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7/23/2019 HFA District Report - Keich
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Health Facility Assessment Balochistan
District Keich
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Acknowledgement
TRF acknowledges the cooperation and support of Contech International Health
Consultants, Lahore who worked on the assignment and authored the report. The final
reports were quality assured by Jennifer Sanchos, HLSP Health Systems Consultants, and
Ms. Pamela Sequeria, M & E Specialist TRF.
Disclaimer
This document is issued for the party which commissioned it and for specific purposes
connected with the above-captioned project only. It should not be relied upon by any other
party or used for any other purpose.
We accept no responsibility for the consequences of this document being relied upon by any
other party, or being used for any other purpose, or containing any error or omission which is
due to an error or omission in data supplied to us by other parties.
June 2012
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Table of Contents
List of Tables ................................................................................................................ iv
List of Figures .............................................................................................................. vi
Acronyms .................................................................................................................... vii
Executive Summary ...................................................................................................... 1
Section 1: Introduction ................................................................................................. 3
Survey Objectives ...................................................................................................... 3
Assignment Duration .................................................................................................. 3
Scope Of Hfa ............................................................................................................. 3
Report Organisation ................................................................................................... 4
Section 2: District Information ..................................................................................... 5Geographical Location ............................................................................................... 5
Administrative Setup .................................................................................................. 6
Demographic Information ........................................................................................... 6
Socioeconomic And Health Indicators ........................................................................ 6
Section 3: Health Facility Assessment Survey Findings............................................ 8
MNCH Services ......................................................................................................... 8
8/6 Preventive MNCH Services At BHU ................................................................ 924/7 Basic EmONC Services At RHC .................................................................. 12
24/7 Comprehensive EmONC Services at SHC Hospital .................................... 15
24/7 Basic EmONC Services at THQ Hospital..................................................... 19
Management Basics ................................................................................................. 20
Human Resource ................................................................................................ 20
Work Coordination And Supervision .................................................................... 23
Management Information System ........................................................................ 24
Drugs And Supplies ............................................................................................ 26
Fee For Services ................................................................................................. 27
Infection Control .................................................................................................. 29
Death Review ...................................................................................................... 31
Facility Utilisation ..................................................................................................... 31
Well Baby Clinic ....................................................................................................... 34
Donor Contribution ................................................................................................... 34
Clients Perspective .................................................................................................. 35
Procurement Estimates ............................................................................................ 37
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Equipment ........................................................................................................... 37
Civil Works .......................................................................................................... 37
Section 4: Key Findings ............................................................................................. 39
Infrastructure ............................................................................................................ 39
Human Resource ..................................................................................................... 39
Equipment ................................................................................................................ 40
Drugs And Supplies ................................................................................................. 40
Support Services ...................................................................................................... 41
Management Basics ................................................................................................. 41
Donor Contribution ................................................................................................... 42
Clients Perspective .................................................................................................. 42
Annexes ....................................................................................................................... 43
Annex 1: District Health Department ......................................................................... 44
Annex 2: Input Criteria For MNCH Services .............................................................. 50
Annex 3 A: Status of Surveyed HF Against Minimal Level of Inputs .................... 63
Annex 3 B: List of Items Required .......................................................................... 69
Annex 4: Scope of Civil Works Required .................................................................. 79
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List of Tables
Table 1.1: Scope of HFA ................................................................................................ 4
Table 2.1:Demographic profile ....................................................................................... 6
Table 2.2: Population groups .......................................................................................... 6Table 2.3: Socio-economic and health indicators ............................................................ 7
Table 3.1: Status of assessed infrastructure in BHU ..................................................... 10
Table 3.2: Status of MNCH related staff in BHU ........................................................... 10
Table 3.3:Status of functional equipment in BHU ......................................................... 11
Table 3.4:Status of drugs and supplies in BHU............................................................ 11
Table 3.5: Status of support services in BHU................................................................ 11
Table 3.6:Status of assessed infrastructurein RHC...................................................... 12Table 3.7: Status of MNCH related staff in RHC ........................................................... 13
Table 3.8:Status of functional equipment in RHC ........................................................ 14
Table 3.9: Status of drugs and supplies in RHC ........................................................... 14
Table 3.10:Status of support services in RHC ............................................................. 15
Table 3.11:Status of assessed infrastructure in DHQ hospital .................................... 15
Table 3.12:Status of MNCH related staff in DHQ hospital ............................................ 18
Table 3.13:Status of functional equipment in SHC hospital.......................................... 18
Table 3.14:Status of drugs and supplies in SHC hospital ............................................ 19
Table 3.15:Status of support services in SHC hospital ................................................ 19
Table 3.16: Status of HR at SHC hospital ..................................................................... 20
Table 3.17: Status of HR at RHC .................................................................................. 20
Table 3.18:Status of HR at surveyed BHU ................................................................... 21
Table 3.19:Reasons of non-availability of HR at RHC.................................................. 22
Table 3.20: Reasons of non-availability of HR on 24/7 basis at SHC hospital ............... 22
Table 3.21:Capacity building of MNCH related staff .................................................... 22
Table 3.22: Status of coordination and supervision ...................................................... 23
Table 3. 25:Status of MIS ............................................................................................. 24
Table 3.24: Reasons for stock out reported by surveyed facilities................................. 26
Table 3.25: Status of fee for service ............................................................................. 28
Table 3.26: Mechanisms of social protection available ................................................. 29
Table 3.27: Status of infection control & waste management practices ........................ 30
Table 3.28:Status of death reviews .............................................................................. 31
Table 3.29: Status of services utilisation ....................................................................... 31
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Table 3.30: Average monthly MNCH services provided ................................................ 32
Table 3.31: Average monthly FP services provided ...................................................... 33
Table 3.32:Status of WBC established ........................................................................ 34
Table 3.33: Status of donor contribution ....................................................................... 34
Table 3.34:Clients perspective .................................................................................... 36
Table 3.35: Summary of estimated cost for procurement of equipments & civil works .. 38
Table 2.4: Number of public sector health facilities in the district .................................. 44
Table 2.5: Human resourse in office of DHO ................................................................ 44
Table 2.6:Availability of MNCH services staffing in district Keich ................................. 45
Table 2.7: Financial allocation in district Keich.............................................................. 46
Table 2.8:NMNCHP monitoring indicators (year 2010) ................................................ 47
Table 2.9: Number of facilities with staff provided by the NMNCHP .............................. 48
Table 2.10: Number of staff trained on delivering MNCH services ................................ 49
Table 2.11:Status of CMW training and deployment .................................................... 49
i. Status of assessed infrastructure in BHU ................................................................ 63
ii. Status of MNCH related staff in BHU ...................................................................... 63
iii. Status of functional equipment in BHU.................................................................... 63
iv. Status of drugs and supplies in BHU ...................................................................... 63
v. Status of support services in BHU ........................................................................... 64
i. Status of assessed infrastructure in RHC ................................................................ 64
ii. Status of MNCH related staff in RHC ..................................................................... 65
iii. Status of functional equipment in RHC ................................................................... 65
iv. Status of drugs and supplies in RHC ...................................................................... 66
v. Status of support services in RHC .......................................................................... 66
i. Status of assessed infrastructure in SHC hospital ................................................... 66
ii. Status of MNCH related staff in SHC hospital ........................................................ 67
iii. Status of functional equipment in SHC hospital ...................................................... 67
iv. Status of drugs and supplies in SHC hospital ......................................................... 68
v. Status of support services in SHC hospital ............................................................. 68
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List of Figures
Figure 1:Map of Keich ................................................................................................... 5
Figure 2:Range of services that signal fully functional MNCH services.......................... 8
Figure 3:Status of management basics ....................................................................... 21
Figure 4:Level of satisfaction with examination and attitude of staff ............................ 37
Figure 5:Availability of medicines and lab services ...................................................... 37
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ACRONYMS
ANC Antenatal Care
AVD Assisted Vaginal Deliveries
BB technician Blood Bank TechnicianBHU Basic Health Unit
CBA Child bearing age
CEI Client Exit Interview
CH Civil Hospital
CMW Community Midwives
CWAQ Civil Works Assessment Questionnaire
CDC Communicable Disease Control
DCO District Coordination Officer
DDCT District Data Collection TeamsDHO District Health Officer
DHDC District Health Development Centre
DHIS District Health Information System
DHQH District Headquarter Hospital
DLQ District Level Questionnaire
EDOs Executive District Officers
EmONC Emergency Obstetric and Newborn Care
ENC Emergency Newborn Care
EAQ Equipment Assessment QuestionnaireEPI Expanded Programme of Immunisation
FP & PHC Family Planning and Primary Health Care
HF Health Facilities
HFA Health Facility Assessments
HID Health Institution Database
HIV Human Immunodeficiency Virus
HMIS Health Management Information System
HR Human Resource
IDI EDOH In-depth Interview of EDO HealthIMNCI Integrated Management of Neonatal and Childhood Illnesses
IMPAC Integrated Management of Pregnancy and Childbirth
JD Job Description
LHS Lady Health Supervisor
LHV Lady Health Visitor
LHW Lady Health Worker
MDGs Millennium Development Goals
M&E Monitoring and Evaluation
MICS Multiple Indicator Cluster Survey
MIS Management Information System
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MNCH Maternal, Neonatal and Child Health
MO Medical Officer
NMNCHP National Maternal Newborn and Child Health Programme
NVD Normal Vaginal Deliveries
OBGYN Obstetrics and GynaecologyOPD Out Patient Department
OT Operation Theatre
PC-1 Planning Commission Proforma 1
PDHS Pakistan Demographic and Health Survey
PNC Post natal care
PPHI Peoples Primary Health care Initiative
PSLM Pakistan Social & Living Standards Measurement Survey
RHC Rural Health Centre
SBA Skilled Birth AttendantsSD&MB Service Delivery and Management Basics
SE Socioeconomic
SHC hospitals Secondary health care
SPSS Statistical Package for the Social Sciences
TA Technical Assistance
THQ Tehsil Headquarter hospital
TRF Technical Resource Facility
TT Tetanus Toxoid
WMO Women Medical OfficerWBC Well Baby Clinics
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Executive Summary
Health Facility Assessment 2011 (HFA) is aimed at assessing the availability, functioning,
and quality of health care services in public sector health facilities with a focus on maternal,
new-born and child health services. This report provides the findings of the HFA for eachsurveyed health facility in the district. It is baseline information for the district and the
National Maternal New-born and Child Health Programme (NMNCHP), to set performance
benchmarks and realign activities for bridging the gaps existing in Maternal New-born and
Child Health (MNCH) services for achieving the objectives of the programme.
