mianwali-1

THREE YEARS ROLLING PLAN 2010-2013 DISTRICT MIANWALI

THREE YEARS ROLLING PLAN 2010-2013 DISTRICT MIANWALI

Table of ContentsAcronyms4Executive Summary6SECTION 1: DISTRICT HEALTH PROFILE8Vision of the District8Background of the District8Map of the District9Demography9Socio-Economic Indicators11Health Indicators11Organizational Structure of District Health Administration12Health Resources131.Health Facilities13a)Public13b)Private132.Human Resource14a)Administrative14b)Facility Based15c)Outreach24d)Training Institutions24Health Financing25Disease Pattern26Status of Vertical Programs291.National Program for FP & PHC292.EPI293.MNCH Program294.TB Control Program305.Malaria Control Program306.HIV/AIDS Control Program307.Hepatitis Control Program318.School Health Services Program31SECTION 2: PROBLEM ANALYSIS32Objectives32Plan Development Process32Problem Identification33Health Problems33Problem Prioritization34Underlying causes of prioritized problems36Service delivery/Management problems38MDGs and MSDS39a)Human Resource39i.DHQ Hospital40ii.THQ Hospital41b)Equipment42i.DHQ Hospital42ii.THQ Hospitals(3)50SECTION 3: INTERVENTIONS AND TARGETS60Health Problems61Management Problems71SECTION 4: COSTING AND FINANCING PLAN76Activity based costing76Problem wise cost summary of Health Problems76a)Health Problems77Problem wise cost summary of Management Problems88b)Management Problems89Financial Outlay95Budget Summary95SECTION 5: MONITORING & EVALUATION96M&E of Plan96Annex-I99Annex-II100THQ Hospital Mianwali102 Acronyms

3YRPThree Years Rolling plan

ADBAsian Development Bank

APMOAdditional Principal Medical Officer

ARIAcute Respiratory Infections

BHUBasic Health Center

BoDBurden of Dieses

CDCCommunicable Disease Control

CDRCase Detection Rate

CPRContraceptive Prevalence Rate

DHISDistrict Health Information System

DHQHDistrict Head Quarter Hospital

DoHDepartment of Health

DRDefault Rate

EDO(H)Executive District Officer Health

EPIExpended Program on Immunization

HSRPHealth Sector Reforms Program

IMRInfant Mortality Rate

IPCInterpersonal Communication

M & EMonitoring and Evaluation

M & EMaintenance and Repair

MCHMaternal Child Health

MMRMaternal Mortality Ratio

MNCHMaternal Newborn and Child Health

MOMedical Officer

MoVMeans of Verification

MSDSMinimum Service Delivery Standards

PDSSP Punjab Devolved Social Services Program

PHCPrimary Health Care

PMOPrincipal Medial Officer

POLPetrol, Oil and Lubricant

RHCRural Health Center

SCRSputum Conversion Rate

SHCSecondary Health Care

SMOSenior Medical Officer

TAMATechnical Assistance Management Agency

TBTuberculosis

THQHTehsil Head Quarter Hospital

TNATraining Need Assessment

WHOWorld Health Organization

WMOWomen 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 Program Social Services Programme (PDSSP). This year government of the Punjab through Health Sector Reforms Program (HSRP) with the technical assistance from a team of consultants (SP09) and wide consultations/inputs from all key stake holders has established a bench mark in standardization of the format of 3YRP. Capacity building of the districts has been done on the standardized format.Current 3 Years Rolling Plan (3YRP) plan is first attempt by the district on that agreed format. First section of the format (District Health Profile) contains all relevant information on Geography, Demographic, Socioeconomic and Health indicators of the district. It also takes stock of health resources in terms of human resource, infrastructure and others. District diseases pattern compiled from DHIS Primary and Secondary Health Care reports and current status of vertical /national programs is part of the profile. In fact district profile is a health related fact sheet of the district and depicts the true picture of health status and health resources/services of the district. An accurate district health profile provides a sound basis for evidence-based planning. 3YRP plan has been developed by following the standard planning cycle approach. 3YRP details the current year activities, physical targets and fiscal targets. Projections of second and third year physical and financial targets are given. Section Two includes problems identification from various perspectives, and their prioritization by applying WHO prioritization criteria. This section also contains underlying causes of the prioritized problems. Section Three of the plan relates to developing best possible interventions/activities and setting physical targets for each year. Section Four consists of costing based on additional requirements taking account of implementation of current status of activities. Best available estimates have been used to accurately cost the activities. The detailed activity based costing of the Health and Service Delivery problems has been developed on automated Excel sheets, and annexed for details as ready reference. Last section of the 3YRP consists of Monitoring and Evaluation of plan to gauge the progress of different activities and targets of the plan using reliable district data sources. This permits timely remedial action for smooth implementation of planned activities.

DISTRICT MIANWALISECTION 1: DISTRICT HEALTH PROFILEVision of the DistrictThe District Health Government Mianwali is looking to provide efficient Health Care Delievery Servicesthrough Primary and Secondary health facilities with the collaboration of Government and non-government stake holders. The District Health Government is also committed to improve the Healthy Life Style of the people of Mianwali district.Mission of the DistrictThe District Health Government Mianwali has been providing promotive, preventive and curative services through net work of Health Institutions. At present curative services are being utilized by the population of the District, whereas in preventive programmes achievement of Department has been 90% of the targets. Background of the District Geographical location: District Mianwali shares its borders with district Attock in the North-East, with Chakwal and Khushab on the East, Bhakkar on the South, and NWFP on the West and North-West. River Indus flows across the district from North to South.

Main Town: The main towns of this district are Isa Khel, Kamar Mushani, Kalabagh, Wan Bhacharan, Daud Khel, Piplan, Kundian and Harnoli . It has 56 union councils.

Communication linkages (Roads, Railway): Roads and Railway

Source of livelihood: Agriculture

Map of the District

Demography

Total Population 13,88,516 Total Area 584 square kilometers Annual growth rate 2.24 % Population density 237 Per Sq. Km

Area-wise populationAreaPopulationPercentage

Rural109134378.60%

Urban29717321.40%

Source: Standard Demographic population groups based on DHIS Gender-wise populationGenderPopulationPercentage

Male70217451%

Female68634249%

Source: Standard Demographic population groups based on DHIS Population groupsPopulation GroupsStandard Demographic (%)Estimated Population

Under 1 year of age2.749015

Under 5 years13.4222163

Under 15 years44610947

Women in child bearing age (15-49 years)22305473

Married Child Bearing age Women16222163

Expected pregnancies3.456929

Source: Standard Demographic population groups based on DHIS

Tehsil wise distributionTehsilNumber of UCPopulation

Mianwali28676298

Piplan 14347447

Isa Khel14364771

Ethnic groups and languagesThe district is home to a variety of the tribes, the important ones being,Niazi, Awan, Arien, Jat, Rajput, Gujjar, Kundi and Pathan

Socio-Economic Indicators

Education and Literacy

Literacy rateMaleFemale

Urban87.6%55.6%

Rural72.1%32.4%

Overall District 74.8%38.3%

Source: EDO Literacy and Formal Education Sargodha

Health Indicators Infant Mortality Rate 78/1000 Neonatal mortality Rate 58/1000 Under 5 mortality Rate 113/1000 Maternal mortality Ratio 227/100000* Malnutrition (women and children) 34/1000 Underweight prevalence 33 Stunting prevalence 36 Wasting prevalence 18 Life expectancy 63-years for males 61-years for females Proportion of children under 2 years immunized 88% Sources: MICS 2007-2008,EDO(Health)Office Mianwali*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:Health Resources

1. Health Facilitiesa) PublicDetails of physical infrastructure of public health facilities in the district is given in the table belowFacility TypeName of FacilityBed StrengthNo. of Functional BedsRemarks

