Acronyms - Punjabphsrp.punjab.gov.pk/downloads/3yrp/muzaffargarh.docx · Web viewEach element has...

Three Years Rolling Plan 2010-2013 District Muzaffargarh

THREE YEARS ROLLING PLAN 2010-2013

DISTRICT MUZZAFARGARH


Table of ContentsAcronyms..............................................................................................................5Executive Summary..............................................................................................7SECTION 1: DISTRICT HEALTH PROFILE...............................................................91. Vision of the District........................................................................................92. Background of the District..............................................................................93. Map of the District.........................................................................................104. Demography.................................................................................................115. Socio-Economic Indicators............................................................................126. Health Indicators...........................................................................................137. Organizational Structure of District Health Administration...........................13Organogram of District Muzaffargarh.................................................................148. Health Resources..........................................................................................15

A. Health Facilities................................................................................15i. Public.............................................................................................15ii. Private...........................................................................................15

B. Human Resource..............................................................................15i. Administrative................................................................................16ii. Facility Based.................................................................................16iii. Outreach.....................................................................................22iv. Training Institutions....................................................................22

C. Health Financing...............................................................................239. Disease Pattern.............................................................................................2410. Status of Vertical Programs........................................................................26

a. National Program for FP & PHC.........................................................26b. EPI.....................................................................................................26c. MNCH Program.................................................................................26d. TB Control Program..........................................................................26e. Malaria Control Program...................................................................27f. Hepatitis Control Program................................................................27g. School Health Services Program.......................................................27

SECTION 2: PROBLEM ANALYSIS........................................................................28


1. Objectives.....................................................................................................282. Plan Development Process............................................................................29i. Problem Identification...................................................................................30a. Health Problems............................................................................................30ii. Problem Prioritization....................................................................................31iii. Underlying causes of prioritized problems.................................................32b. Service delivery/Management problems.......................................................33

Underlying causes of Management Problems.........................................343. MDGs and MSDS...........................................................................................35

a) Human Resource..............................................................................35i. DHQ Hospital (Category C)............................................................36ii. THQ Hospitals................................................................................36

b) Equipment........................................................................................37i. DHQ Hospital.................................................................................37ii. THQ Hospital Kot Adu...................................................................43iii. THQ Hospital Alipur.....................................................................48

SECTION 3: INTERVENTIONS AND TARGETS.....................................................56a) Health Problems............................................................................................56b) Management Problems.................................................................................67SECTION 4: COSTING AND FINANCING PLAN....................................................771. Activity based costing...................................................................................77

a) Health Problems...............................................................................77b) Management Problems.....................................................................89

1. Inadequate allocation of budget for POL.........................................................907. Financial Outlay............................................................................................99

I. Health Problems...............................................................................99II. Management Problems................................................................100

8. Summaries..................................................................................................101I. Problem-wise Costing.....................................................................101

a) Health Problems..........................................................................101b) Management Problems................................................................102

II. Activity-wise Costing......................................................................103a) Health Problems..........................................................................103


b) Management Problems................................................................107SECTION 5: MONITORING & EVALUATION.......................................................111M&E of Plan.......................................................................................................111Annex-I..............................................................................................................115Annex-II.............................................................................................................117


Acronyms3YRP Three Years Rolling planADB Asian Development BankAE Assistant EntomologistAPMO Additional Principal Medical OfficerARI Acute Respiratory InfectionsASV Assistant Superintendent VaccinationBHU Basic Health CenterBoD Burden of DiseaseCDC Communicable Disease ControlCDR Case Detection RateCPR Contraceptive Prevalence Rate DC District CoordinatorDHIS District Health Information SystemDHQH District Head Quarter HospitalDoH Department of HealthDR Default RateDSV District Superintendent VaccinationEDO(H) Executive District Officer HealthEPI Expended Program on Immunization HSRP Health Sector Reforms ProgramIMR Infant Mortality RateIPC Interpersonal CommunicationIV Inspector VaccinationM & E Monitoring and EvaluationM & R Maintenance and RepairMCH Maternal Child HealthMMR Maternal Mortality RatioMNCH Maternal Newborn and Child HealthMO Medical OfficerMoV Means of VerificationMSDS Minimum Service Delivery StandardsPDSSP Punjab Devolved Social Services ProgramPHC Primary Health CarePMO Principal Medial Officer


POL Petrol, Oil and LubricantRHC Rural Health CenterSCR Sputum Conversion RateSHC Secondary Health CareSMO Senior Medical OfficerTAMA Technical Assistance Management AgencyTB TuberculosisTHQH Tehsil Head Quarter HospitalTNA Training Need AssessmentWHO World Health OrganizationWMO 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 MUZAFFARGARRH

SECTION 1: DISTRICT HEALTH PROFILE

1. Vision 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.

2. Background of the District

This is the most underdeveloped region with little or no social and physical infrastructure to promote development. There is very little social cohesion among the people here due to marginalization during the colonial period and the stranglehold of feudalism since independence.

Geographical location: District Muzaffargarh lies in the form of a strip between the river Chenab and Indus, which passes along the Eastern and Western boundaries respectively of the district and forms a triangle at Alipur tehsil of the district. The district is bounded on the North by district Layyah, on the South by Bahawalpur and Rahimyar Khan Districts across the river Chenab. Districts Multan and Khanewal are on the Eastern side of district Muzaffargarh, across the river Chenab. District Jhang also touches on North-East. While Dera Ghazi Khan and Rajanpur districts lie on the Western side across the river Indus. Muzarffargarh is about 34 Kilometers away from Multan.

Communication linkages (Roads, Railway): The district has a total Metalled road-length of 1084 Kilometers. The district is linked with Multan, Rajanpur, D.G.Khan and Rahimyar Khan Districts


through metalled roads; while it is linked with Multan and D.G.Khan districts through railway network

Topography: Underground water resources are adequate in the district. The sub soil water throughout the district, except the belt in between Chowk Sarwar Shaheed and Rangpur is sweet where the sub soil water is brackish.

Source of livelihood: Major crops fruits and vegetables are Wheat, Sugarcane and Cotton; Mangoes, Dates, Citrus and Pomegranate; and Onion, Carrot, Cauliflower and Peas. 102110 acres of land is covered by forests.

3. Map of the District


4. Demographyo Total Population 3927996

o Annual growth rate 3%

o Population density 319.5 persons per sq. km

Area-wise population

Area Population PercentageRural 549919 14%Urban 3378076 86%

Source: DCR-1998

Gender-wise population

Gender Population PercentageMale 2034701 51.8%

Female 1893294 48.2% Source: DCR-1998

Population groups

Population Groups Standard Demographic (%)

Estimated Population

Under 1 year of age 2.7 106056

Under 5 years 13.4 526351

Under 15 years 44 1728318

Women in child bearing age (15-49 years)

22 864159

Married Child Bearing age Women 16 628479

Expected pregnancies 3.4 133552

Source: DHIS


Tehsil wise distribution

Tehsil Number of UC Population

Alipur 14 597450

Kotadu 28 1192259

M.Garh 35 1485680

Jatoi 16 652607Source: Bureau of Statistics (Census 1998)

5. Socio-Economic Indicators

Education and Literacy

Literacy rate Male FemaleOverall District 41% 14.08%

Age group Literacy RateLiteracy rate 10+ years 45%Adult literacy rate 15+ years 41Adult literacy rate 15+ years 55%

Source: EDO Education& MICS 2007

Housing: o Household characteristics:

- Finished floor (pacca) 35 - Finished roof (pacca) 64 - Finished wall (pacca) 53

Mean household size 6.6

Persons per room 4.1


Rooms per housing unit 5.4

Water and Sanitation

o Safe drinking water without bacteria 99%

o Proper disposal of Waste water 99%

o Proper disposal of Solid waste 0.5%

o Hand washing adequately before meal 47%

o Hand washing adequately after using latrine 51%

(Source: MICS 2007-08)

6. Health Indicators Infant Mortality Rate 128/1000 L.B

Under 5 mortality Rate 86/1000 L.B

Maternal mortality Ratio 195/100000 L.B

Malnutrition children less then 5yrs

o Underweight prevalence (moderate & severe) 43o Underweight prevalence (severe) 14

Life expectancy 65 years

Proportion of children under 2 years immunized 85

Source: MICS 2007-2008


7. 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:

Organogram of District Muzaffargarh


8. Health Resources

A. Health Facilitiesi. Public

Details of physical infrastructure of public health facilities in the district is given in the table below

Facility TypeName/

Number of Facility

Bed Strength

No. of Functional

BedsRemarks

DHQ Hospital 1 240 240 -------

ORGANIZATION CHART (HEALTH DEPT.) MUZAFFARGARH Executive District Officer (H)

Muzaffargarh

DOH M.Garh

Secretary DCQB

Drug Insp. M.Garh

Sup. EDO(H)

DSI

Prog Director DHDC

Med Supt. DHQ/THQ

s

Vertical Program

DDOH

Dist.Coord NP

DSV CDCO Principal SN DHQ

ASV(3)

Vacc.

NP

CDCI TSI(3) 13-RHC

Steno

MNCH

UNFFA TB DOTS

NCHD

Clerks

71-BHU Out Reach

Teams

CDC Sup.

SI

Adnan Leghari


Facility TypeName/

Number of Facility

Bed Strength

No. of Functional

BedsRemarks

THQ Hospital 2 100 100 -------RHCs 13 260 260 -------BHUs 71 142 142 -------Govt. Rural Dispensaries 3 -- -- -------MCH Centers 4 -- -- --Sub Health Centers 26 -- -- --TB Hospital 1 36 36City Dispensaries 1 -- -- --Health houses 2215 -- -- --Data source: DHIS/EDOH office

ii. PrivateThe 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 need to develop an effective coordination between public and private sector. Detailed list of private sector health facilities is attached as Annex-I.

B. Human Resource The Human resource of district health department has been placed in following categories:

i. Administrativeii. Facility basediii. Outreachiv. Training institutions

i. AdministrativeSr. No.

Name of Post Sanctioned

Filled

1 Executive District Officer Health 1 12 District Officer Health 1 13 Deputy District Officer Health 4 44 Program Director DHDC 1 1


5 District Coordinator National Program

*0 1

6 District Coordinator EPI Surveillance

*0 1

7 District Sanitary Inspector 1 08 CDC Officer 1 19 CDC Inspector 3 010 Drug Inspector 5 511 District Superintendent

Vaccination1 1

12 Assistant Superintendent Vaccination

3 3

13 Tehsil Sanitary Inspector 3 314 Inspector Vaccination 3 3

*The post is not sanctioned

ii. Facility Baseda. Basic Health Units Sr. No.

Name of Post/ Designation

Sanctioned Filled Vacant

1 Medical Officer 71 69 22 School Health &

Nutrition Supervisor 71 68 3

3 Medical Assistant 14 10 44 Computer Operator 71 56 155 Medical Technician 57 55 26 LHV 71 71 07 Dispenser 71 67 48 Midwife 213 113 1009 N/Qasid 71 71 010 Chowkidar 71 71 011 Sanitary Worker 27 0 27


b. Rural Health CentreSr. No.

Name of Post/Designation


1 Senior Medical Officers

13 12 1

2 Women Medical Officers

13 12 1

Woman Medical Officer (MNCH)

13 10 3

3 Dental Surgeons 13 12 14 Medical Officers 13 12 15 Charge Nurses 78 68 106 Homeo Doctors 0 0 07 Hakeems 1 1 08 Computer Operators 13 4 99 Medical /Health

Technician8 8 0

10 LHV 26 26 0LHV (MNCH) 13 13 0

11 Lab. Technician 13 2 1112 Dental Technician 13 3 1013 R.H.I 34 31 314 Junior Clerk 13 6 715 Vaccinator 18 14 416 Homeo Dispenser 0 0 017 Dawasaz 1 1 018 Radiographer 14 14 019 Dresser 13 13 020 Anesthesia Assistant 13 0 1321 O.T.A 13 13 022 Dispenser 39 37 223 Dental Assistant 0 0 024 Laboratory Assistant 13 13 025 Midwife 51 51 026 Driver 15 15 027 T.O 13 13 028 Homeo Naib Qasid 0 0 029 Dawa Kob 1 1 030 Ward Servant 38 38 031 Sweepers 38 38 032 Sanitary Worker 26 6 2033 Sanitary Patrol 51 51 0


Sr. No.

