06Th ) MONTHLY REVIEW MEETING of DISTRICT HYDERABAD

MINUTES OF THE (06th ) MONTHLY REVIEW MEETING OF DISTRICT HYDERABAD

Monthly Review Meeting (M.R.M) of District, Hyderabad for the Month of April, 2012 was held on 15.05.2012 at meeting Hall of Ex-Zila Nazim Office, Hyderabad. ritten invitations to participate were sent to the Administrator/ DCO, the D.H.O, all Focal persons of Vertical Programs, District Population Officer i.e EPI, TB DOTS,MNCH, National Program, Malaria Control, Hepatitis, DHIS & DEWS, representatives WHO, all I/c Medical Officers/ FMOs/LHVs etc.

List of Participants:

Sr. Names Designation S # Names Designation 1. Agha Shahnawaz Babar D.C Hyderabad 45 Dr. Aruna Kumari FMO 2. Abid Salemm A.D. C, Hyd. 46 Dr. Aqsa Mushtaque FMO 3. Abdul Shakoor Shaikh DSM, PPHI 47 Dr. Rubina Abro FMO 4. Dr. Altaf Khero Act: DHO 48 Dr. Jahan Ara FMO 5. Dr. Iqtedar Hussain DTC Hyd 49 Dr. Naila Sheikh FMO 6. Dr. Qazi Rasheed Ahmed F.P, DHIS 50 Dr. Sadia Pir FMO 7. Mr. Athar Ali Memon Ex: M&E 51 Dr. Rukhsana Dal Sonologist 8. Maqsood Ahmed SO 52 Dr. Farzana Chachar Sonologist 9. Dr. Rafique Ahmed SMO 53 Dr. Shazia Zeeshan FMO 10. Dr. Muhammad Ali MO 54 Dr. Anaila Soomro WMO 11. Dr. Ammnullah Shahani SMO 55 Dr. Rahila Solangi WMO MNCH 12. Dr. Capt: Nasarullah SMO (MS) 56 Dr. Mumtaz Rajper FMO 13. Dr. Azeem Shah SMO I/C 57 Dr. Neelofer Kazi FMO 14. Dr. A. Majeed Samoon SMO I/C 58 Dr. Rubina Sheikh SWMO 15. Dr. Raza Muhammad SMO I/C 59 Dr. Samira Tebani WMO 16. Dr. Muqadus Ali MO 60 Dr. Abdul Hai Dental Surgeon 17. Dr, Thanwar Das MO I/C 61 Dr. Athar Ali Memon Ex: M&E 18. Dr. Khadim Hussain SMO / IC 62 Mr. Maqsood Ahmed SO 19. Dr. Khalid Dawich MO I/C 63 Mr. Waseem Jokhio SO 20. Dr. Nusrat Hussain SMO 65 Mr. M Yousuf SO 21. Dr. Iftekhar Ahmed MO 65 Mr. Shoaib Memon Assistant Admin: 22. Dr. Abullah Nizamani I/C MO 66 Dr. Shahnawaz Dal M O 23. Dr. Manzoor Memon I/C MO 67 Dr. Yasir MO 24. Dr. Sohrab Hisbani S M O I/C 68 Dr. Mehwish FMO 25. Dr. Riaz Ahmed SMO I/C 69 Dr. Fareeda FMO 26. Dr. Qadir Bux Laghari SMO I / C 70 Dr. Shabnum Tunio FMO 27. Dr. Ali Asgher Mangi Dispenser 71 Dr. Liaquat Siyal MO 28. Dr. Ramesh Kumar MO I /C 72 Dr. Farzana Agha WMO 29. Dr. M Qasim Soomro I/C MO 73 Dr. Kapil Dev M O HQ 30. Dr. Muneer Thalo SMO I/C 74 Sanjar Kumar Asst. 31. Dr. Abdul Hamid Mangi SMO I/C 75 Dr. Abdul Rahim SMO 32. Dr. Shewak Ram MO 76 Dr. Yasir Ali MO 33. Dr. Khem Chand SMO I/C 78 Dr. Shahbuddin MO 34. Dr. Pervez Talpur M O 79 Dr. Naveed Soomro MO 35. Dr. Mehboob Qadir M O I/C 80 Dr. Junaid MO 36. Dr. Talib Memon MO 81 Dr. Qasim Bhatti MO 37. Dr. M Asif I/C MO 82 Dr. Liaquat Ali MO 38. Dr. Shoaib Haanif I/C MO 83 Dr. Fareeda FMO 39. Dr. Ahbdul Wali SMO 84 Dr. Sameena Rasheed FMO 1

40. Dr. Shabana Junejo WMO 85 Dr. Sameena Bano FMO 41. Dr. Shahida Din Sonologist 86 Dr. Shabnum FMO 42. Dr. Erij Kamal Abbasi FMO 87 Dr. Azra Skeikh FMO 43. Dr. Sadaf Sheikh FMO 88 Dr. Mehwish Muneer FMO 44. Dr. Wali Muhammad M O 89

The following could not attend the meeting for the reasons stated against each:-

S # Names Reasons for absence 1 Dr. Abdul Mjeed Samoon On ill leave 2 Dr. Khalid Siddiqui On Leave 3 Dr. Riaz Ahmed Qureshi On Leave

A. HFs WITH PPHI

RHC: 03 BHUs: 13 MCHCs: 03 Dispensaries: 22 TOTAL: 41

B. Population of the Catchments Area: 385,898

C. STAFF STRENGTH

Sanctioned Government PPHI Vacant Working Posts (Govt.) Employees Contract (Sanc-Govt) MOs 66 59 7 43 WMO 13 13 0 FMOs 17 12 0 8 LHVs 4 14 19 1 Male MTs/MAs Female 40 39 34 09 Dispensers

D. CLUSTERS OF HFs

WITH ONE MO

Previous Month Total Month under Review Total Clusters of 6 HFs Clusters of 6 HFs Clusters of 5 HFs Clusters of 5 HFs Clusters of 4 HFs Clusters of 4 HFs Clusters of 3 HFs Clusters of 3 HFs Clusters of 2 HFs 1 Clusters of 2 HFs 1 Single HFs 38 Single HFs 38

WITH ONE FMO

Previous Month Total Month under Review Total Clusters of 5 HFs Clusters of 5 HFs Clusters of 4 HFs Clusters of 4 HFs Clusters of 3 HFs Clusters of 3 HFs Clusters of 2 HFs 10 Clusters of 2 HFs 10 Single HFs 5 Single HFs 5

E. CAPACITY BUILDING

F. REVIEW OF THE PERFORMANCE (I) PREVENTIVE HEALTHCARE During Month under Review

1. Vaccination / Immunization

No. of Doses of Immunization Administered to Children at Health Facilities. 2,133 No. of TT vaccines provided to pregnant / Child Bearing Age Women at Health Facilities. 982 No. of Immunization & Vaccination Administered by outreach EPI Teams Total vaccination / immunization for the month of April 2012 3115

2. National Immunization Days (NIDs) for Polio

Total Target of Percentage of Dates of NIDs Actual coverage coverage coverage 23/24/25 April 2012

3. Other Preventive/Promotional Services

S # Service Number 1 Passive Case Detection (APCD) Slides 2 Malaria Metro Survey (MMS) Slides 894 3 Slides 7 4 Follow up 0

(II) MOTHER, CHILD & REPRODUCTIVE HEALTH

1. Female Health

NUMBER OF OBSTETRICAL Total PATIENT OPD Total Diagnostic Tests S. NAME OF FMO Post women OPD No Antenatal Natal and (Childs) Women Natal 1st Visit 1st childs PT BS HB visit Total Total Total 1 Dr. Fareeda 409 63 0 8 1155 644 17 8 0

2 Dr. Rubina Abro 764 95 0 16 1222 368 40 16 0

3 Dr. Azra Sheikh 652 130 0 9 730 130 21 0 0 4 Dr. Jahan Ara 1312 152 0 16 1943 631 19 11 16 5 Dr. Yasmeen 211 15 0 5 257 46 0 0 0 Dr. Mumtaz 708 133 0 9 885 177 9 29 0 6 Khatoon DR. Mehwish 256 94 0 6 333 77 2 7 14 7 Muneer

Dr. Sameena 127 17 0 0 158 31 0 0 0 8 Rasheed

9 Dr. Aruna Kumari 810 98 0 12 1095 247 51 54 0 Dr. Aqsa 537 77 0 5 705 338 0 0 0 10 Mushtaque 11 Dr. Erij Kamal 567 248 0 6 1601 138 44 32 0 12 Dr. Neelofer Kazi 932 34 0 2 1132 393 12 11 0

13 Dr. Sadaf Sheikh 735 145 2 10 1293 558 28 19 0 14 Dr. Sadia Pir 806 54 0 2 1110 237 3 12 0 15 Dr. Naila Sheikh 491 54 0 16 848 153 21 28 0 16 Dr. Shabnum 32 16 4 2 0 0 0 0 0 17 Dr. Sameena 179 59 5 5 0 0 0 0 0 Dr. Shazia 18 506 70 0 8 614 108 27 0 0 Zesshan Dr. Rubina Sheikh, 19 Dr. Sameera, 2332 184 0 15 2286 677 32 22 0 Dr. Farzana Dr. Mumtaz Soomro, Dr. 20 Aneela Soomro, 0 205 89 210 2023 0 47 104 265 Dr. Fernaz Andleeb Dr. Safia 21 956 43 0 0 1103 147 16 0 0 Dr. Shabana

During Month under Review

2. Deliveries Assisted

S # Service Number 1 Deliveries Assisted at HFs 91 2 Deliveries Assisted at Homes

3. Lab/ Diagnostic Tests

S # Test Number 1 Pregnancy Tests 389 2 Blood Sugar Tests 353 3 Hemoglobin Tests 395 4 Ultra Sound Test 1,771 5 Other

3. Important Discussion on Mother and Child and Reproductive Health during MRM

a. Pre-diagnosis screening of patients for vaccine should be done religiously. b. Where vaccinator are provided under National Program, the duty roster should be signed by I/c Medical Officer and absence report should immediately be sent to Focal Person. c. Pregnant females should be encouraged for delivery at BHU. 4

d. F.P advice should be part of diagnosis and separate record be maintained. e. Sonologists shall furnish their presentation on the findings, referral and follow up. f. MNCH record and Growth monitoring record should be maintained by FMOs where LHV is not provided. In all cases, record should be legible, complete and traceable. g. Baby Weighing Scales/ Adult Bath Scales, Hemoglobin Meters and Height Charts have been provided. Ensure proper usage of the equipments and report of out of order weight machines should be immediately conveyed to I/c MO in writing. h. Training on Hemoglobin meters have been provided to all Medical and Paramedical Staff for blood tests preferably for Pregnant women and same will be repeated for retention. i. Focal Person (EPI) has declined to provide District Government vaccinators during FMO Days at the places where FMO cover is provided. The Vaccinator at all FMO covered facilities for that day used to bring vaccines in carrier and remarkable increase had been achieved in coverage for TT and BCG vaccines. But, now such matter will thoroughly be discussed with EDO (Health).

3. Provision of Family Planning Services during the Month

S # Name of the Items / Service Number Consultation / Advice 411 Oral Pills 178 IUCDs 8 Injections 160 Others 550 Total 1301

(III) COMMUNITY PARTICIPATION During Month under Review

1. Number of Male SGs: 30 Number of Female SGs: 01

2. Performance of Social Organizers

Meetings of Support Groups CHSs/SHSs arranged by him Names of Social Organizers conducted by him No. of No. of No. No. Participants Participants Maqsood Ahmed 3 67 15 557 Wasim Jokhio 2 41 9 345 Yousuf Seelro 0 0 5 75 Total 5 108 29 977

1. School Health Sessions & Community Health Sessions

MEDICAL OFFICERS ACTIVITIES April 2012 CHS SHS S.# Name Session Part NO EXA TREATED 1 Dr. Asif 1 28 0 0 0 2 Dr. Muqadus Rizvi 1 39 1 60 0 3 Dr. Shewak Ram 0 0 1 23 4

4 Dr. Khalid Dawich 1 17 1 17 8 5 Dr. Shoaib Hanif 1 21 1 15 5 1 Dr. Erij Kamal RHC Hoosri 1 45 DCD Noor Khan 2 Dr. Neelofer Kazi 1 19 8 Chang 3 Dr. Sadaf Sheikh MCHC Jhando Khoso 1 60 0 1 76 4 Dr. Shazia Zesshan RHC Tando Qaisar 1 15 BHU Massu Bhurgri 1 12 4 1 10 5 DR. Fareeda GD Taaj Muhammad 1 105 6 1 15 Junejo BHU khesana Mori 1 45 1 1 45 6 Dr. Rubina Abro DCD Mori Mangar 1 40 2 1 30 BHU Jhando Narejo 1 70 5 1 36 7 Dr. Jahan Ara BHU Bahawal Zaunr 1 30 8 1 39 BHU M A B Talpur 1 30 Dr. Mumtaz 8 GD Habibullah Khatoon 1 33 Memon DR. Mehwish BHU Sono Khan 9 0 0 0 1 20 Muneer Almani BHU Moosa Khatian 0 0 0 1 25 10 Dr. Aruna Kumari GD Arif Khatian 1 25

4. Important Points during Support Group Meetings.

• The CSG members should help in monitoring and facilitation. • I/c Medical Officer has been trained for undertaking necessary day to day equipments/asset repairs on need basis after seeking administrative approval from DSM- should be regular feature. • Moral support to medical/paramedical staff working at HF. • Arranging of awareness sessions at their respective villages • Information sharing to the rest of the villages regarding facilities at HF • Reformation of CSGs and individual roles of the members • Effective local facilitation by CSG members to the hf staff • Developing greenery at HFs by the CSG members • Ownership of the HFs

5. Important Points during SHSs

• To drink clean & safe water and Washing hands after toilet. • Awakening health consciousness in children regarding new aspects of diseases like Dengue Fever, Swine Flue, Congo Fever etc. • Nutritional awareness to be transferred to mothers through their kids. • Hair trimming clean clothes nails clipping, washing fruit/vegetables before eating.

6. Important Points during CHSs

• Primary health care awareness. • Educate about immunization against infectious disease. • Personal Hygiene and worm infestation. • De-worming of children • Prevention from diabetes • Precautions from Malaria and Hepatitis • Importance of family Planning • Importance of Vaccination • Importance of ultrasound • Importance of antenatal and postnatal care

7. Topics for SHSs for the Month

Sr. No. Topics 1 Diarrhea 2 Malaria/Dengue

8. Topics for CHSs for the Month

S # Topics 1 Hepatitis C 2 Hygiene

9. Important Discussion on Community Participation during MRM

• Community Health Sessions are to be planned and held on Sonologist days. • Participation should be ensured through formal contact with LHWs. • Sessions are to be held preferably at Health Facility or at community home duly coordinated and facilitated by DSU/HF staff. • DSU field staff shall attend 50% of all the CSG meetings conducted during the month. • TORs of CSG must be shared with CSG members in every meeting of CSG. • Formal invitation to the CSG members in meeting • Presiding of the meeting by the CSG members • Participation of notable CSG member in MRM • Effective Mobilization of female CSGs and developing their ownership at H.Facility. • Involvement of notable in solving day to day problems of HFs. • CSG should be held at BHU. • Developing greenery at HFs.

10. Health Camps: Number Held: 16 Fixed and 06 Mobile camps Number of Patients:

11. Measures for improvement / provision of Services by other Department / Agencies

Sr No Description Recommendation To whom Present status sent I Sanitation Not discussed in this meeting. Normally, a separate Quarterly Ii Drainage / sewerage Review meeting of Public Representatives and District Government Iii ……… drinking water officials/officers/NGOs is being held where such issues are Iv Prevention of adulteration discussed and decisions are taken.

V Tree Plantation Vi Roads and infrastructure Vii Environmental Improvement Viii Others

(IV) CURATIVE SERVICES DURING THE MONTH UNDER REVIEW

1. OPD*

New patients treated Old patients treated Total OPD during the month (New during the month during the month + Old) 64,509 5,889 70,398

2. Maximum OPD**

01 RHC Tando Jam 9,887 02 RHC Tando Qaiser 3,369 03 RHC Hoosri 3,932 BHUtan Sehrish 4 3,559 Nagar

3. Top Five Diseases Treated during School Health Sessions/Camps

S # Diseases No. of Patients 1 ARI 25 2 Allergic Rhnites 15 3 Scabies 20 4 Malaria 20 5 Diarrhea 3

*All HFs — BHUs and others. **Reflects OPD at BHUs only — not at other HFs.

4. Top Five Diseases During OPD

S # Disease S # Disease 1 ARI 14,987 6 Cough more than 2 week 2 Malaria 5,961 7 Suspected Viral Hepatitis 114 3 Scabies 3,961 8 Dog Bite 35 4 Diarrhea 7,080 9 5 Dysentery 10

4. ARV / ASV used during the month

Particulars No. of Patients Dog bite cases reported 35

ARV Administered ( @ 5 Dozes per patient) 00 ARV Available Doses ( @ 24 dozes/vial) 00 Snake bite cases reported 00 ASV Vaccine Administered 00 ASV Vaccine Available Doses 00

6. Lab / Diagnostic Tests: Includes Tests Reported at No. (II) (Mother, Ch & Reproductive Health) 3. (Lab / Diagnostic Tests)

S # Tests Number 1 Blood Sugar Tests 353 2 Hemoglobin 295 3 X-Rays (if available) 63 4 Ultra Sound 1,771 5 Others (Lab Tests) 1,397

7. B & C SCREENING TESTS

No. of Tests No. of cases No. of cases referred Total referred Follow up Screening Performed found positive for treatment upto date result Hepatitis B 29 0 0 0 0 Hepatitis C 26 0 0 0 0

8. TUBERCLOSIS

Patients New Cases During Under Diagnosis Receiving Treatment the Month 55 170 70

9. Referrals

S.No Totals Cases Referred To 1 TB DOT Deliveries Others RHCs THQs DHQs 2 84 60 3

10. Inverse Referrals

S.No Totals Cases Referred from 1 ARV ASV Others RHCs THQs DHQs 2 3

G. MONITORING DURING MONTH UNDER REVIEW

1. Monitoring Visits during the month

DSM Executive Monitoring Other Staff Total 40 70 105 215

2. Important Points/Issues arising from Visits

S # Name of HF Issue Action Remarks 01 Newly functionalized Non-availability of Waiting for Tender Minutes Dispensaries Furniture/Bed Sheets of sub-committee 02

H. AVAILABILITY OF MEDICINES/MEDICAL MATERIALS

1. Medicines available for: 30 Weeks

2. Important Issues raised relating to Medicines, etc. during MRM

I. REPAIR / MAINTENANCE / ELECTRIFICATION OF / AT HFS

Description of Repair / S # Name of HFs Status / Remarks Maintenance incl. Electrification BHU Moosa Khatain Electric Transformer Repaired In Progress

Inspections / Visits of PPHI HFs

Visitors* Health Facilities Visited Overall Comments

* To reflect only non-PPHI Visitors.

J- DISCUSSION DURING MRM

On Staff Matters:

• The DSM, PPHI Hyderabad requested the in charges of health facilities for their timely submission of HMIS reports, Monthly Medicines Requisition, Referral Cases regarding the TB, Polio Dog Bite, Measles, Diarrhea etc. • Leaves availed through SMS should be subsequently submitted on prescribed format and got approved otherwise will be treated as absence. • Late coming/Early going will be marked as “ x” and two such crosses will result in one absence. • All I/c M.Os should counter-sign on Bin Cards and Stock registers at every receiving and usage of stocks. • Waste Disposal pit be properly ditched and regular burning of hospital waste as per protocol must be observed. • Proper record of ARV ampules be maintained and used ampules be submitted at DSU before issuance of new stock. • Expiry or near to expiry medicines be separated and disposed as per protocol already circulated.

On Preventive Health: • All I/c M.Os should ensure checking of temperature chart as well as stock and expiry of vaccines. • Quality of HE sessions not yet improved. S.O should facilitate in arranging most of The CHS in communities • After completion of training of 06 Vaccinators, 06 PPHI EPI Centers are running. On Curative Health: • Quality of medicines has improved with clear impact on increased cost of medicines. • Normal Delivery Centers have been opened at 16 facilities of the district. • Rise in OPD and consequent rise in medicine consumption. • Patient coming from farther areas demand for more medicine dosages.

On Mother, Child & Reproductive Health: • Baby Weighing Scales have been provided at all 30 facilities where FMO cover has been provided. • MNCH registers and Growth monitoring registers will be maintained at each facility where FMO cover is provided. Training has already been provided to all FMOs in this regard. • The registers will be maintained by LHVs wherever provided. Otherwise, FMO will record and maintain. • For NVDs, FMOs should motivate to pregnant ladies for deliveries at BHUs.

Other Matters:

• One Pathological laboratory and X-ray unit have been made functional at RHC Tando Qaisar. Now, 02 Pathological Laboratories and 02 X-ray units have started functioning and periodically they have become self sustainable for purchasing diagnosis kits. Planning is in hand for opening up 01 more Pathological Laboratory at RHC hoosri. • I/c Medical Officers requested not to wait for DSU for minor repairs and to undertake necessary repair in lines with procedures and policies already shared and claim reimbursements. • Lot of improvements have been brought in newly taken over RHC Tando Jam as (1) X-ray Plant has started functioning, (2) Pathological Laboratory started after purchase of regents and training of Lab. Technician (2) Additional FMO and Dispenser have been provided. • Night shift at RHC has been started with male doctors in all three shifts and female doctors in morning shift. Full fledge show is to start as soon. • Date /Time for Next MRM: Tentative Date for next MRM is 15-6-12

Comments on Targets vs Achievements (by DSM) • DSM conveyed his displeasure to all those FMOs having less number of ante-natal. • DEWS reports don’t reach in time causing embarrassment and delay in reporting. • Complaint/Suggestion Box has been provided to Every H.F but no feedback is shared. • Pre-Post R&R photos are not found at H.Fs. • Tree Plantation targets.

(Abdul Shakoor Shaikh), District Support Manager, PPHI, Hyderabad.

Copy for information to:

1) Secretary to Government of Sindh for Health Department, Karachi. 2) Program Director, PSU, PPHI, Karachi. 3) District Coordination Officer, District Government, hyderabad. 4) Director General Health, Directorate of Health Hyderabad. 5) Regional Program Director, Region-I @ Hyderabad 6) DHO Hyderabad.. 7) Incharge Medical Officer(s) all PPHI managed Health Facilities,Hyderabad.

(Abdul Shakoor Shaikh), District Support Manager, PPHI, Hyderabad.

MINUTES OF THE (39th) MONTHLY REVIEW MEETING OF DISTRICT_DADU

Monthly Review Meeting (MRM) of District, DADU for the Month of APRIL, 2012 was held on 10/05/2012 at DC Darbar Hall Dadu. Written invitations to participate were sent to the DC, the EDO(H), the EDO(F&P) and District Incharge of EPI, LHW and all other National Programs as usual. The list of participants follows:

List of Participants:

S # Names/Designation S # Names/Designation Mr. Moula Bux Solangi Dr. Abdul Rasheed Qureshi 1 2 DSM PPHI Dadu THO Dadu Dr. Abdul Razaque Junejo Dr. Abdul Hameed Meerani 3 4 DO Admn CRMO Civil Hospital Dadu Peer Ashfaque Ahmad Abdul Sattar Soomro 5 6 Executive (M&E) Executive (F&A) Dr. Ghullmullah Samoo Dr. Sanaullah Soomro 7 8 I/C MO BHU Patt I/c BHU Aminani Dr. Sayed Lal Shah Dr. Bashir Ahmad Channa 9 10 I/c MO BHU Sita Village MO I/c BHU Makhdoom Bilawal Dr. Bhajan Lal Matlani Dr. Fayaz Ahmad Panhwar 11 12 MO I/c BHU Phakka I/c MO BHU Ibrahim Panhwar Dr. Abdul Hakeem Solangi Dr. Abdul Kareem Jamali 13 14 I/c MO BHU Piaro Goth MO I/c BHU Samtani Dr. Shams Din Jokhio Dr. Muhammad Saleh Gadhi 15 16 I/c MO BHU Betto I/c MO BHU Phulji Station Dr. Deedar Hussain Abbasi Dr. Akbar Ali Panhwar 17 18 I/c MO BHU Fareed Abad I/c MO Sijawal Khan Alkhani Dr. Allah Dino Khoso Dr. Nizakat Ali Sahar 19 20 I/c MO GD Nawab jo Patt MO I/c BHU Thareri Mohabat Dr. Altaf Ahmad Qureshi Dr. Mohammad Naeem Mahesar 21 22 Dr. GD Jatt Shahdad I/c BHU Aghamani Dr. Nazeer Ahmad Kandhro Dr. Ammanullah Chandio 23 24 MO I/c BHU Kolachi MO I/c GD Gul Mohammad Jatoi Dr. Ashok Kumar Dr. Mohammad Azam Chandio 25 26 I/c MO BHU Butt Serai I/c BHU Gozo Dr. Hidayatullah Chandio Dr. Rasheed Ahmad Chandio 27 28 MO I/c GD Qadir Bux Rind I/c MO BHU Thallo Dr. Abdul Raheem Saryo Dr. Karam Yousif Outho 29 30 MO I/c MCH Khanpur I/c MO BHU Dhani Bux Bughio Dr. Akram Ali Soomro Dr. Imdad Hussain Kalhoro 31 32 I/c MO BHU Dougar I/c MO BHU Burera Dr. Assadullah Lakhair Dr. Ihsan Iqbal Thebani 33 34 MO I/c BHU Essa Kahn Thebo I/c MO BHU Baid Dr. Irshad Ahmad Shah Dr. Abdullah Sameejo 35 36 I/C MO BHU Boriri I/C MO BHU Bahawalpur Dr. Khalid Hussain Laghari Dr. Altaf Ahmed Lund 37 38 I/c MO BHU Allahyarani I/c BHU Kamal Khan Lund Dr. Mohammad Waseem Arain Ali Raza Jamali 39 40 I/c MO BHU Haji Khan I/C Dispenser GD Moundar khan Jamali

Dr. Qamarudin Abbasi Mr. Allahwarayo Khoso 41 42 MO I/c GD Peer Gaji Shah I/c GD Paryo Jamali Dr. Manzoor Ali Sario Dr. Farhana Shah 43 44 I/C BHU Qasbo Female Medical Officer Dr. Zubair Ahmad Panhwar Dr. Sabiha Khaskheli 45 46 I/c MO BHU Wahi Pandhi FEMALE MEDICAL OFFICER Dr, Awais Ahmad Bughio Dr. Kalsoom Janwary 47 48 I/c MO GD Mureed Babar Female Medical Officer Mr. Mohammad Khan Rustamani Dr. Fahmeeda Shaikh 49 50 Dispenser GD Murad Khan Jamali Female Medical Officer Disp. Imam Bux Laghari Dr. Ameena Bughio 51 52 GD. K.B.Chakkar Khan Shahani FEMALE MEDICAL OFFICER Dr. Shabnam Niaz Gorar Mansoor Ali Panhwar 53 54 FEMALE MEDICAL OFFICER Social Mobilizer Dr. Afshan Memon Syed Abdul Gaffar Shah 55 56 FEMALE MEDICAL OFFICER Assistant Admin Dr. Naheed Akbar Janwari Dr, Naheed Solangi 57 58 FEMALE MEDICAL OFFICER Female Medical Officer Dr. Fareeda Noonari Mr. Abdul Hafeez Bhatti 59 60 Female Medical Officer Social Mobilizer .Dr. Zakia Larik Dr. Rehana Joyo 61 62 FEMALE MEDICAL OFFICER FEMALE MEDICAL OFFICER Dr. Abida Dawach Dr. Shoaib Qazi 63 64 FEMALE MEDICAL OFFICER MO (HQ) Dr. Naheed Shaikh Abid Ali Jatoi 65 66 FEMALE MEDICAL OFFICER Assistant Accounts Dr. Farzana Jokhio Ghulam Rabbani Panhwar 67 68 FEMALE MEDICAL OFFICER Store Incharge Dr. Jameela Khoso Naveed Ali Junejo 69 70 FEMALE MEDICAL OFFICER Social Mobilizer Mr. Hakim Ali Jatoi 71 Social Mobilizer

The following could not attend the meeting for the reasons stated against each:-

S # Names/Designation Reasons S # Names/Designation Reasons Dr. Mehnaz Saeed Dr. Mumataz Ali Khand On 2 months 1 2 Soomro Absent I/c MO BHU Chorr C/L Female Medical Officer Dr. Shamas Din Dr. Adeela Soodhar Kalhoro 3 Absent 4 C/L Sonologist I/c MO GD Gul Mohammad Chandio Dr. Farzana Qureshi Dr. Nizamudin Abro 5 CL 6 C/L Female Medical Officer MO I/c BHU Mounder Dr. Akhtar Hussain Shaikh 7 C/L I/c MO BHU Qazi Arif

B. HFs WITH PPHI

BHUs: 35 Dispensaries: 12 MCHCs: 02 Others:______

TOTAL: 49 14

B. Population of the Catchments Area: 699342

E. STAFF STRENGTH

Sanctioned Government PPHI Vacant Working Posts (Govt.) Employees Contract (Sanc-Govt) MOs 49 45 20 25 29 WMO FMOs - 20 0 20 06 LHVs 8 35 8 27 20 Male - - - - MTs/Mas Female - - - - Dispensers/HT 78 58 28 30 0

F. CLUSTERS OF HFs

WITH ONE MO

WITH ONE FMO

Previous Month Total Month under Review Total Clusters of 5 HFs Clusters of 5 HFs Clusters of 4 HFs Clusters of 4 HFs Clusters of 3 HFs Clusters of 3 HFs Clusters of 2 HFs 12 Clusters of 2 HFs 15 Single HFs 4 Single HFs 4

NOTE: One Sonologist is working

E. CAPACITY BUILDING

1. First Session: During MRM Dr. Awais Bughio (MO), GD Mureed Babar in his lecture focused on DIABETES MELLITUS on the following points:- • Defination • Classification • Type 1 DM • Type 2 DM • Gestetional DM • Other Specific Causes of DM • Diagnosis of DM • Difference in Type 1 & Type 2 DM

• Principle Management of DM • Dietary Modification • Complication of Diabetes • Treatment

2. Second Session: During MRM

5. Capacity Building of LHVs / Dispensers During Month under Review

No. of Names of the Resource Persons with dates Date Venue Topic Participants 9/4/2012 BHU Essa Dr. Assadullah Lakhair Malaria 12 Khan Thebo 18/4/2012 BHU Saeed Dr. Ammanullah Chandio Vaccination 17 Pur

F. REVIEW OF THE PERFORMANCE (I) PREVENTIVE HEALTHCARE During Month under Review

1. Vaccination / Immunization

No. of Doses of Immunization Administered to Children at Health Facilities. 3812 No. of TT vaccines provided to pregnant / Child Bearing Age Women at Health Facilities. 1391 No. of Immunization & Vaccination Administered by outreach EPI Teams - Total vaccination / immunization for the month February 2012 5203

2. National Immunization Days (NIDs)

Percentage of Dates of NIDs Target of coverage Actual coverage coverage Data Has not Been complied

3. Other Preventive/Promotional Services .

S # Service Number 1 Passive Case Detection (PCD) Slides 1227 2 Active Case Detection (ACD) Slides - 3 Visits to Check Sanitation (individual house holds + streets) - 4 Notices issued against Poor Sanitation - 5 Challans sent to Court against Poor Sanitation - 6 Patients Nebulized -

(II) MOTHER, CHILD & REPRODUCTIVE HEALTH During Month under Review 1. Female Health

S # Names of FMOs Ante-Natal Cases Neo-Natal Cases Other OPD Total 1 Dr. Abida Dawach 9 0 169 178 2 Dr.Afshan Memon 87 8 407 502 3 Dr.Ameena Bughio 185 11 514 710 4 Dr Fahmeda Shaikh 116 3 524 643

5 Dr.Fareeda Noonari 31 2 419 452 6 Dr.Farhana Shah 203 14 663 880 7 Dr Farzana Jokhio 218 7 465 690 8 Dr.Farzana Quershi 52 4 264 320 9 Dr Jamila Khoso 107 11 334 452 10 DR. Kalsoom Janwari 144 16 501 661 11 Dr.Mehnaz Soomro 63 6 258 327 12 Dr.Naheed Akbar 292 17 715 1024 13 Dr. Naheed Shaikh 16 2 175 193 14 Dr Naheed Solangi 135 16 552 703 15 Dr. Rehana Joyo 33 1 146 180 16 Dr.Sabiha Khaskheli 92 8 497 597 17 Dr.Shabnam Niaz 37 5 168 210 18 Dr. Uzma Soomro 50 4 211 265 19 Dr.Zakia Larik 43 5 297 345 TOTAL 1913 140 7279 9332

2. Deliveries Assisted

S # Service Number 1 Deliveries Assisted at HFs 35 2 Deliveries Assisted at Homes 00

3. Lab/ Diagnostic Tests

S # Test Number 1 Pregnancy Tests 82 2 Blood Sugar Tests 7 3 Hemoglobin Tests 51 4 Ultra Sound Test 1125 5 Other 102 6. Important Discussion on Mother and Child and Reproductive Health during MRM The MOs and FMOs demanded that supply of the Tables Ponstan, Paracetamol, Brufen and Amoxil Drops. Increase quantity of peads: medicine especially in suspension form and Tablet forms.

