Senior National STTA – Clinical Pharmacy/Antimicrobial Stewardship Expert
E4H KPTA: Development and Institutionalisation of a Certificate in Applied Antimicrobial Resistance and Antimicrobial Stewardship (AMR/AMS): From AMR Surveillance and Diagnostics to Rational Antimicrobial Use and Quality Improvement.
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.
Background
Antimicrobial resistance (AMR) is a growing public health and health security challenge in Pakistan, threatening the effective management of infectious diseases, patient safety and the sustainability of healthcare services. Inappropriate antimicrobial prescribing, limited use of microbiological diagnostics, gaps in surveillance and inadequate implementation of antimicrobial stewardship (AMS) programmes contribute to the emergence and spread of resistant organisms.
Addressing AMR requires a multidisciplinary workforce capable of translating surveillance and diagnostic information into evidence-informed antimicrobial prescribing, infection prevention and control (IPC), and continuous quality improvement. Clinicians, pharmacists, microbiologists, nurses, public health professionals and hospital managers have complementary roles in implementing effective facility-level AMS programmes.
Although AMR surveillance, antimicrobial use monitoring and stewardship are increasingly recognised as priorities, structured opportunities for applied, competency-based AMR/AMS education remain limited within postgraduate and continuing professional development (CPD) pathways. Existing educational approaches may emphasise theoretical knowledge without sufficiently developing practical competencies in interpreting antibiograms, conducting prescribing audits, applying WHO AWaRe classifications and designing facility-level stewardship interventions.
The WHO competency-based educational framework for AMR provides a foundation for strengthening both pre-service and in-service education. Public-sector academic and training institutions in Khyber Pakhtunkhwa (KP), including medical universities and the Provincial Health Services Academy (PHSA), provide potential institutional platforms for developing and sustaining an applied AMR/AMS certificate programme linked to provincial health system priorities.
Goal and Objectives
The overall goal of this technical assistance (TA) is to establish a sustainable, competency-based certificate programme in Applied AMR and AMS within selected public-sector academic and training institutions in KP, strengthening healthcare professionals' capacity to translate AMR surveillance, microbiological diagnostics and antimicrobial-use data into rational prescribing, effective stewardship and facility-level quality improvement. We will achieve this by pursuing three objectives:
Objectives
Objective 1: Develop and contextualise a multidisciplinary, competency-based certificate curriculum in Applied AMR/AMS, aligned with WHO educational guidance, national and provincial AMR priorities, and practical healthcare delivery requirements.
Objective 2: Strengthen faculty and institutional capacity to deliver, assess and sustain applied AMR/AMS education using case-based learning, diagnostic interpretation, prescribing audits, antibiogram analysis and supervised facility-based improvement projects.
Objective 3: Institutionalise the certificate within relevant postgraduate and CPD pathways, establishing arrangements for academic approval, assessment, quality assurance, faculty ownership and continued delivery, with explicit links to facility-level AMS implementation.
Strategic Approach
Contributions to health systems strengthening: The TA will strengthen KP's health system by addressing the gap between AMR knowledge and its application in clinical practice. By integrating AMR epidemiology, clinical microbiology, antimicrobial prescribing, surveillance, IPC, quality improvement and programme leadership into a structured certificate, the intervention will develop a multidisciplinary workforce capable of making evidence-informed antimicrobial decisions. The programme will move beyond classroom-based training by requiring participants to use facility data to identify stewardship problems, conduct audits or antibiogram analyses and develop practical AMS improvement projects. This will strengthen the use of routine hospital information for prescribing decisions, accountability and continuous improvement. Institutionalising the certificate within established academic and CPD systems will create a sustainable mechanism for developing AMR/AMS competencies, reducing reliance on standalone training and supporting the longer-term establishment and functioning of facility-level AMS programmes.
Alignment with other E4H TAs/investments: The TA will complement E4H’s broader investments in health workforce development, institutional capacity strengthening, surveillance, health security and sustainable education systems in Khyber Pakhtunkhwa (KP). It will build on existing E4H-supported approaches to competency-based curriculum development, faculty strengthening and integration of priority health system competencies within public-sector academic and training institutions, including relevant institutionalisation experience involving the Provincial Health Services Academy (PHSA) and other provincial institutions. In particular, the TA will draw on E4H’s ongoing support to strengthen public-sector institutions for multisectoral surge capacity response, which focuses on contextualising national competency-based training packages, strengthening faculty capacity and institutionalising priority health security competencies within postgraduate and continuing professional development pathways. The assignment will focus specifically on applied antimicrobial resistance (AMR) and antimicrobial stewardship (AMS) competencies, complementing these wider workforce development initiatives while avoiding duplication of existing general infection prevention and control, laboratory training or surveillance activities. Where relevant, existing national and provincial AMR guidance, training resources and institutional arrangements will be reviewed and incorporated.
