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Three Years Rolling Plan 2010-2013 District Multan

Three Year Rolling Plan

2010-2013

DISTRICT KHANEWAL

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Three Years Rolling Plan 2010-2013 District Khanewal

Table of Contents

Acronyms..............................................................................................................................................5

Executive Summary.............................................................................................................................7

SECTION 1: DISTRICT HEALTH PROFILE...........................................................................................8

Vision of the District....................................................................................................................8

Background of the District...........................................................................................................8

Map of the District........................................................................................................................9

Demography.................................................................................................................................9

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

Health Indicators.........................................................................................................................11

i. Reproductive Health*..............................................................................................................11

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

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

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

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

b) Private.................................................................................................................................13

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

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

b) Facility Based......................................................................................................................13

c) Outreach..............................................................................................................................17

d) Training Institutions...........................................................................................................17

3. Health Financing....................................................................................................................18

Disease Pattern..........................................................................................................................19

Status of Vertical Programs.......................................................................................................20

1. National Program for FP & PHC............................................................................................20

2. EPI...........................................................................................................................................20

3. MNCH Program......................................................................................................................21

4. TB Control Program...............................................................................................................21

5. Malaria Control Program.......................................................................................................21

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6. HIV/AIDS Control Program...................................................................................................21

7. Hepatitis Control Program....................................................................................................21

8. School Health Services Program...........................................................................................22

SECTION 2: PROBLEM ANALYSIS.....................................................................................................23

A. Objectives...................................................................................................................................23

B. Plan Development Process........................................................................................................24

1. Problem Identification.............................................................................................................24

Health Problems.................................................................................................................................24

1. Problem Prioritization...............................................................................................................25

Underlying causes of prioritized problems......................................................................................26

Service delivery/Management problems.............................................................................................27

Underlying causes of Management Problems..............................................................................27

C. MDGs and MSDS.........................................................................................................................29

a) Human Resource....................................................................................................................29

i. DHQ Hospital (Category c).................................................................................................30

ii. THQ Hospital Kabir Wala (Category B).............................................................................30

iii. THQ Hospital Mian Channu (Category B).......................................................................30

iv. THQ Hospital Jahanian (Category C)..................................................................................31

b) Equipment..............................................................................................................................31

i. DHQ Hospital Khanewal.....................................................................................................32

ii. THQ Hospital Kabir wala....................................................................................................36

iii. THQ Hospital Mian Channu............................................................................................40

iv. THQ Hospital Jahanian.......................................................................................................45

SECTION 3: INTERVENTIONS AND TARGETS..................................................................................51

A. Health Problems.........................................................................................................................51

B. Management Problems..............................................................................................................60

SECTION 4: COSTING AND FINANCING PLAN.................................................................................69

A. Activity based costing................................................................................................................69

i. Health Problems.........................................................................................................................69

ii. Management Problems..............................................................................................................78

B. Financial Outlay including 3YRP Activities..............................................................................89

i. Health Problems.....................................................................................................................89

ii. Management Problems..........................................................................................................91

C. Summaries..................................................................................................................................92

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1. Problem-wise Costing..............................................................................................................92

a) Health Problems..................................................................................................................92

b) Management Problems.......................................................................................................93

2. Activity-wise Costing................................................................................................................94

a) Health Problems.................................................................................................................94

b) Management Problems.......................................................................................................99

SECTION 5: MONITORING & EVALUATION...................................................................................104

M&E of Plan......................................................................................................................................104

Annex-I..............................................................................................................................................107

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Acronyms3YRP Three Years Rolling plan

ADB Asian Development Bank

AE Assistant Entomologist

APMO Additional Principal Medical Officer

ARI Acute Respiratory Infections

ASV Assistant Superintendent Vaccination

BHU Basic Health Center

BoD Burden of Disease

CDC Communicable Disease Control

CDR Case Detection Rate

CPR Contraceptive Prevalence Rate

DC District Coordinator

DHIS District Health Information System

DHQH District Head Quarter Hospital

DoH Department of Health

DR Default Rate

DSV District Superintendent Vaccination

EDO(H) Executive District Officer Health

EPI Expended Program on Immunization

HSRP Health Sector Reforms Program

IMR Infant Mortality Rate

IPC Interpersonal Communication

IV Inspector Vaccination

M & E Monitoring and Evaluation

M & R Maintenance and Repair

MCH Maternal Child Health

MMR Maternal Mortality Ratio

MNCH Maternal Newborn and Child Health

MO Medical Officer

MoV Means of Verification

MSDS Minimum Service Delivery Standards

PDSSP Punjab Devolved Social Services Program

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PHC Primary Health Care

PMO Principal Medial Officer

POL Petrol, Oil and Lubricant

RHC Rural Health Center

SCR Sputum Conversion Rate

SHC Secondary Health Care

SMO Senior Medical Officer

TAMA Technical Assistance Management Agency

TB Tuberculosis

THQH Tehsil Head Quarter Hospital

TNA Training Need Assessment

WHO World Health Organization

WMO Women Medical Officer

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Executive Summary

Prior to devolution, planning process was carried out at provincial level. Districts were supposed to implement plans and programs developed/designed at provincial and federal levels. Devolution brought a paradigm shift where planning became a district responsibility. This change provided an opportunity to the district at one hand and challenge on other due to their limited capacity in planning and budgeting. Planning focus also changed from short term to medium term planning recognizing the flexibility /adaptability it provided. Government envisions that medium term plan .i.e. 3YRP will be instrumental in using health resources effectively and efficiently through adapting Minimum Service Delivery Standards (MSDS) as the strategy to achieve objectives of MDGs.

Districts have been preparing 3YRP (medium term plan) for last few years under the auspices/patronage of Department of Health (DoH) Government of Punjab through technical assistance of Punjab Devolved Program Social Services Programme (PDSSP). This year government of the Punjab through Health Sector Reforms Program (HSRP) with the technical assistance from a team of consultants (SP09) and wide consultations/inputs from all key stake holders has established a bench mark in standardization of the format of 3YRP. Capacity building of the districts has been done on the standardized format.

Current 3 Years Rolling Plan (3YRP) plan is first attempt by the district on that agreed format. First section of the format (District Health Profile) contains all relevant information on Geography, Demographic, Socioeconomic and Health indicators of the district. It also takes stock of health resources in terms of human resource, infrastructure and others. District diseases pattern compiled from DHIS Primary and Secondary Health Care reports and current status of vertical /national programs is part of the profile. In fact district profile is a health related fact sheet of the district and depicts the true picture of health status and health resources/services of the district. An accurate district health profile provides a sound basis for evidence-based planning.

3YRP plan has been developed by following the standard planning cycle approach. 3YRP details the current year activities, physical targets and fiscal targets. Projections of second and third year physical and financial targets are given. Section Two includes problems identification from various perspectives, and their prioritization by applying WHO prioritization criteria. This section also contains underlying causes of the prioritized problems. Section Three of the plan relates to developing best possible interventions/activities and setting physical targets for each year. Section Four consists of costing based on additional requirements taking account of implementation of current status of activities. Best available estimates have been used to accurately cost the activities. The detailed activity based costing of the Health and Service Delivery problems has been developed on automated Excel sheets, and annexed for details as ready reference. Last section of the 3YRP consists of Monitoring and Evaluation of plan to gauge the progress of different activities and targets of the plan using reliable district data sources. This permits timely remedial action for smooth implementation of planned activities.

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DISTRICT KHANEWAL

SECTION 1: DISTRICT HEALTH PROFILE

Vision of the District

Our vision is to provide preventive, curative, promotive and rehabilitative health services to each and every individual of district Khanewal, especially mothers and child.

Background of the District

Khanewal city was little more than a village up to 1919 when given the status of area committee, later upgraded to Municipal Committee in 1933; then to a district in 1985.

It is situated in the center of the country at an almost equal distance from Karachi and Peshawar and on the main routes of the railway and grand trunk road. The district is bounded on the north by district Jhang and district Toba Tek Singh; on the south by Vehari district; on the east by district Sahiwal and on the west by Multan district.

Geographically, district Khanewal lies in the upper Indus planes and its physical features are mainly the result of river action. The district is irrigated by a network of canals from various sources on the Ravi and Chenab rivers. Climate temperature ranges between 21ºC and 5ºC in January, and 42ºC and 29ºC in June respectively. A railway line connects Khanewal with Faisalabad and Multan. Khanewal district is basically an agricultural area with no significant industry and most of the people earn their living through agriculture.

About 63% of the district population speaks Punjabi language. Saraiki is the second most widely spoken language by 26 % of the population. Other languages spoken are Urdu and Pushto. The district is home to a variety of clans. The principle ones being the Arian , Jatt, Niazi , Gujjar, Pathan, Rajput Khiarah and Rehmani.

Area: The total area of the district is 4,349 square kilometers. Total population: 2,76,34,85

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Map of the District

Demography

o Total Population 2763485o Annual growth rate 2.45%o Population density 850 persons per sq. km

1. Area-wise population

Area Population PercentageRural 165809 6%Urban 2597675 94%

Source: DCR 1998 (Projected population)

2. Gender-wise population

Gender Population PercentageMale 1354107 49Female 1409377 51

Source: DCR 1998 (Projected population)

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3. Population groups

Population GroupsStandard Demographic

(%)Estimated Population

Under 1 year of age 2.7 74614Under 5 years 13.4 370307Under 15 years 44 1215933Women in child bearing age (15-49 years) 22 607966Married Child Bearing age Women 16 442157Expected pregnancies 3.4 93958Source: Standard Demographic Population groups may be based on DHIS

4. Tehsil wise distribution

Tehsil Number of UC Population

Khanewal 28 823579

Mian Channu 26 729031

Kabirwala 34 882618

Jahanian 12 328258

Source: Bureau of Statistics (Projected from Census 1998)

Socio-Economic Indicators

1. Education and Literacy

Overall district: 10+ years 56% Adult 51%

Source: MICS 2007

2. Housing

Ownership of house 86% Mean household size 6.6 Mean number of persons per room 3.6

3. Water and Sanitation

Access to drinking water 97% Use of improved drinking water sources 99% Use of properly treated water 1.1% Safe drinking water without bacteria 60%

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Use of sanitary means of excreta disposal 64% Use of improved water sources and improved sanitation 64%

Health Indicators Infant Mortality Rate (per 1,000 births) 92 Under 5 mortality Rate (per 1,000 births) 138 Maternal mortality Ratio(per 100,000 births) 320 Malnutrition

Stunting prevalence: 24 % Wasting prevalence: 3.1 % Underweight prevalence: 10 %

Proportion of children under 2 years 80 % Fully immunized (Third Party Survey conducted by WHO in October 2009)

i. Reproductive Health*

a) Contraception

Use of contraceptives (any method) 24

Contraceptive drop out 1.6

Unwilling pregnancy 22

b) Maternal and newborn health

Antenatal care (ANC) 44 Skilled attendant at delivery 36 Institutional deliveries 31 Postnatal care (PNC) 36

* ( Source: MICS 2007-08)

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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Health Resources

1. Health Facilities

a) Public

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

Sr Facility TypeNo. of

Health Facilities

Bed Strength

No. of Functional

BedsRemarks

1 DHQ Hospital Khanewal 1 125 1252 THQ Hospitals (60,60,40) 3 160 1603 Rural Health Centres 4 80 804 Basic Health Units 82 164 1645 Dispensaries 25 RDs -- --6 MCH Centres 4 -- -- --7 GRD 3 -- --8 TB Clinics 2 -- --9 Health Houses 1745 -- -- --

Data source: DHIS/EDOH office

b) Private

The district has provided a list of private service providers including hospitals, clinics, laboratories and maternity homes. These private providers are used for providing support in preventive programs like Polio and other EPI activities. With the passage of time, role of private providers will expand, and there is a need to develop an effective coordination between public and private sector.

