hfa district report - panjgur

7/23/2019 HFA District Report - Panjgur

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Health Facility Assessment Balochistan

District Panjgur


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Acknowledgement

TRF acknowledges the cooperation and support of Contech International Health

Consultants, Lahore who worked on the assignment and authored the report. The final

reports were quality assured by Jennifer Sanchos, HLSP Health Systems Consultants, and

Ms. Pamela Sequeria, M & E Specialist TRF.

Disclaimer

This document is issued for the party which commissioned it and for specific purposes

connected with the above-captioned project only. It should not be relied upon by any other

party or used for any other purpose.

We accept no responsibility for the consequences of this document being relied upon by any

other party, or being used for any other purpose, or containing any error or omission which is

due to an error or omission in data supplied to us by other parties.

June 2012


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Table of Contents

List of Tables ................................................................................................................ iv

List of Figures .............................................................................................................. vi

Acronyms .................................................................................................................... vii

Executive Summary ...................................................................................................... 1

Section 1: Introduction ................................................................................................. 3

Survey Objectives ...................................................................................................... 3

Assignment Duration .................................................................................................. 3

Scope of HFA ............................................................................................................. 3

Report Organisation ................................................................................................... 4Section 2: District Information ..................................................................................... 5

Geographical Location ............................................................................................... 5

Administrative Setup .................................................................................................. 6

Demographic Information ........................................................................................... 6

Socioeconomic and Health Indicators ........................................................................ 6

Section 3: Health Facility Assessment Survey Findings............................................ 8

MNCH Services ......................................................................................................... 88/6 Preventive MNCH Services at BHU ................................................................. 9

24/7 Basic EmONC Services at RHC .................................................................. 12

24/7 Comprehensive EmONC Services at SHC Hospitals ................................... 15

24/7 Basic EmONC Services at THQ Hospital..................................................... 21

Management Basics ................................................................................................. 21

Human Resource ................................................................................................ 22

Work Coordination and Supervision .................................................................... 25

Management Information System ........................................................................ 26

Drugs and Supplies ............................................................................................. 27

Fee for Services .................................................................................................. 27

Infection Control .................................................................................................. 28

Death Review ...................................................................................................... 29

Facility Utilisation ..................................................................................................... 29

Well Baby Clinic ....................................................................................................... 31

Donor Contribution ................................................................................................... 31


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Clients Perspective .................................................................................................. 31

Procurement Estimates ............................................................................................ 33

Equipment ........................................................................................................... 33

Civil Works .......................................................................................................... 33

Section 4: Key Findings ............................................................................................. 35

Infrastructure ............................................................................................................ 35

Human Resource ..................................................................................................... 35

Equipment ................................................................................................................ 36

Drugs and Supplies .................................................................................................. 36

Support Services ...................................................................................................... 36

Management Basics ................................................................................................. 37

Donor Contribution ................................................................................................... 37

Clients Perspective .................................................................................................. 38

Annexes ....................................................................................................................... 39

Annex 1: District Health Department ......................................................................... 40

Annex 2: Input Criteria for MNCH Services ............................................................... 46

Annex 3 A: Status of Surveyed HF Against Minimal Level of Inputs ..................... 59

Annex 3 B: List of Items Required .......................................................................... 65

Annex 4: Scope of Civil Works Required .................................................................. 70


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List of Tables

Table 1.1 :Scope of HFA ............................................................................................... 4

Table 2.1 : Demographic profile ...................................................................................... 6

Table 2.2 :Population groups ......................................................................................... 6

Table 2.3 :Socio-economic and health indicators ........................................................... 7

Table 3.1:Status of assessed infrastructure in BHU ..................................................... 10

Table 3.2:Status of MNCH related staff in BHU ........................................................... 11

Table 3.3: Status of functional equipment in BHU ......................................................... 11

Table 3.4:Status of drugs and supplies in BHU............................................................ 11

Table 3.5:Status of support services in BHU................................................................ 12

Table 3.6:Status of assessed infrastructure in RHC..................................................... 12

Table 3.7:Status of MNCH related staff in RHC ........................................................... 14

Table 3.8:Status of functional equipment in RHC ........................................................ 14

Table 3.9: Status of drugs and supplies in RHC ........................................................... 14

Table 3.10:Status of support services in RHC ............................................................. 15

Table 3.11:Status of assessed infrastructure in SHC hospital ...................................... 15

Table 3.12:Status of MNCH related staff in SHC hospital ............................................ 19

Table 3.13:Status of functional equipment in SHC hospital.......................................... 20

Table 3.14:status of drugs and supplies in SHC hospital ............................................. 21

Table 3.15:Status of support services in SHC hospital ................................................ 21

Table 3.16:Status of HR at SHC hospital ..................................................................... 22

Table 3.17: Status of HR at RHC .................................................................................. 23

Table 3.18:Status of HR at surveyed BHU ................................................................... 23

Table 3.19:Reasons of non-availability 24/7 of HR at RHC .......................................... 24

Table 3.20:Reasons of non-availability 24/7 of HR at SHC hospital ............................. 25

Table 3.21 :Capacity building of MNCH related staff at the surveyed facilities ............. 25

Table 3.22: Status of coordination and supervision at surveyed facilities ...................... 25

Table 3.23:Status of MIS at surveyed facilities ............................................................ 26

Table 3.24: reasons for stock out reported by surveyed facilities .................................. 27

Table 3.25: Status of fee for service at surveyed facilities ............................................ 27

Table 3.26:Mechanisms of social protection available at surveyed facilities ................ 28


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Table 3.27:Status of infection control & waste management practices at surveyed

facilities ......................................................................................................................... 28

Table 3.28:Status of clinical audit practices at surveyed facilities ................................ 29

Table 3.29:Status of services utilisation at surveyed facilities ..................................... 29

Table 3.30: Average monthly MNCH services provided at surveyed facilities ............... 30

Table 3.31:Average monthly FP services provided at surveyed facilities ..................... 30

Table 3.32: Status of WBC established at surveyed facilities ........................................ 31

table 3.33: Status of donor contribution at surveyed facilities ....................................... 31

Table 3.34:Clients perspective .................................................................................... 32

Table 3.35: Summary of estimated cost for procurement of equipments & civil works .. 34

Table 2.4:Number of public sector health facilities in the district .................................. 40

Table 2.5:Human resourse in DHO office .................................................................... 40

Table 2.6: Availability of MNCH services staffing in Panjgur ......................................... 41

Table 2.7: Financial allocation in district Panjgur .......................................................... 42

Table 2.8:NMNCHP monitoring indicators (year 2010) ................................................ 43

Table 2.9: Number of facilities with staff provided by the NMNCHP .............................. 44

Table 2.10:Number of staff trained on delivering MNCH services ................................ 45

Table 2.11: Status of CMW training and deployment .................................................... 45

i. Status of assessed infrastructure in BHU ................................................................ 59

ii. Status of MNCH related staff in BHU....................................................................... 59

iii. Status of functional equipment in BHU .................................................................... 59

iv. Status of drugs and supplies in BHU ....................................................................... 59

v. Status of support services in BHU ........................................................................... 60

i. Status of assessed infrastructure in RHC ................................................................ 60

ii. Status of MNCH related staff in RHC ..................................................................... 61

iii. Status of functional equipment in RHC .................................................................... 61

iv. Status of drugs and supplies in RHC ....................................................................... 61

v. Status of support services in RHC ........................................................................... 62

i. Status of assessed infrastructure in SHC hospital ................................................... 62

ii. Status of MNCH related staff in SHC hospital ........................................................ 63

iii. Status of functional equipment in SHC hospitals ..................................................... 63

iv. Status of drugs and supplies in SHC hospital .......................................................... 64

v. Status of support services in SHC hospital .............................................................. 64


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List of Figures

Figure 1:Map of district Panjgur.................................................................................... 5

Figure 2:Range of services that signal fully functional MNCH services......................... 8

Figure 3:Status of management basics at surveyed facilities ..................................... 24

Figure 4: Level of satisfaction ...................................................................................... 33

Figure 5:Availability of medicines and lab services ..................................................... 33


