Three Years Rolling Plan 2010-2013 District Toba Tek Singh

THREE YEARS ROLLING PLAN 2010-2013 DISTRICT TOBA TEK SINGH

1 Three Years Rolling Plan 2010-2013 District Toba Tek Singh

Table of Contents

Acronyms 3YRP Three Years Rolling plan ADB Asian Development Bank APMO Additional Principal Medical Officer ARI Acute Respiratory Infections BHU Basic Health Center BoD Burden of Dieses CDC Communicable Disease Control CDR Case Detection Rate CPR Contraceptive Prevalence Rate DHIS District Health Information System DHQH District Head Quarter Hospital DoH Department of Health DR Default Rate EDO(H) Executive District Officer Health EPI Expended Program on Immunization HSRP Health Sector Reforms Program IMR Infant Mortality Rate IPC Interpersonal Communication M & E Monitoring and Evaluation M & E Maintenance and Repair MCH Maternal Child Health MMR Maternal Mortality Ratio MNCH Maternal Newborn and Child Health MO Medical Officer MoV Means of Verification MSDS Minimum Service Delivery Standards PDSSP Punjab Devolved Social Services PHC PrimaryProgram Health Care PMO Principal Medial Officer POL Petrol, Oil and Lubricant RHC Rural Health Center 2 Three Years Rolling Plan 2010-2013 District Toba Tek Singh SCR Sputum Conversion Rate SHC Secondary Health Care SMO Senior Medical Officer TAMA Technical Assistance Management TB TuberculosisAgency THQH Tehsil Head Quarter Hospital TNA Training Need Assessment WHO World Health Organization WMO Women Medical Officer

Executive Summary

Prior to devolution, planning process was carried out at provincial level. Districts were supposed to implement plans and programs developed/designed at provincial and federal levels. Devolution brought a paradigm shift where planning became a district responsibility. This change provided an opportunity to the district at one hand and challenge on other due to their limited capacity in planning and budgeting. Planning focus also changed from short term to medium term planning recognizing the flexibility /adaptability it provided. Government envisions that medium term plan .i.e. 3YRP will be instrumental in using health resources effectively and efficiently through adapting Minimum Service Delivery Standards (MSDS) as the strategy to achieve objectives of MDGs.

Districts have been preparing 3YRP (medium term plan) for last few years under the auspices/patronage of Department of Health (DoH) Government of Punjab through technical assistance of Punjab Devolved 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 4 Three Years Rolling Plan 2010-2013 District Toba Tek Singh 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.

Toba Tek Singh

SECTION 1: DISTRICT HEALTH PROFILE

Vision of the District

The District Health Government Toba Tek Singh is looking to provide efficient “Health Care Delivery Services” through 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 Toba Tek Singh district.

Mission of the District

6 Three Years Rolling Plan 2010-2013 District Toba Tek Singh The District Health Government Toba Tek Singh 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 92% of the targets.

Background of the District

 Geographical location: Toba Tek Singh has district Faisalabad on the north-east side, district Jhang on the west, Khanewal on the north, and Sahiwal on the south-east side.  Communication linkages: A large network of roads is present, which links different parts of the district with each other, and connects the district to other districts as well. Toba Tek Singh is connected with other districts through railway line as well.

 Topography: District Toba Tek Singh enjoys four natural seasons (spring, summer, winter, autumn). Most of the land in the district is suitable for agricultural purposes. However the border area along with district Jhang is sandy and not suitable for cultivation.

 Source of livelihood: 82% population of the district resides in rural Areas and depends upon agriculture; while 18 % of urban population depends upon businesses and services for their livelihood.

Map of the District

Demography o Total Population 2085795

o Total Area 3259 square kilometers

o Annual growth rate 2.12%

o Population density 640 persons per sq. km

Area-wise population

Area Population Percentage

Rural 1693630 81.20

Urban 392165 18.80

Source: Standard Demographic population groups based on DHIS

Gender-wise population 8 Three Years Rolling Plan 2010-2013 District Toba Tek Singh Gender Population Percentage

Male 1085239 52

Female 1000556 48

Source: Standard Demographic population groups based on DHIS

Population groups

Standard Estimated Population Groups Demographic (%) Population

Under 1 year of age 2.7 56316

Under 5 years 13.4 279497

Under 15 years 44 917750

Women in child bearing age (15-49 years) 22 458875

Married Child Bearing age Women 16 333727

Expected pregnancies 3.4 70917

Standard Demographic population groups based on DHIS

Tehsil wise distribution

Tehsil Number of UC Population

Gojra 24 63453

Toba Tek Singh 32 793987

Kamalia 26 656355

Ethnic groups and languages

The main ethnic groups in the district are Arain, Jat, Awan, Sial, Khiral, Pathan. Punjabi and Urdu are the main languages spoken in the district.

Socio-Economic Indicators

Education and Literacy

Literacy rate Male Female

Urban 38% 32%

Rural 30% 19%

Overall District 68% 51%

Source: EDO Literacy and Informal Education

Health Indicators

 Infant Mortality Rate 34 /1000

 Neonatal mortality Rate 15 /1000 Live births

 Under 5 mortality Rate 38/1000 Live births

 Maternal mortality Ratio 104 /100000

 Malnutrition (women and children) 35 %

 Life expectancy 60-70 years

 Proportion of children under 1 years immunized 84%

against measles

Source: EDO (Health) Office Toba Tek Singh

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 Facilities a) Public Details of physical infrastructure of public health facilities in the district is given in the table below

No. of Bed Facility Type Name/Number of Facility Functional Remarks Strength Beds

DHQ Hospital DHQ Hospital Toba Tek Singh 125 125 -----

THQ Hospital Gojra 150 150 ---- THQ Hospital THQ Hospital Kamalia 110 110 ----

Chak No.338/JB Nia Lahore 20 20 -----

Chak No.740/GB 20 20 -----

Pir Mahal 20 20 ----- RHCs Chak No.316/GB Chatiana 20 20 -----

Chak No.394/JB Jaja 20 20 -----

Rajana 20 20 -----

BHUs 66 Basic Health Units 132 132 -----

12 Three Years Rolling Plan 2010-2013 District Toba Tek Singh No. of Bed Facility Type Name/Number of Facility Functional Remarks Strength Beds

Govt. Rural Nil ------Dispensaries

MCH Centers 3 MCH Centers ------

Sub Health 20 Sub health centers ------Centers

TB Clinics TB Clinic Toba Tek Singh ------

Data source: DHIS/EDOH office

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

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

a) Administrative

b) Facility based

c) Outreach

d) Training institutions

13 Three Years Rolling Plan 2010-2013 District Toba Tek Singh a) Administrative Sr. Name of Post Sanctioned Filled No.

1 Executive District Officer Health 01 01

2 District Officer Health 01 01

3 Deputy District Officer Health 03 03

4 Program Director DHDC 01 01

5 District Coordinator National Program 0 01

6 District Coordinator EPI Surveillance 0 01

7 District Sanitary Inspector 01 0

8 CDC Officer 01 01

9 CDC Inspector 03 0

10 Drug Inspector 06 05

11 District Superintendent Vaccination 01 01

12 Assistant Superintendent Vaccination 06 06

13 Tehsil Sanitary Inspector 02 01

14 Inspector Vaccination 06 06

b) Facility Based

i. Basic Health Units (66) Sr. No Name of Post/Designation Sanctioned Filled Vacant .

1 Medical Officer 66 50 16

School Health & Nutrition 2 66 0 66 Supervisor

3 Medical Assistant 07 03 04

4 Computer Operator 66 0 66

6 LHV 66 66 0 14 Three Years Rolling Plan 2010-2013 District Toba Tek Singh

7 Dispenser 66 66 0

8 Midwife 66 65 1

9 N/Qasid 66 66 0

1 Chowkidar 66 66 0 0

1 Sanitary Worker 66 66 0 1

ii. Rural Health Centres (6) Sr. No Name of Post/Designation Sanctioned Filled Vacant .

1 Senior Medical Officers 6 6 0

2 Women Medical Officers 6 3 3

3 Dental Surgeons 6 6 0

4 Medical Officers 6 4 2

5 Charge Nurses 36 28 8

6 Computer Operators 6 6 0

7 Homeo Doctors 3 2 1

8 Hakeems 2 2 0

9 Dental Tech. 6 6 0

10 Lab Tech. 6 4 2

11 LHV 12 12 0

15 Three Years Rolling Plan 2010-2013 District Toba Tek Singh Sr. No Name of Post/Designation Sanctioned Filled Vacant .

12 Senior Clerk 6 5 1

13 RHI 18 18 0

14 Dresser 6 6 0

15 OTA 6 1 5

16 Anesthesia Assistant 6 0 6

17 Radiographer 6 6 0

18 Dispenser 24 24 0

19 Homoeo Dispenser 3 2 1

20 Dawasaz 2 2 0

21 Lab. Assistant 6 5 1

22 Driver 7 7 0

23 Tubewell Operator 6 6 0

24 Midwife 24 18 6

25 Ward servant (M/F) 12 12 0

26 Naib Qasid 24 24 0

27 Water Carrier 6 6 0

28 Sanitary Worker (M/F) 24 21 3

29 Cook 2 2 0

30 Chowkidar 12 12 0

31 Mali 6 6 0

32 Dawakob 2 2 0

iii. THQ Hospital Kamalia Sr. No. Name of post Sanctioned Filled

1. Medical Superintendent 1 1

16 Three Years Rolling Plan 2010-2013 District Toba Tek Singh Sr. No. Name of post Sanctioned Filled

2. APMO/APWMO 3 1

3. Surgeon 1 0

4. Gynecologist 2 1

5. Child specialist 1 1

6. ENT Specialist 1 1

7. Radiologist 1 0

8. Pathologist 1 0

9. Anesthetist 1 0

10. Physician 1 0

11. SMO 4 2

12. MO 12 7

13. WMO 6 1

14. Dental Surgeon 1 1

15. Pharmasist 1 1

16. Head Nurse 1 1

17. Charge Nurse 16 15

18. Refractionist 1 1

19. Hakeem 1 1

20. Homeo Doctors 1 1

21. Dental Tech. 1 0

22. LHV 1 1

23. Data Entry Operator 1 0

24. Statistical Assistant 1 0

25. Lab Tech. 1 1

26. Accountant 1 1

27. Junior Clerk 2 0

28. Radiographer 2 2

29. Dispenser 8 8

30. OTA 2 1

17 Three Years Rolling Plan 2010-2013 District Toba Tek Singh Sr. No. Name of post Sanctioned Filled

31. Dawasaz 1 0

32. Store Keeper 2 0

33. Lab. Asst 2 1

34. Driver 2 2

35. Tube well Operator 1 1

36. Mid wife 2 1

37. Ward Servant 10 9

38. Sanitary Worker 12 10

39. Mali 2 2

40. Gate Keeper 1 1

41. Dhobi 1 1

42. Dawakob 1 0

43. Dai 2 1

44. Cook 2 1

45. Chowkidar 2 2

46. Naib Qasid 2 2

47. Mashki 1 1

48. Bearer 1 1

49. Baildar 3 2

50. Masalachi 1 1

iv. Govt. Eye cum General Hospital Gojra( THQ Hospital)