The HFA started in October 2010 and completed in May 2011. Contech accomplished the
assignment in a participatory way by maintaining constant liaison with the entire key
stakeholder. Nineteen (19) health facilities were assessed in District Keich,
including 1 DHQhospital, 11 RHC and 7 BHU. The BHU were assessed for availability of 8/6 Preventive
MNCH services; RHC were assessed for availability of 24/7 Basic EmONC services; and
DHQ Hospital was assessed for availability of 24/7 Comprehensive EmONC services. An
assessment criterion was formulated to ascertain gaps in availability of inputs1, including
Infrastructure; Human Resource (HR); Drugs and Supplies; Equipment; and Level specific
support services. Summarised HFA findings (detailed findings are given in Section 4) of
HFA, are as follows:
In infrastructure, major gaps existed in availability of labour room at all BHU and 4 RHC,
female ward at RHC Gomazai, RHC Gower Koop and RHC Bal Nigor;LHV residence at
all BHU, 3 RHC
Regarding HR, required number of WMO were not available at all RHC except RHC
Dasht Khudan; required number of LHV were present at 6 RHC; and major gaps were
related to gynaecologist, anaesthetist, anesthesia technician and OT technician at
DHQH
Majority of the required equipment items were not available at the surveyed health
facilities, although complete range of items was not available at any of the facility
Drugs, Supplies, Vaccines and FP commodities were assessed using facility specific list
of tracer items for their availability on the day of survey and stock-out status during last
1
1 (1) ; ,
.
3 A 1
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one month. Majority of the items were available at the RHC and DHQ Hospital, but most
of the required items were not available at the surveyed BHU.The most common reason
for stockout of drugs was poor quantification and delayed supply
Level specific required items for delivery of support services were assessed at the
surveyed health facilities. In District Keich, both DHQH and RHC were provided with
majority of items for delivering support services, however, gaps existed at BHU.
Management basics assessed at the surveyed facilities included availability of job
description and service delivery protocols, work coordination and supervision, MIS, infection
control practices, death reviews of maternal and neonatal deaths, fee for services and
available mechanisms of social protection, and facility utilisation of MNCH services
Majority of the health facilities were conducting regular performance review meetings but
its record was not maintained
Health Management Information System (HMIS) was being practiced in the District Keich
and HMIS tools were available at all surveyed health facilities but not maintained
properly at the surveyed facilities
Major gaps existed in availability of materials for infection control measures
Review of maternal and neonatal deaths was not conducted as death review committee
was not available at any health facility
No Well Baby Clinic established in any of the facilities except at DHQH Keich.
In order to assess the perceptions of the clients, a total of 65 Client Exit Interviews were
conducted in the DHQH and RHC. Clients perspective on quality of care revealed that
majority of the clients were satisfied with the care provided at the public facilities.
Findings of the HFA at all levels revealed significant gaps in the required inputs for provision
of quality MNCH services. This warrants immediate need to bridge these gaps in order to
improve the MNCH services.
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Section 1: Introduction
This section includes survey objectives, its scope and duration, and organisation of the
District Report
Survey Objectives
The HFA was aimed at assessing the availability, functioning, and quality of health care
delivery system in the public sector facilities with a focus on maternal, new-born and child
health services.
Specific objectives of the HFA were:
To assess the health facility status and quality of MNCH services (Comprehensive and
Basic EmONC, Preventive MNCH and Family Planning) at district level
To assess clients satisfaction and perception of MNCH services
To provide information for systematic planning for procurement and supply of goods and
commodities (listing the medical equipment and instruments which needs to be replaced
or purchased); and
To update and assess the contributions made by the development partners for improving
MNCH and FP services in the selected districts
Assignment Duration
Estimated duration of the assignment was 7 months. The assignment started in October
2010 and completed in May 2011.
Scope of HFA
The survey included District Headquarter Hospital (DHQH), Tehsil Headquarter Hospital
(THQH), Rural Health Centres (RHC) and 20% of Basic Health Units (BHU) randomly
selected within the district. Selection of the BHU was through geographical stratification on
the basis of proportionate distribution. Client exit interviews were conducted at the surveyed
facilities (10 at DHQH, 5 at each THQH and RHC), excluding BHU. Table 1.1 shows the
number of health facilities in the district and health facilities surveyed.
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TABLE 1.1:SCOPEOF HFA
District KeichNumber of Health Facilities by type
DHQH THQH RHC BHU Total
Number of facilities listed by HID 1 0 11 36 48
Number of facilities surveyed 1 0 11 7 19
Report Organisation
HFA District Report has been structured in four sections. While the introduction to the
survey, its scope and methodology is described in Section 1, Section 2 District Information
contains information collected from the District Health Department using DLQ as well as the
secondary data sources and it comprises of demographic, economic and education relatedinformation of the district as well as the organisation of health care delivery system in the
district. This section also includes information about the monitoring indicators of National
MNCH Programme.
Details of the assessment are contained in Section 3 HFA Findings. This section presents
information about NMNCHP analytical framework indicators, status of the MNCH service
availability based on optimal level of inputs including infrastructure, human resource,
equipment, drugs and supplies and availability of support services. Information onmanagement basics like work coordination, MIS etc., is also contained in this section. The
information presented in this section gives snapshot in time of the surveyed health facilities.
At the end information about the satisfaction and perspective of the clients on the MNCH
services provided at the public sector health facilities. Section 4 comprises of key findings of
HFA at district level.
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.
Section 2: District Information
This section includes district brief, information on demographic, socioeconomic and health
indicators. It also contains information on health resources and NMNCHP indicator compiled
at district level. The data sources of the information are DHO office using District Level
Questionnaire (DLQ) and published documents. The information collected from DHO office
may not match with subsequent tables containing similar information collected from
respective health facilities included in survey.
Geographical Location
District Keich is in the northwest of province Balochistan having 22,539 km 2 areas. The
whole population has always been rural. A small portion of the population is residing in urban
areas. The main Baloch tribes in the district are the Gichki, Pogh, Naushervani, Buledai Mir,
Hoth, Khushk, Rais, Rind, Sangur, Lundi, Kattawar, Kalyar, Kaunda, Bizanjo and Darzada.
Tump is very famous tehsil of district Keich, there are so many villages and union council in
Tump after the Turbat tehsil; tump tehsil is beginning from Hothabad village and going end
last border of Iran called Mand. District Kech is connected to adjacent districts and the
provincial capital through a network of roads and rail.
FIGURE 1: MAPOF KEICH
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Administrative Setup
Like other districts in the province, district Keich is headed by Deputy Commissioner (DC)
assisting the Divisional Commissioner and is accountable to him. The DC is appointed by
the provincial government from the Federal or Provincial Civil Service.
Demographic Information
TABLE2.1:DEMOGRAPHICPROFILE
Indicators Value Indicators Value
Total Population (thousands) 432,569 Urban Population 17%
Population of Tehsil Turbat 205,753 Rural Population 83%
Population of Tehsil Buleda 79,250Population density (persons
per sq.km)19
Population of Tehsil Dashat 67,866Sex ratio (number of males
over 100 females) at birth108
Population of Tehsil Tump 91,304
SOURCE:HMISCELLDHOOFFICE
TABLE2.2:POPULATIONGROUPS
PopulationGroups
StandardDemographic
(%)
Estimatedpopulation
PopulationGroups
StandardDemographic
(%)
Estimatedpopulation
Under 1 year 2.7011,679
Women 15-49years
22.0095,165
Under 5 years 13.4057,964
Married WomenChild Bearing
Age (CBA)16.00
69,211Under 15
years 41.97 181,549 Pregnant women 3.40 14,707Expected Births 2.9 12,545
SOURCE:PDHS2006-07
Socioeconomic and Health Indicators
Selected Socio-Economic (SE) and health indicators are given in the table 2.3. The sources
include, Pakistan Demographic and Health Survey (PDHS) 2006-7, Pakistan Social and
Living standards Measurement Survey (PSLM) 2008-09, Immunisation Coverage Evaluation
Survey Pakistan (CES) 2006-7, District EPI Cell.
