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Terms of Reference for National Consultant to undertake
Comparative Assessment of ILO’s Nursing Personnel Convention, 1977 (No. 149) And Decent Work Deficits for Nursing Personnel in Pakistan
Pakistan has a comprehensive health system comprising of an elaborate Health Regulatory machinery, health surveillance system, and a network of health facilities including Rural Health Centers, Basic Health Units (BHU), secondary and tertiary hospitals. While some hospitals work directly under the administrative control of Health Departments, there are a number of health facilities working under Employees’ Social Security Institutions in each Province. Apart from a large Public sector health network, there is an equal number of private health facilities. In 2019, the Government of Pakistan initiated a process to provide ‘Universal Health Coverage’ to all citizens – starting from KP Province (completed in 2020) and now expending in Punjab Province.
As per 18th Constitutional Amendment, the Federal Health Ministry was devolved to the Provinces. While there are strong Health Departments in each Province, there is a Federal Ministry for National Health Services Regulation and Coordination – primarily to deal with international matters and coordination.
Pakistan Labour Standards Portfolio
Being a member of ILO since 1947, Pakistan has ratified 36 ILO Conventions including all eight ‘Fundamental Conventions’, two out of four ‘Governance Conventions’ and 26 Technical Conventions. Last Convention was ratified in 2006. Accordingly, there is an elaborate list of Labour Legislation and institutions to ensure application of these ratified Labour Conventions.
However, Pakistan has not ratified ILO’s Nursing Personnel Convention, 1977 (No. 149), which 41 countries have ratified to date.
This analysis is undertaken within and in support of the implementation of the ILO-OECD-WHO ‘Working For Health’ (W4H) Programme – funded by ‘Working for Health Multi-Partner Trust Fund.’
This analysis contributes to the Pakistan Decent Work Country Programme 2016-2020 (extended to 2022), Priority Area 4: “Extending Social Protection”, with international Labour Standards being a cross-cutting theme. In light of the ongoing General Survey 2021-2022 (Decent work for care economy workers in a changing economy) that includes C 149 and its Recommendation 157, this study would also be very timely providing additional information to the Survey report.
Globally, this work contributes to Outcome 2 “International Labour Standards and authoritative and effective supervision” and Outcome 8 “Comprehensive and sustainable social protection for all” as envisaged in the ILO Programme and Budget for 2020–21. This work will also contribute to Outcome 6: Gender equality and equal opportunities and treatment for all in the world of work. Output 6.1 addresses: Increased capacity of the ILO constituents to promote investments in the care economy and a more balanced sharing of family responsibilities – under which nursing personnel falls as well.
In turn, the work would contribute to UN Strategic Development Framework 2018-2022 (Pakistan), Outcome 10 “Social Protection” and the SDG target 1.3
Health Sector faces many challenges including: low financial allocation for health, and high out of pocket expenditure; economic, social and geographical constraints in access to health services and achieving UHC; weak governance and poor quality in health care delivery; and a critical shortage and mal-distribution of human resources for health.
There is an overall shortage of health workforce (1.4 physicians, nurses, midwives per 1,000 population density, as compared to the threshold of 4.5). To this adds low employability, low salaries and unconducive working conditions, resulting in high attrition and migration of key health workers. This shortage is more pronounced for nurses and midwives. There is a skill mix imbalance of more physicians than nurses. To overcome this, a large number of nurses need to be trained, absorbed and retained by 2030.
Up till 2017 Diploma Nursing program was offered in majority of public and private nursing institutes, however government has discontinued the diploma and replaced it with a Bachelor’s in Nursing degree program. By end of 2017 there were 215 nursing and midwifery institutes (including 145 in the Public sector), with this production capacity the target set for 2030 cannot be achieved. Additionally, there is acute shortage of nursing faculty, particularly for the new Bachelor’s in Nursing degree.
