HFA District Report - Panjgur
-
Upload
fahad-shabbir-baloch -
Category
Documents
-
view
217 -
download
0
Transcript of HFA District Report - Panjgur
-
7/23/2019 HFA District Report - Panjgur
1/86
Health Facility Assessment Balochistan
District Panjgur
-
7/23/2019 HFA District Report - Panjgur
2/86
Acknowledgement
TRF acknowledges the cooperation and support of Contech International Health
Consultants, Lahore who worked on the assignment and authored the report. The final
reports were quality assured by Jennifer Sanchos, HLSP Health Systems Consultants, and
Ms. Pamela Sequeria, M & E Specialist TRF.
Disclaimer
This document is issued for the party which commissioned it and for specific purposes
connected with the above-captioned project only. It should not be relied upon by any other
party or used for any other purpose.
We accept no responsibility for the consequences of this document being relied upon by any
other party, or being used for any other purpose, or containing any error or omission which is
due to an error or omission in data supplied to us by other parties.
June 2012
-
7/23/2019 HFA District Report - Panjgur
3/86
Table of Contents
List of Tables ................................................................................................................ iv
List of Figures .............................................................................................................. vi
Acronyms .................................................................................................................... vii
Executive Summary ...................................................................................................... 1
Section 1: Introduction ................................................................................................. 3
Survey Objectives ...................................................................................................... 3
Assignment Duration .................................................................................................. 3
Scope of HFA ............................................................................................................. 3
Report Organisation ................................................................................................... 4Section 2: District Information ..................................................................................... 5
Geographical Location ............................................................................................... 5
Administrative Setup .................................................................................................. 6
Demographic Information ........................................................................................... 6
Socioeconomic and Health Indicators ........................................................................ 6
Section 3: Health Facility Assessment Survey Findings............................................ 8
MNCH Services ......................................................................................................... 88/6 Preventive MNCH Services at BHU ................................................................. 9
24/7 Basic EmONC Services at RHC .................................................................. 12
24/7 Comprehensive EmONC Services at SHC Hospitals ................................... 15
24/7 Basic EmONC Services at THQ Hospital..................................................... 21
Management Basics ................................................................................................. 21
Human Resource ................................................................................................ 22
Work Coordination and Supervision .................................................................... 25
Management Information System ........................................................................ 26
Drugs and Supplies ............................................................................................. 27
Fee for Services .................................................................................................. 27
Infection Control .................................................................................................. 28
Death Review ...................................................................................................... 29
Facility Utilisation ..................................................................................................... 29
Well Baby Clinic ....................................................................................................... 31
Donor Contribution ................................................................................................... 31
-
7/23/2019 HFA District Report - Panjgur
4/86
Clients Perspective .................................................................................................. 31
Procurement Estimates ............................................................................................ 33
Equipment ........................................................................................................... 33
Civil Works .......................................................................................................... 33
Section 4: Key Findings ............................................................................................. 35
Infrastructure ............................................................................................................ 35
Human Resource ..................................................................................................... 35
Equipment ................................................................................................................ 36
Drugs and Supplies .................................................................................................. 36
Support Services ...................................................................................................... 36
Management Basics ................................................................................................. 37
Donor Contribution ................................................................................................... 37
Clients Perspective .................................................................................................. 38
Annexes ....................................................................................................................... 39
Annex 1: District Health Department ......................................................................... 40
Annex 2: Input Criteria for MNCH Services ............................................................... 46
Annex 3 A: Status of Surveyed HF Against Minimal Level of Inputs ..................... 59
Annex 3 B: List of Items Required .......................................................................... 65
Annex 4: Scope of Civil Works Required .................................................................. 70
-
7/23/2019 HFA District Report - Panjgur
5/86
List of Tables
Table 1.1 :Scope of HFA ............................................................................................... 4
Table 2.1 : Demographic profile ...................................................................................... 6
Table 2.2 :Population groups ......................................................................................... 6
Table 2.3 :Socio-economic and health indicators ........................................................... 7
Table 3.1:Status of assessed infrastructure in BHU ..................................................... 10
Table 3.2:Status of MNCH related staff in BHU ........................................................... 11
Table 3.3: Status of functional equipment in BHU ......................................................... 11
Table 3.4:Status of drugs and supplies in BHU............................................................ 11
Table 3.5:Status of support services in BHU................................................................ 12
Table 3.6:Status of assessed infrastructure in RHC..................................................... 12
Table 3.7:Status of MNCH related staff in RHC ........................................................... 14
Table 3.8:Status of functional equipment in RHC ........................................................ 14
Table 3.9: Status of drugs and supplies in RHC ........................................................... 14
Table 3.10:Status of support services in RHC ............................................................. 15
Table 3.11:Status of assessed infrastructure in SHC hospital ...................................... 15
Table 3.12:Status of MNCH related staff in SHC hospital ............................................ 19
Table 3.13:Status of functional equipment in SHC hospital.......................................... 20
Table 3.14:status of drugs and supplies in SHC hospital ............................................. 21
Table 3.15:Status of support services in SHC hospital ................................................ 21
Table 3.16:Status of HR at SHC hospital ..................................................................... 22
Table 3.17: Status of HR at RHC .................................................................................. 23
Table 3.18:Status of HR at surveyed BHU ................................................................... 23
Table 3.19:Reasons of non-availability 24/7 of HR at RHC .......................................... 24
Table 3.20:Reasons of non-availability 24/7 of HR at SHC hospital ............................. 25
Table 3.21 :Capacity building of MNCH related staff at the surveyed facilities ............. 25
Table 3.22: Status of coordination and supervision at surveyed facilities ...................... 25
Table 3.23:Status of MIS at surveyed facilities ............................................................ 26
Table 3.24: reasons for stock out reported by surveyed facilities .................................. 27
Table 3.25: Status of fee for service at surveyed facilities ............................................ 27
Table 3.26:Mechanisms of social protection available at surveyed facilities ................ 28
-
7/23/2019 HFA District Report - Panjgur
6/86
Table 3.27:Status of infection control & waste management practices at surveyed
facilities ......................................................................................................................... 28
Table 3.28:Status of clinical audit practices at surveyed facilities ................................ 29
Table 3.29:Status of services utilisation at surveyed facilities ..................................... 29
Table 3.30: Average monthly MNCH services provided at surveyed facilities ............... 30
Table 3.31:Average monthly FP services provided at surveyed facilities ..................... 30
Table 3.32: Status of WBC established at surveyed facilities ........................................ 31
table 3.33: Status of donor contribution at surveyed facilities ....................................... 31
Table 3.34:Clients perspective .................................................................................... 32
Table 3.35: Summary of estimated cost for procurement of equipments & civil works .. 34
Table 2.4:Number of public sector health facilities in the district .................................. 40
Table 2.5:Human resourse in DHO office .................................................................... 40
Table 2.6: Availability of MNCH services staffing in Panjgur ......................................... 41
Table 2.7: Financial allocation in district Panjgur .......................................................... 42
Table 2.8:NMNCHP monitoring indicators (year 2010) ................................................ 43
Table 2.9: Number of facilities with staff provided by the NMNCHP .............................. 44
Table 2.10:Number of staff trained on delivering MNCH services ................................ 45
Table 2.11: Status of CMW training and deployment .................................................... 45
i. Status of assessed infrastructure in BHU ................................................................ 59
ii. Status of MNCH related staff in BHU....................................................................... 59
iii. Status of functional equipment in BHU .................................................................... 59
iv. Status of drugs and supplies in BHU ....................................................................... 59
v. Status of support services in BHU ........................................................................... 60
i. Status of assessed infrastructure in RHC ................................................................ 60
ii. Status of MNCH related staff in RHC ..................................................................... 61
iii. Status of functional equipment in RHC .................................................................... 61
iv. Status of drugs and supplies in RHC ....................................................................... 61
v. Status of support services in RHC ........................................................................... 62
i. Status of assessed infrastructure in SHC hospital ................................................... 62
ii. Status of MNCH related staff in SHC hospital ........................................................ 63
iii. Status of functional equipment in SHC hospitals ..................................................... 63
iv. Status of drugs and supplies in SHC hospital .......................................................... 64
v. Status of support services in SHC hospital .............................................................. 64
-
7/23/2019 HFA District Report - Panjgur
7/86
List of Figures
Figure 1:Map of district Panjgur.................................................................................... 5
Figure 2:Range of services that signal fully functional MNCH services......................... 8
Figure 3:Status of management basics at surveyed facilities ..................................... 24
Figure 4: Level of satisfaction ...................................................................................... 33
Figure 5:Availability of medicines and lab services ..................................................... 33
-
7/23/2019 HFA District Report - Panjgur
8/86
ACRONYMS
ANC Antenatal Care
AVDAssisted Vaginal Deliveries
BB technician Blood Bank Technician
BHU Basic Health Unit
CBA Child bearing age
CEI Client Exit Interview
CH Civil Hospital
CMW Community Midwives
CWAQ Civil Works Assessment Questionnaire
CDC Communicable Disease Control
DCO District Coordination OfficerDDCT District Data Collection Teams
DHO District Health Officer
DHDC District Health Development Centre
DHIS District Health Information System
DHQH District Headquarter Hospital
DLQ District Level Questionnaire
EDOs Executive District Officers
EmONC Emergency Obstetric and Newborn Care
ENC Emergency Newborn CareEAQ Equipment Assessment Questionnaire
EPI Expanded Programme of Immunisation
FP & PHC Family Planning and Primary Health Care
HF Health Facilities
HFA Health Facility Assessments
HID Health Institution Database
HIV Human Immunodeficiency Virus
HMIS Health Management Information System
HR Human ResourceIDI EDOH In-depth Interview of EDO Health
IMNCI Integrated Management of Neonatal and Childhood Illnesses
IMPAC Integrated Management of Pregnancy and Childbirth
JD Job Description
LHS Lady Health Supervisor
LHV Lady Health Visitor
LHW Lady Health Worker
MDGs Millennium Development Goals
M&E Monitoring and EvaluationMICS Multiple Indicator Cluster Survey
-
7/23/2019 HFA District Report - Panjgur
9/86
MIS Management Information System
MNCH Maternal, Neonatal and Child Health
MO Medical Officer
NMNCHP National Maternal Newborn and Child Health Programme
NVD Normal Vaginal DeliveriesOBGYN Obstetrics and Gynaecology
OPD Out Patient Department
OT Operation Theatre
PC-1 Planning Commission Proforma 1
PDHS Pakistan Demographic and Health Survey
PNC Post natal care
PPHI Peoples Primary Health care Initiative
PSLM Pakistan Social & Living Standards Measurement Survey
RHC Rural Health CentreSBA Skilled Birth Attendants
SD&MB Service Delivery and Management Basics
SE Socioeconomic
SHC hospitals Secondary health care
SPSS Statistical Package for the Social Sciences
TA Technical Assistance
THQ Tehsil Headquarter hospital
TRF Technical Resource Facility
TT Tetanus ToxoidWMO Women Medical Officer
WBC Well Baby Clinics
-
7/23/2019 HFA District Report - Panjgur
10/86
District Report - Panjgur
1
Executive Summary
Health Facility Assessment 2011 (HFA) was aimed at assessing the availability, functioning,
and quality of health care delivery system in the public sector health facilities with a focus on
maternal, new-born and child health services. This district report provides the findings of theHFA for each surveyed health facility in the district. It is baseline information for the district
and the National Maternal Newborn and Child Health Programme (NMNCHP), to set
performance benchmarks and realign activities for bridging the gaps existing in MNCH
services for achieving the objectives of the programme.