DHQ HospitalDHQ Hospital Mianwali233233

THQ HospitalsTHQ Hospital Kalabagh 4040

THQ Hospital Isa Khel 4040

THQ Hospital Piplan 4040

RHCs9 RHCs18018020 Beds in each RHC

BHUs40 BHUs80802 Beds in each BHU

Govt. Rural Dispensaries1300

MCH Centers0600

Sub Health Centers2000

TB Clinics200

Health houses103500

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

2. Human Resource The Human resource of district health department has been placed in following categories:a) Administrativeb) Facility basedc) Outreachd) Training institutions

a) AdministrativeSr. No.Name of PostSanctionedFilled

1Executive District Officer Health11

2District Officer Health11

3Deputy District Officer Health21

4Program Director DHDC11

5District Coordinator National Program01

6District Coordinator EPI Surveillance01

7District Sanitary Inspector10

8CDC Officer10

9CDC Inspector21

10Drug Inspector11

11District Superintendent Vaccination11

12Assistant Superintendent Vaccination22

13Tehsil Sanitary Inspector20

14Inspector Vaccination22

b) Facility Based

i. Basic Health Units (40)Sr. No.Name of Post/DesignationSanctionedFilledVacant

1. Medical Officer40733

2. School Health & Nutrition Supervisor40400

3. Medical Assistant170314

4. Computer Operator40040

5. Medical Technician23158

6. Female medical/Health Technician422

7. LHV401723

8. Sanitary inspector401525

9. Dispenser402812

10. Midwife801466

11. N/Qasid402812

12. Chowkidar403010

13. Sweeper 401921

ii. Rural Health Centres (9)Sr. NoName of PostSanctionedFilledVacant

1Senior Medical Officer963

2Medical Officer972

3Woman Medical Officer954

4Dental Surgeon963

5Chage Nurses543816

6Homeo Doctor440

7Computer Operator909

8Hakim220

9Lady Health Visitor17161

10FMT330

11Dental Technician936

12Health Technician220

13Lab. Technician963

14RHI28028

15Homeo Dispenser413

16Anthesia Assistant927

17OTA927

18Radiographer1578

19Dispenser35296

20Dresser945

21Dawasaz220

22Vacciantor440

23Senior Clerk909

24Lab. Assiastant972

25X-Ray Assistant505

26J/Clerk990

27Midwife/Dai392910

28TWO651

29Driver14104

30Ward Servant18144

31Sweeper301317

32Naib Qasid25232

33Chowkidar15510

34Water Carrier981

35Sanitary Petrol30264

36Mali972

37Cook927

38Dawakoab220

39Homeo Naib Qasid110

40Sanitary Worker532

iii. THQ Hospitals(3)Sr. NoName of PostSanctionedFilled Vacant

1Medical Superintendent303

2Add: Principal Medical Officer (M)202

3Add: Principal Medical Officer (F)101

4Senior Dental Surgeon202

5 Surgeon303

6Orthopedic Surgeon101

7Physician101

8Anesthetist202

9Gynecologist505

10Pathologist101

11Radiologist202

12Ophthalmologist / Eye Specialist312

13Pediatrician312


15Senior Woman Medical Officer303

16Casualty Women Medical Officer101

17Pharmacist 220

18Medical Officer / CMO972

19Women Medical Officer541

20Dental Surgeon110

21Head Nurse202

22Staff/Charge Nurse1569

23Male Nurse202

24Refractionist101

25Homeo Doctor110

26Hakim110

27Lady Health Visitor330

28ECG Technician202

29Dental Technician211

30Opthalmic Technician202

31Laboratory Technician202

32Senior Clerk211

33Junior Clerk321

34Radiographer422

35Dispenser/Dresser15150

36Homeo Dispenser110

37Dawasaz101

38Operation Theatre Assistant413

39Store keeper202

40Laboratory Assistant541

41Driver321

42Midwife220

43Nursing Ordly110

44Tube Well Operator 211

45OT Attendant101

46Lab: Attendant110

47X-Ray Attendant211

48Ward Servant 1138

49Dai431

50Aya220

51Ward Boy110

52Naib Qasid523

53Masalchi101

54Ward Cleaner /Sweeper1569

55Cook101

56Gate Keeper220

57Dawakoab110

58Chowkidar 523

59Mali523

60Sever Man101

61Dhobi 202

62Bahishti 404

iv. DHQ Hospital MianwaliSr. NoName Of Post.SanctionedFilledVacant

1.Chief Consultant.101

2.Senior Consultant.422

3Medical Superintendent.110

4.APMO (Male)431

5.APMO (Female)303

8Urologist.110

9Radiologist110

10Pathologist.110

11Physician110

12Cardiologist.110

13ENT Specialist110

14Chest Specialist101

15Anesthetist.101

16Ophthalmologist110

17Gynaecologist.220

18Dermatologist.101

19Orthopedic Surgeon.110

20Child Specialist.110

21Psychiatrist.110

22Dy: Medical Superintendent.303


24Nursing Superintendent.101

25Medical Officers.501634

26Woman Medical Officer.1367

27Physiotherapist.110

28Budget and Account Officer.101

29Statistical Officer.101

30Health Education Officer.101

31Pharmacist 110

32 Principal Dental Surgeon.101

33Dental Surgeon.110

34Nursing Instructor.101

35Deputy Nursing Superintendent.110

36House Officers.1697

37Head Nurse.615

38Refractionist.110

39Charge Nurses.48453

40Public Health Nursing Supervisor.101

41Office Superintendent.110

42Homeopathic Doctor.110

43Hakeem.110

44Stenographer.110

45Head Clerk.101

46Accountant.101

47Statistical Assistant.101

48L.H.V.440

49ECG Technician.220

50Dental Technician.211

51House Keeper.101

52Lab: Technician.110

53Projectionist.101

54Almoner.110

55Cashier/Senior Clerk.211

56Junior Clerk.440

57X-Ray Technician.110

58Store Keeper211

59Radiographer.440

60Homeopathic Dispenser110

61Dispenser.990

62Dresser440

63Dawasaz110

64OTA633

65Physiotherapy Aid.110

66Lab: Assistant.440

67Driver.422

68Midwife.220

69Nurse Dais.330

70Tailor.101

71Tubewel Operator.211

72Lab: Attendant.202

73Dhobi.211

74O.T. Attendant.422

75Dai.101

76Aya.101

77Ward Servant.403010

78Water Carear.422

79Naib Qasid.660

80Mali.431

81Gate Keeper.220

82Dawacob. (cum Naib Qasid)101

83Cook.404

84Chowkidar.651

85Baildar.303

86Stretcher Bearer.541

87Ward Boy.20020

88Misalchi.101

89Cleaner.101

90Sweeper.30030

91Ward Cleaner.403010

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

Vaccinators5048

CDC Supervisors3729

Sanitary Inspectors4017

d) Training Institutions A number of training institutions are working in the district, which include the following:Type of institute Number

DHDC1

General Nursing school1

i. DHDC PostSanctionedFilled

Programme Director0101

MPPT0101

LHV Trainer0101

Assistant0101

Driver0101

Naib Qasid0101

Chowkidar0202

Sanitary Worker0101

ii. General Nursing School Name of Post/DesignationSanctionedFilled

Principal School of Nursing0101

Nursing Instructor0301

House Keeper0101

Sweeper0201

Naib Qasid0101

Chowkidar/Gate Keeper0403

Cook0202

Masalchi00

Health FinancingThe 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. MillionSource of fundingYear

2007-082008-092009-10 upto 03/2010

AllocationExp.AllocationExp.AllocationExp.

Non-Development314.229190.113259.840289.170379.557139.912

Development------

Sub Total314.229190.113259.840289.170379.557139.912

PHSRP009.402600011.40260010.142464

PMDGP0057.85840.68649.68334.370

PDSSP000019.19216.645

Provincial Development Funds (ADP)000000

Grand Total628.458380.226586.9406619.026839.3916340.98146

User charges (like parchi fee, fees for diagnostic services)3.48204.17900.6550

Disease PatternThe 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 GroupTotal%age

Respiratory disease

1Acute (upper) respiratory infections28662923.82

2Pneumonia < 5 yrs.195431.62

3Pneumonia > 5 yrs.146371.22

4TB Suspects96620.80

5Chronic Obstructive Pulmonary Disease36540.30

6Asthma298202.48

Gastro Intestinal Disease

7Diarrhea / Dysentery < 5 yrs691325.75

8Diarrhea / Dysentery > 5 yrs578094.80

9Enteric / Typhoid Fever187701.56

10Worm Infestations255152.12

11Peptic Ulcer Disease931567.74

12Cirrhosis of Liver5210.04

Urinary Tract Disease

13Urinary Tract Infections394023.27

14Nephritis / Nephrosis17930.15

15Sexually Transmitted Infections11150.09

16Benign Enlargement of Prostrate13690.11

Other Communicable Diseases

17Suspected Malaria235791.96

18Suspected Meningitis17050.14

19Fever due to other causes640425.32

Vaccine Preventable Disease

20Suspected Measles6410.05

21Suspected Viral Hepatitis10350.09

22Suspected Neonatal Tetanus60.00

Cardiovascular Diseases

23Ischemic heart disease53380.44

24Hypertension559404.65

Skin Diseases

25Scabies1099509.137

26Dermatitis589724.90

27Cutaneous Leishmaniasis2100.02

Endocrine Disease

28Diabetes Mellitus371913.09

Neuro-Psychiatric Diseases

29Depression135891.13

30Drug Dependence8590.07

31Epilepsy6470.05

Eye & ENT

32Cataract235981.96

33Trachoma50950.42

34Glaucoma8760.07

35Otitis Media506584.21

Oral Diseases

36Dental Caries455763.79

Injuries/Poisoning

37Road traffic accidents169181.41

38Fractures39000.32

39Burns28160.23

40Dog bite67790.56

41Snake bite (with signs/symptoms of poisoning)5360.04

Miscellaneous Disease

42Acute Flaccid Paralysis3300.03

43Suspected HIV/AIDS0

TOTAL1203313100

44Any other Unusual disease (specify)

Source: Compiled from PHC and SHC DHIS Reports.

