Health Asp Improvement Guidelines 1St Indicative List

GUIDELINES FOR DEVELOPMENT OF THREE YEAR ROLLING PLAN FOR HEALTH

Prepared by:

Punjab Devolved Social Services Program 2008-09 to 2010-11

Revised by:

Punjab Health Sector Reforms Program 2009-10 to 2011-12 2 C O N T E N T S

Description Page # Introduction 7

Situation Analysis and Need Base Planning 13

A District Characteristics 14

A-1 Geographical and Demographic Characteristics 14

A-2 Key Health Problems 14

B. Situation and Planning of Selective Health Indicators: 15

Table # B-1 Information on selective indicators 15

Table # B-2 Information about SBAs 16

Table # B-3 Proportion of births attended by SBA 16

Table # B-4 Pre/Ante-natal, Post-natal and Neo-natal 16 consultation practices (2007-08)

Table # B-5 Pre/Ante-natal, Post-natal and Neo-natal 17 consultation practices (2008-09)

Table # B-6 Number of births taking place at health facilities 17

Table # B-7 Post-natal care consultation 17

Table # B-8 Contraceptive Prevalence Rate (CPR) 18

Table # B-9 Percentage of 1 year old children immunized against 18 first dose of Measles

Table # B-10 Vaccination coverage for TT, Routine EPI, Polio 18

i Diarrhea & other epidemic cases/fatalities 19 Table # B-11 (Under 1 year age)

ii Diarrhea & other epidemic cases/fatalities 19 (Under 5 year age)

Table # B-12 Information on parasitic and infectious diseases / 19 epidemics and their toll

Table # B-13 Reported Hepatitis “C” positive cases/fatalities 20

Table # B-14 Information on control of Malaria, TB and ARI 20

Table # B-15 (MDG-6) Information – Malaria 20

Table # B-16 TB cases 21

Table # B-17 Reported HIV/AIDS positive cases / fatalities 21

3 Table # B-18 Information on ECCD (Early Childhood Care for 21 Development)

Table # B-19 Closure of health facilities (For the last 2 years i.e. 22 2006-08)

Table # B-20 Trauma and emergency care (2008-09) 22

Table # B-21 Needs / Requirements to improve trauma and 22 emergency care

C. Situation and Planning of Human Resource:

Table # C-1 Staffing position 23

Table # C-2 Details of sanctioned posts DHQ Hospitals 23

Table # C-3 Details of sanctioned posts THQ Hospitals 23

Table # C-4 Details of sanctioned posts RHCs 24

Table # C-5 Details of sanctioned posts BHUs 24

D. Situation and Planning of Service Delivery:

Table # D-1 Referral System / Cases (2008-09) 25

Table # D-2 Action taken against quacks, spurious drugs 25

i Number of cases registered 25

ii Case processing / follow of register cases 25

Table # D-3 Details on School Health Program 26

i Situational analysis 26

ii Statistical data 26

Table # D-4 Information on Hospital Waste Management 26

Table # D-5 Gender mainstreaming (Year 2008-09) 27

Table # D-6 Health Monitoring Committees 27

i Role of Women Councilors in Health 27 Monitoring Committees

ii Behavior Change (BC) Communication 27 Campaign (2008-09)

iii Performance of Health Sector Monitoring 27 Committee (2007-08)

E. Situation and Planning of Finances

Table # E-1 Information on funds received by DGs 29

Table # E-2 Allocation made by District Government for Health 29 Sector against total resources of the District

4 Table # E-3 Functional allocation for non-dev budget 30

Table # E-4 Level specific allocation 30

Table # E-5 Overall trends in allocation and expenditure in the 31 sector (Allocation and Utilization under Non- Development/recurring budget)

Table # E-6 Financial Requirements for Medicine 31

Table # E-7 i Budget outlays for in-service training of 32 personnel in Health Sector.

ii Area of training (2008-09) 32

Financial requirement for equipment 33

i BHU equipment 33 Table # E-8 ii. RHC requirement 33

iii. THQ requirement 33

iv. DHQ requirement 34

Table # E-9 Information on Patient-Welfare Associations 34

Table # E-10 Information of NGOs and CBOs and private sector 34 working in the Health Sector

Table # E-11 CCB initiatives (2008-09) 35

Table # E-12 Any partnership with PRSP or NCHD 35

Table # E-13 Health Schemes implemented / planned under ADP 35

F. Out put and out come indicators

Table # F-1 Input indicators 36

Table # F-2 Out put indicators 36

Table # F-3 Out come indicators 37

Table # F-4 Stakeholder consultation that went into preparation 37 of this 3YR Rolling Plan

