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THREE YEAR ROLLING PLAN2010 – 2013

District Mandi Baha-ud-Din

Three Year Rolling Plan (2010-2013) District Mandi Bahauddin

Table of Contents

Acronyms......................................................................................................................... 4Executive Summary.........................................................................................................6SECTION 1: DISTRICT PROFILE.........................................................................................8A. Vision Statement.......................................................................................................8B. Mission of the District................................................................................................8C. Background of the District.........................................................................................8D. Map of the District.....................................................................................................9E. Demography..............................................................................................................9F. Socio-Economic Indicators.......................................................................................10G. Health Indicators.....................................................................................................11

Reproductive Health.........................................................................................12I. Health Resources.....................................................................................................13

1. Health Facilities..........................................................................................13a) Public................................................................................................................. 13b) Private...............................................................................................................13

2. Human Resource........................................................................................14a) Administrative...................................................................................................14b) Facility Based....................................................................................................14c) Outreach Staff...................................................................................................20d) Training Institutions...........................................................................................20

3. Health Financing........................................................................................21J. Disease Pattern.......................................................................................................21K. Status of National/Provincial Programs....................................................................23

1. National Program for FP and PHC...............................................................242. EPI..............................................................................................................243. MNCH Program...........................................................................................244. TB Control Program....................................................................................245. Malaria Control Program.............................................................................256. HIV/AIDS CONTROL PROGRAM....................................................................257. Hepatitis Control Program..........................................................................258. School Health Services Program.................................................................25

SECTION 2: PROBLEM ANALYSIS....................................................................................26L. Objectives..................................................................................................26


M. Plan Development Process......................................................................271. Problem Identification................................................................................28

a) Health Problems................................................................................................282. Problem Prioritization.................................................................................283. Underlying causes of prioritized problems.................................................29

b) Service delivery/Management problems...........................................................30Underlying causes of Management Problems..........................................................31

N. MDGs and MSDS.........................................................................................32a) Human Resource...............................................................................................32b) Equipment.........................................................................................................34

SECTION 3: INTERVENTIONS AND TARGETS...................................................................44Health Problems.............................................................................................................44Management Problems..................................................................................................59SECTION 4: COSTING & FINANCING PLAN......................................................................69O. Activity based costing..............................................................................................69

a) Health Problems.........................................................................................69b) Management Problems...............................................................................82P. Financial outlay including 3YRP activities...................................................91i. Health Problems.........................................................................................91ii. Management Problems...............................................................................92Q. Summaries.................................................................................................94I. Problem wise Summary..............................................................................94

a) Health Problems................................................................................................94b) Management Problems......................................................................................95

II. Activity wise Summary...............................................................................96a) Health Problems................................................................................................96b) Management Problems....................................................................................102

SECTION 5: MONITORING & EVALUATION....................................................................107M&E of Plan.................................................................................................................. 107Annex-I......................................................................................................................... 113Annex-II........................................................................................................................ 114


Acronyms3YRP Three Years Rolling plan

ADB Asian Development Bank

AE Assistant Entomologist

APMO Additional Principal Medical Officer

ARI Acute Respiratory Infections

ASV Assistant Superintendent Vaccination

BHU Basic Health Center

BoD Burden of Disease

CDC Communicable Disease Control

CDR Case Detection Rate

CPR Contraceptive Prevalence Rate

DC District Coordinator

DHIS District Health Information System

DHQH District Head Quarter Hospital

DoH Department of Health

DR Default Rate

DSV District Superintendent Vaccination

EDO(H) Executive District Officer Health

EPI Expended Program on Immunization

HSRP Health Sector Reforms Program

IMR Infant Mortality Rate

IPC Interpersonal Communication

IV Inspector Vaccination

M & E Monitoring and Evaluation

M & R Maintenance and Repair

MCH Maternal Child Health

MMR Maternal Mortality Ratio

MNCH Maternal Newborn and Child Health


MO Medical Officer

MoV Means of Verification

MSDS Minimum Service Delivery Standards

PDSSP Punjab Devolved Social Services Program

PHC Primary Health Care

PMO Principal Medial Officer

POL Petrol, Oil and Lubricant

RHC Rural Health Center

SCR Sputum Conversion Rate

SHC Secondary Health Care

SMO Senior Medical Officer

TAMA Technical Assistance Management Agency

TB Tuberculosis

THQH Tehsil Head Quarter Hospital

TNA Training Need Assessment

WHO World Health Organization

WMO Women Medical Officer


Executive Summary

Prior to devolution, planning process was carried out at provincial level. Districts were

supposed to implement plans and programs developed/designed at provincial and

federal levels. Devolution brought a paradigm shift where planning became a district

responsibility. This change provided an opportunity to the district at one hand and

challenge on other due to their limited capacity in planning and budgeting. Planning

focus also changed from short term to medium term planning recognizing the

flexibility /adaptability it provided. Government envisions that medium term plan .i.e.

3YRP will be instrumental in using health resources effectively and efficiently through

adapting Minimum Service Delivery Standards (MSDS) as the strategy to achieve

objectives of MDGs.

Districts have been preparing 3YRP (medium term plan) for last few years under the

auspices/patronage of Department of Health (DoH) Government of Punjab through

technical assistance of Punjab Devolved Program Social Services Programme (PDSSP).

This year government of the Punjab through Health Sector Reforms Program (HSRP)

with the technical assistance from a team of consultants (SP09) and wide

consultations/inputs from all key stake holders has established a bench mark in

standardization of the format of 3YRP. Capacity building of the districts has been done

on the standardized format.

Current 3 Years Rolling Plan (3YRP) plan is first attempt by the district on that agreed

format. First section of the format (District Health Profile) contains all relevant

information on Geography, Demographic, Socioeconomic and Health indicators of the

district. It also takes stock of health resources in terms of human resource,

infrastructure and others. District diseases pattern compiled from DHIS Primary and

Secondary Health Care reports and current status of vertical /national programs is part

of the profile. In fact district profile is a health related fact sheet of the district and

depicts the true picture of health status and health resources/services of the district. An

accurate district health profile provides a sound basis for evidence-based planning.

3YRP plan has been developed by following the standard planning cycle approach. 3YRP

details the current year activities, physical targets and fiscal targets. Projections of

second and third year physical and financial targets are given. Section Two includes

problems identification from various perspectives, and their prioritization by applying


WHO prioritization criteria. This section also contains underlying causes of the

prioritized problems. Section Three of the plan relates to developing best possible

interventions/activities and setting physical targets for each year. Section Four consists

of costing based on additional requirements taking account of implementation of

current status of activities. Best available estimates have been used to accurately cost

the activities. The detailed activity based costing of the Health and Service Delivery

problems has been developed on automated Excel sheets, and annexed for details as

ready reference. Last section of the 3YRP consists of Monitoring and Evaluation of plan

to gauge the progress of different activities and targets of the plan using reliable district

data sources. This permits timely remedial action for smooth implementation of

planned activities.


DISTRICT MANDI BAHAUDDIN

SECTION 1: DISTRICT PROFILE

A. Vision Statement

Provision of quality health care services to every human being inhabitant of the district,

especially who are poor and underprivileged, without prejudice and bias regarding,

race, creed etc.

B. Mission of the District

To provide affordable, effective and efficient health care services to whole community

without any discrimination and directed towards improvement of health status of

population in the district.

C. Background of the District

District M B Din was established in 1993. It consists of three Tehsils, MB Din, Phalia, and

Malakwal. District has boundaries with Sargodha, Gujrat, Hafizabad and Jehlum.

Topographically, the district consists of river belt, mountainous, and fertile agricultural

land. The main sources of livelihood are agriculture, labour, government and private

jobs, and businesses. M B Din in linked to other parts of the province and country,

through a network of roads and railway tracks.

Total Area of the district: 2613 sq. Km

Total Population in the district: 14, 49,511


D. Map of the District

E. Demography

o Total Population 14,49511

o Total Area 2613 sq. Km

o Annual growth rate 1.87%

o Population density 437 persons per sq. km


1. Area Wise Population

Area Population PercentageRural 1258917 87%Urban 190594 13%

Source: DCR-1998 projected

2. Male-female population

Gender Population PercentageMale 710260 49%

Female 739251 51% Source: DCR-1998 Projected

3. Population groups

Standard Demographic population groups are based on DHIS:

Population GroupsStandard

Demographic (%)Estimated Population

Under 1 year of age 2.7 39137Under 5 years 13.4 194234Under 15 years 44 637785Women in child bearing age (15-49 years) 22 318892Married Child Bearing age Women 16 231922Expected pregnancies 3.4 49283

4. Tehsil wise distribution

Tehsil Number of UC PopulationMB DIN 27 598195PHALIA 21 499462

MALAKWAL 17 351854TOTAL 65 14,49511

Source: Bureau of Statistics (Census 1998) projected

F. Socio-Economic Indicators1. Education and Literacy

Literacy Rate Male FemaleUrban 54.5% 33.7%Rural 31.3% 9.8%Overall District 33.4% 12.1%


Source: EDO Education

Literacy rate 10+ years 65

Adult literacy rate 15+ years 59

Adult literacy rate 15+ years 85

Source: MICS 2007-8

2. Per capita income

980 US$

3. Housing

Ownership of House = 82

Mean household size = 6.4

Mean number of Persons per room = 3.5

4. Water and Sanitation

o Safe drinking water without bacteria = 86%

o Proper disposal of Waste water = 70%

o Proper disposal of Solid waste = 4%

o Hand washing adequately before meal = 48%

o Hand washing adequately after using latrine = 53%

(Source: MICS 2007-08)

G. Health Indicators Infant Mortality Rate 78/1000 live birth

Under 5 Mortality Rate 113/1000 live birth

Maternal Mortality Ratio 240/100000

Malnutrition (Children under 5) 25% Malnourished

Life Expectancy 65

TFR 6.1 (MICS 2003-04)

CPR 41%

Proportion of children under 2 years immunized 70%


Reproductive Health

Contraception

Use of contraceptives (any method) 41

Contraceptive drop out 10

Unwilling pregnancy 34

Maternal and newborn health

n Antenatal care (ANC) 59

n Skilled attendant at delivery 35

n Institutional deliveries 31

n Postnatal care (PNC) 34

Source: MICS 2007-08

H. Organizational Structure of District Health Administration

There exists a three-tier system in the health sector in the country. At federal level,

Federal Secretary of Health is responsible to administer and supervise the health

related activities and programs. Major function of federal tier is to provide policy

guidelines and ensure quality of health care standards through federal legislation.

After the 18th amendment in the constitution, and announcement of National

Finance Award, most of the existing federal level programs will be transferred to the

provincial level. At provincial level, provincial Secretary of Health along with

Director General Health Services is responsible for managing and supervising health

care services. The district is still an administrative entity in the system and EDO

(Health) acts as head of the district health department, under overall supervision of

DCO. The organizational structure at district level is as under:


I. Health Resources

1. Health Facilities

a) Public

Details of physical infrastructure of public health facilities in the district

Facility Type Name/Number of Facility

Beds Strength

No. of functional Beds

Teaching hospital 00 00 00DHQ Hospital 01 70 70THQ Hospital 01 40 40Gulshan Eye Hospital 01RHCs 08 160 160BHUs 50 100 100Govt. Rural Dispensaries

14 00 00

MCH Centers 05 00 00Sub Health Centers 00 00TB Clinics 00 00 00Health houses 1204 00 00

Data source: DHIS/EDOH office

b) Private

The district has provided a list of private service providers including hospitals,

clinics, laboratories and maternity homes. These private providers are used for

providing support in preventive programs like Polio and other EPI activities.

With the passage of time, role of private providers will expand, and there is a

Executive District Officer (H)DOHDSIDSVCDCODDOHTSIASV/IVCDCINational ProgramDrug InspectorSMO-RHCsMO-BHUsDOH-IIDispensaries (ZC)DOH-(HQ)Establishment EDOHMS-DHQHMS-THQHPublic Health SpecialistPrincipal School of Nursing


need to develop an effective coordination between public and private sector. The

detailed list of private health practitioners is attached as Annex-I.

2. Human Resource

a) Administrative

Sr. No.

Name of Post Sanctioned Filled

1 Executive District Officer Health 1 12 District Officer Health 1 13 Deputy District Officer Health 3 24 Program Director DHDC Not Applicable5 District Coordinator National Program *0 16 District Coordinator EPI Surveillance *0 17 District Sanitary Inspector 1 18 CDC Officer 1 19 CDC Inspector 1 1

10 Drug Inspector 3 111 District Superintendent Vaccination 1 112 Assistant Superintendent Vaccination 3 013 Tehsil Sanitary Inspector 2 114 Inspector Vaccination 3 1

*The post is not sanctioned

b) Facility Based

The staff of primary and secondary health facilities is given below:

i. Basic Health Units

Sr.No.

Name of Post Sanctioned Filled Vacant

1. MO / WMO 50 16 342. School Health and

Nutrition Supervisor50 46 4

3. Medical Assistant / Health Technician

50 30 20

4. LHV 50 35 155. Dispenser 50 48 26. Midwife 100 60 407. Computer Operator 50 40 108. Sanitary Inspector 50 34 169. Naib Qasid 50 48 210. Chowkidar 50 46 411. Sanitary Worker (M/F) 50 40 10


ii. Rural Health Centres

Sr.No.