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ACRONYMS

ANC Antenatal Care

AVDAssisted Vaginal Deliveries

BB technician Blood Bank Technician

BHU Basic Health Unit

CBA Child bearing age

CEI Client Exit Interview

CH Civil Hospital

CMW Community Midwives

CWAQ Civil Works Assessment Questionnaire

CDC Communicable Disease Control

DCO District Coordination OfficerDDCT District Data Collection Teams

DHO District Health Officer

DHDC District Health Development Centre

DHIS District Health Information System

DHQH District Headquarter Hospital

DLQ District Level Questionnaire

EDOs Executive District Officers

EmONC Emergency Obstetric and Newborn Care

ENC Emergency Newborn CareEAQ Equipment Assessment Questionnaire

EPI Expanded Programme of Immunisation

FP & PHC Family Planning and Primary Health Care

HF Health Facilities

HFA Health Facility Assessments

HID Health Institution Database

HIV Human Immunodeficiency Virus

HMIS Health Management Information System

HR Human ResourceIDI EDOH In-depth Interview of EDO Health

IMNCI Integrated Management of Neonatal and Childhood Illnesses

IMPAC Integrated Management of Pregnancy and Childbirth

JD Job Description

LHS Lady Health Supervisor

LHV Lady Health Visitor

LHW Lady Health Worker

MDGs Millennium Development Goals

M&E Monitoring and EvaluationMICS Multiple Indicator Cluster Survey


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MIS Management Information System

MNCH Maternal, Neonatal and Child Health

MO Medical Officer

NMNCHP National Maternal Newborn and Child Health Programme

NVD Normal Vaginal DeliveriesOBGYN Obstetrics and Gynaecology

OPD Out Patient Department

OT Operation Theatre

PC-1 Planning Commission Proforma 1

PDHS Pakistan Demographic and Health Survey

PNC Post natal care

PPHI Peoples Primary Health care Initiative

PSLM Pakistan Social & Living Standards Measurement Survey

RHC Rural Health CentreSBA Skilled Birth Attendants

SD&MB Service Delivery and Management Basics

SE Socioeconomic

SHC hospitals Secondary health care

SPSS Statistical Package for the Social Sciences

TA Technical Assistance

THQ Tehsil Headquarter hospital

TRF Technical Resource Facility

TT Tetanus ToxoidWMO Women Medical Officer

WBC Well Baby Clinics


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District Report - Panjgur

1

Executive Summary

Health Facility Assessment 2011 (HFA) was aimed at assessing the availability, functioning,

and quality of health care delivery system in the public sector health facilities with a focus on

maternal, new-born and child health services. This district report provides the findings of theHFA for each surveyed health facility in the district. It is baseline information for the district

and the National Maternal Newborn and Child Health Programme (NMNCHP), to set

performance benchmarks and realign activities for bridging the gaps existing in MNCH

services for achieving the objectives of the programme.

The HFA started in October 2010 and completed in May 2011. Contech accomplished the

assignment in a participatory way by maintaining constant liaison with the entire key

stakeholder. Five (5) health facilities were assessed in District Panjgur, including 1 DHQ

hospital, 1 RHC and 3 BHU. The BHU were assessed for availability of 8/6 Preventive

MNCH services; RHC were assessed for availability of 24/7 Basic EmONC services; and

DHQ Hospital was assessed for availability of 24/7 Comprehensive EmONC services. An

assessment criterion was formulated to ascertain gaps in availability of inputs1, including

Infrastructure; Human Resource (HR); Drugs and Supplies; Equipment; and Level specific

support services. Summarised HFA findings (detailed findings are given in Section 4) of

HFA, are as follows:

In infrastructure, major gaps existed in availability of labour room staff residences at

BHU; paediatric ward, paediatric nursery, blood bank, and residences for gynaecologist,

anaesthetist and paediatrician at DHQH Ranjgur

Regarding HR, none of the health facility had staff available against optimal level of

inputs and major gaps were related to WMO at the RHC; anaesthetist and paediatrician

and blood bank technician at DHQH

The complete set of required equipment items was not available at any of the surveyed

facilities

Drugs, Supplies, Vaccines and FP commodities were assessed using facility specific list

of tracer items for their availability on the day of survey and stock-out status during last

1 1 (1)

; , .

3 1


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one month. The complete range of items was not available at any of the surveyed

facilities. The most common reason for stockout of drugs was poor quantification

The complete range of required inputs for delivery of support services was not available

at most of the surveyed facilities

In District Panjgur, none of the health facility was conducting regular performance review

meeting

Health Management Information System (HMIS) was being practiced in District Panjgur

and HMIS tools were available but not maintained at most of the surveyed facilities.

MNCH related staff job descriptions and MNCH service delivery protocols were not

present at any of the health facility

Major gaps existed in availability of materials for infection control practices

Review of maternal and neonatal deaths was not conducted at any level as death review

committee was not constituted at any health facility.

In order to assess the perceptions of the clients, a total of 15 Client Exit Interviews were

conducted at DHQH and RHC. Clients perspective on quality of care revealed that majority

of the clients were satisfied with the care provided at the public facilities.

Findings of the HFA at all levels revealed significant gaps in the required inputs for provision

of quality MNCH services. This warrants immediate need to bridge these gaps in order to

improve the MNCH services.


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Section 1: Introduction

This section includes survey objectives, its scope and duration, and organisation of the

District Report.

Survey Objectives

The HFA was aimed at assessing the availability, functioning, and quality of health care

delivery system in the public sector facilities with a focus on maternal, new-born and child

health services.

Specific objectives of the HFA were:

To assess the health facility status and quality of MNCH services (Comprehensive and

Basic EmONC, Preventive MNCH and Family Planning) at district level

To assess clients satisfaction and perception of MNCH services

To provide information for systematic planning for procurement and supply of goods and

commodities (listing the medical equipment and instruments which needs to be replaced

or purchased); and

To update and assess the contributions made by the development partners for improving

MNCH and FP services in the selected districts

Assignment Duration

Estimated duration of the assignment was 7 months. The assignment started in October

2010 and completed in May 2011.

Scope of HFA

The survey included District Headquarter Hospital (DHQH), Rural Health Centres (RHC) and

20% of Basic Health Units (BHU) randomly selected within the district. Selection of the BHU

was through geographical stratification on the basis of proportionate distribution. Client exit

interviews were conducted at the surveyed facilities (10 at DHQH, 5 at each THQH and

RHC), excluding BHU. Table 1.1 shows the number of health facilities in the district and

health facilities surveyed.


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TABLE 1.1:SCOPEOF HFA

District PanjgurNumber of Health Facilities by type

DHQH THQH RHC BHU Total

Number of facilities listed by HID 1 0 1 15 17

Number of facilities surveyed 1 0 1 3 5

Report Organisation

HFA District Report has been structured in four sections. While the introduction to the

survey, its scope and methodology is described in Section 1, Section 2 District Information

contains information collected from the District Health Department using DLQ as well as the

secondary data sources and it comprises of demographic, economic and education related

information of the district as well as the organisation of health care delivery system in the

district. This section also includes information about the monitoring indicators of National

MNCH Programme.

Details of the assessment are contained in Section 3 HFA Findings. This section presents

information about NMNCHP analytical framework indicators, status of the MNCH service

availability based on optimal level of inputs including infrastructure, human resource,

equipment, drugs and supplies and availability of support services. Information onmanagement basics like work coordination, MIS etc., is also contained in this section. The

information presented in this section gives snapshot in time of the surveyed health facilities.

At the end information about the satisfaction and perspective of the clients on the MNCH

services provided at the public sector health facilities. Section 4 comprises of key findings of

HFA at district level.


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Section 2: District Information

This section includes district brief, information on demographic, socioeconomic and health

indicators. It also contains information on health resources and NMNCHP indicator compiled

at district level. The data sources of the information are DHO office using District LevelQuestionnaire (DLQ) and published documents. The information collected from DHO office

may not match with subsequent tables containing similar information collected from

respective health facilities included in survey.

Geographical Location

District Panjgur having 16,891 km2 areas is situated in the west of province Balochistan.

Panjgur was one of the three Tehsils of Makran District until 1 July 1977. The district is

administratively subdivided into three Tehsils which contain a total of 16 Union councils. Tar

Office is the main town of Panjgur, where most of the offices are situated. Tar office used to

be offices for British Army during British Raj as the headquarter of Makran. A few

archaeological sites including centuries old tombs, an old dam named Band-e-Gillar and

remnants of a fort at Khudabadan are of interest in the district. Panjgur Airport is a domestic

airport; it has one of the shortest runways of Pakistan with total length of only 1524 meters.

Only Pakistan International Airlines operates flights to Karachi and Quetta. District Panjgur is

linked to adjacent districts and the provincial capital through a number of roads.

FIGURE 1: MAPOF DISTRICTPANJGUR


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Administrative Setup

Like other districts in the province, Panjgur is headed by Deputy Commissioner (DC)

assisting the Divisional Commissioner and is accountable to him. The DC is appointed by

the provincial government from the Federal or Provincial Civil Service.

Demographic Information

Demographic information2is given in the following table.