G Punjab Millennium Development Goals Program (Allocations, Expenditure and Projections

Table # G-1 Allocation of funds under PMDGP 38

Table # G-2 Distribution of the PMDGP funds 38

i Training 38

ii MNCH related activities except training 38

5 6 INTRODUCTION

Objectives:

The objective of the Government of the Punjab is to achieve progress on the Millennium Development Goals (MDGs) related to poverty, gender, education, health, and water supply and sanitation. The Program’s objective is to strengthen devolved social services for a more equitable, efficient, effective, and sustainable delivery of social services in line with the Punjab Local Government Ordinance 2001 (PLGO).

The Program is built around three principal policy outcomes:

 Realigning intergovernmental relations to support devolved social services;  Rationalizing and setting minimum standards for social services; and  Strengthening the public accountability mechanisms and promoting public-private partnership

The Program is designed to support the devolution of health services for 3 years, covering all 35 district governments. The TA component for strengthening the devolution of social sector services is for a period of 4 years commencing after the release of the first Tranche. Evidence based approach of this plan may be adapted.

The advantages of incrementally over other formal systems is that no time is wasted planning for outcomes which may not occur. Disadvantages are that time may be wasted dealing with the immediate problems and no overall strategy is developed. Incremental planning is a process of bargaining between institutions under conditions of uncertainty. Uncertainty is caused by general limitation to knowledge and by the complexity of the budget.

Without a central planning framework incremental planning is difficult to support within structured systems and therefore requires a degree of self reliance, skills and experience of those dealing with the problems such as is found in autonomous work groups.

An evidence based approach encourages planners to place particular emphasis on why the plan is necessary, whilst also considering the plan's aims, objectives, target audience and expected strategic outcomes.

The policies and programs designed to bring about improvements in the health status of rural and remote residents have been limited by the absence of systematic statistical data.

The information provided by community members, stakeholders or other agencies can be useful. This must be presented in some consistent way so that it will support and legitimize the evidence-based process. A good needs analysis should be informed by both quantitative and qualitative data.

Measurement of Evidence is imperative to use it for evaluation process. The concept of 'evidence' refers to a range of tangible information that can be used to identify a problem and the need for a response. This can be used for evaluation and research purposes.

7 Information and data can be broadly considered in two categories; quantitative (such as statistical information) and qualitative (such as anecdotal data provided during consultations).

Medium-Term Development Framework (MTDF)

MTDF is a system for making the development planning process more strategic i.e. looking beyond the one year period and responsive to the priorities of the Government, by introducing a medium term (3 year) horizon to the planning process. The main objectives of medium term planning are as follows:

 To align local government priorities with the Provincial development priorities;

 To minimize adhocism and focus on effective strategic development planning;

 To reduce throw-forward and midway abandoning of development schemes; an

 To promote fiscal discipline.

The MTDF is currently in use in the Provincial Government at the Provincial level since last three years. The Planning and Development Department is responsible for preparation of the Medium-Term Development Framework for the province; which is mainly a collation of the development frameworks of the various provincial departments. On the other hand, the provincial Finance Department is responsible for compilation and finalization of the provincial Medium-Term Budgetary Framework. A lot of information on MTDF and MTBF is available on the web pages of these two provincial departments. Additionally, the Federal Government also has a website on MTBF. The readers are encouraged to look at these websites, if they have internet access.

The Medium-Term Development Framework is based on a process that is different from the traditional incremental development planning being followed at the local government level. The MTDF process involves laying down the mission statement of the local government for each sector along with setting up of output indicators that are to be achieved on implementation of the development activity. The Local Government Planning Manual (chapter 2) provides in detail information on setting up indicators and the planning process that is to be followed to prepare an Annual Development Plan.

Guidelines for Preparation of MTDF The Provincial Planning and Development Department has also issued guidelines for preparation of MTDF. A modified version of these guidelines, while retaining the original message, is reproduced below for use in preparation of three year rolling plans for PDSSP and ADP by the local governments on MTDF mode:

i. The Annual Sector Plan will be formulated in the medium-term development framework mode as a three-year rolling plan within the spirit, policies, strategies and decisions of the Provincial Government taken from time to time. The program will contain schemes based portfolio for the financial year 2009 -- 10 and projections for the subsequent years 20010- 11 and 2011-12.