The HFA started in October 2010 and completed in May 2011. Contech accomplished the
assignment in a participatory way by maintaining constant liaison with the entire key
stakeholder. Five (5) health facilities were assessed in District Panjgur, including 1 DHQ
hospital, 1 RHC and 3 BHU. The BHU were assessed for availability of 8/6 Preventive
MNCH services; RHC were assessed for availability of 24/7 Basic EmONC services; and
DHQ Hospital was assessed for availability of 24/7 Comprehensive EmONC services. An
assessment criterion was formulated to ascertain gaps in availability of inputs1, including
Infrastructure; Human Resource (HR); Drugs and Supplies; Equipment; and Level specific
support services. Summarised HFA findings (detailed findings are given in Section 4) of
HFA, are as follows:
In infrastructure, major gaps existed in availability of labour room staff residences at
BHU; paediatric ward, paediatric nursery, blood bank, and residences for gynaecologist,
anaesthetist and paediatrician at DHQH Ranjgur
Regarding HR, none of the health facility had staff available against optimal level of
inputs and major gaps were related to WMO at the RHC; anaesthetist and paediatrician
and blood bank technician at DHQH
The complete set of required equipment items was not available at any of the surveyed
facilities
Drugs, Supplies, Vaccines and FP commodities were assessed using facility specific list
of tracer items for their availability on the day of survey and stock-out status during last
1 1 (1)
; , .
3 1
-
7/23/2019 HFA District Report - Panjgur
11/86
District Report - Panjgur
2
one month. The complete range of items was not available at any of the surveyed
facilities. The most common reason for stockout of drugs was poor quantification
The complete range of required inputs for delivery of support services was not available
at most of the surveyed facilities
In District Panjgur, none of the health facility was conducting regular performance review
meeting
Health Management Information System (HMIS) was being practiced in District Panjgur
and HMIS tools were available but not maintained at most of the surveyed facilities.
MNCH related staff job descriptions and MNCH service delivery protocols were not
present at any of the health facility
Major gaps existed in availability of materials for infection control practices
Review of maternal and neonatal deaths was not conducted at any level as death review
committee was not constituted at any health facility.
In order to assess the perceptions of the clients, a total of 15 Client Exit Interviews were
conducted at DHQH and RHC. Clients perspective on quality of care revealed that majority
of the clients were satisfied with the care provided at the public facilities.
Findings of the HFA at all levels revealed significant gaps in the required inputs for provision
of quality MNCH services. This warrants immediate need to bridge these gaps in order to
improve the MNCH services.
-
7/23/2019 HFA District Report - Panjgur
12/86
District Report - Panjgur
3
Section 1: Introduction
This section includes survey objectives, its scope and duration, and organisation of the
District Report.
Survey Objectives
The HFA was aimed at assessing the availability, functioning, and quality of health care
delivery system in the public sector facilities with a focus on maternal, new-born and child
health services.
Specific objectives of the HFA were:
To assess the health facility status and quality of MNCH services (Comprehensive and
Basic EmONC, Preventive MNCH and Family Planning) at district level
To assess clients satisfaction and perception of MNCH services
To provide information for systematic planning for procurement and supply of goods and
commodities (listing the medical equipment and instruments which needs to be replaced
or purchased); and
To update and assess the contributions made by the development partners for improving
MNCH and FP services in the selected districts
Assignment Duration
Estimated duration of the assignment was 7 months. The assignment started in October
2010 and completed in May 2011.
Scope of HFA
The survey included District Headquarter Hospital (DHQH), Rural Health Centres (RHC) and
20% of Basic Health Units (BHU) randomly selected within the district. Selection of the BHU
was through geographical stratification on the basis of proportionate distribution. Client exit
interviews were conducted at the surveyed facilities (10 at DHQH, 5 at each THQH and
RHC), excluding BHU. Table 1.1 shows the number of health facilities in the district and
health facilities surveyed.
-
7/23/2019 HFA District Report - Panjgur
13/86
District Report - Panjgur
4
TABLE 1.1:SCOPEOF HFA
District PanjgurNumber of Health Facilities by type
DHQH THQH RHC BHU Total
Number of facilities listed by HID 1 0 1 15 17
Number of facilities surveyed 1 0 1 3 5
Report Organisation
HFA District Report has been structured in four sections. While the introduction to the
survey, its scope and methodology is described in Section 1, Section 2 District Information
contains information collected from the District Health Department using DLQ as well as the
secondary data sources and it comprises of demographic, economic and education related
information of the district as well as the organisation of health care delivery system in the
district. This section also includes information about the monitoring indicators of National
MNCH Programme.
Details of the assessment are contained in Section 3 HFA Findings. This section presents
information about NMNCHP analytical framework indicators, status of the MNCH service
availability based on optimal level of inputs including infrastructure, human resource,
equipment, drugs and supplies and availability of support services. Information onmanagement basics like work coordination, MIS etc., is also contained in this section. The
information presented in this section gives snapshot in time of the surveyed health facilities.
At the end information about the satisfaction and perspective of the clients on the MNCH
services provided at the public sector health facilities. Section 4 comprises of key findings of
HFA at district level.
-
7/23/2019 HFA District Report - Panjgur
14/86
District Report - Panjgur
5
Section 2: District Information
This section includes district brief, information on demographic, socioeconomic and health
indicators. It also contains information on health resources and NMNCHP indicator compiled
at district level. The data sources of the information are DHO office using District LevelQuestionnaire (DLQ) and published documents. The information collected from DHO office
may not match with subsequent tables containing similar information collected from
respective health facilities included in survey.
Geographical Location
District Panjgur having 16,891 km2 areas is situated in the west of province Balochistan.
Panjgur was one of the three Tehsils of Makran District until 1 July 1977. The district is
administratively subdivided into three Tehsils which contain a total of 16 Union councils. Tar
Office is the main town of Panjgur, where most of the offices are situated. Tar office used to
be offices for British Army during British Raj as the headquarter of Makran. A few
archaeological sites including centuries old tombs, an old dam named Band-e-Gillar and
remnants of a fort at Khudabadan are of interest in the district. Panjgur Airport is a domestic
airport; it has one of the shortest runways of Pakistan with total length of only 1524 meters.
Only Pakistan International Airlines operates flights to Karachi and Quetta. District Panjgur is
linked to adjacent districts and the provincial capital through a number of roads.
FIGURE 1: MAPOF DISTRICTPANJGUR
-
7/23/2019 HFA District Report - Panjgur
15/86
District Report - Panjgur
6
Administrative Setup
Like other districts in the province, Panjgur is headed by Deputy Commissioner (DC)
assisting the Divisional Commissioner and is accountable to him. The DC is appointed by
the provincial government from the Federal or Provincial Civil Service.
Demographic Information
Demographic information2is given in the following table.