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TABLE 2.3:SOCIO-ECONOMIC ANDHEALTH INDICATORS
Indicators Value Indicators Value
District Specific figures PSLM 2008-09
Literacy rate 52%
Malnutrition*
Women
Children
- % children
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Section 3: Health Facility Assessment Survey
Findings
MNCH Services
The packages of MNCH services assessed include Preventive MNCH services at BHU,
Basic EmONC services at RHC and Comprehensive EmONC services at THQ and DHQ
hospitals2. The range of MNCH services are given below.
FIGURE 2: RANGEOF SERVICES THATSIGNAL FULLYFUNCTIONAL MNCHSERVICES
2 NMNCHP PC -1
BHU: Facility
available for
RHC: Facility
available for
DHQ/THQ
Hospitals: Facility
available for
8/6 Preventive
MNCH Services
Antenatal checkup
Lab (Anemia,
Malaria, pregnancy
test, urine test for
sugar & Protein)
Normal delivery
Family planning
services (at least 3
methods)
TT immunisation
EPI vaccination
Growth monitoring
Nutrition counseling
HR (at least oneLHV or Doctor)
24/7 Basic EmONC
Services
Parenteral
antibiotics
Parenteral oxytocic
drugs
Parenteral
anticonvulsants for
pregnancy induced
convulsions (due to
hypertension)
Manual removal of
placenta
Removal of
retained products
Assisted vaginal
delivery (vacuum
extraction, forceps)
Newborn
resuscitation+
Post abortion care
HR (skilled female
providers-WMO
and LHV), and
Preventive MNCH
24/7
Comprehensive
EmONC services
Surgery (C-section)
Blood transfusion
Newborn care
(resuscitation &
incubator)
+
Gynaecological
care
Comprehensive
family planning
services including
sterilisation
HR (skilled staff for
conducting, C-
section, blood
transfusion and
anaesthesia),
and
Preventive MNCH
and Basic EmONC
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Functional capacity of health facilities were assessed against 5 specified inputs, which
include:
1. Infrastructure
2. Human Resource
3. Drugs and Supplies
4. Equipment
5. Level specific support services
Health facilities assessment findings are presented against two levels of inputs including:
1. Optimal level of Inputs are those proposed in the PC-1 of the National MNCH
Programme, required to make a health facility fully functional for provision of level
specific package of MNCH services.
Optimal level of inputs provides a strategic norm upon which gaps are identified and
up-gradation are proposed for improving accessibility of quality MNCH services
through development and implementation of an integrated and sustainable MNCH
programme at all levels of the health care delivery system.
2. Minimal level of Inputs, which are bare minimum requirement of the inputs, required for
delivering the package specific MNCH services at the health facilities.Findings related
to minimal level of inputs are given as Annex 2.
Following tables present the status of assessed facilities for availability of the optimal
level of inputs
8/6 Preventive MNCH Services at BHU
BHU operating within District Keich were assessed for provision of Preventive MNCH
services available for 8 hours a day, 6 days a week (8/6). Seven BHU were assessed for
availability of optimal level of inputs as summarised in Tables 3.1 - 3.5 by individual BHU.
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TABLE 3.1:STATUS OF ASSESSED INFRASTRUCTURE IN BHU
*THEBHUDASHAT, ANDBHUKUNCHITY AREAFFECTED BY FLOOD.
Doctor or LHV is required for provision of Preventive MNCH Services.Status of assessed
BHU for availability of Human Resource (HR) (both regular posted and provided by
NMNCHP),against the required number mentioned in PC-1 of NMNCHP is presented below:
TABLE 3.2:STATUS OF MNCHRELATED STAFF IN BHU
Equipment items (general items, equipment for OPD and LHV room) for BHU are listed in
PC-1 of NMNCHP. Status of functional quantity of these items at assessed BHU is
presented below:
Infrastructure Status
Status of building components at Surveyed BHU
BHUDastuk*
BHUGawak
BHUKohad
BHUBalgather
BHUGokdan
BHUDrachkoo
BHUKunchity*
OPD1. Consultation
area
A Y Y Y Y Y Y Y
F N N Y N Y N N
2. Examinationarea
A N N N N N N N
F N N N N N N N
3. Hand washingA N N N N N N N
F N N N N N N N
LHV Room1. Consultation
area
A Y Y Y Y Y Y Y
F N N Y N Y N N2. Examination
area
A N N N N N N N
F N N N N N N N
3. Hand washingA N N N N N N N
F N N N N N N N
Labour room1. Delivery room
A N N N N N N N
F N N N N N N N
2. Scrub areaA N N N N N N N
F N N N N N N N
3. Patient washroom
A N N N N N N N
F N N N N N N N
ResidenceDoctor
A N N N N N N N
F N N N N N N N
ResidenceLHV
A N N N N N Y Y
F N N N N N N N
Staffcategories
Requirednumber
Number of MNCH related staff available at each BHUBHU
Dastuk
BHU
Gawak
BHU
Kohad
BHU
Balgather
BHU
Gokdan
BHU
Drachkoo
BHU
Kunchity
WMO 1 0 1 1 0 2 1 1
LHV 1 0 1 1 0 1 0 0
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TABLE 3.3:STATUS OF FUNCTIONAL EQUIPMENT IN BHU
List of essential drugs and supplies for MNCH services is contained in PC-1 of NMNCHP.
Tracer items were selected from the list (Annex 1) for assessing their availability at surveyed
facilities. Status of surveyed BHU regarding available quantity of tracer items is presented
below:
TABLE3.4:STATUS OF DRUGS ANDSUPPLIES IN BHU
Facility for basic laboratory tests (test strips and HR) was assessed at surveyed BHU and
their status is presented below
TABLE 3.5:STATUS OF SUPPORTSERVICES IN BHU
Equipment
TotalItems
required
at eachBHU
Number of functional equipment items available at each surveyedBHU
BHU
Dastuk
BHU
Gawak
BHU
Kohad
BHU
Balgather
BHU
Gokdan
BHU
Drachkoo
BHU
Kunchity
General items 3 0 0 0 0 0 0 0
OPD 14 1 2 2 2 6 6 5
LHV Room 12 5 9 3 0 8 0 0
Item groups
T
otalItems
r
equiredat
eachBHU Number of items available at each surveyed BHU
BHU
Dastuk
BHU
Gawak
BHU
Kohad
BHU
Balgather
BHU
Gokdan
BHU
Drachkoo
BHU
Kunchity
Supplies 6 4 2 5 4 3 3 3
Drugs 12 10 9 11 8 10 6 7
Vaccines 5 0 0 0 0 1 0 0
FPCommodities
6 0 0 4 0 0 0 0
Supportservices
TotalItems
required ateach BHU
Number of items available at each surveyed BHU
BHU
Dastuk
BHU
Gawak
BHU
Kohad
BHU
Balgather
BHU
Gokdan
BHU
Drachkoo
BHU
Kunchity
Basic labtests
2 0 1 1 0 1 1 1
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24/7 Basic EmONC Services at RHC
RHC operating within District Keich were assessed for provision of Basic EmONC services
available for 24 hours a day, 7 days a week (24/7). Eleven RHC were assessed for
availability of optimal level of inputs as summarised in Tables 3.6 - 3.10 by individual RHC.
Infrastructure of the RHC has been assessed for availability of OPD, indoor ward, LHV room,
labour room and clinical laboratory as service provision areas and residences for
accommodation of required staff. Service provision areas have been assessed as single
room having facilities like consultation, examination and hand washing etc., as contained in
table below. Findings are presented as status of building components available and
functional:
TABLE 3.6:STATUS OF ASSESSED INFRASTRUCTURE IN RHC
Infrastructure Status
Status of building components at each RHC
RHCBuleda
RHCGomazai
RHCMand
RHCTump
RHCGower
Koop
RHCKalatak
RHC
Nasirabad
RHCPidark
RHCBal
Nigore*
RHC
Khudan
RHCZaring
Bag
OPD
1. Consultationarea
A Y Y Y Y Y Y Y Y Y Y Y
F Y Y Y Y Y Y Y Y Y Y Y
2. Examinationarea
A N N N N N N Y N N N N
F N N N N N N Y N N N N
3. Handwashing
A N N N N N N N N N N N
F N N N N N N N N N N N
Female ward1. Patient area
A Y N Y Y N Y Y Y N Y Y
F N N Y Y N N Y N N Y N
2. Patient washroom
A Y N Y Y N Y Y Y N Y Y
F N N N N N N N Y N N N
Labour room
1. Deliveryroom
A Y N Y Y N N Y Y N Y Y
F Y N Y N N N N N N Y N
2. Scrub areaA N N N N N N N N N N Y
F N N N N N N N N N N N
3. Patient washroom
A Y N Y Y N N Y Y N Y Y
F N N N N N N Y Y N Y Y
Clinical lab.1. Laboratory
room
A Y Y Y Y N Y Y Y N Y Y
F Y Y N Y N Y Y N N N Y
2. Working areaA N N N N N N N N N N Y
F N N N N N N N N N N N
3. Pt. washroom
A Y Y Y Y N Y Y Y N Y Y
F N N Y Y N Y Y Y N N Y
LHV Room1. Consultation
area
A Y Y Y Y Y N N N Y N Y
F Y N Y Y N N N N N N N
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Infrastructure Status
Status of building components at each RHC
RHCB
uleda
RHCGo
mazai
RHCM
and
RHCT
ump
RHCG
ower
Koop
RHCKalatak
RH
C
Nasirabad
RHCP
idark
RHC
Bal
Nigo
re*
RHC
K
hudan
RHCZ
aring
Ba
g
2. Examinationarea
A Y N N N N N N N N N N
F Y N N N N N N N N N N
3. Handwashing
A N N N N N N N N N N N
F N N N N N N N N N N N
ResidenceDoctor
A N N Y Y Y N Y N Y Y Y
F N N N N Y N N N N N N
ResidenceLHV
A N N Y Y N Y Y N Y Y Y
F N N Y N N N N N N N N
*THERHC BALNIGORE IS AFFECTED BY FLOOD
PC-1 of NMNCHP contains category and number of staff required for Basic EmONC
services. Status of RHC for availability of HR (both regular posted and provided by
NMNCHP), against required numbers is presented in table below:
TABLE 3.7:STATUS OF MNCHRELATED STAFFIN RHC
Equipment items for various service components at RHC are listed in PC-1 of NMNCHP.