Name of Post/Designation


34 Naib Qasid 36 36 035 Mali 13 13 036 Cook 13 13 037 Chowkidar 26 26 038 Water Carrier 13 13 0

c. THQ Hospitals (Ali Pur & Kot Adu) Sr. No. Name of post Sanctioned Filled

1 Medical Superintendent 2 2

2 APMO. 4 43 APWMO. 2 24 Gynecologist 4 45 Pediatrician 2 26 Surgeon 2 2

7 MO/CMO 18 18

8 WMO 5 59 Dental Surgeon 2 210 Hospital Pharmacist 2 2

Head Nurse 2 211 Head Nurse 1 112 Charge Nurses 22 2213 Homeo Doctor 2 214 Hakim 2 215 LHV. 1 1

16 Clerk 2 217 Dispenser/Dresser 12 12


Sr. No. Name of post Sanctioned Filled

18 Homeo Dispenser 2 219 Dawasaz 2 220 OTA 2 221 Radiographer 4 422 Laboratory Assistant 4 423 Dental Assistant 0 0

24 Driver 2 225 Ward servant 12 1226 NQ 2 2

27 Dawakob 2 228 Bearer 0 0

29 Ward Barrier 1 130 Gate Keeper 2 231 Mashki 3 332 Baildar 2 233 Chowkidar 2 234 Cook 2 2

35 Sweeper 7 7

d. DHQ Hospital Sr. No. Name of post Sanctioned Filled

1Medical Superintendent 1 1

2 Chief Consultant 1 03 PMO 0 04 PWMO 0 0



5 AMS 0 06 APMO 5 57 APWMO 3 3

8Causality Medical Officer 6 2

9 Physician 1 110 Anesthetist 1 111 Cardiologist 1 012 Chest specialist 1 113 DMS / SMO 2 214 Neuro Surgeon 0 0

15Nursing Superintendent

1 0

16 Nursing Instructor 1 0

17Deputy Nursing Instructor 1 0

18 Nephrologist 0 019 Pediatrician 1 120 Pathologist 1 121 Radiologist 1 122 Chief Radiologist 1 023 Surgeon 1 124 E.N.T. Specialist 1 125 Eye Specialist 1 1

26Senior Dental Surgeon 1 1

27 Urologist 1 028 Dental Surgeon 2 2

29Internees/House Officer

2 2

30 Medical Officer 9 931 Pharmacist 1 132 Physiotherapist 1 033 W.M.O 2 234 Charge Nurses 28 2635 Head Nurse 7 236 Male Nurse 0 0



37 Hakeem 1 138 Homeo Doctor 1 139 Almoner 0 040 Computer Operator 0 041 Stenographer 0 042 Accountant 0 0

43E.C.G. Haemo & CT Technician 1 1

44 Senior Clerk 1 145 Sanitary Inspector 0 046 Junior Clerk 3 347 Dawasaz 1 148 Dispenser 10 1049 Homeo Dispenser 1 1

50Operation Theater Assistant 5 5

51Physiotherapist Aide

0 0

52 Radiographer 7 753 Dental Assistant 0 054 Lab. Assistant 7 755 Store Keeper 1 156 Driver 1 157 Midwife 3 358 Tailor Master 0 059 Tube well Operator 0 060 Lab. Attendant 1 161 O.T. Attendant 0 062 X-Ray Attendant 1 163 Bearer 2 264 Baildar 4 465 Chowkidar 5 566 Cook 4 467 Dawakob 1 168 Dhobi 2 269 Gate Man 1 1



70 Mali 1 171 Masalchi 0 072 Sanitary Worker 2 073 Sweeper 22 2274 Ward Cleaner 1 175 Ward Servant 26 2676 Water Carrier 3 377 Naib Qasid 5 5

iii. OutreachThis information is about outreach program workers such as Vaccinators, CDC Supervisors and Sanitary Inspectors which are not part of above mentioned health facilities.

Post Sanctioned FilledVaccinators 110 102

CDC Supervisors 76 66Sanitary Inspectors 69 65Nutrition Supervisor 71 68

iv. Training InstitutionsA number of training institutions are working in the district, which include the following:

Type of institute NumberDHDC 1General Nursing school & Midwifery school 1

a) DHDC Post Sanctioned Filled

Programme Director 1 1MPPT 1 0LHV Trainer 1 0


Assistant 1 1Driver 1 1Naib Qasid 1 1Chowkidar 2 2Sanitary Worker 1 1

b) General Nursing & Midwifery School

Name of Post/Designation Sanctioned FilledPrincipal School of Nursing 1 1Nursing Instructor 3 3House Keeper 1 0Sweeper 3 3Naib Qasid 2 1Chowkidar/Gate Keeper 4 4Cook 2 1Masalchi 0 0Clinical instructor 0 0Public Health Nursing Supervisor 2 2Stenographer 1 1Head clerk 1 0Accountant 1 1Senior clerk 1 0Junior clerk 1 1Aya 2 2

C. 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 up to

03/2010Allocatio

n Exp. Allocation Exp. Allocatio

n Exp.

Non-Development 438.42 341.49 532.09 596.64 781.52 780.423

Development 102.63 71.05 76.004 61.128PHSRP 3.935 3.135 143.000 58.525 -- --PMDGP -- -- 107.84 -- 107.84 69.29PDSSP 34.173 -- 34.173 16.394 38.227 38.171Provincial Development Funds (ADP)

Not Applicable

Not Applicable

Not Applicable

Not Applicable

280.790(Will be allocated)

Grand Total 579.158 344.625 888.153 671.559 1003.591 949.012User charges (like parchi fee, fees for diagnostic services)

2.790 -- 2.840 -- 3.124 --

9. 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 Magnitude

Respiratory Diseases

1Acute (Upper) Respiratory Infections

11.110

2 Pneumonia <5 years 0.9933 Pneumonia >5 years 0.7094 TB Suspects 0.469



5Chronic Obstructive Pulmonary Diseases

0.449

6 Asthma 0.925Gastro Intestinal Disease

7 Diarrhoea/Dysentery in <5 yrs 2.5758 Diarrhoea/Dysentery in >5 yrs 2.1039 Enteric / Typhoid Fever 0.204

10 Worm Infestations 1.97711 Peptic Ulcer Diseases 1.55012 Cirrhosis of Liver 0.022

Urinary Tract Diseases 13 Urinary Tract Infections 0.82014 Nephritis/Nephrosis 0.05715 Sexually Transmitted Infections 0.04316 Benign Enlargement of Prostrate 0.54

Other Communicable Diseases 17 Suspected Malaria 1.22418 Suspected Meningitis 0.00319 Fever due to other causes 2.567

Vaccine Preventable Diseases 20 Suspected Measles 0.00321 Suspected Viral Hepatitis 0.01822 Suspected Neo Natal Tetanus 0.0004

Cardiovascular Diseases 23 Ischemic Heart Disease 0.03324 Hypertension 0.374

Skin Diseases 25 Scabies 4.05926 Dermatitis 0.98827 Cutaneous Leishmaniasis 0.0014

Endocrine Diseases 28 Diabetes Mellitus 0.256

Neuro-Psychiatric Diseases 29 Depression 0.35830 Drug Dependence 0.03931 Epilepsy 0.033

Eye & ENT 32 Cataract 0.11833 Trachoma 0.07934 Glaucoma 0.01435 Otitis Media 0.472

Oral Diseases 36 Dental Caries 0.659

Injuries / Poisoning 37 Road traffic accidents 0.590



38 Fractures 0.07139 Burns 0.17140 Dog bite 0.123

41Snake bite (with signs/symptoms of poisoning)

0.028

Miscellaneous Diseases (Surveillance Importance) 42 Acute Flaccid Paralysis 0.0004543 Suspected HIV/AIDS 0

Any other Unusual Diseases (Specify) 0.0

Source: DHIS Report

10. Status of Vertical Programs

The 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.

a. National Program for FP & PHC No. of seats allocated for LHWs 2215 No. of LHWs working 2193 Percentage of Population covered by the program 62 % Important program indicators

o IMR 32/1000o MMR 152/100000o CPR 49%o No. of antenatal visits 90%o TT Coverage of pregnant women 87%

b. EPI EPI Coverage rate of the district 85% Fully immunized children 0-23 months 85% Pregnant women received TT vaccine ( TT-2) 49% Availability of cold chain equipment 70


(Health Facilities carefully equipped with cold chain while remaining 17 are facing equipment shortage along with repair and maintenance problem).

c. MNCH Program CMW Students Admitted 53 Passed 53 Fresh CMWs batch 40

d. TB Control Program CDR all types 68% CDR NSS positive 44% SCR 90% TSR 91% DR 4%

e. Malaria Control Program No. of slides examined 60027 No. of positive slides 605 Slides positivity ratio 1.008%

Percentage of plasmodium falciparum 13.2%

f. Hepatitis Control Program No. of hepatitis tests conducted 404 No. of positive cases detected 31 (B)&(C) No. of persons vaccinated against Hepatitis B 3195 No. of cases treated for Hepatitis B 31 No. of cases treated for Hepatitis C 193 No. of positive C-Positive cases detected 379 No. of persons vaccinated against Hepatitis B ------

No. of cases treated for Hepatitis B 84 No. of cases treated for Hepatitis C 647


g. School Health Services Program

Source: DHDC Muzaffargarh

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.

Total Visits to the School 2616

No. Students Examined 24164No of students referred to BHUs

9366

No. Students Treated at BHU 22071No. of Students referred from BHU to higher facilities

30841

No. of Schools in catchment Areas

2120 ( 923 Girls+1197 boys)

No. of Students 314578No of Teachers Trained 5307 ( 6490)

No of SH & NS 69


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.

1. 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.


2. Plan Development ProcessPlan 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 headquarters. 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

i. Problem IdentificationThis 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.

a) Health Problemsb) Health Service Delivery or Management Problems

a. Health ProblemsThe district specific health problems identification process started during the three years rolling plans workshop. The planning team in the initial stage prepared a long list of the health problems. The identification of health problems was based on various information sources including DHIS, and district specific reports. The enlisted health problems of the district are given in the following table.

1. Diarrhea2. Hepatitis (B&C)3. Trauma4. Diabetes5. Hypertension6. Scabies7. Malaria8. Drug Addiction9. Complications of pregnancy 10.Scabies

ii. Problem PrioritizationWHO has developed standard criteria for prioritization of health problems; which is based on the following five elements:

Magnitude Severity/danger Vulnerability to intervention (feasibility) Cost-effectiveness of the intervention Political expediency

Each element has been assigned a score from 1 to 4 depending upon grade/scale of that element i.e. Very High=4, High=3, Medium=2 and Low=1.


Elements of the prioritization criteria were applied to each of the enlisted health problems. The aggregate of individual scores assigned to the elements of the prioritization criteria gave the total score for a health problem. This total score was then used to prioritize the health problems. A cut-off point was decided, to establish the priority health problems of the district. These problems will be addressed in the three years rolling plan.

Problem Magnitude

Severity

Vulnerability to

intervention

Cost Effectiven

ess

Political Expedien

cy

Total Score

Priority Numbe

r

Diarrhea 4 4 4 4 4 20 1

Hepatitis (B&C)

4 4 3 2 3 16 3

Trauma 4 3 4 3 3 17 2

Diabetes 3 3 3 4 2 15 4

Hypertension 4 3 3 3 2 15 4

Malaria 3 2 4 3 2 14 5

Drug Addiction

2 1 2 1 1 7 6

Complications of pregnancy

3 3 3 4 3 16 3

iii. Underlying causes of prioritized problemsHealth 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 pertaining to the district.

