THREE YEARS ROLLING PLAN 2010-2013 DISTRICT...

THREE YEARS ROLLING PLAN 2010-2013 DISTRICT SHEIKHUPURA

Table of ContentsAcronyms...........................................................................................................................................................4

EXECUTIVE SUMMARY........................................................................................................................................5

SECTION 1: DISTRICT HEALTH PROFILE........................................................................................................7

Vision of the District.........................................................................................................................................7

Background of the District...............................................................................................................................7

Three Years Rolling Plan 2010-2013 District Sheikhupura

Map of the District............................................................................................................................................8

Demography......................................................................................................................................................8

Area-wise population.......................................................................................................................................8

Socio-Economic Indicators.............................................................................................................................10

Health Indicators............................................................................................................................................10

Organizational Structure of District Health Administration........................................................................11

Health Resources............................................................................................................................................12

1. Health Facilities...................................................................................................................................12

a) Public...............................................................................................................................................12

b) Private..............................................................................................................................................12

2. Human Resource.................................................................................................................................13

a) Administrative.................................................................................................................................13

b) Facility Based...................................................................................................................................14

Post..............................................................................................................................................................18

c) Outreach...........................................................................................................................................21

d) Training Institutions........................................................................................................................21

Health Financing.............................................................................................................................................24

Disease Pattern...............................................................................................................................................25

Status of Vertical Programs............................................................................................................................27

1. National Program for FP and PHC.........................................................................................................27

2. EPI.........................................................................................................................................................27

3. MNCH Program.....................................................................................................................................28

4. TB Control Program..............................................................................................................................28

5. Malaria Control Program......................................................................................................................28

6. Hepatitis Control Program....................................................................................................................28

7. School Health Services Program...........................................................................................................29

8. Any other District Specific Program......................................................................................................29

SECTION 2: PROBLEM ANALYSIS..................................................................................................................30

Objectives........................................................................................................................................................30

Plan Development Process.............................................................................................................................30

Problem Identification....................................................................................................................................31

Health Problems.............................................................................................................................................31

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Problem Prioritization................................................................................................................................32

Underlying causes of prioritized problems...............................................................................................33

Service delivery/Management problems......................................................................................................35

MDGs and MSDS..............................................................................................................................................36

a) Human Resource.................................................................................................................................37

i. DHQ Hospital Sheikhupura..............................................................................................................37

ii. THQ Hospital....................................................................................................................................38

b) Equipment...........................................................................................................................................38

i. DHQ Hospital Sheikhupura..............................................................................................................39

ii. THQ Hospital....................................................................................................................................46

SECTION 3: INTERVENTIONS AND TARGETS...............................................................................................55

Health Problems.............................................................................................................................................56

Management Problems...................................................................................................................................66

Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned Posts............................66

SECTION 4: COSTING AND FINANCING PLAN..............................................................................................71

Activity based costing.....................................................................................................................................71

Problem wise cost summary of Health Problems.............................................................................................71

a) Health Problems..................................................................................................................................72

Problem wise cost summary of Management Problems..................................................................................87

b) Management Problems.......................................................................................................................88

Financial Outlay..............................................................................................................................................93

Budget Summary..........................................................................................................................................93

SECTION 5: MONITORING & EVALUATION..................................................................................................94

M&E of Plan.....................................................................................................................................................94

Annex-I............................................................................................................................................................97

Annex- II.........................................................................................................................................................103

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Acronyms

3YRP Three Years Rolling planADB Asian Development BankAPMO Additional Principal Medical OfficerARI Acute Respiratory InfectionsBHU Basic Health CenterBoD Burden of DiesesCDC Communicable Disease ControlCDR Case Detection RateCPR Contraceptive Prevalence Rate DHIS District Health Information SystemDHQH District Head Quarter HospitalDoH Department of HealthDR Default RateEDO(H) Executive District Officer HealthEPI Expended Program on Immunization HSRP Health Sector Reforms ProgramIMR Infant Mortality RateIPC Interpersonal CommunicationM & E Monitoring and EvaluationM & E 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 OfficerPOL 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

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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.

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SHEIKHUPURA

SECTION 1: DISTRICT HEALTH PROFILE

Vision of the DistrictDistrict Health Government has evolved strategies to address all the components of the Primary Health Care in a befitting manner for enhanced utilization of the services by the community.

Mission of the District

Health for all, to provide quality health care services to the community through an efficient and effective service delivery system i.e. accessible, equitable, culturally acceptable, affordable and sustainable.

Background of the DistrictSheikhupura is one of the oldest districts in the Punjab province, established in 19thcentury in the

name of a Mughal emperor Jahangir, who was called Sheikhu.

This District is sandwiched by eight districts of the province and one district of India (Amritsar). River

Ravi traverses from north to west boundary of the district. The district is expanded by 103km in length

and 74km by width.

Sheikhupura district has 4 tehsils (Sheikhupura, Muridke, Ferozewala, Sharaqpur Sharif) in its revenue

limits.

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Map of the District

Demographyo Total Population 2820139

o Total Area 4160 square kilometers

o Annual growth rate 2.41%

o Population density 678 persons per sq. km

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Area-wise populationArea Population Percentage

Rural 18,89,493 67

Urban 9,30,646 33

Source: Standard Demographic population groups based on DHIS

Gender-wise population

Gender Population Percentage

Male 2307720 49

Female 2401912 51

Source: Standard Demographic population groups based on DHIS

Population groups

Population GroupsStandard Demographic

(%)Estimated Population

Under 1 year of age 2.7 76144

Under 5 years 13.4 377899

Under 15 years 44 1240861

Women in child bearing age (15-49 years) 22 620430

Married Child Bearing age Women 16 451222

Expected pregnancies 3.4 95885

Standard Demographic population groups based on DHIS

Tehsil wise distribution

Tehsil Number of UC Population

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Sheikhupura 51 14,30,762

Ferozewala 21 6,14,246

Muridke 21 5,76,979

Sharaq pur 8 1,98,152

Languages

Punjabi is the main language spoken in the district.

Socio-Economic Indicators

Education and Literacy

Literacy rate Male Female

Urban 75.6% 71.1%

Rural 61.9% 54.7%

Overall District 66% 66%

Source: EDO Literacy and Formal Education Sheikhupura

Health Indicators Infant Mortality Rate 79/1000

Under 5 mortality Rate 116/1000 Live births

Maternal mortality Ratio 227/1,000 Live births(Provincial

Figure*)

Malnutrition (women and children)

o Over all (Moderate & Severe) 29%o Over all (Severe) 10%o Stunting Prevalence (Moderate & Severe) 38%o Stunting Prevalence (Severe) 21%o Wasting Prevalence (Moderate & Severe) 11%o Wasting Prevalence (Severe) 4.3%

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Life expectancy 63 years

Proportion of children 0-23 months immunized 92%

Source: MICS 2007-08

*Source: EDO (Health) Office Sheikhupura

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:

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M S D H Q H osp . P D D H D C

D D O H S K P D D O H F .w a la D S V D S I A s s is t . E n tom olog is t A IH S C D C I

D O H D C N P M S TH Q H os p .M u rid k e

D ru g In sp ec to r

E D O (H )

D C O

Z ila N az im


Health Resources

1. Health Facilitiesa) Public

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

Facility Type Name/Number of FacilityBed

Strength

No. of Functional

BedsRemarks

DHQ Hospital DHQ Hospital Sheikhupura 368 368 -------

THQ Hospital THQ Hospital Muridke 68 68 -------

RHCs 07 20 each RHC 20 each RHC -------

BHUs 65 02 each BHU 02 each BHU -------

Govt. Rural Dispensaries

04 Nil Nil -------

MCH Centers 04 1 each MCH Center

1 each MCH Center

-------

Sub Health Centers 15 Nil Nil Closed in 2008

TB Hospital 1 TB Clinics (PATA) is functioning in the District.

-------

Health houses 859 Nil Nil -------12


Facility Type Name/Number of FacilityBed

Strength

No. of Functional

BedsRemarks

Data source: DHIS/EDOH office

b) 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.

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

a) Administrativeb) Facility basedc) Outreachd) Training institutions

a) Administrative

Sr. # NAME OF POST SANCTION FILLED

1 Executive District Officer Health

01 01

2 District Officer Health 1 1

3 DDOH 2 2

4 Program Director 1 1

5 MREO 1 1

6 CDCO 1 1

7 D.S.I 1 1

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8 DSV 1 1

9 ASV 2 2

10 AIHC 1 1

11 DSC 1 1

12 DFO (TB DOTS) 1 1

13 Senior Microscopes 1 1

14 Assistant Entomologist 1 1

b) Facility Based

i. Basic Health Units (65)Sr. No. Name of Post/Designation Sanctioned Filled Vacant

1 Medical Officer 65 53 12

2School Health & Nutrition Supervisor 65 62

3

3 Medical Assistant 65 20 45

4 Computer Operator 65 32 33

5 Medical Technician 65 59 6

6 LHV 65 65 0

7 Dispenser 130 111 19

8 Midwife 65 63 3

9 N/Qasid 65 61 4

10 Chowkidar 65 48 17

11 Sanitary Worker 65 53 12

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ii. Rural Health Centres (7)

Sr. No.

Name of Post/Designation Sanctioned Filled Vacant

1 Senior Medical Officers 7 5 2

2 Women Medical Officers 7 1 6

3 Dental Surgeons 7 3 4

4 Medical Officers 7 7 0

5 Charge Nurses 44 34 10

8 Computer Operators 7 2 5

9 Medical /Health Technician 6 3 3

10 LHV 12 12 0

11 Lab. Technician 7 0 7

12 Dental Technician 11 9 2

13 R.H.I 14 14 0

14 Junior Clerk 10 6 4

15 Vaccinator 13 13 0

17 Dawasaz 1 1 0

18 Radiographer/X-Ray Asstt. 7 3 4

19 Dresser 7 7 0

20 Anesthesia Assistant 7 2 5

21 O.T.A 2 1 1

22 Dispenser 25 24 1

23 Dental Assistant 1 0 1

24 Laboratory Assistant 7 5 2

25 Midwife 26 24 2

26 Driver 11 11 0

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Sr. No.