Status of functional quantity of these items at RHC, is presented in the table below:
Staffcategories
Requirednumberat
eachRHC
Number of MNCH related staff available at each RHC
RHCBuleda
RHCGomazai
RHCMand
RHCTump
RHCGowerKoop
RHCKalatak
RHCNasirabad
RHCPidark
RHCBalNigore
RHC
Khudan
RHCZaringBag
WMO 2 0 0 0 0 0 0 0 0 0 2 0
LHV 2 7 0 2 1 1 2 4 3 1 0 0
Labtechnician
1 1 1 1 1 0 1 1 1 0 1 1
OTtechnician
1 1 1 1 1 0 1 0 1 0 0 0
Ambulancedriver
1 1 0 0 1 0 0 1 0 1 1 0
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TABLE 3.8:STATUS OF FUNCTIONAL EQUIPMENTIN RHC
List of essential drugs and supplies for MNCH services is contained in PC-1 of NMNCHP.
Tracer items were selected from the list (Annex 1) for assessing their availability at surveyed
facilities. Status of surveyed RHC regarding available quantity of tracer items is presented
below:
TABLE 3.9:STATUS OF DRUGS ANDSUPPLIES IN RHC
Facility for support services including basic laboratory tests (space, test strips and HR) and
ambulanceservices (functional vehicle and driver) was assessed at surveyed RHC.
Availability status of these services at RHC is presented below:
Equipment
TotalItems
requiredateach
RHC
Number of functional equipment items available at each RHC
RHCBuleda
RH
CGomazai
R
HCMand
R
HCTump
RHCGower
Koop
RH
CKalatak
RHC
N
asirabad
RHCPidark
RHCBal
Nigore
RH
CKhudan
RHCZaring
Bag
Generalitems
4 0 0 0 0 0 0 0 0 0 0 0
Femaleward
9 6 0 8 6 0 0 6 0 0 2 3
WMO OPD 15 10 8 10 2 0 0 10 0 0 10 9
Labourroom
19 12 0 10 8 0 0 0 0 0 5 16
LHV Room 10 7 0 7 7 6 5 6 6 0 0 7
Item groups
TotalItems
requiredateach
RHC
Number of items available at each RHC
RHCBuleda
RHCGomazai
RHCMand
RHCTump
RHCGower
Koop
RHCKalatak
RHCNasirabad
RHCPidark
RHCBalNigore
RHC
Khudan
RHCZaringBag
Supplies 6 2 4 6 5 3 4 6 2 3 6 4
Drugs 18 11 10 12 13 13 14 15 14 15 13 11
Vaccines 5 4 5 5 5 0 5 5 5 5 5 4
FPCommodities
6 4 0 3 4 0 3 2 0 2 2 1
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TABLE 3.10:STATUS OF SUPPORTSERVICES IN RHC
24/7 Comprehensive EmONC Services at SHC Hospital
DHQ Hospital operating within District Keich was assessed for provision of Comprehensive
EmONC services available for 24 hours a day, 7 days a week (24/7). DHQ Hospital was
assessed for availability of optimal level of inputs as summarised in Tables 3.11 - 3.15.
Infrastructure of the DHQ hospital has been assessed for availability of OPD, indoor wards,
LHV room, labour room, operation theatre, paediatric nursery, blood bank, ultrasound room
and clinical laboratory as service provision areas and residences for accommodation of
required staff. Service provision areas have been assessed for availability of essential space
in respective areas e.g., consultation area, examination area and hand washing in OPD;
patient area, nursing station, store rooms and attached washrooms in indoor wards, etc., as
contained in table below. Findings are presented as status of building components available
and functional:
TABLE 3.11:STATUS OF ASSESSED INFRASTRUCTURE IN DHQHOSPITAL
Supportservices
TotalItemsrequired
ateachRHC
Number of items available at each RHC
RHCBuleda
R
HCGomazai
RHCMand
RHCTump
RHCGowerKoop
R
HCKalatak
RHCNasirabad
RHCPidark
RH
CBalNigore
R
HC
Khudan
RH
CZaringBag
Basic labtests
8 4 4 4 5 4 6 6 5 4 3 7
Ambulanceservice
2 0 0 0 1 0 0 1 0 1 1 0
Infrastructure StatusAvailability of building components
DHQH Keich
OPD:
1. Consultation area
A Y
F Y
2. Examination areaA Y
F Y
3. Privacy of examination areaA N
F N
4. Hand washingA N
F N
Female ward:
1. Patient area
A Y
F Y
2. Nursing stationA Y
F Y
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3. Patient wash roomA Y
F Y
4. Store for general itemsA N
F N
5. Store for equipmentA N
F NLabour room:
1. Delivery room
A Y
F Y
2. Preparation /stage roomA Y
F Y
3. Scrub areaA Y
F Y
4. Staff duty roomA N
F N
5. Patient wash roomA Y
F Y
6. Staff wash roomA Y
F Y
7. Store for general itemsA N
F N
8. Store for equip.A N
F N
Operation theatre:
1. Patient preparation room
A N
F N
2. Operating roomA Y
F Y
3. Recovery roomA N
F N
4. Scrub areaA Y
F Y
5. Sterilisation areaA N
F N
6. Doctors roomA Y
F Y
7. Support staff duty roomA N
F N
8. Store for general items A N
F N
9. Store for equipmentA N
F N
10. Attached washroom for staffA N
F N
Paediatrics ward:
1. Patient area
A Y
F Y
2. Nursing stationA Y
F Y
3. Store for generalitems/drugs or equip.
A N
F N
4. Patient wash room A YF N
Paediatric nursery: A Y
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1. Patient area F Y
2. Nursing stationA N
F N
3. Store for generalitems/drugs or equip.
A N
F N
4. Change room/areaA NF N
Clinical lab.:
1. Laboratory room
A Y
F Y
2. Working areaA Y
F Y
3. Doctors duty roomA Y
F Y
4. Store for general reagents orequip.
A Y
F Y
5. Attached wash room A YF Y
Blood bank:
1. Blood collection room
A Y
F Y
2. Working areaA Y
F Y
3. Staff duty roomA N
F N
4. Store for general reagents orequip.
A N
F N
5. Attached wash room
A Y
F Y
LHV Room:
1. Consultation area
A Y
F Y
2. Examination areaA Y
F Y
3. Privacy for examinationA N
F N
4. Hand washing facilityA N
F N
Ultrasound room:
Examination area
A Y
FY
Residence:
Gynaecologist
A Y
F N
Residence:
Anaesthetist
A Y
F N
Residence:
Paediatrician
A Y
F N
Residence:
WMO
A Y
F N
Residence:
LHV
A Y
F N
Residence:
Nurses
A Y
F Y
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PC-1 of NMNCHP contains category and number of staff required for Comprehensive
EmONC services. Status of DHQ hospital for availability of HR (both regular posted and
provided by NMNCHP), against required numbers is presented in table below:
TABLE 3.12:STATUS OF MNCHRELATEDSTAFFIN DHQHOSPITAL
Equipment items for various service components at DHQ hospital are listed in PC-1 of
NMNCHP. Status of functional quantity of these items at SHC hospitals, is presented in the
table below:
TABLE3.13:STATUS OF FUNCTIONAL EQUIPMENTIN SHCHOSPITAL
Residence
Lab technician
A N
F N
Residence:
BB technician
A N
F N
Residence:Anaesthesia technician
A NF N
Staff categories
Availability of MNCH related staff at SHC Hospital
DHQH Keich
Required number Available number
Gynaecologist 2 1
Anaesthetist 2 1
Paediatrician 2 3
WMO 6 6
OT technician 4 0
BB technician 4 1
Lab technician 3 2
Anaesthesia technician 4 0
Nurses 20 0
LHV 4 3
Ambulance drivers 4 3
Staff categoriesNumber of functional equipment at
Total required Items DHQH Keich
General items 4 3
Female ward 19 14
OPD 12 9
Paediatric nursery 13 11
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List of essential drugs and supplies for MNCH services is contained in PC-1 of NMNCHP.
