Mianwali 1

THREE YEARS ROLLING PLAN 2010-2013 DISTRICT MIANWALI
Three Years Rolling Plan 2010-2013 District Mianwali
Table of Contents
Acronyms ............................................................................................................................................................. 4 Executive Summary............................................................................................................................................ 5 SECTION 1: DISTRICT HEALTH PROFILE......................................................................................................... 7 Vision of the District........................................................................................................................................... 7 Background of the District ................................................................................................................................. 7 Map of the District .............................................................................................................................................. 8 Demography ....................................................................................................................................................... 8 Socio-Economic Indicators .............................................................................................................................. 10 Health Indicators .............................................................................................................................................. 10 Organizational Structure of District Health Administration ......................................................................... 11 Health Resources .............................................................................................................................................. 12 1. a) b) 2. a) b) c) d) Health Facilities .................................................................................................................................... 12 Public ................................................................................................................................................. 12 Private ............................................................................................................................................... 12 Human Resource .................................................................................................................................. 13 Administrative ................................................................................................................................... 13 Facility Based .................................................................................................................................... 14 Outreach ............................................................................................................................................ 23 Training Institutions ......................................................................................................................... 23
Health Financing............................................................................................................................................... 24 Disease Pattern ................................................................................................................................................. 25 Status of Vertical Programs ............................................................................................................................. 28 1. 2. 3. 4. 5. 6. 7. 8. National Program for FP & PHC .......................................................................................................... 28 EPI.......................................................................................................................................................... 28 MNCH Program ..................................................................................................................................... 28 TB Control Program ............................................................................................................................. 29 Malaria Control Program ..................................................................................................................... 29 HIV/AIDS Control Program ................................................................................................................. 29 Hepatitis Control Program................................................................................................................... 30 School Health Services Program ......................................................................................................... 30 2
SECTION 2: PROBLEM ANALYSIS ................................................................................................................... 31 Objectives .......................................................................................................................................................... 31 Plan Development Process .............................................................................................................................. 31 Problem Identification ..................................................................................................................................... 32 Health Problems ............................................................................................................................................... 32 Problem Prioritization ................................................................................................................................. 33 Underlying causes of prioritized problems ................................................................................................ 35 Service delivery/Management problems ....................................................................................................... 37 MDGs and MSDS ............................................................................................................................................... 38 a) i. ii. b) i. ii. Human Resource .................................................................................................................................. 38 DHQ Hospital ..................................................................................................................................... 39 THQ Hospital ..................................................................................................................................... 40 Equipment............................................................................................................................................. 41 DHQ Hospital ..................................................................................................................................... 41 THQ Hospitals(3)............................................................................................................................... 49
SECTION 3: INTERVENTIONS AND TARGETS ............................................................................................... 59 Health Problems ............................................................................................................................................... 60 Management Problems .................................................................................................................................... 70 SECTION 4: COSTING AND FINANCING PLAN ............................................................................................... 75 Activity based costing ...................................................................................................................................... 75 Problem wise cost summary of Health Problems ............................................................................................. 75 a) Health Problems ................................................................................................................................... 76
Problem wise cost summary of Management Problems ................................................................................... 87 b) Management Problems ........................................................................................................................ 88 Financial Outlay ................................................................................................................................................ 94 Budget Summary .......................................................................................................................................... 94 SECTION 5: MONITORING & EVALUATION ................................................................................................... 95 M&E of Plan....................................................................................................................................................... 95 Annex-I .............................................................................................................................................................. 98 Annex-II .............................................................................................................................................................. 99 THQ Hospital Mianwali ................................................................................................................................ 101 3
Acronyms
3YRP ADB APMO ARI BHU BoD CDC CDR CPR DHIS DHQH DoH DR EDO(H) EPI HSRP IMR IPC M&E M&E MCH MMR MNCH MO MoV MSDS PDSSP PHC PMO POL RHC SCR SHC SMO TAMA TB THQH TNA WHO WMO Three Years Rolling plan Asian Development Bank Additional Principal Medical Officer Acute Respiratory Infections Basic Health Center Burden of Dieses Communicable Disease Control Case Detection Rate Contraceptive Prevalence Rate District Health Information System District Head Quarter Hospital Department of Health Default Rate Executive District Officer Health Expended Program on Immunization Health Sector Reforms Program Infant Mortality Rate Interpersonal Communication Monitoring and Evaluation Maintenance and Repair Maternal Child Health Maternal Mortality Ratio Maternal Newborn and Child Health Medical Officer Means of Verification Minimum Service Delivery Standards Punjab Devolved Social Services Program Primary Health Care Principal Medial Officer Petrol, Oil and Lubricant Rural Health Center Sputum Conversion Rate Secondary Health Care Senior Medical Officer Technical Assistance Management Agency Tuberculosis Tehsil Head Quarter Hospital Training Need Assessment World Health Organization Women Medical Officer
Executive Summary
Prior to devolution, planning process was carried out at provincial level. Districts were supposed to implement plans and programs developed/designed at provincial and federal levels. Devolution brought a paradigm shift where planning became a district responsibility. This change provided an opportunity to the district at one hand and challenge on other due to their limited capacity in planning and budgeting. Planning focus also changed from short term to medium term planning recognizing the flexibility /adaptability it provided. Government envisions that medium term plan .i.e. 3YRP will be instrumental in using health resources effectively and efficiently through adapting Minimum Service Delivery Standards (MSDS) as the strategy to achieve objectives of MDGs. Districts have been preparing 3YRP (medium term plan) for last few years under the auspices/patronage of Department of Health (DoH) Government of Punjab through technical assistance of Punjab Devolved Program Social Services Programme (PDSSP). This year government of the Punjab through Health Sector Reforms Program (HSRP) with the technical assistance from a team of consultants (SP09) and wide consultations/inputs from all key stake holders has established a bench mark in standardization of the format of 3YRP. Capacity building of the districts has been done on the standardized format. Current 3 Years Rolling Plan (3YRP) plan is first attempt by the district on that agreed format. First section of the format (District Health Profile) contains all relevant information on Geography, Demographic, Socioeconomic and Health indicators of the district. It also takes stock of health resources in terms of human resource, infrastructure and others. District diseases pattern compiled from DHIS Primary and Secondary Health Care reports and current status of vertical /national programs is part of the profile. In fact district profile is a health related fact sheet of the district and depicts the true picture of health status and health resources/services of the district. An accurate district health profile provides a sound basis for evidence-based planning. 3YRP plan has been developed by following the standard planning cycle approach. 3YRP details the current year activities, physical targets and fiscal targets. Projections of second and third year physical and financial targets are given. Section Two includes problems identification from various perspectives, and their prioritization by applying WHO prioritization criteria. This section also contains underlying causes of the prioritized problems. Section Three of the plan relates to developing best possible interventions/activities and setting physical targets for each year. Section Four consists of 5
costing based on additional requirements taking account of implementation of current status of activities. Best available estimates have been used to accurately cost the activities. The detailed activity based costing of the Health and Service Delivery problems has been developed on automated Excel sheets, and annexed for details as ready reference. Last section of the 3YRP consists of Monitoring and Evaluation of plan to gauge the progress of different activities and targets of the plan using reliable district data sources. This permits timely remedial action for smooth implementation of planned activities.
DISTRICT MIANWALI
SECTION 1: DISTRICT HEALTH PROFILE
Vision of the District
The District Health Government Mianwali is looking to provide efficient Health Care Delievery Servicesthrough Primary and Secondary health facilities with the collaboration of Government and non-government stake holders. The District Health Government is also committed to improve the Healthy Life Style of the people of Mianwali district.
Mission of the District

The District Health Government Mianwali has been providing promotive, preventive and curative services through net work of Health Institutions. At present curative services are being utilized by the population of the District, whereas in preventive programmes achievement of Department has been 90% of the targets.
Background of the District

Geographical location: District Mianwali shares its borders with district Attock in the NorthEast, with Chakwal and Khushab on the East, Bhakkar on the South, and NWFP on the West and North-West. River Indus flows across the district from North to South. Main Town: The main towns of this district are Isa Khel, Kamar Mushani, Kalabagh, Wan Bhacharan, Daud Khel, Piplan, Kundian and Harnoli . It has 56 union councils. Communication linkages (Roads, Railway): Roads and Railway Source of livelihood: Agriculture
Map of the District
Demography
o o o o Total Population Total Area Annual growth rate Population density 13,88,516
584 square kilometers

2.24 % 237 Per Sq. Km
Area-wise population
Area Rural Urban Population 1091343 297173 Percentage 78.60% 21.40%
Source: Standard Demographic population groups based on DHIS
Gender-wise population
Gender Male Female Population 702174 686342 Percentage 51% 49%
Population groups
Population Groups Under 1 year of age Under 5 years Under 15 years Women in child bearing age (15-49 years) Married Child Bearing age Women Expected pregnancies
Standard Demographic (%) 2.7 13.4 44 22 16 3.4
Estimated Population 49015 222163 610947 305473 222163 56929
Tehsil wise distribution

