3YRP-District Gujrat 2011-2013 - Punjabphsrp.punjab.gov.pk/downloads/3yrp/gujrat.docx · Web...

Three Years Rolling Plan (2010-2013) District Gujrat

THREE YEARS ROLLING PLAN

DISTRICT GUJRAT

2010-2013

SARDAR AKRAM JAVAIDDISTRICT COORDINATION OFFICERGUJRAT

DR. MUNIR AHMAD EXECUTIVE DISTRICT OFFICER (HEALTH), GUJRAT

DR.AZHAR MEHMOOD CH. DISTRICT OFFICER HEALTH, GUJRAT


ContentsAcronyms..............................................................................................................5Executive Summary..............................................................................................7SECTION 1: DISTRICT HEALTH PROFILE...............................................................81. Vision of the District........................................................................................82. Mission of the District......................................................................................83. Background of the District..............................................................................84. Map of the District...........................................................................................95. Demography...................................................................................................96. Socio-Economic Indicators............................................................................117. Health Indicators...........................................................................................118. Organizational Structure of District Health Administration...........................129. Health Resources..........................................................................................139.1. Health Facilities..........................................................................................13

a). Public.......................................................................................................13b). Private......................................................................................................14

9.2. Human Resource........................................................................................149.2.1. Administrative.........................................................................................149.2.2. Facility Based Staff..................................................................................15

9.2.2.1. Basic Health Units...........................................................................159.2.2.2. Rural Health Centres......................................................................159.2.2.3. THQ Hospital Kharian.....................................................................179.2.2.4. DHQ (ABS) Hospital........................................................................18

9.2.3. Outreach Staff.........................................................................................209.2.4. Training Institutions................................................................................21

a) DHDC.......................................................................................................21b) General Nursing & Midwifery School.......................................................21

9.3. Health Financing........................................................................................2210. Disease Pattern..........................................................................................2311. Status of Vertical Programs........................................................................2411.1. National Program for FP & PHC...............................................................2411.2. EPI...........................................................................................................25


11.3. MNCH Program........................................................................................2511.4. TB Control Program.................................................................................2511.5. Malaria Control Program..........................................................................2511.6. HIV/AIDS Control Program.......................................................................2511.7. Hepatitis Control Program.......................................................................2511.8. School Health Services Program.............................................................25SECTION 2: PROBLEM ANALYSIS........................................................................27

1. Objectives..................................................................................................272. Plan Development Process.........................................................................282.1. Problem Identification.............................................................................28Health Problems...............................................................................................282.2. Problem Prioritization..............................................................................292.3. Underlying causes of prioritized problems..............................................30Service delivery/Management problems..........................................................31

Underlying causes of Management problems...............................................323. MDGs and MSDS...........................................................................................32

1) Human Resource........................................................................................332) Equipment..................................................................................................34

SECTION 3: INTERVENTIONS AND TARGETS.....................................................44Health Problem...................................................................................................44Management Problems.......................................................................................58SECTION 4: COSTING AND FINANCING PLAN....................................................67I. Activity based costing...................................................................................67

a) Health Problems.........................................................................................67a) Management Problems..............................................................................79

II. Financial Outlay including 3YRP Activities....................................................87a) Health Problems.........................................................................................87b) Management Problems..............................................................................89

III. Summaries.................................................................................................90a) Problem wise Costing.................................................................................90

i. Health Problems......................................................................................90ii. Management Problems............................................................................91

b) Activity-wise costing..................................................................................92


i. Health Problems......................................................................................92ii. Management Problems............................................................................98

SECTION 5: Monitoring and Evaluation...........................................................102I. M&E of Plan.................................................................................................102Annex-I..............................................................................................................106


Acronyms3YRP Three Years Rolling plan

ADB Asian Development Bank

AE Assistant Entomologist

APMO Additional Principal Medical Officer

ARI Acute Respiratory Infections

ASV Assistant Superintendent Vaccination

BHU Basic Health Center

BoD Burden of Disease

CDC Communicable Disease Control

CDR Case Detection Rate

CPR Contraceptive Prevalence Rate

DC District Coordinator

DHIS District Health Information System

DHQH District Head Quarter Hospital

DoH Department of Health

DR Default Rate

DSV District Superintendent Vaccination

EDO(H) Executive District Officer Health

EPI Expended Program on Immunization

HSRP Health Sector Reforms Program

IMR Infant Mortality Rate

IPC Interpersonal Communication

IV Inspector Vaccination

M & E Monitoring and Evaluation

M & R Maintenance and Repair

MCH Maternal Child Health

MMR Maternal Mortality Ratio


MNCH Maternal Newborn and Child Health

MO Medical Officer

MoV Means of Verification

MSDS Minimum Service Delivery Standards

PDSSP Punjab Devolved Social Services Program

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.


GUJRAT

SECTION 1: DISTRICT HEALTH PROFILE

1. Vision of the District

Our vision is to ensure effective and efficient use of human and material resources to improve the health status of people primarily focusing on maternal and child health in order to achieve Millennium Development Goals (MDGs).

2. Mission of the District

Our dedicated, devoted and hard working staff will try level best to provide quality health services to people of district Gujrat without discrimination of gender, religion and socio-economic status.

3. Background of the District

Gujrat is a district of Punjab Province in Pakistan. It is an ancient district located in between two famous rivers, the Jhelum and Chenab. Because of its proximity with the rivers the land is good for cultivation with rice and sugar cane as main crops. It is bounded on the northeast by Mirpur, on the northwest by the River Jhelum which separates it from Jhelum District, on the east and southeast by the Chenab River, separating it from the districts of Gujranwala and Sialkot, and on the West by Mandi Bahauddin. District Gujrat is spread over an area of 3,192 square kilometres, and is divided into three tehsils, Gujrat, Kharian, and Sarai Alamgir. There are many historic villages and towns in the district such as Chakdina, Kunjah, Dinga. This district has moderate climate, which is hot in summer and cold in winter. During peak summer, the day temperature shoots up to 50 °C, but the hot spells are comparatively shorter due to proximity of Azad Kashmir Mountains. The winter months are very pleasant and the minimum temperature may fall below 2 °C. The average rainfall on the Kashmir border is over 1000 mm, at Kharian it is 750 mm, at Gujrat 670 mm, and at Dinga 500 mm.

Gujrat has a unique status throughout the Punjab due to some of its manufacturing capabilities and productions. Jalalpur is a large town of Gujrat, where several small and large textile industrial unit have been established. There are many other industrial units and factories engaged in manufacturing of electrical goods (Fan), Electric Motors, Earthen Utensils, Shoes, Rubber Tyre Tube, Sanitary Ware and Rice. The principal tribes of the districts are Syeds, Gujjars, Jats, , Mughals, Rajputs and Kashmiris.


4. Map of the District

5. Demography

o Total Population 26,65,399

o Total Area 3192 square kilometers

o Annual growth rate 2.4 %

o Population density 835 persons per sq. km

Area-wise populationArea Population Percentage

Rural 719658 27 %

Urban 1945741 73 %

Source: DCR-1998


Gender-wise population

Gender Population Percentage

Male 1330301 49.91 %

Female 1335098 50.09 %

Source: DCR-1998

Population groups

Population GroupsStandard Demographic

(%)Estimated Population

Under 1 year of age 2.7 94,169

Under 5 years 13.4 357164

Under 15 years 44 1172776

Women in child bearing age (15-49 years)

22 586388

Married Child Bearing age Women

16 426464

Expected pregnancies 3.4 90624

Standard Demographic population groups may be based on DHIS

Tehsil wise distribution

Tehsil Number of UC Population

Gujrat 65 1398251

Sarai Alamgir 9 246231

Kharian 43 + (2 Cantt) 1020917

Total 119 2665399

Source: Bureau of Statistics (Census 1998)

Ethnic groups and languages

The main ethnic groups in the district are Punjabi Jat. Punjabi and Urdu are the main languages spoken in the district.


6. Socio-Economic Indicators

Education and Literacy Overall district:

10+ years 74% Adult literacy rate 15+ years 71% Adult literacy rate 15-24 years 90

Source: MICS 2007

Housing Ownership of house 89%

Mean household size 6.3

Mean number of persons per room 3.3

Water and Sanitation Access to drinking water 93%

Use of improved drinking water sources 93%

Use of properly treated water 8.1%

Safe drinking water without bacteria 63%

Use of sanitary means of excreta disposal 81%

Use of improved water sources and improved sanitation 76%

Source: MICS 2007

7. Health Indicators

Infant Mortality Rate 70/1000 L.B

Under 5 mortality Rate 100/1000 L.B.

Maternal mortality Ratio 172/100000 L.B

Malnutrition

Underweight prevalence (severe) 5%

Stunting prevalence (severe) 13%

Wasting prevalence (severe) 2.8%

Life expectancy 65 Years

Proportion of children under 1 years immunized 94.5 %


against measles

Source: MICS 2007

8. Organizational Structure of District Health Administration

There exists a three-tier system in the health sector in the country. At federal level, Federal

Secretary of Health is responsible to administer and supervise the health related activities and

programs. Major function of federal tier is to provide policy guidelines and ensure quality of

health care standards through federal legislation. After the 18th amendment in the constitution,

and announcement of National Finance Award, most of the existing federal level programs will

be transferred to the provincial level. At provincial level, provincial Secretary of Health along

with Director General Health Services is responsible for managing and supervising health care

services. The district is still an administrative entity in the system and EDO (Health) acts as head

of the district health department, under overall supervision of DCO. The organizational

structure at district level is as under:

EDO (HEALTH)PR. GNSPD DHDCMS THQ


9. Health Resources

9.1. Health Facilities

a). Public

Details of physical infrastructure of public health facilities in the district

Facility Type No. of Facility Bed Strength

No. of Functional

BedsRemarks

Teaching hospitals - - - -

DHQ Hospital

1 322 322

Declared as Teaching Hospital(70 Bedded ward constructed by Ch. Zahoor Illahi Trust not yet notified.)

THQ Hospital 1 44 44 Kharian

Civil Hospital 1 20 20

Govt. Maternity Hospital

3 62 62

RHCs 9 180 180

BHUs 89 178 178

Govt. Rural Dispensaries

3 - -

MCH Centers 9 - -

Sub Health Centers

34

TB Clinics -

Rural Dispensaries (ZC)

18

City Dispensaries 1

Health house 2176

Data source: DHIS/EDOH office


b). Private

Private sector is also contributing in provision of health services in the district. In absence of

any registration and regulatory mechanism, actual situation of private sector is not known.

With the passage of time, role of private health care providers will expand and there is a

need to develop an effective coordination between public and private sector.