TABLE2.1:DEMOGRAPHICPROFILE
Indicators Value Indicators Value
Total Population 290,376 Urban Population 9%
Population of Tehsil Gawargo 85,822 Rural Population 91%
Population of Tehsil Panjgur 204,554Population density (persons
per sq.km)17
Sex ratio (number of males
over 100 females) at birth117
SOURCE:HMISCELLDHOOFFICE
TABLE2.2:POPULATION GROUPS
Population
Groups
Standard
Demographic(%)
Estimated
population
Population
Groups
Standard
Demographic(%)
Estimated
population
Under 1 year 2.707,840
Women 15-49years
22.0063,883
Under 5 years 13.4038,910
Married CBA 16.0046,460
Under 15years
41.97121,871
Pregnant women 3.409,873
Expected Births 2.98,421
SOURCE:PDHS2006-07
Socioeconomic and Health Indicators
Selected Socio-Economic (SE) and health indicators are given in the table 2.3. The sources
include, Pakistan Demographic and Health Survey (PDHS) 2006-7, Immunisation Coverage
Evaluation Survey Pakistan (CES) 2006-7, District EPI Cell.
2 2010.
-
7/23/2019 HFA District Report - Panjgur
16/86
District Report - Panjgur
7
TABLE 2.3:SOCIO-ECONOMIC ANDHEALTH INDICATORS
Indicators Value
District figures
% children
-
7/23/2019 HFA District Report - Panjgur
17/86
District Report - Panjgur
8
Section 3: Health Facility Assessment Survey
Findings
MNCH Services
The packages of MNCH services assessed include Preventive MNCH services at BHU,
Basic EmONC services at RHC and Comprehensive EmONC services at THQ and DHQ
hospitals3. The range of MNCH services are given below.
FIGURE 2 :RANGE OF SERVICES THATSIGNALFULLYFUNCTIONAL MNCH SERVICES
3 NMNCHP PC -1
BHU: Facility
available for
RHC: Facility
available for
DHQ/THQ
Hospitals: Facilityavailable for
8/6 Preventive
MNCH Services
Antenatal checkup
Lab (Anemia,
Malaria, pregnancy
test, urine test for
sugar & Protein)
Normal delivery
Family planning
services (at least 3
methods)
TT immunisation
EPI vaccination
Growth monitoring
Nutrition counseling
HR (at least oneLHV or Doctor)
24/7 Basic EmONC
Services
Parenteral
antibiotics
Parenteral oxytocic
drugs
Parenteral
anticonvulsants for
pregnancy inducedconvulsions (due to
hypertension)
Manual removal of
placenta
Removal of
retained products
Assisted vaginal
delivery (vacuum
extraction, forceps)
Newborn
resuscitation+
Post abortion care
HR (skilled female
providers-WMO
and LHV), and
Preventive MNCH
24/7
Comprehensive
EmONC services
Surgery (C-section)
Blood transfusion
Newborn care
(resuscitation &
incubator)
+
Gynaecological
care
Comprehensive
family planning
services including
sterilisation
HR (skilled staff for
conducting, C-
section, blood
transfusion andanaesthesia),
and
Preventive MNCH
and Basic EmONC
-
7/23/2019 HFA District Report - Panjgur
18/86
District Report - Panjgur
9
Functional capacity of health facilities were assessed against 5 specified inputs, which
include:
1. Infrastructure
2. Human Resource
3. Drugs and Supplies
4. Equipment
5. Level specific support services
Health facilities assessment findings are presented against two levels of inputs including:
1. Optimal level of Inputs are those proposed in the PC-1 of the National MNCH
Programme, required to make a health facility fully functional for provision of level
specific package of MNCH services (Annex 1).
Optimal level of inputs provides a strategic norm upon which gaps are identified and
up-gradation are proposed for improving accessibility of quality MNCH services
through development and implementation of an integrated and sustainable MNCH
programme at all levels of the health care delivery system.
2. Minimal level of Inputs, which are bare minimum requirement of the inputs, required for
delivering the package specific MNCH services at the health facilities.Findings related
to minimal level of inputs are given as Annex 2.
Following tables present the status of assessed facilities for availability of the optimal level of
inputs.
8/6 Preventive MNCH Services at BHUBHU operating within District Panjgur were assessed for provision of Preventive MNCH
services available for 8 hours a day, 6 days a week (8/6). Three BHU were assessed for
availability of optimal level of inputs as summarised in Tables 3.1 - 3.5 by individual BHU.
Infrastructure of the BHU has been assessed for availability of OPD, LHV room and labour
room as service provision areas and residences for accommodation of required staff. OPD
and LHV rooms have been assessed as single room having facilities for consultation,
examination and hand washing; similarly labour room also assessed as single room having
-
7/23/2019 HFA District Report - Panjgur
19/86
District Report - Panjgur
10
facility for delivery, scrub area and attached toilet facility for patient. Findings are presented
as status of building components available and functional.
TABLE 3.1:STATUS OF ASSESSED INFRASTRUCTURE IN BHU
Doctor or LHV is required for provision of Preventive MNCH Services. Status of assessed
BHU for availability of Human Resource (HR) (both regular posted and provided by
NMNCHP), against the required number mentioned in PC-1 of NMNCHP is presented below:
Infrastructure Status
Status of building components at Surveyed
BHU
BHU
BonistanBHU Gichk BHU Washbood
OPD1. Consultation area
A Y Y Y
F Y Y Y
2. Examination areaA N N N
F N N N
3. Hand washingA N N N
F N N N
LHV Room1. Consultation area
A Y Y Y
F Y Y Y
2. Examination areaA N Y N
F N Y N
3. Hand washingA N N N
F N N N
Labour Room1. Delivery room
A N N N
F N N N
2. Scrub areaA N N N
F N N N
3. Patient wash roomA N N N
F N N N
ResidenceDoctor
A N N N
F N N N
ResidenceLHV
A N N N
F N N N
-
7/23/2019 HFA District Report - Panjgur
20/86
District Report - Panjgur
11
TABLE 3.2:STATUS OF MNCHRELATED STAFF IN BHU
Equipment items (general items, equipment for OPD and LHV room) for BHU are listed in
PC-1 of NMNCHP. Status of functional quantity of these items at assessed BHU is
presented below:
TABLE 3.3:STATUS OF FUNCTIONAL EQUIPMENT IN BHU
List of essential drugs and supplies for MNCH services is contained in PC-1 of NMNCHP.
Tracer items were selected from the list (Annex 1) for assessing their availability at surveyed
facilities. Status of surveyed BHU regarding available quantity of tracer items is presented
below:
TABLE3.4:STATUS OF DRUGS ANDSUPPLIES IN BHU
Staff categories Required
number
Number of MNCH related staff available at each BHU
BHU Bonistan BHU Gichk BHU Washbood
WMO 1 0 0 1
LHV 1 1 1 1
EquipmentTotal Items
required at eachBHU
Number of functional equipment items available at eachsurveyed BHU
BHU Bonistan BHU Gichk BHU Washbood
General items 3 0 0 0
OPD 14 6 7 6
LHV Room 12 8 5 7
Item groups
Total Items
required at each
BHU
Number of items available at each surveyed BHU
BHU Bonistan BHU Gichk BHU Washbood
Supplies 6 4 5 6
Drugs 12 6 3 8
Vaccines 5 5 0 5
FP Commodities 6 2 0 4
-
7/23/2019 HFA District Report - Panjgur
21/86
District Report - Panjgur
12
Facility for basic laboratory tests (test strips and HR) was assessed at surveyed BHU and
their status is presented below:
TABLE 3.5:STATUS OF SUPPORTSERVICES IN BHU
24/7 Basic EmONC Services at RHC
RHC operating within District Panjgur was assessed for provision of Basic EmONC servicesavailable for 24 hours a day, 7 days a week (24/7). One RHC was assessed for availability of
optimal level of inputs as summarised in Tables 3.6 - 3.10.
Infrastructure of the RHC has been assessed for availability of OPD, indoor ward, LHV room,
Labour room and clinical laboratory as service provision areas and residences for
accommodation of required staff. Service provision areas have been assessed as single
room having facilities like consultation, examination and hand washing etc., as contained in
table below. Findings are presented as status of building components available andfunctional:
TABLE 3.6:STATUS OF ASSESSED INFRASTRUCTURE IN RHC
Infrastructure Status
Status of building components at eachRHC
RHC Paroom
OPD
1. Consultation area
AY
F Y
2. Examination areaA Y
FY
3. Hand washingA N
FN
Female ward1. Patient area
A Y
F Y
2. Patient wash room A Y
Support services
Total Items
required at each
BHU
Number of items available at each surveyed BHU
BHU Bonistan BHU Gichk BHU Washbood
Basic lab tests 2 1 1 2
-
7/23/2019 HFA District Report - Panjgur
22/86
District Report - Panjgur
13
Infrastructure Status
Status of building components at eachRHC
RHC Paroom
FY
Labour Room1. Delivery room
A Y
FY
2. Scrub areaA
N
FN
3. Patient wash roomA
Y
FN
Clinical Lab.
1. Laboratory room
AY
F Y
2. Working areaA
Y
FY
3. Pt. wash roomA
Y
F N
LHV Room1. Consultation area
A N
FN
2. Examination areaA N
F N
3. Hand washingA
N
F N
ResidenceDoctor
AY
F Y
ResidenceLHV
A Y
FY
PC-1 of NMNCHP contains category and number of staff required for Basic EmONC
services. Status of RHC for availability of HR (both regular posted and provided by
NMNCHP), against required numbers is presented in table below:
-
7/23/2019 HFA District Report - Panjgur
23/86
District Report - Panjgur
14
TABLE 3.7:STATUS OF MNCHRELATED STAFFIN RHC
Equipment items for various service components at RHC are listed in PC-1 of NMNCHP.
Status of functional quantity of these items at RHC, is presented in the table below:
TABLE 3.8:STATUS OF FUNCTIONAL EQUIPMENTIN RHC
List of essential drugs and supplies for MNCH services is contained in PC-1 of NMNCHP.
