Lahore

Three Years Rolling Plan 2010-2013 District Lahore
1

THREE YEARS ROLLING PLAN
2010-2013
DISTRICT LAHORE


2

Contents
Acronyms ................................................................................................................................................. 4
Executive Summary ................................................................................................................................ 5
LAHORE ................................................................................................................................................. 7
SECTION 1: DISTRICT HEALTH PROFILE ............................................................................................ 7
Vision of the District ................................................................................................................................ 7
Background of the District ..................................................................................................................... 7
Map to the District ................................................................................................................................... 8
Demography ........................................................................................................................................... 8
Socio-Economic Indicators .................................................................................................................. 10
Health Indicators .................................................................................................................................... 10
Organizational Structure of District Health Administration ............................................................ 10
Health Resources .................................................................................................................................. 11
1. Health Facilities ......................................................................................................................... 11
a) Public ................................................................................................................................... 11
b) Private ................................................................................................................................. 12
2. Human Resource ....................................................................................................................... 12
a) Administrative .................................................................................................................... 12
b) Facility Based ...................................................................................................................... 13
c) Outreach .............................................................................................................................. 18
d) Training Institutions ........................................................................................................... 19
Health Financing ................................................................................................................................... 19
Disease Pattern ..................................................................................................................................... 20
Status of Vertical Programs ................................................................................................................. 22
1. National Program for FP & PHC ............................................................................................... 22
2. EPI ............................................................................................................................................... 22
3. MNCH Program .......................................................................................................................... 23
4. TB Control Program ................................................................................................................... 23
5. Malaria Control Program .......................................................................................................... 23
6. Hepatitis Control Program ....................................................................................................... 24
7. School Health Services Program .............................................................................................. 24
SECTION 2: PROBLEM ANALYSIS ....................................................................................................... 25
Objectives .............................................................................................................................................. 25
Plan Development Process .................................................................................................................. 25
Problem Identification ......................................................................................................................... 26
Health Problems ................................................................................................................................... 26
Problem Prioritization ........................................................................................................................ 27
Underlying causes of prioritized problems .................................................................................... 29

3

Service delivery/Management problems ........................................................................................... 30
MDGs and MSDS ................................................................................................................................... 31
a) Human Resource .................................................................................................................... 32
DHQ Hospital 1( Mian Munshi) .................................................................................................... 32
THQ Hospital Shahdara ................................................................................................................. 33
b) Equipment .............................................................................................................................. 34
DHQ Hospital-1 Mian Munshi ...................................................................................................... 35
DHQ Hospital Kot Khw. Saeed ..................................................................................................... 40
THQ Hospital Mozang ................................................................................................................... 45
SECTION 3: INTERVENTIONS AND TARGETS ................................................................................... 66
Health Problems ................................................................................................................................... 67
Management Problems ........................................................................................................................ 78
Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned Posts ................ 78
SECTION 4: COSTING AND FINANCING PLAN ................................................................................... 79
Activity based costing .......................................................................................................................... 79
Problem wise costing of Health Problems ............................................................................................. 79
a) Health Problems .................................................................................................................... 80
Problem wise costing of Management Problem .................................................................................... 92
b) Management Problems ......................................................................................................... 93
Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned Posts ................ 93
Financial Outlay .................................................................................................................................... 99
Budget Summary ............................................................................................................................... 99
SECTION 5: MONITORING & EVALUATION ..................................................................................... 100
M&E of Plan ......................................................................................................................................... 100
Annex-I ................................................................................................................................................ 103


4

Acronyms

3YRP Three Years Rolling plan
ADB Asian Development Bank
APMO Additional Principal Medical Officer
ARI Acute Respiratory Infections
BHU Basic Health Center
BoD Burden of Dieses
CDC Communicable Disease Control
CDR Case Detection Rate
CPR Contraceptive Prevalence Rate
DHIS District Health Information System
DHQH District Head Quarter Hospital
DoH Department of Health
DR Default Rate
EDO(H) Executive District Officer Health
EPI Expended Program on Immunization
HSRP Health Sector Reforms Program
IMR Infant Mortality Rate
IPC Interpersonal Communication
M & E Monitoring and Evaluation
M & E Maintenance and Repair
MCH Maternal Child Health
MMR Maternal Mortality Ratio
MNCH Maternal Newborn and Child Health
MO Medical Officer
MoV Means of Verification
MSDS Minimum Service Delivery Standards
PDSSP Punjab Devolved Social Services Program
PHC Primary Health Care
PMO Principal Medial Officer
POL Petrol, Oil and Lubricant
RHC Rural Health Center
SCR Sputum Conversion Rate
SHC Secondary Health Care
SMO Senior Medical Officer
TAMA Technical Assistance Management Agency
TB Tuberculosis
THQH Tehsil Head Quarter Hospital
TNA Training Need Assessment
WHO World Health Organization
WMO Women Medical Officer

5

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

6

year. Section Four consists of costing based on additional requirements taking account of
implementation of current status of activities. Best available estimates have been used to
accurately cost the activities. The detailed activity based costing of the Health and Service
Delivery problems has been developed on automated Excel sheets, and annexed for details as
ready reference. Last section of the 3YRP consists of Monitoring and Evaluation of plan to gauge
the progress of different activities and targets of the plan using reliable district data sources.
This permits timely remedial action for smooth implementation of planned activities.


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LAHORE
_____________________________________________________________________________________________________________

SECTION 1: DISTRICT HEALTH PROFILE

Vision of the District

The District Health Government Lahore is looking to provide efficient Health Care Delivery
Services through 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 Lahore district.

Mission of the District

The District Health Government Lahore 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

Lahore is the 5
th
largest city in South Asia and 30
th
largest city in the world. It is also the 2
nd

largest as well as 2
nd
most populous city of Pakistan. The city of Lahore is bounded by
Sheikhupura district in the West and by Wagha on the east, while on South it is surrounded by
the Kasur district on the northern side it is bordered by Ravi River.
Lahore is well connected through a wide Road and rail networks. The city is easily accessible
from different parts of the country and world through air transport.


8

Map to the District

Demography

o Total Population 8190421
o Total Area 2014 square kilometers
o Annual growth rate 5.6%
o Population density 8,200 persons per sq. km
o
Area-wise population
Area Population Percentage
Rural 2076174 25.35%
Urban 6114247 74.65%
Source: Standard Demographic population groups based on DHIS


9

Gender-wise population
Gender Population Percentage
Male 3685690 45%
Female 4504731 55%
Source: Standard Demographic population groups based on DHIS
Population groups
Population Groups
Standard
Demographic (%)
Estimated
Population
Under 1 year of age 2.7 221141
Under 5 years 13.4 296329
Under 15 years 44 130385
Women in child bearing age (15-49
years)
22 28685

Married Child Bearing age Women 16 38437
Expected pregnancies 3.4 1307
Standard Demographic population groups based on DHIS

Tehsil wise distribution
Tehsil/Town Number of UC Population
NISHTAR TOWN 17
972491

GULBERG TOWN 15 801769
AZIZ BHATTI TOWN 13 684010
ALLAMA IQBAL TOWN 19 1160619
RAVI TOWN 18 1044030
SHALAMAR TOWN 17 868513
SAMNABAD TOWN 19 1039831
WAGAH TOWN 12 655773
DATA GUNJ BUKSH TOWN 18 963385

Languages: Urdu, Punjabi and English are the main languages spoken in the district.


10

Socio-Economic Indicators

Education and Literacy

Literacy rate Male Female
Urban 77.9% 69.9%
Rural ---- ---
Overall District 74 %
Source: EDOH Office Lahore

Health Indicators

Infant Mortality Rate 50/1000 live births

Under 5 mortality Rate 68/1000
Maternal mortality Ratio 236/1000
Malnutrition (women and children) Male 27%,Female 25% Total=26%
Life expectancy 63 years approximately.
Proportion of children under 1 years
Immunized against measles 92%
Sources: EDO (Health) Lahore

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 18
th
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:


11

EXECUTIVE DISTRICT OFFICER(HEALTH)
DISTRICT COORDINATION OFFICER
SENIOR DRUG
INSPECTOR/
SEC. DQCB
DOH-III
LAHORE
DOH (HQ)
EDO(H) OFFICE
DOH-II
LAHORE
DO(PH)
LAHORE
DOH-I
LAHORE
MS
DHQ/THQ
HOSPITALS
10 DRUG
INSPECTORS
01 FOR EACH
TOWN
INCLUDING
CANTONMENT
DO-MCH
MCH CENTERS
(55)
DDOH
1.Vacc. Staff
2.Dog Killing Staff
3. Malaria Control Staff
4. Death & Birth Reg.
1. Diagnostic Center
2. Dispensaries
3. Unani Shifa Khanas
4. Homeo Dispen.
5. DHDC
Rural Disp.
(24) DO (Food)
1.Chief Food Insp.
2.Food Insp.
EXECUTIVE DISTRICT OFFICER(HEALTH)
DISTRICT COORDINATION OFFICER
ORGANOGRAM
Estab. Of EDO(H)
Office

Health Resources

1. Health Facilities

a) Public
A Detail of physical infrastructure of public health facilities under the administrative control of
EDO (health) in the district is given below.

Facility Type Name of Facility
Bed
Strength
No. of
Functional
Beds
Remarks
DHQ Hospital Government Mian Munshi
Hospital- DHQ-I
Government Kot Khawaja
Saeed Hospital- DHQ-II
150
149
150
149
DHQ Hospitals
required to be up -
graded
THQ Hospital
Said Mutha Hosptal -THQ-I-
Mozang Hospital-THQ-II
50
20
50
20

RHCs 6 RHCS 120 120 -----
BHUs 37 74 74
------
MCH Centers 23 --- ---
------

12

Data source: DHIS/EDOH office

b) Private

The district has town wise exhaustive lists 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. It is not possible to annex at all the lists of private providers working in mega
city of Lahore.

2. Human Resource

The Human resource of district health department has been placed in following
Categories:

a) Administrative
b) Facility based
c) Outreach
d) Training institutions

a) Administrative

Sr.
No.
Name of Post Sanctioned Filled
1 Executive District Officer Health 1 1
2 District Officer Health 5 5
3 Deputy District Officer Health 1 1
4 Program Director DHDC 1 1
5 District Coordinator National Program 0 1
6 District Coordinator EPI Surveillance 0 1
7 District Sanitary Inspector 1 0
8 CDC Officer 1 0
9 CDC Inspector 2 2
10 Drug Inspector 10 10
11 District Superintendent Vaccination 3 3
12 Assistant Superintendent Vaccination 4 0
13 Tehsil Sanitary Inspector 1 1
Sub Health
Centers
2 --- ---
------
TB Clinics Government infectious
diseases hospital

Health houses 1856 ---- -----
------

13

14 Inspector Vaccination 3 3

b) Facility Based

i. Basic Health Unsets (37)

Sr.
#
Name of Post/Designation Sanctioned Filled Vacant
1 Medical Officer 37
37 0
2 School Health & Nutrition Supervisor 37
37 0
3 Medical Assistant 10
9 1
4 Computer Operator 37
- -
5 Medical Technician 34
34 0
6 LHV 33
33 0
7 Dispenser 37
37 0
8 Midwife 37
37 0
9 N/Qasid 37
37 0
10 Chowkidar 37
37 0
11 Sanitary Worker 43
43 0
- No information available
ii. Rural Health Centres (6)

Sr.
#
1 Senior Medical Officers 6 6 0
2 Women Medical Officers 6 6 0
3 Dental Surgeons 6 6 0
4 Medical Officers 7 7 0
5 Charge Nurses 36 36 0
6 Homeo Doctors 3 3 0
7 Hakeems 2 2 0
8 Computer Operators 6 6 0
9
Medical / Technician
4 4 0

14

Sr.
#
10
LHV
12 12 0
11
Lab. Technician
6 6 0
12
Dental Technician
6 6 0
13
R.H.I
29 14 15
14
Junior Clerk
6 6 0
15
Vaccinator
0 0 0
16
Homeo Dispenser
3 3 0
17
Dawasaz
2 2 0
18
Radiographer/X-Ray Asstt.
6 6 0
19
Dresser
0 0 0
20
Anesthesia Assistant
6 6 0
21
O.T.A
6 6 0
22
Dispenser
24 24 0
23
Dental Assistant
0 0 0
24
Laboratory Assistant
6 6 0
25
Midwife
27 27 0
26
Driver
7 7 0
27
T.O
6 6 0
28
Homeo Naib Qasid
3 3 0
29
Dawa Kob
2 2 0
30
Ward Servant
12 12 0
31
Sweepers
24 24 0
32
Sanitary Worker
0 0 0
33
Sanitary Patrol
29 29 0
34
Naib Qasid
18 18 0
35
Mali
6 6 0
36
Cook
6 0 0
37
Chowkidar
12 12 0
38
Water Career/Bhashthi
6 6 0

iii. THQ Hospitals (2)


15

S# Name of post Sanctioned Filled
1 Medical Superintendent 2 2
2 APMO. 3 3
3 APWMO. 2 0
4 Gynecologist 2 2
5 Pediatrician 2 2
6 Surgeon 2 0
7 MO/CMO
18 14
8 WMO
7 5
9 Dental Surgeon 1 1
10 Hospital Pharmacist 2 2
11 Head Nurse 2 1
12 Charge Nurses 21 21
13 Homeo Doctor 0 0
14 Hakim 0 0
15 LHV. 2 2
16 Clerk 4 4
17 Dispenser/Dresser 8 2
18 Homeo Dispenser 0 0
19 Dawasaz 0 0
20 OTA. 3 1
21 Radiographer/X-Ray Assistant 3 2
22 Laboratory Assistant 2 2
23 Dental Assistant 0 0
24 Driver 4 4
25 Tub well operator 1 1
26 Midwife 3 3
27 Ward servant 16 16
28 NQ/Dawakob 10 10
29 Bearer 3 3
30 Dhobi 2 2
31 Gate Keeper 4 4

