top of page

Khyber Pakhtunkwa Human Capital Investment Project, Pakistan


I first became involved in the Khyber Pakhtunkwa Human Capital Investment Project in late 2021 when I was asked to work on both the education and health components of the project.  My involvement with the education component did not last long as a local consultant soon took over, but I continued to work on the health component until June 2024.

The objective of the Project was to improve availability, utilization, and quality of primary healthcare services and elementary education services in four selected districts of Khyber Pakhtunkhwa Province (KP): Peshawar, Haripur, Nowshera and Swabi Districts. These districts cover close to a quarter of the provincial population (8 million people) and host two-thirds (519,303) of the Afghan refugee population in KP.

The project had three main components: Component 1: Improving Delivery of Quality Primary Health Care Services; Component 2: Improving Availability and Quality of Education Services; Component 3: Strengthening Community Engagement and Accountability.

The objective of Component 1 was to improve the delivery of primary healthcare in the four selected districts by improving the efficiency and resilience of the health system. The interventions were to focus on improving the utilisation of primary health care as the first point of entry to the health system in close proximity to where people live and work.

Sub-component 1.1 focused on improving the delivery of quality primary health care services through the carrying out of minor works to health facilities and the provision of technical assistance and essential health equipment and supplies to basic health units (BHUs) and rural health centres (RHCs) and the upgrading of intensive care units at selected hospitals.

Strengthening of infrastructure, equipment and healthcare commodities at BHUs and RHCs was to be carried out according to the KP MHSDP and Infrastructure Standards (which, however, did not seem to exist) and infrastructure development was to include adoption of climate resilient and environmentally friendly designs.

In order to ensure the continuum of care for Maternal, Newborn and Child Health services, the sub-component was also to support the establishment of a network of health care facilities based on geographic distribution; the upgrading of selected secondary health care facilities to provide basic emergency obstetric and neonatal care (BEMONC) services at BHUs; and comprehensive emergency obstetric and neonatal care (CEMONC) services at RHCs and category-D hospitals, the latter to include C-section operating theatres and blood banks.

During implementation of the project, it was agreed that it would support major renovations of health facilities (but not construction of new facilities on green field sites) and another component was added, that of the renovation and/or replacement of health facilities affected by the flooding in 2020.

My initial work involved the writing of terms of reference for local consultants to undertake surveys of existing health facilities and the preparation of designs and contract documents for the renovation of selected health facilities.  When the latter consultants were appointed, I spent a lot of time reviewing their proposals for the re-planning and renovation of health facilities including category-D hospitals to provide CEMONC services and I also prepared a proposal for a new building to house BEMONC services at existing BHUs and RHCs (see the drawing attached).  I also wrote terms of reference for consultants to prepare infrastructure standards for health facilities but these had not been appointed at the time that I left the project.

As one of the project requirements was that the renovation and/or construction of health facilities should follow climate-resilient and environmentally designs and as there did not appear to be any guidelines for such designs in existence in Pakistan, I was asked to develop guidelines that would cover the four main climatic zones in the country.  I then spent a great deal of time researching and writing the design and construction section of these guidelines (entitled Climate and Health: Guidelines for the Design of Climate-Resilient Health Facilities in Pakistan) which I worked on as part of a team led by the project manager and senior health specialist, Kanako Yamashita-Allen and assisted by another consultant, Dr Mazvita Zaname.  When I left the project in June 2024, the guidelines had not been completely finalised or adopted but a draft is attached.

bottom of page