Position: Ongoing Recruitment – STTA Mid National: Trainer 2 – Maternal and Child Health (MNCH) 

Palladium Pakistan (Pvt.) Limited

Job Location: Lahore

Country: Pakistan

Positions: 1

Job Type: Consultancy

Department / Job Category: STTA

Last Date: 30th July 2025

TA Title: Training of Trainers on Integrated Training Curriculum for Community Health Inspectors (CHIs)

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

Over the past three decades, Pakistan’s community health workforce has been anchored by the Lady Health Worker (LHW) programme, a globally recognized initiative that has provided essential primary healthcare (PHC), maternal and child health services, and immunization follow-ups at the doorstep. However, the LHW program has faced mounting operational challenges in recent years due to declining recruitment, deviation from their original scope of work, uneven coverage across districts, and limited integration with digital health innovations. This has created critical gaps in service quality, supervision, referral and real-time reporting—particularly in underserved and rural areas of Punjab.

In response, the Government of Punjab, through the Public-Private Mix (PPM) framework, is launching a new cadre known as Community Health Inspectors (CHIs). These CHIs are envisioned as a digitally enabled, accountability-driven replacement with an upgraded scope of work to the traditional LHW model. CHIs will be responsible for comprehensive household coverage, maternal and child health(Antenatal Care, Skilled Birth Delivery and post-natal care) , immunization (administering vaccines according to EPI protocols) and community referrals etc.

As this cadre is rolled out, the province faces a dual challenge: onboarding newly recruited CHIs and transitioning the existing LHW and community midwife’s workforce into CHI roles. This transition involves a significant shift in responsibilities, including adoption of digital reporting tools, and field-level implementation of PHC priorities such as maternal care, Communicable & non-communicable disease (CD & NCD) screening, hygiene promotion, and school health referrals.

Despite the urgency and scale of this transformation, there is no standardized, modular training curriculum that can bridge the experience of existing LHWs with the competencies expected of CHIs. Current trainings vary by district and are often fragmented, lacking alignment across thematic areas such as infection prevention and control (IPC), NCD screening, communication for behaviour change, and digital tool usage. The Training Curriculum is being developed through UNICEF support to the H&PD and expected to be completed by mid-August 2025 

Strategic Approach

Against this backdrop, the proposed technical assistance aims to support the H&PD and train district-level master trainers through structured Training of Trainers (ToT) modules. Ultimately, this initiative seeks to strengthen the health workforce in Punjab and ensure continuity, efficiency, and quality in community-based PHC service delivery. 

Moreover, this TA aims to institutionalise and link the Trainings with the Learning Management System (LMS) and the Provincial Health Development Centre (PHDC) and District Health Development Centres (DHDCs) in line with the Sustainable Training System Framework developed in previous year of E4H.

This technical assistance aligns with the Government of Punjab’s broader health systems strengthening agenda, particularly its transition toward a harmonised and digitally enabled community health workforce. It directly supports Output Indicators 1.4 and 3.2 of the E4H Programme Theory of Change, which prioritize improved public health preparedness and the development of a strengthened health workforce as enablers of universal access to quality primary healthcare.

By institutionalising an integrated training approach for the upgraded CHI cadre, the TA enhances workforce readiness, harmonizes community-level competencies, thereby contributing to enhanced capacities for implementation and emergency preparedness. This alignment with Output 1.4 ensures systemic improvements in public health surveillance, response coordination, and service continuity.

Moreover, the intervention supports Output 3.2 by building workforce capacity in underserved areas, promoting equitable service delivery, and reinforcing the foundational health system building blocks of Health Workforce and Service Delivery. It also advances NHSP DLI-11, which aims to increase community engagement in LHW-uncovered areas, especially in lagging districts, by equipping CHIs to deliver integrated PHC aligned with local needs.