8 ii. For each sector of the plan there will be a short vision and mission statement clearly indicating as to what has been envisaged to be achieved during the financial year 2009- 10 and for the two subsequent years. Outcome based sector briefs, i.e. a page or two containing policy objectives and targets during 2009-10 with special linkages wherever they are relevant with the Millennium Development Goals, shall be included in the plan.

iii. The program should be worked out and Information supplied on Three Year Rolling Plan template developed by PHSRP. iv. Schemes proposed for inclusion in the three-year rolling plan (including annual development program) should be arranged in order of priority within each sector/sub sector.

v. The ratio of allocation between ongoing and new schemes should be 70:30 respectively. vi. Ongoing development projects at an advanced stage of completion (projects where 70% of cost is already incurred), may be fully funded for completion during 2009 – 10. vii. Development schemes targeted for completion during 2009 - 10, may be separately indicated. viii. Social sectors along with the new reform initiatives are to be assigned special priority within the policy of the Government focused at poverty reduction strategy. ix. Development schemes to be initiated in the following years i.e. 2010 – 11 and 2011 – 12 are to be listed separately in the plan.

x. The three-year rolling plans are to be forwarded to the PMU-PHSRP, after seeking approval from the Council of the local government concerned. The attached schedule is to be strictly followed by all the local governments so that the 3 Year Rolling Plans are prepared on time, approved by the Council concerned and forwarded to the PSU. xi. The Planning and Development Department, Government of Punjab has laid down the following development objectives for the year 2009- 10:

a. Accelerating economic growth;

b. Reduction in poverty;

c. Balanced regional, gender and minority development;

d. Consolidation of existing physical and social infrastructure;

e. Improvements in public service delivery in education, health and water

supply and sanitation sectors and enhanced coverage; and

f. New infrastructure development through public private partnership.

9 xii. The Planning and Development Department, Government of Punjab has laid down the following strategy for development program 2009- 10:

a. Higher across the board allocation for all sectors, with an emphasis on pro-poor sectors; b. Maximum allocations to ongoing schemes to avoid deferring benefits; c. Required counterpart funding for foreign aided projects; d. Allocations for regional development projects; e. Adequate new programs to increase coverage in social sectors; and f. Containment of throw forward. xiii. The financial projections for the financial year 2009- 10, 2010-11 in 2011- 12 to be part of the three-year rolling plan, as per the template. Whereas these allocations are purely tentative, they definitely have a linkage with the envisaged three-year rolling plan (medium-term development plan) and every effort is to be made to remain within these allocations in the subsequent years.

10 MILLENNIUM DEVELOPMENT GOALS

Goal 1 Eradicate Extreme Hunger and Poverty

Goal 2 Achieve Universal Primary Education

Goal 3 Promote Gender Equality and Empower Women

Goal 4 Reduce Child Mortality

Goal 5 Improve Maternal Health

Goal 6 Combat HIV / AIDS, Malaria & TB DOTS

Goal 7 Ensure Environmental Sustainability

Goal 8 Development a Global Partnership for Development

Health related Goals: Goal – 4, 5 and 6

11 12 SITUATION ANALYSIS AND NEEDS-BASED PLANNING

The situation analysis will indicate existing situation with a detailed description of the District, mapping of existing sector infrastructure, review of on-going sector-wide activities and their status.

It would also contain details as given in the tables below. This will be complemented by targets based on the assessed needs.

13 A. DISTRICT CHARACTERISTICS

A-1 Geographical and Demographic Characteristics

 Outlining of geographical and demographic characteristics including

population projections

 Age and sex breakups

 Population density and distribution

 Socio-economic factors affecting health.

 Any other specific demographic feature of the district.

A-2 Key Health Problems

 Health situation (to become the basis of health needs).

 Key health problems and causes, with a table of key health status

indicators.