Tracer items were selected from the list (Annex 1) for assessing their availability at surveyed
facilities. Status of DHQ hospital regarding available quantity of tracer items is presented in
the table below:
TABLE 3.14:STATUS OF DRUGS ANDSUPPLIES IN SHCHOSPITAL
Facility for support services including laboratory tests (space, test strips and HR), blood
transfusion services (space, supplies and HR), ambulanceservices (functional vehicle and
driver), operation theatre (space, drugs and supplies, equipment items and HR) was
assessed at surveyed DHQ hospital. Availability status of these services at SHC hospitals ispresented below:
TABLE 3.15:STATUSOF SUPPORTSERVICES IN SHCHOSPITAL
24/7 Basic EmONC Services at THQ Hospital
There is no THQH in this District.
Paediatric ward 10 8
Labour room 24 18
Operation theatre 31 23
Clinical laboratory 5 2
Item groups Total ItemsNumber of items available at
DHQH Keich
Supplies 9 9
Drugs 21 14
Vaccines 5 5
FP Commodities 7 5
Item groups Total ItemsNumber of items available at
DHQH Keich
Basic laboratory tests 17 15
Blood transfusion 5 5
Ambulance services 2 2
Radiology services 3 2
Operation theatre 62 35
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Management Basics
Findings related to facility management basics are presented below:
Human ResourceInformation about sanctioned and filled posts of MNCH related staff was collected from the
surveyed facilities; and their status is presented in table 3.16 - 3.18. Filled status of staff
categories presented in following tables, include regular posting only, as reported by the
respective facility on the day of survey.
TABLE 3.16:STATUS OF HR AT SHCHOSPITAL
Staff Status of HR at SHC HospitalDHQH Keich
Sanctioned Filled
Gynaecologist 1 1
Anaesthetist1 1
Paediatrician 3 3
WMO 6 6
OT technician1 0
BB technician 1 1
Lab technician 2 2
Anaesthesia technician 0 0
Nurses 14 0
LHV2 2
Ambulance drivers 3 3
TABLE 3.17:STATUSOF HR AT RHC
Staff
Number of posts sanctioned and filled at each RHC
RHCBuleda
RHC
Gomazai
RHCMand
RHCTump
RHCGower
Koop
RHC
Kalatak
RHC
Nasirabad
RHCPidark
RHCBal
Nigore
RHC
Khudan
RHCZaring
Bag
S F S F S F S F S F S F S F S F S F S F S F
WMO 1 0 0 0 1 0 1 0 0 0 1 0 1 0 1 0 0 0 1 2 1 0
Lab
technician1 1 1 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 1 1 1 1
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Nurse 0 0 0 0
LHV 4 4 1 0
Ambulance
drivers1 1 1 0
TABLE
Staff BHUDashat G
S F S
WMO/MO 0 0 0
LHV 1 0 1
Availability of job description
assessed and their findings a
FIGU
Reasons for non-availability
3.19 and 3.20.
0
2
4
6
8
10
12
1
11
1
0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
1 1 1 1 0 1 1 2 2 2 2 1
0 1 1 0 0 1 0 1 1 1 0 1
3.18:STATUS OF HR AT SURVEYED BHU
Number of posts filled at BHU
HU
wak
BHU
Kohad
BHU
Balgather
BHU
Gokdan
F S F S F S F
1 1 1 1 0 2 2
1 1 1 1 0 1 1
s, service delivery protocols and staff as p
re presented in the Figure 3.
E 3: STATUS OF MANAGEMENT BASICS
f staff on 24/7 basis at RHC and SHC ar
B
7
00
3
00
00
0
A
A
21
0 0 0 0 0
1 1 0 1 0
1 1 1 0 0
BHU
rachkoo
BHU
Kunchity
F S F
1 1 1 1
1 0 1 0
er duty roster was
provided in Table
()
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TABLE3.19:REASONS OF NON-AVAILABILITY OF HR AT RHC
Reasons of non-availabilityStatus in RHC
WMO LHV Ambulance Driver
Residence not available 0 5 0Residence damaged 0 1 0
Security reasons 0 0 0
Lack of basic amenities 0 0 0
TABLE 3.20:REASONS OF NON-AVAILABILITY OF HR ON 24/7BASISAT SHCHOSPITAL
Reasons of non-availability
Status of DHQ Hospital
G
ynaecologist
Anaesthetist
Paediatrician
BloodBank
Technician
Laboratory
Technician
WMO
LHV
Residence not available 0 0 0 0 0 0 0
Residence damaged 0 0 0 0 0 0 0
Security reasons 0 0 0 0 0 0 0
Lack of basic amenities 0 0 0 0 0 0 0
Health facilities having staffed trained for providing MNCH services is presented in the Table
3.21.
TABLE 3.21:CAPACITY BUILDING OF MNCHRELATED STAFF
Health
Facility
MNCH related training conducted
EmONC ENC IMNCI IMPACFP
surgicalFP
counsellingClient
centeredness
DHQH Keich Y N Y N Y Y N
RHC Buleda N N N N N Y
RHC Gomazai N N N N N Y
RHC Mand N N N N N Y
RHC Tump N N N N N Y
RHC Gower
KoopN N N N N Y
RHC Kalatak N N N N N Y
RHC
Nasirabad N N N N N Y
RHC Pidark N N N N N Y
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Health
Facility
MNCH related training conducted
EmONC ENC IMNCI IMPACFP
surgicalFP
counsellingClient
centeredness
RHC Bal
NigoreN N N N N Y
RHC DashtKhudan N N N N N Y
RHC Zaring
BagN N N N N Y
BHU Dashat N N N N N Y
BHU Gawak N N N N N Y
BHU Kohad N N N N N Y
BHU
BalgatherN N N N N Y
BHU Gokdan N N N Y N NBHU
DrachkooN N N N N Y
BHU Kunchity N N N N N Y
Work Coordination and Supervision
Health facilities in the district were assessed for work coordination and supervisory activities,
including facility staff meetings, participation of facility in charges in district level meetings
and conduction of supervisory visits and feedbacks by district health managers. Findings ofeach surveyed health facility are presented in Table 3.22.
TABLE 3.22:STATUS OF COORDINATION ANDSUPERVISION
Health Facility
Work Coordination and Supervision
Regular facility PRM*
Participation indistrict PRM*
Monthly Supervisory Visit
Meetingheld
Recordmaintained
Facilityvisited
Facility receivedvisit feedback
DHQH Keich Y N Y Y Y
RHC Buleda N N N Y Y
RHC Gomazai Y N N Y N
RHC Mand Y Y Y Y Y
RHC Tump Y Y Y Y N
RHC Gower Koop N N N Y N
RHC Kalatak N N Y Y Y
RHC Nasirabad Y Y Y Y Y
RHC Pidark N N N Y Y
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Health Facility
Work Coordination and Supervision
Regular facility PRM*
Participation indistrict PRM*
Monthly Supervisory Visit
Meetingheld
Recordmaintained
Facilityvisited
Facility receivedvisit feedback
RHC Bal Nigore Y Y Y Y Y
RHC Dasht Khudan N N N N N
RHC Zaring Bag N N N Y Y
BHU Dashat N N N N N
BHU Gawak N N N Y Y
BHU Kohad Y Y Y Y Y
BHU Balgather N N N N N
BHU Gokdan Y N Y Y Y
BHU Drachkoo N N N Y N
BHU Kunchity N N N Y Y
* PRM=Performance Review Meeting
Management Information System
District Keich was practicing Health Management Information System (HMIS). Surveyed
facilities were assessed for availability and maintenance of HMIS tools and their findings are
presented in Table 3.23.
