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Three Years Rolling Plan 2010-2013 District Attock

THREE YEARS ROLLING PLAN2010 - 2013

DISTRICT LODHRAN

Three Years Rolling Plan (2010-2013) District Lodhran

Table of Contents

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

Executive Summary....................................................................................6

SECTION 1: DISTRICT HEALTH PROFILE.......................................................9

I. Vision of the District..............................................................................9

II. Background of the District.....................................................................9

III. Map of the District............................................................................10

IV. Demography.....................................................................................10

V. Socio Economic Indicators................................................................12

VI. Health Indicators..............................................................................13

a) Reproductive Health.........................................................................13

VII. Organizational Structure of District Health Administration...............14

VIII. Health Resources..............................................................................15

i. Health Facilities................................................................................15

a) Public.............................................................................................15

b) Private...........................................................................................17

ii. Human Resource..............................................................................17

a) Administrative................................................................................17

b) Facility Based.................................................................................18

c) Outreach........................................................................................28

d) Training Institutions....................................................................28

iii. Health Financing............................................................................30

IX. Disease Pattern................................................................................31

X. Status of Vertical Programs..............................................................34

i. National Program for FP & PHC.........................................................34

ii. EPI.....................................................................................................34

iii. MNCH Program..............................................................................35


iv. TB Control Program........................................................................35

v. Malaria Control Program...................................................................35

vi. Hepatitis Control Program.............................................................35

vii. School Health Services Program....................................................36

SECTION 2: PROBLEM ANALYSIS................................................................37

I. Objectives............................................................................................37

II. Plan Development Process..................................................................38

a) Problem Identification.......................................................................39

i. Health Problems.............................................................................39

b) Problem Prioritization.......................................................................40

Underlying causes of prioritized problems.............................................41

ii. Service delivery/Management problems........................................42

Underlying causes of Management Problems.........................................43

III. MDGs and MSDS...............................................................................44

a) Human Resource..............................................................................45

i. DHQ Hospital.................................................................................45

ii. THQ Hospitals................................................................................46

b) Equipment........................................................................................47

i. DHQ Hospital.................................................................................48

ii. THQ Hospital..................................................................................56

SECTION 3: INTERVENTIONS AND TARGETS..............................................66

I. Health Problems..................................................................................66

II. Management Problems........................................................................80

SECTION 4: COSTING AND FINANCING PLAN.............................................93

I. Activity based costing..........................................................................93

a) Health Problems...............................................................................93

b) Management Problems...................................................................106


II. Financial Outlay including 3YRP Activities.........................................115

a) Health Problems.............................................................................115

b) Management Problems...................................................................117

III. Summaries......................................................................................120

a) Problem-wise Costing.....................................................................120

i. Health Problem............................................................................120

ii. Management Problems...................................................................121

b) Activity-wise Costing......................................................................122

i. Health Problems..........................................................................122

ii. Management Problems................................................................127

SECTION 5: MONITORING & EVALUATION................................................133

I. M&E of Plan.......................................................................................133

Annex - I..................................................................................................138

Annex-II...................................................................................................141


Acronyms

3YRP Three Years Rolling plan

ADB Asian Development Bank

AE Assistant Entomologist

APMO Additional Principal Medical Officer

ARI Acute Respiratory Infections

ASV Assistant Superintendent Vaccination

BHU Basic Health Center

BoD Burden of Disease

CDC Communicable Disease Control

CDR Case Detection Rate

CPR Contraceptive Prevalence Rate

DC District Coordinator

DHIS District Health Information System

DHQH District Head Quarter Hospital

DoH Department of Health

DR Default Rate

DSV District Superintendent Vaccination

EDO(H) Executive District Officer Health

EPI Expended Program on Immunization

HSRP Health Sector Reforms Program

IMR Infant Mortality Rate

IPC Interpersonal Communication

IV Inspector Vaccination

M & E Monitoring and Evaluation

M & R Maintenance and Repair

MCH Maternal Child Health

MMR Maternal Mortality Ratio


MNCH Maternal Newborn and Child Health

MO Medical Officer

MoV Means of Verification

MSDS Minimum Service Delivery Standards

PDSSP Punjab Devolved Social Services Program

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

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 Social Services Programme (PDSSP). This year government of the Punjab through Health Sector Reforms Program (HSRP) with the technical assistance from a team of consultants (SP09) and wide consultations/inputs from all key stake holders has established a bench mark in standardization of the format of 3YRP. Capacity building of the districts has been done on the standardized format.

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


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


District Lodhran

SECTION 1: DISTRICT HEALTH PROFILE

I. Vision of the District

Health Department District Government Lodhran aims to provide to every citizen (1.62 M) regardless of the socio0economic status, an effective, efficient, and most modern health care delivery system, by mean acceptable to them, base on scientific method, at a cost that community and country can afford, in the true spirit of self realize.

II. Background of the District

The foundation of Lodhran city was laid in 1830. The British rule extended to Punjab, district Multan including the area of Lodhran also came under the British rule. At that time district Multan comprised of five pargana (Tehsil) i.e. Multan, Shuja Abad, Lodhran, Malsi and Sarai Sadhu.Settalement operation in tehsil Lodhran was started in 1873 which concluded in April 1875.Kehror Pacca and Dunyapur were the part of tehsil Malsi which were annexed with Lodhran in 1924.

Lodhran District is located on the North side of the river Satluj.On its north are the districts of Multan, Khaniwal and Vehari while Bahawalpur is on its southern side. On the east lies the districts of Vehari and Bahawalpur while district Multan lies on the western side. Lodhran lies between 29° 0 21°, to 29° – 55° latitudes and 71° – 23° to 72° – 11° longitudes. Total area is 2778 square Kilometers or 111105 acres. It is almost rectangular in shape with one arm 34.54 kilometers and other 51.80 kilometers long. It comprises 438 Mauzas.


The climate of the district is hot and dry in summer and cold in winter season. The summer season begins in April and continues till October. The hottest months are May, June and July. The maximum and minimum temperature ranges between 42 0 28 centigrade respectively. The entire area is smooth plain, almost whole under cultivation through canals and tube wells. The soil is suitable for growing Mangos,

The District Headquarter is connected with its Tehsil Headquarters through Railway line and roads. Lodhran railway station is junction of railway lines. Total metalled raods length is about 853 killometers. The district is linked with Multan, Bahawalpur, Vehari, Khaniwal, Jalapur and Shuja abad through metalled raods. The main ethnic groups are Gujjar, Bhutta, Jam, Mughal, Rajput, Awan, kanjoo, Balouch, Arain and Sandhi.

III. Map of the District


IV. Demography

Total Population 16, 20, 795 persons

Annual growth rate 2.0 %

Population density 422 persons per sq. km

Area wise population

Area Population Percentage

Rural 13, 90, 795 85.80%

Urban 2, 30, 00 14.20%

Source: DCR 1998 (Projected population)

Gender wise population

Gender Population Percentage

Male 8, 42, 813 52%

Female 7, 77, 982 48%

Source: DCR 1998 (Projected population)

Population groups

Population GroupsStandard Demographic (%)

Estimated Population

Under 1 year of age 2.7 43, 761

Under 5 years 13.4 2, 17, 186

Under 15 years 44 7, 13, 149

Women in child bearing age (15-49 years)

22 3, 56, 574

Married Child Bearing age Women 16 2, 59, 327

Expected pregnancies 3.4 55, 107


Source: Bureau of Statistics (Projected from Census 1998)

V. Socio Economic Indicators

Education and Literacy

Age Literacy Rate

10+yrs 45%

Adult 15+yrs 41%

Adult 15024yrs 60%

Literacy rateRural Urban

Male FemaleOverall District

%age 26.8% 47.7% 26.8

16.0

29.9

Source: MICS 2070208

Per capita income 875 $/Annum

HousingOwnership of house 76%Mean household size 6.8Mean number of persons per room 3.7Total Housing Units 861437Pacca Housing Units 504369Electrified 183988Piped water supply 21510Gas for Cooking 2500


Mean household sizeOverall district 6.8 personsTehsil Lodhran 6.7 personsTehsil Dunya Pur 6.9 personsTehsil Kehror Pacca 7.0 persons

Water and SanitationPhysical access to drinking water (within dwelling) 93 %Use of improved drinking water sources 99 %Use of properly treated water 1.5 %Safe drinking water without bacteria 32 %Use of sanitary means of excreta disposal 58 %Use of improved water sources and improved Sanitation 58 % Proper disposal of ; Waste water 24 %Solid waste 4.3 %Hand washing adequately;Before meal 48%After using latrine 52 %

VI. Health Indicators

Infant Mortality Rate 71.9/100

Neonatal mortality Rate 45/100

Under 5 mortality Rate 94/1000 Live births

Maternal mortality Ratio 222/100,000

Life expectancy 65 years


Proportion of children under 1 years immunized 85%against measles

a) Reproductive Health

Contraception Use of contraceptives (any method)

23% Contraceptive drop out

3.6% Unwilling pregnancy

27%

Maternal and newborn health

Antenatal care (ANC) 46% Skilled attendant at delivery 31% Institutional deliveries 28% Postnatal care (PNC) 29%

Source: MICS 2007-2008

VII. Organizational Structure of District Health Administration

There exists a three-tier system in the health sector in the country. At federal level, Federal Secretary of Health is responsible to administer and supervise the health related activities and programs. Major function of federal tier is to provide policy guidelines and ensure quality of health care standards through federal legislation. After the 18th amendment in the constitution, and announcement of National Finance Award, most of the existing federal level programs will be transferred to the provincial level. At provincial level, provincial Secretary of Health along with Director General Health Services is responsible for managing and supervising health care services. The district is still an administrative entity in the system and EDO (Health) acts as head of the district health department,

ORGANOGRAM

(Executive District Officer (Health)

MS THQHosp Dunyapur

DistrictOfficerHealth

PrincipalGeneral Nursing School

Deputy District Officer Health

Drug Inspector

DSI CDCO Entamologist

District Coordination Officer

MS DHQHosp. Lodhran


under overall supervision of DCO. The organizational structure at district level is as under:

VIII. Health Resources

i. Health Facilities

a) Public

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


Facility Type No. of FacilityBed Strength

No. of Functional Beds

Remarks

Teaching hospitals

0 0 0 0

DHQ Hospital 1 40 40

New DHQ of 125 Beds is under construction

THQ Hospital 2 40 2812 more beds are required

RHCs 4 32 24RHC 53 M is 8 bedded

BHUs 48 96 96

Govt. Rural Dispensaries

1 0 0 0

MCH Centers 0 0 0 0

Sub Health Centers

0 0 0 0

TB Clinics 0 0 0 0

Rural Dispensaries (ZC)