7. Provision of Family Planning Services during the Month

S # Name of the Items / Service Number 1 Consultation / Advice 658 2 Oral Pills 264 3 IUCDs 04 4 Injections Depo 271 5 Injection Noregest 07 6 Others (Condoms) 522 Total 1726

(III) COMMUNITY PARTICIPATION During Month under Review

1. Number of Male SGs: ------47------Number of Female SGs: ------02------

2. Performance of Social Organizers

Names of Social Meetings of Support Groups CHSs/SHSs arranged by him Organizers conducted by him Total No. of No. of Male Female No. Participants Participants Mr.Abdul Hafeez Bhatti 90 5x18=90 8 8x22=176 Mr.Hakim Ali Jatoi 102 6x17=102 6 6x20=120 Mr.Naveed Ali Junejo 60 3x20=60 5 5x20=100 Mr.Mansoor Ali Panhwar 100 5x20=100 4 4x23=92 Total 352 352 23 784

2. School Health Sessions & Community Health Sessions

Community Health Sessions School Health Sessions Names of MO / FMOs / Paramedics Children Children Sessions Participants Sessions Examined Treated

Dr. Altaf Lund 1 26 1 8 8 Dr. Akbar Panhwar 1 13 1 12 Dr. Ammanullah Chandio 1 25 1 7 4 Dr. Ashok Kumar - - 1 10 5 Dr. Bashir Ahmad Channa 1 30 1 6 4 Dr. Deedar Ali Abbasi 1 26 1 - - Dr. Hidyatullah Chandio 1 14 1 - - Dr. Manzoor Ahmad Saryo 1 30 1 10 8 Dr. Mohammad Akram Soomro 1 12 1 9 8 Dr. Mohammad Azam Chandio 1 16 1 5 5 Dr. Mohammad Naeem Mahesar 1 10 1 3 1 Dr. Mohammad Waseem Arain 1 9 1 16 16 Dr. Mujahid Ali Saand 1 20 1 7 6 Dr. Nizakat Ali Sahar - - 1 8 4 Dr. Nizam u Din Abro 1 10 - - - Dr. Qamar Din Kalhoro 1 10 1 11 6 Dr. Shams Din Kalhoro 1 10 - - - Dr. Sayed Lal Shah 1 18 1 12 2 Dr. Abida Dawach - - - - - Dr.Afshan Memon 2 45 2 17 16 Dr.Ameena Bughio 2 65 2 9 9 Dr Fahmeda Shaikh 2 57 2 10 6 Dr.Fareeda Noonari 2 55 2 8 7 Dr.Farhana Shah 2 59 2 8 6 Dr Farzana Jokhio 2 65 2 10 8 Dr.Farzana Quershi 2 45 2 9 6 Dr Jamila Khoso 2 60 2 11 5 DR. Kalsoom Janwari 2 53 2 35 10 Dr.Mehnaz Soomro 2 42 2 10 5 Dr.Naheed Akbar 2 57 2 9 5 Dr Naheed Solangi 2 50 - - - Dr. Naheed Shaikh - - - - -

Dr. Rehana Joyo - - - - - Dr.Sabiha Khaskheli 2 40 2 11 7 Dr.Shabnam Niaz 2 46 2 18 7 Dr Uzma Soomro 2 44 Dr.Zakia Larik 2 30 2 17 7

Totals 48 1092 44 306 181

4. Important Points during Support Group Meetings. a) CSG demanded that the Ultrasound facility may be provided at uncovered areas. b) CSG members demanded that health facilities may be repaired.

5. Important Points during SHSs A) Prevention of Scabbies b) Prevention of Diarrhea c) Increase awareness regarding the prevention of Malaria. d) Precaution of Acute respiratory Infection.

6. Important Points during CHSs c Prevention of Diarrhea b) Prevention of Polymylitis c) Prevention of Family Planning d) Prevention of Maleria

7. Topics for SHSs for the Month

Sr. No. Topics 1 Malaria 2 Health & Hygine 3 Typhoid 4 Sun Stroke 5 Cholera

8. Topics for CHSs for the Month

S # Topics 1 Polio 2 Diarrhoea 3 Dermatitus 4 Family Planning

9. Important Discussion on Community Participation during MRM The DSM urged the MOs and FMOs to conduct regular monthly meetings with CSG/ CHS/ SHS and send a copy of minutes of the meeting to DSU for record purpose. He further directed keep record of the same and focus on the staff regularity and punctuality.

10. Health Camps: Number Held: 01. Number of Patients: 313

11. Measures for improvement / provision of Services by other Department / Agencies

Sr No Description Recommendation To whom sent Present status I Sanitation - - - Ii Drainage / sewerage - - - 19

Iii ……… drinking water - - - Iv Prevention of adulteration - - - V Tree Plantation - - - Vi Roads and infrastructure - - - Vii Environmental Improvement - - - Viii Others - - -

(IV) CURATIVE SERVICES DURING THE MONTH UNDER REVIEW

1. OPD*

New patients treated Old patients treated Total OPD during the during the month during the month month (New + Old) 63978 886 64864

2. Maximum OPD** Minimum OPD**

S # BHU OPD BHU OPD 1 BHU Wahi Pandhi 3976 GD Mondar Khan Jamali 616 2 BHU Betto 2672 BHU Chorr 708 3 BHU Allahyarani 2329 BHU Phulji Station 791

3. Top Five Diseases Treated during School Health Sessions/Camps

S # Diseases No. of Patients 1 Respiratory Disease 96 2 DIARRHOEA 85

3 SCABBIES 72 4 MALARIA 64 5 EYE INFECTION 42 *All HFs — BHUs and others. **Reflects OPD at BHUs only — not at other HFs.

4. Top Five Diseases During OPD

S # Disease No. of Patients 1 ARI 10940 2 DIARRHOEA / DYSENTERY 7315 3 SKIN DISEASE 5989 4 SUSPECTED MALARIA 5362 5 EYE/ENT 1140

8. ARV / ASV used during the month No. of Patients Dog bite cases reported 304 ARV Administered 195 ARV Available Doses 466 Snake bite cases reported 0 ASV Vaccine Administered 3 ASV Vaccine Available Doses 1

9. Lab / Diagnostic Tests: Includes Tests Reported at No. (II) (Mother, Child & Reproductive Health) 3. (Lab / Diagnostic Tests)

S # Tests Number 1 Pregnancy Tests 561 2 Blood Sugar Tests 19 3 Haemoglobin 51 4 X-Rays (if available) - 5 Ultra Sound 1125 6 Others (please specify) 102

10. B & C SCREENING TESTS

No. of Tests No. of cases No. of cases referred Total referred Follow up Screening Performed found positive for treatment upto date result Hepatitis B 9 1 - - - Hepatitis C 9 0 - - -

11. TUBERCLOSIS

Patients New Cases During Under Diagnosis Receiving Treatment the Month 53 4 64

9. Referrals

S.No Totals Cases Referred To 1 TB DOT Deliveries Others RHCs THQs DHQs 2 ------

10. Inverse Referrals

S.No Totals Cases Referred from 1 ARV ASV Others RHCs THQs DHQs 2 ------

G. MONITORING DURING MONTH UNDER REVIEW

2. Monitoring Visits during the month

DSM Executive Monitoring Other Staff Total 40 49 136 225

2. Important Points/Issues arising from Visits

S # Name of HF Issue Action Remarks MO demanded repair of Main 1 BHU Kolachi Repair has been done Gate 2 BHU Thareri Mohabat MO demanded repair of moter Work has been done 3 BHU Moundar MO demanded repair of moter Work has been done

H. AVAILABILITY OF MEDICINES/MEDICAL MATERIALS

1. Medicines available for ……………… Weeks

2. Important Issues raised relating to Medicines, etc. during MRM

Few Doctors pointed out that the quality of medicine may be improved and also increase the quantity of medicine. The DSM apprised the medical officers that 10 items of medicine were procured from multinational companies and rest of the items are also of good quality and efficacious.

I. REPAIR / MAINTENANCE / ELECTRIFICATION OF / AT HFS

Description of Repair / S # Name of HFs Status / Remarks Maintenance incl. Electrification 1 BHU Aminani Completed MB recorded Completed 2 BHU Ibrahim Panhwar Completed MB recorded Completed 3 BHU Khanpur Completed MB recorded Completed 4 BHU Makhdoom Bilawal Completed MB recorded Completed 5 BHU Pyaro Goth Completed MB recorded Completed 6 BHU Kolachi Completed MB recorded Completed 7 BHU Allahyarani Completed MB recorded Completed 8 BHU Bahawalpur Completed MB recorded Completed 9 BHU Gozo Completed MB recorded Completed 10 BHU Betto Completed MB recorded Completed 11 BHU Kamal Khan Lund Completed MB recorded Completed 12 BHU Phakka Completed MB recorded Completed 13 BHU Samtani Completed MB recorded Completed 14 BHU Qazi Arif Completed MB recorded Completed 15 BHU Boriri Completed MB recorded Completed 16 BHU Thallo Completed MB recorded Completed 17 BHU Haji Khan Completed MB recorded Completed 18 BHU Thareri Mohabat Completed MB recorded Completed 19 BHU Moundar Work Completed Completed 20 BHU Dhani Bux Bughio Work Completed Completed 21 BHU Phulji Station Work Completed Completed 22 GD G.Mohammad Chandio Work Completed Completed 23 BHU Sita Village Work Completed Completed 24 BHU Essa Khan Thebo Work Completed Completed 25 BHU Burera Work in progress 95% 26 BHU Wahi Pandhi Work in progress 95% 27 BHU Baid Work in progress 95% 28 BHU Patt Work in progress 80% 29 BHU Fareed Abad Work in progress 50%

Inspections / Visits of PPHI HFs

Visitors* Health Facilities Visited Overall Comments ------* To reflect only non-PPHI Visitors.

J- DISCUSSION DURING MRM

On Staff Matters: • Involve of PPHI staff in NIDs . • Regularity and punctuality. • HF Record updated.

On Preventive Health: • The DSM emphasizes the regular CSG Meetings and CHS Meeting. • Keeping the view the Polio Drops, the awareness of this disease was on top priority. • Establish the Wastage Pitch. • Role on awareness rising about vaccination and it was shared with the forum that DSU-PPHI Dadu has appointed the 10 vaccinator for said purpose.

On Curative Health: • Properly usage of laboratory machine, Pregnancy strips, Nabulizer Machine and Glucometer strips. • The DSM emphasize on the properly Keeping Record and HF cleanliness.

On Mother, Child & Reproductive Health: • Female Deliveries. • The DSM appreciate the increase in Vaccination. • Ensure the fully participation in NIDs

Other Matters:

The DSM stressed upon furnishing the record of inverse cases of HB / HC.

Date /Time for Next MRM:

Date /Time for Next MRM: On 09 JUNE at 10:00 am.

Comments on Targets vs Achievements (by DSM) • Repair of the HFs. • Provided ARVs / ASVs • Provided Water Connection at HFs • Maintaince of HFs Record • Regularity and Punctuality of Staff • Established link with Community Support Group and meeting there and tell them about PPHI and there Services at HFs.

MOULA BUX SOLANGI DISTRICT SUPPORT MANAGER

MINUTES OF THE 46th MONTHLY REVIEW MEETING OF DISTRICT KHAIRPUR

Monthly Review Meeting of District Khairpur for the Month of April-2012 was held on 10th & 11th May- 2012 at DHDC Meeting Hall DSU-PPHI Khairpur Mir’s. Written invitations to participants were sent to the Deputy Commisioner, the DHO, the DO (F&P), DO(CDD), District Population Welfare Officer, Taluka Health Officer(s) (all), District Coordinator National Program Khairpur, District Focal Person EPI, District Focal Person TB, District Coordinator, Malaria Control Program and NMO (WHO) as usual.

The list of participants is enclosed.

S No Name of In-charge Designation S No Name of In-charge Designation 1 Yar Mohammad Markhand M.O 55 Mehtab Phul M.O 2 Gobind Ram M.O 56 Ali Mohammad Bhanbhro M.O 3 Saifullah Bugti M.O 57 Javed Ahmed soomro M.O 4 Parvez Iqbal M.O 58 Abdul Qadir Shaikh M.O 5 Abdul Rauf Shaikh M.O 59 Ayaz Shaikh M.O 6 Shafique Ahmed M.O 60 Atta Mohammad Memon M.O 7 Mohammad Panah Bozdar M.O 61 Gayoor Abbas Solangi M.O 8 Nizamuddin Bozdar M.O 62 Abdul Munam Shar M.O 9 Kalash Pati M.O 63 Abdul Razaque Chang M.O 10 G.Hyder Phul M.O 64 Mumtaz Ali Wassan M.O 11 Fayaz Memon M.O 65 Abdul Qayoom Memon M.O 12 Mohammad Ali Sikandar M.O 66 Mohammad Juman Sahito M.O 13 G.Murtaza M.O 67 Mir Sarfraz M.O 14 Noor Din Abro M.O 68 Sohail Ahmed Memon M.O 15 Mukhtiar Ahmed Wassan M.O 69 Abdul Karim M.O 16 Abdul Rahman Memon M.O 70 Khalid Memon M.O 17 Khalique Dino Wassan M.O 71 Ali Qasim Jaffri M.O 18 Maqsood Ahmed Bozdar M.O 72 Falak sher M.O 19 Ali Sher Maitlo M.O 73 Azharuddin Arejo M.O 20 Dharampal M.O 74 Waheed Ali M.O 21 Ayaz Mirani M.O 75 Ghulam Mustafa Shaikh M.O 22 Washoo Mal M.O 76 Javed Ahmed Memon M.O 23 Ahsan Solangi M.O 77 Atta Hussain Narejo M.O 24 Saif ullah Mahesar M.O 78 Gada Hussain Bhutto M.O 25 Mahkumuddin M.O 79 Waqar Ahmed Khaskheli M.O 26 Ghulam Mujtaba Memon M.O 80 Pardeep Kumar M.O 27 Mohammad Azam Ghambhir M.O 81 Abdul Hameed Shaikh M.O 28 Mir Iqbal M.O 82 Noor Ahmed M.O 29 Qaiser Boazdar M.O 83 Kher Mohammad M.O 30 Kundan Das M.O 84 G.Mujtaba Rajper M.O 31 Ghulam Hussain Bhelar M.O 85 G.Murtaza Rajar M.O 32 Kamran Rasool Mangi M.O 86 Bashir Ahmed Narejo M.O 33 Abdul Ahad Mahesar M.O 87 Bagh Ali Bozdar M.O 34 Nek Mohammad Memon M.O 88 Ramesh M.O 35 Bashir Ahmed Khuhro M.O 89 Niaz Wassan M.O

36 Irshad Hussain Sahito M.O 90 Aslam Baloch M.O 37 Zafar Hussain M.O 91 G. Murtaza Bugti M.O 38 Mukhtiar Hussain M.O 92 Sanaullah Bharejo M.O 39 Khair Mohammad Shah M.O 9394 Abdul Majeed Kanhar M.O 40 Anwar Illahi Sahito M.O 95 Sayed Nadeem Abbas M.O 41 Israr Ahmed M.O 96 Mohammad Ayoob Jogi M.O 42 Rab Dino Rajper M.O 97 Tarique Bhambhro M.O 43 Hashim Ali Shah M.O 98 Zulfiquar Ali M.O 44 M.Afzal M.O 99 Abdul Rasheed Joyo M.O 45 Ayaz Ali Chandio M.O 100 Parwez Iqbal Shaikh M.O 46 Khalid Javed Awan M.O 101 Shahid Hussain Khaskheli M.O 47 Mukesh Kumar M.O 102 Imtiaz Ahmed Maitlo M.O 48 Wajid Mahar M.O 103 Mir Arif Hussain Al-Hussaini M.O 50 Safdar Lakho M.O 104 Ghulam Mohammad Memon M.O 51 Mohammad Hassan Shaikh M.O 105 Qadam Ali Jamro M.O 52 Abdul Majeed Memon M.O 106 Taj Mohammad Shaikh M.O 53 Mian Khalid Basheer M.O 107 Dr Bashir Ahmed Lashari M.O 54 Abdul Hafeez Narejo M.O 108 Narain Mal M.O

Following Medical Officers remained absent from Monthly Review meeting

1 Gh.Hyder Wassan M.O 9 Wazir Ali Bozdar M.O 2 Ghulam Akbar M.O 10 Rafique Ahmed Soomro M.O 3 Mohammad Waris M.O 11 Karam Abbas Solangi M.O 4 Raheem Bux Rind M.O 12 Akhtar Khuhro M.O 5 Gada Hussain Soomro M.O 13 Asadullah Channa M.O 6 Ahsanullah Channa M.O 14 Aijaz Ali Solangi M.O 7 Asghar Ali Arain M.O 15 Abdul JAbbar Lashari M.O 8 Abdul Qayoom Solangi M.O 16 Muneer Ahmed Lund M.O

List of Female Medical Officers attended Monthly Review meeting Name of Female Medical Name of Female Medical S No Designation S No Designation Officer Offcer 1 Sobia Parveen Memon FMO 24 Nazia Noor FMO 2 Aliya Nazir FMO 25 Aisha Baloch FMO 3 Rabia Sangi FMO 26 Shazia Shaikh FMO 4 Asia Bhatti FMO 27 Shabiran Mari FMO 5 Sanober Soomro FMO 28 Shaihda Mangrio FMO 6 Naheed Akhtar Memon FMO 29 Hameeda Rajper FMO 7 Zainab Bozdar FMO 30 Sangeeta washoo FMO 8 Madiha Saangri FMO 31 Abida Memon FMO 9 Meharnussa FMO 32 Tahira Sonologist 10 Zeenat Memon FMO 33 Fakhar Nisa FMO 11 Nadia Sharaf FMO 34 Suneeta FMO 12 Rehana Zulifqar FMO 35 Nusrat Wassan FMO 13 Afshan Shaikh FMO 36 Farzana Kanhar FMO 14 Roshan Begum FMO 37 Sajida Parveen FMO 15 Asma Shaikh FMO 38 Sanam Shaikh FMO

16 Naseem Dharejo FMO 39 Reshman FMO 17 Samina Shaikh FMO 40 Rukhsana Sohu FMO 18 Rozina Murtaza FMO 41 Rozina Soomro FMO 19 Robina Begum FMO 42 Shamshad Shaikh FMO 20 Kkhadija Soomro FMO 43 Anjuman Ara FMO 21 Sangeeta Mukesh FMO 44 Irshad Rajper FMO 22 Maryam Shaikh FMO 45 Ghazala Lashari FMO 23 Hameda Rajpar sr FMO 46 Farzana Keerio FMO

Following Female Medical Officers remained absent from Monthly Review meeting

Name of Female Medical Name of Female Medical S. No Designation S. No Designation Officer Officer 1 Reeta FMO 5 Reena (NMC) FMO 2 Firdous Ara FMO 6 Sadaf Raheel FMO 3 Fahmeeda Abro FMO 7 Rukhsana Maitlo FMO Rizwana Andleep Sonologist Sonologist 4 8 Lal Khatoon (Medical Leave)

List of DSU Staff attended the monthly review meeting

01 Mr.Ammanat Ali Shar DSM 07 Mr. Akhtar Hussain Khaskhlei S.O 02 Mr.Aijaz Phull ADSM 08 Mr. Mohsin Mehboob Bhatti S.O 03 Mr. Sana ullah Mangi EO (M&E) 09 Mr. Abdul Rahman Shar S.O 04 Yasir Abbas Shah Assistant 10 Mr. M Ibrahim Chandio S.O 05 Mr. Bhai Khan Khemtio S.O 11 Mr. Amjad Hussain Sahito S.O 06 Mr. Kaleem Ullah, Khilji S.O 12 Mr. Amanullah, Keerio S.O

C. HFs WITH PPHI

BHUs: 82 Dispensaries: 45 MCHCs: 09 Others: 14

TOTAL: 150

B. Population of the Catchments Area:

G. STAFF STRENGTH

Sanctioned Working Government PPHI Vacant Posts Employees Contract Mos 151 60 87 WMOs(Govt) 04 04 0 --- FMO 61 0 56 07 Sonologist 06 - 06 LHVs 73 11 62 --- Male ------MTs/MAs Female ------Dispensers 152 112 40 ---

H. CLUSTERS OF HFs

WITH ONE MO

Previous Month Total at Present Month under Review Total at Present Clusters of 6 HFs 00 Clusters of 6 HFs 00 Clusters of 5 HFs 00 Clusters of 5 HFs 00 Clusters of 4 HFs 00 Clusters of 4 HFs 00 Clusters of 3 HFs 00 Clusters of 3 HFs 00 Clusters of 2 HFs 09 Clusters of 2 HFs 10 Single HFs 130 Single HFs 130

WITH ONE FMO

Previous Month Total at Present Month under Review Total at Present Clusters of 5 HFs 00 Clusters of 5 HFs 00 Clusters of 4 HFs 00 Clusters of 4 HFs 00 Clusters of 3 HFs 00 Clusters of 3 HFs 00 Clusters of 2 HFs 47 Clusters of 2 HFs 47 Single HFs 10 Single HFs 09

E. CAPACITY BUILDING

1. First Session: During MRM “Haemoglobin”

Capacity Building of LHVs / Dispensers during Month under Review

Names of the Resource Persons with No. of Topic dates Date Venue Participants Dr. Samina Shaikh (FMO) 10/05/2012 DHDC-Hall Haemoglobin 87 Dr. Jawaid Samo (FCPS) 11/05/2012 DHDC-Hall Chronic Liver 83 Asstt: Prof: GMC-Sukkur Deseases

F. REVIEW OF THE PERFORMANCE (I) PREVENTIVE HEALTHCARE During Month under Review 1. Vaccination / Immunization

No. of Doses of Immunization Administered in Children at Health Facilities. 8152 No. of Immunization & Vaccination Administered by outreach EPI Teams 1664 Total vaccination / immunization for the month of April 2011 N/A Total 9816

2. National Immunization Days (NIDs) for Polio

Dates of NIDs Target of coverage Actual coverage Percentage of coverage 23-25 April 2012, 100% NA

3. Other Preventive/Promotional Services

S # Service Number 1 Passive Case Detection (PCD) Slides NA

2 Active Case Detection (ACD) Slides NA 3 Visits to Check Sanitation (individual house holds + streets) NA 4 Notices issued against Poor Sanitation NA 5 Challans sent to Court against Poor Sanitation NA 6 Patients Nebulized NA

S # Names of FMOs Ante-Natal Cases Neo-Natal Cases Other OPD Total OPD 1 Dr: Nusrat Wassan 230 5 394 1453 2 Dr: Asma Shaikh 30 0 72 757 3 Dr: Madiha Rahman 84 0 301 695 4 Dr: Sanober Soomro 45 0 0 564 5 Dr: Rena Kumari 0 0 0 0 6 Dr: Rozina Soomro 105 0 488 1036 7 Dr: Naila Soomro 197 0 41 1218 8 Dr: Samina Shaikh 95 0 5 896 9 Dr: Farzana Kerio 0 0 0 0 10 Dr: Naheed Akhtar 62 1 348 799 11 Dr: Naseem Dharejo 37 0 37 437 12 Dr: Ghazala Lashari 0 0 0 0 13 Dr: Firdos Ara 0 0 0 0 14 Dr: Irshad Rajper 120 3 32 1130 15 Dr: Hameeda Rajper Jr 0 0 0 0 16 Dr: Sobia Fayaz Memon 23 0 22 640 17 Dr: Zainab Bozdar 143 11 79 1316 18 Dr: Marium Shaikh 169 0 40 1355 19 Dr: Mehrunisa 42 1 0 836 20 Dr: Fakhrunisa 0 0 0 0 21 Dr: Afsheen Khamisani ICU- 22 Dr: Farzana Kanhar 109 23 59 912 23 Dr: Shabiran Mari 61 0 0 802 24 Dr: Sana Sadaf 48 0 111 645 25 Dr: Shahida Parveen 138 28 0 988 26 Dr: Abida Parveen 23 0 8 342 27 Dr: Suneeta 47 0 194 1004 28 Dr: Rukhsana Sohu 180 7 160 465 29 Dr: Khadija Soomro 56 0 159 1286 30 Dr: Aliya Nazir 61 0 67 705 31 Dr: Rehana Zulfiqar 40 0 10 500 32 Dr: Rukhsana Maitlo 114 0 181 1807 33 Dr Tahira Sonologist 34 Dr: Nadia Sharaf 0 0 0 0 Dr: Hameeda Rajper 35 MEDICAL LEAVE (Sr) 36 Dr Reshman 22 0 301 673 37 Dr Sajida Parveen 12 0 141 505 38 Dr: Rubina Rajper 25 4 3 300

39 Dr: Sanam Shaikh 7 0 5 588 40 Dr. Afshan Shoukat 0 0 0 0 41 Dr: Lal Khatoon Red Crescent Unit 42 Dr: Nusrat Memon 41 0 6 446 43 Dr: Nazia Noor 94 0 95 740 44 Dr: Shamshad Shaikh 54 0 26 671 45 Dr: Zeenat Memon 40 0 237 902 46 Dr: Roshan Waqar 60 0 144 849 47 Dr: Zahida Soomro Sonologist 48 Dr: Asia Bhatti 47 0 188 798 50 Dr: Aisha Balouch 59 0 140 451 52 Dr: Shabnam Phull Neonatal Ward 53 Dr: Reeta SMBB Poly Clinic 55 Dr: Samina Channa 121 0 255 1335 56 Dr: Shahida Mangrio 138 28 0 988 57 Dr: Rabia Sangi 26 0 0 561 58 Dr: Sangeeta Mukesh 26 1 10 366 59 Dr: Afshan Shaikh 35 0 264 785 60 Dr:Rozina Lakho Sonologist 61 Dr:Rizwana Andleep Sonologist 62 Dr: Shazia Shaikh 89 0 235 1032

(II) MOTHER, CHILD & REPRODUCTIVE HEALTH During Month under Review 1. Female Health

2. Deliveries Assisted

S # Service Number 1 Deliveries Assisted at HFs 49 2 Deliveries Assisted at homes 02

3. Lab/ Diagnostic Tests

S # Name of Test Number

1 Pregnancy Tests. 1082 2 Blood Sugar Tests. 773 3 Haemoglobin Tests. 392 4 Ultra Sound Test. 3034 5 Other. 3831

4. Important Discussion on Mother and Child and Reproductive Health during MRM

It was informed by DSM that since Family Planing material is being supplied to HFs. The FMOs were also directed to pay more attention over vaccination of children and women and provide family planning advice.