Name of post Sanctioned Filled Vacant

1 Senior Medical Officer I/C 8 8 02 MO 8 7 1

3 WMO 8 0 84 Dental Surgeon 8 8 05 LHV 16 16 06 Dispenser/ Dresser 16 16 0

7 Midwife 28 28 08 Homeo-doctor 1 0 19 Dental Technician 8 1 7

10 Laboratory Technician 8 1 711 Hakeem / Tabeeb 8 1 712 Dawakob 8 0 813 Dawasaz 8 1 714 Homeo Dispenser 8 1 715 Charge Nurse 48 40 816 Computer Operator 8 3 517 Sanitary Patrol 33 33 018 Naib Qasid 16 16 219 Chowkidar 16 16 020 Sanitary Worker M/F 32 24 821 Senior Clerk 8 8 0

22 Driver 8 8 023 Tube well Operator 8 8 024 Ward Servant 16 14 225 Water Carrier 8 7 1

26 Mali 8 8 027 Operation Theatre

Assistant8 1 7

28 Laboratory Assistant 8 7 1

iii. THQ Hospital

Sr.No.


Management staff1 Medical

Superintendent1 1 0

2 A.M.S. 0 0 0

3 D.M.S. 0 0 0

Specialist


Sr.No.


4 Physician 1 0 15 Surgeon 1 1 06 Gynecologist 1 1 07 Pediatrician 1 1 08 Anesthetist 1 0 19 Ophthalmologist 1 0 1

10 ENT Specialist 1 0 111 Pathologist 1 0 122 T.B. & Chest

Specialist1 0 1

Medical Staff23 Medical Officers

(MOs)2 2 0

24 PMOs 0 0 025 APMOs 2 0 226 SMOs 1 1 027 EMOs 3 1 228 WMOs for labour

room3 1 2

29 MOs (Intensive Care)

0 0 0

30 Dental Surgeon 1 1 0Nursing Staff

31 Charge Nurses 12 12 032 Head Nurse 1 1 033 Nursing

Superintendent0 0 0

34 Deputy Nursing Superintendent

0 0 0

35 Nursing Instructor/Tutor

0 0 0

Non Medical Staff36 Accountant 0 0 037 Social Welfare

Officer0 0 0

38 Pharmacist 1 1 039 Health Education

Officer0 0 0

40 Health and Nutrition Officer

0 0 0

Para medical staff41 Radiographer 2 2 042 Dental Technician 1 1 0


Sr.No.


43 Laboratory Technician

2 2 0

44 Laboratory Technician for B.T.O.

0 0 0

45 Laboratory Assistant

2 2 0

46 Dispenser 4 4 047 Eye Refractionist 2 0 248 Ophthalmic

Technician1 0 1

49 ECG Technician 0 0 050 Operation Theater

Technician (OTT)2 2 0

51 Lady Health Visitor 1 1 052 Dresser 2 2 053 Midwife 2 2 0

Support staff54 Store Keeper 0 0 055 Computer Operator 0 0 056 Naib Qasid 2 2 057 Chowkidar 2 2 058 Senior Clerk 2 0 259 Driver 2 2 060 Water Carrier 2 2 061 Cashier 0 0 062 Junior Clerk 1 1 063 Head Clerk 0 0 064 Baildar 1 1 065 Carpenter 0 0 066 Cook 1 1 067 Plumber 0 0 068 Almoner 0 0 069 Gate Keeper 1 1 070 Dental Assistant 1 1 071 Telephone

Operator0 0 0

72 Projectionist 0 0 073 Physiotherapy

Technician0 0 0

74 Stretcher Bearer 0 0 075 Operation Theatre 2 2 0


Sr.No.


Assistant76 Sanitary Inspector 0 0 077 Laboratory

Assistant2 2 0

78 Gardner 1 1 079 Sanitary Worker 8 8 080 Ward Servant 8 8 081 Tailor 0 0 082 Dhobi/Washer man 1 1 083 Tube well Operator 2 2 0

iv. DHQ Hospital

Sr.No.

Name of Posts Sanctioned Filled Vacant

Management staff1 Medical

Superintendent1 1 0

2 A.M.S. 0 0 03 D.M.S. 0 0 0

Specialist4 Physician 1 0 15 Surgeon 1 1 06 Gynaecologist 1 1 07 Paediatrician 1 1 08 Anesthetist 1 0 19 Ophthalmologist 1 0 1

10 ENT Specialist 1 0 111 Pathologist 1 0 112 Radiologist 1 0 113 Orthopedic

Surgeon1 0 1

19 Cardiologist 1 0 122 T.B. & Chest

Specialist1 0 1

24 Pediatrics Surgeon

0 0 0

Medical Staff27 Medical Officers

(MOs) / CMO3 3 0

28 PMOs 0 0 0APMOs 4 3 1SMOs 2 2 0

29 EMOs 0 0 030 WMOs for labour

room2 1 1

31 MOs (Intensive 0 0 0


Sr.No.


Care)32 Blood Transfusion

Officer1 1 0

33 Dental Surgeon 1 1 0Nursing Staff

34 Charge Nurses 5 3 235 Head Nurse 1 1 036 Nursing

Superintendent0 0 0

37 Deputy Nursing Superintendent

0 0 0

38 Nursing Instructor/Tutor

0 0 0

Non Medical Specialist40 Accountant 0 0 041 Social Welfare

Officer0 0 0

42 Pharmacist 1 1 043 Health Education

Officer0 0 0

44 Health and Nutrition Officer

0 0 0

46 Physiotherapist 0 0 0Paramedical staff

49 Radiographer 2 2 050 Dental Technician 1 0 151 Laboratory

Technician1 1 0

53 Laboratory Assistant

1 1 0

54 Dispenser 6 6 055 Eye Refractionist 2 2 056 Ophthalmic

Technician1 1 0

58 ECG Technician 0 0 059 Operation Theater

Assistant (OTA)1 1 0

60 Lady Health Visitor

1 1 0

61 Dresser 2 2 062 Midwife 2

Support staff63 Store Keeper 0 0 064 Computer

Operator0 0 0

65 Naib Qasid 3 3 066 Chowkidar 3 3 067 Senior Clerk 0 0 068 Driver 1 1 0


Sr.No.


69 Water Carrier 1 1 070 Cashier 0 0 071 Junior Clerk 1 1 072 Head Clerk 0 0 073 Baildar 2 2 075 Cook 2 2 077 Almoner 0 0 078 Gate Keeper 1 1 079 Dental Assistant 0 0 083 Stretcher Bearer 0 0 085 OTA 1 1 086 Sanitary Inspector 0 0 087 Lab. Assistant 2 2 088 Gardner 1 1 089 Sanitary Worker 8 8 090 Ward Servant 7 7 091 Electrician 0 0 092 Tailor 0 0 093 Washer man 0 0 094 Air Conditioner

Mechanic0 0 0

95 Tube well Op. 1 1 0Total 82 66 13

c) Outreach Staff

This information is about outreach program workers such as Vaccinators, CDC

Supervisors and Sanitary Inspectors who are not part of above mentioned health

facilities.

POST SANCTIONED FILLED

Vaccinator 71 71CDC Supervisor 55 46

Sanitary Inspector 51 38

d) Training Institutions

General Nursing & Midwifery School


Principal 01 01



Nursing Instructor 03 00Assistant Nursing Instructor 01 01Public Health Nursing Supervisor 02 02Stenographer 01 01Liberian 01 01Senior Clerk 01 00Accountant 01 01House Keeper 01 01Junior Clerk 01 01Driver 01 01Aya 02 00Chowkidar 04 04Bearer 02 02Mali 03 03Cook 02 01Naib Qasid 01 01Sanitary Worker 03 03

3. Health Financing

The provision of financial resources at district level is prime responsibility of district

government. However, keeping in view the budget constraints at the district level,

federal and provincial governments also augment financial resources in form of kind


and cash, through different programs. Financial resources of the district during the last

three years out of different sources are given as under:

Rs. Million

Source of Funding Year2007-08 2008-09 2009-10

Allocation Exp Allocation Exp Allocation ExpDistrict health budget

Development Non-Development User charges (like

perchi Fee, fees for diagnostic services)

Total

2.400183.354

185.754

1.935200.829

202.864

2.640211.812

214.452

2.02211.812

124.181

338.013

2.904222.482

225.386

61.447222.482

283.929

PHRSP 57M 43.775 44.200 30.975 44.684 31.459PMDGP 0 0 69.940 2.497 67.443 20.23PDSSP 17.305 9.482 7.823 4.380 19.358 3.780M

Provincial development budget for District

1740.514 13.844 1914.565 --- 78.919 14.500

Other source(MPA) 23.075 1.846 4.00 1.86MGRAND TOTAL 260.059 45.71 368.972 46.865 439.79 71.829

J. Disease Pattern

The disease pattern is determined through regular and periodic reporting through

surveys and studies. Punjab health department has adopted DHIS as regular reporting

mechanism to collect information on diseases and other variables. Currently, DHIS is in

transitional stage, and is establishing itself as a tool to be used for evidence based

planning and management. The following trend of the diseases has been taken from the

consolidated DHIS reports that include reports from PHC and SHC facilities.

Disease Group Percentage of MagnitudeRespiratory disease

1 Acute (upper) respiratory infections 235788

2 Pneumonia < 5 yrs. 6312


Disease Group Percentage of Magnitude3 Pneumonia > 5 yrs. 5652

4 TB Suspects 11172

5 Chronic Obstructive Pulmonary Disease 4560

6 Asthma 21768

Gastro Intestinal Disease7 Diarrhea / Dysentery < 5 yrs 11400

8 Diarrhea / Dysentery > 5 yrs 18432

9 Enteric / Typhoid Fever 456

10 Worm Infestations 9660

11 Peptic Ulcer Disease 14976

12 Cirrhosis of Liver 348

Urinary Tract Disease13 Urinary Tract Infections 13020

14 Nephritis / Nephrosis 636

15 Sexually Transmitted Infections 72

16 Benign Enlargement of Prostrate 756

Other Communicable Diseases 17 Suspected Malaria 11004

18 Suspected Meningitis 733

19 Fever due to other causes 6551

Vaccine Preventable Disease20 Suspected Measles 607

21 Suspected Viral Hepatitis 530

22 Suspected Neonatal Tetanus 323

Cardiovascular Diseases23 Ischemic heart disease 1541

24 Hypertension 16020

Skin Diseases25 Scabies 37344

26 Dermatitis 3816

27 Cutaneous Leishmaniasis 00

Endocrine Disease28 Diabetes Mellitus 17064

Neuro-Psychiatric Diseases29 Depression 8712

30 Drug Dependence 1164


Disease Group Percentage of Magnitude31 Epilepsy 540

Eye & ENT32 Cataract 3456

33 Trachoma 2160

34 Glaucoma 1740

35 Otitis Media 3024

Oral Diseases36 Dental Caries 8760

Injuries/Poisoning37 Road traffic accidents 15900

38 Fractures 4500

39 Burns 600

40 Dog bite 744

41 Snake bite (with signs/symptoms of poisoning) 12

Miscellaneous Disease42 Acute Flaccid Paralysis 0

43 Suspected HIV/AIDS 0

44 Any other Unusual disease (specify)

(Source: DHIS Specific Reports)

K. Status of National/Provincial ProgramsThe following paragraphs depict the current status of the program being

implemented in the district. The indicators and their values have been taken from

the program reports.

1. National Program for FP and PHC

No. of seats allocated for LHWs 1423

No. of LHWs working 1204

Percentage of Population covered by the program 82%

Important program indicators

o IMR 39/1000o MMR 57/100000o CPR 45%


o No. of antenatal visits 1666o TT Coverage of pregnant women 97%

2. EPI

EPI Coverage rate of the District

o Based on Program Information 101%

o Based on Third Party Evaluation Not Conducted

Fully immunized children 0-23months 107% Pregnant women received TT Vaccine 80% Availability of cold chain Equipment 81%

3. MNCH Program

No of CMWs Required 123

Working CMWs 98

Deployed in Field 42

4. TB Control Program

CDR all type 93.5%

CDR NSS Positive 73%

SCR 95.25%

TSR 97.75%

DR 0.6%

5. Malaria Control Program

No. of slides examined 46588

No. of positive slides 06

Slides positive ratio 0.01

Percentage of plasmodium falciparum 0%

6. HIV/AIDS CONTROL PROGRAM

No. of HIV/AIDS tests Conducted 444

No. of positive cases detected NIL

No. of HIV/AIDS patients treated NA

No. of sentinel centers NA


7. Hepatitis Control Program

No. of hepatitis test conducted HBs: 2286 HCV: 2327

No. of positive cases detected HBs:21 HCV: 488

No. of person vaccinated against Hepatitis B 2963

No. of cases treated for Hepatitis B 01

No. of cases treated for Hepatitis C 170

8. School Health Services Program

Total visits to the School 473

No. of students examined 2106

No. of students referred to BHUs 2106

No. of student’s treated t BHUs 651

No. of student’s referred to BHUs to higher facilities 173

No. of school in catchment areas 544

No. of students 110840

No. of SH&NS 47

No. of teachers trained 2915


SECTION 2: PROBLEM ANALYSIS

The Health sector in Punjab is facing enormous health and service delivery problems.