S# Name of post Sanctioned Filled

18 Three Years Rolling Plan 2010-2013 District Toba Tek Singh S# Name of post Sanctioned Filled

2. Deputy Medical Superintendent 1 1

3. APMO. 2 1

4. APWMO. 2 0

5. Chief Consultant Pediatrician 1 1

6. Senior Consultants 2 1

7. Surgeon 1 1

8. Physician 1 0

9. Gynecologist 3 1

10. Anesthetist 1 1

11. Eye Surgeon/Specialists 2 1

12. E.N.T Surgeon / Specialist 2 1

13. Pathologist 1 0

14. Radiologist 1 0

15. Paediatrician 1 0

16. SMO 4 4

17. SWMO 3 0

18. Senior Dental Surgeon 1 1

19. MOs 12 7

20. WMOs 6 3

21. Blood Transfusion Officer 1 1

22. Hospital Pharmacist 1 1

23. Head Nurse 2 2

25. Charge Nurse 17 17

26. Homeo Doctor 1 1

27. Hakeem 1 1

28. LHV 1 1

29. Senior Store Keeper 1 1

31. E.C.G Tech. 1 1

32. Lab. Tech 1 1

33. Senior Clerk Cum Accountant 1 1

34. Ophthalmic Tech. 2 0

36. Dispensers 7 7

37. Dresser 1 1

38. Homeo Dresser 1 1

39. Dawasaaz 1 1

41. X-ray Assistant 1 1

42. OT Assistant 1 1

43. Dark Room Assistant 1 1

44. Lab Assistant 2 2

45. Lab Assistant (Blood Bank) 3 0

46. Drivers 1 1

47. Nurse Dai 1 0

48. X-ray Attendant 1 1

49. O.T Attendant 1 1

50. Tube Well Operator 1 1

51. Tailor 1 1

52. Laboratory Attendant (Blood Bank) 1 1

53. Dawakob 1 1

54. Ward Servants (M&F) 18 18

55. Naib Qasid 1 1

56. Water Carrier 1 1

57. Chowkidar 2 2

58. Mali 1 1

59. Sanitary Worker/ Sweepers (M&F) 15 13

60. Bearer 1 1

61. Bearer (Blood Bank) 1 1

62. Gate Keeper 3 3

63. Cook 2 2

64. Dhobi 2 2

65. Baildar 2 2

v. DHQ Hospital

Sr. No Name of post Sanctioned Filled

2. Deputy Medical Superintendent 3 1

3. Chief Consultant 1 0

4. Senior Consultant 2 1

5. Principal Dental Surgeon 1 1

6. APMO 4 2

7. APWMO 3 2

8. ENT Surgeon 1 1

9. Gynecologist 3 3

10. Cardiologist 1 1

11. Surgeon 1 1

12. Pathologist 1 0

21 Three Years Rolling Plan 2010-2013 District Toba Tek Singh Sr. No Name of post Sanctioned Filled

13. Anesthetist 1 1

14. Physician 1 1

15. Ophthalmologist 1 1

16. Pediatrician 1 1

17. Radiologist 1 1

18. Orthopedic Surgeon 1 1

19. SWMO 9 0

20. SMO 13 3

21. Dental Surgeon 1 1

22. WMO 3 3

23. MO/CMO 7 7

24. Physiotherapist 1 0

25. Pharmacist 1 0

26. Head Nurse 2 2

28. Charge nurse 15 15

29. Homoeo Doctor 1 1

30. Hakim 1 1

31. Head Clerk 1 1

32. Senior Clerk 1 1

34. LHV 2 2

35. Lab. Tech. 1 1

37. ECG Tech. 1 1

38. Ophthalmic Tech. 4 0

39. Dispenser / Dresser 10 10

40. Homeo Dispenser 1 1

41. Dawasaz 1 1

43. Operation theater Asst. 1 1

44. Laboratory Assistant 3 3

45. Store Keeper 1 1

46. Dark Room Assistant 1 1

47. Midwife 1 0

48. Drivers 3 3

49. Operation Theater Attendant 1 1

50. Tailor Master 1 1

51. Tube well Operator 1 1

52. Lab. Attendant 1 1

53. Aya 1 1

54. X-ray Attendant 1 1

55. Dai 1 1

56. Bearer 1 1

57. Dawakob 1 1

58. Cook 2 2

59. Ward Servant (M&F) 22 20

60. Gate Keeper 3 3

61. Chowkidar 3 3

62. Naib Qasid 3 3

63. Beldar 2 2

64. Mali 2 1

65. Water Carrier 2 2

66. Dhobi 2 2

67. Sanitary Worker (M&F) 21 20

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

Post Sanctioned Filled

Vaccinators 76 73

CDC Supervisors 55 43

Sanitary Inspectors 66 28

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

Type of institute Number DHDC 1 General Nursing school 2

i. DHDC Post Sanctioned Filled

Programme Director 1 1

MPPT 1 1

LHV Trainer 1 1

Assistant 1 1

Driver 1 1

Naib Qasid 1 1

Chowkidar 2 2

Sanitary Worker 1 1

ii. General Nursing School

25 Three Years Rolling Plan 2010-2013 District Toba Tek Singh Name of Post/Designation Sanctioned Filled

Principal School of Nursing 2 1

Nursing Instructor 6 2

House Keeper 2 1

Sweeper 3 3

Naib Qasid 2 2

Chowkidar/Gate Keeper 8 8

Cook 6 6

Masalchi 0 0

iii. General Nursing School General Hospital Gojra

Name of Post/Designation Sanctioned Filled

Principal School of Nursing 2 1

Nursing Instructor 6 2

House Keeper 2 1

Sweeper 3 3

Naib Qasid 2 2

Chowkidar/Gate Keeper 8 8

Cook 6 6

Masalchi Nil Nil

Health Financing The provision of financial resources at district level is prime responsibility of district government. However, keeping in view the budget constraints at the district level, federal and provincial governments also augment financial resources in form of kind and cash, through different programs. Financial resources of the district during the last three years out of different sources are given as under:

Rs. Million

2007-08 2009-10 up to 02/2010 Source of funding E Allocation x Allocation Exp. Allocation Exp. p.

Non-Development 366.796 36 409.137 415.098 528.733 325.459 1. 79

1. Development 2.537 56 35.613 12.728 34.600 11.770 3

36 3. Sub Total 369.333 444.75 427.826 563.333 337.299 35 5

PHSRP 13.400 - 25.000 18.597 6.403 -

PMDGP - - 90.080 15.043 75.037 38.725

PDSSP - - 15.694 7.706 6.088 3.012

Provincial Development Nil Nil Nil Nil Nil Nil Funds (ADP)

3 6 3. Grand Total 382.733 575.524 469.172 650.861 379.036 3 5 5

User charges (like parchi --- fee, fees for diagnostic 3.969 5.469 --- 4.177 ---- - services)

28 Three Years Rolling Plan 2010-2013 District Toba Tek Singh Disease Pattern The disease pattern is determined through regular and periodic reporting through surveys and studies. Punjab health department has adopted DHIS as regular reporting mechanism to collect information on diseases and other variables. Currently, DHIS is in transitional stage, and is establishing itself as a tool to be used for evidence based planning and management. The following trend of the diseases has been taken from the consolidated DHIS reports that include reports from PHC and SHC facilities.

Disease Group No of Patients Percentage

Respiratory disease

1 Acute (upper) respiratory infections 570164 39.55

2 Pneumonia < 5 yrs. 23804 1.65

3 Pneumonia > 5 yrs. 30424 2.11

4 TB Suspects 18780 1.30

5 Chronic Obstructive Pulmonary 17504 1.21 Disease

6 Asthma 58416 4.05

Gastro Intestinal Disease

7 Diarrhea / Dysentery < 5 yrs 37352 2.59

8 Diarrhea / Dysentery > 5 yrs 41796 2.90

9 Enteric / Typhoid Fever 5980 0.41

10 Worm Infestations 17668 1.23

11 Peptic Ulcer Disease 79640 5.52

12 Cirrhosis of Liver 2604 0.18

Urinary Tract Diseases

13 Urinary Tract Infections 33984 2.36

14 Nephritis / Nephrosis 1668 0.12

15 Sexually Transmitted Infections 2224 0.15

16 Benign Enlargement of Prostrate 1368 0.09

Other Communicable Diseases

17 Suspected Malaria 20388 1.41

29 Three Years Rolling Plan 2010-2013 District Toba Tek Singh Disease Group No of Patients Percentage

18 Suspected Meningitis 368 0.03

19 Fever due to other causes 59596 4.13

Vaccine Preventable Diseases

20 Suspected Measles 144 0.01

21 Suspected Viral Hepatitis 4140 0.29

22 Suspected Neonatal Tetanus 540 0.04

Cardiovascular Diseases

23 Ischemic heart disease 5628 0.39

24 Hypertension 77812 5.40

Skin Diseases

25 Scabies 101180 7.02

26 Dermatitis 45352 3.15

27 Cutaneous Leishmaniasis 0 0.00

Endocrine Diseases

28 Diabetes Mellitus 64552 4.48

Neuro-Psychiatric Diseases

29 Depression 7408 0.51

30 Drug Dependence 1728 0.12

31 Epilepsy 856 0.06

Eye & ENT

32 Cataract 9884 0.69

33 Trachoma 6144 0.43

34 Glaucoma 5384 0.37

35 Otitis Media 20304 1.41

Oral Diseases

36 Dental Caries 39240 2.72

30 Three Years Rolling Plan 2010-2013 District Toba Tek Singh Disease Group No of Patients Percentage

Injuries / Poisoning

37 Road traffic accidents 18872 1.31

38 Fractures 1492 0.10

39 Burns 3900 0.27

40 Dog bite 3196 0.22

41 Snake bite (with signs/symptoms of 36 0.002 poisoning)

Miscellaneous Diseases (Surveillance Importance)

42 Acute Flaccid Paralysis 0 0

43 Suspected HIV/AIDS 0 0

Total 1441520 100

44 Any other Unusual disease (specify)

Source: DHIS Report

Status of Vertical Programs The following paragraphs depict the current status of the program being implemented in the district. The indicators and their values have been taken from the program reports.

1. National Program for FP & PHC  No. of seats allocated for LHWs 1500  No. of LHWs working 1289  No of Lady Health Supervisors allocated 60  No. of LHS working 50  Percentage of Population covered by the program No. of LHWs Area Population Percentage

200 Urban 195110 52%

1089 Rural 1141264 69%

 Important program indicators

31 Three Years Rolling Plan 2010-2013 District Toba Tek Singh o IMR 32/1000

o MMR 98/100,000

o CPR 42%

o No. of antenatal visits 87% (8881 in March 2010)

o TT Coverage of pregnant women 92% 2. EPI  EPI Coverage rate of the district o Based on program information 99% o Based on third party validation -  Fully immunized children 0-23 months 92.72%  Pregnant women received TT vaccine 79  Availability of cold chain equipment Available o ILR 93

o Deep Freezer 23

o Refrigerator 68

o Cold Boxes 14

o Vaccine Carrier 270

3. MNCH Program  1st batch of 33 CMWs passed out &have been deployed.

 2nd batch of 24 CMWs have appeared in the exams and waiting for results and attached to the nearest DHQ/THQ/RHCs for skills improvement

 3rd batch of 32 CMWs is under 6 Month practical training at health facilities. w.e.f. 01- 04-2010

 4th batch of 30 are under training GNS Sargodha w.e.f.1-4-2010.

 WMOs working at RHCs = 6

 Vacant Seats of WMOs at RHCs = 5

 LHVs working at all RHCs = 05

32 Three Years Rolling Plan 2010-2013 District Toba Tek Singh 4. TB Control Program  CDR all types 71.49%

 CDR NSS positive 76%  SCR 90.03%  TSR 90%  DR 2.14%

5. Malaria Control Program  No. of slides examined 36950

 No. of positive slides Nil

 Slides positivity ratio Nil

 Percentage of plasmodium falciparum Nil

6. Hepatitis Control Program The statistics shown below are from July 2009 to April 2010

 No. of hepatitis tests conducted 4750  No. of positive cases detected 1612  No. of cases treated for Hepatitis B 58  No. of cases treated for Hepatitis C 944  No of patients on treatment for Hepatitis C 268  No of patients on treatment for Hepatitis B Nil  No of patients awaiting treatment for Hepatitis C 400

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 34 Three Years Rolling Plan 2010-2013 District Toba Tek Singh  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 Process Plan development has been a systematic and consultative process. A core planning team consisting of EDO (H), DOH, MS DHQ and THQs, Statistical officer, and Budget and Accounts Officer, was designated by Director General Health Services Punjab. This team received three days customized training from SP-09 team at divisional 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 Identification This step involved assessment of the current situation from various perspectives to establish the actual health situation in terms of health and service delivery/management problems. Problem identification is based on the district health profile, review of previous plans, MIS (DHIS, Program reports and periodic reports etc.), District specific surveys (MICS), MSDS, and national and provincial policy guidelines.

The district planning team held meetings and started with identification of problem using the training received from SP-09 team and consulting the above mentioned documents. The problems identified were broadly divided into two categories i.e.

a) Health Problems

b) Health Service Delivery or Management Problems

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

1. Acute respiratory tract infections (ARI) 2. Skin Diseases (Scabies) 3. Diarrheal Diseases

4. Acid Peptic Disease 5. Enteric Fever 6. Diabetes Mellitus

7. Asthma 8. High under 5 Mortality 9. High Maternal Mortality 10.Dental Caries 11.Hepatitis 12.Road side accident & injuries 13.Anemia 14.Pulmonary Tuberculosis 15.Ischemic Heart diseases

16.Suspected Malaria 17.UTI 18.Hypertension 19.Worm infestation Problem Prioritization WHO has developed standard criteria for prioritization of health problems; which is based on the following five elements:

 Magnitude  Severity/danger  Vulnerability to intervention (feasibility) 36 Three Years Rolling Plan 2010-2013 District Toba Tek Singh  Cost-effectiveness of the intervention  Political expediency

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

Problem Magnitude Severity Vulnerability Cost Political Total Priority to intervention Effective Expediency Score Number ness

ARI (under 5) 4 3 4 3 2 16 3

Scabies 3 1 3 4 1 12 7

Diarrheal 3 3 4 3 2 15 4 Diseases

Acid Peptic 3 1 3 2 1 10 10 Disease

Enteric Fever 3 2 2 2 1 10 9

Diabetes 2 2 2 2 1 9 13 Mellitus

Asthma 2 2 2 2 1 9 15

High under five 4 3 4 3 3 17 2 mortality

High maternal 4 4 4 3 3 18 1 mortality

Dental Caries 2 2 2 2 1 9 14

Hepatitis 3 3 2 3 2 13 6

Road side accidents & 3 2 2 2 2 11 8 Injuries

Anemia (including in 3 3 3 3 2 14 5 pregnancy)

Pulmonary 2 2 2 1 1 8 19 Tuberculosis

37 Three Years Rolling Plan 2010-2013 District Toba Tek Singh Problem Magnitude Severity Vulnerability Cost Political Total Priority to intervention Effective Expediency Score Number ness

Ischemic Heart 3 2 2 2 1 10 11 diseases

Suspected 2 2 2 1 1 8 17 Malaria

UTI 2 2 2 1 1 8 18

Hypertension 2 2 2 2 1 9 16

Worm 1 1 3 3 1 9 12 infestation

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

Sr.# Health Problem Causes

1 High Maternal  Poor access to healthcare delivery services Mortality  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)

 Capacity Issues related to maternal care

 Maternal Anemia

38 Three Years Rolling Plan 2010-2013 District Toba Tek Singh Sr.# Health Problem Causes

2 High under 5  Poor antenatal natal and post natal coverage Mortality  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 3 ARI (under 5)  Malnutrition

 Air contamination

 Over-crowding/Poor housing facilities

 Lack of proper sanitation

 Seasonal variation

 Lack of awareness and hygienic practices

4 Diarrhoeal  Poor Sanitation diseases  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 39 Three Years Rolling Plan 2010-2013 District Toba Tek Singh Sr.# Health Problem Causes

5 Anaemia (in  Lack of awareness about balanced diet pregnancy)  Gender discrimination

 Social taboos and norms

 Worm infestation

 Infections

 Poor quality of MNCH services 6 Hepatitis  Poor sanitation

 Unsafe drinking water

 Sharing of used syringes

 Transfusion of unsafe blood and blood products

 Unsafe sexual practices

 Ear piercing and tattooing

 Use of unsterilized equipment by dentists and barbers 7 Accidents and  Lack of traffic sense Injuries  Poor maintenance of vehicles