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Executive District Officer

(Health)

Program Director

DHDC (1)

Medical Superintendent DHQ/THQ Hospitals (4)

District Officer (H)

01

Principal School of Nursing

(1)

Blood Transfusion Officer

(1)

District Superinte

ndent Vaccinati

on

CDC

Officer

District Sanitary Inspector

Medical Officer Basic

Health Units

Medical Officer Rural

Dispensaries Zila

Council

Drug Inspecto

r

Dy: District

Officer (H) 03

Medical Officer Govt. Rural

Dispensaries

Senior Medical

Officer RHCs (04)

Vertical

Programs


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 Sanctioned Filled

1 Executive District Officer Health 1 12 District Officer Health 1 1

3District Coordinator National Program/ Deputy District Officer Health (HQ)

0* 1

4 Deputy District Officers Health 3 35 Program Director DHDC 1 16 District Coordinator EPI Surveillance 0** 17 Drug Inspectors 4 48 District Sanitary Inspector 1 09 CDC Officer 1 0

10 District Superintendent Vaccination 1 111 Assistant Superintendent Vaccination 3 2

12 Tehsil Sanitary Inspector 3 113 Inspector Vaccination 3 2

** Post not sanctioned

b) Facility Based

i. Basic Health Units (82)

Sr. Name of Post/Designation Sanctioned Filled Vacant

1 Medical Officer 82 64 18

2School Health & Nutrition Supervisor

82 74 8

3 Medical Assistant 1 1 04 Computer Operator 82 70 125 Medical Technician 77 45 326 LHV 82 82 07 Dispenser 82 82 08 Midwife 164 52 1129 N/Qasid 82 82 0

10 Chowkidar 82 82 011 Sanitary Worker 82 81 1

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ii. Rural Health Centre (4)

Sr. Name of Post/Designation Sanctioned Filled Vacant

1 Senior Medical Officers 4 4 02 Women Medical Officers 8 7 13 Dental Surgeons 4 3 14 Medical Officers 5 4 15 Charge Nurses 24 24 06 Homeo Doctors 3 2 17 Hakeems 1 1 08 Computer Operators 4 4 09 LHV 8 8 0

10 Lab. Technician 7 3 411 Dental Technician 6 6 012 Senior Clerk 4 4 013 Vaccinator 1 1 014 Homeo Dispenser 3 2 1

151 Dawasaz 1 1 016 Radiographer/X-Ray Asstt. 4 3 117 Dresser 4 4 018 Anesthesia Assistant 4 0 419 O.T.A 4 4 020 Dispenser 16 16 021 Dental Assistant 4 4 022 Laboratory Assistant 4 2 223 Midwife 16 8 824 Driver 4 4 025 T.O 4 4 026 Homeo Naib Qasid 2 2 027 Dawa Kob 1 1 028 Ward Servant 12 12 029 Sanitary Patrol 9 9 030 Naib Qasid 12 12 031 Mali 4 3 132 Cook 4 4 033 Chowkidar 8 8 034 Bahishti 4 4 0

iii. THQ Hospitals (3)

Sr. Post Sanctioned Filled Vacant1. Medical Superintendent 3 2 12. Addl. Principle Medical Officer 6 4 23. Addl. Principle Women Medical Officer 3 3 04. Surgeon 3 3 0

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Sr. Post Sanctioned Filled Vacant5. Physician 4 0 46. Gynecologist 6 4 27. Pediatrician 3 3 08. Pathologist 3 3 09. Radiologist 3 0 310. Anesthetist 3 2 111. Ophthalmologist 3 2 112. Medical Officer 21 18 313. CMO 6 6 014. Women Medical Officer 9 7 215. Dental Surgeon 3 3 016. Pharmacist 2 2 017. Head Nurse 3 1 118. Charge Nurse 31 26 519. Hakeem 2 2 020. Homeo Doctor 3 3 021. Lady Health Visitor 3 3 022. Dawasaz 2 2 023. Homeo Dispenser 3 3 024. Dispenser / Dresser 19 19 025. Radiographer 6 6 026. Laboratory Assistant 3 3 027. Dental Assistant 3 3 028. Junior Clerk 3 3 029. Driver 5 5 030. Gate Keeper 3 3 031. Tube Well Operator 3 3 032. Ward Servant 14 12 233. Naib Qasid 3 3 034. Sweeper / Sweepress 15 15 035. Dhobi 3 3 036. Baildar 3 3 037. Chowkidar 3 3 038. Bahishti 2 2 039. Cook 2 2 040. Dawakob 2 2 0

iv. DHQ Hospital

Sr. No Post Sanctioned Filled Vacant

1. Medical Superintendent 1 1 02. Surgeon 1 1 03. Physician 1 1 0

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Sr. No Post Sanctioned Filled Vacant

4. Gynecologist 3 3 05. Pediatrician 1 0 16. Orthopedic Surgeon 1 0 17. Pathologist 1 1 08. Radiologist 1 0 19. Cardiologist 1 1 010. E.N.T. Specialist 1 1 011. Anesthetist 1 0 112. Ophthalmologist 1 1 013. Senior Medical Officer 1 1 014. Medical Officer/ Casualty Medical Officer 14 10 415. Women Medical Officer 6 6 016. Dental Surgeon 1 1 017. Pharmacist 1 1 018. Head Nurse 3 3 019. Charge Nurse 15 15 020. Hakeem 1 1 021. Homeo Doctor 1 1 022. Dawasaz 1 1 023. Homeo Dispenser 1 1 024. Dispenser / Dresser 11 11 025. Store Keeper 2 1 126. Radiographer 3 3 027. Laboratory Assistant 3 2 128. Junior Clerk 2 1 129. Midwife 2 2 030. Driver 3 3 031. Tube Well Operator 1 1 032. Ward Servant 23 23 033. Ward Cleaner 24 24 034. Naib Qasid 3 2 135. Dhobi 3 3 036. Baildar 1 0 137. Mali 2 2 038. Chowkidar 3 3 039. Bahishti 3 3 040. Cook 1 0 1

c) Outreach

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

Sr. Post Sanctioned Filled

1 Vaccinators 92 902 CDC Supervisors 70 673 Sanitary Inspectors 77 774 Nutrition Supervisor 82 74

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5 Social mobilizer NCHD 82 566 Sanitary Supervisor 82 82

d) Training Institutions

A number of training institutions are working in the district, which include the

following:

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

i. DHDC

Name of Post Sanctioned Filled Vacant

Program Director 1 1 0LHV Trainer 1 1 0Assistant 1 0 1Driver 1 1 0Naib Qasid 1 1 0Chowkidar 1 1 0

ii. General School of Nursing

Name of Post Sanctioned Filled Vacant

Principal 1 1 0Nursing Instructor 3 3 0Stenographer 1 1 0Accountant 1 1 0Senior Clerk 1 1 0Junior Clerk 1 0 1Sweeper 3 3 0Naib Qasid 1 1 0Chowkidar 2 2 0

iii. Midwifery School

No of current CMW students 34 No of passed and deployed in the community 131 No of passed CMWs 54

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3. Health Financing

The provision of financial resources at district level is prime responsibility of district government. However, keeping in view the budget constraints at the district level, federal and provincial governments also augment financial resources in form of kind and cash, through different programs. Financial resources of the district during the last three years out of different sources are given as under:

Rs. Million

Source of funding

Year

2007-08 2008-09 2009-10 up to 01/2010

Allocation Exp. Allocation Exp. Allocation Exp.

Non-Development 318.333 269.925 361.926 342.565 413.901 306.852

Development 11.077 10.688 7.542 4.637 0.773 0.743

Sub Total 329.4 280.6 369.468 347.202 414.674 307.595

PHSRP 0.450 0.415 11.950 10.833 - -

PMDGP - - 102.220 - - 20.861

PDSSP 18.468 18.004 25.674 19.721 28.720 5.750

Grand Total 348.325 299.032 509.312 377.756 443.394 334.206

User charges

(like parchi fee, fees

for diagnostic

services)

2007-08 2008-09 2009-10 up to 03/2010

Target Remittance Target Remittance Target Remittance

4.149 3.984 4.896 4.901 4.896 4.160

Disease Pattern

The disease pattern is determined through regular and periodic reporting through surveys and studies. Punjab health department has adopted DHIS as regular reporting mechanism to collect information on diseases and other variables. Currently, DHIS is in transitional stage, and is establishing itself as a tool to be used for evidence based planning and management. The following trend of the diseases has been taken from the consolidated DHIS reports that include reports from PHC and SHC facilities.

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Disease Group Percentage of MagnitudeRespiratory Diseases

1 Acute (Upper) Respiratory Infections 18.972 Pneumonia <5 years 0.433 Pneumonia >5 years 0.404 TB Suspects 1.26

5Chronic Obstructive Pulmonary Diseases

1.47

6 Asthma 2.64Gastro Intestinal Disease

7 Diarrhoea/Dysentery in <5 yrs 2.438 Diarrhoea/Dysentery in >5 yrs 2.629 Enteric / Typhoid Fever 0.32

10 Worm Infestations 1.0111 Peptic Ulcer Diseases 2.0912 Cirrhosis of Liver 0.06

Urinary Tract Diseases 13 Urinary Tract Infections 1.3014 Nephritis/Nephrosis 0.0515 Sexually Transmitted Infections 0.0816 Benign Enlargement of Prostrate 0.03

Other Communicable Diseases 17 Suspected Malaria 1.0818 Suspected Meningitis 0.0319 Fever due to other causes 3.83

Vaccine Preventable Diseases 20 Suspected Measles 0.0221 Suspected Viral Hepatitis 0.1022 Suspected Neo Natal Tetanus 0.00

Cardiovascular Diseases 23 Ischemic Heart Disease 0.7624 Hypertension 2.62

Skin Diseases 25 Scabies 6.5826 Dermatitis 2.0627 Cutaneous Leishmaniasis 0.05

Endocrine Diseases 28 Diabetes Mellitus 1.63

Neuro-Psychiatric Diseases 29 Depression 0.4930 Drug Dependence 0.0431 Epilepsy 0.02

Eye & ENT 32 Cataract 0.8733 Trachoma 0.5634 Glaucoma 0.14

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Disease Group Percentage of Magnitude35 Otitis Media 1.13

Oral Diseases 36 Dental Caries 2.20

Injuries / Poisoning 37 Road traffic accidents 1.9038 Fractures 0.1239 Burns 0.1540 Dog bite 0.22

41Snake bite (with signs/symptoms of poisoning)

0.003

Miscellaneous Diseases (Surveillance Importance)

42 Acute Flaccid Paralysis 0.0

43 Suspected HIV/AIDS 0.0Any other Unusual Diseases (Specify) 0.0

Source: DHIS Reports

Status of Vertical Programs

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

1. National Program for FP & PHC

No. of seats allocated for LHWs 2200 No. of LHWs working 1784 Percentage of Population covered by the program 43 % Important program indicators

a. IMR 72/1000b. MMR 342/100000 LBc. CPR 36%d. TT Coverage of pregnant women 92.6%

2. EPI

EPI Coverage rate of the district 95% Fully immunized children 0-23 months 95% Pregnant women received TT vaccine 49% Availability of cold chain equipment 90 Facilities have cold chain equipment while 4 facilities do not have required equipment

3. MNCH Program

We have developed 72 community midwifery homes. 50 more CMW homes will be established till 14th May 2010. 34 students class is currently under training. Community awareness and sensitization events are held on regular basis in the district.

CMW Students Admitted 194

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Passed 185

4. TB Control Program

CDR all types 83% CDR NSS positive 66% SCR 91% TSR 89% DR 6%

5. Malaria Control Program

No. of slides examined 44577 No. of positive slides 04 Slides positively ratio 04% Percentage of plasmodium falciparum 0

6. HIV/AIDS Control Program

No. of HIV tests conducted 135000 No. of positive cases detected 0 No. of HIV/AIDS patients treated 0 No. of sentinel centres 0

7. Hepatitis Control Program

No. of Hepatitis tests conducted

o HBs 2090 o HCV 2854

No. of positive cases detected 299 C/ 35 B No. of persons vaccinated against Hepatitis B 5100 No. of cases treated for Hepatitis C 151

8. School Health Services Program

Total Visits to the School 729 No. Students Examined 5705 No of students referred to BHUs 4976 No. Students Treated at BHU 3310

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No. of Students referred from BHU to higher facilities

571

No. of Schools in catchment Areas 1584 No. of Students 317696 No of Teachers Trained 5807 No of SH & NS 82

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

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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.

A. 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.

B. Plan Development Process

Plan development has been a systematic and consultative process. A core planning team consisting of EDO (H), DOH, MS DHQ and THQs, Statistical officer, and Budget and Accounts Officer, was designated by Director General Health Services Punjab. This team received three days customized training from SP-09 team at divisional 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.

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The district planning team adopted the following steps for the preparation of three years rolling plan:

Problem identification Prioritization of identified problems Identifying underlying causes of prioritized problems Developing interventions and activities Setting targets Determining resource requirements, costing and budgeting Preparing action plans Preparing monitoring plan

1. Problem 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 Problems

The 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. ARI

2. Diarrhea3. Hepatitis4. T.B5. Road Side accidents6. Deliveries by unskilled birth attendants7. Diabetes 8. Dog Bite

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1. Problem Prioritization

WHO 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. A cut-off point was decided, to establish the priority health problems of the district. This total score was then used to prioritize the health problems. 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

ARI 4 3 4 2 4 17 2Diarrhea 4 4 4 2 4 19 1Hepatitis 2 3 2 3 2 12 6

T.B 3 3 4 2 2 14 4RSA 3 3 2 2 1 11 7

Deliveries by Unskilled

Birth Attendants

3 4 4 3 2 16 3

Diabetes Mellitus

2 3 3 2 2 12 6

Anemia (in pregnancy)

2 3 3 3 2 13 5

Underlying causes of prioritized problems

Health problems have their underlying causes. It is important to know the underlying causes of the health problems so that appropriate interventions are developed. There may be a long list of these causes but only few of them are vital ones; and rectifying these causes can resolve the problem to a large extent. Following table gives common causes of the prioritized health problems pertaining to the district.