Name of Post/Designation Sanctioned Filled Vacant

27 T.O 8 7 1

30 Ward Servant 20 19 1

31 Sweepers 2 1 1

32 Sanitary Worker 28 16 12

33 Sanitary Patrol 30 30 0

34 Naib Qasid 13 13 0

35 Mali 7 7 0

36 Cook 8 6 2

37 Chowkidar 13 11 2

38 Water Career 6 6 0

iii. THQ Hospital Muridke

Sr.No. Post Sanctioned Filled

01 Medical Superintendent 1 1

02 APMO 2 2

03 Senior Medical Officer 1 1

04 Surgeon 1 1

05 Pediatrician 1 1

06 Anesthetist 1 0

07 Eye Specialist 1 0

08 Gynecologist 2 1

09 Dental Surgeon 1 1

10 Medical Officer 5 4

11 WMO 2 2

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12 Pharmacist 1 1

13 Head Nurse 1 1

14 Charge Nurses 11 10

15 Homeopathic Doctor 1 1

16 Hakim 1 1

17 Lady Health Visitor 1 1

18 Dental Technician 1 1

19 Junior Clerk 1 1

20 Radiographer 2 0

21 Homeopathic Dispenser 1 1

22 Dispenser 8 7

23 Store Keeper 1 1

24 Operation Theatre Assistant 1 0

25 Dawasaz 1 1

26 Laboratory Assistant 2 1

27 Driver 2 2

28 Midwife 2 2

29 Tube-well operator 1 1

30 Water Carrier 1 1

31 Ward Servant 10 9

32 Ward Bearer 1 1

33 Sanitary Worker 11 7

34 Naib Qasid 2 2

35 Masalchi 1 117



36 Mali 1 1

37 Gate Keeper 1 1

38 Dhobi 1 0

39 Dawacob 1 0

40 Dai 1 0

41 Cook 2 0

42 Chowkidar 3 2

43 Baildar 3 3

iv. DHQ Hospital Sheikhupura


1. Medical Superintendent 1 1

2. Chief Consultant Surgeon 3 3

3. PMO 1 1

4. PWMO 1 0

5. APMO 5 4

6. APWMO 3 1

7. Principal Dental Surgeon 2 2

8. Surgeon 1 1

9. Senior Consultant 4 3

10. Trauma Surgeon 1 1

11. T.B & Chest Specialist 1 1

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12. Senior Medical Officer 3 1

13. Physician 2 0

14. Pathologist 1 0

15. Pediatrician 1 0

16. Ophthalmologist 1

17. Orthopedic Surgeon 1 1

18. Nursing Superintendent 1 1

19. Gynecologist 3 1

20. ENT Specialist 1

21. DMS 4 3

22. Anesthetist 1 1

23. AMS 2 1

24. Cardiologist 1 2

25. CMO 1

26. WMO 20 7

27. Radiologist 1 0

28. Pharmacist 2 2

29. Medical Officer 64 19

30. Physiotherapist 1 0

31. Dental Surgeon 1 1

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32 Nursing Sister/Head Nurse 13 12

33 Charge Nurses 74 71

34 Internee /House Officers 8 4

35 Hakim 1 1

36 Homeo Doctor 1 1

37 AMO 1 1

38 House Keeper 1 1

39 Medical Technician 2 2

40 Dental Technician 2 1

41 ECG Technician 2 1

42 Blood Technician 1 1

43 Senior Clerk 1 1

44 Junior Clerk 5 4

45 O.T. Assistant 5 5

46 Radiographer/X-Ray Assistant 6 3

47 Homeo Dispenser 1 1

48 Dawasaz 1 1

49 Store Keeper 1 1

50 Dispenser/ Dresser 13 13

51 Record Keeper 1 1

52 Lab: Assistant 5 4

53 Nursing Orderlies 3 3

54 Driver 3 3

55 Midwife 2 2

56 Tailor 1 1

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57 O.T. Attendant 3 3

58 Daftri 1

59 Lab: Attendant 1 1

60 X-Ray Attendant 1 1

61 Naib Qasid 7 7

62 Attendant 3 2

63 Dhobi 2 2

64 Gate Keeper 6 6

65 Ward Servant 39 39

66 Chowkidar 5 5

67 Cook 3 3

68 Mali 3 3

69 Bearer 13 12

70 Bahishti 3 3

71 Dawakob 1 1

72 Sanitary Worker 36 30

73 Baildar 2 2

c) 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 Filled

Vaccinators 92 92

CDC Supervisors 60 52

Sanitary Inspectors 66 42

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d) Training Institutions A number of training institutions are working in the district, which include the following:

Type of institute Number

DHDC 01

General Nursing school 01

Midwifery school 01

i. DHDC


Program Director 1 1

Multipurpose Paramedical staff 1 0

Monitoring Re-& Evaluation Officer 1 1

Health Nutrition Education Officer 1 0

LHV Trainers 1 0

Assistants 1 1

Driver 1 1

Naib Qasid 1 1

Sweeper 1 1

Chowkidar 2 2

ii. General Nursing School


Principal 1 1

Nursing Instructor 3 3

Head Nurse 4 4

Charge Nurse 2 2

Stenographer 1 1

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Head Clerk 1 1

Accountant 1 0

House Keeper 1 1

Senior Clerk 1 1

Junior Clerk 1 1

Ayya 1 1

Sweeper 3 1

Naib Qasid 3 1

Masalchi 1 1

Cook 1 1

Chowkidar 2 2

iii. Midwifery School

Posts are same in Midwifery School as mentioned in Nursing School.

iv. Community Midwifery SchoolMNCH Program is providing community midwifery training at General Nursing School DHQ Hospital Sheikhupura. Following staff has been provided by National MNCH Program.


Principal 1(Principal GNS dual charge)

1

CMW Tutor 3 3Computer Operator 1 1Security Guard 2 2

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v. Paramedics (UTD) TrainingNo specific post have been designated for training of paramedics in DHQ Hospital Sheikhupura, however one medical officer and one pharmacist from the DHQ hospital has been detailed to impart training to the dispenser class.

Health FinancingThe 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 Year

2007-08 2008-09 2009-10

Allocation Exp Allocation Exp Allocation Exp

District Health Budget

Non-developmental

-407.9

-298.5

-559.3

-412.7

-915.7

-407.7

PHSRP - - 12,.0 11.5 10.8 8.2

PMDGP - - 76.7 13.5 63.1 11.5

PDSSP 8.5 8.2 14.5 5.5 23.8 5.7

Provincial development budget for district

- - - - - -

Other sources (Specify source)

- - - - - -

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Grand Total 416.4 306.7 662.5 443.2 1013.4 433.1

Disease PatternThe 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 Total

Respiratory Diseases

1 Acute (upper) respiratory infections 14.52796855

2 Pneumonia < 5 yrs. 0.341548439

3 Pneumonia >5 yrs. 0.360846237

4 TB Suspects 1.147993227

5 Chronic Obstructive Pulmonary diseases 0.31373027

6 Asthma 1.096701713

Gastro Intestinal Diseases

7 Diarrhea / Dysentery < 5 yrs. 2.603735534

8 Diarrhea / Dysentery < 5 yrs. 2.579415796

9 Eneric / Typhoid Fever 0.204714644

10 Worm infestations 0.7206768

11 Peptic Ulcer Diseases 1.4370652

12 Cirrhosis of Liver 0.045705309

Urinary Tract Diseases

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13 Urinary Tract Infections 1.006532474

14 Nephritis / Nephrosis 0.013655166

15 Sexually Transmitted Infections 0.056313455

16 Benign Enlargement of Prostrate 0.034758605

Other Communication Diseases

17 Suspected Malaria 0.806275508

18 Suspected Meningitis 0.035774279

19 Fever due to other causes 2.74852544

Vaccine Preventable Diseases

20 Suspected Measles 0.001467084

21 Suspected viral Hepatitis 0.162225634

22 Suspected Neonatal Tetanus 0.004401252

Cardiovascular diseases

23 Ischemic heart disease 0.118382393

24 Hypertension 1.232971246

Skin Diseases

25 Scabies 6.088229303

26 Dermatitis 1.343566808

27 Cutaneous Leishmaniasis -

Endocrine Diseases

28 Diabetes Mellitus 0.658720714

Neuro-Psychiatric Diseases

29 Depression 0.214081411

30 Drug Dependence 0.008520372

31 Epilepsy 0.026971775

Eye & ENT

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32 Cataract 0.140840064

33 Trachoma 0.075046989

34 Glaucoma 0.029567385

35 Otitis Media 0.582545199

Oral Diseases

36 Dental Caries 2.106337634

Injuries / Poisoning

37 Road traffic accidents 1.136595112

38 Fractures 0.123517187

39 Burns0.130119065

40 Dog bite 0.075329121

41 Snake bite (with signs/ symptoms of poisoning) 0.003724136

Miscellaneous Diseases

42 Acute Flaccid Paralysis 0.00000056

43 Suspected HIV/AIDS 0.006827583

44 Any Other Unusual Diseases (Specify) -

Total 100%

Source: Compiled from PHC and SHC reports of DHIS

Status of Vertical ProgramsThe following paragraphs depict the current status of the program being implemented in the district. The indicators and their values have been taken from the program reports.

1. National Program for FP and PHC No. of seats allocated for LHWs 899 No. of LHWs working 859 Percentage of population covered by the program 30% Important Program indicators

o IMR 42 per 1000 live birthso MMR 55 per 100000 live births

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o CPR 38.7%o No. of antenatal visits 99%o TT Coverage of Pregnant women 98%

2. EPI EPI coverage rate of the district

o Based on program information 92%o Based on Third Party Validation 89%

Fully immunized children 0-23 months 91%

Pregnant women received TT vaccine 56% Availability of cold chain equipment 80%

3. MNCH Program

Status of Recruitment of WMOs, Nurses, LHVs & MIDWIFEs

4. TB Control Program CDR all types 74% CDR NSS Positive 79% SCR 78% TSR 99% DR 1%

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S.# Name Of Post Sanctioned Filled Vacant

1 WMO (MNCH) 07 02 05

WMO (Health) 34 13 21

2 Nurses 155 120 35

3 LHVs (MNCH) 07 07 0

LHVs (Health) 80 76 04

4 Midwifes (Health)

130 95 35


5. Malaria Control Program No. of slides examined 38937 No. of positive slides 9 Slides positively ratio 0.02 Percentage of plasmodium Falciparum 0.0006

6. Hepatitis Control Program No. of hepatitis tests conducted 1552 No. of positive cases detected 235 No. of persons vaccinated against Hepatitis B 1402 No. of cases treated for Hepatitis B 0 No. of cases treated for Hepatitis C 37

7. School Health Services Program Total visits to the schools 4269 No. of students examined 122543 No. of students referred to BHUs 35963 No. of students treated in BHUs 26567 No. of students referred from BHUs to higher facilities 3650 No. of schools in catchment areas 941 No. of students 123730 No. of SH & NS 62 No. of teachers trained 1807

8. Any other District Specific Program

Universal Salt Iodization Program is functional in the district.

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SECTION 2: PROBLEM ANALYSIS

The Health sector in Punjab is facing enormous health and service delivery problems. Common health problems are communicable, non communicable, MNCH related diseases and accident/ trauma. The society is passing through demographic and epidemiological transition. This is due to changing life style, urbanization, ecological and other factors. Disease pattern is changing where non communicable diseases are gradually increasing and the communicable diseases are still posing serious threat. Punjab is practically facing Double Burden of Disease (BOD). Besides, health problems service delivery/ managerial issues are also hindering the access and quality of health services to the population. The service delivery/management problems are diverse in nature, and include shortage of technical human resource, capacity issues, lack of infrastructure and equipment.