9.2. Human Resource

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

a) Administrative

b) Facility based

c) Outreach

d) Training institutions

9.2.1. Administrative

Sr. No. Name of Post Sanctioned Filled

1 Executive District Officer Health 1 12 District Officer Health 1 13 Deputy District Officer Health 3 34 Program Director DHDC 1 15 District Coordinator National Program *0 16 District Coordinator Preventive Programs 2 17 District Sanitary Inspector 1 18 CDC Officer 1 19 CDC Inspector 2 2

10 Drug Inspector 3 211 District Superintendent Vaccination 3 312 Assistant Superintendent Vaccination 3 313 Tehsil Sanitary Inspector 2 214 Inspector Vaccination 2 2

*The post is not sanctioned


9.2.2. Facility Based Staff

9.2.2.1. Basic Health Units

Sr.# Name of Post/Designation Sanctioned Filled Vacant

1 Medical Officer 89 74 15

2School Health & Nutrition Supervisor

89 7118

3 Medical Assistant 16 12 4

4 Computer Operator 89 46 43

5 Medical Technician 77 62 15

6 LHV 85 79 6

7 Dispenser 85 81 4

8 Midwife 267 113 154

9 Naib Qasid 89 89 0

10 Chowkidar 89 89 0

11 Sanitary Worker 52 52 0

12 Sanitary Inspector 88 42 46

9.2.2.2. Rural Health Centres


1 Senior Medical Officers 9 9 0

2 Women Medical Officers 9 8 1

3 Woman Medical Officer (MNCH) 9 7 2

4 Dental Surgeons 9 9 0

5 Medical Officers 9 9 0

6 Charge Nurses 54 50 4

7 Homeo Doctors 2 2 0

8 Hakeems 1 1 0

9 Computer Operators 9 1 8

10 Medical /Health Technician 2 2 0



11 LHV 18 18 0

12 LHV (MNCH) 9 9 0

13 Lab. Technician 9 6 3

14 Dental Technician 9 9 0

15 R.H.I 41 41 0

16 Junior Clerk 9 9 0

17 Vaccinator 1 1 0

18 Homeo Dispenser 2 2 0

19 Dawasaz 1 1 0

20 Radiographer/X-Ray Asstt. 10 10 0

21 Dresser 18 18 0

22 Anesthesia Assistant 9 0 9

23 O.T.A 9 3 6

24 Dispenser 9 9 0

25 Dental Assistant 9 9 0

26 Laboratory Assistant 9 9 0

27 Midwife 9 9 0

28 Driver 10 10 0

29 T.O 7 7 0

30 Homeo Naib Qasid 2 2 0

31 Dawa Kob 1 1 0

32 Ward Servant 18 18 0

33 Sweepers 18 18 0

34 Sanitary Worker 18 18 0

35 Sanitary Patrol 41 41 0

36 Naib Qasid 23 23 0

37 Mali 9 9 0

38 Chowkidar 9 9 0

39 Water Carrier 9 9 0


9.2.2.3. THQ Hospital Kharian The staff for Sara-i-Alamgir has not yet been sanctioned.

Sr. # Name of Post/ Designation Sanctioned Filled Vacant

01 Medical Superintendent 1 1 0

02 APMO 2 2 0

03 APWMO 1 0 1

04 Gynecologist 2 2 0

05 Physician 1 0 1

06 Pathologist 1 1 0

07 Anesthesia Specialist 1 0 1

08 Eye Specialist 1 1 0

09 Surgeon 1 1 0

10 Pediatrician 1 1 0

11 Medical Officer / CMO 11 7 3

12 WMO 3 1 2

14 Dental Surgeon 1 1 0

15 Pharmacist 1 1 0

16 Head Nurse 0 0 0

17 Male Nurse 0 0 0

18 Charge Nurse 10 7 3

19 Dental Technician 1 1 0

20 ECG Technician 0 0 0

21 Dispenser 5 5 0

22 OTA 2 2 0

23 Radiographer 3 3 0

24 Lab. Assistant 2 2 0

25 Junior Clerk 1 1 0

26 Ward Servant 7 7 0

27 Driver 2 2 0


Sr. # Name of Post/ Designation Sanctioned Filled Vacant

28 Nurse Dai 0 0 0

29 Peon 3 3 0

30 Cook 0 0 0

31 OT Boy 0 0 0

32 Water Carrier 1 1 0

33 Mali 2 2 0

34 Gateman 1 1 0

35 Ward Barrier 1 1 0

36 Baildar 3 3 0

37 Chowkidar 4 3 1

38 Sweeper 10 10 0

39 Homeo Doctor 1 1 0

40 Homeo Dispenser 1 1 0

41 Hakeem 1 1 0

42 Dawasaz 1 1 0

43 Dawa Kob 1 1 0

9.2.2.4. DHQ (ABS) Hospital

Sr. # Name of Post/Designation Sanctioned Filled Vacant

1 Medical Superintendent 1 1 02 Chief Consultant Surgeon 1 1 03 Chief Consultant Pediatrician 1 1 04 Chief Consultant Pathologist 1 1 0

5Senior Consultant Ophthalmologist

1 0 1

6 Senior Consultant Anesthetist 1 1 07 Senior Consultant 1 0 18 Consultant Surgeon 1 1 09 Consultant Anesthetist 2 0 2

10 Consultant Gynecologist 3 3 011 Consultant Radiologist 1 1 012 Consultant Physicians 2 1 1

13 Consultant Neuro-Surgeon 1 0 1



14 Consultant ENT 1 1 015 Consultant Dermatologist 1 0 116 Consultant Cardiologist 1 0 117 Consultant Urologist 1 1 018 Consultant TB/Chest Specialist 1 1 019 Consultant Orthopedic Surgeon 1 1 020 APMO 4 4 021 APWMO 3 3

22 Principal Dental Surgeon 1 1 023 Senior Dental Surgeon 1 1 024 Nursing Superintendent 1 1 025 Hospital Pharmacist 9 7 226 Physiotherapist 1 0 1

27Public Health Nutrition Supervisor

1 0 1

28 CMO 9 0 929 Medical Officers 39 29 1030 Women Medical Officers 8 8 031 Deputy Nursing Superintendent 1 0 132 Budget & Accounts Officer 1 0 133 House Officer 16 15 134 Clinical Nursing Instructor 1 0 135 Head Nurse 13 13 036 Charge Nurses 78 74 0437 Office Superintendent 1 1 038 Refractionist 1 0 139 Hemeo Pathic Doctor 1 1 040 Hakeem 1 1 041 Stenographer 1 1 042 Head Clerk 1 1 043 Accountant 1 1 044 House Keeper 1 1 045 Ophthalmic Technician 4 1 346 Lady Health Visitor 2 2 047 ECG Technician 6 1 548 Dental Technician 2 2 049 Laboratory Technician 4 2 250 Exercise Tolerance Technician 2 0 251 Physiotherapist Aid 1 0 152 ECO Technician 2 0 253 X-Ray Technician 3 0 354 Senior Clerk 1 0 155 Junior Clerk 5 5 0



56 Record Keeper 1 1 057 Dresser 1 1 058 Homeo Dispenser 1 1 059 Dispenser 13 13 060 Dawasaz 1 1 061 X-Ray Assistant 4 4 062 Operation Theater Assistant 6 3 363 Store Keeper 2 2 064 Laboratory Assistant 4 2 265 Driver 6 6 066 Midwife 2 2 067 Tubewell Operator 2 0 268 Dai 1 1 069 Bearer 15 12 370 Operation Theater Attendant 4 4 071 Lab Attendant 3 3 072 Water Carrier 2 2 073 Ward Boy 20 19 174 Ward Servant 65 65 075 Chowkidar 10 9 176 Cook 5 3 277 Attendant 3 2 178 Baildar 4 4 079 Dawa Kob 1 1 080 Naib Qasid 8 6 281 Gate Keeper 5 3 282 Ward Cleaner 33 29 483 Sanitary Worker 50 50 084 Mali 4 4 0

9.2.3. Outreach Staff

This information is about outreach program workers such as Vaccinators, CDC

Supervisors and Sanitary Inspectors which are not part of above mentioned health

facilities.

Sr. Post Sanctioned Filled Vacant

1 Vaccinators 112 101 112 CDC Supervisors 72 48 24


3 Sanitary Inspectors 87 43 444 Nutrition Supervisor 89 78 115 Social mobilizor NCHD 89 72 176 Sanitary Supervisor 02 01 01

9.2.4. Training Institutions

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

a) DHDC

b) General Nursing & Midwifery school

a) DHDC

Post Sanctioned Filled Vacant

Programme Director 1 1 0MPPT 1 1 0LHV Trainer 1 1 0Assistant 1 1 0Driver 1 1 0Naib Qasid 1 1 0Chowkidar 2 1 1Sanitary Worker 1 1 0

b) General Nursing & Midwifery School

Name of Post/Designation Sanctioned Filled Vacant

Principal School of Nursing 1 1 0Nursing Instructor 3 3 0House Keeper 3 3 0Sweeper 3 3 0Naib Qasid 2 2 0Chowkidar/Gate Keeper 6 6 0Cook 2 1 1Masalchi 3 0 3Clinical instructor 0 0 0Public Health Nursing Supervisor 0 0 0Stenographer 1 1 0Head clerk 1 0 1Accountant 1 1 0Senior clerk 0 0 0Junior clerk 1 1 0Aya 3 2 1


9.3. Health Financing

The provision of financial resources at district level is prime responsibility of district

government. However, keeping in view the budget constraints at the district level, federal

and provincial governments also augment financial resources in form of kind and cash,

through different programs. Financial resources of the district during the last three years

out of different sources are given as under:

Rs. Million

Source of funding Year

2007-08 2008-09 2009-2010

Allocation Exp. Allocation Exp. Allocation Exp.

Non-Development 328.303 325.917 347.521 346.127 462.871 242.902

Development 350.000 348.000 443.042 423.000 527.000 523.00

Sub Total 678.303 673.917 790.563 769.127 989.871 580.182

PHSRP 95.750 95.750 14.000 14.000 14.000 14.000

PMDGP 0 0 0 0 84.62 58.157

PDSSP 21.232 21.145 23.348 21.955 0 0

Provincial Development Funds (ADP)

0 0 43.000 43.000 0 0

Grand Total 1473.59 1464.73 1661.47 1617.21 2078.36 1418.24

User charges (like parchi fee, fees for diagnostic services)

Year

2007-08 2008-09 July, 2009 To Feb, 2010

Target Remittance Target Remittance Target Remittance

3.000 2.151 3.250 2.500 3.500 2.300

10. 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 Disease1 Acute upper respiratory infection 11.1102 Pneumonia < 5years 0.9933 Pneumonia < 5years 0.7094 TB Suspects 0.4695 Chronic Obstructive Pulmonary Disease 0.4496 Asthma 0.925Gastro Intestinal Disease7 Diarrhea / Dysentery < 5 years 2.5758 Diarrhea / Dysentery < 5 years 2.1039 Enteric / Typhoid Fever 0.20410 Worm infestations 1.97711 Peptic Ulcer 1.55012 Cirrhosis of Liver 0.022Urinary Tract Disease13 Urinary Tract infection 0.82014 Nephritis / Nephrosis 0.05715 Sexually Transmitted Infections 0.04316 Benign Enlargement of Prostrate 0.54Other Communicable Disease17 Suspected Malaria 1.22418 Suspected Meningitis 0.00319 Fever due to other causes 2.567Vaccine Preventable Disease20 Suspected Measles 0.00321 Suspected Viral Hepatitis 0.01822 Suspected Neo-natal Tetanus 0.0004Cardiovascular Disease23 Ischemic Heart disease 0.03324 Hypertension 0.374Skin Disease25 Scabies 4.05926 Dermatitis 0.98827 Cutaneous Leishmaniasis 0.0014Endocrine Disease28 Diabetes Mellitus 0.256Neuro- Psychiatric Disease29 Depression 0.35830 Drug Dependence 0.03931 Epilepsy 0.033Eye & ENT32 Cataract 0.11833 Trachoma 0.079


Disease Group Percentage of Magnitude

34 Glaucoma 0.01435 Otitis Media 0.472Oral Disease36 Dental Carries 0.659Injuries / Poisoning37 Road Traffic Accidents 0.59038 Fractures 0.07139 Burns 0.17140 Dog Bites 0.12341 Snake Bites ( with sign/symptoms of

poisoning0.028

Miscellaneous Disease42 Acute Flaccid Paralysis 0.0004543 Suspected HIV/AIDS 18444 Any other unusual disease (specify) 0(Source: DHIS Specific Reports)

11. 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.