 Poor road conditions

 Lack of safety measures at work place

 Fire-arm injuries

 Domestic accidents

 Burns

 Bomb blasts/terrorist activities

 Lack of tolerance in the society

8 Scabies  Lack of awareness  Unhygienic practices  Over-crowding/Poor housing facilities  Poor water and sanitation  Seasonal variation

40 Three Years Rolling Plan 2010-2013 District Toba Tek Singh Service delivery/Management problems

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

Sr.No Management / Service Problems

1 Shortage of human resource

2 Inadequate budget for POL

3 Shortage of infrastructure for:

i. EDOH & DDOH (Gojra)Offices

ii. Residences of PD DHDC , DDOH (Head Quarter)and DDOH ,Drug Inspector, Tehsil Sanitary Inspector& Staff (Gojra),

iii. Conference room(50x30 feet) for DHQH

iv. 2 -Store rooms (25x17 feet) for DHQH

v. DHO office cold chain store

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

5 Lack of office equipment

i. DHIS Strengthening

ii. Others

41 Three Years Rolling Plan 2010-2013 District Toba Tek Singh MDGs and MSDS

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

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

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

Hospital Category Bed Strength

A 400 and above Beds DHQ Hospital B 251-400 Beds C Up to 250 Beds A Above 60 Beds THQ Hospital B 41-60 Beds C Up to 40 Beds

42 Three Years Rolling Plan 2010-2013 District Toba Tek Singh i. DHQ Hospital (Category C)

Sr. Post Standar Sanctione Fille Vacancy Vacancy No. d as per d d Gap in Gap in MSDS relation relation to to filled sanctione positions d positions

1 Gynaecologist 3 3 3 0 0

2 Paediatricians 3 1 1 2 2

3 Anesthetists 3 1 1 2 2

4 Medical Officers 74 25 13 49 61 including SMO,APMO & PMOs

5 Women Medical 27 15 5 12 22 Officers including SWMO, APWMO &PMOs

6 Lady Health 11 2 2 9 9 Visitors

7 Nurses 75 17 17 58 58

ii. THQ Hospital Gojra (Category A)

Sr. Post Standard Sanctione Filled Vacancy Vacancy No. as per d Gap in Gap in MSDS relation relation to to filled sanctione positions d positions

2 Paediatricians 3 1 1(workin 2 2

43 Three Years Rolling Plan 2010-2013 District Toba Tek Singh Sr. Post Standard Sanctione Filled Vacancy Vacancy No. as per d Gap in Gap in MSDS relation relation to to filled sanctione positions d positions

g as chief consultan t)

5 Women Medical 11 10 4 1 7 Officers including SWMO APWMO & PMOs

7 Nurses 30 19 19 11 11

iii. THQ Hospital Kamalia (Category A)

Sr. Post Standard Sanctione Filled Vacancy Vacancy No. as per d Gap in Gap in MSDS relation to relation sanctione to filled d positions positions

2 Paediatricians 3 1 1 2 2

44 Three Years Rolling Plan 2010-2013 District Toba Tek Singh Sr. Post Standard Sanctione Filled Vacancy Vacancy No. as per d Gap in Gap in MSDS relation to relation sanctione to filled d positions positions

5 Women Medical 11 7 1 4 10 Officers including SWMO APWMO & PMOs

7 Nurses 30 17 16 13 14

b) Equipment Government 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.

45 Three Years Rolling Plan 2010-2013 District Toba Tek Singh i. DHQ Hospital Sr. Equipment Standard Available Gap Remarks No. as per MSDS

(Qty.)

1 CTG (Cardiac 1 1 2 1 Tocography)

2 Foetal Doppler 3 5 5 3

3 Diagnostic 1 1 2 1 Laparoscope

4 Bulb Sucker 1 2 2 10 0 0 0

5 Baby Warmer 3 3 6 2

6 Mechanical Sucker 3 3 6 2

7 Fetal Stethoscope 4 4 4 4

8 Delivery Table 2 2 3 1

9 D&C Set 2 3 4 1

10 Outlet forceps 4 4 4 2

11 Myoma Screw 2 2 2 2

12 Kochers forceps 4 4 8 3

13 Volselum forceps 6 8 1 4 0

14 Lanes Tissue holding 2 2 4 2 forceps

15 Vaginal Retractors 1 1 1 10 0 0 0

16 Polypectomy forceps 2 2 2 2

17 Sponge holder 1 1 2 7 0 5 0

46 Three Years Rolling Plan 2010-2013 District Toba Tek Singh Sr. Equipment Standard Available Gap Remarks No. as per MSDS

(Qty.)

18 Uterine elevator 1 1 1 1

19 Cusco Speculum 6 1 1 0 0 0 Small, Medium, Large (for each category)

20 Examination light 3 3 6 1

21 Suction Curette 1 2 2 1

22 Infant Resuscitation 1 1 2 1 Trolley (with life saving medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light)

23 Mother 1 1 2 1 Resuscitation Trolley (with life saving medicines, Laryngoscope, Endo- tracheal tube, BP Apparatus, Chargeable light)

24 Cardiac Monitor 1 1 2 1

25 Pump Breast 1 1 1 1 Electronic

26 Vaginal 2 2 4 Hysterectomy Set

26.1 Toothed Tissue 2 2 4 2 Forceps (8”)

(Qty.)

26.2 Non-Tooted Tissue 2 2 4 2 Forceps (8”)

26.3 Dissection Scissors 2 2 4 2 (Curved 7”)

26.4 Dissection Scissors 2 2 4 2 (Straight 7”)

26.5 Hysterectomy 8 8 1 5 Clamps (Straight) 6

26.6 Hysterectomy 8 8 1 5 Clamps (Curved) 6

26.7 Uterine Sound 2 2 4 2

26.8 Needle Holder (7”) 2 2 4 0

26.9 Needle Holder (10”) 2 2 4 1

26.1 Artery Forceps 1 1 3 13 0 (Straight 6”) 6 6 2

26.1 Artery Forceps 1 1 3 13 1 (Curved 6”) 6 6 2

26.1 Allis Forceps 8 8 1 2 2 6

26.1 Towel Clamps 8 8 1 6 3 6

26.1 Single blade Sims 4 4 8 4 4 speculum

26.1 Double blade Sims 4 4 8 2 5 speculum

26.1 Sponge holding 8 8 1 6 6 forceps 6

(Qty.)

26.1 Volselum forceps 4 4 8 3 7

26.1 Uterine Sound 2 2 4 2 8

26.1 Bladder Sound 2 2 4 2 9

27 Delivery Sets 1 1 1 0 0 5

27.1 Episiotomy Scissors 1 1 1 8 0 0 5

27.2 Straight Scissors 1 1 1 7 0 0 5

27.3 Needle holder 1 1 1 7 0 0 5

27.4 Non-toothed tissue 1 1 1 10 forceps 8 inches 0 0 5

27.5 Toothed tissue 1 1 1 8 forceps 8 inches 0 0 5

27.6 Sims Speculum 2 2 3 20 single blade 0 0 0

27.7 Sims Speculum 2 2 3 14 double blade 0 0 0

27.8 Sponge holding 4 4 6 34 forceps 0 0 0

27.9 Artery forceps 4 4 6 30 0 0 0

(Qty.)

27.1 Straight clamps 2 2 3 14 0 (cord) 0 0 0

27.1 Vacuum Extractor 1 1 1 1 1 pump

27.1 Towel clip 4 4 6 34 2 0 0 0

28 Caesarian Section 6 8 1 0

28.1 Scalpel 6 8 1 4 0

28.2 Artery Forceps 2 3 4 22 Straight 6 inches 4 2 0

28.3 Artery Forceps 2 3 4 22 Curved 6 inches 4 2 0

28.4 Artery forceps 8 2 3 4 24 inches 4 2 0

28.5 Myoma Scissors 6 8 1 5 straight 7 inches 0

28.6 Dissecting scissors 6 8 1 5 (curved) 7 inches 0

28.7 Green Armtage 2 3 4 14 forceps 8 inches 4 2 0

28.8 Obstetric outlet 6 8 1 5 forceps (pair) 0

28.9 Doyene’s Retractor 6 8 1 4 0

(Qty.)

28.1 Small Retractors 1 1 2 12 0 2 6 0

28.1 Towel Clippers 2 3 4 22 1 4 2 0

28.1 Suction Nozzle 6 8 1 5 2 0

29 MNCH Related Radiology Equipments

29.1 Ultrasound Machine 1 2 3 1

29.2 X-Ray Unit 500 kw 1 1 1 0

29.3 Color Doppler 0 1 1 0

29.4 Lead Screen for X- 1 1 1 1 Ray Unit

29.5 0.5 MN Lead Apron. 1 1 1 1 Lead Gloves, Goggles and Thyroid and Gonadal Sheets

29.6 Safe Light 1 1 1 0

29.7 X-RT Film 1 1 1 0 Processing Tank

29.8 Chest Stand 1 1 1 0

29.9 X-Ray film 2 2 2 0 Illuminator

29.1 X-Ray Film Hangers 4 4 4 0 0 All sizes

(Qty.)

30 MNCH Related Paediatrics Equipments

30.1 Paediatric Ventilator 1 2 2 1

30.2 Incubator 1 1 2 0

30.3 Photo Therapy Unit 1 1 1 0

30.4 Over-head Radiant 1 1 1 0 Warmer

30.5 Infant Length 2 2 2 2 Measuring Scale

30.6 Infant Weighing 2 2 2 0 Machine

30.7 Nebulizer 1 1 2 0

30.8 Billiubino-meter 1 1 2 1

30.9 Exchange Blood 1 1 2 1 Transfusion Set

30.1 Nasal Probe Paed 2 2 4 2 0 size

31 Anaesthesia/ICU

31.1 Anaesthesia 1 1 2 0 Machine

31.2 Ventilators 1 1 1 1

31.4 Pulse Oximetry 1 1 1 1

31.5 Defibrillator 1 1 1 0

(Qty.)

31.6 Airway Oral and 2 3 4 0 Nasal

31.7 Tracheostomy tube 2 2 4 0 (adult and paeds)

31.8 Face mask of all 2 2 4 0 sizes

31.9 Double Cuff 1 2 2 0 Tourniquet (for regional block)

31.1 AMBO bag adult 2 2 4 0 0

31.1 AMBO Bag paeds 2 2 4 0 1

31.1 Red Rubber Nasal 4 4 8 0 2 tubes all sizes without cuff

32 Blood Bank

32.1 Blood storage 1 1 2 4 cabinet (100 bag capacity)

32.2 Packed cell machine 1 1 1 1

32.3 Cell Separator 1 1 1 1

32.4 Freezer for Fresh 1 1 1 1 Frozen Plasma

32.5 Blood bag shaker 1 1 2 1

32.6 RH view box 2 2 4 1

32.7 Water bath 2 2 2 1

(Qty.)

32.8 Micro-pipette 4 6 8 1

32.9 Blood grouping tiles 3 3 6 2

32.1 Plasma Extractor 1 1 1 3 0

32.1 Platelets agitator 1 1 1 3 1

32.1 Blood thawing bath 1 1 1 1 2

32.1 Microscopes 1 1 2 1 3

33 Gynae & Labour Room Related Laboratory Equipment

33.1 Hematology 1 1 1 1 Analyzer

33.2 Electrolyte Analyzer 1 1 1 1

33.3 Analyzer Bio- 1 1 1 1 chemistry Semi- automatic

33.4 Glucometer 2 2 2 1

33.5 Haemoglobino- 2 2 4 0 meter

33.6 Centrifuge 1 1 2 2

54 Three Years Rolling Plan 2010-2013 District Toba Tek Singh ii. THQ Hospital Gojra Sr. Equipment Standard Available Gap Remarks No. as per MSDS

(Qty.)

1 CTG (Cardiac 1 1 1 0 1 Tocography)

2 Foetal Doppler 2 2 3 0 3

3 Diagnostic 1 1 1 0 1 Laparoscope

4 Bulb Sucker 5 1 2 18 0 0

5 Baby Warmer 2 2 3 0 3

6 Mechanical Sucker 3 3 3 0 3

7 Fetal Stethoscope 2 3 4 4

8 Delivery Table 2 2 2 2 0

9 D&C Set 2 2 2 1 1

10 Outlet forceps 4 4 4 2 0

11 Myoma Screw 2 2 2 1 1

12 Kochers forceps 4 4 4 4 0

14 Lanes Tissue holding 2 2 2 0 2 forceps

15 Vaginal Retractors 4 4 6 2 6

16 Polypectomy forceps 2 2 2 0 2

17 Sponge holder 1 1 1 0 7 0 0 5

18 Uterine elevator 1 1 1 0 1

(Qty.)

19 CosCo Speculum 4 6 6 1 6

Small, Medium, Large (for each category)

20 Examination light 3 3 3 1 1

21 Suction Curette 1 1 2 1 1

22 Infant Resuscitation 1 1 1 0 1 Trolley (with life saving medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light)

23 Mother 1 1 1 0 1 Resuscitation Trolley (with life saving medicines, Laryngoscope, Endo- tracheal tube, BP Apparatus, Chargeable light)

24 Cardiac Monitor 1 1 1 0 1

25 Pump Breast 1 1 1 0 1 Electronic

26 Vaginal Hysterectomy Set

26.1 Toothed Tissue 2 2 2 2 0 Forceps (8”)

(Qty.)