Common health problems are communicable, non communicable, MNCH related

diseases and accident/ trauma. The society is passing through demographic and

epidemiological transition. This is due to changing life style, urbanization, ecological and

other factors. Disease pattern is changing where non communicable diseases are

gradually increasing and the communicable diseases are still posing serious threat.

Punjab is practically facing Double Burden of Disease (BOD). Besides, health problems

service delivery/ managerial issues are also hindering the access and quality of health

services to the population. The service delivery/management problems are diverse in

nature, and include shortage of technical human resource, capacity issues, lack of

infrastructure and equipment.

Devolution was introduced during 2001 affecting the administrative and financial set up

of the districts. The devolution also brought political culture in the decision making of

the districts in the shape of Nazims, Naib-Nazims and Councilors. This system is now in

the phase of reshaping and it is not clear what will be future structure and managerial

shape when new local bodies system is put in place. The District Manager and

functionaries are in the state of uncertainty and confusion in this scenario. However,

one thing is clear that the district shall remain a hub of all primary and secondary health

services delivery. Despite the source of funding in the future, either from provincial or

district government, health planning at district level shall continue to play a pivotal role

in provision of quality health services.

In view of the above situation the district considers following objectives for developing

three year rolling plan.

L. Objectives

Improve health status of the population

Meeting the requirements of national and provincial health policies

Achievement of MDGs through MSDS

Introducing evidence-based planning culture by addressing district specific

problems/issues


Addressing emerging health needs or re-emergence of health problems (e.g.

H1N1, HIV-AIDS, Polio, T.B)

Ensuring effective inter-sectoral coordination with a view to improving health

indicators

The objectives would guide in problem analysis, designing interventions, setting

/phasing the targets, costing and monitoring the plan activities.

M. Plan Development Process

Plan development has been a systematic and consultative process. A core planning

team consisting of EDO (H), DOH, MS DHQ and THQs, Statistical officer, and Budget

and Accounts Officer, was designated by Director General Health Services Punjab.

This team received three days customized training from SP-09 team at divisional

headquarter. The main components of the trainings were: (i) developing a three-

year rolling health sector plan using the standard three year rolling plan format; (ii)

costing of the plan; (iii) preparing related budget projections; (iv) accounting

procedures; (v) preparing adequate financial reports on the use of funds.

The district planning team adopted the following steps for the preparation of three

years rolling plan:

Problem identification

Prioritization of identified problems

Identifying underlying causes of prioritized problems

Developing interventions and activities

Setting targets

Determining resource requirements, costing and budgeting

Preparing action plans

Preparing monitoring plan


1. Problem Identification

This step involved assessment of the current situation from various perspectives to

establish the actual health situation in terms of health and service

delivery/management problems. Problem identification is based on the district

health profile, review of previous plans, MIS (DHIS, Program reports and periodic

reports etc.), District specific surveys (MICS), MSDS, and national and provincial

policy guidelines.

The district planning team held meetings and started with identification of problem

using the training received from SP-09 team and consulting the above mentioned

documents. The problems identified were broadly divided into two categories i.e.

Health Problems, and Health Service Delivery or Management Problems. In the

initial stage an exhaustive list of these problems was prepared. The enlisted health

and service delivery problems of the district are given in the following tables.

a) Health Problems

1. Acute Respiratory Infection2. Gastroenteritis3. Urinary Tract Infection4. Skin (Scabies)5. Malaria6. Hepatitis7. Tuberculosis8. Anemia in Pregnancy

2. Problem Prioritization

Prioritization is making decisions on how limited resources could be best

allocated/utilized to priority health problems or needs. The health problems given

above have been prioritized keeping in view the WHO criteria of:

Magnitude

Severity/danger

Vulnerability to intervention (feasibility)

Cost-effectiveness of the intervention

Political expediency


The health problems prioritized by the district are given in the following table:

Problem Magnitude Severity Vulnerability to

intervention

Cost Effectiveness

Political Expediency

Total Score

Priority Number

ARI 4 3 3 2 2 14 2

G.E 4 4 4 4 2 18 1

UTI 2 2 3 3 1 11 5

Skin (Scabies) 2 1 4 3 1 11 5

Malaria 2 2 3 2 1 10 6

HCV 3 4 2 2 2 13 3

T.B 3 3 2 3 1 12 4

Anemia in Pregnancy

3 2 3 3 1 12 4

3. Underlying causes of prioritized problems

Health problems have their underlying causes. It is important to know the underlying

causes of the health problems so that appropriate interventions are developed. There

may be a long list of these causes but only few of them are vital ones; and rectifying

these causes can resolve the problem to a large extent. Following table gives common

causes of the prioritized health problems and selected service delivery problems

pertaining to the district.

Sr. # Health Problem Causes1. Diarrhea Poor sanitation

Lack of safe drinking water Unhygienic practices Lack of awareness among mothers about feeding and

weaning practices Low EPI coverage

6. ARI Bacterial or Viral infection Common cold Allergic rhinitis Tonsillitis Smoking Sore throat

7. Hepatitis (C) Poor sanitation Unsafe drinking water Sharing of used syringes Transfusion of unsafe/unscreened blood and blood

products


Sr. # Health Problem Causes Unsafe sexual practices Ear piercing and tattooing Use of unsterilized equipment by dentists and barbers

14. Anemia in Pregnancy Malnutrition Lack of education Insufficient MCH Services Multiple pregnancies Poor family planning practices

15. TB Too much smoking Mental stress and strain Unhealthy living style Low body resistance Imbalance diet Living in stuffy rooms (Poor Ventilation) Malnourishment Poor vaccination of HCG

16. Scabies Overcrowding in schools and homes Low socio-economic conditions Poor Health Education Incomplete treatment (poor compliance)

17. Malaria Breeding places for mosquitoes Decline area of district Lack of awareness for prevention

b) Service delivery/Management problems

This segment entails the district specific management problems. Management

problems are result of deficiency/lack of resources; these problems range from

administrative to financial issues, and cause hindrance in the smooth delivery of

health services in the district. It was observed that solution of some of these

problems lies with the provincial government; whereas remaining can be addressed

at the district level. While proposing the interventions, their action at provincial or

district level has been specifically mentioned. The planning team discussed these

problems in detail and enlisted the main problems as under:

1. HR Deficiency as per yard stick (WMO/LHV)2. Inadequate medicines and supplies3. Deficient health budget (POL)4. Deficient logistic support (vehicles)


5. DHDC non availability6. Outdated/Insufficient equipments

Underlying causes of Management Problems

Sr. # Service Causes1. Shortage of skilled

(MNCH) staff including WMOs/LHV/ Pediatrician etc

Vacant positions Non-availability of staff according to MSDS Lack of permanent postings Lack of incentivized and differential pay package Frequent transfer postings Job insecurity Lack of basic amenities at workplace Lack of conducive environment including insecurity

and transport of children for education Political interference

10. Inadequate medicines and supplies

Less budget allocation for medicines Frequent increase in drug prices

11. Outdated/inadequate equipment

Deficient equipment to cater basic and comprehensive EmONC at primary and secondary level of care

Old and un-serviceable equipment Shortage of regular budget for M&R Frequent cuts on M&R budget

12. Deficient logistic support (Vehicles)

Provision of inadequate funds for purchase of vehicles Ban on procurement of vehicles by the government Complicated procedure for purchase of new vehicles Poor maintenance of vehicles Frequent increase in drug prices

13. Inadequate budget for POL

Frequent increase in prices of POL Less allocation for POL budget

14. DHDC non-availability

Unavailability of budget

N. MDGs and MSDS

The government is committed to achieve the MDGs targets. For this purpose, the

government of Punjab has decided to adopt Minimum Service Delivery Standards

(MSDS) as strategy to achieve the MDGs within the province. Health Department of

Punjab is especially focusing on MNCH related component of MSDS for which

substantial resources are coming from Asian Development Program funded Punjab

Millennium Development Goal Program (PMDGP). MSDS entails a level-specific service

delivery package (for primary and secondary health care) along with their standards


and system specifications including human, infrastructure, equipment, medical supplies,

medicine and other consumables.

a) Human Resource

With regard to MSDS gap analysis for human resource, the difference between

the standards proposed in MSDS and filled posts has been calculated as the

vacancy gap. The hospitals have been categorized based on their bed strength as

follows:

Hospital Category Bed Strength

DHQ HospitalA 400 and above BedsB 251-400 BedsC Up to 250 Beds

THQ HospitalA Above 60 BedsB 41-60 BedsC Up to 40 Beds

i. DHQ Hospital

Sr. No.

Post Standard as per MSDS

Sanctioned Filled Vacancy gap

in relation with

sanctioned posts

Vacancy gap in

relation with filled posts

1 Gynecologist 3 1 0 2 32 Pediatrician 3 1 1 2 23 Anesthetist 3 1 1 2 24 Medical officers

including SMO, APMO and PMOs

74 9 9 65 65

5 Women medical officers including SWMO, APWMO and PMOs

27 0 0 27 27

6 LHVs 11 1 1 10 107 Nurses 75 5 5 70 70


ii. THQ Hospital

Sr. No.


Sanctioned Filled Vacancy gap in

relation with

sanctioned posts

Vacancy gap in relation with filled

posts

1 Gynaecologist 2 1 1 1 12 Pediatricians 2 1 1 1 1

3 Anesthetists 3 1 0 2 3

4Medical Officers including SMO,APMO & PMOs

16 8 4 8 12

5Women Medical Officers including SWMO APWMO & PMOs

9 3 1 6 8

6 Lady Health Visitors 8 1 1 7 77 Nurses 15 13 13 2 2

iii. Rural Health Centers

Sr. No.


Sanctioned Filled Vacancy gap in

relation to sanctioned

posts

Vacancy gap in

relation to filled

posts1 Senior Medical

Officers 8 8 8 0 0

2 Medical Officers 24 8 7 16 173 Women Medical

Officers16 8 0 8 16

4 Nurses 80 48 40 32 405 Lady Health

Visitors24 16 16 8 8

iv. Basic Health Units

Sr. No. Post Standard as per MSDS

Sanctioned Filled Vacancy Gap

1 Medical Officer 50 50 16 0


2 Health and Nutrition Supervisor

50 50 46 0

3 Lady Health Visitors 100 50 31 0

b) Equipment

Government of Punjab has notified a standard list as yard-stick of MNCH related

equipment to provide comprehensive EmONC services in the DHQ and THQ

hospitals. Provision of comprehensive EmONC services is essentially required to

decrease the high MMR and IMR prevailing in the province.

Gaps in relation to the MNCH related equipment have been identified taking into

account the equipment purchased or under process of purchase from all funds

including PMDGP funds allocated/sanctioned to the district. The cost of

equipment gap has been included in the equipment portion of the

Management/Service delivery problems. The detailed costing of equipment gaps

for DHQ and THQ hospitals is attached as Annex-II.

a) DHQ Hospital

Sr. No.

Equipment Standard as per MSDS(Qty.)

Available Gap

C B A1 CTG (Cardiac

Tocography)1 1 2 0 1

2 Foetal Doppler 3 5 5 0 33 Diagnostic

Laparoscope1 1 2 0 1

4 Bulb Sucker 10 20 20 10 05 Baby Warmer 3 3 6 0 36 Mechanical Sucker 3 3 6 3 07 Fetal Stethoscope 4 4 4 0 48 Delivery Table 2 2 3 2 09 D&C Set 2 3 4 2 0

10 Outlet forceps 4 4 4 2 211 Myoma Screw 2 2 2 1 112 Kochers forceps 4 4 8 23 013 Volselum forceps 6 8 10 8 0


Sr. No.


Available Gap

C B A14 Lanes Tissue holding

forceps2 2 4 6 4

15 Vaginal Retractors 10 10 10 0 216 Polypectomy forceps 2 2 2 12 1217 Sponge holder 10 15 20 4 018 Uterine elevator 1 1 1 2 419 CosCo Speculum

Small, Medium, Large (for each category)

6 10 10 0 3

20 Examination light 3 3 6 0 121 Suction Curette 1 2 2 0 122 Infant Resuscitation

Trolley (with life saving medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light)

1 1 2 1 0

23 Mother Resuscitation Trolley (with life saving medicines, Laryngoscope, Endo-tracheal tube, BP Apparatus, Chargeable light)

1 1 2 1 0

24 Cardiac Monitor 1 1 2 0 125 Pump Breast

Electronic1 1 1 4 0

26 Vaginal Hysterectomy Set

2 2 4 12 0

26.1 Toothed Tissue Forceps (8”)

2 2 4 12 0

26.2 Non-Tooted Tissue Forceps (8”)

2 2 4 4 0

26.3 Dissection Scissors (Curved 7”)

2 2 4 4 0

26.4 Dissection Scissors (Straight 7”)

2 2 4 10 0

26.5 Hysterectomy Clamps (Straight)

8 8 16 5 0

26.6 Hysterectomy Clamps (Curved)

8 8 16 0 0

26.7 Uterine Sound 2 2 4 5 026.8 Needle Holder (7”) 2 2 4 0 026.9 Needle Holder (10”) 2 2 4 12 0


Sr. No.