0 0 0 0

City Dispensaries

0 0 0 0

Health house 1011 0 0 0

Data source: DHIS/EDOH office


b) Private

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

ii. Human Resource

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

a) Administrativeb) Facility basedc) Outreachd) Training institutions

a) Administrative

Sr.No Post Sanctioned Filled

1. Executive District Officer Health

1 1

2. District Officer Health 1 1

3. Deputy DOH Lodhran 1 1

4. Drug Inspector 1 1

5. Assistant Entomologist 1 1

6. CDC Officer 1 1



7. Statistical Officer 1 1

8. Office Superintendent 1 1

9. District Sanitary Inspector 1 1

10. Assistant 1 0

11. Head Clerk 1 1

12. Statistical Assistant 1 1

13. Assistant Superintendent Vaccination

1 1

14. Assistant Inspectoress Health Centers

1 0

15. Tehsil Sanitary Inspector 1 0

16. Senior Clerk 4 4

17. Junior Clerk 5 3

18. Accountant 1 0

19. Drivers 3 3



20. Insect Collector 2 2

21. Naib Qasid 7 7

22. Chowkidar 5 5

23. Ward Cleaner 1 1

b) Facility Based

Basic Health Units

Sr.No

Post Sanctioned

Filled

1. Medical Officer 48 48

2. Nutrition Supervisors 48 48

3. Computer Operator 48 0

4. Deputy Medical Officer 4 2

5. Medical Technician 44 44

6. Lady Health Visitor 48 48

7. Sanitary Inspectors 48 48

8. Dispenser 48 48

9. Midwife 44 44

10. Naib qasid 48 48

11. Chowkidar 48 48


Sr.No

Post Sanctioned

Filled

12. Ward Cleaner 30 30

Rural Health Centres

Sr.No

Post Sanctioned

Filled

1. Senior Medical Officer 4 4


3. Woman Medical Officer

4 4

4. Dental Surgeon 4 4

5. Charge Nurses 24 6

6. Homeopathic Healer 2 2

7. Homeopathic Dispenser

2 2

8. Hakeem 2 2

9. Dawasaz 2 2

10. Dispenser 16 15

11. Dresser 8 7


13. Computer Operator 4 0


Sr.No

Post Sanctioned

Filled

14. Dental Technician 4 0

15. Laboratory Technician

4 1

16. Radiographer 4 4



19. Laboratory Assistant 4 4

20. Midwife 16 0

21. Driver 4 4

22. Naib Qasid 8 8

23. Chowkidar 8 8

24. Mali 4 0

25. Water Carrier 4 0

26. Ward Servant (M&F) 12 0


Sr.No

Post Sanctioned

Filled

27. Sweepers 16 16

28. Dawakoob 2 2

29. WMO MNCH 4 1

30. LHV MNCH 4 4

THQ Hospitals

Sr. No. Nomenclature of Post

Sanctioned Filled Vacancy Gap

1 Medical Superintendent

2 2 0

2 Additional MS 0 0 0

3 D.M.S 0 0 0

4 Physician 2 1 1

5 Surgeon 2 2 0

6 Gynecologist 2 2 0

7 Pediatrician 2 2 0

8 Anesthetist 2 1 1

9 Opthathmologist 2 2 0

10 ENT Specialist 2 0 2

11 Pathologist 0 0 0

12 Radiologist 0 0 0




13 Orthopedic Surgeon

0 0 0

14 Clinical Psychologist

0 0 0

15 Emergency Specialist

0 0 0

16 Trauma Surgeon 0 0 0

17 Forensic Expert 0 0 0

18 Urologist 0 0 0

19 Cardiologist 0 0 0

20 Neurosurgeon 0 0 0

21 Psychiatrist 0 0 0

22 TB & Chest Specialist

0 0 0

23 Dermatologist 0 0 0

24 Pediatric Surgeon

0 0 0

25 Neurologist 0 0 0

26 Epidemiologist 0 0 0

27 Medical Officer 6 6 0

28 APMO 3 3 0

29 APWMO 0 0 0

30 EMO 4 4 0




31 WMO Labor Room

6 6 0

32 MO Intensive care

4 4 0

33 BTO 0 0 0

34 Dental Surgeon 2 2 0

35 Charge Nurse 20 20 0

36 Head Nurse 2 2 0

37 Nursing Superintendent

0 0 0

38 Budget & Accounts Officer

0 0 0

39 Accountant 0 0 0

40 Social Welfare Officer

0 0 0

41 Bio Medical Engineer

0 0 0

42 Pharmacist 0 0 0

43 Health & Nutrition Supervisor

0 0 0

44 Speech Therapist

0 0 0

45 Statistical Specialist

0 0 0




46 Radiographer 4 4 0

47 Dental Technician

0 0 0

48 Lab Technician 0 0 0

49 Lab Assistant 4 4 0

50 Dispenser 8 8 0

51 Eye Refractions 0 0 0

52 Ophthalmic Technician

0 0 0

53 Bio Medical Technician

0 0 0

54 ECG Technician 0 0 0

55 OT Technician 6 0 6

56 LHV 2 2 0

57 Dresser 2 2 0

58 Midwifes 0 0 0

59 Store keeper 2 2 0

60 Computer Operator

0 0 0

61 Naib Qasid 6 6 0

62 Chowkidar 6 6 0

63 Senior Clerk 0 0 0

64 Driver 4 4 0

65 Water Carrier 0 0 0




66 Cashier 0 0 0

67 Junior Clerk 2 2 0

68 Head Clerk 0 0 0

69 Baildar 0 0 0

70 Car Painter 0 0 0

71 Cook 2 2 0

72 Plumber 0 0 0

73 Almoner 0 0 0

74 Gate Keeper 0 0 0

75 Dental Assistant 2 2 0

76 Telephone Operator

0 0 0

77 Physiotherapy/ Aids Technician

0 0 0

78 Structure Bearer 0 0 0

79 Projectionist 0 0 0

80 St. Assistant 0 0 0

81 OTA 2 2 0

82 Sanitary Inspector

0 0 0

83 Lab Attendant 0 0 0

84 Gardner/ Mali 4 4 0

85 Sanitary Worker 14 14 0




86 Ward Servant 14 14 0

87 Electrician 0 0 0

88 Tailor 0 0 0

89 Dhobi/ Washer Man

2 0 2

90 A.C Mechanic 0 0 0

91 Tube Well Operator

2 2 0

DHQ Hospital

Sr.No Post Sanctioned

Filled

1. Medical Superintendent 1 1

2. Physician 1 0

3. Surgeon 1 1

4. Gynecologist 1 1

5. Pediatrician 1 1

6. Anestheseist 1 0

7. Ophthalmologist 1 1

8. ENT Specialist 1 0

9. Pathologist 1 0

10. Radiologist 1 0

11. Orthopedic Surgeon 1 1



Filled

12. Cardiologist 1 1

13. Psychiatrist 1 0


15. APMO 5 2

16. APWMO 3 0

17. EMO 6 6

18. WMO Labour Room 2 2

19. MO Intensive Care 3 3

20. Blood Transfusion Officer 1 0

21. Dental Surgeon 2 1

22. Head Nurse 2 0

23. Charge Nurse 13 13

24. Accountant 1 1

25. Pharmacist 1 1

26. Radiographer 3 3

27. Dental Technician 1 1

28. Laboratory Assistant 3 2

29. Dispenser 8 8


31. Head Clerk 1 1



34. Dental Assistant 1 1



Filled

35. Store Keeper 2 1

36. OTA 1 1

37. Dresser 3 3

38. Midwife 3 2

39. Naib Qasid 9 9

40. Chowkidar 5 4

41. Driver 9 9

42. Baildar 2 2

43. Cook 3 3

44. Gate Keeper 1 1

45. Gardener 2 2

46. Sanitary Worker 14 13

47. Ward Servant 12 12

48. Dhobi 1 1

49. Tube well Operator 1 1

c) Outreach

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

Post Sanctioned Filled

Vaccinator 55 54

CDC Supervisor 40 37


Sanitary Inspector 48 22

d) Training Institutions

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

Type of institute Number

DHDC Nil

General Nursing school1

DHDC

DHDC in Lodhran is still to be established. All types of trainings are being arranged in the existing EDO(H) office building at District Complex 10 M chak. DOH is officiating the job of Program Director DHDC. It is requested that the appropriate measures must be taken for the DEVELOPMENT of District Health Development Center. The following posts are require to be sanctioned for DHDC Lodhran along with the standard DHDC building.

General Nursing School


Filled

1. Principal 1 1

2. Instructor 3 2

3. Assistant Instructor

1 1

4. Public Health Supervisor

2 0



Filled

5. Librarian 1 1

6. House Keeper 1 1

7. Stenographer 1 0

8. Senior Clerk 1 1

9. Accountant 1 1


11. Naib Qasid 1 1

12. Chowkidar 4 4

13. Cook 1 1

14. Bearer 2 2

15. Mali 3 2

16. Aya Female 2 2

17. Sweeper 3 3

18. Driver 1 1

19. Computer Operator MNCH

1 0



Filled

20. Instructor Midwifery MNCH

2 0

21. Clinical Supervisor MNCH

1 0

22. Driver MNCH 1 1

23. Security Guard MNCH

1 0

iii. 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

20708 20809 209010

Allocation

Exp. Allocation

Exp. Allocation

Exp.

Developmental 111.00 67.00 202.914 135.645

148.269 62.00

Non developmental

199.522 173.563

206.583 212.187

302.464 194.638


Sub-Total 30.522 240.563

409.497 347.832

450.733 256.638

PHRSP 23.976 0 44.576 5.232 39.344 0PMDGP 0 0 73.720 0 73.720 21.30 PDSSP 18.151 0 18.151 15.287 24.260 2.864 Provincial development budget

--- ---- ---- ---- ---- ----

Other sources (CM initiative)

0 0 1.440 0 1.440 0.920

Total

42.127 0 137.887 20.519 138.764 25.084

Grand Total 342.649 240.563

547.384 368.351

589.497 281.722

IX. 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 Percentage of Magnitude

Respiratory Disease

1 Acute upper respiratory infection

20.7411

2 Pneumonia < 5years 1.483

3 Pneumonia < 5years 1.6358



4 TB Suspects 0.6243

5 Chronic Obstructive Pulmonary Disease

0.4673

6 Asthma 1.3559

Gastro Intestinal Disease

7 Diarrhea / Dysentery < 5 years 3.2152

8 Diarrhea / Dysentery < 5 years 3.1476

9 Enteric / Typhoid Fever 0.1228

10 Worm infestations 0.7736

11 Peptic Ulcer 1.8906

12 Cirrhosis of Liver 0.0741

Urinary Tract Disease

13 Urinary Tract infection 0.8437

14 Nephritis / Nephrosis 0.013

15 Sexually Transmitted Infections

0.0361

16 Benign Enlargement of Prostrate

0.0187

Other Communicable Disease

17 Suspected Malaria 1.9014

18 Suspected Meningitis 0.0102

19 Fever due to other causes 2.3807

Vaccine Preventable Disease

20 Suspected Measles 0.1328

21 Suspected Viral Hepatitis 0.0701



22 Suspected Neo0natal Tetanus 0.0393

Cardiovascular Disease

23 Ischemic Heart disease 0.1418

24 Hypertension 1.5694

Skin Disease

25 Scabies 5.3454

26 Dermatitis 1.0812

27 Cutaneous Leishmaniasis 0.026

Endocrine Disease

28 Diabetes Mellitus 1.1266

Neuro Psychiatric Disease

29 Depression 0.3025

30 Drug Dependence 0.0157

31 Epilepsy 0.0141


Eye & ENT

32 Cataract 0.2518

33 Trachoma 0.1057

34 Glaucoma 0.0625

35 Otitis Media 0.7758

Oral Disease

36 Dental Carries 0.9861

Injuries / Poisoning

37 Road Traffic Accidents 1.8177



38 Fractures 0.0933

39 Burns 0.1566

40 Dog Bites 0.1638

41 Snake Bites ( with sign/symptoms of poisoning

0.045

Miscellaneous Disease

42 Acute Flaccid Paralysis 0.0226

43 Suspected HIV/AIDS 0

44 Any other unusual disease ( specify )

0

Source: DHIS Reports

X. 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.

i. National Program for FP & PHC

No. of seats allocated for LHWs 1011 No. of LHWs working 922 Percentage of Population covered by the program 65

% Important program indicators

IMR 32/1000

MMR 152/100,000

CPR 49% No. of antenatal visits 90% TT Coverage of pregnant women

87%


ii. EPI

EPI Coverage rate of the district 85% Fully immunized children 023 months 85% Pregnant women received TT vaccine (TT02)

69% Availability of cold chain equipment 55 Health Facilities

are fully equipped with cold chain however 3 BHUs are facing equipment shortage along with repair and

maintenance problem).

iii. MNCH Program

CMW Students Admitted 53 Passed 53 Fresh CMWs batch 40 Post Sanctione

dFilled

Public Health Specialist 1 0

Social Organizer/Community coordinator

1 1

Account Assistant 1 1

iv. TB Control Program

Quarter Wise DOTS Indicators

Indicator

Q1 2009 Q2 2009 Q3 2009 Q4 2009

CDR All Types

64% 87% 93% 68%

CDR NSS+

59% 64% 106% 66%

SCR 90% 92% 91% 92%

TSR 92% 91% 91% 90%

DR 4% 5% 5% 5%


v. Malaria Control Program

No. of slides examined 39072No. of positive slides 03 Slides positively ratio 0.08%Percentage of plasmodium falciparum 0 %

vi. Hepatitis Control Program

No. of hepatitis tests conducted 704No. of positive cases detected 522 (B)&(C)No. of persons vaccinated against Hepatitis B 2595No. of cases treated for Hepatitis B 103No. of cases treated for Hepatitis C 419

vii. School Health Services Program1. Total Visits to the School 2616

2. No. Students Examined 24164

3. No of students referred to BHUs

9366

4. No. Students Treated at BHU

22071

5. No. of Students referred from BHU to higher facilities

30841

6. No. of Schools in catchment Areas

2120 ( 923 Girls+1197 boys)

7. No. of Students 314578

8. No of Teachers Trained 5307 ( 6490)

9. No of SH & NS 69

Source; DHDC Lodhran


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 201 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.