26.2 Non-Tooted Tissue 2 2 2 2 0 Forceps (8”)

26.3 Dissection Scissors 2 2 2 0 0 (Curved 7”)

26.4 Dissection Scissors 2 2 2 0 0 (Straight 7”)

26.5 Hysterectomy 8 8 8 0 8 Clamps (Straight)

26.6 Hysterectomy 8 8 8 6 0 Clamps (Curved)

26.8 Needle Holder (7”) 2 2 4 4 0

26.9 Needle Holder (10”) 2 2 2 2 2

26.1 Artery Forceps 1 1 1 0 0 0 (Straight 6”) 6 6 6

26.1 Artery Forceps 1 1 1 16 8 1 (Curved 6”) 6 6 6

26.1 Towel Clamps 8 8 8 0 0 3

26.1 Single blade Sims 4 4 4 0 3 4 speculum

26.1 Double blade Sims 4 4 4 0 2 5 speculum

26.1 Sponge holding 8 8 8 0 6 6 forceps

(Qty.)

26.1 Volselum forceps 4 4 4 2 4 7

26.1 Uterine Sound 2 2 2 2 2 8

26.1 Bladder Sound 2 2 2 0 2 9

27 Delivery Sets

27.1 Episiotomy Scissors 6 6 1 12 0 0

27.2 Straight Scissors 6 6 1 10 0

27.3 Needle holder 6 6 1 4 0 0

27.4 Non-toothed tissue 6 6 1 10 0 forceps 8 inches 0

27.5 Toothed tissue 6 6 1 4 forceps 8 inches 0

27.6 Sims Speculum 1 1 2 1 20 single blade 2 2 0

27.7 Sims Speculum 1 1 2 2 20 double blade 2 2 0

27.8 Sponge holding 4 4 4 8 40 forceps 0 0 0

27.9 Artery forceps 4 4 4 40 0 0 0 0

27.1 Straight clamps 2 2 3 0 30 0 (cord) 0 0 0

(Qty.)

27.1 Vacuum Extractor 1 1 1 0 1 1 pump

27.1 Towel clip 4 4 4 36 38 2 0 0 0

28 Caesarian Section Set

28.1 Scalpel 4 4 6 6 0

28.2 Artery Forceps 1 1 2 6 24 Straight 6 inches 6 6 4

28.3 Artery Forceps 1 1 2 24 0 Curved 6 inches 6 6 4

28.4 Artery forceps 8 1 1 2 1 24 inches 6 6 4

28.5 Myoma Scissors 4 4 6 0 6 straight 7 inches

28.6 Dissecting scissors 4 4 6 6 6 (curved) 7 inches

28.7 Green Armtage 1 1 2 12 16 forceps 8 inches 6 6 4

28.8 Obstetric outlet 4 4 6 2 6 forceps (pair)

28.1 Small Retractors 8 8 1 2 12 0 2

28.1 Towel Clippers 1 1 2 10 24 1 6 6 4

(Qty.)

29.1 Ultrasound Machine 1 1 2 1 1

29.2 X-Ray Unit 500 kw 1 1 1 1 0

29.3 Color Doppler 0 0 0 0 0

29.4 Lead Screen for X- 1 1 1 1 0 Ray Unit

29.5 0.5 MN Lead Apron. 1 1 1 0 1 Lead Gloves, Goggles and Thyroid and Gonadal Sheets

29.6 Safe Light 1 1 1 1 0

29.7 X-RT Film 1 1 1 1 1 Processing Tank

29.8 Chest Stand 1 1 1 1 0

29.9 X-Ray film 2 2 2 2 0 Illuminator

29.1 X-Ray Film Hangers 4 4 4 4 0 0 All sizes

30.1 Paediatric Ventilator 1 1 2 0 2

30.2 Incubator 1 1 1 2

(Qty.)

30.3 Photo Therapy Unit 1 1 1 1

30.4 Over-head Radiant 1 1 1 1 Warmer

30.5 Infant Length 2 2 2 2 Measuring Scale

30.6 Infant Weighing 2 2 2 0 Machine

30.8 Billiubino-meter 1 1 1 1

30.9 Exchange Blood 1 1 1 1 Transfusion Set

30.1 Nasal Probe Paed 1 2 2 2 0 size

31 Anaesthesia/ICU

31.1 Anaesthesia 1 1 1 1 Machine

31.2 Ventilators 1 1 1 1

31.4 Pulse Oximetry 1 1 1 1

31.5 Defibrillator 1 1 1 1

31.6 Airway Oral and 1 2 2 2 Nasal

31.7 Tracheostomy tube 1 2 2 2 (adult and paeds)

31.8 Face mask of all 1 2 2 1 sizes

(Qty.)

31.9 Double Cuff 1 1 1 1 Tourniquet (for regional block)

31.1 AMBO bag adult 1 2 2 0 0

31.1 AMBO Bag paeds 2 2 2 1 1

31.1 Red Rubber Nasal 4 4 4 3 2 tubes all sizes without cuff

32 Blood Bank

32.1 Blood storage 1 1 1 1 cabinet (100 bag capacity)

32.2 Packed cell machine 1 1 1 1

32.3 Cell Separator 1 1 1 1

32.4 Freezer for Fresh 1 1 1 1 Frozen Plasma

32.5 Blood bag shaker 1 1 1 1

32.6 RH view box 1 2 2 1

32.7 Water bath 2 2 2 2

32.8 Micro-pipette 4 4 6 3

32.9 Blood grouping tiles 3 3 3 3

32.1 Plasma Extractor 1 1 1 1 0

32.1 Platelets agitator 1 1 1 1 1

(Qty.)

32.1 Blood thawing bath 1 1 1 1 2

32.1 Microscopes 1 1 1 0 3

33.1 Hematology 1 1 1 1 Analyzer

33.2 Electrolyte Analyzer 1 1 1 0

33.3 Analyzer Bio- 1 1 1 1 chemistry Semi- automatic

33.4 Glucometer 2 2 2 2

33.5 Haemoglobino- 1 1 1 0 meter

33.6 Centrifuge 1 1 1 0

63 Three Years Rolling Plan 2010-2013 District Toba Tek Singh iii. THQ Hospital Kamalia Sr. Equipment Standard Available Gap Remarks No. as per MSDS

(Qty.)

1 CTG (Cardiac 1 1 1 0 1 Tocography)

2 Foetal Doppler 2 2 3 0 3

3 Diagnostic 1 1 1 0 1 Laparoscope

4 Bulb Sucker 5 1 2 1 19 0 0

5 Baby Warmer 2 2 3 0 3

6 Mechanical Sucker 3 3 3 1 2

7 Fetal Stethoscope 2 3 4 0 4

8 Delivery Table 2 2 2 2 0

9 D&C Set 2 2 2 1 1

10 Outlet forceps 4 4 4 1 3

11 Myoma Screw 2 2 2 2 0

12 Kochers forceps 4 4 4 0 4

14 Lanes Tissue holding 2 2 2 0 2 forceps

15 Vaginal Retractors 4 4 6 0 6

16 Polypectomy forceps 2 2 2 0 2

17 Sponge holder 1 1 1 0 15 0 0 5

18 Uterine elevator 1 1 1 0 1

(Qty.)

19 CosCo Speculum 4 6 6 0 6

Small, Medium, Large (for each category)

20 Examination light 3 3 3 1 2

21 Suction Curette 1 1 2 0 2

22 Infant Resuscitation 1 1 1 0 1 Trolley (with life saving medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light)

23 Mother 1 1 1 0 1 Resuscitation Trolley (with life saving medicines, Laryngoscope, Endo- tracheal tube, BP Apparatus, Chargeable light)

24 Cardiac Monitor 1 1 1 0 1

25 Pump Breast 1 1 1 0 1 Electronic

26 Vaginal Hysterectomy Set

26.1 Toothed Tissue 2 2 2 1 1 Forceps (8”)

(Qty.)

26.2 Non-Tooted Tissue 2 2 2 0 2 Forceps (8”)

26.3 Dissection Scissors 2 2 2 1 1 (Curved 7”)

26.4 Dissection Scissors 2 2 2 1 1 (Straight 7”)

26.5 Hysterectomy 8 8 8 3 5 Clamps (Straight)

26.6 Hysterectomy 8 8 8 0 8 Clamps (Curved)

26.8 Needle Holder (7”) 2 2 4 1 3

26.9 Needle Holder (10”) 2 2 2 0 2

26.1 Artery Forceps 1 1 1 0 16 0 (Straight 6”) 6 6 6

26.1 Artery Forceps 1 1 1 8 8 1 (Curved 6”) 6 6 6

26.1 Towel Clamps 8 8 8 0 8 3

26.1 Single blade Sims 4 4 4 0 4 4 speculum

26.1 Double blade Sims 4 4 4 0 4 5 speculum

26.1 Sponge holding 8 8 8 0 8 6 forceps

(Qty.)

26.1 Volselum forceps 4 4 4 0 4 7

26.1 Uterine Sound 2 2 2 0 2 8

26.1 Bladder Sound 2 2 2 0 2 9

27 Delivery Sets

27.1 Episiotomy Scissors 6 6 1 0 10 0

27.2 Straight Scissors 6 6 1 0 10 0

27.3 Needle holder 6 6 1 0 10 0

27.4 Non-toothed tissue 6 6 1 0 10 forceps 8 inches 0

27.5 Toothed tissue 6 6 1 0 10 forceps 8 inches 0

27.6 Sims Speculum 1 1 2 0 20 single blade 2 2 0

27.7 Sims Speculum 1 1 2 0 20 double blade 2 2 0

27.8 Sponge holding 4 4 4 0 40 forceps 0 0 0

27.9 Artery forceps 4 4 4 0 40 0 0 0

27.1 Straight clamps 2 2 3 0 30 0 (cord) 0 0 0

(Qty.)

27.1 Vacuum Extractor 1 1 1 0 1 1 pump

27.1 Towel clip 4 4 4 0 40 2 0 0 0

28 Caesarian Section Set

28.1 Scalpel 4 4 6 1 5

28.2 Artery Forceps 1 1 2 4 20 Straight 6 inches 6 6 4

28.3 Artery Forceps 1 1 2 0 24 Curved 6 inches 6 6 4

28.4 Artery forceps 8 1 1 2 0 24 inches 6 6 4

28.5 Myoma Scissors 4 4 6 0 6 straight 7 inches

28.6 Dissecting scissors 4 4 6 0 6 (curved) 7 inches

28.7 Green Armtage 1 1 2 0 24 forceps 8 inches 6 6 4

28.8 Obstetric outlet 4 4 6 0 6 forceps (pair)

28.1 Small Retractors 8 8 1 0 12 0 2

28.1 Towel Clippers 1 1 2 0 24 1 6 6 4

(Qty.)

29.1 Ultrasound Machine 1 1 2 1 1

29.2 X-Ray Unit 500 kw 1 1 1 1 0

29.3 Color Doppler 0 0 0 0 0

29.4 Lead Screen for X- 1 1 1 0 1 Ray Unit

29.5 0.5 MN Lead Apron. 1 1 1 0 1 Lead Gloves, Goggles and Thyroid and Gonadal Sheets

29.6 Safe Light 1 1 1 0 1

29.7 X-RT Film 1 1 1 0 1 Processing Tank

29.8 Chest Stand 1 1 1 0 1

29.9 X-Ray film 2 2 2 0 2 Illuminator

29.1 X-Ray Film Hangers 4 4 4 0 4 0 All sizes

30.1 Paediatric Ventilator 1 1 2 0 2

30.2 Incubator 1 1 1 1 0

(Qty.)

30.3 Photo Therapy Unit 1 1 1 0 1

30.4 Over-head Radiant 1 1 1 0 1 Warmer

30.5 Infant Length 2 2 2 0 2 Measuring Scale

30.6 Infant Weighing 2 2 2 0 2 Machine

30.7 Nebulizer 1 1 1 0 1

30.8 Billiubino-meter 1 1 1 0 1

30.9 Exchange Blood 1 1 1 0 1 Transfusion Set

30.1 Nasal Probe Paed 1 2 2 0 2 0 size

31 Anaesthesia/ICU

31.1 Anaesthesia 1 1 1 1 0 Machine

31.2 Ventilators 1 1 1 0 1

31.3 Nebulizer 1 1 1 0 1

31.4 Pulse Oximetry 1 1 1 0 1

31.5 Defibrillator 1 1 1 0 1

31.6 Airway Oral and 1 2 2 0 2 Nasal

31.7 Tracheostomy tube 1 2 2 0 2 (adult and paeds)

31.8 Face mask of all 1 2 2 0 2 sizes

(Qty.)

31.9 Double Cuff 1 1 1 0 1 Tourniquet (for regional block)

31.1 AMBO bag adult 1 2 2 0 2 0

31.1 AMBO Bag paeds 2 2 2 0 2 1

31.1 Red Rubber Nasal 4 4 4 0 4 2 tubes all sizes without cuff

32 Blood Bank

32.1 Blood storage 1 1 1 0 1 cabinet (100 bag capacity)

32.2 Packed cell machine 1 1 1 0 1

32.3 Cell Separator 1 1 1 0 1

32.4 Freezer for Fresh 1 1 1 0 1 Frozen Plasma

32.5 Blood bag shaker 1 1 1 0 1

32.6 RH view box 1 2 2 0 2

32.7 Water bath 2 2 2 0 2

32.8 Micro-pipette 4 4 6 0 6

32.9 Blood grouping tiles 3 3 3 0 3

32.1 Plasma Extractor 1 1 1 0 1 0

32.1 Platelets agitator 1 1 1 0 1 1

(Qty.)