 Suggestions and recommendations to redress the key health

problems of the district

14 B. Situation and Planning of Selective Health Indicators:

Table # B-1 Information on Selective Indicators

Category 2007-08 2008-09 Planned Steps Proposed Target for for achieving 2009-10 the targets Average Absenteeism (%) out of total Medical staff Average Absenteeism (%) out of total Paramedic Staff Doctor-Population Ratio Nurse-Population Ratio Doctor-Nurse Ratio Doctor-Bed Ratio Nurse-Bed Ratio Bed Occupancy Rate Number of Patients attended the outdoor in primary Health Care facilities (BHUs, RHCs, Dispensaries, MCH Centers etc) Number of Patients attending the OPD in Secondary Health Care facilities (THQ / DHQ Hospitals) Number of admitted patients in RHCs Number of indoor patients at Secondary level facilities. Number of surgeries (minor/major*) taking place at secondary level. Total Blood Transfusions in Secondary Health Care facilities (THQ / DHQ Hospitals) Total Laboratory tests in Secondary Health Care facilities (THQ / DHQ Hospitals) Total X-Rays & Ultra Sounds in Secondary Health Care facilities (THQ / DHQ Hospitals)

* Minor surgeries are defined as surgeries performed as OPD, and Major surgeries require admission in the hospital.

Table # B-2 Information about SBAs

15 Year Number of SBAs % age Change as Give brief about steps Situation Target Achieve compared to last taken to increase the year* number of SBAs (Please Annex) 2006-07 2007-08 2008-09 Planned Target 2009-10 2010-11 2011-12

* (current year / previous years * 100) - 100

Table # B-3 Proportion of Births attended by SBA

Year Expected No. of Deliveries in Percentage of Births the District attended by SBA in the district* 1 2 3 Situation 2006-07 2007-08 2008-09 Planning 2009-10 2010-11 2011-12

*Births attended by SBAs / Expected No. of Deliveries x 100

Table # B-4 Pre/Ante-natal, Post natal and Neo-natal consultation practices (2007-08)

{Make Separate table for each year} Name of Number of Pre- Vaccination Number of Number of Neo-natal Health Facility natal for pregnant Post natal Consultations Consultations women consultations BHU or Below RHC THQ H DHQ H Others* Total * Others include MCH, civil hospital, maternity hospitals etc.

Table # B-5 Pre/Ante-natal, Post natal and Neo-natal consultation practices (2008-09)

{Make Separate table for each year} Name of Health Number of Vaccination Number of Post Number of Neo-natal

16 Facility Pre-natal for pregnant natal Consultations Consultations women consultations BHU or Below RHC THQ H DHQ H Others* Total * Others include MCH, civil hospital, maternity hospitals etc.

Table # B-6 Number of births taking place at health facilities

Year/Facility BHU or RHC THQ DHQ Others* Total %age Below H H Increase (for total)** 1 2 3 4 5 6 7 8 Situation 2006-07 2007-08 2008-09 Planning 2009-10 2010-11 2011-12 *Others include MCH Centers, Civil Hospitals, and MCH Hospitals. ** (current year / previous years * 100) - 100

Table # B-7 Post-natal Care Consultation

Year Total No. of Expected Consultation by SBAs Births in the District (%age)* Situation 2006-07 2007-08 2008-09 Plan 2009-10 2010-11 2011-12 *Consultation by SBAs / Total expected deliveries x 100

Table # B-8 Contraceptive Prevalence Rate (CPR)

Year Target (Eligible Couples) CPR (Any Method) [%] Situation 2006-07 2007-08 2008-09 Planned Target 2009-10

17 2010-11 2011-12

Table # B-9 Percentage of 1 year old children immunized against first dose of Measles

Year Total Number of Percentage of 1 year Children of 1 year old children received Age (000) 1st dose of Measles* Situation 2006-07 2007-08 2008-09 Planned Target for 2009-10 2010-11 2011-12

*Children received 1st dose of measles / Total No. of Children x 100

Table # B-10 Vaccination coverage for TT, Routine EPI, Polio 0 1 2

Immunization Number of % age of Part of Target for 2008-09 1 1 1 - 0 0 9

Children to be Children c the Reasons for 2 2 0 - - 0 administered overed District shortfall /remedies 0 1 2 1 1

0 0 (Target for (Coverage) lagging to be taken to r 2 2 o

f r r 2008-09) behind* meet shortfall t o o f f e

t t g r e e a g g r r T a a T T TT Polio Routine EPI Other

*Please indicate specific areas of the district that have not been covered.