TABLE2.1:DEMOGRAPHICPROFILE

Indicators Value Indicators Value

Total Population 290,376 Urban Population 9%

Population of Tehsil Gawargo 85,822 Rural Population 91%

Population of Tehsil Panjgur 204,554Population density (persons

per sq.km)17

Sex ratio (number of males

over 100 females) at birth117

SOURCE:HMISCELLDHOOFFICE

TABLE2.2:POPULATION GROUPS

Population

Groups

Standard

Demographic(%)

Estimated

population

Population

Groups

Standard

Demographic(%)

Estimated

population

Under 1 year 2.707,840

Women 15-49years

22.0063,883

Under 5 years 13.4038,910

Married CBA 16.0046,460

Under 15years

41.97121,871

Pregnant women 3.409,873

Expected Births 2.98,421

SOURCE:PDHS2006-07

Socioeconomic and Health Indicators

Selected Socio-Economic (SE) and health indicators are given in the table 2.3. The sources

include, Pakistan Demographic and Health Survey (PDHS) 2006-7, Immunisation Coverage

Evaluation Survey Pakistan (CES) 2006-7, District EPI Cell.

2 2010.


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TABLE 2.3:SOCIO-ECONOMIC ANDHEALTH INDICATORS

Indicators Value

District figures

% children


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Section 3: Health Facility Assessment Survey

Findings

MNCH Services

The packages of MNCH services assessed include Preventive MNCH services at BHU,

Basic EmONC services at RHC and Comprehensive EmONC services at THQ and DHQ

hospitals3. The range of MNCH services are given below.

FIGURE 2 :RANGE OF SERVICES THATSIGNALFULLYFUNCTIONAL MNCH SERVICES

3 NMNCHP PC -1

BHU: Facility

available for

RHC: Facility

available for

DHQ/THQ

Hospitals: Facilityavailable for

8/6 Preventive

MNCH Services

Antenatal checkup

Lab (Anemia,

Malaria, pregnancy

test, urine test for

sugar & Protein)

Normal delivery

Family planning

services (at least 3

methods)

TT immunisation

EPI vaccination

Growth monitoring

Nutrition counseling

HR (at least oneLHV or Doctor)

24/7 Basic EmONC

Services

Parenteral

antibiotics

Parenteral oxytocic

drugs

Parenteral

anticonvulsants for

pregnancy inducedconvulsions (due to

hypertension)

Manual removal of

placenta

Removal of

retained products

Assisted vaginal

delivery (vacuum

extraction, forceps)

Newborn

resuscitation+

Post abortion care

HR (skilled female

providers-WMO

and LHV), and

Preventive MNCH

24/7

Comprehensive

EmONC services

Surgery (C-section)

Blood transfusion

Newborn care

(resuscitation &

incubator)

+

Gynaecological

care

Comprehensive

family planning

services including

sterilisation

HR (skilled staff for

conducting, C-

section, blood

transfusion andanaesthesia),

and

Preventive MNCH

and Basic EmONC


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Functional capacity of health facilities were assessed against 5 specified inputs, which

include:

1. Infrastructure

2. Human Resource

3. Drugs and Supplies

4. Equipment

5. Level specific support services

Health facilities assessment findings are presented against two levels of inputs including:

1. Optimal level of Inputs are those proposed in the PC-1 of the National MNCH

Programme, required to make a health facility fully functional for provision of level

specific package of MNCH services (Annex 1).

Optimal level of inputs provides a strategic norm upon which gaps are identified and

up-gradation are proposed for improving accessibility of quality MNCH services

through development and implementation of an integrated and sustainable MNCH

programme at all levels of the health care delivery system.

2. Minimal level of Inputs, which are bare minimum requirement of the inputs, required for

delivering the package specific MNCH services at the health facilities.Findings related

to minimal level of inputs are given as Annex 2.

Following tables present the status of assessed facilities for availability of the optimal level of

inputs.

8/6 Preventive MNCH Services at BHUBHU operating within District Panjgur were assessed for provision of Preventive MNCH

services available for 8 hours a day, 6 days a week (8/6). Three BHU were assessed for

availability of optimal level of inputs as summarised in Tables 3.1 - 3.5 by individual BHU.

Infrastructure of the BHU has been assessed for availability of OPD, LHV room and labour

room as service provision areas and residences for accommodation of required staff. OPD

and LHV rooms have been assessed as single room having facilities for consultation,

examination and hand washing; similarly labour room also assessed as single room having


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facility for delivery, scrub area and attached toilet facility for patient. Findings are presented

as status of building components available and functional.

TABLE 3.1:STATUS OF ASSESSED INFRASTRUCTURE IN BHU

Doctor or LHV is required for provision of Preventive MNCH Services. Status of assessed

BHU for availability of Human Resource (HR) (both regular posted and provided by

NMNCHP), against the required number mentioned in PC-1 of NMNCHP is presented below:

Infrastructure Status

Status of building components at Surveyed

BHU

BHU

BonistanBHU Gichk BHU Washbood

OPD1. Consultation area

A Y Y Y

F Y Y Y

2. Examination areaA N N N

F N N N

3. Hand washingA N N N

F N N N

LHV Room1. Consultation area

A Y Y Y

F Y Y Y

2. Examination areaA N Y N

F N Y N

3. Hand washingA N N N

F N N N

Labour Room1. Delivery room

A N N N

F N N N

2. Scrub areaA N N N

F N N N

3. Patient wash roomA N N N

F N N N

ResidenceDoctor

A N N N

F N N N

ResidenceLHV

A N N N

F N N N


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TABLE 3.2:STATUS OF MNCHRELATED STAFF IN BHU

Equipment items (general items, equipment for OPD and LHV room) for BHU are listed in

PC-1 of NMNCHP. Status of functional quantity of these items at assessed BHU is

presented below:

TABLE 3.3:STATUS OF FUNCTIONAL EQUIPMENT IN BHU

List of essential drugs and supplies for MNCH services is contained in PC-1 of NMNCHP.

Tracer items were selected from the list (Annex 1) for assessing their availability at surveyed

facilities. Status of surveyed BHU regarding available quantity of tracer items is presented

below:

TABLE3.4:STATUS OF DRUGS ANDSUPPLIES IN BHU

Staff categories Required

number

Number of MNCH related staff available at each BHU

BHU Bonistan BHU Gichk BHU Washbood

WMO 1 0 0 1

LHV 1 1 1 1

EquipmentTotal Items

required at eachBHU

Number of functional equipment items available at eachsurveyed BHU


General items 3 0 0 0

OPD 14 6 7 6

LHV Room 12 8 5 7

Item groups

Total Items

required at each

BHU

Number of items available at each surveyed BHU


Supplies 6 4 5 6

Drugs 12 6 3 8

Vaccines 5 5 0 5

FP Commodities 6 2 0 4


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Facility for basic laboratory tests (test strips and HR) was assessed at surveyed BHU and

their status is presented below:

TABLE 3.5:STATUS OF SUPPORTSERVICES IN BHU

24/7 Basic EmONC Services at RHC

RHC operating within District Panjgur was assessed for provision of Basic EmONC servicesavailable for 24 hours a day, 7 days a week (24/7). One RHC was assessed for availability of

optimal level of inputs as summarised in Tables 3.6 - 3.10.

Infrastructure of the RHC has been assessed for availability of OPD, indoor ward, LHV room,

Labour room and clinical laboratory as service provision areas and residences for

accommodation of required staff. Service provision areas have been assessed as single

room having facilities like consultation, examination and hand washing etc., as contained in

table below. Findings are presented as status of building components available andfunctional:

TABLE 3.6:STATUS OF ASSESSED INFRASTRUCTURE IN RHC


Status of building components at eachRHC

RHC Paroom

OPD

1. Consultation area

AY

F Y

2. Examination areaA Y

FY

3. Hand washingA N

FN

Female ward1. Patient area

A Y

F Y

2. Patient wash room A Y

Support services

Total Items

required at each

BHU

Number of items available at each surveyed BHU


Basic lab tests 2 1 1 2


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Status of building components at eachRHC

RHC Paroom

FY

Labour Room1. Delivery room

A Y

FY

2. Scrub areaA

N

FN

3. Patient wash roomA

Y

FN

Clinical Lab.

1. Laboratory room

AY

F Y

2. Working areaA

Y

FY

3. Pt. wash roomA

Y

F N


A N

FN

2. Examination areaA N

F N

3. Hand washingA

N

F N

ResidenceDoctor

AY

F Y

ResidenceLHV

A Y

FY

PC-1 of NMNCHP contains category and number of staff required for Basic EmONC

services. Status of RHC for availability of HR (both regular posted and provided by

NMNCHP), against required numbers is presented in table below:


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TABLE 3.7:STATUS OF MNCHRELATED STAFFIN RHC

Equipment items for various service components at RHC are listed in PC-1 of NMNCHP.