I. Objectives

Improve health status of the population Meeting the requirements of national and provincial health policies Achievement of MDGs through MSDS Introducing evidence0based planning culture by addressing district

specific problems/issues Addressing emerging health needs or re0emergence of health

problems (e.g. H1N1, HIV0AIDS, Polio, T.B) Ensuring effective inter0sectoral 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.

II. 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 SP09 team at divisional headquarters. The main components of the trainings were: (i) developing a three0year rolling health sector plan using the standard three year rolling plan format; (ii) costing of the plan; (iii) preparing related budget projections; (iv)


accounting procedures; (v) preparing adequate financial reports on the use of funds.

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

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

a) 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 SP09 team and consulting the above mentioned documents. The problems identified were broadly divided into two categories i.e.

a) Health Problemsb) Health Service Delivery or Management Problems

i. 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.

Sr.No Health Problems1. Diarrhea (Acute & Chronic)

2. ARI (Pneumonia)

3. Hepatitis B & C

4. Anemia (Pregnant Ladies and Children under 5)

5. Complications during pregnancies

6. T.B

7. Worm Infestations

8. Scabies

9. Goiter

10. Malnutrition

b) 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) Cost0effectiveness of the intervention Political expediency

Each element has been assigned a score from 1 to 4 depending upon grade/scale of that element i.e. Very High=4, High=3, Medium=2 and Low=1.


Elements of the prioritization criteria were applied to each of the enlisted health problems. The aggregate of individual scores assigned to the elements of the prioritization criteria gave the total score for a health problem. A cut-off point was decided, to establish the priority health problems of the district. This total score was then used to prioritize the health problems. These problems will be addressed in the three years rolling plan.

Problem Magnitude Severity Vulnerabilit

y to

intervention

Cost

Effectiv

eness

Political

Expedienc

y

Total

Score

Priorit

y No.

Diarrhea (Acute

& Chronic)

3 2 4 4 1 14 3

ARI (Pneumonia) 4 3 4 4 1 16 2

Hepatitis B & C 3 2 3 1 2 11 5

Complications of

pregnancies

3 3 3 3 4 16 2

Anemia

(Pregnant Ladies

and Children

under 5)

4 3 4 4 2 17 1

T.B 2 2 3 3 2 12 4

Worm

Infestations

2 2 2 2 1 9 7

Scabies 3 1 3 2 1 10 6

Goiter 2 1 2 2 1 8 8

Malnutrition 4 3 3 3 1 14 3

Underlying causes of prioritized problems

Health problems have their underlying causes. It is important to know the underlying causes of the health problems so that appropriate


interventions are developed. There may be a long list of these causes but only few of them are vital ones; and rectifying these causes can resolve the problem to a large extent. Following table gives common causes of the prioritized health problems pertaining to the district.

Sr. # Health Problem Causes

1. Anemia in Pregnancy

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

3. ARI Malnutrition Air Contamination Over Crowding/Poor housing facilities Lack of proper sanitation Seasonal Variation Lack of awareness related to winter season and

hygienic practices4. Diarrhea under

5 Children Poor hygiene and sanitation Lack of safe drinking water Unhygienic practices Lack of awareness among mothers about feeding

and weaning practices

5. Tuberculosis Low socioeconomic status Overcrowding/Poor Housing Facilities Malnutrition Seasonal Variation Lack of proper sanitation Lack of awareness and hygienic practices

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

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

barbers


Sr. # Health Problem Causes

7. Scabies Overcrowding in schools and homes Low socio-economic conditions Poor Health Education

ii. Service delivery/Management problems

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

Sr.No

Management Problems

1. Shortage of Skilled Staff MNCH related

2. Lack of Budget for POL

3. Lack of equipment

4. Deficient Infrastructure

5. Lack of Monitoring and Supervision

Underlying causes of Management Problems

Sr. #

Service Causes

1. Shortage of skilled (MNCH) Non-availability of trained staff Non-sanctioning of staff according to


Sr. #

Service Causes

staff

MSDS Lack of permanent postings Lack of incentivized and differential

pay package Frequent transfer postings Job insecurity Lack of conducive environment

including insecurity and transport of children for education

Political and media interference

2. Inadequate budget for POL Generator provision for backup of electricity supply

Frequent increase in prices of POL Less allocation for POL budget

3. Inadequate Equipment Deficient equipment to cater basic and comprehensive EmONC at primary and secondary level of care

Old and un-serviceable equipment Shortage of regular budget for M&R Frequent cuts on M&R budget

4. Deficient infrastructure (Staff residencies)

Debilitated condition of existing infra-structure

Lack of budget for repair and maintenance

Inadequate infrastructure for Emergency, Operation Theatre, OPD and inpatients, residences for staff at THQ and DHQ Hospitals

5. Ineffective Supervision and Monitoring system

Absence of M&E policy Inadequate resources Lack of Skills


III. 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 level0specific service delivery package (for primary and secondary health care) along with their standards and system specifications including human, infrastructure, equipment, medical supplies, medicine and other consumables.

In order to achieve the MDGs, the government of Punjab has adopted MSDS as strategic framework. During the development of three years rolling plans, gaps under MSDS focusing on MNCH interventions have been identified. Most essential areas for which gaps have been identified are human resource and equipment of DHQ and THQ hospitals, as per lists notified by the government in accordance with MSDS standards.

a) Human Resource

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

Hospital Category Bed Strength

DHQ Hospital

A 40 and above Beds

B 251040 Beds

C Up to 250 Beds

THQ Hospital A Above 60 Beds


B 41060 Beds

C Up to 40 Beds

i. DHQ Hospital


Standard as per MSDS

C Category

Sanctioned

Filled Vacancy Gap in relation to sanctioned posts

Vacancy Gap in relation to filled posts

1. Gynaecologist

3 3 3 0 0

2. Paediatrician

3 1 1 2 2

3. Anesthetist 4 1 0 3 4

4. Medical Officer including APMO, EMO

21 17 5 4 16

5. WMO, APWMO

6 5 0 5 6

6. Nurse 36 17 15

19 21

ii. THQ Hospitals

There are five THQ hospitals in the district. The following table shows the consolidated position of all the THQ hospitals in the district.


Sr. No.

Nomenclature of Post

Standard as per MSDS

C Category

Sanctioned

Filled

Vacancy Gap in relation to sanctioned posts

Vacancy Gap in relation to filled posts

1. Gynecologist

4 2 2 0 2

2. Pediatrician 4 2 2 0 2

3. Anesthetist 6 2 1 5 3

4. Medical Officers including SMO,APMO & PMOs

34 17 4 17 30

5. Women Medical Officers including SWMO APWMO & PMOs

8 6 6 0 2

6. Nurses 34 22 22 0 12

7. Head Nurse 2 2 2 0 0

b) Equipment

Government of Punjab has notified a standard list as yard0stick of MNCH related equipment to provide comprehensive EmONC services in the DHQ and THQ hospitals. Provision of comprehensive EmONC services is


essentially required to decrease the high MMR and IMR prevailing in the province.

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

i. DHQ Hospital

Sr. No.

Equipment Standard as per MSDS

(Qty.)

Available

Gap

C B A

1 CTG (Cardiac Tocography)

1 1 2 0 1

2 Foetal Doppler 3 5 5 0 3

3 Diagnostic Laparoscope

1 1 2 0 1

4 Bulb Sucker 10

20

20

10 0

5 Baby Warmer 3 3 6 0 3

6 Mechanical Sucker 3 3 6 4 0

7 Fetal Stethoscope 4 4 4 4 0

8 Delivery Table 2 2 3 1 1

9 D&C Set 2 3 4 2 0

10 Outlet forceps 4 4 4 4 0


Sr. No.


(Qty.)

Available

Gap

C B A

11 Myoma Screw 2 2 2 2 0

12 Kochers forceps 4 4 8 4 0

13 Volselum forceps 6 8 10

6 0

14 Lanes Tissue holding forceps

2 2 4 2 0

15 Vaginal Retractors 10

10

10

10 0

16 Polypectomy forceps 2 2 2 2 0

17 Sponge holder 10

15

20

10 0

18 Uterine elevator 1 1 1 1 0

19 CosCo Speculum

Small, Medium, Large (for each category)

6 10

10

6 0

20 Examination light 3 3 6 2 1

21 Suction Curette 1 2 2 1 0


Sr. No.


(Qty.)

Available

Gap

C B A

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

1 1 2 0 1

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

1 1 2 1 0

24 Cardiac Monitor 1 1 2 5 0

25 Pump Breast Electronic

1 1 1 1 0

26 Vaginal Hysterectomy Set

2 2 4 2 0

26.1 Toothed Tissue Forceps (8”)

2 2 4 2 0

26.2 Non-Toothed Tissue Forceps (8”)

2 2 4 2 0


Sr. No.


(Qty.)

Available

Gap

C B A

26.3 Dissection Scissors (Curved 7”)

2 2 4 2 0

26.4 Dissection Scissors (Straight 7”)

2 2 4 2 0

26.5 Hysterectomy Clamps (Straight)

8 8 16

8 0

26.6 Hysterectomy Clamps (Curved)

8 8 16

8 0

26.7 Uterine Sound 2 2 4 2 0

26.8 Needle Holder (7”) 2 2 4 2 0

26.9 Needle Holder (10”) 2 2 4 2 0

26.10

Artery Forceps (Straight 6”)

16

16

32

16 0

26.11

Artery Forceps (Curved 6”)

16

16

32

16 0

26.12

Allis Forceps 8 8 16

8 0

26.13

Towel Clamps 8 8 16

8 0

26.14

Single blade Sims speculum

4 4 8 4 0


Sr. No.


(Qty.)

Available

Gap

C B A

26.15

Double blade Sims speculum

4 4 8 4 0

26.16

Sponge holding forceps

8 8 16

8 0

26.17

Volselum forceps 4 4 8 4 0

26.18

Uterine Sound 2 2 4 2 0

26.19

Bladder Sound 2 2 4 2 0

27 Delivery Sets 10

10

15

10 0

27.1 Episiotomy Scissors 10

10

15

10 0

27.2 Straight Scissors 10

10

15

10 0

27.3 Needle holder 10

10

15

10 0

27.4 Non-toothed tissue forceps 8 inches

10

10

15

10 0

27.5 Toothed tissue forceps 8 inches

10

10

15

10 0


Sr. No.


(Qty.)