32.1 Blood thawing bath 1 1 1 0 1 2

32.1 Microscopes 1 1 1 1 0 3

33.1 Hematology 1 1 1 0 1 Analyzer

33.2 Electrolyte Analyzer 1 1 1 0 1

33.3 Analyzer Bio- 1 1 1 0 1 chemistry Semi- automatic

33.4 Glucometer 2 2 2 0 2

33.5 Haemoglobino- 1 1 1 0 1 meter

33.6 Centrifuge 1 1 1 1 0

SECTION 3: INTERVENTIONS AND TARGETS

After enlisting the vital causes of prioritized health problems, team proposed appropriate interventions to tackle the problems. Once interventions and activities had been identified, next task the planning team performed was to set the number and quality of specific activities (targets) that have to be carried out. It is pertinent to mention over here that the plan envisages additional activities along with routine activities under regular budget.

Health Problems Targe t for Target for Target for Sr. No. Problem Causes Intervention Activities Unit Plan Activities Targets Remarks 2010- 2011-12 2012-13 11 Message 36 12 12 12 1 High MMR  Poor  Health  Messages on access education/promotion local cable to network health care deliver y service s

Brochure 300000 40000 300000 300000  Lack of  Behavior change  Printing and 0 aware communication for distribution of ness Mothers of child IPC material about bearing age danger No. of trainings 66 66 - -  Low  Provision of Quality  Training of ante- basic EmONC services LHWs on BCC natal at BHU & RHC covera ge

Targe t for Target for Target for Sr. No. Problem Causes Intervention Activities Unit Plan Activities Targets Remarks 2010- 2011-12 2012-13 11 - - - -  Low  Provision of Quality  Procurement of skilled Comprehensive vehicles for birth EmONC services at transportation attend THQs hospital through CCBs ance

- - - -  Three  Improving  Operation and delays transportation of the management of (seeki patients vehicles ng through CCBs health care, transp ortatio n, and lack of referra l back- up service s)

- - - -  Compli  Repair of non cation functional s of ambulances for pregna timely ncy transportation of pregnant mothers

Targe t for Target for Target for Sr. No. Problem Causes Intervention Activities Unit Plan Activities Targets Remarks 2010- 2011-12 2012-13 11 - - - -  Capaci  Replacement of ty the non Issues functional related ambulances for to timely mater transportation nal of pregnant care mother

- - - -  Mater  Procurement of nal the MNCH Anemi related a equipment and Instruments

- - - -  Pregna ncy followi ng  Implementation chroni of the referrals c protocols severe diseas es

Packs 40000 20000 10000 10000  Procurement of Micro-nutrients

No. of tablets 40000 20000 10000 10000  Procurement and distribution of Calci-D

Targe t for Target for Target for Sr. No. Problem Causes Intervention Activities Unit Plan Activities Targets Remarks 2010- 2011-12 2012-13 11 Injection 90 30 30 30  Procurement and distribution of Anti-D

Message 36 12 12 12 2 High under 5  Poor  Health  Message on Mortality antena awareness/education local cable tal natal Number of Trainings - - - -  Neo-  Provision of the quality  BCC of mothers natal basic EMONC services at 0n promotion Infecti BHU & RHC of breast ons feeding and weaning practices Assessment - - - -  Birth  Provision of the quality  Provision of the Traum Comprehensive EMONC deficient a & services at THQH & infrastructure Asphy DHQH at THQ xia

No. of trainings 10 5 3 2  Prema  Improvement of feeding  Trainings on turity and weaning practices IMNCI

Assessment -  Poor  Capacity building of  Need - - - feedin Human Resource dealing assessment of g and child health care food weani supplements ng practic es

Assessment - - - -  Diarrh  Enhancing EPI coverage  procurement ea from DGHs office

Targe t for Target for Target for Sr. No. Problem Causes Intervention Activities Unit Plan Activities Targets Remarks 2010- 2011-12 2012-13 11 Assessment - - - -  ARI  Poverty elevation  Distribution of food supplements to mothers & children through LHWs & community mid wives

Assessment - - - -  Lack of  Provision of food  Raising income capacit supplements of the poor y of families staff through Baitul for Mall and Zakat provisi on of proper child health care (diagn ostic and timely referra ls)

- - - -  Low  Revising the socio micro plans of econo Vaccinators mic status

- - - -  Malnut rition

Targe t for Target for Target for Sr. No. Problem Causes Intervention Activities Unit Plan Activities Targets Remarks 2010- 2011-12 2012-13 11 - - - -  Lack of birth spacin g

- - - -  Low EPI Covera ge

12 4 4 4 3 Acute (upper)  Malnut  Capacity building of  Messages on Message respiratory rition health staff in ARI case local cable infections management networks

Message 12 4 4 4  Air  Capacity building of  Messages conta health staff in Integrated through FM minati Management of radio channels on Childhood Illnesses (IMCI)

Brochure 500000 20000 150000 150000  Over-  Provision of medicines  Printing and 0 crowdi for ARI distribution of ng/Po IPC material or housin g faciliti es

No. of trainings - - - -  Lack of  Timely referral of  Training of proper complicated cases medics and sanitat Para-medics in ion IMCI

Targe t for Target for Target for Sr. No. Problem Causes Intervention Activities Unit Plan Activities Targets Remarks 2010- 2011-12 2012-13 11 Antibiotic (Syrup) 100000 40000 30000 30000  Season  Procurement al and distribution variati of Antibiotic on Syrup Amoxicillin

Injection 30000 10000 10000 10000  Lack of  Procurement aware and distribution ness of Inj. and Cefotaxine 1gm hygien (at DHQH) ic practic es

Injection 30000 10000 10000 10000  Procurement and distribution of Inj. Cefotriaxone 1gm (at DHQH)

Meeting 12 4 4 4 4 Diarrhea  Poor  Improvement of water  Quarterly co- sanitat supply and sanitation ordination ion Meeting with TMA and other agencies

Message 12 4 4 4  Lack of  Health Education  Messages on safe campaign local cable drinki network ng water

Targe t for Target for Target for Sr. No. Problem Causes Intervention Activities Unit Plan Activities Targets Remarks 2010- 2011-12 2012-13 11 Message 12 4 4 4  Unhygi  Improving literacy rate  Message on FM enic through coordination Radio practic with education es department

Brochure 600000 30000 150000 150000  Lack of  Proper treatment of  Printing and 0 aware Diarrhea including ORT distribution of ness in IPC material genera l popula tion

Session 4920 4920 - -  Lack of  Capacity building of  Address in aware health staff in Integrated school ness Management of assemblies among Childhood Illnesses mothe (IMNCI) rs about feedin g and weani ng practic es

No. of trainings - - - -  Low   Training of Socio medics and Econo paramedics in mic IMNCI status

ORS packets 150000 50000 50000 50000  Malnut  Procurement rition and distribution of ORS

Targe t for Target for Target for Sr. No. Problem Causes Intervention Activities Unit Plan Activities Targets Remarks 2010- 2011-12 2012-13 11 Syrup 600000 300,0 150000 150000  Procurement 00 and distribution of Syp. Zinc Sulphate

Syrup 150000 50,00 50,000 50,000  Procurement 0 and Distribution of Syp Metronidazole

Message 36 12 12 12 5 Anemia  Lack of  Awareness raising for  Messages on (including aware behavior change local cable pregnancy) ness network about balanc ed diet

Brochure 600000 30000 150000 150000  Gende  Awareness raising for  Printing and 0 r behavior change distribution of discri IPC material minati on

Session - - - -  Social  Awareness raising for  Counseling of taboos behavior change pregnant and mothers norms

No. of doses 150000 50000 50000 50000  Worm  De-worming campaign  Procurement of infesta de-worming tion tablets

Targe t for Target for Target for Sr. No. Problem Causes Intervention Activities Unit Plan Activities Targets Remarks 2010- 2011-12 2012-13 11 - - - -  Infecti  Diagnosis and treatment  Distribution ons of infections through LHWs and health facilities

No. of trainings - - - -  Poor  Strengthening MNCH  Refresher quality Services Trainings of of LHWs on BCC, MNCH balanced diet and service provision of s micro-nutrients

- - - -  Povert  Equity of services  Provision of y/ Low Sehat Suhlat socio Card/health econo voucher mic status

Meetings 0 3 3 4 6 Hepatitis  Poor  Health  Quarterly co- sanitat Education/Promotion ordination ion meetings with TMA and other agencies

Message 36 12 12 12  Unsafe  Improving water &  Messages on drinki sanitation local cable ng network water

Brochure 500000 20000 200000 100000  Sharin  Campaign against 0 g of quackery  Printing and used distribution of syring IPC material es

Targe t for Target for Target for Sr. No. Problem Causes Intervention Activities Unit Plan Activities Targets Remarks 2010- 2011-12 2012-13 11 Stickers 1000 3000 - -  Transf  · Strengthening blood  Printing and usion transfusion services for pasting of of safe transfusions stickers at unsafe clinics and blood Barber shop and highlighting use blood of new syringes produc & Razors ts

1 1 - -  Unsafe  Regulatory mechanism  Hepatitis sexual to ensure use of safe awareness practic instruments by dentists, week es barbers etc. ( walk/display banners/semin ars)

Kits 30000 10000 10000 10000  Ear &  Procurement & Nose Distribution of piercin HCV Device g and tattooi Kits 30000 10000 10000 10000  Use of unsteri lized equip  Procurement & ment Distribution of by BSAG Device dentist s and barber s

Kits 30000 10000 10000 10000  Procurement & Distribution of HIV Device

Targe t for Target for Target for Sr. No. Problem Causes Intervention Activities Unit Plan Activities Targets Remarks 2010- 2011-12 2012-13 11 Kits 30 10 10 10  Procurement and supply of Eliza kits

Syringe cutter 1800 600 600 600  Procurement of syringe cutters

Courses 800 400 200 200  Procurement and distribution of Interforan Injection

- - - -  Documentation of expense of disposable syringes

- - - -  Supportive supervision to ensure above activities

Meeting 12 4 4 4 7 Road accident  Lack of  Coordination with police  Quarterly co- & Injuries traffic department to improve ordination sense traffic sense and meetings with ensuring observance of Traffic Police traffic rules department

Meeting 12 4 4 4  Poor  Advocacy for improving  Quarterly co- mainte the condition of roads ordination nance meetings with of Highway vehicle department s

Targe t for Target for Target for Sr. No. Problem Causes Intervention Activities Unit Plan Activities Targets Remarks 2010- 2011-12 2012-13 11 Plan - - - -  Poor  Health  Preparation of road education/promotion to Disaster conditi prevent domestic Management ons accidents Plan including the Patient Management protocols

No. of Trainings 5 5 - -  Lack of  Ensure enforcement of  Training of the safety safety laws at work medics and the measu places paramedics res at work place

Emergency. Kits 800 400 200 200  Fire-  Provision of arm emergency kits injurie for blast victims s

- - - -  Domes  Procurement of tic equipments / accide instruments / nts various splints and Plaster casts

- - - -  Burns

- - - -  Bomb blasts/ terrori st activiti es

Targe t for Target for Target for Sr. No. Problem Causes Intervention Activities Unit Plan Activities Targets Remarks 2010- 2011-12 2012-13 11 - - - -  Lack of tolera nce in the society

Message 12 4 4 4 8 Scabies  Lack of  Health education &  Messages on aware Promotion local cable ness networks

Message 12 4 4 4  Unhygi  Improving water and  Messages enic sanitation through FM practic radio channels es

Brochure 200000 10000 500000 50000  Over-  Proper diagnosis and  Printing and 0 crowdi treatment distribution of ng/Po IPC material or housin g faciliti es

Lotion 100000 50000 25000 25000  Poor  Procurement water and distribution and of Benzyl sanitat Benzoate ion Lotion

 Season al variati on

Management Problems Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned Posts

Physical Targets Basic Sr.No. Name of Post Basic Pay Allowances Requirement as per Gap Scale Year I Year II Year III

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

2 Paediatricians 18 12,910 18,099 6 2 2 2

3 Anesthetists 18 12,910 18,099 8 3 3 2

4 MO / WMO 17 9,850 15,345 74 34 20 20

5 Nurses 16 6,060 8,934 82 32 25 25

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

Targe Probl Target for t for Target for Sr. No Causes Intervention Activities Plan Activities Targets Remarks em 2010-11 2011- 2012-13 12 1 - - - - Shorta  Vacant positions  Filling of the  Temporary Filling of the vacant ge of vacant posts posts of medics and the paramedics skille through existing recruitment d staff committees - - - -  Non-sanctioning of staff  Sanctioning of  Demand generation and request to according to MSDS positions the Department of Health by the according to districts for recruitment through MSDS PSC against vacant posts - - - -  Lack of permanent  Recruitment  Districts to prepare the incentivized postings through Public pay package with consultation of all Service stockholders Commission on regular basis - - - -  Lack of incentives and  Incentivized  Consensus building between the differential pay packages pay package at districts for uniform incentivized all levels pay package for all categories and levels staff

- - - -  Frequent transfer  Well defined  Request to the Provincial postings career Government for approval and structure implementation of agreed pay including packages opportunities for higher education - - - -  Job insecurity  Conducive  Review and revise the career working structure of medics, paramedics environment and technical staff like SOs, Health Education officers etc - - - -  Lack of basic amenities at  Provision of  Availability of recreation, education workplace staff and other facilities for children of Residences staff working in rural areas

Targe Probl Target for t for Target for Sr. No Causes Intervention Activities Plan Activities Targets Remarks em 2010-11 2011- 2012-13 12 - - - -  Lack of conducive  High level  Construction of the residences for environment including political the staff insecurity and transport commitment of children for education for providing protection to staff working in health facilities - - - -  Political & Media  provision of recreation facilities Interference (Parks/Play area/common rooms) - - - - 4  Deficient transparent  Provision of the transport of staff accountability children for the education purposes

- - - -  Shortage of the  Capacity and need assessment of residences the medics and the paramedics - - - -  Medico-legal work  Prepare training programs for specially for Females providing higher professional education based on TNA

- - - - 2 Inade  Installation of the  Rational  Assessing additional need for POL quate Generator for back up increase in POL budge electricity supply Budget t for POL 491,169 - - -  Frequent increase in  Costing & Submit ion the additional prices of POL Demand for POL (Liters)