Status of Vertical ProgramsThe following paragraphs depict the current status of the program being implemented in the district. The indicators and their values have been taken from the program reports. 1. National Program for FP & PHC No. of seats allocated for LHWs 1140 No. of LHWs working 1035 Percentage of Population covered by the program 85% Important program indicators IMR 34/1000 MMR 156/100000 CPR 43% No. of antenatal visits 15192 TT Coverage of pregnant women 97%

2. EPI EPI Coverage rate of the district 93% Fully immunized children 0-23 months 88% Pregnant women received TT vaccine 63% Availability of cold chain equipment 98%

3. MNCH Program 1st batch of 34 qualified and deployed in the district. 2nd batch of 18 qualified and awaiting for deployment. 3-Batches of 23 CMW are undergoing training in District Mianwali. Under this Programme the following staff is recruited:

Sr. No.Name of PostSanctioned Filled vacant

1. District Coordinator / Public Health Specialist110

2. WMO954

3. CMW Tutors330

4. Community Social Organizer110

5. LHV981

4. TB Control Program CDR all types 109/100,000 population CDR NSS positive 77.8% SCR 97% TSR 95.4% DR 0%

5. Malaria Control Program No. of slides examined 13529 No. of positive slides 32 Slides positively ratio 0.24% Percentage of plasmodium falciparum 15.6%6. HIV/AIDS Control Program No. of HIV/AIDS tests conducted 2000 No. of positive cases detected 0 No. of HIV/AIDS patients treated 0 No. of sentinel centers 0

7. Hepatitis Control Program No. of hepatitis tests conducted 6898 No. of positive cases detected 302a) Hepatitis B+ve 140b) Hepatitis C+ve 162 No. of persons vaccinated against Hepatitis B 8. School Health Services Program Total visits to the schools 406 No. of students examined 27263 No. of students referred to BHUs 7263 No. of students treated in BHUs 6158 No. of students referred from BHUs to higher facilities 1105 No. of schools in catchment areas 541 No. of SH & NS 21 No. of teachers trained Nil

SECTION 2: PROBLEM ANALYSIS

The Health sector in Punjab is facing enormous health and service delivery problems. Common health problems are communicable, non communicable, MNCH related diseases and accident/ trauma. The society is passing through demographic and epidemiological transition. This is due to changing life style, urbanization, ecological and other factors. Disease pattern is changing where non communicable diseases are gradually increasing and the communicable diseases are still posing serious threat. Punjab is practically facing Double Burden of Disease (BOD). Besides, health problems service delivery/ managerial issues are also hindering the access and quality of health services to the population. The service delivery/management problems are diverse in nature, and include shortage of technical human resource, capacity issues, lack of infrastructure and equipment. Devolution was introduced during 2001 affecting the administrative and financial set up of the districts. The devolution also brought political culture in the decision making of the districts in the shape of Nazims, Naib-Nazims and Councilors. This system is now in the phase of reshaping and it is not clear what will be future structure and managerial shape when new local bodies system is put in place. The District Manager and functionaries are in the state of uncertainty and confusion in this scenario. However, one thing is clear that the district shall remain a hub of all primary and secondary health services delivery. Despite the source of funding in the future, either from provincial or district government, health planning at district level shall continue to play a pivotal role in provision of quality health services.In view of the above situation the district considers following objectives for developing three year rolling plan. Objectives Improve health status of the population Meeting the requirements of national and provincial health policies Achievement of MDGs through MSDS Introducing evidence-based planning culture by addressing district specific problems/issues Addressing emerging health needs or re-emergence of health problems (e.g. H1N1, HIV-AIDS, Polio, T.B) Ensuring effective inter-sectoral coordination with a view to improving health indicators The objectives would guide in problem analysis, designing interventions, setting /phasing the targets, costing and monitoring the plan activities. Plan Development ProcessPlan development has been a systematic and consultative process. A core planning team consisting of EDO (H), DOH, MS DHQ and THQs, Statistical officer, and Budget and Accounts Officer, was designated by Director General Health Services Punjab. This team received three days customized training from SP-09 team at divisional headquarters. The main components of the trainings were: (i) developing a three-year rolling health sector plan using the standard three year rolling plan format; (ii) costing of the plan; (iii) preparing related budget projections; (iv) accounting procedures; (v) preparing adequate financial reports on the use of funds. The district planning team adopted the following steps for the preparation of three years rolling plan: Problem identification Prioritization of identified problems Identifying underlying causes of prioritized problems Developing interventions and activities Setting targets Determining resource requirements, costing and budgeting Preparing action plans Preparing monitoring plan Problem IdentificationThis step involved assessment of the current situation from various perspectives to establish the actual health situation in terms of health and service delivery/management problems. Problem identification is based on the district health profile, review of previous plans, MIS (DHIS, Program reports and periodic reports etc.), District specific surveys (MICS), MSDS, and national and provincial policy guidelines.The district planning team held meetings and started with identification of problem using the training received from SP-09 team and consulting the above mentioned documents. The problems identified were broadly divided into two categories i.e. a) Health Problemsb) Health Service Delivery or Management ProblemsHealth 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. Acute respiratory tract infections (ARI) 2. Diarrheal Diseases3. Skin diseases

4. Anemia (including in pregnancy) 5. High under 5 Mortality6. High Maternal Mortality

7. Hepatitis8. Anxiety Neurosis

9. Diabetes Mellitus

10. Hypertension11. Cataract 12. Dental Problems

13. Enteric fever14. Peptic ulcer disease15. Asthma

16. Road side accident & injuries17. Worm infestation18. Otitis Media

19. UTI20. Pulmonary Tuberculosis

Problem PrioritizationWHO 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 expediencyEach element has been assigned a score from 1 to 4 depending upon grade/scale of that element i.e. Very High=4, High=3, Medium=2 and Low=1. Elements of the prioritization criteria were applied to each of the enlisted health problems. The aggregate of individual scores assigned to the elements of the prioritization criteria gave the total score for a health problem. This total score was then used to prioritize the health problems. A cut-off point of was decided, to establish the priority health problems of the district. These problems will be addressed in the three years rolling plan.

ProblemMagnitude

Severity

Vulnerability to interventionCost EffectivenessPolitical ExpediencyTotal ScorePriority Number

ARI (under 5)42341145

Diarrheal Diseases44441171

Skin diseases32341137

Anemia ( including in pregnancy)32441 144

High under five mortality44333172

High maternal mortality44333173

Hepatitis23214128

Anxiety Neurosis322311111

Diabetes Mellitus12212816

Hypertensions12212817

Cataract213411112

Dental Problems11111519

Enteric Fever13331119

Peptic ulcer disease22221915

Asthma22221914

Road side Accidents & Injuries12221818

Otitis Media32321119

U T I223211013

Pulmonary Tuberculosis22332128

Worm infestation313311112

Underlying causes of prioritized problemsHealth problems have their underlying causes. It is important to know the underlying causes of the health problems so that appropriate interventions are developed. There may be a long list of these causes but only few of them are vital ones; and rectifying these causes can resolve the problem to a large extent. Following table gives common causes of the prioritized health problems pertaining to the district.