Provision of Family Planning Services during the Month

S # Name of the Items / Service Number 1 Consultation / Advice 1264 2 Oral Pills 447 3 IUCDs 142 4 Injections 112 05 Others 2873 Total 4838

(III) COMMUNITY PARTICIPATION During Month under Review

1. Number of Male CSGs: 120 Number of female SGs: 0

2. Performance of Social Organizers

Meetings of Support Groups Names of Social Organizers CHSs/SHSs arranged by him conducted by him No. of No. of No. No. Participants Participants Bhai Khan 01 09 01 13 Muhammad Ibrahim 02 23 04 47 Akhtar Hussain 08 150 06 166 Abdul Rehman 28 684 26 494 Kaleemullah Khilji 03 59 02 38 Mohsin Ali 04 75 13 105 Total 46 1000 52 833

3. School Health Sessions & Community Health Sessions

Community Health Sessions School Health Sessions

S Names of MO / Children Children No. Sessions Participants Sessions FMOs/Paramedics Examined Treated

01 Dr: Nusrat Wassan 01 20 01 0 0 02 Dr: Asma Shaikh 03 24 01 12 08 03 Dr: Sanober Soomro 03 38 01 22 08 04 Dr: Madiha Rahman 03 38 01 13 03 05 Dr: Rena Kumari 0 0 0 0 0 06 Dr: Rozina Soomro 0 0 0 0 0 07 Dr: Naila Soomro SMBB Poly Clinic 08 Dr: Samina Shaikh 03 62 01 22 06 09 Dr: Farzana Kerio 0 0 0 0 0 10 Dr: Naheed Akhtar 03 21 01 29 08 11 Dr: Naseem Dharejo 03 56 01 13 08 12 Dr: Ghazala Lashari 0 0 0 0 0 13 Dr: Firdos Ara 0 0 0 0 0 14 Dr: Irshad Rajper 03 36 03 42 0 15 Dr: Hameeda Rajper (Sn) C/L 16 Dr: Sobia Fayaz Memon 02 26 01 5 3 17 Dr: Zainab Bozdar 03 43 01 03 02

18 Dr: Marium Shaikh 03 115 01 0 0 19 Dr: Mehrunisa 03 37 01 25 10 20 Dr: Fakhrunisa Bhambhro 0 0 0 0 0 21 Dr: Afsheen Khamisani Red Crescent Unit 22 Dr: Farzana Kanhar 02 44 02 106 0 23 Dr: Shabiran Mari 03 35 01 13 13 24 Dr: Sana Sadaf 02 20 0 0 0 25 Dr: Shahida Parveen 02 28 01 30 14 26 Dr: Abida Parveen 0 0 0 0 0 27 Dr: Suneeta 02 32 01 11 11 28 Dr: Rukhsana Sohu 01 6 0 0 0 29 Dr: Khadija Soomro 03 44 01 7 6 30 Dr: Aliya Nazir 03 70 01 20 20 31 Dr: Rehana Zulfiqar 03 40 01 20 0 32 Dr: Rukhsana Maitlo 02 33 02 20 07 33 Dr Tahira Sonologist 34 Dr: Nadia Sharaf On Maternity Leave 35 Dr: Hameeda Rajper (JN) Sonologist 36 Dr Reshman 03 45 01 20 10 37 Dr Sajida Parveen 02 25 0 0 0 38 Dr: Rubina Rajper 02 40 01 20 0 39 Dr. Sanam Shaikh 02 20 01 10 0 40 Dr. Afshan Shoukat 0 0 0 0 0 41 Dr: Nazia Noor 02 62 01 42 16 42 Dr: Lal Khatoon Red Crescent Unit 43 Dr: Nusrat Memon 0 0 0 0 0 44 Dr: Shamshad Shaikh 03 48 01 13 0 45 Dr: Zeenat Memon 03 38 01 13 46 Dr: Roshan Waqar 03 47 0 0 0 47 Dr: Zahida Soomro Sonologist 48 Dr: Asia Bhatti 02 39 02 25 2 50 Dr: Aisha Balouch 02 20 01 05 05 52 Dr: Shabnam Phull Neonatal Ward 53 Dr: Reta SMBB Polyclinic 55 Dr: Samina Channa SMBB Polyclinic 56 Dr: Rabia Sangi 0 0 0 0 0 57 Dr: Sangeeta Washoo 03 65 02 40 05 58 Dr: Afshan Shaikh 03 36 01 0 0 59 Dr: Rozina Lakho Sonologist 60 Dr: Rizwana Andleep Sonologist 61 Dr. Shazia Shaikh 04 46 04 36 12 62 Dr. Sangeta Mukesh 02 37 02 45 40 0* Report not received

4. Important Points during Support Group Meetings. - Shortage of Auxiliary Staff specially sanitary workers and Chokidars & H.T/Disp. - R & R of BRHFs, Proper immunization

5. Important Points during SHSs - FMOs should provide the knowledge about the causes and preventive measures of most common diseases to the students and teachers. Female Medical Officer(s) also informed about preventive

measures for diseases and also shared the signs and symptoms and prevention measures of different diseases and treat the affected.

6. Important Points during CHSs - Medical Officers and Female Medical Officer(s) provide information for the preventive measures to be taken inside the house and village for prevention of different diseases. - They inform about signs and symptoms of different diseases and provide guidelines for treatment.

7. Topics for SHSs for the Month

S No. Topics 1 General Hygene 2 Dirrehoea 3 Scabies

8. Topics for CHSs for the Month

S # Topics 1 Malaria 2 Hepatitis A,B,C & D

9. Important Discussion on Community Participation during MRM

- Holding of regular Community Support Groups Meetings. - Errors in DHIS reports, Timely submission of Monthly reports, FMO reports & Medicine requitions - Involvement of Active community members in BRHFs issues and in R&R and problems faced by BRHFs. - Support from community member in holding Community Health Sessions and SHS & their participation.. - All Male & Female Medical Officers were instructed to keep hf neat & clean & plantation.

10. Health Camps: Number Held: Number of Patients:

11. Measures for improvement / provision of Services by other Department / Agencies

Sr No Description Recommendation To whom sent Present status I Sanitation NIL Ii Drainage / sewerage NIL Iii Drinking water NIL Iv Prevention of adulteration NIL V Tree Plantation NIL Vi Roads and infrastructure NIL Vii Environmental Improvement NIL Viii Others NIL

(IV) CURATIVE SERVICES DURING THE MONTH UNDER REVIEW

1. OPD*

New patients treated during Total OPD during the Old patients treated during the month month (New + Old) the month 225,176 231,816 6,640

2. Maximum OPD** Minimum OPD**

S # BRHF OPD BRHF OPD 1 BHU Khuhra 5995 DCD Suleman Aradin 179 2 BHU Bozdar Wada 5662 BHU Pir Bux Gaho 310 3 BHU Kumb 4480 BHU Bago Maitlo 321 4 BHU Drib Mehar Shah 4177 GD Model Village Tajjal 365 5 NMC Choondko 4121 DCD Atta Muhammad Rajpar 414

3. Top Five Diseases Treated during School Health Sessio ns/Camps

S # Diseases No. of Patients 1 ARI 2 Malaria

3 Scabies

4 Dermatitis

5 Otatitus Media 0 *All HFs — BHUs and others. **Reflects OPD at BHUs only — not at other HFs.

4. Top Five Diseases During OPD

S # Disease No. of Patients 1 ARI 30807 2 Malaria 26333 3 Diarrhea 26460 4 SkinDisease 12921 5 Fever(due to other causes) 16400

12. ARV / ASV used during the month

No. of Patients Dog bite cases reported 775 ARV Administered 775 ARV Available Doses 553 Snake bite cases reported 10 ASV Vaccine Administered 10 ASV Vaccine Available Doses 00

13. Lab / Diagnostic Tests: Includes Tests Reported at No. (II) (Mother, Child & Reproductive Health) (Lab / Diagnostic Tests)

S # Tests Number 1 Blood Sugar Tests 773 2 Hemoglobin 392 3 X-Rays (if available) 45 4 Ultra Sound 3034 5 Others (Malaria+Lab Test) 3831

B & C SCREENING TESTS

No. of Tests No. of cases No. of cases referred Total referred Follow up Screening Performed found positive for treatment up to date result Hepatitis B NA Hepatitis C NA

8. TUBERCLOSIS

Patients New Cases During Under Diagnosis Receiving Treatment the Month 31

9. Referrals

S. No Totals Cases Referred To 1 TB DOT Deliveries Others RHCs THQs DHQs 104 31 50 02 15 0 06

10. Inverse Referrals

S.No Totals Cases Referred from ARV ASV Others RHCs THQs DHQs 69 69 0 0 40 12 17

G. MONITORING DURING MONTH UNDER REVIEW

1. Monitoring Visits during the month

DSM Executive Monitoring Other Staff Total 39 111 251 401

2. Important Points/Issues arising from Visits

S # Name of HF Issue Action Remarks

H. AVAILABILITY OF MEDICINES/MEDICAL MATERIALS

2. Important Issues raised relating to Medicines, etc. during MRM • Late Submission of timely medicine requisitions DHIS, FMO Reports, Dews Reports by Medical Officer and Female Medical Officers

I. REPAIR / MAINTENANCE / ELECTRIFICATION OF / AT HFS

S # Name of Description of Repair / Status / Remarks HFs Maintenance incl. Electrification 01 BHU Dhoro 100% 02 BHU Dubi 100% 03 BHU Hindyari 100%

04 BHU Kabir Khan Siyal 100% 05 BHU Kharrah 100% 06 BHU Tarko 100% 07 GD Deparja 100% 08 GD Mangho Fakir Shar 100% 09 GD Sutyaro 100% 10 BHU Bachal Bhambhro 100% 11 BHU Khalifo Huryah 100% 12 BHU New Goth Sahito 100% 13 BHU Sami 100% 14 BHU Rukrani 100% 15 BHU Bhelar wada 100% 16 BHU Razal Memon 100% 17 BHU Gadeji 100% 18 BHU Kathore 100% 19 BHU Bachal Bhambhro (Nara) 100% 20 BHU Sikanadr Abad 100% 21 MCHC Choondiko 100% 22 BHU Layari 100% 23 BHU Mithri 100% 24 GD Fateh pur 100% 25 BHU Amir Ali Shah 100% 26 BHU Arab Solangi 100% 27 BHU Jiskani 100% 28 GD Murad Gopang 100% 29 BHU Nawab Khan Wassan 100% 30 BHU Imam Bux Palh 100% 31 BHU Jan M Wandiar 100% 32 BHU Hashim Shah Jagir 100% 33 BHU Karam Ali Khan Lashari 100% 34 BHU Babar wada 100% 35 BHU Bago daro 100% 36 GD Talpur wada 100% 37 BHU Hadal Shah 100% 38 BHU Kot Mir Muhammad 100% 39 BHU Sadarji Bhatyoon 100% 40 BHU Rahooja 100% 41 BHU Mahesar wada 100% 42 BHU Manghanwari 100% 43 BHU Bahar Larik 100% 44 BHU Kolab Jial 100%

45 GD Ali Hyder Jalbani 100% 46 BHU Thehri 100% 47 BHU Babarloi 100% 48 GD Mitho Mari 100% 49 BHU Machyoon wada 100% 50 BHU Pir Mangio 100% 51 BHU Bago Maitlo 100% 52 BHU Tando Masti 100% 53 BHU Gagri 100% 54 BHU Lal Bux Mangi 100% 55 BHU Long Fakir 100% 56 GD Allah Bux Katohar 100% 57 GD Manjhi Khan Katohar 100% 58 GD Siming 100% 59 BHU Tando Nazar Ali 100% 60 GD Razi Goth 100% 61 GD Gabar Maitlo 100% 62 GD Nihal Khan 100% 63 BHU Ripri 100% 64 GD Arab Phull 100% 65 BHU M Ramzan Mullo 100% 66 BHU Araro 100% 67 BHU Bhango Behan 100% 68 BHU Zafarabad 100% 69 BHU Ubhri 100% 70 BHU Tando Mir Ali 100% 71 BHU Phori Chadio 100% 72 GD Shah Ali Jamro 70% 73 BHU Pir Hayat Shah 40%' 74 GD Imdad Ali Sahito 40% 75 BHU Tando Mir Karam 95% 76 BHU Sagyoon 75% 77 BHU Tajjal Sharif 90%' 78 BHU Pir Bux Gaho 50%' 79 BHU Hussain Abad 60% 80 GD Kandhar 50% 81 BHU Ahmed Pur 90% 82 BHU Drib Mahar Shah 60% 83 BHU Piryaloi 95% 84 BHU Phat 80%

85 GD Akan Behan 50% 86 BHU Sadi Lower 65% 87 GD Fakir M Lakho 70% 88 BHU Akri 70%' 89 BHU Ghulam Nabi Rajper 20%' 90 BHU Bozdar Wada 70% 91 BHU Setharja 90%

Inspections / Visits of PPHI HFs

Visitors* Health Facilities Visited Overall Comments

* To reflect only non-PPHI Visitors.

J- DISCUSSION DURING MRM On Staff Matters: - Avoid Absence in MRM, regularity & punctuality, R&R,

On Preventive Health: - Non Conduction of community and school health sessions especially from MO side. - Active Participation and Cooperation regarding vertical programs. On Curative Health: - Medicine supply to be made possible according to requisition. On Mother, Child & Reproductive Health: - The training of FMOs for family planning techniques is required, improving ANC, PNC,etc Other Matters: - Maintenance of Record,punctuality of time by M.O & FMO.

Date /Time for Next MRM: 09th & 10th of June 2012/ 10:00am

Comments by DSM The strong demand for iv fludes , equipments, purchase HB metre, solution, Delevery kits ceiling fans electric transformers and refregeratos were strongly demended for generators for MCHC and AAtra sound machines were also demande for soniligist. Some HFs have no building at all. Improvement is needed in the order to extend coverage of FMO in hard areas of Nara, Faizganj.

MINUTES OF THE (41st) MONTHLY REVIEW MEETING OF DISTRICT MATIARI

Monthly Review Meeting (MRM) of District Matiari for the Month of April, 2012 was held on 10th May, 2012 at DSU PPHI Matiari Office. Written invitations to participate were sent to the Deputy Commissioner, the DHO(H), the EDO(F&P) and District Incharge of EPI, LHW, T.B Program, Malaria ,family planning and all other National Programs as usual. The list of participants as follows:

List of Participants:

1. Inam-ur-Raheem Abro District Support Manager DSU PPHI Matiari 2. Mr.Imran Qureshi Ex(F/A) DSU PPHI Matiari 3. Dr.Shahida Soomro Assistant Professor LUMHS Jamshoro (Guest Speaker) 4. Dr.Haji Ahmed Memon DDO RCH DHO Office Matiari 5. Dr.Salma Shah I/C Sr.WMO DCD Jumo Shahoke 6. Dr.Nizamuddin Abro SMO BHU Udero lal Village 7. Dr.Imtiaz Ali Memon I/C SMO BHU Karam Khan Nizamani 8. Dr.Ishtiaque Ansari Dental Surgeon RHC Bhit Shah 9. Dr.Nadeem Shah I/C MO BHU Bhanothe 10. Dr.Amir Ali Sangrasi I/C MO BHU Seerachoo Kaka 11. Dr.Safdar Ali Rajpar I/C MO GD Sher M. Thora 12. Dr.Sache Dino I/C MO DCD Zair Pir 13. Dr.Khuda Dino Memon I/C MO GD Old Saeedabad 14. Dr.Shuja Muhammad Shah I/C MO BHU Udero Lal Village 15. Dr.M.Soomar Memon I/C MO BHU Bhanothe 16. Dr.Munir Jamali I/C MO BHU Nabi Bux Jamali 17. Dr.Abdul Fatah Abro I/C MO BHU Bau Khan Pathan 18. Dr.Ghulam Abbas I/C MO BHU Nabi Bux Jamali 19. Dr.Jamaluddin Ansari I/C MO BHU Yousuf Hajano 20. Dr.Adeel Shahzad I/C MO BHU Tahir Hingoro/DCD Dhaloo Khaskheli 21. Dr.Faisal Shahzad I/C MO BHU Shahmeer Rahu 22. Dr.Abdul Sattar Dakhan I/C MO BHU Laloo Mangwano 23. Dr.Shahid Memon I/C MO BHU Fakir Nooh Hothiani 24. Dr.Naeem Ahmed Memon I/C MO BHU Khando 25. Dr.Shakeel Ahmed I/C MO GD Soomar Chand 26. Dr.Shahzeb Ali Shah I/C MO BHU Panj Moro 27. Dr.Waseem Ahmed Laghari I/C MO DCD Jumo Shahoke 28. Dr.Aijaz Ali Memon I/C MO DCD Pali Jani 29. Dr.Parvez Ahmed MO RHC Bhit Shah 30. Dr.Shakeel Ahmed MO BHU Hala Old 31. Dr.Sajida Raza FMO BHU K.K.Nizamani/ GD Old Saeedabad 32. Dr.Saeeda bano FMO GD Sher M.Thora/BHU Laloo Mangwano 33. Dr.Parveen Hafeez FMO MCH/BHU Udero lal Village 34. Dr.Shazia Shaikh FMO DCD M.M.Khan/DCD Zair Pir 35. Dr.Saran Shakeel FMO GD Punhal Khan Jamali/BHU Ilyas Abrejo 36. Dr.Shabana Shah FMO MCH/BHU Sekhat 38

37. Dr Rukhsana Zahid FMO BHU Tahir Hingoro&DCD Dhaloo Khaskheli 38. Dr.Shahnaz Altaf FMO BHU Nabi Bux Jamali/BHU B.Khan Jamali 39. Dr.Jameela Memon FMO BHU Yousuf Hajano/ BHU Bhanothe 40. Dr.Irum Zain Memon FMO BHU Mahar Shah/DCD Awal Chachar 41. Dr.Sumera Naz FMO BHU Fakir Nooh Hothiani/GD Soomar Chand 42. Dr.Zainab Abro FMO GD Khanothe/ GD Rano Bughio 43. Dr.Fozia Zaheer FMO MCHC BHU Khando 44. Dr.Saba Shahnawaz FMO MCH BHU Saeed Khan Laghari 45. Dr.Romi Aijaz Ali Memon FMO DCD Pali Jani/GD Shahmeer Ji Wasi 46. Dr.Amina Bano Sonologist Taluka Matiari 47. Dr.Shazia Atta Sonologist Taluka Saeedabad 48. Dr.Safina Ahmed Sonologist Taluka Hala 49. Rabdino Abid Kazi SO-I/Assistant Taluka Hala 50. Hakim Ali Bhatti SO-III Taluka Matiari 51. Liaqat Jamali SO-II Taluka Saeedabad 52. Ayaz Soomro Assistant Admin DSU PPHI Matiari 53. Imran Memon Assistant DSU PPHI Matiari 54. Mr.Abdul Ghaffar Assistant DSU PPHI Matiari 55. Waqas Anjum Assistant DSU PPHI Matiari 56. Mr.Kirshan Mal Store Manager DSU PPHI Matiari

The following could not attend the meeting for the reasons stated against each:-

1. Dr.M.Ismail Laghari I/C SMO MCH Week 2. Dr.Toufeeque Ahmed Memon I/C SMO MCH Week 3. Dr.Mushtaq Ahmed Memon I/C SMO MCH Week 4. Dr.Anwar Ali Soomro I/C SMO Casual Leave 5. Dr.Khalid Saghir I/C SMO MCH Week 6. Dr.Sahib Dino Memon I/C MO MCH Week 7. Dr.Afshan Rafique FMO Casual Leave 8. Dr.Sana Hussain FMO Casual Leave 9. Dr.Ghulam Fatima FMO Casual Leave

D. HFs WITH PPHI

BHUs: 13 Dispensaries: 16 MCHCs: 06 Others: 01(RHC)

TOTAL: 36

B. Population of the Catchments Area: 546512

I. STAFF STRENGTH

Sanctioned Government PPHI Vacant Working Posts (Govt.) Employees Contract (Sanc-Govt) MOs 32 14 21 31 10 WMO 02 02 - 39

FMOs - 24 - 27 - LHVs/MW/F. Nurse 41 45 23 24 18 Male 16 16 0 MTs/MAs 22 06 Female - - - Dispensers 1 22 1 21 0

J. CLUSTERS OF HFs

WITH ONE MO

WITH ONE FMO

Previous Month Total Month under Review Total Clusters of 5 HFs Clusters of 5 HFs Clusters of 4 HFs Clusters of 4 HFs Clusters of 3 HFs Clusters of 3 HFs Clusters of 2 HFs 13 Clusters of 2 HFs 14 Single HFs 6 Single HFs 9

E. CAPACITY BUILDING

1. First Session: During MRM

Dr. Aftab Ahmed Soomro, Assistant Professor, LUMHS Jamshoro, in his lecture on TYPHOID FEVER AND PARATYPHOID FEVER, focused on following points:

1. Typhoid and Paratyphoid 2. Etiology 3. Susceptibility and immunity 4. Pathogenesis 5. Clinical manifestations 6. Clinical forms 7. Laboratory findings

9. Capacity Building of LHVs / Dispensers During Month under Review

No. of Names of the Resource Persons with dates Date Venue Topic Participants

F. REVIEW OF THE PERFORMANCE (I) PREVENTIVE HEALTHCARE During Month under Review

1. Vaccination / Immunization

No. of Doses of Immunization Administered to Children at Health Facilities. 1887 No. of TT vaccines provided to pregnant / Child Bearing Age Women at Health Facilities. 2408 No. of Immunization & Vaccination Administered by outreach EPI Teams - Total vaccination / immunization for the month April 2012 4295

2. National Immunization Days (NIDs) for Polio

Percentage of Dates of NIDs Target of coverage Actual coverage coverage

3. Other Preventive/Promotional Services

S # Service Number 1 Passive Case Detection (PCD) Slides 2 Active Case Detection (ACD) Slides 3 Visits to Check Sanitation (individual households + streets) 4 Notices issued against Poor Sanitation 5 Challans sent to Court against Poor Sanitation 6 Patients Nebulizer

(II) MOTHER, CHILD & REPRODUCTIVE HEALTH During Month under Review 1. Female Health

S # Names of FMOs Ante-Natal Cases Neo-Natal Cases Other OPD Total OPD 1 Dr.Naheed & Dr.Ruqia 562 2590 3152 2 Dr.Azeema Raza 315 1731 2046 3 Dr.Fozia Zaheer 88 1840 1928 4 Dr.Sana Hussain 179 1406 1585 5 Dr Roomi Aijaz 117 1202 1319 6 Dr.Gh.Fatima 145 1152 1297 7 Dr.Parveen Hafeez 116 1167 1283 8 Dr.Sumera Naz 97 1098 1195 9 Dr.Shabana 252 919 1171 10 Dr. Erum Zain Memon 144 976 1120 11 Dr Salma Shah 85 955 1040 12 Dr.Saba Faiz 124 837 961 13 Dr.Zainab Abro 152 808 960 14 Dr.Jamila 107 774 881 15 Dr.Shahnaz Altaf 80 783 863 16 Dr.Sajida Raza 116 743 859 17 Dr.Saran Shakeel 29 796 825 18 Dr.Afshan Rafiq 45 736 781 19 Dr.Rukhsana Zahid 107 674 781 20 Dr. Shazia Shaikh 53 478 531 21 Dr. Saeeda Memon 61 204 265 Total 2974 0 21869 24843

2. Deliveries Assisted

S # Service Number 1 Deliveries Assisted at HFs 150 2 Deliveries Assisted at Homes ---

3. Lab/ Diagnostic Tests

S # Test Number 1 Pregnancy Tests 612 2 Blood Sugar Tests 274 3 Hemoglobin Tests 311 4 Ultra Sound Test 2117 5 Other --

10. Important Discussion on Mother and Child and Reproductive Health during MRM

11. Provision of Family Planning Services during the Month

S # Name of the Items / Service Number 1 Consultation / Advice 345 2 Oral Pills 132 3 IUCDs 55 4 Injections 32 5 Others(RC) 111 Total 675

(III) COMMUNITY PARTICIPATION During Month under Review

1. Number of Male SGs: 34 Number of Female SGs: ------

2. Performance of Social Organizers

Meetings of Support Groups CHSs/SHSs arranged by him conducted by him Names of Social Organizers Total No. of No. of Male Female No. Participants Participants Abid Kazi 5 - 28 12 111 Liaqat Jamali 7 - 42 25 212 Hakim Bhatti 9 - 55 36 312 Total 21 - 125 73 635

3. School Health Sessions & Community Health Sessions

Sr. CHS School Health Session Name of FMO/ MO No No. Part: NO. Examined Treated 1 Dr. Saran Shakeel 2 50 2 0 0 2 Dr. Shahnaz 2 37 2 19 12

3 Dr. Erum Zain 2 40 2 1 1 4 Dr. Jamila 2 82 2 0 0 5 Dr. Ghulam Fatima 1 56 1 35 15 6 Dr. Parveen Hafeez 1 34 7 Dr. Salma Shah 1 8 1 20 20 8 Dr. Zainab 2 34 2 3 3 9 Dr. Sajida Raza 2 54 2 13 12 10 Dr. Azeema Raza 1 35 1 60 35 11 Dr. Roomi Aijaz 2 63 2 0 0 12 Dr. Saeeda Mansoor 2 30 13 Dr. Sumera Habib 2 55 2 31 0 14 Dr. Sana Hussain 2 50 2 23 15 15 Dr. Shabana 1 23 1 0 0 16 Dr. Saba Shahnawaz 1 44 1 0 0 17 Dr. Rukhsana Zahid 2 35 2 120 0 18 Dr. Afshan Rafiq 2 89 2 0 0 19 Dr. Fozia Zaheer 1 44 1 58 0 20 Dr. Khalid Saghir 1 25 1 0 0 21 Dr. Sachedino Memon 1 19 1 0 0 22 Dr. Muner Ahmed Jamali 1 17 1 26 26 23 Dr. Khuda Dino Memon 1 20 1 30 0 24 Dr. Mushtaq Ali 1 23 1 0 0 25 Dr. Shahzeb Shah 1 15 1 10 10 26 Dr. Amir Ali Sangrasi 1 15 1 1 1 27 Dr. Ghulam Abbas 1 14 1 0 0 28 Dr. Jamal uddin Ansari 1 25 1 0 0 29 Dr. Faisal Shahzad 1 18 1 0 0 30 Dr. M. Soomar Memon 1 22 1 0 0 31 Dr. Adeel Shahzad 2 28 2 5 5 32 Dr. Anwer Ali Soomro 1 27 1 22 11 33 Dr. Waseem Ahmed 2 11 2 12 2 34 Dr. Shahid Ahmed 1 10 1 5 3 35 Dr. Shakeel Ahmed 1 22 1 0 0 36 Dr. Abdul Sattar 1 17 1 12 12 37 Dr. Aijaz Ali Memon 1 12 1 0 0 38 Dr. Sahib Dino Memon 1 24 1 0 0 39 Dr. Imtiaz Ali Memon 3 2 2 40 Dr. Naeem Ahmed 1 26 1 0 0 41 Dr. Ismail Laghari 1 44 1 12 0 42 Dr. Safdar Ali 1 15 1 0 0 43 Dr. Abdul Fatah 1 29 1 0 0 Total 56 1341 56 520 185

4. Important Points during Support Group Meetings. • Dissemination the message of facilities available at HFs. • Role of the community support group in vaccination and polio campaigns. • Role of the community support group for the arrangements of school health sessions. • Role of the community support group for the arrangements of Community health sessions for male and female participants. • Support of the community during the R&R work. • Support of the community groups for plantation.

• Increasing the number of members in each community meeting while inviting the social people of the catchments area of the facility.

5. Important Points during SHSs • Immunization • Personal Health and hygiene • Nutrition • Use of fruits and vegetables in daily life

6. Important Points during CHSs Participants were guided that during the polio campaign they should cooperate with the teams and support in vaccination and immunization process at their villages or Muhallas. They were guided regarding their personal health and Hygiene. Doctors shared the facilities available at the nearest health facility to that community. The use of vegetables and fruits was also focused.

7. Topics for SHSs for the Month

Sr. No. Topics 1 Immunization 2 Personal Health and hygiene 3 Nutrition 4 Diarrhea (Prevention & Treatment)

8. Topics for CHSs for the Month

S # Topics 1 Immunization 2 Personal Health and hygiene 3 Nutrition 4 Mother and child health

9. Important Discussion on Community Participation during MRM

The schedule of the CSG meetings was shared and finalized with MOs consultation. DSM guided the MOs to arrange the community support groups on mentioned dates in the schedule. Invite and ensure the maximum participation of the members in the CSG meetings. The DSM guided the MOs to increase the number of the participants while inviting the new members from the CAs of the health facility.

10. Health Camps: Number Held: 00 . Number of Patients: 00

11. Measures for improvement / provision of Services by other Department / Agencies

Sr Description Recommendation To whom Present No sent status I Sanitation No No No Ii Drainage / sewerage No No No Iii ……… drinking water No No No Iv Prevention of adulteration No No No V Tree Plantation No No No Vi Roads and infrastructure No No No Vii Environmental Improvement No No No Viii Others No No No

(IV) CURATIVE SERVICES DURING THE MONTH UNDER REVIEW

1. OPD*

New patients treated Old patients treated during Total OPD during the during the month the month month (New + Old) 70,143 3634 73,777

2. Maximum OPD** Minimum OPD**

S # BHU OPD BHU OPD 1 RHC Bhit Shah 9107 DC Dispensary Mari Muhammad Khan 994 2 BHU Hala Old 4578 BHU Laloo Mangwano 1085 3 BHU Sekhat 3267 BHU Yousuf Hajano 1216 4 BHU Khando 3029 BHU Ilyas Abrejo 1233 5 BHU Panj Moro 2677 BHU Mahar Shah 1270 6 GD Sher Muhammad Thora 2530 GD Shahmeer JI Wasi 1416 7 BHU Udero lal Village 2448 GD Punhal Khan Jamali 1444 8 DC Dispensary Pali Jani 2436 DC Dispensary Jumo Shahoke 1481 9 DC Dispensary Awal Chachar 2373 BHU Fakir Nooh Hothiani 1516 10 BHU Karam Khan Nizamani 2271 GD Rano Bughio 1524 11 BHU Saeed Khan Laghari 2201 dC Dispensary Zair Pir 1527 12 GD Old Saeedabad 2060 BHU Allah Dino Sand 1576 13 BHU Bau Khan Pathan 1981 BHU Bagho Khan Jamali 1673 14 BHU Bhanothe 1969 BHU Nabi Bux Jamali 1726 15 DC Dispensary Dhaloo Khaskheli 1956 BHU Tahir Hingoro 1748 16 BHU Shahmeer Rahu 1934 BHU Seerachoo Kaka 1817 17 GD Khanothe 1889 GD Soomar Chand 1825

3. Top Five Diseases Treated during School Health Sessions/Camps

S # Diseases No. of Patients 1

2 3 4

*All HFs — BHUs and others. **Reflects OPD at BHUs only — not at other HFs.