Sr. #

Health Problem Causes

1. Diarrhoeal Diseases

Poor sanitation Lack of safe drinking water Unhygienic practices Lack of awareness among mothers about

feeding and weaning practices


Sr. #

Health Problem Causes

Low EPI coverage6. Accidents and

injuries Lack of traffic sense Poor maintenance of vehicles Poor road conditions Lack of safety measures at work place Fire-arm injuries Domestic accidents Burns Bomb blasts/terrorist activities Lack of tolerance in the society

15. Complications of pregnancy

Low access to appropriate health services

Lack of awareness about danger signs of pregnancy

Three delays (seeking health care, transportation, and lack of referral back-up services)

Lack of skilled birth attendants19. Hepatitis (B&C) Poor sanitation

Unsafe drinking water Sharing of used syringes Transfusion of unsafe/unscreened blood

and blood products Unsafe sexual practices Ear piercing and tattooing Use of unsterilized equipment by

dentists and barbers26. Resistant Malaria

(Falciparum) Breeding places for mosquitoes Decline area of district Lack of awareness for prevention

27. Diabetes Obesity Inactive life style Lack of recreational sites Genetics

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:

Underlying causes of Management ProblemsSr. #

Service Causes

1. Inadequate allocation of budgets for POL

Frequent increase in prices of POL Less allocation for POL budget Usage of POL in generators

2. Shortage of skilled (MNCH) staff

Vacant positions Non-availability of sanctioned posts as

per MSDS 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 interference3. Inadequate

budget for medicines and supplies

Less budget allocation for medicines Frequent increase in drug prices

5. Deficient infrastructure for

Debilitated condition of existing infra-structure

1. Inadequate allocation of budgets for POL2. Inadequate medical and paramedical staff3. Lack of functional equipment4. Inadequate civil structure/buildings 5. Undue political interference 6. Deficiency of vehicles/ lack of transport for supervisory

staff


MNCH services at primary and secondary care facilities with reference to MSDS

Lack of repair and maintenance Inadequate infrastructure for

Emergency, Operation Theatre, OPD and Inpatients, residences for staff at THQ and DHQ hospitals

Lack of blood transfusion services especially at THQ

Lack of back-up electrical power facilities

10. Lack of equipment (with reference to notified list) at all levels of care

Cumbersome procedure to procure new equipment

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

11. Shortage of functional vehicles including ambulances

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

3. MDGs and MSDSThe 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.

In order to achieve the MDGs, the government of Punjab has adopted MSDS as strategic framework. During the development of three years rolling plans, gaps under MSDS focusing on MNCH interventions have been identified. Most essential areas for which gaps have been identified


are human resource and equipment of DHQ and THQ hospitals, as per lists notified by the government in accordance with MSDS standards.

a) Human ResourceWith 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 (Category C) Sr. No.

Post Standard as per

MSDS

Sanctioned

Filled

Vacancy Gap in relation

to sanctio

ned position

s

Vacancy Gap

in relatio

n to filled

positions

1. Gynaecologist 3 3 3 0 02. Paediatricians 3 1 1 2 23. Anesthetists 3 1 1 2 24. Medical Officers

/WMO/APMO/APWMO101 27 19 74 82

5. Lady Health Visitors 11 1 1 10 106. Nurses 90 35 28 55 62

ii. THQ Hospitals There are two THQ hospitals in the district. THQ Kot Adu is a Category B hospital, while THQ hospital Ali pur belongs to Category C. A composite list of MSDS gap analysis for human resource, for both these hospitals is given below:

Sr. Post Standa Sanction Filled Vacancy Vacanc


No. rd as per

MSDS

ed Gap in relation

to sanction

ed position

s

y Gap in

relation to filled positio

ns

1. Gynaecologist 4 4 4 0 02. Pediatricians 4 2 2 2 23. Anesthetists 6 2 1 4 54. Medical officers

including SMO, APMO, PMO

35 22 22 13 13

5. Women Medical Officers including SWMO, APWMO, PWMO.

19 7 7 12 12

6. Nurses 39 23 23 16 167. Lady Health

Visitors16 1 1 15 15

b) EquipmentGovernment 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 costs of equipment gaps according to MSDS are attached as Annex-2.


i. DHQ HospitalSr. No.

Equipment Standard as per MSDS(Qty.)

Available

Gap Remarks

C B A1 CTG (Cardiac

Tocography)1 1 2 2 0

2 Foetal Doppler 3 5 5 0 33 Diagnostic

Laparoscope1 1 2 0 1

4 Bulb Sucker 10

20

20

3 7

5 Baby Warmer 3 3 6 2 16 Mechanical Sucker 3 3 6 15 07 Fetal Stethoscope 4 4 4 0 48 Delivery Table 2 2 3 4 09 D&C Set 2 3 4 4 0

10 Outlet forceps 4 4 4 8 011 Myoma Screw 2 2 2 1 112 Kochers forceps 4 4 8 0 413 Volselum forceps 6 8 1

08 0

14 Lanes Tissue holding forceps

2 2 4 4 0

15 Vaginal Retractors 10

10

10

3 7

16 Polypectomy forceps

2 2 2 3 0

17 Sponge holder 10

15

20

33 0

18 Uterine elevator 1 1 1 0 119 CosCo Speculum

Small, Medium, Large (for each category)

6 10

10

6 0

20 Examination light 3 3 6 1 221 Suction Curette 1 2 2 2 0


Sr. No.


Available

Gap Remarks

C B A22 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 4 025 Pump Breast

Electronic1 1 1 0 1

26 Vaginal Hysterectomy Set

26.1 Toothed Tissue Forceps (8”)

2 2 4 54 0

26.2 Non-Tooted Tissue Forceps (8”)

2 2 4 54 0

26.3 Dissection Scissors (Curved 7”)

2 2 4 17 0

26.4 Dissection Scissors (Straight 7”)

2 2 4 20 0

26.5 Hysterectomy Clamps (Straight)

8 8 16

25 0

26.6 Hysterectomy Clamps (Curved)

8 8 16

30 0

26.7 Uterine Sound 2 2 4 2 026.8 Needle Holder (7”) 2 2 4 30 026.9 Needle Holder

(10”)2 2 4 8 0


Sr. No.


Available

Gap Remarks

C B A26.1

0Artery Forceps (Straight 6”)

16

16

32

50 0

26.11

Artery Forceps (Curved 6”)

16

16

32

104 0

26.12

Allis Forceps 8 8 16

106 0

26.13

Towel Clamps 8 8 16

51 0

26.14

Single blade Sims speculum

4 4 8 4 0

26.15

Double blade Sims speculum

4 4 8 4 0

26.16

Sponge holding forceps

8 8 16

33 0

26.17

Volselum forceps 4 4 8 2 2

26.18

Uterine Sound 2 2 4 2 0

26.19

Bladder Sound 2 2 4 2 0

27 Delivery Sets27.1 Episiotomy

Scissors10

10

15

5 5

27.2 Straight Scissors 10

10

15

20 0

27.3 Needle holder 10

10

15

30 0

27.4 Non-toothed tissue forceps 8 inches

10

10

15

54 0

27.5 Toothed tissue forceps 8 inches

10

10

15

54 0

27.6 Sims Speculum single blade

20

20

30

4 16

27.7 Sims Speculum double blade

20

20

30

0 20

27.8 Sponge holding forceps

40

40

60

33 7

27.9 Artery forceps 40

40

60

104 0


Sr. No.


Available

Gap Remarks

C B A27.1

0Straight clamps (cord)

20

20

30

25 0

27.11

Vacuum Extractor pump

1 1 1 0 1

27.12

Towel clip 40

40

60

51 0

28 Caesarian Section

28.1 Scalpel 6 8 10

27 0

28.2 Artery Forceps Straight 6 inches

24

32

40

50 0

28.3 Artery Forceps Curved 6 inches

24

32

40

104 0

28.4 Artery forceps 8 inches

24

32

40

30 0

28.5 Myoma Scissors straight 7 inches

6 8 10

1 5

28.6 Dissecting scissors (curved) 7 inches

6 8 10

17 0

28.7 Green Armtage forceps 8 inches

24

32

40

20 4

28.8 Obstetric outlet forceps (pair)

6 8 10

8 0

28.9 Doyene’s Retractor 6 8 10

8 0

28.10

Small Retractors 12

16

20

43 0

28.11

Towel Clippers 24

32

40

51 0

28.12

Suction Nozzle 6 8 10

8 0

29 MNCH Related Radiology Equipments

29.1 Ultrasound Machine

1 2 3 3 0

29.2 X-Ray Unit 500 kw 1 1 1 4 029.3 Color Doppler 0 1 1 0 0


Sr. No.


Available

Gap Remarks

C B A29.4 Lead Screen for X-

Ray Unit1 1 1 2 0

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

1 1 1 6 0

29.6 Safe Light 1 1 1 2 029.7 X-RT Film

Processing Tank1 1 1 2 0

29.8 Chest Stand 1 1 1 4 029.9 X-Ray film

Illuminator2 2 2 2 0

29.10

X-Ray Film Hangers All sizes

4 4 4 30 0

30 MNCH Related Paediatrics Equipments

30.1 Paediatric Ventilator

1 2 2 0 1

30.2 Incubator 1 1 2 3 030.3 Photo Therapy Unit 1 1 1 1 030.4 Over-head Radiant

Warmer1 1 1 2 0

30.5 Infant Length Measuring Scale

2 2 2 1 1

30.6 Infant Weighing Machine

2 2 2 1 1

30.7 Nebulizer 1 1 2 12 030.8 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 2

31 Anaesthesia/ICU31.1 Anaesthesia

Machine1 1 2 4 0

31.2 Ventilators 1 1 1 1 031.3 Nebulizer 1 1 1 12 031.4 Pulse Oximetry 1 1 1 1 0


Sr. No.


Available

Gap Remarks

C B A31.5 Defibrillator 1 1 1 3 031.6 Airway Oral and

Nasal2 3 4 3 0

31.7 Tracheostomy tube (adult and paeds)

2 2 4 1 1

31.8 Face mask of all sizes

2 2 4 2 0

31.9 Double Cuff Tourniquet (for regional block)

1 2 2 2 0

31.10

AMBO bag adult 2 2 4 5 0

31.11

AMBO Bag paeds 2 2 4 5 0

31.12

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 0 1

32.2 Packed cell machine

1 1 1 0 1

32.3 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 5 032.6 RH view box 2 2 4 0 232.7 Water bath 2 2 2 0 2

32.8 Micro-pipette 4 6 8 0 432.9 Blood grouping

tiles3 3 6 0 3

32.10

Plasma Extractor 1 1 1 0 1

32.11

Platelets agitator 1 1 1 0 1

32.12

Blood thawing bath 1 1 1 0 1


Sr. No.


Available

Gap Remarks

C B A32.1

3Microscopes 1 1 2 0 1

33 Gynae & Labour Room Related Laboratory Equipment

33.1 Hematology Analyzer

1 1 1 0 1

33.2 Electrolyte Analyzer

1 1 1 0 1

33.3 Analyzer Bio-chemistry Semi-automatic

1 1 1 0 1

33.4 Glucometer 2 2 2 0 233.5 Haemoglobino-

meter2 2 4 0 2

33.6 Centrifuge 1 1 2 0 1ii. THQ Hospital Kot Adu Sr. No.


Available

Gap Remarks

C B A1 CTG (Cardiac

Tocography)1 1 1 0 1



4 Bulb Sucker 5 10

20

01 9

5 Baby Warmer 2 2 3 01 16 Mechanical Sucker 3 3 3 0 37 Fetal Stethoscope 2 3 4 01 28 Delivery Table 2 2 2 02 09 D&C Set 2 2 2 01 1

10 Outlet forceps 4 4 4 0 411 Myoma Screw 2 2 2 0 212 Kochers forceps 4 4 4 0 413 Volselum forceps 4 4 6 0 4


Sr. No.


Available

Gap Remarks

C B A14 Lanes Tissue

holding forceps2 2 2 01 1

15 Vaginal Retractors 4 4 6 0 416 Polypectomy

forceps2 2 2 0 2

17 Sponge holder 10

10

15

04 6

18 Uterine elevator 1 1 1 0 119 CosCo Speculum

Small, Medium, Large (for each category)

4 6 6 0 6

20 Examination light 3 3 3 01 221 Suction Curette 1 1 2 0 122 Infant


1 1 1 0 1


1 1 1 0 1

24 Cardiac Monitor 1 1 1 0 125 Pump Breast

Electronic1 1 1 0 1


2 2 2 01 1


2 2 2 0 2


Sr. No.


Available

Gap Remarks

C B A26.2 Non-Tooted Tissue

Forceps (8”)2 2 2 0 2


2 2 2 0 2


2 2 2 0 2


8 8 8 0 8


8 8 8 04 4

26.7 Uterine Sound 2 2 2 01 126.8 Needle Holder (7”) 2 2 4 01 126.9 Needle Holder

(10”)2 2 2 01 1

26.10

Artery Forceps (Straight 6”)

16

16

16

04 12

26.11


16

16

16

04 12

26.12

Allis Forceps 8 8 8 04 4

26.13

Towel Clamps 8 8 8 02 6

26.14


4 4 4 0 4

26.15


4 4 4 0 4

26.16


8 8 8 02 6

26.17


26.18


26.19


27 Delivery Sets 6 6 10

0 6

27.1 Episiotomy Scissors

6 6 10

02 4

27.2 Straight Scissors 6 6 10

02 4


Sr. No.