16

32 Mashki 0 0
33 Baildar 0 0
34 Chowkidar 4 4
35 Cook 2 2

iv. DHQ Hospital (2)

1 Medical Superintendent 2 2
2 Chief Consultant 0 0
3 PMO 0 0
4 PWMO 0 0
5 AMS 1 0
6 APMO 12 5
7 APWMO 9 2
8 Physician 4 4
9 Anesthetist 6 5
10 Cardiologist 4 0
11 Chest specialist 2 0
12 DMS 3 0
SMO 2 1
13 Neuro Surgeon 0 0
14 Nursing Superintendent 5 3
15 Nephrologist 1 1
16 Pediatrician 2 2
17 Pathologist 2 0
18 Radiologist 2 2
19 Surgeon 4 2
20 E.N.T. Specialist 2 0
21 Eye Specialist 2 2
22 Senior Dental Surgeon 1 1

17

23 Urologist 2 0
24 Dental Surgeon 2 2
25 Internees 0 0
26 Medical Officer 117 91
27 Pharmacist 6 6
28 Physiotherapist 2 2
29 W.M.O 40 19
30 Charge Nurses 324 217
31 Head Nurse 16 8
32 Male Nurse 0 0
33 Hakeem 0 0
34 Homeo Doctor 2 2
35 Almoner 1 1
36 Computer Operator 4 4
37 Stenographer 2 2
38 Accountant 2 1
39 E.C.G. Technician 8 6
Haemo Technician 0 0
CT Technician 0 0
40 Senior Clerk 4 2
41 Sanitary Inspector 6 6
42 Junior Clerk 9 9
43 Dawasaz 0 0
44 Dispenser 33 26
45 Homeo Dispenser 2 1
46 Operation Theater Assistant 20 7
47 Physiotherapist Aid 1 1
48 Radiographer 2 2
49 Dental Assistant 0 0
50 Lab. Assistant 8 5
51 Store Keeper 6 5
52 Driver 15 13

18

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 Sanctioned Filled
Vaccinators 365 365
CDC Supervisors 37 37
Sanitary Inspectors 45 45

53 Midwife 2 2
54 Tailor Master 4 4
55 Tube well Operator 5 5
56 Lab. Attendant 9 9
57 O.T. Attendant 14 14
58 X-Ray Attendant 2 2
59 Ambulance Cleaner 0 0
60 Bearer 0 0
61 Baildar 5 5
62 Chowkidar 18 18
63 Cook 8 8
64 Dawakob 0 0
65 Dhobi 8 8
66 Gate Man 18 18
67 Mali 8 8
68 Masalchi 1 1
69 Sanitary Worker 90 90
70 Ward Cleaner 40 40
71 Ward Servant 75 75
72 Water Carrier 0 0
73 Naib Qasid 29 29

19

d) Training Institutions

A number of training institutions are working in the district which includes the following:
i. DHDC
Post Sanctioned Filled
Programme Director 1
1
MPPT
0 0
LHV Trainer 1
1
Assistant
1 1
Driver
0 0
Naib Qasid 1
1
Chowkidar 1
1
Sanitary Worker 0
0

ii. Community Midwifery School
Currently two midwifery schools are functioning at Public Health Nursing School Montgomery Road
and Lady Aitcheson hospital Lahore.

Health Financing

The provision of financial resources at district level is prime responsibility of district
government. However, keeping in view the budget constraints at the district level, federal and
provincial governments also augment financial resources in form of kind and cash, through
different programs. Financial resources of the district during the last three years out of different
sources are given as under:
Rs. Million
Source of funding
Year
2007-08 2008-09 2009-10 up to 02/2010
Allocation Exp. Allocation Exp. Allocation Exp.
Non-Development 673.061 611.802 836.053

821.332 1060.273

611.891
Development --- --- --- --- --- ---

20

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 Total Percentage
Respiratory disease
1 Acute (upper) respiratory infections 256374
42%
2 Pneumonia < 5 yrs. 3869
1%
3 Pneumonia > 5 yrs. 5667
1%
4 TB Suspects 8222
1%
5 Chronic Obstructive Pulmonary Disease 7188
1%
6 Asthma 15798
3%
Gastro Intestinal Disease
7 Diarrhea / Dysentery < 5 yrs 32046
5%
8 Diarrhea / Dysentery > 5 yrs 28532
5%
9 Enteric / Typhoid Fever 3845
1%
10 Worm Infestations 4878
1%
11 Peptic Ulcer Disease 29017
5%
12 Cirrhosis of Liver 1886
0%
Sub Total 673.061 611.802 836.053 821.332 1060.273 611.891
PHSRP 22.000(B)- 22.000(B)- 8.000(E) 5.738(E) - -
PMDGP - - 78.830 63.834 14.995 2.612
PDSSP 7.683(B)
36.884(E)
6.818(B)
7.425(E)
2.661(B)
37.458(E)
2.022(B)
7.121(E)
4.909(E)

-

Provincial Development Funds
(ADP)
3.000(B)
8.087(E)
3.000(B)
6.650(E)
113.910(B) 101.423(B) 197.147(B) 179.374(B)
Grand Total
750.715 657.695 1103.912 1001.470 1277.324 793.877
User charges (like purchi fee, fees
for diagnostic services)
4.742 - 6.880 - 8.991 -

21

Urinary Tract Disease
13 Urinary Tract Infections 12529
2%
14 Nephritis / Nephrosis 382
0%
15 Sexually Transmitted Infections 662
0%
16 Benign Enlargement of Prostrate 735
0%
Other Communicable Diseases
17 Suspected Malaria 6849
1%
18 Suspected Meningitis 1513
0%
19 Fever due to other causes 22801
4%
Vaccine Preventable Disease
20 Suspected Measles 228 0%
21 Suspected Viral Hepatitis 2019 0%
22 Suspected Neonatal Tetanus 322 0%
Cardiovascular Diseases
23 Ischemic heart disease 1017 0%
24 Hypertension 19076 3%
Skin Diseases
25 Scabies 60544 10%
26 Dermatitis 29592 5%
27 Cutaneous Leishmaniasis 51 0%
Endocrine Disease
28 Diabetes Mellitus 21703 4%
Neuro-Psychiatric Diseases
29 Depression
1741
0%
30 Drug Dependence
96
0%
31 Epilepsy
12
0%
Eye & ENT
32 Cataract 1031 0%
33 Trachoma 1110 1%
34 Glaucoma 4335 1%
35 Otitis Media 7839 1%

22

Oral Diseases
36 Dental Caries 12605 2%
Injuries/Poisoning
37 Road traffic accidents 12722 2%
38 Fractures 2117 0%
39 Burns 1660 0%
40 Dog bite 955 0%
41 Snake bite (with signs/symptoms of
poisoning)
6 0%
Miscellaneous Disease
42 Acute Flaccid Paralysis 1737 0%
43 Suspected HIV/AIDS 0 0%

44 Any other Unusual disease (specify) 0% 0%

Total 612589 100%
Source: Compiled from PHC and SHC DHIS Reports

Status of Vertical Programs

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

1. National Program for FP & PHC

No. of seats allocated for LHWs 2167
No. of LHWs working 1856
No. of LHSs working
Percentage of Population covered by the program 20%
Important program indicators
o IMR 53 per/1000 live births

o MMR 227 /100000 live births
o CPR 45%
o No. of antenatal visits 30619

2. EPI

EPI Coverage rate of the district 92%

23

Fully immunized children 0-23 months 98%
Pregnant women received TT vaccine TT.I-84%,TTII-74%
Availability of cold chain equipment Available

3. MNCH Program

LIST OF STAFF MNCH PROGRAM, DISTRICT LAHORE

PUBLIC HEALTH SPECIALIST 1
WMOs 5
CMW TUTOR /CLINICAL TUTOR 1
SOCIAL ORGANIZER 1
ACCOUNTS ASSISTANT 1
LHVs 6
COMPUTER OPERATORS 2
DRIVERS 2
SECURITY GAURDS 4

4. TB Control Program

CDR all types 56%
CDR NSS positive 45%
SCR 95%
TSR 98%
DR 2%

5. Malaria Control Program

No. of slides examined 7919
No. of positive slides 23
Slides positively ratio 0.29
Percentage of plasmodium Falciparum 07%


24

6. Hepatitis Control Program

No. of hepatitis tests conducted for Hepatitis C 15690

No. of persons/patients positive for Hepatitis C 1184
Patients completed treatment for Hepatitis C 520
Patients under treatment for Hepatitis C 141
Patients registered/awaiting for Hepatitis C treatment 250
No. of hepatitis tests conducted for Hepatitis B 15710

No. of persons/patients positive for Hepatitis B 594
Patients under treatment for Hepatitis B 95
Patients registered/awaiting for Hepatitis B treatment 250

7. School Health Services Program

Total visits to the schools 138
No. of students examined 5844
No. of students referred to BHUs 5844
No. of students treated in BHUs 485
No. of schools in catchment areas 225
No. of students 5844
No. of SH & NS 243


25

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 by Director General Health Services Punjab. This team received three
days customized training from SP-09 team at divisional headquarters. The main components of
the trainings were: (i) developing a three-year rolling health sector plan using the standard
three year rolling plan format; (ii) costing of the plan; (iii) preparing related budget projections;
(iv) accounting procedures; (v) preparing adequate financial reports on the use of funds.

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

26

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.

1. Diarrheal Diseases 2. Acute respiratory tract
infections (ARI)
3. Pulmonary Tuberculosis
4. Hepatitis 5. High under 5 Mortality 6. Ischemic Heart disease
7. High Maternal Mortality 8. Diabetes mellitus 9. Anemia (including in
pregnancy)
10. Dog Bite 11. Scabies 12. Hypertension
13. Road side accident &
Injuries
14. Peptic Ulcer Diseases 15. Asthma
16. UTI 17. Dental Caries


27

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.


28

Problem Magnitude

Severity

Vulnerability to
intervention
Cost
Effectiveness
Political
Expediency
Total
Score
Priority
Number
Diarrheal Diseases
4 3 4 4 2 17 1
ARI (under 5)
4 3 4 4 2 17 2
Pulmonary Tuberculosis
3 1 4 4 3 15 8
Hepatitis
4 3 2 2 4 15 6
High under five mortality
3 4 3 3 3 16 4
Ischemic Heart disease
3 4 2 2 2 13 11
High maternal mortality
3 4 3 3 4 17 3
Diabetes mellitus
3 2 3 3 2 13 9
Anemia ( including in
pregnancy)
2 2 4 4 4 16 5
Dog Bite
1 1 4 4 2 12 13
Scabies
4 2 4 3 2 15 7
Hypertension
2 3 2 3 1 11 15
Road side accident & Injuries
2 3 3 2 2 12 12
Peptic ulcer Disease
2 2 3 2 1 10 16
Asthma
2 2 3 3 1 11 14
Urinary Tract Infections
2 2 3 2 1 10 17
Dental Caries
2 3 3 3 2 13 10

29

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
1 Diarrheal Diseases

Poor sanitation
Lack of safe drinking water
Unhygienic practices
Lack of awareness in general population
Lack of awareness among mothers about feeding and weaning practices
Low Socio Economic status
Malnutrition

2 Acute (upper)
respiratory infections

Malnutrition
Air contamination
Over-crowding/Poor housing facilities
Lack of proper sanitation
Seasonal variation
Lack of awareness and hygienic practices

3 High MMR

Poor access to healthcare delivery services
Lack of awareness about danger signs of pregnancy
Low ante-natal coverage
Low skilled birth attendance
Three delays (seeking health care, transportation, and lack of referral
back-up services)
Complications of pregnancy
Capacity Issues related to maternal care
Maternal Anemia
Pregnancy following chronic severe diseases

30

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
4

High under 5 Mortality

Poor antenatal natal and post natal coverage
Neo-natal Infections
Birth Trauma & Asphyxia
Prematurity
Poor feeding and weaning practices
Diarrhea
ARI
Lack of capacity of staff for provision of proper child health care
(diagnostic and timely referrals)
Low socio economic status
Malnutrition
Lack of birth spacing
Low EPI Coverage
5 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
6 Hepatitis

Poor sanitation
Unsafe drinking water
Sharing of used syringes
Transfusion of unsafe blood and blood products
Unsafe sexual practices
Ear & Nose piercing and tattooing
Use of unsterilized equipment by dentists and barbers

7 TB Suspects

Low socio-economic status
Seasonal variation
Lack of proper sanitation
Lack of awareness and hygienic practices
8 Scabies

Lack of awareness
Unhygienic practices
Over-crowding/Poor housing facilities
Poor water and sanitation
Seasonal variation


31

at provincial or district level has been specifically mentioned. The planning team discussed these
problems in detail and enlisted the main problems as under

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.