11.1. National Program for FP & PHC

No. of seats allocated for LHWs 2176

No. of LHWs working 1716

Percentage of Population covered

by the program 62 %

Important program indicators

IMR 42/1000 MMR 170/100000 CPR 41% No. of antenatal visits 91% TT Coverage of pregnant women 95%

11.2. EPI

EPI Coverage rate of the district 94.5% Fully immunized children 0-23 months 94.5% Pregnant women received TT-2 vaccine 95% Availability of cold chain equipment* 98 %


*Health Facilities carefully equipped with cold chain while remaining 2 is facing equipment shortage along with repair and maintenance problem

11.3. MNCH Program

CMW Students Admitted 53 Passed 53 Fresh CMWs batch 23

11.4. TB Control Program

CDR all types 72% CDR NSS positive 71% SCR 90% TSR 91% DR 0.5%

11.5. Malaria Control Program

No. of slides examined 60027 No. of positive slides 605 Slides positively ratio 1.008% Percentage of plasmodium falciparum 13.2%

11.6. HIV/AIDS Control Program

Total cases diagnosed 184

11.7. Hepatitis Control Program

No. of hepatitis tests conducted 24256 No. of positive cases detected 1812 No. of persons vaccinated against Hepatitis B 3195 No. of cases treated for Hepatitis B 31 No. of cases treated for Hepatitis C 490

11.8. School Health Services Program

The school health services program is functional in the district. Regular visits are being conducted by the medical officers of School Health Services (SHS) program. The detail of program activities is as under:

Total Visits to the School 2616

No. Students Examined 24164

No of students referred to BHUs

9366

No. Students Treated at BHU 22071


No. of Students referred from BHU to higher facilities

30841

No. of Schools in catchment Areas

2120 ( 923 Girls+1197 boys)

No. of Students 314578

No of Teachers Trained 5307 ( 6490)

No of SH & NS 69

Source: DHDC Gujrat


SECTION 2: PROBLEM ANALYSIS

The Health sector in Punjab is facing enormous health and service delivery problems. Common health problems are communicable, non communicable, MNCH related diseases and accident/ trauma. The society is passing through demographic and epidemiological transition. This is due to changing life style, urbanization, ecological and other factors. Disease pattern is changing where non communicable diseases are gradually increasing and the communicable diseases are still posing serious threat. Punjab is practically facing Double Burden of Disease (BOD). Besides, health problems service delivery/ managerial issues are also hindering the access and quality of health services to the population. The service delivery/management problems are diverse in nature, and include shortage of technical human resource, capacity issues, lack of infrastructure and equipment.

Devolution was introduced during 2001 affecting the administrative and financial set up of the districts. The devolution also brought political culture in the decision making of the districts in the shape of Nazims, Naib-Nazims and Councilors. This system is now in the phase of reshaping and it is not clear what will be future structure and managerial shape when new local bodies system is put in place. The District Manager and functionaries are in the state of uncertainty and confusion in this scenario. However, one thing is clear that the district shall remain a hub of all primary and secondary health services delivery. Despite the source of funding in the future, either from provincial or district government, health planning at district level shall continue to play a pivotal role in provision of quality health services.

In view of the above situation the district considers following objectives for developing three year rolling plan.

1. Objectives

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

problems/issues Addressing emerging health needs or re-emergence of health problems (e.g. H1N1, HIV-

AIDS, Polio, T.B) Ensuring effective inter-sectoral coordination with a view to improving health

indicators

The objectives would guide in problem analysis, designing interventions, setting /phasing the targets, costing and monitoring the plan activities.


2. Plan Development Process

Plan development has been a systematic and consultative process. A core planning team consisting of EDO (H), DOH, MS DHQ and THQs, Statistical officer, and Budget and Accounts Officer, was designated by Director General Health Services Punjab. This team received three days customized training from SP-09 team at divisional headquarter. The main components of the trainings were: (i) developing a three-year rolling health sector plan using the standard three year rolling plan format; (ii) costing of the plan; (iii) preparing related budget projections; (iv) accounting procedures; (v) preparing adequate financial reports on the use of funds.

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

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

2.1. Problem Identification

This step involved assessment of the current situation from various perspectives to establish the actual health situation in terms of health and service delivery/management problems. Problem identification is based on the district health profile, review of previous plans, MIS (DHIS, Program reports and periodic reports etc.), District specific surveys (MICS), MSDS, and national and provincial policy guidelines.

The district planning team held meetings and started with identification of problem using the training received from SP-09 team and consulting the above mentioned documents. The problems identified were broadly divided into two categories i.e. Health Problems, and Health Service Delivery or Management Problems. In the initial stage an exhaustive list of these problems was prepared. The enlisted health and service delivery problems of the district are given in the following tables.

Health ProblemsThe district specific health problems identification process started during the three years rolling plans workshop. The planning team in the initial stage prepared a long list of the health problems. The identification of health problems was based on various information sources including DHIS, and district specific reports. The enlisted health problems of the district are given in the following table.


1. Diarrhea

2. Accidents and Injuries

3. Hepatitis (B&C)

4. Diabetes

5. Malaria

6. Scabies

7. Complications of pregnancy

8. Drug Addiction

9. Pulmonary tuberculosis

10. Hypertension

2.2. Problem Prioritization

WHO has developed standard criteria for prioritization of health problems; which is based on the following five elements:

Magnitude Severity/danger Vulnerability to intervention (feasibility) Cost-effectiveness of the intervention Political expediency

Each element has been assigned a score from 1 to 4 depending upon grade/scale of that element

i.e. Very High=4, High=3, Medium=2 and Low=1.

Elements of the prioritization criteria were applied to each of the enlisted health problems. The

aggregate of individual scores assigned to the elements of the prioritization criteria gave the

total score for a health problem. This total score was then used to prioritize the health


problems. A cut-off point was decided, to establish the priority health problems of the district.

These problems will be addressed in the three years rolling plan.

Problem Magnitude Severity Vulnerability to

intervention

Cost Effectiveness

Political Expediency

Total Score

Priority Number

Diarrhea 4 4 4 4 4 20 1

Hepatitis (B&C) 4 4 3 2 3 16 3

Accidents and Injuries

4 3 4 3 3 17 2

Diabetes 3 3 3 4 2 15 4

Hypertension 3 3 2 3 2 13 8

Scabies 3 3 4 3 1 14 6

Malaria 3 2 4 3 2 14 5

Drug Addiction 3 2 3 2 2 12 9

Complications of pregnancy

3 3 3 3 2 14 7

2.3. 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 and selected service delivery problems pertaining to the district.

Sr. # Health Problem Causes

1 Diarrhoeal Diseases Poor hygiene and sanitation Lack of safe drinking water Unhygienic practices Lack of awareness among mothers about feeding and

weaning practices2 Accidents and injuries Lack of traffic sense

Poor maintenance of vehicles Poor road conditions Lack of safety measures at work place Fire-arm injuries Domestic accidents Burns Bomb blasts/terrorist activities Natural calamities like flood


Sr. # Health Problem Causes

Lack of tolerance in the society 3 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

4 Diabetes Obesity Inactive life style Lack of health awareness in Diabetes Genetics and Infections

5 Resistant Malaria (Falciparum)

Breeding places for mosquitoes Injudicious use of anti-malarial by GPs and HCPs Lack of awareness for prevention

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

7 Complications of pregnancy

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

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

Service delivery/Management problemsThis 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 which need to be addressed:

1. Shortage of skilled (MNCH

2. Inadequate medicines and supplies

3. Inadequate budget for POL

4. Inadequate MNCH elated equipment

5. Deficient logistic support


Underlying causes of Management problemsSr. # Service Causes

1. Shortage of skilled (MNCH)

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

transport of children for education Political and media interference

2. Inadequate medicines and supplies

Less budget allocation for medicines Frequent increase in drug prices


Generator provision for back-up of electricity supply Less budget allocation Frequent increase in prices

4. Inadequate MNCH related 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

5. Shortage of functional vehicles

Provision of inadequate funds for purchase of vehicles Ban on procurement of vehicles by the government Complicated procedure for purchase of new vehicles

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


and system specifications including human, infrastructure, equipment, medical supplies, medicine and other consumables.

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

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

Hospital Category Bed Strength

DHQ Hospital A 400 and above BedsB 251-400 BedsC Up to 250 Beds

THQ Hospital A Above 60 BedsB 41-60 BedsC Up to 40 Beds

ABS Hospital DHQ (B)

Sr. No.

Post Standard as per MSDS

Sanctioned Filled Vacancy Gap*

1 Gynaecologist 3 3 3 02 Paediatricians 3 1 1 23 Anesthetists 5 1 1 44 MO/SMO/APMO/PMO 104 16 6 15 SMO/SWMO 39 5 2 186 Charge Nurses 114 78 69 217 Lady Health Visitors 11 1 1 10

*Vacancy Gap in relation to Sanctioned Posts and MSDS

THQ Hospital Kharian (Category C)

Sr. Post Standard as per MSDS


1. Gynaecologist 2 2 2 02. Pediatricians 2 1 1 1




3. Anesthetists 4 1 0 44. Physician 2 1 1 15. Surgeon 2 1 1 16. Eye Specialist 1 1 1 07. APMO/APWMO 2 3 3 08. SMO/SWMO 5 0 0 59. Medical Officers 15 7 7 8

10. CMO 4 3 3 1 11. Lady Health Visitors 8 1 1 7 12. Nurses 75 10 7 65


Rural Health Centers

Sr. No.

Post Standard as per MSDS


1 Senior Medical Officers 9 9 9 02 Medical Officers 18 13 12 143 Women Medical Officers 9 13 12 14 Nurses 54 78 65 135 LHV 26 26 26 0


Basic Health Units



1 Medical Officer 89 71 69 22 H & N Supervisor 89 71 68 33 L HVs 89 71 69 2


2) EquipmentGovernment of Punjab has notified a standard list as yard-stick of MNCH related equipment to provide comprehensive EmONC services in the DHQ and THQ hospitals. Provision of comprehensive EmONC services is essentially required to decrease the high MMR and IMR prevailing in the province. Gaps in relation to the MNCH related equipment have been identified taking into account the equipment purchased or under process of purchase from all funds including PMDGP funds allocated/sanctioned to the district. The cost of equipment gap has been included in the equipment portion of the


Management/Service delivery problems. Detailed costing of equipment gaps according to MSDS is attached as Annex-I.

i. DHQ Hospital

Sr. No. Equipment Standard as per MSDS(Qty.)