Available Gap

C B A26.10 Artery Forceps

(Straight 6”)16 16 32 16 0

26.11 Artery Forceps (Curved 6”)

16 16 32 16 00

26.12 Allis Forceps 8 8 16 10 026.13 Towel Clamps 8 8 16 8 026.14 Single blade Sims

speculum4 4 8 0 4

26.15 Double blade Sims speculum

4 4 8 8 0

26.16 Sponge holding forceps

8 8 16 12 0

26.17 Volselum forceps 4 4 8 5 026.18 Uterine Sound 2 2 4 5 026.19 Bladder Sound 2 2 4 1 1

27 Delivery Sets 10 10 1527.1 Episiotomy Scissors 10 10 15 2 827.2 Straight Scissors 10 10 15 6 427.3 Needle holder 10 10 15 10 027.4 Non-toothed tissue

forceps 8 inches10 10 15 12 0

27.5 Toothed tissue forceps 8 inches

10 10 15 12 0

27.6 Sims Speculum single blade

20 20 30 12 0

27.7 Sims Speculum double blade

20 20 30 8 0


40 40 60 12 28

27.9 Artery forceps 40 40 60 40 027.10 Straight clamps (cord) 20 20 30 20 027.11 Vacuum Extractor

pump1 1 1 0 0

27.12 Towel clip 40 40 60 8 3228 Caesarian Section 6 8 10 2 4

28.1 Scalpel 6 8 10 10 028.2 Artery Forceps

Straight 6 inches24 32 40 24 0

28.3 Artery Forceps Curved 6 inches

24 32 40 24 0

28.4 Artery forceps 8 inches

24 32 40 24 0

28.5 Myoma Scissors straight 7 inches

6 8 10 2 4

28.6 Dissecting scissors (curved) 7 inches

6 8 10 3 3


Sr. No.


Available Gap

C B A28.7 Green Armtage

forceps 8 inches24 32 40 12 12

28.8 Obstetric outlet forceps (pair)

6 8 10 6 0

28.9 Doyene’s Retractor 6 8 10 1 528.10 Small Retractors 12 16 20 6 628.11 Towel Clippers 24 32 40 8 1628.12 Suction Nozzle 6 8 10 2 4

29 MNCH Related Radiology Equipments

29.1 Ultrasound Machine 1 2 3 1 029.2 X-Ray Unit 500 kw 1 1 1 1 029.3 Color Doppler 0 1 1 0 029.4 Lead Screen for X-Ray

Unit1 1 1 0 1

29.5 0.5 MN Lead Apron. Lead Gloves, Goggles and Thyroid and Gonadal Sheets

1 1 1 0 1

29.6 Safe Light 1 1 1 0 129.7 X-RT Film Processing

Tank1 1 1 0 1

29.8 Chest Stand 1 1 1 0 129.9 X-Ray film Illuminator 2 2 2 0 2

29.10 X-Ray Film Hangers All sizes

4 4 4 0 4

30 MNCH Related Paediatrics Equipments

30.1 Paediatric Ventilator 1 2 2 0 130.2 Incubator 1 1 2 2 030.3 Photo Therapy Unit 1 1 1 0 130.4 Over-head Radiant

Warmer1 1 1 0 1

30.5 Infant Length Measuring Scale

2 2 2 0 2

30.6 Infant Weighing Machine

2 2 2 1 1

30.7 Nebulizer 1 1 2 0 130.8 Billiubino-meter 1 1 2 0 130.9 Exchange Blood

Transfusion Set1 1 2 0 1

30.10 Nasal Probe Paed size 2 2 4 0 231 Anaesthesia/ICU

31.1 Anaesthesia Machine 1 1 2 1 1


Sr. No.


Available Gap

C B A31.2 Ventilators 1 1 1 1 131.3 Nebulizer 1 1 1 0 131.4 Pulse Oximetry 1 1 1 0 131.5 Defibrillator 1 1 1 0 131.6 Airway Oral and Nasal 2 3 4 0 231.7 Tracheostomy tube

(adult and paeds)2 2 4 0 2

31.8 Face mask of all sizes 2 2 4 0 231.9 Double Cuff

Tourniquet (for regional block)

1 2 2 0 1

31.10 AMBO bag adult 2 2 4 1 131.11 AMBO Bag paeds 2 2 4 0 231.12 Red Rubber Nasal

tubes all sizes without cuff

4 4 8 0 4

32 Blood Bank32.1 Blood storage cabinet

(100 bag capacity)1 1 2 1 0

32.2 Packed cell machine 1 1 1 0 132.3 Cell Separator 1 1 1 0 132.4 Freezer for Fresh

Frozen Plasma1 1 1 0 1

32.5 Blood bag shaker 1 1 2 0 132.6 RH view box 2 2 4 1 132.7 Water bath 2 2 2 1 132.8 Micro-pipette 4 6 8 0 432.9 Blood grouping tiles 3 3 6 0 3

32.10 Plasma Extractor 1 1 1 0 132.11 Platelets agitator 1 1 1 0 132.12 Blood thawing bath 1 1 1 1 032.13 Microscopes 1 1 2 1 0

33 Gynae & Labour Room Related Laboratory Equipment

33.1 Hematology Analyzer 1 1 1 0 133.2 Electrolyte Analyzer 1 1 1 0 133.3 Analyzer Bio-

chemistry Semi-automatic

1 1 1 1 0

33.4 Glucometer 2 2 2 0 233.5 Haemoglobino-meter 2 2 4 2 033.6 Centrifuge 1 1 2 2 0


b) THQ Hospital

Sr. No.


Available Gap

C B A1 CTG (Cardiac

Tocography)1 1 1 0 1

2 Foetal Doppler 2 2 3 0 23 Diagnostic

Laparoscope1 1 1 0 1

4 Bulb Sucker 5 10 20

2 3

5 Baby Warmer 2 2 3 0 26 Mechanical Sucker 3 3 3 0 37 Fetal Stethoscope 2 3 4 0 28 Delivery Table 2 2 2 2 09 D&C Set 2 2 2 1 1

10 Outlet forceps 4 4 4 3 111 Myoma Screw 2 2 2 1 112 Kochers forceps 4 4 4 4 013 Volselum forceps 4 4 6 1 314 Lanes Tissue holding

forceps2 2 2 0 2

15 Vaginal Retractors 4 4 6 0 416 Polypectomy forceps 2 2 2 0 217 Sponge holder 10 10 1

52 8

18 Uterine elevator 1 1 1 0 119 CosCo Speculum

Small, Medium, Large (for each category)

4 6 6 2 2

20 Examination light 3 3 3 1 221 Suction Curette 1 1 2 1 022 Infant Resuscitation

Trolley (with life saving medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light)

1 1 1 0 1


1 1 1 0 1

24 Cardiac Monitor 1 1 1 0 1


Sr. No.


Available Gap

C B A25 Pump Breast

Electronic1 1 1 0 1


2 2 2 1 1


2 2 2 2 0


2 2 2 2 0


2 2 2 2 0


2 2 2 2 0


8 8 8 0 8


8 8 8 0 8

26.7 Uterine Sound 2 2 2 1 126.8 Needle Holder (7”) 2 2 4 2 026.9 Needle Holder (10”) 2 2 2 2 0

26.10 Artery Forceps (Straight 6”)

16 16 16

0 16

26.11 Artery Forceps (Curved 6”)

16 16 16

16 0

26.12 Allis Forceps 8 8 8 8 026.13 Towel Clamps 8 8 8 0 826.14 Single blade Sims

speculum4 4 4 0 4


4 4 4 0 4


8 8 8 6 2

26.17 Volselum forceps 4 4 4 1 326.18 Uterine Sound 2 2 2 1 126.19 Bladder Sound 2 2 2 0 2

27 Delivery Sets 6 6 10

2 4

27.1 Episiotomy Scissors 6 6 10

2 4

27.2 Straight Scissors 6 6 10

6 0

27.3 Needle holder 6 6 10

6 0

27.4 Non-toothed tissue forceps 8 inches

6 6 10

6 0


6 6 10

0 6


Sr. No.


Available Gap

C B A27.6 Sims Speculum single

blade12 12 2

00 12


12 12 20

0 12


40 40 40

5 35

27.9 Artery forceps 40 40 40

20 20

27.10 Straight clamps (cord) 20 20 30

0 20

27.11 Vacuum Extractor pump

1 1 1 0 1

27.12 Towel clip 40 40 40

0 40

28 Caesarian Section 4 4 6 2 228.1 Scalpel 4 4 6 0 428.2 Artery Forceps

Straight 6 inches16 16 2

40 16


16 16 24

16 0


16 16 24

16 0


4 4 6 0 4


4 4 6 0 4

28.7 Green Armtage forceps 8 inches

16 16 24

8 8


4 4 6 0 4

28.9 Doyene’s Retractor 4 4 6 1 328.10 Small Retractors 8 8 1

28 0

28.11 Towel Clippers 16 16 24

0 16

28.12 Suction Nozzle 4 4 6 0 429 MNCH Related

Radiology Equipments

0

29.1 Ultrasound Machine 1 1 2 1 029.2 X-Ray Unit 500 kw 1 1 1 1 029.3 Color Doppler 0 0 0 0 029.4 Lead Screen for X-Ray

Unit1 1 1 0 1


Sr. No.


Available Gap

C B A29.5 0.5 MN Lead Apron.

Lead Gloves, Goggles and Thyroid and Gonadal Sheets

1 1 1 1 0

29.6 Safe Light 1 1 1 1 029.7 X-RT Film Processing

Tank1 1 1 1 0

29.8 Chest Stand 1 1 1 1 029.9 X-Ray film Illuminator 2 2 2 2 0


4 4 4 4 0


0

30.1 Paediatric Ventilator 1 1 2 0 130.2 Incubator 1 1 1 1 030.3 Photo Therapy Unit 1 1 1 0 130.4 Over-head Radiant

Warmer1 1 1 0 1


2 2 2 0 2


2 2 2 1 1

30.7 Nebulizer 1 1 1 0 130.8 Billiubino-meter 1 1 1 0 130.9 Exchange Blood

Transfusion Set1 1 1 0 1

30.10 Nasal Probe Paed size 1 2 2 0 131 Anaesthesia/ICU 0

31.1 Anaesthesia Machine 1 1 1 1 031.2 Ventilators 1 1 1 1 031.3 Nebulizer 1 1 1 0 131.4 Pulse Oximetry 1 1 1 1 031.5 Defibrillator 1 1 1 0 131.6 Airway Oral and Nasal 1 2 2 10 031.7 Tracheostomy tube

(adult and paeds)1 2 2 0 1

31.8 Face mask of all sizes 1 2 2 0 131.9 Double Cuff

Tourniquet (for regional block)

1 1 1 0 1

31.10 AMBO bag adult 1 2 2 1 031.11 AMBO Bag paeds 2 2 2 1 131.12 Red Rubber Nasal


4 4 4 0 4


Sr. No.


Available Gap

C B A32 Blood Bank 0

32.1 Blood storage cabinet (100 bag capacity)

1 1 1 2 0

32.2 Packed cell machine 1 1 1 0 132.3 Cell Separator 1 1 1 0 132.4 Freezer for Fresh

Frozen Plasma1 1 1 0 1

32.5 Blood bag shaker 1 1 1 0 132.6 RH view box 1 2 2 1 032.7 Water bath 2 2 2 0 232.8 Micro-pipette 4 4 6 0 432.9 Blood grouping tiles 3 3 3 0 3

32.10 Plasma Extractor 1 1 1 0 132.11 Platelets agitator 1 1 1 0 132.12 Blood thawing bath 1 1 1 0 132.13 Microscopes 1 1 1 1 0


0

33.1 Hematology Analyzer 1 1 1 0 133.2 Electrolyte Analyzer 1 1 1 0 133.3 Analyzer Bio-

chemistry Semi-automatic

1 1 1 0 1

33.4 Glucometer 2 2 2 1 133.5 Haemoglobino-meter 1 1 1 1 033.6 Centrifuge 1 1 1 1 0


`

SECTION 3: INTERVENTIONS AND TARGETS

After enlisting the vital causes of prioritized health problems, team proposed appropriate interventions to tackle the problems. Once

interventions and activities had been identified, next task the planning team performed was to set the number and quality of specific

activities (targets) that have to be carried out. It is pertinent to mention over here that the plan envisages additional activities along with

routine activities under regular budget.