Sr. No.Health ProblemCauses

1Diarrheal Diseases

Poor sanitation

Lack of safe drinking water

Unhygienic practices

Lack of awareness in general population

Lack of awareness among mothers about feeding and weaning practices

Low Socio Economic status

Malnutrition

2High under 5 Mortality

Poor antenatal natal and post natal coverage

Neo-natal Infections

Birth Trauma & Asphyxia

Prematurity

Poor feeding and weaning practices

Diarrhea

ARI

Lack of capacity of staff for provision of proper child health care (diagnostic and timely referrals)

Low socio economic status

Malnutrition

Lack of birth spacing

Low EPI Coverage

2High MMR

Poor access to healthcare delivery services

Lack of awareness about danger signs of pregnancy

Low ante-natal coverage

Low skilled birth attendance

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

Complications of pregnancy

Capacity Issues related to maternal care

Maternal Anemia

Pregnancy following chronic severe diseases

4Anemia ( including pregnancy)

Lack of awareness about balanced diet

Gender discrimination

Social taboos and norms

Worm infestation

Infections

Poor quality of MNCH services

Poverty/ Low socio economic status

5Acute (upper) respiratory infections

Malnutrition

Air contamination

Over-crowding/Poor housing facilities

Lack of proper sanitation

Seasonal variation

Lack of awareness and hygienic practices

6Scabies

Lack of awareness

Unhygienic practices

Over-crowding/Poor housing facilities

Poor water and sanitation

Seasonal variation

7Hepatitis

Poor sanitation

Unsafe drinking water

Sharing of used syringes

Transfusion of unsafe blood and blood products

Unsafe sexual practices

Ear & Nose piercing and tattooing

Use of unsterilized equipment by dentists and barbers

8TB

Low socio-economic status

Seasonal variation

Lack of proper sanitation

Lack of awareness and hygienic practices

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:1. Shortage of Human Resource due to: Ban on permanent postings Non availability of incentivized pay package and career stuture Medico-legal work for WMOs Non sactioning of posts according to MSDS

2. Shortage of vehicles for (educational visit of nursing students A.C Vehicles 35 seaters) due to : Off Road and codemnation Emerging need

3. Shortage of Infrastructurei. EDO Officeii. Stores( drugs, equipment & General)iii. Residences (EDOH,DDOH)iv. Up gradation of Nursing School

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

5. Shortage of equipment (with reference to notified list) at secondary care level

MDGs and MSDSThe 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. a) Human ResourceWith 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:

HospitalCategoryBed Strength

DHQ HospitalA400 and above Beds

B251-400 Beds

CUp to 250 Beds

THQ HospitalAAbove 60 Beds

B41-60 Beds

CUp to 40 Beds

i. DHQ Hospital (Category C)Sr. No.PostStandard as per MSDSSanctioned

FilledVacancy Gap in relation to sanctioned positionsVacancy Gap in relation to filled positions

1Gynaecologist32211

2Paediatricians31122

3Anesthetists31023

4Medical Officers including SMO,APMO & PMOs7458221652

5Women Medical Officers including SWMO, APWMO &PMOs271661121

6Lady Health Visitors114477

7Nurses7554462129

ii. THQ Hospital (Category C) There are three THQ hospitals in the district, and all three belong to C category. Following is a composite list of human resource gaps for these THQ hospitals. Sr. No.PostStandard as per MSDS

Sanctioned

FilledVacancy Gap in relation to sanctioned positionsVacancy Gap in relation to filled positions

1Gynaecologist65016

2Paediatricians63135

3Anesthetists92079

4Medical Officers including SMO,APMO & PMOs481673241

5Women Medical Officers including SWMO APWMO & PMOs27941823

6Lady Health Visitors24332121

7Nurses451962639

b) 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. i. DHQ HospitalSr. No.EquipmentStandard as per MSDS(Qty.)Available GapRemarks

CBA

1CTG (Cardiac Tocography)11201

2Foetal Doppler35503

3Diagnostic Laparoscope11201

4Bulb Sucker 10202019

5Baby Warmer33640

6Mechanical Sucker336420

7Fetal Stethoscope44450

8Delivery Table22320

9D&C Set23420

10Outlet forceps44440

11Myoma Screw22230

12Kochers forceps448130

13Volselum forceps681033

14Lanes Tissue holding forceps22402

15Vaginal Retractors101010010

16Polypectomy forceps22230

17Sponge holder101520560

18Uterine elevator11130

19CosCo Speculum Small, Medium, Large (for each category)6101024

20Examination light33612

21Suction Curette12280

22Infant Resuscitation Trolley (with life saving medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light)11201

23Mother Resuscitation Trolley (with life saving medicines, Laryngoscope, Endo-tracheal tube, BP Apparatus, Chargeable light)11201

24Cardiac Monitor112140

25Pump Breast Electronic11101

26Vaginal Hysterectomy Set22420

26.1Toothed Tissue Forceps (8)224200

26.2Non-Tooted Tissue Forceps (8)224200

26.3Dissection Scissors (Curved 7)224300

26.4Dissection Scissors (Straight 7)224400

26.5 Hysterectomy Clamps (Straight)881644

26.6Hysterectomy Clamps (Curved)881644

26.7Uterine Sound22420

26.8Needle Holder (7)224160


26.10Artery Forceps (Straight 6)161632600

26.11Artery Forceps (Curved 6)161632300

26.12Allis Forceps88162440

26.13Towel Clamps88161000

26.14Single blade Sims speculum44804

26.15Double blade Sims speculum44804

26.16Sponge holding forceps8816560

26.17Volselum forceps44831


26.19Bladder Sound22440

27Delivery Sets101015

27.1Episiotomy Scissors10101546

27.2Straight Scissors10101564

27.3Needle holder10101564

27.4Non-toothed tissue forceps 8 inches10101546

27.5Toothed tissue forceps 8 inches10101546

27.6Sims Speculum single blade202030218

27.7Sims Speculum double blade202030218


27.9Artery forceps404060400

27.10Straight clamps (cord)202030200

27.11Vacuum Extractor pump11110

27.12Towel clip4040603010

28Caesarian Section6810

28.1Scalpel681080

28.2Artery Forceps Straight 6 inches2432401000

28.3Artery Forceps Curved 6 inches2432401000

28.4Artery forceps 8 inches2432401200

28.5Myoma Scissors straight 7 inches681060

28.6Dissecting scissors (curved) 7 inches681060

28.7Green Armtage forceps 8 inches243240186

28.8Obstetric outlet forceps (pair)681006

28.9Doyenes Retractor 681042

28.10Small Retractors121620200

28.11Towel Clippers243240204

28.12 Suction Nozzle681080

29MNCH Related Radiology Equipments

29.1Ultrasound Machine12330

29.2X-Ray Unit 500 kw11110

29.3 Color Doppler01100

29.4Lead Screen for X-Ray Unit11120

29.50.5 MN Lead Apron. Lead Gloves, Goggles and Thyroid and Gonadal Sheets11101

29.6Safe Light11130

29.7X-RT Film Processing Tank11101

29.8Chest Stand11120

29.9X-Ray film Illuminator22230

29.10X-Ray Film Hangers All sizes444500

30MNCH Related Paediatrics Equipments

30.1Paediatric Ventilator12201

30.2Incubator11240

30.3Photo Therapy Unit11120

30.4Over-head Radiant Warmer11101

30.5Infant Length Measuring Scale22202

30.6Infant Weighing Machine22220

30.7Nebulizer112180

30.8Billiubino-meter11201

30.9Exchange Blood Transfusion Set11201

30.10Nasal Probe Paed size22402

31Anaesthesia/ICU

31.1Anaesthesia Machine11250

31.2Ventilators11110

31.3Nebulizer11110

31.4Pulse Oximetry11110

31.5Defibrillator11110

31.6Airway Oral and Nasal23402

31.7Tracheostomy tube (adult and paeds)22460

31.8Face mask of all sizes22402

31.9Double Cuff Tourniquet (for regional block)12201

31.10AMBO bag adult224150

31.11AMBO Bag paeds22490

31.12Red Rubber Nasal tubes all sizes without cuff44804

32Blood Bank

32.1Blood storage cabinet (100 bag capacity)11220

32.2Packed cell machine11101

32.3Cell Separator11101

32.4Freezer for Fresh Frozen Plasma11101

32.5Blood bag shaker11220

32.6RH view box22402

32.7Water bath22211

32.8Micro-pipette46804

32.9Blood grouping tiles33603

32.10Plasma Extractor11101

32.11Platelets agitator11101

32.12Blood thawing bath11101

32.13Microscopes11220

33Gynae & Labour Room Related Laboratory Equipment

33.1Hematology Analyzer11101

33.2Electrolyte Analyzer11101

33.3Analyzer Bio-chemistry Semi-automatic11110

33.4Glucometer22202

33.5Haemoglobino-meter22411

33.6Centrifuge11220

ii. THQ Hospitals(3)Sr. No.EquipmentStandard as per MSDS(Qty.)Available GapRemarks

CBA

1CTG (Cardiac Tocography)11103

2Foetal Doppler22306

3Diagnostic Laparoscope11103

4Bulb Sucker 51020015

5Baby Warmer22306

6Mechanical Sucker333063

7Fetal Stethoscope234310

8Delivery Table22242

9D&C Set22233

10Outlet forceps444012

11Myoma Screw22224

12Kochers forceps44466

13Volselum forceps44648

14Lanes Tissue holding forceps22260

15Vaginal Retractors446210

16Polypectomy forceps22224

17Sponge holder101015380


19CosCo Speculum Small, Medium, Large (for each category)46666

20Examination light33381


22Infant Resuscitation Trolley (with life saving medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light)11103

23Mother Resuscitation Trolley (with life saving medicines, Laryngoscope, Endo-tracheal tube, BP Apparatus, Chargeable light)11103