Available Gap

C B A

1 CTG (Cardiac Tocography) 1 1 2 1 02 Foetal Doppler 3 5 5 1 23 Diagnostic Laparoscope 1 1 2 1 04 Bulb Sucker 10 20 2

010 0

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

10 Outlet forceps 4 4 4 4 011 Myoma Screw 2 2 2 2 012 Kochers forceps 4 4 8 4 013 Volselum forceps 6 8 1

06 0

14 Lanes Tissue holding forceps 2 2 4 2 015 Vaginal Retractors 10 10 1

010 0

16 Polypectomy forceps 2 2 2 2 017 Sponge holder 10 15 2

010 0

18 Uterine elevator 1 1 1 1 019 CosCo Speculum

Small, Medium, Large (for each category)

6 10 10

6 0

20 Examination light 3 3 6 3 021 Suction Curette 1 2 2 1 0



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 1 0

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 1 025 Pump Breast Electronic 1 1 1 1 026 Vaginal Hysterectomy Set 2 2 4 2 0

26.1 Toothed Tissue Forceps (8”) 2 2 4 2 026.2 Non-Tooted Tissue Forceps

(8”)2 2 4 2 0

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 2 026.8 Needle Holder (7”) 2 2 4 2 026.9 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 4 026.15 Double blade Sims speculum 4 4 8 4 026.16 Sponge holding forceps 8 8 1

68 0

26.17 Volselum forceps 4 4 8 4 0



Available Gap

C B A

26.18 Uterine Sound 2 2 4 2 026.19 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

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 1 027.12 Towel clip 40 40 6

040 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

28.4 Artery forceps 8 inches 24 32 40

24 0

28.5 Myoma Scissors straight 7 inches

6 8 10

6 0



Available Gap

C B A

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 1 029.2 X-Ray Unit 500 kw 1 1 1 1 029.3 Color Doppler 0 1 1 1 029.4 Lead Screen for X-Ray Unit 1 1 1 1 029.5 0.5 MN Lead Apron. Lead

Gloves, Goggles and Thyroid and Gonadal Sheets

1 1 1 1 0

29.6 Safe Light 1 1 1 1 029.7 X-RT Film Processing Tank 1 1 1 1 029.8 Chest Stand 1 1 1 1 029.9 X-Ray film Illuminator 2 2 2 2 0

29.10 X-Ray Film Hangers All sizes 4 4 4 4 030 MNCH Related Paediatrics

Equipments30.1 Paediatric Ventilator 1 2 2 1 030.2 Incubator 1 1 2 1 030.3 Photo Therapy Unit 1 1 1 1 030.4 Over-head Radiant Warmer 1 1 1 1 030.5 Infant Length Measuring Scale 2 2 2 2 030.6 Infant Weighing Machine 2 2 2 2 030.7 Nebulizer 1 1 2 1 030.8 Billiubino-meter 1 1 2 1 030.9 Exchange Blood Transfusion

Set1 1 2 1 0



Available Gap

C B A

30.10 Nasal Probe Paed size 2 2 4 2 031 Anaesthesia/ICU

31.1 Anaesthesia Machine 1 1 2 1 031.2 Ventilators 1 1 1 1 031.3 Nebulizer 1 1 1 1 031.4 Pulse Oximetry 1 1 1 1 031.5 Defibrillator 1 1 1 1 031.6 Airway Oral and Nasal 2 3 4 2 031.7 Tracheostomy tube (adult and

paeds)2 2 4 2 0

31.8 Face mask of all sizes 2 2 4 2 031.9 Double Cuff Tourniquet (for

regional block)1 2 2 1 0

31.10 AMBO bag adult 2 2 4 2 031.11 AMBO Bag paeds 2 2 4 2 031.12 Red Rubber Nasal tubes all

sizes without cuff4 4 8 4 0

32 Blood Bank32.1 Blood storage cabinet (100

bag capacity)1 1 2 1 0

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

Plasma1 1 1 1 0

32.5 Blood bag shaker 1 1 2 1 032.6 RH view box 2 2 4 2 032.7 Water bath 2 2 2 2 032.8 Micro-pipette 4 6 8 4 032.9 Blood grouping tiles 3 3 6 3 0

32.10 Plasma Extractor 1 1 1 0 132.11 Platelets agitator 1 1 1 0 132.12 Blood thawing bath 1 1 1 1 032.13 Microscopes 1 1 2 1 0

33 Gynae & Labour Room Related Laboratory Equipment

33.1 Hematology Analyzer 1 1 1 1 033.2 Electrolyte Analyzer 1 1 1 1 0



Available Gap

C B A

33.3 Analyzer Bio-chemistry Semi-automatic

1 1 1 1 0

33.4 Glucometer 2 2 2 2 033.5 Haemoglobino-meter 2 2 4 2 033.6 Centrifuge 1 1 2 1 0

ii. THQ Hospital KharianSr. Equipment Standard

as per MSDS

(Qty.)

Available Gap

C B A

1 CTG (Cardiac Tocography) 1 1 1 0 1

2 Foetal Doppler 2 2 3 0 2

3 Diagnostic Laparoscope 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 4 014 Lanes Tissue holding forceps 2 2 2 2 015 Vaginal Retractors 4 4 6 4 016 Polypectomy forceps 2 2 2 2 017 Sponge holder 10 1

015 10 0

18 Uterine elevator 1 1 1 1 0


Sr. Equipment Standard as per MSDS

(Qty.)

Available Gap

C B A

19 CosCo Speculum Small, Medium, Large (for each category)

4 6 6 4 0

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

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

1 1 1 1 0


1 1 1 1 0

24 Cardiac Monitor 1 1 1 1 025 Pump Breast Electronic 1 1 1 1 026 Vaginal Hysterectomy Set

26.1 Toothed Tissue Forceps (8”) 2 2 2 2 026.2 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


8 8 8 8 0

26.7 Uterine Sound 2 2 2 2 026.8 Needle Holder (7”) 2 2 4 2 026.9 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 8 026.13 Towel Clamps 8 8 8 8 0



(Qty.)

Available Gap

C B A

26.14 Single blade Sims speculum 4 4 4 4 026.15 Double blade Sims speculum 4 4 4 4 026.16 Sponge holding forceps 8 8 8 8 026.17 Volselum forceps 4 4 4 4 026.18 Uterine Sound 2 2 2 2 026.19 Bladder Sound 2 2 2 2 0

27 Delivery Sets27.1 Episiotomy Scissors 6 6 10 6 027.2 Straight Scissors 6 6 10 6 027.3 Needle holder 6 6 10 6 027.4 Non-toothed tissue forceps 8

inches6 6 10 6 0


6 6 10 6 0

27.6 Sims Speculum single blade 12 12

20 12 0

27.7 Sims Speculum double blade 12 12

20 12 0

27.8 Sponge holding forceps 40 40

40 40 0

27.9 Artery forceps 40 40

40 30 10

27.10 Straight clamps (cord) 20 20

30 15 5

27.11 Vacuum Extractor pump 1 1 1 1 027.12 Towel clip 40 4

040 30 10

28 Caesarian Section28.1 Scalpel 4 4 6 4 028.2 Artery Forceps Straight 6

inches16 1

624 16 0


16 16

24 16 0

28.4 Artery forceps 8 inches 16 16

24 16 0


4 4 6 4 0



(Qty.)

Available Gap

C B A


4 4 6 4 0


16 16

24 16 0

28.8 Obstetric outlet forceps (pair) 4 4 6 4 028.9 Doyene’s Retractor 4 4 6 4 0

28.10 Small Retractors 8 8 12 8 028.11 Towel Clippers 16 1

624 16 0

28.12 Suction Nozzle 4 4 6 4 029 MNCH Related Radiology

Equipments29.1 Ultrasound Machine 1 1 2 1 029.2 X-Ray Unit 500 kw 1 1 1 1 029.3 Color Doppler 0 0 0 0 029.4 Lead Screen for X-Ray Unit 1 1 1 1 029.5 0.5 MN Lead Apron. Lead

Gloves, Goggles and Thyroid and Gonadal Sheets

1 1 1 1 0

29.6 Safe Light 1 1 1 1 029.7 X-RT Film Processing Tank 1 1 1 1 029.8 Chest Stand 1 1 1 1 029.9 X-Ray film Illuminator 2 2 2 2 0

29.10 X-Ray Film Hangers All sizes 4 4 4 4 030 MNCH Related Paediatrics

Equipments30.1 Paediatric Ventilator 1 1 2 1 030.2 Incubator 1 1 1 1 030.3 Photo Therapy Unit 1 1 1 1 030.4 Over-head Radiant Warmer 1 1 1 1 030.5 Infant Length Measuring

Scale2 2 2 2 0

30.6 Infant Weighing Machine 2 2 2 2 030.7 Nebulizer 1 1 1 1 030.8 Billiubino-meter 1 1 1 1 030.9 Exchange Blood Transfusion

Set1 1 1 1 0

30.10 Nasal Probe Paed size 1 2 2 1 0



(Qty.)

Available Gap

C B A

31 Anaesthesia/ICU31.1 Anaesthesia Machine 1 1 1 1 031.2 Ventilators 1 1 1 1 031.3 Nebulizer 1 1 1 1 031.4 Pulse Oximetry 1 1 1 1 031.5 Defibrillator 1 1 1 1 031.6 Airway Oral and Nasal 1 2 2 1 031.7 Tracheostomy tube (adult

and paeds)1 2 2 1 0

31.8 Face mask of all sizes 1 2 2 1 031.9 Double Cuff Tourniquet (for

regional block)1 1 1 1 0

31.10 AMBO bag adult 1 2 2 1 031.11 AMBO Bag paeds 2 2 2 2 031.12 Red Rubber Nasal tubes all

sizes without cuff4 4 4 4 0

32 Blood Bank32.1 Blood storage cabinet (100

bag capacity)1 1 1 1 0

32.2 Packed cell machine 1 1 1 1 032.3 Cell Separator 1 1 1 1 032.4 Freezer for Fresh Frozen

Plasma1 1 1 1 0

32.5 Blood bag shaker 1 1 1 1 032.6 RH view box 1 2 2 1 032.7 Water bath 2 2 2 2 032.8 Micro-pipette 4 4 6 4 032.9 Blood grouping tiles 3 3 3 3 0

32.10 Plasma Extractor 1 1 1 1 032.11 Platelets agitator 1 1 1 1 032.12 Blood thawing bath 1 1 1 1 032.13 Microscopes 1 1 1 1 0


33.1 Hematology Analyzer 1 1 1 1 033.2 Electrolyte Analyzer 1 1 1 1 0



(Qty.)