Government and Institutional Engagement: The TA will coordinate with WHO, UKHSA and other Pandemic Fund (PF) consortium partners to ensure that the contextualised surge capacity training complements ongoing health security and One Health investments in Pakistan. Alignment with the Pandemic Fund will help link the TA with its investments in multisectoral workforce development, surge capacity and national, provincial One Health coordination, while WHO and UKHSA technical inputs will be leveraged, where relevant, for competency-based and simulation-oriented training. Coordination through provincial government and training institutions will help avoid duplication and ensure that these complementary investments contribute to a coherent and sustainable provincial workforce development system.
Scope of Work and Methodology
The TA will support selected public-sector academic and training institutions in KP to design, contextualise, validate and institutionalise a Certificate in Applied AMR/AMS. The certificate will combine six competency-based modules with an applied facility-level practicum/capstone, ensuring that participants acquire both technical knowledge and practical competencies required to support antimicrobial stewardship. Implementation will follow five interconnected phases.
Phase 1: Inception, Needs Assessment and Institutional Engagement
The TA will begin with a rapid review of relevant WHO AMR/AMS educational guidance, national and provincial AMR policies, existing curricula, stewardship training resources and institutional arrangements for certificate and CPD programmes. Consultations with academic institutions, the Department of Health, hospital management, clinicians, pharmacists, microbiologists, IPC professionals and other relevant stakeholders will identify priority competencies, target participants, faculty requirements and suitable institutional pathways. The assessment will also examine the feasibility of accessing anonymised facility-level prescribing, microbiology and antimicrobial-use data for practical learning and capstone projects. An inception report will define the curriculum development approach, institutional roles, delivery model, assessment framework and implementation arrangements.
Phase 2: Development and Contextualisation of the Certificate Curriculum
The TA will develop a structured, competency-based certificate comprising six integrated modules and an applied practicum. The following modules and thematic areas are indicative and will serve as a guiding framework rather than a prescribed curriculum structure. As discussed and agreed with DOH, the participating academic institution(s) will develop and finalise the curriculum, including the module structure, content, learning outcomes and assessment approaches, based on identified competency needs, relevant national and international guidance, and institutional requirement
Module 1 – AMR Epidemiology, One Health and Health Security: This module will cover the burden and drivers of AMR, One Health perspectives, AMR governance, national and provincial surveillance architecture, health security implications and interpretation of AMR trends. Participants will develop the ability to interpret epidemiological and surveillance information and identify its implications for healthcare delivery and stewardship priorities.
Module 2 – Clinical Microbiology and Diagnostics for Stewardship: This module will address appropriate specimen selection and collection, antimicrobial susceptibility testing (AST), interpretation of culture and sensitivity reports, common resistance mechanisms and diagnostic stewardship. Emphasis will be placed on the development, interpretation and clinical application of facility antibiograms to inform empirical and targeted antimicrobial treatment.
Module 3 – Antimicrobial Prescribing and Stewardship: This module will focus on translating AMR knowledge into rational prescribing behaviour. Topics will include empirical versus targeted treatment, WHO AWaRe classification, antimicrobial selection, dose and duration, de-escalation, intravenous-to-oral switching, surgical antimicrobial prophylaxis, restricted antibiotic policies and prospective audit with feedback. Case-based clinical exercises will be used to strengthen prescribing decisions.
Module 4 – Measuring Antimicrobial Use and Resistance: This module will build competencies in antimicrobial use and consumption (AMU/AMC) measurement, prescribing indicators, point-prevalence surveys, prescribing audits, AWaRe-based analysis, AMR surveillance, dashboard development and interpretation of routine data. Participants will learn to translate facility-level findings into actionable clinical and stewardship recommendations.
Module 5 – AMS, IPC and Quality Improvement: This module will examine the relationship between antimicrobial use, resistant organisms and infection prevention and control. Participants will learn to identify priority facility-level problems, design practical stewardship interventions, apply audit-feedback and behaviour-change approaches, and monitor improvement through appropriate indicators and quality improvement cycles.
Module 6 – Leadership and Implementation of an AMS Programme: This module will focus on establishing, managing and sustaining institutional AMS programmes. It will cover AMS committee structures, multidisciplinary roles and responsibilities, leadership engagement, development of policies and standard operating procedures (SOPs), monitoring indicators, reporting arrangements and institutional accountability. Participants will develop the competencies required to lead or contribute effectively to hospital AMS programmes. Applied Practicum/Capstone: Each participant or multidisciplinary team will undertake a supervised facility-based assignment using available hospital data. This may involve a prescribing or AWaRe audit, analysis of antimicrobial consumption, interpretation of an antibiogram or identification of a priority stewardship gap. Based on the findings, participants will develop a practical AMS quality improvement project, including a problem statement, baseline assessment, proposed intervention, responsible stakeholders, measurable indicators and an implementation and monitoring plan. The capstone will be assessed through a structured project report and presentation to faculty and relevant facility stakeholders. Where feasible within the programme period, participants will initiate or pilot the proposed intervention.The curriculum package will include learning outcomes, module outlines, facilitator guides, participant materials, practical exercises, case studies, assessment tools and capstone guidance. The content will be validated with relevant academic, government and technical stakeholders.