Targe Probl Target for t for Target for Sr. No Causes Intervention Activities Plan Activities Targets Remarks em 2010-11 2011- 2012-13 12 - - -  Less allocation for POL budget

- - - 3 Lack  Emerging need of the  Provision of of District Offices & infras Residences at tructu different level re of District

- - -  Strengthening of DHIS Office

- - - 4 Defici  Deficient equipment to  Make up the  Purchase of MNCH related ent cater basic and deficiencies Equipment at DHQH equip comprehensive EmONC at against ment primary and secondary standard (with level of care notified MNCH refere related nce to equipments notifie d list) at all levels of care

- - -  Old and un-serviceable  Purchase of MNCH related equipment Equipment at THQH Gojra

Targe Probl Target for t for Target for Sr. No Causes Intervention Activities Plan Activities Targets Remarks em 2010-11 2011- 2012-13 12 - - -  Devise  Purchase of MNCH related appropriate Equipment at THQH Kamalia mechanisms for repair and maintenance

SECTION 4: COSTING AND FINANCING PLAN Activity based costing The planning team has used the best available data sources, for calculation of estimates for the intervention/activities. It is pertinent to mention that the costing of the plan is based on additional needs and activities. The detailed activity based costing of the Health and Service Delivery problems has been performed on automated Excel sheets, which are hyperlinked as H & M Sheets. A moderate estimate of equipment cost has been taken, as there is wide variation between the minimum and maximum cost. The detailed cost of MNCH related equipment has been attached as Annex- II. The summary of activity and problem wise costing is given below. a) Health Problems

Problem wise Summary of Health Problems Sr. Problem F Y I FY II FY III Total Cost No. Amount Amount Amount Rs. (Rs.) (Rs.) (Rs.) 1 High maternal mortality 3,027,600 1,883,200 2,071,520 6,982,320

2 High under five mortality 1,408,250 1,198,725 1,125,905 3,732,880

3 ARI (under 5) 2,426,000 2,228,600 2,451,460 7,106,060

4 Diarrheal Diseases 13,048,000 7,917,800 8,709,580 29,675,38 0 5 Anemia ( including in 2,162,000 1,718,200 1,890,020 5,770,220 pregnancy) 6 Hepatitis 8,902,000 6,052,200 6,173,420 21,127,62 0 7 Road side accident & 2,625,450 1,429,560 1,572,516 5,627,526 Injuries 8 Skin Diseases 1,466,000 980,100 1,078,110 3,524,210

Total 35,065,300 23,408,385 25,072,531 83,546,21 6

Define Financial Targets Total Sr. P Activity Year II Year III Unit Rate Quantity Year I Cost (10 %) (10 %) 1 H  Messages on local cable network Message 51,000 36 612,000 673,200 740,520 2,025,720 i

Brochure 4 300000 1,600,000 1,320,000 1,452,000 4,372,000  Printing and distribution of IPC material

 Training of LHWs on BCC No. of 11,600 66 765,600 - - 765,600 trainings

 Procurement of vehicles for Costed in service - - - - transportation through CCBs delivery problems

 Operation and management of Costed in service - - - - vehicles through CCBs delivery problems

 Repair of non functional Costed in service - - - - - ambulances for timely delivery problems transportation of pregnant mothers

 Replacement of the non Costed in service - - - - - functional ambulances for timely delivery problems transportation of pregnant mother

Define Financial Targets Total Sr. P Activity Year II Year III Unit Rate Quantity Year I Cost (10 %) (10 %)  Procurement of the MNCH Costed in service - - - - - related equipment and delivery problems Instruments

Costed in MSDS Gaps - - - - -  Implementation of the referrals protocols

Packs 35 40000 700,000 385,000 423,500 1,508,500  Procurement of Micro-nutrients

No. of tablets 20 40000 400,000 220,000 242,000 862,000  Procurement and distribution of Calci-D

 Procurement and distribution of Injection 5000 90 150,000 150,000 150,000 450,000 Anti-D

4,227,600 2,763,200 3,039,520 10,030,320

2 H  Message on local cable Message 51,000 36 612,000 673,200 740,520 2,025,720

 BCC of mothers 0n promotion of Number of LHWs training - - - - - breast feeding and weaning Trainings already costed in practices through LHWs HMM Problem

Define Financial Targets Total Sr. P Activity Year II Year III Unit Rate Quantity Year I Cost (10 %) (10 %)

 Provision of the deficient Assessment As proposed in MSDS - - - - - infrastructure at THQ Gaps

796,250 525,525 385,385 1,707,160  Trainings on IMNCI No. of 159250 10 trainings

 Need assessment of food Assessment Assessing below - supplements poverty pregnant mother through LHWs and providing them food supplement through DGHS & Financial support from BaitulMall & Zakat

 procurement from DGHs office Assessment Assessing below - poverty pregnant mother through LHWs and providing them food supplement through DGHS & Financial support from BaitulMall & Zakat

 Distribution of food supplements Assessment Assessing below - to mothers & children through poverty pregnant LHWs & community mid wives mother through LHWs and providing them food supplement through DGHS & Financial support from BaitulMall & Zakat

 Raising income of the poor Assessment Assessing below - families through Baitul Mall and poverty pregnant Zakat mother through LHWs and providing them food supplement through DGHS & Financial support from BaitulMall & Zakat

 Revising the micro plans of Vaccinators

1,408,250 673,200 1,125,905 3,207,355

3 A  Messages on local cable networks Message 51,000 12 204,000 224,400 246,840 675,240

 Messages through FM radio Message 28,000 12 112,000 123,200 135,520 370,720 channels

 Printing and distribution of IPC Brochure 4 500000 800,000 660,000 726,000 2,186,000 material

 Training of medics and Para- No. of IMNCI Training - - - - - medics in IMCI trainings package costed in High Under Five also includes management of ARI

 Procurement and distribution of Antibiotic 20 100000 800,000 660,000 726,000 2,186,000 Antibiotic Syrup Amoxicillin (Syrup)

 Procurement and distribution of Injection 25 30000 250,000 275,000 302,500 827,500 Inj. Cefotaxine 1gm (at DHQH)

 Procurement and distribution of Injection 26 30000 260,000 286,000 314,600 860,600 Inj. Cefotriaxone 1gm (at DHQH)

2,426,000 2,046,400 2,068,840 6,541,240

4 D  Quarterly co-ordination Meeting Meeting 8,000 12 32,000 35,200 38,720 105,920 with TMA and other agencies

 Messages on local cable network Message 51000 12 204,000 224,400 246,840 675,240

 Message on FM Radio Message 28000 12 112000 123,200 135,520 370,720

 Printing and distribution of IPC Brochure 4 600000 1,200,000 660,000 726,000 2,586,000 material

 Address in school assemblies Session School Health & 4920 - - - - Nutrition Supervisors did this task

 Training of medics and No. of Already costed in - - - - - paramedics in IMNCI trainings problem High under five mortality

 Procurement and distribution of ORS packets 5 150000 250,000 275,000 302,500 827,500 ORS

 Procurement and distribution of Syrup 35 600000 10,500,000 5,775,000 6,352,500 22,627,500 Syp. Zinc Sulphate

 Procurement and Distribution of Syrup 15 150000 750,000 825,000 907,500 2,482,500 Syrp Metronidazole

13,048,000 7,917,800 8,709,580

5 A  Messages on local cable network Message 51,000 36 612,000 673,200 740,520 2,025,720

 Printing and distribution of IPC Brochure 4 600000 1,200,000 660,000 726,000 2,586,000 material

 Counseling of pregnant mothers Session LHWs are expected - - - - to conduct counseling session on behavior change during their visit to pregnant ladies

 Procurement of de-worming No. of doses 7 150000 350,000 385,000 423,500 1,158,500 tablets

 Distribution through LHWs and health facilities

 Refresher Trainings of LHWs on No. of LHWs training - - - - - BCC, balanced diet and provision trainings already costed in of micro-nutrients HMM Problem

 Provision of Sehat Suhlat Card/health voucher

2,162,000 1,718,200 1,890,020 5,770,220

6 H  Quarterly co-ordination meetings Meetings Costed in diarrheal - - - - - with TMA and other agencies disease

 Messages on local cable network Message 51000 36 612,000 673,200 740,520 2,025,720

 Printing and distribution of IPC Brochure 4 500000 800,000 880,000 484,000 2,164,000 material

 Printing and pasting of stickers at Stickers 50 1000 50,000 - - 50,000 clinics and Barber shop highlighting use of new syringes & Razors

 Hepatitis awareness week Lump sum 1 250,000 250,000 ( walk/display banners/seminars)

 Procurement & Distribution of Kits 30 30000 300000 330,000 363,000 993,000 HCV Device

 Procurement & Distribution of Kits 30 30000 300000 330,000 363,000 993,000 BSAG Device

 Procurement & Distribution of Kits 30 30000 300000 330,000 363,000 993,000 HIV Device

 Procurement and supply of Eliza Kits 10000 30 100,000 110,000 121,000 331,000 kits

 Procurement of syringe cutters Syringe cutter 150 1800 90,000 99,000 108,900 297,900

 Procurement and distribution of Courses 15000 800 6,000,000 3,300,000 3,630,000 12,930,000 Interforan Injection

 Documentation of expense of disposable syringes

Define Financial Targets Total Sr. P Activity Year II Year III Unit Rate Quantity Year I Cost (10 %) (10 %) 8,802,000 6,052,200 6,173,420 21,027,620  Supportive supervision to ensure above activities

7 R  Quarterly co-ordination meetings Meeting 4,500 12 18,000 19,800 21,780 59,580 with Traffic Police department

 Quarterly co-ordination meetings Meeting 4500 12 18,000 19,800 21,780 59,580 with Highway department

 Preparation of Disaster Plan EDO/DOH & MS - - - - Management Plan including the Patient Management protocols

 Training of the medics and the No. of 12450 5 62,250 - - 62,250 paramedics Trainings

 Provision of emergency kits for Emg. Kits 6318 800 2,527,200 1,389,960 1,528,956 5,446,116 blast victims

 Procurement of equipments / instruments / various splints and Plaster casts 2,625,450 1,429,560 1,572,516 5,627,526

8 S  Messages on local cable networks Message 51,000 12 204,000 224,400 246,840 675,240

 Messages through FM radio Message 28,000 12 112,000 123,200 135,520 370,720 channels

 Printing and distribution of IPC Brochure 2 200000 200,000 1,100,000 121,000 1,421,000 material

 Procurement and distribution of Lotion 15 100000 750,000 412,500 453,750 1,616,250 Benzyl Benzoate Lotion

1,266,000 1,860,100 957,110 4,083,210

b) Management Problems

Problem wise Summary of Management Problems

F Y I FY II FY III

Sr. No. Problem Amo Total Cost Rs. unt (Rs.) Amount (Rs.) Amount (Rs.) 1 HR Plan 19,2 98,3 04 35,666,096 54,539,777 109,504,178

2 POL for newly installed Generators 38,3 - - 38,311,200 11,2 00 3 Deficient Infrastructure 52,1 - - 52,177,500 77,5 00 4 Lack of MNCH Machinery & Equipment 71,8 - - 71,805,345 05,3 45 Total 181, 35,666,096 54,539,777 271,798,223 592, 349

Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned Posts

Financial Targets

Requir Year I Year III Sr.No Basic Basic ement Name of Post Allowances . Scale Pay as per Gap Allo Pay of Pay of other Allow Pay of Pay of other Pay of Pay of other Allowanc wan Officers staff ances Officers staff Officers staff es ces

1 Gynaecologist 18 12,91 18,099 1 154,920 - 217,1 170,412 238, 187,453 262,797 0 88 907

2 Paediatricians 18 12,91 18,099 6 309,840 - 434,3 681,648 955, 1,124,719 1,576,785 0 76 627

3 Anesthetists 18 12,91 18,099 8 464,760 - 651,5 1,022,472 1,43 1,499,626 2,102,380 0 64 3,44 1

4 MO / WMO 17 9,850 15,345 74 4,018,80 - 6,260, 7,021,080 10,9 10,583,628 16,487,89 0 760 37,9 6 16

5 Nurses 16 6,060 8,934 82 2,327,04 - 3,430, 4,559,544 6,72 7,215,278 10,637,17 0 656 1,94 8 2

6 Lady Health 9 3,820 4,750 23 458,400 570,0 857,208 1,06 1,275,727 1,586,310 Visitors 00 5,90 0

7,275,360 458,400 11,56 13,455,15 857,208 21,3 20,610,704 1,275,727 32,653,346 4,544 6 53,7 32

Total Define Financial Targets Cost Sr. Problem Activity No. Year II Year III Unit Rate Quantity Year I (10 %) (10 %)

1 Inadequate  Assessing, Costing & P O L 78 491,169(Liters) 38,311,200 - - 38,311,200 budget for POL Submission of the additional Demand for POL

38,311,200 38,311,200

2 Lack of Construction Detail Annex 44,372,500 44,372,500 infrastructure

Detail Annex 105,000 105,000  Strengthening of Office DHIS Office Equipment 44,477,500 44,477,500

Total Define Financial Targets Cost Sr. Problem Activity No. Year II Year III Unit Rate Quantity Year I (10 %) (10 %)

3 Detail Annex 18,688,035 18,688,035 Deficient  Purchase of MNCH Equipment equipment related Equipment (with reference at DHQH to notified list) at all levels of care

Detail Annex 24,888,450 24,888,450  Purchase of MNCH Equipment related Equipment at THQH Gojra Detail Annex 28,228,860 28,228,860  Purchase of MNCH Equipment related Equipment at THQH Kamalia 143,610,690 143,610,690