Sr.No Problem/cause
1 Shortage of human resource due to:
Ban on permanent postings
Non availability of incentivized pay package and career structure
Medico-legal work for WMOs
Non sanctioning of posts according to MSDS

2 Deficient facilities for smooth functioning of :
DHDC
DHIS Cell

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

3 Capacity issues of staff related to:
Financial Management
Supportive Supervision
Use of information in decision making
4 Shortage of Vehicles
Ambulances(7)
Mobile Clinic Ambulances(2)
Suzuki Car(800 CC)

5 Shortage of equipment
General equipment( for various facilities)
MNCH related

32

a) Human Resource

With regard to MSDS gap analysis for human resource, the difference between the standards
proposed in MSDS and filled posts has been calculated as the vacancy gap. The hospitals have
been categorized based on their bed strength as follows:

Hospital Category Bed Strength
DHQ Hospital
A 400 and above Beds
B 251-400 Beds
C Up to 250 Beds
THQ Hospital
A Above 60 Beds
B 41-60 Beds
C Up to 40 Beds

DHQ Hospital 1( Mian Munshi)
Sr.
No.
Post Standard
as per
MSDS
Sanctioned

Filled Vacancy
Gap in
relation to
sanctioned
positions
Vacancy
Gap in
relation
to filled
positions
1 Gynaecologist 3 3 3 0 0
2 Paediatricians 3 1 1 2 2
3 Anesthetists 3 2 1 1 2
4 Medical Officers
including
SMO,APMO & PMOs
74 47 31 27 43
5 Women Medical
Officers including
SWMO, APWMO
&PMOs
27 18 11 9 16
6 Lady Health
Visitors
11 4 3 7 8
7 Nurses 75 47 45 28 30

DHQ Hospital 2 (Kot Khawaja Saeed)

Sr.
No.
Post Standard
as per
MSDS
Sanctioned

Filled Vacancy
Gap in
relation to
sanctioned
positions
Vacancy
Gap in
relation
to filled
positions
4 Medical Officers
including
SMO,APMO & PMOs
74 84 66 0 8

33

Sr.
No.
Post Standard
as per
MSDS
Sanctioned

Filled Vacancy
Gap in
relation to
sanctioned
positions
Vacancy
Gap in
relation
to filled
positions
5 Women Medical
Officers including
SWMO, APWMO
&PMOs
27 33 21 0 6
6 Lady Health
Visitors
11 4 4 7 7
7 Nurses 75 196 181 0 0

THQ Hospital Shahdara

Sr.
No.
Post Standard
as per
MSDS

Sanctioned

Filled Vacancy
Gap in
relation to
sanctioned
positions
Vacancy
Gap in
relation
to filled
positions
4 Medical Officers
including
SMO,APMO &
PMOs
16 6 4 10 12
5 Women Medical
Officers including
SWMO APWMO
& PMOs
9 3 3 6 6
6 Lady Health
Visitors
8 1 1 7 7
7 Nurses 15 5 5 10 10

THQ Hospital Model Town
Sr. No. Post Standard as
per MSDS

Sanctioned

Filled Vacancy Gap
in relation to
sanctioned
positions
1 Gynaecologist 2 2 2 0
2 Paediatricians 2 1 1 1
3 Anesthetists 3 1 1 2
4 Medical Officers
including
SMO,APMO &
PMOs
16 11 5
5 Women Medical
Officers including
SWMO APWMO &
PMOs
9 5 4

34

Sr. No. Post Standard as
per MSDS

Sanctioned

Filled Vacancy Gap
in relation to
sanctioned
positions
6 Lady Health Visitors 8 1 7
7 Nurses 15 11 4

THQ Hospital Said Mittah

Sr.
No.
Post Standard
as per
MSDS

Sanctioned

Filled Vacancy
Gap in
relation to
sanctioned
posts
Vacancy
Gap in
relation to
filled posts
4 Medical Officers
including
SMO,APMO & PMOs
19 10 5 9 14
5 Women Medical
Officers including
SWMO APWMO &
PMOs
10 3 1 7 9
6 Lady Health Visitors 8 1 1 7 7
7 Nurses 24 12 11 12 13

THQ Hospital Mozang

Sr.
No.
Post Standard
as per
MSDS

Sanctioned

Filled Vacancy
Gap in
relation to
sanctioned
positions
Vacancy
Gap in
relation to
filled
positions
4 Medical Officers
including
SMO,APMO & PMOs
16 11 8 5 8
5 Women Medical
Officers including
SWMO APWMO &
PMOs
9 5 3 4 6
6 Lady Health Visitors 8 1 1 7 7
7 Nurses 15 11 11 4 4

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.

35

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.

DHQ Hospital-1 Mian Munshi

Sr.
No.
Equipment Standard as
per MSDS
(Qty.)
Available Gap Remarks
C B A
1 CTG (Cardiac
Tocography)
1 1 2 2 0
2 Foetal Doppler 3 5 5 5 0
3 Diagnostic Laparoscope 1 1 2 1 0
4 Bulb Sucker 10 20 20 29 0
5 Baby Warmer 3 3 6 2 1
6 Mechanical Sucker 3 3 6 1 2
7 Fetal Stethoscope 4 4 4 2 2
8 Delivery Table 2 2 3 2 0
9 D&C Set 2 3 4 13 0
10 Outlet forceps 4 4 4 11 0
11 Myoma Screw 2 2 2 10 0
12 Kochers forceps 4 4 8 27 0
13 Volselum forceps 6 8 10 23 0
14 Lanes Tissue holding
forceps
2 2 4 24 0
15 Vaginal Retractors 10 10 10 18 0
16 Polypectomy forceps 2 2 2 4 0
17 Sponge holder 10 15 20 30 0
18 Uterine elevator 1 1 1 1 0
19 CosCo Speculum
Small, Medium, Large
(for each category)
6 10 10 25 0
20 Examination light 3 3 6 7 0
21 Suction Curette 1 2 2 5 0

36

Sr.
No.
per MSDS
(Qty.)
C B A
22 Infant Resuscitation
Trolley (with life saving
medicines, baby
laryngoscope, Endo-
tracheal tube, Infant BP
Apparatus, Chargeable
Light)
1 1 2 5 0
23 Mother Resuscitation
medicines,
Laryngoscope, Endo-
tracheal tube, BP
light)
1 1 2 0 1
24 Cardiac Monitor 1 1 2 4 0
25 Pump Breast Electronic 1 1 1 0 1
26 Vaginal Hysterectomy
Set
2 2 4
26.1 Toothed Tissue Forceps
(8)
2 2 4 67 0
26.2 Non-Tooted Tissue
Forceps (8)
2 2 4 34 0
26.3 Dissection Scissors
(Curved 7)
2 2 4 27 0
(Straight 7)
2 2 4 13 0
26.5 Hysterectomy Clamps
(Straight)
8 8 16 6 2
(Curved)
8 8 16 16 0
26.7 Uterine Sound 2 2 4 13 0
26.8 Needle Holder (7) 2 2 4 17 0
26.9 Needle Holder (10) 2 2 4 67 0
26.10 Artery Forceps (Straight
6)
16 16 32 17 0
26.11 Artery Forceps (Curved
6)
16 16 32 34 0
26.12 Allis Forceps 8 8 16 53 0
26.13 Towel Clamps 8 8 16 17 0
26.14 Single blade Sims
speculum
4 4 8 7 0
26.15 Double blade Sims
speculum
4 4 8 17 0
26.16 Sponge holding forceps 8 8 16 35 0
26.17 Volselum forceps 4 4 8 23 0

37

Sr.
No.
per MSDS
(Qty.)
C B A
26.19 Bladder Sound 2 2 4 1 1
27 Delivery Sets 10 10 15
27.1 Episiotomy Scissors 10 10 15 13 0
27.2 Straight Scissors 10 10 15 3 7
27.3 Needle holder 10 10 15 6 4
27.4 Non-toothed tissue
forceps 8 inches
10 10 15 5 5
27.5 Toothed tissue forceps 8
inches
10 10 15 5 5
27.6 Sims Speculum single
blade
20 20 30 7 13
27.7 Sims Speculum double
blade
20 20 30 10 10
27.9 Artery forceps 40 40 60 23 17
27.10 Straight clamps (cord) 20 20 30 12 8
27.11 Vacuum Extractor pump 1 1 1 1 0
27.12 Towel clip 40 40 60 6 34
28 Caesarian Section 6 8 10
28.1 Scalpel 6 8 10 63 0
28.2 Artery Forceps Straight 6
inches
24 32 40 12 12
28.3 Artery Forceps Curved 6
inches
24 32 40 35 0
28.4 Artery forceps 8 inches 24 32 40 2 22
28.5 Myoma Scissors straight
7 inches
6 8 10 15 0
28.6 Dissecting scissors
(curved) 7 inches
6 8 10 8 0
28.7 Green Armtage forceps 8
inches
24 32 40 8 16
28.8 Obstetric outlet forceps
(pair)
6 8 10 20 0
28.9 Doyenes Retractor 6 8 10 10 0
28.10 Small Retractors 12 16 20 10 2
28.11 Towel Clippers 24 32 40 20 4
28.12 Suction Nozzle 6 8 10 11 0

38

Sr.
No.
per MSDS
(Qty.)
C B A
29 MNCH Related
Radiology Equipments

29.1 Ultrasound Machine 1 2 3 2 0
29.2 X-Ray Unit 500 kw 1 1 1 1 0
29.3 Color Doppler 0 1 1 0 0
29.4 Lead Screen for X-Ray
Unit
1 1 1 2 0
29.5 0.5 MN Lead Apron. Lead
Gloves, Goggles and
Thyroid and Gonadal
Sheets
1 1 1 1 0
29.6 Safe Light 1 1 1 1 0
29.7 X-RT Film Processing
Tank
1 1 1 1 0
29.8 Chest Stand 1 1 1 1 0
29.9 X-Ray film Illuminator 2 2 2 12 0
29.10 X-Ray Film Hangers All
sizes
4 4 4 30 0
30 MNCH Related
Paediatrics
Equipments

30.1 Paediatric Ventilator 1 2 2 0 1
30.2 Incubator 1 1 2 2 0
30.3 Photo Therapy Unit 1 1 1 3 0
30.4 Over-head Radiant
Warmer
1 1 1 2 0
30.5 Infant Length Measuring
Scale
2 2 2 1 1
30.6 Infant Weighing Machine 2 2 2 5 0
30.7 Nebulizer 1 1 2 4 0
30.8 Billiubino-meter 1 1 2 0 1
30.9 Exchange Blood
Transfusion Set
1 1 2 0 1
30.10 Nasal Probe Paed size 2 2 4 0 2
31 Anaesthesia/ICU
31.1 Anaesthesia Machine 1 1 2 5 0
31.2 Ventilators 1 1 1 3 0
31.3 Nebulizer 1 1 1 8 0

39

Sr.
No.
per MSDS
(Qty.)
C B A
31.4 Pulse Oximetry 1 1 1 7 0
31.5 Defibrillator 1 1 1 2 0
31.6 Airway Oral and Nasal 2 3 4 70 0
31.7 Tracheostomy tube
(adult and paeds)
2 2 4 2 0
31.8 Face mask of all sizes 2 2 4 10 0
31.9 Double Cuff Tourniquet
(for regional block)
1 2 2 1 0
31.10 AMBO bag adult 2 2 4 12 0
31.11 AMBO Bag paeds 2 2 4 8 0
31.12 Red Rubber Nasal tubes
all sizes without cuff
4 4 8 5 0
32 Blood Bank
32.1 Blood storage cabinet
(100 bag capacity)
1 1 2 2 0
32.2 Packed cell machine 1 1 1 0 1
32.3 Cell Separator 1 1 1 0 1
32.4 Freezer for Fresh Frozen
Plasma
1 1 1 0 1
32.5 Blood bag shaker 1 1 2 0 1
32.6 RH view box 2 2 4 1 1
32.7 Water bath 2 2 2 2 0
32.8 Micro-pipette 4 6 8 1 3
32.9 Blood grouping tiles 3 3 6 2 1
32.10 Plasma Extractor 1 1 1 0 1
32.11 Platelets agitator 1 1 1 0 1
32.12 Blood thawing bath 1 1 1 1 0
32.13 Microscopes 1 1 2 1 0
33 Gynae & Labour Room
Related Laboratory
Equipment

33.1 Hematology Analyzer 1 1 1 1 0
33.2 Electrolyte Analyzer 1 1 1 0 1
33.3 Analyzer Bio-chemistry
Semi-automatic
1 1 1 1 0
33.4 Glucometer 2 2 2 8 0

40

Sr.
No.
per MSDS
(Qty.)
C B A
33.5 Haemoglobino-meter 2 2 4 1 1
33.6 Centrifuge 1 1 2 2 0

DHQ Hospital Kot Khw. Saeed

Sr.
No.
per MSDS
(Qty.)
C B A
1 CTG (Cardiac
Tocography)
1 1 2 1 0
4 Bulb Sucker 10 20 20 6 4
9 D&C Set 2 3 4 14 0
forceps
2 2 4 36 0

41

Sr.
No.
per MSDS
(Qty.)
C B A
19 CosCo Speculum
(for each category)
6 10 10 25 0
medicines, baby
laryngoscope, Endo-
Light)
1 1 2 1 0
medicines,
Laryngoscope, Endo-
tracheal tube, BP
light)
1 1 2 0 1
Set
2 2 4 2
(8)
2 2 4 0 2
Forceps (8)
2 2 4 0 2
(Curved 7)
2 2 4 0 2
(Straight 7)
2 2 4 0 2
(Straight)
8 8 16 15 0
(Curved)
8 8 16 12 0
26.8 Needle Holder (7) 2 2 4 0 2
26.9 Needle Holder (10) 2 2 4 0 2
6)
16 16 32 12 4
6)
16 16 32 24 0
26.12 Allis Forceps 8 8 16 39 0
26.13 Towel Clamps 8 8 16 130 0
speculum
4 4 8 0 4

42

Sr.
No.
per MSDS
(Qty.)
C B A
speculum
4 4 8 0 4
27 Delivery Sets 10 10 15 13
27.3 Needle holder 10 10 15 94 0
forceps 8 inches
10 10 15 0 10
inches
10 10 15 0 10
blade
20 20 30 0 20
blade
20 20 30 0 20
27.9 Artery forceps 40 40 60 40 0
27.12 Towel clip 40 40 60 0 40
28 Caesarian Section 6 8 10 18
28.1 Scalpel 6 8 10 0 6
inches
24 32 40 0 24
inches
24 32 40 28 0
7 inches
6 8 10 0 6
(curved) 7 inches
6 8 10 6 0
inches
24 32 40 6 18
(pair)
6 8 10 0 6

43

Sr.
No.
per MSDS
(Qty.)
C B A
28.11 Towel Clippers 24 32 40 0 24
29 MNCH Related

29.2 X-Ray Unit 500 kw 1 1 1 0 1
Unit
1 1 1 2 0
Gloves, Goggles and
Thyroid and Gonadal
Sheets
1 1 1 4 0
29.6 Safe Light 1 1 1 3 0
Tank
1 1 1 2 0
29.8 Chest Stand 1 1 1 2 0
sizes
4 4 4 65 0
30 MNCH Related
Paediatrics
Equipments

