TORs: Senior National Governance Specialist
Fed TA – 16: Governance Review of Pakistan Medical & Dental Council (PMDC) and Development of Institutional Reform Plan

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.
Problem Statement
The National Health Vision (2016-25) - Pillar IV (Human Resources for Health) and Human Resource for Health Vision (2018-2030) aimed at addressing the critical gaps in the health workforce and to establish a national and provincial health workforce planning and development capability that provides the necessary tools (strategies, governance mechanism, legislation) and resources to deliver a health workforce of sufficient size, composition, capability and distribution to meet the health needs of the population. Both visions set goals and objectives to ensure an adequate, competent, and equitably distributed health workforce to achieve universal health coverage and improved health outcomes.

• The medical professions related to physicians and dentists were regulated by the Pakistan Medical and Dental Council (PMDC) Act 1962, which was repealed by the Pakistan Medical Commission Ordinance 2019 and subsequently lapsed. Later, the Pakistan Medical Commission Act 2020 was passed as a new law to regulate the medical and dental workforce and Institutions. This law was also replaced by the PMDC Act 2022 and is currently the cornerstone for regulating Pakistan's physicians and dentists.
• The PMDC Act 2022 empowers the council to set educational standards, license and register practitioners, regulate professional practice, and ensure continuous professional development, quality assurance, and accreditation of academic institutions. The Act also involves the PMDC in its policy formulation, maintaining comprehensive professional records, and ensuring accountability and competence in the workforce.
• Regulations of physicians and dentists is linked with similar reforms in UK including the Medical Act 1858, followed by major revision and defining procedures In 1983, introduction of revalidation and enhanced regulatory powers In 2002, and further adjustments to the COVID-19 pandemic. This reflects evolving role In regulating the medical profession and changes to practices considering societal needs to ensure high-quality healthcare In UK.
• Similarly, PMDC is going through a transition period for reforms and to effectively implement the PMDC Act 2022, a governance review is critically required while considering international best practices and reviewing different aspects of governance. Such review will help in identification of gaps and challenges and establish institutional reform plans, ultimately ensuring that physicians, dentists, and their institutions deliver high-quality care and safeguard public health and safety.

Objectives
The overall objective of the technical support is to review the PMDC's governance mechanism to identify gaps and existing challenges and develop a robust institutional reform plan that will help streamline operations and implement best practices to improve governance, accountability, and results.
Scope of Work and Methodology
As a part of this TA assignment, the consultant will cover the following scope of work:
I. Brief situation analysis/ evidence and challenges
II. Process for Governance review with identification of challenges and future recommendations
III. Findings of Governance review focusing on: i) strategic framework/ roadmap, ii) legislative framework, organisational structure, iii) coordination mechanisms; iv) regulatory and accountability mechanism including grievance redressal, v) evidence and intelligence, vi) efficiency, vii) effectiveness, viii) equity, ix) ethics and x) transparency. The review should include pendency cases pertaining to registration and licencing of academic institutions.
IV. Institutional reform plan with strategic priorities and actions, prioritising quality aspects and pendency issues related to registration and licensing
V. Coordination mechanism while ensuring transparency, accountability and grievance redressal mechanism
VI. Monitoring & Evaluation Framework: Define KPIs, data collection methods, reporting procedures, and a plan for continuous improvement.
8. Presenting the Governance review and Institutional reform plan: Deliver a clear and concise presentation of the M/o NHSR&C, PMDC leadership and key stakeholders.
Focal points nominated by the Director General (Health) and the President of PMDC, along with Director (Regulations) will be actively engaged, where possible, in the activity. Staff of HPSIU, Ministry and PMDC will also be engaged in the activity. The team will work closely with the backup support from the WHO EMRO, UK NHS health systems and others.
Timeline and LOE
The level of effort for the role is 50 working days, from Sep 2024 –Dec 2024.
Requirement
Technical Expertise
Competencies
Deliverables