Tehsil Mianwali Piplan Isa Khel Number of UC 28 14 14 Population 676298 347447 364771
Ethnic groups and languages The district is home to a variety of the tribes, the important ones being,Niazi, Awan, Arien, Jat, Rajput, Gujjar, Kundi and Pathan
Socio-Economic Indicators
Education and Literacy Literacy rate Urban Rural Overall District Source: EDO Literacy and Formal Education Sargodha Male 87.6% 72.1% 74.8% Female 55.6% 32.4% 38.3%
Health Indicators
Infant Mortality Rate Neonatal mortality Rate Under 5 mortality Rate Maternal mortality Ratio Malnutrition (women and children) Underweight prevalence o o Stunting prevalence Wasting prevalence 78/1000 58/1000 113/1000 227/100000* 34/1000 33 36 18 10
Life expectancy
63-years for males 61-years for females
Proportion of children under 2 years immunized Sources: MICS 2007-2008,EDO(Health)Office Mianwali*
88%
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 is given in the table below Bed Strength 233 40 40 40 180 80 No. of Functional Beds 233 40 40 40 180 80 20 Beds in each RHC 2 Beds in each BHU
Facility Type
Name of Facility
Remarks
DHQ Hospital
DHQ Hospital Mianwali THQ Hospital Kalabagh
THQ Hospitals
THQ Hospital Isa Khel THQ Hospital Piplan
RHCs
9 RHCs 40 BHUs
BHUs Govt. Rural Dispensaries MCH Centers Sub Health Centers TB Clinics Health houses
13 06 20 2 1035
0 0 0 0 0
0 0 0 0 0
Data source: DHIS/EDOH Office Mianwali 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. Detailed list of private sector health facilities is attached as Annex-I.
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2. Human Resource
The Human resource of district health department has been placed in following categories: a) b) c) d) Administrative Facility based Outreach Training institutions
a) Administrative Sr. No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Name of Post
Sanctioned 1 1 2 1 0 0 1 1 2 1 1 2 2 2
Filled 1 1 1 1 1 1 0 0 1 1 1 2 0 2
Executive District Officer Health District Officer Health Deputy District Officer Health Program Director DHDC District Coordinator National Program District Coordinator EPI Surveillance District Sanitary Inspector CDC Officer CDC Inspector Drug Inspector District Superintendent Vaccination Assistant Superintendent Vaccination Tehsil Sanitary Inspector Inspector Vaccination
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b) Facility Based i. Basic Health Units (40) Name of Post/Designation Medical Officer School Health & Nutrition Supervisor Medical Assistant Computer Operator Medical Technician Female medical/Health Technician LHV Sanitary inspector Dispenser Midwife N/Qasid Chowkidar Sweeper Sanctioned 40 40 17 40 23 4 40 40 40 80 40 40 40 Filled 7 40 03 0 15 2 17 15 28 14 28 30 19 Vacant 33 0 14 40 8 2 23 25 12 66 12 10 21
Sr. No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.
ii.
Rural Health Centres (9) Name of Post Senior Medical Officer Medical Officer Woman Medical Officer Dental Surgeon Sanctioned 9 9 9 9 Filled 6 7 5 6 Vacant 3 2 4 3
Sr. No 1 2 3 4
14
Sr. No 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
Name of Post Chage Nurses Homeo Doctor Computer Operator Hakim Lady Health Visitor FMT Dental Technician Health Technician Lab. Technician RHI Homeo Dispenser Anthesia Assistant OTA Radiographer Dispenser Dresser Dawasaz Vacciantor Senior Clerk Lab. Assiastant X-Ray Assistant J/Clerk Midwife/Dai
Sanctioned 54 4 9 2 17 3 9 2 9 28 4 9 9 15 35 9 2 4 9 9 5 9 39
Filled 38 4 0 2 16 3 3 2 6 0 1 2 2 7 29 4 2 4 0 7 0 9 29
Vacant 16 0 9 0 1 0 6 0 3 28 3 7 7 8 6 5 0 0 9 2 5 0 10
15
Sr. No 28 29 30 31 32 33 34 35 36 37 38 39 40
Name of Post TWO Driver Ward Servant Sweeper Naib Qasid Chowkidar Water Carrier Sanitary Petrol Mali Cook Dawakoab Homeo Naib Qasid Sanitary Worker
Sanctioned 6 14 18 30 25 15 9 30 9 9 2 1 5
Filled 5 10 14 13 23 5 8 26 7 2 2 1 3
Vacant 1 4 4 17 2 10 1 4 2 7 0 0 2
iii.
THQ Hospitals(3)
Name of Post Medical Superintendent Add: Principal Medical Officer (M) Add: Principal Medical Officer (F) Senior Dental Surgeon Surgeon Orthopedic Surgeon Physician Anesthetist Sanctioned 3 2 1 2 3 1 1 2 Filled 0 0 0 0 0 0 0 0 Vacant 3 2 1 2 3 1 1 2
Sr. No 1 2 3 4 5 6 7 8
16
Sr. No 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33
Name of Post Gynecologist Pathologist Radiologist Ophthalmologist / Eye Specialist Pediatrician Senior Medical Officer Senior Woman Medical Officer Casualty Women Medical Officer Pharmacist Medical Officer / CMO Women Medical Officer Dental Surgeon Head Nurse Staff/Charge Nurse Male Nurse Refractionist Homeo Doctor Hakim Lady Health Visitor ECG Technician Dental Technician Opthalmic Technician Laboratory Technician Senior Clerk Junior Clerk
Sanctioned 5 1 2 3 3 5 3 1 2 9 5 1 2 15 2 1 1 1 3 2 2 2 2 2 3
Filled 0 0 0 1 1 0 0 0 2 7 4 1 0 6 0 0 1 1 3 0 1 0 0 1 2
Vacant 5 1 2 2 2 5 3 1 0 2 1 0 2 9 2 1 0 0 0 2 1 2 2 1 1
17
Sr. No 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58
Name of Post Radiographer Dispenser/Dresser Homeo Dispenser Dawasaz Operation Theatre Assistant Store keeper Laboratory Assistant Driver Midwife Nursing Ordly Tube Well Operator OT Attendant Lab: Attendant X-Ray Attendant Ward Servant Dai Aya Ward Boy Naib Qasid Masalchi Ward Cleaner /Sweeper Cook Gate Keeper Dawakoab Chowkidar
Sanctioned 4 15 1 1 4 2 5 3 2 1 2 1 1 2 11 4 2 1 5 1 15 1 2 1 5
Filled 2 15 1 0 1 0 4 2 2 1 1 0 1 1 3 3 2 1 2 0 6 0 2 1 2
Vacant 2 0 0 1 3 2 1 1 0 0 1 1 0 1 8 1 0 0 3 1 9 1 0 0 3
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Sr. No 59 60 61 62
Name of Post Mali Sever Man Dhobi Bahishti
Sanctioned 5 1 2 4
Filled 2 0 0 0
Vacant 3 1 2 4
iv.
DHQ Hospital Mianwali Name Of Post. Chief Consultant. Senior Consultant. Medical Superintendent. APMO (Male) APMO (Female) Urologist. Radiologist Pathologist. Physician Cardiologist. ENT Specialist Chest Specialist Anesthetist. Ophthalmologist Gynaecologist. Dermatologist. Orthopedic Surgeon. Child Specialist. Sanctioned 1 4 1 4 3 1 1 1 1 1 1 1 1 1 2 1 1 1 Filled 0 2 1 3 0 1 1 1 1 1 1 0 0 1 2 0 1 1 Vacant 1 2 0 1 3 0 0 0 0 0 0 1 1 0 0 1 0 0 19
Sr. No 1. 2. 3 4. 5. 8 9 10 11 12 13 14 15 16 17 18 19 20
Sr. No 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44
Name Of Post. Psychiatrist. Dy: Medical Superintendent. Senior Medical Officer Nursing Superintendent. Medical Officers. Woman Medical Officer. Physiotherapist. Budget and Account Officer. Statistical Officer. Health Education Officer. Pharmacist Principal Dental Surgeon. Dental Surgeon. Nursing Instructor. Deputy Nursing Superintendent. House Officers. Head Nurse. Refractionist. Charge Nurses. Public Health Nursing Supervisor. Office Superintendent. Homeopathic Doctor. Hakeem. Stenographer.
Sanctioned 1 3 4 1 50 13 1 1 1 1 1 1 1 1 1 16 6 1 48 1 1 1 1 1
Filled 1 0 3 0 16 6 1 0 0 0 1 0 1 0 1 9 1 1 45 0 1 1 1 1
Vacant 0 3 1 1 34 7 0 1 1 1 0 1 0 1 0 7 5 0 3 1 0 0 0 0 20
Sr. No 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68
Name Of Post. Head Clerk. Accountant. Statistical Assistant. L.H.V. ECG Technician. Dental Technician. House Keeper. Lab: Technician. Projectionist. Almoner. Cashier/Senior Clerk. Junior Clerk. X-Ray Technician. Store Keeper Radiographer. Homeopathic Dispenser Dispenser. Dresser Dawasaz OTA Physiotherapy Aid. Lab: Assistant. Driver. Midwife.
Sanctioned 1 1 1 4 2 2 1 1 1 1 2 4 1 2 4 1 9 4 1 6 1 4 4 2
Filled 0 0 0 4 2 1 0 1 0 1 1 4 1 1 4 1 9 4 1 3 1 4 2 2
Vacant 1 1 1 0 0 1 1 0 1 0 1 0 0 1 0 0 0 0 0 3 0 0 2 0 21
Sr. No 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91
Name Of Post. Nurse Dais. Tailor. Tubewel Operator. Lab: Attendant. Dhobi. O.T. Attendant. Dai. Aya. Ward Servant. Water Carear. Naib Qasid. Mali. Gate Keeper. Dawacob. (cum Naib Qasid) Cook. Chowkidar. Baildar. Stretcher Bearer. Ward Boy. Misalchi. Cleaner. Sweeper. Ward Cleaner.
Sanctioned 3 1 2 2 2 4 1 1 40 4 6 4 2 1 4 6 3 5 20 1 1 30 40
Filled 3 0 1 0 1 2 0 0 30 2 6 3 2 0 0 5 0 4 0 0 0 0 30
Vacant 0 1 1 2 1 2 1 1 10 2 0 1 0 1 4 1 3 1 20 1 1 30 10
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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. Post Vaccinators CDC Supervisors Sanitary Inspectors Sanctioned 50 37 40 Filled 48 29 17
d) Training Institutions A number of training institutions are working in the district, which include the following: Type of institute DHDC General Nursing school i. DHDC Post Programme Director MPPT LHV Trainer Assistant Driver Naib Qasid Chowkidar Sanitary Worker Sanctioned 01 01 01 01 01 01 02 01 Filled 01 01 01 01 01 01 02 01 Number 1 1
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ii.
General Nursing School Sanctioned 01 03 01 02 01 04 02 0 Filled 01 01 01 01 01 03 02 0
Name of Post/Designation Principal School of Nursing Nursing Instructor House Keeper Sweeper Naib Qasid Chowkidar/Gate Keeper Cook Masalchi
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
Year 2007-08 Source of funding 2008-09 2009-10 upto 03/2010
Allocation
Non-Development Development Sub Total PHSRP PMDGP PDSSP 314.229 314.229 0 0 0
Exp.
190.113 190.113 0 0 0
Allocation
259.840 259.840 9.402600 57.858 0
Exp.
289.170 289.170 0 40.686 0
Allocatio n
379.557 379.557 11.402600 49.683 19.192
Exp.
139.912 139.912 10.142464 34.370 16.645
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Provincial Development Funds (ADP) Grand Total User charges (like parchi fee, fees for diagnostic services)
628.458 3.482
380.226 0
586.9406 4.179
619.026 0
839.3916 0.655
340.98146 0
Disease Pattern
The disease pattern is determined through regular and periodic reporting through surveys and studies. Punjab health department has adopted DHIS as regular reporting mechanism to collect information on diseases and other variables. Currently, DHIS is in transitional stage, and is establishing itself as a tool to be used for evidence based planning and management. The following trend of the diseases has been taken from the consolidated DHIS reports that include reports from PHC and SHC facilities.
Disease Group Respiratory disease 1 2 3 4 5 6 Acute (upper) respiratory infections Pneumonia < 5 yrs. Pneumonia > 5 yrs. TB Suspects Chronic Obstructive Pulmonary Disease Asthma
Total
%age
286629 19543 14637 9662 3654 29820
23.82 1.62 1.22 0.80 0.30 2.48
Gastro Intestinal Disease 7 8 9 10 11 12 Diarrhea / Dysentery < 5 yrs Diarrhea / Dysentery > 5 yrs Enteric / Typhoid Fever Worm Infestations Peptic Ulcer Disease Cirrhosis of Liver 69132 57809 18770 25515 93156 521 5.75 4.80 1.56 2.12 7.74 0.04 25
Urinary Tract Disease 13 14 15 16 Urinary Tract Infections Nephritis / Nephrosis Sexually Transmitted Infections Benign Enlargement of Prostrate 39402 1793 1115 1369 3.27 0.15 0.09 0.11
Other Communicable Diseases 17 18 19 Suspected Malaria Suspected Meningitis Fever due to other causes 23579 1705 64042 1.96 0.14 5.32
Vaccine Preventable Disease 20 21 22 Suspected Measles Suspected Viral Hepatitis Suspected Neonatal Tetanus 641 1035 6 0.05 0.09 0.00
Cardiovascular Diseases 23 24 Ischemic heart disease Hypertension 5338 55940 0.44 4.65
Skin Diseases 25 26 27 Scabies Dermatitis Cutaneous Leishmaniasis 109950 58972 210 9.137 4.90 0.02
Endocrine Disease 28 Diabetes Mellitus 37191 3.09
Neuro-Psychiatric Diseases 29 30 Depression Drug Dependence 13589 859 1.13 0.07 26
31
Epilepsy
647
0.05
Eye & ENT 32 33 34 35 Cataract Trachoma Glaucoma Otitis Media 23598 5095 876 50658 1.96 0.42 0.07 4.21
Oral Diseases 36 Dental Caries 45576 3.79
Injuries/Poisoning 37 38 39 40 41 Road traffic accidents Fractures Burns Dog bite Snake bite (with signs/symptoms of poisoning) 16918 3900 2816 6779 536 1.41 0.32 0.23 0.56 0.04
Miscellaneous Disease 42 43 Acute Flaccid Paralysis Suspected HIV/AIDS TOTAL 44 Any other Unusual disease (specify) 330 0 1203313 100 0.03
Source: Compiled from PHC and SHC DHIS Reports.
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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 No. of LHWs working Percentage of Population covered by the program Important program indicators o o o o o IMR MMR CPR No. of antenatal visits TT Coverage of pregnant women 34/1000 156/100000 43% 15192 97% 1140 1035 85%
2. EPI
EPI Coverage rate of the district Fully immunized children 0-23 months Pregnant women received TT vaccine Availability of cold chain equipment 93% 88% 63% 98%
3. MNCH Program
1st batch of 34 qualified and deployed in the district. 2nd batch of 18 qualified and awaiting for deployment. 3-Batches of 23 CMW are undergoing training in District Mianwali. Under this Programme the following staff is recruited:
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Sr. No. 1. 2. 3. 4. 5.
Name of Post District Coordinator / Public Health Specialist WMO CMW Tutors Community Social Organizer LHV
Sanctioned 1 9 3 1 9
Filled 1 5 3 1 8
vacant 0 4 0 0 1
4. TB Control Program
CDR all types CDR NSS positive SCR TSR DR 109/100,000 population 77.8% 97% 95.4% 0%
5. Malaria Control Program