Available

Gap

C B A

27.6 Sims Speculum single blade

20

20

30

20 0

27.7 Sims Speculum double blade

20

20

30

20 0

27.8 Sponge holding forceps

40

40

60

40 0

27.9 Artery forceps 40

40

60

40 0

27.10

Straight clamps (cord)

20

20

30

20 0

27.11

Vacuum Extractor pump

1 1 1 0 1

27.12

Towel clip 40

40

60

40 0

28 Caesarian Section 6 8 10

6 0

28.1 Scalpel 6 8 10

6 0

28.2 Artery Forceps Straight 6 inches

24

32

40

24 0

28.3 Artery Forceps Curved 6 inches

24

32

40

24 0


Sr. No.


(Qty.)

Available

Gap

C B A

28.4 Artery forceps 8 inches

24

32

40

24 0

28.5 Myoma Scissors straight 7 inches

6 8 10

6 0

28.6 Dissecting scissors (curved) 7 inches

6 8 10

6 0

28.7 Green Armtage forceps 8 inches

24

32

40

24 0

28.8 Obstetric outlet forceps (pair)

6 8 10

6 0

28.9 Doyene’s Retractor 6 8 10

6 0

28.10

Small Retractors 12

16

20

12 0

28.11

Towel Clippers 24

32

40

24 0

28.12

Suction Nozzle 6 8 10

6 0

29 MNCH Related Radiology Equipments

29.1 Ultrasound Machine 1 2 3 1 0

29.2 X0Ray Unit 50 kw 1 1 1 1 0


Sr. No.


(Qty.)

Available

Gap

C B A

29.3 Color Doppler 0 1 1 0 0

29.4 Lead Screen for X0Ray Unit

1 1 1 1 0

29.5 0.5 MN Lead Apron. Lead Gloves, Goggles and Thyroid and Go0dal Sheets

1 1 1 1 0

29.6 Safe Light 1 1 1 1 0

29.7 X0RT 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 2 0

29.10

X-Ray Film Hangers All sizes

4 4 4 4 0

30 MNCH Related Paediatrics Equipments

30.1 Paediatric Ventilator 1 2 2 0 1

30.2 Incubator 1 1 2 0 1

30.3 Photo Therapy Unit 1 1 1 1 0

30.4 Over-head Radiant Warmer

1 1 1 1 0


Sr. No.


(Qty.)

Available

Gap

C B A

30.5 Infant Length Measuring Scale

2 2 2 2 0

30.6 Infant Weighing Machine

2 2 2 2 0

30.7 Nebulizer 1 1 2 1 0

30.8 Billirubino0meter 1 1 2 1 0

30.9 Exchange Blood Transfusion Set

1 1 2 0 1

30.10

Nasal Probe Paed size 2 2 4 2 0

31 Anesthesia/ICU 0

31.1 Anesthesia Machine 1 1 2 1 0

31.2 Ventilators 1 1 1 1 0

31.3 Nebulizer 1 1 1 1 0

31.4 Pulse Oximetry 1 1 1 1 0

31.5 Defibrillator 1 1 1 1 0

31.6 Airway Oral and 0sal 2 3 4 2 0

31.7 Tracheostomy tube (adult and paeds)

2 2 4 2 0

31.8 Face mask of all sizes 2 2 4 2 0


Sr. No.


(Qty.)

Available

Gap

C B A

31.9 Double Cuff Tourniquet (for regio0l block)

1 2 2 1 0

31.10

AMBO bag adult 2 2 4 2 0

31.11

AMBO Bag paeds 2 2 4 2 0

31.12

Red Rubber 0sal tubes all sizes without cuff

4 4 8 4 0

32 Blood Bank 0

32.1 Blood storage cabinet (10 bag capacity)

1 1 2 1 0

32.2 Packed cell machine 1 1 1 1 0

32.3 Cell Separator 1 1 1 1 0

32.4 Freezer for Fresh Frozen Plasma

1 1 1 1 0

32.5 Blood bag shaker 1 1 2 1 0

32.6 RH view box 2 2 4 2 0

32.7 Water bath 2 2 2 2 0

32.8 Micro-pipette 4 6 8 4 0

32.9 Blood grouping tiles 3 3 6 3 0


Sr. No.


(Qty.)

Available

Gap

C B A

32.10

Plasma Extractor 1 1 1 1 0

32.11

Platelets agitator 1 1 1 1 0

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 1 0

33.3 Analyzer Bio-chemistry Semi0automatic

1 1 1 1 0

33.4 Glucometer 2 2 2 2 0

33.5 Haemoglobino0meter 2 2 4 2 0

33.6 Centrifuge 1 1 2 1 0


ii. THQ Hospital

Sr. No. Equipment Standard as per MSDS

(Qty.)

Available

Gap

C B A


1 1 1 0 1

2 Foetal Doppler 2 2 3 0 2


1 1 1 1 0

4 Bulb Sucker 5 10

20

5 0

5 Baby Warmer 2 2 3 2 0

6 Mechanical Sucker 3 3 3 3 0

7 Fetal Stethoscope 2 3 4 2 0

8 Delivery Table 2 2 2 2 0

9 D&C Set 2 2 2 2 0

10 Outlet forceps 4 4 4 4 0

11 Myoma Screw 2 2 2 2 0

12 Kochers forceps 4 4 4 4 0

13 Volselum forceps 4 4 6 4 0


2 2 2 2 0

15 Vaginal Retractors 4 4 6 4 0



(Qty.)

Available

Gap

C B A

16 Polypectomy forceps

2 2 2 2 0

17 Sponge holder 10

10

15

10 0

18 Uterine elevator 1 1 1 1 0

19 CosCo Speculum

Small, Medium, Large (for each category)

4 6 6 4 0

20 Examination light 3 3 3 1 0

21 Suction Curette 1 1 2 0 1


1 1 1 0 1



(Qty.)

Available

Gap

C B A

23 Mother Resuscitation Trolley (with life saving medicines, Laryngoscope, Endo0tracheal tube, BP Apparatus, Chargeable light)

1 1 1 1 0

24 Cardiac Monitor 1 1 1 0 1


1 1 1 0 1

26 Vaginal Hysterectomy Set

2 2 2 2 0


2 2 2 2 0

26.2 Non-Tooted Tissue Forceps (8”)

2 2 2 2 0


2 2 2 2 0


2 2 2 2 0


8 8 8 8 0



(Qty.)

Available

Gap

C B A


8 8 8 8 0


26.8 Needle Holder (7”) 2 2 4 2 0

26.9 Needle Holder (10”)

2 2 2 2 0

26.10 Artery Forceps (Straight 6”)

16

16

16

16 0

26.11 Artery Forceps (Curved 6”)

16

16

16

16 0

26.12 Allis Forceps 8 8 8 8 0

26.13 Towel Clamps 8 8 8 8 0

26.14 Single blade Sims speculum

4 4 4 4 0

26.15 Double blade Sims speculum

4 4 4 4 0


8 8 8 8 0

26.17 Volselum forceps 4 4 4 4 0


26.19 Bladder Sound 2 2 2 2 0



(Qty.)

Available

Gap

C B A

27 Delivery Sets 6 6 10

6 0

27.1 Episiotomy Scissors

6 6 10

6 0

27.2 Straight Scissors 6 6 10

6 0

27.3 Needle holder 6 6 10

6 0


6 6 10

6 0


6 6 10

6 0


12

12

20

12 0


12

12

20

12 0


40

40

40

40 0

27.9 Artery forceps 40

40

40

40 0

27.10 Straight clamps (cord)

20

20

30

20 0



(Qty.)

Available

Gap

C B A

27.11 Vacuum Extractor pump

1 1 1 1 0

27.12 Towel clip 40

40

40

40 0

28 Caesarian Section 4 4 6 4 0

28.1 Scalpel 4 4 6 4 0


16

16

24

16 0


16

16

24

16 0


16

16

24

16 0


4 4 6 4 0


4 4 6 4 0


16

16

24

16 0


4 4 6 4 0

28.9 Doyene’s Retractor

4 4 6 4 0



(Qty.)

Available

Gap

C B A

28.10 Small Retractors 8 8 12

8 0

28.11 Towel Clippers 16

16

24

16 0

28.12 Suction Nozzle 4 4 6 4 0


29.1 Ultrasound Machine

1 1 2 1 1

29.2 X0Ray Unit 50 kw 1 1 1 0 1

29.3 Color Doppler 0 0 0 0 0


1 1 1 1 0


1 1 1 1 0

29.6 Safe Light 1 1 1 1 0

29.7 X-Ray Film Processing Tank

1 1 1 1 0

29.8 Chest Stand 1 1 1 1 0



(Qty.)

Available

Gap

C B A

29.9 X-Ray film Illumi0tor

2 2 2 2 0

29.10 X-Ray Film Hangers All sizes

4 4 4 4 0


0

30.1 Paediatric Ventilator

1 1 2 1 1

30.2 Incubator 1 1 1 1 0

30.3 Photo Therapy Unit 1 1 1 1 0

30.4 Over0head Radiant Warmer

1 1 1 1 0


2 2 2 2 0


2 2 2 2 0

30.7 Nebulizer 1 1 1 1 0

30.8 Billirubino-meter 1 1 1 1 0


1 1 1 1 1



(Qty.)

Available

Gap

C B A

30.10 Nasal Probe Paed size

1 2 2 1 0

31 Anesthesia/ICU

31.1 Anesthesia Machine

1 1 1 1 1

31.2 Ventilators 1 1 1 1 0

31.3 Nebulizer 1 1 1 1 0

31.4 Pulse Oximetry 1 1 1 1 0

31.5 Defibrillator 1 1 1 1 0

31.6 Airway Oral and 0sal

1 2 2 1 0


1 2 2 1 0

31.8 Face mask of all sizes

1 2 2 1 0


1 1 1 1 0

31.10 AMBO bag adult 1 2 2 0 1

31.11 AMBO Bag paeds 2 2 2 0 2



(Qty.)

Available

Gap

C B A

31.12 Red Rubber 0sal tubes all sizes without cuff

4 4 4 4 0

32 Blood Bank 0


1 1 1 1 0

32.2 Packed cell machine

1 1 1 1 0

32.3 Cell Separator 1 1 1 1 0


1 1 1 1 0

32.5 Blood bag shaker 1 1 1 1 0

32.6 RH view box 1 2 2 1 0

32.7 Water bath 2 2 2 2 0

32.8 Micro-pipette 4 4 6 4 0

32.9 Blood grouping tiles

3 3 3 3 0

32.10 Plasma Extractor 1 1 1 1 0

32.11 Platelets agitator 1 1 1 1 0

32.12 Blood thawing bath

1 1 1 1 0



(Qty.)

Available

Gap

C B A

32.13 Microscopes 1 1 1 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 1 0

33.3 Analyzer Bio-chemistry Semi-automatic

1 1 1 1 0

33.4 Glucometer 2 2 2 2 0

33.5 Haemoglobinometer

1 1 1 1 0

33.6 Centrifuge 1 1 1 1 0


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.

I. Health Problems

Problem CausesIntervention

Activity UnitPlan Activities Targets

Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

1.