30.2 Incubator 1 1 2 7 0
Warmer
1 1 1 0 1
Scale
2 2 2 0 2
30.7 Nebulizer 1 1 2 15 0
30.9 Exchange Blood
Transfusion Set
1 1 2 0 1
31 Anaesthesia/ICU

44

Sr.
No.
per MSDS
(Qty.)
C B A
31.3 Nebulizer 1 1 1 0 1
(adult and paeds)
2 2 4 0 2
1 2 2 0 1
31.10 AMBO bag adult 2 2 4 16 0
4 4 8 0 4
32 Blood Bank
(100 bag capacity)
1 1 2 2 0
Plasma
1 1 1 0 1
32.6 RH view box 2 2 4 1 1
32.7 Water bath 2 2 2 1 1
Related Laboratory
Equipment


45

Sr.
No.
per MSDS
(Qty.)
C B A
Semi-automatic
1 1 1 2 0
33.4 Glucometer 2 2 2 10 0

THQ Hospital Mozang

Sr.
No.
per MSDS
(Qty.)
C B A
1 CTG (Cardiac
Tocography)
1 1 2 2 0
4 Bulb Sucker 10 20 20 20 0
9 D&C Set 2 3 4 18 0
forceps
2 2 4 10 0

46

Sr.
No.
per MSDS
(Qty.)
C B A
19 CosCo Speculum
(for each category)
6 10 10 11 0
medicines, baby
laryngoscope, Endo-
Light)
1 1 2 1 0
medicines,
Laryngoscope, Endo-
tracheal tube, BP
light)
1 1 2 0 1
Set
2 2 4 5
(8)
2 2 4 10 0
Forceps (8)
2 2 4 12 0
(Curved 7)
2 2 4 9 0
(Straight 7)
2 2 4 9 0
(Straight)
8 8 16 20 0
(Curved)
8 8 16 15 0
26.8 Needle Holder (7) 2 2 4 13 0
26.9 Needle Holder (10) 2 2 4 21 0
6)
16 16 32 36 0
6)
16 16 32 28 0

47

Sr.
No.
per MSDS
(Qty.)
C B A
26.12 Allis Forceps 8 8 16 17 0
26.13 Towel Clamps 8 8 16 12 0
speculum
4 4 8 4 0
speculum
4 4 8 6 0
27.3 Needle holder 10 10 15 57 0
forceps 8 inches
10 10 15 10 0
inches
10 10 15 20 0
blade
20 20 30 14 6
blade
20 20 30 9 11
27.9 Artery forceps 40 40 60 15 35
27.12 Towel clip 40 40 60 12 28
28.1 Scalpel 6 8 10 18 0
inches
24 32 40 20 4
inches
24 32 40 50 0
7 inches
6 8 10 3 3
(curved) 7 inches
6 8 10 22 0

48

Sr.
No.
per MSDS
(Qty.)
C B A
inches
24 32 40 22 2
(pair)
6 8 10 2 4
28.11 Towel Clippers 24 32 40 12 12
29 MNCH Related

29.2 X-Ray Unit 500 kw 1 1 1 1 0
Unit
1 1 1 1 0
Gloves, Goggles and
Thyroid and Gonadal
Sheets
1 1 1 1 0
29.6 Safe Light 1 1 1 1 0
Tank
1 1 1 1 0
29.8 Chest Stand 1 1 1 1 0
sizes
4 4 4 30 0
30 MNCH Related
Paediatrics
Equipments

30.2 Incubator 1 1 2 2 0
Warmer
1 1 1 0 1
Scale
2 2 2 0 2
30.7 Nebulizer 1 1 2 5 0

49

Sr.
No.
per MSDS
(Qty.)
C B A
30.9 Exchange Blood
Transfusion Set
1 1 2 0 1
31 Anaesthesia/ICU
31.3 Nebulizer 1 1 1 0 1
(adult and paeds)
2 2 4 0 2
1 2 2 0 1
31.10 AMBO bag adult 2 2 4 2 0
4 4 8 0 4
32 Blood Bank
(100 bag capacity)
1 1 2 0 1
Plasma
1 1 1 0 1
32.6 RH view box 2 2 4 0 2
32.7 Water bath 2 2 2 0 2

50

Sr.
No.
per MSDS
(Qty.)
C B A
Related Laboratory
Equipment

Semi-automatic
1 1 1 1 0

THQ Model Town

Sr.
No.
per MSDS
(Qty.)
C B A
1 CTG (Cardiac
Tocography)
1 1 1 0 1
4 Bulb Sucker 5 10 20 0 5
9 D&C Set 2 2 2 1 1
forceps
2 2 2 0 2

51

Sr.
No.
per MSDS
(Qty.)
C B A
19 CosCo Speculum
(for each category)
4 6 6 0 4
medicines, baby
laryngoscope, Endo-
Light)
1 1 1 0 1
medicines,
Laryngoscope, Endo-
tracheal tube, BP
light)
1 1 1 0 1
Set
2 2 2 0
(8)
2 2 2 0 2
Forceps (8)
2 2 2 0 2
(Curved 7)
2 2 2 0 2
(Straight 7)
2 2 2 0 2
(Straight)
8 8 8 0 8
(Curved)
8 8 8 0 8
26.8 Needle Holder (7) 2 2 4 10 0
26.9 Needle Holder (10) 2 2 2 0 2
6)
16 16 16 08 8
6)
16 16 16 6 10

52

Sr.
No.
per MSDS
(Qty.)
C B A
26.12 Allis Forceps 8 8 8 0 8
26.13 Towel Clamps 8 8 8 0 8
speculum
4 4 4 0 4
speculum
4 4 4 0 4
27 Delivery Sets 6 6 10
27.3 Needle holder 6 6 10 24 0
forceps 8 inches
6 6 10 0 6
inches
6 6 10 0 6
blade
12 12 20 0 12
blade
12 12 20 0 12
27.9 Artery forceps 40 40 40 35 5
27.12 Towel clip 40 40 40 0 40
28.1 Scalpel 4 4 6 0 4
inches
16 16 24 0 16
inches
16 16 24 0 16
7 inches
4 4 6 0 4
(curved) 7 inches
4 4 6 0 4

53

Sr.
No.
per MSDS
(Qty.)
C B A
inches
16 16 24 0 16
(pair)
4 4 6 0 4
28.11 Towel Clippers 16 16 24 0 16
29 MNCH Related

29.2 X-Ray Unit 500 kw 1 1 1 0 1
Unit
1 1 1 0 1
Gloves, Goggles and
Thyroid and Gonadal
Sheets
1 1 1 0 1
29.6 Safe Light 1 1 1 1 0
Tank
1 1 1 2 0
29.8 Chest Stand 1 1 1 2 0
sizes
4 4 4 5 0
30 MNCH Related
Paediatrics
Equipments

30.2 Incubator 1 1 1 1 0
Warmer
1 1 1 0 1
Scale
2 2 2 0 2
30.7 Nebulizer 1 1 1 2 0

54

Sr.
No.
per MSDS
(Qty.)
C B A
30.9 Exchange Blood
Transfusion Set
1 1 1 0 1
31 Anaesthesia/ICU
31.3 Nebulizer 1 1 1 0 1
(adult and paeds)
1 2 2 0 1
1 1 1 0 1
4 4 4 0 4
32 Blood Bank
(100 bag capacity)
1 1 1 0 1
Plasma
1 1 1 0 1
32.6 RH view box 1 2 2 0 1
32.7 Water bath 2 2 2 0 2

55

Sr.
No.
per MSDS
(Qty.)
C B A
Related Laboratory
Equipment

Semi-automatic
1 1 1 0 1

THQ Hospital Said Mittah

Sr.
No.
per MSDS
(Qty.)
C B A
1 CTG (Cardiac
Tocography)
1 1 1 0 1
4 Bulb Sucker 5 10 20 0 5
9 D&C Set 2 2 2 1 1
forceps
2 2 2 0 2

56

Sr.
No.
per MSDS
(Qty.)
C B A
19 CosCo Speculum
(for each category)
4 6 6 0 4
medicines, baby
laryngoscope, Endo-
Light)
1 1 1 0 1
medicines,
Laryngoscope, Endo-
tracheal tube, BP
light)
1 1 1 0 1
Set
2 2 2 0
(8)
2 2 2 0 2
Forceps (8)
2 2 2 0 2
(Curved 7)
2 2 2 0 2
(Straight 7)
2 2 2 0 2
(Straight)
8 8 8 0 8
(Curved)
8 8 8 0 8
26.8 Needle Holder (7) 2 2 4 0 2
26.9 Needle Holder (10) 2 2 2 0 2
6)
16 16 16 0 16
6)
16 16 16 2 14

57

Sr.
No.
per MSDS
(Qty.)
C B A
26.13 Towel Clamps 8 8 8 9 0
speculum
4 4 4 0 4
speculum
4 4 4 0 4
forceps 8 inches
6 6 10 0 6
inches
6 6 10 0 6
blade
12 12 20 0 12
blade
12 12 20 0 12
27.9 Artery forceps 40 40 40 0 40
27.12 Towel clip 40 40 40 0 40
28.1 Scalpel 4 4 6 0 4
inches
16 16 24 0 16
inches
16 16 24 0 16
7 inches
4 4 6 0 4
(curved) 7 inches
4 4 6 0 4

58

Sr.
No.
per MSDS
(Qty.)
C B A
inches
16 16 24 0 16
(pair)
4 4 6 0 4
28.11 Towel Clippers 16 16 24 0 16
29 MNCH Related

29.2 X-Ray Unit 500 kw 1 1 1 0 1
Unit
1 1 1 0 1
Gloves, Goggles and
Thyroid and Gonadal
Sheets
1 1 1 0 1
29.6 Safe Light 1 1 1 1 0
Tank
1 1 1 1 0
29.8 Chest Stand 1 1 1 1 0
sizes
4 4 4 4 0
30 MNCH Related
Paediatrics
Equipments

30.2 Incubator 1 1 1 0 1
Warmer
1 1 1 0 1
Scale
2 2 2 0 2
30.7 Nebulizer 1 1 1 1 0

59

Sr.
No.
per MSDS
(Qty.)
C B A
30.9 Exchange Blood
Transfusion Set
1 1 1 0 1
31 Anaesthesia/ICU
31.3 Nebulizer 1 1 1 0 1
(adult and paeds)
1 2 2 0 1
1 1 1 0 1
4 4 4 0 4
32 Blood Bank
(100 bag capacity)
1 1 1 0 1
Plasma
1 1 1 0 1
32.6 RH view box 1 2 2 0 1
32.7 Water bath 2 2 2 0 2

60

Sr.
No.
per MSDS
(Qty.)
C B A
Related Laboratory
Equipment

Semi-automatic
1 1 1 0 1

THQ Shahdara

Sr.
No.
per MSDS
(Qty.)
C B A
1 CTG (Cardiac
Tocography)
1 1 1 0 1
4 Bulb Sucker 5 10 20 10 0
9 D&C Set 2 2 2 2 0

61

Sr.
No.
per MSDS
(Qty.)
C B A
forceps
2 2 2 0 2
19 CosCo Speculum
(for each category)
4 6 6 0 4
medicines, baby
laryngoscope, Endo-
Light)
1 1 1 0 1
medicines,
Laryngoscope, Endo-
tracheal tube, BP
light)
1 1 1 0 1
Set
2 2 2
(8)
2 2 2 0 2
Forceps (8)
2 2 2 0 2
(Curved 7)
2 2 2 0 2
(Straight 7)
2 2 2 4 0
(Straight)
8 8 8 0 8

62

Sr.
No.
per MSDS
(Qty.)
C B A
(Curved)
8 8 8 0 8
26.8 Needle Holder (7) 2 2 4 0 2
26.9 Needle Holder (10) 2 2 2 0 2
6)
16 16 16 12 4
6)
16 16 16 6 10
26.13 Towel Clamps 8 8 8 0 8
speculum
4 4 4 1 3
speculum
4 4 4 0 4
forceps 8 inches
6 6 10 0 6
inches
6 6 10 0 6
blade
12 12 20 1 11
blade
12 12 20 0 12
27.9 Artery forceps 40 40 40 18 22
27.12 Towel clip 40 40 40 0 40

63

Sr.
No.
per MSDS
(Qty.)
C B A
28.1 Scalpel 4 4 6 0 4
inches
16 16 24 0 16
inches
16 16 24 0 16
7 inches
4 4 6 0 4
(curved) 7 inches
4 4 6 0 4
inches
16 16 24 0 16
(pair)
4 4 6 0 4
28.11 Towel Clippers 16 16 24 0 16
29 MNCH Related

29.2 X-Ray Unit 500 kw 1 1 1 1 0
Unit
1 1 1 0 1
Gloves, Goggles and
Thyroid and Gonadal
Sheets
1 1 1 2 0
29.6 Safe Light 1 1 1 2 0
Tank
1 1 1 1 0
29.8 Chest Stand 1 1 1 1 0
sizes
4 4 4 24 0
30 MNCH Related
Paediatrics
Equipments

30.2 Incubator 1 1 1 0 1

64

Sr.
No.
per MSDS
(Qty.)
C B A
Warmer
1 1 1 0 1
Scale
2 2 2 0 2
30.7 Nebulizer 1 1 1 2 0
30.9 Exchange Blood
Transfusion Set
1 1 1 0 1
31 Anaesthesia/ICU
31.3 Nebulizer 1 1 1 2 0
(adult and paeds)
1 2 2 0 1
1 1 1 0 1
4 4 4 0 4
32 Blood Bank
(100 bag capacity)
1 1 1 0 1
Plasma
1 1 1 0 1
32.6 RH view box 1 2 2 0 1

65

Sr.
No.
per MSDS
(Qty.)
C B A
32.7 Water bath 2 2 2 0 2
Related Laboratory
Equipment

Semi-automatic
1 1 1 1 0


66

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.