Available Gap

C B A


1 1 1 1 0

33.4 Glucometer 2 2 2 2 033.5 Haemoglobino-meter 1 1 1 1 033.6 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.

Health Problem

Problem Causes Intervention Activity UnitPlan

Activities Targets

Target for 2010-11

Target for 2011-12

Target for 2012-13 Remarks

1 Diarrhoeal diseases

Poor Hygiene & sanitation

Coordination with TMA for improvement of water supply and sanitation

Quarterly co-ordination meetings with TMA and other agencies

Meetings 12 8 4 4

Lack of safe drinking water

Awareness raising campaign

Messages on local cable network

Monthly Telecast

36 24 12 12



Activities Targets

Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

Unhygienic practices

Proper treatment of Diarrhoea including ORT

Printing and distribution of IPC material

Brochure 300,000 200,000 100,000 100,000

Lack of awareness among mothers about feeding and weaning practices

Health awareness in the community

Conduction of HES in the community

Session 240 160 80 80

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

Training of medics and paramedics in IMCI

Training 8 4 2 2

- - Procurement and distribution of ORS and Zinc

ORS packets 3,600,000 2,400,000 1,200,000 1,200,000



Activities Targets

Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

Sulphate

Syrup 300,000 200,000 100,000 100,000

2 Accidents And Injuries

Lack of traffic sense

Coordination with police department to improve traffic sense and ensuring observance of traffic rules

· Quarterly co-ordination meetings with Traffic Police department

Meetings 12 8 4 4

Poor maintenance of vehicles

Advocacy for improving the condition of roads

· Quarterly co-ordination meetings with Highway department

Meetings 12 8 4 4

Poor road conditions

Health education/promotion to prevent domestic accidents

· Preparation of Disaster Management Plan

- - - - -



Activities Targets

Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

including the Patient Management protocols

Lack of safety measures at work place

Ensure enforcement of safety laws at work places

· Training of the medics and the paramedics in first aid and emergency

Training in Batch for 25 trainees

20 10 5 5

Fire-arm injuries

Provision of emergencies medicines

· Provision of emergency kits for victims

Kits 1,500 1,000 500 500

Domestic accidents

· Procurement of equipments / instruments / various splints and

- - - - -



Activities Targets

Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

Plaster casts

Burns ·Drugs Drugs 1,500 1,000 500 500

3 Hepatitis B & C Poor sanitation

Health Education/Promotion

·Quarterly co-ordination meetings with TMA and other agencies

- - - - -

Unsafe drinking water

Campaign against quackery

·Messages on local cable network

Monthly Package

- - - -

Sharing of used syringes

Strengthening blood transfusion services for safe transfusions

·Printing and distribution of IPC and hepatitis awareness material

Brochure 30,000 20,000 10,000 10,000

Transfusion of

Campaign against drug

·Procureme

Kits 300,000 200,000 100,000 100,000



Activities Targets

Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

unsafe/unscreened blood and blood products

addiction nt and supply of screening kits

Unsafe sexual practices

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

·Procurement of safety boxes

Syringe cutter

600 400 200 200

Ear piercing and tattooing

·Procurement of drugs for treatment of Hepatitis patients

Injection 9,000 6,000 3,000 3,000

4 Diabetes Obesity Health Education campaign regarding healthy life style

Health educational sessions in community

Seminar - - - -

Inactive life Strengthening Printing Brochure 150,000 100,000 50,000 50,000



Activities Targets

Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

style diagnostic services for early detection

and distribution of Health Education material

Lack of health awareness on Diabetes

Provision of lab equipment/reagents

glucometer with Sticks

400 200 100 100

· Genetics & Infections

Provision of medicines

Drug 60,000 40,000 20,000 20,000

5 Malaria Breeding places for mosquitoes

Public awareness campaign

Printing and distribution of Health Education material

Poster 60,000 40,000 20,000 20,000

In judicious use of anti malarial by GPs And HCPs

Strengthening Malaria eradication program


Microscope , allied kit

100 - - -



Activities Targets

Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

· Lack of awareness for prevention

Training of health care providers / GPs on Roll back malaria

Training 8 4 2 2

Antimalarial drugs aursonate tablets,

Tablet (Pack of 100)

2,000 1,000 500 500

Antimalarial drugs Primaquin,


7,000 4,000 2,000 2,000

Antimalarial drugs Chloroquin


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

Fogging Machine

Machine 2 - - -



Activities Targets

Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

Purchase of diesel for fogging

Litre 9,000 6,000 3,000 3,000

Spray Pumps

pumps 150 100 50 50

Uniform for spray man

Uniform 150 - - -

Glasses/ gloves, Bucket, soap

Misc 150 100 50 50

Purchase of insecticide delta methrine (Powder 5 % WDP)

Kg 10,000 6,000 4,000 2,000

Purchase of insecticide delta

Litre 6,000 4,000 2,000 2,000



Activities Targets

Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

methrine (Liquid 1.5 % )

Purchase of larvicidal Drug (Phenthion Granules)

Kg 5,000 3,000 2,000 1,000

Purchase of larvicidal Drug ( Temiphos) Liquid

Litre 1,600 1,000 500 500

Spray man 4 Squad of 6 persons x 25 days

15 10 5 5

Purchase of motor cycle for CDCSs

Motor cycle 60 25 15 10



Activities Targets

Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

POL for motor cycles

litre 26,100 19,800 9,000 10,800

6 Scabies Overcrowding in schools and homes

· Awareness raising campaign

Community health education sessions

HES 240 160 80 80

Low socio-economic conditions

· Provision of medicines

Printing & Distribution of IPC Material

Brochure 150,000 100,000 50,000 50,000

Poor Health Education

- Supply of anti scabies drugs

drug 250,000 150,000 75,000 75,000

7 Complication of pregnancy

Low access to appropriate health services

Behaviour Change Communication (BCC)


Monthly Package

- - - -

Lack of awareness about danger signs of

Improving transportation to appropriate level of care

Printing and distribution of IPC

Brochure 200,000 100,000 50,000 50,000



Activities Targets

Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

pregnancy material

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

Strengthening healthcare facilities

Activation and use of Health Committees and women groups under LHWs

- - - - -

Lack of skilled birth attendants

Refresher courses for TBAs

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

Batch of 25 TBAs for 2 days Training

20 10 5 5

Deployment of community midwives

Placement of mid-wives in their catchment area

- - - - -

Repair of non

Ambulance 4 - - -



Activities Targets

Target for 2010-11

Target for 2011-12

Target for 2012-13

Remarks

functional ambulances for timely transportation of pregnant mothers

Replacement of non functional ambulances for timely transportation of pregnant mothers

Ambulance 12 6 4 2

POL for ambulances

Litre 28,800 24,000 9,600 14,400


Management Problems

Human resource plan to bridge gap between MSDS and Existing sanctioned posts

Sr. No. Name of PostBasic Scale

Basic Pay AllowancesRequirement

as per Gap

Physical Targets

Year I Year II Year III

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

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

3 Anesthetists 18 12,910 18,099 4 2 1 1

4 MO / WMO 17 9,850 15,345 107 53 26 26

5 Nurses 16 6,060 8,934 23 11 6 6

6 Lady Health Visitors 9 3,820 4,750 10 5 3 2



Activities Targets

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 permanent postings

·Incentivized pay package at all levels

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

- - - - - Plan

Lack of Well defined ·Orientation Batch 6 4 1 1 -



Activities Targets

Target for 2010-11

Target for 2011-12


incentivized and differential pay package

career structure including opportunities for higher education

trainings of the recruited staffs

Frequent transfer postings

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

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

- - - - - Meeting

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

- - - - - Plan

Lack of basic amenities at

·Review and revise the career

- - - - - Technical assistance



Activities Targets

Target for 2010-11

Target for 2011-12


workplace structure of medics and paramedics

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

· Filling of Human Resource gaps as per MSDS

Posts 136 67 34 35 Detail HR plan is attached

Posts 10 5 3 2 Detail HR plan is attached

Political and media interference

HR 146 72 37 37 Detail HR plan is attached

·Capacity and need assessment of the medics and the paramedics

- - - - - NO COST ACTIVITY



Activities Targets

Target for 2010-11

Target for 2011-12


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

- - - - - TNA

2. Inadequate medicine and supply

Less budget allocation for medicines

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

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

- - - - - Need assessment

Frequent increase in price

Demand generation for medicine.

- - - - - Demand generation

Procurement of essential drugs on the basis of allocated budget

- - - - - Already addressed in health problems



Activities Targets

Target for 2010-11

Target for 2011-12



· 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

- - - - - -

· Frequent increase in prices

· Provision of POL budget for supervisory vehicles for DHQ

litre 39,600 13,200 13,200 13,200 -

· Provision of POL budget for supervisory vehicles for THQ

litre 74,160 24,720 24,720 24,720 -

· Provision of POL budget for generator

litre 594,000 198,000 198,000 198,000 -

4. Inadequate

Deficient equipment to

· Provision of the equipment

Procurement of equipments for

- - - - - Detail attached



Activities Targets

Target for 2010-11

Target for 2011-12


MNCH related Equipment

cater basic and comprehensive EmONC at primary and secondary level of care

in accordance with the notified equipment list

THQ and DHQ hospitals based on the 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 M&R

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

Orientation of staffs in maintenance of logos for equipments

- - - - - Plan

5. Deficient logistic support

·Provision of inadequate funds for purchase of vehicles

· Provision of sufficient funds for purchase of vehicles

· Condemnation of the old and off-road vehicles

- - - - - As per demand by district



Activities Targets

Target for 2010-11

Target for 2011-12


- ·Ban on procurement of vehicles by the government

· Seeking exemptions for procurement of specific vehicle

· Preparation and submission of demand for replacement five ambulances at RHC

- - - - - Demand submission

- ·Complicated procedure for purchase of new vehicles

· Expedite the procurement procedure

· Procurement of ambulances

Ambulance - - - - Addressed in health problem no. 07

· Demand sufficient funds for repair and maintenance of vehicles and expedite the repair

· Demand submission for replacement four supervisory vehicles at HQ AND THQ

- - - - - Demand submission

· Procurement of supervisory vehicles at DHQ

vehicles 1 1 - - -



Activities Targets

Target for 2010-11

Target for 2011-12


·Poor maintenance of vehicles

- - - - - - - NO COST ACTIVITY

· Procurement of supervisory vehicles at THQ

vehicles 8 4 2 2 -

SECTION 4: COSTING AND FINANCING PLAN

I. Activity based costingThe planning team has used the best available data sources, for calculation of estimates for the intervention/activities. It is pertinent to mention that the costing

of the plan is based on additional needs and activities. The detailed activity based costing of the Health and Service Delivery problems has been performed on

automated Excel sheets, which are hyperlinked with the plan as Annex-II and Annex-III. A moderate estimate of equipment cost has been taken, as there is

wide variation between the minimum and maximum cost. The summary of activity and problem wise costing is given below.


a) Health ProblemsSr. No.

Problem Activity Define Financial Targets Total Cost Remarks

Unit Rate Quantity Year I Year II Year III

1 Diarrhoeal diseases

Quarterly co-ordination meetings with TMA and other agencies

Meetings 3,000 12 12,000 54,240 14,520 39,720 -


Monthly Telecast

35,000 36 420,000 1,898,400 508,200 1,390,200 -


Brochure 5 300,000 500,000 2,260,000 605,000 1,655,000 -


Session 2,000 240 160,000 723,200 193,600 529,600 -


Training 245,000 8 980,000 2,704,800 592,900 2,111,900 -


Sr. No.



Procurement and distribution of ORS and Zinc Sulphate

ORS packets

5 3,600,000 6,000,000 27,120,000 7,260,000 19,860,000 -

- Syrup 60 300,000 6,000,000 27,120,000 7,260,000 19,860,000 -

2 Accidents And Injuries

· Quarterly co-ordination meetings with Traffic Police department

Meetings 5,000 12 20,000 90,400 24,200 66,200 -


Meetings 5,000 12 20,000 90,400 24,200 66,200 -

· Preparation of Disaster Management Plan including the Patient Management

- - - - - - - Plan


Sr. No.



protocols


Training in Batch for 25 trainees

50,000 20 500,000 1,380,000 302,500 1,077,500 Including medics and paramedics


Kits 3,000 1,500 1,500,000 6,780,000 1,815,000 4,965,000 -

· Procurement of equipments / instruments / various splints and Plaster casts

- - - - - - - Plan

· Drugs Drugs 300 1,500 150,000 678,000 181,500 496,500 -

3 Hepatitis B & C

· Quarterly co-ordination meetings with TMA and other

- - - - - - - Integrated activity


Sr. No.



agencies

· Messages on local cable network

Monthly Package

- - - - - - Integrated activity

· Printing and distribution of IPC and hepatitis awareness material

Brochure 30 30,000 300,000 1,356,000 363,000 993,000 -

· Procurement and supply of screening kits

Kits 50 300,000 5,000,000 22,600,000 6,050,000 16,550,000 -

· Procurement of safety boxes

Syringe cutter

500 600 100,000 452,000 121,000 331,000 -

· Procurement of drugs for treatment of Hepatitis patients

Injection 12,000 9,000 36,000,000

162,720,000

43,560,000 119,160,000 -


Sr. No.