24Cardiac Monitor11130

25Pump Breast Electronic11103

26Vaginal Hysterectomy Set22215

26.1Toothed Tissue Forceps (8)22260

26.2Non-Tooted Tissue Forceps (8)22260

26.3Dissection Scissors (Curved 7)222190

26.4Dissection Scissors (Straight 7)222170

26.5 Hysterectomy Clamps (Straight)888024

26.6Hysterectomy Clamps (Curved)888024




26.10Artery Forceps (Straight 6)1616161236

26.11Artery Forceps (Curved 6)1616161236

26.12Allis Forceps8881212

26.13Towel Clamps888915

26.14Single blade Sims speculum444210

26.15Double blade Sims speculum444210


26.17Volselum forceps444111


26.19Bladder Sound22206

27Delivery Sets6610018

27.1Episiotomy Scissors6610117

27.2Straight Scissors6610117

27.3Needle holder6610220

27.4Non-toothed tissue forceps 8 inches6610117

27.5Toothed tissue forceps 8 inches6610117

27.6Sims Speculum single blade121220036

27.7Sims Speculum double blade121220036


27.9Artery forceps4040409327

27.10Straight clamps (cord)202030654

27.11Vacuum Extractor pump11112

27.12Towel clip4040405664

28Caesarian Section446012

28.1Scalpel446220

28.2Artery Forceps Straight 6 inches161624642

28.3Artery Forceps Curved 6 inches161624642

28.4Artery forceps 8 inches161624642

28.5Myoma Scissors straight 7 inches446111

28.6Dissecting scissors (curved) 7 inches446111

28.7Green Armtage forceps 8 inches161624048

28.8Obstetric outlet forceps (pair)446012

28.9Doyenes Retractor 446111

28.10Small Retractors8812123

28.11Towel Clippers161624345

28.12 Suction Nozzle446210

29MNCH Related Radiology Equipments

29.1Ultrasound Machine11230

29.2X-Ray Unit 500 kw11150

29.3 Color Doppler00000

29.4Lead Screen for X-Ray Unit11130

29.50.5 MN Lead Apron. Lead Gloves, Goggles and Thyroid and Gonadal Sheets11170

29.6Safe Light11130

29.7X-RT Film Processing Tank11140

29.8Chest Stand11140

29.9X-Ray film Illuminator22242

29.10X-Ray Film Hangers All sizes4442630

30MNCH Related Paediatrics Equipments

30.1Paediatric Ventilator11203

30.2Incubator11121

30.3Photo Therapy Unit11121

30.4Over-head Radiant Warmer11103

30.5Infant Length Measuring Scale22206

30.6Infant Weighing Machine22224

30.7Nebulizer11150

30.8Billiubino-meter11103

30.9Exchange Blood Transfusion Set11103

30.10Nasal Probe Paed size12203

31Anaesthesia/ICU

31.1Anaesthesia Machine11140

31.2Ventilators11112

31.3Nebulizer11103

31.4Pulse Oximetry11103

31.5Defibrillator11112

31.6Airway Oral and Nasal12230

31.7Tracheostomy tube (adult and paeds)12203

31.8Face mask of all sizes12203


31.10AMBO bag adult12212

31.11AMBO Bag paeds22215

31.12Red Rubber Nasal tubes all sizes without cuff444012

32Blood Bank

32.1Blood storage cabinet (100 bag capacity)111040

32.2Packed cell machine11103

32.3Cell Separator11103

32.4Freezer for Fresh Frozen Plasma11103

32.5Blood bag shaker11112

32.6RH view box12203

32.7Water bath22224

32.8Micro-pipette44684

32.9Blood grouping tiles333018

32.10Plasma Extractor11103

32.11Platelets agitator11112

32.12Blood thawing bath11103

32.13Microscopes111170

33Gynae & Labour Room Related Laboratory Equipment

33.1Hematology Analyzer11103

33.2Electrolyte Analyzer11103

33.3Analyzer Bio-chemistry Semi-automatic11103

33.4Glucometer222500

33.5Haemoglobino-meter11130

33.6Centrifuge11190

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.

Three Years Rolling Plan 2010-2013 District Mianwali

69

Health Problems

Sr. No.ProblemCausesInterventionActivitiesUnitPlan Activities TargetsTarget for 2010-11Target for 2011-12Target for 2012-13Remarks

1Diarrhea Poor sanitation improvement of water supply and sanitation Quarterly co-ordination Meeting under the chairmanship of DCO with TMA and other agencies Meeting12444

Lack of safe drinking water Health Education campaign Messages on local cable networkMessage12444

Unhygienic practices Improving literacy rate through coordination with education department Printing and distribution of IPC materialBroucher200000500000250000250000

Lack of awareness in general population Proper treatment of Diarrhoea including ORT Address in school assemblies Session12001200--

Lack of awareness among mothers about feeding and weaning practices Capacity building of health staff in Integrated Management of Childhood Illnesses (IMCI) Training of medics and paramedics in IMCI No. of trainings963-

Low Socio Economic status Procurement and distribution of ORSORS packets150,000200000200000200000

Malnutrition Procurement and distribution of Syp. Zinc SulfateSyrup150,000100,0005000050000

Procurement and Distribution of Syrp MetonidazoleSyrup15000050,00050,00050,000

Procurement and distribution of IV fludisIV Fludis---

2High under 5 Mortarity Poor antenatal natal and post natal coverage Health awareness/education Message on local cableMessage36121212

Neo-natal Infections Provision of the quality basic EMONC services at BHU & RHC BCC of mothers 0n promotion of breast feeding and weaning practices through LHWsNumber of Trainings54301212

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

Prematurity Improvement of feeding and weaning practices Trainings on IMCINo. of trainings----

Poor feeding and weaning practices Capacity building of Human Resource dealing child health care Need assessment of food supplementsAssessment----

Diarrhoea Enhancing EPI coverage procurement from DGHs office Assessment----

ARI Poverty elevation Distribution of food suplemwnts to mothers & children through LHWs & community mid wivesAssessment----

Lack of capacity of staff for provision of proper child health care (diagnostic and timely referrals) Provision of food suplements Raising income of the poor famlies through Baitul Mall and Zakat Assessment----

Low socio economic status Revising the micro plans of Vaccinators----

Malnutrition----

Lack of birth spacing----

Low EPI Coverage----

3High MMR Poor access to healthcare delivery services Health education/promotion Messages on local cable networkMessage36121212

Lack of awareness about danger signs of pregnancy Behaviour change communication for Mothers of child bearing age Printing and distribution of IPC materialBroucher150000500005000050000

Low ante-natal coverage Provision of Quality basic EmONC services at BHU & RHC Training of LHWs on BCCNo. of trainings----

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

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

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

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

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

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

Procurement of Micro-nutrientsPacks50000250001300012000

Procurement and distribution of Calci-DPacks50000250001250012500

Porcurement and distribution of Anti-DInjection60301515

4Aneamia ( including pregnency) Lack of awareness about balanced diet Awareness raising for behaviour change Messages on local cable networkMessage36121212

Gender discrimination Awareness raising for behaviour change Printing and distribution of IPC materialBroucher150,000500005000050000

Social taboos and norms Awareness raising for behaviour change Counselling of pregnant mothersSession---

Worm infestation Deworming campaign Procurement of de-worming tablets No. of doses100,000500002500025000

Infections Diagnosis and treatment of infections Distribution through LHWs and health facilities ----

Poor quality of MNCH services Strengthening MNCH Services Refresher Trainings of LHWs on BCC, balanced diet and provision of micro-nutrientsNo. of trainings

----

Poverty/ Low socio economic status Equity of services Provision of Sehat Suhlat Card/health voucher----

5Acute (upper) respiratory infections Malnutrition Capacity building of health staff in ARI case management Messages on local cable networksMessage12444

Air contamination Capacity building of health staff in Integrated Management of Childhood Illnesses (IMCI) Printing and distribution of IPC materialBroucher2000001000005000050000

Over-crowding/Poor housing facilities Provision of medicines for ARI Training of medics and para-medics in IMCINo. of trainings----

Lack of proper sanitation Timely referral of complicated cases Procurement and distribution of Antibiotic Syrup AmoxycillinAntibiotic (Syrup) ----

Seasonal variation Procurement and distribution of Antibiotic Syrup Co-triAntibiotic (Syrup) ----

Lack of awareness and hygienic practices----

6Scabies Lack of awareness Health education & Promotion Messages on local cable networksMessage12444

Unhygenic practices Imprroving water and sanitation Messages through FM radio channelsMessage12444

Over-crowding/Poor housing facilities Proper diagonosies and treatment Printing and distribution of IPC materialBroucher20000010000050000050000

Poor water and sanitation Procourement and distribution of Benzyl Benzoate LotionLotion100000500002500025000