Devolution was introduced during 2001 affecting the administrative and financial set up of the districts. The devolution also brought political culture in the decision making of the districts in the shape of Nazims, Naib-Nazims and Councilors. This system is now in the phase of reshaping and it is not clear what will be future structure and managerial shape when new local bodies system is put in place. The District Manager and functionaries are in the state of uncertainty and confusion in this scenario. However, one thing is clear that the district shall remain a hub of all primary and secondary health services delivery. Despite the source of funding in the future, either from provincial or district government, health planning at district level shall continue to play a pivotal role in provision of quality health services.

In view of the above situation the district considers following objectives for developing three year rolling plan.

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.

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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

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

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. Diarrheal Diseases 2. Acute respiratory tract infections (ARI)

3. Hepatitis 4. Suspected Tuberculoses

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5. Road Side Accident/Injuries 6. Suspected Malaria

7. Anemia 8. High maternal mortality

9. High under five mortality 10. Scabies

11. Dental Caries 12. Hypertension

13. Peptic Ulcer Diseases 14. Asthma

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 of

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 Effectiveness

Political Expediency

Total Score

Priority Number

Diarrheal Diseases

3 4 4 4 1 16 1

ARI (under 5) 3 3 4 3 1 14 3

Hepatitis 3 3 3 2 3 14 4

Tuberculosis 2 3 3 3 2 13 7

Accidents & Injuries

2 3 2 2 2 11 8

Suspected 1 2 3 3 2 11 9

32


Problem Magnitude Severity Vulnerability to

intervention

Cost Effectiveness

Political Expediency

Total Score

Priority Number

Malaria

Anemia 3 3 3 4 2 15 2

High maternal mortality

3 3 3 3 2 14 5

High under five mortality

3 2 3 3 3 14 6

High infant mortality

2 2 2 2 1 9 10

Pneumonia 1 1 3 2 1 8 11

Ischemic Heart Diseases

1 2 2 1 2 8 12

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. No. Health Problem Causes

1 Diarrheal Diseases Poor sanitation

Lack of safe drinking water

Unhygienic practices

Lack of awareness in general population

Lack of awareness among mothers about feeding and weaning practices

Low Socio Economic status

Malnutrition

33



2 Anemia ( including pregnancy)

Lack of awareness about balanced diet

Gender discrimination

Social taboos and norms

Worm infestation

Infections

Poor quality of MNCH services

Poverty/ Low socio economic status

3 Acute (upper) respiratory infections

Malnutrition

Air contamination

Over-crowding/Poor housing facilities

Lack of proper sanitation

Seasonal variation

Lack of awareness and hygienic practices

4 Hepatitis Poor sanitation

Unsafe drinking water

Sharing of used syringes

Transfusion of unsafe blood and blood products

Unsafe sexual practices

Ear & Nose piercing and tattooing

Use of unsterilized equipment by dentists and barbers

5 High MMR Poor access to healthcare delivery services

Lack of awareness about danger signs of pregnancy

Low ante-natal coverage

Low skilled birth attendance

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

Complications of pregnancy

Capacity Issues related to maternal care

Maternal Anemia

Pregnancy following chronic severe diseases

34



6 High under 5 Mortality Poor antenatal natal and post natal coverage

Neo-natal Infections

Birth Trauma & Asphyxia

Prematurity

Poor feeding and weaning practices

Diarrhea

ARI

Lack of capacity of staff for provision of proper child health care (diagnostic and timely referrals)

Low socio economic status

Malnutrition

Lack of birth spacing

Low EPI Coverage

7 TB Suspects Low socio-economic status Seasonal variation



8 Road traffic accidents

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

35


Service delivery/Management problemsThis 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:

Sr.No

Service Delivery / Management Problems

1 Shortage of skilled staff due to: Ban on permanent postings Non availability of incentivized pay package and career structure Medico-legal work for WMOs Non sanctioning of posts according to MSDS

36


2 Deficient MNCH related equipment (with reference to standard notified list) at: DHQH THQHs

3 Capacity issues related to: Financial Management Supportive Supervision and Use of information

4 Inadequate budget for POL due to: Price hikes Installation and use of generators

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

37


(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 Hospital

A 400 and above Beds

B 251-400 Beds

C Up to 250 Beds

THQ Hospital

A Above 60 Beds

B 41-60 Beds

C Up to 40 Beds

i. DHQ Hospital Sheikhupura(Category A)

38


Sr. No.

Post Standard as per MSDS

Sanctioned Filled Vacancy Gap in

relation to sanctioned positions

Vacancy Gap in

relation to filled

positions

1 Gynecologist 4 3 1 1 3

2 Pediatricians 3 3 1 0 2

3 Anesthetists 5 1 3 4 4

4 Medical Officers including SMO,APMO & PMOs

125 73 25 52 100

5 Women Medical Officers including SWMO, APWMO &PMOs

48 24 8 24 40

6 Lady Health Visitors 11 0 0 11

7 Nurses 189 87 73 102 116

ii. THQ Hospital (Category B)

Sr. No. Post Standard as per MSDS



Vacancy Gap in

relation to filled

positions

1 Gynecologist 2 2 0 0 2

2 Pediatricians 2 1 1 1 1

3 Anesthetists 3 1 0 2 3

4 Medical Officers including SMO,APMO & PMOs

19 8 6 11 13

5 Women Medical Officers including SWMO, APWMO &PMOs

10 11 2 2 9

6 Lady Health Visitors 8 1 1 7 7

39


Sr. No. Post Standard as per MSDS



Vacancy Gap in

relation to filled

positions

7 Nurses 24 12 11 12 13

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.

i. DHQ Hospital Sheikhupura

Sr. No.

Equipment Standard as per MSDS

(Qty.)

Available Gap Remarks

C B A

1 CTG (Cardiac Topography)

1 1 2 2 -

2 Foetal Doppler 3 5 5 2 3

3 Diagnostic Laparoscope 1 1 2 1 1

4 Bulb Sucker 10 20 20 1 20

5 Baby Warmer 3 3 6 2 4

6 Mechanical Sucker 3 3 6 4 2

7 Fetal Stethoscope 4 4 4 0 4

40


Sr. No.


(Qty.)


C B A

8 Delivery Table 2 2 3 2 1

9 D&C Set 2 3 4 1 3

10 Outlet forceps 4 4 4 1 3

11 Myoma Screw 2 2 2 2 0

12 Kochers forceps 4 4 8 1 7

13 Volselum forceps 6 8 10 8 2

14 Lanes Tissue holding forceps

2 2 4 12 -

15 Vaginal Retractors 10 10 10 2 8

16 Polypectomy forceps 2 2 2 - 2

17 Sponge holder 10 15 20 20 -

18 Uterine elevator 1 1 1 - 1

19 CosCo Speculum

Small, Medium, Large (for each category)

6 10 10 1 9

20 Examination light 3 3 6 2 4

21 Suction Curette 1 2 2 0 2

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

1 1 2 0 2

41


Sr. No.


(Qty.)


C B A

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

1 1 2 0 2

24 Cardiac Monitor 1 1 2 1 1

25 Pump Breast Electronic 1 1 1 - 1

26 Vaginal Hysterectomy Set

2 2 4 0 4

26.1 Toothed Tissue Forceps (8”)

2 2 4 0 4

26.2 Non-Tooted Tissue Forceps (8”)

2 2 4 0 4

26.3 Dissection Scissors (Curved 7”)

2 2 4 5 -

26.4 Dissection Scissors (Straight 7”)

2 2 4 0 4

26.5 Hysterectomy Clamps (Straight)

8 8 16 6 10

26.6 Hysterectomy Clamps (Curved)

8 8 16 3 13

26.7 Uterine Sound 2 2 4 6 -

26.8 Needle Holder (7”) 2 2 4 21 -

26.9 Needle Holder (10”) 2 2 4 24 -

42


Sr. No.


(Qty.)


C B A

26.10 Artery Forceps (Straight 6”)

16 16 32 - -

26.11 Artery Forceps (Curved 6”)

16 16 32 47 -

26.12 Allis Forceps 8 8 16 109 -

26.13 Towel Clamps 8 8 16 1 15

26.14 Single blade Sims speculum

4 4 8 2 6

26.15 Double blade Sims speculum

4 4 8 4 3

26.16 Sponge holding forceps 8 8 16 - 16

26.17 Volselum forceps 4 4 8 - 8

26.18 Uterine Sound 2 2 4 0 4

26.19 Bladder Sound 2 2 4 4 0

27 Delivery Sets 10 10 15 1 14

27.1 Episiotomy Scissors 10 10 15 1 14

27.2 Straight Scissors 10 10 15 1 12

27.3 Needle holder 10 10 15 1 14

27.4 Non-toothed tissue forceps 8 inches

10 10 15 1 14

27.5 Toothed tissue forceps 8 inches

10 10 15 0 15

27.6 Sims Speculum single blade

20 20 30 1 29

43


Sr. No.


(Qty.)


C B A

27.7 Sims Speculum double blade

20 20 30 1 29

27.8 Sponge holding forceps 40 40 60 2 58

27.9 Artery forceps 40 40 60 0 60

27.10 Straight clamps (cord) 20 20 30 2 28

27.11 Vacuum Extractor pump 1 1 1 1 0

27.12 Towel clip 40 40 60 0 60

28 Caesarian Section 6 8 10 - 10

28.1 Scalpel 6 8 10 42 -

28.2 Artery Forceps Straight 6 inches

24 32 40 - 40

28.3 Artery Forceps Curved 6 inches

24 32 40 - 40

28.4 Artery forceps 8 inches 24 32 40 - 40

28.5 Myoma Scissors straight 7 inches

6 8 10 - 10

28.6 Dissecting scissors (curved) 7 inches

6 8 10 - 10

28.7 Green Armtage forceps 8 inches

24 32 40 4 36

28.8 Obstetric outlet forceps (pair)

6 8 10 1 9

28.9 Doyene’s Retractor 6 8 10 1 9

28.10 Small Retractors 12 16 20 2 18

44


Sr. No.


(Qty.)


C B A

28.11 Towel Clippers 24 32 40 - 40

28.12 Suction Nozzle 6 8 10 2 8

29 MNCH Related Radiology Equipments

29.1 Ultrasound Machine 1 2 3 1 2

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

29.3 Color Doppler 0 1 1 1 0

29.4 Lead Screen for X-Ray Unit

1 1 1 1 0

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

1 1 1 1 0

29.6 Safe Light 1 1 1 1 0

29.7 X-RT Film Processing Tank

1 1 1 1 0

29.8 Chest Stand 1 1 1 - 1

29.9 X-Ray film Illuminator 2 2 2 2 0

29.10 X-Ray Film Hangers All sizes

4 4 4 4 0

30 MNCH Related Pediatrics Equipments

30.1 Pediatric Ventilator 1 2 2 - 2

30.2 Incubator 1 1 2 2 0

30.3 Photo Therapy Unit 1 1 1 1 0

45


Sr. No.