Tracer items were selected from the list (Annex 1) for assessing their availability at surveyed
facilities. Status of surveyed RHC regarding available quantity of tracer items is presented
below:
TABLE 3.9:STATUS OF DRUGS ANDSUPPLIES IN RHC
Staff categoriesRequired number at each
RHC
Number of MNCH related staffavailable at RHC
Paroom
WMO 2 0
LHV 2 1
Lab technician 1 1
OT technician 1 1
Ambulance driver 1 1
EquipmentTotal Items required at
each RHC
Number of functional equipment itemsavailable at RHC
Paroom
General items 4 1
Female ward 9 6
WMO OPD 15 7
Labour room 19 0
LHV Room 10 5
Item groupsTotal Items required
at RHC
Number of itemsavailable at RHC
Paroom
Supplies 6 5
Drugs 18 12
Vaccines 5 0
FP Commodities 6 3
-
7/23/2019 HFA District Report - Panjgur
24/86
District Report - Panjgur
15
Facility for support services including basic laboratory tests (space, test strips and HR) and
ambulance services (functional vehicle and driver) was assessed at surveyed RHC.
Availability status of these services at RHC is presented below:
TABLE 3.10:STATUS OF SUPPORTSERVICES IN RHC
24/7Comprehensive EmONC Services at SHC HospitalsDHQ Hospital operating within District Panjgur was assessed for provision of
Comprehensive EmONC services available for 24 hours a day, 7 days a week (24/7). DHQH
was assessed for availability of optimal level of inputs as summarised in Tables 3.11 - 3.15.
Infrastructure of the DHQ hospital has been assessed for availability of OPD, indoor wards,
LHV room, labour room, operation theatre, paediatric nursery, blood bank, ultrasound room
and clinical laboratory as service provision areas and residences for accommodation of
required staff. Service provision areas have been assessed for availability of essential space
in respective areas e.g., consultation area, examination area and hand washing in OPD;
patient area, nursing station, store rooms and attached washrooms in indoor wards, etc., as
contained in table below. Findings are presented as status of building components available
and functional:
TABLE3.11:STATUS OF ASSESSED INFRASTRUCTURE IN SHCHOSPITAL
Support services
Total Items
required at
RHC
Number of itemsavailable at RHC
Paroom
Basic lab tests 8 7
Ambulance service 2 2
Infrastructure Status
Availability of building components
DHQH Panjgur
OPD:
1. Consultation area
AY
FY
2. Examination areaA
Y
FY
3. Privacy of examination area A N
-
7/23/2019 HFA District Report - Panjgur
25/86
District Report - Panjgur
16
FN
4. Hand washingA
Y
FY
Female ward:
1. Patient area
A Y
FY
2. Nursing stationA
Y
FY
3. Patient wash roomA
Y
FN
4. Store for general itemsA
N
F N
5. Store for equipmentA N
FN
Labour room:
1. Delivery room
A Y
F Y
2. Preparation /stage roomA
Y
F Y
3. Scrub areaA N
FN
4. Staff duty roomA Y
FY
5. Patient wash roomA Y
F N
6. Staff wash room
AY
F Y
7. Store for general itemsA Y
FY
8. Store for equip.A
Y
FY
Operation theatre:
1. Patient preparation room
AY
FY
2. Operating room AY
-
7/23/2019 HFA District Report - Panjgur
26/86
District Report - Panjgur
17
FY
3. Recovery roomA
Y
FY
4. Scrub areaA Y
FY
5. Sterilisation areaA
Y
FN
6. Doctors roomA
N
FN
7. Support staff duty roomA
N
F N
8. Store for general items A N
FN
9. Store for equipmentA N
F N
10. Attached washroom for staffA
N
F N
Paediatrics ward:
1. Patient area
A N
FN
2. Nursing stationA N
FN
3. Store for general items/drugs orequip.
A N
F N
4. Patient wash room
AN
F N
Paediatric nursery:
1. Patient area
A N
FN
2. Nursing stationA
N
FN
3. Store for general items/drugs orequip.
AN
FN
4. Change room/area AN
-
7/23/2019 HFA District Report - Panjgur
27/86
District Report - Panjgur
18
FN
Clinical lab.:
1. Laboratory room
AY
FN
2. Working areaA Y
FY
3. Doctors duty roomA
Y
FN
4. Store for general reagents or equip.A
Y
FY
5. Attached wash roomA
Y
F N
Blood bank:
1. Blood collection room
A N
FN
2. Working areaA N
F N
3. Staff duty roomA
N
F N
4. Store for general reagents or equip.A N
FN
5. Attached wash roomA N
FN
LHV Room:
1. Consultation area
A Y
F Y
2. Examination area
AY
F Y
3. Privacy for examinationA N
FN
4. Hand washing facilityA
Y
FY
Ultrasound room:
Examination area
AY
FY
Residence: AN
-
7/23/2019 HFA District Report - Panjgur
28/86
District Report - Panjgur
19
PC-1 of NMNCHP contains category and number of staff required for Comprehensive
EmONC services. Status of DHQ hospital for availability of HR (both regular posted and
provided by NMNCHP), against required numbers is presented in table below:
TABLE3.12:STATUS OF MNCHRELATED STAFFIN SHCHOSPITAL
Gynaecologist FN
Residence:
Anaesthetist
AN
FN
Residence:
Paediatrician
A N
FN
Residence:
WMO
AY
FY
Residence:
LHV
AY
FY
Residence:
Nurses
AN
F N
Residence
Lab Technician
A Y
FN
Residence:
BB Technician
A N
F N
Residence:
Anaesthesia Technician
AN
F N
Staff categories
Availability of MNCH related staff at
DHQH Panjgur
Required numberAvailablenumber
Gynaecologist 2 1
Anaesthetist 2 0
Paediatrician 2 0
WMO 6 1
OT technician 4 2
BB technician 4 0
-
7/23/2019 HFA District Report - Panjgur
29/86
District Report - Panjgur
20
Equipment items for various service components at DHQ hospital are listed in PC-1 of
NMNCHP. Status of functional quantity of these items at SHC hospitals, is presented in the
table below.
TABLE3.13:STATUS OF FUNCTIONAL EQUIPMENTIN SHCHOSPITAL
List of essential drugs and supplies for MNCH services is contained in PC-1 of NMNCHP.
Tracer items were selected from the list (Annex 1) for assessing their availability at surveyed
facilities. Status of DHQ hospital regarding available quantity of tracer items is presented in
the table below.
Lab technician 3 3
Anaesthesia technician 4 1
Nurses 20 4
LHV 4 7
Ambulance drivers 4 2
Staff categories
Number of functional equipment at
DHQH Panjgur
Total requiredItems
Available items
General items 4 2
Female ward 19 15
OPD 12 12
Paediatric nursery 13 0
Paediatric ward 10 0
Labour room 24 20
Operation theatre 31 29
Clinical laboratory 5 4
-
7/23/2019 HFA District Report - Panjgur
30/86
District Report - Panjgur
21
TABLE 3.14:STATUS OF DRUGS ANDSUPPLIES IN SHCHOSPITAL
Facility for support services including laboratory tests (space, test strips and HR), blood
transfusion services (space, supplies and HR), ambulance services (functional vehicle and
driver), operation theatre (space, drugs and supplies, equipment items and HR) was
assessed at surveyed DHQ hospital. Availability status of these services at SHC hospitals is
presented below:
TABLE 3.15:STATUSOF SUPPORTSERVICES IN SHCHOSPITAL
24/7 Basic EmONC Services at THQ Hospital
There is no THQH in this District.
Management Basics
Findings related to facility management basics are presented below:
Item groups Total Items
Number of itemsavailable at
DHQH Panjgur
Supplies 9 9
Drugs 21 11
Vaccines 5 5
FP Commodities 7 7
Item Groups Total Items
Number of itemsavailable at
DHQH Panjgur
Basic laboratory tests 17 13
Blood transfusion 5 4
Ambulance services 2 2
Radiology services 3 3
Operation theatre 62 47
-
7/23/2019 HFA District Report - Panjgur
31/86
District Report - Panjgur
22
Human Resource
Information about sanctioned and filled posts of MNCH related staff was collected from the
surveyed facilities;and their status is presented in table 3.16 - 3.18. Filled status of staff
categories presented in following tables,include regular posting only,as reported by the
respective facility on the day of survey.
TABLE 3.16:STATUS OF HR AT SHCHOSPITAL
Staff
Status of HR at
DHQH Panjgur
Sanctioned
Gynaecologist 1
Anaesthetist 1
Paediatrician0
WMO 5
OT technician3
BB technician1
Lab technician5
Anaesthesia technician1
Nurses
4
LHV4
Ambulance drivers2
Filled
Gynaecologist 1
Anaesthetist 0
Paediatrician 0
WMO 1
OT technician 2
BB technician 0
Lab technician 3
Anaesthesia technician 1
Nurses 4
LHV 4
Ambulance drivers 2
-
7/23/2019 HFA District Report - Panjgur
32/86
District Report - Panjgur
23
TABLE 3.17:STATUSOF HR AT RHC
TABLE 3.18:STATUS OF HR AT SURVEYED BHU
Availability of job descriptions, service delivery protocols and staff as per duty roster was
assessed and their findings are presented in the Figure 3.