Anemia in pregnancy

· Poverty & malntrition

· Awareness raising for behaviour change

· Messages on local cable network

Monthly Messages telecat packages

36 12 12 12 -

Lack of Improving Printing Brochur 300,000 100,000 100,000 100,000 -




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

awareness about balanced diet

ante-natal coverage

and distribution of IPC material

e

Multiple

pregnancies Improving ante-natal coverage

Printing and distribution of IPC material

Poster 30,000 10,000 10,000 10,000 -

Inadequate and poor MCH services

Deworming campaign

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

Batch of 50 LHWs For 1 Days

20 10 5 5 -




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

nutrients

Gender discrimination

Provision/ Distribution of micro-nutrient supplements

Procurement of de-worming tablets

No. of courses

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

Worm infestation

Diagnosis and treatment of infections

Purchase of medicine ( Folic Acid)

Pack of 100 Tablets

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




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

Purchase of medicine (Ferrous Sulphate)

Pack of 100 Tablets

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

2. ARI Malnutrition Health

promotion campaign

Messages on local cable networks

Monthly Telecast

36 12 12 12 Integrated Activity

Air contamination

Capacity building of health staff in Integrated Management of Childhood Illnesses

Messages through FM radio channels

Monthly Telecast

36 12 12 12 -




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

(IMCI)

Over-crowding/Poor housing facilities

Provision of medicines for ARI


Poster 30,000 10,000 10,000 10,000 -

Lack of proper sanitation

Timely referral of complicated cases

Training of medics and para-medics in IMCI

Batch 6 3 2 1 -

Seasonal variation

- Procurement of drugs

Oral Medicine Package

390,000 130,000 130,000 130,000 -

Lack of awareness

- - Injectable

78,000 26,000 26,000 26,000 -




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

related to winter season and hygienic practices

Procurement of nebulizing drugs

Drug 6,000 3,000 1,500 1,500 -

3. Diarrhea

Poor Hygiene & sanitation

Coordination with TMA for improvement of water supply and sanitation

Quarterly co-ordination meetings with TMA and other agencies

Meetings

12 4 4 4 -




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

Lack of safe drinking water

Awareness raising campaign

Messages on local cable network

Monthly Telecast


Unhygienic practices

Proper treatment of Diarrhea including ORT


Poster 30,000 10,000 10,000 10,000 -

Lack of awareness among mothers about feeding and weaning

Health awareness in the community

Conduction of HES in Schools

Sessions 1,000 500 300 200 -




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

practices

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

Training of medics and paramedics in IMCI

Batch 6 3 2 1 In

tegrated Activity

- Procurement and distribution of ORS and Zinc

ORS packets

1,200,000 400,000 400,000 400,000 -




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

Sulphate

Procurement and distribution of Zinc Sulphate

Syrup 600,000 200,000 200,000 200,000 -

4. TB Low socio-economic status

Health education/promotion

Messages on local cable networks

Monthly telecast

36 12 12 12 Integrated activity

Over-crowding/Poor housing facilities

Str

engthening TB DOTS program through involvement of


Monthly telecast

36 12 12 12 Integrated activity




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

private sector

Malnutrition - Printing and distribution of IPC and TB awareness material

Poster 30,000 10,000 10,000 10,000 -

Seasonal variation

- Procurement of drugs to address deficiency according to regimen

treatment day

6,000 2,000 2,000 2,000 -

Lack of proper

- Procurement of reagents

Diagnostics

- - - - Need Assessm




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

sanitation and slides for notified diagnostic facilities under DOTS program

ent

5. Hepatitis

Poor sanitation

Health Education/Promotion

Quarterly co-

ordination meetings with TMA and other agencies

- 12 4 4 4 Integrated Activity

Unsafe drinking water

Campaign against quackery


Monthly Package





Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

Sharing of used syringes

Strengthening blood transfusion services for safe transfusions

· Printing and distribution of IPC and hepatitis awareness material

Poster 20,000 10,000 5,000 5,000 -

Transfusion of

u

nsafe/unscreened blood and blood products

Campaign against drug addiction

Procurement and supply of screening kits

Kits 400,000 150,000 150,000 100,000 -

Unsafe sexual practices

Regulatory mechanism to ensure

Procurement of safety boxes

Syringe cutter

400 200 100 100 -




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

use of safe instruments by dentists, barbers etc.

Ear piercing and tattooing

Procurement of drugs for treatment of Hepatitis patients

Injection 1,500 500 500 500 -

Use of unsterilized equipment by dentists and barbers

Develop and implement SOPs for sterilization of

- - - - - SOPs




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

equipment

6. Scabies

Overcrowding in schools and homes

Awareness raising campaign

Community health education sessions

HES 100 50 25 25 No Cost

Low socio-economic conditions

Provision of medicines

Printing & Distribution of IPC Material

Brochure 15,000 5,000 5,000 5,000 -

Poor Health Education

- Supply of anti scabies drugs

drug 250,000 100,000 75,000 75,000 -


II. Management Problems

Human Resource Plan to bridge gap between MSDS and Existing 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 Gynaecologist 18 12,910

18,099 2 1 1 0

2 Paediatricians 18 12,910

18,099 4 2 1 1

3 Anesthetists 18 12,910

18,099 6 3 2 1

4 MO / WMO 17 9,850 15,345 67 33 17 17


5 Nurses 16 6,060 8,934 72 36 18 18

6 Lady Health Visitors 9 3,820 4,750 23 10 7 6




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

1. Shortage of skilled staffs MNCH related

Non-availability of trained staff

Filling of the vacant posts

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

- - - - - Recruitment

- Non-sanctioning of staff according to MSDS

Sanctioning of trained staffs according to MSDS

Temporary filling of vacant positions on contract

- - - - - Recruitment

- Lack of Incentivize Demand - - - - - Plan




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

permanent postings

d pay package at all levels

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

- Lack of incentivized and differential

Well defined career structure

Orientation trainings of the recruited staffs

Batch 7 3 2 2 -




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

pay package

including opportunities for higher education

- Frequent transfer postings

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

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

- - - - - Meeting




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

staff

- Job insecurity

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

- - - - - Plan

- Lack of basic amenities at

- Review and revise the career structure of

- - - - - Technical assistanc




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

workplace medics and paramedics

e

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

- Filling of Human Resource gaps as per MSDS

Posts 151 75 39 37 Detail HR plan is attached

- - - - Posts 23 10 7 6 Detail HR plan is attached




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

- Political and media interference

- - HR 174 85 46 43 Detail HR plan is attached

2. Inadequate budget for POL

Generator provision for backup of electricity supply

Rational increase in POL budget

Assessment of additional requirement

- - - - - NO COST ACTIVITY

Less budget allocation

- Costing and submission of additional demand

- - - - - -




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

· Frequent increase in prices

- Provision of POL budget for District Level supervisor

litre 86,400 28,800 28,800 28,800 -

Provision of POL budget for EPI

litre 27,000 9,000 9,000 9,000 -

Provision of POL budget for generator

litre 87,600 29,200 29,200 29,200 -

3. Deficient infra

Debilitated condition of existing

Make up the deficiencie

Identify the gaps in infrastructur

- - - - - Need Assessment




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

structure

infra-structure

s against standards specified in MSDS

e of THQ and DHQ hospitals individually

- Lack of repair and maintenance

Devise appropriate mechanisms for repair and maintenance

Costing of the gaps

- - - - - Plan

- Inadequate infrastructure for

Provision of infrastruct

Phasing - - - - - Demand submission




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

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

ure at THQ and DHQ according to the MSDS

- - Construction of residence of WMO at DHQ and

Construction of residences at DHQ hospital

1100 per squared yard

1,750 1,750 - - -




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

THQ hospital

- - - Construction of residences at THQ hospitals (2*1)

1100 per square yard

3,500 1,750 1,750 - -

4. Lack of MNCH related equipments

Deficient equipment to cater basic and comprehensive EmONC at

Provision of the equipment in accordance with the notified

Procurement of equipments for THQ and DHQ hospitals based on the

- - - - - Detail attached




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

primary and secondary level of care

equipment list

gaps between MSDS and existing available

Old and un-serviceable equipment

Provision of adequate budget for maintenance and repair

Allocation of enhanced amount for M&R of equipments

- - - - - Submission of demand

Shortage of regular budget for

Capacity building of staff

Orientation of staffs in maintenance

- - - - - Plan




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

M&R regarding maintenance of log books of each equipment

of logos for equipments

5. Ineffective supervision / monitoring

No monitoring policy

Development of supervision/ monitoring policy

Training of district managers in supervision and monitoring

batch 6 2 2 2 -

Lack of Capacity building of

Procurement of

Vehicles 1 1 - - -




Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

skills mangers transport for supervision

Inadequate resources

Arrange logistic support

- Vehicles 4 2 2 - -

Development and printing of monitoring tools

Stationery checklist visit form

300 100 100 100 -


SECTION 4: COSTING AND FINANCING PLAN

I. Activity based costing

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


a) Health Problems

Sr. No.

Problem Activity Define Financial Targets Total Cost

Remarks

Unit Rate Quantity


1 Anemia in pregnancy


Monthly Messages telecast packages

35,000 36 420,000

462,000

508,200 1,390,200

-


Brochure

5 300,000 500,000

550,000

605,000 1,655,000

-

Printing and distribution

Poster 30 30,000 300,000

330,000

363,000 993,000 -


Sr. No.


Remarks

Unit Rate Quantity


of IPC material

Short refresher

trainings of LHWs about balanced diet and provision of micro-nutrients

Batch of 50 LHWs For 1 Days

79,000 20 790,000

434,500

477,950 1,702,450

-

· Procurement of de-worming tablets

No. of coursers

20 150,000 1

,000,000

1,100,000

1,210,000

3,310,000

-


Sr. No.


Remarks

Unit Rate Quantity


Purchase of medicine ( Folic Acid)

Pack of 100 Tablets

30 150,000 1,500,000

1,650,000

1,815,000

4,965,000

-

Purchase of medicine (Ferrous Sulphat)

Pack of 100 Tablets

50 150,000 2,500,000

2,750,000

3,025,000

8,275,000

-

2 ARI Messages on local cable networks

Monthly Telecast

- 36 _ _ _ - Integrated Activity

Messages

through FM radio channels

Monthly Telecast

35,000 36 420,000

462,000

508,200 1,390,200

-


Sr. No.


Remarks

Unit Rate Quantity



Poster 30 30,000 300,000

330,000

363,000 993,000 -

Training of medics and Para-medics in IMCI

Batch 240,000 6 720,000

528,000

290,400 1,538,400

-

Procurement of drugs

Oral Medicine Package

70 390,000

9,100,000

10,010,000

11,011,000

30,121,000

-


Sr. No.


Remarks

Unit Rate Quantity


- Injectable

800 78,000 20,800,000

22,880,000

25,168,000

68,848,000

-

Procurement of nebbulizing drugs

Drug 30 6,000 90,000

49,500 54,450 193,950 -

3 Diarrheal diseases


Meetings

3,000 12 12,000

13,200 14,520 39,720 -

Messages on local cable

Monthly

- 36 - - - - Integrated Activity


Sr. No.


Remarks

Unit Rate Quantity


network Telecast


Poster 30 30,000 300,000

330,000

363,000 993,000 -


Sessions

2,000 1,000 1,000,000

660,000

484,000 2,144,000

-


Batch - 6 - - - - Integrated Activity

Procurement and

ORS packets

5 1,200,000

2,000,000

2,200,000

2,420,000

6,620,000

-


Sr. No.


Remarks

Unit Rate Quantity


distribution of ORS and Zinc Sulphate


Syrup 60 600,000 12,000,000

13,200,000

14,520,000

39,720,000

-

4 TB Messages on local cable networks

Monthly telecast

- 36 - - - - Integrated activity

Messages through FM radio

Monthly telecas

- 36 - - - - Integrated activity


Sr. No.


Remarks

Unit Rate Quantity


channels t

Printing and distribution of IPC and TB awareness material

Poster 30 30,000 300,000

330,000

363,000 993,000 -

Procurement of drugs to address deficiency according to regimen

Treatment day

4,800 6,000 9,600,000

10,560,000

11,616,000

31,776,000

-

Procurement of reagents and slides for

Diagnostics

- - - - - - Need Assessment


Sr. No.


Remarks

Unit Rate Quantity


notified diagnostic facilities under DOTS program

5 Hepatitis


- - 12 - - - - Integrated Activity


Monthly Package

- 36 - - - - Integrated Activity


Sr. No.