67

Health Problems

Sr. No. Problem Causes Intervention Activities Unit
Plan Activities
Targets
Target
for
2010-11
Target
for
2011-12
Target
for
2012-13
Remarks
1
Diarrhea

Poor
sanitation
improvement of
water supply
and sanitation
Quarterly co-
ordination
Meeting under the
chairmanship of
DCO with TMA
and other
agencies
Meeting 12 4 4 4

Lack of safe
drinking
water
Health
Education
campaign
Messages on local
cable network
Message 12 4 4 4

Unhygienic
practices
Improving
literacy rate
through
coordination
with education
department
Printing and
distribution of IPC
material
Boucher 1,000,000 500,000 250,000 250,000

Lack of
awareness in
general
population
Proper
treatment of
Diarrhea
including ORT
Address in school
assemblies
Session 3,800 3,000 800 -

Lack of
awareness
among
mothers about
feeding and
weaning
practices
Capacity
building of
health staff in
Integrated
Management of
Childhood
Illnesses
(IMNCI)
Training of
medics and
paramedics in
IMNCI
No. of
trainings
12 6 6 -

Low Socio
Economic
status
Procurement and
distribution of
ORS
ORS packets 80,000 40,000 20,000 20,000


68

Plan Activities
Targets
Target
for
2010-11
Target
for
2011-12
Target
for
2012-13
Remarks

Malnutrition Procurement and
distribution of
Syp. Zinc Sulfate
Syrup 80,000 40,000 20,000 20,000

Procurement and
Distribution of
Syrup
Metronidazole
Syrup 80,000 40,000 20,000 20,000

Procurement and
Distribution of
Tablet
Metronidazole
400mg
No. of tablets 300,000 150,000 75,000 75,000

Procurement and
Distribution of Inj.
Metronidazole
100ml
Injection 70,000 30,000 20,000 20,000

Procurement and
distribution of IV
fluids ( Infusion
Ringer Lactate
1000 ml) with
drip set
IV Fluids 24,000 8,000 8,000 8,000

2
Acute
(upper)
respiratory
infections
Malnutrition Capacity
building of
health staff in
ARI case
management
Messages on local
cable networks
Message 12 4 4 4


69

Plan Activities
Targets
Target
for
2010-11
Target
for
2011-12
Target
for
2012-13
Remarks

Air
contamination
Capacity
building of
health staff in
Integrated
Management of
Childhood
Illnesses
(IMNCI)
Printing and
distribution of IPC
material
Brochure 300,000 150,000 100,000 50,000

Over-
crowding/Poo
r housing
facilities
Provision of
medicines for
ARI
Training of
medics and para-
medics in IMNCI
No. of
trainings
- - - -

Lack of proper
sanitation
Timely referral
of complicated
cases
Procurement and
distribution of
Antibiotic Syrup
Amoxicillin
Antibiotic
(Syrup)
150,000 80,000 35,000 35,000

Seasonal
variation
Procurement and
distribution of
Antibiotic Syrup
Co-tri
Antibiotic
(Syrup)
100,000 50,000 25,000 25,000

Lack of
awareness
and hygienic
practices
Procurement and
distribution of
Antibiotic Tab.
Co-trimoxazole
BD (Blister Pack)
Tablet 800,000 400,000 200,000 200,000

3
High MMR Poor access to
healthcare
delivery
services
Health
education/prom
otion
Messages on local
cable network
Message 36 12 12 12

Lack of
awareness
about danger
signs of
pregnancy
Behaviour
change
communication
for Mothers of
child bearing age
Printing and
distribution of IPC
material
Brochure 350,000 150,000 100,000 100,000


70

Plan Activities
Targets
Target
for
2010-11
Target
for
2011-12
Target
for
2012-13
Remarks

Low ante-
natal coverage
Provision of
Quality basic
EmONC services
at BHU & RHC
Training of LHWs
on BCC
No. of
trainings
77 77 - -

Low skilled
birth
attendance
Provision of
Quality
Comprehensive
EmONC services
at THQs hospital
Procurement of
vehicles for
transportation
through CCBs
- - - -

Three delays
(seeking
health care,
transportation
, and lack of
referral back-
up services)
Improving
transportation of
the patients
Operation and
management of
vehicles through
CCBs
- - - -

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

Capacity
Issues related
to maternal
care
Replacement of
the non functional
ambulances for
timely
transportation of
pregnant mother
- - - -

Maternal
Anemia
Procurement of
the MNCH related
equipment and
Instruments
- - - -


71

Plan Activities
Targets
Target
for
2010-11
Target
for
2011-12
Target
for
2012-13
Remarks

Pregnancy
following
chronic severe
diseases
Implementation
of the referrals
protocols
- - - -

Procurement of
Micro-nutrients
(Tab. Ferrous
Sulphate )
Packs 7,000 4,000 1,500 1,500

Procurement of
Micro-nutrients
(Tab. Folic Acid)
Packs 20,000 10,000 5,000 5,000

Procurement and
distribution of
Anti-D
Injection 300 100 100 100

4
High under 5
Mortality
Poor
antenatal
natal and post
natal coverage
Health
awareness/educ
ation
Message on local
cable
Message 36 12 12 12

Neo-natal
Infections
Provision of the
quality basic
EMONC services
at BHU & RHC
BCC of mothers
0n promotion of
breast feeding
and weaning
practices through
LHWs
Number of
Trainings
- - - -

Birth Trauma
& Asphyxia
Provision of the
quality
Comprehensive
EMONC services
at THQH &
DHQH
Provision of the
deficient
infrastructure at
DHQH
Assessment - - - -


72

Plan Activities
Targets
Target
for
2010-11
Target
for
2011-12
Target
for
2012-13
Remarks

Prematurity Improvement of
feeding and
weaning
practices
Provision of the
deficient
infrastructure at
THQH
Assessment - - - -

Poor feeding
and weaning
practices
Capacity
building of
Human Resource
dealing child
health care
Trainings on
IMNCI
No. of
trainings
- - - -

Diarrhea Enhancing EPI
coverage
Need assessment
of food
supplements
Assessment - - - -

ARI Poverty
elevation
procurement
from DGHs office
Assessment - - - -

Lack of
capacity of
staff for
provision of
proper child
health care
(diagnostic
and timely
referrals)
Provision of food
supplements
Distribution of
food supplements
to mothers &
children through
LHWs &
community mid
wives
Assessment - - - -

Low socio
economic
status
Raising income of
the poor families
through Baitul
Mall and Zakat
Assessment - - - -

Malnutrition Revising the
micro plans of
Vaccinators
- - - -


73

Plan Activities
Targets
Target
for
2010-11
Target
for
2011-12
Target
for
2012-13
Remarks

Lack of birth
spacing
- - - -

Low EPI
Coverage
- - - -

5
Anemia (
including
pregnancy)
Lack of
awareness
about balanced
diet
Awareness raising
for behavior
change
Messages on local
cable network
Message 12 12 12 1,410,00
0

Gender
discrimination
De-worming
campaign
Printing and
distribution of IPC
material
Brochure 150,000 75,000 75,000 450,000

Social taboos
and norms
Diagnosis and
treatment of
infections
Counseling of
pregnant mothers
Session - - - -

Worm
infestation
Strengthening
MNCH Services
Procurement of
Syp. Albendazole
10ml. For Children
under 10 years
No. of doses 40,000 20,000 20,000 800,000

Infections Equity of services Distribution
through LHWs and
health facilities
- - - -

Poor quality of
MNCH services
Refresher
Trainings of LHWs
on BCC, balanced
diet and provision
of micro-nutrients
No. of
trainings
- - - -


74

Plan Activities
Targets
Target
for
2010-11
Target
for
2011-12
Target
for
2012-13
Remarks

Poverty/ Low
socio economic
status

6
Hepatitis Poor sanitation Health
Education/Promo
tion
Quarterly co-
ordination
meetings with TMA
and other agencies
Meetings - - - -

Unsafe drinking
water
Improving water
& sanitation
Messages on local
cable network
Message 12 12 12 12

Sharing of used
syringes
Campaign against
quackery
Messages on FM
Radio
Message 12 12 12 12

Transfusion of
unsafe blood
and blood
products
Strengthening
blood transfusion
services for safe
transfusions
Printing and
distribution of IPC
material
Brochure 100,000 50,000 50,000 100,000

Unsafe sexual
practices
Regulatory
mechanism to
ensure use of safe
instruments by
dentists, barbers
etc.
Printing and
pasting of stickers
at clinics and
Barber shop
highlighting use of
new syringes &
Razors
Stickers 2,000 - - 2,000

Ear & Nose
piercing and
tattooing
Hepatitis
awareness week (
walk/display
banners/seminars)
1 1 1 1


75

Plan Activities
Targets
Target
for
2010-11
Target
for
2011-12
Target
for
2012-13
Remarks

Use of
unsterilized
equipment by
dentists and
barbers
Procurement and
supply of Eliza kits
for Hepatitis B
Kits 10 10 10 10

Procurement and
for Hepatitis C
Kits 10 10 10 10

Procurement of
syringe cutters
Syringe
cutter
- - - -

Procurement and
distribution of
Interferon Injection
Courses 200 150 150 200

Procurement and
supply of HCV
Device
Devices 50,000 50,000 50,000 50,000

Procurement and
supply of HbsAg
Device
Devices 50,000 50,000 50,000 50,000

Procurement and
supply of HIV
Device
Devices 10,000 10,000 10,000 10,000

Documentation of
expense of
disposable syringes


76

Plan Activities
Targets
Target
for
2010-11
Target
for
2011-12
Target
for
2012-13
Remarks

Supportive
supervision to
ensure above
activities

7
Scabies Lack of
awareness
Health education
& Promotion
Messages on local
cable networks
Message 12 4 4 12

Unhygienic
practices
Improving water
and sanitation
Printing and
distribution of IPC
material
Brochure 800,000 400,000 200,000 800,000

Over-
crowding/Poor
housing
facilities
Proper diagnosis
and treatment
Procurement and
distribution of
Benzyl Benzoate
Lotion
Lotion 300,000 150,000 75,000 300,000

Poor water and
sanitation

8
TB Suspects Low socio-
economic
status
Health
education/promo
tion
Messages on local
cable networks
Message 36 12 12 12

Seasonal
variation
Strengthening TB
DOTS program
through
involvement of
private sector
Printing and
distribution of IPC
material
Brochure 75,000 25,000 25,000 25,000

Lack of proper
sanitation
Involvement of
private providers
through public
private
partnership
Procurement of
drugs to ensure
deficiency
according to
regimen
ATT course 600 200 200 200


77

Plan Activities
Targets
Target
for
2010-11
Target
for
2011-12
Target
for
2012-13
Remarks

Lack of
awareness and
hygienic
practices
Procurement of
reagents for
notified diagnostic
facilities under
DOTS programme
Packs 50 20 15 15

Trainings on DOTS
protocols
No. of
trainings
11 5 3 3


78

Management Problems

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

Sr.No. Name of Post
Basic
Scale
Basic Pay Allowances
Requirement as per
Gap
Physical Targets
Year I Year II Year III
1
Gynecologist 18 12,910 18,099 1 1 - -
2
Pediatricians 18 12,910 18,099 7 3 2 2
3
Anesthetists 18 12,910 18,099 9 3 3 3
4
MO / WMO 17 9,850 15,345 86 30 30 26
5
Nurses 16 6,060 8,934 42 15 15 12
6
Lady Health Visitors 9 3,820 4,750 58 20 20 18


79

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 hyperlinked as
H & M Sheet. A moderate estimate of equipment cost has been taken, as there is wide
variation between the minimum and maximum cost. The detailed cost of MNCH equipment
has been annexed as Annex I
The summary of problem and activity wise costing is given below.

Problem wise costing of Health Problems

Sr.
No.
Health Problem
2010-2011 2011-2012 2012-2013
Total Cost Rs.
Amount (Rs.)
Amount
(Rs.)
Amount
(Rs.)
1 Diarrheal Diseases

8,458,400

4,893,240

4,189,020

17,540,660
2 ARI (under 5)

4,460,000

2,695,000

2,722,500

9,877,500
3 High maternal mortality

3,770,300

2,598,750

2,858,625

9,227,675
4 High under five mortality

1,410,000

1,551,000

1,706,100

4,667,100
5
Anemia ( including in
pregnancy)

2,660,000

2,238,500

2,462,350

7,360,850
6 Hepatitis

9,216,000

8,967,600

9,849,360

28,032,960
7 Scabies

3,920,000

2,414,500

2,655,950

8,990,450
8 Tuberculosis

1,212,000

1,241,680

1,365,848

3,819,528

Total

35,106,700

26,600,270

27,809,753

89,516,723

80

a) Health Problems
Sr. Problem Activity
Define Financial Targets
Total
Cost
Unit Rate Quantity Year I
Year II
(10 %)
Year III
(10 %)
1
Diarrhea

Quarterly co-
ordination
Meeting under the
chairmanship of
DCO with TMA
and other
agencies
Meeting 3,000 12 12,000 13,200 14,520 39,720
Messages on local
cable network
Message 117,500 12 470,000 517,000 568,700 1,555,700
Printing and
distribution of IPC
material
Brochure 3 1,000,000 1,500,000 825,000 907,500 3,232,500

Address in school
assemblies
Session school health &
nutrition supervisor
gives address to the
school assemblies
3,800 - - - -
Training of
medics and
paramedics in
IMNCI
No. of
trainings
164,400 12 986,400 1,085,040 - 2,071,440

Procurement and
distribution of
ORS
ORS packets 6 80,000 240,000 132,000 145,200 517,200

81

Total
Cost
Year II
(10 %)
Year III
(10 %)

Procurement and
distribution of
Syp. Zinc Sulfate
Syrup 35 80,000 1,400,000 770,000 847,000 3,017,000
Procurement and
Distribution of
Syrp
Metronidazole
Syrup 12 80,000 480,000 264,000 290,400 1,034,400