4. Top Five Diseases during OPD

S # Disease No. of Patients 1 ARI 10023 2 Diarrhea 3584 3 Fever(clinical Malaria) 5999 4 Scabies 2249 5 Dog Bite 103

12. ARV / ASV used during the month 45

No. of Patients Dog bite cases reported 103 ARV Administered 103 ARV Available Doses 671 Snake bite cases reported 00 ASV Vaccine Administered 00 ASV Vaccine Available Doses 05

14. Lab / Diagnostic Tests: Includes Tests Reported at No. (II) (Mother, Child & Reproductive Health) 3. (Lab / Diagnostic Tests)

S # Tests Number 1 Pregnancy Tests 310 2 Blood Sugar Tests 412 3 Hemoglobin 311 4 X-Rays (if available) 271 5 Ultra Sound (Male) 0 6 Others (please specify) --

15. B & C SCREENING TESTS

No. of Tests No. of cases No. of cases referred Total referred Follow up Screening Performed found positive for treatment upto date result Hepatitis B 423 11 11 11 Hepatitis C 423 31 31 31

16. TUBERCLOSIS

Patients New Cases During Under Diagnosis Receiving Treatment the Month 142 19 --

9. Referrals

S.No Totals Cases Referred To 1 TB DOT Deliveries Others RHCs THQs DHQs 2 22 22 22 3 4

10. Inverse Referrals

S.No Totals Cases Referred from 1 ARV ASV Others RHCs THQs DHQs 2 40 32 0 08 40 3 4

G. MONITORING DURING MONTH UNDER REVIEW

3. Monitoring Visits during the month

DSM Executive Monitoring Other Staff Total 33 31 284 348

2. Important Points/Issues arising from Visits

S # Name of HF Issue Action Remarks

H. AVAILABILITY OF MEDICINES/MEDICAL MATERIALS

1. Medicines available for Weeks: 27 weeks 2. Important Issues raised relating to Medicines, etc. during MRM

I. REPAIR / MAINTENANCE / ELECTRIFICATION OF / AT HFS

Description of Repair / S # Name of HFs Status / Remarks Maintenance incl. Electrification 1 BHU Laloo Mangwano R&R Work Completed 2 BHU Tahir Hingoro - Completed 3 BHU Udero Lal Village - Completed 4 BHU Khando - Completed 5 BHU Bhanothe - Completed 6 BHU Saeed Khan Laghari - Completed 7 GD Old Saeedabad - Completed 8 GD Sher Muhammad Thora - Completed 9 GD Punhal Khan Jamali - Completed 10 GD Rano Bughio -- Completed 11 GD Soomar Chand -- Completed 12 GD Shahmeer Ji Wasi -- Completed 13 DC Dispensary Jumo Shahoke - Completed 14 DC Dispensary Dhaloo Khaskheli - Completed 15 DC Dispensary Mari Muhammad Khan - Completed 16 BHU Hala Old - Completed 17 BHU Ilyas Abrejo - Completed 18 BHU Mahar Shah - Completed 19 BHU Yousuf Hajano - Completed 20 DC Dispensary Zair Pir - Completed 21 BHU Seerachoo Kaka - Completed 22 BHU Nabi Bux Jamali - Completed 23 BHU Bau Khan Pathan - Completed 24 BHU Karam Khan Nizamani - Completed 25 BHU Panj Moro - Completed 26 BHU Shahmeer Rahu - Completed 27 BHU Bagho Khan Jamali - Completed

Inspections / Visits of PPHI HFs

Visitors* Health Facilities Visited Overall Comments

* To reflect only non-PPHI Visitors.

J- DISCUSSION DURING MRM

DSM made presentation on Monthly Progress of health facilities and female Medical Officer, and also appreciated the incharge MOs regarding their efforts for the better health services provision at the HFs. He directed all Inchrges to check the record of their EPI centre on daily basis.

Date /Time for Next MRM: 7th of June 2012 at 10:00am

Comments on Targets vs Achievements (by DSM)

MINUTES OF THE (48th ) MONTHLY REVIEW MEETING OF DISTRICT NAUSHEHRO FEROZE

48th Monthly Review Meeting (MRM) of District, Naushehro Feroze for the Month of April-2012 was held on 10th-May-2012 at DC-Committee room NF. Written invitations to participants were sent to the DC, the DO (H), the DO (F&P) and District Incharge of EPI, notable of CSG members and Incharge of all other National Programs as usual. The list of participants is as follows:

List of Participants: (Enclosed as annex.)

The following could not attend the meeting for the reasons stated against each:-

S # Names/Designation Reasons S # Names/Designation Reasons 1 Dr. Aftab Ahmed Siyal Leave Dr. Zulfiqar Ali Soomro Emergency leave 3 Dr. Shokat Ali Memon Illness Dr. Bashir Khaskheli Leave 5 Dr. Sajjad Hyder Shah Leave Dr. Nuzhat Anwar Leave

E. HFs WITH PPHI

BHUs: 46 Dispensaries: 3 MCHCs: Others: ______

TOTAL: 49

B. Population of the Catchments Area: 856,442

K. STAFF STRENGTH

Sanctioned Government PPHI Vacant Working Posts (Govt.) Employees Contract (Sanc-Govt) MOs 49 29 23 51 22 WMO 1 01 00 FMOs 00 30 00 30 00 LHVs 3 00 00 26 3 Male 4 4 00 MTs/MAs 71 64 Female 3 3 00 Dispensers/Vacci: 4 66 34 31 13

L. CLUSTERS OF HFs

WITH ONE MO

WITH ONE FMO

Previous Month Total Month under Review Total Clusters of 5 HFs Clusters of 5 HFs Clusters of 4 HFs Clusters of 4 HFs Clusters of 3 HFs Clusters of 3 HFs Clusters of 2 HFs 17 Clusters of 2 HFs 17 Single HFs 08 Single HFs 12

E. CAPACITY BUILDING

1. First Session: During MRM

Capacity building session conducted by Dr A.Hafeez on e-dews. The session was followed by power point presetation.

i. Capacity Building of LHVs / Dispensers During Month under Review

No. of Names of the Resource Persons with dates Date Venue Topic Participants N/A

F. REVIEW OF THE PERFORMANCE (I) PREVENTIVE HEALTHCARE During Month under Review

1. Vaccination / Immunization

No. of Doses of Immunization Administered to Children at Health Facilities. 2694 No. of TT vaccines provided to pregnant / Child Bearing Age Women at Health Facilities. 616 No. of Immunization & Vaccination Administered by outreach EPI Teams - Total vaccination / immunization for the month 3310

2. National Immunization Days (NIDs) for Polio

Percentage of Dates of NIDs Target of coverage Actual coverage coverage 23-25 April 2012 257846 272580 106%

3. Other Preventive/Promotional Services

S # Service Number 1 Passive Case Detection (PCD) Slides - 2 Active Case Detection (ACD) Slides - 3 Visits to Check Sanitation (individual house holds + streets) - 4 Notices issued against Poor Sanitation - 5 Challans sent to Court against Poor Sanitation - 6 Patients Nebulized 78

(II) MOTHER, CHILD & REPRODUCTIVE HEALTH During Month under Review 50

1. Female Health

NAME OF FMO Neo-Natal Post-Natal Other OPD Total OPD

Dr. Asma Memon 3 20 120 1239 Dr. Amber Khehro 4 4 52 867 Dr. Aneesa Sahito 2 4 194 842 Dr. AQeela Qureshi 1 5 52 639 Dr. Arfeen Korai 2 0 128 859 Dr. Fozia Abbassi 5 1 310 1322 Dr. Ghulam Qubra Buriro' 2 0 76 429 Dr. Ghulam Zaineb 5 10 290 1703 Dr. Khoula Naz 6 4 196 698 Dr. Marya Khaskheli 3 7 180 1639 Dr. Shaista Qurban 2 5 62 439 Dr. Naseem Khatoon Rajper 2 1 121 704 Dr. Nusrat Parween 1 0 232 1003 Dr. Nuzhat Anwar 3 5 91 878 Dr. Ruqaya Samo 1 4 63 1043 Dr. Sadia Shah 2 3 235 968 Dr. Safia Memon 3 7 71 827 Dr. Salma Amjad 2 8 52 813 Dr. Shamasunisa 3 2 80 745 Dr. Shehnaz Begum 5 8 73 847 Dr. Rehana Sardar 0 9 21 1013 Dr. Sughra Badar 5 31 58 1623 Dr. Tabbasum Buriro' 3 11 51 785 Dr. Usha 2 0 78 980 Dr. Shahzadi Sarwat 0 4 181 895 Dr. Azra 0 0 294 1715 Dr. Zareena Noonari 2 35 140 1578

2. Deliveries Assisted

S # Service Number 1 Deliveries Assisted at HFs 22 D&C 10 2 Deliveries Assisted at Homes 310

3. Lab/ Diagnostic Tests

S # Test Number 1 Pregnancy Tests 763 2 Blood Sugar Tests 609 3 Hemoglobin Tests 616 4 Ultra Sound Test 1581 5 Other -

13. Important Discussion on Mother and Child and Reproductive Health during MRM

14. Provision of Family Planning Services during the Month

S # Name of the Items / Service Number Consultation / Advice 692 Oral Pills 480 IUCDs 72 Injections 576 Others 00 Total 1820

(III) COMMUNITY PARTICIPATION During Month under Review

1. Number of Male SGs: 48 Number of Female SGs: 48

2. Performance of Social Organizers

Meetings of Support Groups CHSs/SHSs arranged by conducted by him him Total No. of No: of Names of Social Organizers Male Female Participants No: Participants Zubair Ahmed Memon-SM1 8 - 136 7 285 Zia-ur-Rehman Mastoi-SM2 7 - 119 10 455 Waheed Bhatti- SM3 7 - 119 9 435 Munawar Kaleri- SM4 6 - 102 11 421 Total 28 476 37 1596

3. School Health Sessions & Community Health Sessions

Community Health Sessions School Health Sessions Names of MO / Children Children FMOs/Paramedics Sessions Participants Sessions Examined Treated All MOs and FMOs 59 1374 48 2947 438 Totals 59 1374 48 2947 438

4. Important Points during Support Group Meetings. • Support of CSG members during Polio Campaign • Coverage of PPHI- EPI centers and working of the new appointed EPI vaccinators • Facility of the different Tests at MCHCs • Encouraging support group members to help during NIDs. • Floating the message of PPHI service to the people of respective catchment area. • Arranging of awareness sessions at their respective villages • Developing greenery at HFs

15. Important Points during SHSs • Prevention from Dengue fever • Importance of primary healthcare • Personal hygiene • Cleanliness • Importance of household cleanliness

6. Important Points during CHSs • Prevetion from Dengue fever • Schedule of TT vaccination • Importance of familty planning • Prevention from Diarrhea • Prevention from Malaria

7. Topics for SHSs for the Month

Sr. No. Topics 1 Malaria 2 Primary health 3 Scabies 4 Personal hygiene 5 Dengue-Fever

8. Topics for CHSs for the Month

S # Topics 1 Family Planning 2 Importance of TT vaccination 3 Diarrhea 4 Dengue Fever

9. Important Discussion on Community Participation during MRM

• Sensitization to CSG members about family planning • Role of CSG members in Polio Campaign • Involvement and solution of day to day problems at HF by CSG members • Presiding of the CSG meeting by all members on rotation basis. • Regular meeting with CSG members and proper updating of the minutes • Review of TORs of CSG must be shared with CSG members in every meeting of CSG. • Establishment of greenery at all HFs • Formal invitation to the CSG members for monthly meeting • Effective Mobilization of female CSGs and developing their ownership @ hf.

10. Health Camps: Nil.

11. Measures for improvement / provision of Services by other Department / Agencies

Sr No Description Recommendation To whom Present sent status i Sanitation ii Drainage / sewerage iii ……… drinking water iv Prevention of adulteration v Tree Plantation vi Roads and infrastructure vii Environmental Improvement viii Others

(IV) CURATIVE SERVICES DURING THE MONTH UNDER REVIEW

1. OPD*

Follow-up patients New patients treated during the Total OPD during the month treated during the month (New+Old+Ultrasonologist) month 80,473 1,393 83,447

2. Maximum OPD** Minimum OPD**

S# Name of BHU OPD Name of BHU OPD 1 Bhirya Road 4320 Saeedpur 1055 2 Lakha Road 3509 Mehmood Chandio 989 3 Phull 3251 Fazul Sahito 977 4 Jiando Rajpar 3213 Pinjal Fakir 976 5 Kundha Khahee 2756 Ali Mohammad Phariro 539

3. Top Five Diseases Treated during School Health Sessions/Camps

S # Diseases No. of Patients 1 ARI 188 2 Suspected Fever 95 3 Diarrhea/Dysentry 80 4 Scabies 75 5 Ulcer 00 *All HFs — BHUs and others. **Reflects OPD at BHUs only — not at other HFs.

4. Top Five Diseases during OPD

S # Disease No. of Patients 1 ARI 11075 2 Suspected Fever 11612 3 Diarrhea/ Dysentery 8860 4 Scabies 4092 5 Ulcer 3012

16. ARV / ASV used during the month

Names No. of Patients Dog bite cases reported 124 ARV vial used/ Administered 88 ARV Available Ampules 630 Snake bite cases reported 00 ASV Vaccine Administered 00 ASV Vaccine Available Doses

17. Lab / Diagnostic Tests: Includes Tests Reported at No. (II) (Mother, Child & Reproductive Health) 3. (Lab / Diagnostic Tests)

S # Tests Number 1 Pregnancy Tests 763 2 Blood Sugar Tests 609 3 Hemoglobin Tests 616 4 X-Rays (if available) 2 Units 6 5 Ultra Sound 1581 6 Others (please specify) -

18. B & C SCREENING TESTS

No. of No. of cases No. of cases Total referred Follow up Screening Tests found referred for upto date result Performed positive treatment Hepatitis B 0 0 0 - - Hepatitis C 2 0 0 - Nil-

19. TUBERCLOSIS

Patients New Cases During Under Diagnosis Receiving Treatment the Month 00 24 -

9. Referrals

S.No Cases Referred To Totals TB DOT Deliveries Others RHCs THQs DHQs 1 24 24 0 0 17 3 4 2 3

10. Inverse Referrals

S.No Totals Cases Referred from 1 ARV ASV Others RHCs THQs DHQs 2 3 4

G. MONITORING DURING MONTH UNDER REVIEW 4. Monitoring Visits during the month

DSM Executive Monitoring Other Staff Total 29 34 233 296

2. Important Points/Issues arising from Visits

S # Name of HF Issue Action Remarks 01 N/A N/A N/A N/A 55

H. AVAILABILITY OF MEDICINES/MEDICAL MATERIALS

1. Medicines available for 30 Weeks

2. Important Issues raised relating to Medicines, etc. during MRM

I. REPAIR / MAINTENANCE / ELECTRIFICATION OF / AT HFS

Description of Repair / S # Name of HFs Status / Remarks Maintenance incl. Electrification 1 Repair and Renovation work of all assigned HFs have been completed satisfactorily.

Inspections / Visits of PPHI HFs

Visitors* Health Facilities Visited Overall Comments

* To reflect only non-PPHI Visitors.

J- DISCUSSION DURING MRM On Staff Matters: • Wearing of aprons by all staff members • Proper timing and facilitation of patients • Regularity and punctuality of the staff • Proper updating and reconciliation of the record especially stock and daily expense register • Daily visit of the MO and FMO of the medicine store • Medicine management On Preventive Health: • Holding awareness sessions in schools and colleges of catchment area • Waste disposal pit must be properly used • Getting proper history of the patients • Arranging of quality CHS session • Agenda of the sessions must be with planning and in simple language. • Cleanliness of the HFs on regular basis. On Curative Health: • Lab: tests at HFs • Medicine must be properly managed • Proper record also maintained and reconciled • Least use of injections • House keeping of the HFs is must. • X-Ray and Ultrasound facility On Mother, Child & Reproductive Health: Other Matters: • Most of the Medical officers demanded xylocaine Inj for HFs Date /Time for Next MRM:

Next 49th MRM shall be held on 8th June-2012 at 10:00 am.

Comments on Targets vs Achievements (by DSM)

MINUTES OF THE 38th MONTHLY REVIEW MEETING OF DISTRICT THATTA

Monthly Review Meeting (MRM) of District, Thatta for the Month of April, 2012 was held on 11th May, 2012 at DHDC Hall, DHO Complex Makli. Written invitations were sent to the DC, the DHO Thatta and District Incharge of EPI, LHW and all other National Programs as usual.

The list of participants follows:

S # Names/Designation S # Names/Designation 1 Sq Ldr Maqsood Ahmed Baloch/DSM-Thatta 2 Dr Rahim Bux Samoo, FP Polio Thatta. 3 Dr Ghulam Qadir Sheikh, THO Thatta 4 Dr Maqbool Ahmed Memon,DCO NP Thatta 5 Dr Shafi Wassan SO DEWS 6 Dr Wasdev DTC TB Thatta 7 Mr Hassan Ali Memon/Ex M&E Thatta. 8 Dr Jai Kumar/MO BHU Rahoot. 9 Dr Naseem Bano, FMO. 10 Dr Imtiaz Jogro MO BHU G.M Baran 11 Dr Devi Sadho/FMO 12 Dr Samiullah,MO BHU Sajanwari 13 Dr Zareen Kehar,FMO 14 Dr Abdul Jabbar Memon MO BHU Kot Alamo. 15 Dr Rubina Khokhar/FMO 16 Dr Imam Bux MO BHU Raj Sheikh Bachal 17 Dr Umaira Jabeen/FMO 18 Dr M.Umer Memon MO BHU Banno. 19 Dr Rukhsana Leghari,FMO 20 Dr Gulzar Uqaili,MO BHU Acher Jakhro 21 Dr Zehra Abbasi, Sonologist. 22 Dr Sadhu Ram I/C MO BHU Mureed khoso 23 Dr Marvi Shah/FMO 24 Dr M.Jaffar Almani MO BHU Ladiyoon 25 Dr Zuhra Kiran/FMO 26 Dr Jamal Memon/MO BHU Pir Jo Goth. 27 Dr Razia Raheem,FMO 28 Dr Murad Baloch MO BHU Jokhio village 29 Dr Devi Sadhu,FMO 30 Dr Anwar Memon,MO BHU Bello 31 Dr Farah Rafique, Sonologist. 32 Dr Asif Behrani MO BHU Jhimpir. 33 Dr Saba Fatima/FMO 34 Dr Naimatullah/MO BHU Mureed Jarejo 35 Dr Shaheen Brohi,FMO 36 Dr Imtiaz kakepoto /MO BHU Khair Bux Leghari 37 Dr Mehnaz Ghouri FMO 38 Dr Ashfaque Ahmed MO Boohar 39 Dr Ruqia Turk ,FMO 40 Dr Nisar Memon,MO BHU Nodo Baran 41 Dr Shehla Sheikh FMO 42 Dr Aijaz Khawaja MO BHU Gariwah. 43 Dr Asha Kumar,FMO 44 Dr Anwar Khawaja/MO BHU Garho. 45 Dr Hakima Palijo.,FMO 46 Dr A.Ghani Soomro /MO BHU Ghorabari. 47 Dr Sumera Aftab,FMO 48 Dr Akhtar Ali shah /MO BHU Chatochand 49 Dr Sanam Bakhtyar,FMO 50 Dr Akhtar Hussain katiyar ,MO BHU Kothi 51 Dr Girdhari Lal,MO BHU Goongani 52 Dr Dost Muhammad MO BHU M.K Rind 53 Dr Altaf Hussain,MO BHU Muzaffar Leghari 54 Dr Abdul Wahab MO BHU Ali Bahar. 55 Dr Attaullah Baloch /MO BHU Buhara 56 Dr Shafi Memon/C MO BHU N.M.Thaheem 57 Dr Zeeshan Shah/MO BHU Jhangri 58 Dr M Aslam I/C MO BHU Jungo Jalbani 59 Dr Sajid Kehar MO BHU Ghulamullah 60 Dr M.Ibrahim Soomro MO, BHU Gujjo. 61 Dr A.Rasheed Memon,MO BHU T.H Shah 62 Dr Ghulam Mustafa Leghari MO BHU SQD Shah 63 Dr Abdul Hussain Shah/MO BHU Gail Mori 64 Dr Hussain Gul MO BHU Dhabeji 65 Dr Soofi Azeem MO BHU Jhoke Sharif. 66 Dr Parkash Kumar,MO BHU Marho Bula Khan 67 Mr Teerath Das,Ex.const Thatta 68 Dr Aftab Ahmed Joyo,MO BHU Muzaffar Leghari 69 Dr Narain Das,MO BHU G.M Shah 70 Dr Ali Akbar Brohi,MO GD Aresor 71 Mr Chetan Lal SM-4 72 Mr Lutuf Ali Shah SM-1 73 Mr Munawar Leghari SM-2 74 Mr Zubair Memon SM-3

The following could not attend the meeting for the reasons stated against each:-

S S Names/Designation Reasons Names/Designation Reasons # # Dr Muzaffar Shah/MO-BHU C/L Dr Irshad Memon,MO BHU C/L 1 2 Jaar Laiqpur Dr Ghulam Murtaza MO BHU Dr Karim Khawaja MO C/L 3 ABSENT 4 Ali M.Guggo BHU HM Sodho. Dr M.Ibrahim Memon,MO BHU C/L 5 C/L 6 DR Noreen Sharif FMO Kandra 7 Dr Farhana Memon FMO C/L

F. HFs WITH PPHI

BHUs: 50 Dispensaries: 01 MCHCs: 0 Others: 0

TOTAL: 51

B. Population of the Catchments Area: 1.00 million

M. STAFF STRENGTH

Sanctioned Government PPHI Vacant Working Posts (Govt.) Employees Contract (Sanc-Govt) MOs 47 11 36 51 4 WMO 0 0 0 FMOs 31 19 0 19 12 LHVs 51 20 12 8 31 Male 34 34 20 MTs/MAs 51 0 Female 0 0 0 Dispensers 51 36 16 0

N. CLUSTERS OF HFs WITH ONE MO

WITH ONE FMO

Previous Month Total Month under Review Total Clusters of 5 HFs Clusters of 5 HFs Clusters of 4 HFs Clusters of 4 HFs Clusters of 3 HFs 0 Clusters of 3 HFs 0 Clusters of 2 HFs 14 Clusters of 2 HFs 12 Single HFs 06 Single HFs 07

E. CAPACITY BUILDING

1. First Session: During MRM

Dr. Wasdev, District TB Coordinator Thatta his lecture on “TUBERCLOSIS” focused on the following points:-

• What is TB? • What is Inflammation? • Diagnosis • Treatment • Referrals

17. Capacity Building of LHVs / Dispensers During Month under Review

No. of Names of the Resource Persons with dates Date Venue Topic Participants

F. REVIEW OF THE PERFORMANCE (I) PREVENTIVE HEALTHCARE During Month under Review

1. Vaccination / Immunization

No. of Doses of Immunization Administered to Children at Health Facilities.& outreach 8264 EPI Teams No. of TT vaccines provided to pregnant / Child Bearing Age Women at Health Facilities. 2740 Total vaccination / immunization for the month APRIL 2012 11004

2. National Immunization Days (NIDs) for Polio

Percentage of Dates of NIDs Target of coverage Actual coverage coverage 23-25 April 2012 282960 98%

3. Other Preventive/Promotional Services

S # Service Number 1 Passive Case Detection (PCD) Slides NA 2 Active Case Detection (ACD) Slides NA 3 Visits to Check Sanitation (individual households + streets) NA 4 Notices issued against Poor Sanitation NA 5 Challans sent to Court against Poor Sanitation NA 6 Patients Nebulized 268

(II) MOTHER, CHILD & REPRODUCTIVE HEALTH

During Month under Review

1. Female Health

S # Names of FMOs Ante-Natal Cases Natal Cases Other OPD Total OPD 01 Dr Devi Sadhu 148 0 24 1122 02 Dr Razia Palijo 142 01 183 1064 03 Dr Zehra Qureshi 135 0 195 1051 04 Dr Rukhsana Leghari 72 01 62 1043 05 Dr Marvi Shah 285 0 90 959 06 Dr Umaira Bhutto 80 0 161 916 07 Dr Rubina Chander 76 0 18 804 08 Dr Zareen Kehar 89 0 87 777 09 Dr Naseem Bano 111 0 128 746 10 Dr Hakima Palijo 99 0 41 720 11 Dr Noreen Sharif 49 0 272 709 12 Dr Ruqia Turk 71 0 77 669 13 Dr Mehnaz Ghouri 46 0 106 665 14 Dr Saba Fatima 13 32 73 616 15 Dr Shaheen Brohi 46 0 49 549 16 Dr Asha Kumari 29 04 72 461 17 Dr Shehla Sheikh 15 0 43 432 TOTAL 1506 38 1681 13303

2. Deliveries Assisted

S # Service Number 1 Deliveries Assisted at HFs 48 2 Deliveries Assisted at Homes 81

3. Lab/ Diagnostic Tests

S # Test Number 1 Pregnancy Tests 258 2 Blood Sugar Tests 524 3 Hemoglobin Tests 20 4 Ultra Sound Test 730 5 Other (RDT)Malaria 414

18. Important Discussion on Mother and Child and Reproductive Health during MRM All FMOs were directed to conduct normal deliveries at BHUs and refer complicated cases to secondary/tertiary level HF.

19. Provision of Family Planning Services during the Month

S # Name of the Items / Service Number 1 Consultation / Advice 625 2 Oral Pills 301 3 IUCDs 0 4 Injections 254 5 Others 165 Total 1345

(III) COMMUNITY PARTICIPATION During Month under Review

1. Number of Male SGs: 51 Number of Female SGs: 06

2. Performance of Social Organizers

Names of Social Meetings of Support Groups CHSs/SHSs arranged by him Organizers conducted by him Total No. of No. of Male Female No. Participants Participants Mr. Lutif Ali Shah 06 0 53 13 322 Mr. Zubair Ahmed 0 0 0 02 101 Mr Munawar leghari 07 0 71 11 279 Mr Chetan Lal 04 0 44 11 235 Total 17 0 168 37 937

I. School Health Sessions & Community Health Sessions

Community Health Sessions School Health Sessions Names of MO / Children Children FMOs/Paramedics Sessions Participants Sessions Examined Treated Dr Devi Sadhu 02 55 02 34 29 Dr Razia Palijo 03 40 01 23 2 Dr Zehra Qureshi 02 23 02 0 0 Dr Rukhsana Leghari 02 32 02 25 17 Dr Marvi Shah 02 40 02 10 3 Dr Umaira Bhutto 03 65 01 0 0 Dr Rubina Chander 03 76 01 10 4 Dr Zareen Kehar 02 24 02 48 0 Dr Naseem Bano 02 19 02 19 7 Dr Hakima Palijo 02 25 02 15 9 Dr Noreen Sharif 02 35 02 45 14 Dr Ruqia Turk 02 27 02 31 13 Dr Mehnaz Ghouri 03 65 01 17 17 Dr Shaheen Brohi 03 55 01 06 0 Dr Asha Kumari 02 27 02 0 0 Dr Shehla Sheikh 02 21 02 0 0 Dr Saba Fatima 0 0 0 0 0 FMOs 37 629 27 283 115 MOs 39 610 36 398 128 TOTAL 76 1239 63 681 243

4. Important Points during Support Group Meetings.

• Role of the community support group in vaccination and polio campaigns. • Role of the community support group for the arrangements of school health sessions. • Role of the community support group for the arrangements of Community health sessions for male and female participants. • Support of the community during the R&R work. • Support of the community groups for plantation. • Increasing the number of members in each community meeting while inviting the social people of the catchments area of the facility

II. Important Points during SHSs

• Immunization • Personal Health and hygiene • Nutrition • Polio • Skin disease

20. Important Points during CHSs

• Family Planning • Vaccination/Polio • Personal Hygiene. • Scabies. • Antenatal care. • TB

I. Topics for SHSs for the Month

Sr. No. Topics 1 Personal Hygiene 2 Importance of vaccination/Polio

8 Topics for CHSs for the Month

S # Topics 1 Antenatal care 2 Polio 3 Family Planning

10. Important Discussion on Community Participation during MRM

• To Conduct regular CSG meetings • Active Participation of CSG members • Change / Replace inactive members of CSG • Develop Ownership of BHUs among community • Cooperation for arranging SHS & CHS. • Active Participation of CSG members in polio campaign

10. Health Camps: Number Held: 0 7

11. Measures for improvement / provision of Services by other Department / Agencies

Sr No Description Recommendation To whom sent Present status i Sanitation ii Drainage / sewerage iii ……… drinking water iv Prevention of adulteration v Tree Plantation vi Roads and infrastructure

vii Environmental Improvement viii Others

(IV) CURATIVE SERVICES DURING THE MONTH UNDER REVIEW

I. OPD*

New patients treated Old patients treated Total OPD during the during the month during the month month (New + Old) 57535 1516 59051

2. Maximum OPD** Minimum OPD**

S # BHU OPD BHU OPD 1 Chatochand 2727 Ali Mohd Guggo 233 2 Gujjo 2324 Jhangri 343 3 Buhara 2122 Raj Malik 423 4 Acher Jakhro 1948 Jungo Jalbani 447 5 Banno 1832 Jeand Zangejo 489

3. Top Five Diseases Treated during School Health Sessions/Camps

S # Diseases

1 RTI

2 Scabies 3 GIT 4 ENT 5 Malaria

4. Top Five Diseases during OPD

S # Disease 1 ARI 2 Malaria 3 Diarrhea 4 Scabies 5 Suspected T.B

21. ARV / ASV used during the month

No. of Patients Dog bite cases reported 248 ARV Administered 226 ARV Available Doses 120 Snake bite cases reported 05 ASV Vaccine Administered 02 ASV Vaccine Available Doses 48 20. Lab / Diagnostic Tests: Includes Tests Reported at No. (II) (Mother, Child & Reproductive Health)

S # Tests Number 1 Pregnancy Tests 258 2 Blood Sugar Tests 524 3 Hemoglobin 20 4 X-Rays (if available) 0 5 Ultra Sound 730 6 Others (Malaria) 414

21. B & C SCREENING TESTS: N/A

No. of Tests No. of cases No. of cases referred Total referred Follow up Screening Performed found positive for treatment upto date result Hepatitis B Hepatitis C

22. TUBERCLOSIS

Patients New Cases During Under Diagnosis Receiving Treatment the Month 08 0 09

9. Referrals

S.No Totals Cases Referred To TB DOT Deliveries Others RHCs THQs DHQs 1 16 09 1 06 (Hepatitis)08 02 06

10. Inverse Referrals

S.No Totals Cases Referred from ARV ASV Others RHCs THQs DHQs 1 186 186 0 0 50 15 121

I. MONITORING DURING MONTH UNDER REVIEW

5. Monitoring Visits during the month

DSM Executive Monitoring Other Staff Total 29 32 172 233

2. Important Points/Issues arising from Visits

S # Name of HF Issue Action Remarks 01 BHU Mathino khan Water supply and Letter written to RPD Pending Rind,Gail Mori and drainage work left for transfer of funds. Mureed Khoso incompleted by contractor.