(Qty.)


C B A

30.4 Over-head Radiant Warmer

1 1 1 1 0

30.5 Infant Length Measuring Scale

2 2 2 2 0

30.6 Infant Weighing Machine

2 2 2 1 1

30.7 Nebulizer 1 1 2 1 1

30.8 Billiubino-meter 1 1 2 - 2

30.9 Exchange Blood Transfusion Set

1 1 2 1 1

30.10 Nasal Probe Paed size 2 2 4 1 3

31 Anesthesia/ICU

31.1 Anesthesia Machine 1 1 2 3 -

31.2 Ventilators 1 1 1 1 0

31.3 Nebulizer 1 1 1 1 0

31.4 Pulse Oximetry 1 1 1 7 -

31.5 Defibrillator 1 1 1 6 -

31.6 Airway Oral and Nasal 2 3 4 1 3

31.7 Tracheostomy tube (adult and paeds)

2 2 4 4 0

31.8 Face mask of all sizes 2 2 4 100 -

31.9 Double Cuff Tourniquet (for regional block)

1 2 2 2 0

31.10 AMBO bag adult 2 2 4 20 -

46


Sr. No.


(Qty.)


C B A

31.11 AMBO Bag paeds 2 2 4 - 4

31.12 Red Rubber Nasal tubes all sizes without cuff

4 4 8 - 8

32 Blood Bank

32.1 Blood storage cabinet (100 bag capacity)

1 1 2 1 1

32.2 Packed cell machine 1 1 1 - 1

32.3 Cell Separator 1 1 1 - 1

32.4 Freezer for Fresh Frozen Plasma

1 1 1 - 1

32.5 Blood bag shaker 1 1 2 1 1

32.6 RH view box 2 2 4 1 3

32.7 Water bath 2 2 2 1 1

32.8 Micro-pipette 4 6 8 1 7

32.9 Blood grouping tiles 3 3 6 - 6

32.10 Plasma Extractor 1 1 1 - 1

32.11 Platelets agitator 1 1 1 - 1

32.12 Blood thawing bath 1 1 1 - 1

32.13 Microscopes 1 1 2 1 1

33 Gynae & Labor Room Related Laboratory Equipment

33.1 Hematology Analyzer 1 1 1 - 1

47


Sr. No.


(Qty.)


C B A

33.2 Electrolyte Analyzer 1 1 1 - 1

33.3 Analyzer Bio-chemistry Semi-automatic

1 1 1 - 1

33.4 Glucometer 2 2 2 - 2

33.5 Haemoglobino-meter 2 2 4 - 4

33.6 Centrifuge 1 1 2 - 2

ii. THQ Hospital

Sr. No.


(Qty.)


C B A

1 CTG (Cardiac Topography)

1 1 1 - 1

2 Foetal Doppler 2 2 3 - 2

3 Diagnostic Laparoscope

1 1 1 - 1

48


Sr. No.


(Qty.)


C B A

4 Bulb Sucker 5 10 20 1 9

5 Baby Warmer 2 2 3 1 1

6 Mechanical Sucker 3 3 3 1 2

7 Fetal Stethoscope 2 3 4 - 3

8 Delivery Table 2 2 2 - 2

9 D&C Set 2 2 2 - 2

10 Outlet forceps 4 4 4 1 3

11 Myoma Screw 2 2 2 1 1

12 Kochers forceps 4 4 4 - 4

13 Volselum forceps 4 4 6 1 3

14 Lanes Tissue holding forceps

2 2 2 1 1

15 Vaginal Retractors 4 4 6 1 3

16 Polypectomy forceps 2 2 2 - 2

17 Sponge holder 10 10 15 3 7

18 Uterine elevator 1 1 1 - 1

19 CosCo Speculum

Small, Medium, Large (for each category)

4 6 6 1 5

20 Examination light 3 3 3 1 2

21 Suction Curette 1 1 2 - 1

49


Sr. No.


(Qty.)


C B A

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

1 1 1 1 0


1 1 1 1 0

24 Cardiac Monitor 1 1 1 - 1

25 Pump Breast Electronic

1 1 1 - 1

26 Vaginal Hysterectomy Set

2 2 2 - 2

26.1 Toothed Tissue Forceps (8”)

2 2 2 6 -

26.2 Non-Tooted Tissue Forceps (8”)

2 2 2 6 -

26.3 Dissection Scissors (Curved 7”)

2 2 2 1 1

26.4 Dissection Scissors (Straight 7”)

2 2 2 1 1

26.5 Hysterectomy Clamps (Straight)

8 8 8 - 8

50


Sr. No.


(Qty.)


C B A

26.6 Hysterectomy Clamps (Curved)

8 8 8 - 8


26.8 Needle Holder (7”) 2 2 4 4 -

26.9 Needle Holder (10”) 2 2 2 4 -

26.10 Artery Forceps (Straight 6”)

16 16 16 12 4

26.11 Artery Forceps (Curved 6”)

16 16 16 12 4

26.12 Allis Forceps 8 8 8 10 -

26.13 Towel Clamps 8 8 8 8 0

26.14 Single blade Sims speculum

4 4 4 1 3

26.15 Double blade Sims speculum

4 4 4 1 3


26.17 Volselum forceps 4 4 4 1 3


26.19 Bladder Sound 2 2 2 - 2

27 Delivery Sets 6 6 10 2 4

27.1 Episiotomy Scissors 6 6 10 3 3

27.2 Straight Scissors 6 6 10 6 0

27.3 Needle holder 6 6 10 6 0

51


Sr. No.


(Qty.)


C B A

27.4 Non-toothed tissue forceps 8 inches

6 6 10 6 0

27.5 Toothed tissue forceps 8 inches

6 6 10 4 2

27.6 Sims Speculum single blade

12 12 20 1 11

27.7 Sims Speculum double blade

12 12 20 1 11


27.9 Artery forceps 40 40 40 12 28

27.10 Straight clamps (cord) 20 20 30 2 18

27.11 Vacuum Extractor pump

1 1 1 - 1

27.12 Towel clip 40 40 40 8 32

28 Caesarian Section 4 4 6 2 2

28.1 Scalpel 4 4 6 4 0

28.2 Artery Forceps Straight 6 inches

16 16 24 6 10

28.3 Artery Forceps Curved 6 inches

16 16 24 12 4

28.4 Artery forceps 8 inches 16 16 24 - 16

28.5 Myoma Scissors straight 7 inches

4 4 6 - 4

28.6 Dissecting scissors (curved) 7 inches

4 4 6 2 2

52


Sr. No.


(Qty.)


C B A

28.7 Green Armtage forceps 8 inches

16 16 24 - 16

28.8 Obstetric outlet forceps (pair)

4 4 6 2 2

28.9 Doyene’s Retractor 4 4 6 2 2

28.10 Small Retractors 8 8 12 6 2

28.11 Towel Clippers 16 16 24 8 8

28.12 Suction Nozzle 4 4 6 1 3

29 MNCH Related Radiology Equipments

29.1 Ultrasound Machine 1 1 2 1 0

29.2 X-Ray Unit 500 kw 1 1 1 - 1

29.3 Color Doppler 0 0 0 - 0

29.4 Lead Screen for X-Ray Unit

1 1 1 - 1


1 1 1 - 1

29.6 Safe Light 1 1 1 - 1

29.7 X-RT Film Processing Tank

1 1 1

29.8 Chest Stand 1 1 1 1

29.9 X-Ray film Illuminator 2 2 2 2

53


Sr. No.


(Qty.)


C B A

29.10 X-Ray Film Hangers All sizes

4 4 4 4

30 MNCH Related Pediatrics Equipments

30.1 Pediatric Ventilator 1 1 2 - 1

30.2 Incubator 1 1 1 - 1

30.3 Photo Therapy Unit 1 1 1 - 1

30.4 Over-head Radiant Warmer

1 1 1 - 1

30.5 Infant Length Measuring Scale

2 2 2 - 2

30.6 Infant Weighing Machine

2 2 2 - 2

30.7 Nebulizer 1 1 1 1 0

30.8 Billiubino-meter 1 1 1 - 1

30.9 Exchange Blood Transfusion Set

1 1 1 - 1

30.10 Nasal Probe Paed size 1 2 2 1 1

31 Anesthesia/ICU

31.1 Anesthesia Machine 1 1 1 1 0

31.2 Ventilators 1 1 1 - 1

31.3 Nebulizer 1 1 1 1 0

31.4 Pulse Oximetry 1 1 1 1 0

54


Sr. No.


(Qty.)


C B A

31.5 Defibrillator 1 1 1 1 0

31.6 Airway Oral and Nasal 1 2 2 2 0

31.7 Tracheostomy tube (adult and paeds)

1 2 2 - 2

31.8 Face mask of all sizes 1 2 2 - -

31.9 Double Cuff Tourniquet (for regional block)

1 1 1 - 1

31.10 AMBO bag adult 1 2 2 1 1

31.11 AMBO Bag paeds 2 2 2 1 1

31.12 Red Rubber Nasal tubes all sizes without cuff

4 4 4 - 4

32 Blood Bank

32.1 Blood storage cabinet (100 bag capacity)

1 1 1 - 1

32.2 Packed cell machine 1 1 1 - 1

32.3 Cell Separator 1 1 1 - 1

32.4 Freezer for Fresh Frozen Plasma

1 1 1 - 1

32.5 Blood bag shaker 1 1 1 - 1

32.6 RH view box 1 2 2 - 2

32.7 Water bath 2 2 2 - 2

32.8 Micro-pipette 4 4 6 - 4

55


Sr. No.


(Qty.)


C B A

32.9 Blood grouping tiles 3 3 3 - 3

32.10 Plasma Extractor 1 1 1 - 1

32.11 Platelets agitator 1 1 1 - 1

32.12 Blood thawing bath 1 1 1 - 1

32.13 Microscopes 1 1 1 1 0

33 Gynae & Labor Room Related Laboratory Equipment

33.1 Hematology Analyzer 1 1 1 - 1

33.2 Electrolyte Analyzer 1 1 1 - 1

33.3 Analyzer Bio-chemistry Semi-automatic

1 1 1 - 1

33.4 Glucometer 2 2 2 1 1

33.5 Haemoglobino-meter 1 1 1 1 0

33.6 Centrifuge 1 1 1 1 0

56


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.

57


Health Problems

Sr. No.