Procurement and
Distribution of
Tablet
Metronidazole
400mg
No. of tablets 2 300,000 600,000 165,000 181,500 946,500

Procurement and
Distribution of Inj.
Metronidazole
100ml
Injection 35 70,000 2,450,000 770,000 847,000 4,067,000

Procurement and
distribution of IV
fluids ( Inje.
Ringer Lactate
1000 ml) with
drip set
IV Fluids 40 24,000 320,000 352,000 387,200 1,059,200
8,458,400 4,893,240 4,189,020 17,540,660

82

Total
Cost
Year II
(10 %)
Year III
(10 %)
2
Acute (upper)
respiratory
infections
Messages on local
cable networks
Message 117,500 12 470,000 517,000 568,700 1,555,700

Printing and
distribution of IPC
material
Brochure 4 300,000 600,000 440,000 242,000 1,282,000

Training of
medics and para-
medics in IMNCI
No. of
trainings
IMNCI Training
package costed in
Diarrhea also
includes
management of ARI
- - - - -

Procurement and
distribution of
Antibiotic Syrup
Amoxicillin
Antibiotic
(Syrup)
23 150,000 1,840,000 885,500 974,050 3,699,550

Procurement and
distribution of
Antibiotic Syrup
Co-tri
Antibiotic
(Syrup)
15 100,000 750,000 412,500 453,750 1,616,250

Procurement and
distribution of
Antibiotic Tab. Co-
trimoxazole DD
(Blister Pack)
Tablet 2 800,000 800,000 440,000 484,000 1,724,000

4,460,000 2,695,000 2,722,500 9,877,500

83

Total
Cost
Year II
(10 %)
Year III
(10 %)
3
High MMR Messages on local
cable network
Message 117,500 36 1,410,000 1,551,000 1,706,100 4,667,100

Printing and
distribution of IPC
material
Brochure 3 350,000 450,000 330,000 363,000 1,143,000

Training of LHWs
on BCC
No. of
trainings
13,900 77 1,070,300 - - 1,070,300

Procurement of
vehicles for
transportation
through CCBs
Costed in service
delivery problems
- - - -

Operation and
management of
vehicles through
CCBs
Costed in service
delivery problems
- - - - -

Repair of non
functional
ambulances for
timely
transportation of
pregnant mothers
Costed in service
delivery problems
- - - - -

84

Total
Cost
Year II
(10 %)
Year III
(10 %)

Replacement of
the non functional
ambulances for
timely
transportation of
pregnant mother
Costed in service
delivery problems
- - - - -

Procurement of
the MNCH related
equipment and
Instruments
Costed in service
delivery problems
- - - - -

Implementation
of the referrals
protocols
Costed in MSDS
Gaps
- - - -

Procurement of
Micro-nutrients
(Tab. Ferrous
Sulphate )
Packs 35 7,000 140,000 57,750 63,525 261,275

Procurement of
Micro-nutrients
(Tab. Folic Acid)
Packs 20 20,000 200,000 110,000 121,000 431,000

Procurement and
distribution of
Anti-D
Injection 5,000 300 500,000 550,000 605,000 1,655,000

3,770,300 2,598,750 2,858,625 9,227,675

85

Total
Cost
Year II
(10 %)
Year III
(10 %)
4
High under 5
Mortality
Message on local
cable
Message 117,500 36 1,410,000 1,551,000 1,706,100 4,667,100

BCC of mothers
0n promotion of
breast feeding and
weaning practices
through LHWs
Number of
Trainings
Already costed in
problem HMM
-

Provision of the
deficient
infrastructure at
DHQH
Assessment As proposed in MSDS
Gaps
-

Provision of the
deficient
infrastructure at
THQH
Assessment As proposed in MSDS
Gaps
-

Trainings on
IMNCI
No. of
trainings
As proposed in
Diarrhea
-

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


86

Total
Cost
Year II
(10 %)
Year III
(10 %)

procurement from
DGHs office
poverty pregnant
mother through
LHWs and providing
them food
supplement through
DGHS & Financial
support from Baitul
Mal & Zakat
-
- - -

Distribution of
food supplements
to mothers &
children through
LHWs &
community mid
wives
poverty pregnant
mother through
LHWs and providing
them food
supplement through
DGHS & Financial
support from Baitul
Mal & Zakat
-
- - -

Raising income of
the poor families
through Baitul
Mall and Zakat
poverty pregnant
mother through
LHWs and providing
them food
supplement through
DGHS & Financial
support from Baitul
Mal & Zakat
-
- - -

Revising the
micro plans of
Vaccinators

-
- - -

1,410,000 1,551,000 1,706,100 4,667,100

87

Total
Cost
Year II
(10 %)
Year III
(10 %)
5
Anemia (
including
pregnancy)
Messages on local
cable network
Message 117,500 36 1,410,000 1,551,000 1,706,100 4,667,100

Printing and
distribution of IPC
material
Brochure 3 300,000 450,000 247,500 272,250 969,750

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

Procurement of
Syp. Albendazole
10ml. For Children
under 10 years
No. of doses 20 80,000 800,000 440,000 484,000 1,724,000

Distribution
through LHWs and
health facilities
Already
distributed
- - -

Refresher
Trainings of LHWs
on BCC, balanced
diet and provision
of micro-nutrients
No. of
trainings
Already costed in
problem High
Maternal Mortality
- - -

2,660,000 2,238,500 2,462,350 7,360,850

88

Total
Cost
Year II
(10 %)
Year III
(10 %)
6
Hepatitis Quarterly co-
ordination
meetings with TMA
and other agencies
Meetings Costed in
diarrhoeal
disease
- - - -

Messages on local
cable network
Message 117,500 36 1,410,000 1,551,000 1,706,100 4,667,100

Messages on FM
Radio
Message 28,000 36 336,000 369,600 406,560 1,112,160

Printing and
distribution of IPC
material
Brochure 4 200,000 400,000 220,000 242,000 862,000

Printing and
pasting of stickers
at clinics and
Barber shop
highlighting use of
new syringes &
Razors
Stickers 50 2,000 100,000 - - 100,000

Hepatitis
awareness week (
walk/display
banners/seminars)
Lump sum 3 150,000 150,000 150,000 450,000

Procurement and
for Hepatitis B
Kits 10,000 30 100,000 110,000 121,000 331,000

89

Total
Cost
Year II
(10 %)
Year III
(10 %)

Procurement and
for Hepatitis C
Kits 10,000 30 100,000 110,000 121,000 331,000
Procurement of
syringe cutters
Syringe cutter Available - - - - -
Procurement and
distribution of
Interferon Injection
Courses 15,000 500 3,000,000 2,475,000 2,722,500 8,197,500

Procurement and
supply of HCV
Device
Devices 32 150,000 1,600,000 1,760,000 1,936,000 5,296,000

Procurement and
supply of HbsAg
Device
Devices 32 150,000 1,600,000 1,760,000 1,936,000 5,296,000

Procurement and
supply of HIV
Device
Devices 42 30,000 420,000 462,000 508,200 1,390,200

Documentation of
expense of
disposable syringes

Supportive
supervision to
ensure above
activities


90

Total
Cost
Year II
(10 %)
Year III
(10 %)

9,216,000 8,967,600 9,849,360 28,032,960
7
Scabies Messages on local
cable networks
Message 117,500 12 470,000 517,000 568,700 1,555,700

Printing and
distribution of IPC
material
Brochure 3 800,000 1,200,000 660,000 726,000 2,586,000

Procurement and
distribution of
Benzyl Benzoate
Lotion
Lotion 15 300,000 2,250,000 1,237,500 1,361,250 4,848,750

3,920,000 2,414,500 2,655,950 8,990,450
8
Tuberculosis Messages on local
cable networks
Message 42,000 36 504,000 554,400 609,840 1,668,240

Printing and
distribution of IPC
material
Brochure 2 750,000 500,000 550,000 605,000 1,655,000

Procurement of
drugs to ensure
deficiency
according to
regimen
ATT course To be procured from
the PTP
600 - - - -

91

Total
Cost
Year II
(10 %)
Year III
(10 %)

Procurement of
reagents for
notified diagnostic
facilities under
DOTS programme
Packs To be procured from
the PTP
50 - - - -

Trainings on DOTS
protocols
No. of
trainings
41,600 11 208,000 137,280 151,008 496,288

1,212,000 1,241,680 1,365,848 3,819,528


92

Problem wise costing of Management Problem

Sr. No.

Management Problem

F Y I FY II FY III Total Cost
Rs. Amount
(Rs.)
Amount
(Rs.)
Amount
(Rs.)
1
Human Resource Plan (Senction
of Posts against MSDS Gaps)

16,430,676

35,328,850

55,477,014

107,236,540
2 POL

2,000,000

-

-

2,000,000
3 Capacity Issues of Staff

102,600

102,600

102,600

307,800
4 Deficient Infrastructure

4,620,500

-

-

4,620,500
5 Shortage of Vehicles

22,250,000

10,200,000

-

32,450,000
6
Lack of General Hospital
Equipment

66,450,000

7 MNCH Related Equipment

121,161,615

-

-

121,161,615

Total

233,015,391

45,631,450

55,579,614

267,776,455

93

b) Management Problems

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

Sr.No. Name of Post
Basic
Scale
Basic
Pay
Allowances
Requirement
as per Gap
Financial Targets
Year I Year II Year III
Pay of
Officers
Pay of
other
staff
Allowances
Pay of
Officers
Pay of
other
staff
Allowances
Pay of
Officers
Pay of
other staff
Allowances
1 Gynecologist 18 12,910 18,099 1 154,920 - 217,188 170,412 238,907 187,453 262,797
2 Pediatricians 18 12,910 18,099 7 464,760 - 651,564 852,060 1,194,534 1,312,172 1,839,582
3 Anesthetists 18 12,910 18,099 9 464,760 - 651,564 1,022,472 1,433,441 1,687,079 2,365,177
4 MO / WMO 17 9,850 15,345 86 3,546,000 - 5,524,200 7,801,200 12,153,240 12,299,892 19,161,608
5 Nurses 16 6,060 8,934 42 1,090,800 - 1,608,120 2,399,760 3,537,864 3,695,630 5,448,311
6 Lady Health
Visitors
9 3,820 4,750 58 916,800 1,140,000 2,016,960 2,508,000 3,217,051 4,000,260
5,721,240 916,800 9,792,636 12,245,904 2,016,960 21,065,986 19,182,227 3,217,051 33,077,736


94

Total
Cost
Year II
(10 %)
Year III
(10 %)
1 Shortage of
skilled staff
Temporary Filling of the
vacant posts of medics and
the paramedics through
existing recruitment
committees
Recruitment
- - - No Cost activities
Demand generation and
request to the Department
of Health by the districts
for recruitment through
PSC against vacant posts
Plan
1 1 1
Districts to prepare the
incentivized pay package
with consultation of all
stockholders
Pay Package
1 1 1

Consensus building
between the districts for
uniform incentivized pay
package for all categories
and levels staff
Meeting
1 1 1
Request to the Provincial
Government for approval
and implementation of
agreed pay packages
Plan

1 1 1

95

Total
Cost
Year II
(10 %)
Year III
(10 %)

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

Availability of recreation,
education and other
facilities for children of
staff working in rural areas
Plan EDOH
1 1 1
Construction of the
residences for the staff
Requirement
Plan
1 1 1

provision of recreation
facilities (Parks/Play
area/common rooms)
Plan EDOH
1 1 1

Provision of the transport
of staff children for the
education purposes
Plan EDOH
1 1 1

Capacity and need
assessment of the medics
and the paramedics
TNA

Prepare training programs
for providing higher
professional education
based on TNA
Plan
1 1 1

96

Total
Cost
Year II
(10 %)
Year III
(10 %)
2 Inadequate
budget for POL

Assessing additional need
for POL

Costing & Submission the
additional Demand for POL
P O L 76 26,316 2,000,000

2,000,000

2,000,000

2,000,000

3 Capacity issues
of the staff
Financial Management
workshops
No. of
trainings
39000 3 39,000 39,000 39,000 117,000
Supportive supervision
training workshops
No. of
trainings
31800 3 31,800 31,800 31,800 95,400
Workshops on Use of
information
No. of
trainings
31800 3 31,800 31,800 31,800 95,400

-
102,600 102,600 102,600 307,800
4 Lack of
infrastructure

Up gradation of DHDC Up gradation Detail
Annexed
1 4,246,500 4,246,500

97

Total
Cost
Year II
(10 %)
Year III
(10 %)

Strengthening of DHIS Cell Up gradation Detail
Annexed
1 374,000 - - 374,000

-
4,620,500 - - 4,620,500
5 Shortage of
Vehicles
Purchase of Ambulances
for different Filter clinics
mentioned in workings
Vehicle 3,400,000 7 13,600,000 10,200,000 - 23,800,000

Purchase of 2 Ambulances
for Mobile Clinics
Vehicle 4,000,000 2 8,000,000 - - 8,000,000

Purchase of Suzuki Car for
DHIS Co-Coordinator
Vehicle 650,000 1 650,000 - - 650,000
- 22,250,000 10,200,000 - 32,450,000
6
Deficient
General
Equipment
Purchase of necessary
Equipment at DHQH Kot
Khawaja Saeed
Equipment Detail Annex - 8,500,000 - - 8,500,000
Purchase of necessary
equipment at various health
facilities
Equipment Detail Annex - 57,950,000 - - 57,950,000
- 66,450,000 - - 66,450,000

98

Total
Cost
Year II
(10 %)
Year III
(10 %)
7
Deficient
equipment
(with reference
to notified list)
at DHQHs and
THQHs
Purchase of MNCH related
Equipment at DHQH Mian
Munshi
Equipment Detail
Annexed
- 12,147,260 - - 12,147,260
Equipment at DHQH Kot
Khawaja Saeed
Equipment Detail
Annexed
- 19,842,130 - - 19,842,130
Equipment at THQH
Mazang
Equipment Detail
Annexed
- 16,416,410 - - 16,416,410
Equipment at THQH Said
Mittah
Equipment Detail
Annexed
- 27,354,880 - - 27,354,880
Equipment at THQH
Shahdara
Equipment Detail
Annexed
- 20,385,740 - - 20,385,740
Equipment at THQH Model
Town
Equipment Detail
Annexed
- 25,015,195 - - 25,015,195