Remarks

Unit Rate Quantity


Printing and distribution of IPC and hepatitis awareness material

Poster 30 20,000 300,000

165,000

181,500 646,500 -


Kits 50 400,000 7,500,000

8,250,000

6,050,000

21,800,000

-


Syringe cutter

500 400 100,000

55,000 60,500 215,500 -

Procurement of drugs for

Injection

15,000 1,500 7,500,000

8,250,000

9,075,000

24,825,000

-


Sr. No.


Remarks

Unit Rate Quantity


treatment of Hepatitis patients

Develop and implement SOPs for sterilization of equipment

- - - - - - - SOPs

6 Scabies Community health education sessions

HES - 100 - - - - No Cost

Printing & Distribution of IPC

Brochure

30 15,000 150,000

165,000

181,500 496,500 -


Sr. No.


Remarks

Unit Rate Quantity


Material

Supply of anti scabies drugs

drug 50 250,000

5,000,000

4,125,000

4,537,500

13,662,500

-

- - - - - - - - -

- - - 84,202,000

89,839,200

95,265,720

269,306,920

-


b) Management Problems

Human Resource Plan to bridge between MSDS and existing Sanctioned posts

Sr. No.

Name of Post

BS

Basi

c Pa

y

Allo

wan

ces

Requirement as per Gap

Financial Targets


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 Gynaecologist

18 12,910

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

2 Paediatricians 18 12,910

18,099 4 309,840 - 434,376 511,236 - 716,720 749,813 - 1,051,190

3 Anesthetists 18 12,910

18,099 6 464,760 - 651,564 852,060 - 1,194,534 1,124,719 - 1,576,785

4 MO / WMO 17 9,850

15,345 67 3,900,600 - 6,076,620 6,501,000 - 10,127,70

0

9,582,474 - 14,928,230

5 Nurses 16 6,060

8,934 72 2,617,920 - 3,859,488 4,319,568 - 6,368,155 6,335,366 - 9,339,961

6 Lady Health Visitors

9 3,820

4,750 23 - 458,400 570,000 -

857,208

1,065,900 -

1,275,727

1,586,310

Grand Total 7,448,040 458,400 11,809,236 12,524,688 857,208 19,950,82

3

18,167,279 1,275,727 29,008,071

Sr. No.


Remarks

Unit Rate Quantity Year I Year II Year III

1 Shortage of skilled staffs MNCH related

Filling of the vacant posts of medics and the paramedics through existing

- - - - - - - Recruitment


Sr. No.


Remarks


recruitment committees

Temporary filling of vacant positions on contract

- - - - - - - Recruitment

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

- - - - - - - Plan


Sr. No.


Remarks


posts


Batch 330,500 2,518,410

991,500

727,100

799,810 2,518,410

-

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

- - - - - - - Meeting

Request to the Provincial Government

- - - - - - - Plan


Sr. No.


Remarks


for approval and implementation of agreed pay packages

Review and revise the career structure of medics and paramedics

- - - - - - - Technical assistance

Filling of Human Resource gaps as per MSDS

Posts - 38,140,007

7,448,040

12,524,688

18,167,279

38,140,007

Detail HR plan is attached


Sr. No.


Remarks


Posts - 2,591,335

458,400

857,208

1,275,727

2,591,335


HR - 60,768,130

11,809,236

19,950,823

29,008,071

60,768,130


2 Inadequate budget for POL


- - - - - - - NO COST ACTIVITY

Costing and submission of additional demand

- - - - - - - -

Provision of POL budget for

litre 75 7,149,600

2,160,000

2,376,000

2,613,600

7,149,600

-


Sr. No.


Remarks


District Level supervisor

Provision of POL budget for EPI

litre 75 2,234,250

675,000

742,500

816,750 2,234,250

-


litre 75 7,248,900

2,190,000

2,409,000

2,649,900

7,248,900

-

3 Deficient infra structure

Identify the gaps in infrastructure of THQ and DHQ hospitals individually

- - - - - - - Need Assesment


Sr. No.


Remarks


· Costing of the gaps

- - - - - - - Plan

Phasing - - - - - - - Demand submission



1,100 1,925,000

1,925,000

- - 1,925,000 -

Construction of residences at THQ hospitals (2*1)


1,100 4,042,500

1,925,000

2,117,500

- 4,042,500 -

4 Lack of Procurement - - 16,628, 7,189, 9,438,5 - 16,628,0 Detail


Sr. No.


Remarks


MNCH related equipments

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

045 500 45 45 attached


- - - - - - - Submission of demand

Orientation of staffs in maintenance of logos for equipments

- - - - - - - Plan


Sr. No.


Remarks


5 Ineffective supervision / monitoring


batch 35,000 231,700 70,000 77,000 84,700 231,700 -

Procurement of transport for supervision

Vehicles

3,800,000 3,800,000

3,800,000

- - 3,800,000

-

- Vehicles

900,000 3,780,000

1,800,000

1,980,000

- 3,780,000

-


Stationery checklist visit

10,000 3,310,000

1,000,000

1,100,000

1,210,000

3,310,000

-


Sr. No.


Remarks


form

II. Financial Outlay including 3YRP Activities

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

a) Health Problems

Object Classifica

tion

2010-2011 2011-2012 2012-2013

Regular Additional

Total Regular Additional


Total

A03907 547,637 840,000 1,387,637 629,783 924,000 1,553,783 724,250 1,016,40 1,740,65


Object Classifica

tion

2010-2011 2011-2012 2012-2013

Regular Additional



Total

0 0

A03902 1,800,250

2,150,000

3,950,250 2,070,288

2,200,000

4,270,288 2,380,831 2,420,000

4,800,831

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

A03927 73,142,000

71,090,000

144,232,000

84,113,300

76,774,500

160,887,800

96,730,295

84,451,950

181,182,245

A13101 4,546,900

- 4,546,900 5,228,935

- 5,228,935 6,013,275 - 6,013,275

A09501 - - - - - - - - -

A09601 20,578,000

- 20,578,000

23,664,700

- 23,664,700

27,214,405

- 27,214,405

A03903 - 1,000,000

1,000,000 - 660,000 660,000 - 484,000 484,000

A03801 - 1,510,00 1,510,000 - 962,500 962,500 - 768,350 768,350


Object Classifica

tion

2010-2011 2011-2012 2012-2013

Regular Additional



Total

0

A09601 20,578,000

- 20,578,000

23,664,700

- 23,664,700

27,214,405

- 27,214,405

A09404 600,000 7,600,000

8,200,000 690,000 8,305,000

8,995,000 793,500 6,110,500

6,904,000

A03807 15,448,250

- 15,448,250

17,765,488

- 17,765,488

20,430,311

- 20,430,311

A03906 313,150 - 313,150 360,123 - 360,123 414,141 - 414,141

A09802 - - - - - - - - -

A13001 6,026,000

- 6,026,000 6,929,900

- 6,929,900 7,969,385 - 7,969,385

Total 143,580,187

84,202,000

227,782,187

165,117,215

89,839,200

254,956,415

189,884,797

95,265,720

285,150,517

A03907 547,637 840,000 1,387,637 629,783 924,000 1,553,783 724,250 1,016,40 1,740,65


Object Classifica

tion

2010-2011 2011-2012 2012-2013

Regular Additional



Total

0 0

b) Management Problems

Object Classificati

on

2010-2011 2011-2012 2012-2013

Regular Additional



Total

A03801 - 991,500 991,500 - 727,100 727,100 - 799,810 799,810

A09601 1,248,900

7,189,500

8,438,400

1,436,235

9,438,545

10,874,780

1,651,670

- 1,651,670

A01101 - 7,448,040

7,448,040

- 12,524,688

12,524,688

- 18,167,279

18,167,279

A01270 - 11,809,2 11,809,2 - 19,950, 19,950,8 - 29,008, 29,008,071


Object Classificati

on

2010-2011 2011-2012 2012-2013

Regular Additional



Total

36 36 823 23 071

A09501 1,150 5,600,000

5,601,150

1,323 1,980,000

1,981,323

1,521 - 1,521

A03820 - - - - - - - - -

A03807 9,223,000

5,095,000

14,318,000

10,606,450

5,604,500

16,210,950

12,197,418

6,164,950

18,362,368

A03902 645,150 1,000,000

1,645,150

741,923 1,100,000

1,841,923

853,211 1,210,000

2,063,211

A01102 - 458,400 458,400 - 857,208 857,208 - 1,275,727

1,275,727

A03903 - - - - - - - - -

A12402 - 3,850,000

3,850,000

- 2,117,500

2,117,500

- - -

Total 11,118,2 43,441,67 54,559,87 12,785,93 54,300,3 67,086,29 14,703,8 56,625,8 71,329,656


Object Classificati

on

2010-2011 2011-2012 2012-2013

Regular Additional



Total

00 6 6 0 64 4 20 37

III. Summaries

a) Problem-wise Costing

i. Health Problem

Sr. No.

Problem FY I FY II FY IIITotal Cost Rs.

Amount Amount Amount Amount


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

1 Aaemia in pregnancy

7,010,000 7,276,500 8,004,150 22,290,650

2 ARI 31,430,000

34,259,500

37,395,050

103,084,550

3 Diarrhoeal diseases 15,312,000

16,403,200

17,801,520

49,516,720

4 TB 9,900,000 10,890,000

11,979,000

32,769,000

5 Hebititus 15,400,000

16,720,000

15,367,000

47,487,000

6 Scabies 5,150,000 4,290,000 4,719,000 14,159,000

Total 84,202,000

89,839,200

95,265,720

269,306,920


ii. Management Problems

Sr. No.

ProblemFY I FY II FY III

Total Cost Rs.

Amount (Rs.)

Amount (Rs.)

Amount (Rs.)

Amount (Rs.)


20,707,176 34,059,819 49,250,887

104,017,882


5,025,000 5,527,500 6,080,250 16,632,750


3,850,000 2,117,500 - 5,967,500

4 Lack of MNCH related equipments

7,189,500 9,438,545 - 16,628,045


6,670,000 3,157,000 1,294,700 11,121,700


Total 43,441,676 54,300,364 56,625,837

154,367,877


b) Activity-wise Costing

i. Health Problems

Sr. No.

Problem ActivityFY-I FY-II FY-III Total

1 Anemia in pregnancy Messages on local cable network

420,000 462,000 508,200 1,390,200


500,000 550,000 605,000 1,655,000


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

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

790,000 434,500 477,950 1,702,450

Procurement of de-worming tablets

1,000,000

1,100,000

1,210,000

3,310,000

Purchase of medicine 1,500,00 1,650,00 1,815,00 4,965,000


Sr. No.


( Folic Acid) 0 0 0

Purchase of medicine (Ferrous Sulphat)

2,500,000

2,750,000

3,025,000

8,275,000

2 ARI Messages on local cable networks

_ _ _ -


420,000 462,000 508,200 1,390,200


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

Training of medics and Para-medics in IMCI

720,000 528,000 290,400 1,538,400

Procurement of drugs 9,100,000

10,010,000

11,011,000

30,121,000

- 20,800,000

22,880,000

25,168,000

68,848,000


Sr. No.


Procurement of nebbulizing drugs

90,000 49,500 54,450 193,950

3 Diarrheal diseases Quarterly co-ordination meetings with TMA and other agencies

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


- - - -


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


1,000,000

660,000 484,000 2,144,000


- - - -


Sr. No.


Procurement and distribution of ORS and Zinc Sulphate

2,000,000

2,200,000

2,420,000

6,620,000


12,000,000

13,200,000

14,520,000

39,720,000

4 TB Messages on local cable networks

- - - -


- - - -

Printing and distribution of IPC and TB awareness material

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

Procurement of drugs to address deficiency according to regimen

9,600,000

10,560,000

11,616,000

31,776,000


Sr. No.