Phase 3: Faculty and Institutional Capacity Strengthening
The TA will strengthen a multidisciplinary core group of faculty and institutional trainers drawn from relevant academic institutions and clinical disciplines. A training-of-trainers (ToT) approach will combine technical orientation with practical instruction in competency-based teaching, case facilitation, antibiogram interpretation, prescribing audits, data analysis, capstone supervision and assessment. Faculty will participate in supervised teaching, co-facilitation, practical exercises and structured feedback to develop the capacity to deliver the certificate independently. The approach will promote collaboration between academic faculty and hospital-based clinicians, pharmacists, microbiologists and AMS/IPC teams, ensuring that teaching remains connected to routine healthcare practice.
Phase 4: Training of Trainers (ToT) and Applied Learning
The TA will support the delivery of two batches of Training of Trainers (ToT) for selected faculty members from public-sector academic institutions, institutional trainers and relevant healthcare professionals, in coordination with the Department of Health (DOH). The ToTs will focus on strengthening participants' capacity to deliver the competency-based AMR/AMS certificate through interactive teaching methods, clinical case discussions, interpretation of microbiology and antimicrobial-use data, prescribing audits, practical exercises and facility-based quality improvement approaches. Participants' knowledge and teaching competencies will be assessed through pre- and post-training assessments, practical exercises and structured feedback. The training will also provide opportunities for participants to practise facilitation and application of the curriculum. Feedback from both ToT batches will inform refinement of the curriculum, training materials and assessment approaches, while establishing a pool of trained faculty capable of independently delivering and sustaining the certificate within relevant academic and CPD programmes.
Phase 5: Institutionalisation within Postgraduate and CPD Systems
The TA will support participating in public-sector academic institutions, in coordination with the Department of Health (DOH), to define a clear pathway for the eventual institutionalisation of the AMR/AMS certificate within relevant postgraduate and continuing professional development (CPD) programmes. This will include identifying appropriate academic and administrative mechanisms for curriculum approval, certification, faculty ownership, quality assurance and sustained delivery, in line with existing institutional requirements and procedures. The TA will facilitate consultations with relevant academic and institutional authorities to develop an institutionalisation roadmap, outlining the necessary steps, responsible stakeholders and indicative timelines for formal adoption and integration of the certificate. The validated curriculum, strengthened faculty capacity and agreed institutionalisation roadmap will provide a foundation for participating institutions to advance the certificate through established academic and CPD systems, ensuring long-term institutional ownership and sustainability.
Sustainability: Capacity Building, Institutionalisation, and/or Transition Planning
- Capacity building: The TA will establish a multidisciplinary pool of trained faculty and institutional resource persons capable of independently delivering the certificate, facilitating practical exercises, assessing participants and supervising facility-based capstone projects. Structured ToT, co-teaching and mentoring will support the transfer of technical and educational competencies.
- Institutionalisation: The certificate will be integrated into relevant postgraduate or CPD pathways through established academic review and approval mechanisms. Participating institutions will assume responsibility for curriculum delivery, assessment, certification, quality assurance and periodic updating, with linkages to relevant provincial AMR/AMS priorities and facility stewardship structures.
- Transition and sustainability: The TA will develop an institutional sustainability plan defining faculty responsibilities, programme coordination, resource requirements, access to practical learning data and arrangements for subsequent certificate cohorts. Academic institutions and relevant government stakeholders will progressively assume ownership of the programme following completion of E4H-supported technical assistance.
- Scale-up: The validated curriculum and trained faculty will provide a foundation for extending the certificate to additional public-sector institutions, hospitals and professional cadres, subject to institutional capacity and provincial priorities.
Timeline and Days
The proposed LOE is 40 days from November 2026 – March 2027, subject to final confirmation from client.
Requirement
Technical Expertise
- Postgraduate qualification in Clinical Pharmacy, Pharmacy Practice, Pharmacology or a relevant discipline, with demonstrated expertise in antimicrobial stewardship.
- Minimum 15 years of relevant experience in clinical pharmacy, antimicrobial prescribing optimisation, antimicrobial-use monitoring and hospital-based stewardship programmes.
- Demonstrated expertise in WHO AWaRe classification, prescribing audits, antimicrobial consumption analysis, dose and duration optimisation, de-escalation, IV-to-oral switching and prospective audit with feedback.
- Experience in multidisciplinary clinical training and development of stewardship interventions.
Competencies
Strong competencies in rational antimicrobial use, prescribing analysis and evidence-based clinical decision-making; ability to design and facilitate practical prescribing audits, interpret antimicrobial-use data and develop stewardship recommendations; effective multidisciplinary teamwork, training facilitation, analytical and communication skills.