Staff
Number of posts sanctioned and
filled at RHC
RHC Paroom
Sanctioned
WMO 4
Lab technician 1
Nurse 2
LHV 3
Ambulance drivers 1
Filled
WMO 0
Lab technician 1
Nurse 0
LHV 1
Ambulance drivers 1
Staff
Number of posts sanctioned and filled at each BHU
BHU Bonistan BHU Gichk BHU Washbood
Sanctioned
WMO/ MO 1 1 1
LHV 1 1 1
Filled
WMO/ MO 0 0 1
LHV 1 1 1
-
7/23/2019 HFA District Report - Panjgur
33/86
District Report - Panjgur
FIGURE 3: STATUS
Reasons for non-availability
3.19 and 3.20.
TABLE 3.19:RE
Reasons of non-availability
Residence not available
Residence damaged
Security reasons
Lack of basic amenities
0
0.5
1
1.5
2
2.5
3
11
0
1
0 0
OF MANAGEMENT BASICS AT SURVEYED FA
f staff on 24/7 basis at RHC and SHC ar
SONSOF NON-AVAILABILITY 24/7OF HR AT
Status in RHC
WMO LHV
0 0
0 0
0 0
0 0
3
00
00
00
00
24
ILITIES
provided in Table
HC
Ambulance Driver
0
0
0
0
()
-
7/23/2019 HFA District Report - Panjgur
34/86
District Report - Panjgur
25
TABLE 3.20:REASONS OF NON-AVAILABILITY 24/7OF HR AT SHC HOSPITAL
Reasons of non-
availability
Status of DHQ Hospital
Gynaecologist
Anae
sthetist
Paed
iatrician
Bloo
dBank
Technician
Laboratory
Technician
W
MO
L
HV
Residence not available 0 0 0 0 0 0 0
Residence damaged 0 0 0 0 0 0 0
Security reasons 0 0 0 0 0 0 0
Lack of basic amenities 0 0 0 0 0 0 0
TABLE 3.21:CAPACITY BUILDING OF MNCHRELATED STAFFAT THESURVEYED FACILITIES
Health
Facility
MNCH related training conducted
EmONC ENC IMNCI IMPACFP
surgicalFP
counsellingClient
centeredness
DHQH
PanjgurY N N N N N N
RHC Paroom N N N N N Y
BHU Bonistan N N N N N Y
BHU Gichk N N N N N YBHU
WashboodN N N N N Y
Work Coordination and Supervision
Health facilities in the district were assessed for work coordination and supervisory activities,
including facility staff meetings, participation of facility in charges in district level meetings
and conduction of supervisory visits and feedbacks by district health managers. Findings of
each surveyed health facility are presented in Table 3.22.
TABLE3.22:STATUS OF COORDINATION ANDSUPERVISION AT SURVEYED FACILITIES
Health Facility
Work Coordination and Supervision
Regular facility PRM*Participation indistrict PRM**
Monthly Supervisory Visit
Meetingheld
Recordmaintained
Facilityvisited
Facility receivedvisit feedback
DHQH Panjgur N N Y Y N
RHC Paroom N N Y Y N
BHU Bonistan N N N N N
-
7/23/2019 HFA District Report - Panjgur
35/86
District Report - Panjgur
26
Health Facility
Work Coordination and Supervision
Regular facility PRM*Participation indistrict PRM**
Monthly Supervisory Visit
Meetingheld
Recordmaintained
Facilityvisited
Facility receivedvisit feedback
BHU Gichk N N N N N
BHU Washbood N N N N N
* PRM=Performance Review Meeting
Management Information System
District Panjgur was practicing Health Management Information System (HMIS). Surveyed
facilities were assessed for availability and maintenance of HMIS tools and their findings are
presented in Table 3.23.
TABLE3.23:STATUS OF MISAT SURVEYED FACILITIES
HealthFacility
Status of MIS Tools
OPDticket
OPDregister
Motherhealth
register
Birthregister
Childhealth
register
FamilyPlanning
register
EPIregister
Meetingregister
MedicineStock
register
Dailyexpense
register
HMISmonthly
report
TBregister
DiseaseEarly
WarningSystem
DEWSchart
row
Monitoring
MIS Tools Available
DHQH
Panjgur Y Y Y Y Y Y Y N Y Y Y Y Y Y N
RHC Paroom Y Y Y Y Y Y N N Y Y Y N N Y N
BHU Bonistan Y Y N N Y Y Y N Y Y Y N N N N
BHU Gichk Y Y Y Y N Y N N Y N Y N Y N N
BHU
WashboodY Y N N Y Y Y N Y Y Y Y N N N
MIS Tools Maintained
DHQH
Panjgur
Y Y Y Y Y Y Y N Y N Y Y Y Y
RHC Paroom Y Y N N N Y Y N Y Y Y Y Y Y
BHU Bonistan Y Y N N N Y N N Y Y Y N N Y
BHU Gichk N N N N N N Y N N N Y N N N
BHU
WashboodY Y N N N Y N N Y N Y N N N
-
7/23/2019 HFA District Report - Panjgur
36/86
District Report - Panjgur
27
Drugs and Supplies
Availability of drugs and supplies has been described under individual MNCH service
packages. The reasons of their non-availability were identified at the surveyed facilities and
presented in the Table 3.24.
TABLE 3.24:REASONS FORSTOCKOUTREPORTED BY SURVEYED FACILITIES
Health Facilities
citing stock out
Reasons for stock out
Poorquantification
Delayeddemand
submission
Unavailabilityof
bufferstock
Lackofstorage
capacity
Delayedsupply
Undersupply
Noprocurement
powers
Insufficientbudget
Lackofcold-chain
DHQH Panjgur Y N N N N N N Y N
RHC Paroom Y N Y N N N Y N N
BHU Bonistan Y N N N N N N N N
BHU Gichk Y N N N N N Y N N
BHU Washbood Y N N N N N N N N
Fee for Services
Fee for MNCH services and availability of social protection mechanisms for the poor were
assessed at surveyed facilities and their findings are presented in Table 3.25 and 3.26.
TABLE 3.25:STATUS OF FEEFORSERVICE AT SURVEYED FACILITIES
Health Facilities
where service arecharged
Services provided free of cost
OPD Indoor Ambulanceservices
OPDTicket
OP
DLaboratory
OP
DUltrasound
OPDX-rays
OPDMedicines
A
dmissionfee
Wardbed
Inpatient
Laboratory
Inpatient
Ultrasound
InpatientX-rays
Blo
odgrouping&
cr
ossmatching
Inpa
tientmedicines
DHQH Panjgur Y N N Y Y Y Y N N Y N N Y
RHC Paroom N N N N Y N Y N N N N Y
BHU Bonistan Y N Y
BHU Gichk Y N Y
-
7/23/2019 HFA District Report - Panjgur
37/86
District Report - Panjgur
28
Health Facilities
where service are
charged
Services provided free of cost
OPD Indoor Ambulan
ceservices
O
PDTicket
OPD
Laboratory
OPD
Ultrasound
OPDX-rays
OPD
Medicines
Admissionfee
W
ardbed
Inpatient
Laboratory
Inpatient
Ultrasound
Inpa
tientX-rays
Bloodgrouping&
crossmatching
Inpatientmedicines
BHU Washbood Y N Y
TABLE 3.26:MECHANISMS OF SOCIAL PROTECTIONAVAILABLE AT SURVEYED FACILITIES
Health Facilities with available
Social Protection
Social Protection Mechanism
Bait-ul-Maal Zakat Patient WelfareSociety
DHQH Panjgur N Y N
RHC Paroom N N N
BHU Bonistan N N N
BHU Gichk N N N
BHU Washbood N N N
Infection Control
Health facilities were assessed for practices of infection control and waste management, and
availability of related material. Findings of individual surveyed facilities are presented in table
3.27.
TABLE3.27:STATUS OF INFECTIONCONTROL &WASTEMANAGEMENT PRACTICES AT SURVEYED FACILITIES
Health Facilities
Availability of Materials Infection Control Practices
Wastemanagementplan
Wastecollectionmaterials
Personalprotectionmaterials
Wastetreatmentequipment
FunctionalIncinerators
Handwashingpracticesof
HCP
Disinfectionofservice
provisionarea
HepBVaccinationofStaff
Wastesegregation
DisposalofWastethrough
Burning
DisposalthroughThrowing-
away
DisposalthroughMunicipal
Arrangement
DHQH Panjgur N N N N N Y Y Y N Y Y N
RHC Paroom N N N . N Y Y Y N . Y N
-
7/23/2019 HFA District Report - Panjgur
38/86
District Report - Panjgur
29
Health Facilities
Availability of Materials Infection Control Practices
Wastem
anagementplan
Wasteco
llectionmaterials
Personalp
rotectionmaterials
Wastetre
atmentequipment
Functio
nalIncinerators
Handwashingpracticesof
HCP
Disinfe
ctionofservice
pro
visionarea
HepBVa
ccinationofStaff
Wast
esegregation
Disposal
ofWastethrough
Burning
DisposalthroughThrowing-
away
Disposal
throughMunicipal
Ar
rangement
BHU Bonistan N N N . N Y N Y N . Y N
BHU Gichk N N N . N Y N Y N . Y N
BHU Washbood N N N . N Y N Y N . Y N
Death Review
Findings related to availability and functioning of death review committees are presented in
the Table 3.28.
