Senior National - Health Financing Expert

E4H FED TA: Development of the Pakistan Immunisation Sustainability, Transition, and Local Vaccine Production Roadmap (PISTR)-2026-35

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 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.

Position Summary

The main goal of this TA is to create a practical Pakistan Immunisation Sustainability, Transition, and Local Vaccine Production Plan (PISTR). The plan will act as a clear roadmap to achieve vaccine and financial independence by 2035, explicitly aiming for complete independence from Gavi vaccines and funding, as a roadmap to a fully domestically funded EPI supported by national production capabilities The TA will assist government leadership in building a self-sufficient financial system, while enhancing coordination among the public sector, industry, and development partners.

Specific objectives are to:

• Review of the Draft National Policy for Advancing indigenous Vaccine Production
• Conduct a quick financial situational analysis of the EPI Pakistan including all provinces, quantifying the current financing gap, donor dependency, and the fiscal impact of the Gavi transition.
• Develop a robust, dynamic financial model and investment case/roadmap , including a quick cost-benefit analysis of the local vaccine production pathway and the staged financial transition.
• Design the detailed financial architecture for the plan's two core pillars:
  • The staged fiscal transition pathway and the blended finance/ PPP model for local vaccine production.
  • The financial transition pathway and the strategy for local vaccine production are distinct and should be treated as separate objectives to improve strategic focus and accountability, especially since each area involves different stakeholders, implementation mechanisms, and success metrics
• Formulate a comprehensive financial accountability  framework with key performance indicators (KPIs) to track the roadmap progress and a risk management strategy for its financial components.
• Build Sustainable Local Capacity by systematically transferring knowledge, skills, and tools to a local team within the M/o NHSR&C and structured transfer to local consultants via joint work and training ensuring they can independently manage, update, and oversee the financial components of the PISTR after the conclusion of the TA in the future.

Strategic Approach

Contributions to Health Systems Strengthening: This initiative is designed to strengthen the core building blocks of Pakistan's health system, with a primary and direct impact on health financing and leadership/governance.

Alignment with other E4H TAs/Investments/National Standards:  The plan will be Pakistan’s key strategic document, including the National Health and Population Policy (NHPP) 2025-34, and the draft National Health Financing Framework. 

Alignment with other donors (if relevant): No direct financing from different development partners is foreseen in this TA. Key stakeholders, including the GAVI, WHO, UNICEF, Gates Foundation, and Global Health Initiatives, will be consulted throughout the process to ensure ownership and sustainability.

Scope of Work and Methodology

The technical approach will include:

Phase-1 (Desk Review)

Review of the Draft National Policy for Advancing indigenous Vaccine Production

• Review the Draft National Policy for Indigenous Vaccine Production to assess its alignment with national health priorities, regulatory and legal frameworks, global best practices (including WHO Global Manufacturing Practices and prequalification standards), and health security and pandemic preparedness objectives, identifying gaps and implementation risks.
• Provide prioritised, actionable roadmap/ recommendations to strengthen the policy, including clarity on governance and institutional roles, financing and market sustainability, and regulatory pathways.

Phase-2 (In-person Engagement)

Financial Situational Analysis and Baseline Development:

• Analyse current financing flows for the EPI (domestic, Gavi, other donors).
• Quantify the historical and projected costs of the immunisation Programme, including vaccine procurement, supply chain, and delivery costs.
• Establish a clear baseline for the "Cost per Fully Immunised Child (FIC)" and the domestic share of financing.

Financial Modelling and Investment Case Development:

• Build a dynamic financial model that projects costs and savings for the 2026-2035 period, incorporating the provided strategic outline.
• Model the "Local Production Scenario" vs. the "Current Import Model" to rigorously develop the investment case,
• Conduct extensive sensitivity analysis on key variables (e.g., production cost variances, currency fluctuation, birth cohort changes) to test the robustness of the plan and identify key financial risks.

Design the Staged Financial Transition  

• Define the specific annual increments for increasing the domestic financing share in the implementation plan.
• Explore flexible financing instruments (e.g., Vaccine Security Sukuk or alternatives) without pre-commitment
• Develop transition pathways for EPI integration into PHC/EPHS, with improved domestic resource mobilisation from provinces

Structuring the Local Production Financing:

• Develop the detailed financial structure for the local production through PPP, including proposed equity splits, debt financing, and requirements for Viability Gap Funding (VGF), including the PPP feasibility study
• Draft the financial terms and conditions for a 10-year government off-take agreement, outlining volume commitments, pricing mechanisms, and escalation clauses.
• Estimate the total capital investment required and propose a blended finance package to secure it.

Stakeholder Engagement and Validation

• Work closely with the M/o NHSR&C, National Institute of Health, Ministry of Finance, Ministry of Planning, Ministry of Commerce, Drug Regulatory Authority (DRAP), Provincial Health Departments, development partners, and private sector to validate assumptions and secure buy-in for the roadmap.
• Present the financial model and investment case to the M/o NHSR&C and DRAP for review and endorsement.

Final Roadmap Formulation and M&E Framework

• Consolidate all financial analyses into the final PISTR document.
• Define the financial KPIs for the s M&E framework.
• Develop a risk matrix specifically for the financial components of the plan.