Available

Gap Remarks

C B A27.3 Needle holder 6 6 1

002 4


6 6 10

02 4


6 6 10

02 4


12

12

20

04 8


12

12

20

04 8


40

40

40

20 20


40

40

20 20

27.10

Straight clamps (cord)

20

20

30

05 15

27.11


1 1 1 0 1

27.12

Towel clip 40

40

40

20 20


4 4 6 0 4

28.1 Scalpel 4 4 6 0 428.2 Artery Forceps

Straight 6 inches16

16

24

08 8


16

16

24

08 8


16

16

24

08 8


4 4 6 0 4


4 4 6 0 4


16

16

24

04 12


4 4 6 0 4

28.9 Doyene’s Retractor

4 4 6 0 4


Sr. No.


Available

Gap Remarks

C B A28.1

0Small Retractors 8 8 1

202 6

28.11

Towel Clippers 16

16

24

08 8

28.12

Suction Nozzle 4 4 6 02 2


0


1 1 2 01 0

29.2 X-Ray Unit 500 kw 1 1 1 01 029.3 Color Doppler 0 0 0 0 029.4 Lead Screen for X-

Ray Unit1 1 1 01 0


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

Illuminator2 2 2 01 1

29.10

X-Ray Film Hangers All sizes

4 4 4 04 0


0


1 1 2 0 1

30.2 Incubator 1 1 1 0 130.3 Photo Therapy

Unit1 1 1 0 1

30.4 Over-head Radiant Warmer

1 1 1 0 1


2 2 2 0 2


Sr. No.


Available

Gap Remarks

C B A30.6 Infant Weighing

Machine2 2 2 01 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 2

31 Anaesthesia/ICU 031.1 Anaesthesia

Machine1 1 1 0 1

31.2 Ventilators 1 1 1 0 131.3 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

Nasal1 2 2 0 2


1 2 2 0 2


1 2 2 0 2


1 1 1 0 1

31.10

AMBO bag adult 1 2 2 0 2

31.11


31.12


4 4 4 0 4

32 Blood Bank 032.1 Blood storage

cabinet (100 bag capacity)

1 1 1 0 1


1 1 1 0 1

32.3 Cell Separator 1 1 1 0 1


Sr. No.


Available

Gap Remarks

C B A32.4 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 0 232.7 Water bath 2 2 2 0 232.8 Micro-pipette 4 4 6 0 432.9 Blood grouping

tiles3 3 3 0 3

32.10

Plasma Extractor 1 1 1 0 1

32.11


32.12

Blood thawing bath

1 1 1 0. 1

32.13

Microscopes 1 1 1 1 0


0 0


1 1 1 0 1


1 1 1 0 1


1 1 1 0 1

33.4 Glucometer 2 2 2 01 133.5 Haemoglobino-

meter1 1 1 01 0

33.6 Centrifuge 1 1 1 0 1

iii. THQ Hospital Alipur Sr. No.

Equipment Standard as per MSDS

Available

Gap Remarks

(Qty.)C B A


1 CTG (Cardiac Tocography)

1 1 1 0 1



4 Bulb Sucker 5 10 20 1 45 Baby Warmer 2 2 3 1 16 Mechanical

Sucker3 3 3 0 3

7 Fetal Stethoscope

2 3 4 1 1

8 Delivery Table 2 2 2 2 09 D&C Set 2 2 2 1 1

10 Outlet forceps 4 4 4 0 411 Myoma Screw 2 2 2 0 212 Kochers forceps 4 4 4 0 413 Volselum forceps 4 4 6 0 414 Lanes Tissue

holding forceps2 2 2 1 1

15 Vaginal Retractors

4 4 6 0 4


2 2 2 0 2

17 Sponge holder 10 10 15 4 618 Uterine elevator 1 1 1 0 1

19 CosCo Speculum 4 6 6 0 420 Examination

light3 3 3 1 2

21 Suction Curette 1 1 2 0 122 Infant


1 1 1 0 1



1 1 1 0 1

24 Cardiac Monitor 1 1 1 0 1

25 Pump Breast Electronic

1 1 1 0 1



2 2 2 0 2


2 2 2 0 2


2 2 2 0 2


2 2 2 0 2


8 8 8 0 8


8 8 8 4 4

26.7 Uterine Sound 2 2 2 1 1

26.8 Needle Holder (7”)

2 2 4 1 1


2 2 2 1 1

26.1 Artery Forceps (Straight 6”)

16 16 16 4 12

26.11


16 16 16 4 12


26.12

Allis Forceps 8 8 8 4 4

26.13

Towel Clamps 8 8 8 2 6

26.14


4 4 4 0 4

26.15


4 4 4 0 4

26.16


8 8 8 2 6

26.17


26.18


26.19


27 Delivery Sets


6 6 10 2 4

27.2 Straight Scissors 6 6 10 2 4

27.3 Needle holder 6 6 10 2 4


6 6 10 2 4


6 6 10 2 4


12 12 20 4 8


12 12 20 4 8


40 40 40 20 20

27.9 Artery forceps 40 40 40 20 20

27.1 Straight clamps (cord)

20 20 30 5 15


27.11


1 1 1 0 1

27.12

Towel clip 40 40 40 20 20


28.1 Scalpel 4 4 6 0 4


16 16 24 8 8


16 16 24 8 8


16 16 24 8 8


4 4 6 0 4


4 4 6 0 4


16 16 24 4 12


4 4 6 0 4


4 4 6 0 4

28.1 Small Retractors 8 8 12 2 6

28.11

Towel Clippers 16 16 24 8 8

28.12

Suction Nozzle 4 4 6 2 2



1 1 2 1 0

29.2 X-Ray Unit 500 kw

1 1 1 1 0

29.3 Color Doppler 0 0 0 0 0


29.4 Lead Screen for X-Ray Unit

1 1 1 1 0


1 1 1 0 1

29.6 Safe Light 1 1 1 0 1

29.7 X-RT Film Processing Tank

1 1 1 0 1

29.8 Chest Stand 1 1 1 0 1

29.9 X-Ray film Illuminator

2 2 2 1 1

29.1 X-Ray Film Hangers All sizes

4 4 44 0



1 1 2 0 1

30.2 Incubator 1 1 1 0 1

30.3 Photo Therapy Unit

1 1 1 0 1


1 1 1 0 1


2 2 2 0 2


2 2 2 1 1

30.7 Nebulizer 1 1 1 0 1

30.8 Billiubino-meter 1 1 1 0 1

30.9 Exchange Blood Transfusion Set

1 1 1 0 1

30.1 Nasal Probe Paed size

1 2 2 0 1


31 Anaesthesia/ICU

31.1 Anaesthesia Machine

1 1 1 0 1

31.2 Ventilators 1 1 1 0 1

31.3 Nebulizer 1 1 1 0 1

31.4 Pulse Oximetry 1 1 1 0 1

31.5 Defibrillator 1 1 1 0 1

31.6 Airway Oral and Nasal

1 2 2 0 1


1 2 2 0 1


1 2 2 0 1


1 1 1 0 1

31.1 AMBO bag adult 1 2 2 0 1

31.11


31.12


4 4 4 0 4

32 Blood Bank

32.1 Blood storage cabinet (100 bag capacity)

1 1 1 0 1


1 1 1 0 1

32.3 Cell Separator 1 1 1 0 1

32.4 Freezer for Fresh Frozen Plasma

1 1 1 0 1

32.5 Blood bag shaker 1 1 1 0 1

32.6 RH view box 1 2 2 0 1


32.7 Water bath 2 2 2 0 2

32.8 Micro-pipette 4 4 6 0 4

32.9 Blood grouping tiles

3 3 3 0 3

32.1 Plasma Extractor 1 1 1 0 1

32.11


32.12

Blood thawing bath

1 1 1 0 1

32.13

Microscopes 1 1 1 1 0



1 1 1 0 1


1 1 1 0 1


1 1 1 0 1

33.4 Glucometer 2 2 2 1 1

33.5 Haemoglobino-meter

1 1 1 1 0

33.6 Centrifuge 1 1 1 0 1


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.

a) Health Problems

Problem Causes Intervention Activity UnitPlan

Activities Targets

Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

1. Diarrhea

Poor 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

Lack of safe drinking water

Health Education campaign

Messages on local cable network

Monthly Telecast 36 12 12 12



Activities Targets

Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

Unhygienic practices

Strengthening EPI coverage

Printing and distribution of IPC material

Brochure 250,000 100,000 100,000 50,000

Lack of awareness among mothers about feeding and weaning practices

Proper treatment of Diarrhoea including ORT

Address in school assemblies

Session 1,000 500 250 250

Low EPI coverage

Improving literacy through coordination with education department

Training of medics and paramedics in IMCI

Trainee 10 5 3 2

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

Procurement and distribution of ORS

ORS packets 9,000,000

3,000,000

3,000,0003,000,00

0



Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

Accident & Injuries

Lack of traffic sense

Coordination with police department to improve traffic sense and ensuring observance of traffic rules

Quarterly co-ordination meetings with Traffic Police department

Meetings 12 4 4 4

Poor maintenance of vehicles

Advocacy for improving the condition of roads

Quarterly co-ordination meetings with Highway department

Meetings 12 4 4 4

Poor road conditions

Health education/promotion to prevent domestic accidents

Preparation of Disaster Management Plan including the Patient Management protocols

- - Plan

Lack of safety measures at work place

Ensure enforcement of safety laws at work places

Training of the medics and the paramedics

Training in Batch for 20 trainees

10 5 3 2



Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

Fire-arm injuriesProvision of emergencies medicines

Provision of emergency kits for victims

Kits 3,000 1,000 1,000 1,000

Domestic accidents

Procurement of various splints and Plaster casts

Assets 3,000 1,000 1,000 1,000

Burns Drugs Drugs 3,000 1,000 1,000 1,000

Bomb blasts/terrorist activities

Disaster management plan

Natural calamities flood

Lack of tolerance in the society



Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

Complication of Pregnancy

Low access to appropriate

health services

Behavior Change

Communication (BCC)

Messages on local cable

network

Monthly Package - - - -

Integrated Activity

Lack of awareness

about danger signs of

pregnancy

Improving transportation to appropriate level of care


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

Three delays (seeking health

care, transportation,

and lack of referral back-up services)

Strengthening healthcare facilities

Activation and use of Health

Committees and women groups under LHWs

- Plan

Lack of skilled birth attendants

Refresher courses for

TBAs

Training of TBAs with

specific focus on safe delivery and

danger signs

Batch of 25 TBAs for 2

days Training

20 10 5 5

Deployment of

community midwives

Placement of mid-wives in

their catchment area

- Plan

Repair of non

functional Ambulance 10 10 - -



Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

ambulances for timely

transportation of pregnant mothers

Replacement of non functional ambulances for

timely transportation of pregnant mothers

Ambulance 15 5 5 5Toyota hilux

POL for ambulances Litre 72,000 12000 24000 36000



Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

Hepatitis Poor sanitationHealth

Education/ Promotion


- - -

Integrated activity

Unsafe drinking water

Campaign against quackery


Monthly Package

Integrated activity

Sharing of used syringes

Strengthening blood transfusion services for safe transfusions


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

Transfusion of unsafe/unscreened blood and blood products

Campaign against drug addiction

Procurement and supply of screening kits

Kits 900,000 300,000 300,000 300,000

Unsafe sexual practices

Regulatory mechanism to ensure use of safe

Procurement of syringe cutters

Syringe cutter 500 300 100 100



Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

instruments by dentists, barbers etc.