Seasonal variation ----

7Hepatitis Poor sanitation Health Education/Promotion Quarterly co-ordination meetings with TMA and other agencies Meetings0334

Unsafe drinking water Improving water & sanitation Messages on local cable networkMessage36121212

Sharing of used syringes Campaign against quackery Printing and distribution of IPC materialBroucher2000001000005000050000

Transfusion of unsafe blood and blood products Strengthening blood transfusion services for safe transfusions Printing and pasting of stickers at clinicks and Barbar shop highliting use of new syringes & RazersStickers20002000--

Unsafe sexual practices Regulatory mechanism to ensure use of safe instruments by dentists, barbers etc. Hepatitis awareness week ( walk/display banners/seminars)11--

Ear & Nose piercing and tattooing Procurement and supply of Eliza kitsKits12444

Use of unsterilized equipment by dentists and barbers Procurement of syringe cuttersSyringe cutter----

Documentation of expense of disposable syringes----

Suportive supervision to ensure above activities----

8T B Low socio-economic status Health education/promotion Messages on local cable networksMessage12444

Seasonal variation Strengthening TB DOTS program through involvement of private sector Printing and distribution of IPC materialBroucher50000250001300012000

Lack of proper sanitation Involvement of priviate providors through public priviate partnership Procurement of drugs to ensure deficiency according to regimenATT course2001005050

Lack of awareness and hygienic practices Procurement of reagents for notified diagnostic facilities under DOTS programmePacks----

Trainings on DOTS protocolsNo. of trainings321-

Management Problems

Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned PostsSr.No.Name of PostBasic ScaleBasic Pay AllowancesRequirement as per GapPhysical Targets

Year IYear IIYear III

1Gynaecologist1812,91018,099211-

2Paediatricians1812,91018,0995221

3Anesthetists1812,91018,0998332

4MO / WMO179,85015,34572252522

5Nurses166,0608,9342810108

6Lady Health Visitors93,8204,75045151515

Sr. NoProblemCausesInterventionActivitiesUnitPlan Activities TargetsTarget for 2010-11Target for 2011-12Target for 2012-13Remarks

1Shortage of skilled staff Vacant positions Filling of the vacant posts Temporary Filling of the vacant posts of medics and the paramedics through existing recruitment committeesRecruitment-----

Non-sanctioning of staff according to MSDS Sanctioning of positions according to MSDS Demand generation and request to the Department of Health by the districts for recruitment through PSC against vacant postsPlan-----

Lack of permanent postings Recruitment through Public Service Commission on regular basis Districts to prepare the incentivized pay package with consultation of all stockholdersPay Package-----

Lack of incentivies and differential pay packages Incentivized pay package at all levels Consensus building between the districts for uniform incentivized pay package for all categories and levels staffMeeting-----

Frequent transfer postings Well defined career structure including opportunities for higher education Request to the Provincial Government for approval and implementation of agreed pay packagesPlan-----

Job insecurity Conducive working environment Review and revise the career structure of medics, paramedics and technical staff like Sos, Health Education officers etcT A-----

Lack of basic amenities at workplace Provision of staff Residences Availability of recreation, education and other facilities for children of staff working in rural areasPlan EDOH-----

Lack of conducive environment including insecurity and transport of children for education High level political commitment for providing protection to staff working in health facilities Construction of the residences for the staffRequirement Plan-----

Political & Media Interference provision of recreation facilities (Parks/Play area/common rooms)Plan EDOH-----

Deficient transparent accountability Provision of the transport of staff children for the education purposesPlan EDOH-----

Shortage of the residences Capacity and need assessment of the medics and the paramedicsTNA-----

Medicoleagel work specially for Females Prepare training programs for providing higher professional education based on TNAPlan-----

2 Inadequate budget for POL

Installation of the Generator for back up electricity supply Rational increase in POL Budget Assessing additional need for POL-----

Frequent increase in prices of POL Costing & Submission the additional Demand for POLP O L449,826(Liters)

449,826

---

Less allocation for POL budget

3Lack of infrastructure

Office for EDOH Provision of the deficient infrastructure

Rough cost estimateCost Estimate

Residence for EDOH Submission of PC-1 PC-1

DDOH residence Approval by the concern authority

Stores ( drugs, equipment & General)

Upgradation of Nursing Schoolconstruction11--

4Shortage of Vehicles

Required for field/Educational visit of nursing students A.C Vehicles 35 seaters according to basic Nursing curriculum of P.N.C. Provision of vehicle Coaster 25 Seaters A.C.

Purchase of 25 Seaters AC CoasterVehicle11

5 Deficient equipment (with reference to notified list) at THQHs and DHQH. Deficient equipment to cater basic and comprehensive EmONC at primary and secondary level of care Make up the deficiencies against standards specified in MSDS Purchase of MNCH related equipment at DHQ Hospital MianwaliEquipment11

Purchase of MNCH related equipment at THQs Hospitals (Kalabagh, Piplan, Iesa Khail)Equipment11

SECTION 4: COSTING AND FINANCING PLANActivity 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 hyoerlinked as H & M Sheet. A moderate estimate of equipment cost has been taken, as there is wide variation between the minimum and maximum cost. Detailed cost of MNCH related equipment is annexed as Annex-II. The summary of problem and activity wise costing is given below. Problem wise cost summary of Health Problems

Sr. No.Health ProblemF Y IFY IIFY IIITotal Cost Rs.

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

1Diarrhea8,585,7005,851,8355,812,84020,250,375

2Under 5 Mortality681,000473,880521,2681,676,148

3HMM3,150,0001,771,0001,863,4006,784,400

4Anemia914,000812,900894,1902,621,090

5ARI288,000206,800227,480722,280

6Sabies1,219,6002,249,060840,4664,309,126

7Hepatitis954,000499,400549,3402,002,740

8TB254,400189,420135,520579,340

TOTAL16,046,70012,054,29510,844,50438,945,499

a) Health Problems

Sr.ProblemActivityDefineFinancial TargetsTotalCost

UnitRateQuantityYear IYear II (10 %)Year III (10 %)

1Diarrhea Quarterly co-ordination Meeting under the chairmanship of DCO with TMA and other agenciesMeeting4,0001216,00017,60019,36052,960

Messages on local cable networkMessage220001288,00096,800106,480291,280

Printing and distribution of IPC materialBroucher42000002,000,0001,100,0001,210,0004,310,000

Address in school assembliesSessionschool health & nutrition supervisor gives address to the school assemblies1200----

Training of medics and paramedics in IMCINo. of trainings186,90091,031,700567,435-1,599,135

Procurement and distribution of ORSORS packets6150,0001,200,0001,320,0001,452,0003,972,000

Procurement and distribution of Syp. Zinc SulfateSyrup35150,0003,500,0001,925,0002,117,5007,542,500

Procurement and Distribution of Syrp MetonidazoleSyrup15150000750,000825,000907,5002,482,500

Procurement and distribution of IV fludisIV FludisStock available-----

8,585,7005,851,8355,812,84020,250,375

2High under 5 Mortarity Message on local cableMessage22,00036264,000290,400319,440873,840

BCC of mothers 0n promotion of breast feeding and weaning practices through LHWsNumber of Trainings1390054417,000183,480201,828802,308

Provision of the deficient infrastructure at THQAssessment-----

Trainings on IMCINo. of trainingsAs proposed in Diarrhoea-----

Need assessment of food supplementsAssessmentAssessing below poverty pregnant mother through LHWs and providing them food suplement through DGHS & Financial suport from BaitulMall & Zakat-----

procurement from DGHs officeAssessmentAssessing below poverty pregnant mother through LHWs and providing them food suplement through DGHS & Financial suport from BaitulMall & Zakat-----

Distribution of food suplemwnts to mothers & children through LHWs & community mid wivesAssessmentAssessing below poverty pregnant mother through LHWs and providing them food suplement through DGHS & Financial suport from BaitulMall & Zakat-----

Raising income of the poor famlies through Baitul Mall and ZakatAssessmentAssessing below poverty pregnant mother through LHWs and providing them food suplement through DGHS & Financial suport from BaitulMall & Zakat-----

Revising the micro plans of Vaccinators-----

681,000473,880521,2681,676,148

3High MMR Messages on local cable networkMessage22,00036264,000290,400319,440873,840

Printing and distribution of IPC materialBroucher2150000100,000110,000121,000331,000

Training of LHWs on BCCNo. of trainingsAlready costed in problem High Under 5 Mortality-----

Procourment of vehicles for transportation through CCBsCosted in service delivery problems----

Operation and mangement of vehicles trhough CCBsCosted in service delivery problems-----

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

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

Procourment of the MNCH related equipment and InstrumentsCosted in service delivery problems----