121,161,615 121,161,615

99

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-II. Overall
financial outlay of the plan is as under:

Budget Summary

2010-2011 2011-2012 2012-2013
Regular Budget 1,255,874,944 1,490,214,136 1,713,746,256
Proposed additional
budget based on
problem identification
268,122,091 72,231,720 83,389,367
Total 1,523,997,035 1,562,445,856 1,797,135,624


100

SECTION 5: MONITORING & EVALUATION

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

M&E of Plan

Indicators Target %
Achievement
MoV Responsibility Frequency
of
monitoring
Remarks
% of planned
supervisory visits
conducted
50 visits
/year
Inspection
Book/Attendance
register
EDOH/DOH/
DDOH/Dist.
Monitoring
officer
Quarterly
% of RHCs with
availability of
services (on
rotational basis) of
essential specialties
(Physician,
Surgeon,
Pediatrician and
Gynecologist)
100%
During 1
st

year
Movement
register/visit
book/Attendance
register
EDOH / DOH Quarterly
% of health
facilities with
availability of
essential MNCH
related equipment
(level specific)
100%
During 1
st

year
Stock Register EDOH/ DOH/
MSs
6 monthly
Availability of
relevant (MNCH)
laboratory
equipment at
appropriate level of
care
100%
During 1
st

year
Stock Register EDOH/
DOH/MSs,
Store keeper
Quarterly
% facilities with
availability of
essential medicines
100%
During 1
st

year
Stock Register EDOH/ DOH/
MSs, Store
keeper
Monthly
% of functional
ambulances in the
district
100%
(DHQH/
THQH/
RHCs)
Log Book EDOH/DOH/
Transport
officer
Quarterly

101

Indicators Target %
Achievement
of
monitoring
Remarks
% utilization of
sanctioned budget
100% of
yearly
budget
Quarterly Reports EDOH/ DOH/
MSs/
Accounts
officer
Quarterly
% of facilities with
availability of basic
EmONC
100%
(50%
during 1
st

year)
Supervisory visit
report
EDOH/DoH/
DDOH
Quarterly
% of DHQ/THQ
hospitals with
Comprehensive
EmONC services
100% in 3
years
(50%
during 1
st

year)
Supervisory visit
report
EDOH/DoH/
DDOH
Quarterly
% of facilities with
availability of
separate or
partitioned room
reserved
exclusively for
delivery
100% in 3
years (50%
during 1
st

year)
Supervisory visit
report
EDOH/DoH/
DDOH
Quarterly
% of targeted
pregnant women
newly registered by
LHW
Target
according
to
population
DHIS Report EDOH/
Statistical
Officer
Quarterly
% of targeted
pregnant women
received TT-2
vaccine
Target
according
to
population
DHIS Report EDOH/ DHIS
Coordinator/
Statistical
Officer
Quarterly
Delivery conducted
by or under
supervision of
skilled persons
reported
60 %
During 1
st

year
Coordinator/
Statistical
Officer
Quarterly
%of target children
between 18 - 23
months of age fully
immunized
Target
according
to
population
Coordinator/
Statistical
Officer
Quarterly
% of referred cases
attended
100% DHIS Report/
LHWs monthly
report
EDOH/ DHIS
Coordinator/
Statistical
Officer
Quarterly

102

Indicators Target %
Achievement
of
monitoring
Remarks
% of targeted
eligible couples
provided
knowledge and
information on
Family Planning
methods
Target
according
to
population
LHWs monthly/
quarterly report
EDOH/
Statistical
Officer
/Coordinator
NP-FP&PHC
Quarterly
No. of meetings
with participation
from other sectors
12
meetings
per year
Minutes of
meetings
EDOH/ Focal
person/s
Quarterly


103

Annex-I
Cost of MNCH related equipment gaps for DHQ and THQ
Hospitals

DHQ Mian Munshi Hospital

Sr. No. Equipment Gap
Unit
Cost
Total cost(Rs.)
5 Baby Warmer 1 850000
850,000.00
23 Mother Resuscitation Trolley (with life saving medicines,
Laryngoscope, Endo-tracheal tube, BP Apparatus, Chargeable
light)
1 110000
110,000.00
25 Pump Breast Electronic 1 250000
250,000.00
26.5 Hysterectomy Clamps (Straight) 2 150
300.00
26.19 Bladder Sound 1 1500
1,500.00
27.2 Straight Scissors 7 360
2,520.00
27.3 Needle holder 4 135
540.00
27.4 Non-toothed tissue forceps 8 inches 5 100
500.00
27.5 Toothed tissue forceps 8 inches 5 100
500.00
27.6 Sims Speculum single blade 13 275
3,575.00
27.7 Sims Speculum double blade 10 250
2,500.00
27.8 Sponge holding forceps 31 250
7,750.00
27.9 Artery forceps 17 275
4,675.00
27.1 Straight clamps (cord) 8 175
1,400.00
27.12 Towel clip 34 125
4,250.00
28.2 Artery Forceps Straight 6 inches 12 125
1,500.00
28.4 Artery forceps 8 inches 22 175
3,850.00
28.7 Green Armtage forceps 8 inches 16 300
4,800.00
28.1 Small Retractors 2 300
600.00
28.11 Towel Clippers 4 125
500.00
30.1 Paediatric Ventilator 1 1200000
1,200,000.00
30.5 Infant Length Measuring Scale 1 5000
5,000.00
30.8 Billiubino-meter 1 36000

104

Unit
Cost
Total cost(Rs.)
36,000.00
30.9 Exchange Blood Transfusion Set 1 2000
2,000.00
30.1 Nasal Probe Paed size 2 7000
14,000.00
32.2 Packed cell machine 1 600000
600,000.00
32.3 Cell Separator 1 5225000
5,225,000.00
32.4 Freezer for Fresh Frozen Plasma 1 1150000
1,150,000.00
32.5 Blood bag shaker 1 10000
10,000.00
32.6 RH view box 1 1000
1,000.00
32.8 Micro-pipette 3 8000
24,000.00
32.9 Blood grouping tiles 1 3000
3,000.00
32.1 Plasma Extractor 1 1000000
1,000,000.00
32.11 Platelets agitator 1 1000000
1,000,000.00
33.2 Electrolyte Analyzer 1 625000
625,000.00
33.5 Haemoglobino-meter 1 1000
1,000.00

Total cost of equipment

12,147,260.00

DHQ Kot Khawaja Hospital

Unit
cost
Total cost(Rs.)
3 Diagnostic Laparoscope 1 1200000 1,200,000.00
4 Bulb Sucker 4 45 180.00

105

Unit
cost
Total cost(Rs.)
5 Baby Warmer 1 850000 850,000.00
11 Myoma Screw 2 320 640.00
12 Kochers forceps 4 235 940.00
13 Volselum forceps 6 235 1,410.00
15 Vaginal Retractors 4 350 1,400.00
17 Sponge holder 10 300 3,000.00
18 Uterine elevator 1 150 150.00
light)
1 110000 110,000.00
25 Pump Breast Electronic 1 250000 250,000.00
26.1 Toothed Tissue Forceps (8) 2 55 110.00
26.2 Non-Tooted Tissue Forceps (8) 2 55 110.00
26.3 Dissection Scissors (Curved 7) 2 150 300.00
26.4 Dissection Scissors (Straight 7) 2 150 300.00
26.7 Uterine Sound 2 90 180.00
26.8 Needle Holder (7) 2 150 300.00
26.9 Needle Holder (10) 2 300 600.00
26.1 Artery Forceps (Straight 6) 4 110 440.00
26.14 Single blade Sims speculum 4 275 1,100.00
26.15 Double blade Sims speculum 4 250 1,000.00
26.19 Bladder Sound 2 1500 3,000.00
27.2 Straight Scissors 10 360 3,600.00
27.4 Non-toothed tissue forceps 8 inches 10 100 1,000.00
27.5 Toothed tissue forceps 8 inches 10 100 1,000.00
27.6 Sims Speculum single blade 20 275 5,500.00
27.7 Sims Speculum double blade 20 250 5,000.00
27.8 Sponge holding forceps 40 250 10,000.00
27.1 Straight clamps (cord) 10 175 1,750.00
27.12 Towel clip 40 125 5,000.00
28.1 Scalpel 6 50 300.00
28.2 Artery Forceps Straight 6 inches 24 125 3,000.00
28.4 Artery forceps 8 inches 24 175 4,200.00
28.5 Myoma Scissors straight 7 inches 6 150 900.00
28.7 Green Armtage forceps 8 inches 18 300 5,400.00
28.8 Obstetric outlet forceps (pair) 6 900 5,400.00
28.1 Small Retractors 12 300 3,600.00
28.11 Towel Clippers 24 125 3,000.00
29.2 X-Ray Unit 500 kw 1 6000000 6,000,000.00

106

Unit
cost
Total cost(Rs.)
30.1 Paediatric Ventilator 1 1200000 1,200,000.00
30.4 Over-head Radiant Warmer 1 910000 910,000.00
30.5 Infant Length Measuring Scale 2 5000 10,000.00
30.8 Billiubino-meter 1 36000 36,000.00
30.9 Exchange Blood Transfusion Set 1 2000 2,000.00
30.1 Nasal Probe Paed size 2 7000 14,000.00
31.3 Nebulizer 1 165000 165,000.00
31.7 Tracheostomy tube (adult and paeds) 2 1000 2,000.00
31.8 Face mask of all sizes 2 1000 2,000.00
31.9 Double Cuff Tourniquet (for regional block) 1 320 320.00
31.12 Red Rubber Nasal tubes all sizes without cuff 4 1000 4,000.00
32.2 Packed cell machine 1 600000 600,000.00
32.3 Cell Separator 1 5225000 5,225,000.00
32.4 Freezer for Fresh Frozen Plasma 1 1150000 1,150,000.00
32.6 RH view box 1 1000 1,000.00
32.7 Water bath 1 3000 3,000.00
32.8 Micro-pipette 3 8000 24,000.00
32.9 Blood grouping tiles 2 3000 6,000.00
32.1 Plasma Extractor 1 1000000 1,000,000.00
32.11 Platelets agitator 1 1000000 1,000,000.00
32.12 Blood thawing bath 1 3000 3,000.00
33.5 Haemoglobino-meter 1 1000 1,000.00


19,842,130

THQ Mazang Hospital

Sr. No. Equipment Gap Unit
cost
Total cost(Rs.)
3 Diagnostic Laparoscope 1 1200000 1,200,000

107

cost
Total cost(Rs.)
5 Baby Warmer 2 850000 1,700,000
10 Outlet forceps 2 900 1,800
11 Myoma Screw 1 320 320
15 Vaginal Retractors 8 350 2,800
16 Polypectomy forceps 2 750 1,500
17 Sponge holder 2 300 600
18 Uterine elevator 1 150 150
21 Suction Curette 1 95 95
light)
1 110000 110,000
25 Pump Breast Electronic 1 250000 250,000
26.18 Uterine Sound 2 1500 3,000
26.19 Bladder Sound 2 1500 3,000
27.6 Sims Speculum single blade 6 275 1,650
27.7 Sims Speculum double blade 11 250 2,750
27.9 Artery forceps 35 275 9,625
27.1 Straight clamps (cord) 12 175 2,100
27.12 Towel clip 28 125 3,500
28.2 Artery Forceps Straight 6 inches 4 125 500
28.5 Myoma Scissors straight 7 inches 3 150 450
28.7 Green Armtage forceps 8 inches 2 300 600
28.8 Obstetric outlet forceps (pair) 4 900 3,600
28.9 Doyenes Retractor 4 200 800
28.1 Small Retractors 10 300 3,000
28.11 Towel Clippers 12 125 1,500
28.12 Suction Nozzle 3 250 750
30.1 Paediatric Ventilator 1 1200000 1,200,000
30.4 Over-head Radiant Warmer 1 910000 910,000
30.5 Infant Length Measuring Scale 2 5000 10,000
30.8 Billiubino-meter 1 36000 36,000
30.9 Exchange Blood Transfusion Set 1 2000 2,000
30.1 Nasal Probe Paed size 2 7000 14,000
31.2 Ventilators 1 525000 525,000
31.3 Nebulizer 1 165000 165,000
31.6 Airway Oral and Nasal 2 500 1,000
31.7 Tracheostomy tube (adult and paeds) 2 1000 2,000
31.9 Double Cuff Tourniquet (for regional block) 1 320 320
31.12 Red Rubber Nasal tubes all sizes without cuff 4 1000 4,000

108

cost
Total cost(Rs.)
32.1 Blood storage cabinet (100 bag capacity) 1 812000 812,000
32.2 Packed cell machine 1 600000 600,000
32.3 Cell Separator 1 5225000 5,225,000
32.4 Freezer for Fresh Frozen Plasma 1 1150000 1,150,000
32.5 Blood bag shaker 1 10000 10,000
32.6 RH view box 2 1000 2,000
32.7 Water bath 2 3000 6,000
32.9 Blood grouping tiles 3 3000 9,000
32.1 Plasma Extractor 1 1000000 1,000,000
32.11 Platelets agitator 1 1000000 1,000,000
32.12 Blood thawing bath 1 3000 3,000
33.2 Electrolyte Analyzer 1 425000 425,000
33.5 Haemoglobino-meter 1 1000 1,000