4 Diabetes Health educational sessions in community

Seminar - - - - - - Integrated Activity


Brochure 5 150,000 250,000 1,130,000 302,500 827,500 -


Glucometer with Sticks

7,000 400 1,400,000 3,864,000 847,000 3,017,000 -

Provision of medicines

Drug 4,800 60,000 96,000,000

433,920,000

116,160,000 317,760,000 -

5 Malaria Printing and distribution of Health Education material

Poster 25 60,000 500,000 2,260,000 605,000 1,655,000 -


Sr. No.




Microscope , allied kit

60,000 100 6,000,000 6,000,000 - 6,000,000 -

Training of health care providers / GPs on Roll back malaria

Training 50,800 8 203,200 560,832 122,936 437,896 -



2,000 2,000 2,000,000 5,520,000 1,210,000 4,310,000 -

Antimalarial drugs Primaquin,


1,000 7,000 3,000,000 10,040,000 2,420,000 7,620,000 -

Antimalarial drugs Chloroquin


50 200,000 5,000,000 13,800,000 3,025,000 10,775,000 -


Sr. No.



Fogging Machine

Machine 90,000 2 180,000 180,000 - 180,000 -

Purchase of diesel for fogging

Litre 76 9,000 228,000 1,030,560 275,880 754,680 -

Spray Pumps pumps 7,000 150 350,000 1,582,000 423,500 1,158,500 -

Uniform for spray man

Uniform 500 150 75,000 75,000 - 75,000 -

Glasses/ gloves, Bucket, soap

Misc 1,000 150 50,000 226,000 60,500 165,500 -


Sr. No.




Kg 800 10,000 3,200,000 10,592,000 1,936,000 8,656,000 -

Purchase of insecticide delta methrine (Liquid 1.5 % )

Litre 1,200 6,000 2,400,000 10,848,000 2,904,000 7,944,000 -


Kg 500 5,000 1,000,000 3,310,000 605,000 2,705,000 -


Litre 2,000 1,600 1,200,000 4,720,000 1,210,000 3,510,000 -

Spray man 4 Squad of 6 persons x 25 days

65,000 15 325,000 1,469,000 393,250 1,075,750 -


Sr. No.




Motor cycle

60,000 60 2,100,000 4,542,000 726,000 3,816,000 -

POL for motor cycles

litre 75 26,100 472,500 3,175,200 980,100 2,195,100 -

6 Scabies Community health education sessions

HES 2,000 240 160,000 723,200 193,600 529,600 -


Brochure 5 150,000 250,000 1,130,000 302,500 827,500 -

Supply of anti scabies drugs

drug 50 250,000 5,000,000 18,200,000 4,537,500 13,662,500 -


Sr. No.



7 Complication of pregnancy


Monthly Package

- - - - - - Integrated Activity


Brochure 5 200,000 500,000 1,380,000 302,500 1,077,500 -


- - - - - - - Plan


Batch of 25 TBAs for 2 days Training

51,000 20 510,000 1,407,600 308,550 1,099,050 -

Placement of mid-wives in their catchment area

- - - - - - - placement in progress


Sr. No.



Repair of non functional ambulances for timely transportation of pregnant mothers

Ambulance

25,000 4 100,000 100,000 - 100,000 -


Ambulance

3,800,000 12 22,800,000

57,912,000 9,196,000 48,716,000 -

POL for ambulances

Litre 76 28,800 364,800 3,815,808 1,324,224 2,491,584 -


a) Management ProblemsHuman Resource plan to bridge gap between MSDS and existing sanctioned positions

Sr. No.

Name of Post BS

Basi

c Pa

y

Allo

wan

ces Requi

rement as per Gap

Financial Targets

Year I Year II Year III

Pay of Officers

Pay of other staff

Allowances

Pay of Officers

Pay of other staff

Allowances

Pay of Officers

Pay of other staff

Allowances

1 Gynaecologist 18 12,910

18,099 - - - - - - - - - -

2 Paediatricians 18 12,910

18,099 2 154,920 - 217,188 340,824 - 477,814 749,813 - 1,051,190

3 Anesthetists 18 12,910

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

4 MO / WMO 17 9,850 15,345 107 6,264,600 - 9,759,420 10,271,580 - 16,001,766 15,017,310 - 23,394,987

5 Nurses 16 6,060 8,934 23 799,920 - 1,179,288 1,359,864 - 2,004,790 2,023,798 - 2,983,599

6 Lady Health Visitors

9 3,820 4,750 10 - 229,200 285,000 - 403,392 501,600 - 554,664 689,700

Grand Total 7,529,280 229,200 11,875,272 12,483,504 403,392 19,702,690 18,540,733 554,664 29,170,665


Sr. No.



1 Shortage of skilled MNCH related staff

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

- - - - - - - Recruitment


- - - - - - - Recruitment

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

- - - - - - - Plan


Sr. No.



· Orientation trainings of the recruited staffs

Batch 350,500 6 1,402,000

385,550 424,105 2,211,655 -

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

- - - - - - - Meeting

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

- - - - - - - Plan

· Review and revise the career structure of medics and paramedics

- - - - - - - Technical assistance


Sr. No.



· Filling of Human Resource gaps as per MSDS

Posts - 136 7,529,280

12,483,504

18,540,733 38,553,517 Detail HR plan is attached

- Posts - 10 229,200 403,392 554,664 1,187,256 Detail HR plan is attached

- HR - 146 11,875,272

19,702,690

29,170,665 60,748,627 Detail HR plan is attached

· Capacity and need assessment of the medics and the paramedics


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

- - - - - - - TNA


Sr. No.



2 Inadequate medicine and supply

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

- - - - - - - Need assessment


- - - - - - - Demand generation

Procurement of essential drugs on the basis of allocated budget

- - - - - - - Already addressed in health problems

3 Inadequate budget POL

Assessment of additional requirement



Sr. No.




- - - - - - - -


litre 75 39,600 990,000 1,089,000 1,197,900 3,276,900 -


litre 75 74,160 1,854,000 2,039,400 2,243,340 6,136,740 -


litre 75 594,000 14,850,000

16,335,000

17,968,500 49,153,500 -

4 Inadequate MNCH related Equipment

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

- - - 9,727,000 2,692,845 - 12,419,845 Detail attached


Sr. No.



available


- - - - - - - Submission of demand


- - - - - - - Plan

5 Deficient logistic support

· Condemnation of the old and off-road vehicles

- - - - - - - As per demand by district


- - - - - - - Demand submission


Sr. No.



· Procurement of ambulances

Ambulance

- - - - - - Addressed in health problem no. 07


- - - - - - - Demand submission


vehicles 3,800,000 1 3,800,000 - - 3,800,000 -

- - - - - - - - NO COST ACTIVITY


vehicles 900,000 8 3,600,000 1,980,000 2,178,000 7,758,000 -


II. Financial Outlay including 3YRP ActivitiesThe 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 Classification

2010-2011 2011-2012 2012-2013

Regular Additional Total Regular Additional Total Regular Additional Total

A03907 5,750 420,000 425,750 6,613 462,000 468,613 7,604 508,200 515,804

A03902 5,750 2,300,000 2,305,750 6,613 2,255,000 2,261,613 7,604 2,480,500 2,488,104

A03820 - 52,000 52,000 - 57,200 57,200 - 62,920 62,920

A03927 - 166,950,000 166,950,000 - 177,100,000

177,100,000

- 192,269,000

192,269,000

A13101 5,750 - 5,750 6,613 - 6,613 7,604 - 7,604

A09501 - 24,900,000 24,900,000 - 17,710,000 17,710,000 - 9,922,000 9,922,000

A09601 - 530,000 530,000 - 385,000 385,000 - 423,500 423,500

A03903 - 320,000 320,000 - 352,000 352,000 - 387,200 387,200

A03801 - 2,193,200 2,193,200 - 1,206,260 1,206,260 - 1,326,886 1,326,886



2010-2011 2011-2012 2012-2013


A09601 - - - - - - - - -

A09404 - 14,000,000 14,000,000 - 8,030,000 8,030,000 - 8,833,000 8,833,000

A03807 - 1,065,300 1,065,300 - 1,795,860 1,795,860 - 2,580,204 2,580,204

A03906 - 75,000 75,000 - - - - - -

A09802 - 50,000 50,000 - 55,000 55,000 - 60,500 60,500

A01277 - 325,000 325,000 - 357,500 357,500 - 393,250 393,250

A13001 - 100,000 100,000 - - - - - -

Total 17,250 213,280,500 213,297,750 19,838 209,765,820 209,785,658 22,813 219,247,160 219,269,973


b) Management Problems


2010-2011 2011-2012 2012-2013


A03801 - 1,402,000 1,402,000 - 385,550 385,550 - 424,105 424,105

A01101 - 7,529,280 7,529,280 - 12,483,504 12,483,504 - 18,540,733 18,540,733

A01270 678,854 11,875,272 12,554,126 780,682 19,702,690 20,483,372 897,785 29,170,665 30,068,450

A09501 - 7,400,000 7,400,000 - 1,980,000 1,980,000 - 2,178,000 2,178,000

A03807 - 17,694,000 17,694,000 - 19,463,400 19,463,400 - 21,409,740 21,409,740

A09601 - 9,727,000 9,727,000 - 2,692,845 2,692,845 - - -

A01102 - 229,200 229,200 - 403,392 403,392 - 554,664 554,664

Total 678,854 55,856,752 56,535,606 780,682 57,111,381 57,892,063 897,785 72,277,908 73,175,692


III. Summaries

a) Problem wise Costing

i. Health Problems

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

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

1 Diarrhoeal diseases 14,072,000 14,940,200 16,434,220 45,446,420

2 Accidents And Injuries 2,190,000 2,134,000 2,347,400 6,671,400

3 Hepatitis B & C 41,400,000 45,540,000 50,094,000 137,034,000

4 Diabetes 97,650,000 106,645,000 117,309,500 321,604,500

5 Malaria 28,283,700 17,852,560 16,897,166 63,033,426

6 Scabies 5,410,000 4,576,000 5,033,600 15,019,600

7 Complication of pregnancy 24,274,800 18,078,060 11,131,274 53,484,134

Total 213,280,500 209,765,820 219,247,160 642,293,480


ii. Management Problems

Sr. No. Problem

FY I FY II FY III Total Cost Rs.

Amount (Rs.) Amount (Rs.)Amount

(Rs.)Amount (Rs.)