Sr. # Health Problem Causes

1. Diarrhea Poor hygiene and sanitation

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Sr. # Health Problem Causes

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

weaning practices

2. ARI Malnutrition Air Contamination Over-Crowding/Poor Housing Facilities Lack of proper sanitation Seasonal Variation Lack of awareness related to winter season and

hygienic practices3. Deliveries by

unskilled birth attendants

Low access to appropriate health services Lack of awareness about danger signs of pregnancy Three delays (seeking health care, transportation,

and lack of referral back-up services) Lack of skilled birth attendants

4. Tuberculosis (TB) Low socio-economic status Over-Crowding/Poor housing facilities Malnutrition Seasonal Variation Lack of proper sanitation Lack of awareness and hygienic practices

5. Anemia (in pregnancy)

Poverty and malnutrition Lack of awareness about balanced diet Multiple pregnancies Inadequate and poor MCH Services Gender discrimination Worm Infestation

6. Hepatitis B&C Poor sanitation Unsafe drinking water Sharing of used syringes Transfusion of unsafe/unscreened blood and blood

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

barbers

Service delivery/Management problems

This segment entails the district specific management problems. Management problems are result of deficiency/lack of resources; these problems range from administrative to financial issues, and cause hindrance in the smooth delivery of health services in the district. It was observed that solution of some of these problems lies with the provincial government; whereas remaining can be addressed at the district level. While proposing the interventions, their action at provincial or district level has been specifically mentioned. The planning team discussed these problems in detail and enlisted the main problems as under:

Page 26


1. Shortages of skilled staff (Medics, Paramedics)

2. Shortage of medicines and supplies

3. Political/ Media interference

4. Inadequate district health budget for POL

5. Lack of equipment

6. Deficient infrastructure for MSDS services

Underlying causes of Management Problems

Sr. Service Causes

1. Shortage of skilled staff (Medics, Paramedics)

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

and transport of children for education Political and media interference

2. Inadequate medicines and supplies

Less budget allocation for medicines Frequent increase in drug prices

3. Political and media interference

Undue pressure from local political figures especially in medico-legal cases

6. Inadequate district health budget for POL

Generator provision of backup of electricity supply Less budget allocation Frequent increase in prices

7. Deficient

infrastructure for MSDS services

Debilitated condition of existing infrastructure Lack of repair and maintenance Inadequate infrastructure for emergency, Operation

Theatre, OPD and inpatients, residencies for staff at THQ and BHQ Hospitals

8. Inadequate equipments

Deficient equipment to cater basic and comprehensive EmONC

Old and unserviceable equipment Shortage of budget for M&R Frequent cuts on M&R budget

Page 27


C. MDGs and MSDS

The government is committed to achieve the MDGs targets. For this purpose, the government of Punjab has decided to adopt Minimum Service Delivery Standards (MSDS) as strategy to achieve the MDGs within the province. Health Department of Punjab is especially focusing on MNCH related component of MSDS for which substantial resources are coming from Asian Development Program funded Punjab Millennium Development Goal Program (PMDGP). MSDS entails a level-specific service delivery package (for primary and secondary health care) along with their standards and system specifications including human, infrastructure, equipment, medical supplies, medicine and other consumables.

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

Page 28


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 Resource

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

proposed in MSDS and filled posts has been calculated as the vacancy gap. The hospitals

have been categorized based on their bed strength as follows:

Hospital Category Bed Strength

DHQ 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 (Category c)

Sr. PostStandard

as per MSDS

Sanctioned Filled

Vacancy Gap in

relation to Sanctioned Positions

Vacancy Gap in

relation to Filled

Positions1. Gynaecologist 3 3 3 0 02. Paediatricians 3 1 0 2 33. Anesthetists 3 1 1 2 24. MO/WMO/APMO/

SMO/SWMO APWMO

111 29 23 82 88

5. Lady Health Visitors 11 1 1 10 106. Nurses 75 15 15 60 60

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ii. THQ Hospital Kabir Wala (Category B)

Sr. No.

PostStandard

as per MSDS

SanctionedFilled

Vacancy Gap in


Vacancy Gap in relation to

Filled Positions

1. Gynaecologist 2 2 1 0 12. Paediatricians 2 1 1 1 13. Anesthetists 3 1 0 2 34. Medical Officers/

APMO/APWMO WMO/ /SMO/SWMO

29 17 15 12 14

5. Lady Health Visitors

8 1 1 7 7

6. Nurses 24 11 8 13 16

iii. THQ Hospital Mian Channu (Category B)

Sr. No.

PostStandard

as per MSDS

SanctionedFilled

Vacancy Gap in


Vacancy Gap in

relation to Filled

Positions1. Gynaecologist 2 2 2 0 02. Paediatrician 2 1 1 1 13. Anesthetists 4 1 1 3 34. MO/ WMO /

SMO/ SWMO / APMO/APWMO

29 17 17 12 12

5. Lady Health Visitors

8 1 1 7 7

6. Nurses 24 11 11 13 13

iv. THQ Hospital Jahanian (Category C)

Sr. No.

PostStandard

as per MSDS

SanctionedFilled

Vacancy Gap in


Vacancy Gap in

relation to Filled

Positions1. Gynaecologist 2 2 1 0 1

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2. Paediatricians 2 1 1 1 13. Anesthetists 3 1 1 2 24. Medical

Officers / WMO / SMO/ SWMO / APMO/APWMO

12 10 8 2 4

5. Nurses 15 9 7 6 86. LHVs 8 1 1 7 7

b) Equipment

Government of Punjab has notified a standard list as yard-stick of MNCH related equipment to provide comprehensive EmONC services in the DHQ and THQ hospitals. Provision of comprehensive EmONC services is essentially required to decrease the high MMR and IMR prevailing in the province.

Gaps in relation to the MNCH related equipment have been identified taking into account the equipment purchased or under process of purchase from all funds including PMDGP funds allocated/sanctioned to the district. The cost of equipment gap has been included in the equipment portion of the Management/Service delivery problems. The equipment gaps for DHQ and THQ hospitals are attached as Annex-I.

i. DHQ Hospital Khanewal

(Category C)

Sr. No. Equipment Standard as per MSDS

(Qty.)

Available Gap

C B A1 CTG (Cardiac

Tocography)1 1 2 1 0

2 Foetal Doppler 3 5 5 4 03 Diagnostic

Laparoscope1 1 2 0 1

4 Bulb Sucker 10 20 20 0 105 Baby Warmer 3 3 6 1 26 Mechanical Sucker 3 3 6 3 07 Fetal Stethoscope 4 4 4 4 08 Delivery Table 2 2 3 4 09 D&C Set 2 3 4 4 0

10 Outlet forceps 4 4 4 2 211 Myoma Screw 2 2 2 1 1

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(Qty.)

Available Gap

C B A12 Kochers forceps 4 4 8 4 013 Volselum forceps 6 8 10 6 014 Lanes Tissue holding

forceps2 2 4 2 0

15 Vaginal Retractors 10 10 10 2 816 Polypectomy forceps 2 2 2 1 117 Sponge holder 10 15 20 10 018 Uterine elevator 1 1 1 1 019 Cusco Speculum

Small, Medium, Large (for each category)

6 10 10 10 0

20 Examination light 3 3 6 3 021 Suction Curette 1 2 2 30 022 Infant Resuscitation

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

1 1 2 1 0

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

1 1 2 0 1

24 Cardiac Monitor 1 1 2 1 025 Pump Breast

Electronic1 1 1 0 1

26 Vaginal Hysterectomy Set

26.1 Toothed Tissue Forceps (8”)

2 2 4 3 0

26.2 Non-Tooted Tissue Forceps (8”)

2 2 4 4 0

26.3 Dissection Scissors (Curved 7”)

2 2 4 5 0

26.4 Dissection Scissors (Straight 7”)

2 2 4 5 0

26.5 Hysterectomy Clamps (Straight)

8 8 16 5 3

26.6 Hysterectomy Clamps (Curved)

8 8 16 5 3

26.7 Uterine Sound 2 2 4 1 126.8 Needle Holder (7”) 2 2 4 5 026.9 Needle Holder (10”) 2 2 4 2 0

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(Qty.)

Available Gap

C B A26.10 Artery Forceps

(Straight 6”)16 16 32 16 0

26.11 Artery Forceps (Curved 6”)

16 16 32 16 0

26.12 Allis Forceps 8 8 16 8 026.13 Towel Clamps 8 8 16 6 226.14 Single blade Sims

speculum4 4 8 2 2

26.15 Double blade Sims speculum

4 4 8 0 4

26.16 Sponge holding forceps

8 8 16 8 0

26.17 Volselum forceps 4 4 8 2 226.18 Uterine Sound 2 2 4 2 026.19 Bladder Sound 2 2 4 1 1

27 Delivery Sets27.1 Episiotomy Scissors 10 10 15 2 827.2 Straight Scissors 10 10 15 10 027.3 Needle holder 10 10 15 18 027.4 Non-toothed tissue

forceps 8 inches10 10 15 10 0

27.5 Toothed tissue forceps 8 inches

10 10 15 10 0

27.6 Sims Speculum single blade

20 20 30 16 4

27.7 Sims Speculum double blade

20 20 30 20 0


40 40 60 40 0

27.9 Artery forceps 40 40 60 20 2027.10 Straight clamps (cord) 20 20 30 20 027.11 Vacuum Extractor

pump1 1 1 1 0

27.12 Towel clip 40 40 60 10 3028 Caesarian Section

28.1 Scalpel 6 8 10 5 128.2 Artery Forceps

Straight 6 inches24 32 40 24 0

28.3 Artery Forceps Curved 6 inches

24 32 40 24 0

28.4 Artery forceps 8 inches

24 32 40 24 0

28.5 Myoma Scissors straight 7 inches

6 8 10 6 0

28.6 Dissecting scissors (curved) 7 inches

6 8 10 6 0

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(Qty.)

Available Gap

C B A28.7 Green Armtage


28.8 Obstetric outlet forceps (pair)

6 8 10 6 0

28.9 Doyene’s Retractor 6 8 10 6 028.10 Small Retractors 12 16 20 10 228.11 Towel Clippers 24 32 40 16 828.12 Suction Nozzle 6 8 10 6 0

29 MNCH Related Radiology Equipments

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

Unit1 1 1 0 1

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

1 1 1 1 0

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

Tank1 1 1 1 0

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

29.10 X-Ray Film Hangers All sizes

4 4 4 10 0

30 MNCH Related Paediatrics Equipments

30.1 Paediatric Ventilator 1 2 2 0 130.2 Incubator 1 1 2 1 030.3 Photo Therapy Unit 1 1 1 1 030.4 Over-head Radiant

Warmer1 1 1 1 0

30.5 Infant Length Measuring Scale

2 2 2 1 1

30.6 Infant Weighing Machine

2 2 2 1 1

30.7 Nebulizer 1 1 2 1 030.8 Billiubino-meter 1 1 2 0 130.9 Exchange Blood

Transfusion Set1 1 2 0 1

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

31.1 Anaesthesia Machine 1 1 2 3 031.2 Ventilators 1 1 1 2 0

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(Qty.)

Available Gap

C B A31.3 Nebulizer 1 1 1 1 031.4 Pulse Oximeter 1 1 1 0 131.5 Defibrillator 1 1 1 1 031.6 Airway Oral and Nasal 2 3 4 2 031.7 Tracheostomy tube

(adult and paeds)2 2 4 0 2

31.8 Face mask of all sizes 2 2 4 2 031.9 Double Cuff

Tourniquet (for regional block)

1 2 2 0 1

31.10 AMBO bag adult 2 2 4 1 131.11 AMBO Bag paeds 2 2 4 1 131.12 Red Rubber Nasal

tubes all sizes without cuff

4 4 8 4 0

32 Blood Bank32.1 Blood storage cabinet

(100 bag capacity)1 1 2 2 0

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

Frozen Plasma1 1 1 0 1

32.5 Blood bag shaker 1 1 2 1 032.6 RH view box 2 2 4 1 132.7 Water bath 2 2 2 1 132.8 Micro-pipette 4 6 8 6 032.9 Blood grouping tiles 3 3 6 2 1

32.10 Plasma Extractor 1 1 1 0 132.11 Platelets agitator 1 1 1 0 132.12 Blood thawing bath 1 1 1 0 132.13 Microscopes 1 1 2 1 0

33 Gynae & Labour Room Related Laboratory Equipment

33.1 Hematology Analyzer 1 1 1 0 133.2 Electrolyte Analyzer 1 1 1 1 033.3 Analyzer Bio-

chemistry Semi-automatic

1 1 1 1 0

33.4 Glucometer 2 2 2 1 133.5 Haemoglobino-meter 2 2 4 1 133.6 Centrifuge 1 1 2 1 0

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ii. THQ Hospital Kabir wala

(Category B)


(Qty.)