106 Three Years Rolling Plan 2010-2013 District Toba Tek Singh Financial Outlay including 3YRP Activities The costing of the plan includes routine recurring budget with 15% price escalation for subsequent years and additional cost involved on the basis of health and management problems; which is essentially required to bring visible improvement in the health system. Other financial resources expected from provincial level through ADP and PMDGP are also part of this plan. 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 2010-2011 2011-2012 2012-2013

Regular district budget 686,938,800 821,303,300 944,498,795

Additional budget based on problem 216,657,649 59,074,481 79,612,308 identification

Total 903,596,449 880,377,781 1,024,111,103

107 Three Years Rolling Plan 2010-2013 District Toba Tek Singh 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

Indicators Target % MoV Responsibility Frequency Remarks Achievement of monitoring

% of planned 50 visits Inspectio EDOH/DOH/ Quarterly supervisory visits /year n DDOH/Dist. conducted Book/Att Monitoring officer endance register

% of RHCs with 100% Movemen EDOH / DOH Quarterly availability of t During 1st services (on register/v year rotational basis) of isit essential specialties book/Atte (Physician, Surgeon, ndance Paediatrician and register Gynaecologist)

% of health facilities 100% Stock EDOH/ DOH/ MSs 6 monthly with availability of Register During 1st essential MNCH year related equipment (level specific)

Availability of 100% Stock EDOH/ DOH/MSs, Quarterly relevant (MNCH) Register Store keeper During 1st laboratory year equipment at appropriate level of care

% facilities with 100% Stock EDOH/ DOH/ MSs, Monthly availability of Register Store keeper During 1st essential medicines year

% of functional 100% Log Book EDOH/DOH/ Quarterly ambulances in the Transport officer (DHQH/ district THQH/ RHCs)

% utilization of 100% of Quarterly EDOH/ DOH/ MSs/ Quarterly sanctioned budget yearly Reports Accounts officer budget

% of facilities with 100% Superviso EDOH/DoH/ DDOH Quarterly availability of basic ry visit (50% EmONC report during 1st year)

% of DHQ/THQ 100% in 3 Superviso EDOH/DoH/ DDOH Quarterly hospitals with years ry visit Comprehensive report (50% EmONC services during 1st year)

% of facilities with 100% in 3 Superviso EDOH/DoH/ DDOH Quarterly availability of years ry visit separate or (50% report partitioned room during 1st reserved exclusively year) for delivery

% of targeted Target DHIS EDOH/ Statistical Quarterly pregnant women according Report Officer newly registered by to LHW population

% of targeted Target DHIS EDOH/ DHIS Quarterly pregnant women according Report Coordinator/ received TT-2 to Statistical Officer vaccine population

Delivery conducted 60 % DHIS EDOH/ DHIS Quarterly by or under During 1st Report Coordinator/ supervision of year Statistical Officer skilled persons reported

%of target children Target DHIS EDOH/ DHIS Quarterly between 18 - 23 according Report Coordinator/ months of age fully to Statistical Officer immunized population

% of referred cases 100% DHIS EDOH/ DHIS Quarterly attended Report/ Coordinator/ LHWs Statistical Officer monthly report

% of targeted Target LHW’s EDOH/ Statistical Quarterly eligible couples according monthly/ Officer /Coordinator provided knowledge to quarterly NP-FP&PHC and information on population report Family Planning methods

No. of meetings with 12 Minutes EDOH/ Focal Quarterly participation from meetings of person/s other sectors per year meetings

Annex-I Private Health Facilities in District Toba Tek Singh

Name of Facility/ Hospital Name of Doctor’s Qualification

TEHSIL TOBA TEK SINGH

Al-Gahfoor Eye ClinicEid Gah Road Toba Dr. Aman Ullah Qasim M.B.B.S/ Tek Singh DOMS

Zahid Eye Clinic Iqbal Nagar Toba Tek Dr.Zahid Sattar M.B.B.S/ Singh DOMS

Anwar Clinic AkalWala Road Toba Tek Dr.Capt. Muhammad Anwar M.B.B.S Singh

Saleemi Surgical & Maternity Home Eid Dr. Uzma Tariq M.B.B.S Gah Road Toba Tek Singh

Ehsan Clinic & Materity Home Jhang Road Dr. Khalida Asghar M.B.B.S Toba Tek Singh

City Clinic &Materinty Home Akal wala Dr. Zahida Ayyaz M.B.B.S Road Toba Tek Singh

Mubshar Sugical Center Jhang Road Toba Dr. Abdul Ghani Mubshar M.B.B.S Tek Singh

Mehmood Clinic Jhang Road Toba Tek Dr.Mehmood Akhtar Bajawa M.B.B.S Surgn. Singh &Medi.Spec.

Maqbool Clinic Civil Line Toba Tek Singh Dr. Capt. Maqbool Ahmad M.B.B.S

Suleman Medical Center Gojra Road Toba Dr. Shahina Khursheed M.B.B.S Tek Singh

Waqas General Hospital Shorkot Road Dr. Abdul Manaf M.B.B.S Toba Tek Singh

Rabia Eye Clinic Hospital Housing Colony Dr.Muhammad AslamTahir M.B.B.S FCPS Eyes Toba Tek Singh

Malik Hospital Canal Road Toba Tek Dr. M. Aslam Awan M.B.B.S 111 Three Years Rolling Plan 2010-2013 District Toba Tek Singh Singh Dr. Sajida Aslam

M.B.B.S

Al-Shifa Poly Clinic Canal Road Toba Tek Dr.Muhammad Afzal M.B.B.S/DCH Singh

Shahzad Family Clinic Heart Care Center Dr. Muhammad Ijaz M.B.B.S Grain Market Toba Tek Singh

Naseer Clinic Jhang Road Toba Tek Singh Dr.Zahid Hussain M.B.B.S/DCH

Zahid Clinic Near GPO Toba Tek Singh Dr.Zahid Rafique M.B.B.S/DCH

Overseas Foundation Hospital Rajana

TEHSIL GOJRA

Dr. Abdul Rouf Sheikh M.B.B.S Bashir Clinic Qaid-e-Azam Road Gojra Dr. Tariq Sheikh M.B.B.S

National Hospital Mehandi Shah Bazar Dr. Muhammad Akram M.B.B.S Gojra

Rehman Clinic Mehandi Shah Bazar Gojra Dr. Ubaid ur Rehman M.B.B.S

Ameen General Hospital Medhandi Bazar Dr. Skindar Ameen M.B.B.S Gojra

Nadeem General Hospital Imam Bargah Dr. Nadeem Sheikh M.B.B.S Road Gojra Dr. Sameea Sheikh M.B.B.S

Shahista Hospital Jhang Road Gojra Dr. Shahista Anwar M.B.B.S

Suriya Hospital Jhang Road Gojra Dr. Surriya Starr M.B.B.S

Rehman Hospital Jhang Road Gojra Dr. Raheela Hayee M.B.B.S

Rasheed Surgical Jhang Road Gojra Dr. Seemi Naseem Cheem M.B.B.S M.B.B.S

Dr. Naeem Cheema

Amanat Hospital Jhang Road Gojra Dr. Amanat M.B.B.S/DOMS

Hafiz Hospital Jhang Road Gojra Dr. Hafiz Ashafq Wahala M.B.B.S

Waseem Hospital Jhang Road Gojra Dr. Waseem Iqbal M.B.B.S/ FCPS/ Asrtho

112 Three Years Rolling Plan 2010-2013 District Toba Tek Singh TEESIL KAMALIA

Zafar Sugicial Hospital Mandi Mord Kamalia Dr. Zafar Iqbal M.B.B.S

Mian Hospital Rajan Road Kamalia Dr. Shahid Iqbal M.B.B.S

Ameen Surgical Hospital Zia Road Rajana Dr. Muhammad Ameen M.B.B.S Kamalia

Zaheer Surgical Hospital Chichawatni Road Dr. M. Zaheer Iqbal M.B.B.S M.B.B.S Kamalia Dr. Abdul Rouaf Butt

Al-Sadaq Surgical Hospital Chichawatni Dr. Mazhar Iqbal M.B.B.S M.B.B.S Dip Road Kamalia Card Dr. Zia Ahmad Khan

Zarina Hospital Bus Stand Kamalia Dr. Zarina M.B.B.S

Umair Hospital Wapada Chowk Pir Mahal Dr. Asghar M.B.B.S

Mazamal Hospital Wapada Chowk Pir Mahal Dr. Hafiz Muhammad Sharif M.B.B.S

Naseer Hospital Rajana Road Pir Mahal Dr. Naseer Ahmad M.B.B.S

Yameen Surgical Hospital Ghala Mandi Pir Dr. Muhammad Tariq M.B.B.S Mahal

Mian Hospital Grain Market Pir Mahal Dr. Ghulam Hussain M.B.B.S

Usama Hospital Thana Road Pir Mahal Dr. Zahid Jamshaid M.B.B.S

Tahir Hospital Wapada Chowk Pir Mahal Dr. Tahir M.B.B.S

Dr. Khalid Mukhtar M.B.B.S

113 Three Years Rolling Plan 2010-2013 District Toba Tek Singh Annex-II Costing of MNCH related equipment at DHQ and THQ Hospitals

DHQ T T Singh

Total Cost Sr. No. Equipment Gap Unit Cost (Rs.) 1 CTG (Cardiac Tocography) 1 285,000 285,000 2 Foetal Doppler 3 10,000 30,000 3 Diagnostic Laparoscope 1 1,200,000 1,200,000 4 Bulb Sucker 10 45 450 5 Baby Warmer 2 850,000 1,700,000 6 Mechanical Sucker 2 28,000 56,000 7 Fetal Stethoscope 4 1,500 6,000 9 D&C Set 1 2,100 2,100 10 Outlet forceps 2 900 1,800 11 Myoma Screw 2 320 640 12 Kochers forceps 3 235 705 13 Volselum forceps 4 235 940 14 Lanes Tissue holding forceps 2 400 800 15 Vaginal Retractors 10 350 3,500 16 Polypectomy forceps 2 750 1,500 17 Sponge holder 7 300 2,100 18 Uterine elevator 1 150 150 20 Examination light 1 18,000 18,000 21 Suction Curette 1 95 95 22 Infant Resuscitation Trolley (with life saving 1 95,000 95,000 medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light) 23 Mother Resuscitation Trolley (with life saving 1 110,000 110,000 medicines, Laryngoscope, Endo-tracheal tube, BP Apparatus, Chargeable light) 24 Cardiac Monitor 1 500,000 500,000 25 Pump Breast Electronic 1 250,000 250,000 26.1 Toothed Tissue Forceps (8”) 2 55 110 26.2 Non-Tooted Tissue Forceps (8”) 2 55 110 26.3 Dissection Scissors (Curved 7”) 2 150 300 26.4 Dissection Scissors (Straight 7”) 2 150 300 26.5 Hysterectomy Clamps (Straight) 5 150 750 26.6 Hysterectomy Clamps (Curved) 5 175 875 26.7 Uterine Sound 2 90 180 26.9 Needle Holder (10”) 1 300 300 26.1 Artery Forceps (Straight 6”) 13 110 1,430 114 Three Years Rolling Plan 2010-2013 District Toba Tek Singh

Total Cost Sr. No. Equipment Gap Unit Cost (Rs.) 26.11 Artery Forceps (Curved 6”) 13 125 1,625 26.12 Allis Forceps 2 230 460 26.13 Towel Clamps 6 125 750 26.14 Single blade Sims speculum 4 275 1,100 26.15 Double blade Sims speculum 2 250 500 26.16 Sponge holding forceps 6 200 1,200 26.17 Volselum forceps 3 250 750 26.18 Uterine Sound 2 1,500 3,000 26.19 Bladder Sound 2 1,500 3,000 27.2 Straight Scissors 7 360 2,520 27.3 Needle holder 7 135 945 27.4 Non-toothed tissue forceps 8 inches 10 100 1,000 27.5 Toothed tissue forceps 8 inches 8 100 800 27.6 Sims Speculum single blade 20 275 5,500 27.7 Sims Speculum double blade 14 250 3,500 27.8 Sponge holding forceps 34 250 8,500 27.9 Artery forceps 30 275 8,250 27.1 Straight clamps (cord) 14 175 2,450 27.11 Vacuum Extractor pump 1 19,000 19,000 27.12 Towel clip 34 125 4,250 28.1 Scalpel 4 50 200 28.2 Artery Forceps Straight 6 inches 22 125 2,750 28.3 Artery Forceps Curved 6 inches 22 125 2,750 28.4 Artery forceps 8 inches 24 175 4,200 28.5 Myoma Scissors straight 7 inches 5 150 750 28.6 Dissecting scissors (curved) 7 inches 5 270 1,350 28.7 Green Armtage forceps 8 inches 14 300 4,200 28.8 Obstetric outlet forceps (pair) 5 900 4,500 28.1 Small Retractors 12 300 3,600 28.11 Towel Clippers 22 125 2,750 28.12 Suction Nozzle 5 250 1,250 29.1 Ultrasound Machine 1 575,000 575,000 29.4 Lead Screen for X-Ray Unit 1 30,000 30,000 29.5 0.5 MN Lead Apron. Lead Gloves, Goggles and 1 100,000 100,000 Thyroid and Gonadal Sheets 30.1 Paediatric Ventilator 1 1,200,000 1,200,000 30.5 Infant Length Measuring Scale 2 5,000 10,000 30.8 Billiubino-meter 1 36,000 36,000 30.9 Exchange Blood Transfusion Set 1 2,000 2,000 30.1 Nasal Probe Paed size 2 7,000 14,000 31.2 Ventilators 1 525,000 525,000 31.4 Pulse Oximetry 1 21,000 21,000 32.1 Blood storage cabinet (100 bag capacity) 1 812,000 812,000 115 Three Years Rolling Plan 2010-2013 District Toba Tek Singh