No. of slides examined No. of positive slides Slides positively ratio Percentage of plasmodium falciparum 13529 32 0.24% 15.6%
6. HIV/AIDS Control Program

No. of HIV/AIDS tests conducted No. of positive cases detected No. of HIV/AIDS patients treated No. of sentinel centers 2000 0 0 0
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7.

Hepatitis Control Program

No. of hepatitis tests conducted No. of positive cases detected a) Hepatitis B+ve b) Hepatitis C+ve 6898 302 140 162
No. of persons vaccinated against Hepatitis B Total visits to the schools No. of students examined No. of students referred to BHUs No. of students treated in BHUs No. of students referred from BHUs to higher facilities No. of schools in catchment areas No. of SH & NS No. of teachers trained 406 27263 7263 6158 1105 541 21 Nil
8. School Health Services Program
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SECTION 2: PROBLEM ANALYSIS

The Health sector in Punjab is facing enormous health and service delivery problems. Common health problems are communicable, non communicable, MNCH related diseases and accident/ trauma. The society is passing through demographic and epidemiological transition. This is due to changing life style, urbanization, ecological and other factors. Disease pattern is changing where non communicable diseases are gradually increasing and the communicable diseases are still posing serious threat. Punjab is practically facing Double Burden of Disease (BOD). Besides, health problems service delivery/ managerial issues are also hindering the access and quality of health services to the population. The service delivery/management problems are diverse in nature, and include shortage of technical human resource, capacity issues, lack of infrastructure and equipment. Devolution was introduced during 2001 affecting the administrative and financial set up of the districts. The devolution also brought political culture in the decision making of the districts in the shape of Nazims, Naib-Nazims and Councilors. This system is now in the phase of reshaping and it is not clear what will be future structure and managerial shape when new local bodies system is put in place. The District Manager and functionaries are in the state of uncertainty and confusion in this scenario. However, one thing is clear that the district shall remain a hub of all primary and secondary health services delivery. Despite the source of funding in the future, either from provincial or district government, health planning at district level shall continue to play a pivotal role in provision of quality health services. In view of the above situation the district considers following objectives for developing three year rolling plan.
Objectives
Improve health status of the population
Meeting the requirements of national and provincial health policies Achievement of MDGs through MSDS Introducing evidence-based planning culture by addressing district specific problems/issues Addressing emerging health needs or re-emergence of health problems (e.g. H1N1, HIV-AIDS, Polio, T.B) Ensuring effective inter-sectoral coordination with a view to improving health indicators
The objectives would guide in problem analysis, designing interventions, setting /phasing the targets, costing and monitoring the plan activities.
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 31
by Director General Health Services Punjab. This team received three days customized training from SP09 team at divisional headquarters. The main components of the trainings were: (i) developing a threeyear rolling health sector plan using the standard three year rolling plan format; (ii) costing of the plan; (iii) preparing related budget projections; (iv) accounting procedures; (v) preparing adequate financial reports on the use of funds. The district planning team adopted the following steps for the preparation of three years rolling plan: Problem identification Prioritization of identified problems Identifying underlying causes of prioritized problems Developing interventions and activities Setting targets Determining resource requirements, costing and budgeting Preparing action plans Preparing monitoring plan
Problem Identification
This step involved assessment of the current situation from various perspectives to establish the actual health situation in terms of health and service delivery/management problems. Problem identification is based on the district health profile, review of previous plans, MIS (DHIS, Program reports and periodic reports etc.), District specific surveys (MICS), MSDS, and national and provincial policy guidelines. The district planning team held meetings and started with identification of problem using the training received from SP-09 team and consulting the above mentioned documents. The problems identified were broadly divided into two categories i.e. a) Health Problems b) 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.
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1. Acute respiratory tract infections (ARI) 4. Anemia (including in pregnancy) 7. Hepatitis 10. Hypertension 13. Enteric fever 16. Road side accident & injuries 19. UTI
2. Diarrheal Diseases 5. High under 5 Mortality 8. Anxiety Neurosis 11. Cataract 14. Peptic ulcer disease 17. Worm infestation 20. Pulmonary Tuberculosis
3. Skin diseases 6. High Maternal Mortality 9. Diabetes Mellitus 12. Dental Problems 15. Asthma 18. Otitis Media
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. This total score was then used to prioritize the health problems. A cut-off point of was decided, to establish the priority health problems of the district. These problems will be addressed in the three years rolling plan.
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Problem
Magnitude
Severity
Vulnerability to intervention 3 4 3
Cost Effectiveness
Political Expediency
Total Score
Priority Number
ARI (under 5) Diarrheal Diseases Skin diseases Anemia ( including in pregnancy) High under five mortality High maternal mortality Hepatitis Anxiety Neurosis Diabetes Mellitus Hypertensions Cataract Dental Problems Enteric Fever Peptic ulcer disease Asthma Road side Accidents & Injuries Otitis Media UTI Pulmonary Tuberculosis Worm infestation
4 4 3
2 4 2
4 4 4
1 1 1
14 17 13
5 1 7
14
17
4 2 3 1 1 2 1 1 2 2
4 3 2 2 2 1 1 3 2 2
3 2 2 2 2 3 1 3 2 2
3 1 3 1 1 4 1 3 2 2
3 4 1 2 2 1 1 1 1 1
17 12 11 8 8 11 5 11 9 9
3 8 11 16 17 12 19 9 15 14
18
3 2 2 3
2 2 2 1
3 3 3 3
2 2 3 3
1 1 2 1
11 10 12 11
9 13 8 12
34
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. No.
Health Problem
Causes
Diarrheal Diseases
Poor sanitation Lack of safe drinking water Unhygienic practices Lack of awareness in general population Lack of awareness among mothers about feeding and weaning practices
Low Socio Economic status Malnutrition 2 High under 5 Mortality 2 High MMR Poor antenatal natal and post natal coverage Neo-natal Infections Birth Trauma & Asphyxia Prematurity Poor feeding and weaning practices Diarrhea ARI Lack of capacity of staff for provision of proper child health care (diagnostic and timely referrals) Low socio economic status Malnutrition Lack of birth spacing Low EPI Coverage Poor access to healthcare delivery services Lack of awareness about danger signs of pregnancy Low ante-natal coverage Low skilled birth attendance Three delays (seeking health care, transportation, and lack of referral back-up services) Complications of pregnancy Capacity Issues related to maternal care Maternal Anemia Pregnancy following chronic severe diseases
35
Anemia ( including pregnancy)
Lack of awareness about balanced diet Gender discrimination Social taboos and norms Worm infestation Infections Poor quality of MNCH services Poverty/ Low socio economic status Malnutrition Air contamination Over-crowding/Poor housing facilities Lack of proper sanitation Seasonal variation Lack of awareness and hygienic practices Lack of awareness Unhygienic practices Over-crowding/Poor housing facilities Poor water and sanitation Seasonal variation Poor sanitation Unsafe drinking water Sharing of used syringes Transfusion of unsafe blood and blood products Unsafe sexual practices Ear & Nose piercing and tattooing Use of unsterilized equipment by dentists and barbers Low socio-economic status Seasonal variation Lack of proper sanitation Lack of awareness and hygienic practices
Acute (upper) respiratory infections
Scabies
Hepatitis
TB
36
Service delivery/Management problems

This segment entails the district specific management problems. Management problems are result of deficiency/lack of resources; these problems range from administrative to financial issues, and cause hindrance in the smooth delivery of health services in the district. It was observed that solution of some of these problems lies with the provincial government; whereas remaining can be addressed at the district level. While proposing the interventions, their action at provincial or district level has been specifically mentioned. The planning team discussed these problems in detail and enlisted the main problems as under: 1. Shortage of Human Resource due to: Ban on permanent postings Non availability of incentivized pay package and career stuture Medico-legal work for WMOs Non sactioning of posts according to MSDS 2. Shortage of vehicles for (educational visit of nursing students A.C Vehicles 35 seaters) due to : Off Road and codemnation Emerging need 3. Shortage of Infrastructure i. EDO Office ii. Stores( drugs, equipment & General) iii. Residences (EDOH,DDOH) iv. Up gradation of Nursing School 4. Inadequate budget for POL due to: Price hikes Installation and use of generators Inadequate budget for POL 5. Shortage of equipment (with reference to notified list) at secondary care level
37
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 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
A
Bed Strength
400 and above Beds 251-400 Beds Up to 250 Beds Above 60 Beds 41-60 Beds Up to 40 Beds
DHQ Hospital
B C A
THQ Hospital
B C
38
i.
DHQ Hospital (Category C) Sr. No. Post Standard Sanctioned Filled as per MSDS Vacancy Gap in relation to sanctioned positions
1 2 2 22 16
Vacancy Gap in relation to filled positions