Problem Causes Intervention Activities UnitPlan Activities

Targets

Target for 2010-

11

Target for 2011-

12

Target for 2012-

13Remarks

1 Diarrhea Poor sanitation Coordination with TMA for improvement of water supply and sanitation

Quarterly co-ordination Meeting with TMA and other agencies

Meeting 12 4 4 4

Lack of safe drinking water

Health Education campaign

Messages on local cable network

Message 36 12 12 12

Unhygienic practices

Improving literacy through coordination with education department

Printing and distribution of IPC material

Brochure 100,000 40,000 30,000 30,000

Lack of awareness in general population

Proper treatment of Diarrhea including ORT

Address in school assemblies

Session 2,000 2,000 2,000 2,000

Lack of awareness among mothers about feeding and weaning practices

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

Training of medics and paramedics in IMCI

No. of trainings

15 15 - -

Low Socio Economic status

Procurement and distribution of ORS

ORS packets 100,000 40,000 35,000 25,000

58


Sr. No.


Targets

Target for 2010-

11

Target for 2011-

12

Target for 2012-

13Remarks

Malnutrition Procurement and distribution of Syp. Zink Sulphate

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

Procurement and Distribution of Syrup Metronidazole

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

Procurement and Distribution of Inj. Metronidazole

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

Procurement & Distribution of IV Fluids

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


Lack of awareness about balanced diet

Awareness raising for behavior change


Message 36 12 12 12

Gender discrimination



Brochure 100,000 40,000 30,000 30,000

Social taboos and norms


Counseling of pregnant mothers

Session - - -

Worm infestation Deworming campaign

Procurement of de-worming tablets

No. of doses 100,000 35,000 35,000 30,000

Infections Diagnosis and treatment of infections

Distribution through LHWs and health facilities

- - - -

59


Sr. No.


Targets

Target for 2010-

11

Target for 2011-

12

Target for 2012-

13Remarks

Poor quality of MNCH services

Strengthening MNCH Services

Refresher Trainings of LHWs on BCC, balanced diet and provision of micro-nutrients

No. of trainings

65 35 30 -

Poverty/ Low socio economic status

Equity of services Provision of Sehat Suhlat Card/health voucher

- - - -


Malnutrition Capacity building of health staff in ARI case management

Messages on local cable networks

Message 36 12 12 12

Air Contamination

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

Messages through FM radio channels

Message 36 12 12 12

Over-crowding/Poor housing facilities

Provision of medicines for ARI


Brochure 400,000 200,000 100,000 100,000


Timely referral of complicated cases

Training of medics and para-medics in IMCI

No. of trainings

- - - -

Seasonal variation

Procurement and distribution of Antibiotic Syrup Amoxicillin

Antibiotic (Syrup)

60,000 20,000 20,000 20,000

60


Sr. No.


Targets

Target for 2010-

11

Target for 2011-

12

Target for 2012-

13Remarks


Procurement and distribution of Inj. Cefotaxime Sodium 1mg

Injection 25,000 10,000 8,000 7,000


Injection 25,000 10,000 8,000 7,000


Injection 25,000 10,000 8,000 7,000

4 Hepatitis Poor sanitation Health Education/Promotion

Quarterly co-ordination meetings with TMA and other agencies

Meetings - - - -

Unsafe drinking water

Improving water & sanitation


Message 36 12 12 12

Sharing of used syringes

Campaign against quackery


Brochure 500000 200000 200000 100000

Transfusion of unsafe blood and blood products

Strengthening blood transfusion services for safe transfusions

Printing and pasting of stickers at clinics and Barber shop highlighting use of new syringes & Razors

Stickers 1500 1500 - -

61


Sr. No.


Targets

Target for 2010-

11

Target for 2011-

12

Target for 2012-

13Remarks

Unsafe sexual practices

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

Hepatitis awareness week ( walk/display banners/seminars)

3 1 1 1

Ear & Nose piercing and tattooing

Procurement & Distribution of HCV Device

Kits 30000 10000 10000 10000

Use of unsterilized equipment by dentists and barbers

Procurement & Distribution of BSAG Device

Kits 30000 10000 10000 10000

Procurement & Distribution of HIV Device

Kits 30000 10000 10000 10000

Procurement and supply of HCV Eliza kits

Kits 18 6 6 6

Procurement and supply of HBV Eliza kits

Kits 9 3 3 3

Procurement of syringe cutters

Syringe cutter

1800 600 600 600

Procurement and distribution of Interforan Injection

Courses 1200 400 400 400

62


Sr. No.


Targets

Target for 2010-

11

Target for 2011-

12

Target for 2012-

13Remarks

Documentation of expense of disposable syringes

- - - -

Procurement & Distribution of SGPT

Kits 36 12 12 12

Procurement & Distribution of SGOT

Kits 36 12 12 12

5 High MMR Poor access to healthcare delivery services

Health education/promotion


Message 36 12 12 12

Lack of awareness about danger signs of pregnancy

Behaviour change communication for Mothers of child bearing age


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

Low ante-natal coverage

Provision of Quality basic EmONC services at BHU & RHC

Training of LHWs on BCC

No. of trainings

65 65 - -

Low skilled birth attendance

Provision of Quality Comprehensive EmONC services at THQs hospital

Procurement of vehicles for transportation through CCBs

- - - -

63


Sr. No.


Targets

Target for 2010-

11

Target for 2011-

12

Target for 2012-

13Remarks

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

Improving transportation of the patients

Operation and management of vehicles through CCBs

- - - -

Complications of pregnancy

Repair of non functional ambulances for timely transportation of pregnant mothers

- - - -

Capacity Issues related to maternal care

Replacement of the non functional ambulances for timely transportation of pregnant mother

- - - -

Maternal Anemia Procurement of the MNCH related equipment and Instruments

- - - -

Pregnancy following chronic severe diseases

Implementation of the referrals protocols

- - - -

Procurement of Micro-nutrients

Packs 60,000 30,000 15,000 15,000

Procurement and distribution of Calci-D

No. of tablets 60,000 30,000 15,000 15,000

64


Sr. No.


Targets

Target for 2010-

11

Target for 2011-

12

Target for 2012-

13Remarks

Procurement and distribution of Anti-D

Injection 30 10 10 10

6 High under 5 Mortality

Poor antenatal natal and post natal coverage

Health awareness/education

Message on local cable

Message 36 12 12 12

Neo-natal Infections

Provision of the quality basic EMONC services at BHU & RHC

BCC of mothers 0n promotion of breast feeding and weaning practices through LHWs

Number of Trainings

- - - -

Birth Trauma & Asphyxia

Provision of the quality Comprehensive EMONC services at THQH & DHQH

Provision of the deficient infrastructure at THQ

Assessment - - - -

No cost activity

Prematurity Improvement of feeding and weaning practices

Trainings on IMNCI No. of trainings

- - - -

Poor feeding and weaning practices

Capacity building of Human Resource dealing child health care

Need assessment of food supplements

Assessment - - - -

Diarrhea Enhancing EPI coverage

procurement from DGHs office

Assessment - - - -

65


Sr. No.


Targets

Target for 2010-

11

Target for 2011-

12

Target for 2012-

13Remarks

ARI Poverty elevation Distribution of food supplements to mothers & children through LHWs & community mid wives

Assessment - - - -

Lack of capacity of staff for provision of proper child health care (diagnostic and timely referrals)

Provision of food supplements

Raising income of the poor families through Baitul Mall and Zakat

Assessment - - - -

Low socio economic status

Revising the micro plans of Vaccinators

- - - -

Malnutrition - - - -

Lack of birth spacing

- - - -

Low EPI Coverage

- - - -

7 TB Suspects Low socio-economic status

Health education/promotion


Message 36 12 12 12

66


Sr. No.


Targets

Target for 2010-

11

Target for 2011-

12

Target for 2012-

13Remarks

Seasonal variation

Strengthening TB DOTS program through involvement of private sector


Brochure 400,000 200,000 100,000 100,000


Involvement of private providers through public private partnership

Procurement of drugs to ensure deficiency according to regimen

ATT course 600 200 200 200


Procurement of reagents for notified diagnostic facilities under DOTS programme

Packs 80 30 30 20

Trainings on DOTS protocols

No. of trainings

20 10 10 -

8 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

Meeting 12 4 4 4

Poor maintenance of vehicles

Advocacy for improving the condition of roads

Quarterly co-ordination meetings with Highway department

Meeting 12 4 4 4

67


Sr. No.


Targets

Target for 2010-

11

Target for 2011-

12

Target for 2012-

13Remarks

Poor road conditions

Health education/promotion to prevent domestic accidents

Preparation of Disaster Management Plan including the Patient Management protocols

1 1 - -

Lack of safety measures at work place

Ensure enforcement of safety laws at work places

Training of the medics and the paramedics

- - - -

Fire-arm injuries Provision of emergency kits for blast victims

Kits 1,100 800 300 -

Domestic accidents

Procurement of equipments / instruments / various splints and Plaster casts

- - - -

Burns - - - -

Bomb blasts/terrorist activities

- - - -

Lack of tolerance in the society

- - - -

68


Management Problems

Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned Posts

Sr.No. Name of PostBasic Scale Basic Pay Allowances

Requirement as per Gap

Physical Targets

Year I Year II Year III

1 Gynecologist 18 12,910 18,099 1 1 - -

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

3 Anesthetists 18 12,910 18,099 7 3 2 2

69


4 MO / WMO 17 9,850 15,345 68 24 22 22

5 Nurses 16 6,060 8,934 45 15 15 15

6 Lady Health Visitors 9 3,820 4,750 18 6 6 6

Sr. No


TargetsTarget for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

1 Shortage of skilled staff

Vacant positions Filling of the vacant posts

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

Recruitment - - - - -

Non-sanctioning of staff according to MSDS

Sanctioning of positions according to MSDS

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

Plan - - - - -

Lack of permanent postings

Recruitment through Public Service Commission on regular basis

Districts to prepare the incentivized pay package with consultation of all stockholders

Pay Package - - - - -

Lack of incentivies and differential pay packages

Incentivized pay package at all levels

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

Meeting - - - - -

70


Sr. No



Target for 2011-12

Target for 2012-13

Remarks

Frequent transfer postings

Well defined career structure including opportunities for higher education

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

Plan - - - - -

Job insecurity Conducive working environment

Review and revise the career structure of medics, paramedics and technical staff like Sos, Health Education officers etc

T A - - - - -

Lack of basic amenities at workplace

Provision of staff Residences

Availability of recreation, education and other facilities for children of staff working in rural areas

Plan EDOH - - - - -

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

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

Construction of the residences for the staff

Requirement Plan

- - - - -

Political & Media Interference

provision of recreation facilities (Parks/Play area/common rooms)

Plan EDOH - - - - -

Deficient transparent accountability

Provision of the transport of staff children for the education purposes

Plan EDOH - - - - -

Shortage of the residences

Capacity and need assessment of the medics and the paramedics

TNA - - - - -

71


Sr. No



Target for 2011-12

Target for 2012-13

Remarks

Medico-legal work specially for Females

Prepare training programs for providing higher professional education based on TNA

Plan - - - - -

2 Inadequate budget for POL

Installation of the Generator for back up electricity supply

Rational increase in POL Budget

Assessing additional need for POL

- - - - -

Frequent increase in prices of POL

Costing & Submit ion the additional Demand for POL

P O L 60,143

Liters

60143

Less allocation for POL budget

- - - - -

Increase in Vehicles

- - - - -

72


Sr. No



Target for 2011-12

Target for 2012-13

Remarks

3 Capacity Issues of

Staff

Delayed release and use of funds due to procedural in- familiarity and clarity

Lack of culture of Supportive Supervision

Limited capacity in transforming data in to information

Lack of evidence based decision making in planning and management

Capacity building of DDOs and other related staff in financial management

Capacity building in Supportive Supervision

Capacity building in use of information

Financial Management workshops

No. of trainings

1 1 - - -

Training on Use of Information No. of trainings

1 1 - - -

Training on Supportive supervision

No. of trainings

1 1 - - -

73


Sr. No



Target for 2011-12

Target for 2012-13

Remarks

4 Deficient equipment (with reference to notified list) at DHQH,THQHs

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

Make up the deficiencies against gaps identified

Purchase of MNCH related equipment at DHQ Hospital Sheikhupura

Equipment 1 1 - - -

Purchase of MNCH related equipment at THQ Hospital Muridke

Equipment 1 1 - - -

74


SECTION 4: COSTING AND FINANCING PLANActivity 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 hyperlinked as H & M sheets .