Available Gap

C B A1 CTG (Cardiac





10 Outlet forceps 4 4 4 4 011 Myoma Screw 2 2 2 2 012 Kochers forceps 4 4 4 4 013 Volselum forceps 4 4 6 4 214 Lanes Tissue holding

forceps2 2 2 2 0

15 Vaginal Retractors 4 4 6 4 016 Polypectomy forceps 2 2 2 2 017 Sponge holder 10 10 15 10 018 Uterine elevator 1 1 1 1 019 CosCo Speculum


4 6 6 4 0



1 1 1 0 1


1 1 1 0 1


Electronic1 1 1 0 1

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(Qty.)

Available Gap

C B A26 Vaginal

Hysterectomy Set26.1 Toothed Tissue

Forceps (8”)2 2 2 2 0


2 2 2 2 0


2 2 2 2 0


2 2 2 2 0


8 8 8 8 0


8 8 8 8 0


26.10 Artery Forceps (Straight 6”)

16 16 16 16 0


16 16 16 16 0


speculum4 4 4 0 4


4 4 4 8 0


8 8 8 4 4





6 6 10 6 0


12 12 20 0 12


12 12 20 12 0


40 40 40 40 0

27.9 Artery forceps 40 40 40 40 0

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(Qty.)

Available Gap

C B A27.10 Straight clamps (cord) 20 20 30 20 027.11 Vacuum Extractor

pump1 1 1 1 0





16 16 24 16 0


16 16 24 16 0


4 4 6 4 0


4 4 6 4 0

28.7 Green Armtage forceps 8 inches

16 16 24 16 0


4 4 6 4 0



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

Unit1 1 1 0 1


1 1 1 0 1

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

Tank1 1 1 1 0

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


4 4 4 4 0


30.1 Paediatric Ventilator 1 1 2 0 1

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(Qty.)

Available Gap

C B A30.2 Incubator 1 1 1 1 030.3 Photo Therapy Unit 1 1 1 1 030.4 Over-head Radiant

Warmer1 1 1 1 0


2 2 2 2 0


2 2 2 2 0

30.7 Nebulizer 1 1 1 1 030.8 Billirubino-meter 1 1 1 1 030.9 Exchange Blood



31.1 Anaesthesia Machine 1 1 1 1 031.2 Ventilators 1 1 1 1 031.3 Nebulizer 1 1 1 1 031.4 Pulse Oximetry 1 1 1 1 031.5 Defibrillator 1 1 1 1 031.6 Airway Oral and Nasal 1 2 2 1 031.7 Tracheostomy tube




1 1 1 1 0



4 4 4 4 0







Page 39



(Qty.)

Available Gap

C B A33 Gynae & Labour

Room Related Laboratory Equipment



1 1 1 0 1


iii. THQ Hospital Mian Channu

(Category B)

Sr. No.

Equipment Standard as per MSDS

(Qty.)

Available Gap

C B A1 CTG (Cardiac





10 Outlet forceps 4 4 4 0 411 Myoma Screw 2 2 2 3 012 Kochers forceps 4 4 4 0 413 Volselum forceps 4 4 6 5 014 Lanes Tissue holding

forceps2 2 2 3 0

15 Vaginal Retractors 4 4 6 2 216 Polypectomy forceps 2 2 2 1 117 Sponge holder 10 10 15 2 818 Uterine elevator 1 1 1 0 119 CosCo Speculum


4 6 6 0 6

20 Examination light 3 3 3 2 121 Suction Curette 1 1 2 3 1

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Sr. No.


(Qty.)

Available Gap

C B A22 Infant Resuscitation


1 1 1 1 0


1 1 1 0 1


Electronic1 1 1 0 1



2 2 2 2 0


2 2 2 2 0


2 2 2 0 2


2 2 2 0 2


8 8 8 0 8


8 8 8 0 8



16 16 16 2 14


16 16 16 0 16


speculum4 4 4 0 4


4 4 4 0 4


8 8 8 0 8

26.17 Volselum forceps 4 4 4 0 426.18 Uterine Sound 2 2 2 0 2

Page 41


Sr. No.


(Qty.)

Available Gap

C B A26.19 Bladder Sound 2 2 2 0 2




6 6 10 0 6


12 12 20 0 12


12 12 20 0 12


40 40 40 0 40

27.9 Artery forceps 40 40 40 0 4027.10 Straight clamps

(cord)20 20 30 0 20

27.11 Vacuum Extractor pump

1 1 1 1 0





16 16 24 0 16


16 16 24 0 16


4 4 6 0 4


4 4 6 0 4


16 16 24 4 12


4 4 6 0 4



29.1 Ultrasound Machine 1 1 2 1 029.2 X-Ray Unit 500 kw 1 1 1 0 129.3 Color Doppler 0 0 0 0 0

Page 42


Sr. No.


(Qty.)

Available Gap

C B A29.4 Lead Screen for X-Ray

Unit1 1 1 0 1


1 1 1 0 1

29.6 Safe Light 1 1 1 0 129.7 X-Ray Film

Processing Tank1 1 1 0 1

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

Illuminator2 2 2 0 2


4 4 4 0 4


30.1 Paediatric Ventilator 1 1 2 0 130.2 Incubator 1 1 1 1 030.3 Photo Therapy Unit 1 1 1 1 030.4 Over-head Radiant

Warmer1 1 1 1 0


2 2 2 1 1


2 2 2 1 1

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



31.1 Anaesthesia Machine 1 1 1 1 031.2 Ventilators 1 1 1 0 131.3 Nebulizer 1 1 1 0 131.4 Pulse Oximetry 1 1 1 0 131.5 Defibrillator 1 1 1 0 131.6 Airway Oral and

Nasal1 2 2 0 2

31.7 Tracheostomy tube (adult and paeds)

1 2 2 0 2



1 1 1 0 1

31.10 AMBO bag adult 1 2 2 0 231.11 AMBO Bag paeds 2 2 2 0 2

Page 43


Sr. No.


(Qty.)

Available Gap

C B A31.12 Red Rubber Nasal


4 4 4 0 4










1 1 1 0 1


iv. THQ Hospital Jahanian

(Category B)

Sr. No.

Equipment Standard as per MSDS(Qty.)

Available Gap

C B A1 CTG (Cardiac




Page 44


Sr. No.


Available Gap

C B A4 Bulb Sucker 5 10 20 5 55 Baby Warmer 2 2 3 2 26 Mechanical Sucker 3 3 3 3 07 Fetal Stethoscope 2 3 4 2 18 Delivery Table 2 2 2 2 09 D&C Set 2 2 2 2 0

10 Outlet forceps 4 4 4 4 011 Myoma Screw 2 2 2 2 012 Kochers forceps 4 4 4 4 013 Volselum forceps 4 4 6 4 014 Lanes Tissue

holding forceps2 2 2 2 0

15 Vaginal Retractors 4 4 6 4 416 Polypectomy

forceps2 2 2 2 0

17 Sponge holder 10 10 15 10 018 Uterine elevator 1 1 1 1 019 CosCo Speculum


4 6 6 4 2



1 1 1 0 1


1 1 1 0 1


Electronic1 1 1 0 1

Page 45


Sr. No.


Available Gap

C B A26 Vaginal

Hysterectomy Set26.1 Toothed Tissue

Forceps (8”)2 2 2 2 0


2 2 2 2 0


2 2 2 2 0


2 2 2 2 0


8 8 8 8 0


8 8 8 8 0



16 16 16 16 0


16 16 16 16 0


speculum4 4 4 0 4


4 4 4 8 0


8 8 8 4 4





6 6 10 6 0


12 12 20 0 12

Page 46


Sr. No.


Available Gap

C B A27.7 Sims Speculum

double blade12 12 20 12 0


40 40 40 40 0

27.9 Artery forceps 40 40 40 40 027.10 Straight clamps

(cord)20 20 30 20 0


1 1 1 1 0





16 16 24 16 0


16 16 24 16 0


4 4 6 4 0


4 4 6 4 0


16 16 24 16 0


4 4 6 4 0



29.1 Ultrasound Machine 1 1 2 1 029.2 X-Ray Unit 500 kw 1 1 1 1 129.3 Color Doppler 0 0 0 0 029.4 Lead Screen for X-

Ray Unit1 1 1 0 1

Page 47


Sr. No.


Available Gap

C B A29.5 0.5 MN Lead Apron.

Lead Gloves, Goggles and Thyroid and Gonadal Sheets

1 1 1 0 1

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

Processing Tank1 1 1 1 0

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

Illuminator2 2 2 2 0


4 4 4 4 0


30.1 Paediatric Ventilator

1 1 2 0 1

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

Warmer1 1 1 1 0


2 2 2 2 0


2 2 2 2 0

30.7 Nebulizer 1 1 1 1 030.8 Billirubino-meter 1 1 1 1 030.9 Exchange Blood


30.10 Nasal Probe Paed size

1 2 2 0 2

31 Anaesthesia/ICU31.1 Anaesthesia

Machine1 1 1 1 0

31.2 Ventilators 1 1 1 1 031.3 Nebulizer 1 1 1 1 031.4 Pulse Oximetry 1 1 1 1 031.5 Defibrillator 1 1 1 1 031.6 Airway Oral and

Nasal1 2 2 1 1

Page 48


Sr. No.


Available Gap

C B A31.7 Tracheostomy tube


31.8 Face mask of all sizes

1 2 2 1 1

31.9 Double Cuff Tourniquet (for regional block)

1 1 1 1 0



4 4 4 4 0

32 Blood Bank32.1 Blood storage

cabinet (100 bag capacity)

1 1 1 1 0






33.1 Hematology Analyzer

1 1 1 0 1

33.2 Electrolyte Analyzer

1 1 1 0 1

33.3 Analyzer Bio-chemistry Semi-automatic

1 1 1 0 1

33.4 Glucometer 2 2 2 0 2

Page 49


Sr. No.


Available Gap

C B A33.5 Haemoglobino-

meter1 1 1 0 1

33.6 Centrifuge 1 1 1 0 1

Page 50


SECTION 3: INTERVENTIONS AND TARGETS

After enlisting the vital causes of prioritized health problems, team proposed appropriate interventions to tackle the problems. Once interventions and activities had been identified, next task the planning team performed was to set the number and quality of specific activities (targets) that have to be carried out. It is pertinent to mention over here that the plan envisages additional activities along with routine activities under regular budget.

A. Health Problems

Problem Causes Intervention Activity Unit Plan Activities Targets

Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

1. Diarrhoeal diseases

Poor Hygiene & sanitation

Coordination with TMA for improvement of water supply and sanitation

Quarterly co-ordination meetings with TMA and other agencies

Meetings 12 4 4 4 -

Lack of safe drinking water

Awareness raising campaign

Messages on local cable network

Monthly Telecast

36 12 12 12 -

Unhygienic practices

Proper treatment of Diarrhoea including ORT

Printing and distribution of IPC material

Brochure 150,000 50,000 50,000 50,000 -

Page 51


Problem Causes Intervention Activity UnitPlan Activities

TargetsTarget for 2010-11

Target for 2011-12

Target for 2012-13 Remarks

Lack of awareness among mothers about feeding and weaning practices

Health awareness in the community

Training of medics and paramedics in IMCI

Batch 20 10 5 5 -

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

Procurement and distribution of ORS and Zinc Sulphate

ORS packets 700,000 220,000 230,000 250,000 -

- - Procurement and distribution of Zinc Sulphate

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

2. Acute Respiratory Infections

Air contamination

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

Messages on local cable networks

Monthly Telecast

36 12 12 12 Integrated activity

Page 52




Target for 2011-12


Over-crowding/Poor housing facilities

Provision of medicines for ARI

Messages through FM radio channels

Brochure & Poster

45,000 15,000 15,000 15,000 -

Lack of proper sanitation

Timely referral of complicated cases


Batch 20 10 5 5 Integrated activity

Seasonal variation

- Training of medics and para-medics in IMCI

Oral Medicine Package

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

Lack of awareness related to winter season and hygienic practices

- Procurement of drugs

Injectable 45,000 15,000 15,000 15,000 -

- - - Drug 27,000 9,000 9,000 9,000

3. Delivery by unskilled birth attendants

Low access to appropriate health services

Behaviour Change Communication (BCC)