1 2 3 52
1 2 3 4
Gynaecologist Paediatricians Anesthetists Medical Officers including SMO,APMO & PMOs Women Medical Officers including SWMO, APWMO &PMOs Lady Health Visitors Nurses
3 3 3 74
2 1 1 58 0
2 1
27
16
11
21
11
75
54
46
21
29
39
ii.
THQ Hospital (Category C) There are three THQ hospitals in the district, and all three belong to C category. Following is a composite list of human resource gaps for these THQ hospitals. Sr. No. Post Standard as per MSDS Sanctioned Filled Vacancy Vacancy Gap in Gap in relation to relation to sanctioned filled positions positions 1 3 7 32 6 5 9 41
1 2 3 4
Gynaecologist Paediatricians Anesthetists Medical Officers including SMO,APMO & PMOs Women Medical Officers including SWMO APWMO & PMOs Lady Health Visitors Nurses
6 6 9 48
5 3 2 16
0 1 0 7
27
18
23
24
21
21
45
19
26
39
40
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. i. DHQ Hospital Sr. Equipment No.
Standard as per MSDS (Qty.) C B 1 A 2
Available
Gap
Remarks
CTG (Cardiac Tocography) Foetal Doppler Diagnostic Laparoscope Bulb Sucker Baby Warmer Mechanical Sucker Fetal Stethoscope Delivery Table D&C Set Outlet forceps Myoma Screw Kochers forceps Volselum forceps
2 3
3 1
5 1
5 2
0 0
3 1
4 5 6 7 8 9 10 11 12 13
10 20 20 3 3 4 2 2 4 2 4 6 3 3 4 2 3 4 2 4 8 6 6 4 3 4 4 2 8 10
1 4 42 5 2 2 4 3 13 3
9 0 0 0 0 0 0 0 0 3
41
Sr. No.
Equipment
Available
Gap
Remarks
14
Lanes Tissue holding forceps Vaginal Retractors Polypectomy forceps Sponge holder Uterine elevator CosCo Speculum Small, Medium, Large (for each category)
15 16 17 18 19
10 10 10 2 2 2
0 3 56 3 2
10 0 0 0 4
10 15 20 1 6 1 1
10 10
20 21 22
Examination light Suction Curette Infant Resuscitation Trolley (with life saving medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light) Mother Resuscitation Trolley (with life saving medicines, Laryngoscope, Endotracheal tube, BP Apparatus, Chargeable light) Cardiac Monitor
3 1 1
3 2 1
6 2 2
1 8 0
2 0 1
23
24
14
42
Sr. No.
Equipment
Available
Gap
Remarks
25
Pump Breast Electronic Vaginal Hysterectomy Set Toothed Tissue Forceps (8) Non-Tooted Tissue Forceps (8) Dissection Scissors (Curved 7) Dissection Scissors (Straight 7) Hysterectomy Clamps (Straight) Hysterectomy Clamps (Curved) Uterine Sound Needle Holder (7) Needle Holder (10)
26
26.1
20
26.2
20
26.3
30
26.4
40
26.5
16
26.6
16
26.7 26.8 26.9
2 2 2
2 2 2
4 4 4
2 16 20 60
0 0 0 0
26.10 Artery Forceps (Straight 6) 26.11 Artery Forceps (Curved 6) 26.12 Allis Forceps 26.13 Towel Clamps
16 16 32
16 16 32
30
8 8
8 8
16 16
244 100
0 0 43
Sr. No.
Equipment
Available
Gap
Remarks
26.14 Single blade Sims speculum 26.15 Double blade Sims speculum 26.16 Sponge holding forceps 26.17 Volselum forceps 26.18 Uterine Sound 26.19 Bladder Sound 27 27.1 27.2 27.3 27.4 Delivery Sets Episiotomy Scissors Straight Scissors Needle holder Non-toothed tissue forceps 8 inches Toothed tissue forceps 8 inches Sims Speculum single blade
16
56
4 2 2
4 2 2
8 4 4
3 4 4
1 0 0
10 10 15 10 10 15 10 10 15 10 10 15 10 10 15 4 6 6 4 6 4 4 6
27.5
10 10 15
27.6
20 20 30
18
27.7
Sims Speculum double 20 20 30 blade Sponge holding forceps Artery forceps 40 40 60
18
27.8
34
27.9
40 40 60
40
0 44
Sr. No.
Equipment
Standard as per MSDS (Qty.) C B A
Available
Gap
Remarks
27.10 Straight clamps (cord) 27.11 Vacuum Extractor pump 27.12 Towel clip 28 28.1 28.2 Caesarian Section Scalpel Artery Forceps Straight 6 inches Artery Forceps Curved 6 inches Artery forceps 8 inches Myoma Scissors straight 7 inches Dissecting scissors (curved) 7 inches Green Armtage forceps 8 inches Obstetric outlet forceps (pair) Doyenes Retractor
20 20 30 1 1 1
20 1
0 0
40 40 60 6 6 8 8 10 10
30
10
8 100
0 0
24 32 40
28.3
24 32 40
100
28.4
24 32 40
120
28.5
10
28.6
10
28.7
24 32 40
18
28.8
10
28.9
10
4 20 20 8
2 0 4 0 45
28.10 Small Retractors 28.11 Towel Clippers 28.12 Suction Nozzle
12 16 20 24 32 40 6 8 10
Sr. No.
Equipment
Available
Gap
Remarks
29
MNCH Related Radiology Equipments Ultrasound Machine X-Ray Unit 500 kw Color Doppler Lead Screen for X-Ray Unit 0.5 MN Lead Apron. Lead Gloves, Goggles and Thyroid and Gonadal Sheets Safe Light X-RT Film Processing Tank Chest Stand X-Ray film Illuminator 1 1 0 1 2 1 1 1 3 1 1 1 3 1 0 2 0 0 0 0
29.1 29.2 29.3 29.4
29.5
29.6 29.7
1 1
1 1
1 1
3 0
0 1
29.8 29.9
1 2 4
1 2 4
1 2 4
2 3 50
0 0 0
29.10 X-Ray Film Hangers All sizes 30 MNCH Related Paediatrics Equipments Paediatric Ventilator Incubator Photo Therapy Unit
30.1 30.2 30.3
1 1 1
2 1 1
2 2 1
0 4 2
1 0 0 46
Sr. No.
Equipment
Available
Gap
Remarks
30.4
Over-head Radiant Warmer Infant Length Measuring Scale Infant Weighing Machine Nebulizer Billiubino-meter Exchange Blood Transfusion Set
30.5
30.6
30.7 30.8 30.9
1 1 1
1 1 1
2 2 2
18 0 0
0 1 1
30.10 Nasal Probe Paed size 31 31.1 31.2 31.3 31.4 31.5 31.6 31.7 Anaesthesia/ICU Anaesthesia Machine Ventilators Nebulizer Pulse Oximetry Defibrillator Airway Oral and Nasal Tracheostomy tube (adult and paeds) Face mask of all sizes
1 1 1 1 1 2 2
1 1 1 1 1 3 2
2 1 1 1 1 4 4
5 1 1 1 1 0 6
0 0 0 0 0 2 0
31.8
47
Sr. No.
Equipment
Available
Gap
Remarks
31.9
Double Cuff Tourniquet (for regional block)
31.10 AMBO bag adult 31.11 AMBO Bag paeds 31.12 Red Rubber Nasal tubes all sizes without cuff 32 32.1 Blood Bank Blood storage cabinet (100 bag capacity) Packed cell machine Cell Separator Freezer for Fresh Frozen Plasma Blood bag shaker RH view box Water bath Micro-pipette Blood grouping tiles
2 2 4
2 2 4
4 4 8
15 9 0
0 0 4
32.2 32.3 32.4
1 1 1
1 1 1
1 1 1
0 0 0
1 1 1
32.5 32.6 32.7 32.8 32.9
1 2 2 4 3 1 1 1
1 2 2 6 3 1 1 1
2 4 2 8 6 1 1 1
2 0 1 0 0 0 0 0
0 2 1 4 3 1 1 1 48
32.10 Plasma Extractor 32.11 Platelets agitator 32.12 Blood thawing bath
Sr. No.
Equipment
Available
Gap
Remarks
32.13 Microscopes 33 Gynae & Labour Room Related Laboratory Equipment Hematology Analyzer Electrolyte Analyzer Analyzer Biochemistry Semiautomatic Glucometer Haemoglobino-meter Centrifuge
33.1 33.2 33.3
1 1 1
1 1 1
1 1 1
0 0 1
1 1 0
33.4 33.5 33.6
2 2 1
2 2 1
2 4 2
0 1 2
2 1 0
ii. THQ Hospitals(3) Sr. Equipment No.
Available
Gap
Remarks
CTG (Cardiac Tocography) Foetal Doppler Diagnostic Laparoscope
2 3
2 1
2 1
3 1
0 0
6 3
49
Sr. No.
Equipment
Available
Gap
Remarks
4 5 6 7 8 9 10 11 12 13 14
Bulb Sucker Baby Warmer Mechanical Sucker Fetal Stethoscope Delivery Table D&C Set Outlet forceps Myoma Screw Kochers forceps Volselum forceps Lanes Tissue holding forceps Vaginal Retractors Polypectomy forceps Sponge holder Uterine elevator CosCo Speculum Small, Medium, Large (for each category)
5 2 3 2 2 2 4 2 4 4 2
10 20 2 3 3 2 2 4 2 4 4 2 3 3 4 2 2 4 2 4 6 2
0 0 06 31 4 3 0 2 6 4 6
15 6 3 0 2 3 12 4 6 8 0
15 16 17 18 19
4 2
4 2
6 2
2 2 38 2 6
10 4 0 1 6
10 10 15 1 4 1 6 1 6
20 21
Examination light Suction Curette
3 1
3 1
3 2
8 2
1 1
50
Sr. No.
Equipment
Available
Gap
Remarks
22
Infant Resuscitation Trolley (with life saving medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light) Mother Resuscitation Trolley (with life saving medicines, Laryngoscope, Endotracheal tube, BP Apparatus, Chargeable light) Cardiac Monitor Pump Breast Electronic Vaginal Hysterectomy Set Toothed Tissue Forceps (8) Non-Tooted Tissue Forceps (8) Dissection Scissors (Curved 7) Dissection Scissors (Straight 7)
23
24 25
1 1
1 1
1 1
3 0
0 3
26
26.1
26.2
26.3
19
26.4
17
51
Sr. No.
Equipment
Available
Gap
Remarks
26.5
Hysterectomy Clamps (Straight) Hysterectomy Clamps (Curved) Uterine Sound Needle Holder (7) Needle Holder (10)
24
26.6
24
26.7 26.8 26.9
2 2 2
2 2 2
2 4 2
4 2 2 12
2 4 4 36
26.10 Artery Forceps (Straight 6) 26.11 Artery Forceps (Curved 6) 26.12 Allis Forceps 26.13 Towel Clamps 26.14 Single blade Sims speculum 26.15 Double blade Sims speculum 26.16 Sponge holding forceps 26.17 Volselum forceps 26.18 Uterine Sound 26.19 Bladder Sound 27 Delivery Sets
16 16 16
16 16 16
12
36
8 8 4
8 8 4
8 8 4
12 9 2
12 15 10
10
23
4 2 2 6
4 2 2 6
4 2 2 10
1 1 0 0
11 5 6 18
52
Sr. No.
Equipment
Standard as per MSDS (Qty.) C B 6 6 6 6 A 10 10 10 10
Available
Gap
Remarks
27.1 27.2 27.3 27.4
Episiotomy Scissors Straight Scissors Needle holder Non-toothed tissue forceps 8 inches Toothed tissue forceps 8 inches Sims Speculum single blade Sims Speculum double blade Sponge holding forceps Artery forceps
6 6 6 6
1 1 22 1
17 17 0 17
27.5
10
17
27.6
12 12 20
36
27.7
12 12 20
36
27.8
40 40 40
119
27.9
40 40 40 20 20 30 1 1 1
93 6 1
27 54 2
27.10 Straight clamps (cord) 27.11 Vacuum Extractor pump 27.12 Towel clip 28 28.1 28.2 Caesarian Section Scalpel Artery Forceps Straight 6 inches Artery Forceps Curved 6 inches
40 40 40 4 4 4 4 6 6
56 0 22 6
64 12 0 42
16 16 24
28.3
16 16 24
42
53
Sr. No.
Equipment
Available
Gap
Remarks
28.4
Artery forceps 8 inches Myoma Scissors straight 7 inches Dissecting scissors (curved) 7 inches Green Armtage forceps 8 inches Obstetric outlet forceps (pair) Doyenes Retractor
16 16 24
42
28.5
11
28.6
11
28.7
16 16 24
48
28.8
12
28.9
4 8
4 8
6 12
1 1 3 2
11 23 45 10
28.10 Small Retractors 28.11 Towel Clippers 28.12 Suction Nozzle 29 MNCH Related Radiology Equipments Ultrasound Machine X-Ray Unit 500 kw Color Doppler Lead Screen for X-Ray Unit
16 16 24 4 4 6
29.1 29.2 29.3 29.4
1 1 0 1
1 1 0 1
2 1 0 1
3 5 0 3
0 0 0 0
54
Sr. No.
Equipment
Available
Gap
Remarks
29.5
0.5 MN Lead Apron. Lead Gloves, Goggles and Thyroid and Gonadal Sheets Safe Light X-RT Film Processing Tank Chest Stand X-Ray film Illuminator
29.6 29.7
1 1
1 1
1 1
3 4
0 0
29.8 29.9
1 2 4
1 2 4
1 2 4
4 4 263
0 2 0
29.10 X-Ray Film Hangers All sizes 30 MNCH Related Paediatrics Equipments Paediatric Ventilator Incubator Photo Therapy Unit Over-head Radiant Warmer Infant Length Measuring Scale Infant Weighing Machine Nebulizer Billiubino-meter
30.1 30.2 30.3 30.4
1 1 1 1
1 1 1 1
2 1 1 1
0 2 2 0
3 1 1 3
30.5
30.6
30.7 30.8
1 1
1 1
1 1
5 0
0 3 55
Sr. No.
Equipment
Available
Gap
Remarks
30.9
Exchange Blood Transfusion Set
30.10 Nasal Probe Paed size 31 31.1 31.2 31.3 31.4 31.5 31.6 31.7 Anaesthesia/ICU Anaesthesia Machine Ventilators Nebulizer Pulse Oximetry Defibrillator Airway Oral and Nasal Tracheostomy tube (adult and paeds) Face mask of all sizes Double Cuff Tourniquet (for regional block)
1 1 1 1 1 1 1
1 1 1 1 1 2 2
1 1 1 1 1 2 2
4 1 0 0 1 3 0
0 2 3 3 2 0 3
31.8 31.9
1 1
2 1
2 1
0 0
3 3
31.10 AMBO bag adult 31.11 AMBO Bag paeds 31.12 Red Rubber Nasal tubes all sizes without cuff 32 Blood Bank
1 2 4
2 2 4
2 2 4
1 1 0
2 5 12
56
Sr. No.
Equipment
Available
Gap
Remarks
32.1
Blood storage cabinet (100 bag capacity) Packed cell machine Cell Separator Freezer for Fresh Frozen Plasma Blood bag shaker RH view box Water bath Micro-pipette Blood grouping tiles
04
32.2 32.3 32.4
1 1 1
1 1 1
1 1 1
0 0 0
3 3 3
32.5 32.6 32.7 32.8 32.9
1 1 2 4 3 1 1 1 1
1 2 2 4 3 1 1 1 1
1 2 2 6 3 1 1 1 1
1 0 2 8 01 0 1 0 17
2 3 4 4 8 3 2 3 0
32.10 Plasma Extractor 32.11 Platelets agitator 32.12 Blood thawing bath 32.13 Microscopes 33 Gynae & Labour Room Related Laboratory Equipment Hematology Analyzer Electrolyte Analyzer
33.1 33.2
1 1
1 1
1 1
0 0
3 3
57
Sr. No.
Equipment
Available
Gap
Remarks
33.3
Analyzer Biochemistry Semiautomatic Glucometer Haemoglobino-meter Centrifuge
33.4 33.5 33.6
2 1 1
2 1 1
2 1 1
50 3 9
0 0 0
58
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.
59
Health Problems
Sr. No. 1
Problem
Causes
Intervention
Activities
Unit
Plan Activities Targets
Target for 2010-11 4
Remarks
Diarrhea
Poor sanitation
improvement of water supply and sanitation
Quarterly co-ordination Meeting under the chairmanship of DCO with TMA and other agencies Messages on local cable network Printing and distribution of IPC material
Meeting
12
Lack of safe drinking water Unhygienic practices
Health Education campaign Improving literacy rate through coordination with education department Proper treatment of Diarrhoea including ORT Capacity building of health staff in Integrated Management of Childhood Illnesses (IMCI)
Message Broucher
12 200000
4 500000
4 250000
4 250000
Lack of awareness in general population Lack of awareness among mothers about feeding and weaning practices
Address in school assemblies Training of medics and paramedics in IMCI
Session
1200
1200
No. of trainings
Low Socio Economic status
Procurement and distribution of ORS
ORS packets
150,000
200000
200000
200000
60
Sr. No.
Problem
Causes
Intervention
Activities
Unit
Target for 2010-11 100,000
Target for 2011-12 50000
Target for 2012-13 50000
Remarks
Malnutrition
Procurement and distribution of Syp. Zinc Sulfate Procurement and Distribution of Syrp Metonidazole Procurement and distribution of IV fludis
Syrup
150,000
Syrup
150000
50,000
50,000
50,000
IV Fludis
High under 5 Mortarity
Poor antenatal natal and post natal coverage Neo-natal Infections
Health awareness/education
Message on local cable
Message
36
12
12
12
Provision of the quality basic EMONC services at BHU & RHC Provision of the quality Comprehensive EMONC services at THQH & DHQH Improvement of feeding and weaning practices
BCC of mothers 0n promotion of breast feeding and weaning practices through LHWs Provision of the deficient infrastructure at THQ
Number of Trainings
54
30
12
12
Birth Trauma & Asphyxia
Assessment
Prematurity
Trainings on IMCI
No. of trainings
61
Sr. No.
Problem
Causes
Intervention
Activities
Unit
Target for 2010-11 -
Remarks
Poor feeding and weaning practices
Capacity building of Human Resource dealing child health care Enhancing EPI coverage
Need assessment of food supplements
Assessment
Diarrhoea
procurement from DGHs office
Assessment
ARI
Poverty elevation
Distribution of food suplemwnts to mothers & children through LHWs & community mid wives Raising income of the poor famlies through Baitul Mall and Zakat
Assessment
Lack of capacity of staff for provision of proper child health care (diagnostic and timely referrals) Low socio economic status
Provision of food suplements
Assessment
Revising the micro plans of Vaccinators
Malnutrition
Lack of birth spacing
62
Sr. No.
Problem
Causes
Intervention
Activities
Unit
Remarks
Low EPI Coverage
High MMR
Poor access to healthcare delivery services Lack of awareness about danger signs of pregnancy Low ante-natal coverage
Health education/promotion
Messages on local cable network
Message
36
12
12
12
Behaviour change communication for Mothers of child bearing age Provision of Quality basic EmONC services at BHU & RHC Provision of Quality Comprehencive EmONC services at THQs hospital Improving transpotation of the patients
Printing and distribution of IPC material
Broucher
150000
50000
50000
50000
Training of LHWs on BCC
No. of trainings
Low skilled birth attendance
Procourment of vehicles for transportation through CCBs Operation and mangement of vehicles trhough CCBs
Three delays (seeking health care, transportation, and lack of referral backup services) Complications of pregnancy
Repair of non functional ambulances for timely transportation of pregnant mothers
63
Sr. No.
Problem
Causes
Intervention
Activities
Unit
Remarks
Capacity Issues related to maternal care Maternal Anemia
Replacement of the non functional ambulances for timely transportation of pregnant mother Procourment of the MNCH related equipment and Instruments Implementation of the refrrals protocols
Pregnancy following chronic severe diseases
Procurement of Micronutrients
Packs
50000
25000
13000
12000
Procurement and distribution of Calci-D
Packs
50000
25000
12500
12500
Porcurement and distribution of Anti-D
Injection
60
30
15
15
Aneamia ( including pregnency)
Lack of awareness about balanced diet
Awareness raising for behaviour change
Message
36
12
12
12
64
Sr. No.
Problem
Causes
Intervention
Activities
Unit
Target for 2010-11 50000
Target for 2011-12 50000
Target for 2012-13 50000
Remarks
Gender discrimination
Broucher
150,000
Social taboos and norms
Counselling of pregnant mothers
Session
Worm infestation
Deworming campaign
Procurement of deworming tablets
No. of doses
100,000
50000
25000
25000
Infections
Diagnosis and treatment of infections
Distribution through LHWs and health facilities Refresher Trainings of LHWs on BCC, balanced diet and provision of micro-nutrients Provision of Sehat Suhlat Card/health voucher No. of trainings
Poor quality of MNCH services
Strengthening MNCH Services
Poverty/ Low socio economic status
Equity of services
Acute (upper) respiratory infections
Malnutrition
Capacity building of health staff in ARI case management
Messages on local cable networks
Message
12
65
Sr. No.
Problem
Causes
Intervention
Activities
Unit
Target for 2010-11 100000
Target for 2011-12 50000
Target for 2012-13 50000
Remarks
Air contamination
Overcrowding/Poor housing facilities Lack of proper sanitation
Capacity building of health staff in Integrated Management of Childhood Illnesses (IMCI) Provision of medicines for ARI
Broucher
200000
Training of medics and para-medics in IMCI
No. of trainings
Timely referral of complicated cases
Procurement and distribution of Antibiotic Syrup Amoxycillin Procurement and distribution of Antibiotic Syrup Co-tri
Antibiotic (Syrup)
Seasonal variation
Antibiotic (Syrup)
Lack of awareness and hygienic practices 6 Scabies Lack of awareness Health education & Promotion Messages on local cable networks Message
12
Unhygenic practices
Imprroving water and sanitation
Messages through FM radio channels
Message
12
66
Sr. No.
Problem
Causes
Intervention
Activities
Unit
Target for 2010-11 100000
Target for 2011-12 500000
Target for 2012-13 50000
Remarks
Overcrowding/Poor housing facilities Poor water and sanitation
Proper diagonosies and treatment
Broucher
200000
Procourement and distribution of Benzyl Benzoate Lotion
Lotion
100000
50000
25000
25000
Seasonal variation
Hepatitis
Poor sanitation
Health Education/Promotion
Quarterly co-ordination meetings with TMA and other agencies Messages on local cable network
Meetings
Unsafe drinking water
Improving water & sanitation
Message
36
12
12
12
Sharing of used syringes
Campaign against quackery
Broucher
200000
100000
50000
50000
Transfusion of unsafe blood and blood products
Strengthening blood transfusion services for safe transfusions
Printing and pasting of stickers at clinicks and Barbar shop highliting use of new syringes & Razers
Stickers
2000
2000
67
Sr. No.
Problem
Causes
Intervention
Activities
Unit
Remarks
Unsafe sexual practices
Regulatory mechanism to ensure use of safe instruments by dentists, barbers etc.
Hepatitis awareness week ( walk/display banners/seminars)
Ear & Nose piercing and tattooing
Procurement and supply of Eliza kits
Kits
12
Use of unsterilized equipment by dentists and barbers
Procurement of syringe cutters
Syringe cutter
Documentation of expense of disposable syringes Suportive supervision to ensure above activities Health education/promotion Strengthening TB DOTS program through involvement of private sector Messages on local cable networks Printing and distribution of IPC material
TB
Low socio-economic status Seasonal variation
Message
12
Broucher
50000
25000
13000
12000
68
Sr. No.
Problem
Causes
Intervention
Activities
Unit
Remarks
Lack of proper sanitation
Involvement of priviate providors through public priviate partnership
Procurement of drugs to ensure deficiency according to regimen
ATT course
200
Lack of awareness and hygienic practices
Procurement of reagents for notified diagnostic facilities under DOTS programme Trainings on DOTS protocols
Packs
No. of trainings
69
Management Problems Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned Posts
Physical Targets Sr.No. Name of Post Basic Scale
18 18 18 17 16 9
Basic Pay
Allowances
Requirement as per Gap Year I Year II