Table # B-11 i. Diarrhea & Other Epidemic Cases/Fatalities (Under 1 year Age)

Year Number of Number of Number of Number of Diarrhea Other Fatalities Fatalities Epidemics Epidemics resulting resulting Reported Reported from from Other Diarrhea diseases No. of

18 2006-07 2007-08 2008-09

Table # B-11. ii. Diarrhea & Other Epidemic Cases/ Fatalities (Under 5 year Age)

Year Number of Number of Number of Number of Diarrhea Other Fatalities Fatalities Epidemics Epidemics resulting resulting Reported Reported from from Other Diarrhea diseases No. of 2006-07 2007-08 2008-09

Table # B-12. Information on Parasitic and Infectious Diseases/ Epidemics and their Toll

Year Prevalence of Parasitic & Fatalities due to Infectious Diseases as % of Parasitic & Infectious Total Disease Burden Diseases (as % of Total Situation Total Disease *%age of Fatalities) Burden of the Parasitic & District Infectious Diseases 2006-07 2007-08 2008-09 Planned Target 2009-10 2010-11 2011-12

*Parasitic & Infectious Diseases / Total Burden of Disease x 100

Table # B-13. Reported Hepatitis “C” Positive Cases/Fatalities

Year Number of Number of Number of Number of reported HCV HCV patients Fatalities Positive patients treated and resulting HCV Cases under rehabilitated from HCV treatment (required dose Reported given) 2006-07 2007-08 2008-09

Table # B-14. Information on control of Malaria, TB and ARI

Year Malaria Cases *% age ARI % age TB Cases % age reported Increase/ Cases Increase / Reported Increase/

19 Decrease Reported Decrease Decrease Situation 2006-07 2007-08 2008-09 Planned Target 2009-10 2010-11 2011-12 * (current year / previous years * 100) – 100

Table # B-15. (MDG-6) Information - Malaria

Year Percentage of population in Percentage of population in malaria-risk areas using effective malaria-risk areas given malaria prevention treatment Situation Target Achieve 2006-07 2007-08 2008-09 Planned Target 2009-10 2010-11 2011-12

Table # B-16. TB Cases

Year Prevalence Incidence Mortality Case Treatment of Disease of Disease Rate* Detection Success (Old + New (New Rate Rate Patients) Patients) Situation 2006-07 2007-08 2008-09 Planned Target 2009-10 2010-11 2011-12

*Deaths due to TB in one year / Total No. of Deaths in one year x 100

Table # B-17. Reported HIV/AIDS Positive Cases/Fatalities

Year Number of reported Number of Fatalities Positive HIV / AIDS resulting from HIV/AIDS cases Reported 2006-07

20 2007-08 2008-09

Table # B-18. Information on ECCD (Early childhood care for development)

. Cross-Sectoral Issues (with Education Department etc.)

. Child Nutrition Program (2008-09)

Supplement Number of % age of Part of Reasons Target Target Target Children to Children the for short for for for be covered District fall if any. 2009-10 2010- 2011- administered (Coverage) lagging 2011 2012 (Target for behind* 2008-09) Vitamin ‘A’ Iron Iodine Micro-nutrients Dietary Supplements

*Please indicate specific areas of the district that have not been covered.

Table # B-19. Closure of Health Facilities (For the last 2 years i.e. 2006-08)

Name of Health Facility* Date of Reason/Action taken to Closure Operationalize the same

*Please cover only BHU, RHC, THQ H and DHQ H Table # B-20. Trauma and Emergency Care (2008-09) i. Situational analysis

No. of cases No. of No. of cases No. of cases No. of cases reported to A&E cases admitted treated and referred to Deptt. treated discharged higher facility BHUs RHCs THQ hospitals DHQ hospitals Others* *Others include MCH Centers, Civil Hospitals and MCH Hospitals.

Table # B-21Needs/Requirements to improve trauma and emergency Care. (Please indicate separately for RHCs, THQ and DHQ hospitals)

21 Health Facility Name of Required in Available in Short fall in Plan to Equipment NO. NO. NO. meet short fall. BHUs

THQ hospitals

DHQ hospitals

Others*

22 23 A. C. Situation and Planning of Human Resource:

Table # C-1. Staffing Position

Staff Category Sanctioned Filled Vacant % of Number of Number of (by designation Posts vacant posts filled posts to be of existing staff) posts during 2008-09. filled in 2009-10

Table # C-2. Details of Sanctioned Posts DHQ Hospitals (Note: If more than one DHQ Hospitals use new table for each hospital)

Name of DHQ Hospital______Sr. Nomenclature of Posts No. of existing No. of posts No. of No. Sanctioned notified in remaining posts Posts MSDS to be sanctioned

Table # C-3. Details of Sanctioned Posts THQ Hospitals (Note: For each THQ Hospitals use new Table)

Name of THQ Hospital______Sr. Nomenclature of Posts No. of existing No. of posts No. of remaining No. Sanctioned notified in posts to be Posts MSDS sanctioned