Monthly Package

36 12 12 12 Integrated Activity

Page 53




Target for 2011-12


Lack of awareness about danger signs of pregnancy

Improving transportation to appropriate level of care


Brochure 30,000 10,000 10,000 10,000 -

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

Strengthening healthcare facilities

Activation and use of Health Committees and women groups under LHWs

- 12 4 4 4 No cast Activity

Lack of skilled birth attendants

Refresher courses for TBAs

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

Batch of 25 TBAs for 2 days Training

16 8 4 4 -

- Provision of delivery kits

Procurement Kit 270,000 90,000 90,000 90,000 -

- Strengthening of referral system and provision of transport

Capacity building of WMOs and LHVs

training 20 10 5 5 -

Page 54




Target for 2011-12


- Deployment of community midwives

Placement of mid-wives in their catchment area

- - - - - Plan

- - Repair of non functional ambulances for timely transportation of pregnant mothers

Ambulance 5 3 1 1 demand submission

- - Replacement of non functional ambulances for timely transportation of pregnant mothers

Ambulance 6 3 2 1 -

- - POL for ambulances

Litre 33,600 7,200 12,000 14,400 -

4. Tuberculosis (TB)

Low socio-economic status

Health education/promotion


Monthly telecast


Page 55




Target for 2011-12


Over-crowding/Poor housing facilities

Strengthening TB DOTS program through involvement of private sector


Alternate Month

- - - - Integrated activity

Malnutrition - Printing and distribution of IPC and TB awareness material

Brochure 30,000 10,000 10,000 10,000 -

Seasonal variation

- Procurement of drugs to address deficiency according to regimen

Treatment 14,922,819 4,974,273 4,974,273 4,974,273 -

5. Anaemia in pregnancy

· Poverty & malnutrition

Awareness raising for behaviour change


Monthly Messages telecast packages


· Lack of awareness about balanced diet

Improving ante-natal coverage


Brochure 30,000 10,000 10,000 10,000 -

Page 56




Target for 2011-12


· Multiple pregnancies

Improving ante-natal coverage


Brochure 30,000 10,000 10,000 10,000 -

· Inadequate and poor MCH services

Deworming campaign

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

Batch of 50 LHWs For 1 Days

36 16 10 10 -

· Gender discrimination

· Provision/Distribution of micro-nutrient supplements

· Procurement of de-worming tablets

No. of coursrs

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

· Worm infestation

· Diagnosis and treatment of infections

· Purchase of medicine

Pack of 100 Tablets

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

- - · Purchase of medicine

Pack of 100 Tablets

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

6. Hepatitis Poor Health Education/Prom

· Quarterly co-ordination

Others 12 4 4 4 Integrated activity

Page 57




Target for 2011-12


sanitation otion meetings with TMA and other agencies

Unsafe drinking water

Campaign against quackery

· Messages on local cable network

Advertising & Publicity


Sharing of used syringes

Strengthening blood transfusion services for safe transfusions

· Printing and distribution of IPC material

Printing and publication

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

Transfusion of unsafe/unscreened blood and blood products

Campaign against drug addiction

· Procurement and supply of screening kits

Medical and laboratory

450,000 150,000 150,000 150,000 -

Unsafe sexual practices

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

· Procurement of syringe cutters


500 300 100 100 -

Ear piercing and tattooing

- · Procurement of drugs for treatment of Hepatitis patients

Purchase of drug and medicines

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

Page 58


B. Management Problems

Human Resource Plan to bridge gap between MSDS and existing sanctioned positions

Sr. No. Name of PostBasic Scale

Basic Pay

AllowancesRequirement

as per Gap

Physical Targets

Year I Year II Year III

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

2 Paediatricians 18 12,910 18,099 5 2 2 1

3 Anesthetists 18 12,910 18,099 9 4 3 2

4 MO / WMO 17 9,850 15,345 114 54 30 30

Page 59


5 Nurses 16 6,060 8,934 94 44 25 25

6 Lady Health Visitors 9 3,820 4,750 31 15 8 8



Target for 2011-12


1. Shortage of MNCH related

· Non- availability of trained staff

· Filling of the vacant posts

· Filling of the vacant posts of medics and the

- - - - - Recruitment

Page 60




Target for 2011-12


skilled staff paramedics through existing recruitment committees

· Non-sanctioning of staff according to MSDS

· Sanctioning of trained staffs according to MSDS

Temporary filling of vacant positions on contract


· Lack of permanent postings

· Incentivized pay package at all levels

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

- - - - - Plan

· Lack of incentivized and differential pay package

· Well defined career structure including opportunities for higher education

· Orientation trainings of the recruited staffs

Batch 10 4 3 3 -

Page 61




Target for 2011-12


· Frequent transfer postings

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

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

- - - - - Meeting

· Job insecurity

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

- - - - - Plan

· Lack of basic amenities at workplace

- · Review and revise the career structure of medics and paramedics

- - - - - Technical assistance

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

- · Filling of Human Resource gaps as per MSDS

Posts 224 105 61 58 Detail HR plan is attached

Page 62




Target for 2011-12


education

- Posts 31 15 8 8 Detail HR plan is attached

· Political and media interference

- HR 255 120 69 66 Detail HR plan is attached

- · Capacity and need assessment of the medics and the paramedics

- - - - - NO COST ACTIVITY

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

- - - - - TNA

2. Inadequate medicine and supply

Less budget allocation for medicines

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

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

- - - - - Need assessment

Page 63




Target for 2011-12


supplies to the needs

Frequent increase in price

- Demand generation for medicine.

- - - - - Demand generation

- Procurement of essential drugs on the basis of allocated budget

- - - - - Already addressed in health problems

3. Political interference

· Undue pressure from local political figures especially in medico-legal cases

· High level political commitment to provide protection to the health staff against undue political interference

· Formulation of the Health committees

- - - - - plan

Advocacy at higher political level

· Meetings with political leaders

- - - - - Plan

Page 64




Target for 2011-12


- Advocacy seminars

Seminar 6 2 2 2 -

4. Inadequate budget for POL

· Generator provision for backup of electricity supply

Rational increase in POL budget

Assessment of additional requirement


· Less budget allocation

- Costing and submission of additional demand

- - - - - -

· Frequent increase in prices

- · Provision of POL budget for supervisory vehicles for DHQ

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

- · Provision of POL budget for EPI

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

- · Provision of POL budget for generator

litre 540,000 180,000 180,000 180,000 -

Page 65




Target for 2011-12


5. Deficient infra structure

· Debilitated condition of existing infrastructure

· Make up the deficiencies against standards specified in MSDS

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

- - - - - -

· Lack of repair and maintenance

· Devise appropriate mechanisms for repair and maintenance

· Costing of the gaps

- - - - - -

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

· Provision of infrastructure at THQ and DHQ according to the MSDS

· Phasing - - - - - Demand submission

· Construction of residence of WMO at DHQ and THQ hospital

Construction of residences at DHQ hospital Khanewal

1100 per square yard

3,500 1,750 1,750 - -

Page 66




Target for 2011-12


- Construction of residences at THQ hospitals (3*2)


10,500 5,250 5,250 - -

6. Lack of MNCH related equipments

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

· Provision of the equipment in accordance with the notified equipment list

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

- - - - - Detail attached

· Old and unserviceable equipment

· Provision of adequate budget for maintenance and repair

Allocation of enhanced amount for M&R of equipments

- - - - - Submission of demand

· Shortage of regular budget for M&R

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

Orientation of staffs in maintenance of logos for equipments

- - - - - Plan

Page 67


SECTION 4: COSTING AND FINANCING PLAN

A. Activity based costing

The planning team has used the best available data sources, for calculation of estimates for the intervention/activities. It is pertinent to mention that the costing of the plan is based on additional needs and activities. The detailed activity based costing of the Health and Service Delivery problems has been performed on automated Excel sheets, which are annexed with the plan as Annex-II and Annex-III. A moderate estimate of equipment cost has been taken, as there is wide variation between the minimum and maximum cost. The summary of activity and problem wise costing is given below.

i. Health Problems

ProblemActivity Define Financial Targets Total Cost Remarks

Unit Rate Quantity Year I Year II Year III

1 Diarrhoeal diseases

Quarterly co-ordination meetings with TMA and other agencies

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

Page 68





Monthly Telecast

36,000 36 432,000 475,200 522,720 1,429,920 -


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


Batch 83,000 20 830,000 456,500 502,150 1,788,650 -


ORS packets

5 700,000 1,100,000 1,265,000 1,512,500 3,877,500 -

Procurement and distribution of Zinc Sulphate

Syrup 60 450,000 600,000 9,900,000 10,890,000 21,390,000 -

2 Acute Messages on local cable

Monthly Telecast

35,000 36 - - - - Integrated activity

Page 69




Respiratory

Infections

ARI

networks


Brochure & Poster

30 45,000 450,000 495,000 544,500 1,489,500 -


Batch - 20 - - - - Integrated activity

Training of medics and para-medics in IMCI

Oral Medicine Package

70 300,000 7,000,000 7,700,000 8,470,000 23,170,000 -

Procurement of drugs

Injectable 800 45,000 12,000,000

13,200,000

14,520,000 39,720,000 -

Page 70




- Drug 30 27,000 270,000 297,000 326,700 893,700 verify the cost

3 Deliveries by unskilled birth attendants


Monthly Package

- 36 - - - - Integrated Activity


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


- - 12 - - - - No cast Activity


Batch of 25 TBAs for 2 days Training

50,000 16 400,000 220,000 242,000 862,000 -

Page 71




Procurement Kit 50 270,000 4,500,000 4,950,000 5,445,000 14,895,000 -

Capacity building of WMOs and LHVs

Training 61,000 20 610,000 335,500 369,050 1,314,550 -


- - - - - - - Plan

Repair of non functional ambulances for timely transportation of pregnant mothers

Ambulance

20,000 5 60,000 22,000 24,200 106,200 demand submission

Replacement of non functional ambulances for timely transportation of pregnant mothers

Ambulance

3,800,000 6 11,400,000

8,360,000 4,598,000 24,358,000 -

Page 72




POL for ambulances

Litre 76 33,600 547,200 1,003,200 1,324,224 2,874,624 -

4 TB Messages on local cable networks

Monthly telecast

- 36 - - - - Integrated activity


Alternate Month

- - - - - - Integrated activity

Printing and distribution of IPC and TB awareness material

Brochure 5 30,000 50,000 55,000 60,500 165,500 -

Procurement of drugs to address deficiency according to regimen

Treatment 25 14,922,819 124,356,825

136,792,508

150,471,758 411,621,091 -

Page 73




5 Anaemia in pregnancy


Monthly Messages telecast packages

- 36 - - - - Integrayed activity


Brochure 5 30,000 50,000 55,000 60,500 165,500 -


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


Batch of 50 LHWs For 1 Days

52,000 36 832,000 572,000 629,200 2,033,200 -


No. of courses

20 200,000 2,000,000 1,100,000 1,210,000 4,310,000 -

Page 74





Pack of 100 Tablets

30 150,000 1,500,000 1,650,000 1,815,000 4,965,000 -


Pack of 100 Tablets

50 150,000 2,500,000 2,750,000 3,025,000 8,275,000 -

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

Others - 12 - - - - Integrated activity


Advertising & Publicity

Monthly Package

36 - - - - Integrated activity


Printing and publication

Brochure 3,000 5,000 5,500 6,050 16,550 -

Page 75






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

· Procurement of syringe cutters


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

· Procurement of drugs for treatment of Hepatitis patients

Purchase of drug and medicines

Injection 3,000 12,000,000

13,200,000

14,520,000 39,720,000 -

- - - - 192,005,025

214,112,608

231,267,572 637,385,205 -

ii. Management Problems

Human Resource Plan to bridge gap between MSDS and existing sanctioned posts

Page 76


Sr. No.

Name of Post

Bas

ic S

cale

Bas

ic P

ay

All

owan

ces

Req

uir

emen

t as

per

Gap

Financial Targets

Year I Year II Year III

Pay of Officers

Pay of other staff

AllowancesPay of

OfficersPay of

other staffAllowances

Pay of Officers

Pay of other staff

Allowances

1 Gynaecologist 18 12,910 18,099 2 154,920 - 217,188 340,824 477,814 374,906 525,595

2 Paediatricians 18 12,910 18,099 5 309,840 - 434,376 681,648 955,627 937,266 1,313,987

3 Anesthetists 18 12,910 18,099 9 619,680 - 868,752 1,192,884 1,672,348 1,687,079 2,365,177

4 MO / WMO 17 9,850 15,345 114 6,382,800 - 9,943,560 10,921,680 17,014,536 16,304,508 25,400,272

5 Nurses 16 6,060 8,934 94 3,199,680 - 4,717,152 5,519,448 8,137,087 8,271,173 12,193,838

6Lady Health

Visitors9 3,820 4,750 31 687,600 855,000 1,159,752 1,442,100 1,719,458 2,138,070

Total10,666,92

0687,600 17,036,028 18,656,484 1,159,752 29,699,512 27,574,932 1,719,458 43,936,939

Page 77


Sr. No.