1 2 3 25 10 15
Year III
1 2 22 8 15
1 2 3 4 5 6
Gynaecologist Paediatricians Anesthetists MO / WMO Nurses Lady Health Visitors
12,910 12,910 12,910 9,850 6,060 3,820
18,099 18,099 18,099 15,345 8,934 4,750
2 5 8 72 28 45
1 2 3 25 10 15
70
Sr. No 1
Problem
Causes
Intervention
Filling of the vacant posts
Activities
Temporary 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 Districts to prepare the incentivized pay package with consultation of all stockholders Consensus building between the districts for uniform incentivized pay package for all categories and levels staff Request to the Provincial Government for approval and implementation of agreed pay packages Review and revise the career structure of medics, paramedics and technical staff like Sos, Health Education officers etc Availability of recreation, education and other facilities for children of staff working in rural areas
Unit
Plan Activities Targets -
Remarks
Shortage of skilled staff
Vacant positions
Recruitment
Non-sanctioning of staff according to MSDS Lack of permanent postings Lack of incentivies and differential pay packages Frequent transfer postings
Sanctioning of positions according to MSDS
Plan
Recruitment through Public Service Commission on regular basis Incentivized pay package at all levels
Pay Package
Meeting
Well defined career structure including opportunities for higher education Conducive working environment
Plan
Job insecurity
TA
Lack of basic amenities at workplace
Provision of staff Residences
Plan EDOH
71
Sr. No
Problem
Causes
Intervention
High level political commitment for providing protection to staff working in health facilities
Activities
Construction of the residences for the staff
Unit
Plan Activities Targets -
Remarks
Lack of conducive environment including insecurity and transport of children for education Political & Media Interference Deficient transparent accountability Shortage of the residences Medicoleagel work specially for Females
Requirement Plan
provision of recreation facilities (Parks/Play area/common rooms) Provision of the transport of staff children for the education purposes
Plan EDOH
Plan EDOH
Capacity and need assessment of the medics and the paramedics Prepare training programs for providing higher professional education based on TNA Rational increase in POL Budget Assessing additional need for POL
TNA
Plan
Inadequate budget for POL
Installation of the Generator for back up electricity supply Frequent increase in prices of POL Less allocation for POL budget
Costing & Submission the additional Demand for POL
POL
449,826(Liters)
449,826
72
Sr. No 3
Problem
Causes
Office for EDOH
Intervention
Provision of the deficient infrastructure
Activities
Rough cost estimate
Unit
Cost Estimate
Target for 2010-11
Target for 2011-12
Target for 2012-13
Remarks
Lack of infrastructure
Residence for EDOH DDOH residence Stores ( drugs, equipment & General) Upgradation of Nursing School 4
Submission of PC-1
PC-1
Approval by the concern authority
construction
Shortage of Vehicles
Required for field/Educational visit of nursing students A.C Vehicles 35 seaters according to basic Nursing curriculum of P.N.C.
Provision of vehicle Coaster 25 Seaters A.C.
Purchase of 25 Seaters AC Coaster
Vehicle
73
Sr. No
5
Problem Deficient equipment (with reference to notified list) at THQHs and DHQH.
Causes
Deficient equipment to cater basic and comprehensive EmONC at primary and secondary level of care
Intervention
Make up the deficiencies against standards specified in MSDS
Activities
Purchase of MNCH related equipment at DHQ Hospital Mianwali
Unit
Equipment