TABLE 3. 1: STATUS OF MIS
HealthFacility
Status of MIS Tools
OPD
ticket
OPDr
egister
Motherhealthregister
Birthregister
Childhealthregister
FamilyPlanning
reg
ister
EPIregister
Meeting
register
MedicineStock
reg
ister
Dailyexpenseregister
HMISmon
thlyreport
TBre
gister
DiseaseEa
rlyWarning
Sys
tem
DEWSchart
GrowthM
onitoring
Reg
ister
MIS Tools Available
DHQH Keich Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y
RHC Buleda Y Y Y Y N Y Y Y Y Y Y N N N N
RHC
GomazaiY Y Y Y Y Y Y Y Y Y Y N N N N
RHC Mand Y Y Y Y N Y Y Y Y Y Y N N N N
RHC Tump Y Y Y Y N Y Y Y Y Y Y Y N N N
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HealthFacility
Status of MIS Tools
OPD
ticket
OPDr
egister
Motherhealthregister
Birthregister
Childhealthregister
FamilyPlanning
reg
ister
EPIregister
Meeting
register
MedicineStock
reg
ister
Dailyexpenseregister
HMISmon
thlyreport
TBre
gister
DiseaseEa
rlyWarning
Sys
tem
DEWSchart
GrowthM
onitoring
Reg
ister
RHC Gower
KoopY Y Y Y Y Y N Y Y Y Y N N N N
RHC Kalatak Y Y Y Y Y Y Y Y Y Y Y N N N N
RHC
NasirabadY Y Y Y Y Y Y Y Y Y Y Y Y Y N
RHC Pidark Y Y Y Y Y Y Y Y Y Y Y N N N N
RHC Bal
NigoreY Y Y Y Y Y Y Y Y Y Y N N Y N
RHC Dasht
KhudanN Y N N N N Y N Y Y Y N Y Y N
RHC Zaring
BagY Y Y Y Y Y Y Y Y Y Y Y Y N N
BHU Dashat Y Y N N N N N N Y Y N N N N N
BHU Gawak Y Y Y Y N Y N Y Y Y Y N N N N
BHU Kohad Y Y Y Y N Y N Y Y Y Y N N Y N
BHU
BalgatherY Y Y Y N Y N N Y Y Y N N N N
BHU Gokdan Y Y Y Y N N N Y Y Y Y N N Y N
BHU
DrachkooY Y N Y N N N Y Y Y Y N N N N
BHU Kunchity Y Y Y Y Y N N N Y Y Y N N N N
MIS Tools Maintained
DHQH Keich Y Y Y Y Y Y Y Y Y Y Y Y Y Y
RHC Buleda Y Y Y Y N Y Y N Y Y Y N N N
RHC
GomazaiY Y N N N N Y N Y Y Y N N N
RHC Mand Y Y Y Y N Y Y Y Y Y Y N N N
RHC Tump Y Y N Y N Y Y Y Y Y Y N N N
RHC Gower
KoopY Y N N N N N N N Y N N N N
RHC Kalatak Y Y N Y Y Y Y N Y Y Y N N N
RHC
Nasirabad Y Y N N N N Y Y Y Y Y N Y N
RHC Pidark Y Y N N N N Y N Y Y Y N N N
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HealthFacility
Status of MIS Tools
OPD
ticket
OPDr
egister
Motherhealthregister
Birthregister
Childhealthregister
FamilyPlanning
reg
ister
EPIregister
Meeting
register
MedicineStock
reg
ister
Dailyexpenseregister
HMISmon
thlyreport
TBre
gister
DiseaseEa
rlyWarning
Sys
tem
DEWSchart
GrowthM
onitoring
Reg
ister
RHC Bal
NigoreY Y N Y N N Y Y Y Y Y N N Y
RHC Dasht
KhudanN Y N N N N Y N Y Y Y N N Y
RHC Zaring
BagY Y N N N N N N Y Y N N N N
BHU Dashat Y Y N N N N N N Y Y N N N N
BHU Gawak Y Y N N N N N N Y Y Y N N N
BHU Kohad Y Y Y Y N Y N Y Y Y Y N N Y
BHU
BalgatherY Y N N N N N N Y Y N N N N
BHU Gokdan Y Y Y Y N N N Y Y Y N N N Y
BHU
DrachkooY Y N Y N N N N Y Y Y N N N
BHU Kunchity Y Y N N N N N N Y N Y N N N
Drugs and Supplies
Availability of drugs and supplies has been described under individual MNCH service
packages. The reasons of their non-availability were identified at the surveyed facilities and
presented in the Table 3.24.
TABLE 3.24:REASONS FORSTOCKOUTREPORTED BY SURVEYEDFACILITIES
Health facilities
citing stock out
Reasons for stock out
Poorquantification
Delayeddemand
submission
Unavailabilityof
bufferstock
Lackofstorage
capacity
Delayedsupply
Undersupply
Noprocurement
powers
Insufficientbudget
Lackofcold-chain
DHQH Keich N N N N Y N N N N
RHC Buleda Y N N N Y N N N N
RHC Gomazai Y N N N Y N N N N
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Health facilities
citing stock out
Reasons for stock out
Poorquan
tification
Delayeddemand
submission
Unavailabilityof
bufferstock
Lackofs
torage
capacity
Delayed
supply
Unders
upply
Noprocu
rement
powers
Insufficien
tbudget
Lackofco
ld-chain
RHC Mand N N N N Y N N N N
RHC Tump N N N N Y N N N N
RHC Gower Koop Y N N Y Y N N N N
RHC Kalatak N N N Y Y N N N N
RHC Nasirabad N N N N Y N N N N
RHC Pidark N N N N Y N N N N
RHC Bal Nigore N N N N Y N N N N
RHC Dasht Khudan Y N N N Y N N N N
RHC Zaring Bag N N N N Y N N N N
BHU Dashat N N N N Y N N N N
BHU Gawak Y N N N Y N N N N
BHU Kohad N Y N N N N N N N
BHU Balgather Y N N Y N N N N N
BHU Gokdan N N N N Y N N N N
BHU Drachkoo Y N N N Y N N N N
BHU Kunchity N N N N Y N N N N
Fee for Services
Fee for MNCH services and availability of social protection mechanisms for the poor wereassessed at surveyed facilities and their findings are presented in Table 3.25 and 3.26.
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TABLE3.25:STATUS OF FEEFORSERVICE
Health facilities
where service are
charged
Services provided free of cost
OPD IndoorAmbulanceservices
OPDTicket
OPDLaboratory
OPDUltrasound
OPDX-rays
OPDMedicines
Admissionfee
Wardbed
InpatientLaboratory
InpatientUltrasound
InpatientX-rays
Bloodgrouping&
crossmatching
Inpatientmedicines
DHQH Keich N N N N N N N N N N N N N
RHC Buleda Y Y N N Y Y Y Y N N Y Y
RHC Gomazai Y Y N N Y Y Y Y N N Y N
RHC Mand Y Y N N Y Y Y Y N N Y Y
RHC Tump Y Y N Y Y Y Y Y N N Y Y
RHC Gower Koop Y N N N Y N N N N N N N
RHC Kalatak Y Y N N Y Y Y Y N N Y N
RHC Nasirabad Y Y N N N Y Y Y N N Y Y
RHC Pidark Y N N N Y N N N N N N N
RHC Bal Nigore Y Y N N Y N N N N N N N
RHC Dasht
KhudanY Y N N Y Y Y Y N N Y Y
RHC Zaring Bag Y Y N N Y N N N N N N N
BHU Dashat Y N Y
BHU Gawak Y N Y
BHU Kohad Y N Y
BHU Balgather Y N Y
BHU Gokdan Y Y Y
BHU Drachkoo N N Y
BHU Kunchity Y N Y
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TABLE3.26:MECHANISMS OF SOCIAL PROTECTIONAVAILABLE
Health Facilities with available
Social Protection
Social Protection Mechanism
Bait-ul MaalZakat
Patient Welfare
Society
DHQH Keich Y N N
RHC Buleda N N N
RHC Gomazai N N N
RHC Mand N N N
RHC Tump N N N
RHC Gower Koop N N N
RHC Kalatak N N N
RHC Nasirabad N N N
RHC Pidark N N N
RHC Bal Nigore N N N
RHC Dasht Khudan N N N
RHC Zaring Bag N N N
BHU Dashat N N N
BHU Gawak N N N
BHU Kohad N N N
BHU Balgather N N N
BHU Gokdan N N N
BHU Drachkoo N N N
Infection Control
Health facilities were assessed for practices of infection control and waste management, and
availability of related material. Findings of individual surveyed facilities are presented in table
3.27.
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TABLE 3.27:STATUS OF INFECTIONCONTROL&WASTEMANAGEMENT PRACTICES
Health facilities
Availability of Materials Infection Control Practices
Wastemanagementplan
Wastecollectionmaterials
P
ersonalprotectionmaterials
Wastetreatmentequipment
FunctionalIncinerators
Handwashingpracticesof
HCP
Disinfectionofservice
provisionarea
HepBVaccinationofStaff
Wastesegregation
Disposalofwastethrough
burning
DisposalthroughThrowing-
away
DisposalthroughMunicipal
Arrangement
DHQH Keich Y N N N Y Y Y Y N N N Y
RHC Buleda Y N N N Y N N N N N
RHC Gomazai N N N N Y N Y N N N
RHC Mand N N N N Y Y Y N N N
RHC Tump N N N N Y Y Y N N N
RHC Gower
KoopN N N N Y N Y N N N
RHC Kalatak N N N N Y N Y N N N
RHC Nasirabad Y N N N Y N Y N N N
RHC Pidark N N N N Y N Y N N N
RHC Bal Nigore N N N N Y N Y N N N
RHC Dasht
KhudanN N N N Y N Y N N N
RHC Zaring Bag N N N N Y N Y N N N
BHU Dashat N N N N Y N N N N N
BHU Gawak N N N N Y N N N N N
BHU Kohad N N N N Y N Y N N N
BHU Balgather N N N N Y N N N N N
BHU Gokdan N N N N Y N Y N Y N
BHU Drachkoo N N N N Y N N N N N
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Death Review
Findings related to availability and functioning of death review committees are presented in
the Table 3.28.
TABLE 3.28:STATUS OF DEATHREVIEWS
Health Facility
Status of Death Review
DeathReview
CommitteeAvailable
Maternal Deaths Neonatal Deaths
AnnualNumber
Reviewed bycommittee
AnnualNumber
Reviewed bycommittee
DHQ Keich N 7 0 0 0
RHC Buleda N 0 0 0 0
RHC Gomazai N 0 0 0 0
RHC Mand N 0 0 0 0
RHC Tump N 0 0 0 0
RHC Gower Koop N 0 0 0 0
RHC Kalatak N 0 0 0 0
RHC Nasirabad N 0 0 0 0
RHC Pidark N 0 0 0 0
RHC Bal Nigore N 0 0 0 0
RHC Dasht Khudan N 0 0 0 0
Facility Utilisation
Findings of services utilisation at surveyed facilities are given as monthly aggregate from
July to December 2010, annual utilisation of year 2010 and facility-wise average monthly
utilisation are presented in Tables 3.29, 3.30 and 3.31.
