E4H Punjab TA: ASSESSMENT OF HEALTH FACILITIES FOR ACCESSIBILITY AND INCLUSIVITY OF DISABLED AND SPECIAL NEEDS PERSONS

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 for preparedness and emergency response.
• Output 2: Strengthened evidence-based decision-making for accountability and performance.
• Output 3: Improved implementation of Universal Health Coverage (UHC).

Background and Problem Statement

Despite Pakistan’s gradual progress in expanding public health infrastructure and advancing toward Universal Health Coverage (UHC), persons with disabilities continue to face systemic barriers in accessing equitable healthcare. According to the 2023 Population and Housing Census, 3.41 percent of Pakistan’s population - and 3.84 percent in Punjab - live with a disability.[1] In alignment with the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), this technical assistance (TA) defines disability as long-term physical, sensory, intellectual, cognitive, or psychosocial impairments which, in interaction with environmental and attitudinal barriers, hinder full and effective participation in society on an equal basis with others.

Health equity and UHC cannot be achieved unless health systems are inclusive and accessible to all, including persons with disabilities. Global evidence, including WHO’s Global Report on Health Equity for Persons with Disabilities (2022)[2], confirms that persons with disabilities are more likely to experience delayed care, poor health outcomes, and financial hardship due to inaccessible services. Inclusive health systems are not only a rights-based obligation but also a critical enabler of service quality, resilience, and population coverage.

Punjab, the country’s most populous province, hosts a significant share of Pakistan’s health infrastructure and disease burden. While efforts have been made to improve service delivery, inclusivity remains poorly integrated into infrastructure design, human resource development, and service protocols. Currently, no systematic data exists on the accessibility of health facilities for persons with disabilities in the province.

At the policy level, Pakistan has committed to disability inclusion through:

• The UNCRPD (ratified 2011), which outlines the right to the highest attainable standard of health without discrimination[3].
• The National Policy for Persons with Disabilities (2002), which calls for integrated health services and assistive technologies.
• The Punjab Empowerment of Persons with Disabilities Act (2022) mandates non-discriminatory, barrier-free access to all public and private facilities.

However, operationalisation of these commitments within the health sector remains limited. The Punjab Health Sector Strategy (2019–2028) articulates a vision for equitable service delivery but does not fully address disability inclusion in facility design or service operations. Moreover, global frameworks such as WHO’s Disability-Inclusive Health Services Toolkit and Health Equity for Persons with Disabilities: A Guide for Action emphasise the need to address barriers across physical, informational, communication, and attitudinal dimensions.

In this context, this Technical Assistance (TA) will conduct a structured assessment of public health facilities across selected urban and rural districts in Punjab. The aim is to evaluate the inclusivity of health services across infrastructure, staff capacity, and service delivery processes—benchmarked against national legislation and international best practices. The assessment will generate actionable recommendations and a prioritised roadmap for institutionalising disability-inclusive practices across the provincial health system.

Strategic Approach

This TA was a direct ask from the Special Secretary (Operations), H&PD, during an engagement. This TA will support implementation of UHC reforms by identifying systemic barriers that prevent equitable access to essential health services for persons with disabilities, directly contributing to SDG 3.8 (achieve UHC, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all) and SDG 10.2 (empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.). It also aligns with Pakistan’s EPHS by assessing whether inclusive standards are upheld at the facility level. It also aligns directly with national and provincial disability policies by translating commitments into actionable reforms. It supports the implementation of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), ratified by Pakistan in 2011, which commits the country to ensuring equal access to health and rehabilitation services for persons with disabilities.¹

Crucially, this TA demonstrates E4H’s demand-responsive model and exemplifies how E4H mobilises timely technical support in response to provincial priorities while advancing its broader systemic goals. The TA also complements other E4H-supported efforts—such as Primary Healthcare (PHC) revamping, deployment of Clinic on Wheels (COWs), and engagement with Community Health Inspectors (CHIs)—by embedding disability inclusion within existing delivery platforms and operational frameworks. In doing so, it strengthens the coherence and reach of E4H’s broader programming.

Objectives

The specific objectives of the TA are:

1. To assess the disability inclusion readiness of public health facilities across six selected districts in Punjab, by evaluating infrastructure, service delivery and staff readiness, and institutional processes against international benchmarks (WHO, UNCRPD)/ framework, and identifying key gaps.
2. To generate actionable, system-level recommendations and a scalable assessment framework that can inform inclusive health reforms, guide infrastructural upgrades, and support the institutionalization of disability-responsive practices within Punjab’s health system.

Domain & Description

• Physical Accessibility: Infrastructure, signage, ramps, restrooms
• Attitudinal Barriers: Staff attitudes, awareness, inclusion training
• Communication Barriers: Use of sign language, visual aids, etc.
• Financial Accessibility: Awareness of entitlements, subsidies, or costs

Scope of Work and Methodology

The scope of this TA encompasses a comprehensive, multi-phase assessment of 30 public health facilities across six selected districts in Punjab (three urban and three rural), focusing on their accessibility and inclusivity for persons with disabilities. The TA will employ a mixed-methods approach - combining infrastructure assessments, staff and patient interviews, and policy reviews - to identify systemic and facility-level barriers to inclusive service delivery. The assignment will be delivered over a six-month period and structured in five sequential phases:

Phase 1: Planning and Inception

• Conduct preliminary consultations with H&PD to finalise scope and stakeholder engagement strategy (including engaging relevant statutory bodies existing in the province).
• Select districts and facilities using stratified sampling to ensure geographic and service-level diversity (e.g., BHUs, RHCs, DHQs and THQs).
• Develop an Inception Report outlining the work plan, roles, risk mitigation plan, and contextual analysis.