1
Target for 2010-11

1
Target for 2011-12
Target for 2012-13
Remarks
Purchase of MNCH related equipment at THQs Hospitals (Kalabagh, Piplan, Iesa Khail)
Equipment
74
SECTION 4: COSTING AND FINANCING PLAN

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 hyoerlinked as H & M Sheet. A moderate estimate of equipment cost has been taken, as there is wide variation between the minimum and maximum cost. Detailed cost of MNCH related equipment is annexed as Annex-II. The summary of problem and activity wise costing is given below.
Problem wise cost summary of Health Problems

FYI Sr. No. 1 2 3 4 5 6 7 8 Health Problem Amount (Rs.) 8,585,700 681,000 3,150,000 914,000 288,000 1,219,600 954,000 254,400 16,046,700 FY II Amount (Rs.) 5,851,835 473,880 1,771,000 812,900 206,800 2,249,060 499,400 189,420 12,054,295 FY III Total Cost Rs. Amount (Rs.) 5,812,840 521,268 1,863,400 894,190 227,480 840,466 549,340 135,520 10,844,504 20,250,375 1,676,148 6,784,400 2,621,090 722,280 4,309,126 2,002,740 579,340 38,945,499 75
Diarrhea
Under 5 Mortality HMM Anemia ARI Sabies Hepatitis TB TOTAL
a) Health Problems
Define Sr. Problem Activity Unit 1 Diarrhea Quarterly coordination Meeting under the chairmanship of DCO with TMA and other agencies Messages on local cable network Meeting Rate 4,000 Quantity 12 Year I 16,000
Financial Targets Year II (10 %) 17,600 Year III (10 %) 19,360
Total Cost 52,960
Message
22000
12
88,000
96,800
106,480
291,280
Printing and distribution of IPC material Address in school assemblies
Broucher
200000
2,000,000
1,100,000
1,210,000
4,310,000
Session
school health & nutrition supervisor gives address to the school assemblies 186,900
1200
Training of medics and paramedics in IMCI Procurement and distribution of ORS
No. of trainings
1,031,700
567,435
1,599,135
ORS packets
150,000
1,200,000
1,320,000
1,452,000
3,972,000
76
Define Sr. Problem Activity Unit Procurement and distribution of Syp. Zinc Sulfate Procurement and Distribution of Syrp Metonidazole Procurement and distribution of IV fludis Syrup Rate 35 Quantity 150,000 Year I 3,500,000
Financial Targets Year II (10 %) 1,925,000 Year III (10 %) 2,117,500
Total Cost 7,542,500
Syrup
15
150000
750,000
825,000
907,500
2,482,500
IV Fludis
Stock available
8,585,700
5,851,835
5,812,840
20,250,375
High under 5 Mortarity
Message on local cable BCC of mothers 0n promotion of breast feeding and weaning practices through LHWs Provision of the deficient infrastructure at THQ
Message
22,000
36
264,000
290,400
319,440
873,840
Number of Trainings
13900
54
417,000
183,480
201,828
802,308
Assessment
77
Define Sr. Problem Activity Unit Trainings on IMCI No. of trainings Rate As proposed in Diarrhoea Assessing below poverty pregnant mother through LHWs and providing them food suplement through DGHS & Financial suport from BaitulMall & Zakat Assessing below poverty pregnant mother through LHWs and providing them food suplement through DGHS & Financial suport from BaitulMall & Zakat Quantity Year I -
Financial Targets Year II (10 %) Year III (10 %) -
Total Cost -
Need assessment of food supplements
Assessment
procurement from DGHs office
Assessment
78
Define Sr. Problem Activity Unit Distribution of food suplemwnts to mothers & children through LHWs & community mid wives Assessment Rate Assessing below poverty pregnant mother through LHWs and providing them food suplement through DGHS & Financial suport from BaitulMall & Zakat Assessing below poverty pregnant mother through LHWs and providing them food suplement through DGHS & Financial suport from BaitulMall & Zakat Quantity Year I -
Total Cost -
Raising income of the poor famlies through Baitul Mall and Zakat
Assessment
Revising the micro plans of Vaccinators
681,000
473,880
521,268
1,676,148
High MMR
Message
22,000
36
264,000
290,400
319,440
873,840
79
Define Sr. Problem Activity Unit Printing and distribution of IPC material Training of LHWs on BCC Procourment of vehicles for transportation through CCBs Operation and mangement of vehicles trhough CCBs Repair of non functional ambulances for timely transportation of pregnant mothers Replacement of the non functional ambulances for timely transportation of pregnant mother Broucher Rate 2 Quantity 150000 Year I 100,000
Total Cost 331,000
No. of trainings
Already costed in problem High Under 5 Mortality Costed in service delivery problems
Costed in service delivery problems
80
Define Sr. Problem Activity Unit Procourment of the MNCH related equipment and Instruments Implementation of the refrrals protocols Procurement of Micro-nutrients Procurement and distribution of Calci-D Porcurement and distribution of AntiD Packs Rate Costed in service delivery problems Quantity Year I -
Total Cost
Costed in MSDS Gaps
70
50000
1,750,000
1,001,000
1,016,400
3,767,400
Packs
50
50000
1,250,000
687,500
756,250
2,693,750
Injection
5000
60
150,000
82,500
90,750
323,250
3,150,000
1,771,000
1,863,400
6,784,400
Aneamia ( including pregnency)
Messages on local cable network Printing and distribution of IPC material
Message
22,000
36
264,000
290,400
319,440
873,840
Broucher
150,000
300,000
330,000
363,000
993,000
81
Define Sr. Problem Activity Unit Counselling of pregnant monthers Session Rate LHWs are expected to conduct counselling session on behavior change during their visit to pregnant ladies 7 100,000 Quantity Year I -
Total Cost -
Procurement of deworming tablets Distribution through LHWs and health facilities
No. of doses
350,000
192,500
211,750
754,250
Refresher Trainings of LHWs on BCC, balanced diet and provision of micro-nutrients Provision of Sehat Suhlat Card/health voucher
No. of trainings
Already costed in Problem HMM
914,000
812,900
894,190
2,621,090
82
Define Sr. Problem Activity Unit 5 Acute (upper) respiratory infections Messages on local cable networks Printing and distribution of IPC material Training of medics and para-medics in IMCI Message Rate 22,000 Quantity 12 Year I 88,000
Total Cost 291,280
Broucher
200000
200,000
110,000
121,000
431,000
No. of trainings
IMCI Training package costed in Diarrhoea also includes management of ARI Stock available
Procurement and distribution of Antibiotic Syrup Amoxycillin Procurement and distribution of Antibiotic Syrup Cotri
Antibiotic (Syrup)
Antibiotic (Syrup)
Stock available
288,000
206,800
227,480
722,280
83
Define Sr. Problem Activity Unit 6 Scabies Messages on local cable networks Messages through FM radio channels Printing and distribution of IPC material Procourement and distribution of Benzyl Benzoate Lotion Message Rate 22,000 Quantity 12 Year I 88,000
Total Cost 291,280
Message
20,400
12
81,600
89,760
98,736
270,096
Broucher
200000
300,000
1,650,000
181,500
2,131,500
Lotion
15
100000
750,000
412,500
453,750
1,616,250
1,219,600
2,249,060
840,466
4,309,126
Hepatitis
Quarterly coordination meetings with TMA and other agencies Messages on local cable network
Meetings
Costed in diarrhoral disease
Message
22000
36
264,000
290,400
319,440
873,840
84
Define Sr. Problem Activity Unit Printing and distribution of IPC material Printing and pasting of stickers at clinicks and Barbar shop highliting use of new syringes & Razers Hepatitis awareness week ( walk/display banners/seminars) Procurement and supply of Eliza kits Procurement of syringe cutters Documentation of expense of disposable syringes Kits Broucher Rate 3 Quantity 200000 Year I 300,000
Total Cost 646,500
Stickers
50
2000
100,000
100,000
Lumpsum
250,000
250,000
10000
12
40,000
44,000
48,400
132,400
Syringe cutter
Available
954,000
499,400
549,340
2,002,740
85
Define Sr. Problem Activity Unit 8 TB Messages on local cable networks Printing and distribution of IPC material Procurement of drugs to ensure deficiency according to regimen Procurement of reagents for notified diagnostic facilities under DOTS programme Trainings on DOTS protocols Message Rate 22,000 Quantity 22,000 Year I 88,000
Total Cost 291,280
Broucher
50,000
28,600
29,040
107,640
ATT course
To be procurred from the PTP
Packs
No. of trainings
58200
58200
116,400
64,020
180,420
254,400
189,420
135,520
579,340
86
Problem wise cost summary of Management Problems