Health Problems

Sr. Problem Causes Intervention Activity UnitPlan

Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

1Diarrhea in children

· Poor Hygiene & sanitation

· Coordination with TMA for improvement of water supply and sanitation

· Quarterly co-ordination meetings with TMA and other agencies

Meetings

12 4 4 4

45


`


Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

· Lack of safe drinking water

· Awareness raising campaign

· Messages on local cable network

Monthly Telecast

36 12 12 12

· Unhygienic practices

· Proper treatment of Diarrhoea including ORT

· Printing and distribution of IPC material

Brochure

200,000 100,000 50,000 50,000

· Lack of awareness among mothers about feeding and weaning practices

· Health awareness in the community

· Conduction of HES in the community

Session 200 100 50 50

· Capacity building of health staff in Integrated Management of Childhood Illnesses (IMCI)

· Training of medics and paramedics in IMCI

Batch 12 6 4 2

46


`


Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

· Procurement and distribution of ORS and Zinc Sulphate

ORS packets

1,850,000 500,000 500,000 850,000

Procurement and distribution of Zinc Sulphate

Syrup 450,000 150,000 150,000 150,000

2 ARI Malnutrition Health promotion campaign

Messages on local cable networks

Monthly Telecast

Integrated activity

Air contamination

Capacity building of health staff in Integrated Management of Childhood Illnesses (IMCI)

Messages through FM radio channels

Monthly Telecast

36 12 12 12

47


`


Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

Over-crowding/Poor housing facilities

Provision of medicines for ARI

Printing and distribution of IPC material

Brochure &

Poster100,000 50,000 25,000 25,000

Lack of proper sanitation

Timely referral of complicated cases

Training of medics and para-medics in IMCI

BatchNo. of

Batches6 4 2

Integrated activity

Seasonal variation

Procurement of drugs

Oral Medicine Package

603,700 203,700 200,000 200,000

Lack of awareness related to winter season and hygienic practices

Injectable

42,750 14,250 14,250 14,250

48


`


Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

Procurement of nebulizing drugs

Drug 42,750 14,250 14,250 14,250

3 Hepatitis Poor sanitation

Health Education/ Promotion


12 4 4 4Integrated Activity

Unsafe drinking water

Campaign against quackery


Monthly Package

36 12 12 12Integrated Activity

Sharing of used syringes

Strengthening blood transfusion services for safe transfusions

· Printing and distribution of IPC and hepatitis awareness material

Brochure

30,000 10,000 10,000 10,000

49


`


Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

Transfusion of unsafe/unscreened blood and blood products

Campaign against drug addiction

· Procurement and supply of screening kits

Kits 450,000 150,000 150,000 150,000

Unsafe sexual practices

Regulatory mechanism to ensure use of safe instruments by dentists, barbers etc.

· Procurement of safety boxes

Syringe cutter

500 300 100 100

Ear piercing and tattooing

· Procurement of drugs for treatment of Hepatitis patients

Injection

5,000 5,000 5,000 2,000

Use of unsterilized equipment by dentists and barbers

· Develop and implement SOPs for sterilization of equipment -

SOPs

50


`


Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks


Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

4Anaemia in pregnancy

Poverty

Awareness raising for behavior change

Messages on local cable network

Message 36 12 12 12 Integrated

Activity

Lack of awareness about balanced diet

Improving ante-natal coverage


Brochure

150,000 50,000 50,000 50,000

Gender discrimination

Deworming campaign

Short refresher trainings of LHWs about balanced diet and provision of micro-nutrients

Batch25

15 5 5

51


`


Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

Social taboos and norms

Provision/Distribution of micro-nutrient supplements

Distribution of foods supplement through LHW & CMW

No. of tablets

- - - -

Through coordination of Bait

ul Maal and social

welfare deptt.

Infections

Assistant of poor family through Bait ul Maal and Zakat Fund

Coordination with Bait ul Maal and Social welfare department

- - - - DO

Purchase of Folic Acid and Ferrus sulphate tablet (Packs)

Packet 450,000 150,000 150,000 150,000

52


`


Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

Procurement of de-worming tablets

Packet 450,000 150,000 150,000 150,000

5 Tuberculosis Low socio-economic status

Health education/promotion

Messages on local cable networks

Monthly telecast

36 12 12 12 Integrated

activity

Over-crowding/Poor housing facilities

Strengthening TB DOTS program through involvement of private sector


Monthly telecast

36 12 12 12 Integrated

activity

Malnutrition

Printing and distribution of IPC and TB awareness

Brochure

300,000 100,000 100,000 100,000

53


`


Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

material

Seasonal variation

Procurement of drugs to address deficiency according to regimen

treatment day

2,196,000 720,000 732,000 744,000

Lack of proper sanitation

Procurement of reagents and slides for notified diagnostic facilities under DOTS programme

treatment

54,900 18,000 18,300 18,600

Lack of awareness and hygienic practices

54


`


Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

6 ScabiesOvercrowding in schools and homes

Awareness raising campaign

Community health education sessions

HES 1,500 1,000 250 250

Low socio-eceonomic conditions

Provision of medicines

Printing & Distribution of IPC Material

Brochure

20,000 10,000 5,000 5,000

Poor Health Education

Supply of anti scabies drugs

drug 450,000 150,000 150,000 150,000

7Resistant Malaria (Falciparum)

Breeding places for mosquitoes

Public awareness campaign

Printing and distribution of Health Education material

Poster 30,000 10,000 10,000 10,000

In judicious use of anti malarial by GPs And HCPs

Strengthening Malaria eradication program

Provision of lab equipment/reagents

Microscope , allied kit

50 50 - -

Lack of awareness for prevention

Training of health care providers / GPs on Roll back malaria

Training 20 10 5 5

55


`


Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

Antimalarial drugs aursonate tablets,

Tablet (Pack of 100)

1,800 1,000 400 400

Antimalarial drugs Primaquin,


6,000 3,000 1,500 1,500

Antimalarial drugs Chloroquin


180,000 80,000 50,000 50,000

Fogging Machine

Machine 2 2 - -

Purchase of diesel for fogging

Litre 3,000 1,000 1,000 1,000

56


`


Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

Spray Pumps pumps 150 100 25 25

Uniform for spray man

Uniform 80 80 - -

Glasses/ gloves, Bucket, soap

Misc 100 100 - -

Purchase of insecticide delta methrine (Powder 5 % WDP)

Kg 9,000 3,000 2,000 2,000

Purchase of insecticide delta methrine (Liquid 1.5 % )

Litre 6,000 2,000 2,000 2,000

57


`


Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

Purchase of larvicidal Drug (Phenthion Granules)

Kg 4,000 2,000 1,000 1,000

Purchase of larvicidal Drug ( Temiphos) Liquid

Litre 1,500 500 500 500

Spray man

4 Squad of 6 persons x 25 days

12 4 4 4

Purchase of motor cycle for CDCSs

Motor cycle

65 35 15 15

POL for motor

cycleslitre 27000 6300 9000 11700

58


`

Management Problems

59

Sr.

No.Name of Post

Basic

Scale

Basic

Pay Allowances

Requiremen

t as per Gap

Physical Targets

Year I Year II Year III

1 Gynaecologist 18 12,910 18,099 3 2 1 -

2 Paediatricians 18 12,910 18,099 3 2 1 -

3 Anesthetists 18 12,910 18,099 3 2 1 -

4 MO / WMO 17 9,850 15,345 110 50 30 30

5 Nurses 16 6,060 8,934 71 35 18 18

6 Lady Health

Visitors

9 3,820 4,750 17 9 4 4


`

Sr. Problem Causes Intervention Activity Unit Plan Activities Targets

Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

1 Shortage of Skilled Staffs

· Non-availability of trained staff

· Filling of the vacant posts

· Filling of the vacant posts of medics and the paramedics through existing recruitment

- - - - - Recruitment

60


`


Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

committees · Non-

sanctioning of staff according to MSDS

· Sanctioning of trained staffs according to MSDS

Temporary filling of vacant positions on contract

- - - - Recruitment

· Lack of permanent postings

· Incentivized pay package at all levels

· Demand generation and request to the Department of Health by the districts for recruitment through PSC against vacant posts

- - - - - Plan

· Lack of incentivized and differential pay package

· Well defined career structure including opportunities for higher education

Batch 9 4 3 2

· Frequent transfer postings

· High level political commitment for providing protection to

· Consensus building between the districts for uniform incentivized pay

Meeting

61


`


Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

staff working in health facilities

package for all categories and levels staff

· Job insecurity

· Request to the Provincial Government for approval and implementation of agreed pay packages

Plan

· Lack of basic amenities at workplace

· Review and revise the career structure of medics and paramedics

Technical assistance

· Lack of conducive environment including insecurity and transport of children for education

· Filling of Human Resource gaps as per MSDS

Posts 91 51 48 Detail HR plan is attached

Posts 9 4 4 Detail HR plan is attached

62


`


Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

· Political and media interference

HR 100 55 52 Detail HR plan is attached

· Capacity and need assessment of the medics and the paramedics

NO COST ACTIVITY

· Prepare training programs for providing higher professional education based on TNA

TNA

2 Inadequate medicines and supplies

Less budget allocation for medicines

· Need-based demand for provision of sufficient budget for medicines and supplies

· Inclusion of enhanced amount for medicines and supplies in the proposed annual budget according to the needs

Need assessment

63


`


Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

Frequent increase in price

Demand generation for medicine.

Demand generation

procurement of essential drugs on the basis of allocated budget

Already addressed in health problems

3 Shortage of functional vehicles and POL

· Provision of inadequate funds for purchase of vehicles

· Provision of sufficient funds for purchase of vehicles

· Condemnation of the old and off-road vehicles

As per demand by district

· Ban on procurement of vehicles by the government

· Seeking exemptions for procurement of specific vehicle

· Preparation and submission of demand for replacement five ambulances at RHC

Demand submission

64


`


Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

· Complicated procedure for purchase of new vehicles

· Expedite the procurement procedure

· Procurement of ambulances

Ambulance 4 2 1 1

· Demand sufficient funds for repair and maintenance of vehicles and expedite the repair

· Demand submission for replacement of vehicles for district and tehsil level supervisors

Demand submission

· Procurement of vehicles for District level supervisors

vehicles 1 1 - -

vehicles 2 1 1 -

· Procurement of vehicles for Tehsil level supervisors

vehicles 2 1 1 -

65


`

Sr. Problem causes Intervention Activity UnitPlan

Activities Targets

Target for

2010-11

Target for

2011-12

Target for 2012-

13

Remarks

4 Inadequate district health budget

Generator provision for backup of electricity supply

Rational increase in POL budget

Assessment of additional requirement

NO COST ACTIVITY

Less budget allocation

Costing and submission of additional demand

Frequent increase in prices

· Provision of POL budget for vehicles for District supervisors

litre 14,400 4,800 4,800 4,800

· Provision of POL budget for vehicles for Tehsil level supervisors

litre 7,200 2,400 2,400 2,400

66


`


Activities Targets

Target for

2010-11

Target for

2011-12

Target for 2012-

13

Remarks

· Provision of POL budget for generator

litre 540,000 180000 180000 180000

5 Inadequate equipments

Deficient equipment to cater basic and comprehensive EmONC at primary and secondary level of care

Provision of the equipment in accordance with the notified equipment list

Procurement of equipments for THQ and DHQ hospitals based on the gaps between MSDS and existing available

Detail attached

Old and un-serviceable equipment

Provision of adequate budget for maintenance and repair

Allocation of enhanced amount for M&R of equipments

Submission of demand

Shortage of regular budget for

Capacity building of staff regarding maintenance

Orientation of staffs in maintenance of logos for

Plan

67


`


Activities Targets

Target for

2010-11

Target for

2011-12

Target for 2012-

13

Remarks

M&R of log books of each equipment

equipments

Frequent cuts on M&R budget

68


`

SECTION 4: COSTING & FINANCING PLAN

O. Activity based costing The planning team has used the best available data sources, for calculation of estimates for the intervention/activities. It is

pertinent to mention that the costing of the plan is based on additional needs and activities. The detailed activity based

costing of the Health and Service Delivery problems has been performed on automated Excel sheets, which are annexed with

the plan as Annex-II and Annex-III. A moderate estimate of equipment cost has been taken, as there is wide variation

between the minimum and maximum cost. The summary of activity and problem wise costing is given below:

a) Health Problems

Sr. Problem ActivityDefine Financial Targets

Total Cost RemarksUnit Rate Quantity Year I Year II Year III

1 Diarrhea in children


Meetings 3,000 12 12,000 13,200 14,520 39,720

69


`



· Messages

on local cable network

Monthly Telecast

35,000 36 420,000 462,000 508,200 1,390,200

· Printing

and distribution of IPC material

Brochure 5 200,000 500,000 275,000 302,500 1,077,500

· Conduction

of HES in the community

Session 2000 200 200,000 110,000 121,000 431,000

· Training of medics and paramedics in IMCI

Batch 240,000 12 1,440,000 1,056,000 580,800 3,076,800

· Procurement and distribution of ORS and Zinc Sulphate

ORS packets

5 1,500,000 2,500,000 2,750,000 5,142,500 10,392,500

70


`



Procurement

and distribution of Zinc Sulphate

Syrup 60 450,000 9,000,000 9,900,000 10,890,000 29,790,000

Total 46,197,720

Sr. Problem Activity

Define Financial Targets

Total Cost Remarks

Unit Rate Quantity Year I Year II Year III

2 ARI· Messages on local cable networks

Monthly Telecast

- - -

- Integrated activity

· Messages through FM radio channels

Monthly Telecast

35,000 36

420,000 462,000 508,200

1,390,200

71


`




Brochure & Poster

30 100,000

1,500,000

825,000 907,500

3,232,500

· Training of medics and para-medics in IMCI

Batch No. of Batches

- - -

- Integrated activity

· Procurement of drugs

Oral Medicine Package

70 603,700 14,259,000 15,400,000 16,940,000 46,599,000

Injectable 800 42,750 11,400,000 12,540,000 13,794,000 37,734,000

· Procurement of nebulizing

drugs

Drug 30 42,750 427,500 470,250 517,275 1,415,025

Total 90,370,725

72


`



3 Hepatitis


- 12 - - - -

Integrated Activity


Monthly Package

- 36 - - - -

Integrated Activity


Brochure 30 30,000 300,000 330,000 363,000 993,000


Kits 50 450,000 7,500,000 8,250,000 9,075,000 24,825,000

· Procurement of safety boxes

Syringe cutter

500 500 150,000 55,000 60,500 265,500

73


`




Injection 15,000 5,000 75,000,000 82,500,000 36,300,000 193,800,000

· Develop and implement SOPs for sterilization of equipment

-

- - - - SOPs

Total219,883,50

0

4 Anemia in pregnancy


Message 36 - - - - Integrated Activity


Brochure 5 150,000 250,000 275,000 302,500 827,500

74


`



· Short refresher trainings of LHWs about balanced diet and provision of micro-nutrients