H. AVAILABILITY OF MEDICINES/MEDICAL MATERIALS

1. Medicines available for 11 Weeks

2. Important Issues raised relating to Medicines, etc. during MRM

I. REPAIR / MAINTENANCE / ELECTRIFICATION OF / AT HFS

Description of Repair / S # Name of HFs Status / Remarks Maintenance incl. Electrification 01 BHU Aachar Jakhro Completed MB recorded 02 BHU Gujjo Completed MB recorded 03 BHU NM Thaheem Completed MB recorded 04 BHU Jokhio Village Completed MB recorded 05 BHU Ali Bahar Completed MB Recorded 06 BHU Chato Chand Completed MB recorded 07 BHU Haji M. Sodho Completed MB recorded 08 BHU Dhabeji Completed MB Recorded 09 BHU Ghari Wah Completed MB recorded 10 BHU Garho Completed MB recorded 11 BHU Ghorabari Completed MB recorded 12 BHU Khair Bux Leghari Completed MB recorded 13 BHU Kandra Completed MB recorded 14 BHU S.Qadir dino Shah Completed MB recorded 15 BHU Muzaffar Leghari 90% In progress 16 BHU Shahnawaz Leghari 100% In progress 17 BHU Laiqpur 100% In progress 18 BHU Banno 1000% In progress 19 BHU Jhoke Sharif Completed In progress 20 BHU Mureed Khoso 80% In progress 21 BHU MK Rind 80% In progress 22 BHU Gail Mori 80% In progress 23 BHU Sajanwari 90% In progress 24 BHU T.H Shah 80% In progress 25 BHU Goongani 10% In progress 26 BHU Rahoot 90% In progress 27 BHU G.M Baran 20% In progress 28 BHU Mureed Jarejo 80% In progress 29 BHU Ghulamullah 20% In progress

Inspections / Visits of PPHI HFs

Visitors* Health Facilities Visited Overall Comments

* To reflect only non-PPHI Visitors.

J- DISCUSSION DURING MRM

On Staff Matters: • Regularity & punctuality of staff. • Maintenance of all records. • Submission of reports on time.

On Preventive Health:

• Conduct health sessions on regular basis and include topics of seasonal disease. • Arranging of quality/genuine health sessions.

On Curative Health: • MOs & FMOs with low OPD were directed to increase liaison with community and make regular CSG meetings. On Mother, Child & Reproductive Health: • During MRM it was emphasized that all female medical officers should concentrate more on mother and child health, besides their general OPD they should focus on ANC/PNC, normal delivery cases and also make counseling of patients. Make public family planning services to the clients. Other Matters: Date /Time for Next MRM: • The tentative date for next MRM was fixed on June 07,2012

Comments on Targets vs. Achievements (by DSM):

DSM gave detailed presentation about the progress achieved in the month of March 2012. The performance of each HF was discussed one by one and MOs In charge were directed to cover the deficiencies where ever found. The performance of each FMO was also discussed and they were directed lay special focus on mother and child health. The participants were also informed about the recent meeting held in connection with improving the EPI coverage in high risk UCs. All doctors were directed to perform their duty as focal persons with commitment and dedication.

MINUTES OF THE (42) MONTHLY REVIEW MEETING OF DISTRICT TANDO MUHAMMAD KHAN

Monthly Review Meeting (M.R.M) of District, Tando Muhammad Khan for the Month of April, 2012 was held on 08-05-2012 at meeting Hall of District Government Complex. Written invitations to participate were sent to the Deputy Commissioner, the DHO, the Additional Deputy Commisionar-1, Focal Persons, EPI, TB DOTS, National Program, Malaria Control, Hepatitis, HMIS & DEWS, District Population Welfare Officer, representatives Bridge Consultants, representatives WHO, all I/c Medical Officers/ FMOs/LHVs etc.

List of Participants:

S # Names Designation S # Names Designation 1 Mustafa Kamal Tagar DSM T.M.Khan 39 Dr. Naima Memon FMO-PPHI 2 Dr. M. Ismail Soomro F/P (HMIS) 40 Dr. Farzana Jarwar FMO- PPHI 3 Dr. Gaajan Mastoi D.O HQ 41 Dr. Zaid Jamali FMO- PPHI 4 Ghulam Rasool Memon DO(D.P.W) 42 Dr. Hifza Kinat Shah FMO- PPHI 5 Dr. Mir Hassan Turk MO-DG 43 Dr. Rubeena Abbassi FMO-PPHI 6 Dr. M. Hussain Notkani MO- DG 44 Dr. Shazia Sattar FMO- PPHI 7 Dr. Makhdom Ali Nawaz MO- DG 45 Dr. Farzana Malik FMO- PPHI 8 Dr. Shamshad Memon MO-DG 46 Shela Gul LHV 9 Dr. A.Kareem Leghari MO- DG 47 Farhat Parveen LHV 10 Dr. Dhaloo Mal MO- DG 48 Ghazala LHV 11 Dr. Karim Bux Nizamani MO- DG 49 Najma Parveen LHV 12 Dr. Abdul Malik Shaikh MO- DG 50 Ajmal Memon (D.P.W) 13 Dr. Shahbaz Mughal MO-HQ 51 Dr. Hafeez Pasha D.O (H) 14 Dr. Aamir Khushk MO-PPHI 52 Sharjeel Siddique Ex (M&E) 15 Dr. Intekhab Alam MO-PPHI 53 Haji Noor Muhammad S.O 16 Dr Nizam Soomro MO-PPHI 54 Muhammad Azeem S.O 17 Dr. Raja M. Ishaque MO-PPHI 55 18 Dr. Ali Muhammad MO-PPHI 56 19 Dr. Ghulam Sarwar MO-PPHI 57 20 Dr. Kashif Faraz Hingoro MO-PPHI 58 21 Dr. Ali Anwar MO-PPHI 59 22 Dr. Sabir Kolachi MO-PPHI 60 23 Dr. Sajan Sawai MO-PPHI 61 24 Dr. Saddique Khowaja MO-PPHI 62 25 Dr. Manoj Kumar MO-PPHI 63 26 Dr. Ayoub Memon MO- DG 64 27 Dr. Abdul Rahim Bhurgri MO-PPHI 65 28 Dr. Chatro Mal MO-PPHI 66 29 Dr. Aslam Chana MO-PPHI 67 30 Dr. Kashif Jafferi MO-PPHI 68 31 Dr. Muhammad Khalid MO-PPHI 69 32 Dr. Irshad Fareed FMO-PPHI 70 33 Dr. Sofia Balouch FMO-PPHI 71 34 Dr. Sajida Memon FMO-PPHI 72 35 Dr. Shazia Qayoom FMO-PPHI 73 36 Dr. Sadaf Faraz FMO-PPHI 74 37 Dr. Najma Memon FMO-PPHI 75 38 Dr. Razia Khowaja FMO-PPHI 76

The following could not attend the meeting for the reasons stated against each:-

S # Names Reasons for absence 1 Dr. Asghar Talpur On Leave 2 Dr. Waheed Abbass On Leave 3 Dr. Shazia Dal On Leave 4 Dr. Mumtaz Bhatti On Leave 5 Dr. Laila Khowaja On Leave 6 Dr. Narinder Kumar On Leave 7 Dr. Sadaf Sabir On Leave

G. HFs WITH PPHI

RHC: 01 BHUs: 13 Dispensaries: 20 Others: 01

TOTAL: 35

Population of the Catchments Area: 639000 O. STAFF STRENGTH

Sanctioned Government PPHI Vacant Working Posts (Govt.) Employees Contract (Sanc-Govt) MOs 36 11 25 42 30 WMO 01 01 0 FMOs include sonolgist 0 17 0 17 00 LHVs 4 19 7 12 0 Male MTs/MAs Female 32 41 07 34 25 Dispensers

P. CLUSTERS OF HFs WITH ONE MO

WITH ONE FMO

Previous Month Total Month under Review Total Clusters of 5 HFs Clusters of 5 HFs Clusters of 4 HFs Clusters of 4 HFs Clusters of 3 HFs 4 Clusters of 3 HFs 4 Clusters of 2 HFs 10 Clusters of 2 HFs 12 Single HFs 0 Single HFs 1

E. CAPACITY BUILDING

1. 1st Session: Dr. Zaid Jamali, FMO on conducted session on Infertility and focused on the following points:-

• Introduction • Case definition • Definition • cause • Treatment

2. 2nd Session: Dr. Najma Memon FMO (Cluster) conducted session on Malaria and focused on the following points:-

• Introduction • Learning Objectives • Classification • Investigation • Treatment

2. Capacity Building of LHVs / Dispensers During Month under Review

Names of the Resource Persons with No. of Date Venue Topic dates Participants

F. REVIEW OF THE PERFORMANCE (I) PREVENTIVE HEALTHCARE During Month under Review 1. Vaccination / Immunization

No. of Doses of Immunization Administered to Children at Health Facilities. 7,321 No. of TT vaccines provided to pregnant / Child Bearing Age Women at Health Facilities. 2,752 No. of Immunization & Vaccination Administered by outreach EPI Teams Total vaccination / immunization for the month April, 2011 10,073

2. National Immunization Days (NIDs) for Polio

Total Target of Percentage of Dates of NIDs Actual coverage coverage coverage 23rd 24th 25th April 106,124 112,107 106%

3. Other Preventive/Promotional Services

S # Service Number 1 Passive Case Detection (APCD) Slides 572 2 Malaria Metro Survey (MMS) Slides 286 3 +ve Slides 25 4 Follow up 21

(II) MOTHER, CHILD & REPRODUCTIVE HEALTH During Month under Review 2. Female Health

OBSTETRICAL Sr # NAME OF FMO Total Antenatal Natal Post Natal Total

1 Dr. Mahjabeen - 5 60 65 283

Dr. Shazia Dal 3 2 50 00 74 906

3 Dr. Laila Khowaja 1 107 109 1,530

4 Dr. Shazia Sattar 8 123 1 132 858

Dr.Farzana Jarwar - 6 5 96 102 649

6 Dr. Rubina Abbasi - 1 71 72 577

7 Dr.Irshad Fareed 11 127 1 139 891

Dr.Zaid 35 8 160 27 222 1,811

9 Dr. Hifza Kainat Shah - - 25 25 867

10 Dr. Sajida Memon 9 88 1 98 1,196

Dr. Sofia Baloch 18 11 303 12 333 930

12 Dr. Najima Memon - - 32 32 853

13 Dr.Farzana Malik 4 7 85 96 720

Dr. Sadaf Faraz - 6 14 62 68 847

15 Dr. Naima Memon - - 75 75 656

16 Dr. Shazia Qayoom 20 117 29 166 1,916 Total 1,581 75 130 1,808 15,490

2. Deliveries Assisted

S # Service Number 1 Deliveries Assisted at HFs 75 2 Deliveries Assisted at Homes 00

3. Lab/ Diagnostic Tests

S # Test Number 1 Pregnancy Tests 759 2 Blood Sugar Tests 535 70

3 Hemoglobin Tests 170 4 Ultra Sound Test 625 5 Other 1,621

5. Important Discussion on Mother and Child and Reproductive Health during MRM

a. No: of Deliveries has greatly increased at 24 hours MCHCs. Medicine indent has been circulated by PSU and medicines have been purchased. P.O for tablet cytotec has been supplied at Delivery centers. b. Pre-diagnosis screening of patients for vaccine should be done religiously. c. Where vaccinator are provided under National Program, the duty roster should be signed by I/c Medical Officer and absence report should immediately be sent to Focal Person. d. Pregnant females should be encouraged for delivery at BHU. e. F.P advice should be part of diagnosis and separate record be maintained. f. Sonologists shall furnish their presentation on the findings, referral and follow up. g. MNCH record and Growth monitoring record should be maintained by FMOs where LHV is not provided. In all cases, record should be legible, complete and traceable. h. Baby Weighing Scales/ Adult Bath Scales, Hemoglobin Meters and Height Charts have been provided. Ensure proper usage of the equipments and report of out of order weight machines should be immediately conveyed to I/c MO in writing. i. Training on Hemoglobin meters have been provided to all Medical and Paramedical Staff for blood tests preferably for Pregnant women and same will be repeated for retention. j. Focal Person (EPI) has declined to provide District Government vaccinators during FMO Days at the places where FMO cover is provided. The Vaccinator at all FMO covered facilities for that day used to bring vaccines in carrier and remarkable increase had been achieved in coverage for TT and BCG vaccines. But, now such matter will thoroughly be discussed with EDO (Health).

22. Provision of Family Planning Services during the Month

S # Name of the Items / Service Number Consultation / Advice 978 Oral Pills 187 IUCDs 25 Injections 19 Others 145 Total 1,354

(III) COMMUNITY PARTICIPATION During Month under Review

1. Number of Male SGs: 35 Number of Female SGs: 00

2. Performance of Social Organizers

Meetings of Support Groups CHSs/SHSs arranged by him Names of Social Organizers conducted by him No. of No. of No. No. Participants Participants Haji Noor Muhammad 06 88 13 616 Naveed Khaskeli 08 99 11 576 Muhammad Azeem 10 125 13 896

Total 26 312 79 2088

3. School Health Sessions & Community Health Sessions

S. FACILITY NAME CHS SHS No. MO Part: FMO Part: TOT MO Part: FMO Part: TOT 1 RHC Rajo Nizamani 0 0 0 0 0 0 0 0 0 0 2 BHU&MCH Shaikh Bhirkio 0 0 0 0 0 0 0 0 0 0 3 BHU Nago Shah 0 0 1 35 35 0 0 0 0 0 4 BHU Saeed Pur 0 0 1 31 31 1 48 1 39 87 5 BHU Mullakatiar 0 0 1 30 30 0 0 1 21 21 6 BHU Saeed Matto 1 23 0 0 23 1 40 1 26 66 7 BHU&MCH Saeed Khan Lund 0 0 0 0 0 0 0 0 0 0 8 BHU Seehrani 1 15 2 66 81 0 0 0 0 0 9 BHU Dadoon 0 0 1 20 20 0 0 0 0 0 10 BHU Jinhan Soomro 1 56 1 28 84 1 35 1 17 52 11 BHU Wasi Malook Shah 1 10 0 0 10 1 40 0 0 40 12 BHU Ghulam Muhammad Jat 0 0 0 0 0 0 0 0 0 0 13 BHU Nazar Pur 1 20 0 0 20 1 10 0 0 10 14 BHU Ghulam Shah Bagrani 1 12 1 20 32 1 8 1 21 29 15 DCD Haji Karim Dino Siyal 0 0 1 20 20 1 15 0 0 15 16 DCD Tando Saindad 1 10 1 23 33 2 40 1 14 54 17 DCD Kouro Lashari 1 10 1 18 28 0 0 0 0 0 18 DCD Sain Bux Khoso 0 0 0 0 0 1 4 0 0 4 19 DCD Ali Ghulam Chandio 2 37 1 13 50 2 44 1 3 47 20 DCD Abdul Rahim Katiar 0 0 0 0 0 1 25 0 0 25 21 DCD Anwar Rind 1 16 0 0 16 0 0 0 0 0 22 DCD Asgharabad 0 0 0 0 0 1 8 0 0 8 23 DCD Soomar Leghari 1 21 1 21 42 1 25 1 16 41 24 DCD Mohbat Bhurgri 0 0 25 DCD Saindad Wasan 0 0 0 0 0 0 0 0 0 0 26 DCD Suleman Soomro 1 10 1 15 25 0 0 0 0 0 27 DCD Baqar Nizamani 0 0 1 20 20 1 25 1 25 50 28 DCD Hakimani Syed 1 11 1 30 41 1 27 1 27 54 29 DCD Saddique Jagsi 0 0 1 12 12 0 0 1 14 14 30 DCD Allah Yar Turk 1 65 2 60 125 1 40 0 0 40 31 DCD Mohammad Khan Mangsi 1 12 0 0 12 1 32 0 0 32 32 DCD Lakhat 1 12 1 8 20 2 45 0 0 45 33 Unani Shafa Khana 1 10 1 10 20 1 72 1 72 144 34 DCD Shameer khan lund 0 0 0 0 0 0 0 0 0 0 35 DCD Mir Muhammad Warrer 1 10 0 0 10 1 4 1 5 9 19 360 21 480 840 23 587 13 300 887

4. Important Points during Support Group Meetings.

• The CSG members should help in monitoring and facilitation. • RHC Rajo Nizamani shall be inaugurated by Federal Minister for Water and Power in the month of November as R&R work is still left. However, purchase of O.T equipment is in process. 72

• RHC Rajo Nizamani has been made functional for 24 hours with 03 shifts having medical and paramedical staff. • I/c Medical Officer has been trained for undertaking necessary day to day equipments/asset repairs on need basis after seeking administrative approval from DSM- should be regular feature. • Moral support to medical/paramedical staff working at HF. • Arranging of awareness sessions at their respective villages • Information sharing to the rest of the villages regarding facilities at HF • Reformation of CSGs and individual roles of the members • Effective local facilitation by CSG members to the hf staff • Developing greenery at HFs by the CSG members • Ownership of the HFs

5. Important Points during SHSs

• To drink clean & safe water and Washing hands after toilet. • Awakening health consciousness in children regarding new aspects of diseases like Dengue Fever, Swine Flue, Congo Fever etc. • Nutritional awareness to be transferred to mothers through their kids. • Hair trimming, clean clothes, nails clipping, washing fruit/vegetables before eating.

6. Important Points during CHSs

7. Topics for SHSs for the Month

Sr. No. Topics 1 Diarrhea 2 Malaria/Dengue

8. Topics for CHSs for the Month

S # Topics 1 Diarrhea 2 Malaria/Dengue

9. Important Discussion on Community Participation during MRM

• Community Health Sessions are to be planned and held on Sinologist days. • Participation should be ensured through formal contact with LHWs.

• Sessions are to be held preferably at Health Facility or at community home duly coordinated and facilitated by DSU/HF staff. • DSU field staff shall attend 50% of all the CSG meetings conducted during the month. • TORs of CSG must be shared with CSG members in every meeting of CSG. • Formal invitation to the CSG members in meeting • Presiding of the meeting by the CSG members • Participation of notable CSG member in MRM • Effective Mobilization of female CSGs and developing their ownership at H.Facility. • Involvement of notable in solving day to day problems of HFs. • CSG should be held at BHU. • Developing greenery at HFs.

10. Health Camps: Number Held: 00 Fixed and 00 Mobile camps Number of Patients:

11. Measures for improvement / provision of Services by other Department / Agencies

(IV) CURATIVE SERVICES DURING THE MONTH UNDER REVIEW

1. OPD*

New patients treated Old patients treated Total OPD during the month (New during the month during the month + Old) 53,926 1,095 55,567

2. Maximum OPD** Minimum OPD**

S # BHU OPD BHU OPD 1 RHC Rajo Nizamani 5,791 BHU Dadoon 1,777 2 MCH Saeed Khan Lund 4,260 BHU Nazar Pur 1,489 3 MCH Shaikh Bhirkio 3,295 BHU Saeed Pur 1,374 4 BHU Jinhan Soomro 3,014 BHU Seehrani 1,244 5 BHU Ghulam M Jat 1,882 BHU Saeed Matto 1,277

3. Top Five Diseases Treated during School Health Sessions/Camps

S # Diseases No. of Patients 1 ARI 55 2 Allergic Rhnites 31 3 Scabies 47 74

4 Malaria 36 5 Diarrhea 08 *All HFs — BHUs and others. **Reflects OPD at BHUs only — not at other HFs.

4. Top Five Diseases During OPD

S # Disease S # Disease 1 ARI 12,429 6 Suspected Viral Hepatitis 49 2 Scabies 5,063 7 Dog Bite 44 3 Diarrhea 4,523 8 4 Malaria 2,920 9 5 Cough more than 2 week 129 10

23. ARV / ASV used during the month

No. of Patients Particulars

Dog bite cases reported 44 ARV Administered ( @ 5 Dozes per patient) 00 ARV Available Doses ( @ 24 dozes/vial) 110 Snake bite cases reported 00 ASV Vaccine Administered 00 ASV Vaccine Available Doses 51

23. Lab / Diagnostic Tests: Includes Tests Reported at No. (II) (Mother, Ch & Reproductive Health) 3. (Lab / Diagnostic Tests)

S # Tests Number 1 Blood Sugar Tests 378 2 Hemoglobin 512 3 X-Rays (if available) 127 4 Ultra Sound 288 5 Others (Lab Tests) 1632

24. B & C SCREENING TESTS

No. of No. of cases No. of cases Total referred Follow up Screening Tests found referred for upto date result Performed positive treatment Hepatitis B Hepatitis C

25. TUBERCLOSIS

Patients New Cases During Under Diagnosis Receiving Treatment the Month 37

9. Referrals

S.No Totals Cases Referred To 1 TB DOT Deliveries Others RHCs THQs DHQs 2 37 37 37 3

10. Inverse Referrals

S.No Totals Cases Referred from 1 ARV ASV Others RHCs THQs DHQs 2 37 37 0 0 0 0 37 3

G. MONITORING DURING MONTH UNDER REVIEW

6. Monitoring Visits during the month

DSM Executive Monitoring Other Staff Total 36 74 151 261

2. Important Points/Issues arising from Visits

S # Name of HF Issue Action Remarks 01 02

H. AVAILABILITY OF MEDICINES/MEDICAL MATERIALS

1. Medicines available for: 30 Weeks

2. Important Issues raised relating to Medicines, etc. during MRM

I. REPAIR / MAINTENANCE / ELECTRIFICATION OF / AT HFS

Description of Repair / S # Name of HFs Status / Remarks Maintenance incl. Electrification

Inspections / Visits of PPHI HFs

Visitors* Health Facilities Visited Overall Comments

* To reflect only non-PPHI Visitors.

J- DISCUSSION DURING MRM On Staff Matters:

• All I/c M.Os/FMOs were asked to prepare the base data of that area and set the targets for A.N/P.N, immunization, Deliveries ets. Just reporting the figure does not solve the problems • Every Medical Officer has to commence a journey to become Health Officer sensitized for all 08 components of Primary Health. • All I/c M.Os/FMOs were given Leave formats to discourage sms leaves or hand written applications. • The DSM, PPHI TM Khan requested the in charges of health facilities for their timely submission of DHIS reports, Along with self created form for data required for MPR etc. • DSM advised all MO/FMO Submit advance leave application of planed leaves. • DSM advised all Incharge MO share all access medicine with other BHU with the help of monitoring team • All I/c M.Os should counter-sign on Bin Cards and Stock registers at every receiving and usage of stocks. On Preventive Health: • All I/c M.Os should ensure checking of temperature chart as well as stock and expiry of vaccines. • Quality of HE sessions not yet improved. S.O should facilitate in arranging most of The CHS in communities On Curative Health: • Quality of medicines has improved with clear impact on increased cost of medicines. • Rise in OPD and consequent rise in medicine consumption. • Patient coming from farther areas demand for more medicine dosages. On Mother, Child & Reproductive Health: • Baby Weighing Scales have been provided at all 35 facilities where FMO cover has been provided. • New DHIS MNCH registers and Growth monitoring registers will be maintained at each facility where FMO cover is provided. Training has already been provided to all FMOs in this regard. The DHO office will provide new DHIS register as per requirement. • The registers will be maintained by LHVs wherever provided. Otherwise, FMO will record and maintain. • For NVDs, FMOs should motivate to pregnant ladies for deliveries at BHUs. • All staff members of BHU Saeed Khan Lund and BHU Shaikh Bhirkyo were appreciated for conducting 55 deliveries during the month . Other Matters: • One Pathological laboratory has been made functional at BHU Jinhan Soomro. Now, 04 Pathological Laboratories and 03 X-ray units have started functioning and periodically they have become self sustainable for purchasing diagnosis kits. • I/c Medical Officers requested not to wait for DSU for minor repairs and to undertake necessary repair in lines with procedures and policies already shared and claim reimbursements.

Date /Time for Next MRM: Tentative Date for next MRM is 08-05-2012 Comments on Targets vs Achievements (by DSM) • MEETING WAS SUCCESSFUL

(Mustafa Kamal Tagar), District Support Manager, PPHI, Tando Muhammad Khan.

Copy for information to: 8) P.S to Syed Naveed Qamar Zaman Shah Sahib, Federal Minister for Water & Power, Govt of Pakistan.

9) Secretary to Government of Sindh for Health Department, Karachi. 10) Program Director, PSU, PPHI, Karachi. 11) Deputy Commissioner, District Tando Muhammad Khan. 12) Director General Health, Directorate of Health Hyderabad. 13) Regional Program Director, Region-I @ Hyderabad. 14) District Health Officer, District T.M Khan. 15) Dr. Wahab, S.O, WHO. 16) Incharge Medical Officer(s) all PPHI managed Health Facilities, T.M Khan.

(Mustafa Kamal Tagar), District Support Manager, PPHI,

MINUTES OF THE (8th) MONTHLY REVIEW MEETING OF DISTRICT JAMSHORO

8th Monthly Review Meeting (MRM) of District Jamshoro for the Month of April, 2012 held on 10th May, 2012 at Deputy Commissioner’s Conference Hall - Jamshoro. Written invitations were sent to the DC, the EDO(H), the EDO(F&P) and District Incharges of EPI, LHW, T.B Program, Malaria ,DHIS, family planning, District Surveillance Officer WHO and all other National Programs as usual. The list of participants is as follows:

List of Participants:

57. Mr. Saleem Baloch Add: Deputy Commissioner-1 Dist Jamshoro 58. Dr. Abdul Rehman Assistant Professor LUHMS 59. Mr. Saifullah Abro District Support Manager DSU PPHI Jamshoro 60. Dr. Abdul Wahab Shaikh District Surveillance Officer DEWS WHO 61. Dr. Khalid Memon MO (HQ) PPHI Jamshoro 62. Mr. Niaz Hussain Channa EO(M&E) DSU PPHI Jamshoro 63. Dr. Tahseen Panhwar Sonologist 64. Dr. Zulekha Memon FMO BHU Laki / GD Manju 65. Dr. Shahida Shoro FMO BHU Karo Khao / GD Budhapur 66. Dr. Shazia Memon FMO BHU khando / GD Christian Colony 67. Dr. Naheed FMO SHC Dhamach 68. Dr. Fareeha FMO BHU Thano Ahmed Khan 69. Dr. Rozina FMO BHU KK BAsti 70. Dr. Shah Bano FMO GD Bihar Colony 71. Dr. Khalida FMO LSB+BHU Khanoth 72. Dr. Naseem Junejo FMO GD Akro + BHU Amri 73. Dr. Irum Naz FMO GD Khurshed Colony & BHU Sari 74. Dr. Shakeela FMO BHU Lakha / GD Saharabad 75. Dr. Hafeez Memon MO BHU KK Basti 76. Dr. Ghulam Nabi SMO BHU Wahur 77. Dr. Mohan Lal I/C MO BHU Karo Khao 78. Dr. Ferozuddin MO BHU Talti

79. Dr. Niisar Ahmed MO Band Maanchar 80. Dr. Javed Ahmed MO BHU Thano Ahmed Khan 81. Dr. Irshad Noonari MO SHC Thano Arab Khan 82. Dr. Saifullah MO BHU Tajuji 83. Dr Abdul Khalique MO BHU Laki 84. Dr. Zakir Ali MO BHU Garwari 85. Dr. Sultan Ali MO GD Qubi 86. Dr. Taqi Soomro MO GD LSB Jamshoro 87. Dr. Aijaz Ali MO BHU Toung 88. Dr. Aftab Soomro MO BHU Walidad Gabol 89. Dr. M Ramzan MO BHu Bubak 90. Dr. Riaz ahmed MO Christian Colony 91. Dr. Jehanzaib Bhatti MO GD Sindh University 92. Dr. Asan Das MO BHU Mole 93. Dr. Assar Mal MO BHU Sari 94. Dr. Faisal Channar MO GD Khursheed Colony 95. Dr. Zunair Shoro MO GD Budhapur 96. Dr. Premchand MO GD Manhdapalari 97. Dr. Aneel Kumar MO GD Ali Murad Barejo 98. Dr. Shahid Hussain MO BHU Amri 99. Dr. Allah Juriyo MO GD Bajara 100.Dr. Imamauddin MO BHU Khando 101.Dr. Faraz Hanif Memon MO BHU Lakha 102.Mr. Qurban Ali Vacc BHU Sari 103.Mr. Tayyab Ali Dispenser GD Karchat 104.Mr. Allah Dino SO-/Assistant DSU PPHI Jamshoro 105.Mr. Fahad Chhana Guest 106.Mr. Shahzad Ali SO DSU 107.Mr. Akhtiar Ali Assistant R&R DSU 108.Mr. Zaheer Abass Assistant Adm DSU 109.Mr. Nazar Hussain Assistant Accounts DSU 110.Mr. Tarique Ahmed Shaikh Executive F/A DSU 111.Mr. Rashid Shah Attendant DSU 112.Mr. Asif Ali Assistant Store DSU 113.Mr. Pervaiz Khan Driver DSU

The following could not attend the meeting for the reasons stated against each:-

1. Dr. Anjum Shaikh WMO GD Sindh University Medical Leave 2. Dr. Muzamil I/C MO SHC Dhamach Leave

H. HFs WITH PPHI

BHUs: 19 Dispensaries: 16 MCHCs: 01 Others: 01(RHC)

TOTAL: 37

B. Population of the Catchments Area: 640303

Q. STAFF STRENGTH

Sanctioned Government PPHI Vacant Working Posts (Govt.) Employees Contract (Sanc-Govt) MOs 32 13 22 37 22 WMO 02 02 00 FMOs - 12 - 12 - LHVs/MW/F. Nurse 20 26 20 08 0 Male 26 26 0 MTs/MAs 26 0 Female - - - Dispensers 11 21 11 18 0

R. CLUSTERS OF HFs WITH ONE MO

WITH ONE FMO

Previous Month Total Month under Review Total Clusters of 5 HFs Clusters of 5 HFs Clusters of 4 HFs Clusters of 4 HFs Clusters of 3 HFs Clusters of 3 HFs Clusters of 2 HFs 08 Clusters of 2 HFs 08 Single HFs 05 Single HFs 05

E. CAPACITY BUILDING 1. First Session: During MRM

DR Abdul Rehman Siyal Assistant Professor Pediatrics Department LUMHS gave lecture on Diarrhea and Role of Zinc in Diarrhea (topic) focused on the following points:-

a) What is Diarrhea b) Signs and Symptoms of Diarrhea c) Classification of Diarrhea d) Management of Diarrhea e) Complications f) Prevention g) Treatment.