Phase 2: Tool Development and Training

• Design and adapt data collection tools based on technical guidance from WHO and similar bodies. Which includes incorporating global best practices, tools, and country examples (i.e., Saudi Arabia, Kenya, South Africa) that offer replicable or adaptable models (i.e., WHO Disability-Inclusive Health Services Toolkit; WHO Health Equity for Persons with Disabilities: A Guide for Action; UNFP Disability Awareness Checklist for Healthcare Services etc.
• Customize checklists to capture physical access (ramps, signage, pathways), service readiness, staff training, and patient dignity elements.
• Conduct a focused review of relevant global and regional assessments to extract applicable design features, indicators, and implementation lessons. Examples should inform the development of a tailored, context-specific assessment checklist and methodology adapted to Punjab’s health system. The resulting tools should reflect both international standards and local realities, ensuring practical relevance and alignment with disability-inclusive service delivery principles.
• Develop training materials for field teams, emphasising ethical considerations and standardised scoring protocols.
• Conduct a training workshop for surveyors, including field pilots at 1–2 test sites, to refine instruments.

 Phase 3: Field Assessment and Data Collection

• Deploy survey teams across selected districts to conduct on-site assessments, supported by a civil engineer, disability expert, and data analyst.
• Activities include:
  • Physical assessments (entrances, restrooms, wards, signage)
  • Staff interviews on care practices and institutional culture (Proportionate variety of disabled persons need to be interviewed across health facilities of both health departments, as well as officers deputed in each district from the Department of Social Welfare and Bait-ul-Mal) PESSI
  • Patient feedback (where applicable), with attention to gender and disability types
  • Collection of photographic and geospatial evidence
• Ensure quality control through routine check-ins and centralised data monitoring.

Phase 4: Data Analysis and Interpretation

• Consolidate and clean raw data from all assessment sites.
• Analyse findings to identify:
  • Recurring infrastructure and service barriers
  • Facility readiness scores
  • Variations by district and facility type
• Map results against international standards and national benchmarks to assess compliance and identify critical gaps.
• Prepare a feasibility matrix outlining interventions by cost, urgency, and policy alignment.
• Assess the scalability potential of tools for institutionalisation in the department and replication in other districts.

Phase 5: Reporting and Dissemination

• Draft facility-wise assessment reports and one consolidated analytical report.
• Develop a technical policy brief and slide deck summarising key findings and recommendations for decision-makers.
• Organize a validation workshop with H&PD and relevant stakeholders to present and refine the proposed recommendations.
  • H&PD
  • SHC&MED
  • Statutory bodies/councils
  • Department of Social Welfare and Bait ul Mal
  • PESSI; among others.
• Incorporate feedback and submit final deliverables, including a replicable methodology guide and raw data archive for institutional use.

This phased and participatory methodology will ensure that the TA delivers context-sensitive insights, promotes local ownership, and builds a foundation for long-term integration of disability-inclusive standards in health infrastructure planning and service delivery.

Capacity Transfer, Sustainability and Transition Planning

This TA will ensure sustainability, capacity transfer, and transition by initiating a paradigm shift in how disability is perceived within Punjab’s health system—moving from ad hoc adjustments to a culture of inclusiveness that underpins UHC. The Special Secretary (Operations) will be the focal point, the process will sensitise institutions and staff, challenging stigma and embedding disability inclusion into everyday practice. The tools and data generated will not only provide an evidence base but also tell an inclusive story that shapes future policies, guidelines, infrastructural standards, signage improvements, and staff attitudes. By institutionalising these practices and helping to create both societal and departmental change, the TA marks a decisive step toward building a health system that recognises equity as a core value and sustains inclusive service delivery well beyond the project period.

Deliverables

This TA will generate a series of structured deliverables aligned with the key phases of the assignment. These deliverables will support both immediate decision-making and long-term institutional integration of disability-inclusive health system practices.

• Inception Report and Presentation (Methodology, workplan, and stakeholder engagement)
• Customized Assessment Tools (Checklists, interview guides, and assessment templates)
• Facility & Consolidated Reports (Facility profiles and synthesized findings)
• Feasibility & Prioritization Matrix (Ranked, costed reform recommendations)
• Final Report & Policy Brief (Summary of key findings and reform options)

Position: Research Associate

Level: Junior National

LOE: 126 days

Performance Period: Sep 2025 – Mar 2026

Role Requirements
Coordinate fieldwork, manage timelines, lead documentation, and draft reports/briefs.

Technical Expertise

• Bachelor’s/Master’s in public health, sociology, development studies, or relevant degree.
• 5+ years’ overall experience. Experience in field studies, stakeholder coordination, reporting.
• Strong documentation and organisational skills.

Core Competencies

• Planning & delivering work
• Working with others
• Documentation
• Analysis & use of information

Deliverables/KPIs
Same as above.