Ear piercing and tattooing

Procurement of drugs for treatment of Hepatitis patients

Injection 12,000 4,000 4,000 4,000

Use of unsterilized equipment by dentists and barbers

Develop and implement SOPs for sterilization of equipment



Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

Resistant Malaria (Falciparum)

Breeding places for mosquitoes

Public awareness campaign

Printing and distribution of Health Education material

Poster 100,000 50,000 25,000 25,000

Decline area of district

Strengthening Malaria eradication program

Provision of lab equipment/reagents

Microscope

20 10 5 5

Lack of awareness for prevention

Provision of mosquito nets (LLIN)

Mosquito nets

50,000 30,000 10,000 10,000

Antimalarial drugs aursonate tablets,

Tablet (Pack of 100)

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

Antimalarial drugs Primaquin,


10,000 4,000 3,000 3,000

Antimalarial drugs Chloroquin


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

Fogging Machine

2 2 - -



Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

Spray Pumps 300 200 50 50

Purchase of insecticide delta methrine (Powder)

Kg 15,000 5,000 5,000 5,000

Purchase of insecticide delta methrine (Liquid)

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

Purchase of larvicidal Drug (Phenthion Granules)

Kg 3,000 1,000 1,000 1,000

Purchase of larvicidal Drug ( Temiphos) Liquid

Litre 1,500 500 500 500

Spray man Squad of 6 persons x 60 days

150 50 50 50



Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

Purchase of motor cycle for CDCSs

Motor cycle

76 40 20 16


Activities Targets

Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

Diabetes

Obesity Health Education campaign regarding healthy life style

Health educational sessions in community

Seminar 3 1 1 1

Inactive life style

Strengthening diagnostic services for early detection


poster 30000 10,000 10,000 10,000

Lack of health awareness on Diabetes


Glucometer with Sticks

100 50 50 -

Genetics & Infections

Provision of medicines

Drug 15000 5,000 5,000 5,000


b) Management ProblemsHuman Resource Plan to bridge gap between MSDS standard and sanctioned posts

Sr. No. Name of Post Basic Scale

Basic Pay

Allowances

Requirement as per

Gap

Physical Targets

Year I

Year II Year III

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

2 Paediatricians 18 12,910 18,099 4 2 1 1

3 Anesthetists 18 12,910 18,099 6 3 2 1

4 MO / WMO 17 9,850 15,345 109 55 27 27

5 Nurses 16 6,060 8,934 76 38 20 18

6 Lady Health Visitors 9 3,820 4,750 25 13 6 6


Problem causes Intervention Activity UnitPlan

Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

Inadequate district health budget

Generator provision for backup of electricity supply

Rational increase in POL budget

Assessment of additional requirement

NO COST ACTIVITY



Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

Less budget allocation

Costing and submission of additional demand

Plan

Frequent increase in prices

Provision of POL budget for supervisory vehicles for District level managers

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

Provision of POL budget for supervisory vehicles for Tehsil level managers

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

Provision of POL budget ambulances

litre 54,000 18,000 18,000 18,000



Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

Provision of POL budget for EPI staff

litre 63,000 21,000 21,000 21,000

Provision of POL budget for generator litre 864,000 288,000 288,000 288,000


Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

Shortage Non-availability Filling of the Filling of the - - - - - Recruitment



Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

of Skilled Staffs

of trained staff vacant posts

vacant posts of medics and the paramedics through existing recruitment 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

Orientation trainings of the recruited staffs

Batch 11 6 3 2



Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

for higher education

Frequent transfer postings

High level political commitment for providing protection to staff working in health facilities

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

- Meeting

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

Filling of Human

Posts 195 98 50 47 . Detail HR plan is attached



Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

environment including insecurity and transport of children for education Resource gaps

as per MSDS

Posts 25 13 6 6 Detail HR plan is attached

Political and media interference

HR 220 111 56 53 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

- TNA



Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

based on TNA


Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

Deficient Infrastructure

Debilitated condition of existing infra-structure

Make up the deficiencies against standards specified in MSDS

Identify the gaps in infrastructure of THQ and DHQ hospitals individually

Lack of repair and maintenance

Devise appropriate mechanisms for repair and maintenance

Costing of the gaps

Inadequate infrastructure for Emergency, Operation Theatre, OPD and Inpatients, residences for staff at THQ and

Provision of infrastructure at THQ and DHQ according to the MSDS

Phasing Demand submission



Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

DHQ hospitals

Construction of residence of WMO at DHQ and THQ hospital

DHQ hospitals1100 per square yard

7875 2625 5250 0

THQH Kot Adu1100 per square yard

7000 3500 3500 0

THQH Ali pur1100 per square yard

3500 1750 1750 0


Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

Inadequate equipments

Deficient equipment to

Provision of the equipment in

Procurement of equipments for Detail

attached


cater basic and comprehensive EmONC at primary and secondary level of care

accordance with the notified equipment list

THQ and DHQ hospitals based on the gaps between MSDS and existing available

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 M&R

Capacity building of staff regarding maintenance of log books of each equipment

Orientation of staffs in maintenance of logos for equipments

Plan

Frequent cuts on M&R budget



Activities Targets

Target for

2010-11

Target for

2011-12

Target for

2012-13Remarks

Shortage of functional vehicles

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

Complicated procedure for purchase of new vehicles

Expedite the procurement procedure

Procurement of ambulances Ambulance 15 5 5 5

Addressed in health problem no. 03

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

Demand submission


SECTION 4: COSTING AND FINANCING PLAN

1. Activity based costingThe 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-III and Annex-IV. 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

1. Diarrhoea

ActivityDefine Financial Targets

Total Cost Remarks

Unit Rate Quantity Year I Year II Year III


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



Total Cost Remarks



Monthly Telecast 36,000 36 432,000 475,200 522,720 1,429,920


Brochure 5 250,000 500,000 550,000 302,500 1,352,500

Address in school assemblies Session 2,000 1,000 1,000,000 550,000 605,000 2,155,000


Trainee 125,000 10 625,000 412,500 302,500 1,340,000

Procurement and distribution of ORS ORS packets 5 9,000,000 15,000,000 16,500,000 18,150,000 49,650,000


2. Accidents and Injuries

Activity

Define Financial Targets

Total Cost Remarks



Meetings 5,000 12 20,000 22,000 24,200 66,200


Meetings 5,000 12 20,000 22,000 24,200 66,200


- - - - - Plan


Training in Batch for 20 trainees

43,000 10 215,000 141,900 104,060 460,960

Provision of emergency kits for victims

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


Activity


Total Cost Remarks



Assets 2,000 3,000 2,000,000 2,200,000 2,420,000 6,620,000

Drugs Drugs 500 3,000 500,000 550,000 605,000 1,655,000

Disaster management plan

- - - -

Total

18,798,360

3. Complications of pregnancy



Total Cost Remarks



Monthly Package - - - - - -

Integrated Activity

Printing and distribution of IPC material Brochure 5 200,000 500,000 275,000 302,500 1,077,500

Activation and use of Health Committees and women groups under

LHWs

- - - - - - Plan

Training of TBAs with specific focus on safe

delivery and danger signs

Batch of 25 TBAs for 2

days Training

50,000 20 500,000 275,000 302,500 1,077,500

Placement of mid-wives in their catchment area - - - - Plan



Total Cost Remarks


Repair of non functional ambulances for timely

transportation of pregnant mothers

Ambulance 25,000 10 250,000 - - 250,000

Replacement of non functional ambulances

for timely transportation of pregnant mothers

Ambulance 3,200,000 15 16,000,000 17,600,000 19,360,000 52,960,000

POL for ambulances Litre 76 72000 912,000 2,006,400 3,310,560 6,228,960

61,593,960

4. Hepatitis



Total Cost Remarks


· Quarterly co-ordination meetings with TMA and other agencies

- - - - - -

Integrated activity

· Messages on local cable network

Monthly Package - - - -

Integrated activity

· Printing and distribution of IPC material

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

· Procurement and supply of screening kits

Kits 50 900,000 15,000,000 16,500,000 18,150,000 49,650,000



Total Cost Remarks


· Procurement of syringe cutters

Syringe cutter 500 500 150,000 55,000 60,500 265,500

· Procurement of drugs for treatment of Hepatitis patients

Injection 12,000 12,000 48,000,000 52,800,000 58,080,000 158,880,000

· Develop and implement SOPs for sterilization of equipment

- - - SOPs

210,450,500

5. Malaria


Activity


Total Cost Remarks



Poster 25 100,000 1,250,000 687,500 756,250 2,693,750


Microscope

50,000 20 500,000 275,000 302,500 1,077,500

Provision of mosquito nets (LLIN)

Mosquito nets

700 50,000 21,000,000 7,700,000 8,470,000 37,170,000

Antimalarial drugs aursonate tablets,


2,000 3,000 2,000,000 2,200,000 2,420,000 6,620,000

Antimalarial drugs Primaquin,


1,000 10,000 4,000,000 3,300,000 3,630,000 10,930,000

Antimalarial drugs Chloroquin


501,500,00

025,000,000 27,500,000 30,250,000 82,750,000


Activity


Total Cost Remarks


Fogging Machine 90,000 2 180,000 - - 180,000

Spray Pumps 10,000 300 2,000,000 550,000 605,000 3,155,000


Kg 800 15,000 4,000,000 4,400,000 4,840,000 13,240,000


Litre 1,200 6,000 2,400,000 2,640,000 2,904,000 7,944,000


Kg 500 3,000 500,000 550,000 605,000 1,655,000


Litre 2,000 1,500 1,000,000 1,100,000 1,210,000 3,310,000

Spray man Squad of 6 persons x 60 days

108,000 150 5,400,000 5,940,000 6,534,000 17,874,000


Activity


Total Cost Remarks


Purchase of motor cycle for CDCSs

Motor cycle

60,000 76 2,400,000 1,320,000 1,161,600 4,881,600

193,480,850

6. Diabetes

Activity


Total Cost RemarksUnit Rate Quantity Year I Year II Year III

Health educational sessions in community

Seminar 10,000 3 10,000 11,000 12,100 33,100

Printing and

distribution of Health Education material poster 30 30,000 300,000 330,000 363,000 993,000


Provision of lab equipment/reagents glucometer

with Sticks7,000 100 350,000 385,000 - 735,000

Provision of medicines Drug 4,000 15,000 20,000,000 22,000,000 24,200,000 66,200,000

67,961,100

b) Management Problems

Sr.No.

Name of Post

Basic Scale

Basic

Pay

Allowances

Requirement as per Gap

Financial Targets

Year I Year II Year III

Pay of Officers

Pay of other staff

Allowances

Pay of Officers

Pay of

other

staff

Allowances

Pay of Officers

Pay of

other staff

Allowances

1 Gynaecologist

18 12,910

18,099 -


- - - - - - -

2 Paediatricians

18 12,910

18,099 4

309,840 -

434,376

511,236

716,720

749,813

1,051,190

3 Anesthetists

18 12,910

18,099 6

464,760 -

651,564

852,060

1,194,534

1,124,719

1,576,785

4 MO / WMO 17 9,850

15,345 109

6,501,000 -

10,127,700

10,661,640

16,609,428

15,589,398

24,286,225

5 Nurses 16 6,060

8,934 76

2,763,360 -

4,073,904

4,639,536

6,839,870

6,687,331

9,858,848

6 Lady Health Visitors

9 3,820

4,750 25

595,920 741,000

958,056

1,191,300

1,386,660

1,724,250

10,634,880 -

16,028,544

17,622,528

-

26,551,853

25,537,921

-

38,497,297


1. Inadequate allocation of budget for POL

Activity


Total Cost Remarks


Assessment of additional requirement

-

-

- -

NO COST ACTIVITY


-

-

- - Plan


litre 75 14,400 360,000 396,000 435,600 1,191,600

Provision of POL budget for supervisory vehicles for Tehsil level managers

litre 75 14,400 360,000 396,000 435,600 1,191,600


Activity


Total Cost Remarks


Provision of POL budget ambulances litre 75 54,000 1,350,000 1,485,000 1,633,500 4,468,500

Provision of POL budget for EPI staff litre 75 63,000 1,575,000 1,732,500 1,905,750 5,213,250

Provision of POL budget for generator

litre 75 864,000 21,600,000 23,760,000 26,136,000 71,496,000

83,560,950


2. Shortage of MNCH related staff

Activity



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

- - - - - - - Recruitment


- - - - - - - 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 277,000 11 1,662,000 914,100 670,340 3,246,440

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

- - - - Meeting


Activity



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 10,038,960 16,664,472 24,151,261 50,854,693 Detail HR plan is attached