Batch 75,000 25 1,125,000 412,500 453,750 1,991,250

· Distribution of foods supplement through LHW & CMW

No. of tablets

- - - - - -

Through coordination of Bait

ul Maal and social

welfare deppt

· Coordination with Bait ul Maal and Social welfare department

- - - - - - DO

· Purchase of Folic Acid and Ferrus sulphate tablet (Packs)

Packet 40 450,000 6,000,000 6,600,000 7,260,000 19,860,000

75


`



· Procurement of de-worming tablets

Packet 20 450,000 3,000,000 3,300,000 3,630,000 9,930,000

Total32,608,75

0

5 Tuberculosis

· Messages on local cable networks

Monthly telecast

36 - - - - Integrated activity

· Messages

through FM radio channels

Monthly telecast

36 - - - - Integrated activity

· Printing and distribution of IPC and TB awareness material

Brochure 5 300,000 500,000 550,000 605,000 1,655,000

·

Procurement of treatment day

25 2,196,000 18,000,000 20,130,000 22,506,000 60,636,000

76


`



drugs to address deficiency according to regimen

· Procurement of reagents and slides for notified diagnostic facilities under DOTS programme

treatment 30 54,900 540,000 603,900 675,180 1,819,080

Total 64,110,080

6 ScabiesCommunity health education sessions

HES 2,000 1,500 2,000,000

550,000 605,000 3,155,000


Brochure 5 20,000 50,000

27,500 30,250 107,750

Supply of anti scabies drugs

drug 50 450,000 7,500,000

8,250,000 9,075,000 24,825,000

77


`



Total 28,087,750

7

Resistant Malaria (Falciparum)

Printing and distribution of Health Education material

Poster 25 30,000 250,000

275,000

302,500

827,500


Microscope , allied kit

60,000 50 3,000,000

-

-

3,000,000


Training 75,000 20 750,000

412,500

453,750

1,616,250



2,000 1,800 2,000,000

880,000

968,000

3,848,000

Antimalarial drugs Primaquin,


1,000 6,000 3,000,000

1,650,000

1,815,000

6,465,000

78


`



Antimalarial drugs Chloroquin


50 180,000 4,000,000

2,750,000

3,025,000

9,775,000

Fogging Machine Machine 90,000 2 180,000

-

-

180,000

Purchase of disel for fogging

Litre 76 3,000 76,00

0 83,

600 9

1,960 251,56

0

Spray Pumps pumps 7,000 150 700,000

192,500

211,750

1,104,250

Uniform for spray man

Uniform 500 80 40,000

-

-

40,000

Glasses/ gloves, Backet, soap

Mis 1,000 100 100,000

-

-

100,000

79


`




Kg 800 9,000 2,400,000

1,760,000

1,936,000

6,096,000


Litre 1,200 6,000 2,400,000

2,640,000

2,904,000

7,944,000


Kg 500 4,000 1,000,000

550,000

605,000

2,155,000


Litre 2,000 1,500 1,000,000

1,100,000

1,210,000

3,310,000

Spray man 4 Squad of 6 persons x 25 days

65,000 12 260,000

286,000

314,600

860,600


Motor cycle

60,000 65 2,100,000

990,000

1,089,000

4,179,000

80


`



POL for motor cycles

litre 75 27000 472,500

742,500

1,061,775

2,276,775

Total 54,028,935

b) Management Problems

Sr. No.

Name of PostBasic Scale

Basic Pay

Allowances

Requirement as per Gap

Financial Targets

Year I Year II Year III

Pay of Officers

Pay of other staff

AllowancesPay of

Officers

Pay of other staff

AllowancesPay of

Officers

Pay of other staff

Allowances

1 Gynaecologist 18 12,910 18,099 3 309,840 - 434,376 511,236 716,720 562,360 788,392

81


`

2 Paediatricians 18 12,910 18,099 3 309,840 - 434,376 511,236 716,720 562,360 788,392

3 Anesthetists 18 12,910 18,099 3 309,840 - 434,376 511,236 716,720 562,360 788,392

4 MO / WMO 17 9,850 15,345 110 5,910,000 - 9,207,000 10,401,600 16,204,320 15,732,420 24,509,034

5 Nurses 16 6,060 8,934 71 2,545,200 - 3,752,280 4,239,576 6,250,226 6,247,375 9,210,239

6 Lady Health Visitors

9 3,820 4,750 17

412,560 513,000 655,512 815,100 942,929 1,172,490

9,797,280 - 14,775,408 16,830,396 - 25,419,808 24,609,803 - 37,256,941



Total Cost Remarks


1Shortage of Skilled Staffs

· Filling of the vacant posts of medics and the paramedics

- - - - - -

- Recruitment

82


`



Total Cost Remarks


through existing recruitment committees


- - - - - -

- Recruitment

· Demand generation and request to the Department of Health by the districts for recruitment through PSC against vacant posts

- - - - - -

- Plan

· Orientation trainings of the recruited staffs

Batch 330,000 9 1,320,000 1,089,000 798,600 3,207,600

· Consensus building between the districts for

- - -

- Meeting

83


`



Total Cost Remarks


uniform incentivized pay package for all categories and levels staff

· Request to the Provincial Government for approval and implementation of agreed pay packages

- - -

- Plan

· Review and revise the career structure of medics and paramedics

- - -

- Technical assistance

· Filling of Human

Resource gaps as per MSDS

Posts 9,384,720 16,174,884 23,666,874 49,226,478 Detail HR plan is attached

Posts 412,560 655,512 942,929 2,011,001 Detail HR

plan is attached

84


`



Total Cost Remarks


HR 14,775,408 25,419,808 37,256,941 77,452,156 Detail HR

plan is attached

· Capacity and need assessment of the medics and the paramedics

- - -

- NO COST ACTIVITY

· Prepare training programs for providing higher professional education based on TNA

- - -

- TNA

Total 131,897,235

2 Inadequate medicines and supplies

· Inclusion of enhanced amount for medicines and supplies in the proposed annual budget according to the needs

- - - -

- Need

assessment

85


`



Total Cost Remarks


Demand generation for medicine. - -

-

- Demand

generation

Procurement of essential drugs on the basis of allocated budget

- - -

-

Already addressed in

health problems

3

Shortage of functional vehicles and POL

· Condemnation of the old and off-road vehicles

- -

-

- As per demand by district


- -

-

- Demand submission

· Procurement of ambulances

Ambulance

3,800,000 4 7,600,000 4,180,000 4,598,000 16,378,000

86


`



Total Cost Remarks



- -

-

- Demand submission

· Procurement of vehicles for District

level supervisors

vehicles 3,800,000 1 3,800,000 - - 3,800,000

vehicles 900,000

2 900,000

990,000

-

1,890,000


vehicles 900,000

2 900,000

990,000

-

1,890,000

87


`



Total Cost Remarks


Total 23,958,000

4

Inadequate district health budget

Assessment of additional requirement

-

-

-

- NO COST ACTIVITY


-

-

- -


litre 75

14,400

360,000

396,000

435,600

1,191,600


litre 75

7,200

180,000

198,000

217,800

595,800

88


`



Total Cost Remarks



litre 75

540,000

13,500,000

14,850,000

16,335,000

44,685,000

Total46,472,400

5 Inadequate equipments


18,926,985 18,276,260

-

37,203,245

Detail attached


- -

- -

Submission of demand

Orientation of staffs in maintenance of logos for equipments

- -

- - Plan

89


`



Total Cost Remarks


Total 37,203,245

90


`

P. Financial outlay including 3YRP activities

The costing of the plan includes routine recurring budget with 15% price escalation for subsequent years and additional cost involved on the

basis of health and management problems; which is essentially required to bring visible improvement in the health system. Other financial

resources expected from provincial level through ADP and PMDGP are also part of this plan. Overall financial outlay of the plan is as under:

i. Health ProblemsObject Classification

2010-2011 2011-2012 2012-2013

Regular Additional Total Regular Additional Total Regular Additional Total

A03907 315,100 840,000 1,155,100 362,365 924,000 1,286,365 416,720 1,016,400 1,433,120

A03902 529,000 3,350,000 3,879,000 608,350 2,557,500 3,165,850 699,603 2,813,250 3,512,853

A03820 - 12,000 12,000 - 13,200 13,200 - 14,520 14,520

A03927 26,450,000 163,426,500 189,876,500 30,417,500 173,774,150 204,191,650 34,980,125 139,192,955 174,173,080

A09501 115,000 2,100,000 2,215,000 132,250 990,000 1,122,250 152,088 1,089,000 1,241,088

A09601 1,092,500 880,000 1,972,500 1,256,375 192,500 1,448,875 1,444,831 211,750 1,656,581

A03903 - 2,200,000 2,200,000 - 660,000 660,000 - 726,000 726,000

A03801 - 3,315,000 3,315,000 - 1,881,000 1,881,000 - 1,488,300 1,488,300

A09404 - 10,650,000 10,650,000 - 8,305,000 8,305,000 - 9,135,500 9,135,500

91


`

Object Classification

2010-2011 2011-2012 2012-2013


A03807 5,686,750 548,500 6,235,250 6,539,763 826,100 7,365,863 7,520,727 1,153,735 8,674,462

A03906 2,300 40,000 42,300 2,645 - 2,645 3,042 - 3,042

A09802 - 100,000 100,000 - - - - - -

A01277 - 260,000 260,000 - 286,000 286,000 - 314,600 314,600

Total 34,190,650 187,722,000 221,912,650 39,319,248 190,409,450 229,728,698 45,217,135 157,156,010 202,373,145

ii. Management ProblemsObject

Classification2010-2011 2011-2012 2012-2013


A03801 - 1,320,000 1,320,000 - 1,089,000 1,089,000 - 798,600 798,600

A09601 1,092,500 18,926,985 20,019,485 1,256,375 18,276,260

19,532,635 1,444,831 - 1,444,831

A01101 - 9,384,720 9,384,720 - 16,174,884

16,174,884 - 23,666,874

23,666,874

A01270 - 14,775,408 14,775,408 - 25,419,80 25,419,808 - 37,256,94 37,256,941

92


`

Object Classification

2010-2011 2011-2012 2012-2013


8 1

A09501 115,000 13,200,000 13,315,000 132,250 6,160,000 6,292,250 152,088 4,598,000 4,750,088

A03807 5,686,750 14,040,000 19,726,750 6,539,763 15,444,000

21,983,763 7,520,727 16,988,400

24,509,127

A03902 529,000 - 529,000 608,350 - 608,350 699,603 - 699,603

A01102 - 412,560 412,560 - 655,512 655,512 - 942,929 942,929

Total 7,423,250 72,059,673 79,482,923 8,536,738 83,219,464 91,756,201 9,817,248 84,251,743 94,068,992

93


`

Q. Summaries

I. Problem wise Summary

a) Health Problems

Sr. No. Problem

FY I FY II FY IIITotal Cost

Rs.

Amount (Rs.) Amount (Rs.) Amount (Rs.)Amount

(Rs.)

1 Diarrhoeal diseases 14,072,000 14,566,200 17,559,520 46,197,720

2 ARI 28,006,500 29,697,250 32,666,975 90,370,725

3 hepatitis 82,950,000 91,135,000 45,798,500 219,883,500

4 Anaemia in pregnancy 10,375,000 10,587,500 11,646,250 32,608,750

5 TB 19,040,000 21,283,900 23,786,180 64,110,080

6 Scabies 9,550,000 8,827,500 9,710,250 28,087,750

7 Malaria 23,728,500 14,312,100 15,988,335 54,028,935

Total 187,722,000 190,409,450 157,156,010 535,287,460

94


`

b) Management Problems

Sr. No. Problem

FY I FY II FY III Total Cost Rs.

Amount (Rs.) Amount (Rs.)Amount

(Rs.)Amount (Rs.)