Problem Activity Define Financial Targets Total Cost Remarks


1 Shortage of skilled staffs MNCH related

· Non-availability of trained staff

· Filling of the vacant posts

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


· Non-sanctioning of staff according to MSDS

· Sanctioning of trained staffs according to MSDS



· Lack of permanent postings

· Incentivized pay package at all levels

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

- - - - - Plan

Page 78


Sr. No.



against vacant posts

· Lack of incentivized and differential pay package

· Well defined career structure including opportunities for higher education


Batch 10 4 3 3 -

· Frequent transfer postings

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


- - - - - Meeting

· Job insecurity - · Request to the Provincial Government

- - - - - Plan

Page 79


Sr. No.



for approval and implementation of agreed pay packages

· Lack of basic amenities at workplace

- · Review and revise the career structure of medics and paramedics

- - - - - Technical assistance

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

- · Filling of Human Resource gaps as per MSDS

Posts 224 105 61 58 Detail HR plan is attached

- - - Posts 31 15 8 8 Detail HR plan is attached

Page 80


Sr. No.



· Political and media interference

- - HR 255 120 69 66 Detail HR plan is attached

- - · Capacity and need assessment of the medics and the paramedics


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

- - - - - TNA

2 Inadequate medicine and supply

Less budget allocation for medicines

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

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

- - - - - Need assessment

Page 81


Sr. No.



supplies according to the needs

Frequent increase in price

- Demand generation for medicine.

- - - - - Demand generation

- - precurment of essentional drugs on the basis of allocated budget

- - - - - Already addressed in health problems

3 Political interference

· Undue pressure from local political figures especially in medico-legal cases

· High level political commitment to provide protection to the health staff against undue political interference

· Formulation of the Health committees

- - - - - plan

Page 82


Sr. No.



- Advocacy at higher political level


- - - - - Plan

- - Advocacy seminars

Seminar 6 2 2 2 -

4 Inadequate budget for POL

· Generator provision for backup of electricity supply

Rational increase in POL budget

Assessment of additional requirement


· Less budget allocation

- Costing and submission of additional demand

- - - - - -

· Frequent increase in prices

- · Provision of POL budget for supervisory vehicles for DHQ

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

Page 83


Sr. No.



- - · Provision of POL budget for EPI

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

- - · Provision of POL budget for generator

litre 540,000 180,000 180,000 180,000 -

5 Deficient infra structure

· Debilitated condition of existing infra-structure

· Make up the deficiencies against standards specified in MSDS

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

- - - - - -

· Lack of repair and maintenance

· Devise appropriate mechanisms for repair and maintenance

· Costing of the gaps

- - - - - -

· Inadequate infrastructure for Emergency,

· Provision of infrastructu

· Phasing - - - - - Demand submission

Page 84


Sr. No.



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

re at THQ and DHQ according to the MSDS

- Construction of residence of WMO at DHQ and THQ hospital



3,500 1,750 1,750 - -

- - Construction of residences at THQ hospitals (3*2)


10,500 5,250 5,250 - -

6 Lack of MNCH related equipments

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

Provision of the equipment in accordance with the notified equipment list

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

- - - - - Detail attached

Page 85


Sr. No.



available

· Old and un-serviceable equipment

Provision of adequate budget for maintenance and repair


- - - - - Submission of demand

· Shortage of regular budget for M&R

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

Orientation of staffs in maintenance of logos for equipments

- - - - - Plan

Page 86


B. Financial Outlay including 3YRP Activities

The costing of the plan includes routine recurring budget with 15% price escalation for subsequent years and additional cost involved on the basis of health and management problems; which is essentially required to bring visible improvement in the health system. Other financial resources expected from provincial level through ADP and PMDGP are also part of this plan. Overall financial outlay of the plan is as under:

i. Health Problems

Object Classification

2010-2011 2011-2012 2012-2013

Regular Additional Total Regular Additional Total Regular Additional Total

A03907 258,750 432,000 690,750 297,563 475,200 772,763 342,197 522,720 864,917

A03902 341,550 1,405,000 1,746,550 392,783 1,545,500 1,938,283 451,700 1,700,050 2,151,750

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

A03927 402,500 163,326,825 163,729,325 462,875 187,854,508 188,317,383 532,306 206,760,958 207,293,265

A13101 1,107,450 - 1,107,450 1,273,568 - 1,273,568 1,464,603 - 1,464,603

A09501 - - - - - - - - -

A09601 1,099,400 11,400,000 12,499,400 1,264,310 8,360,000 9,624,310 1,453,957 4,598,000 6,051,957

A03903 - - - - - - - - -

A03801 - 2,672,000 2,672,000 - 1,584,000 1,584,000 - 1,742,400 1,742,400

Page 87



2010-2011 2011-2012 2012-2013


A09601 1,099,400 - 1,099,400 1,264,310 - 1,264,310 1,453,957 - 1,453,957

A09404 - 12,150,000 12,150,000 - 13,255,000 13,255,000 - 14,580,500 14,580,500

A03807 12,259,000 547,200 12,806,200 14,097,850 1,003,200 15,101,050 16,212,528 1,324,224 17,536,752

A03906 44,850 - 44,850 51,578 - 51,578 59,314 - 59,314

A09802 - - - - - - - - -

A01277 - - - - - - - - -

A13001 1,610,000 60,000 1,670,000 1,851,500 22,000 1,873,500 2,129,225 24,200 2,153,425

Total 18,222,900 192,005,025 210,227,925 20,956,335 214,112,608 235,068,943 24,099,785 231,267,572 255,367,358

Page 88


ii. Management Problems


2010-2011 2011-2012 2012-2013


A03801 - 1,322,000 1,322,000 - 1,090,650 1,090,650 - 1,199,715 1,199,715

A09601 1,099,400 14,047,555 15,146,955 1,264,310 39,222,230 40,486,540 1,453,957 24,603,770 26,057,727

A01101 - 10,666,920 10,666,920 - 18,656,484 18,656,484 - 27,574,932 27,574,932

A01270 - 17,036,028 17,036,028 - 29,699,512 29,699,512 - 43,936,939 43,936,939

A03820 - 40,000 40,000 - 44,000 44,000 - 48,400 48,400

A03807 12,259,000 15,210,000 27,469,000 14,097,850 16,731,000 30,828,850 16,212,528 18,404,100 34,616,628

A03902 341,550 - 341,550 392,783 - 392,783 451,700 - 451,700

A01102 - 687,600 687,600 - 1,159,752 1,159,752 - 1,719,458 1,719,458

A12402 - 7,700,000 7,700,000 - 8,470,000 8,470,000 - - -

Total 13,699,950 66,710,103 80,410,053 15,754,943 115,073,628 130,828,570 18,118,184 117,487,315 135,605,498

Page 89


C. Summaries

1. Problem-wise Costing

a) Health Problems

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

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

1 Diarrhoeal diseases 3,224,000 12,384,900 13,744,390 29,353,290

2 Acute Respiratory Infections 19,720,000 21,692,000 23,861,200 65,273,200

3 Delivery by unskilled birth attendants

17,817,200 15,220,700 12,365,474 45,403,374

4 Tuberculosis (TB) 124,406,825 136,847,508 150,532,258 411,786,591

5 Anaemia in pregnancy 7,182,000 6,457,000 7,102,700 20,741,700

6 Hepatitis 19,655,000 21,510,500 23,661,550 64,827,050

Total 192,005,025 214,112,608 231,267,572 637,385,205

Page 90


b) Management Problems

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

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

1 Shortage of skilled staffs MNCH related

29,712,548 50,606,398 74,431,045 154,749,990

2 Inadequate medicine and supply - - - -

3 Political interference 40,000 44,000 48,400 132,400

4 Inadequate budget for POL 15,210,000 16,731,000 18,404,100 50,345,100

5 Deficient infra structure 7,700,000 8,470,000 - 16,170,000

6 Lack of MNCH related equipments 14,047,555 39,222,230 24,603,770 77,873,555

Total 66,710,103 115,073,628 117,487,315 299,271,045

Page 91


2. Activity-wise Costing

a) Health Problems

Sr. Problem Activity FY-I FY-II FY-III Total

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

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


432,000 475,200 522,720 1,429,920


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


830,000 456,500 502,150 1,788,650


1,100,000 1,265,000 1,512,500 3,877,500

Procurement and distribution of Zinc Sulphate

600,000 9,900,000 10,890,000 21,390,000

2 Acute Respiratory Infections


- - - -

Messages through FM radio 450,000 495,000 544,500 1,489,500

Page 92



channels


- - - -

Training of medics and para-medics in IMCI

7,000,000 7,700,000 8,470,000 23,170,000

Procurement of drugs 12,000,000 13,200,000 14,520,000 39,720,000

- 270,000 297,000 326,700 893,700

3 Delivery by unskilled birth attendants


- - - -


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


- - - -


400,000 220,000 242,000 862,000

Procurement 4,500,000 4,950,000 5,445,000 14,895,000

Capacity building of WMOs 610,000 335,500 369,050 1,314,550

Page 93



and LHVs


- - - -

Repair of non functional ambulances for timely transportation of pregnant mothers

60,000 22,000 24,200 106,200

Replacement of non functional ambulances for timely transportation of pregnant mothers

11,400,000 8,360,000 4,598,000 24,358,000

POL for ambulances 547,200 1,003,200 1,324,224 2,874,624

4 Tuberculosis (TB) Messages on local cable networks

- - - -


- - - -

Printing and distribution of IPC and TB awareness material

50,000 55,000 60,500 165,500

Procurement of drugs to address deficiency according to regimen

124,356,825 136,792,508 150,471,758 411,621,091

Page 94



5 Anaemia in pregnancy · Messages on local cable network

- - - -


50,000 55,000 60,500 165,500


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


832,000 572,000 629,200 2,033,200


2,000,000 1,100,000 1,210,000 4,310,000

· Purchase of medicine 1,500,000 1,650,000 1,815,000 4,965,000

· Purchase of medicine 2,500,000 2,750,000 3,025,000 8,275,000

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

- - - -


- - - -


5,000 5,500 6,050 16,550

Page 95




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

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

· Procurement of drugs for treatment of Hepatitis patients

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

Total 192,005,025 214,112,608 231,267,572 637,385,205

b) Management Problems

Page 96


Sr. No. Problem Activity Costing (Rs.)

FY-I FY-II FY-III Total

1 Shortage of MNCH related skilled staff

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

- - - -


- - - -

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

- - - -


1,322,000 1,090,650 1,199,715 3,612,365


- - - -

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

- - - -

Page 97




packages

· Review and revise the career structure of medics and paramedics

- - - -

· Filling of Human Resource gaps as per MSDS

10,666,920 18,656,484 27,574,932 56,898,336

- 687,600 1,159,752 1,719,458 3,566,810

- 17,036,028 29,699,512 43,936,939 90,672,479

· Capacity and need assessment of the medics and the paramedics

- - - -

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

- - - -

2 Inadequate medicine and supply

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

- - - -

Demand generation for - - - -

Page 98




medicine.

Procurement of essential drugs on the basis of allocated budget

- - - -

3 Political interference · Formulation of the Health committees

- - - -


- - - -

Advocacy seminars 40,000 44,000 48,400 132,400

4 Inadequate budget for POL Assessment of additional requirement

- - - -

Costing and submission of additional demand

- - - -

· Provision of POL budget for supervisory vehicles for DHQ

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

· Provision of POL budget for EPI

1,350,000 1,485,000 1,633,500 4,468,500

· Provision of POL budget for generator

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

Page 99




5 Deficient infra structure · Identify the gaps in infrastructure of THQ and DHQ hospitals individually

- - - -

· Costing of the gaps - - - -

· Phasing - - - -


1,925,000 2,117,500 - 4,042,500

Construction of residences at THQ hospitals (3*2)

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

6 Lack of MNCH related equipment

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

14,047,555 39,222,230 24,603,770 77,873,555


- - - -

Orientation of staff in maintenance of logs for equipments

- - - -

Total 66,710,103 115,073,62 117,487,31 299,271,04

Page 100




8 5 5

Page 101


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 by

each supervisor

Inspection Book

EDOH/DOH/ DDOH

Quarterly

% of RHCs with availability of specialists of essential specialties (Physician, Surgeon, Paediatrician and Gynaecologist)

100%During 1st

year

Pay Roll EDOH / DOH 6 monthly

% of health facilities with availability of essential MNCH related equipment (level specific)

100%During 1st

year

Stock Register

EDOH/ DOH/ MSs 6 monthly

Availability of relevant (MNCH) laboratory equipment at appropriate level of care

100%During 1st

year

Stock Register

EDOH/ DOH/MSs, Store keeper

Quarterly

% facilities with availability of essential medicines

100%During 1st

year

Stock Register

EDOH/ DOH/ MSs, Store keeper

Monthly

% of functional ambulances in the district

100%(DHQH/ THQH/ RHCs)

Log Book EDOH/DOH/ Transport officer

Quarterly

% utilization of sanctioned budget

100% of yearly budget

Quarterly Reports

EDOH/ DOH/ MSs/ Accounts officer

Quarterly

% of facilities with availability of basic EmONC services

100% in 3 years(50%

during 1st

year)

Supervisory visit report

EDOH/DoH/ DDOH

Quarterly

Page 102


Indicators Target % Achievement MoV Responsibility Frequency of

monitoring

Remarks

% 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

50000 pregnant

women in 3 years

(30000 during 1st

year)

DHIS Report EDOH/ Statistical Officer

Quarterly

% of targeted pregnant women received TT-2 vaccine

50000 pregnant

women in 3 years

(30000 during 1st

year)

DHIS Report EDOH/ DHIS Coordinator/ Statistical Officer

Quarterly

Delivery conducted by or under supervision of skilled persons reported

90%(60%

During 1st

year)


Quarterly

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

100%(200,000 children)


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

70% 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

Page 103


ANNEXURE

Page 104


Annex-I

Costing of Equipment gaps for DHQ and THQs

DHQ HOSPITAL KHANEWAL

Sr. No.