A moderate estimate of equipment cost has been taken, as there is wide variation between the

minimum and maximum cost. The detailed cost of MNCH related equipment has been annexed as

Annex II

The summary of problem and activity wise costing is given below.

Problem wise cost summary of Health Problems

Sr. No

.Problem

F Y I FY II FY IIITotal Cost Rs.

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

1 Diarrheal Diseases 7,819,000 4,339,500 4,712,950 16,871,450

2Anemia ( including in pregnancy)

1,519,000

1,524,600

929,280

3,972,880

3 ARI (under 5) 2,584,000 2,235,200 2,366,760 7,185,960

4 Hepatitis 8,555,000 9,313,000 9,745,300 27,613,300

5 High maternal mortality 3,597,000 1,719,300 1,891,230 7,207,530

6 High under five mortality 288,000 316,800 348,480 953,280

7 Tuberculosis 1,272,000 959,200 832,480 3,063,680

8Road side accident & Injuries

4,496,800 1,871,430 29,040 6,397,270

Total 30,130,800 22,279,030 20,855,520 73,265,350

75


a) Health Problems

Sr. Problem Activity

Define Financial TargetsTotal

CostUnit Rate Quantity Year IYear II

(10 %)

Year III

(10 %)

1 Diarrhea Quarterly co-ordination Meeting with TMA and other agencies

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


Message 24,000 36 288,000 316,800 348,480 953,280


Boucher 4 100,000 160,000 132,000 145,200 437,200

Address in school assemblies

Session 2,000 - - - -

Training of medics and paramedics in IMCI

No. of trainings

120,600 15 1,809,000 - - 1,809,000

76





(10 %)

Year III

(10 %)

Procurement and distribution of ORS

ORS packets 5 100,000 200,000 192,500 151,250 543,750

Procurement and distribution of Syp. Zink Sulphate

Syrup 35 200,000 3,500,000 1,925,000 2,117,500 7,542,500

Procurement and Distribution of Syrup Metronidazole

Syrup 15 150,000 750,000 825,000 907,500 2,482,500

Procurement and Distribution of Inj. Metronidazole

Injection 60 30,000 600,000 660,000 726,000 1,986,000

Procurement & Distribution of IV Fluids

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

- - 7,819,000 4,339,500 4,712,950 16,871,450

77





(10 %)

Year III

(10 %)



Message 24,000 36 288,000 316,800 348,480 953,280


Boucher 4 100,000 160,000 132,000 145,200 437,200

Counseling of pregnant mothers

Session LHWs are expected to conduct counseling session on behavior change during their visit to pregnant ladies

- - - -

Procurement of de-worming tablets

No. of doses 12 100,000 420,000 462,000 435,600 1,317,600

Distribution through LHWs and health facilities

- - - - - -

78





(10 %)

Year III

(10 %)

·Refresher Trainings of LHWs on BCC, balanced diet and provision of micro-nutrients

No. of trainings

18,600 65 651,000 613,800 - 1,264,800

- - 1,519,000 1,524,600 929,280 3,972,880



Message 24,000 36 288,000 316,800 348,480 953,280

Messages through FM radio channels

Message 28,000 36 336,000 369,600 406,560 1,112,160


Boucher 4 400,000 800,000 440,000 484,000 1,724,000

79





(10 %)

Year III

(10 %)

Training of medics and para-medics in IMCI

No. of trainings

IMCI Training package costed in Diarrhea also includes management of ARI

- - - - -

Procurement and distribution of Antibiotic Syrup Amoxicillin

Antibiotic (Syrup)

20 60,000 400,000 440,000 484,000 1,324,000


Injection 25 25,000 250,000 220,000 211,750 681,750


Injection 26 25,000 260,000 228,800 220,220 709,020


Injection 25 25,000 250,000 220,000 211,750 681,750

- - 2,584,000 2,235,200 2,366,760 7,185,960

80





(10 %)

Year III

(10 %)

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

Meetings Costed in diarrhoeal disease

- - - - -


Message 24000 36 288,000 316,800 348,480 953,280


Boucher 4 500000 800,000 880,000 484,000 2,164,000

Printing and pasting of stickers at clinics and Barber shop highlighting use of new syringes & Razors

Stickers 50 1500 75,000 - - 75,000

Hepatitis awareness week ( walk/display banners/seminars)

Lump sum 3 150,000 150,000 150,000 450,000

Procurement & Distribution of HCV Device

Kits 30 30000 300000 330,000 363,000 993,000

81





(10 %)

Year III

(10 %)

Procurement & Distribution of BSAG Device

Kits 30 30000 300000 330,000 363,000 993,000

Procurement & Distribution of HIV screening Devices

Kits 30 30000 300000 330,000 363,000 993,000

Procurement and supply of HCV Eliza kits

Kits 10000 18 60,000 66,000 72,600 198,600

Procurement and supply of HBV Eliza kits

Kits 8000 9 24000 26,400 29,040 79,440

Procurement of syringe cutters

Syringe cutter 150 1800 90,000 99,000 108,900 297,900

Procurement and distribution of Interferon Injection

Courses 15000 1200 6,000,000 6,600,000 7,260,000 19,860,000

Documentation of expense of disposable syringes

- - - - - -

82





(10 %)

Year III

(10 %)

Procurement & Distribution of SGPT

Kits 7000 36 84,000 92,400 101,640 278,040

Procurement & Distribution of SGOT

Kits 7000 36 84000 92,400 101,640 278,040

- - 8,555,000 9,313,000 9,745,300 27,613,300

5 High MMR Messages on local cable network

Message 24,000 36 288,000 316,800 348,480 953,280


Boucher 4 300,000 400,000 440,000 484,000 1,324,000

Training of LHWs on BCC

No. of trainings

18,600 65 1,209,000 - - 1,209,000

Procurement of vehicles for transportation through CCBs

Costed in service delivery problems

- - -

83





(10 %)

Year III

(10 %)

Operation and management of vehicles through CCBs


- - - -

Repair of non functional ambulances for timely transportation of pregnant mothers


- - - -

Replacement of the non functional ambulances for timely transportation of pregnant mother


- - - -

Procurement of the MNCH related equipment and Instruments


- - - -

Implementation of the referrals protocols

Costed in MSDS Gaps

- - - - -

84





(10 %)

Year III

(10 %)

Procurement of Micro-nutrients

Packs 35 60,000 1,050,000 577,500 635,250 2,262,750

Procurement and distribution of Calci-D

No. of tablets 20 60,000 600,000 330,000 363,000 1,293,000

Procurement and distribution of Anti-D

Injection 5,000 30 50,000 55,000 60,500 165,500

- - 3,597,000 1,719,300 1,891,230 7,207,530

6 High under 5 Mortality

Message on local cable

Message 24,000 36 288,000 316,800 348,480 953,280

BCC of mothers 0n promotion of breast feeding and weaning practices through LHWs

Number of Trainings

LHWs training on BCC of mothers on promotion of breast feedings

- - - - -

85





(10 %)

Year III

(10 %)

Provision of the deficient infrastructure at THQ

Assessment As proposed in MSDS Gaps

- - - - -

Trainings on IMNCI No. of trainings

IMNCI Training package costed in Problem Diarrhea also includes management of ARI

- - - - -

Need assessment of food supplements

Assessment Assessing below poverty pregnant mother through LHWs and providing them food supplement through DGHS & Financial support from Baitul Mall & Zakat

- - - - -

86





(10 %)

Year III

(10 %)

procurement from DGHs office

Assessment Assessing below poverty pregnant mother through LHWs and providing them food supplement through DGHS & Financial support from Baitul Mal & Zakat

- - - - -

Distribution of food supplements to mothers & children through LHWs & community mid wives

Assessment Assessing below poverty pregnant mother through LHWs and providing them food supplement through DGHS & Financial support from Baitul Mall & Zakat

- - - - -

Raising income of the poor families through Baitul Mall and Zakat

Assessment Assessing below poverty pregnant mother through LHWs and providing them food supplement through DGHS & Financial support from Baitul Mal & Zakat

- - - - -

87





(10 %)

Year III

(10 %)

Revising the micro plans of Vaccinators

- - - - -

288,000 316,800 348,480 953,280

7 TB Suspects Messages on local cable networks

Message 24,000 36 288,000 316,800 348,480 953,280


Boucher 4 400,000 800,000 440,000 484,000 1,724,000

Procurement of drugs to ensure deficiency according to regimen

ATT course To be procured from the PTP

600 - - - -

Procurement of reagents for notified diagnostic facilities under DOTS programme

Packs To be procured from the PTP

80 - - - -

Trainings on DOTS protocols

No. of trainings

18,400 20 184,000 202,400 - 386,400

88





(10 %)

Year III

(10 %)

1,272,000 959,200 832,480 3,063,680

8 Accident & Injuries

Quarterly co-ordination meetings with Traffic Police department

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

Quarterly co-ordination meetings with Highway department

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

Preparation of Disaster Management Plan including the Patient Management protocols

EDOH prepared the plan

1 - - - -

Training of the medics and the paramedics

- - - - -

Provision of emergency kits for blast victims

Kits 5,591 1,100 4,472,800 1,845,030 - 6,317,830

89





(10 %)

Year III

(10 %)

Procurement of equipments / instruments / various splints and Plaster casts

- - - - - -

- - 4,496,800 1,871,430 29,040 6,397,270

90


Problem wise cost summary of Management Problems

91

Sr. No. Problem

F Y I FY II FY III Total Cost Rs.