Status of functional quantity of these items at RHC, is presented in the table below:

TABLE 3.8:STATUS OF FUNCTIONAL EQUIPMENTIN RHC



facilities. Status of surveyed RHC regarding available quantity of tracer items is presented

below:

TABLE 3.9:STATUS OF DRUGS ANDSUPPLIES IN RHC

Staff categoriesRequired number at each

RHC

Number of MNCH related staffavailable at RHC

Paroom

WMO 2 0

LHV 2 1

Lab technician 1 1

OT technician 1 1

Ambulance driver 1 1

EquipmentTotal Items required at

each RHC

Number of functional equipment itemsavailable at RHC

Paroom

General items 4 1

Female ward 9 6

WMO OPD 15 7

Labour room 19 0

LHV Room 10 5

Item groupsTotal Items required

at RHC

Number of itemsavailable at RHC

Paroom

Supplies 6 5

Drugs 18 12

Vaccines 5 0

FP Commodities 6 3


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Facility for support services including basic laboratory tests (space, test strips and HR) and

ambulance services (functional vehicle and driver) was assessed at surveyed RHC.

Availability status of these services at RHC is presented below:

TABLE 3.10:STATUS OF SUPPORTSERVICES IN RHC

24/7Comprehensive EmONC Services at SHC HospitalsDHQ Hospital operating within District Panjgur was assessed for provision of

Comprehensive EmONC services available for 24 hours a day, 7 days a week (24/7). DHQH

was assessed for availability of optimal level of inputs as summarised in Tables 3.11 - 3.15.

Infrastructure of the DHQ hospital has been assessed for availability of OPD, indoor wards,

LHV room, labour room, operation theatre, paediatric nursery, blood bank, ultrasound room

and clinical laboratory as service provision areas and residences for accommodation of

required staff. Service provision areas have been assessed for availability of essential space

in respective areas e.g., consultation area, examination area and hand washing in OPD;

patient area, nursing station, store rooms and attached washrooms in indoor wards, etc., as

contained in table below. Findings are presented as status of building components available

and functional:

TABLE3.11:STATUS OF ASSESSED INFRASTRUCTURE IN SHCHOSPITAL

Support services

Total Items

required at

RHC

Number of itemsavailable at RHC

Paroom

Basic lab tests 8 7

Ambulance service 2 2


Availability of building components

DHQH Panjgur

OPD:


AY

FY

2. Examination areaA

Y

FY

3. Privacy of examination area A N


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FN

4. Hand washingA

Y

FY

Female ward:

1. Patient area

A Y

FY

2. Nursing stationA

Y

FY

3. Patient wash roomA

Y

FN

4. Store for general itemsA

N

F N

5. Store for equipmentA N

FN

Labour room:

1. Delivery room

A Y

F Y

2. Preparation /stage roomA

Y

F Y

3. Scrub areaA N

FN

4. Staff duty roomA Y

FY

5. Patient wash roomA Y

F N

6. Staff wash room

AY

F Y

7. Store for general itemsA Y

FY

8. Store for equip.A

Y

FY

Operation theatre:

1. Patient preparation room

AY

FY

2. Operating room AY


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17

FY

3. Recovery roomA

Y

FY

4. Scrub areaA Y

FY

5. Sterilisation areaA

Y

FN

6. Doctors roomA

N

FN

7. Support staff duty roomA

N

F N

8. Store for general items A N

FN

9. Store for equipmentA N

F N

10. Attached washroom for staffA

N

F N

Paediatrics ward:

1. Patient area

A N

FN

2. Nursing stationA N

FN

3. Store for general items/drugs orequip.

A N

F N

4. Patient wash room

AN

F N

Paediatric nursery:

1. Patient area

A N

FN

2. Nursing stationA

N

FN

3. Store for general items/drugs orequip.

AN

FN

4. Change room/area AN


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18

FN

Clinical lab.:

1. Laboratory room

AY

FN

2. Working areaA Y

FY

3. Doctors duty roomA

Y

FN

4. Store for general reagents or equip.A

Y

FY

5. Attached wash roomA

Y

F N

Blood bank:

1. Blood collection room

A N

FN

2. Working areaA N

F N

3. Staff duty roomA

N

F N

4. Store for general reagents or equip.A N

FN

5. Attached wash roomA N

FN

LHV Room:


A Y

F Y

2. Examination area

AY

F Y

3. Privacy for examinationA N

FN

4. Hand washing facilityA

Y

FY

Ultrasound room:

Examination area

AY

FY

Residence: AN


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19

PC-1 of NMNCHP contains category and number of staff required for Comprehensive

EmONC services. Status of DHQ hospital for availability of HR (both regular posted and

provided by NMNCHP), against required numbers is presented in table below:

TABLE3.12:STATUS OF MNCHRELATED STAFFIN SHCHOSPITAL

Gynaecologist FN

Residence:

Anaesthetist

AN

FN

Residence:

Paediatrician

A N

FN

Residence:

WMO

AY

FY

Residence:

LHV

AY

FY

Residence:

Nurses

AN

F N

Residence

Lab Technician

A Y

FN

Residence:

BB Technician

A N

F N

Residence:

Anaesthesia Technician

AN

F N

Staff categories

Availability of MNCH related staff at

DHQH Panjgur

Required numberAvailablenumber

Gynaecologist 2 1

Anaesthetist 2 0

Paediatrician 2 0

WMO 6 1

OT technician 4 2

BB technician 4 0


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20

Equipment items for various service components at DHQ hospital are listed in PC-1 of

NMNCHP. Status of functional quantity of these items at SHC hospitals, is presented in the

table below.

TABLE3.13:STATUS OF FUNCTIONAL EQUIPMENTIN SHCHOSPITAL



facilities. Status of DHQ hospital regarding available quantity of tracer items is presented in

the table below.

Lab technician 3 3

Anaesthesia technician 4 1

Nurses 20 4

LHV 4 7

Ambulance drivers 4 2

Staff categories

Number of functional equipment at

DHQH Panjgur

Total requiredItems

Available items

General items 4 2

Female ward 19 15

OPD 12 12

Paediatric nursery 13 0

Paediatric ward 10 0

Labour room 24 20

Operation theatre 31 29

Clinical laboratory 5 4


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21

TABLE 3.14:STATUS OF DRUGS ANDSUPPLIES IN SHCHOSPITAL

Facility for support services including laboratory tests (space, test strips and HR), blood

transfusion services (space, supplies and HR), ambulance services (functional vehicle and

driver), operation theatre (space, drugs and supplies, equipment items and HR) was

assessed at surveyed DHQ hospital. Availability status of these services at SHC hospitals is

presented below:

TABLE 3.15:STATUSOF SUPPORTSERVICES IN SHCHOSPITAL

24/7 Basic EmONC Services at THQ Hospital

There is no THQH in this District.

Management Basics

Findings related to facility management basics are presented below:

Item groups Total Items

Number of itemsavailable at

DHQH Panjgur

Supplies 9 9

Drugs 21 11

Vaccines 5 5

FP Commodities 7 7

Item Groups Total Items

Number of itemsavailable at

DHQH Panjgur

Basic laboratory tests 17 13

Blood transfusion 5 4

Ambulance services 2 2

Radiology services 3 3

Operation theatre 62 47


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22

Human Resource

Information about sanctioned and filled posts of MNCH related staff was collected from the

surveyed facilities;and their status is presented in table 3.16 - 3.18. Filled status of staff

categories presented in following tables,include regular posting only,as reported by the

respective facility on the day of survey.

TABLE 3.16:STATUS OF HR AT SHCHOSPITAL

Staff

Status of HR at

DHQH Panjgur

Sanctioned

Gynaecologist 1

Anaesthetist 1

Paediatrician0

WMO 5

OT technician3

BB technician1

Lab technician5

Anaesthesia technician1

Nurses

4

LHV4

Ambulance drivers2

Filled

Gynaecologist 1

Anaesthetist 0

Paediatrician 0

WMO 1

OT technician 2

BB technician 0

Lab technician 3

Anaesthesia technician 1

Nurses 4

LHV 4

Ambulance drivers 2


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23

TABLE 3.17:STATUSOF HR AT RHC

TABLE 3.18:STATUS OF HR AT SURVEYED BHU

Availability of job descriptions, service delivery protocols and staff as per duty roster was

assessed and their findings are presented in the Figure 3.

Staff

Number of posts sanctioned and

filled at RHC

RHC Paroom

Sanctioned

WMO 4

Lab technician 1

Nurse 2

LHV 3

Ambulance drivers 1

Filled

WMO 0

Lab technician 1

Nurse 0

LHV 1

Ambulance drivers 1

Staff

Number of posts sanctioned and filled at each BHU


Sanctioned

WMO/ MO 1 1 1

LHV 1 1 1

Filled

WMO/ MO 0 0 1

LHV 1 1 1


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FIGURE 3: STATUS

Reasons for non-availability

3.19 and 3.20.