1 Shortage of skilled staffs MNCH related

21,035,752 32,975,136 48,690,168 102,701,055

2 Inadequate medicine and supply - - - -

3 Inadequate budget POL 17,694,000 19,463,400 21,409,740 58,567,140


9,727,000 2,692,845 - 12,419,845

5 Deficient logistic support 7,400,000 1,980,000 2,178,000 11,558,000

Total 55,856,752 57,111,381 72,277,908 185,246,040


b) Activity-wise costing

i. Health Problems

Sr. No. Problem Activity FY-I FY-II FY-III Total

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

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


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


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


160,000 176,000 193,600 529,600


980,000 539,000 592,900 2,111,900

Procurement and distribution of ORS and Zinc Sulphate

6,000,000 6,600,000 7,260,000 19,860,000

- 6,000,000 6,600,000 7,260,000 19,860,000

2 Accidents And Injuries · Quarterly co-ordination meetings with Traffic Police

20,000 22,000 24,200 66,200



department


20,000 22,000 24,200 66,200

· Preparation of Disaster Management Plan including the Patient Management protocols

- - - -


500,000 275,000 302,500 1,077,500


1,500,000 1,650,000 1,815,000 4,965,000

· Procurement of equipments / instruments / various splints and Plaster casts

- - - -

· Drugs 150,000 165,000 181,500 496,500

3 Hepatitis B & C · Quarterly co-ordination meetings with TMA and other agencies

- - - -

· Messages on local cable network

- - - -

· Printing and distribution of IPC 300,000 330,000 363,000 993,000



and hepatitis awareness material

· Procurement and supply of screening kits

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

· Procurement of safety boxes 100,000 110,000 121,000 331,000

· Procurement of drugs for treatment of Hepatitis patients

36,000,000 39,600,000 43,560,000 119,160,000

4 Diabetes Health educational sessions in community

- - - -


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


1,400,000 770,000 847,000 3,017,000

Provision of medicines 96,000,000 105,600,000

116,160,000

317,760,000

5 Malaria Printing and distribution of Health Education material

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


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

Training of health care providers / GPs on Roll back

203,200 111,760 122,936 437,896



malaria


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

Antimalarial drugs Primaquin, 3,000,000 2,200,000 2,420,000 7,620,000

Antimalarial drugs Chloroquin 5,000,000 2,750,000 3,025,000 10,775,000

Fogging Machine 180,000 - - 180,000

Purchase of disel for fogging 228,000 250,800 275,880 754,680

Spray Pumps 350,000 385,000 423,500 1,158,500

Uniform for spray man 75,000 - - 75,000

Glasses/ gloves, Bucket, soap 50,000 55,000 60,500 165,500


3,200,000 3,520,000 1,936,000 8,656,000

Purchase of insecticide delta methrine (Liquid 1.5 % )

2,400,000 2,640,000 2,904,000 7,944,000


1,000,000 1,100,000 605,000 2,705,000


1,200,000 1,100,000 1,210,000 3,510,000

Spray man 325,000 357,500 393,250 1,075,750




2,100,000 990,000 726,000 3,816,000

POL for motor cycles 472,500 742,500 980,100 2,195,100

6 Scabies Community health education sessions

160,000 176,000 193,600 529,600


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

Supply of anti scabies drugs 5,000,000 4,125,000 4,537,500 13,662,500

7 Complication of pregnancy Messages on local cable network

- - - -


500,000 275,000 302,500 1,077,500


- - - -


510,000 280,500 308,550 1,099,050

Placement of mid-wives in - - - -



their catchment area

Repair of non functional ambulances for timely transportation of pregnant mothers

100,000 - - 100,000


22,800,000 16,720,000 9,196,000 48,716,000

POL for ambulances 364,800 802,560 1,324,224 2,491,584

Total 13,280,500 09,765,820 19,247,160 42,293,480

ii. Management Problems


Sr. No. Problem Activity Costing (Rs.)

FY-I FY-II FY-III Total

1 Shortage of skilled staffs MNCH related

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

- - - -


- - - -

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

- - - -

· Orientation trainings of the recruited staffs

1,402,000 385,550 424,105 2,211,655

· 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

- - - -

Filling of Human Resource gaps as per MSDS

7,529,280 12,483,504 18,540,733 38,553,517

229,200 403,392 554,664 1,187,256

11,875,272 19,702,690 29,170,665 60,748,627

· Capacity and need assessment of the medics and the paramedics

- - - -

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

- - - -

2 Inadequate medicine and supply

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

- - - -


- - - -

Procurement of essential drugs - - - -




on the basis of allocated budget

3 Inadequate budget POL Assessment of additional requirement

- - - -


- - - -


990,000 1,089,000 1,197,900 3,276,900


1,854,000 2,039,400 2,243,340 6,136,740


14,850,000 16,335,000 17,968,500 49,153,500


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

9,727,000 2,692,845 - 12,419,845


- - - -


- - - -




5 Deficient logistic support · Condemnation of the old and off-road vehicles

- - - -


- - - -

· Procurement of ambulances - - - -


- - - -


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


3,600,000 1,980,000 2,178,000 7,758,000

55,856,752 7,111,381 2,277,908 185,246,040


SECTION 5: Monitoring and 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 % Achievemen

t

MoV Responsibility

Frequency of

monitoring

Remarks

% of planned supervisory visits conducted

50 visits /year

Inspection Book

EDOH/DOH/ DDOH

Quarterly

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

100%

During 1st

year

Pay Roll EDOH / DOH 6 monthly

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

100%

During 1st

year

Stock Register

EDOH/ DOH/ MSs

6 monthly


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

100%

During 1st

year

Stock Register

EDOH/ DOH/MSs, Store keeper

Quarterly

% facilities with availability of essential medicines

100%

During 1st

year

Stock Register

EDOH/ DOH/ MSs, Store keeper

Monthly

% of functional ambulances in the district

100%

(DHQH/ THQH/ RHCs)

Log Book EDOH/DOH/ Transport officer

Quarterly

% utilization of sanctioned budget

100% of yearly budget

Quarterly Reports

EDOH/ DOH/ MSs/ Accounts officer

Quarterly

% of facilities with availability of basic EmONC

100%

(50% during 1st

year)

Supervisory visit report

EDOH/DoH/ DDOH

Quarterly

% of DHQ/THQ hospitals with Comprehensive EmONC services

100% in 3 years

(50% during 1st

year)


EDOH/DoH/ DDOH

Quarterly

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

100% in 3 years (50%

during 1st

year)


EDOH/DoH/ DDOH

Quarterly

% of targeted pregnant women newly registered by LHW

Target according

to populatio

n

DHIS Report

EDOH/ Statistical Officer

Quarterly


% of targeted pregnant women received TT-2 vaccine

Target according

to populatio

n

DHIS Report

EDOH/ DHIS Coordinator/ Statistical Officer

Quarterly

Delivery conducted by or under supervision of skilled persons reported

90%

(…. % During 1st

year)

DHIS Report


Quarterly

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

Target according

to populatio

n

DHIS Report


Quarterly

% of referred cases attended

100% DHIS Report/ LHWs monthly report


Quarterly

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

Target according

to populatio

n

LHW’s monthly/ quarterly report

EDOH/ Statistical Officer /Coordinator NP-FP&PHC

Quarterly

No. of meetings with participation from other sectors

12 meetings per year

Minutes of meetings

EDOH/ Focal person/s

Quarterly


Annexure


Annex-I

Costing of Equipment gaps for DHQ and THQ Hospitals

DHQ HOSPITAL GUJRAT

Sr. No.

Equipment Standard as per MSDS Available Gap Cost/Unit

Total Cost(Qty.)

C B A1 CTG (Cardiac

Tocography)1 1 2 1 0 285000 0

2 Foetal Doppler 3 5 5 1 2 101000 2020003 Diagnostic Laparoscope 1 1 2 1 0 1200000 04 Bulb Sucker 10 20 20 10 0 45 05 Baby Warmer 3 3 6 1 2 850000 17000006 Mechanical Sucker 3 3 6 3 0 28000 07 Fetal Stethoscope 4 4 4 4 0 1500 08 Delivery Table 2 2 3 2 0 17500 09 D&C Set 2 3 4 2 0 2100 0

10 Outlet forceps 4 4 4 4 0 900 011 Myoma Screw 2 2 2 2 0 320 012 Kochers forceps 4 4 8 4 0 235 013 Volselum forceps 6 8 10 6 0 235 014 Lanes Tissue holding

forceps2 2 4 2 0 400 0

15 Vaginal Retractors 10 10 10 10 0 350 016 Polypectomy forceps 2 2 2 2 0 750 017 Sponge holder 10 15 20 10 0 300 018 Uterine elevator 1 1 1 1 0 150 0

19 CosCo Speculum 6 10 10 6 0 550 020 Examination light 3 3 6 3 0 18000 021 Suction Curette 1 2 2 1 0 95 022 Infant Resuscitation

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

1 1 2 1 0 95000 0


1 1 2 1 0 110000 0

24 Cardiac Monitor 1 1 2 1 0 500000 0


25 Pump Breast Electronic 1 1 1 1 0 250000 026 Vaginal Hysterectomy

Set2 2 4 2 0 30000 0

26.1 Toothed Tissue Forceps (8”)

2 2 4 2 0 55 0

26.2 Non-Tooted 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 90 026.8 Needle Holder (7”) 2 2 4 2 0 150 026.9 Needle Holder (10”) 2 2 4 2 0 300 026.1 Artery Forceps (Straight

6”)16 16 32 16 0 110 0

26.11

Artery Forceps (Curved 6”)

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

Single blade Sims speculum

4 4 8 4 0 275 0

26.15

Double blade Sims speculum

4 4 8 4 0 250 0

26.16

Sponge holding forceps 8 8 16 8 0 200 0

26.17

Volselum forceps 4 4 8 4 0 250 0

26.18

Uterine Sound 2 2 4 2 0 1500 0

26.19

Bladder Sound 2 2 4 2 0 1500 0

27 Delivery Sets 10 10 15 10 0 027.1 Episiotomy Scissors 10 10 15 10 0 125 027.2 Straight Scissors 10 10 15 10 0 360 027.3 Needle holder 10 10 15 10 0 135 027.4 Non-toothed tissue

forceps 8 inches10 10 15 10 0 100 0


10 10 15 10 0 100 0

27.6 Sims Speculum single blade

20 20 30 20 0 275 0

27.7 Sims Speculum double blade

20 20 30 20 0 250 0

27.8 Sponge holding forceps 40 40 60 40 0 250 0


27.9 Artery forceps 40 40 60 40 0 275 027.1 Straight clamps (cord) 20 20 30 20 0 175 027.1

1Vacuum Extractor pump 1 1 1 1 0 19000 0

27.12

Towel clip 40 40 60 40 0 125 0

28 Caesarian Section 6 8 10 6 0 028.1 Scalpel 6 8 10 6 0 50 028.2 Artery Forceps Straight 6

inches24 32 40 24 0 125 0


24 32 40 24 0 125 0

28.4 Artery forceps 8 inches 24 32 40 24 0 175 028.5 Myoma Scissors straight 7

inches6 8 10 6 0 150 0


6 8 10 6 0 270 0


24 32 40 24 0 300 0

28.8 Obstetric outlet forceps (pair)

6 8 10 6 0 900 0

28.9 Doyene’s Retractor 6 8 10 6 0 200 028.1 Small Retractors 12 16 20 12 0 300 028.1

1Towel Clippers 24 32 40 24 0 125 0

28.12

Suction Nozzle 6 8 10 6 0 250 0


0

29.1 Ultrasound Machine 1 2 3 1 0 575000 029.2 X-Ray Unit 500 kw 1 1 1 1 0 6000000 0

29.3 Color Doppler 0 1 1 1 0 5750000 029.4 Lead Screen for X-Ray

Unit1 1 1 1 0 30000 0

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

1 1 1 1 0 100000 0

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

Tank1 1 1 1 0 5000 0

29.8 Chest Stand 1 1 1 1 0 4500 029.9 X-Ray film Illuminator 2 2 2 2 0 4000 029.1 X-Ray Film Hangers All

sizes4 4 4 4 0 4000 0

30 MNCH Related Paediatrics Equipments

0

30.1 Paediatric Ventilator 1 2 2 1 0 1200000 030.2 Incubator 1 1 2 1 0 1500000 030.3 Photo Therapy Unit 1 1 1 1 0 22000 0