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

1 HR Plan 12,80

4,768 26,27

7,385 42,31

6,478 81,

398,631

2 POL 4,51

0,725 -

-

4,510,725

3 Capacity Issues 10

2,600 -

-

102,600

4Lack of MNCH Equipment

47,133,060

-

-

47,133,060

TOTAL 64,55

1,153 26,27

7,385 42,31

6,478 133,

145,016


b) Management Problems

Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned Posts

Sr.No. Name of PostBasic Scale

Basic Pay

AllowancesRequirement

as per Gap

Financial Targets

Year I Year II Year III

Pay of Officers

Pay of other staff

AllowancesPay of

Officers

Pay of other staff

AllowancesPay of

OfficersPay of

other staffAllowances

1 Gynecologist 18 12,910 18,099 1 154,920 - 217,188 170,412 238,907 187,453 262,797

2 Pediatricians 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 7 464,760 - 651,564 852,060 1,194,534 1,312,172 1,839,582

4 MO / WMO 17 9,850 15,345 68 2,836,800 - 4,419,360 5,980,920 9,317,484 9,725,496 15,151,039

5 Nurses 16 6,060 8,934 45 1,090,800 - 1,608,120 2,399,760 3,537,864 3,959,604 5,837,476

6 Lady Health Visitors

9 3,820 4,750 18 275,040 342,000 605,088 752,400 998,395 1,241,460

4,857,120 275,040

7,672,608 9,914,388 605,088 15,757,909 15,934,538 998,395 25,383,545

92



Define Financial TargetsTotalCost

Unit Rate Quantity Year I Year II (10 %) Year III (10 %)

1 Shortage of skilled staff

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

Recruitment - - - - - -

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

Plan - - - - - -

Districts to prepare the incentivized pay package with consultation of all stockholders

Pay Package - - - - - -

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

Meeting - - - - - -

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

Plan - - - - - -

93





Review and revise the career structure of medics, paramedics and technical staff like Sos, Health Education officers etc

T A - - - - - -

Availability of recreation, education and other facilities for children of staff working in rural areas

Plan EDOH - - - - - -

Construction of the residences for the staff

Requirement Plan

- - - - - -

provision of recreation facilities (Parks/Play area/common rooms)

Plan EDOH - - - - - -

Provision of the transport of staff children for the education purposes

Plan EDOH - - - - - -

Capacity and need assessment of the medics and the paramedics

TNA - - - - - -

94





Prepare training programs for providing higher professional education based on TNA

Plan - - - - - -

2 Inadequate budget for POL

Assessing additional need for POL

- - - - - -

Costing & Submit ion the additional Demand for POL

P O L 75 60,143 4,510,725 4,510,725

4,510,725 4,510,725

3 Capacity issues of Management and Technical staff

Pursuance of EDO ( F&P) for timely release of funds

- - - - - -

Financial Management workshops

No. of trainings 39000

1 39,000 - - 39,000

Training on Use of Information


1 31,800 - - 31,800

95





Training on Supportive supervision


1 31,800 - - 31,800

- - - 102,600 - - 102,600

4 Deficient equipment (with reference to notified list) at THQHs and DHQH

Purchase of MNCH related equipment at DHQ Hospital Sheikhupura

Equipment Detail Annexed

21,813,280 - - 21,813,280

Purchase of MNCH related equipment at THQ Hospital Muridke

Equipment Detail Annexed

25,319,780 - - 25,319,780

- - - 47,133,060 - - 47,133,060

96


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. Details of the financial estimates for three years rolling plan are attached as Annex-III . Overall financial outlay of the plan is as under:

Budget Summary

2010-2011 2011-2012 2012-2013

Regular district budget 1,054,880,135 1,128,482,592 1,297,754,980

Additional budget based on problem identification

94,681,953 48,556,415 63,171,998

Total 1,149,562,088 1,177,039,007 1,360,926,978

97


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 Plan

Indicators Target % Achievement

MoV Responsibility Frequency of

monitoring

Remarks

% of planned supervisory visits conducted

50 visits /year

Inspection Book/Attendance

register

EDOH/DOH/ DDOH/Dist. Monitoring officer

Quarterly

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

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

% facilities with availability of essential medicines

100%

During 1st

year

Stock Register EDOH/ DOH/ MSs, Store keeper

Monthly

98




monitoring

Remarks

% 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 according to population

DHIS Report EDOH/ Statistical Officer

Quarterly

% of targeted pregnant women received TT-2 vaccine


DHIS Report EDOH/ DHIS Coordinator/ Statistical Officer

Quarterly

Delivery conducted by or under supervision of skilled persons reported

60 % During 1st

year


Quarterly

99




monitoring

Remarks

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



Quarterly

% 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


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

100


Annex-I

Private Health Facilities in District Sheikhupura

No. of Private Medical Practitioners in District Sheikhupura

Private Practitioners

Male Female Total

2013 78 2091

Private Hospitals

Sr. No.

Name of Location of Hospital

Name of Tehsil

Urban / Rural

Beds

Male Female Total

1. Haider Hospital G.T. Road Muridke

Muridke Urban 10 10 20

2. Raza-e-Habib Hospital G.T. Road Murdke

Muridke Urban 4 4 8

3. Husssain Hospital G.T. Road Muridke

Muridke Urban 3 3 6

4. Tippu Hospital G.T. Road Muridke

Muridke Urban 4 4 8

5. Tariq Hospital G.T. Road Muridke

Muridke Urban 3 3 6

6. Ijaz Hospital G.T. Road Muridke

Muridke Urban 2 2 4

7. Zaneb Hospital G.T. Road Muridke

Muridke Urban 4 4 8

8. Chatha Hospital G.T. Road Muridke

Muridke Urban 5 5 10

9. Mash-al-Clinic G.T. Road Muridke

Muridke Urban 3 3 6

10. Faisal Clinic, Tailway Station Narang Mandi.

Muridke Urban 4 4 8

11. Shahi Hospital G.T. Road Rachna Town F/Wala

Feroze Wala Urban 3 3 6

101


Sr. No.


Name of Tehsil

Urban / Rural

Beds

Male Female Total

12. Malik Hospital G.T. Road Rachna Town F/Wala


13. Bajwa Hospital G.T. Road Rachna Town F/Wala


14. Bismillah Hospital Mian Road Kot Abdul Malik.


15. Sarwer General Hospital, Sharif Park Kot Abdul Malik

Feroze Wala Urban

16. Mudassar Hospital Circular Road Sharaq Pur Sharif.

Sharaqpur Sharif

Urban 3 3 6

17. Alfarooq Hospital Circular Road Sharaq Pur Sharif.

Sharaqpur Sharif

Urban 5 5 10

18. Malik Hospital Circular Road Sharaq Pur Sharif.

Sharaqpur Sharif

Urban 4 4 8

19. Umair Hospital Bairoon Gare Sharq Pur.

Sharaqpur Sharif

Urban 5 5 10

20. Yousaf Qureshi Hospital Sargodha Road City Sheikhupura

Sheikhupura Urban 10 10 20

21. Jinnah General Hospital Sargodha Road City Sheikhupura


22. Tariq Hospital Gujran Wala Road Sheikhupura.


23. Sadiqe Children Hospital Lahore Toad City Sheikhupura.


24. Punjab Hospital Sheikhupura Urban 5 5 10

102


Sr. No.


Name of Tehsil

Urban / Rural

Beds

Male Female Total

Civil Lines Lahore Road City Sheikhupura

25. Shafa Hospital Civil Lines Lahore Road City Sheikhupura


26. Ahmad Hospital Khalid Road City Sheikhupura.


27. Centrel City Hospital Lahore Toad City Sheikhupura.


28. Zaheer Hospital Lahore Toad City Sheikhupura.


29. Pakistan Medical Complex Jadarta Road City Sheikhupura


30. Akhter Memorial Hospital Lahor Road Housing Colon City Sheikhupura


31. Muhammad Yousaf Saddiquee Hospital Gujeranwala Road City Sheikhupura.


32. Saddiqre Hart & General Hospital


33. Fatma Memorial Hospital Lahore Road City Sheikhuupura.


34. National Hospital, Road Tasvir Mehal Cinema Ciity Sheikhupura.


35. Medical Center, Jinnah Park City Sheikhupura.


103


Sr. No.


Name of Tehsil

Urban / Rural

Beds

Male Female Total

36. Shafi Clinic, Salahudin Road Moh. Jahangirabad City Sheikhupura.


37. Nimra Gaini Hospital Near Taxi Stand City Sheikhupura.


38. Khan Hospital Sergodha Road City Sheikhupura.


39. Dar-ul- Berkat Medi Care Civil lines City Sheikhupura.


40. Alsabah Hospital Khalid rod City Sheikhupura.


41. Kangna Hospital Civil Lines City Sheikhupura.


42. Ghazala Hospital Civil Lines City "Sheikhupura.


43. Chlidren Clinic Lahore Road City Sheikhupura.


44. Khawer Sergical Hospital Lahore Road City Sheikhupura.


45. Zubada Memorial Clinic Railway Road SKP


46. Yasib Hospital Civil Lines SKP


47. Sheikhupura. Medical Complex


48. Malik Hospital opposite Aftab Aslam Plaza City SKP


104


Sr. No.


Name of Tehsil

Urban / Rural

Beds

Male Female Total

49. Ramzan Memorial Sheikhupura 2 2 450. Virk Hospital

Railway Road Ghala Mandi SKP


51. Zahid Eye Hospital Near Taxi Stand City Sheikhupura


52. Jabir General & Gaini Hospital Bhakhi

Sheikhupura Rural 2 2 4

53. Mukhtar Memoreal Hospital Khan Colony


54. Mohsan Clinic Khalid Road


55. Family Hospital Shah Jamal Road SKP


56. Shafa Hosopital Gujeranwala Road City Sheikhupurawala


57. Nazir Surgical and Gaini Hospital Gujeranwala Road City Sheikhupura.


58. Akbar Hosputal Gujeranwala road City Sheikhupura.


59. Haji Muhammad Sadiq Memorial Hospital


60. Islam Hospital Nankana Road Mana Wala


61. Manzoor Hospital Nankana Road Mananwala


62. Soikarno Hospital Nankana Road Mananwala


105


Sr. No.


Name of Tehsil

Urban / Rural

Beds

Male Female Total

63. Abdul Hayee Memorial Hospital Lahore Road Farooq Abad


64. Syed Hospital City Farooq Abad


65. Virk Hospital Chock Dabay Shah Farooq Abad


66. Children and General Hospital Farooqabad


67. Jamshed Hospital Chock Dabay Shah Farooq Abad


68. Anjum Hospital Chock Dabay Shah Farooq Abad


69. Quraishi Hospital Gurunanak Pura Lahore Road Farooqabad


106


Annex- II

Costing of MNCH related equipment gaps for DHQ and THQ Hospitals

DHQ Hospital

Sr. No. Equipment GapUnit cost

Total cost(Rs.)