3. Capacity Building of LHVs / Dispensers During Month under Review

Names of the Resource Persons with Date Venue Topic No. of

dates Participants

F. REVIEW OF THE PERFORMANCE (I) PREVENTIVE HEALTHCARE During Month under Review 1. Vaccination / Immunization

No. of Doses of Immunization Administered to Children at Health Facilities. 1437 No. of TT vaccines provided to pregnant / Child Bearing Age Women at Health 327 Facilities. No. of Immunization & Vaccination Administered by outreach EPI Teams Total vaccination / immunization for the month March 2012 1764

2. National Immunization Days (NIDs) for Polio

Percentage of Dates of NIDs Target of coverage Actual coverage coverage 23rd April to 26th April

3. Other Preventive/Promotional Services

S # Service Number 1 Passive Case Detection (PCD) Slides 2 Active Case Detection (ACD) Slides 3 Visits to Check Sanitation (individual house holds + streets) 4 Notices issued against Poor Sanitation 5 Challans sent to Court against Poor Sanitation 6 Patients Nebulized 133

(II) MOTHER, CHILD & REPRODUCTIVE HEALTH During Month under Review

1. Female Health

S # Names of FMOs Ante-Natal Cases Neo-Natal Cases Other OPD Total OPD 1 Dr. Anjum Shaikh 9 0 493 500 2 Dr. Rozina Memon 67 0 616 683 3 Dr. Fareha Javed 13 0 344 357 4 Dr. Naheed Akhtar 32 1 282 315 5 Dr. Shah Bano 84 0 2439 2523 6 Dr. Shazia Memon 53 0 1497 1550 7 Dr. Khalida Buriro 65 0 1057 1122 8 Dr. Shahida Shoro - 0 0 0 9 Dr. Irum Naz 71 0 1317 1388 10 Dr. Naseem Junejo 11 1 306 318 11 Dr. Zulekha Sadique 22 0 292 314 12 Dr. Anna Abro 1 0 133 134

Total 428 2 8776 9204

2. Deliveries Assisted

S # Service Number 1 Deliveries Assisted at HFs 07 2 Deliveries Assisted at Homes -

3. Lab/ Diagnostic Tests

S # Test Number 1 Pregnancy Tests 118 2 Blood Sugar Tests 138 3 Hemoglobin Tests - 4 Ultra Sound Test 212 5 Other -

4. Important Discussion on Mother and Child and Reproductive Health during MRM

5. Provision of Family Planning Services during the Month

S # Name of the Items / Service Number Consultation / Advice 164 Oral Pills 91 IUCDs 0 Injections 85 Others(RC) 18 Total 467

(III) COMMUNITY PARTICIPATION During Month under Review

1. Number of Male SGs: 23 Number of Female SGs: ------

2. Performance of Social Organizers

Meetings of Support Groups CHSs/SHSs arranged by him conducted by him Names of Social Organizers Total No. of No. of Male Female No. Participants Participants Shahzad Ali Soomro 06 - 103 9 187 Mujeeb-u-Rehman Shaikh 04 - 50 6 134 Allah Dino Otho 09 - 123 10 268 Total 25 256 25 589

3. School Health Sessions & Community Health Sessions

Sr. CHS School Health Session Name of FMO/ MO No No. Part: NO. Examined Treated 1 Dr. Anjum Shaikh 1 22 1 25 15 82

2 Dr. Rozina Memon 2 34 2 3 3 3 Dr. Fareha Javed 1 10 1 60 40 4 Dr. Naheed Akhtar 1 57 2 43 20 5 Dr. Shah Bano 1 13 1 15 8 6 Dr. Shazia Memon 2 150 2 45 20 7 Dr. Khalida Buriro 2 62 2 27 6 8 Dr. Shahida Shoro - - - - - 9 Dr. Irum Naz 2 62 2 0 0 10 Dr. Naseem Junejo 2 48 2 16 4 11 Dr. Zulekha Sadique 2 45 2 0 0 12 Dr. Anna Abro - - - - - Total 16 503 17 234 116

4. Important Points during Support Group Meeting • Support in polio eradication campaign • Arrange CHS & SHS in catchment area • Arrange medical camps.

5. Important Points during SHSs • Discussed importance of immunization, personal health & hygiene, nutritional status and other diseases.

6. Important Points during CHSs • Importance of breast feeding and maternal health.

7. Topics for SHSs for the Month

Sr. No. Topics 1 Immunization 2 Personal Health and hygiene 3 Nutrition 4 Diarrhea (Prevention & Treatment) 5 Malaria

8 Topics for CHSs for the Month

S # Topics 1 Immunization 2 Personal Health and hygiene 3 Nutrition 4 Mother and child health

9. Important Discussion on Community Participation during MRM

The schedule of the CSG meetings was shared and finalized with MOs consultation. DSM guided the MOs to arrange the community support groups on mentioned dates in the schedule. Invite and ensure the maximum participation of the members from the CAs of the health facility in the CSG meetings.

10. Health Camps: Number Held: 00. Number of Patients: 00.

11. Measures for improvement / provision of Services by other Department / Agencies

Sr No Description Recommendation To whom sent Present status I Sanitation No No No Ii Drainage / sewerage No No No Iii ……… drinking water No No No Iv Prevention of adulteration No No No V Tree Plantation No No No Vi Roads and infrastructure No No No Vii Environmental Improvement No No No viii Others No No No

(IV) CURATIVE SERVICES DURING THE MONTH UNDER REVIEW 1. OPD*

New patients treated Old patients treated during Total OPD during the during the month the month month (New + Old) 35890 1889 37,779

2. Maximum OPD** Minimum OPD**

S S BHF name OPD BHF name OPD # # 01 GD Bihar Colony 4041 20 BHU Amri 859 02 GD Khurshed Colony 3336 21 BHU Walidad Gabol 818 03 GD Christian Colony 2113 22 SHC Thano Arib Khan 802 04 GD LSB Jamshoro Colony 1930 23 BHU Taung 772 05 GD Sindh University 1852 27 BHU Tajuji 758 06 BHU Khuda ki basti 1847 25 BHU Lakha 756 07 GD Bajara 1522 27 GD Budhapur 728 08 BHU Karo Khao 1395 28 GD Karchat 719 09 SHC Dhamach 1208 29 BHU Bubak 702 10 BHU Seri 1091 30 BHU Laki 700 11 BHU Khanot 1057 26 BHU Thano Ahmed Khan 653 12 BHU Wahur 1033 26 GD Ali Murad Barejo 590 14 GD Band Manchar 1023 31 BHU Garwari 451 15 BHU Khado Village 902 32 GD Gu Muhammadl Sehtan 391 16 GD Qubi 890 33 GD Manjhoo 209 17 GD Mehenda palari 890 33 RHC Unerpur - 18 BHU Mole 880 34 MCHC Sewhan N/A 19 BHU Talti 861

3. Top Five Diseases Treated during School Health Sessions/Camps.

S # Diseases No. of Patients 1 ARI 79 97 2 Diarrhea 3 Fever(clinical Malaria) 40 4 Scabies 18 TOTAL 234

4. Top Five Diseases During OPD

S # Disease No. of Patients 1 ARI 7122 2 Diarrhea 4007 3 Fever(clinical Malaria) 2889 4 Scabies 1008 5 Peptic Ulcer 805

6. ARV / ASV used during the month No. of Patients Dog bite cases reported 08 ARV Administered 0 ARV Available Doses 308 Snake bite cases reported 1 ASV Vaccine Administered 1 ASV Vaccine Available Doses 42

26. Lab / Diagnostic Tests: Includes Tests Reported at No. (II) (Mother, Child & Reproductive Health) 3. (Lab / Diagnostic Tests)

S # Tests Number 1 Pregnancy Tests - 2 Blood Sugar Tests - 3 Hemoglobin 0 4 X-Rays (if available) 0 5 Ultra Sound 0 6 Others (please specify) 0

27. B & C SCREENING TESTS

No. of Tests No. of cases No. of cases referred Total referred Follow up Screening Performed found positive for treatment upto date result Hepatitis B 0 0 0 0 0 Hepatitis C 0 0 0 0 0

28. TUBERCLOSIS

Patients New Cases During Under Diagnosis Receiving Treatment the Month 0 0 0

9. Referrals

S.No Totals Cases Referred To 1 TB DOT Deliveries Others RHCs THQs DHQs 2 36 36 0 0 0 36 - 3 4

10. Inverse Referrals

S.No Totals Cases Referred from 1 ARV ASV Others RHCs THQs DHQs 2 0 0 0 0 0 0 - 3 4

G. MONITORING DURING MONTH UNDER REVIEW

7. Monitoring Visits during the month

DSM Executive Monitoring Other Staff Total 13 22 75 110

2. Important Points/Issues arising from Visits

S # Name of HF Issue Action Remarks

H. AVAILABILITY OF MEDICINES/MEDICAL MATERIALS

1. Medicines available for Weeks: 24 weeks

8. Important Issues raised relating to Medicines, etc. during MRM a. Shortage of bandages b. ATS is required by MOs c. One month FP Injection by FMOs

I. REPAIR / MAINTENANCE / ELECTRIFICATION OF / AT HFS

Description of Repair / Maintenance S # Name of HFs Status / Remarks incl. Electrification 1 BHU KK Basti R&R 95 % Complete 2 GD Christian Colony R&R 95 % Complete 3 BHU Wahur R&R 45% Complete 4 BHU Talti R&R 10% Complete 5 GD LSB Jamshoro Colony R&R 5% Complete 6 GD Sindh University R&R 5% Complete 7 BHU Bubak R&R Work Stopped BHU Karo Khaho R&R In Tender 8 (Work in Progress) 9 BHU Khado R&R In Tender 10 BHU Garwari R&R In Tender 11 BHU Laki R&R TS Approved 12 BHU Thano Ahmed Khan R&R TS Approved 13 BHU Khanot R&R TS Approved 14 BHU Sari R&R TS Approved 15 BHU Tajuji R&R TS Approved 16 SHC Dhamach R&R TS Approved

Inspections / Visits of PPHI HFs

Visitors* Health Facilities Visited Overall Comments

* To reflect only non-PPHI Visitors.

J- DISCUSSION DURING MRM

DSM presented the progress of PPHI and openly discussed the issues related to health facilities.

Date / Time for Next MRM: 6th of June 2012 at 09:30am

Comments on Targets v/s Achievements (by DSM)

DSM Appreciated the efforts of the MOs and FMOs regarding their working at HFs. He said that the cases of TB must be referred to the TB Diagnostic centers and then must be followed.

MINUTES OF THE (50TH) MONTHLY REVIEW MEETING OF DISTRICT MIRPURKHAS

Monthly Review Meeting (50th MRM) of District, Mirpurkhas for the Month of APRIL, 2012 was held on 10th MAY, 2012 at Tharparker Gymkhana , Hyderabad Road Mirpurkhas. Written invitations to participate were sent to the DCO, and District In charge of EPI, LHW and all other National Programs as usual but they could not attend the meeting due to their engagements. The list of participants follows:

List of Participants:

S. Names Designation S. Names Designation 1 Engr M Juman Thebo DSM,PPHI MPS 56 Dr Nazish FMO 2 Mr Nadim Memon Deputy Commissioner, MPS 57 Dr Urooj FMO 3 Dr Hanif Baloch DO, Health, Mirpurkhas 58 Dr Shaheen FMO 4 Dr Naseer Ahmed THO, Mirpurkhas 59 Dr Ghazanfar Abbas MO-PPHI 5 Mr Aijaz Baloch DEO CDP Mirpurkhas 60 Dr Wishan Das MO-PPHI-MPS 6 Mr Adil Rasheed Exe(A&A) 61 Dr. Rasheed Mari MO-PPHI-MPS 7 Haji Imdad Ali Exe(M/E) 62 Dr Zahid Hussain MO-PPHI-MPS 8 Dr Safdar Ali SMO Govt 63 Dr Baldev MO PPHI Mps 9 Dr Shahid Rizwan MO Govt 64 Dr Kishore Kella MO PPHI Mps 10 Dr. Khan Mohd SMO Govt 65 Dr Neel Kanth MO PPHI Mps 11 Dr Atta Hussain SMO Govt 66 Dr A Latif MO PPHI Mps 12 Dr Narain SMO Govt 67 Dr Nadeem MO PPHI Mps 13 Dr Narain Das MO I/C 68 Dr Haroon MO-PPHI-MPS 14 Dr Noor Hasan MO I/C 69 Dr Afzal Laghari MO-PPHI-MPS 15 Dr Ghulam Mustafa SMO Govt 70 Dr Pardeep MO-PPHI 16 Dr Imtiaz Ali MO Govt 71 Dr M Saleem MO-PPHI 17 Dr Arshad Nihal SMO Govt 72 Dr M Urs MO PPHI Mps 18 Dr Allah Ditto SMO Govt 73 Dr Mukesh MO-PPHI 19 Dr Farouque MO Govt 74 Dr Muneer MO PPHI 20 Dr Arif Shamim MO I/C 75 Dr A Rauf MO PPHI Mps 21 Dr Saleh Memon MO Govt 76 Dr Liaquat Hussain MO-PPHI 22 Dr Naveen Kumar MO Govt 77 Dr Naraindar Sufi MO PPHI 23 Dr Ashoke Kumar MO Govt 78 Dr Ramesh Kumar MO PPHI 24 Dr Rajni Davi FMO U/S 79 Dr. Rajesh Kumar MO PPHI 25 Dr Salma Khan FMO U/S 80 Dr.Narendar Kumar MO PPHI 26 Dr. Ramila FMO U/S 81 Dr Dileep Kumar MO PPHI 27 Dr Sheerin FMO-PPHI 82 Dr.MehmoodHassan MO PPHI 28 Dr Faria FMO-PPHI 83 Dr Vishan Das MO PPHI 29 Dr Naina Kumari FMO 84 Dr Mozzam Ali MO PPHI 30 Dr Hamida Ali FMO-PPHI 85 Dr Naeem Sheikh MO PPHI 31 Dr Aneela Zahoor FMO-PPHI 86 Dr Anis Mari MO-PPHI-MPS 32 Dr Gulshad FMO-PPHI 87 Dr Attaullah MO PPHI 33 Dr Kamni Kumari FMO 88 Dr Shankar lal MO-PPHI 34 Dr Asia Narejo FMO 89 Dr Sakib Shah MO-PPHI-MPS 35 Dr Sana Ayoub FMO 90 Dr Sakib Baloch MO-PPHI 36 Dr Amna Idrees FMO 91 Dr Imran Laghari MO-PPHI 37 Dr Mohni FMO-PPHI 92 Dr Munwer MO-PPHI 38 Dr Adeela FMO -PPHI-MPS 93 Dr Khalid MO-PPHI 39 Dr Saba Ilyas FMO-PPHI 94 Dr Arif MO-PPHI-MPS 40 Dr Azra Parveen FMO-PPHI 95 Dr Ramesh Kumar MO-PPHI-MPS 88

41 Dr Shehla Yasir FMO 96 Dr Zulfiquar Ali MO 42 Dr Samreen Shafee FMO-PPHI 97 Dr Mumtaz Ali MO 43 Dr Kiran Kumari FMO 98 Dr Imran Jarwar MO 44 Dr Shazia FMO 99 Dr Pir Nasir Jan MO 45 Dr Saneela FMO 100 Dr A Hameed MO 46 Dr. Fahmida Kolachi FMO 101 Dr Parkash MO 47 Dr Nargis Naz FMO 102 Dr Ranu Mal SMO Govt 48 Dr Irum FMO 103 Dr Shamsher Mardan MO HQ DSU-MPS 49 Dr Nighat FMO 104 Mr Diljit Kumar Store Manager 50 Dr Quratulain FMO MCH 105 Mr Farhan Rasheed SO DSU-PPHI 51 Dr Noor Nisa FMO MCH 106 Mr Jethanand SO DSU-PPHI 52 Dr Saeeda Mari FMO MCH 107 Mr Bharji SO DSU-PPHI 53 Dr Hina Karim FMO MCH 108 Mr Mohsin SO DSU-PPHI 54 Dr Shaista FMO MCH 109 Mr Khair Mohammad SO DSU-PPHI 55 Dr Bushra Farhin FMO MCH 110 Mr Nikhtu HT BHU Sindhri

The following could not attend the meeting for the reasons stated against each:-

S # Names/Designation Reasons S # Names/Designation Reasons 1 Dr Yousif Medical Leave 2 Dr Sajida Leave 3 Dr Mohidin Leave 4 Dr Salik Nazir Leave 5 Dr Ghulam Mustafa Medical Leave 6 Dr A Kabir Leave 7 8

I. HFs WITH PPHI BHUs: ______38 Dispensaries: ______48 MCHCs: ______10 others: ______2 TOTAL: ______98 B. Population of the Catchments Area: 1681107

S. STAFF STRENGTH

Sanctioned Government PPHI Vacant Working Posts (Govt.) Employees Contract (Sanc-Govt) MOs 79 69 20 49 10 WMO 04 3 3 0 01 FMOs 56 37 0 37 19 LHVs 08 40 8 32 0 Male 55 50 0 MTs/MAs 79 5 Female 24 24 0 Dispensers 06 46 6 40 0

T. CLUSTERS OF HFs WITH ONE MO

Previous Month Total Month under Review Total Clusters of 6 HFs 0 Clusters of 6 HFs 0 Clusters of 5 HFs 0 Clusters of 5 HFs 0 Clusters of 4 HFs 0 Clusters of 4 HFs 0 Clusters of 3 HFs 0 Clusters of 3 HFs 0 Clusters of 2 HFs 10 Clusters of 2 HFs 10 Single HFs 59 Single HFs 59

WITH ONE FMO

Previous Month Total Month under Review Total Clusters of 6 HFs 03 Clusters of 6 HFs 03 Clusters of 5 HFs 0 Clusters of 5 HFs 0 Clusters of 4 HFs 0 Clusters of 4 HFs 0 Clusters of 3 HFs 0 Clusters of 3 HFs 0 Clusters of 2 HFs 23 Clusters of 2 HFs 27 Single HFs 9 Single HFs 08

E. CAPACITY BUILDING 1. First Session: During MRM Dr. Shamsher Mardan, MO HQ, PPHI MPS in his lecture on ‘Health Indicators and Targets focused on the following points:- Health Indicators and introduction Importance Population decreased after new Census Targets of Immunization, TT Vaccine, Family Planning, Antenatal care and Post Natal care All I/Cs ensured to achieve their targets.

24. Capacity Building of LHVs / Dispensers During Month under Review

No. of Names of the Resource Persons with dates Date Venue Topic Participants

F. REVIEW OF THE PERFORMANCE (I) PREVENTIVE HEALTHCARE During Month under Review 1. Vaccination / Immunization

No. of Doses of Immunization Administered to Children at Health Facilities. 12,221 No. of TT vaccines provided to pregnant / Child Bearing Age Women at Health Facilities. 2642 No. of Immunization & Vaccination Administered by outreach EPI Teams 625 Total vaccination / immunization for the month ______APRIL-2012 15,488

2. National Immunization Days (NIDs) for Polio

Percentage of Dates of NIDs Target of coverage Actual coverage coverage 23-24-25 APRIL-2012 248116 99% 99%

3. Other Preventive/Promotional Services

S # Service Number 1 Passive Case Detection (PCD) Slides 0 2 Active Case Detection (ACD) Slides 0 3 Visits to Check Sanitation (individual house holds + streets) 0 4 Notices issued against Poor Sanitation 0 5 Challans sent to Court against Poor Sanitation 0 6 Patients Nebulized 128

(II) MOTHER, CHILD & REPRODUCTIVE HEALTH During Month under Review

1. Female Health

S# NAME OF FMO Ante-Natal Cases Neo-Natal Cases Total Other OPD Total OPD 1 Dr. Faria Atif 46 8 54 1480 1534 2 Dr.Shella Yasir 75 29 104 1136 1240 3 Dr. Kamni 184 14 198 637 835 4 Dr.Sahira Baloch 53 2 55 521 576 5 Dr. Aasia Karim Narejo 36 1 37 364 401 6 Dr Gulshad Leghari 35 9 44 908 952 7 Dr Sana Ayoub 27 6 33 853 886 8 Dr Mohni 76 19 95 946 1041 9 Dr Aneela Zahoor 28 4 32 546 578 10 Dr Kiran Kumari 37 9 46 372 418 11 Dr Sheerin Khan 162 7 169 1138 1307 12 Dr Azra Parveen 76 8 84 816 900 13 Dr Nighat Ashraf 58 9 67 775 842 14 Dr Adeela Sohail 52 12 64 732 796 15 Dr Hamida Ali 56 3 59 555 614 16 Dr Samreen Shafee 47 7 54 919 973 17 Dr Shazia Zulfqar 24 4 28 582 610 18 Dr Amna Idrees 15 3 18 311 329 19 Dr Saba Ilyas 45 8 53 828 881 20 Dr Saneela Mughal 17 5 22 661 683 21 Dr Fahmeeda Kolache 41 10 51 1003 1054 22 Dr Nargis 38 2 40 548 588 23 Dr Shaista Parveen 65 1 66 935 1001 24 Dr Naina 21 0 21 557 578 25 Dr Sajida Tahir 240 10 250 572 822 26 Dr Asma Rasool 241 11 252 1228 1480 27 Dr Saeeda Mari 107 22 129 1314 1443 28 Dr Hina Karim 80 6 86 1042 1128 29 Dr Quratulain 102 25 127 2906 3033 30 Dr Bushra Farhin 0 3 3 986 989 31 Dr Noorunnisa 79 12 91 1291 1382 32 Dr. Erum Naz Memon 62 4 66 837 903 Total 2225 273 2498 28299 30797

2. Deliveries Assisted

S # Service Number 1 Deliveries Assisted at HFs 168 2 Deliveries Assisted at Homes 298

3. Lab/ Diagnostic Tests

S # Test Number 1 Pregnancy Tests 470 2 Blood Sugar Tests 731

3 Hemoglobin Tests 272 4 Ultra Sound Test 1720 5 Other (X Rays) 24 Total 3217

Important Discussion on Mother and Child and Reproductive Health during MRM • Antenatal and postnatal performance shared with the participants.

Provision of Family Planning Services during the Month

S # Name of the Items / Service Number 1 Consultation / Advice 1087 2 Oral Pills 233 3 IUCDs 07 4 Injections 196 5 Others 1252 Total 2775

(III) COMMUNITY PARTICIPATION During Month under Review

1. Number of Male SGs: ------94 Number of Female SGs: ------04

2. Performance of Social Organizers

Meetings of Support Groups CHSs/SHSs arranged by him Names of Social conducted by him Organizers Total No. of No. of Male Female No. Participants Participants Jetanand 05 0 72 14 580 Farhan Rasheed 04 0 66 08 405 Mohsin 03 0 39 5 225 Bhareji 02 0 31 5 286 Khair Mohammad 05 0 82 7 426 Total 19 0 290 39 1922

3. School Health Sessions & Community Health Sessions

Community Health Sessions School Health Sessions Names of MO / Children Children FMOs/Paramedics Sessions Participants Sessions Examined Treated Dr Munwer 1 17 1 8 7 Dr Safdar Ali 1 13 1 1 1 Dr Afzal 1 10 1 0 0 Dr Khalid 1 15 1 3 1 Dr Narain 1 18 1 2 2 Dr Zahid Hussain 1 20 1 6 6 Dr A Kabir 1 24 1 12 4 Dr Khan Mohd 0 0 1 0 0 Dr Abdul Rasheed 1 12 1 4 4 Dr Allah Ditto 1 28 1 5 5

Dr Narain 1 26 1 6 5 Dr Haroon 1 12 0 0 0 Dr Urs 1 60 1 10 10 Dr Mukesh 1 12 0 0 0 Dr Liaquat 0 0 1 10 10 Dr Imtiaz 1 19 0 0 0 Dr Naseem 1 12 0 0 0 Dr Ghazanfer 1 29 1 2 2 Dr Rano Mal 1 35 1 10 5 Dr Noor Hasan 1 18 1 0 0 Dr Muneer 1 35 1 9 4 Dr Wishan 1 26 1 0 0 Dr Neel Kanth 1 26 1 7 6 Dr Pardeep 1 12 1 16 10 Dr Parkash 1 20 0 0 0 Dr Atta Shah 1 10 1 0 0 Dr A Rauf 1 35 1 0 0 Dr A Latif 0 0 1 20 10 Dr Saleem 1 12 1 10 6 Dr Kishore 1 10 1 4 4 Dr Ghualm Mustafa 1 12 0 0 0 Dr Baldeve 1 18 1 15 10 Dr Nadeem 1 22 0 0 0 Dr Zulfiquar Ali 1 7 1 80 20 Dr Ashoke-Kumar 1 11 1 3 3 Dr Arshad Nihal 1 30 1 35 35 Dr Mumtaz 1 17 1 2 2 Dr Imran Jarwar 1 23 1 15 15 Dr Mehmoodulhasan 1 14 1 19 3 Dr Rajesh 1 10 1 20 20 Dr Ramesh 1 11 0 0 0 Dr Abdul Hameed 1 14 1 6 3 Dr Mozzam 1 10 1 10 5 Dr Imran Laghari 1 60 1 5 5 Dr Nasir Jan 0 0 1 19 0 Dr Wishan 1 30 1 5 2 Dr Shankar 1 12 1 30 20 Dr Narander kumar 1 30 1 20 7 Dr Shahid Rizwan 1 35 1 10 7 Dr Ramesh 1 20 1 0 0 Dr Anis Mari 1 10 1 8 8 Dr Naraindar 1 22 1 13 13 Dr Attaullah 1 10 0 0 0 Dr Sakib Shah 0 0 1 10 0 Dr Chandar Parkash 2 43 2 2 2 Dr Saleh Memon 1 30 1 2 2 Dr Mohidin 1 24 1 5 2 Dr Naeem Sheikh 1 12 0 0 0 Dr Farouque 1 10 1 10 2 Dr Saqib baloch 1 10 1 3 3 Dr Shaista Parveen 1 15 2 6 2 Dr Farhana Qureshi 1 12 1 4 4 93

Dr Sajida Tahir 1 10 1 20 0 Dr Asma Rasool 1 30 0 0 0 Dr Saeeda 1 40 1 0 0 Dr Hina Karim 1 26 1 3 1 Dr Quratulain 1 48 1 20 12 Dr Bushra 1 20 1 10 5 Dr. Faria 1 12 1 6 6 Dr. Kamni 1 42 1 8 8 Dr Shehla Yasir 1 22 1 171 171 Dr.Sahira Baloch 1 15 1 8 8 Dr. Aasia Narejo 1 20 0 0 0 Dr Gulshad Baloch 1 21 1 5 3 Dr Mohni 1 28 1 12 8 Dr Aneela Zahoor 1 20 1 30 0 Dr Kiran Kumari 1 26 1 6 3 Dr Sheerin Khan 1 28 1 10 10 Dr Azra Parveen 1 22 1 10 5 Dr Nighat Ashraf 1 15 1 6 4 Dr Adeela 2 37 1 2 2 Dr Hamida Ali 1 11 1 0 0 Dr Samreen Shafee 1 12 1 5 5 Dr Shazia 1 8 1 4 2 Dr Sanila Mufti 0 0 1 0 0 Dr Amna Idrees 1 12 1 8 8 Dr Sabah 1 15 1 18 9 Dr Fahmeeda 1 37 1 18 5 Dr Nargis 1 16 1 4 4 Dr Naino 1 30 1 0 0 Dr Irum 1 20 1 9 8 Total 87 1793 81 895 584

4. Important Points during Support Group Meetings. • Help in NID • Help in establishing lawn • ARV s Cluster needed • LHVs needed • Over all cleanliness of HF

5. Important Points during SHSs • Skin Disease and its prevention • Personal Health and Hygiene • Diarrhea and prevention • Fever and its importance

6. Important Points during CHSs • NID and EPI • Pneumonia and treatment • Respiratory infection • Skin Disease and prevention

7. Topics for SHSs for this Month

Sr. No. Topics 1 Pure water and its usage 2 TB Suspected 3 Dengue Fever 4 Routine EPI 5 Water borne diseases

8. Topics for CHSs for this Month

S # Topics 1 Hyper-tension 2 Usage of sugar 3 Skin Diseases 4 Malaria 5 NIDs

9. Important Discussion on Community Participation during MRM NO ANY

10. Health Camps: Number Held: ------0. Number of Patients: ------.

11. Measures for improvement / provision of Services by other Department / Agencies

Sr Description Recommendation To whom Present No sent status i Sanitation ii Drainage / sewerage iii ……… drinking water iv Prevention of adulteration v Tree Plantation vi Roads and infrastructure vii Environmental Improvement For the cleaning of garbage at BHU TMO, No any action St Town Mirpurkhas taken by him Viii Others

(IV) CURATIVE SERVICES DURING THE MONTH UNDER REVIEW 1. OPD*

New patients treated Old patients treated Total OPD during the during the month during the month month (New + Old) 102,407 2,760 105,167

2. Maximum OPD** Minimum OPD**

S # BHU OPD BHU OPD 1 Hameedpura 3317 Usman Junejo 664 2 Kot Mirs 2311 Jhuluri 700 3 Makhan Samoon 1826 Hingorno 780 4 Dengan Bhurgri 1780 Doulat Laghari 805 5 Nawab Colony 1768 Fazal Bhanbro 851

3. Top Five Diseases Treated during School Health Sessions/Camps

S # Diseases No. of Patients 1 ARI 232 2 Diarrhea 168

3 Malaria Fever 116

4 Scabies 114

5 Others 228 *All HFs — BHUs and others. **Reflects OPD at BHUs only — not at other HFs.

4. Top Five Diseases during OPD

S # Disease No. of Patients 1 ARI 23544 2 Diarrhea 12147 3 Scabies 6993 4 Fever (Clinical Malaria) 5574 5 Pneumonia 3808

25. ARV / ASV used during the month

Cases No. of Patients Dog bite cases reported 230 ARV Administered 466 ARV Available Doses 472 Snake bite cases reported 0 ASV Vaccine Administered 0 ASV Vaccine Available Doses 13

29. Lab / Diagnostic Tests: Includes Tests Reported at No. 30. (II) (Mother, Child &Reproductive Health) 3. (Lab / Diagnostic Tests)

S # Tests Number 1 Pregnancy Tests 470 2 Blood Sugar Tests 731 3 Hemoglobin 272 4 X-Rays (if available) 24 5 Ultra Sound 1720 6 Others (please specify) 0

31. B & C SCREENING TESTS NO ANY SCREENING TEST OF HB & C AVAILABLE AT PPHI HFs. No. of Tests No. of cases No. of cases referred Total referred Follow up Screening Performed found positive for treatment upto date result Hepatitis B Hepatitis C

32. TUBERCLOSIS

Patients New Cases During Under Diagnosis Receiving Treatment the Month 02 25 23

9. Referrals

S.No Totals Cases Referred To 1 TB DOT Viral HB Others RHCs THQs DHQs 2 48 25 23 0 14 12 22

10. Inverse Referrals

S.No Totals Cases Referred from ARV ASV Others RHCs THQs DHQs 1 88 88 02 08 78

G. MONITORING DURING MONTH UNDER REVIEW

9. Monitoring Visits during the month

DSM Exe M/E Executive Monitoring Other Staff Total 37 58 42 374 511

2. Important Points/Issues arising from Visits

S # Name of HF Issue Action Remarks No any No any No any No any

H. AVAILABILITY OF MEDICINES/MEDICAL MATERIALS

1. Medicines available for ………………………28 weeks

2. Important Issues raised relating to Medicines, etc. during MRM

I. REPAIR / MAINTENANCE / ELECTRIFICATION OF / AT HFS

Description of Repair / Maintenance S # Name of HFs Status / Remarks incl. Electrification 1 GD Dilber Maher Water fitting and water pump repairing Water available

Inspections / Visits of PPHI HFs

Visitors* Health Facilities Visited Overall Comments DC Mirpurkhas DCD Kathri Best * To reflect only non-PPHI Visitors.