TABLE 3.29:STATUS OF SERVICES UTILISATION
Type of serviceMonthly utilisation (July to December 2010) Annual
utilisation(2010)July Aug Sep Oct Nov Dec
1st Antenatal Care visits (ANC-1) 351 323 241 231 237 266 3,611
Normal vaginal deliveries 236 300 254 257 231 246 2,548
Assisted vaginal deliveries 0 0 0 0 0 0 0
C-sections 8 23 14 13 18 23 216
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Type of serviceMonthly utilisation (July to December 2010) Annual
utilisation(2010)July Aug Sep Oct Nov Dec
1st Postnatal Care visits (PNC-1) 106 146 149 192 99 105 1,320
Pregnant women given TT2
vaccine
563 524 532 542 484 441 6,802
FP services 208 165 167 197 92 172 1,829
Diarrhoea/Dysentery casestreated (< 5 years of age)
1,607 1,380 1,826 1,661 1,330 1,175 18,222
Pneumonia cases treated(< 5 years of age)
943 827 893 765 784 791 9,466
TABLE 3.30:AVERAGEMONTHLYMNCHSERVICES PROVIDED
HealthFacility
Average Monthly Utilisation
ANC -1
NVDAssisted
VDC
SectionPNC -
1TT2
Diarrhoea/
Dysentery(in
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BHU
Drachkoo0 0 0 0 0 23 63
BHU
Kunchity28 10 0 2 112 31 45
TABLE 3.31:AVERAGEMONTHLYFP SERVICES PROVIDED
HealthFacility
Average Monthly Utilisation of FP Services
COC POP DPMANet-en
Condoms IUCDs ImplantsSurgical (Tubal
Ligation Vasectomy)
DHQH
Keich0 39 64 14 0 0 0 1
RHC Buleda 1 0 8 0 0 0 0
RHCGomazai
0 0 0 0 0 0 0
RHC Mand 0 0 0 13 0 0 0
RHC Tump 0 3 0 11 0 0 0
RHC Gower
Koop8 10 0 0 0 0 0
RHC
Kalatak0 0 0 0 0 0 0
RHC
Nasirabad0 0 0 0 0 0 0
RHC Pidark 0 0 0 0 0 0 0
RHC Bal
Nigore0 0 0 0 0 0 0
RHC Dasht
Khudan0 0 0 0 0 0 0
RHC Zaring
Bag0 0 0 0 0 0 0
BHU Dashat 0 0 0 0 0 0 0
BHU Gawak 0 0 0 0 0 0 0
BHU Kohad 0 0 0 0 0 0 0
BHU
Balgather0 0 0 0 0 0 0
BHU
Gokdan0 0 0 0 0 0 0
BHU
Drachkoo0 0 0 0 0 0 0
BHU
Kunchity1 0 8 0 0 0 0
KEY: COC=Combined Oral Contraceptive, POP=Progesterone-Only Pills, DPMA=Depot
Medroxyprogesterone Acetate, Net-en=norethisterone enanthate, IUCDs=Intrauterine ContraceptiveDevices
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Well Baby Clinic
Surveyed health facilities were assessed for established Well Baby Clinic (WBC) and its
findings are presented in Table 3.32.
TABLE3.32:STATUS OF WBCESTABLISHED
Name of health facility WBC Established Name of health facility WBC Established
DHQ Keich Y RHC Dasht Khudan N
RHC Buleda N RHC Zaring Bag N
RHC Gomazai N BHU Dashat N
RHC Mand N BHU Gawak N
RHC Tump N BHU Kohad N
RHC Gower Koop N BHU Balgather N
RHC Kalatak N BHU Gokdan N
RHC Nasirabad N BHU Drachkoo N
RHC Pidark N BHU Kunchity N
RHC Bal Nigore N
Donor Contribution
Donor Contribution during last three years was assessed regarding human resource,
infrastructure, equipment including ambulances, and drugs and supplies and findings are
presented in Table 3.33.
TABLE 3.33:STATUS OF DONORCONTRIBUTION
Health Facilities
Donor Contribution
Human Resource Infrastructure EquipmentDrugs andSupplies
Provisionofke
y
staff
Capacitybuildin
g
StaffIncentive
Constructiono
f
newbuilding
Renovationof
existingbuildin
g
Provisionofne
w
equipment
Provisionofne
w
vehicle/
ambulance
Provisionof
Medicines
Provisionof
Consumables
DHQ Keich N N N N N N N N N
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Health Facilities
Donor Contribution
Human Resource Infrastructure EquipmentDrugs andSupplies
Pr
ovisionofkey
staff
Ca
pacitybuilding
S
taffIncentive
Constructionof
newbuilding
R
enovationof
ex
istingbuilding
Provisionofnew
equipment
Provisionofnew
vehicle/
ambulance
Provisionof
Medicines
Provisionof
C
onsumables
RHC Buleda N N N N N N N N N
RHC Gomazai N N N N N N N N N
RHC Mand N N N N N N N N N
RHC Tump N N N N N N N N N
RHC Gower Koop N N N N N N N N N
RHC Kalatak N N N N N N N N N
RHC Nasirabad N N N N N N N N N
RHC Pidark N N N N N N N N N
RHC Bal Nigore N N N N N N N N N
RHC Dasht Khudan N N N N N N N N N
RHC Zaring Bag N N N N N N N N N
BHU Dashat N N N N N N N N N
BHU Gawak N N N N N N N N N
BHU Kohad N N N N N N N N N
BHU Balgather N N N N N N N N N
BHU Gokdan N N N N N N N N N
BHU Drachkoo N N N N N N N N N
BHU Kunchity N N N N N N N N N
Clients Perspective
Client Exit Interviews (CEI) was conducted within the scope of the HFA Survey to assess
clients perspective on provided services. Findings of these interviews were analysed for
assessing their perspective on access, quality and preference for health care and are
presented in Table 3.34 and Figures 4 and 5.
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TABLE3.34:CLIENTS PERSPECTIVE
No of interviewed clients (Total: 65)
DHQH RHC
Time to reach facility
Less than 30 minutes 6 46
30 minutes to 1 hour 2 4
More than 1 hour2 5
Means of transport
Walk 0 6
Personal transport 1 42
Public transport 9 7
Waiting time at facility
Less than 10 minutes 2 16
10 minutes to 20 minutes 5 31
20 minutes to 30 minutes 05
More than 30 minutes 3 3
Fee for services
Paid fee for services 10 0
Health Education Material
Received Education Material0 0
Preference for healthcare
Public HF 10 54
Private sector 0 1
Reasons for visiting public HF
Close to home 1 29
Good quality 5 17
Staff attitude 0 1
Affordability 4 8
Lack of choice 0 5
Overall satisfaction
Very satisfied 3 20
Satisfied 7 34
Not satisfied 0 1
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FIGURE 4: LEVEL OF SA
FIGURE 5: A
Procurement Estim
EquipmentBased on the information col
have been identified for i
Summary of estimated cost
required equipment for each
cost estimates for individual f
Civil Works
A yardstick has been used f
building components (Anne
0%
A
A
0% 20%
ISFACTIONWITHEXAMINATIONANDATTITU
AILABILITYOF MEDICINES ANDLABSERVICE
ates
lected, procurement needs for provision of r
dividual surveyed facilities to strengthen
or procurement of required equipment is g
surveyed facility is presented as Annex 3
cilities is given in Annex 3 B.
r assessing the scope of civil works of vari
1). Identified scope of work to complet
35
39
39
40
65
61
61
55
20
5
20% 40% 60% 80% 100%
60
62
30
38
10
0
40% 60% 80% 100%
37
EOF STAFF
S
equired equipment
MNCH services.
iven below. List of
and details about
ous MNCH related
the infrastructure
()
()
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needs of the individual surveyed facilities is presented in Annex 4. Summary of estimated
cost for
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execution of civil works including repair and maintenance, renovation and new construction
of missing facilities; is given in table below and details about cost estimates for individual
facilities is given in Annex 4.
TABLE 3.35:SUMMARYOF ESTIMATED COST FORPROCUREMENT OF EQUIPMENTS&CIVILWORKS
ProcurementEstimated Cost (PKR in Millions)
DHQH RHC BHU Total
Equipment 8.4 71 4.5 84
Civil Works 20 124 37 181
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Section 4: Key Findings
In district Keich, total of 19 health facilities were assessed including 7 BHU, 11 RHC, and 1
DHQH. The BHU were assessed for availability of 8/6 Preventive MNCH services; RHC
were assessed for availability of 24/7 Basic EmONC services; and DHQ Hospital wasassessed for availability of 24/7 Comprehensive EmONC services.
The key findings have been presented based on the availability of specified inputs including,
Infrastructure, Human Resource, Equipment, Drugs and Supplies, and Support services.
Status of each input has been described at one place for all levels. This is followed by key
findings on Management basics, Donor contribution and Clients perspective on the quality of
MNCH services.
Infrastructure
At BHU, OPD was available at all the BHU while labour rooms were not available at all
BHU; LHV residences were available only at BHU Drachkoo and Kunchity but none of
these were in good condition
OPD was available at all eleven RHC while female ward was not present at 3 RHC i.e.,
RHC Gomazai, RHC Gower Koop and RHC Bal Nigore. Labour room was not availableat 4 RHC, clinical laboratory was not available at RHC Gower Koop and RHC Bal Nigore.