FYI Sr. No. Health Problem 1 Human Resource Plan (Senction of Posts against MSDS Gaps) Amount (Rs.) 13,133,028 FY II Amount (Rs.) 28,892,662 FY III Total Cost Rs. Amount (Rs.) 44,789,220 86,814,909
2 3 4
POL Shortage of Vehicles MNCH Related Equipment
35,086,428 3,800,000 67,739,800 119,759,256
28,892,662
44,789,220
35,086,428 3,800,000 67,739,800 193,441,137
Total
87
b) Management Problems
Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned Posts
Financial Targets Year I Sr.No. Name of Post Basic Scale Basic Pay Allowances Requirement as per Gap Pay of Officers 1 Gynaecologist 18 12,910 18,099 2 Pay of other staff Allowances Pay of Officers 340,824 Pay of other staff Allowances Pay of Officers Pay of other staff Allowances Year II Year III
154,920
217,188
477,814
374,906
525,595
Paediatricians
18
12,910
18,099
309,840
434,376
681,648
955,627
937,266
1,313,987
Anesthetists
18
12,910
18,099
464,760
651,564
1,022,472
1,433,441
1,499,626
2,102,380
MO / WMO
17
9,850
15,345
72
2,955,000
4,603,500
6,501,000
10,127,700
10,297,584
16,042,277
Nurses
16
6,060
8,934
28
727,200
1,072,080
1,599,840
2,358,576
2,463,754
3,632,207
Lady Health Visitors
3,820
4,750
45
687,600
855,000
1,512,720
1,881,000
2,495,988
3,103,650
4,611,720
687,600
7,833,708
10,145,784
1,512,720
17,234,158
15,573,136
2,495,988
26,720,096
88
Define Sr. Problem Activity Unit 1 Shortage of skilled staff Temporary 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 Districts to prepare the incentivized pay package with consultation of all stockholders Recruitment Rate Quantity Year I -
Financial Targets Year II (10 %) Year III (10 %) Total Cost
Plan
Pay Package
Consensus building between the districts for uniform incentivized pay package for all categories and levels staff
Meeting
89
Define Sr. Problem Activity Unit Request to the Provincial Government for approval and implementation of agreed pay packages Review and revise the career structure of medics, paramedics and technical staff like Sos, Health Education officers etc Availability of recreation, education and other facilities for children of staff working in rural areas Construction of the residences for the staff provision of recreation facilities (Parks/Play area/common rooms) Provision of the transport of staff children for the education purposes Plan Rate Quantity Year I -
Financial Targets Year II (10 %) Year III (10 %) Total Cost -
TA
Plan EDOH
Requirement Plan Plan EDOH
Plan EDOH
90
Define Sr. Problem Activity Unit Capacity and need assessment of the medics and the paramedics Prepare training programs for providing higher professional education based on TNA 2 Inadequate budget for POL Assessing additional need for POL TNA Rate Quantity Year I -
Plan
Costing & Submission the additional Demand for POL
POL
78
449,826
35,086,428
35,086,428
35,086,428
35,086,428
Lack of infrastructure
Rough cost estimate
Cost Estimate
Submission of PC-1
PC-1
91
Define Sr. Problem Activity Unit Approval by the concern authority Upgradation of Nursing School 4 Shortage of Vehicles Upgradation Rate Quantity Year I -
Detail annexed -
5,100,000 -
5,100,000 -
Purchase of 25 Seaters AC Coaster
Vehicle
3,800,000
3,800,000
3,800,000
3,800,000
3,800,000
Deficient equipment (with reference to notified list) at THQHs and DHQH
Purchase of MNCH related equipment at DHQ Hospital Mianwali
Equipment
Detail Annexed
14,412,110
14,412,110
92
Define Sr. Problem Activity Unit Purchase of MNCH related equipment at THQs Hospitals (Kalabagh, Piplan, Iesa Khail) Equipment Rate Detail Annexed Quantity Year I 53,327,690
Financial Targets Year II (10 %) Year III (10 %) Total Cost 53,327,690
67,739,800
67,739,800
93
Financial Outlay
The costing of the plan includes routine recurring budget with 15% price escalation for subsequent years and additional cost involved on the basis of health and management problems; which is essentially required to bring visible improvement in the health system. Other financial resources expected from provincial level through ADP and PMDGP are also part of this plan. Details of the financial estimates for three years rolling plan are attached as Annex-III. Overall financial outlay of the plan is as under:
Budget Summary
2010-2011 Regular district budget Additional budget based on problem identification Total 136,169,956 2011-2012 41,347,357 2012-2013 56,074,164
135,805,956
271,975,912
40,946,957
82,294,314
55,633,724
111,707,888
94
SECTION 5: MONITORING & EVALUATION

The monitoring and evaluation targets and indicators mentioned below will be used to gauge the progress of implementation of the plan. Monitoring and evaluation of the three years rolling plan would be carried out through the proposed indicators, targets and means of verifications, by the district health authorities.
M&E of Plan
Indicators Target % Achievement MoV Responsibility Frequency of monitoring Remarks
% of planned supervisory visits conducted
50 visits /year
Inspection Book/Attendance register
EDOH/DOH/ DDOH/Dist. Monitoring officer EDOH / DOH
Quarterly
% of RHCs with availability of services (on rotational basis) of essential specialties (Physician, Surgeon, Paediatrician and Gynaecologist) % of health facilities with availability of essential MNCH related equipment (level specific) Availability of relevant (MNCH) laboratory equipment at appropriate level of care % facilities with availability of essential medicines
100% During 1st year
Movement register/visit book/Attendance register
Quarterly
Stock Register
EDOH/ DOH/ MSs
6 monthly
Stock Register
EDOH/ DOH/MSs, Store keeper
Quarterly
Stock Register
EDOH/ DOH/ MSs, Store keeper
Monthly
95
Indicators
Target
% Achievement
MoV
Responsibility
Frequency of monitoring
Remarks
% of functional ambulances in the district
100% (DHQH/ THQH/ RHCs) 100% of yearly budget 100% (50% during 1st year) 100% in 3 years (50% during 1st year) 100% in 3 years (50% during 1st year)
Log Book
EDOH/DOH/ Transport officer
Quarterly
% utilization of sanctioned budget
Quarterly Reports
EDOH/ DOH/ MSs/ Accounts officer EDOH/DoH/ DDOH
Quarterly
% of facilities with availability of basic EmONC
Supervisory visit report
Quarterly
% of DHQ/THQ hospitals with Comprehensive EmONC services
EDOH/DoH/ DDOH
Quarterly
% of facilities with availability of separate or partitioned room reserved exclusively for delivery % of targeted pregnant women newly registered by LHW % of targeted pregnant women received TT-2 vaccine
EDOH/DoH/ DDOH
Quarterly
Target according to population Target according to population
DHIS Report
EDOH/ Statistical Officer EDOH/ DHIS Coordinator/ Statistical Officer EDOH/ DHIS Coordinator/ Statistical Officer
Quarterly
DHIS Report
Quarterly
Delivery conducted by or under supervision of skilled persons reported
60 % During 1st year
DHIS Report
Quarterly
96
Indicators
Target
% Achievement
MoV
Responsibility
Frequency of monitoring
Remarks
%of target children between 18 - 23 months of age fully immunized % of referred cases attended
Target according to population
DHIS Report
EDOH/ DHIS Coordinator/ Statistical Officer EDOH/ DHIS Coordinator/ Statistical Officer EDOH/ Statistical Officer /Coordinator NP-FP&PHC EDOH/ Focal person/s
Quarterly
100%
DHIS Report/ LHWs monthly report
Quarterly
% of targeted eligible couples provided knowledge and information on Family Planning methods No. of meetings with participation from other sectors
Target according to population
LHWs monthly/ quarterly report
Quarterly
12 meetings per year
Minutes of meetings
Quarterly
97
Annex-I
Private Health Facilities in District Mianwali