TABLE 3.28:STATUS OF CLINICAL AUDITPRACTICES AT SURVEYED FACILITIES
Health Facility
Status of Death Review
DeathReview
CommitteeAvailable
Maternal Deaths Neonatal Deaths
AnnualNumber
Reviewed bycommittee
AnnualNumber
Reviewed bycommittee
DHQH Panjgur N 24 12 16 0
RHC Paroom N 0 0 0 0
Facility Utilisation
Findings of services utilisation at surveyed facilities are given as monthly aggregate from
July to December 2010, annual utilisation of year 2010 and facility-wise average monthlyutilisation are presented in Tables 3.29, 3.30 and 3.31.
TABLE3.29:STATUS OF SERVICES UTILISATIONAT SURVEYED FACILITIES
Type of serviceMonthly utilisation (July to December 2010) Annual
utilisation(2010)July Aug Sep Oct Nov Dec
1st Antenatal Care visits (ANC-1) 204 159 58 228 201 186 2,036
Normal vaginal deliveries 14 13 21 16 9 7 131
Assisted vaginal deliveries 5 3 3 6 4 5 37
-
7/23/2019 HFA District Report - Panjgur
39/86
District Report - Panjgur
30
Type of serviceMonthly utilisation (July to December 2010) Annual
utilisation(2010)July Aug Sep Oct Nov Dec
C-sections 5 5 5 5 5 5 67
1st Postnatal Care visits (PNC-1) 9 13 5 29 7 8 113
Pregnant women given TT2vaccine
75 72 53 55 39 37 549
FP services 35 37 29 19 32 49 456
Diarrhoea/Dysentery cases treated(< 5 years of age)
698 867 1,031 665 427 397 7,718
Pneumonia cases treated(< 5 years of age)
289 193 170 174 451 539 3,011
TABLE 3.30:AVERAGEMONTHLYMNCHSERVICES PROVIDED AT SURVEYED FACILITIES
HealthFacility
Average Monthly Utilisation
ANC -1
NVDAssisted
VDC
SectionPNC -
1TT2
Diarrhoea/
Dysentery(in
-
7/23/2019 HFA District Report - Panjgur
40/86
District Report - Panjgur
31
Well Baby Clinic
Surveyed health facilities were assessed for established Well Baby Clinic (WBC) and its
findings are presented in Table 3.32.
TABLE 3.32:STATUS OF WBCESTABLISHED AT SURVEYED FACILITIES
Name of HealthFacility
WBC EstablishedName of Health
FacilityWBC Established
DHQH Panjgur N BHU Gichk N
RHC Paroom N BHU Washbood N
BHU Bonistan N
Donor ContributionDonor Contribution during last three years was assessed regarding human resource,
infrastructure, equipment including ambulances, and drugs and supplies and findings are
presented in Table 3.33.
TABLE 3.33:STATUS OF DONORCONTRIBUTION AT SURVEYED FACILITIES
Health Facilities
Donor Contribution
Human Resource Infrastructure EquipmentDrugs andSupplies
Provisionof
keystaff
Capacity
building
StaffIncentive
Constructionof
newbuilding
Renovationof
existing
building
Provisionof
newequipment
Provisionof
newvehicle/
ambulance
Provisionof
Medicines
Provisionof
Consumables
DHQH Panjgur Y Y N Y N N Y N N
RHC Paroom Y N N Y Y N Y Y N
BHU Bonistan N N N N N N N N N
BHU Gichk N N N N N N N N N
BHU Washbood N N N N N N N N N
Clients Perspective
Client Exit Interviews (CEI) was conducted within the scope of the HFA Survey to assess
clients perspective on provided services. Findings of these interviews were analysed for
assessing their perspective on access, quality and preference for health care and are
presented in Table 3.34 and Figures 4 and 5.
-
7/23/2019 HFA District Report - Panjgur
41/86
District Report - Panjgur
32
TABLE3.34:CLIENTS PERSPECTIVE
No of interviewed clients (Total: 15)
DHQH THQH RHC
Time to reach facility
Less than 30 minutes 2 3
30 minutes to 1 hour4 1
More than 1 hour 4 1
Means of transport
Walk3 2
Personal transport0 0
Public transport7 3
Waiting time at facility
Less than 10 minutes1 2
10 minutes to 20minutes
4 2
20 minutes to 30minutes 5
0
More than 30minutes
0 1
Fee for services
Paid fee for services 10 4
Health Education Material
Received EducationMaterial
0 0
Preference for healthcare
Public HF10 5
Private sector0 0
Reasons for visiting public HF
Close to home1 1
Good quality2 0
Staff attitude0 0
Affordability7 4
Lack of choice1 2
Overall satisfaction
Very satisfied 5 1
Satisfied4 3
Not satisfied 1 1
-
7/23/2019 HFA District Report - Panjgur
42/86
District Report - Panjgur
FI
FIGURE 5:A
Procurement Estim
Equipment
Based on the information colhave been identified for i
Summary of estimated cost
required equipment for each
cost estimates for individual f
Civil Works
A yardstick has been used f
building components (Anne
needs of the individual surve
0%
7
0% 20%
GURE 4: LEVEL OF SATISFACTION
AILABILITYOF MEDICINES ANDLABSERVIC
ates
lected, procurement needs for provision of rdividual surveyed facilities to strengthen
or procurement of required equipment is g
surveyed facility is presented as Annex 3
cilities is given in Annex 3 B.
r assessing the scope of civil works of vari
1). Identified scope of work to complet
ed facilities is presented in Annex 4. Summ
40
47
40
54
60
40
40
33
0
13
20
13
20% 40% 60% 80% 100%
64
53
22
40
14
40% 60% 80% 100%
33
S
equired equipmentMNCH services.
iven below. List of
and details about
ous MNCH related
the infrastructure
ary of estimated
()
()
-
7/23/2019 HFA District Report - Panjgur
43/86
District Report - Panjgur
34
cost for execution of civil works including repair and maintenance, renovation and new
construction of missing facilities; is given in table below and details about cost estimates for
individual facilities is given in Annex 4.
TABLE 3.35:SUMMARYOF ESTIMATED COST FORPROCUREMENT OF EQUIPMENTS&CIVILWORKS
Procurement
Estimated Cost (PKR in Millions)
DHQHTHQH
RHC BHU Total
Equipment18
1.7 1.4 21.1
Civil Works 28 11 31 70
-
7/23/2019 HFA District Report - Panjgur
44/86
District Report - Panjgur
35
Section 4: Key Findings
In district Panjgur, total of 5 health facilities were assessed including 3 BHU, 1 RHC, and 1
DHQH. The BHU were assessed for availability of 8/6 Preventive MNCH services; RHC was
assessed for availability of 24/7 Basic EmONC services; and DHQ Hospital was assessedfor availability of 24/7 Comprehensive EmONC services.
The key findings have been presented based on the availability of specified inputs including,
Infrastructure, Human Resource, Equipment, Drugs and Supplies, and Support services.
Status of each input has been described at one place for all levels. This is followed by key
findings on Management basics, Donor contribution and Clients perspective on the quality of
MNCH services.
Infrastructure
OPD was available at all the BHU while labour rooms were not available at all the three
BHU; Staff residences were not available at any of the surveyed BHU
OPD, labour room, female ward and clinical laboratory were available at RHC Paroom.
Residences for WMO were in good living condition
OPD, female ward, labour room, operation theatre and clinical laboratory were available
at DHQH Ranjgur, whereas Paediatric ward, paediatric nursery and blood bank were not
available. Further, residences were not available for Gynaecologist, anaesthetist and
paediatrician at DHQH
Human Resource
The required staff was available at all BHU
WMO was not available at RHC Paroom; laboratory technician, OT technician and
ambulance driver were available at RHC
Gynaecologist was available at DHQH Panjgur while the posts of Anaesthetist and
Paediatrician were vacant. No Blood bank technician was available while the technicians
in other categories were available but not in required number. LHV were surplus in
number
-
7/23/2019 HFA District Report - Panjgur
45/86
District Report - Panjgur
36
Staff at DHQH received training on EmONC while the staff on other surveyed facilities
received training on Client centredness.
Equipment
The complete set of required equipment items was not available at any of the surveyed
facilities
General equipment items were not available at any of the surveyed BHU
Labour room equipment was not available at RHC Paroom
Equipment for Paediatric nursery and ward was not available at DHQH, while OPD
equipment was available in required number.
Drugs and Supplies
The complete list of tracer drugs, supplies, vaccines and family planning were not
available at any of the surveyed facilities
Vaccines were available at BHU Bonistan and BHU Washbood. All the FP commodities
were missing at BHU Gichk. All the supplies items were available at BHU Washbood
Vaccines were not available at RHC Paroom
All the vaccines,supplies and FP commodities were available at DHQH in required
number
The most common reason for stockout of drugs was poor quantification.
Support Services
The complete range of required inputs for delivery of support services was not available
at most of the surveyed facilities
Inputs required for provision of basic laboratory tests were available at BHU Washbood
Ambulance service was available at RHC and DHQ hospital
All the inputs for Radiology services were available at DHQH
-
7/23/2019 HFA District Report - Panjgur
46/86
District Report - Panjgur
37
Management Basics
Management basics assessed at the surveyed facilities included availability of job
description and service delivery protocols, work coordination and supervision, MIS, infection
control measures, death reviews of maternal and neonatal deaths, fee for services and
available mechanisms of social protection.
All the surveyed facilities were not conducting regular performance review meetings and
facility in-charges of DHQH Ranjgur and RHC Paroom reported regular participation in
district level performance review meetings
DHQH and RHC Paroom reported supervisory visits of district health managers and its
feedback was not received even at these facilities.