Implementation of the refrrals protocolsCosted in MSDS Gaps----

Procurement of Micro-nutrientsPacks70500001,750,0001,001,0001,016,4003,767,400

Procurement and distribution of Calci-DPacks50500001,250,000687,500756,2502,693,750

Porcurement and distribution of Anti-DInjection500060150,00082,50090,750323,250

3,150,0001,771,0001,863,4006,784,400

4Aneamia ( including pregnency) Messages on local cable networkMessage22,00036264,000290,400319,440873,840

Printing and distribution of IPC materialBroucher6150,000300,000330,000363,000993,000

Counselling of pregnant monthersSessionLHWs are expected to conduct counselling session on behavior change during their visit to pregnant ladies----

Procurement of de-worming tabletsNo. of doses7100,000350,000192,500211,750754,250

Distribution through LHWs and health facilities-----

Refresher Trainings of LHWs on BCC, balanced diet and provision of micro-nutrientsNo. of trainings

Already costed in Problem HMM-----

Provision of Sehat Suhlat Card/health voucher-----

914,000812,900894,1902,621,090

5Acute (upper) respiratory infections Messages on local cable networksMessage22,0001288,00096,800106,480291,280


Training of medics and para-medics in IMCINo. of trainingsIMCI Training package costed in Diarrhoea also includes management of ARI-----

Procurement and distribution of Antibiotic Syrup AmoxycillinAntibiotic (Syrup)Stock available-----

Procurement and distribution of Antibiotic Syrup Co-triAntibiotic (Syrup)Stock available-----

288,000206,800227,480722,280

6Scabies Messages on local cable networksMessage22,0001288,00096,800106,480291,280

Messages through FM radio channelsMessage20,4001281,60089,76098,736270,096

Printing and distribution of IPC materialBroucher3200000300,0001,650,000181,5002,131,500

Procourement and distribution of Benzyl Benzoate LotionLotion15100000750,000412,500453,7501,616,250

1,219,6002,249,060840,4664,309,126

7Hepatitis Quarterly co-ordination meetings with TMA and other agenciesMeetingsCosted in diarrhoral disease-----

Messages on local cable networkMessage2200036264,000290,400319,440873,840


Printing and pasting of stickers at clinicks and Barbar shop highliting use of new syringes & RazersStickers502000100,000--100,000

Hepatitis awareness week ( walk/display banners/seminars)Lumpsum1250,000250,000

Procurement and supply of Eliza kitsKits100001240,00044,00048,400132,400

Procurement of syringe cuttersSyringe cutterAvailable-----

Documentation of expense of disposable syringes-----

954,000499,400549,3402,002,740

8T B Messages on local cable networksMessage22,00022,00088,00096,800106,480291,280


Procurement of drugs to ensure deficiency according to regimenATT courseTo be procurred from the PTPTo be procurred from the PTP----

Procurement of reagents for notified diagnostic facilities under DOTS programmePacksTo be procurred from the PTPTo be procurred from the PTP----

Trainings on DOTS protocolsNo. of trainings5820058200116,40064,020-180,420

254,400189,420135,520579,340

Problem wise cost summary of Management Problems

Sr. No.Health ProblemF Y IFY IIFY IIITotal Cost Rs.

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

1Human Resource Plan (Senction of Posts against MSDS Gaps) 13,133,028 28,892,662 44,789,220 86,814,909

2POL 35,086,428 - - 35,086,428

3Shortage of Vehicles 3,800,000 - - 3,800,000

4MNCH Related Equipment 67,739,800 - - 67,739,800

Total 119,759,256 28,892,662 44,789,220 193,441,137

b) Management ProblemsHuman Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned PostsSr.No.Name of PostBasic ScaleBasic Pay AllowancesRequirement as per GapFinancial Targets

Year IYear IIYear III

Pay of OfficersPay of other staffAllowancesPay of OfficersPay of other staffAllowancesPay of OfficersPay of other staffAllowances

1Gynaecologist1812,91018,0992154,920-217,188340,824477,814374,906525,595

2Paediatricians1812,91018,0995309,840-434,376681,648955,627937,2661,313,987

3Anesthetists1812,91018,0998464,760-651,5641,022,4721,433,4411,499,6262,102,380

4MO / WMO179,85015,345722,955,000-4,603,5006,501,00010,127,70010,297,58416,042,277

5Nurses166,0608,93428727,200-1,072,0801,599,8402,358,5762,463,7543,632,207

6Lady Health Visitors93,8204,75045687,600855,0001,512,7201,881,0002,495,9883,103,650

4,611,720687,6007,833,70810,145,7841,512,72017,234,15815,573,1362,495,98826,720,096

Sr.ProblemActivity DefineFinancial TargetsTotalCost

UnitRateQuantityYear IYear II (10 %) Year III (10 %)

1Shortage of skilled staff Temporary Filling of the vacant posts of medics and the paramedics through existing recruitment committeesRecruitment----

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

Districts to prepare the incentivized pay package with consultation of all stockholdersPay Package----

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

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

-----

Review and revise the career structure of medics, paramedics and technical staff like Sos, Health Education officers etcT A-----

Availability of recreation, education and other facilities for children of staff working in rural areasPlan EDOH-----

Construction of the residences for the staffRequirement Plan-----

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

Provision of the transport of staff children for the education purposesPlan EDOH-----

Capacity and need assessment of the medics and the paramedicsTNA------

Prepare training programs for providing higher professional education based on TNAPlan------

2Inadequate budget for POL

Assessing additional need for POL------

Costing & Submission the additional Demand for POLP O L78

449,826

35,086,428

35,086,428

35,086,428

35,086,428

3Lack of infrastructure

Rough cost estimateCost Estimate------

Submission of PC-1 PC-1-11---

Approval by the concern authority------

Upgradation of Nursing SchoolUpgradationDetail annexed1 5,100,000 --- 5,100,000 -

4Shortage of Vehicles

------

Purchase of 25 Seaters AC CoasterVehicle

3,800,000

1

3,800,000

--3,800,000

3,800,000

--3,800,000

5 Deficient equipment (with reference to notified list) at THQHs and DHQH Purchase of MNCH related equipment at DHQ Hospital MianwaliEquipment Detail Annexed 14,412,110--14,412,110

Purchase of MNCH related equipment at THQs Hospitals (Kalabagh, Piplan, Iesa Khail)Equipment Detail Annexed 53,327,690--53,327,690

67,739,800--67,739,800

Three Years Rolling Plan 2010-2013 District Mianwali

104

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

Budget Summary

2010-20112011-20122012-2013

Regular district budget136,169,95641,347,35756,074,164

Additional budget based on problem identification135,805,95640,946,95755,633,724

Total271,975,91282,294,314111,707,888

SECTION 5: MONITORING & EVALUATION

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

IndicatorsTarget % Achievement MoVResponsibilityFrequency of monitoringRemarks

% of planned supervisory visits conducted 50 visits /yearInspection Book/Attendance registerEDOH/DOH/ DDOH/Dist. Monitoring officerQuarterly

% of RHCs with availability of services (on rotational basis) of essential specialties (Physician, Surgeon, Paediatrician and Gynaecologist) 100%During 1st yearMovement register/visit book/Attendance registerEDOH / DOHQuarterly

% of health facilities with availability of essential MNCH related equipment (level specific)100%During 1st yearStock RegisterEDOH/ DOH/ MSs6 monthly

Availability of relevant (MNCH) laboratory equipment at appropriate level of care100%During 1st yearStock RegisterEDOH/ DOH/MSs, Store keeperQuarterly

% facilities with availability of essential medicines 100%During 1st yearStock RegisterEDOH/ DOH/ MSs, Store keeperMonthly

% of functional ambulances in the district100%(DHQH/ THQH/ RHCs)Log BookEDOH/DOH/ Transport officerQuarterly

% utilization of sanctioned budget100% of yearly budgetQuarterly ReportsEDOH/ DOH/ MSs/ Accounts officerQuarterly

% of facilities with availability of basic EmONC 100%(50% during 1st year)Supervisory visit reportEDOH/DoH/ DDOHQuarterly

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

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

% of targeted pregnant women newly registered by LHWTarget according to populationDHIS ReportEDOH/ Statistical OfficerQuarterly

% of targeted pregnant women received TT-2 vaccineTarget according to populationDHIS ReportEDOH/ DHIS Coordinator/ Statistical OfficerQuarterly

Delivery conducted by or under supervision of skilled persons reported 60 % During 1st yearDHIS ReportEDOH/ DHIS Coordinator/ Statistical OfficerQuarterly

%of target children between 18 - 23 months of age fully immunized Target according to populationDHIS ReportEDOH/ DHIS Coordinator/ Statistical OfficerQuarterly

% of referred cases attended100%DHIS Report/ LHWs monthly reportEDOH/ DHIS Coordinator/ Statistical OfficerQuarterly

% of targeted eligible couples provided knowledge and information on Family Planning methodsTarget according to populationLHWs monthly/ quarterly reportEDOH/ Statistical Officer /Coordinator NP-FP&PHCQuarterly

No. of meetings with participation from other sectors12 meetings per yearMinutes of meetingsEDOH/ Focal person/sQuarterly

Annex-IPrivate Health Facilities in District Mianwali

Sr. NoName of Hospital/Address

1P.A.E.C Hospital Chashma barrage Mianwali

2P.A.F Hospital Mianwali

3Al khidmat Hospital Mianwali

4Nishtar Polyclinic Mianwali

5Anwar Medical Complex Mianwali

6Al-Imran Hospital Mianwali

7Ubaid Noor Hospital Mianwali

8Al-Shafa Hospital Mianwali

9Fatima Hospital Mianwali

10Jinnah Hospital Mianwali

11Qaisar Eye Hospital Hafiz Wala Mianwali

12Tahir Hospital Hafiz Wala Mianwali

13City clinic piplan district Mianwali

14Abdul kareem kareem eye clinic Piplan

15Al-Mustafa Hospital Kalabagh

Annex-IICosting of MNCH related equipment gaps for DHQ and THQ HospitalsDHQ Hospital Mianwali

Sr. No.EquipmentGapUnit CostTotal Cost(Rs.)