30.4 Over-head Radiant Warmer

1 1 1 1 0 910000 0

30.5 Infant Length Measuring Scale

2 2 2 2 0 5000 0

30.6 Infant Weighing Machine 2 2 2 2 0 3100 030.7 Nebulizer 1 1 2 1 0 22000 030.8 Billiubino-meter 1 1 2 1 0 36000 030.9 Exchange Blood

Transfusion Set1 1 2 1 0 2000 0

30.1 Nasal Probe Paed size 2 2 4 2 0 7000 031 Anaesthesia/ICU 0

31.1 Anaesthesia Machine 1 1 2 1 0 321000 031.2 Ventilators 1 1 1 1 0 525000 031.3 Nebulizer 1 1 1 1 0 165000 031.4 Pulse Oximetry 1 1 1 1 0 21000 031.5 Defibrillator 1 1 1 1 0 500000 031.6 Airway Oral and Nasal 2 3 4 2 0 500 031.7 Tracheostomy tube (adult

and paeds)2 2 4 2 0 1000 0

31.8 Face mask of all sizes 2 2 4 2 0 1000 031.9 Double Cuff Tourniquet

(for regional block)1 2 2 1 0 320 0

31.1 AMBO bag adult 2 2 4 2 0 2450 031.1

1AMBO Bag paeds 2 2 4 2 0 3000 0

31.12

Red Rubber Nasal tubes all sizes without cuff

4 4 8 4 0 1000 0

32 Blood Bank 032.1 Blood storage cabinet

(100 bag capacity)1 1 2 1 0 812000 0

32.2 Packed cell machine 1 1 1 0 1 600000 60000032.3 Cell Separator 1 1 1 0 1 5225000 522500032.4 Freezer for Fresh Frozen

Plasma1 1 1 1 0 1150000 0

32.5 Blood bag shaker 1 1 2 1 0 10000 032.6 RH view box 2 2 4 2 0 1000 032.7 Water bath 2 2 2 2 0 3000 032.8 Micro-pipette 4 6 8 4 0 8000 032.9 Blood grouping tiles 3 3 6 3 0 3000 032.1 Plasma Extractor 1 1 1 0 1 1000000 100000032.1

1Platelets agitator 1 1 1 0 1 1000000 1000000

32.12

Blood thawing bath 1 1 1 1 0 3000 0

32.13

Microscopes 1 1 2 1 0 115000 0


0


33.1 Hematology Analyzer 1 1 1 1 0 425000 033.2 Electrolyte Analyzer 1 1 1 1 0 625000 033.3 Analyzer Bio-chemistry

Semi-automatic1 1 1 1 0 690000 0

33.4 Glucometer 2 2 2 2 0 2500 033.5 Haemoglobino-meter 2 2 4 2 0 1000 033.6 Centrifuge 1 1 2 1 0 133000 0

Total 9727000

THQ KHARIAN

Sr. No.

Equipment Standard as per MSDS Available

Gap Cost/Unit Total Cost(Qty.)

C B A1 CTG (Cardiac

Tocography)1 1 1 0 1 285000 101000

2 Foetal Doppler 2 2 3 0 2 101000 24000003 Diagnostic

Laparoscope1 1 1 1 0 1200000 0

4 Bulb Sucker 5 10 20 5 0 45 05 Baby Warmer 2 2 3 2 0 850000 06 Mechanical

Sucker3 3 3 3 0 28000 0

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

10 Outlet forceps 4 4 4 4 0 900 011 Myoma Screw 2 2 2 2 0 320 012 Kochers forceps 4 4 4 4 0 235 013 Volselum forceps 4 4 6 4 0 235 014 Lanes Tissue

holding forceps2 2 2 2 0 400 0

15 Vaginal Retractors

4 4 6 4 0 350 0

16 Polypectomy forceps

2 2 2 2 0 750 0

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

19 CosCo Speculum 4 6 6 4 0 550 020 Examination light 3 3 3 3 0 95 021 Suction Curette 1 1 2 1 0 95000 0


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

1 1 1 1 0 110000 0


1 1 1 1 0 500000 0

24 Cardiac Monitor 1 1 1 1 0 250000 025 Pump Breast

Electronic1 1 1 1 0 30000 0

26 Vaginal Hysterectomy Set

2 2 2 55 0

26.1 Toothed Tissue Forceps (8”)

2 2 2 2 0 55 0

26.2 Non-Tooted Tissue Forceps (8”)

2 2 2 2 0 150 0


2 2 2 2 0 150 0


2 2 2 2 0 150 0


8 8 8 8 0 175 0


8 8 8 8 0 90 0

26.7 Uterine Sound 2 2 2 2 0 150 026.8 Needle Holder

(7”)2 2 4 2 0 300 0

26.9 Needle Holder (10”)

2 2 2 2 0 110 0

26.1 Artery Forceps (Straight 6”)

16 16 16 16 0 125 0

26.11 Artery Forceps (Curved 6”)

16 16 16 16 0 230 0

26.12 Allis Forceps 8 8 8 8 0 125 026.13 Towel Clamps 8 8 8 8 0 275 0


26.14 Single blade Sims speculum

4 4 4 4 0 250 0

26.15 Double blade Sims speculum

4 4 4 4 0 200 0

26.16 Sponge holding forceps

8 8 8 8 0 250 0

26.17 Volselum forceps 4 4 4 4 0 1500 026.18 Uterine Sound 2 2 2 2 0 1500 026.19 Bladder Sound 2 2 2 2 0 0

27 Delivery Sets 6 6 10 4 2 125 72027.1 Episiotomy

Scissors6 6 10 6 0 360 0

27.2 Straight Scissors 6 6 10 6 0 135 027.3 Needle holder 6 6 10 6 0 100 027.4 Non-toothed

tissue forceps 8 inches

6 6 10 6 0 100 0


6 6 10 6 0 275 0

27.6 Sims Speculum single blade

12 12 20 12 0 250 0

27.7 Sims Speculum double blade

12 12 20 12 0 250 0

27.8 Sponge holding forceps

40 40 40 40 0 275 0

27.9 Artery forceps 40 40 40 30 10 175 19000027.1 Straight clamps

(cord)20 20 30 15 5 19000 625

27.11 Vacuum Extractor pump

1 1 1 1 0 125 0

27.12 Towel clip 40 40 40 30 10 50028 Caesarian

Section4 4 6 4 0 50 0

28.1 Scalpel 4 4 6 4 0 125 028.2 Artery Forceps

Straight 6 inches16 16 24 16 0 125 0


16 16 24 16 0 175 0

28.4 Artery forceps 8 inches

16 16 24 16 0 150 0


4 4 6 4 0 270 0


4 4 6 4 0 300 0


16 16 24 16 0 900 0

28.8 Obstetric outlet forceps (pair)

4 4 6 4 0 200 0

28.9 Doyene’s Retractor

4 4 6 4 0 300 0


28.1 Small Retractors 8 8 12 8 0 125 028.11 Towel Clippers 16 16 24 16 0 250 028.12 Suction Nozzle 4 4 6 4 0 0


575000 0

29.1 Ultrasound Machine

1 1 2 1 0 6000000 0

29.2 X-Ray Unit 500 kw

1 1 1 1 0 0

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

X-Ray Unit1 1 1 1 0 30000 0

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

1 1 1 1 0 100000 0

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

Processing Tank1 1 1 1 0 5000 0

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

Illuminator2 2 2 2 0 4000 0

29.1 X-Ray Film Hangers All sizes

4 4 4 4 0 4000 0

30 MNCH Related Paediatrics Equipments

0

30.1 Paediatric Ventilator

1 1 2 1 0 1200000 0

30.2 Incubator 1 1 1 1 0 1500000 030.3 Photo Therapy

Unit1 1 1 1 0 22000 0

30.4 Over-head Radiant Warmer

1 1 1 1 0 910000 0

30.5 Infant Length Measuring Scale

2 2 2 2 0 5000 0

30.6 Infant Weighing Machine

2 2 2 2 0 3100 0

30.7 Nebulizer 1 1 1 1 0 22000 030.8 Billiubino-meter 1 1 1 1 0 36000 030.9 Exchange Blood

Transfusion Set1 1 1 1 0 2000 0

30.1 Nasal Probe Paed size

1 2 2 1 0 7000 0

31 Anaesthesia/ICU 031.1 Anaesthesia

Machine1 1 1 1 0 321000 0

31.2 Ventilators 1 1 1 1 0 525000 031.3 Nebulizer 1 1 1 1 0 165000 0


31.4 Pulse Oximetry 1 1 1 1 0 21000 031.5 Defibrillator 1 1 1 1 0 500000 031.6 Airway Oral and

Nasal1 2 2 1 0 500 0

31.7 Tracheostomy tube (adult and paeds)

1 2 2 1 0 1000 0

31.8 Face mask of all sizes

1 2 2 1 0 1000 0

31.9 Double Cuff Tourniquet (for regional block)

1 1 1 1 0 320 0

31.1 AMBO bag adult 1 2 2 1 0 2450 031.11 AMBO Bag paeds 2 2 2 2 0 3000 031.12 Red Rubber Nasal

tubes all sizes without cuff

4 4 4 4 0 1000 0

32 Blood Bank 032.1 Blood storage

cabinet (100 bag capacity)

1 1 1 1 0 812000 0

0 Packed cell machine

1 1 1 1 0 600000 0

32.3 Cell Separator 1 1 1 1 0 5225000 032.4 Freezer for Fresh

Frozen Plasma1 1 1 1 0 1150000 0

32.5 Blood bag shaker 1 1 1 1 0 10000 032.6 RH view box 1 2 2 1 0 1000 032.7 Water bath 2 2 2 2 0 3000 032.8 Micro-pipette 4 4 6 4 0 8000 032.9 Blood grouping

tiles3 3 3 3 0 3000 0

32.1 Plasma Extractor 1 1 1 1 0 1000000 032.11 Platelets agitator 1 1 1 1 0 1000000 032.12 Blood thawing

bath1 1 1 1 0 3000 0

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

Room Related Laboratory Equipment

0

33.1 Hematology Analyzer

1 1 1 1 0 425000 0

33.2 Electrolyte Analyzer

1 1 1 1 0 625000 0


1 1 1 1 0 690000 0

33.4 Glucometer 2 2 2 2 0 2500 0


33.5 Haemoglobino-meter

1 1 1 1 0 1000 0

33.6 Centrifuge 1 1 1 1 0 133000 0Total

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