Health Management Information System (HMIS) was being practiced in district Panjgur.
Regarding HMIS tools, complete range of tools was not available at any of the facility,
specifically non-availability of Meeting Register, disease early warning system, DEWS
chart and Growth monitoring register
Social protection mechanisms for the poor was available in the form of Zakat at DHQH
only
Complete range of inputs required for infection control practices were deficient at all the
surveyed facilities. All the facilities reported non-availability of waste management plan,
materials for waste collection, personal protection and waste treatment
Death review committee was not available for review of maternal and neonatal deaths at
any of the surveyed facilities.
Donor Contribution
Donor contribution for supporting delivery of MNCH was assessed at the surveyed facilities
for provision of human resource, infrastructure, equipment, drugs and supplies. In the
district, DHQH Ranjgur and RHC Paroom reported donor contribution for the provision of key
staff, staff capacity building, construction of new building and provision of new equipment
and provision of medicines. .
-
7/23/2019 HFA District Report - Panjgur
47/86
District Report - Panjgur
38
Clients Perspective
Client exit interviews were conducted to assess clients perspective about their satisfaction
with the services utilised at the facility. Total of 15 interviews were conducted in the district
and findings concluded that 40% of the clients were very satisfied, 47% were satisfied and
13% were not satisfied with the availed services.
-
7/23/2019 HFA District Report - Panjgur
48/86
District Report - Panjgur
39
Annexes
-
7/23/2019 HFA District Report - Panjgur
49/86
District Report - Panjgur
40
Annex 1: District Health Department
Public sector district health system consists of Secondary Health Care (DHQH) and Primary
Health Care (RHC, BHU) facilities. DHO acts as head of the district health department,
under supervision of DC.
Health Resources
Health facilities (Public sector)
Public sector facilities providing MNCH services are given in table below:
TABLE 2.4:NUMBER OF PUBLIC SECTORHEALTH FACILITIESIN THE DISTRICT
Type Number Bed strength
Teaching hospitals 0 0
DHQ Hospital 1 36
THQ Hospital 0 0
RHC 1 10
BHU 15 0
Govt. Rural Dispensaries 13
MNCH Centres 4
Sub Health Centres 0
SOURCE:HMISCELL,DHOOFFICE
Human Resource DHO Office
Table 2.5 summarises the HR situation at the DHO Office.
TABLE 2.5:HUMAN RESOURCE IN DHOOFFICE
Name of Post Sanctioned Filled % Filled
District Officer Health 1 1 100
Deputy District Officer Health 2 2 100District Coordinator National Program for FP & PHC 1 1 100
District Coordinator EPI Surveillance 1 1 100
District Coordinator NMNCHP 1 1 100
District Sanitary Inspector 1 1 100
CDC Officer 1 1 100
CDC Inspector 0 0 0
Drug Inspector 1 0 0
District Superintendent Vaccination 1 1 100
-
7/23/2019 HFA District Report - Panjgur
50/86
District Report - Panjgur
41
Name of Post Sanctioned Filled % Filled
Assistant Superintendent Vaccination 2 2 100
Tehsil Sanitary Inspector 0 0 0
Inspector Vaccination0 0 0
Total 12 11 92
SOURCE:DHOOFFICE
MNCH staff in District Panjgur
Table 2.6 summarises the status of MNCH staffing in health facilities including DHQH, RHC
and BHU in the district. The information was collected from DHO office during survey.
This information may not match with subsequent tables containing similar information on
human resource (HR) collected from respective surveyed health facilities (No. 3.7, 3.12,
3.16, 3.17, 3.18).
TABLE 2.6:AVAILABILITYOF MNCHSERVICES STAFFING IN PANJGUR
Posts
Sanctioned
Filled % Filled
Filled posts
R= Regular, C= On Contract
DHQH=1 THQH=0 RHC=1 BHU=15
R C R C R C R C
Gynaecologist 1 1 100 1 0
Paediatrician 1 0 0 0 0
Anaesthetist 1 0 0 0 0
Radiologist 1 0 0 0 0
Pathologist 1 0 0 0 0
Women Medical
Officers (WMO)12 4 75 2 0 1 0 1 0
Medical Officers
(MOs)
18 5 28 3 0 1 0 1 0
Blood Transfusion
Officers1 0 0 0 0
Blood Bank
Technician1 0 0 0 0
O.T. Technician 5 1 20 1 0
Anaesthesia
Technician3 0 0 0 0
LHV 7 5 71 2 0 2 0 1 0
Nurses 6 4 67 4 0 0 0
-
7/23/2019 HFA District Report - Panjgur
51/86
District Report - Panjgur
42
Posts
Sanctioned
Filled % Filled
Filled posts
R= Regular, C= On Contract
DHQH=1 THQH=0 RHC=1 BHU=15
R C R C R C R C
Lady HealthWorkers (LHW)*
52 50 96
Laboratory
Technician5 2 40 2 0 0 0
X-ray Technician 3 3 100 2 0 1 0
Dispenser 15 13 86 8 0 3 0 2 0
Vaccinators 15 11 73 6 0 3 0 2 0
Ambulance
Drivers5 4 80 3 0 1 0
Total 153 103 67 34 0 12 0 7 0
*LHW ARE COMMUNITY BASED SOURCE:HMISCELL,DHOOFFICE
Financial Allocations
Budgetary allocations and expenditures over the last three years for the district (in PKR
Million) were requested from DHO office, but the same were not available, as presented in
table 2.7.
TABLE 2.7:FINANCIAL ALLOCATIONIN DISTRICT PANJGUR
DistrictHealthBudget
2007-08 2008-09 2009-10
Allocation Expenditure Allocation Expenditure Allocation Expenditure
Non-Development
-* - - - - -
Development - - - - - -
Total - - - - - -
SOURCE:DHOOFFICE, * -Data not available
Donor Contribution
Information about donor contribution for MNCH services was asked from DHO office in terms
of financial input. It was reported that donor contribution was provided to this district, but
district health department was unable to provide monetary value of the support provided.
During survey, information about donor inputs on surveyed health facilities was also
collected; however, health facilities were found having received such inputs in terms of
human resource, infrastructure and equipment etc.
-
7/23/2019 HFA District Report - Panjgur
52/86
District Report - Panjgur
43
NMNCH Programme Indicators
Information on NMNCHP indicators is being compiled at office of DHO and this information
has been gathered on the sets of indicators, which is reproduced as such in following
tables.It is important to note that services utilisation data reported by district office take into
account utilisation of all public sector facilities in the district.
This information may not match with subsequent tables containing information on drugs and
supplies (Table No. 3.4, 3.9, 3.14, and 3.19) and C-sections (No. 3.29) collected from
respective health facilities included in survey..
TABLE2.8:NMNCHP MONITORING INDICATORS (YEAR2010)
Services Management
Number of district monthly performance review meetings held during last year -
Number of facilities with stock-out of FP commodities 4
Number of facilities stock outs of essential EmONC drugs 2
Support Services
Number of facilities with laboratory services available 3
Number of facilities with blood transfusion services available 1
Service Utilisation
Antenatal care coverage 5
Percentage of children
-
7/23/2019 HFA District Report - Panjgur
53/86
District Report - Panjgur
44
Community Mid-Wives (NMNCHP)
Number of first antenatal care visits (ANC 1) 1203
Number of ANC revisits 553
Number of TT 2 given 1604
Number of deliveries 62
Number of post natal visits 28
Number of family planning visits (both new and follow-up) 66
Number of FP commodities provided 03
Number of maternal complications referred 20
Number of neonates referred -
Number of clean/safe delivery kits used 500
Stock out of clean/safe delivery kits 650
Stock out of FP commodities -
Number of pregnant women referred by LHW 28
Number of maternal deaths -
Number of neonatal deaths -
SOURCE:HMISCELL,MNCHCELL,EPICELL,MISNP FOR FP&PHC-DHOOFFICE
Provision of Staff by the NMNCHP
The NMNCHP is supposed to provide support in human resource at target health facilities,
including specialists, doctors and paramedics. The programme is currently under
implementation and number of facilities having staff provided by the NMNCHP is given in the
table 2.9.
TABLE 2.9:NUMBER OF FACILITIESWITHSTAFFPROVIDED BY THENMNCHP
Staff CadreNumber of Health facilities
DHQH THQH RHC BHU
Gynaecologist -* - -
Anaesthetist - - -
Paediatrician/Neonatologist - - -
WMO - - -
OT technician - - -
BB technician - - -
Lab technician - - -
Anaesthesia technician - - -
Nurses - - -
LHV - - -
Ambulance drivers - - -
SOURCE:MNCH CELLDHOOFFICE-* DATA NOT AVAILABLE
-
7/23/2019 HFA District Report - Panjgur
54/86
District Report - Panjgur
45
MNCH Staff Trainings
Part of the mandate of the Programme is to build capacity of MNCH related staff through
conducting skill development trainings of the staff in standards of service provision,
counselling techniques and client centeredness. Information about trainings of MNCH staff is
presented in the table 2.10. It is important to note here that this information collected from
district office may not match with similar information contained in Table No. 3.21 collected
from the surveyed facilities.