2 Foetal Doppler 3 10000 30,000

3 Diagnostic Laparoscope 1 1200000

1,200,000.00

4 Bulb Sucker 20 45 900.00

5 Baby Warmer 4 850000 3,400,000.00

6 Mechanical Sucker 2 28000 56,000.00

7 Fetal Stethoscope 4 1500 6,000.00

8 Delivery Table 1 17500 17,500.00

9 D&C Set 3 2100 6,300.00

10 Outlet forceps 3 900 2,700.00

12 Kochers forceps 7 235 1,645.00

13 Volselum forceps 2 235 470.00

15 Vaginal Retractors 8 350 2,800.00

16 Polypectomy forceps 2 750 1,500.00

18 Uterine elevator 1 150 150.00

19 CosCo Speculum 9 550 4,950.00

Small, Medium, Large (for each category) -

20 Examination light 4 18000 72,000.0

107



Total cost(Rs.)

0 21 Suction Curette 2 95 190.0

0 22 Infant Resuscitation Trolley (with life saving

medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light)

2 95000 190,000.00


2 110000 220,000.00

24 Cardiac Monitor 1 500000 500,000.00

25 Pump Breast Electronic 1 250000 250,000.00

26.1 Toothed Tissue Forceps (8”) 4 55 220.00

26.2 Non-Tooted Tissue Forceps (8”) 4 55 220.00

26.4 Dissection Scissors (Straight 7”) 4 150 600.00

26.5 Hysterectomy Clamps (Straight) 10 150 1,500.00

26.6 Hysterectomy Clamps (Curved) 13 175 2,275.00

26.13 Towel Clamps 15 125 1,875.00

26.14 Single blade Sims speculum 6 275 1,650.00

26.15 Double blade Sims speculum 3 250 750.00

26.16 Sponge holding forceps 16 200 3,200.00

26.17 Volselum forceps 8 250 2,000.00

26.18 Uterine Sound 4 1500 6,000.00

27.1 Episiotomy Scissors 14 125 1,750.00

27.2 Straight Scissors 12 360 4,320.00

27.3 Needle holder 14 135 1,890.00

27.4 Non-toothed tissue forceps 8 inches 14 100 1,400.00 108



Total cost(Rs.)

27.5 Toothed tissue forceps 8 inches 15 100 1,500.00

27.6 Sims Speculum single blade 29 275 7,975.00

27.7 Sims Speculum double blade 29 250 7,250.00

27.8 Sponge holding forceps 58 250 14,500.00

27.9 Artery forceps 60 275 16,500.00

27.1 Straight clamps (cord) 28 175 4,900.00

27.12 Towel clip 60 125 7,500.00

28.2 Artery Forceps Straight 6 inches 40 125 5,000.00

28.3 Artery Forceps Curved 6 inches 40 125 5,000.00

28.4 Artery forceps 8 inches 40 175 7,000.00

28.5 Myoma Scissors straight 7 inches 10 150 1,500.00

28.6 Dissecting scissors (curved) 7 inches 10 270 2,700.00

28.7 Green Armtage forceps 8 inches 36 300 10,800.00

28.8 Obstetric outlet forceps (pair) 9 900 8,100.00

28.9 Doyene’s Retractor 9 200 1,800.00

28.1 Small Retractors 18 300 5,400.00

28.11 Towel Clippers 40 125 5,000.00

28.12 Suction Nozzle 8 250 2,000.00

29.1 Ultrasound Machine 2 575000 1,150,000.00

29.8 Chest Stand 1 4500 4,500.00

30.1 Paediatric Ventilator 2 1200000

2,400,000.00

30.6 Infant Weighing Machine 1 3100 3,100.0109



Total cost(Rs.)

0 30.7 Nebulizer 1 22000 22,000.0

0 30.8 Billiubino-meter 2 36000 72,000.0

0 30.9 Exchange Blood Transfusion Set 1 2000 2,000.0

0 30.1 Nasal Probe Paed size 3 7000 21,000.0

0 31.6 Airway Oral and Nasal 3 500 1,500.0

0 31.11 AMBO Bag paeds 4 3000 12,000.0

0 31.12 Red Rubber Nasal tubes all sizes without cuff 8 1000 8,000.0

0 32.1 Blood storage cabinet (100 bag capacity) 1 812000 812,000.0

0 32.2 Packed cell machine 1 600000 600,000.0

0 32.3 Cell Separator 1 522500

0 5,225,000.0

0 32.4 Freezer for Fresh Frozen Plasma 1 115000

0 1,150,000.0

0 32.5 Blood bag shaker 1 10000 10,000.0

0 32.6 RH view box 3 1000 3,000.0

0 32.7 Water bath 1 3000 3,000.0

0 32.8 Micro-pipette 7 8000 56,000.0

0 32.9 Blood grouping tiles 6 3000 18,000.0

0 32.1 Plasma Extractor 1 100000

0 1,000,000.0

0 32.11 Platelets agitator 1 100000

0 1,000,000.0

0 32.12 Blood thawing bath 1 3000 3,000.0

0 32.13 Microscopes 1 115000 115,000.0

0 33.1 Hematology Analyzer 1 425000 425,000.0

0 110



Total cost(Rs.)

33.2 Electrolyte Analyzer 1 625000 625,000.00

33.3 Analyzer Bio-chemistry Semi-automatic 1 690000 690,000.00

33.4 Glucometer 2 2500 5,000.00

33.5 Haemoglobino-meter 4 1000 4,000.00

33.6 Centrifuge 2 133000 266,000.00

Total cost of equipment 21,813,280

THQH Muridke

Sr. No. Equipment Gap Unit cost Total cost(Rs.)

1 CTG (Cardiac Tocography) 1 285000 285,000

2 Foetal Doppler 2 10000 20,000

3 Diagnostic Laparoscope 1 1200000 1,200,000

4 Bulb Sucker 9 45 405

5 Baby Warmer 1 850000 850,000

6 Mechanical Sucker 2 28000 56,000

7 Fetal Stethoscope 3 1500 4,500

8 Delivery Table 2 17500 35,000

9 D&C Set 2 2100 4,200

10 Outlet forceps 3 900 2,700

11 Myoma Screw 1 320 320

12 Kochers forceps 4 235 94

111



0 13 Volselum forceps 3 235 70

5 14 Lanes Tissue holding forceps 1 400 40

0 15 Vaginal Retractors 3 350 1,05

0 16 Polypectomy forceps 2 750 1,50

0 17 Sponge holder 7 300 2,10

0 18 Uterine elevator 1 150 15

0 19 CosCo Speculum 5 550 2,75

0 Small, Medium, Large (for each category) -

20 Examination light 2 18000 36,000

21 Suction Curette 1 95 95

24 Cardiac Monitor 1 500000 500,000

25 Pump Breast Electronic 1 250000 250,000

26.3 Dissection Scissors (Curved 7”) 1 150 150

26.4 Dissection Scissors (Straight 7”) 1 150 150

26.5 Hysterectomy Clamps (Straight) 8 150 1,200

26.6 Hysterectomy Clamps (Curved) 8 175 1,400

26.7 Uterine Sound 1 90 90

26.1 Artery Forceps (Straight 6”) 4 110 440

26.11 Artery Forceps (Curved 6”) 4 125 500

26.14 Single blade Sims speculum 3 275 825

26.15 Double blade Sims speculum 3 250 750

26.17 Volselum forceps 3 250 750

26.18 Uterine Sound 1 1500 1,50

112



0 26.19 Bladder Sound 2 1500 3,00

0 27.1 Episiotomy Scissors 3 125 37

5 27.5 Toothed tissue forceps 8 inches 2 100 20

0 27.6 Sims Speculum single blade 11 275 3,02

5 27.7 Sims Speculum double blade 11 250 2,75

0 27.8 Sponge holding forceps 32 250 8,00

0 27.9 Artery forceps 28 275 7,70

0 27.1 Straight clamps (cord) 18 175 3,15

0 27.11 Vacuum Extractor pump 1 19000 19,00

0 27.12 Towel clip 32 125 4,00

0 28.2 Artery Forceps Straight 6 inches 10 125 1,25

0 28.3 Artery Forceps Curved 6 inches 4 125 50

0 28.4 Artery forceps 8 inches 16 175 2,80

0 28.5 Myoma Scissors straight 7 inches 4 150 60

0 28.6 Dissecting scissors (curved) 7 inches 2 270 54

0 28.7 Green Armtage forceps 8 inches 16 300 4,80

0 28.8 Obstetric outlet forceps (pair) 2 900 1,80

0 28.9 Doyene’s Retractor 2 200 40

0 28.1 Small Retractors 2 300 60

0 28.11 Towel Clippers 8 125 1,00

0 28.12 Suction Nozzle 3 250 75

0 29.2 X-Ray Unit 500 kw 1 6000000 6,000,000

113



29.4 Lead Screen for X-Ray Unit 1 30000 30,000


1 100000 100,000

29.6 Safe Light 1 5000 5,000

29.7 X-RT Film Processing Tank 1 5000 5,000

29.8 Chest Stand 1 4500 4,500

29.9 X-Ray film Illuminator 2 4000 8,000

29.1 X-Ray Film Hangers All sizes 4 4000 16,000

30.1 Paediatric Ventilator 1 1200000 1,200,000

30.2 Incubator 1 1500000 1,500,000

30.3 Photo Therapy Unit 1 22000 22,000

30.4 Over-head Radiant Warmer 1 910000 910,000

30.5 Infant Length Measuring Scale 2 5000 10,000

30.6 Infant Weighing Machine 2 3100 6,200

30.8 Billiubino-meter 1 36000 36,000

30.9 Exchange Blood Transfusion Set 1 2000 2,000

30.1 Nasal Probe Paed size 1 7000 7,000

31.2 Ventilators 1 525000 525,000

31.7 Tracheostomy tube (adult and paeds) 2 1000 2,000

31.8 Face mask of all sizes 2 1000 2,000

31.9 Double Cuff Tourniquet (for regional block) 1 320 320

31.1 AMBO bag adult 1 2450 2,450

31.11 AMBO Bag paeds 1 3000 3,000

31.12 Red Rubber Nasal tubes all sizes without cuff 4 1000 4,000

114



32.1 Blood storage cabinet (100 bag capacity) 1 812000 812,000

32.2 Packed cell machine 1 600000 600,000

32.3 Cell Separator 1 5225000 5,225,000

32.4 Freezer for Fresh Frozen Plasma 1 1150000 1,150,000

32.5 Blood bag shaker 1 10000 10,000

32.6 RH view box 2 1000 2,000

32.7 Water bath 2 3000 6,000

32.8 Micro-pipette 4 8000 32,000

32.9 Blood grouping tiles 3 3000 9,000

32.1 Plasma Extractor 1 1000000 1,000,000

32.11 Platelets agitator 1 1000000 1,000,000

32.12 Blood thawing bath 1 3000 3,000

33.1 Hematology Analyzer 1 425000 425,000

33.2 Electrolyte Analyzer 1 625000 625,000

33.3 Analyzer Bio-chemistry Semi-automatic 1 690000 690,000

33.4 Glucometer 1 2500 2,500

Total cost of equipment 25,319,780

115

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