms and national UHC targets. Grounded in evidence, systems thinking, and stakeholder engagement, the TA will be delivered in four structured phases:

Phase 1: Inception and Situation Analysis

• Conduct inception meetings with H&PD, DGHS, and other stakeholders (if any) to validate objectives and roles.
• Finalise the TA workplan, stakeholder mapping, and technical approach.
• Review and align the scope with NHSP, WHO digital health guidance, and other initiatives.
• Submit a succinct Inception Report and Slide Deck summarising methodology and key milestones.

Phase 2: Scoping & Situation Analysis

• Conduct a comprehensive desk review of existing telemedicine initiatives, policies, and digital health strategies in various regions of Pakistan.
• Benchmark national and global best practices in telemedicine implementation from comparable LMICs to extract scalable and equitable models.
• Undertake a targeted nationwide scoping of various telemedicine approaches/ projects currently in practice in various parts of Pakistan.

Phase 3: Strategic Model and Monitoring Framework

• Propose a scale able model of telemedicine in Punjab considering infrastructural, regulatory, and human resource needs across the province.
• Include recommendations to alleviate barriers to equitable access, with a focus on women, marginalized groups, and persons with disabilities.
• Define performance indicators aligned with NHSP DLI-3 and PHC metrics to inform future implementation.
• Recommend digital dashboard enhancements and integration options with HMIS and EMR.
• Propose verification protocols and feedback mechanisms to support transparency, accountability, and continuous improvement.
• Submit a comprehensive Draft Strategic Design Paper for the H&PD’s telemedicine initiative, synthesising findings and recommendations on infrastructure, financial requirements, regulatory needs, equity considerations, performance indicators, digital integration, verification protocols, and institutional roles to guide scalable implementation and long-term sustainability, among other things.

Phase 4: Finalisation and Dissemination

• Engage stakeholders for validation and refinement of the proposed model and monitoring framework (either through individual consultations or a workshop).
• Submit the Final Report and a Policy Brief after incorporating feedback/inputs from relevant stakeholders.

This participatory and phased approach will ensure that a comprehensive scoping of telemedicine in Pakistan is documented and a telemedicine framework is proposed considering Punjab’s evolving needs, that integrates smoothly with existing digital health systems, and supports long-term sustainability. Designated focal persons from H&PD and PITB will be actively engaged throughout the TA process to ensure alignment, relevance, and ownership.

Capacity Building/ Sustainability and Transition Planning

A designated H&PD focal person, the HISDU lead, as a main point of contact, will be engaged throughout the process to ensure alignment, capacity-building, and a smooth handover. The framework will outline governance roles, integration with HMIS/EMR, and a phased transition to government ownership. Key findings and recommendations from the scoping review will be presented to the Special Secretary H&PD to secure endorsement and facilitate uptake.

Deliverables

• Inception Report & Slide Deck.
• Scoping Review Report.
• Draft Strategic Design Paper (model + framework).
• Final Strategic Design Paper, Policy Brief, & Slide Deck.

Position: Health Systems Expert

Level: Senior National

LOE: 70 days

Period: Sep 2025 – Feb 2026

Role Requirements
Provide strategic direction for an integrated telemedicine model, ensuring alignment with UHC, PHC, and NHSP. Lead stakeholder engagement.

Technical Expertise

• Advanced degree in Public Health, Health Policy, or relevant degree (preferred MBBS).
• 15+ years’ overall experience. Experience in institutional design & multisectoral reforms.
• Strong systems thinking and integration expertise.

Core Competencies

• Strategic planning
• Policy influence
• Treatment pathway design
• Senior engagement

Deliverables/KPIs

Same as above.