Though Pakistan has a long history with health workforce regulation, especially for physicians and dentists, the system needs a thorough review and strengthening with updated practices. Health workforce information is fragmented and incomplete. Registration data of the professional councils is not updated and does not provide information on the status. There is inadequate research which is critical for health workforce planning, implementation and monitoring. A national HRH Vision 2030 was launched in 2018 and provincial health workforce strategic plans are being developed.
At the moment, there is no comprehensive baseline study identifying Decent Work Deficits for Nursing Personnel in Pakistan.
Scope of Work for National Consultant
ILO intends to engage a national Technical Consultant to undertake a Comparative Assessment for C-149 (Nursing Personnel Convention) and identify Decent Work Deficits for Nursing Personnel, by reviewing existing legal and institutional frameworks and after getting inputs from all important stakeholders with two objectives:
- Assess where Pakistan’s Nursing Personnel system stands with respect to the core principles and key minimum benchmarks of ILO Convention No. 149 as a means to gradually transforming it to be aligned with ILO Standards. The assessment will also be guided by the ILO’s vision for the universal health coverage.
- Provide a detailed analysis of Decent Work Deficits (employment opportunities, training opportunities, wage system, freedom of association & collective bargaining, discriminations, occupational safety & health, working hours, and equal opportunities for women) to identify gaps and policy recommendations for building an improved Nursing Personnel and in particular taking into account the health and socioeconomic impacts of the COVID-19 pandemic.
The Consultant will be required to map and draft a detailed review of existing legislation related to Nursing Personnel (at Federal and Provincial levels) and how this legislation interacts with Labour, Industrial Relations, Wages and Rights and also look at implementation aspects. The Consultant will also organize bilateral consultations with WHO; senior nursing officials, tripartite partners (including Nursing personnel, women workers); existing institutions, and other relevant stakeholders (e.g., nursing professional associations Academia, Civil Society Organizations, etc.) and identify key areas to be improved. The Consultant will be required to study/examine following important measures for the comparative assessment:
- Review existing laws, policies and regulations related to Nursing Personnel and assess how they are aligned to the main parameters of Convention No. 149 and identify areas to be improved to align with Convention, based also on their practical application;
- Review existing programmes and institutional arrangements as well as technical capacities to ensure compliance with and application of national legislation as well as reporting on international commitments already ratified by the country and identify areas to be improved;
- Take the lead in discussing with Government (including Ministry of OP&HRD and Ministry of National Health Services and Provincial Health Departments), employers and workers – including from women workers and employers – to assess current level of alignment with Nursing Personnel Convention and identify areas to be improved;
- Discuss with WHO, academia and civil society organizations – particularly the ones working on the subject of Nursing Personnel/Health workforce – to identify areas to be improved in line with Convention;
- Closely collaborate with ILO Technical Specialists for drafting the comprehensive report analyzing the national health personnel system with focus on Nursing Personnel in view of the principles and benchmarks set out in ILO Convention No. 149.
Terms of Reference for Consultant
The Consultant will be required to undertake following assignments:
- Desk review of national legislation, policies, regulations, institutional arrangements, technical capacities, and other related documents - both global as well as from Pakistan;
- Develop an outline of Comparative Assessment study – adequately covering all areas mentioned above (using General Survey Questionnaire for reference);
- Take the lead in organizing individual consultations with all relevant stakeholders including WHO, (Federal Ministries, Provincial Governments, relevant Institutions, Employers and Workers’ Organizations,; existing Institutions, Academia / Experts; and Civil Society Organizations) on current situation of decent work deficits and developing policy recommendations;
- Facilitate a validation workshop (organized by ILO) with all tripartite-plus stakeholders and get feedback;
- Finalize the comparative assessment Report, following the review of the report by ILO Health Sector Specialists experts.
The study will be conducted during April – July 2021.
Consultant will be required to identify number of workdays and fee per day for the assignment – keeping in view the scope of work.