TABLE 3.19:RE

Reasons of non-availability

Residence not available

Residence damaged

Security reasons

Lack of basic amenities

0

0.5

1

1.5

2

2.5

3

11

0

1

0 0

OF MANAGEMENT BASICS AT SURVEYED FA

f staff on 24/7 basis at RHC and SHC ar

SONSOF NON-AVAILABILITY 24/7OF HR AT

Status in RHC

WMO LHV

0 0

0 0

0 0

0 0

3

00

00

00

00

24

ILITIES

provided in Table

HC

Ambulance Driver

0

0

0

0

()


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25

TABLE 3.20:REASONS OF NON-AVAILABILITY 24/7OF HR AT SHC HOSPITAL

Reasons of non-

availability

Status of DHQ Hospital

Gynaecologist

Anae

sthetist

Paed

iatrician

Bloo

dBank

Technician

Laboratory

Technician

W

MO

L

HV

Residence not available 0 0 0 0 0 0 0

Residence damaged 0 0 0 0 0 0 0

Security reasons 0 0 0 0 0 0 0

Lack of basic amenities 0 0 0 0 0 0 0

TABLE 3.21:CAPACITY BUILDING OF MNCHRELATED STAFFAT THESURVEYED FACILITIES

Health

Facility

MNCH related training conducted

EmONC ENC IMNCI IMPACFP

surgicalFP

counsellingClient

centeredness

DHQH

PanjgurY N N N N N N

RHC Paroom N N N N N Y

BHU Bonistan N N N N N Y

BHU Gichk N N N N N YBHU

WashboodN N N N N Y

Work Coordination and Supervision

Health facilities in the district were assessed for work coordination and supervisory activities,

including facility staff meetings, participation of facility in charges in district level meetings

and conduction of supervisory visits and feedbacks by district health managers. Findings of

each surveyed health facility are presented in Table 3.22.

TABLE3.22:STATUS OF COORDINATION ANDSUPERVISION AT SURVEYED FACILITIES

Health Facility


Regular facility PRM*Participation indistrict PRM**

Monthly Supervisory Visit

Meetingheld

Recordmaintained

Facilityvisited

Facility receivedvisit feedback

DHQH Panjgur N N Y Y N

RHC Paroom N N Y Y N

BHU Bonistan N N N N N


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26

Health Facility


Regular facility PRM*Participation indistrict PRM**

Monthly Supervisory Visit

Meetingheld

Recordmaintained

Facilityvisited

Facility receivedvisit feedback

BHU Gichk N N N N N

BHU Washbood N N N N N

* PRM=Performance Review Meeting

Management Information System

District Panjgur was practicing Health Management Information System (HMIS). Surveyed

facilities were assessed for availability and maintenance of HMIS tools and their findings are

presented in Table 3.23.

TABLE3.23:STATUS OF MISAT SURVEYED FACILITIES

HealthFacility

Status of MIS Tools

OPDticket

OPDregister

Motherhealth

register

Birthregister

Childhealth

register

FamilyPlanning

register

EPIregister

Meetingregister

MedicineStock

register

Dailyexpense

register

HMISmonthly

report

TBregister

DiseaseEarly

WarningSystem

DEWSchart

row

Monitoring

MIS Tools Available

DHQH

Panjgur Y Y Y Y Y Y Y N Y Y Y Y Y Y N

RHC Paroom Y Y Y Y Y Y N N Y Y Y N N Y N

BHU Bonistan Y Y N N Y Y Y N Y Y Y N N N N

BHU Gichk Y Y Y Y N Y N N Y N Y N Y N N

BHU

WashboodY Y N N Y Y Y N Y Y Y Y N N N

MIS Tools Maintained

DHQH

Panjgur

Y Y Y Y Y Y Y N Y N Y Y Y Y

RHC Paroom Y Y N N N Y Y N Y Y Y Y Y Y

BHU Bonistan Y Y N N N Y N N Y Y Y N N Y

BHU Gichk N N N N N N Y N N N Y N N N

BHU

WashboodY Y N N N Y N N Y N Y N N N


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27

Drugs and Supplies

Availability of drugs and supplies has been described under individual MNCH service

packages. The reasons of their non-availability were identified at the surveyed facilities and

presented in the Table 3.24.

TABLE 3.24:REASONS FORSTOCKOUTREPORTED BY SURVEYED FACILITIES

Health Facilities

citing stock out

Reasons for stock out

Poorquantification

Delayeddemand

submission

Unavailabilityof

bufferstock

Lackofstorage

capacity

Delayedsupply

Undersupply

Noprocurement

powers

Insufficientbudget

Lackofcold-chain

DHQH Panjgur Y N N N N N N Y N

RHC Paroom Y N Y N N N Y N N

BHU Bonistan Y N N N N N N N N

BHU Gichk Y N N N N N Y N N

BHU Washbood Y N N N N N N N N

Fee for Services

Fee for MNCH services and availability of social protection mechanisms for the poor were

assessed at surveyed facilities and their findings are presented in Table 3.25 and 3.26.

TABLE 3.25:STATUS OF FEEFORSERVICE AT SURVEYED FACILITIES

Health Facilities

where service arecharged

Services provided free of cost

OPD Indoor Ambulanceservices

OPDTicket

OP

DLaboratory

OP

DUltrasound

OPDX-rays

OPDMedicines

A

dmissionfee

Wardbed

Inpatient

Laboratory

Inpatient

Ultrasound

InpatientX-rays

Blo

odgrouping&

cr

ossmatching

Inpa

tientmedicines

DHQH Panjgur Y N N Y Y Y Y N N Y N N Y

RHC Paroom N N N N Y N Y N N N N Y

BHU Bonistan Y N Y

BHU Gichk Y N Y


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28

Health Facilities

where service are

charged

Services provided free of cost

OPD Indoor Ambulan

ceservices

O

PDTicket

OPD

Laboratory

OPD

Ultrasound

OPDX-rays

OPD

Medicines

Admissionfee

W

ardbed

Inpatient

Laboratory

Inpatient

Ultrasound

Inpa

tientX-rays

Bloodgrouping&

crossmatching

Inpatientmedicines

BHU Washbood Y N Y

TABLE 3.26:MECHANISMS OF SOCIAL PROTECTIONAVAILABLE AT SURVEYED FACILITIES

Health Facilities with available

Social Protection

Social Protection Mechanism

Bait-ul-Maal Zakat Patient WelfareSociety

DHQH Panjgur N Y N

RHC Paroom N N N

BHU Bonistan N N N

BHU Gichk N N N

BHU Washbood N N N

Infection Control

Health facilities were assessed for practices of infection control and waste management, and

availability of related material. Findings of individual surveyed facilities are presented in table

3.27.

TABLE3.27:STATUS OF INFECTIONCONTROL &WASTEMANAGEMENT PRACTICES AT SURVEYED FACILITIES

Health Facilities

Availability of Materials Infection Control Practices

Wastemanagementplan

Wastecollectionmaterials

Personalprotectionmaterials

Wastetreatmentequipment

FunctionalIncinerators

Handwashingpracticesof

HCP

Disinfectionofservice

provisionarea

HepBVaccinationofStaff

Wastesegregation

DisposalofWastethrough

Burning

DisposalthroughThrowing-

away

DisposalthroughMunicipal

Arrangement

DHQH Panjgur N N N N N Y Y Y N Y Y N

RHC Paroom N N N . N Y Y Y N . Y N


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29

Health Facilities

Availability of Materials Infection Control Practices

Wastem

anagementplan

Wasteco

llectionmaterials

Personalp

rotectionmaterials

Wastetre

atmentequipment

Functio

nalIncinerators

Handwashingpracticesof

HCP

Disinfe

ctionofservice

pro

visionarea

HepBVa

ccinationofStaff

Wast

esegregation

Disposal

ofWastethrough

Burning

DisposalthroughThrowing-

away

Disposal

throughMunicipal

Ar

rangement

BHU Bonistan N N N . N Y N Y N . Y N

BHU Gichk N N N . N Y N Y N . Y N

BHU Washbood N N N . N Y N Y N . Y N

Death Review

Findings related to availability and functioning of death review committees are presented in

the Table 3.28.

TABLE 3.28:STATUS OF CLINICAL AUDITPRACTICES AT SURVEYED FACILITIES

Health Facility

Status of Death Review

DeathReview

CommitteeAvailable

Maternal Deaths Neonatal Deaths

AnnualNumber

Reviewed bycommittee

AnnualNumber

Reviewed bycommittee

DHQH Panjgur N 24 12 16 0

RHC Paroom N 0 0 0 0

Facility Utilisation

Findings of services utilisation at surveyed facilities are given as monthly aggregate from

July to December 2010, annual utilisation of year 2010 and facility-wise average monthlyutilisation are presented in Tables 3.29, 3.30 and 3.31.