16,416,410

DHQ Said Mittah Hospital

Unit
cost
Total
cost(Rs.)
1 CTG (Cardiac Tocography) 1 285000 285,000.00
2 Foetal Doppler 2 10000 20,000.00
3 Diagnostic Laparoscope 1 1200000 1,200,000.00
4 Bulb Sucker 5 45 225.00
5 Baby Warmer 2 850000 1,700,000.00
6 Mechanical Sucker 3 28000 84,000.00
7 Fetal Stethoscope 2 1500 3,000.00
8 Delivery Table 1 17500 17,500.00
9 D&C Set 1 2100 2,100.00
10 Outlet forceps 3 900 2,700.00
11 Myoma Screw 2 320 640.00
12 Kochers forceps 4 235 940.00
13 Volselum forceps 4 235 940.00
14 Lanes Tissue holding forceps 2 400 800.00
15 Vaginal Retractors 4 350 1,400.00
16 Polypectomy forceps 2 750 1,500.00
17 Sponge holder 10 300 3,000.00
18 Uterine elevator 1 150 150.00
19 CosCo Speculum 4 550 2,200.00
Small, Medium, Large (for each category) -

109

20 Examination light 1 18000 18,000.00
21 Suction Curette 1 95 95.00
22 Infant Resuscitation Trolley (with life saving medicines, baby
laryngoscope, Endo-tracheal tube, Infant BP Apparatus,
Chargeable Light)
1 95000 95,000.00
light)
1 110000 110,000.00
24 Cardiac Monitor 1 500000 500,000.00
25 Pump Breast Electronic 1 250000 250,000.00
26.1 Toothed Tissue Forceps (8) 2 55 110.00
26.2 Non-Tooted Tissue Forceps (8) 2 55 110.00
26.3 Dissection Scissors (Curved 7) 2 150 300.00
26.4 Dissection Scissors (Straight 7) 2 150 300.00
26.5 Hysterectomy Clamps (Straight) 8 150 1,200.00
26.6 Hysterectomy Clamps (Curved) 8 175 1,400.00
26.7 Uterine Sound 2 90 180.00
26.8 Needle Holder (7) 2 150 300.00
26.9 Needle Holder (10) 2 300 600.00
26.1 Artery Forceps (Straight 6) 16 110 1,760.00
26.11 Artery Forceps (Curved 6) 14 125 1,750.00
26.12 Allis Forceps 7 230 1,610.00
26.14 Single blade Sims speculum 4 275 1,100.00
26.15 Double blade Sims speculum 4 250 1,000.00
26.17 Volselum forceps 4 250 1,000.00
26.18 Uterine Sound 2 1500 3,000.00
26.19 Bladder Sound 2 1500 3,000.00
27.1 Episiotomy Scissors 6 125 750.00
27.2 Straight Scissors 6 360 2,160.00
27.3 Needle holder 6 135 810.00
27.4 Non-toothed tissue forceps 8 inches 6 100 600.00
27.5 Toothed tissue forceps 8 inches 6 100 600.00
27.6 Sims Speculum single blade 12 275 3,300.00
27.7 Sims Speculum double blade 12 250 3,000.00
27.9 Artery forceps 40 275 11,000.00
27.1 Straight clamps (cord) 20 175 3,500.00
27.11 Vacuum Extractor pump 1 19000 19,000.00
27.12 Towel clip 40 125 5,000.00
28.1 Scalpel 4 50 200.00

110

28.2 Artery Forceps Straight 6 inches 16 125 2,000.00
28.3 Artery Forceps Curved 6 inches 16 125 2,000.00
28.4 Artery forceps 8 inches 16 175 2,800.00
28.5 Myoma Scissors straight 7 inches 4 150 600.00
28.6 Dissecting scissors (curved) 7 inches 4 270 1,080.00
28.7 Green Armtage forceps 8 inches 16 300 4,800.00
28.8 Obstetric outlet forceps (pair) 4 900 3,600.00
28.9 Doyenes Retractor 4 200 800.00
28.1 Small Retractors 8 300 2,400.00
28.11 Towel Clippers 16 125 2,000.00
28.12 Suction Nozzle 4 250 1,000.00
29.2 X-Ray Unit 500 kw 1 6000000 6,000,000.00
29.4 Lead Screen for X-Ray Unit 1 30000 30,000.00
29.5 0.5 MN Lead Apron. Lead Gloves, Goggles and Thyroid and
Gonadal Sheets
1 100000 100,000.00
30.1 Paediatric Ventilator 1 1200000 1,200,000.00
30.2 Incubator 1 1500000 1,500,000.00
30.3 Photo Therapy Unit 1 22000 22,000.00
30.4 Over-head Radiant Warmer 1 910000 910,000.00
30.5 Infant Length Measuring Scale 2 5000 10,000.00
30.6 Infant Weighing Machine 1 3100 3,100.00
30.8 Billiubino-meter 1 36000 36,000.00
30.9 Exchange Blood Transfusion Set 1 2000 2,000.00
30.1 Nasal Probe Paed size 1 7000 7,000.00
31.1 Anaesthesia Machine 1 321000 321,000.00
31.2 Ventilators 1 525000 525,000.00
31.3 Nebulizer 1 165000 165,000.00
31.4 Pulse Oximetry 1 21000 21,000.00
31.5 Defibrillator 1 500000 500,000.00
31.6 Airway Oral and Nasal 1 500 500.00
31.7 Tracheostomy tube (adult and paeds) 1 1000 1,000.00
31.8 Face mask of all sizes 1 1000 1,000.00
31.9 Double Cuff Tourniquet (for regional block) 1 320 320.00
31.1 AMBO bag adult 1 2450 2,450.00
31.11 AMBO Bag paeds 2 3000 6,000.00
31.12 Red Rubber Nasal tubes all sizes without cuff 4 1000 4,000.00
32.1 Blood storage cabinet (100 bag capacity) 1 812000 812,000.00
32.2 Packed cell machine 1 600000 600,000.00
32.3 Cell Separator 1 5225000 5,225,000.00
32.4 Freezer for Fresh Frozen Plasma 1 1150000 1,150,000.00
32.5 Blood bag shaker 1 10000 10,000.00

111

32.6 RH view box 1 1000 1,000.00
32.7 Water bath 2 3000 6,000.00
32.8 Micro-pipette 3 8000 24,000.00
32.9 Blood grouping tiles 3 3000 9,000.00
32.1 Plasma Extractor 1 1000000 1,000,000.00
32.11 Platelets agitator 1 1000000 1,000,000.00
32.12 Blood thawing bath 1 3000 3,000.00
33.1 Hematology Analyzer 1 425000 425,000.00
33.2 Electrolyte Analyzer 1 625000 625,000.00
33.3 Analyzer Bio-chemistry Semi-automatic 1 690000 690,000.00
33.4 Glucometer 2 2500 5,000.00


27,354,880

THQ Shah Dara Hospital

Sr. No. Equipment Gap Unit cost Total cost(Rs.)
1 CTG (Cardiac Tocography) 1 285000 285,000
2 Foetal Doppler 2 10000 20,000
5 Baby Warmer 2 850000 1,700,000
6 Mechanical Sucker 2 28000 56,000
7 Fetal Stethoscope 2 1500 3,000
8 Delivery Table 1 17500 17,500
12 Kochers forceps 4 235 940
13 Volselum forceps 4 235 940
14 Lanes Tissue holding forceps 2 400 800
17 Sponge holder 8 300 2,400
19 CosCo Speculum 4 550 2,200
20 Examination light 2 18000 36,000
Chargeable Light)
1 95000 95,000

112

light)
1 110000 110,000
24 Cardiac Monitor 1 500000 500,000
26.1 Toothed Tissue Forceps (8) 2 55 110
26.2 Non-Tooted Tissue Forceps (8) 2 55 110
26.3 Dissection Scissors (Curved 7) 2 150 300
26.5 Hysterectomy Clamps (Straight) 8 150 1,200
26.6 Hysterectomy Clamps (Curved) 8 175 1,400
26.7 Uterine Sound 2 90 180
26.8 Needle Holder (7) 2 150 300
26.9 Needle Holder (10) 2 300 600
26.1 Artery Forceps (Straight 6) 4 110 440
26.11 Artery Forceps (Curved 6) 10 125 1,250
26.12 Allis Forceps 8 230 1,840
26.13 Towel Clamps 8 125 1,000
26.14 Single blade Sims speculum 3 275 825
26.15 Double blade Sims speculum 4 250 1,000
26.16 Sponge holding forceps 6 200 1,200
26.17 Volselum forceps 4 250 1,000
26.18 Uterine Sound 2 1500 3,000
26.19 Bladder Sound 2 1500 3,000
27.1 Episiotomy Scissors 4 125 500
27.2 Straight Scissors 2 360 720
27.3 Needle holder 5 135 675
27.4 Non-toothed tissue forceps 8 inches 6 100 600
27.5 Toothed tissue forceps 8 inches 6 100 600
27.11 Vacuum Extractor pump 1 19000 19,000
27.12 Towel clip 40 125 5,000
28.1 Scalpel 4 50 200
28.2 Artery Forceps Straight 6 inches 16 125 2,000
28.3 Artery Forceps Curved 6 inches 16 125 2,000
28.4 Artery forceps 8 inches 16 175 2,800

113

28.6 Dissecting scissors (curved) 7 inches 4 270 1,080
28.7 Green Armtage forceps 8 inches 16 300 4,800
28.11 Towel Clippers 16 125 2,000
28.12 Suction Nozzle 4 250 1,000
29.4 Lead Screen for X-Ray Unit 1 30000 30,000
30.2 Incubator 1 1500000 1,500,000
30.3 Photo Therapy Unit 1 22000 22,000
30.6 Infant Weighing Machine 1 3100 3,100
31.1 Anaesthesia Machine 1 321000 321,000
31.2 Ventilators 1 525000 525,000
31.4 Pulse Oximetry 1 21000 21,000
31.5 Defibrillator 1 500000 500,000
31.6 Airway Oral and Nasal 1 500 500
31.1 AMBO bag adult 1 2450 2,450
31.11 AMBO Bag paeds 2 3000 6,000
32.3 Cell Separator 1 5225000 5,225,000
32.5 Blood bag shaker 1 10000 10,000
32.6 RH view box 1 1000 1,000
32.7 Water bath 2 3000 6,000
32.8 Micro-pipette 4 8000 32,000

114

33.1 Hematology Analyzer 1 425000 425,000
33.4 Glucometer 2 2500 5,000


20,385,740

THQ Model Town Hospital

Sr. No. Equipment Gap Unit cost
Total
cost(Rs.)
1 CTG (Cardiac Tocography) 1 285000 285,000
2 Foetal Doppler 1 10000 10,000
4 Bulb Sucker 5 45 225
5 Baby Warmer 1 850000 850,000
6 Mechanical Sucker 3 28000 84,000
9 D&C Set 1 2100 2,100
12 Kochers forceps 4 235 940
13 Volselum forceps 4 235 940
14 Lanes Tissue holding forceps 2 400 800
17 Sponge holder 5 300 1,500
19 CosCo Speculum 4 550 2,200
Chargeable Light)
1 95000 95,000
light)
1 110000 110,000
24 Cardiac Monitor 1 500000 500,000
26.1 Toothed Tissue Forceps (8) 2 55 110
26.2 Non-Tooted Tissue Forceps (8) 2 55 110

115

Total
cost(Rs.)
26.3 Dissection Scissors (Curved 7) 2 150 300
26.4 Dissection Scissors (Straight 7) 2 150 300
26.5 Hysterectomy Clamps (Straight) 8 150 1,200
26.6 Hysterectomy Clamps (Curved) 8 175 1,400
26.7 Uterine Sound 1 90 90
26.9 Needle Holder (10) 2 300 600
26.1 Artery Forceps (Straight 6) 8 110 880
26.11 Artery Forceps (Curved 6) 10 125 1,250
26.12 Allis Forceps 8 230 1,840
26.13 Towel Clamps 8 125 1,000
26.14 Single blade Sims speculum 4 275 1,100
26.15 Double blade Sims speculum 4 250 1,000
26.17 Volselum forceps 4 250 1,000
26.18 Uterine Sound 1 1500 1,500
26.19 Bladder Sound 2 1500 3,000
27.1 Episiotomy Scissors 6 125 750
27.4 Non-toothed tissue forceps 8 inches 6 100 600
27.5 Toothed tissue forceps 8 inches 6 100 600
27.11 Vacuum Extractor pump 1 19000 19,000
27.12 Towel clip 40 125 5,000
28 Caesarian Section -
28.1 Scalpel 4 50 200
28.2 Artery Forceps Straight 6 inches 16 125 2,000
28.3 Artery Forceps Curved 6 inches 16 125 2,000
28.4 Artery forceps 8 inches 16 175 2,800
28.6 Dissecting scissors (curved) 7 inches 4 270 1,080
28.7 Green Armtage forceps 8 inches 16 300 4,800
28.11 Towel Clippers 16 125 2,000
28.12 Suction Nozzle 4 250 1,000

116

Total
cost(Rs.)
29.2 X-Ray Unit 500 kw 1 6000000 6,000,000
29.4 Lead Screen for X-Ray Unit 1 30000 30,000
29.5 0.5 MN Lead Apron. Lead Gloves, Goggles and Thyroid and
Gonadal Sheets
1 100000 100,000
30.6 Infant Weighing Machine 1 3100 3,100
31.1 Anaesthesia Machine 1 321000 321,000
31.2 Ventilators 1 525000 525,000
31.3 Nebulizer 1 165000 165,000
31.5 Defibrillator 1 500000 500,000
31.8 Face mask of all sizes 1 1000 1,000
31.11 AMBO Bag paeds 1 3000 3,000
32.3 Cell Separator 1 5225000 5,225,000
32.5 Blood bag shaker 1 10000 10,000
32.6 RH view box 1 1000 1,000
32.7 Water bath 2 3000 6,000
32.8 Micro-pipette 4 8000 32,000
32.13 Microscopes 1 115000 115,000
33.1 Hematology Analyzer 1 425000 425,000
33.3 Analyzer Bio-chemistry Semi-automatic 1 690000 690,000
33.4 Glucometer 2 2500 5,000


25,015,195

117

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Three Years Rolling Plan 2010-2013 District Lahore

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