Available Gap Cost/Unit Total Cost

(Qty.)C B A

1 CTG (Cardiac Tocography)

1 1 2 1 0 285000 0

2 Foetal Doppler 3 5 5 4 0 101000 03 Diagnostic

Laparoscope1 1 2 0 1 1200000 1200000

4 Bulb Sucker 10 20 20 0 10 45 4505 Baby Warmer 3 3 6 1 2 850000 17000006 Mechanical

Sucker3 3 6 3 0 28000 0

7 Fetal Stethoscope 4 4 4 4 0 1500 08 Delivery Table 2 2 3 4 0 17500 09 D&C Set 2 3 4 4 0 2100 0

10 Outlet forceps 4 4 4 2 2 900 180011 Myoma Screw 2 2 2 1 1 320 32012 Kochers forceps 4 4 8 4 0 235 013 Volselum forceps 6 8 10 6 0 235 014 Lanes Tissue

holding forceps2 2 4 2 0 400 0

15 Vaginal Retractors

10 10 10 2 8 350 2800

16 Polypectomy forceps

2 2 2 1 1 750 750

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

19 CosCo Speculum 6 10 10 10 0 550 020 Examination light 3 3 6 3 0 18000 021 Suction Curette 1 2 2 30 0 95 0

Page 105


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

1 1 2 1 0 95000 0


1 1 2 0 1 110000 110000

24 Cardiac Monitor 1 1 2 1 0 500000 025 Pump Breast

Electronic1 1 1 0 1 250000 250000


2 2 4 0 2 30000 60000


2 2 4 3 0 55 0


2 2 4 4 0 55 0


2 2 4 5 0 150 0


2 2 4 5 0 150 0


8 8 16 5 3 150 450


8 8 16 5 3 175 525

26.7 Uterine Sound 2 2 4 1 1 90 9026.8 Needle Holder

(7”)2 2 4 5 0 150 0

26.9 Needle Holder (10”)

2 2 4 2 0 300 0


16 16 32 16 0 110 0

Page 106



16 16 32 16 0 125 0

26.12 Allis Forceps 8 8 16 8 0 230 026.13 Towel Clamps 8 8 16 6 2 125 25026.14 Single blade Sims

speculum4 4 8 2 2 275 550


4 4 8 0 4 250 1000


8 8 16 8 0 200 0

26.17 Volselum forceps 4 4 8 2 2 250 50026.18 Uterine Sound 2 2 4 2 0 1500 026.19 Bladder Sound 2 2 4 1 1 1500 1500

27 Delivery Sets 10 10 15 10 027.1 Episiotomy

Scissors10 10 15 2 8 125 1000

27.2 Straight Scissors 10 10 15 10 0 360 027.3 Needle holder 10 10 15 18 0 135 027.4 Non-toothed

tissue forceps 8 inches

10 10 15 10 0 100 0


10 10 15 10 0 100 0


20 20 30 16 4 275 1100


20 20 30 20 0 250 0


40 40 60 40 0 250 0

27.9 Artery forceps 40 40 60 20 20 275 550027.1 Straight clamps

(cord)20 20 30 20 0 175 0


1 1 1 1 0 19000 0

27.12 Towel clip 40 40 60 10 30 125 375028 Caesarian

Section6 8 10 6 0

28.1 Scalpel 6 8 10 5 1 50 5028.2 Artery Forceps

Straight 6 inches24 32 40 24 0 125 0


24 32 40 24 0 125 0


24 32 40 24 0 175 0


6 8 10 6 0 150 0

Page 107



6 8 10 6 0 270 0


24 32 40 0 24 300 7200


6 8 10 6 0 900 0

28.9 Doyene’s Retractor

6 8 10 6 0 200 0

28.1 Small Retractors 12 16 20 10 2 300 60028.11 Towel Clippers 24 32 40 16 8 125 100028.12 Suction Nozzle 6 8 10 6 0 250 0


0 0

29.1 Ultrasound Machine

1 2 3 1 0 575000 0

29.2 X-Ray Unit 500 kw

1 1 1 1 0 6000000 0

29.3 Color Doppler 0 1 1 0 0 5750000 029.4 Lead Screen for

X-Ray Unit1 1 1 0 1 30000 30000


1 1 1 1 0 100000 0

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

Processing Tank1 1 1 1 0 5000 0

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

Illuminator2 2 2 2 0 4000 0


4 4 4 10 0 4000 0


0 0

30.1 Paediatric Ventilator

1 2 2 0 1 1200000 1200000

30.2 Incubator 1 1 2 1 0 1500000 030.3 Photo Therapy

Unit1 1 1 1 0 22000 0

30.4 Over-head Radiant Warmer

1 1 1 1 0 910000 0


2 2 2 1 1 5000 5000

Page 108



2 2 2 1 1 3100 3100

30.7 Nebulizer 1 1 2 1 0 22000 030.8 Billiubino-meter 1 1 2 0 1 36000 3600030.9 Exchange Blood

Transfusion Set1 1 2 0 1 2000 2000

30.1 Nasal Probe Paed size

2 2 4 0 2 7000 14000

31 Anaesthesia/ICU 0 031.1 Anaesthesia

Machine1 1 2 3 0 321000 0

31.2 Ventilators 1 1 1 2 0 525000 031.3 Nebulizer 1 1 1 1 0 165000 031.4 Pulse Oximetry 1 1 1 0 1 21000 2100031.5 Defibrillator 1 1 1 1 0 500000 031.6 Airway Oral and

Nasal2 3 4 2 0 500 0

31.7 Tracheostomy tube (adult and paeds)

2 2 4 0 2 1000 2000

31.8 Face mask of all sizes

2 2 4 2 0 1000 0

31.9 Double Cuff Tourniquet (for regional block)

1 2 2 0 1 320 320

31.1 AMBO bag adult 2 2 4 1 1 2450 245031.11 AMBO Bag paeds 2 2 4 1 1 3000 300031.12 Red Rubber Nasal


4 4 8 4 0 1000 0

32 Blood Bank 0 032.1 Blood storage

cabinet (100 bag capacity)

1 1 2 2 0 812000 0

32.2 Packed cell machine

1 1 1 0 1 600000 600000

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

Frozen Plasma1 1 1 0 1 1150000 1150000

32.5 Blood bag shaker 1 1 2 1 0 10000 032.6 RH view box 2 2 4 1 1 1000 100032.7 Water bath 2 2 2 1 1 3000 300032.8 Micro-pipette 4 6 8 6 0 8000 032.9 Blood grouping

tiles3 3 6 2 1 3000 3000

32.1 Plasma Extractor 1 1 1 0 1 1000000 1000000

Page 109


32.11 Platelets agitator 1 1 1 0 1 1000000 100000032.12 Blood thawing

bath1 1 1 0 1 3000 3000

32.13 Microscopes 1 1 2 1 0 115000 033 Gynae & Labour


0 0

33.1 Hematology Analyzer

1 1 1 0 1 425000 425000

33.2 Electrolyte Analyzer

1 1 1 1 0 625000 0

33.3 Analyzer Bio-chemistry Semi-automatic

1 1 1 1 0 690000 0

33.4 Glucometer 2 2 2 1 1 2500 250033.5 Haemoglobino-

meter2 2 4 1 1 1000 1000

33.6 Centrifuge 1 1 2 1 0 133000 0Grand Total= 14083555

THQ HOSPITAL JAHANIAN

Sr. No.


Available

Gap Cost/Unit

Total Cost

(Qty.)C B A

1 CTG (Cardiac Tocography) 1 1 1

0 1 285000 285000


Laparoscope 1 1 10 1 1200000 1200000


Sucker 3 3 33 0 28000 0


10 Outlet forceps 4 4 4 4 0 900 011 Myoma Screw 2 2 2 2 0 320 012 Kochers forceps 4 4 4 4 0 235 013 Volselum forceps 4 4 6 4 0 235 0

Page 110


14 Lanes Tissue holding forceps 2 2 2

2 0 400 0

15 Vaginal Retractors 4 4 6

4 0 350 0

16 Polypectomy forceps 2 2 2

2 0 750 0

17 Sponge holder 10 10 15 10 0 300 018 Uterine elevator 1 1 1 1 0 150 0

19 CosCo Speculum 4 6 6 4 0 550 020 Examination light 3 3 3 3 0 18000 021 Suction Curette 1 1 2 0 1 95 9522 Infant

Resuscitation Trolley (with life saving medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light) 1 1 1

0 1 95000 95000

23 Mother Resuscitation Trolley (with life saving medicines, Laryngoscope, Endo-tracheal tube, BP Apparatus, Chargeable light) 1 1 1

0 1 110000 110000


Electronic 1 1 10 1 250000 250000

26 Vaginal Hysterectomy Set 2 2 2

2 30000 60000

26.1 Toothed Tissue Forceps (8”) 2 2 2

2 0 55 0

26.2 Non-Tooted Tissue Forceps (8”) 2 2 2

2 0 55 0

26.3 Dissection Scissors (Curved 7”) 2 2 2

2 0 150 0

26.4 Dissection Scissors (Straight 7”) 2 2 2

2 0 150 0

Page 111


26.5 Hysterectomy Clamps (Straight) 8 8 8

8 0 150 0

26.6 Hysterectomy Clamps (Curved) 8 8 8

8 0 175 0


(7”) 2 2 42 0 150 0

26.9 Needle Holder (10”) 2 2 2

2 0 300 0

26.1 Artery Forceps (Straight 6”) 16 16 16

16 0 110 0

26.11

Artery Forceps (Curved 6”) 16 16 16

16 0 125 0

26.12

Allis Forceps8 8 8

8 0 230 0

26.13

Towel Clamps8 8 8

8 0 125 0

26.14

Single blade Sims speculum 4 4 4

0 4 275 1100

26.15

Double blade Sims speculum 4 4 4

8 0 250 0

26.16

Sponge holding forceps 8 8 8

4 4 200 800

26.17

Volselum forceps4 4 4

2 2 250 500

26.18

Uterine Sound2 2 2

2 0 1500 0

26.19

Bladder Sound2 2 2

2 0 1500 0

27 Delivery Sets 6 6 10 6 027.1 Episiotomy

Scissors 6 6 106 0 125 0

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

tissue forceps 8 inches 6 6 10

6 0 100 0

27.5 Toothed tissue forceps 8 inches 6 6 10

6 0 100 0

27.6 Sims Speculum single blade 12 12 20

0 12 275 3300

27.7 Sims Speculum double blade 12 12 20

12 0 250 0

27.8 Sponge holding forceps 40 40 40

40 0 250 0

27.9 Artery forceps 40 40 40 40 0 275 0

Page 112


27.1 Straight clamps (cord) 20 20 30

20 0 175 0

27.11

Vacuum Extractor pump 1 1 1

1 0 19000 0

27.12

Towel clip40 40 40

0 40 125 5000

28 Caesarian Section 4 4 6

4 0 0


Straight 6 inches 16 16 2416 0 125 0

28.3 Artery Forceps Curved 6 inches 16 16 24

16 0 125 0

28.4 Artery forceps 8 inches 16 16 24

16 0 175 0

28.5 Myoma Scissors straight 7 inches 4 4 6

4 0 150 0

28.6 Dissecting scissors (curved) 7 inches 4 4 6

4 0 270 0

28.7 Green Armtage forceps 8 inches 16 16 24

16 0 300 0

28.8 Obstetric outlet forceps (pair) 4 4 6

4 0 900 0

28.9 Doyene’s Retractor 4 4 6

4 0 200 0

28.1 Small Retractors 8 8 12 8 0 300 028.1

1Towel Clippers

16 16 2416 0 125 0

28.12

Suction Nozzle4 4 6

0 4 250 1000


0 0

29.1 Ultrasound Machine 1 1 2

1 0 575000 0

29.2 X-Ray Unit 500 kw 1 1 1

1 0 6000000 0


X-Ray Unit 1 1 10 1 30000 30000

29.5 0.5 MN Lead Apron. Lead Gloves, Goggles and Thyroid and Gonadal Sheets 1 1 1