Posts 595,920 958,056 1,386,660 2,940,636 Detail HR plan is attached

HR 16,028,544 26,551,853 38,497,297 81,077,694 Detail HR plan is attached


Activity



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 138,119,463

3. Deficient infrastructure for MNCH at secondary level


Activity


Total Cost Remarks


Identify the gaps in infrastructure of THQ and DHQ hospitals individually

- -

Costing of the gaps - -

- -

Phasing - -

- -

Demand submission

DHQ hospitals 1100 per squard yard 1100 10500 5,775,000 6,352,500 - 12,127,500

THQH kot addu 1100 per squard yard 1100 7000 3,850,000 4,235,000 - 8,085,000


Activity


Total Cost Remarks


THQH Ali pur 1100 per squard yard 1100 3500 1,925,000 2,117,500 - 4,042,500

Total 24,255,000

4. Inadequate equipment

Activity Define Financial Targets Total Cost Remarks



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

36,677,550 42,541,920 - 79,219,470 Detail attached


- -

- -

Submission of demand


- -

- - Plan

Total 79,219,470

5. Shortage of functional vehicles including ambulances


Activity


Total Cost Remarks


Condemnation of the old and off-road vehicles

-

-

- -

As per demand by district

Preparation and submission of demand for replacement five ambulances at RHC

-

-

- -

Demand submission

Procurement of ambulances Ambulance 15

-

-

- -

Addressed in health problem no. 03


7. Financial Outlay 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

Classification2010-2011 2011-2012 2012-2013

Regular Additional Total Regular Additional Total Regular Additional Total

A03907 718,750 432,000 1,150,750 826,563 475,200 1,301,763 950,547 522,720 1,473,267

A03902 4,778,250 3,050,000 7,828,250 5,494,988 2,392,500 7,887,488 6,319,236 2,329,250 8,648,486

A03820 - 52,000 52,000 - 57,200 57,200 - 62,920 62,920

A03927 158,125,000 122,400,000 280,525,000 181,843,750 133,540,000 315,383,750 209,120,313 146,894,000 356,014,313

A09501 - 18,400,000 18,400,000 - 18,920,000 18,920,000 - 20,521,600 20,521,600

A09601 8,597,400 2,180,000 10,777,400 9,887,010 550,000 10,437,010 11,370,062 605,000 11,975,062

A03903 - 1,010,000 1,010,000 - 561,000 561,000 - 617,100 617,100

A03801 - 1,340,000 1,340,000 - 829,400 829,400 - 709,060 709,060

A09404 - 19,000,000 19,000,000 - 20,515,000 20,515,000 - 22,143,000 22,143,000

A03807 21,677,500 912,000 22,589,500 24,929,125 2,006,400 26,935,525 28,668,494 3,310,560 31,979,054

A09802 - 2,000,000 2,000,000 - 2,200,000 2,200,000 - 2,420,000 2,420,000

A01277 - 5,400,000 5,400,000 - 5,940,000 5,940,000 - 6,534,000 6,534,000


Object Classification

2010-2011 2011-2012 2012-2013


A13001 4,054,900 250,000 4,304,900 4,663,135 - 4,663,135 5,362,605 - 5,362,605

A03971 - 21,000,000 21,000,000 - 7,700,000 7,700,000 - 8,470,000 8,470,000

Total 197,951,800 197,426,000 395,377,800 227,644,570 195,686,700 423,331,270 261,791,256 215,139,210 476,930,466

II. Management ProblemsObject

Classification2010-2011 2011-2012 2012-2013


A03801 - 1,662,000 1,662,000 - 914,100 914,100 - 670,340 670,340

A01101 - 10,038,960 10,038,960 - 16,664,472 16,664,472 - 24,151,261 24,151,261

A01270 - 16,028,544 16,028,544 - 26,551,853 26,551,853 - 38,497,297 38,497,297

A03807 21,677,500 25,245,000 46,922,500 24,929,125 27,769,500 52,698,625 28,668,494 30,546,450 59,214,944

A09601 8,597,400 36,677,550 45,274,950 9,887,010 42,541,920 52,428,930 11,370,062 - 11,370,062

A01102 - 595,920 595,920 - 958,056 958,056 - 1,386,660 1,386,660

A12402 - 11,550,000 11,550,000 - 12,705,000 12,705,000 - - -

Total 30,274,900 101,797,974 132,072,874 34,816,135 128,104,901 162,921,036 40,038,555 95,252,008 135,290,564


8. Summaries

I. Problem-wise Costing

a) Health Problems

Sr. No. ProblemFY I FY II FY III Total Cost Rs.

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

1 Diarrhoeal diseases 17,569,0

00 18,500,9

00 19,897,2

40 55,967,1

40

2 Accidents And Injuries 5,755,000 6,235,900 6,807,460 18,798,360

3 Complication of pregnancy 18,162,000 20,156,400 23,275,560 61,593,960

4 Hepatitis B & C 63,650,000 69,905,000 76,895,500 210,450,500

5 Malaria 71,630,000 58,162,500 63,688,350 193,480,850

6 Diabetes 20,660,000 22,726,000 24,575,100 67,961,100

Total 197,426,000 195,686,700 215,139,210 608,251,910


b) Management ProblemsSr. No. Problem

FY I FY II FY III Total Cost Rs.Amount (Rs.) Amount (Rs.) Amount (Rs.) Amount (Rs.)

1 Inadequate budget POL 25,245,000 27,769,500 30,546,450 83,560,950

2Shortage of skilled staffs MNCH related

28,325,424

45,088,481 64,705,558 138,119,463

3 Deficient infrastructure for MNCH related services

11,550,000

12,705,000 - 24,255,000

4Inadequate EQUIPMENTS

36,677,550

42,541,920 - 79,219,470

5 Shortage of functional vehicles - - - -

Total 101,797,97

4 128,104,901 95,252,008 325,154,883


II. Activity-wise Costing

a) Health ProblemsSr. No. Health Problem Activity

Costing (Rs.)FY-I FY-II FY-III Total

1 Diarrhoeal diseases


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

Messages on local cable network 432,000 475,200 522,720 1,429,920

Printing and distribution of IPC material 500,000 550,000 302,500 1,352,500

Address in school assemblies 1,000,000 550,000 605,000 2,155,000


625,000 412,500 302,500 1,340,000

Procurement and distribution of ORS 15,000,000 16,500,000 18,150,000 49,650,000

2 Accidents And Injuries


20,000 22,000 24,200 66,200


20,000 22,000 24,200 66,200


- - - -


Sr. No. Health Problem Activity



215,000 141,900 104,060 460,960

Provision of emergency kits for victims 3,000,000 3,300,000 3,630,000 9,930,000


2,000,000 2,200,000 2,420,000 6,620,000

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

3 Complication of pregnancy

Messages on local cable network - - - -


Activation and use of Health Committees and women groups under LHWs

- - - -

Training of TBAs with specific focus on safe delivery and danger signs

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

Placement of mid-wives in their catchment area

- - - -

Repair of non functional ambulances for timely transportation of pregnant mothers

250,000 - - 250,000




Replacement of non functional ambulances for timely transportation of pregnant mothers

16,000,000 17,600,000 19,360,000 52,960,000

POL for ambulances 912,000 2,006,400 3,310,560 6,228,960

4 Hepatitis B & C Quarterly co-ordination meetings with TMA and other agencies

- - - -

Messages on local cable network - - - -


Procurement and supply of screening kits

15,000,000 16,500,000 18,150,000 49,650,000

Procurement of syringe cutters 150,000 55,000 60,500 265,500

Procurement of drugs for treatment of Hepatitis patients

48,000,000 52,800,000 58,080,000 158,880,000

5 Malaria Printing and distribution of Health Education material

1,250,000 687,500 756,250 2,693,750

Provision of lab equipment/reagents 500,000 275,000 302,500 1,077,500

Provision of mosquito nets (LLIN) 21,000,000 7,700,000 8,470,000 37,170,000

Antimalarial drugs aursonate tablets, 2,000,000 2,200,000 2,420,000 6,620,000




Antimalarial drugs Primaquin, 4,000,000 3,300,000 3,630,000 10,930,000

Antimalarial drugs Chloroquin 25,000,000 27,500,000 30,250,000 82,750,000

Fogging Machine 180,000 - - 180,000

Spray Pumps 2,000,000 550,000 605,000 3,155,000


4,000,000 4,400,000 4,840,000 13,240,000


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


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


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

Spray man 5,400,000 5,940,000 6,534,000 17,874,000

Purchase of motor cycle for CDCSs 2,400,000 1,320,000 1,161,600 4,881,600

6 Diabetes Health educational sessions in community

10,000 11,000 12,100 33,100


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




Provision of lab equipment/reagents 350,000 385,000 - 735,000

Provision of medicines 20,000,000 22,000,000 24,200,000 66,200,000

Total 197,426,000

195,686,700

215,139,210

608,251,910

b) Management Problems

Sr. No

. Health Problem Activity

Costing (Rs.)

FY-I FY-II FY-III Total1 Inadequate budget

POLAssessment of additional requirement - - - -


- - - -


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

· Provision of POL budget for supervisory vehicles for Tehsil level managers

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

· Provision of POL budget ambulances 1,350,000 1,485,000 1,633,500 4,468,500


Sr. No

.Health Problem Activity


· Provision of POL budget for EPI staff 1,575,000 1,732,500 1,905,750 5,213,250

· Provision of POL budget for generator 21,600,000 23,760,000 26,136,000 71,496,000

2 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

1,662,000 914,100 670,340 3,246,440

· 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 packages

- - - -


Sr. No



· Review and revise the career structure of medics and paramedics

- - - -

·Filling of Human Resource gaps as per MSDS

26,663,424 44,174,381 64,035,218 134,873,023

· Capacity and need assessment of the medics and the paramedics

- - - -

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

- - - -

3 Deficient infrastructure for MNCH related services

· Identify the gaps in infrastructure of THQ and DHQ hospitals individually

- - - -

· Costing of the gaps - - - -

· Phasing - - - -

DHQ hospitals 5,775,000 6,352,500 - 12,127,500

THQH kot addu 3,850,000 4,235,000 - 8,085,000

THQH Ali pur 1,925,000 2,117,500 - 4,042,500

4 Inadequate Procurement of equipments for THQ and 36,677,550 42,541,920 - 79,219,470


Sr. No



equipment DHQ hospitals based on the gaps between MSDS and existing available


- - - -


- - - -

5 Shortage of functional vehicles

· Condemnation of the old and off-road vehicles

- - - -

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

- - - -

· Procurement of ambulances - - - -

Total 101,797,974 128,104,901 95,252,008 325,154,883


SECTION 5: MONITORING & EVALUATION

The monitoring and evaluation targets and indicators mentioned below will be used to gauge the progress of implementation of the plan. Monitoring and evaluation of the three years rolling plan would be carried out through the proposed indicators, targets and means of verifications, by the district health authorities.

M&E of PlanIndicators Target %

Achievement

MoV Responsibility

Frequency of

monitoring

Remarks

% of planned supervisory visits conducted

50 visits /year

Inspection Book/Attendan

ce register

EDOH/DOH/ DDOH/Dist. Monitoring officer

Quarterly

% of RHCs with availability of services (on rotational basis) of essential specialties (Physician, Surgeon, Paediatrician and Gynaecologist)

100%During 1st year

Movement register/visit book/Attendance register

EDOH / DOH Quarterly

% 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


Indicators Target % Achieveme

nt

MoV Responsibility

Frequency of

monitoring

Remarks

% 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

% of facilities with availability of basic EmONC

100%(50%

during 1st

year)

Supervisory visit report

EDOH/DoH/ DDOH

Quarterly

% of DHQ/THQ hospitals with Comprehensive EmONC services

100% in 3 years(50%

during 1st

year)


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)


EDOH/DoH/ DDOH

Quarterly

% of targeted pregnant women newly registered by LHW

Target accordin

g to populatio

n

DHIS Report EDOH/ Statistical Officer

Quarterly

% of targeted pregnant women received TT-2 vaccine

Target accordin

g to populatio

n

DHIS Report EDOH/ DHIS Coordinator/ Statistical Officer

Quarterly

Delivery conducted by or under supervision of skilled persons reported

60 % During 1st year


Quarterly

%of target children between 18 - 23 months of age fully immunized

Target accordin

g to populatio

n


Quarterly


Indicators Target % Achieveme

nt

MoV Responsibility

Frequency of

monitoring

Remarks

% of referred cases attended

100% DHIS Report/ LHWs monthly report

EDOH/ DHIS Coordinator/ Statistical Officer

Quarterly

% of targeted eligible couples provided knowledge and information on Family Planning methods

Target accordin

g 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


AN

NEX

UR

ES


Annex-I

Private Health Facilities in District Muzzafargarh

Sr.No

Name of Facility

1. Farahat Clinic2. Khan Hospital3. Al Shafi Clinic4. Fozia Nudarat5. Rehman Clinic6. Baloch Clinic7. Fatima Tu Zahara8. Sadaf Clinic9. Dr. Qadir10. Al-Hamad Maternity Home11. Dr Ameer Bakhsh12. Dr Mushtaq Ahmed Clinic13. Al Shams Hospital14. Heart Care and Surgical Clinic15. Rai Basheer Memorial Hospital16. Naveed Surgical and Maternity Home17. Naqvi Clinic18. Kaniz Fatima19. Dr Parveen Lal20. Rabia Clinic


21. Home Clinic22. Irshad Clinic23. Sattar Clinic24. Khalid Clinic25. Sultana Clinic26. Fiaz Clinic27. Safdar Clinic28. Rehman Clinic29. Home Clinic30. Maternity and Ultra Sound Clinic31. Aneeq Clinic32. Dr. Riffat Tariq33. Dr. Naheed Shah34. Mother Care Centre35. Home Clinic36. Dr Khadim Hussain Clinic37. Yasir Surgical Hospital38. Naveed Surgical Maternity Home39. Home Clinic40. Bukhari Clinic41. Dr. Khalida Suahail42. Dr Asma Clinic43. Raeesa Clinic44. Niaz Hospital45. Ahmed Medicare46. Al Qureshi Child Hospital47. Shaida Safdar Surgical Hospital48. Al Asim Surgical Hospital49. Rana Free Clinic50. Nasreen Malik


51. Ali Surgical Centre52. Farah Ghafoor53. Yasin Medical Centre54. Akash Hospital

Annex-II

Costing of Equipment gaps for DHQ and THQ Hospitals

DHQ HOSPITAL MUZAFFARGARH

Sr. No.