J- DISCUSSION DURING MRM

On Staff Matters:

On Preventive Health:

On Curative Health:

On Mother, Child & Reproductive Health:

Due to MCH week all In charges ensure de worming to all children and ensure to all ladies for TT vaccination

Other Matters: Pay slips given to all MO/FMOs

Date /Time for Next MRM:

12thJune-2012

Comments on Targets vs Achievements (by DSM)

MINUTES OF THE (46th) MONTHLY REVIEW MEETING OF DISTRICT BADIN

Monthly Review Meeting (MRM) of District, Badin for the Month of April, 2012 was held on 10-05-2012 at Darbar Hall DCO Office Badin. The EDO (H), Civil surgeon, District Population Welfare Officer, District Incharge of EPI, District Coordinator NP, District Focal Person Malaria, District Focal Person TB and District Officer MNCH Badin were also invited to the meeting. Following participants attend the meeting.

List of Participants:

# Names/Designation S # Names/Designation 1 Mr Mustfa Kamal Tagar DSM Badin (Acting) 61 DR GH MURTAZA MEMON 2 Dr Imtiaz Habib WHO 62 DR GH RASOOL MALLAH 3 Mr. Shahbaz Ali Memon Exe M&E 63 DR GULSHAN KOREJO 4 Mr. Naveed Abbass Baloch Ex M&E 64 DR HAFEEZULLAH MEMON 5 Mr Aatif Hussain Ex F&A 65 DR HAJI KHAN NIZAMANI 6 Dr Amir Ali Khawaja MO HQ 66 Dr MOHAMMAD HANIF MEMON 7 Mr Abdul Razzaque Sheikh S.M 67 Dr Ibrahim Pinjaro 8 Mr Aqeel Ahmed Finance Assistant 68 DR IMTIAZ ALI 9 Mr Mshooque Ali Khawaja Assistant 69 DR JAMIL MEMON 10 Mr Abdullah Tunio Sub Engineer 70 DR JAVED IQBAL QAMBRANI 11 Mr Ali Ahmed SO 71 DR JUNAID SHAH 12 Mr Imran Ali Talpur S.O 72 DR MEHMOOD MEMON 13 Mr. Abdul Razzaque Soomro S.O 73 DR MOHAMMAD AYOOB PAHOOR 14 Lemoon Mal Astt: Admin 74 DR MOHAMMAD RAMZAN SOOMRO 15 DR AISHA JAMIL FMO 75 DR MOHAMMAD SIDDIQUE SOOMRO 16 DR ANITA KHAWAJA FMO 76 DR MOHAN LAL 17 DR KAVITA ASHOK FMO 77 Dr Mohd Sharif Chandio 18 DR KHATIJA KAMBRANI FMO 78 DR NADEEM BHURGARI 19 DR SAIMA NAZ FMO 79 Dr Nisar Khawaja 20 DR SHAHNAZ MUNEER FMO 80 DR RAZA ALI 21 DR NEELOFAR SHAH FMO 81 DR SAFIULLAH 22 DR REHANA FAYYAZ FMO 82 DR SAHIB KHOSO 23 DR RUKHSANA MEMON FMO 83 DR SALEEM NOTKANI 24 DR SAEEDA BANO Sonologist 84 DR SANTOSH KUMAR 25 DR SHAZIA RAUF FMO 85 DR SARFRAZ AMIR 26 DR TASLEEM KHAWAJA FMO 86 DR SHAFIQUE AHMED LAGHARI 27 DR FAHMIDA SOOMRO FMO 87 DR SHAHZAD AHMED VIRK 28 Dr Kanwal Sabir FMO 88 Dr Soomar Mal 29 Dr Rkhsana Kazi FMO 89 DR SULEMAN PALIJO 30 Dr Nazia Abbas FMO 90 DR SUNIL KUMAR 31 Dr Natasha Soomro FMO 91 DR TUFAIUL BHAN 32 Dr Tahseen Pitafi FMO 92 DR UQEL ABBAS KHAWAJA 33 Dr Nayab FMO 93 DR ZAHID HUSSAIN KHAWAJA 34 Dr Aisha Raheem FMO 94 Dr Amjad Ali

35 Dr Nazia Noor FMO 95 Dr Mohd Ashraf 36 DR RAFFIQUE AHMED BHURGARI 96 Dr Sunil Kumar Dumbalo 37 DR ABDUL WAHID KHATTI 97 Dr Lalji Mal 38 DR AHMED KHATTI 98 Dr Asan Das 39 DR ILYAS LAGHARI 99 Dr Ashok Kumar Bakho 40 DR MUZAFAR ALI KHAWAJA 100 Dr Kumail Abbas 41 DR BHEMO MAL 101 Dr Kamil Memon 42 DR SIDDIQUE PAHORE 102 Dr Abbas Ali 43 DR MURAD ALI NIZAMANI 103 Dr Vishan Das 44 DR MUNAWAR ARAIN 104 Dr Ghulam Nabi Samoon 45 DR MAQBOOL AHMED MARO 105 Mr. Naimtullah Abbasi Assistant 46 DR SALIM NIZAMANI 106 Mr. Ali Nawaz Disp 47 DR IQBAL AHMED MEMON 107 Mr. Mohd Umar Abro M.H 48 Dr Harchand 108 Mr. Qadir Bux Abro M.H 49 HAKIM GULAM NABI DARS 109 Mr. Fida Hussain M.H 50 DR ABDUL ALI SHAH 110 Mr. Wajid Ali M.H 51 DR ABDUL JABBAR KHASKHELI 111 Mr. Khadim Hussain M.H 52 DR ABDUL REHMAN Bhurgri 112 Mr. Nabi Bux Chand Driver 53 DR ABDUL REHMAN Khatti 113 Mr. Shahzad Ahmed Chand Driver 54 DR AFAQUE AHMED 114 Mr. Abdul Wahid Mallah Driver 55 DR AIJAZUDDIN 115 Mumtaz Ali Chandio Driver 56 DR ALTAF BASHEER 116 Mr. Abdul Wahid Pathan N.Q 57 DR AMIR HASSAN MEMON 117 Mr. Allah Dino Memon N.Q 58 DR ASHOK KUMAR (K Q) 118 Mr. Zakria Bucho Attendent 59 DR ASHOK KUMAR (Kapri Mori) 119 Mr. Kumesh Wandasah Attendent 60 DR CHAIT RAAM 120 Mr. Sikiladho N.Q

The following could not attend the meeting for the reasons stated against each:-

S Names/Designation Reasons S #Names/Designation Reasons # 1 DR NIDA JAFFER FMO C/L 7 DR GULAB KASHMIRI MO C/L 2 Dr Naveen Samoon FMO Absent 8 Dr Asif Ali Rind C/L 3 DR YASMEEN ABBASI FMO C/L 9 Dr Ghulam Mohd C/L 4 Dr Uzma Korejo FMO C/L 10 Dr Nadeem Bhurgri MO C/L 5 Dr Rafique Ahmed Memon C/L 11 DR HARESH KUMAR C/L 6 DR IRFAN ASHRAF SMO Absent 12 DR Sarfraz Ameer On Duty

J. HFs WITH PPHI

BHUs: 36 Dispensaries: 66 MCHC: 01 Others: 01 TOTAL: 104

U. STAFF STRENGTH 200

Sanctioned Government PPHI Vacant Designation Working Posts (Govt.) Employees Contract (Sanc-Govt) MOs 64 17 47 49 32 WMO 0 0 0

100

FMOs 00 17 0 17 17 LHVs 42 48 8 40 34 Male 0 0 0 MTs/MAs 0 0 Female 0 0 0 Dispensers 20 71 17 54 3

V. CLUSTERS OF HFs

WITH ONE MO

Previous Month No of Hfs Month under Review Total Clusters of 6 HFs 0 Clusters of 6 HFs 0 Clusters of 5 HFs 0 Clusters of 5 HFs 0 Clusters of 4 HFs 0 Clusters of 4 HFs 0 Clusters of 3 HFs 1 Clusters of 3 HFs 1 Clusters of 2 HFs 18 Clusters of 2 HFs 18 Single HFs 45 Single HFs 45

WITH ONE FMO

Previous Month No of Hfs Month under Review Total Clusters of 5 HFs 0 Clusters of 5 HFs 0 Clusters of 4 HFs 0 Clusters of 4 HFs 0 Clusters of 3 HFs 1 Clusters of 3 HFs 1 Clusters of 2 HFs 13 Clusters of 2 HFs 13 Single HFs 3 Single HFs 3

E. CAPACITY BUILDING

1. First Session: During MRM Dr. Imtiaz Habib Khawaja Survilliance Officer WHO Badin delivered lecture on “HEALTH EDUCATION”, also discussed different types of Health Education.

2. Second Session: During MRM Dr. MAQBOOL AHMED MAROO SMO BHU MIR MUHAMMAD NIZAMANI has delivered lecture on Red Eyes, he discuss on following topics;

‐ Review of Ocular Anatomy. ‐ Lacrimal system and eye musculature ‐ Possible Causes of a Red Eye ‐ Symptoms ‐ Diagnostic steps to evaluate the patient with the red eye. ‐ How to interpret findings. ‐ Checking Vision ‐ Pattern of Redness. ‐ Corneal opacities ‐ Pupillary abnormalities. ‐ Lacrimal System. ‐ Dacryosystocele treatment. ‐ Conjunctivitis. ‐ Allergic conjunctivitis - treatmental Conjunctivitis. ‐ Dry Eyes. 101

‐ Cornea. ‐ Herpetic Keratitis. ‐ Chemical Injury. ‐ Acid Injuries. ‐ Iritis ‐ Hyphema

F. REVIEW OF THE PERFORMANCE (I) PREVENTIVE HEALTHCARE During Month under Review

1. Vaccination / Immunization

No. of Doses of Immunization Administered to Children at Health Facilities outreach 11108 EPI Teams. No. of TT vaccines provided to pregnant / Child Bearing Age Women at Health 1797 Facilities outreach EPI Teams. Total vaccination / immunization for the month April 2012 12905

2. Other Preventive/Promotional Services

S # Service Number 1 Passive Case Detection (PCD) Slides 654 2 Active Case Detection (ACD) Slides 98 3 Visits to Check Sanitation (individual house holds + streets) 0 4 Notices issued against Poor Sanitation 0 5 Challans sent to Court against Poor Sanitation 0 6 Patients Nebulized 216

(II) MOTHER, CHILD & REPRODUCTIVE HEALTH During Month under Review

1. Female Health

S # Names of FMOs Ante-Natal Cases Post-Natal Cases Other OPD Total OPD 1 Dr Saima Naz 67 10 2307 2384 2 Dr Nida Jaffer 75 3 892 970 3 Dr Tasleem Khawaja 125 41 1758 1924 4 Dr Kavita Ashok 172 9 582 763 5 Dr Rehana Fayaz 152 23 968 1143 6 Dr Neelofar Shah 143 23 1158 1324 7 Dr Uzma Korejo 115 40 1032 1187 8 Dr Aisha Jamil 100 28 498 626 9 Dr Anita Khawaja 44 16 650 710 10 Dr Dr Rukhsana 495 55 1816 2366 11 Dr Shazia Rauf 18 3 814 835 12 Dr. Khatija Qambrani 100 35 788 923 13 Dr Kanwal Sabir 34 3 740 777 14 Dr Fahmida Soomro 132 24 962 1118 15 Dr Shahnaz Muneer 20 3 535 558 16 Dr Naveen Samoon 57 3 277 337 Total 1849 319 15777 17945

102

2. Deliveries Assisted

S # Service Number 1 Deliveries Assisted at HFs 74 2 Deliveries Assisted at Homes 394

3. Lab/ Diagnostic Tests

S # Test Number 1 Pregnancy Tests 105 2 Blood Sugar Tests 44 3 Hemoglobin Tests 191 4 Ultra Sound Test 309 5 Total 649

1. DSM discussed with the participants of MRM in detail regarding; - EPI, The performance of the vaccinators & weekly targets will be analyzed closely through fortnight and monthly meetings. - Target v/s achievements, DSM sb demonstrated the actual performance of MOs & FMOs through the vindicate facts & figures of targeted OPD against the achievements. He encouraged to all functionaries to achieve the monthly targets by head & shoulder efforts. -Low number of SHS & CHS, DSM sb directed that each MO & FMO should deliver at least two SHS & CHS in a month. Ambulance Running, DSM Sb heartened the all MOs & FMOs to share the Ambulance service to the community through the CHSs & with the regular patients as well.

26. Important Discussion on Mother and Child and Reproductive Health during MRM

k. No: of Deliveries has substantially increased at 24 hours MCHCs. Medicine indent should be standardized. l. Pre-diagnosis screening of patients for vaccine should be done relugularly. m. Where vaccinators are provided under National Program, the duty roster should be signed by I/c Medical Officer and absence report should immediately be sent to Focal Person. n. Pregnant females should be encouraged for delivery at BHU. o. F.P advice should be part of diagnosis and separate record be maintained. p. Sinologists shall furnish their presentation on the findings, referral and follow up. q. MNCH record and Growth monitoring record should be maintained by FMOs where LHV is not provided. In all cases, record should be legible, complete and traceable. r. Baby Weighing Scales/ Adult Bath Scales, Hemoglobin Meters and Height Charts have been provided. Ensure proper usage of the equipments and report of out of order weight machines should be immediately conveyed to I/c MO in writing. s. Training on Hemoglobin meters have been provided to all Medical and Paramedical Staff for blood tests preferably for pregnant women and same will be repeated for retention.

27. Provision of Family Planning Services during the Month

S # Service Provided Number 1 Consultation / Advice 354 2 Oral Pills 155 3 IUCDs 17 4 Injections 123 5 Others 406 103

Total 1055

(III) COMMUNITY PARTICIPATION During Month under Review

1. Number of Male Support Groups: 101 Number of Female Support Groups: 11

2. Performance of Social Organizers

Meetings of Support Groups CHSs/SHSs arranged conducted Names of Social Organizers Total No. of No. of Male Female No. Participants Participants Ali Ahmed 5 0 74 5 71 Imran Ali Talpur 4 0 52 5 86 Irfan Khan Soomro 4 0 44 5 91 Abdul Razzaque Soomro 4 0 47 5 59 Total 17 0 217 20 307

3. School & Community Health Sessions

Community Health Sessions School Health Sessions Names of MO / Children Children FMOs/Paramedics Sessions Participants Sessions Examined Treated Dr Saima Naz 2 28 2 20 12 Dr Nida Jaffer 2 44 1 22 10 Dr Tasleem Khawaja 2 39 2 27 20 Dr Kavita Ashok 2 31 1 25 20 Dr Rehana Fayaz 2 25 1 24 14 Dr Neelofar Shah 2 27 1 29 18 Dr Uzma Korejo 2 29 1 31 21 Dr Aisha Jamil 2 30 1 18 16 Dr Anita Khawaja 2 32 2 21 12 Dr Naveen Samoon 2 51 1 20 19 Dr Shazia Rauf 2 29 1 25 16 Dr. Khatija Qambrani 2 34 2 31 13 Dr Kanwal Sabir 2 35 1 18 12 Dr Fahmida Soomro 2 30 2 30 19 Dr Shahnaz Muneer 2 21 1 19 9 Dr Rafique Memon 1 23 1 14 10 Dr Junaid 1 20 1 22 9 Dr Hafeezullah 1 21 1 14 10 Dr Gulshan Korejo 1 27 1 12 5 Dr Soomar Mal 1 17 1 11 8 Dr Raza Ali 1 30 1 9 6 Dr Javed Iqbal 1 24 1 12 8 Dr Abud Ali 1 28 1 11 5 Dr Wahid Khatti 1 20 1 10 4 Dr Abdul Rehman Khatti 1 24 1 10 9 Dr Irfan 1 26 1 12 8 Dr Ashok Kumar KQ 1 25 1 15 16

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Dr Ramzan Soomro 1 24 1 21 10 Dr Chait Raam 1 21 1 20 16 Dr Jamil Memon 1 22 1 18 12 Dr Jabbar Khaskheli 1 21 1 19 11 Dr Raffique Bhurgari 1 20 1 12 4 Dr Santosh Kumar 1 22 1 21 5 Dr Ghulam Murtza Memon 1 30 1 16 7 Dr Ghulam Rasool Mallah 1 27 1 14 5 Dr Ahmed Khatti 1 29 1 12 11 Dr Ghulab Kashmiri 3 66 1 31 12 Dr Maqbool Ahmed Maroo 2 36 1 20 11 Dr Muzafar Ali 1 20 1 24 7 Dr Sunil Kumar 1 22 1 14 10 Dr Zahid Hussain 1 24 1 24 10 Dr Mehmood Memon 2 66 1 20 11 Dr Tufail Ahmed Bhan 1 20 1 20 12 Dr Bheemoon 1 21 1 20 14 Dr Ashok Kumar Ch Fateh 1 20 1 19 14 Dr Mohan Lal 1 28 1 17 16 Dr Mohd Siddique Pahore 1 22 1 20 9 Dr Ibrahim Pinjaro 1 25 1 22 9 Dr Suleman 2 52 1 22 6 Dr Afaque Bhurgari 1 34 1 22 7 Dr Harish Kumar 1 22 1 14 5 Dr Saleem Nizamani 1 30 1 15 5 Dr Murad Nizamani 1 24 1 16 6 Dr Ayoube Pahore 1 31 1 21 11 Dr Mohd Siddique Soomro 1 26 1 19 5 Dr Imtiaz Ahmed 1 22 1 25 6 Dr Shafique Laghari 1 30 1 21 7 Dr Ghulam Mohd 1 20 1 20 8 Dr Sahib Khoso 2 22 1 14 10 Dr Iqbal Memon 1 13 1 19 10 Dr Abdul Rehman 1 27 1 37 10 Dr Nisar Ahmed Jaffery 2 58 1 30 16 Dr Altaf Basheer 1 25 1 18 8 Dr Safiullah 2 52 1 14 9 Dr Aijazudin 2 41 1 20 17 Dr Shahzad Ahmed Virk 2 24 1 17 10 Dr Munwar Arain 1 21 1 16 13 Dr Uqail Abbass 1 20 0 0 0 Mr Chetan Lal Disp 1 24 0 0 0 Total 94 1974 72 1296 714

4. Important Points during Support Group Meetings.

• Introduction of PPHI • Ownership of HFs • Health Awareness Sessions for prevention at Community Level • Health Awareness Program at School Level • Water and sanitation, Electricity, Cleanliness etc Issues of HFs

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• Major and Minor Repair & Renovation of HFs • Suggestions for the improvement of HFs

5. Important Points during SHSs Hand washing before and after taking food, and after bath, Nail cutting, wear clean clothes etc.

28. Important Points during CHSs Breast feeding, Antenatal care, Personal Hygiene, Water and sanitation, Communicable Disease, Vaccination

7. Topics for SHS for the Month

Sr. No. Topics 1 Personal Hygiene 2 Scabies 3 Diarrhea 4 Fever 5 RTI

8. Topics for CHS for the Month

S # Topics 1 Prevention of Dengue Fever 2 Hepatitis 3 RTI 4 HIV Aids 5 Brest Feeding 6 ARV

9. Important Discussion on Community Participation during MRM

• Community Health Sessions are to be planned and held on FMO days. • Participation should be ensured through formal contact with LHWs. • Sessions are to be held preferably at Health Facility or at community home duly coordinated and facilitated by DSU/HF staff.

10. Health Camps: Number Held: 0

11. Measures for improvement / provision of Services by other Department / Agencies No any other Public or Private sector has involved in any regard

Sr No Description Recommendation To whom Present sent status i Sanitation 00 00 00 ii Drainage / sewerage 00 00 00 iii ……… drinking water 00 00 00 iv Prevention of adulteration 00 00 00 v Tree Plantation 00 00 00 vi Roads and infrastructure 00 00 00 vii Environmental Improvement 00 00 00 viii Others 00 00 00

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(IV) CURATIVE SERVICES DURING THE MONTH UNDER REVIEW

1. OPD*

New patients treated Old patients treated Total OPD during the during the month during the month month (New + Old) 116286 1385 117671

2. Maximum OPD** Minimum OPD**

S # BHU OPD BHU OPD 1 MCHC Badin 3234 BHU Yousif Shah 387 2 BHU Haji Mohammad BHU NABI BUX PANJABI 3190 814 Boohar 3 BHU GULAM SHAH MORI 2774 BHU Ali Murad Chandio 875 4 BHU PUNJAB CHAK II 2553 BHU Dadah 959 5 BHU Saeedpur 2102 BHU Mataro Mandhro 960

3. Top Five Diseases Treated during School Health Sessions/Camps

S # Diseases No. of Patients 1 Ari 234 151 2 Fever 3 Scabies 92 4 Diarrhea 90 5 Dysentery 5

6. Top Five Diseases during OPD

S # Disease No. of Patients 1 Acute Respirity Infection 19015 2 Diarrhea / Dysentry 11193 3 Malaria 10411 4 Scabies 5556 5 POU 3982

5. ARV / ASV used during the month

No. of Patients Dog bite cases reported 164 ARV Administered 120 ARV Available Doses 0 Snake bite cases reported 0 ASV Vaccine Administered 0 ASV Vaccine Available Doses 44

33. Lab / Diagnostic Tests: Includes Tests Reported at No. (II) (Mother, Child & Reproductive Health) 3. (Lab / Diagnostic Tests)

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S # Tests Number 1 Pregnancy Tests 105 2 Blood Sugar Tests 44 3 Hemoglobin 191 4 X-Rays (if available) 0 5 Ultra Sound 309 6 Others (please specify) Malaria 654

34. B & C SCREENING TESTS

No. of Tests No. of cases No. of cases referred Total referred Follow up Screening Performed found positive for treatment upto date result 0 0 0 0 0 0

35. TUBERCLOSIS

Patients New Cases During Under Diagnosis Receiving Treatment the Month 0 0 0

9. Referrals

S. No Totals Cases Referred To 1 TB DOT Deliveries Others RHCs THQs DHQs 2 282 45 44 193 21 68 193

10. Inverse Referrals

S. No Totals Cases Referred from 1 ARV ASV Others RHCs THQs DHQs 2 94 94 0 0 24 30 40

G. MONITORING DURING MONTH UNDER REVIEW

10. Monitoring Visits during the month

DSM ADSM Executive Monitoring Other Staff Total 7 0 65 150 222

H. AVAILABILITY OF MEDICINES/MEDICAL MATERIALS

1. Medicines available for: 13.05 weeks

11. Important Issues raised relating to Medicines, etc. during MRM/ Submission date of Medicine Requisition Form from 21st to 20th of every month

I. REPAIR / MAINTENANCE / ELECTRIFICATION OF / AT HFS

The status of running R & R schemes was reviewed thoroughly during the MRM and doctors were advised to fill the gaps. Moreover, the new 12 schemes of BHUs and GDs were thoroughly discussed. MOs were motivated to get to work in full throttle and complete the work well before the commencement of Third Party Evalution. 108

Name of Description of Repair / S # Status / Remarks HFs Maintenance incl. Electrification Tiles, CC Toping, Plaster, Plinth 30% Completed Estimate Sent for 1 GD Seerani protection, Colour, Electricity Revise Tiles, Girder T.R, Plaster, Roof BHU Haji 60% Completed Estimate Sent for 2 Topping, Plinth protection, Colour, Mohammad Boohar Revise Electricity Tiles, Girder T.R, Plaster, Roof 3 BHU Abdullah Shah Topping, Plinth protection, Color, 65 % Completed Electricity Tiles, Girder T.R, Plaster, CC Toping, Roof Topping, Plinth 4 BHU Dadah 100% Completed protection, Colour, Electricity, Girder TR. Plinth Protection Tiles, CC Toping, Plaster, Roof 5 BHU Ahmed Rajo 50% Completed Topping Color, Plinth Protection Tiles, CC Toping, Plaster, Roof BHU Mataro Topping, Color, Electricity , Plinth 6 100 % Completed Mandhro Protection

Tiles, CC Toping, Plaster, Color, 60% Completed Estimate Sent for 7 GD Beero Lanjwani Roof Topping, Revise Electricity , Plinth Protection Tiles, CC Toping, Plaster, Roof 8 BHU Artilary Chak Topping, Electricity , Plinth 80 % Completed Protection, Tiles, Colour, Electricity Tiles, Girder T.iron, Plaster, CC 9 BHU Khalifo Qasim Toping, Color, Electricity, Plinth 100 % Completed Protection Tiles, CC Toping, BHU Ali Tiles, CC Toping, Plaster, Color, 10 100 % Completed Mohammad Maheri Roof Topping, Plinth Protection Tiles, CC Toping, Plaster, Color, 95 % Completed Estimate Sent for 11 BHU Rahooki Roof Topping, Plinth Protection Revise Tiles, CC Toping, Plaster, Color, 12 BHU Saeed Pur Roof Topping, Electricity , Plinth Completed Protection, CC Roof

Inspections / Visits of PPHI HFs

Visitors* Health Facilities Visited Overall Comments Mr: Malik Ahmed Khan. The services of MCHC are Coordinator UNFP MCHC appropriate performing and meet the PPHI’s mission. * To reflect only non-PPHI Visitors.

J- DISCUSSION DURING MRM

Staff Matters:

• Basic issues of HFs & Doctors • Follow-up of TB referral cases

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• OPD ratio and per patient cast • Discussed on FMO Performance including Vaccination, Antenatal, Natal, Post Natal Pregnancy and family Planning • HIMS Monthly Report • Self analyses of HFs by MOs & FMOs • Ownership • Discipline in PPHI

Preventive Health: Regarding school health session and community health session mostly topic for preventive measures including Scabies, Malaria, Diarrhea and Hygiene etc were discussed.

Curative Health:

Issues relating to Mother, Child & Reproductive Health:

More focus on Mother- Child health care. Effort is to be made for institutional birth instead of deliveries at home. More MCHCs center will be opened soon.

Other Matters:

Date /Time for Next MRM: 9-06-2012, Time 10: 00 am

Comments on Targets vs Achievements (by DSM)

Targets vs Achievements: MOs Monitoring Mechanism HMIS Reports Health Sessions Punctuality Doctors have become punctual and are attending their HFs in time, despite the fact that they facing numerous hardships in the difficult-to-access HFs of District Badin. R & R Targets vs Achievements: FMOs Ante-natal care During the month target achieved 1849 cases of antenatal and natal and advised to increase the cases. Family Planning Service FMO’s have improved on the count of Family Planning clientele. Deliveries 74 Deliveries are at HFs and MCH Center. FMOs are advised to increase the deliveries. Health Sessions All FMOs and MOs were advised to perform as per their job description and conduct as many health education/awareness sessions as possible. A total of 166 Health Session’s were conducted majority of FMO’s have done well. Punctuality FMOs have become punctual and are attending their HFs in time, despite the fact that they facing numerous hardships in the difficult-to-access HFs of District Badin. Capacity Building of LHVs Things are improving consistently in Badin. Hopefully, we will be achieving the targets set by PSU in near future Inshallah.