Table # C-4 Details of Sanctioned Posts RHCs (for all RHCs joint case/Table)

Total No. of RHCs in the district ______Sr. Nomenclature of Posts No. of existing No. of posts No. of No. Sanctioned notified in remaining posts Posts MSDS to be sanctioned

24 Table # C-5 Details of Sanctioned Posts BHUs (for all BHUs joint case/Table) Total No. of BHUs in the district ______

Sr. Nomenclature of Posts No. of existing No. of posts No. of No. Sanctioned notified in remaining posts Posts MSDS to be sanctioned

25 D. Situation and Planning of Service Delivery:-

Table # D-1 Referral System/Cases (2008-09)

Health Facility Number of Number of Reasons for Suggestions for Cases Cases referral better Referral Referred to Referred System it by it BHU RHC THQ H DHQ H Others* *Others include MCH Centers, Civil Hospitals and MCH Hospitals.

Table # D-2. Action Taken Against Quacks, Spurious Drugs

i. No. of cases registered.

Year Quacks Spurious Drugs (No. of cases (No. of cases registered) registered) 2006-07 2007-08 2008-09

ii. Case processing/ Follow-up of registered cases*

No. of cases disposed No. of cases referred to off through DQCB PQCB by DQCB Year without With Number of Number of Number of punitive punitive cases cases cases action action. acquitted. where referred to punitive Drug court. action taken. 2006-07 2007-08 2008-09

*use same table separately for Quacks and spurious drugs cases.

26 Table # D-3 Details on School Health Program

i. Situational Analysis.

If School Teachers have been trained then give the following information. Whether If Yes whether Number of Total number Number of School Health School schools in of teacher in teachers Program is Teachers have public sector Public sector trained for functional in been trained schools basic your district. for screening screening. (Yes or No) (Yes or Not)

ii. Statistical Data.

Type of Number of Number Number Referred to Number Initiatives taken in Initiative Initiative Initiatives / Examination students of of Secondary of 2008-09 s s Planned screened Student Students & Tertiary Teacher (Pl. give details – /Planned /Planned for 2011- at school s Treated at Health Care s add additional for for 12 level by Examine BHUs Facilities involved sheets, if needed) 2009-10 2010-11 Health & d at Education BHUs officer/Tea cher. Eye Sight Hearing Dental Skin Anemia Screening RTI/ Asthma Screening Convulsive Disorders Disability Screening Emergency / First Aid Miscellane ous Total

Table # D-4. Information on Hospital Waste Management

Health Facility Present Intervention/s Expected Practice Planned Effect/s BHU RHC THQ Hospital DHQ Hospital Others* *Others include MCH Centers, Civil Hospitals and MCH Hospitals.

Table # D-5. Gender Mainstreaming (Year 2008-09)

27 Plan to increase number of female workforce Total Number of % of 2009-10 2010-11 2011-12 Number of female Female workforce workforce workforce drawing drawing of total pay from pay from workforce Distt. Govt. Distt. Govt. Health Health Deptt. Deptt.

Table # D-6. Health Monitoring Committees

i. Role of Women Councilors

Total Members No. of women No. of proposals given by No of Proposal % of of Health councilors as women councilors as implemented implem Monitoring member of member of HMC during entation Committees HMC* 2008-09

*HMC: Health Monitoring Committees

ii. Behavior Change (BC) Communication Campaign (2008-09)

Year Nature of Number of Children/Student Women Community Diseases** Impact/ campaign* campaigns. Focus Focus focused Expected impact Situation 2006-07 2007-08 2008-09 Planning 2009-10 2010-11 2011-12 *Such as through posters, leaflets, print media ads etc.

**Diseases should indicate the names of Diseases prevalence of which can be checked through BC efforts

iii. Performance of Health Sector Monitoring Committee (2007-08)

Year Number of Number Number Nature of Implementation status mandatory of of directives meetings meetings directions Implemented Not held received. Implemented 2007-08 2008-09

28 E Situation and Planning of Finances:

Table # E-1. Information on Funds received by DGs (All Categories) to be given in the following format:

(Rs. in millions) Year PFC Provincial PHSRP PMDGP Other Total Transfer ADP Funds Funds Sources like + Share PDSSP MPA in lieu of / MNA grant OZT etc (Pl. specify) Situation 2006-07 2007-08 2008-09 Planning 2009-10 2010-11 2011-12

Note 1: Please provide projected figures for the years 2009-12.