Available

Gap

Cost/Unit Total Cost

(Qty.)

C B A


1 1 2 2 0 285000 0

2 Foetal Doppler 3 5 5 0 3 101000 303000

3 Diagnostic Laparoscope

1 1 2 0 1 1200000 1200000

4 Bulb Sucker 10 20 20 3 7 45 315

5 Baby Warmer 3 3 6 2 1 850000 850000

6 Mechanical Sucker 3 3 6 15 0 28000 0

7 Fetal Stethoscope 4 4 4 0 4 1500 6000

8 Delivery Table 2 2 3 4 0 17500 0

9 D&C Set 2 3 4 4 0 2100 0

10 Outlet forceps 4 4 4 8 0 900 0

11 Myoma Screw 2 2 2 1 1 320 320

12 Kochers forceps 4 4 8 0 4 235 940


13 Volselum forceps 6 8 10 8 0 235 0


2 2 4 4 0 400 0

15 Vaginal Retractors 10 10 10 3 7 350 2450


2 2 2 3 0 750 0

17 Sponge holder 10 15 20 33 0 300 0

18 Uterine elevator 1 1 1 0 1 150 150

19 CosCo Speculum 6 10 10 6 0 550 0

20 Examination light 3 3 6 1 2 18000 36000

21 Suction Curette 1 2 2 2 0 95 0

22 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 4 0 500000 0


1 1 1 0 1 250000 250000




2 2 4 54 0 55 0


2 2 4 54 0 55 0


2 2 4 17 0 150 0


2 2 4 20 0 150 0


8 8 16 25 0 150 0


8 8 16 30 0 175 0

26.7 Uterine Sound 2 2 4 2 0 90 0

26.8 Needle Holder (7”) 2 2 4 30 0 150 0


2 2 4 8 0 300 0


16 16 32 50 0 110 0

26.1 Artery Forceps (Curved 6”)

16 16 32 104 0 125 0

26.1 Allis Forceps 8 8 16 106 0 230 0

26.1 Towel Clamps 8 8 16 51 0 125 0

26.1 Single blade Sims speculum

4 4 8 4 0 275 0

26.2 Double blade Sims speculum

4 4 8 4 0 250 0


8 8 16 33 0 200 0


26.2 Volselum forceps 4 4 8 2 2 250 500

26.2 Uterine Sound 2 2 4 2 0 1500 0

26.2 Bladder Sound 2 2 4 2 0 1500 0

27 Delivery Sets


10 10 15 5 5 125 625

27.2 Straight Scissors 10 10 15 20 0 360 0

27.3 Needle holder 10 10 15 30 0 135 0


10 10 15 54 0 100 0


10 10 15 54 0 100 0


20 20 30 4 16 275 4400


20 20 30 0 20 250 5000


40 40 60 33 7 250 1750

27.9 Artery forceps 40 40 60 104 0 275 0


20 20 30 25 0 175 0

27.1 Vacuum Extractor pump

1 1 1 0 1 19000 19000

27.1 Towel clip 40 40 60 51 0 125 0


28.1 Scalpel 6 8 10 27 0 50 0


24 32 40 50 0 125 0



24 32 40 104 0 125 0


24 32 40 30 0 175 0


6 8 10 1 5 150 750


6 8 10 17 0 270 0


24 32 40 20 4 300 1200


6 8 10 8 0 900 0


6 8 10 8 0 200 0

28.1 Small Retractors 12 16 20 43 0 300 0

28.1 Towel Clippers 24 32 40 51 0 125 0

28.1 Suction Nozzle 6 8 10 8 0 250 0



1 2 3 3 0 575000 0

29.2 X-Ray Unit 500 kw 1 1 1 4 0 6000000 0

29.3 Color Doppler 0 1 1 0 0 5750000 0


1 1 1 2 0 30000 0


1 1 1 6 0 100000 0

29.6 Safe Light 1 1 1 2 0 5000 0



1 1 1 2 0 5000 0

29.8 Chest Stand 1 1 1 4 0 4500 0


2 2 2 2 0 4000 0


4 4 4 30 0 4000 0



1 2 2 0 1 1200000 1200000

30.2 Incubator 1 1 2 3 0 1500000 0


1 1 1 1 0 22000 0


1 1 1 2 0 910000 0


2 2 2 1 1 5000 5000


2 2 2 1 1 3100 3100

30.7 Nebulizer 1 1 2 12 0 22000 0

30.8 Billiubino-meter 1 1 2 0 1 36000 36000


1 1 2 0 1 2000 2000


2 2 4 0 2 7000 14000

31 Anaesthesia/ICU 0 0 0


1 1 2 4 0 321000 0

31.2 Ventilators 1 1 1 1 0 525000 0


31.3 Nebulizer 1 1 1 12 0 165000 0

31.4 Pulse Oximetry 1 1 1 1 0 21000 0

31.5 Defibrillator 1 1 1 3 0 500000 0


2 3 4 3 0 500 0


2 2 4 1 1 1000 1000


2 2 4 2 0 1000 0


1 2 2 2 0 320 0

31.1 AMBO bag adult 2 2 4 5 0 2450 0

31.1 AMBO Bag paeds 2 2 4 5 0 3000 0

31.1 Red Rubber Nasal tubes all sizes without cuff

4 4 8 0 4 1000 4000

32 Blood Bank 0 0 0


1 1 2 0 1 812000 812000


1 1 1 0 1 600000 600000

32.3 Cell Separator 1 1 1 0 1 5225000 5225000


1 1 1 0 1 1150000 1150000

32.5 Blood bag shaker 1 1 2 5 0 10000 0

32.6 RH view box 2 2 4 0 2 1000 2000

32.7 Water bath 2 2 2 2 3000 6000

32.8 Micro-pipette 4 6 8 0 4 8000 32000



3 3 6 0 3 3000 9000

32.1 Plasma Extractor 1 1 1 0 1 1000000 1000000

32.1 Platelets agitator 1 1 1 0 1 1000000 1000000

32.1 Blood thawing bath

1 1 1 0 1 3000 3000

32.1 Microscopes 1 1 2 0 1 115000 115000



1 1 1 0 1 425000 425000


1 1 1 0 1 625000 625000


1 1 1 0 1 690000 690000

33.4 Glucometer 2 2 2 0 2 2500 5000


2 2 4 0 2 1000 2000

33.6 Centrifuge 1 1 2 0 1 133000 133000

Total 15841500

THQ HOSPITAL ALI PUR

Sr. No.


Available

Gap Cost/Unit

Total Cost

(Qty.)

C B A



1 1 1 0 1 285000 285000

2 Foetal Doppler 2 2 3 0 2 101000 202000


1 1 1 0 1 1200000 1200000

4 Bulb Sucker 5 10 20 1 4 45 180

5 Baby Warmer 2 2 3 1 1 850000 850000

6 Mechanical Sucker

3 3 3 0 3 28000 84000

7 Fetal Stethoscope

2 3 4 1 1 1500 1500

8 Delivery Table 2 2 2 2 0 17500 0

9 D&C Set 2 2 2 1 1 2100 2100

10 Outlet forceps 4 4 4 0 4 900 3600

11 Myoma Screw 2 2 2 0 2 320 640

12 Kochers forceps 4 4 4 0 4 235 940



2 2 2 1 1 400 400


4 4 6 0 4 350 1400


2 2 2 0 2 750 1500

17 Sponge holder 10 10 15 4 6 300 1800


19 CosCo Speculum 4 6 6 0 4 550 2200

20 Examination light

3 3 3 1 2 18000 36000




1 1 1 0 1 95000 95000


1 1 1 0 1 110000 110000

24 Cardiac Monitor 1 1 1 0 1 500000 500000


1 1 1 0 1 250000 250000



2 2 2 0 2 55 110


2 2 2 0 2 55 110


2 2 2 0 2 150 300


2 2 2 0 2 150 300



8 8 8 0 8 150 1200


8 8 8 4 4 175 700

26.7 Uterine Sound 2 2 2 1 1 90 90


2 2 4 1 1 150 150


2 2 2 1 1 300 300


16 16 16 4 12 1101320

26.11


16 16 16 4 12 125 1500

26.12

Allis Forceps 8 8 8 4 4 230 920

26.13

Towel Clamps 8 8 8 2 6 125 750

26.14


4 4 4 0 4 275 1100

26.15


4 4 4 0 4 250 1000

26.16


8 8 8 2 6 200 1200

26.17

Volselum forceps 4 4 4 0 4 250 1000

26.18

Uterine Sound 2 2 2 1 1 1500 1500

26.19

Bladder Sound 2 2 2 0 2 1500 3000

27 Delivery Sets


6 6 10 2 4 125 500



27.3 Needle holder 6 6 10 2 4 135 540


6 6 10 2 4 100 400


6 6 10 2 4 100 400


12 12 20 4 8 275 2200


12 12 20 4 8 250 2000


40 40 40 20 20 250 5000

27.9 Artery forceps 40 40 40 20 20 275 5500


20 20 30 5 15 175 2625

27.11


1 1 1 0 1 19000 19000

27.12

Towel clip 40 40 40 20 20 125 2500


28.1 Scalpel 4 4 6 0 4 50 200


16 16 24 8 8 125 1000


16 16 24 8 8 125 1000


16 16 24 8 8 175 1400


4 4 6 0 4 150 600



4 4 6 0 4 270 1080


16 16 24 4 12 300 3600


4 4 6 0 4 900 3600


4 4 6 0 4 200 800


28.11

Towel Clippers 16 16 24 8 8 125 1000

28.12

Suction Nozzle 4 4 6 2 2 250 500



1 1 2 1 0 575000 0


1 1 1 1 0 6000000 0

29.3 Color Doppler 0 0 0 0 0 5750000 0


1 1 1 1 0 30000 0


1 1 1 0 1 100000 100000

29.6 Safe Light 1 1 1 0 1 5000 5000


1 1 1 0 1 5000 5000

29.8 Chest Stand 1 1 1 0 1 4500 4500



2 2 2 1 1 4000 4000


4 4 4 4 0 4000 0



1 1 2 0 1 1200000 1200000

30.2 Incubator 1 1 1 0 1 1500000 1500000


1 1 1 0 1 22000 22000


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 1 0 1 22000 22000



1 1 1 0 1 2000 2000


1 2 2 0 1 7000 7000

31 Anaesthesia/ICU


1 1 1 0 1 321000 321000

31.2 Ventilators 1 1 1 0 1 525000 525000

31.3 Nebulizer 1 1 1 0 1 165000 165000

31.4 Pulse Oximetry 1 1 1 0 1 21000 21000


31.5 Defibrillator 1 1 1 0 1 500000 500000


1 2 2 0 1 500 500


1 2 2 0 1 1000 1000


1 2 2 0 1 1000 1000


1 1 1 0 1 320 320

31.1 AMBO bag adult 1 2 2 0 1 2450 2450

31.11

AMBO Bag paeds 2 2 2 0 2 3000 6000

31.12


4 4 4 0 4 1000 4000

32 Blood Bank


1 1 1 0 1 812000 812000


1 1 1 0 1 600000 600000

32.3 Cell Separator 1 1 1 0 1 5225000 5225000


1 1 1 0 1 1150000 1150000

32.5 Blood bag shaker 1 1 1 0 1 10000 10000

32.6 RH view box 1 2 2 0 1 1000 1000

32.7 Water bath 2 2 2 0 2 3000 6000

32.8 Micro-pipette 4 4 6 0 4 8000 32000


3 3 3 0 3 3000 9000



32.11

Platelets agitator 1 1 1 0 1 1000000 1000000

32.12

Blood thawing bath

1 1 1 0 1 3000 3000

32.13

Microscopes 1 1 1 1 0 115000 0



1 1 1 0 1 425000 425000


1 1 1 0 1 625000 625000


1 1 1 0 1 690000 690000

33.4 Glucometer 2 2 2 1 1 2500 2500


1 1 1 1 0 1000 0

33.6 Centrifuge 1 1 1 0 1 133000 133000

Total 20836050

THQ HOSPITAL KOT ADU

Sr. No.