Procurement of reagents and slides for notified diagnostic facilities under DOTS program

- - - -

5 Hepatitis Quarterly co-ordination meetings with TMA and other agencies

- - - -


- - - -

Printing and distribution of IPC and hepatitis awareness material

300,000 165,000 181,500 646,500


7,500,000

8,250,000

6,050,000

21,800,000


100,000 55,000 60,500 215,500


Sr. No.


Procurement of drugs for treatment of Hepatitis patients

7,500,000

8,250,000

9,075,000

24,825,000

Develop and implement SOPs for sterilization of equipment

- - - -

6 Scabies Community health education sessions

- - - -

Printing & Distribution of IPC Material

150,000 165,000 181,500 496,500

Supply of anti scabies drugs

5,000,000

4,125,000

4,537,500

13,662,500

- - - - -

- 84,202,000

89,839,200

95,265,720

269,306,920


ii. Management Problems

Sr. No.

Problem Activity Costing (Rs.)

FY-I FY-II FY-III Total


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

- - - -

- - Temporary filling of vacant positions on contract

- - - -

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

- - - -


Sr. No.




991,500 727,100 799,810 2,518,410

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

- - - -

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

- - - -

Review and revise the career structure of medics and paramedics

- - - -


Sr. No.



Filling of Human Resource gaps as per MSDS

7,448,040 12,524,688

18,167,279

38,140,007

- 458,400 857,208 1,275,727

2,591,335

- 11,809,236

19,950,823

29,008,071

60,768,130



- - - -

Costing and submission of additional demand

- - - -

Provision of POL budget for District Level supervisor

2,160,000 2,376,000

2,613,600

7,149,600

Provision of POL budget 675,000 742,500 816,750 2,234,25


Sr. No.



for EPI 0


2,190,000 2,409,000

2,649,900

7,248,900


Identify the gaps in infrastructure of THQ and DHQ hospitals individually

- - - -

Costing of the gaps - - - -

Phasing - - - -


1,925,000 - - 1,925,000

Construction of residences at THQ hospitals (2*1)

1,925,000 2,117,500

- 4,042,500


Sr. No.



4 Lack of MNCH related equipments

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

7,189,500 9,438,545

- 16,628,045


- - - -

Orientation of staffs in maintenance of logos for equipments

- - - -



70,000 77,000 84,700 231,700

Procurement of transport for supervision

3,800,000 - - 3,800,000


Sr. No.



- 1,800,000 1,980,000

- 3,780,000


1,000,000 1,100,000

1,210,000

3,310,000

- 43,441,676

54,300,364

56,625,837

154,367,877


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.

I. M&E of Plan

Indicators Target % Achievement

MoV Responsibility

Frequency of monitoring

Remarks

% of planned supervisory visits conducted

50 visits /year by each supervisor

Inspection Book

EDOH/DOH/ DDOH

Quarterly



MoV Responsibility


Remarks

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

10%

During 1st year

Pay Roll EDOH / DOH

6 monthly

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

10%

During 1st year

Stock Register

EDOH/ DOH/ MSs

6 monthly



MoV Responsibility


Remarks

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

10%

During 1st year

Stock Register

EDOH/ DOH/MSs, Store keeper

Quarterly

% facilities with availability of essential medicines

10%

During 1st year

Stock Register

EDOH/ DOH/ MSs, Store keeper

Monthly

% of functional ambulances in the district

10%

(DHQH/ THQH/ RHCs)

Log Book EDOH/DOH/ Transport officer

Quarterly

% utilization of sanctioned budget

10% of yearly budget

Quarterly Reports

EDOH/ DOH/ MSs/ Accounts officer

Quarterly



MoV Responsibility


Remarks

% of facilities with availability of basic EmONC services

10% in 3 years

(50% during 1st year)

Supervisory visit report

EDOH/DoH/ DDOH

Quarterly

% of DHQ/THQ hospitals with Comprehensive EmONC services

10% in 3 years



EDOH/DoH/ DDOH

Quarterly

% of facilities with availability of separate or partitioned room reserved exclusively for delivery

10% in 3 years



EDOH/DoH/ DDOH

Quarterly



MoV Responsibility


Remarks

% of targeted pregnant women newly registered by LHW

500 pregnant women in 3 years

(300 during 1st year)

DHIS Report

EDOH/ Statistical Officer

Quarterly

% of targeted pregnant women received TT02 vaccine

500 pregnant women in 3 years

(300 during 1st year)

DHIS Report

EDOH/ DHIS Coordinator/ Statistical Officer

Quarterly

Delivery conducted by or under supervision of skilled persons reported

90%

(60% During 1st year)

DHIS Report


Quarterly



MoV Responsibility


Remarks

%of target children between 18 0 23 months of age fully immunized

10%

(20,00 children)

DHIS Report


Quarterly

% of referred cases attended

10% DHIS Report/ LHWs monthly report


Quarterly

% of targeted eligible couples provided knowledge and information on Family Planning methods

70% LHW’s monthly/ quarterly report

EDOH/ Statistical Officer /Coordinator NP0FP&PHC

Quarterly



MoV Responsibility


Remarks

No. of meetings with participation from other sectors

12 meetings per year

Minutes of meetings

EDOH/ Focal person/s

Quarterly

Annex - I

Private Health Facilities in District Lodhran

(Data source: Information collected by the vaccinator at district level)

TEHSIL DUNYA PUR

S.No. Name of UCs Name of the Clinic Category

1 EID GAH WALI Al shifa hospital, railway road dunyapur Qualified MBBS

2DO

Lahore poly clinic, main bazaar, dunyapur.

Qualified MBBS

3DO

Al nawaz hospital, railway road, dunyapur

Qualified MBBS

4DO

Yousif children hospital, kamate more, dunyapur

Qualified MBBS

5 DO Arshed hospital, near KB bus stand, Qualified MBBS


dunyapur

6237/WB

Family hospital, dokota road adda zakhira, dunyapur

Qualified MBBS

7 EID GAH WALI Ghouri hospital, kahror road, dunyapur. Qualified MBBS

8342/WB

Family hospital makhdoom aali road, dunyapur

Qualified MBBS

9HOUSING SCHEME

Madni eye clinic main bahawalpur road. Dunyapur

Qualified MBBS

10 MUKHDOOM AALI Ali hospital, makhdool aali, dunyapur Qualified MBBS

Tehsil Kahror Pakka

11 Patwarian wala Kirn hospital, railway road. Kehrorpacca Qualified MBBS

12Patwarian wala

Sadaf hospital, railway road, kehrorpacca

Qualified MBBS

13Patwarian wala

Mahreen hospital, gali rehan wali , near thana sadar, kehrorpacca

Qualified MBBS

14Bakshiwala

Suhail surgical hospital near thq hospital, kehrorpacca

Qualified MBBS

15Bakshiwala

Javeed hospital, near thq hospital, kehrorpacca

Qualified MBBS

16Zaffar Abad

Bismillah complex nearMCB bank circular road, kehrorpacca

Qualified MBBS

17Bakshiwala

Haider hospital near peli kathi, kehrorpacca

Qualified MBBS

18 Dianat Pura Al wahid hospital near chandi chowk, Qualified MBBS


kehrorpacca

19 Bakshiwala Siraj hospital kehrorpacca Qualified MBBS

20Zaffar Abad

Bilal hospital, bilalstreet chowk bukhari, kehrorpacca

Qualified MBBS

21Patwarian wala

Masood hospital, chowk bukhari, kehrorpacca

Qualified MBBS

22Zaffar Abad

Wanjara hospital circular road, kehrorpacca

Qualified MBBS

23Dahnote

Ahsn hospital saeed chowk dhanot, kehrorpacca

Qualified MBBS

24Dahnote

Young walfare society hospital, dhanot, kehrorpacca

Qualified MBBS

25Fareed Abad

Atta hospital chowk buddan shah, kehrorpacca

Qualified MBBS

26Patwarian wala

Salamn eye clinic, circular road. Kehrorpacca

Qualified MBBS

27 Dianat Pura Zahid eye hospital, near peli othi Qualified MBBS

28Zaffar Abad

Sharif hospital old mailsi road, kehrorpacca

Qualified MBBS

29 Patwarian wala Shahhospital raiway road, kahrorpacca Qualified MBBS

Tehsil Lodhran

30 Gangay wala Kamal complex kahror road lodhran Qualified MBBS

31 Municipal Committee

Rasheed surgical hospital near children park lodhran

Qualified MBBS

32 Municipal Ali hospital near dhq hospital lodhran Qualified MBBS


Committee


Hamza surgical hospital near dhq hospital, lodhran

Qualified MBBS

34 Railway Station Muhammadi surgivcal hospital, lodhran Qualified MBBS

35Gulab Pura

Wahid surgical hospital, cjhishti wali gali, lodhrn

Qualified MBBS

36Gangay wala

Waseem hospital near post office lodhran

Qualified MBBS

37 Gangay wala Nasir complex near kahror more lodhran Qualified MBBS


Al noor hospital galla mandi chidren park lodhran

Qualified MBBS

39 Gulab Pura Rehman hospitalnear lari adda lodhran Qualified MBBS

40Gangay wala

Masher hospital near purani chungi lodhran

Qualified MBBS

41Railway Station

Al badar hospitalnear super chowk lodhran

Qualified MBBS

Annex-II

Costing of Equipment gaps for DHQ and THQ Hospitals

DHQ HOSPITAL LODHRAN


Sr. No.


Available

Gap Cost/Unit

Total Cost

(Qty.)

C B A


1 1 2 0 1 28500 28500

2 Foetal Doppler 3 5 5 0 3 10100 30300


1 1 2 0 1 12000 12000

4 Bulb Sucker 10 20 20 10 0 45 0

5 Baby Warmer 3 3 6 0 3 8500 25500

6 Mechanical Sucker 3 3 6 4 0 2800 0

7 Fetal Stethoscope 4 4 4 4 0 150 0

8 Delivery Table 2 2 3 1 1 1750 1750

9 D&C Set 2 3 4 2 0 210 0

10 Outlet forceps 4 4 4 4 0 90 0

11 Myoma Screw 2 2 2 2 0 320 0

12 Kochers forceps 4 4 8 4 0 235 0

13 Volselum forceps 6 8 10 6 0 235 0


2 2 4 2 0 40 0

15 Vagi0l Retractors 10 10 10 10 0 350 0



2 2 2 2 0 750 0

17 Sponge holder 10 15 20 10 0 30 0

18 Uterine elevator 1 1 1 1 0 150 0

19 CosCo Speculum 6 10 10 6 0 550 0

20 Exami0tion light 3 3 6 2 1 1800 1800

21 Suction Curette 1 2 2 1 0 95 0

22 Infant Resuscitation Trolley (with life saving medicines, baby laryngoscope, Endo0tracheal tube, Infant BP Apparatus, Chargeable Light)

1 1 2 0 1 9500 9500

23 Mother Resuscitation Trolley (with life saving medicines, Laryngoscope, Endo0tracheal tube, BP Apparatus, Chargeable light)