Note 2: The information to complete the above table is available in the office of EDO (F&P), please obtain the information from there and complete the table. Some projections will have to be made for subsequent years.

PFC = Provincial Finance Commission OZT = Octroi and Zila Tax ADP = Annual Development Program PDSSP = Punjab Devolved Social Services Program

Table # E-2. Allocation made by District Government for Health Sector against total Resources of the District:

Year Total Non- Total Dev. Total Total % of allocation Dev. Allocation for Allocation For Resources for health sector Allocation of Health Sector. Health Sector of the against total Health Sector District available district resources (*4/5x100) 1 2 3 4 5 6 Situation 2005-06 2006-07 2007-08 2008-09 Planning 2009-10 2010-11 2011-12

* Formula for calculation

Note: Non-Development here means all else except the development budget. The details are appearing in the following table.

29 Table # E-3. Functional allocation for non-dev budget. n n Year Trainings Allocation Allocatio Allocation Allocation S Increase o o T i i t t

(Nursing + for n for for Other for B

in %age a a r r

Paramedics) PHC(BHUs, MCH Health Secondary c t

o as o f s l

RHCs, Centers, Facilities and level (THQ, i l n

n compare Dispensarie TB Preventive DHQ i A o i l

t m d to last

s) Clinics Measures Hospts) a a t d c

o year * A o T l l A 1 2 3 4 5 6 7 8 9 10 Situation 2005-06 2006-z07 2007-08 2008-09 Planning 2009-10 2010-11 2011-12

* (current year / previous years * 100) - 100

Table # E-4. Level specific allocation

(Rs. in millions) Year Primary Health Care Secondary Health Care Total Preventive Side Curative Side Preventive Side Curative Side Rev Cap Total Rev Cap Total Rev Cap Tot Rev Cap Tot 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Situation 2005-06 2006-07 2007-08 2008-09 Planning 2009-10 2010-11 2011-12 Note: Please provide projected figures for the years 2009-12.

Note: Rev = Revenue or recurring expenditure Cap = Development Expenditure Tot = Total Please use the standard categorization as done in the DG’s budget.

Table # E-5. Overall trends in allocation and expenditure in the sector (Allocation and Utilization under Non-Development/recurring budget)

Year Salary (Rs.) Operating M &R (Rs.)* Purchase of Total expenses Furniture and Expenses Fixture Alloc Exp. Alloc Exp. Alloc. Exp. Alloc. Exp. Alloc. Exp. . .

30 1 2 3 4 5 6 7 8 9 Situation 2005-06 2006-07 2007-08 2008-09 Planning 2009-10 2010-11 2011-12

Alloc. = Allocation Exp. = Expenditure

Table # E-6. Financial Requirements for Medicine:

Name Budget Expenditure Actual Plan for Plan for Plan for of Allocation on Requirements allocation allocation allocation Facility for Medicines for for for Medicines 2008-09 2009-10 2010-11 2011-12 BHUs RHCs THQ hospital s DHQ hospital s Others*

*Others include MCH Centers, Civil Hospitals and MCH Hospitals.

Table # E-7 (i) Budget Outlays for Training of Personnel in Health Sector.

Rs. in millions) Year Number Trained Funds (Rs.) allocated by: Master Personnels DGs Prov Vertical PDSSP PMDGP Any Total Govt. Programs* other** Trainers 1 4 5 3 4 5 6 7 8 9 Situation 2005-06 2006-07 2007-08

31 2008-09 Planning 2009-10 2010-11 2011-12

*Vertical Programs may be mentioned like EPI Programmes, TB Dots, and National Program. **Specify the source.

E-7 (ii) Area of Training (2008-09)++

Year Area in Level of Training Additional Funding which Trainees i.e. the Period in Requirement / Channel* Training designations of days Planned Imparted trainees Training 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12

++ Historical Trend may be given if info available *Name of agency may be mentioned who arranged training with their funds.