Total Cost Sr. No. Equipment Gap Unit Cost (Rs.) 32.2 Packed cell machine 1 600,000 600,000 32.3 Cell Separator 1 5,225,000 5,225,000 32.4 Freezer for Fresh Frozen Plasma 1 1,150,000 1,150,000 32.5 Blood bag shaker 1 10,000 10,000 32.6 RH view box 1 1,000 1,000 32.7 Water bath 1 3,000 3,000 32.8 Micro-pipette 1 8,000 8,000 32.9 Blood grouping tiles 2 3,000 6,000 32.1 Plasma Extractor 1 1,000,000 1,000,000 32.11 Platelets agitator 1 1,000,000 1,000,000 32.12 Blood thawing bath 1 3,000 3,000 32.13 Microscopes 1 115,000 115,000 33.1 Hematology Analyzer 1 425,000 425,000 33.2 Electrolyte Analyzer 1 625,000 625,000 33.3 Analyzer Bio-chemistry Semi-automatic 1 690,000 690,000 33.4 Glucometer 1 2,500 2,500 33.6 Centrifuge 1 133,000 133,000

Total cost of equipment 18,688,035

THQ Hospital Gojra

Sr. Total Equipment Gap Unit Cost No. Cost(Rs.) 1 CTG (Cardiac Tocography) 1 285,000 285,000 2 Foetal Doppler 3 10,000 30,000 3 Diagnostic Laparoscope 1 1,200,000 1,200,000 4 Bulb Sucker 18 45 810 5 Baby Warmer 3 850,000 2,550,000 6 Mechanical Sucker 3 28,000 84,000 7 Fetal Stethoscope 4 15,000 60,000 9 D&C Set 1 2,100 2,100 11 Myoma Screw 1 320 320 13 Volselum forceps 4 235 940 14 Lanes Tissue holding forceps 2 400 800 15 Vaginal Retractors 6 350 2,100 16 Polypectomy forceps 2 750 1,500 17 Sponge holder 7 300 2,100 116 Three Years Rolling Plan 2010-2013 District Toba Tek Singh

Sr. Total Equipment Gap Unit Cost No. Cost(Rs.) 18 Uterine elevator 1 150 150 19 CosCo Speculum 6 550 3,300 Small, Medium, Large (for each category) - 20 Examination light 1 18,000 18,000 21 Suction Curette 1 95 95 22 Infant Resuscitation Trolley (with life saving 1 95,000 95,000 medicines, baby laryngoscope, Endo- tracheal tube, Infant BP Apparatus, Chargeable Light) 23 Mother Resuscitation Trolley (with life 1 110,000 110,000 saving medicines, Laryngoscope, Endo- tracheal tube, BP Apparatus, Chargeable light) 24 Cardiac Monitor 1 500,000 500,000 25 Pump Breast Electronic 1 250,000 250,000 26.5 Hysterectomy Clamps (Straight) 8 150 1,200 26.11 Artery Forceps (Curved 6”) 8 125 1,000 26.12 Allis Forceps 4 230 920 26.14 Single blade Sims speculum 3 275 825 26.15 Double blade Sims speculum 2 250 500 26.16 Sponge holding forceps 6 200 1,200 26.17 Volselum forceps 4 250 1,000 26.18 Uterine Sound 2 1,500 3,000 26.19 Bladder Sound 2 1,500 3,000 27.2 Straight Scissors 10 360 3,600 27.5 Toothed tissue forceps 8 inches 4 100 400 27.6 Sims Speculum single blade 20 275 5,500 27.7 Sims Speculum double blade 20 250 5,000 27.8 Sponge holding forceps 40 250 10,000 27.1 Straight clamps (cord) 30 175 5,250 27.11 Vacuum Extractor pump 1 19,000 19,000 27.12 Towel clip 38 125 4,750 28.2 Artery Forceps Straight 6 inches 24 125 3,000 28.4 Artery forceps 8 inches 24 175 4,200 28.5 Myoma Scissors straight 7 inches 6 150 900 28.6 Dissecting scissors (curved) 7 inches 6 270 1,620 28.7 Green Armtage forceps 8 inches 16 300 4,800 28.8 Obstetric outlet forceps (pair) 6 900 5,400 28.1 Small Retractors 12 300 3,600 28.11 Towel Clippers 24 125 3,000 28.12 Suction Nozzle 5 250 1,250 29.1 Ultrasound Machine 1 575,000 575,000

Sr. Total Equipment Gap Unit Cost No. Cost(Rs.) 29.5 0.5 MN Lead Apron. Lead Gloves, Goggles 1 100,000 100,000 and Thyroid and Gonadal Sheets 29.7 X-RT Film Processing Tank 1 5,000 5,000 30.1 Paediatric Ventilator 2 1,200,000 2,400,000 30.2 Incubator 2 1,500,000 3,000,000 30.3 Photo Therapy Unit 1 22,000 22,000 30.4 Over-head Radiant Warmer 1 910,000 910,000 30.5 Infant Length Measuring Scale 2 5,000 10,000 30.7 Nebulizer 1 22,000 22,000 30.8 Billiubino-meter 1 36,000 36,000 30.9 Exchange Blood Transfusion Set 1 2,000 2,000 30.1 Nasal Probe Paed size 2 7,000 14,000 31.1 Anaesthesia Machine 1 321,000 321,000 31.2 Ventilators 1 525,000 525,000 31.3 Nebulizer 1 165,000 165,000 31.4 Pulse Oximetry 1 21,000 21,000 31.5 Defibrillator 1 500,000 500,000 31.6 Airway Oral and Nasal 2 500 1,000 31.7 Tracheostomy tube (adult and paeds) 2 1,000 2,000 31.8 Face mask of all sizes 1 1,000 1,000 31.9 Double Cuff Tourniquet (for regional block) 1 320 320 31.11 AMBO Bag paeds 1 3,000 3,000 31.12 Red Rubber Nasal tubes all sizes without 3 1,000 3,000 cuff 32.1 Blood storage cabinet (100 bag capacity) 1 812,000 812,000 32.2 Packed cell machine 1 600,000 600,000 32.3 Cell Separator 1 5,225,000 5,225,000 32.4 Freezer for Fresh Frozen Plasma 1 1,150,000 1,150,000 32.5 Blood bag shaker 1 10,000 10,000 32.6 RH view box 1 1,000 1,000 32.7 Water bath 2 3,000 6,000 32.8 Micro-pipette 3 8,000 24,000 32.9 Blood grouping tiles 3 3,000 9,000 32.1 Plasma Extractor 1 1,000,000 1,000,000 32.11 Platelets agitator 1 1,000,000 1,000,000 32.12 Blood thawing bath 1 3,000 3,000 33.1 Hematology Analyzer 1 425,000 425,000 33.3 Analyzer Bio-chemistry Semi-automatic 1 690,000 690,000 33.4 Glucometer 2 2,500 5,000

118 Three Years Rolling Plan 2010-2013 District Toba Tek Singh THQ Hospital Kamalia

Total Sr. No. Equipment Quantity Unit Cost Cost(Rs.) 1 CTG (Cardiac Tocography) 1 285,000 285,000 2 Foetal Doppler 3 10,000 30,000 3 Diagnostic Laparoscope 1 1,200,000 1,200,000 4 Bulb Sucker 19 45 855 5 Baby Warmer 3 850,000 2,550,000 6 Mechanical Sucker 2 28,000 56,000 7 Fetal Stethoscope 4 1,500 6,000 9 D&C Set 1 2,100 2,100 10 Outlet forceps 3 900 2,700 12 Kochers forceps 4 235 940 13 Volselum forceps 4 235 940 14 Lanes Tissue holding forceps 2 400 800 15 Vaginal Retractors 6 350 2,100 16 Polypectomy forceps 2 750 1,500 17 Sponge holder 15 300 4,500 18 Uterine elevator 1 150 150 19 CosCo Speculum 6 550 3,300 Small, Medium, Large (for each category) - 20 Examination light 2 18,000 36,000 21 Suction Curette 2 95 190 22 Infant Resuscitation Trolley (with life saving medicines, 1 95,000 95,000 baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light) 23 Mother Resuscitation Trolley (with life saving 1 110,000 110,000 medicines, Laryngoscope, Endo-tracheal tube, BP Apparatus, Chargeable light) 24 Cardiac Monitor 1 500,000 500,000 25 Pump Breast Electronic 1 250,000 250,000 26.1 Toothed Tissue Forceps (8”) 1 55 55 26.2 Non-Tooted Tissue Forceps (8”) 2 55 110 26.3 Dissection Scissors (Curved 7”) 1 150 150 26.4 Dissection Scissors (Straight 7”) 1 150 150 26.5 Hysterectomy Clamps (Straight) 5 150 750 26.6 Hysterectomy Clamps (Curved) 8 175 1,400 26.7 Uterine Sound 2 90 180 26.8 Needle Holder (7”) 3 150 450 26.9 Needle Holder (10”) 2 300 600 26.1 Artery Forceps (Straight 6”) 16 110 1,760 26.11 Artery Forceps (Curved 6”) 8 125 1,000 26.12 Allis Forceps 8 230 1,840 26.13 Towel Clamps 8 125 1,000

Total Sr. No. Equipment Quantity Unit Cost Cost(Rs.) 26.14 Single blade Sims speculum 4 275 1,100 26.15 Double blade Sims speculum 4 250 1,000 26.16 Sponge holding forceps 8 200 1,600 26.17 Volselum forceps 4 250 1,000 26.18 Uterine Sound 2 1,500 3,000 26.19 Bladder Sound 2 1,500 3,000 27.2 Straight Scissors 10 360 3,600 27.4 Non-toothed tissue forceps 8 inches 10 100 1,000 27.5 Toothed tissue forceps 8 inches 10 100 1,000 27.6 Sims Speculum single blade 20 275 5,500 27.7 Sims Speculum double blade 20 250 5,000 27.8 Sponge holding forceps 40 250 10,000 27.9 Artery forceps 40 275 11,000 27.1 Straight clamps (cord) 30 175 5,250 27.11 Vacuum Extractor pump 1 19,000 19,000 27.12 Towel clip 40 125 5,000 28.1 Scalpel 5 50 250 28.2 Artery Forceps Straight 6 inches 20 125 2,500 28.3 Artery Forceps Curved 6 inches 24 125 3,000 28.4 Artery forceps 8 inches 24 175 4,200 28.5 Myoma Scissors straight 7 inches 6 150 900 28.6 Dissecting scissors (curved) 7 inches 6 270 1,620 28.7 Green Armtage forceps 8 inches 24 300 7,200 28.8 Obstetric outlet forceps (pair) 6 900 5,400 28.9 Doyene’s Retractor 6 200 1,200 28.1 Small Retractors 12 300 3,600 28.11 Towel Clippers 24 125 3,000 28.12 Suction Nozzle 6 250 1,500 29.1 Ultrasound Machine 1 575,000 575,000 29.4 Lead Screen for X-Ray Unit 1 6,000,000 6,000,000 29.5 0.5 MN Lead Apron. Lead Gloves, Goggles and 1 100,000 100,000 Thyroid and Gonadal Sheets 29.6 Safe Light 1 5,000 5,000 29.7 X-RT Film Processing Tank 1 5,000 5,000 29.8 Chest Stand 1 4,500 4,500 29.1 X-Ray Film Hangers All sizes 4 4,000 16,000 30.1 Paediatric Ventilator 2 1,200,000 2,400,000 30.2 Incubator 0 1,500,000 - 30.3 Photo Therapy Unit 1 22,000 22,000 30.4 Over-head Radiant Warmer 1 910,000 910,000 30.5 Infant Length Measuring Scale 2 5,000 10,000 30.6 Infant Weighing Machine 2 3,100 6,200 30.7 Nebulizer 1 22,000 22,000 120 Three Years Rolling Plan 2010-2013 District Toba Tek Singh

Total Sr. No. Equipment Quantity Unit Cost Cost(Rs.) 30.8 Billiubino-meter 1 36,000 36,000 30.9 Exchange Blood Transfusion Set 1 2,000 2,000 30.1 Nasal Probe Paed size 2 7,000 14,000 31.2 Ventilators 1 525,000 525,000 31.3 Nebulizer 1 165,000 165,000 31.4 Pulse Oximetry 1 21,000 21,000 31.5 Defibrillator 1 500,000 500,000 31.6 Airway Oral and Nasal 2 500 1,000 31.7 Tracheostomy tube (adult and paeds) 2 1,000 2,000 31.8 Face mask of all sizes 2 1,000 2,000 31.9 Double Cuff Tourniquet (for regional block) 1 320 320 31.1 AMBO bag adult 2 2,450 4,900 31.11 AMBO Bag paeds 2 3,000 6,000 31.12 Red Rubber Nasal tubes all sizes without cuff 4 1,000 4,000 32.1 Blood storage cabinet (100 bag capacity) 1 812,000 812,000 32.2 Packed cell machine 1 600,000 600,000 32.3 Cell Separator 1 5,225,000 5,225,000 32.4 Freezer for Fresh Frozen Plasma 1 1,150,000 1,150,000 32.5 Blood bag shaker 1 10,000 10,000 32.6 RH view box 2 1,000 2,000 32.7 Water bath 2 3,000 6,000 32.8 Micro-pipette 6 8,000 48,000 32.9 Blood grouping tiles 3 3,000 9,000 32.1 Plasma Extractor 1 1,000,000 1,000,000 32.11 Platelets agitator 1 1,000,000 1,000,000 32.12 Blood thawing bath 1 3,000 3,000 33.1 Hematology Analyzer 1 425,000 425,000 33.2 Electrolyte Analyzer 1 625,000 625,000 33.3 Analyzer Bio-chemistry Semi-automatic 1 690,000 690,000 33.4 Glucometer 2 2,500 5,000 33.5 Haemoglobino-meter 1 1,000 1,000