1CTG (Cardiac Tocography)1285000 285,000

2Foetal Doppler310000 30,000

3Diagnostic Laparoscope11200000 1,200,000

4Bulb Sucker945 405

13Volselum forceps3235 705

14Lanes Tissue holding forceps2400 800

15Vaginal Retractors10350 3,500

19CosCo Speculum Small, Medium, Large (for each category)4550 2,200

20Examination light218000 36,000

22Infant Resuscitation Trolley (with life saving medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light)195000 95,000

23Mother Resuscitation Trolley (with life saving medicines, Laryngoscope, Endo-tracheal tube, BP Apparatus, Chargeable light)1110000 110,000

24Cardiac Monitor0500000 -

25Pump Breast Electronic1250000 250,000

26.5Hysterectomy Clamps (Straight)4150 600

26.14Single blade Sims speculum4275 1,100

26.15Double blade Sims speculum4250 1,000

26.17Volselum forceps1250 250

27.1Episiotomy Scissors6125 750

27.2Straight Scissors4360 1,440

27.3Needle holder4135 540

27.4Non-toothed tissue forceps 8 inches6100 600

27.5Toothed tissue forceps 8 inches6100 600

27.6Sims Speculum single blade18275 4,950

27.7Sims Speculum double blade18250 4,500

27.8Sponge holding forceps34250 8,500

27.12Towel clip10125 1,250

28.7Green Armtage forceps 8 inches6300 1,800

28.8Obstetric outlet forceps (pair)6900 5,400

28.9Doyenes Retractor2200 400

28.11Towel Clippers4125 500

29.50.5 MN Lead Apron. Lead Gloves, Goggles and Thyroid and Gonadal Sheets1100000 100,000

29.7X-RT Film Processing Tank15000 5,000

30.1Paediatric Ventilator11200000 1,200,000

30.4Over-head Radiant Warmer1910000 910,000

30.5Infant Length Measuring Scale25000 10,000

30.8Billiubino-meter136000 36,000

30.9Exchange Blood Transfusion Set12000 2,000

30.1Nasal Probe Paed size27000 14,000

31.6Airway Oral and Nasal2500 1,000

31.8Face mask of all sizes21000 2,000

31.9Double Cuff Tourniquet (for regional block)1320 320

31.12Red Rubber Nasal tubes all sizes without cuff41000 4,000

32.2Packed cell machine1600000 600,000

32.3Cell Separator15225000 5,225,000

32.4Freezer for Fresh Frozen Plasma11150000 1,150,000

32.6RH view box21000 2,000

32.7Water bath13000 3,000

32.8Micro-pipette48000 32,000

32.9Blood grouping tiles33000 9,000

32.1Plasma Extractor11000000 1,000,000

32.11Platelets agitator11000000 1,000,000

32.12Blood thawing bath13000 3,000

33.1Hematology Analyzer1425000 425,000

33.2Electrolyte Analyzer1625000 625,000

33.4Glucometer22500 5,000

33.5Haemoglobino-meter11000 1,000

Total cost of equipment 14,412,110

THQ Hospital Mianwali

Sr. No.EquipmentGapUnit CostTotal Cost (Rs.)

1CTG (Cardiac Tocography)3285,000855,000

2Foetal Doppler610,00060,000

3Diagnostic Laparoscope31,200,0003,600,000

4Bulb Sucker1545675

5Baby Warmer6850,0005,100,000

6Mechanical Sucker328,00084,000

8Delivery Table217,50035,000

9D&C Set32,1006,300

10Outlet forceps1290010,800

11Myoma Screw43201,280

12Kochers forceps62351,410

13Volselum forceps82351,880

15Vaginal Retractors103503,500

16Polypectomy forceps47503,000


19CosCo Speculum Small, Medium, Large (for each category)65503,300

20Examination light118,00018,000


22Infant Resuscitation Trolley (with life saving medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light)395,000285,000

23Mother Resuscitation Trolley (with life saving medicines, Laryngoscope, Endo-tracheal tube, BP Apparatus, Chargeable light)3110,000330,000

25Pump Breast Electronic3250,000750,000

26.5Hysterectomy Clamps (Straight)241503,600

26.6Hysterectomy Clamps (Curved)241754,200



26.9Needle Holder (10)43001,200

26.1Artery Forceps (Straight 6)361103,960

26.11Artery Forceps (Curved 6)361254,500

26.12Allis Forceps122302,760

26.13Towel Clamps151251,875

26.14Single blade Sims speculum102752,750

26.15Double blade Sims speculum102502,500

26.16Sponge holding forceps232004,600

26.17Volselum forceps112502,750

26.18Uterine Sound51,5007,500

26.19Bladder Sound61,5009,000

27.1Episiotomy Scissors171252,125

27.2Straight Scissors173606,120

27.4Non-toothed tissue forceps 8 inches171001,700

27.5Toothed tissue forceps 8 inches171001,700

27.6Sims Speculum single blade362759,900

27.7Sims Speculum double blade362509,000

27.8Sponge holding forceps11925029,750

27.9Artery forceps272757,425

27.1Straight clamps (cord)541759,450

27.11Vacuum Extractor pump219,00038,000

27.12Towel clip641258,000

28.2Artery Forceps Straight 6 inches421255,250

28.3Artery Forceps Curved 6 inches421255,250

28.4Artery forceps 8 inches421757,350

28.5Myoma Scissors straight 7 inches111501,650

28.6Dissecting scissors (curved) 7 inches112702,970

28.7Green Armtage forceps 8 inches4830014,400

28.8Obstetric outlet forceps (pair)1290010,800

28.9Doyenes Retractor112002,200

28.1Small Retractors233006,900

28.11Towel Clippers451255,625

28.12Suction Nozzle102502,500

29.9X-Ray film Illuminator24,0008,000

30.1Paediatric Ventilator31,200,0003,600,000

30.2Incubator11,500,0001,500,000

30.3Photo Therapy Unit122,00022,000

30.4Over-head Radiant Warmer3910,0002,730,000

30.5Infant Length Measuring Scale65,00030,000

30.6Infant Weighing Machine43,10012,400

30.8Billiubino-meter336,000108,000

30.9Exchange Blood Transfusion Set32,0006,000

30.1Nasal Probe Paed size37,00021,000

31.2Ventilators2525,0001,050,000

31.3Nebulizer3165,000495,000

31.4Pulse Oximetry321,00063,000

31.5Defibrillator2500,0001,000,000

31.7Tracheostomy tube (adult and paeds)31,0003,000

31.8Face mask of all sizes31,0003,000


31.1AMBO bag adult22,4504,900

31.11AMBO Bag paeds53,00015,000

31.12Red Rubber Nasal tubes all sizes without cuff121,00012,000

32.2Packed cell machine3600,0001,800,000

32.3Cell Separator35,225,00015,675,000

32.4Freezer for Fresh Frozen Plasma31,150,0003,450,000

32.5Blood bag shaker210,00020,000

32.6RH view box31,0003,000

32.7Water bath43,00012,000

32.8Micro-pipette48,00032,000

32.9Blood grouping tiles113,00033,000

32.1Plasma Extractor31,000,0003,000,000

32.11Platelets agitator21,000,0002,000,000

32.12Blood thawing bath33,0009,000

33.1Hematology Analyzer3425,0001,275,000

33.2Electrolyte Analyzer3625,0001,875,000

33.3Analyzer Bio-chemistry Semi-automatic3690,0002,070,000

Total cost of equipment(All THQs)53,327,690

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