1Shortage of skilled staffs MNCH related

25,892,688 43,339,204 62,665,343 131,897,235

2Inadequate medicine and supply

- - - -

3Inadequate equipments- MNCH Related

18,926,985 18,276,260 - 37,203,245

4Shortage of functional vehicles

13,200,000 6,160,000 4,598,000 23,958,000

5 Inadequate budget POL 14,040,000 15,444,000 16,988,400 46,472,400

Total 72,059,673 83,219,464 84,251,743 239,530,880

95


`

II. Activity wise Summary

a) Health ProblemsSr. No. Problem Activity FY-I FY-II FY-III Total

1 Diarrhoeal diseases Quarterly co-ordination meetings with TMA and other agencies

12,000 13,200 14,520 39,720

Messages on local cable network 420,000 462,000 508,200 1,390,200


500,000 275,000 302,500 1,077,500

Conduction of HES in the community

200,000 110,000 121,000 431,000

Training of medics and paramedics in IMCI

1,440,000 1,056,000 580,800 3,076,800

Procurement and distribution of ORS and Zinc Sulphate

2,500,000 2,750,000 5,142,500 10,392,500

Procurement and distribution of Zinc Sulphate

9,000,000 9,900,000 10,890,000 29,790,000

2 ARI Messages on local cable networks

- - - -

96


`

Sr. No. Problem Activity FY-I FY-II FY-III Total


420,000 462,000 508,200 1,390,200


1,500,000 825,000 907,500 3,232,500

Training of medics and para-medics in IMCI

- - - -

Procurement ofdrugs 14,259,000 15,400,000 16,940,000 46,599,000

- 11,400,000 12,540,000 13,794,000 37,734,000

Procurement of nebbulizing drugs

427,500 470,250 517,275 1,415,025

3 Hepatitis · Quarterly co-ordination meetings with TMA and other agencies

- - - -


- - - -


300,000 330,000 363,000 993,000


7,500,000 8,250,000 9,075,000 24,825,000

97


`


· Procurement of safety boxes 150,000 55,000 60,500 265,500


75,000,000 82,500,000 36,300,000 193,800,000

· Develop and implement SOPs for sterilization of equipment

- - - -

4 Anaemia in pregnancy Messages on local cable network - - - -


250,000 275,000 302,500 827,500

Short refresher trainings of LHWs about balanced diet and provision of micro-nutrients

1,125,000 412,500 453,750 1,991,250

Distribution of foods supplement through LHW & CMW

- - - -

Coordination with Bait ul Maal and Social welfare department

- - - -

Purchase of Folic Acid and Ferrus sulphate tablet (Packs)

6,000,000 6,600,000 7,260,000 19,860,000

Procurement of de-worming tablets

3,000,000 3,300,000 3,630,000 9,930,000

98


`


5 TB Messages on local cable networks

- - - -


- - - -

Printing and distribution of IPC and TB awareness material

500,000 550,000 605,000 1,655,000

Procurement of drugs to address deficiency according to regimen

18,000,000 20,130,000 22,506,000 60,636,000

Procurement of reagents and slides for notified diagnostic facilities under DOTS programme

540,000 603,900 675,180 1,819,080

6 Scabies Community health education sessions

2,000,000 550,000 605,000 3,155,000


50,000 27,500 30,250 107,750

Supply of anti scabies drugs 7,500,000 8,250,000 9,075,000 24,825,000

7 Malaria Printing and distribution of Health Education material

250,000 275,000 302,500 827,500

99


`



3,000,000 - - 3,000,000


750,000 412,500 453,750 1,616,250


2,000,000 880,000 968,000 3,848,000

Antimalarial drugs Primaquin, 3,000,000 1,650,000 1,815,000 6,465,000

Antimalarial drugs Chloroquin 4,000,000 2,750,000 3,025,000 9,775,000

Fogging Machine 180,000 - - 180,000

Purchase of diesel for fogging 76,000 83,600 91,960 251,560

Spray Pumps 700,000 192,500 211,750 1,104,250

Uniform for spray man 40,000 - - 40,000

Glasses/ gloves, Bucket, soap 100,000 - - 100,000


2,400,000 1,760,000 1,936,000 6,096,000


2,400,000 2,640,000 2,904,000 7,944,000

100


`



1,000,000 550,000 605,000 2,155,000


1,000,000 1,100,000 1,210,000 3,310,000

Spray man 260,000 286,000 314,600 860,600


2,100,000 990,000 1,089,000 4,179,000

POL for motor cycles 472,500 742,500 1,061,775 2,276,775

Total 87,722,000 90,409,450 57,156,010 535,287,460

101


`

b) Management ProblemsSr. No. Problem Activity Costing (Rs.)

FY-I FY-II FY-III Total

1 Shortage of skilled staffs MNCH related

·Filling of the vacant posts of medics and the paramedics through existing recruitment committees

- - - -


- - - -

·Demand generation and request to the Department of Health by the districts for recruitment through PSC against vacant posts

- - - -

·Orientation trainings of the recruited staffs

1,320,000 1,089,000 798,600 3,207,600

·Consensus building between the districts for uniform incentivized pay package for all categories and levels staff

- - - -

·Request to the Provincial Government for approval and implementation of agreed pay

- - - -

102


`

Sr. No. Problem Activity Costing (Rs.)


packages

·Review and revise the career structure of medics and paramedics

- - - -

·Filling of Human Resource gaps as per MSDS

9,384,720 16,174,884 23,666,874 49,226,478

- 412,560 655,512 942,929 2,011,001

- 14,775,408 25,419,808 37,256,941 77,452,156

·Capacity and need assessment of the medics and the paramedics

- - - -

·Prepare training programs for providing higher professional education based on TNA

- - - -

2 Inadequate medicine and supply

·Inclusion of enhanced amount for medicines and supplies in the proposed annual budget according to the needs

- - - -

103


`



Demand generation for medicine.

- - - -

procurement of essential drugs on the basis of allocated budget

- - - -

3 Inadequate equipments- MNCH Related


18,926,985 18,276,260 - 37,203,245


- - - -

Orientation of staffs in maintenance of logos for equipments

- - - -

4 Shortage of functional vehicles · Condemnation of the old and off-road vehicles

- - - -


- - - -

· Procurement of ambulances 7,600,000 4,180,000 4,598,000 16,378,000

104


`




- - - -

· Procurement of vehicles for District level supervisors

3,800,000 - - 3,800,000

- 900,000 990,000 - 1,890,000


900,000 990,000 - 1,890,000

5 Inadequate budget POL Assessment of additional requirement

- - - -


- - - -


360,000 396,000 435,600 1,191,600


180,000 198,000 217,800 595,800

105


`




13,500,000 14,850,000 16,335,000 44,685,000

Total 72,059,673 83,219,464 84,251,743 239,530,880

106


`

SECTION 5: MONITORING & EVALUATION

The proposed monitoring and evaluation targets and indicators will be used to gauge

the progress of implementation of the plan. This will be done through:

Developing indicators

Identifying means of verification (MoV); and

Plan for monitoring and evaluation of the district health plan

M&E of PlanIndicators Target %

Achievemen

t

MoV Responsibilit

y

Frequency

of

monitorin

g

Remark

s

% of planned

supervisory

visits

conducted

50

visits

/year

Inspection

Book

EDOH/DOH/

DDOH

Quarterly

% of RHCs

with

availability of

specialists of

essential

specialties

(Physician,

Surgeon,

Paediatrician

and

Gynaecologist)

100%

During 1st

year

Pay Roll EDOH / DOH 6 monthly

107


`

Indicators Target %

Achievemen

t

MoV Responsibilit

y

Frequency

of

monitorin

g

Remark

s

% of health

facilities with

availability of

essential

MNCH related

equipment

(level specific)

100%

During 1st

year

Stock

Register

EDOH/ DOH/

MSs

6 monthly

Availability of

relevant

(MNCH)

laboratory

equipment at

appropriate

level of care

100%

During 1st

year

Stock

Register

EDOH/

DOH/MSs,

Store keeper

Quarterly

% facilities

with

availability of

essential

medicines

100%

During 1st

year

Stock

Register

EDOH/ DOH/

MSs, Store

keeper

Monthly

% of functional

ambulances in

the district

100%

(DHQH/

THQH/

RHCs)

Log Book EDOH/DOH/

Transport

officer

Quarterly

% utilization of

sanctioned

budget

100% of

yearly

budget

Quarterly

Reports

EDOH/ DOH/

MSs/ Accounts

officer

Quarterly

108


`

Indicators Target %

Achievemen

t

MoV Responsibilit

y

Frequency

of

monitorin

g

Remark

s

% of facilities

with

availability of

basic EmONC

100%

(50%

during 1st

year)

Supervisor

y visit

report

EDOH/DoH/

DDOH

Quarterly

% of DHQ/THQ

hospitals with

Comprehensiv

e EmONC

services

100% in 3

years

(50%

during 1st

year)

Supervisor

y visit

report

EDOH/DoH/

DDOH

Quarterly

% of facilities

with

availability of

separate or

partitioned

room reserved

exclusively for

delivery

100% in 3

years

(50%

during 1st

year)

Supervisor

y visit

report

EDOH/DoH/

DDOH

Quarterly

% of targeted

pregnant

women newly

registered by

LHW

Target

according

to

populatio

n

DHIS

Report

EDOH/

Statistical

Officer

Quarterly

109


`

Indicators Target %

Achievemen

t

MoV Responsibilit

y

Frequency

of

monitorin

g

Remark

s

% of targeted

pregnant

women

received TT-2

vaccine

Target

according

to

populatio

n

DHIS

Report

EDOH/ DHIS

Coordinator/

Statistical

Officer

Quarterly

Delivery

conducted by

or under

supervision of

skilled persons

reported

90%

(…. %

During 1st

year)

DHIS

Report

EDOH/ DHIS

Coordinator/

Statistical

Officer

Quarterly

%of target

children

between 18 -

23 months of

age fully

immunized

Target

according

to

populatio

n

DHIS

Report

EDOH/ DHIS

Coordinator/

Statistical

Officer

Quarterly

% of referred

cases attended

100% DHIS

Report/

LHWs

monthly

report

EDOH/ DHIS

Coordinator/

Statistical

Officer

Quarterly

110


`

Indicators Target %

Achievemen

t

MoV Responsibilit

y

Frequency

of

monitorin

g

Remark

s

% of targeted

eligible

couples

provided

knowledge and

information on

Family

Planning

methods

Target

according

to

populatio

n

LHW’s

monthly/

quarterly

report

EDOH/

Statistical

Officer

/Coordinator

NP-FP&PHC

Quarterly

No. of

meetings with

participation

from other

sectors

12

meetings

per year

Minutes of

meetings

EDOH/ Focal

person/s

Quarterly

111


`

Annexure

112


`

Annex-IList of Private Health Facilities

Sr. No Name of Private Health Facility

1. Shatak Hospital

2. Al Karam Hospital

3. Tarrer Hospital

4. Al Shifa Hospital

5. Akthar Children Hospital

6. General /Al Habib Hospital

7. City Hspital

8. Cheema Hospital

9. Rahat Hospital

10. Tariq Complex

11. Shafer Hospital

12. Nazir Hospital

13. Shafer Hospital

14. Anwar Fatima Hospital

15. Alvi Hospital

16. Javed Ranjha Children Hospital

17. Family Hospital

113


`

18. Al Shifa Hospital Phalia

19. Riaz Gondal Surgical Hospital

20. Chaddhar Eye Hospital

21. Zafar Hospital

22. Aftab Hospital

(Data source: Statistical Assistant EDO H Office)

Annex-II

Costing of Equipment gaps for DHQ and THQ Hospitals

DHQ HOSPITAL M.B DIN

Sr. No.

Equipment Standard as per MSDS

Available Gap Cost/Unit Total Cost

(Qty.) C B A Shortage

1 CTG (Cardiac Tocography)

1 1 2 0 1 285000 285000

2 Foetal Doppler 3 5 5 0 3 101000 3030003 Diagnostic

Laparoscope1 1 2 0 1 1200000 1200000

4 Bulb Sucker 10 20 20 10 0 45 05 Baby Warmer 3 3 6 0 3 850000 25500006 Mechanical

Sucker3 3 6 3 0 28000 0

7 Fetal Stethoscope 4 4 4 0 4 1500 60008 Delivery Table 2 2 3 2 0 17500 09 D&C Set 2 3 4 2 0 2100 0

10 Outlet forceps 4 4 4 2 2 900 180011 Myoma Screw 2 2 2 1 1 320 32012 Kochers forceps 4 4 8 23 0 235 013 Volselum forceps 6 8 10 8 0 235 0

114


`

Sr. No.




14 Lanes Tissue holding forceps

2 2 4 6 4 400 1600

15 Vaginal Retractors

10 10 10 0 2 350 700

16 Polypectomy forceps

2 2 2 12 12 750 9000

17 Sponge holder 10 15 20 4 0 300 018 Uterine elevator 1 1 1 2 4 150 600

19 CosCo Speculum 6 10 10 0 3 550 165020 Examination light 3 3 6 0 1 18000 1800021 Suction Curette 1 2 2 0 1 95 9522 Infant

Resuscitation Trolley (with life saving medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light)

1 1 2 1 0 95000 0


1 1 2 1 0 110000 0

24 Cardiac Monitor 1 1 2 0 1 500000 50000025 Pump Breast

Electronic1 1 1 4 0 250000 0


2 2 4 12 0 30000 0


2 2 4 12 0 55 0


2 2 4 4 0 55 0


2 2 4 4 0 150 0

115


`

Sr. No.





2 2 4 10 0 150 0


8 8 16 5 0 150 0


8 8 16 0 0 175 0

26.7 Uterine Sound 2 2 4 5 0 90 026.8 Needle Holder

(7”)2 2 4 0 0 150 0

26.9 Needle Holder (10”)

2 2 4 12 0 300 0


16 16 32 16 0 110 0

26.11

Artery Forceps (Curved 6”)

16 16 32 16 0 125 0

26.12

Allis Forceps 8 8 16 10 0 230 0

26.13

Towel Clamps 8 8 16 8 0 125 0

26.14

Single blade Sims speculum

4 4 8 0 4 275 1100

26.15

Double blade Sims speculum

4 4 8 8 0 250 0

26.16

Sponge holding forceps

8 8 16 12 0 200 0

26.17

Volselum forceps 4 4 8 5 0 250 0

26.18

Uterine Sound 2 2 4 5 0 1500 0

26.19

Bladder Sound 2 2 4 1 1 1500 1500

27 Delivery Sets 10 10 15 027.1 Episiotomy

Scissors10 10 15 2 8 125 1000

27.2 Straight Scissors 10 10 15 6 4 360 144027.3 Needle holder 10 10 15 10 0 135 027.4 Non-toothed

tissue forceps 8 inches

10 10 15 12 0 100 0


10 10 15 12 0 100 0


20 20 30 12 0 275 0

116


`

Sr. No.