1 1 2 1 0 1100 0


24 Cardiac Monitor 1 1 2 5 0 5000 0


1 1 1 1 0 2500 0

26 Vagi0l Hysterectomy Set

2 2 4 2 0 300 0


2 2 4 2 0 55 0

26.2 Non0Tooted Tissue Forceps (8”)

2 2 4 2 0 55 0


2 2 4 2 0 150 0


2 2 4 2 0 150 0


8 8 16 8 0 150 0


8 8 16 8 0 175 0

26.7 Uterine Sound 2 2 4 2 0 90 0

26.8 Needle Holder (7”) 2 2 4 2 0 150 0


2 2 4 2 0 30 0


16 16 32 16 0 110 0

26.11


16 16 32 16 0 125 0


26.12

Allis Forceps 8 8 16 8 0 230 0

26.13

Towel Clamps 8 8 16 8 0 125 0

26.14


4 4 8 4 0 275 0

26.15


4 4 8 4 0 250 0

26.16


8 8 16 8 0 20 0

26.17

Volselum forceps 4 4 8 4 0 250 0

26.18

Uterine Sound 2 2 4 2 0 150 0

26.19

Bladder Sound 2 2 4 2 0 150 0

27 Delivery Sets 10 10 15 10 0 0


10 10 15 10 0 125 0

27.2 Straight Scissors 10 10 15 10 0 360 0

27.3 Needle holder 10 10 15 10 0 135 0

27.4 Non0toothed tissue forceps 8 inches

10 10 15 10 0 10 0



10 10 15 10 0 10 0


20 20 30 20 0 275 0


20 20 30 20 0 250 0


40 40 60 40 0 250 0

27.9 Artery forceps 40 40 60 40 0 275 0


20 20 30 20 0 175 0

27.11


1 1 1 0 1 1900 1900

27.12

Towel clip 40 40 60 40 0 125 0

28 Caesarian Section 6 8 10 6 0 0

28.1 Scalpel 6 8 10 6 0 50 0


24 32 40 24 0 125 0


24 32 40 24 0 125 0


24 32 40 24 0 175 0


6 8 10 6 0 150 0



6 8 10 6 0 270 0


24 32 40 24 0 30 0


6 8 10 6 0 90 0


6 8 10 6 0 20 0

28.1 Small Retractors 12 16 20 12 0 30 0

28.11

Towel Clippers 24 32 40 24 0 125 0

28.12

Suction Nozzle 6 8 10 6 0 250 0


0


1 2 3 1 0 57500 0

29.2 X0Ray Unit 50 kw 1 1 1 1 0 6000 0

29.3 Color Doppler 0 1 1 0 0 57500 0


1 1 1 1 0 300 0



1 1 1 1 0 1000 0

29.6 Safe Light 1 1 1 1 0 500 0

29.7 X0RT Film Processing Tank

1 1 1 1 0 500 0

29.8 Chest Stand 1 1 1 1 0 450 0

29.9 X0Ray film Illumi0tor

2 2 2 2 0 400 0

29.1 X0Ray Film Hangers All sizes

4 4 4 4 0 400 0


0


1 2 2 0 1 12000 12000

30.2 Incubator 1 1 2 0 1 15000 15000

30.3 Photo Therapy Unit 1 1 1 1 0 2200 0

30.4 Over0head Radiant Warmer

1 1 1 1 0 9100 0


2 2 2 2 0 500 0



2 2 2 2 0 310 0

30.7 Nebulizer 1 1 2 1 0 2200 0

30.8 Billirubino0meter 1 1 2 1 0 3600 0


1 1 2 0 1 200 200

30.1 0sal Probe Paed size

2 2 4 2 0 700 0

31 A0esthesia/ICU 0 0

31.1 A0esthesia Machine

1 1 2 1 0 32100 0

31.2 Ventilators 1 1 1 1 0 52500 0

31.3 Nebulizer 1 1 1 1 0 16500 0

31.4 Pulse Oximetry 1 1 1 1 0 2100 0

31.5 Defibrillator 1 1 1 1 0 5000 0


2 3 4 2 0 50 0


2 2 4 2 0 100 0


2 2 4 2 0 100 0



1 2 2 1 0 320 0

31.1 AMBO bag adult 2 2 4 2 0 2450 0

31.11

AMBO Bag paeds 2 2 4 2 0 300 0

31.12


4 4 8 4 0 100 0

32 Blood Bank 0 0


1 1 2 1 0 81200 0


1 1 1 1 0 6000 0

32.3 Cell Separator 1 1 1 1 0 522500 0


1 1 1 1 0 11500 0

32.5 Blood bag shaker 1 1 2 1 0 100 0

32.6 RH view box 2 2 4 2 0 100 0

32.7 Water bath 2 2 2 2 0 300 0

32.8 Micro0pipette 4 6 8 4 0 800 0


3 3 6 3 0 300 0


32.1 Plasma Extractor 1 1 1 1 0 1000 0

32.11

Platelets agitator 1 1 1 1 0 1000 0

32.12

Blood thawing bath

1 1 1 1 0 300 0

32.13

Microscopes 1 1 2 1 0 11500 0

33 Gy0e & Labour Room Related Laboratory Equipment

0

33.1 Hematology A0lyzer

1 1 1 1 0 42500 0

33.2 Electrolyte A0lyzer 1 1 1 1 0 62500 0

33.3 A0lyzer Bio0chemistry Semi0automatic

1 1 1 1 0 6900 0

33.4 Glucometer 2 2 2 2 0 250 0

33.5 Haemoglobino0meter

2 2 4 2 0 100 0

33.6 Centrifuge 1 1 2 1 0 13300 0

Grand Total= 718950


THQ HOSPITALSr. No.


Available

Gap Cost/Unit

Total Cost

(Qty.)

C B A


1 1 1 0 1 28500 28500

2 Foetal Doppler

2 2 3 0 2 10100 20200


1 1 1 1 0 12000 0

4 Bulb Sucker 5 10 20 5 0 45 0

5 Baby Warmer 2 2 3 2 0 8500 0

6 Mechanical Sucker

3 3 3 3 0 2800 0

7 Fetal Stethoscope

2 3 4 2 0 150 0

8 Delivery Table

2 2 2 2 0 1750 0

9 D&C Set 2 2 2 2 0 210 0

10 Outlet forceps

4 4 4 4 0 90 0

11 Myoma Screw

2 2 2 2 0 320 0


12 Kochers forceps

4 4 4 4 0 235 0

13 Volselum forceps

4 4 6 4 0 235 0


2 2 2 2 0 40 0

15 Vagi0l Retractors

4 4 6 4 0 350 0


2 2 2 2 0 750 0

17 Sponge holder

10 10 15 10 0 30 0

18 Uterine elevator

1 1 1 1 0 150 0

19 CosCo Speculum

4 6 6 4 0 550 0

20 Exami0tion light

3 3 3 1 0 1800 0

21 Suction Curette

1 1 2 0 1 95 95



1 1 1 0 1 9500 9500

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

1 1 1 1 0 1100 0

24 Cardiac Monitor

1 1 1 0 1 5000 5000



1 1 1 0 1 2500 2500

26 Vagi0l Hysterectomy Set

2 2 2 2 0 300 0


2 2 2 2 0 55 0

26.2 Non-Tooted Tissue Forceps (8”)

2 2 2 2 0 55 0


2 2 2 2 0 150 0


2 2 2 2 0 150 0


8 8 8 8 0 150 0


8 8 8 8 0 175 0

26.7 Uterine Sound

2 2 2 2 0 90 0



2 2 4 2 0 150 0


2 2 2 2 0 30 0


16 16 16 16 0 110 0

26.11


16 16 16 16 0 125 0

26.12

Allis Forceps 8 8 8 8 0 230 0

26.13

Towel Clamps

8 8 8 8 0 125 0

26.14


4 4 4 4 0 275 0

26.15


4 4 4 4 0 250 0

26.16


8 8 8 8 0 20 0

26.17

Volselum forceps

4 4 4 4 0 250 0


26.18

Uterine Sound

2 2 2 2 0 150 0

26.19

Bladder Sound

2 2 2 2 0 150 0

27 Delivery Sets 6 6 10 6 0 0


6 6 10 6 0 125 0

27.2 Straight Scissors

6 6 10 6 0 360 0

27.3 Needle holder

6 6 10 6 0 135 0


6 6 10 6 0 10 0


6 6 10 6 0 10 0


12 12 20 12 0 275 0


12 12 20 12 0 250 0



40 40 40 40 0 250 0

27.9 Artery forceps

40 40 40 40 0 275 0


20 20 30 20 0 175 0

27.11


1 1 1 1 0 1900 0

27.12

Towel clip 40 40 40 40 0 125 0

28 Caesarian Section

4 4 6 4 0 0

28.1 Scalpel 4 4 6 4 0 50 0


16 16 24 16 0 125 0


16 16 24 16 0 125 0


16 16 24 16 0 175 0



4 4 6 4 0 150 0


4 4 6 4 0 270 0


16 16 24 16 0 30 0


4 4 6 4 0 90 0


4 4 6 4 0 20 0

28.1 Small Retractors

8 8 12 8 0 30 0

28.11

Towel Clippers

16 16 24 16 0 125 0

28.12

Suction Nozzle

4 4 6 4 0 250 0



0


1 1 2 1 1 57500 57500

29.2 X-Ray Unit 50 kw

1 1 1 0 1 6000 6000

29.3 Color Doppler 0 0 0 0 0 57500 0

29.4 Lead Screen for X-Ray Unit

1 1 1 1 0 300 0


1 1 1 1 0 1000 0

29.6 Safe Light 1 1 1 1 0 500 0

29.7 X-RT Film Processing Tank

1 1 1 1 0 500 0

29.8 Chest Stand 1 1 1 1 0 450 0

29.9 X-Ray film Illumi0tor

2 2 2 2 0 400 0


29.1 X-Ray Film Hangers All sizes

4 4 4 4 0 400 0


0 0


1 1 2 1 1 12000 12000

30.2 Incubator 1 1 1 1 0 15000 0

30.3 Photo Therapy Unit

1 1 1 1 0 2200 0

30.4 Over-head Radiant Warmer

1 1 1 1 0 9100 0


2 2 2 2 0 500 0


2 2 2 2 0 310 0

30.7 Nebulizer 1 1 1 1 0 2200 0

30.8 Billiubino-meter

1 1 1 1 0 3600 0



1 1 1 1 1 200 200

30.1 0sal Probe Paed size

1 2 2 1 0 700 0

31 A0esthesia/ICU

0

31.1 A0esthesia Machine

1 1 1 1 1 32100 32100

31.2 Ventilators 1 1 1 1 0 52500 0

31.3 Nebulizer 1 1 1 1 0 16500 0

31.4 Pulse Oximetry

1 1 1 1 0 2100 0

31.5 Defibrillator 1 1 1 1 0 5000 0


1 2 2 1 0 50 0


1 2 2 1 0 100 0


1 2 2 1 0 100 0



1 1 1 1 0 320 0

31.1 AMBO bag adult

1 2 2 0 1 2450 2450

31.11

AMBO Bag paeds

2 2 2 0 2 300 600

31.12


4 4 4 4 0 100 0

32 Blood Bank 0 0


1 1 1 1 0 81200 0


1 1 1 1 0 6000 0

32.3 Cell Separator

1 1 1 1 0 522500 0


1 1 1 1 0 11500 0

32.5 Blood bag shaker

1 1 1 1 0 100 0


32.6 RH view box 1 2 2 1 0 100 0

32.7 Water bath 2 2 2 2 0 300 0

32.8 Micro-pipette 4 4 6 4 0 800 0


3 3 3 3 0 300 0

32.1 Plasma Extractor

1 1 1 1 0 1000 0

32.11

Platelets agitator

1 1 1 1 0 1000 0

32.12

Blood thawing bath

1 1 1 1 0 300 0

32.13

Microscopes 1 1 1 1 0 11500 0

33 Gy0e & Labour Room Related Laboratory Equipment

0

33.1 Hematology A0lyzer

1 1 1 1 0 42500 0

33.2 Electrolyte A0lyzer

1 1 1 1 0 62500 0


33.3 A0lyzer Bio-chemistry Semi-automatic

1 1 1 1 0 6900 0

33.4 Glucometer 2 2 2 2 0 250 0

33.5 Haemoglobino-meter

1 1 1 1 0 100 0

33.6 Centrifuge 1 1 1 1 0 13300 0

Grand Total= 9438545

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