Available

Gap Cost/Unit

Total Cost

(Qty.)


C B A


1 1 1 0 1 285000 285000

2 Foetal Doppler 2 2 3 0 2 101000 202000


1 1 1 0 1 1200000 1200000

4 Bulb Sucker 5 10

20

1 9 45 405

5 Baby Warmer 2 2 3 1 1 850000 850000

6 Mechanical Sucker

3 3 3 0 3 28000 84000

7 Fetal Stethoscope

2 3 4 1 2 1500 3000

8 Delivery Table 2 2 2 2 0 17500 0

9 D&C Set 2 2 2 1 1 2100 2100

10 Outlet forceps 4 4 4 0 4 900 3600

11 Myoma Screw 2 2 2 0 2 320 640

12 Kochers forceps 4 4 4 0 4 235 940



2 2 2 1 1 400 400


4 4 6 0 4 350 1400


2 2 2 0 2 750 1500

17 Sponge holder 10

10

15

4 6 300 1800


19 CosCo Speculum 4 6 6 0 6 550 3300



3 3 3 1 2 18000 36000



1 1 1 0 1 95000 95000


1 1 1 0 1 110000 110000

24 Cardiac Monitor 1 1 1 0 1 500000 500000


1 1 1 0 1 250000 250000



2 2 2 0 2 55 110


2 2 2 0 2 55 110


2 2 2 0 2 150 300



2 2 2 0 2 150 300


8 8 8 0 8 150 1200


8 8 8 4 4 175 700

26.7 Uterine Sound 2 2 2 1 1 90 90


2 2 4 1 1 150 150


2 2 2 1 1 300 300


16

16

16

4 12 110 1320

26.11


16

16

16

4 12 125 1500

26.12

Allis Forceps 8 8 8 4 4 230 920

26.13

Towel Clamps 8 8 8 2 6 125 750

26.14


4 4 4 0 4 275 1100

26.15


4 4 4 0 4 250 1000

26.16


8 8 8 2 6 200 1200

26.17

Volselum forceps 4 4 4 0 4 250 1000

26.18

Uterine Sound 2 2 2 1 1 1500 1500

26.19

Bladder Sound 2 2 2 0 2 1500 3000


27 Delivery Sets


6 6 10

2 4 125 500

27.2 Straight Scissors 6 6 10

2 4 360 1440

27.3 Needle holder 6 6 10

2 4 135 540


6 6 10

2 4 100 400


6 6 10

2 4 100 400


12

12

20

4 8 275 2200


12

12

20

4 8 250 2000


40

40

40

20 20 250 5000


40

40

20 20 275 5500


20

20

30

5 15 175 2625

27.11


1 1 1 0 1 19000 19000

27.12

Towel clip 40

40

40

20 20 125 2500


4 4 6 0 4 0

28.1 Scalpel 4 4 6 0 4 50 200


16

16

24

8 8 125 1000


16

16

24

8 8 125 1000



16

16

24

8 8 175 1400


4 4 6 0 4 150 600


4 4 6 0 4 270 1080


16

16

24

4 12 300 3600


4 4 6 0 4 900 3600


4 4 6 0 4 200 800

28.1 Small Retractors 8 8 12

2 6 300 1800

28.11

Towel Clippers 16

16

24

8 8 125 1000

28.12

Suction Nozzle 4 4 6 2 2 250 500


0 0


1 1 2 1 0 575000 0


1 1 1 1 0 6000000 0

29.3 Color Doppler 0 0 0 0 0 5750000 0


1 1 1 1 0 30000 0


1 1 1 0 1 100000 100000


29.6 Safe Light 1 1 1 0 1 5000 5000


1 1 1 0 1 5000 5000

29.8 Chest Stand 1 1 1 0 1 4500 4500


2 2 2 1 1 4000 4000


4 4 4 4 0 4000 0


0 0


1 1 2 0 1 1200000 1200000

30.2 Incubator 1 1 1 0 1 1500000 1500000


1 1 1 0 1 22000 22000


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 1 0 1 22000 22000



1 1 1 0 1 2000 2000


1 2 2 0 2 7000 14000

31 Anaesthesia/ICU



1 1 1 0 1 321000 321000

31.2 Ventilators 1 1 1 0 1 525000 525000

31.3 Nebulizer 1 1 1 0 1 165000 165000

31.4 Pulse Oximetry 1 1 1 0 1 21000 21000

31.5 Defibrillator 1 1 1 0 1 500000 500000


1 2 2 0 2 500 1000


1 2 2 0 2 1000 2000


1 2 2 0 2 1000 2000


1 1 1 0 1 320 320

31.1 AMBO bag adult 1 2 2 0 2 2450 4900

31.11

AMBO Bag paeds 2 2 2 0 2 3000 6000

31.12


4 4 4 0 4 1000 4000

32 Blood Bank


1 1 1 0 1 812000 812000


1 1 1 0 1 600000 600000

32.3 Cell Separator 1 1 1 0 1 5225000 5225000


1 1 1 0 1 1150000 1150000

32.5 Blood bag shaker 1 1 1 0 1 10000 10000


32.6 RH view box 1 2 2 0 2 1000 2000

32.7 Water bath 2 2 2 0 2 3000 6000

32.8 Micro-pipette 4 4 6 0 4 8000 32000


3 3 3 0 3 3000 9000


32.11

Platelets agitator 1 1 1 0 1 1000000 1000000

32.12

Blood thawing bath

1 1 1 0 1 3000 3000

32.13

Microscopes 1 1 1 1 0 115000 0



1 1 1 0 1 425000 425000


1 1 1 0 1 625000 625000


1 1 1 0 1 690000 690000

33.4 Glucometer 2 2 2 1 1 2500 2500


1 1 1 1 0 1000 0

33.6 Centrifuge 1 1 1 0 1 133000 133000

Total

20851825

THQ HOSPITAL JATOI


Sr. No.


Available

Gap Cost /Unit

Total Cost

(Qty.)

C B A


1 1 1 0 1 285000 285000

2 Foetal Doppler 2 2 3 0 2 101000 202000


1 1 1 0 1 1200000 1200000

4 Bulb Sucker 5 10 20 0 5 45 225

5 Baby Warmer 2 2 3 0 2 850000 1700000

6 Mechanical Sucker

3 3 3 0 3 28000 84000

7 Fetal Stethoscope

2 3 4 1 1 1500 1500

8 Delivery Table 2 2 2 2 0 17500 0

9 D&C Set 2 2 2 1 1 2100 2100

10 Outlet forceps 4 4 4 0 4 900 3600

11 Myoma Screw 2 2 2 0 2 320 640

12 Kochers forceps 4 4 4 0 4 235 940



2 2 2 1 1 400 400


4 4 6 0 4 350 1400


2 2 2 0 4 750 3000

17 Sponge holder 10 10 15 4 6 300 1800



19 CosCo Speculum 4 6 6 0 4 550 2200


3 3 3 1 2 18000 36000



1 1 1 0 1 95000 95000


1 1 1 0 1 110000 110000

24 Cardiac Monitor 1 1 1 0 1 500000 500000


1 1 1 0 1 250000 250000



2 2 2 0 2 55 110


2 2 2 0 2 55 110



2 2 2 0 2 150 300


2 2 2 0 2 150 300


8 8 8 0 8 150 1200


8 8 8 4 4 175 700

26.7 Uterine Sound 2 2 2 1 1 90 90


2 2 4 1 1 150 150


2 2 2 1 1 300 300


16 16 16 4 12 110 1320

26.1 Artery Forceps (Curved 6”)

16 16 16 4 12 125 1500

26.1 Allis Forceps 8 8 8 4 4 230 920

26.1 Towel Clamps 8 8 8 2 6 125 750

26.1 Single blade Sims speculum

4 4 4 0 4 275 1100

26.2 Double blade Sims speculum

4 4 4 0 4 250 1000


8 8 8 2 6 200 1200

26.2 Volselum forceps 4 4 4 0 4 250 1000

26.2 Uterine Sound 2 2 2 1 1 1500 1500

26.2 Bladder Sound 2 2 2 0 2 1500 3000

27 Delivery Sets



6 6 10 2 4 125 500


27.3 Needle holder 6 6 10 2 4 135 540


6 6 10 2 4 100 400


6 6 10 2 4 100 400


12 12 20 4 8 275 2200


12 12 20 4 8 250 2000


40 40 40 20 20 250 5000

27.9 Artery forceps 40 40 40 20 20 275 5500


20 20 30 5 15 175 2625

27.1 Vacuum Extractor pump

1 1 1 0 1 19000 19000

27.1 Towel clip 40 40 40 20 20 125 2500


28.1 Scalpel 4 4 6 0 4 50 200


16 16 24 8 8 125 1000


16 16 24 8 8 125 1000


16 16 24 8 8 175 1400


4 4 6 0 4 150 600



4 4 6 0 4 270 1080


16 16 24 4 12 300 3600


4 4 6 0 4 900 3600


4 4 6 0 4 200 800


28.1 Towel Clippers 16 16 24 8 8 125 1000

28.1 Suction Nozzle 4 4 6 2 2 250 500



1 1 2 1 0 575000 0


1 1 1 1 0 6000000 0

29.3 Color Doppler 0 0 0 0 0 5750000 0


1 1 1 1 0 30000 0


1 1 1 0 1 100000 100000

29.6 Safe Light 1 1 1 0 1 5000 5000


1 1 1 0 1 5000 5000

29.8 Chest Stand 1 1 1 0 0 4500 0


2 2 2 1 1 4000 4000



4 4 4 4 0 4000 0



1 1 2 0 1 1200000 1200000

30.2 Incubator 1 1 1 0 1 1500000 1500000


1 1 1 0 1 22000 22000


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 1 0 1 22000 22000



1 1 1 0 1 2000 2000


1 2 2 0 2 7000 14000

31 Anaesthesia/ICU


1 1 1 0 1 321000 321000

31.2 Ventilators 1 1 1 0 1 525000 525000

31.3 Nebulizer 1 1 1 0 1 165000 165000

31.4 Pulse Oximetry 1 1 1 0 1 21000 21000

31.5 Defibrillator 1 1 1 0 1 500000 500000



1 2 2 0 1 500 500


1 2 2 0 1 1000 1000


1 2 2 0 1 1000 1000


1 1 1 0 1 320 320

31.1 AMBO bag adult 1 2 2 0 1 2450 2450

31.1 AMBO Bag paeds 2 2 2 0 2 3000 6000

31.1 Red Rubber Nasal tubes all sizes without cuff

4 4 4 0 4 1000 4000

32 Blood Bank


1 1 1 0 1 812000 812000


1 1 1 0 1 600000 600000

32.3 Cell Separator 1 1 1 0 1 5225000 5225000


1 1 1 0 1 1150000 1150000

32.5 Blood bag shaker 1 1 1 0 1 10000 10000

32.6 RH view box 1 2 2 0 1 1000 1000

32.7 Water bath 2 2 2 0 2 3000 6000

32.8 Micro-pipette 4 4 6 0 4 8000 32000


3 3 3 0 3 3000 9000



32.1 Platelets agitator 1 1 1 0 1 1000000 1000000

32.1 Blood thawing bath

1 1 1 0 1 3000 3000

32.1 Microscopes 1 1 1 1 0 115000 0


0 0


1 1 1 0 1 425000 425000


1 1 1 0 1 625000 625000


1 1 1 0 1 690000 690000

33.4 Glucometer 2 2 2 1 1 2500 2500


1 1 1 1 0 1000 0

33.6 Centrifuge 1 1 1 0 1 133000 133000

Total 21690095

Acronyms - Punjabphsrp.punjab.gov.pk/downloads/3yrp/muzaffargarh.docx · Web viewEach element has...

Documents

Transcript of Acronyms - Punjabphsrp.punjab.gov.pk/downloads/3yrp/muzaffargarh.docx · Web viewEach element has...