TABLE 2.10:NUMBER OF STAFF TRAINED ON DELIVERING MNCHSERVICES
Category ofstaff
Number of staff trained (during last three years)
EmONC ENC IMNCI IMPACFP
SurgicalFP
CounsellingClient
centeredness
Gynaecologist 0 0 0 0 0 0 0Paediatrician 0 0 0 0 0 0 0
Anaesthetics 0 0 0 0 0 0 0
WMO 0 0 0 0 0 1 0
MO 1 0 0 0 0 1 0
OT Technician 0 0 0 0 0 0 0
Nurse 1 0 0 0 0 0 0
LHV 3 0 0 0 0 3 0
SOURCE:MNCH CELLDHOOFFICE
CMW Training and Deployment
Part of the mandate of the Programme is to train and deploy CMWs for improving community
based MNCH services. Information collected from district NMNCH cell related to the CMW
training and deployment is presented in the table 2.11.
TABLE2.11:STATUS OF CMWSTRAINING ANDDEPLOYMENT
Training and Deployment of Community Mid-Wives (NMNCHP)
Number of selected CMWs verified for their residential status 14
Number of CMWs with completed training 35
Number of CMWs deployed by NMNCHP 6
Number of CMW Schools where renovation/ construction completed 2
CMW Manual/Books available (Number of sets) 160
CMW training equipment/models available (Number) 10
Number of CMWs sponsored/supported by partners 21
SOURCE:MNCH CELLDHOOFFICE
-
7/23/2019 HFA District Report - Panjgur
55/86
District Report - Panjgur
46
Annex 2: Input Criteria for MNCH services
A. Civil works criteria
CIVIL WORKS SCOPE FOR BHU
OPTIMAL ITEMS
Ob/Gyn OPD or LHV room1. Consultation area
2. Examination area3. Hand washing facilities
Labour room1. Delivery room
2. Scrub area3. Functional attached wash room for patient
WMO or LHV residence1. Available2. Good condition
MINIMAL ITEMS
LHV Room Available
CIVIL WORKS SCOPE FOR RHCOPTIMAL ITEMS
Ob/Gyn OPD1. Consultation area
2. Examination area3. Hand washing facilities
Ob/Gyn Ward1. Patient area
2. Functional attached wash room
Labour room1. Delivery room
2. Scrub area3. Functional attached wash room for patient
Clinical laboratory1. Laboratory room
2. Working area3. Functional attached washroom
LHV Room1. Consultation area
2. Examination area3. Hand washing facilities
WMO residence 1. Available2. Good condition
LHV residence1. Available2. Good condition
MINIMAL ITEMS
Ob/Gyn OPD AvailableOb/Gyn Ward AvailableLabour room AvailableLHV room Available
WMO residence1. Available2. Good condition
LHV residence1. Available2. Good condition
CIVIL WORKS SCOPE FOR DHQH & THQH
OPTIMAL ITEMS
Ob/Gyn OPD1. Consultation area
2. Examination area3. Privacy of examination area4. Hand washing facilities
Ob/Gyn Ward1. Patient area2. Nursing station
3. Store for General items/drugs, or4. Functional attached wash room
Labour room
1. Delivery room2. Preparation/ stage room3. Scrub area
5. Store for General items/drugs,
6. Store for Equipment7. Functional attached wash room for patient8. Functional attached wash room for staff
-
7/23/2019 HFA District Report - Panjgur
56/86
District Report - Panjgur
47
4. Staff duty room
Operation theatre1. Patient preparation room2. Operating room3. Recovery room4. Scrub area
5. Sterilisation area6. Doctors room7. Support staff duty room8. Store for General items/drugs, or equip.9. Store of equipment
10. Functional attached washroom for staffPaediatric ward
1. Patient area2. Nursing station
3. Store for General items/drugs, or equip4. Functional attached wash room
Paediatric nursery1. Patient area2. Nursing station
3. Store for General items/drugs, or equip4. Change room
Clinical laboratory1. Laboratory room2. Working area
3. Doctors duty room4. Store for chemical / reagents, or equip5. Functional attached washroom
Blood bank1. Blood collection room2. Working area
3. Staff duty room4. Store for equipment / reagents5. Functional attached washroom
LHV Room1. Consultation area2. Examination area
3. Privacy of examination area4. Hand washing facilities
Ultrasound room Examination area
Gynaecologist residence Available Good condition
Anaesthetist residence Available Good condition
Paediatrician residence Available Good condition
WMO residence Available Good condition
LHV residence
Available Good condition
Nurse residence Available Good condition
Lab technician residence Available Good condition
BB technician residence Available Good condition
Anaesthesia technician residence Available Good condition
MINIMAL ITEMS
Ob/Gyn OPD AvailableOb/Gyn Ward AvailableLabour room AvailableOperation theatre AvailablePaediatric ward AvailableClinical laboratory Available
Gynaecologist residence Available Good condition
Anaesthetist residence Available Good condition
Paediatrician residence Available Good condition
WMO residence Available Good condition
Lab technician residence Available
Good condition
-
7/23/2019 HFA District Report - Panjgur
57/86
District Report - Panjgur
48
B. Human Resource criteria
HUMAN RESOURCE FOR PREVENTIVEEmONC
HUMAN RESOURCE FOR 24/7 Basic EmONC
OPTIMAL HR FOR BHU OPTIMAL HR FOR RHC
Category Number Category NumberMO, or 1 WMO 2LHV 1 OT technician 1
- - Lab technician 1- - LHV 2- - Ambulance driver 1
MINIMAL HR FOR BHU MINIMAL HR FOR RHC
MO, or 1 WMO 1LHV 1 Lab technician 1
- - LHV 1- - - -
HUMAN RESOURCE FOR 24/7 Comprehensive EmONC
OPTIMAL HR FOR DHQH OPTIMAL HR FOR THQH
Category Number Category Number
Gynaecologist 2 Gynaecologist 1Anaesthetist 2 Anaesthetist 1Paediatrician 2 Paediatrician 1
WMO 6 WMO 4OT technician 4 OT technician 4
BB technician 4 BB technician 4Lab technician 3 Lab technician 2Anaesthesia technician 4 Anaesthesia technician 4
Nurses 20 Nurses 12LHV 4 LHV 4
Ambulance drivers 4 Ambulance drivers 4
MINIMAL HR FOR DHQH MINIMAL HR FOR THQH
Gynaecologist 1 Gynaecologist 1Anaesthetist 1 Anaesthetist 1Paediatrician 1 Paediatrician 1
WMO 4 WMO 2OT technician 1 OT technician 1
Lab technician 1 Lab technician 1Nurses 6 Nurses 4LHV 1 LHV 1
-
7/23/2019 HFA District Report - Panjgur
58/86
District Report - Panjgur
49
C. Equipment criteria
EQUIPMENT FOR BHU
OPTIMAL ITEMS
General hospital equipment1. Electric water cooler
2. Water filter3. Incinerator
OPD / WMO office1. Office / plain chairs2. Examination couch3. Office tables with drawer4. Steel almirah large5. Patient stool6. Weight machine adult
7. Weight machine infant8. Height measuring board9. Height measuring device10. B.P Apparatus mercury-desk type11. Foetal stethoscope12. Steam inhaler13. Nebuliser14. Examination lamp
Lady health visitor's room
1. Weight scale Adult2. Weight scale Infant3. Height measuring device4. Height measuring board5. Disposable syringe cutter6. D & C instruments set
7. P.V. Examination light8. Examination Couch9. Office Chairs10. Office Tables with drawer11. Patient Stool12. Steel almirah large
MINIMAL ITEMS
1. Office chairs2. Office tables with drawer3. B.P Apparatus mercury-desk type4. Foetal stethoscope5. Weight scale Adult
6. Weight scale Infant7. Height measuring device8. Height measuring board9. D & C instruments set10. Examination couch
EQUIPMENT FOR RHC
OPTIMAL ITEMS
General Hospital1. Ambulance2. Electric water cooler
3. Water filter4. Incinerator
Female ward items1. Fowler bed (Iron)2. Attendant's bench3. Bed side locker4. Overhead food trolley
5. Dust bin stainless steel6. Screen folding complete7. Baby cot8. B.P Apparatus mercury-desk type9. Stethoscope
OPD / WMO Office
1. Office chairs2. Plain chairs3. Examination couch4. Office tables with drawer5. Steel almirah large6. Patient stool7. Weight machine adult
8. Weight machine infant
9. Height measuring board10. Height measuring device11. B.P Apparatus mercury-desk type12. Foetal stethoscope13. Steam inhaler14. Nebuliser15. Examination lamp
Labour Room1. UPS power supply system (2000W)2. Suction machine electric3. Infant weight machine4. Foetal stethoscope5. Electric instrument steriliser 12"x6"
6. Jar for forceps7. Spring type dressing forceps (ss)
10. Sim's speculum right angle, large11. Sponge forceps12. Long straight artery forceps13. Uterine sound14. Vulsellum forceps15. Scissors dissecting blunt pointed
16. Artery forceps17. Blunt-ended scissors
-
7/23/2019 HFA District Report - Panjgur
59/86
District Report - Panjgur
50
EQUIPMENT FOR RHC
OPTIMAL ITEMS
8. Sim's speculum right angle, small9. Sim's speculum right angle, medium
18. D & C instruments set19. Infant ambo bag
Lady health visitor's room
1. Weight scale Adult2. Weight scale Infant3. Height measuring device4. Height measuring board5. P.V. Examination light
6. Examination couch
7. Office chairs8. Office tables with drawer9. Patient stool10. Steel almirah large
MINIMAL ITEMS
Female ward items1. Fowler bed (Iron)
2. B.P Apparatus mercury-desk type3. Stethoscope
OPD / WMO Office1. Office chairs2. Examination couch
4.