0 1 100000 100000

29.6 Safe Light 1 1 1 1 0 5000 0

Page 113


29.7 X-RT Film Processing Tank 1 1 1

1 0 5000 0


Illuminator 2 2 22 0 4000 0

29.1 X-Ray Film Hangers All sizes 4 4 4

4 0 4000 0


0 0

30.1 Paediatric Ventilator 1 1 2

0 1 1200000 1200000


Unit 1 1 11 0 22000 0

30.4 Over-head Radiant Warmer 1 1 1

1 0 910000 0

30.5 Infant Length Measuring Scale 2 2 2

2 0 5000 0

30.6 Infant Weighing Machine 2 2 2

2 0 3100 0


Transfusion Set 1 1 11 0 2000 0

30.1 Nasal Probe Paed size 1 2 2

0 1 7000 7000

31 Anaesthesia/ICU 0 031.1 Anaesthesia

Machine 1 1 11 0 321000 0


Nasal 1 2 21 0 500 0

31.7 Tracheostomy tube (adult and paeds) 1 2 2

1 0 1000 0

31.8 Face mask of all sizes 1 2 2

1 0 1000 0

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

1 0 320 0

31.1 AMBO bag adult 1 2 2 1 0 2450 0

Page 114


31.11

AMBO Bag paeds2 2 2

2 0 3000 0

31.12

Red Rubber Nasal tubes all sizes without cuff 4 4 4

4 0 1000 0

32 Blood Bank 0 032.1 Blood storage

cabinet (100 bag capacity) 1 1 1

1 0 812000 0

32.2 Packed cell machine 1 1 1

0 1 600000 600000


Frozen Plasma 1 1 11 0 1150000 0


tiles 3 3 30 3 3000 9000

32.1 Plasma Extractor 1 1 1 1 0 1000000 032.1

1Platelets agitator

1 1 11 0 1000000 0

32.12

Blood thawing bath 1 1 1

0 1 3000 3000

32.13

Microscopes1 1 1

0 1 115000 115000


0 0

33.1 Hematology Analyzer 1 1 1

0 1 425000 425000

33.2 Electrolyte Analyzer 1 1 1

0 1 625000 625000

33.3 Analyzer Bio-chemistry Semi-automatic 1 1 1

0 1 690000 690000


meter 1 1 10 1 1000 1000


Page 115


THQ HOSPITAL KABIR WALA

Sr. No.


Available

Gap

Cost/Unit

Total Cost

(Qty.)C B A


0 1 285000 285000


Laparoscope 1 1 10 1 1200000 1200000

4 Bulb Sucker 5

10

20

10 0 45 0

5 Baby Warmer 2 2 3 0 2 850000 17000006 Mechanical

Sucker 3 3 33 0 28000 0



holding forceps 2 2 20 2 400 800


4 0 350 0


0 2 750 1500

17 Sponge holder 10

10

15

10 0 300 0

18 Uterine elevator 1 1 1 0 1 150 15019 CosCo Speculum 4 6 6 6 0 550 0

20 Examination light 3 3 3 3 0 18000 021 Suction Curette 1 1 2 0 1 95 95

Page 116


22 Infant Resuscitation Trolley (with life saving medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light) 1 1 1

0 1 95000 95000


0 1 110000 110000


Electronic 1 1 10 1 250000 250000


2 0 30000 0


2 0 55 0


2 0 55 0


2 0 150 0


0 2 150 300


0 8 150 1200


0 8 175 1400


(7”) 2 2 42 0 150 0


2 0 300 0

Page 117



16

16

16

16 0 110 0

26.11

Artery Forceps (Curved 6”)

16

16

16

0 16 125 2000

26.12

Allis Forceps8 8 8

8 0 230 0

26.13

Towel Clamps8 8 8

8 0 125 0

26.14

Single blade Sims speculum 4 4 4

4 0 275 0

26.15

Double blade Sims speculum 4 4 4

4 0 250 0

26.16

Sponge holding forceps 8 8 8

8 0 200 0

26.17

Volselum forceps4 4 4

4 0 250 0

26.18

Uterine Sound2 2 2

2 0 1500 0

26.19

Bladder Sound2 2 2

2 0 1500 0

27 Delivery Sets6 6

10

6 0 0

27.1 Episiotomy Scissors 6 6

10

0 6 125 750

27.2 Straight Scissors6 6

10

6 0 360 0

27.3 Needle holder6 6

10

6 0 135 0

27.4 Non-toothed tissue forceps 8 inches 6 6

10

0 6 100 600

27.5 Toothed tissue forceps 8 inches 6 6

10

0 6 100 600


12

12

20

0 12 275 3300


12

12

20

0 12 250 3000


40

40

40

0 40 250 10000

27.9 Artery forceps 40

40

40

40 0 275 0

27.1 Straight clamps (cord)

20

20

30

0 20 175 3500

27.11

Vacuum Extractor pump 1 1 1

1 0 19000 0

27.12

Towel clip 40

40

40

0 40 125 5000

Page 118


28 Caesarian Section 4 4 6

0 4 0


Straight 6 inches16

16

24

0 16 125 2000


16

16

24

0 16 125 2000


16

16

24

16 0 175 0


0 4 150 600


0 4 270 1080


16

16

24

0 16 300 4800


0 4 900 3600


4 0 200 0

28.1 Small Retractors8 8

12

8 0 300 0

28.11

Towel Clippers 16

16

24

0 16 125 2000

28.12

Suction Nozzle4 4 6

0 4 250 1000


0 0


1 0 575000 0

29.2 X-Ray Unit 500 kw 1 1 1

0 1 6000000 6000000


X-Ray Unit 1 1 10 1 30000 30000


0 1 100000 100000


Processing Tank 1 1 10 1 5000 5000


Illuminator 2 2 20 2 4000 8000

Page 119



0 4 4000 16000


0 0


0 1 1200000 1200000


Unit 1 1 10 1 22000 22000


0 1 910000 910000


0 2 5000 10000


0 2 3100 6200




0 2 7000 14000

31 Anaesthesia/ICU

0 0

31.1 Anaesthesia Machine 1 1 1

1 0 321000 0


Nasal 1 2 20 2 500 1000


0 2 1000 2000


0 2 1000 2000


1 0 320 0

31.1 AMBO bag adult 1 2 2 1 1 2450 245031.1

1AMBO Bag paeds

2 2 20 2 3000 6000

31.12

Red Rubber Nasal tubes all sizes without cuff 4 4 4

0 4 1000 4000

32 Blood Bank 0 0

Page 120


32.1 Blood storage cabinet (100 bag capacity) 1 1 1

1 0 812000 0


0 1 600000 600000


Frozen Plasma 1 1 10 1 1150000 1150000


tiles 3 3 33 0 3000 0

32.1 Plasma Extractor 1 1 1 0 1 1000000 100000032.1

1Platelets agitator

1 1 10 1 1000000 1000000

32.12

Blood thawing bath 1 1 1

0 1 3000 3000

32.13

Microscopes1 1 1

1 0 115000 0


0 0


0 1 425000 425000


0 1 625000 625000


1 0 690000 0


meter 1 1 10 1 1000 1000


5

THQ HOSPITAL MAIN CHANNU

Sr. No.


Available Gap Cost/Unit

Total Cost

(Qty.)C B A

Page 121



1 0 285000 0


Laparoscope 1 1 10 1 1200000 1200000


Sucker 3 3 31 2 28000 56000



holding forceps 2 2 23 0 400 0


2 2 350 700


1 1 750 750

17 Sponge holder 10 10 15 2 8 300 240018 Uterine elevator 1 1 1 0 1 150 15019 CosCo Speculum 4 6 6 0 6 550 3300

20 Examination light 3 3 3 2 1 18000 1800021 Suction Curette 1 1 2 3 0 95 022 Infant

Resuscitation Trolley (with life saving medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light) 1 1 1

1 0 95000 0


0 1 110000 110000

Page 122



Electronic 1 1 10 1 250000 250000


2 30000 60000


2 0 55 0


2 0 55 0


0 2 150 300


0 2 150 300


0 8 150 1200


0 8 175 1400


(7”) 2 2 40 2 150 300


0 2 300 600

26.1 Artery Forceps (Straight 6”) 16 16 16

2 14 110 1540

26.1 Artery Forceps (Curved 6”) 16 16 16

0 16 125 2000

26.1 Allis Forceps 8 8 8 8 0 230 026.1 Towel Clamps 8 8 8 0 8 125 100026.1 Single blade Sims

speculum 4 4 40 4 275 1100

26.2 Double blade Sims speculum 4 4 4

0 4 250 1000


0 8 200 1600

26.2 Volselum forceps 4 4 4 0 4 250 100026.2 Uterine Sound 2 2 2 0 2 1500 300026.2 Bladder Sound 2 2 2 0 2 1500 300027 Delivery Sets 6 6 10 6 0

27.1 Episiotomy Scissors 6 6 10

2 4 125 500

27.2 Straight Scissors 6 6 10 2 4 360 144027.3 Needle holder 6 6 10 0 6 135 810

Page 123


27.4 Non-toothed tissue forceps 8 inches 6 6 10

0 6 100 600

27.5 Toothed tissue forceps 8 inches 6 6 10

0 6 100 600

27.6 Sims Speculum single blade 12 12 20

0 12 275 3300

27.7 Sims Speculum double blade 12 12 20

0 12 250 3000


0 40 250 10000

27.9 Artery forceps 40 40 40 0 40 275 1100027.1 Straight clamps

(cord) 20 20 300 20 175 3500

27.1 Vacuum Extractor pump 1 1 1

1 0 19000 0

27.1 Towel clip 40 40 40 0 40 125 500028 Caesarian

Section 4 4 6 4 0


Straight 6 inches 16 16 240 16 125 2000

28.3 Artery Forceps Curved 6 inches 16 16 24

0 16 125 2000

28.4 Artery forceps 8 inches 16 16 24

0 16 175 2800


0 4 150 600


0 4 270 1080

28.7 Green Armtage forceps 8 inches 16 16 24

4 12 300 3600


0 4 900 3600


1 3 200 600

28.1 Small Retractors 8 8 12 0 8 300 240028.1 Towel Clippers 16 16 24 0 16 125 200028.1 Suction Nozzle 4 4 6 12 0 250 029 MNCH Related

Radiology Equipments

0 0


1 0 575000 0

29.2 X-Ray Unit 500 kw 1 1 1

0 1 6000000 6000000

Page 124



X-Ray Unit 1 1 10 1 30000 30000


0 1 100000 100000


Processing Tank 1 1 10 1 5000 5000


Illuminator 2 2 20 2 4000 8000


0 4 4000 16000


0 0


0 1 1200000 1200000


Unit 1 1 11 0 22000 0


1 0 910000 0


1 1 5000 5000


1 1 3100 3100




0 2 7000 14000

31 Anaesthesia/ICU

0 0

31.1 Anaesthesia Machine 1 1 1

1 0 321000 0


Nasal 1 2 20 2 500 1000

Page 125



0 2 1000 2000


0 2 1000 2000


0 1 320 320

31.1 AMBO bag adult 1 2 2 0 2 2450 490031.1 AMBO Bag paeds 2 2 2 0 2 3000 600031.1 Red Rubber Nasal

tubes all sizes without cuff 4 4 4

0 4 1000 4000

32 Blood Bank 0 0 032.1 Blood storage

cabinet (100 bag capacity) 1 1 1

0 1 812000 812000


0 1 600000 600000


Frozen Plasma 1 1 10 1 1150000 1150000


tiles 3 3 30 3 3000 9000

32.1 Plasma Extractor 1 1 1 0 1 1000000 100000032.1 Platelets agitator 1 1 1 0 1 1000000 100000032.1 Blood thawing

bath 1 1 10 1 3000 3000

32.1 Microscopes 1 1 1 0 1 115000 11500033 Gynae & Labour


0 0


0 1 425000 425000


0 1 625000 625000


0 1 690000 690000

33.4 Glucometer 2 2 2 0 2 2500 5000

Page 126


33.5 Haemoglobino-meter 1 1 1

0 1 1000 1000


Page 127

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