WMO residence was available at 7 RHC but was in good condition at RHC Gower Koop
OPD,female ward, Delivery room,Operating Theater,Paediatric ward and Paediatrc
Nursery,clinical laboratory and blood bankand also USG room were at
DHQH.Residences for gynaecologist,paediatrician and anaesthetist were available but
were not in good condition.
Human Resource
All required staff was available at all BHU except at BHU Dashat and BHU Balgather,
where no staff was available
Required number of WMO were available only at RHC Dasht Khudan out of 11 RHC;
while required number of LHV were available at 5 RHC; Laboratory technicians were
available at 9 RHC; while OT technicians were available at 6 RHC. Ambulance drivers
were available only at 5 RHC
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Required number of Paediatrician were present at DHQH. OTand Anaesthesia
techncians were not available at DHQH
Staff residence not being available was the most common reason for non-availability of
staff round the clock at RHC
Staff at DHQH received training on FP counselling, FP surgical, IMNCI and EmONC;staff
at BHU Gokdan received training on IMPAC while all RHC and BHU except BHU
Gokdan received training on client centredness only
Equipment
The complete set of required equipment items was not available at any of the surveyedfacilities
General equipment items were not available at any of the surveyed BHU. LHV room
equipment was not available atBHU Balgather, BHU Drachkoo and BHU Kunchity out of
7 BHU
General equipment items were not available at all RHC. All required female ward
equipment items were not available at 5 RHC. WMO equipment items were not available
at 4 RHC. Labour room equipment items was not available at 6 RHC; while LHV room
equipment items were not available at 3 RHC
Drugs and Supplies
The complete list of tracer drugs and family planning were not available at any of the
surveyed facilities
All the required vaccines were not available at any of the BHUexcept BHU Gokdan while
FP commodities were alsonot available at anyBHU except BHU Kohad
The complete range of vaccines was available at 8 RHC.FP commodities were absent at
3 RHC namely RHC Gomazai, RHC Gower Koop and RHC Pidark.The complete range
of supplies was available at 3 RHC namely RHC Mand, RHC Nasirabad and RHC
Khudan
Complete range of vaccines and supplies were available at DHQH
The most common reason for stockout of drugs was poor quantification and delayed
supply
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Support Services
The complete range of required inputs for delivery of support services was not available
at most of the surveyed facilities
Inputs required for provision of basic laboratory tests were not available at BHU Dastuk
and BHU Balgather
All required inputs for provision of ambulance services were not present at 7 RHC
Blood transfusion and ambulance services were available at DHQH Keich
Management Basics
Management basics assessed at the surveyed facilities included availability of job
description and service delivery protocols, work coordination and supervision, MIS, infection
control practices, death reviews of maternal and neonatal deaths, fee for services and
available mechanisms of social protection, and facility utilisation of MNCH services.
Eight out of nineteen health facilities were conducting regular performance review
meetings but its record was maintained at only 5 of the surveyed facilities. Eight facility
in-charges reported regular participation in district level performance review meetings
Majority of the facilities reported supervisory visits of district health managers and its
feedback was also received at most of the facilities
Health Management Information System (HMIS) was being practiced in district Keich.
Regarding HMIS tools, complete range of tools was not available except at DHQH,
specifically non-availability of TB Register,child health register and DEWS chart
Social protection mechanisms for the poor was found only at DHQH in the form of Bait ulMal
Complete range of inputs required for infection control practices were deficient at all the
surveyed facilities. Out of 19 facilities, 3 reported availability of waste management plan
but materials for waste collection, personal protection and waste treatment were not
available at any of the facility
Death review committee was not available for review of maternal and neonatal deaths at
any of the surveyed facilities.
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Donor Contribution
Donor contribution for supporting delivery of MNCH was assessed at the surveyed facilities
for provision of human resource, infrastructure, equipment, drugs and supplies. In the
district, no facility reported any such contribution.
Clients Perspective
Client exit interviews were conducted to assess clients perspective about their satisfaction
with the services utilised at the facility. Total of 65 interviews were conducted in the district
and findings concluded that 35% of the clients were very satisfied and 63% were satisfied
with the availed services.
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Annexes
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Annex 1: District Health Department
Public sector district health system consists of Secondary Health Care (DHQH) and Primary
Health Care (RHC, BHU) facilities. DHO acts as head of the district health department,
under supervision of DC.
Health Resources
Health facilities (Public sector)
Public sector facilities providing MNCH services are given in table below:
TABLE 2.4:NUMBEROF PUBLIC SECTORHEALTH FACILITIESIN THE DISTRICT
Type Number Bed strength
Teaching hospitals 0 0
DHQ Hospital 1 90
THQ Hospital 0 0
RHC 11 98
BHU 36 0
Govt. Rural Dispensaries 43
MNCH Centres 4
Sub Health Centres 0SOURCE:HMISCELL,DHOOFFICE
Human Resource DHO Office
Table 2.5 summarises the HR situation at the DHO Office.
TABLE 2.5:HUMANRESOURCE IN OFFICE OF DHO
Name of Post Sanctioned Filled % Filled
District Officer Health 1 1 100
Deputy District Officer Health 2 2 100
District Coordinator National Program for FP & PHC 1 1 100
District Coordinator EPI Surveillance 1 1 100
District Coordinator NMNCHP 1 1 100
District Sanitary Inspector 1 1 100
CDC Officer 1 1 100
CDC Inspector 0 0 0
Drug Inspector 2 2 100
District Superintendent Vaccination 1 1 100
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Name of Post Sanctioned Filled % Filled
Assistant Superintendent Vaccination 2 2 100
Tehsil Sanitary Inspector 0 0 0
Inspector Vaccination0 0 0
Total 100
SOURCE:DHOOFFICE
MNCH staff in District Keich
Table 2.6 summarises the status of MNCH staffing in health facilities including DHQH, RHC
and BHU in the district. The information was collected from DHO office during survey.
This information may not match with subsequent tables containing similar information on
human resource (HR) collected from respective surveyed health facilities (No. 3.7, 3.12,
3.16, 3.17, 3.18).
TABLE 2.6:AVAILABILITYOF MNCHSERVICES STAFFING IN DISTRICT KEICH
Posts
Sanctioned
Filled % Filled
Filled posts
R= Regular, C= On Contract
DHQH=1 THQH=0 RHC=11 BHU=36
R C R C R C R C
Gynaecologist 1 2 100 1 1
Paediatrician 1 1 100 0 1
Anaesthetist 1 0 0 0 0
Radiologist 1 0 0 0 0
Pathologist 1 0 0 0 0
Women MedicalOfficers (WMO)
5 3 60 2 0 1 0 0 0
Medical Officers
(MOs)12 9 75 7 0 1 0 1 0
Blood Transfusion
Officers0 0 0 0 0
Blood Bank
Technician0 0 0 0 0
O.T. Technician 6 2 33 2 0
Anaesthesia
Technician6 1 17 1 0
LHV 18 14 78 7 0 7 0 0 0
Nurses 0 0 0 0 0 0 0
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Posts
Sanctioned
Filled % Filled
Filled posts
R= Regular, C= On Contract
DHQH=1 THQH=0 RHC=11 BHU=36
R C R C R C R C
Lady Health
Workers (LHW)10* 10 100
Laboratory
Technician0 0 0 0 0 0 0
X-ray Technician 0 0 0 0 0 0 0
Dispenser 10 9 90 4 0 3 0 2 0
Vaccinators 10 5 50 2 0 3 0 0 0
Ambulance
Drivers2 2 100 1 0 1 0
*LHW ARE COMMUNITY BASED
SOURCE:HMISCELL,DHOOFFICE,
Financial Allocations
Budgetary allocations and expenditures over the last three years for the district (in PKR
Million) are presented in table 2.7; allocations mentioned below are lump sum as provided by
DHO office.
TABLE 2.7:FINANCIAL ALLOCATIONIN DISTRICTKEICH
DistrictHealthBudget
2007-08 2008-09 2009-10
Allocation Expenditure Allocation Expenditure Allocation Expenditure
Non-Development
93.1 92.7 14.2 12.4 139 134
Development 0 0 0 0 0 0
Total 93.1 92.7 14.2 12.4 139 134
SOURCE:DHOOFFICE
Donor Contribution
Information about donor contribution for MNCH services was asked from DHO office in terms
of financial input. It was reported that donor contribution was not provided to this district.
During survey, information about donor inputs on surveyed health facilities was also
collected, and findings were the same.
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NMNCH Programme Indicators
Information on NMNCHP indicators is being compiled at office of DHO and this information
has been gathered on the sets of indicators, which is reproduced as such in following
tables.It is important to note that services utilisation data reported by district office take into
account utilisation of all public sector facilities in the district.
This information may not match with subsequent tables containing information on drugs and
supplies (Table No. 3.4, 3.9, 3.14 and 3.24) and C-sections (No. 3.29) collected from
respective health facilities included in survey.
TABLE2.8:NMNCHP MONITORING INDICATORS (YEAR2010)
Services Management
Number of district monthly performance review meetings held during last year 4
Number of facilities with stock-out of FP commodities 60
Number of facilities stock outs of essential EmONC drugs 0
Support Services
Number of facilities with laboratory services available 11
Number of facilities with blood transfusion services available 5
Service UtilisationAntenatal care coverage 9371
Percentage of children
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