TABLE3.29:STATUS OF SERVICES UTILISATIONAT SURVEYED FACILITIES

Type of serviceMonthly utilisation (July to December 2010) Annual

utilisation(2010)July Aug Sep Oct Nov Dec

1st Antenatal Care visits (ANC-1) 204 159 58 228 201 186 2,036

Normal vaginal deliveries 14 13 21 16 9 7 131

Assisted vaginal deliveries 5 3 3 6 4 5 37


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30

Type of serviceMonthly utilisation (July to December 2010) Annual

utilisation(2010)July Aug Sep Oct Nov Dec

C-sections 5 5 5 5 5 5 67

1st Postnatal Care visits (PNC-1) 9 13 5 29 7 8 113

Pregnant women given TT2vaccine

75 72 53 55 39 37 549

FP services 35 37 29 19 32 49 456

Diarrhoea/Dysentery cases treated(< 5 years of age)

698 867 1,031 665 427 397 7,718

Pneumonia cases treated(< 5 years of age)

289 193 170 174 451 539 3,011

TABLE 3.30:AVERAGEMONTHLYMNCHSERVICES PROVIDED AT SURVEYED FACILITIES

HealthFacility

Average Monthly Utilisation

ANC -1

NVDAssisted

VDC

SectionPNC -

1TT2

Diarrhoea/

Dysentery(in


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31

Well Baby Clinic

Surveyed health facilities were assessed for established Well Baby Clinic (WBC) and its

findings are presented in Table 3.32.

TABLE 3.32:STATUS OF WBCESTABLISHED AT SURVEYED FACILITIES

Name of HealthFacility

WBC EstablishedName of Health

FacilityWBC Established

DHQH Panjgur N BHU Gichk N

RHC Paroom N BHU Washbood N

BHU Bonistan N

Donor ContributionDonor Contribution during last three years was assessed regarding human resource,

infrastructure, equipment including ambulances, and drugs and supplies and findings are

presented in Table 3.33.

TABLE 3.33:STATUS OF DONORCONTRIBUTION AT SURVEYED FACILITIES

Health Facilities

Donor Contribution

Human Resource Infrastructure EquipmentDrugs andSupplies

Provisionof

keystaff

Capacity

building

StaffIncentive

Constructionof

newbuilding

Renovationof

existing

building

Provisionof

newequipment

Provisionof

newvehicle/

ambulance

Provisionof

Medicines

Provisionof

Consumables

DHQH Panjgur Y Y N Y N N Y N N

RHC Paroom Y N N Y Y N Y Y N

BHU Bonistan N N N N N N N N N

BHU Gichk N N N N N N N N N

BHU Washbood N N N N N N N N N

Clients Perspective

Client Exit Interviews (CEI) was conducted within the scope of the HFA Survey to assess

clients perspective on provided services. Findings of these interviews were analysed for

assessing their perspective on access, quality and preference for health care and are

presented in Table 3.34 and Figures 4 and 5.


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32

TABLE3.34:CLIENTS PERSPECTIVE

No of interviewed clients (Total: 15)

DHQH THQH RHC

Time to reach facility

Less than 30 minutes 2 3

30 minutes to 1 hour4 1

More than 1 hour 4 1

Means of transport

Walk3 2

Personal transport0 0

Public transport7 3

Waiting time at facility

Less than 10 minutes1 2

10 minutes to 20minutes

4 2

20 minutes to 30minutes 5

0

More than 30minutes

0 1

Fee for services

Paid fee for services 10 4

Health Education Material

Received EducationMaterial

0 0

Preference for healthcare

Public HF10 5

Private sector0 0

Reasons for visiting public HF

Close to home1 1

Good quality2 0

Staff attitude0 0

Affordability7 4

Lack of choice1 2

Overall satisfaction

Very satisfied 5 1

Satisfied4 3

Not satisfied 1 1


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FI

FIGURE 5:A

Procurement Estim

Equipment

Based on the information colhave been identified for i

Summary of estimated cost

required equipment for each

cost estimates for individual f

Civil Works

A yardstick has been used f

building components (Anne

needs of the individual surve

0%

7

0% 20%

GURE 4: LEVEL OF SATISFACTION

AILABILITYOF MEDICINES ANDLABSERVIC

ates

lected, procurement needs for provision of rdividual surveyed facilities to strengthen

or procurement of required equipment is g

surveyed facility is presented as Annex 3

cilities is given in Annex 3 B.

r assessing the scope of civil works of vari

1). Identified scope of work to complet

ed facilities is presented in Annex 4. Summ

40

47

40

54

60

40

40

33

0

13

20

13

20% 40% 60% 80% 100%

64

53

22

40

14

40% 60% 80% 100%

33

S

equired equipmentMNCH services.

iven below. List of

and details about

ous MNCH related

the infrastructure

ary of estimated

()

()


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34

cost for execution of civil works including repair and maintenance, renovation and new

construction of missing facilities; is given in table below and details about cost estimates for

individual facilities is given in Annex 4.

TABLE 3.35:SUMMARYOF ESTIMATED COST FORPROCUREMENT OF EQUIPMENTS&CIVILWORKS

Procurement

Estimated Cost (PKR in Millions)

DHQHTHQH

RHC BHU Total

Equipment18

1.7 1.4 21.1

Civil Works 28 11 31 70


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35

Section 4: Key Findings

In district Panjgur, total of 5 health facilities were assessed including 3 BHU, 1 RHC, and 1

DHQH. The BHU were assessed for availability of 8/6 Preventive MNCH services; RHC was

assessed for availability of 24/7 Basic EmONC services; and DHQ Hospital was assessedfor availability of 24/7 Comprehensive EmONC services.

The key findings have been presented based on the availability of specified inputs including,

Infrastructure, Human Resource, Equipment, Drugs and Supplies, and Support services.

Status of each input has been described at one place for all levels. This is followed by key

findings on Management basics, Donor contribution and Clients perspective on the quality of

MNCH services.

Infrastructure

OPD was available at all the BHU while labour rooms were not available at all the three

BHU; Staff residences were not available at any of the surveyed BHU

OPD, labour room, female ward and clinical laboratory were available at RHC Paroom.

Residences for WMO were in good living condition

OPD, female ward, labour room, operation theatre and clinical laboratory were available

at DHQH Ranjgur, whereas Paediatric ward, paediatric nursery and blood bank were not

available. Further, residences were not available for Gynaecologist, anaesthetist and

paediatrician at DHQH

Human Resource

The required staff was available at all BHU

WMO was not available at RHC Paroom; laboratory technician, OT technician and

ambulance driver were available at RHC

Gynaecologist was available at DHQH Panjgur while the posts of Anaesthetist and

Paediatrician were vacant. No Blood bank technician was available while the technicians

in other categories were available but not in required number. LHV were surplus in

number


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36

Staff at DHQH received training on EmONC while the staff on other surveyed facilities

received training on Client centredness.

Equipment

The complete set of required equipment items was not available at any of the surveyed

facilities

General equipment items were not available at any of the surveyed BHU

Labour room equipment was not available at RHC Paroom

Equipment for Paediatric nursery and ward was not available at DHQH, while OPD

equipment was available in required number.

Drugs and Supplies

The complete list of tracer drugs, supplies, vaccines and family planning were not

available at any of the surveyed facilities

Vaccines were available at BHU Bonistan and BHU Washbood. All the FP commodities

were missing at BHU Gichk. All the supplies items were available at BHU Washbood

Vaccines were not available at RHC Paroom

All the vaccines,supplies and FP commodities were available at DHQH in required

number

The most common reason for stockout of drugs was poor quantification.

Support Services

The complete range of required inputs for delivery of support services was not available

at most of the surveyed facilities

Inputs required for provision of basic laboratory tests were available at BHU Washbood

Ambulance service was available at RHC and DHQ hospital

All the inputs for Radiology services were available at DHQH


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37

Management Basics

Management basics assessed at the surveyed facilities included availability of job

description and service delivery protocols, work coordination and supervision, MIS, infection

control measures, death reviews of maternal and neonatal deaths, fee for services and

available mechanisms of social protection.

All the surveyed facilities were not conducting regular performance review meetings and

facility in-charges of DHQH Ranjgur and RHC Paroom reported regular participation in

district level performance review meetings

DHQH and RHC Paroom reported supervisory visits of district health managers and its

feedback was not received even at these facilities.

Health Management Information System (HMIS) was being practiced in district Panjgur.