32 Table # E-8. Financial Requirement for Equipment

i. BHU Equipment

Present Position Plan for Procurement (No. of units with cost) 2009-10 2010-11 2011-12 f t t t s s s t s t s Name of No. of units No. of Short o i i

. o o o n n o

equipment in Yardstick/ units fall in C C C u u

criteria already numbers s o o t

available o o n u N N

Note: in case of space problem use separate sheet to provide the information but on the same designed Performa

ii. RHC Requirement

Present Position Plan for Procurement (No. of units with cost) 2009-10 20010-11 2011-12 f t f t f t s s s Name of No. of units No. of Short o o o

o o o o o o

equipment in Yardstick/ units fall in C C C N N N s s s

criteria already numbers t t t i i i

available n n n u u u

Note: in case of space problem use separate sheet to provide the information but on the same designed Performa.

iii. THQ Requirement

Present Position Plan for Procurement (No. of units with cost) 2009-10 2010-11 2011-12 t t t s s s t t t Name of No. of units No. of Short s s s i i i o o o n n n

equipment in Yardstick/ units fall in C C C u u u

criteria already numbers f f f o o o

available o o o N N N

Note: in case of space problem use separate sheet to provide the information but on the same designed performa.

iv. DHQ Requirement

33 Present Position Plan for Procurement (No. of units with cost) 2009-10 2010-11 2011-12 t t t s s s t t t Name of No. of units No. of Short s s s i i i o o o n n n

equipment in Yardstick/ units fall in C C C u u u

criteria already numbers f f f o o o

available o o o N N N

Note: in case of space problem use separate sheet to provide the information but on the same designed Performa.

Table # E-9. Information on Patient-Welfare Associations (Year 2009-10)

Name of Welfare Health Facility Funds Provided Area of interest Association

Table # E-10.Information of NGOs and CBOs and Private Sector working in the Health Sector

Category Number Area of Funds Performance Strategy of Work+ Provided interacting with them in 2009-10 NGOs CBOs Charities Trusts

+ Area of Work should tell clearly about the partnership developed with the Health office

Table # E-11. CCB Initiatives (2008-09)

CCB Number of Total Expenditure Area of Status schemes. Financial (Rs.) Work(Sub (completed/Non Allocations sector) completed) (Rs.)

34 Table # E-12.Any Partnership with PRSP or NCHD (2008-09)

Partnership with Inception Major Interventions/ Funding (Rs. In Organization Initiatives million)

Table # E-13. Health Schemes Implemented/Planned under ADP

Name/Title of Allocation Expenditure Plans* Scheme 2008-09 2008-09 2009-10 2010-11 2011-12

*Pl. list planned schemes in order of priority and in accordance with the funds likely to be available for those years.

35 F. Input, Output and Outcome Indicators for M&E purposes (Information from previous tables)

Table F.1 Input Indicators

Input Indicators Indicator Position in Target for Target for Target for 2008-09 2009-10 2010-11 2011-12

Number of Doctors per bed Number of Nurses per bed Medicines Supplied (Rs.) Equipment procured and supplied (Rs.) Annual Expenditure (Rs.)

Table F-2 Output Indicators

Output Indicators Indicator Position in Target for Target for Target for (Average) 2008-09 2009-10 2010-11 2011-12

Number of patients seen by a Doctor per month* Number of Operations performed per month** Number of Emergencies handled per month*** *[Total numbers of patients / Total numbers of doctors] /12 ** Total numbers of operations / 12 *** Total numbers of emergencies / 12

36 Table F-3 Outcome Indicators

Outcome Indicators Indicator Position in Target for Target for Target for 2008-09 2009-10 2010-11 2011-12

Improved health status Decrease in IMR and MMR Decreased patient mortality

Table # F-4 Stakeholder Consultation that went into preparation of this 3YR Rolling Plan

Number of Type of Number of At which Consultations Stakeholder Participants Stage

** The EDO (Health) to rank on a scale of 1 to 10 (10 being the maximum), the degree of Stakeholder Consultation that affected Plan formulation and its contents.

37 G Punjab Millennium Development Goals Program (Allocations, Expenditure and Projections

Note: Most important – these funds are over and above the routine funds. The funds must not be replaced by routine funds. Table # G-1 Allocation of Funds under PMDGP

Calendar Year Training Other MNCH Total Component related activities allocation (10% of total (90% of total Allocation) Allocation) 2009 2010 2011

Note: Funds for current year (2009) to be mentioned.

Table # G-2 Distribution of the PMDGP funds i Training Calendar DHDC Nursing Paramedics Total Year Schools School 2009 Projection 2010 2011

ii MNCH related activities except training l t r e s s s s l a a n c e c t i o e r e W n o d i o u Y H m T

c e h o r L i p

c i s a d f m s e r u d e

a q R n g M n p E e n l n o i f i a a s t o r C a m u n z u i n o r

i H f t e t a o

u d n p a o r i m t g o a p C d U a s m r l a g o r p o g h U o c r S P 2009 Projection 2010 2011 2012