The training design builds on learnings from successful initiatives such as IMNCI roll-out, which demonstrated the value of district-level ownership, structured feedback loops, and sustainable cascade models. These lessons are embedded in the Training-of-Trainers approach and quality assurance mechanisms to ensure effective scale-up and continuous system improvement

This technical assistance will be anchored within the Sustainable Training System Framework developed through earlier E4H support being institutionalised in the PHDC, ensuring that capacity-building efforts are not ad hoc but systematically embedded across the province. To reinforce long-term institutionalisation, the training content and delivery mechanisms are envisioned to be housed within the Learning Management System (LMS). This will enable continuous learning, facilitate standardization across districts, and allow for performance tracking—paving the way for scalable, adaptive, and sustainable workforce development in community health.

By focusing on workforce capacity-building, the intervention contributes to key health system building blocks: Health Workforce and Service Delivery.

Objective

To support the Government of Punjab in institutionalising a digitally enabled, harmonised, and skilled health workforce to strengthen Community Health Inspector (CHI) cadre equipped to deliver equitable, high-quality primary healthcare (PHC) at the community and household level. 

Strategic Sub-Objectives

1. Cadre Transition and Harmonisation
   Facilitate the realignment of roles and responsibilities across community-level health cadres—including LHWs and School Health & Nutrition Supervisors (SH&NS)—through competency-based training content

2. Scalable Capacity Building
   To roll-out district-level Training of Trainers (ToTs) for CHIs that enable province-wide coverage and foster institutional ownership.

Scope of Work and Methodology

The TA will be structured around three key phases—Inception & Curriculum review and adaptation, ToT Training Package and Implementation. Each phase includes distinct tasks designed to align with the PHC system’s evolving needs and build sustainable capacity among frontline health workers transitioning to the CHI model.

Phase 1: Inception

• Conduct a stakeholder mapping exercise to identify key actors from the LHW Programme, District Health Authorities (DHAs), and CHI implementers (H&PD) and/or any other new structure/unit/initiative created by the Department. Desk Review of relevant available material on CHI initiative.

• Organize introductory consultation meetings with the Directorate General Health Services (DGHS), Health & Population Department (H&PD), relevant programme leads and UNICEF.

• Deliver the Inception Slide Deck, summarizing findings, proposed methodology, timelines, and coordination plans.

Phase 2: Curriculum review and adaptation: ToT Training Package

• Undertake a rapid review of any available material such as TORs for CHIs developed by government if any, and including but not limited to review of curriculum in line with principles such as competency frameworks aligned with PHC priorities, learning principles and outcomes, field testing and adaptation,  

• Review of best practices and LMIC examples to aid in the design of the training materials also need to be included

• Design a Training of Trainers (ToT) package in close collaboration with the department of health and population and other relevant stakeholder, including but not limited to:

• Facilitator guides

• Session-wise walkthroughs

• Roleplay, simulation 

• Incorporate pre/post-training assessments.

Phase 3: District-Level Field Support

• Conduct ToTs for Master Trainers (MTs) in Punjab districts—5 MTs per district with cohorts of 25 trainees. The number of MTs may be adjusted according to the number of CHIs in each district. Define inclusion criteria in collaboration with stakeholders for selection of trainees to ensure maximum impact and sustainability. 

• Monitor trainer fidelity, trainee attendance.

Trend analysis from carefully administered, transparent pre & post tests.

• Maintain a structured adaptation log, documenting refinements based on feedback and context-specific learnings.

• Compile the final Training Report, detailing outcomes, learnings, and recommendations for scale-up.

• Devise a structured plan for post-training supervision, performance monitoring and refresher trainings etc. - component focusing on sustainability of the initiative beyond TA completion.

This phased methodology ensures relevance, feasibility, and alignment with the provincial health workforce transformation agenda while embedding robust quality assurance mechanisms throughout the intervention lifecycle.

Timeline and LOE: 

The level of effort for the role is 98 working days, from August 2025 - February 2026

Requirements

Technical Expertise

• Medical or nursing degree with specialized training in maternal and child health.

• Minimum of 10 years of experience in delivering MNCH training in field or classroom settings.

Competencies

• Effective training delivery and instructional engagement.

• Strong communication and empathy.

• Technical accuracy in MNCH content.

• Ability to work with community-based cadres.

Deliverables/KPIs

1. Inception Slide Deck

2. ToT Training Package

3. Training Report