Regarding HMIS tools, complete range of tools was not available at any of the facility,

specifically non-availability of Meeting Register, disease early warning system, DEWS

chart and Growth monitoring register

Social protection mechanisms for the poor was available in the form of Zakat at DHQH

only

Complete range of inputs required for infection control practices were deficient at all the

surveyed facilities. All the facilities reported non-availability of waste management plan,

materials for waste collection, personal protection and waste treatment

Death review committee was not available for review of maternal and neonatal deaths at

any of the surveyed facilities.

Donor Contribution

Donor contribution for supporting delivery of MNCH was assessed at the surveyed facilities

for provision of human resource, infrastructure, equipment, drugs and supplies. In the

district, DHQH Ranjgur and RHC Paroom reported donor contribution for the provision of key

staff, staff capacity building, construction of new building and provision of new equipment

and provision of medicines. .


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38

Clients Perspective

Client exit interviews were conducted to assess clients perspective about their satisfaction

with the services utilised at the facility. Total of 15 interviews were conducted in the district

and findings concluded that 40% of the clients were very satisfied, 47% were satisfied and

13% were not satisfied with the availed services.


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39

Annexes


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40

Annex 1: District Health Department

Public sector district health system consists of Secondary Health Care (DHQH) and Primary

Health Care (RHC, BHU) facilities. DHO acts as head of the district health department,

under supervision of DC.

Health Resources

Health facilities (Public sector)

Public sector facilities providing MNCH services are given in table below:

TABLE 2.4:NUMBER OF PUBLIC SECTORHEALTH FACILITIESIN THE DISTRICT

Type Number Bed strength

Teaching hospitals 0 0

DHQ Hospital 1 36

THQ Hospital 0 0

RHC 1 10

BHU 15 0

Govt. Rural Dispensaries 13

MNCH Centres 4

Sub Health Centres 0

SOURCE:HMISCELL,DHOOFFICE

Human Resource DHO Office

Table 2.5 summarises the HR situation at the DHO Office.

TABLE 2.5:HUMAN RESOURCE IN DHOOFFICE

Name of Post Sanctioned Filled % Filled

District Officer Health 1 1 100

Deputy District Officer Health 2 2 100District Coordinator National Program for FP & PHC 1 1 100

District Coordinator EPI Surveillance 1 1 100

District Coordinator NMNCHP 1 1 100

District Sanitary Inspector 1 1 100

CDC Officer 1 1 100

CDC Inspector 0 0 0

Drug Inspector 1 0 0

District Superintendent Vaccination 1 1 100


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41

Name of Post Sanctioned Filled % Filled

Assistant Superintendent Vaccination 2 2 100

Tehsil Sanitary Inspector 0 0 0

Inspector Vaccination0 0 0

Total 12 11 92

SOURCE:DHOOFFICE

MNCH staff in District Panjgur

Table 2.6 summarises the status of MNCH staffing in health facilities including DHQH, RHC

and BHU in the district. The information was collected from DHO office during survey.

This information may not match with subsequent tables containing similar information on

human resource (HR) collected from respective surveyed health facilities (No. 3.7, 3.12,

3.16, 3.17, 3.18).

TABLE 2.6:AVAILABILITYOF MNCHSERVICES STAFFING IN PANJGUR

Posts

Sanctioned

Filled % Filled

Filled posts

R= Regular, C= On Contract

DHQH=1 THQH=0 RHC=1 BHU=15

R C R C R C R C

Gynaecologist 1 1 100 1 0

Paediatrician 1 0 0 0 0

Anaesthetist 1 0 0 0 0

Radiologist 1 0 0 0 0

Pathologist 1 0 0 0 0

Women Medical

Officers (WMO)12 4 75 2 0 1 0 1 0

Medical Officers

(MOs)

18 5 28 3 0 1 0 1 0

Blood Transfusion

Officers1 0 0 0 0

Blood Bank

Technician1 0 0 0 0

O.T. Technician 5 1 20 1 0

Anaesthesia

Technician3 0 0 0 0

LHV 7 5 71 2 0 2 0 1 0

Nurses 6 4 67 4 0 0 0


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42

Posts

Sanctioned

Filled % Filled

Filled posts

R= Regular, C= On Contract

DHQH=1 THQH=0 RHC=1 BHU=15

R C R C R C R C

Lady HealthWorkers (LHW)*

52 50 96

Laboratory

Technician5 2 40 2 0 0 0

X-ray Technician 3 3 100 2 0 1 0

Dispenser 15 13 86 8 0 3 0 2 0

Vaccinators 15 11 73 6 0 3 0 2 0

Ambulance

Drivers5 4 80 3 0 1 0

Total 153 103 67 34 0 12 0 7 0

*LHW ARE COMMUNITY BASED SOURCE:HMISCELL,DHOOFFICE

Financial Allocations

Budgetary allocations and expenditures over the last three years for the district (in PKR

Million) were requested from DHO office, but the same were not available, as presented in

table 2.7.

TABLE 2.7:FINANCIAL ALLOCATIONIN DISTRICT PANJGUR

DistrictHealthBudget

2007-08 2008-09 2009-10

Allocation Expenditure Allocation Expenditure Allocation Expenditure

Non-Development

-* - - - - -

Development - - - - - -

Total - - - - - -

SOURCE:DHOOFFICE, * -Data not available

Donor Contribution

Information about donor contribution for MNCH services was asked from DHO office in terms

of financial input. It was reported that donor contribution was provided to this district, but

district health department was unable to provide monetary value of the support provided.

During survey, information about donor inputs on surveyed health facilities was also

collected; however, health facilities were found having received such inputs in terms of

human resource, infrastructure and equipment etc.


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NMNCH Programme Indicators

Information on NMNCHP indicators is being compiled at office of DHO and this information

has been gathered on the sets of indicators, which is reproduced as such in following

tables.It is important to note that services utilisation data reported by district office take into

account utilisation of all public sector facilities in the district.

This information may not match with subsequent tables containing information on drugs and

supplies (Table No. 3.4, 3.9, 3.14, and 3.19) and C-sections (No. 3.29) collected from

respective health facilities included in survey..

TABLE2.8:NMNCHP MONITORING INDICATORS (YEAR2010)

Services Management

Number of district monthly performance review meetings held during last year -

Number of facilities with stock-out of FP commodities 4

Number of facilities stock outs of essential EmONC drugs 2

Support Services

Number of facilities with laboratory services available 3

Number of facilities with blood transfusion services available 1

Service Utilisation

Antenatal care coverage 5

Percentage of children


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Community Mid-Wives (NMNCHP)

Number of first antenatal care visits (ANC 1) 1203

Number of ANC revisits 553

Number of TT 2 given 1604

Number of deliveries 62

Number of post natal visits 28

Number of family planning visits (both new and follow-up) 66

Number of FP commodities provided 03

Number of maternal complications referred 20

Number of neonates referred -

Number of clean/safe delivery kits used 500

Stock out of clean/safe delivery kits 650

Stock out of FP commodities -

Number of pregnant women referred by LHW 28

Number of maternal deaths -

Number of neonatal deaths -

SOURCE:HMISCELL,MNCHCELL,EPICELL,MISNP FOR FP&PHC-DHOOFFICE

Provision of Staff by the NMNCHP

The NMNCHP is supposed to provide support in human resource at target health facilities,

including specialists, doctors and paramedics. The programme is currently under

implementation and number of facilities having staff provided by the NMNCHP is given in the

table 2.9.

TABLE 2.9:NUMBER OF FACILITIESWITHSTAFFPROVIDED BY THENMNCHP

Staff CadreNumber of Health facilities

DHQH THQH RHC BHU

Gynaecologist -* - -

Anaesthetist - - -

Paediatrician/Neonatologist - - -

WMO - - -

OT technician - - -

BB technician - - -

Lab technician - - -

Anaesthesia technician - - -

Nurses - - -

LHV - - -

Ambulance drivers - - -

SOURCE:MNCH CELLDHOOFFICE-* DATA NOT AVAILABLE


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MNCH Staff Trainings

Part of the mandate of the Programme is to build capacity of MNCH related staff through

conducting skill development trainings of the staff in standards of service provision,

counselling techniques and client centeredness. Information about trainings of MNCH staff is

presented in the table 2.10. It is important to note here that this information collected from

district office may not match with similar information contained in Table No. 3.21 collected

from the surveyed facilities.

TABLE 2.10:NUMBER OF STAFF TRAINED ON DELIVERING MNCHSERVICES

Category ofstaff

Number of staff trained (during last three years)

EmONC ENC IMNCI IMPACFP

SurgicalFP

CounsellingClient

centeredness

Gynaecologist 0 0 0 0 0 0 0Paediatrician 0 0 0 0 0 0 0

Anaesthetics 0 0 0 0 0 0 0

WMO 0 0 0 0 0 1 0

MO 1 0 0 0 0 1 0

OT Technician 0 0 0 0 0 0 0

Nurse 1 0 0 0 0 0 0

LHV 3 0 0 0 0 3 0

SOURCE:MNCH CELLDHOOFFICE

CMW Training and Deployment

Part of the mandate of the Programme is to train and deploy CMWs for improving community

based MNCH services. Information collected from district NMNCH cell related to the CMW

training and deployment is presented in the table 2.11.