20 20 30 8 0 250 0


40 40 60 12 28 250 7000

27.9 Artery forceps 40 40 60 40 0 275 027.1 Straight clamps

(cord)20 20 30 20 0 175 0

27.11

Vacuum Extractor pump

1 1 1 0 0 19000 0

27.12

Towel clip 40 40 60 8 32 125 4000

28 Caesarian Section

6 8 10 2 4 0

28.1 Scalpel 6 8 10 10 0 50 028.2 Artery Forceps

Straight 6 inches24 32 40 24 0 125 0


24 32 40 24 0 125 0


24 32 40 24 0 175 0


6 8 10 2 4 150 600


6 8 10 3 3 270 810


24 32 40 12 12 300 3600


6 8 10 6 0 900 0

28.9 Doyene’s Retractor

6 8 10 1 5 200 1000

28.1 Small Retractors 12 16 20 6 6 300 180028.1

1Towel Clippers 24 32 40 8 16 125 2000

28.12

Suction Nozzle 6 8 10 2 4 250 1000


0

29.1 Ultrasound Machine

1 2 3 1 0 575000 0

29.2 X-Ray Unit 500 kw

1 1 1 1 0 6000000 0

29.3 Color Doppler 0 1 1 0 0 5750000 0

117


`

Sr. No.




29.4 Lead Screen for X-Ray Unit

1 1 1 0 1 30000 30000


1 1 1 0 1 100000 100000

29.6 Safe Light 1 1 1 0 1 5000 500029.7 X-RT Film

Processing Tank1 1 1 0 1 5000 5000

29.8 Chest Stand 1 1 1 0 1 4500 450029.9 X-Ray film

Illuminator2 2 2 0 2 4000 8000


4 4 4 0 4 4000 16000


0

30.1 Paediatric Ventilator

1 2 2 0 1 1200000 1200000

30.2 Incubator 1 1 2 2 0 1500000 030.3 Photo Therapy

Unit1 1 1 0 1 22000 22000

30.4 Over-head Radiant Warmer

1 1 1 0 1 910000 910000


2 2 2 0 2 5000 10000


2 2 2 1 1 3100 3100

30.7 Nebulizer 1 1 2 0 1 22000 2200030.8 Billiubino-meter 1 1 2 0 1 36000 3600030.9 Exchange Blood

Transfusion Set1 1 2 0 1 2000 2000

30.1 Nasal Probe Paed size

2 2 4 0 2 7000 14000

31 Anaesthesia/ICU 031.1 Anaesthesia

Machine1 1 2 1 1 321000 321000

31.2 Ventilators 1 1 1 1 1 525000 52500031.3 Nebulizer 1 1 1 0 1 165000 16500031.4 Pulse Oximetry 1 1 1 0 1 21000 2100031.5 Defibrillator 1 1 1 0 1 500000 50000031.6 Airway Oral and

Nasal2 3 4 0 2 500 1000

118


`

Sr. No.




31.7 Tracheostomy tube (adult and paeds)

2 2 4 0 2 1000 2000

31.8 Face mask of all sizes

2 2 4 0 2 1000 2000

31.9 Double Cuff Tourniquet (for regional block)

1 2 2 0 1 320 320

31.1 AMBO bag adult 2 2 4 1 1 2450 245031.1

1AMBO Bag paeds 2 2 4 0 2 3000 6000

31.12

Red Rubber Nasal tubes all sizes without cuff

4 4 8 0 4 1000 4000

32 Blood Bank 032.1 Blood storage

cabinet (100 bag capacity)

1 1 2 1 0 812000 0

32.2 Packed cell machine

1 1 1 0 1 600000 600000

32.3 Cell Separator 1 1 1 0 1 5225000 522500032.4 Freezer for Fresh

Frozen Plasma1 1 1 0 1 1150000 1150000

32.5 Blood bag shaker 1 1 2 0 1 10000 1000032.6 RH view box 2 2 4 1 1 1000 100032.7 Water bath 2 2 2 1 1 3000 300032.8 Micro-pipette 4 6 8 0 4 8000 3200032.9 Blood grouping

tiles3 3 6 0 3 3000 9000

32.1 Plasma Extractor 1 1 1 0 1 1000000 100000032.1

1Platelets agitator 1 1 1 0 1 1000000 1000000

32.12

Blood thawing bath

1 1 1 1 0 3000 0

32.13

Microscopes 1 1 2 1 0 115000 0


0

33.1 Hematology Analyzer

1 1 1 0 1 425000 425000

33.2 Electrolyte Analyzer

1 1 1 0 1 625000 625000

119


`

Sr. No.




33.3 Analyzer Bio-chemistry Semi-automatic

1 1 1 1 0 690000 0

33.4 Glucometer 2 2 2 0 2 2500 500033.5 Haemoglobino-

meter2 2 4 2 0 1000 0

33.6 Centrifuge 1 1 2 2 0 133000 0Grand Total 18926985

THQ HOSPITAL

Sr. No.

Equipment Standard as per MSDS Available Gap Cost/Unit Total Cost(Qty.)

C B A1 CTG (Cardiac

Tocography)1 1 1 0 1 285000 285000

2 Foetal Doppler 2 2 3 0 2 101000 2020003 Diagnostic

Laparoscope1 1 1 0 1 1200000 1200000

4 Bulb Sucker 5 10 20 2 3 45 1355 Baby Warmer 2 2 3 0 2 850000 17000006 Mechanical

Sucker3 3 3 0 3 28000 84000

7 Fetal Stethoscope 2 3 4 0 2 1500 30008 Delivery Table 2 2 2 2 0 17500 09 D&C Set 2 2 2 1 1 2100 2100

10 Outlet forceps 4 4 4 3 1 900 90011 Myoma Screw 2 2 2 1 1 320 32012 Kochers forceps 4 4 4 4 0 235 013 Volselum forceps 4 4 6 1 3 235 70514 Lanes Tissue

holding forceps2 2 2 0 2 400 800

15 Vaginal Retractors

4 4 6 0 4 350 1400

16 Polypectomy forceps

2 2 2 0 2 750 1500

17 Sponge holder 10 10 15 2 8 300 240018 Uterine elevator 1 1 1 0 1 150 150

19 CosCo Speculum 4 6 6 2 2 550 110020 Examination light 3 3 3 1 2 18000 3600021 Suction Curette 1 1 2 1 0 95 0

120


`

Sr. No.


C B A22 Infant

Resuscitation Trolley (with life saving medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light)

1 1 1 0 1 95000 95000


1 1 1 0 1 110000 110000

24 Cardiac Monitor 1 1 1 0 1 500000 50000025 Pump Breast

Electronic1 1 1 0 1 250000 250000


2 2 2 1 1 30000 30000


2 2 2 2 0 55 0


2 2 2 2 0 55 0


2 2 2 2 0 150 0


2 2 2 2 0 150 0


8 8 8 0 8 150 1200


8 8 8 0 8 175 1400

26.7 Uterine Sound 2 2 2 1 1 90 9026.8 Needle Holder

(7”)2 2 4 2 0 150 0

26.9 Needle Holder (10”)

2 2 2 2 0 300 0


16 16 16 0 16 110 1760

121


`

Sr. No.


C B A26.11 Artery Forceps

(Curved 6”)16 16 16 16 0 125 0

26.12 Allis Forceps 8 8 8 8 0 230 026.13 Towel Clamps 8 8 8 0 8 125 100026.14 Single blade Sims

speculum4 4 4 0 4 275 1100


4 4 4 0 4 250 1000


8 8 8 6 2 200 400

26.17 Volselum forceps 4 4 4 1 3 250 75026.18 Uterine Sound 2 2 2 1 1 1500 150026.19 Bladder Sound 2 2 2 0 2 1500 3000

27 Delivery Sets 6 6 10 2 4 027.1 Episiotomy

Scissors6 6 10 2 4 125 500

27.2 Straight Scissors 6 6 10 6 0 360 027.3 Needle holder 6 6 10 6 0 135 027.4 Non-toothed

tissue forceps 8 inches

6 6 10 6 0 100 0


6 6 10 0 6 100 600


12 12 20 0 12 275 3300


12 12 20 0 12 250 3000


40 40 40 5 35 250 8750

27.9 Artery forceps 40 40 40 20 20 275 550027.1 Straight clamps

(cord)20 20 30 0 20 175 3500

27.11 Vacuum Extractor pump

1 1 1 0 1 19000 19000

27.12 Towel clip 40 40 40 0 40 125 500028 Caesarian

Section4 4 6 2 2 0

28.1 Scalpel 4 4 6 0 4 50 20028.2 Artery Forceps

Straight 6 inches16 16 24 0 16 125 2000


16 16 24 16 0 125 0


16 16 24 16 0 175 0

122


`

Sr. No.


C B A28.5 Myoma Scissors

straight 7 inches4 4 6 0 4 150 600


4 4 6 0 4 270 1080


16 16 24 8 8 300 2400


4 4 6 0 4 900 3600

28.9 Doyene’s Retractor

4 4 6 1 3 200 600

28.1 Small Retractors 8 8 12 8 0 300 028.11 Towel Clippers 16 16 24 0 16 125 200028.12 Suction Nozzle 4 4 6 0 4 250 1000


0 0

29.1 Ultrasound Machine

1 1 2 1 0 575000 0

29.2 X-Ray Unit 500 kw

1 1 1 1 0 6000000 0

29.3 Color Doppler 0 0 0 0 0 5750000 029.4 Lead Screen for X-

Ray Unit1 1 1 0 1 30000 30000


1 1 1 1 0 100000 0

29.6 Safe Light 1 1 1 1 0 5000 029.7 X-RT Film

Processing Tank1 1 1 1 0 5000 0

29.8 Chest Stand 1 1 1 1 0 4500 029.9 X-Ray film

Illuminator2 2 2 2 0 4000 0


4 4 4 4 0 4000 0


0 0

30.1 Paediatric Ventilator

1 1 2 0 1 1200000 1200000

30.2 Incubator 1 1 1 1 0 1500000 030.3 Photo Therapy

Unit1 1 1 0 1 22000 22000

123


`

Sr. No.


C B A30.4 Over-head

Radiant Warmer1 1 1 0 1 910000 910000


2 2 2 0 2 5000 10000


2 2 2 1 1 3100 3100

30.7 Nebulizer 1 1 1 0 1 22000 2200030.8 Billiubino-meter 1 1 1 0 1 36000 3600030.9 Exchange Blood

Transfusion Set1 1 1 0 1 2000 2000

30.1 Nasal Probe Paed size

1 2 2 0 1 7000 7000

31 Anaesthesia/ICU 0 031.1 Anaesthesia

Machine1 1 1 1 0 321000 0

31.2 Ventilators 1 1 1 1 0 525000 031.3 Nebulizer 1 1 1 0 1 165000 16500031.4 Pulse Oximetry 1 1 1 1 0 21000 031.5 Defibrillator 1 1 1 0 1 500000 50000031.6 Airway Oral and

Nasal1 2 2 10 0 500 0

31.7 Tracheostomy tube (adult and paeds)

1 2 2 0 1 1000 1000

31.8 Face mask of all sizes

1 2 2 0 1 1000 1000

31.9 Double Cuff Tourniquet (for regional block)

1 1 1 0 1 320 320

31.1 AMBO bag adult 1 2 2 1 0 2450 031.11 AMBO Bag paeds 2 2 2 1 1 3000 300031.12 Red Rubber Nasal


4 4 4 0 4 1000 4000

32 Blood Bank 0 032.1 Blood storage

cabinet (100 bag capacity)

1 1 1 2 0 812000 0

32.2 Packed cell machine

1 1 1 0 1 600000 600000

32.3 Cell Separator 1 1 1 0 1 5225000 522500032.4 Freezer for Fresh

Frozen Plasma1 1 1 0 1 1150000 1150000

32.5 Blood bag shaker 1 1 1 0 1 10000 1000032.6 RH view box 1 2 2 1 0 1000 0

124


`

Sr. No.


C B A32.7 Water bath 2 2 2 0 2 3000 600032.8 Micro-pipette 4 4 6 0 4 8000 3200032.9 Blood grouping

tiles3 3 3 0 3 3000 9000

32.1 Plasma Extractor 1 1 1 0 1 1000000 100000032.11 Platelets agitator 1 1 1 0 1 1000000 100000032.12 Blood thawing

bath1 1 1 0 1 3000 3000

32.13 Microscopes 1 1 1 1 0 115000 033 Gynae & Labour

Room Related Laboratory Equipment

0 0

33.1 Hematology Analyzer

1 1 1 0 1 425000 425000

33.2 Electrolyte Analyzer

1 1 1 0 1 625000 625000

33.3 Analyzer Bio-chemistry Semi-automatic

1 1 1 0 1 690000 690000

33.4 Glucometer 2 2 2 1 1 2500 250033.5 Haemoglobino-

meter1 1 1 1 0 1000 0

33.6 Centrifuge 1 1 1 1 0 133000 0Grand Total 18276260

125

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