Sr. No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Name of Hospital/Address P.A.E.C Hospital Chashma barrage Mianwali P.A.F Hospital Mianwali Al khidmat Hospital Mianwali Nishtar Polyclinic Mianwali Anwar Medical Complex Mianwali Al-Imran Hospital Mianwali Ubaid Noor Hospital Mianwali Al-Shafa Hospital Mianwali Fatima Hospital Mianwali Jinnah Hospital Mianwali Qaisar Eye Hospital Hafiz Wala Mianwali Tahir Hospital Hafiz Wala Mianwali City clinic piplan district Mianwali Abdul kareem kareem eye clinic Piplan Al-Mustafa Hospital Kalabagh
98
Annex-II
Costing of MNCH related equipment gaps for DHQ and THQ Hospitals
DHQ Hospital Mianwali
Sr. No. 1 2 3 4 13 14 15 19 20 22 23 24 25 26.5 26.14 26.15 26.17 27.1 27.2 27.3
Equipment CTG (Cardiac Tocography) Foetal Doppler Diagnostic Laparoscope Bulb Sucker Volselum forceps Lanes Tissue holding forceps Vaginal Retractors CosCo Speculum Small, Medium, Large (for each category) Examination light Infant Resuscitation Trolley (with life saving medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light) Mother Resuscitation Trolley (with life saving medicines, Laryngoscope, Endo-tracheal tube, BP Apparatus, Chargeable light) Cardiac Monitor Pump Breast Electronic Hysterectomy Clamps (Straight) Single blade Sims speculum Double blade Sims speculum Volselum forceps Episiotomy Scissors Straight Scissors Needle holder
Gap 1 3 1 9 3 2 10 4 2 1
Unit Cost 285000 10000 1200000
Total Cost(Rs.) 285,000 30,000 1,200,000
45 235 400 350 550 18000
405 705 800 3,500 2,200 36,000
95000 95,000 110000 1 0 1 4 4 4 1 6 4 4 500000 250000 150 275 250 250 125 360 135 99 600 1,100 1,000 250 750 1,440 250,000 110,000
Sr. No.
Equipment
Gap
Unit Cost 100
Total Cost(Rs.) 540 600
27.4 27.5 27.6 27.7 27.8 27.12 28.7 28.8 28.9 28.11 29.5 29.7 30.1 30.4 30.5 30.8 30.9 30.1 31.6 31.8 31.9 31.12 32.2 32.3 32.4 32.6 32.7 32.8 32.9
Non-toothed tissue forceps 8 inches Toothed tissue forceps 8 inches Sims Speculum single blade Sims Speculum double blade Sponge holding forceps Towel clip Green Armtage forceps 8 inches Obstetric outlet forceps (pair) Doyenes Retractor Towel Clippers 0.5 MN Lead Apron. Lead Gloves, Goggles and Thyroid and Gonadal Sheets X-RT Film Processing Tank Paediatric Ventilator Over-head Radiant Warmer Infant Length Measuring Scale Billiubino-meter Exchange Blood Transfusion Set Nasal Probe Paed size Airway Oral and Nasal Face mask of all sizes Double Cuff Tourniquet (for regional block) Red Rubber Nasal tubes all sizes without cuff Packed cell machine Cell Separator Freezer for Fresh Frozen Plasma RH view box Water bath Micro-pipette Blood grouping tiles
6 6 18 18 34 10 6 6 2 4 1 1 1 1 2 1 1 2 2 2 1 4 1 1 1 2 1 4 3
100 275 250 250 125 300 900 200 400 125 100000 5000 1200000 910000 5000 10,000 36000 2000 7000 500 1000 320 1000 600000 5225000 5,225,000 1150000 1000 3000 8000 3000 32,000 9,000 100 1,150,000 2,000 3,000 36,000 2,000 14,000 1,000 2,000 320 4,000 600,000 500 100,000 5,000 1,200,000 910,000 600 4,950 4,500 8,500 1,250 1,800 5,400
Sr. No. 32.1 32.11 32.12 33.1 33.2 33.4 33.5 Plasma Extractor Platelets agitator
Equipment
Gap 1 1 1 1 1 2 1
Unit Cost 1000000 1000000 3000 425000 625000 2500 1000
Total Cost(Rs.) 1,000,000 1,000,000 3,000 425,000 625,000 5,000 1,000 14,412,110
Blood thawing bath Hematology Analyzer Electrolyte Analyzer Glucometer Haemoglobino-meter Total cost of equipment
THQ Hospital Mianwali

Total Cost (Rs.) 855,000 60,000 3,600,000 675 5,100,000 84,000 35,000 6,300 10,800 1,280 1,410 1,880 3,500 3,000 150 3,300 18,000 95
Sr. No. 1 2 3 4 5 6 8 9 10 11 12 13 15 16 18 19 20 21
Equipment CTG (Cardiac Tocography) Foetal Doppler Diagnostic Laparoscope Bulb Sucker Baby Warmer Mechanical Sucker Delivery Table D&C Set Outlet forceps Myoma Screw Kochers forceps Volselum forceps Vaginal Retractors Polypectomy forceps Uterine elevator CosCo Speculum Small, Medium, Large (for each category) Examination light Suction Curette
Gap 3 6 3 15 6 3 2 3 12 4 6 8 10 4 1 6 1 1
Unit Cost 285,000 10,000 1,200,000 45 850,000 28,000 17,500 2,100 900 320 235 235 350 750 150 550 18,000 95
101
Sr. No. 22
Equipment Infant Resuscitation Trolley (with life saving medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light) Mother Resuscitation Trolley (with life saving medicines, Laryngoscope, Endo-tracheal tube, BP Apparatus, Chargeable light) Pump Breast Electronic Hysterectomy Clamps (Straight) Hysterectomy Clamps (Curved) Uterine Sound Needle Holder (7) Needle Holder (10) Artery Forceps (Straight 6) Artery Forceps (Curved 6) Allis Forceps Towel Clamps Single blade Sims speculum Double blade Sims speculum Sponge holding forceps Volselum forceps Uterine Sound Bladder Sound Episiotomy Scissors Straight Scissors Non-toothed tissue forceps 8 inches Toothed tissue forceps 8 inches Sims Speculum single blade Sims Speculum double blade Sponge holding forceps Artery forceps Straight clamps (cord) Vacuum Extractor pump Towel clip Artery Forceps Straight 6 inches Artery Forceps Curved 6 inches Artery forceps 8 inches Myoma Scissors straight 7 inches
Gap 3
Unit Cost 95,000
Total Cost(Rs.) 285,000
23
110,000
330,000
25 26.5 26.6 26.7 26.8 26.9 26.1 26.11 26.12 26.13 26.14 26.15 26.16 26.17 26.18 26.19 27.1 27.2 27.4 27.5 27.6 27.7 27.8 27.9 27.1 27.11 27.12 28.2 28.3 28.4 28.5
3 24 24 2 4 4 36 36 12 15 10 10 23 11 5 6 17 17 17 17 36 36 119 27 54 2 64 42 42 42 11
250,000 150 175 90 150 300 110 125 230 125 275 250 200 250 1,500 1,500 125 360 100 100 275 250 250 275 175 19,000 125 125 125 175 150
750,000 3,600 4,200 180 600 1,200 3,960 4,500 2,760 1,875 2,750 2,500 4,600 2,750 7,500 9,000 2,125 6,120 1,700 1,700 9,900 9,000 29,750 7,425 9,450 38,000 8,000 5,250 5,250 7,350 1,650 102
Sr. No. 28.6 28.7 28.8 28.9 28.1 28.11 28.12 29.9 30.1 30.2 30.3 30.4 30.5 30.6 30.8 30.9 30.1 31.2 31.3 31.4 31.5 31.7 31.8 31.9 31.1 31.11 31.12 32.2 32.3 32.4 32.5 32.6 32.7 32.8 32.9 32.1
Equipment Dissecting scissors (curved) 7 inches Green Armtage forceps 8 inches Obstetric outlet forceps (pair) Doyenes Retractor Small Retractors Towel Clippers Suction Nozzle X-Ray film Illuminator Paediatric Ventilator Incubator Photo Therapy Unit Over-head Radiant Warmer Infant Length Measuring Scale Infant Weighing Machine Billiubino-meter Exchange Blood Transfusion Set Nasal Probe Paed size Ventilators Nebulizer Pulse Oximetry Defibrillator Tracheostomy tube (adult and paeds) Face mask of all sizes Double Cuff Tourniquet (for regional block) AMBO bag adult AMBO Bag paeds Red Rubber Nasal tubes all sizes without cuff Packed cell machine Cell Separator Freezer for Fresh Frozen Plasma Blood bag shaker RH view box Water bath Micro-pipette Blood grouping tiles Plasma Extractor
Gap 11 48 12 11 23 45 10 2 3 1 1 3 6 4 3 3 3 2 3 3 2 3 3 3 2 5 12 3 3 3 2 3 4 4 11 3
Unit Cost 270 300 900 200 300 125 250 4,000 1,200,000 1,500,000 22,000 910,000 5,000 3,100 36,000 2,000 7,000 525,000 165,000 21,000 500,000 1,000 1,000 320 2,450 3,000 1,000 600,000 5,225,000 1,150,000 10,000 1,000 3,000 8,000 3,000 1,000,000
Total Cost(Rs.) 2,970 14,400 10,800 2,200 6,900 5,625 2,500 8,000 3,600,000 1,500,000 22,000 2,730,000 30,000 12,400 108,000 6,000 21,000 1,050,000 495,000 63,000 1,000,000 3,000 3,000 960 4,900 15,000 12,000 1,800,000 15,675,000 3,450,000 20,000 3,000 12,000 32,000 33,000 3,000,000 103
Sr. No. 32.11 32.12 33.1 33.2 33.3 Platelets agitator
Equipment Blood thawing bath Hematology Analyzer Electrolyte Analyzer Analyzer Bio-chemistry Semi-automatic Total cost of equipment(All THQs)
Gap 2 3 3 3 3
Unit Cost 1,000,000 3,000 425,000 625,000 690,000
Total Cost(Rs.) 2,000,000 9,000 1,275,000 1,875,000 2,070,000 53,327,690
104

Mianwali 1

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THREE YEARS ROLLING PLAN 2010-2013 DISTRICT MIANWALI

Three Years Rolling Plan 2010-2013 District Mianwali

Three Years Rolling Plan 2010-2013 District Mianwali

Three Years Rolling Plan 2010-2013 District Mianwali

Three Years Rolling Plan 2010-2013 District Mianwali

Three Years Rolling Plan 2010-2013 District Mianwali

Three Years Rolling Plan 2010-2013 District Mianwali

Mission of the District

Background of the District

Three Years Rolling Plan 2010-2013 District Mianwali

Map of the District

584 square kilometers

Three Years Rolling Plan 2010-2013 District Mianwali

Source: Standard Demographic population groups based on DHIS

Source: Standard Demographic population groups based on DHIS

Standard Demographic (%) 2.7 13.4 44 22 16 3.4

Estimated Population 49015 222163 610947 305473 222163 56929

Three Years Rolling Plan 2010-2013 District Mianwali

Tehsil wise distribution

Three Years Rolling Plan 2010-2013 District Mianwali

63-years for males 61-years for females

Proportion of children under 2 years immunized Sources: MICS 2007-2008,EDO(Health)Office Mianwali*

Organizational Structure of District Health Administration

Three Years Rolling Plan 2010-2013 District Mianwali

DHQ Hospital Mianwali THQ Hospital Kalabagh

THQ Hospital Isa Khel THQ Hospital Piplan

Three Years Rolling Plan 2010-2013 District Mianwali

a) Administrative Sr. No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Three Years Rolling Plan 2010-2013 District Mianwali

Sr. No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

Three Years Rolling Plan 2010-2013 District Mianwali

Three Years Rolling Plan 2010-2013 District Mianwali

Three Years Rolling Plan 2010-2013 District Mianwali

Three Years Rolling Plan 2010-2013 District Mianwali

Three Years Rolling Plan 2010-2013 District Mianwali

Name of Post Mali Sever Man Dhobi Bahishti

Three Years Rolling Plan 2010-2013 District Mianwali

Three Years Rolling Plan 2010-2013 District Mianwali

Three Years Rolling Plan 2010-2013 District Mianwali

Three Years Rolling Plan 2010-2013 District Mianwali

Three Years Rolling Plan 2010-2013 District Mianwali

General Nursing School Sanctioned 01 03 01 02 01 04 02 0 Filled 01 01 01 01 01 03 02 0

Three Years Rolling Plan 2010-2013 District Mianwali

286629 19543 14637 9662 3654 29820

23.82 1.62 1.22 0.80 0.30 2.48

Three Years Rolling Plan 2010-2013 District Mianwali

Endocrine Disease 28 Diabetes Mellitus 37191 3.09

Neuro-Psychiatric Diseases 29 30 Depression Drug Dependence 13589 859 1.13 0.07 26

Three Years Rolling Plan 2010-2013 District Mianwali

Oral Diseases 36 Dental Caries 45576 3.79

Source: Compiled from PHC and SHC DHIS Reports.

Three Years Rolling Plan 2010-2013 District Mianwali

Status of Vertical Programs

1. National Program for FP & PHC

Three Years Rolling Plan 2010-2013 District Mianwali

5. Malaria Control Program

6. HIV/AIDS Control Program

Three Years Rolling Plan 2010-2013 District Mianwali

Hepatitis Control Program

8. School Health Services Program

Three Years Rolling Plan 2010-2013 District Mianwali

SECTION 2: PROBLEM ANALYSIS

Plan Development Process