TABLE2.11:STATUS OF CMWSTRAINING ANDDEPLOYMENT

Training and Deployment of Community Mid-Wives (NMNCHP)

Number of selected CMWs verified for their residential status 14

Number of CMWs with completed training 35

Number of CMWs deployed by NMNCHP 6

Number of CMW Schools where renovation/ construction completed 2

CMW Manual/Books available (Number of sets) 160

CMW training equipment/models available (Number) 10

Number of CMWs sponsored/supported by partners 21

SOURCE:MNCH CELLDHOOFFICE


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Annex 2: Input Criteria for MNCH services

A. Civil works criteria

CIVIL WORKS SCOPE FOR BHU

OPTIMAL ITEMS

Ob/Gyn OPD or LHV room1. Consultation area

2. Examination area3. Hand washing facilities

Labour room1. Delivery room

2. Scrub area3. Functional attached wash room for patient

WMO or LHV residence1. Available2. Good condition

MINIMAL ITEMS

LHV Room Available

CIVIL WORKS SCOPE FOR RHCOPTIMAL ITEMS

Ob/Gyn OPD1. Consultation area


Ob/Gyn Ward1. Patient area

2. Functional attached wash room

Labour room1. Delivery room

2. Scrub area3. Functional attached wash room for patient

Clinical laboratory1. Laboratory room

2. Working area3. Functional attached washroom



WMO residence 1. Available2. Good condition

LHV residence1. Available2. Good condition

MINIMAL ITEMS

Ob/Gyn OPD AvailableOb/Gyn Ward AvailableLabour room AvailableLHV room Available

WMO residence1. Available2. Good condition

LHV residence1. Available2. Good condition

CIVIL WORKS SCOPE FOR DHQH & THQH

OPTIMAL ITEMS

Ob/Gyn OPD1. Consultation area

2. Examination area3. Privacy of examination area4. Hand washing facilities

Ob/Gyn Ward1. Patient area2. Nursing station

3. Store for General items/drugs, or4. Functional attached wash room

Labour room

1. Delivery room2. Preparation/ stage room3. Scrub area

5. Store for General items/drugs,

6. Store for Equipment7. Functional attached wash room for patient8. Functional attached wash room for staff


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4. Staff duty room

Operation theatre1. Patient preparation room2. Operating room3. Recovery room4. Scrub area

5. Sterilisation area6. Doctors room7. Support staff duty room8. Store for General items/drugs, or equip.9. Store of equipment

10. Functional attached washroom for staffPaediatric ward

1. Patient area2. Nursing station

3. Store for General items/drugs, or equip4. Functional attached wash room

Paediatric nursery1. Patient area2. Nursing station

3. Store for General items/drugs, or equip4. Change room

Clinical laboratory1. Laboratory room2. Working area

3. Doctors duty room4. Store for chemical / reagents, or equip5. Functional attached washroom

Blood bank1. Blood collection room2. Working area

3. Staff duty room4. Store for equipment / reagents5. Functional attached washroom

LHV Room1. Consultation area2. Examination area

3. Privacy of examination area4. Hand washing facilities

Ultrasound room Examination area

Gynaecologist residence Available Good condition

Anaesthetist residence Available Good condition

Paediatrician residence Available Good condition

WMO residence Available Good condition

LHV residence

Available Good condition

Nurse residence Available Good condition

Lab technician residence Available Good condition

BB technician residence Available Good condition

Anaesthesia technician residence Available Good condition

MINIMAL ITEMS

Ob/Gyn OPD AvailableOb/Gyn Ward AvailableLabour room AvailableOperation theatre AvailablePaediatric ward AvailableClinical laboratory Available

Gynaecologist residence Available Good condition

Anaesthetist residence Available Good condition

Paediatrician residence Available Good condition

WMO residence Available Good condition

Lab technician residence Available

Good condition


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B. Human Resource criteria

HUMAN RESOURCE FOR PREVENTIVEEmONC

HUMAN RESOURCE FOR 24/7 Basic EmONC

OPTIMAL HR FOR BHU OPTIMAL HR FOR RHC

Category Number Category NumberMO, or 1 WMO 2LHV 1 OT technician 1

- - Lab technician 1- - LHV 2- - Ambulance driver 1

MINIMAL HR FOR BHU MINIMAL HR FOR RHC

MO, or 1 WMO 1LHV 1 Lab technician 1

- - LHV 1- - - -

HUMAN RESOURCE FOR 24/7 Comprehensive EmONC

OPTIMAL HR FOR DHQH OPTIMAL HR FOR THQH

Category Number Category Number

Gynaecologist 2 Gynaecologist 1Anaesthetist 2 Anaesthetist 1Paediatrician 2 Paediatrician 1

WMO 6 WMO 4OT technician 4 OT technician 4

BB technician 4 BB technician 4Lab technician 3 Lab technician 2Anaesthesia technician 4 Anaesthesia technician 4

Nurses 20 Nurses 12LHV 4 LHV 4

Ambulance drivers 4 Ambulance drivers 4

MINIMAL HR FOR DHQH MINIMAL HR FOR THQH

Gynaecologist 1 Gynaecologist 1Anaesthetist 1 Anaesthetist 1Paediatrician 1 Paediatrician 1

WMO 4 WMO 2OT technician 1 OT technician 1

Lab technician 1 Lab technician 1Nurses 6 Nurses 4LHV 1 LHV 1


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C. Equipment criteria

EQUIPMENT FOR BHU

OPTIMAL ITEMS

General hospital equipment1. Electric water cooler

2. Water filter3. Incinerator

OPD / WMO office1. Office / plain chairs2. Examination couch3. Office tables with drawer4. Steel almirah large5. Patient stool6. Weight machine adult

7. Weight machine infant8. Height measuring board9. Height measuring device10. B.P Apparatus mercury-desk type11. Foetal stethoscope12. Steam inhaler13. Nebuliser14. Examination lamp

Lady health visitor's room

1. Weight scale Adult2. Weight scale Infant3. Height measuring device4. Height measuring board5. Disposable syringe cutter6. D & C instruments set

7. P.V. Examination light8. Examination Couch9. Office Chairs10. Office Tables with drawer11. Patient Stool12. Steel almirah large

MINIMAL ITEMS

1. Office chairs2. Office tables with drawer3. B.P Apparatus mercury-desk type4. Foetal stethoscope5. Weight scale Adult

6. Weight scale Infant7. Height measuring device8. Height measuring board9. D & C instruments set10. Examination couch

EQUIPMENT FOR RHC

OPTIMAL ITEMS

General Hospital1. Ambulance2. Electric water cooler

3. Water filter4. Incinerator

Female ward items1. Fowler bed (Iron)2. Attendant's bench3. Bed side locker4. Overhead food trolley

5. Dust bin stainless steel6. Screen folding complete7. Baby cot8. B.P Apparatus mercury-desk type9. Stethoscope

OPD / WMO Office

1. Office chairs2. Plain chairs3. Examination couch4. Office tables with drawer5. Steel almirah large6. Patient stool7. Weight machine adult

8. Weight machine infant

9. Height measuring board10. Height measuring device11. B.P Apparatus mercury-desk type12. Foetal stethoscope13. Steam inhaler14. Nebuliser15. Examination lamp

Labour Room1. UPS power supply system (2000W)2. Suction machine electric3. Infant weight machine4. Foetal stethoscope5. Electric instrument steriliser 12"x6"

6. Jar for forceps7. Spring type dressing forceps (ss)

10. Sim's speculum right angle, large11. Sponge forceps12. Long straight artery forceps13. Uterine sound14. Vulsellum forceps15. Scissors dissecting blunt pointed

16. Artery forceps17. Blunt-ended scissors


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EQUIPMENT FOR RHC

OPTIMAL ITEMS

8. Sim's speculum right angle, small9. Sim's speculum right angle, medium

18. D & C instruments set19. Infant ambo bag

Lady health visitor's room

1. Weight scale Adult2. Weight scale Infant3. Height measuring device4. Height measuring board5. P.V. Examination light

6. Examination couch

7. Office chairs8. Office tables with drawer9. Patient stool10. Steel almirah large

MINIMAL ITEMS

Female ward items1. Fowler bed (Iron)

2. B.P Apparatus mercury-desk type3. Stethoscope

OPD / WMO Office1. Office chairs2. Examination couch

4.

hfa district report - panjgur

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