Consultant will be required to deliver the following:
- After literature review, share draft ‘Comparative Assessment Outline’ for technical review and inputs by WHO and ILO Health Sector Specialists;
- After data collection and completing stakeholders consultations, draft a synthesis report and draft ‘Comparative Assessment Report’ including the description of the national legal framework and its implementation, to be shared with WHO and ILO Health Sector Specialists for review and inputs;
- Facilitate a tripartite validation meeting to discuss key findings of the comparative assessment and decent work deficits;
- Provide a final comparative assessment & decent work deficits report after incorporating all inputs by stakeholders (in validation workshop) and ILO.
1. Consultant will be responsible to:
a. Bring/procure required technical expertise for all elements of the study;
b. Identify most relevant and recent literature and tools related to the subject;
c. Develop mechanisms to effectively consult relevant stakeholders and get adequate information in a respondent-friendly manner;
d. In view of travel restrictions and other SOPs due to COVID-19 pandemic, make sure to use appropriate technologies and means of communication that suits the requirements of relevant stakeholders;
e. Make a presentation on proposed Comparative Assessment Report for validation workshop;
f. Ensure timely submission of deliverables;
g. Ensure full compliance with ILO and stakeholder inputs in the Comparative Assessment Report;
h. Share all important legislations, regulations, documents and information obtained during consultancy assignment, which are not available online, with ILO;
i. Take all necessary measures to complete the assignment within given resources and timeframe;
2. ILO will be responsible for;
a. Prepare a contract for the Consultant and making necessary payments on different intervals – based on deliverables;
b. Provide an introductory letter to Consultant – which will help him/her to introduce to relevant stakeholders;
c. Provide contact details of various relevant stakeholders;
d. Where possible, extend support in facilitating meetings with relevant stakeholders;
e. Provide technical inputs on outline, and draft Strategy within a reasonable time;
f. ILO will facilitate the ‘Validation Workshop’. If, due to COVID-19 lockdown situation, the workshop has to be online, ILO will provide IT platform for meeting. In case of face-to-face meeting, ILO will manage the entire event including content, venue, and logistics etc.
- COVID-19: Consultant will be required to fully comply with applicable UN and Government regulations and SOPs for prevention against spread of COVID-19 and organize work in such a way to ensure safety of self and other stakeholders.
- Security: As per new UN regulations, if the assignment includes traveling to any city other than Islamabad, Lahore or Karachi, the Consultant will have to complete a special Security Training Course (SSAFE) preferably before starting the assignment. ILO will facilitate enrollment of Consultant to the course (and will pay for the course) – but these training days will not be paid by ILO.
- Reporting: Consultant will be required to report to ILO. All materials produced by Consultant will be reviewed by ILO for technical quality assurance and will be shared with Government as ILO product supported by ILO-OECD-WHO Working for Health Programme.
Required Qualification and Experience
The Consultant should have the following qualification and experience:
- Post-graduation in Law or subjects related to Labour Laws, Industrial Relations or Nursing sciences.
- Minimum 10 year experience of dealing with matters related to Health Sector or social protection, labour and/or industrial relations - either in Pakistan or abroad;
- Must be well aware of institutional and organizational situations of Health system issues in Pakistan;
- Previous work experience with UN System in general and with ILO in particular, will be added advantage;
- Strong competjobence to use computer and office-related software;
How to submit:
Interested individuals are requested to submit the Expressions of Interest, along with following supporting documents (duly dated and signed) through email to: email@example.com, cc: firstname.lastname@example.org by 20th April 2021 with the reference ISB/ILO/2020/003 in the email subject line.
- Provide CV or profile of the individual
- Provide brief methodology to carry out the assignment (not more than 1 page);
- Fee per day (in PKR) – exclusive of all taxes and other expenses
Any offer received after the official closing time and date will not be accepted.
Questions and replies:
Should you have any questions, please contact us at the latest by date only by email (email@example.com; cc firstname.lastname@example.org) quoting the RFQ reference.
 minimum health workforce threshold to reach UHC, established by WHO in 2016 (https://apps.who.int/iris/bitstream/handle/10665/250368/9789241511131-eng.pdf;jsessionid=BEF9E7AB212C27EAF6A4598212A48363?sequence=1)