MINUTES OF THE 55th MONTHLY REVIEW MEETING 110

OF DISTRICT THARPARKAR @ MITHI

Monthly Review Meeting (MRM) of District, Tharparkar for the Month of April, 2012 was held on May 07- 2012 at Karoonjhar Hall Mithi. Written invitations to participate were sent to Deputy Commissioner Tharparkar, The DHO (H), District Population welfare officer and District Incharge of EPI, Secondary Care Doctors, M/S of THQs, Surveillance officer, WHO Team, NGOs and all other National Programs as usual. The list of participants given below:

List of Participants:

S # Names Designation 1 Raiz Ahmed Jakhrani District Support Manager Tharparkar 2 Mohammad Arif Executive Officer (M&E) 3 Dr. Jeewat Rai MO H.Q 4 Dr. Nasrullah Thebo SO (DEWS) WHO 5 Dr. Lekhraj EPI Focal Person 6 Dr. Bhamer Lal Gen Surgeon 7 Dr. Bheem Raj Dental Surgeon 8 Dr. Salma Janjhi Gynecologist 9 Dr.Pirwaiz Sajjad Medical Officer 10 Dr.Shahid Medical Officer 11 Dr. Ishtiaq Shah Medical Officer 12 Dr. Lajpat Rai Medical Officer 13 Dr .Dileep Kumar (GD Goongio) Medical Officer 15 Dr. Mir Imran Talpur Medical Officer 16 Dr. Adu Mal Medical Officer 17 Dr. Nand Lal Medical Officer 18 Dr. Muhammad Misri Medical Officer 19 Dr. Madan Lal Medical Officer 20 Dr. Mahesh Kumar Medical Officer 21 Dr. Dechand Medical Officer 22 Dr. Lachman Medical Officer 23 Dr. Parkash Medical Officer 24 Dr. Ashok Medical Officer 25 Dr. Santosh Kumar Medical Officer 26 Dr. Bheru Lal Medical Officer 27 Dr. Dileep Kumar BHU PABOHAR Medical Officer 28 Dr. Moolchand Medical Officer 29 Dr. Mukesh Kumar Medical Officer 30 Dr., Serwan Kumar Medical Officer 31 Dr. Suneel Medical Officer 32 Dr. Amanullah Medical Officer 33 Dr. Vijay Kumar Medical Officer 34 Dr.Pirbhu Lal Medical Officer 35 Dr. Sundeep Kumar Medical Officer 36 Dr. Ashok Kumar Medical Officer 37 Dr. Sajjad Rahimon Medical Officer 38 Dr. Vikram Kumar Medical Officer 39 Dr. Shagufta Shah Female Medical Officer 40 Dr. Saweena Female Medical Officer (THQ Nagarparkar) 41 Dr. Lata kumara Female Medical Officer

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42 Dr. Meena Kumar Female Medical Officer 43 Dr. Asma Karam Baloch Female Medical Officer 44 Dr.Janta kumara Female Medical Officer 45 Dr. Rizwana Sajjad Female Medical Officer 46 Mrs.Naseera LHV 47 Mr. Soortoji HT 48 Mr. Chandan Kumar HT 49 Mr. Mohammad Hashim HT 50 Mr. Mohammad Mohisin HT 51 Mr. Saindad HT 52 Mr. Arjun MT 53 Mr. Abdul Aziz HT 54 Mr. Dheno mal HT 55 Mr. Aijaz Ali HT 56 Mr. Moroo Mal HT 57 Mr. Amir Bux HT 58 Mr. Pirbhu Lal M.T 59 Mr. Lachman Singh HT 60 Mr. Gomoo Mal HT 61 Mr. Shahab Din HT 62 Mr. Bhopal Singh HT 63 Muhammad Rahim HT 64 Mr. Ab: Hadi HT 65 Mr. Javed Ahmed Social Organizer 66 Mr. Abdul Qadir Social Organizer 67 Mr. Muqeem Ahmed Social Organizer S 68 Mr. Allah Rakhyo Admin Asstt: 69 Mr. Raheel Aziz Account Asstt: 70 Mr. Muneesh Asstt: 71 Mr. Chaman Lal Asstt:

The following could not attend the meeting for the reasons stated against each:

S # Names Designation Place of Posting Reason 1 Dr.Chander Kumar Gen Surgeon THQ Nangarparkar Un Known 2 Dr. Saleem Medical Officer BHU Kankayo Un Known 3 Dr. Nehchal Das Medical Officer BHU Kaloi Alternate Duty 4 Dr. Gotam Medical Officer GD Jogi Marhi Leave 5 Miss Neelam LHV BHU Jadam Janjhi Leave

A. HFs WITH PPHI

BHUs: 31 Dispensaries: 18 MCHCs: Others: 0

TOTAL: 49

B. Population of the Catchments Area: 819,804/=

C. Staff Strength Sanct: Posts Working Govt: PPHI Vacant Sanctioned Staff Remarks (Govt) Employees Contract (Govt) Mos 52 34 07 27 18

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FMOs 0 06 0 6 0 WMOs 0 0 0 0 0 Male 0 0 0 0 - MTs/MAs Female 0 0 0 0 0 LHVs 47 3 1 2 44 Dispensers: 14 7 7 0 55 HTs: 37 18 19 04

D. Clusters: CLUSTERS OF HFs

WITH ONE MO

Previous Month Total Month under Review Total Clusters of 6 HFs 0 Clusters of 6 HFs 0 Clusters of 5 HFs 0 Clusters of 5 HFs 0 Clusters of 4 HFs 0 Clusters of 4 HFs 0 Clusters of 3 HFs 04 Clusters of 3 HFs 04 Clusters of 2 HFs 02 Clusters of 2 HFs 02 Single HFs 28 Single HFs 28

WITH ONE FMO

Previous Month Total Month under Review Total Clusters of 5 HFs 0 Clusters of 5 HFs 0 Clusters of 4 HFs 0 Clusters of 4 HFs 0 Clusters of 3 HFs 06 Clusters of 3 HFs 06 Clusters of 2 HFs 0 Clusters of 2 HFs 0 Single HFs 0 Single HFs 0

E. CAPACITY BUILDING:

1. First Session: During MRM: Dr. Salma Jhanji (Gynaecologist) THQ Nangarparkar, conducted Session on PPH (Post Partum Haemorrhage)

2. Second Session: Dr Bhamar lal Surgeon DHQ Mithi given research/study presentation on BXO (Balanitis Xerotica Obliterans.

3. Third Session: Dr Sundeep Kumar MO Kaloi conducted session on Rheumatic Fever.

Capacity Building of LHVs / Dispensers during month under Review:

Names of the Resource Persons No. of Topic with dates Date Venue Participants

F. REVIEW OF THE PERFORMANCE:

113

DSM Riaz Ahmed Jakhrani Presented DSU Progress

(I) PREVENTIVE HEALTHCARE During Month under Review

1.Vaccination / Immunization

No. of Doses of Immunization Administered in Children at Health Facilities. 2,216 No. of TT vaccines provided to pregnant / Child Bearing Age Women at Health Facilities. 558 No. of Immunization & Vaccination Administered by outreach EPI Teams NO NIND Total vaccination / immunization for the 2,774 month of March, 2012

2. National Immunization Days (NIDs) for Polio:

Actual Percentage of Dates of NIDs Target of coverage coverage coverage 23rd,24th,25th April 2012

Note: According to 3rd Party Evaluation percentage of coverage 98%.

3. Other Preventive/Promotional Services:

S # Service Number 1 Passive Case Detection (PCD) Slides (NEGATIVE) 2318 2 Active Case Detection (ACD) Slides (FALCIPARIUM) 19 3 Active Case Detection (ACD) Slides (VIVAX) 175 4 Active Case Detection (ACD) Slides (MIXED) 81 5 Visits to Check Sanitation (individual house holds + streets) 0 6 Notices issued against Poor Sanitation 0 7 Challans sent to Court against Poor Sanitation 0 8 Patients Nebulized 16

MOTHER, CHILD & REPRODUCTIVE HEALTH: (During the month under Review)

I. Female Health:

S.# Name of FMO ANC cases Natal Post Natal Other OPD Total OPD 1 Dr. Meena 148 0 27 1196 1371 2 Dr.Shagufta 131 0 70 944 1145 3 Dr.Janta 70 0 9 762 841 4 Dr.Lata 85 1 4 765 855 5 Dr.Asma 105 1 35 762 903 6 Dr.Rizwana 20 0 5 725 750 Grand Total 559 2 150 5154 5865

2. Deliveries Assisted

S # Service Number 1 Deliveries Assisted at HFs 05 114

2 Deliveries Assisted at homes 19 Total Deliveries 24

3. Lab/ Diagnostic Tests (by MO & FMOs)

S # Test Number 1 Pregnancy Tests 46 2 Blood Sugar Tests 444 3 Hemoglobin Tests 179 4 Ultra Sound Test 405 5 Other(Malaria) 2593 Grand Total 3667

7. Important Discussion on Mother and Child and Reproductive Health during MRM The FMO were directed to keep record of Mother and Child Health in the facilities, improve the family planning Programme by giving medicine and aware about family planning methods.

8. Provision of Family Planning Services during the Month:

S # Name of the Items / Service Number 1 Consultation / Advice 401 2 Oral Pills 468 3 IUCDs 0 4 Injections 14 5 Others 45 (Condoms) Total 928

(III) COMMUNITY PARTICIPATION: During Month under Review

1. Number of Male SGs: - 49- Number of female SGs: 3

2. Performance of M&E Section:

Meetings of Support Groups CHSs /SHSs arranged Names of Social conducted Organizers No. of No. of No. No. Participants Participants Mohammad Arif 54 3 69 3 Ex: Officer (M&E) Javed Ahmed 3 51 4 105 Muqeem Ahmed 2 34 2 49 Abdul Qadir 4 68 6 126 Total 12 207 15 349

Important Points during Support Group Meetings:

1. Need of Hand pump . 2. Repair of Roof b/c water leakage the Roof. 3. Availability of Female doctors.

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4. School Health Sessions & Community Health Sessions

Community Support Community Group Meetings Health Sessions School Health Session Sessi Sessi Participa Sessio Children Children S# Name on Participant on nt n Examined Treated 1 Dr. Meena N/A 2412 2312 2 Dr.Janta N/A 2432 185 3 Dr.Shagufta Shah N/A 000 00 4 Dr.Asma Karam N/A 2412 296 5 Dr.Rizwana Sajjad N/A 2 48 0 0 0 6 Dr.Lata Kumari N/A 3 58 2 20 20 7 Dr.Saleem 1 12 2 58 1 27 10 8 Dr.Shahid 1 7 2 25 1 32 0 9 Dr.Dechand 1 10 2 46 2 23 4 10 Dr. Ashok Kumar 1 10 2 35 2 38 10 11 Dr.Dileep Sonaro 0 0 2 19 2 30 10 12 Dr.Dileep Kumar 1 23 2 29 2 20 3 13 Dr . Parkash Kumar 1 4 2 40 2 104 14 14 Dr.Gotam 1 10 2 34 2 24 8 15 Dr.Amanullah 1 20 2 35 1 10 2 16 Dr.Adu Mal 1 16 1 24 2 33 5 17 Dr.Mahesh Kumar 1 11 1 15 1 23 0 18 Dr.Bheroo Lal 1 5 2 36 2 9 0 19 Dr. Madan Lal 1 16 2 35 2 11 7 20 Dr.Perwaiz Sajjad 1 18 2 48 2 37 12 21 Dr.Lachman 1 3 2 25 2 45 21 22 Dr. Lajpat Rai 1 27 2 40 2 40 25 23 Dr.Vijay Kumar 1 7 2 31 1 20 2 24 Dr.Nand lal 1 7 1 15 1 21 3 25 Dr.Santosh Kumar 1 13 1 23 1 8 3 Dr.Sarwan Kumar 26 Chelhar 1 13 2 43 2 23 0 Dr.Sundeep Kumar 27 /Nechal 1 15 1 31 1 25 25 28 Dr.Molchand 1 10 2 14 2 29 2 29 Dr.Ishtiaque Shah 1 6 0 0 1 20 1 30 Dr.Pirbhu Lal 1 14 2 79 1 37 11 31 Dr.Misri 1 9 1 19 2 4 4 32 Dr.Mukesh Kumar 1 1 1 15 2 5 2 33 Dr.Suneel Kumar GD 1 7 2 28 2 11 1 34 Dr Ashok(KJV) 1 10 2 29 2 27 5 35 Dr Sajjad 1 10 2 36 1 7 0 36 Dr Vikram 1 6 0 0 2 35 0 37 Dr Mir Imran 1 5 2 28 2 4 0 38 Dr Sarwan(Arokhi) 1 8 2 27 1 6 3 39 HT Chander Lal 1 11 1 21 1 23 0

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40 HT Abdul Aziz 1 20 2 30 2 50 16 41 HT Hashim 1 12 2 34 2 36 0 42 HT Mohsin 1 19 2 55 2 9 5 HT Muhammad 43 Raheem 1 14 1 10 1 2 2 44 HT Sardar Singh 1 12 2282 31 5 45 HT Pirbhu Lal 1 8 2 25 2 16 8 46 HT Amir Bux 1 10 2 40 2 10 2 47 HT Dhino 1 13 1 10 1 25 4 48 HT Mooro Mal 1 8 2 54 2 20 10 49 HT Abdul Sattar 1 12 2 7 1 14 0 50 HT Shahbdin 1 10 2 30 1 13 0 51 HT Aijaz 1 7 2 25 2 14 10 52 HT Saindad Samejo 1 10 2 21 2 14 4 53 HT Lachman Singh 1 11 2 27 1 6 3 54 HT Bhoopal Singh 1 11 1 21 2 36 26 55 HT Chandan Singh 1 16 2 49 2 7 1 Grand Total 48 537 94 1680 88 1204 332

4. Important Points during CHSs:

1. Malaria 2. Gastro 3. Vaccination 4. Heat Stroke and Prevention 5. Hypertension 6. Antenatal Care 7. Hazards of smoking 8. Snake Bite 9. Routine Vaccination 10. Acid Peptic Disease 11. Tuberculosis

5. Topics for CHS for the Month

S # Topics 1 ARI DISEASE 2 GASTRO 3 DENGUE 4 PEPTIC ULCER, ASTHMA

6. Important Discussion on Community Participation during MRM:

All MOs were directed to regularly conduct the CSG meetings and get support of CSG in different RHF level activities & be alert for the out break of Malaria etc.

10. Health Camps (TENT FIX CAMP): Number Held: 0 Number of Patients: - 0

11. Measures for Improvement / provision of Services by other Department / Agencies

S. No Description Recommendation To whom sent Present status 117

I Sanitation - - - II Drainage / sewerage - - - III Drinking water - - - IV Prevention of adulteration V Tree Plantation - - - VI Roads and infrastructure - - - VII Environmental Improvement - - - VIII Others - - -

(IV) CURATIVE SERVICES DURING THE MONTH UNDER REVIEW:

1. OPD*

New patients treated Old patients treated Total OPD during the month (New during the month during the month + Old 45639 456 46095

2. Maximum OPD** Minimum OPD**

S # BHU OPD BHU OPD 1 BHU CHELHAR 1997 GD MITHRIO SUTHER 376 2 BHU KALOI 1942 GD PEELU 411 3 BHU DANO DHANDHAL 1865 BHU CHACHI MOORA 428 4 BHU WAHOORI DURA 1612 BHU KHARIO FAZAL 511 5 BHU JADAM JHANJI 1543 BHU CHANIDA 535

3. Top Five Diseases Treated during School Health Sessions/Camps:

S # Diseases No. of Patients 1 ARI 123 2 Fever 61 3 Ear/Eye Problems 54 4 Cough 68 5 Scabies 26 Total 332 *All HFs — BHUs and others. **Reflects OPD at BHUs only — not at other HFs.

4. Top Five Diseases during OPD:

S # Disease No. of Patients 1 Upper ARI 13224 2 SUSPECTED MALARIA 3371 3 PEPTIC ULCER DISEASE 2158 4 PNEUPMONIA < 5 Years 1989 5 PNEUPMONIA > 5 Years 1706 5. ARV / ASV used during the month:

Detail No. of Patients Dog bite cases reported 30

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ARV Administered 31 ARV Available Doses (DSU) 297 Snake bite cases reported 11 ASV Vaccine Administered 14 ASV Vaccine Available Doses(DSU) 39

Lab / Diagnostic Tests: Includes Tests Reported at No. (II) (Mother Child & Reproductive Health.

3. (Lab / Diagnostic Tests)

S # Tests Number 1 Blood Sugar Tests 444 2 Hemoglobin 179 3 X-Rays (if available) N/A 4 Ultra Sound 405 5 Others 2593 Total 3621

B & C SCREENING TESTS:

No. of Tests No. of cases No. of cases referred Total referred Follow Screening Performed found positive for treatment up-to date up result Hepatitis B 0 0 0 0 0 Hepatitis C 0 0 0 0 0

8. TUBERCLOSIS

Patients Receiving Treatment New Cases During Under Diagnosis the Month

9. Referrals

Cases Referred To S.No Totals TB DOT Deliveries Others RHCs THQs DHQ 1 15 0 0 15 05 07 03

10. Inverse Referrals

Cases Referred from S.No Totals ARV ASV Others RHCs THQs DHQs 1 0 0 0 0 0 0 0

G. MONITORING DURING MONTH UNDER REVIEW

1. Monitoring Visits during the month

119

DSM Executive officer (M&E) Other Staff Total 43 32 147 222

2. Important Points/Issues arising from Visits

S Name of HF Issue Action Remarks # 1 BHU Mithrio Bhatti Solar Fridge non functional Discussed with focal person of EPI 2 BHU Khetlari Water Rooter out of use Given to Mechanic for repair 3 BHU M.Gechu Electricity, approach road, main Contact to Line Deptt: by Admin gate, and boundary wall destroy & resolve electricity problem, due to heavy rain Assign to Engineer for estimate of the damages 4 BHUKhario Fazal R&R Work Executive Engineer must be focus & Complete the on going work. 5 BHU Kot Arbab R&R Work Executive Engineer must be Mir Mohd focus & Complete the on going work.

H. AVAILABILITY OF MEDICINES/MEDICAL MATERIALS

1. Medicines available for: 45 Weeks 2. Important Issues raised relating to Medicines etc. during MRM: No any issue was discussed in the MRM.

I. REPAIR / MAINTENANCE / ELECTRIFICATION OF / AT HFS

Description of Repair / Name of S # Maintenance incl. Electrification Status / Remarks HFs

1 BHU Virawah Work Completed MB Sent to PSU 2 BHU Dano Dhandhal Work Completed MB Sent to PSU 3 BHU Malanhore vena Work Completed MB Sent to PSU 4 BHU Chelhar Work Completed MB Sent to PSU 5 BHU Kantio Work Completed MB Sent to PSU 6 BHU Wahori Work Completed MB Sent to PSU 7 BHU Mubarak Rind Work Completed MB Sent to PSU 8 BHU Verijhap Work Completed MB Sent to PSU 9 BHU Pabhuar Work Completed MB Sent to PSU 10 BHU KG Shah Work Completed MB Sent to PSU 11 BHU Warkio Work Completed MB Sent to PSU 12 BHU Chanida Work Completed MB Sent to PSU 13 BHU Kolhi Ji Veri Work Completed MB Sent to PSU Work Completed 14 BHU Kaloi MB Sent to PSU

15 BHU Hirar Deda Work Completed MB Sent to PSU 16 BHU Jadam Jhanjhi Work Completed MB Sent to PSU 17 GD Kehri Work Completed MB Sent to PSU 18 GD Jado Joyo Work Completed MB Sent to PSU 19 GD Jogi Mari Work Completed MB is complete

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20 GD Bhagisal Work Completed MB is completed 21 GD Peelu Work Completed MB is completed 22 GD Dalan Jo Tar Work Completed MB is completed 23 BHU Amrio Work Completed MB is completed 24 BHU Bhakuo Work Completed 100% work is done 25 BHU Doonjh Work Completed 100% work is done 26 BHU M.Bhatti Work Completed 100% work is done 27 BHU Arokhi Work Completed MB is completed 28 BHU Kankio Work Completed 100 % work done 29 BHU Khetlari Work Completed 100% work done 30 BHU Choopni Work Completed 100% work done 31 BHU Kot Arbab Work in progress 80% work is done & in progress 32 BHU Khario Fazal Work in progress 50% work is done & in progress

Inspections / Visits of PPHI HFs

Visitors* Health Facilities Visited Overall Comments

• To reflect only non-PPHI Visitor:

J- DISCUSSION DURING MRM:

On Staff Matters:

1. The Government Employees were directed to inform the DSM before performing any assignment by EDO Health Office. 2. All In charges of Health Facilities must be inform to the DSU PPHI before giving joining to any newly Appointed staff, also directed to not relieve any employee with-out permission of DSM PPHI. 3. All In charges should be submitted their Monthly Progress Reports before third of the month. 4. All staff under the administration of PPHI district Mithi should be professional, be punctual and bring ownership themselves. 5. Directed to all must be sent requisition with the recommendation of Community Support Group members for Repair and Maintenance of Roof { Kacha Pulster ( Garo) }. 6. Appreciation Certificates issued to Dr. Lata Kumari FMO, Dr. Pirbhoo Mal I/C MO BHU Mubarak Rind, Dr. Sundeep Kumar MO BHU Kaloi, HT Mr Roshan BHU Kankayo, Office Attendent Mr. Nathoo Mal for best performance in the last month.

On Preventive Health:

1. All Doctors has been directed that to conduct regular Health awareness Sessions in the community and Schools as we can prevent the souls of Thar from different diseases. 2. Directed to all must be capture the emergency cases, Health Sessions, Deliveries etc. 3. During any visit by any PPHI official including DSM or any other organization, They must remain there work, no need of protocol. 4. Directed to all must be sent DEWS Report every Saturday 3.00 PM Sharp.

On Curative Health:

The Medical and Paramedical Staff has advised to give three days medicine to the patients. In any center there is shortage of medicine the information should be reached to DSU PPHI at least three days in advance.

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On Mother, Child & Reproductive Health:

Directed to the FMOs for regular Health Sessions, motivation and counseling to Community for the importance of deliveries at BHUs and also appreciated their progress which is satisfactory from previous.

Other Matters:

Directed to all participants be punctual, bring discipline and all reports must be reach before 5TH of the every month.

Date /Time for Next MRM: 09-06-2012 10: 00 AM

Comments on Targets vs. Achievements (DSM):

DSM DSU Tharparkar told that we all are working for the betterment of people, so we should perform our duty honestly with regularly and with the punctuality .He has emphasized over the progress of FMOs and said that FMO should work hard to provide better care of mother and child of respective area. The meeting ended with the vote of thanks to all participants.

MINUTES OF THE 36th MONTHLY REVIEW MEETING OF DISTRICT_SANGHAR

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Monthly Review Meeting (MRM) of District, Sanghar for the Month of March 2012 held on May 12th , 2012 at District Health Office Hall, Sanghar. Written invitations to participates were sent to the District Coordination Officer, the EDO(H), EDO (F&P), In charge WHO, District Sanghar and District Incharge of EPI, LHW and all other National Programs as usual.

The list of participants is enclosed.

Attendance sheet Sr. Sr. Name & Designation Name & Designation # # 1 Mr.Abdul Rasool Golo DSM DSU,Sgr 65 Dr. Rasool Bux I/C M.O 2 Mr. Gul Muhammad Executive (F&A), DSU-Sgr 66 Mr. Ghulam Mohammad I/C PPHI, M.O 3 Mr. Ghulam Murtaza Executive (M&E), DSU-Sgr 67 Dr. Muhammad Zakir I/C PPHI, M.O 4 Mr.Mohammad Tahir Executive (M&E), DSU-Sgr 68 Dr. Muhammad Saeed I/C PPHI, M.O Dr. Sher Muhammad 5 Bhurgri I/C S.M.O 69 Dr. S. Atta ul Mustafa I/C PPHI, M.O 6 Dr. Aftab Ahmed I/C S.M.O 70 7 Dr. Babar Hussain I/C M.O, PPHI 71 Dr. Jetha Nand I/C PPHI, M.O 8 Dr. Syed Tarique Ali I/C PPHI, M.O 72 Dr. Bashir Ahmed I/C M.O 9 Dr. Abdul Waheed I/C PPHI, M.O 73 10 Dr. Abdul Jabbar I/C PPHI, M.O 74 Dr. Naeem Ashraf I/C PPHI, M.O 11 Dr. Bashir Ahmed I/C PPHI, M.O 75 Mr. Bangul Khan Incharge Dispenser 12 Dr. Pitamber Das I/C PPHI, M.O 76 Dr. Jai Ram I/C PPHI, M.O 13 Dr. Shaman Das I/C PPHI, M.O 77 Dr. Ghulam Sarwer I/C PPHI, M.O 14 Dr. Ghulam Abbas I/C M.O 78 Dr. Santosh Kumar I/C PPHI, M.O 15 Dr. Manzoor Ahmed I/C PPHI, M.O 79 Dr. Abdul Hameed I/C PPHI, M.O 16 Dr. Haque Nawaz I/C PPHI, M.O 80 Dr. Amna Fatima F.M.O 17 Dr. Mahesh Kumar I/C M.O 81 Dr. Amna Hayat F.M.O 18 Dr. Muhammad Sharif I/C PPHI, M.O 82 Dr. Asma Jabeen F.M.O 19 Dr. Muhammad Rafique I/C M.O 83 Dr. Asma Malik F.M.O 20 Dr. Talib Hussain I/C PPHI, M.O 84 Dr. Farzana Parveen F.M.O 21 Dr. Ghulam Hyder I/C PPHI, M.O 85 Dr. Fozia Parveen F.M.O 22 Dr. Mahesh Kumar I/C PPHI, M.O 86 Dr. Jai Shree F.M.O 23 Dr. Taj Muhammad I/C PPHI, M.O 87 Dr. Nusrat Jameel F.M.O Dr. Qamar-Un-Nisa 24 Dr. Narain Das I/C, M.O 88 Shumila F.M.O 25 Dr. Ali Bahar Rind I/C S.M.O 89 Dr. Rizwana Channar F.M.O 26 Dr. Aftab Ahmed I/C PPHI, M.O 90 Dr. Ruqayya Chandio F.M.O 27 Dr. Arjan Kumar I/C M.O 91 Dr. Rukhsana F.M.O 28 Dr. Moula Bux I/C M.O 92 Dr. Sadaf F.M.O 29 Dr. Muhammad Aslam I/C PPHI, M.O 93 Dr. Samina Bhatti F.M.O

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30 Dr. Shahid Hussain I/C PPHI, M.O 94 Dr. Satti Jeewat F.M.O 31 Dr. Mouhammd Yousif I/C PPHI, M.O 95 Dr. Shamim Begum F.M.O 32 Dr. Altaf Hussain I/C PPHI, M.O 96 Dr. Shazia Sharif Zardari F.M.O 33 Dr. Gobind Ram I/C PPHI, M.O 97 Dr. Shumaila Khan F.M.O 34 Dr. Dilshad Ali Khan I/C PPHI, M.O 98 Dr. Shumail Naz F.M.O Dr. Shafique Ur 35 Rehman I/C PPHI, M.O 99 Dr. Wajiha F.M.O 36 Dr. Syed Turab Ali Shah I/C PPHI, M.O 100 Dr. Zulekha Pari F.M.O 37 Dr. Muhammad Haroon I/C PPHI, M.O 101 Dr. Rizwana Khokhar F.M.O 38 Dr. Asif Pervaiz I/C M.O 102 Dr. Tasleem Akhtar F.M.O 39 Dr. Qamar-ul-Hassan I/C PPHI, M.O 103 Dr. Zulekha Pari F.M.O 40 Dr. Bhagwan Das I/C PPHI, M.O 104 Dr. Hira Naz F.M.O 41 Dr. Ahsan Gohar I/C M.O 105 Zohra F.M.O 42 Dr. Molla Bux I/C PPHI,M.O 106 Mr.Imtiaz Ali Store Manager Dr. Muhammad 43 Farooque I/C PPHI, M.O 107Mr. S. Imdad Ali Asst. A/Cs 44 Dr. Mehdi Hassan I/C PPHI, M.O 108 Mr. Imtiaz Ali Store Manager 45 Dr. Safar Hussain I/C M.O 109 Mr. Sultan Ali Social Organizer Dr. Muhammad 46 Ramzan I/C M.O 110 Mr. Abdul Ghaffar Social Organizer 47 Dr. Kishwar Das I/C PPHI, M.O 111 Mr. Muhammad Faisal Social Organizer 48 Dr. Faiz Muhammad I/C M.O 112 Mr. Shahidullah Social Organizer 49 Dr. Muhammad Aslam I/C PPHI, M.O 113 Mr. Shabeer Ahmed Asst. Admin 50 Dr. Akmal Baig I/C M.O 114 Mr. Asif Ali Arain ASM 51 Dr. Gul Hassan I/C PPHI, M.O 115 Mr. Muhammad Essa Med. Handler 52 Dr. Jawaher Lal I/C PPHI, M.O 116 Mr. Muhammad Asif Attendant 53 Dr. Aijaz Baig I/C PPHI, M.O 117 Mr. Qaim Ali Attendant 54 Dr. Nand Lal I/C PPHI, M.O 118 Mr. Abdul Rasheed Med. Handler 55 Dr. Tanveer Ahmed I/C PPHI, M.O 56 Dr. Anwar Adil I/C PPHI, M.O 57 Dr. Kirpal Das I/C PPHI, M.O 58 59 Dr. Ghulam Mustafa I/C PPHI, M.O 60 Dr. Rafique Ahmed I/C M.O 61 Dr. Israr Ahmed I/C M.O 62 63 Dr. Persram I/C PPHI, M.O 64 Dr. Jai Ram I/C PPHI, M.O

The following could not attend the meeting for the reasons stated against each:-

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S # Names/Designation Reasons 1 Dr. Irfan 2 Dr.Mujtaba Jamali Dr.Irfan was on leave due to 3 Dr.Amil Khan death of relative, 4 Dr.Mohammad Ramzan other MOs are 5 Dr.Qurban Ali habitual 6 Dr.Rasool Bux absconders. 7 Dr.Shafique Ahmed

A. HFs WITH PPHI

BHUs: 58 Dispensaries: 36 MCHCs: 0 1 Others: 01

TOTAL: 96

B. Population of the Catchments Area:

C. STAFF STRENGTH

Sanctioned Government PPHI Vacant Working Posts Employees Contract (Sanc-Govt) MOs 77 77 30 47 1 W/FMOs 0 28 1 27 - LHVs 77 62 17 45 60 Male 104 32 32 0 72 MTs/MAs Female 0 07 07 0 -07

Dispensers 03 71 32 39 -29

D. CLUSTERS OF HFs

WITH ONE MO

Previous Month Month under Review Total at Present

Clusters of 6 HFs - Clusters of 6 HFs -

Clusters of 5 HFs - Clusters of 5 HFs - Clusters of 4 HFs - Clusters of 4 HFs - Clusters of 3 HFs - Clusters of 3 HFs - Clusters of 2 HFs 04 Clusters of 2 HFs 04

Single HFs 73 Single HFs 73

WITH ONE FMO Previous Month Month under Review Total at Present Clusters of 5 HFs - Clusters of 5 HFs -

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Clusters of 4 HFs - Clusters of 4 HFs - Clusters of 3 HFs - Clusters of 3 HFs - Clusters of 2 HFs 26 Clusters of 2 HFs 23 Single HFs 05 Single HFs 05

E. CAPACITY BUILDING

1. First Session: During MRM

Following persons addressed in MRM.

First session on IMNCH given by the Dr.Sunder Jeevat.

Sr. No. Name of Resource Person Designation Speech Detail DSM, detailed discussed on the following Points. Demographical chart of District Sanghar according to the WHO Standard Percentage on the following Indicators. • Anti natal care, • NVD’s, • Post Natal • Family Planning Advices • FUR OPD • CBA’s • Pregnant women • Immunization, 1 Mr.Abdul Rasool Golo DSM.DSU-PPHI-Sanghar • T.B Referrals, • CSG Meetings , • Community Health Sessions & School Health Sessions. • About the health facilities timing DSM replied to DHO Sanghar that PPHI follows the rule of Sindh Government Notification which is still not notified to the Districts. And also DSM Sanghar said to all BHU I/ M.O to send their weekly EDEWS report to focal person of EDEWS within mean time. Progress of PPHI HFs and FMOs 2 Mr. Mohammad Tahir Executive M&E Progress via Presentation.

Capacity Building of LHVs / Dispensers During Month under Review

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Names of the Resource No. of Topic Persons with dates Date Venue Participants

F. REVIEW OF THE PERFORMANCE (I) PREVENTIVE HEALTHCARE During Month under Review

1. Vaccination / Immunization

No. of Doses of Immunization Administered in Children at Health Facilities. 15625 No. of TT vaccines provided to pregnant / Child Bearing Age Women at Health 1946 Facilities. No. of Immunization & Vaccination Administered by outreach EPI Teams 1320 Total vaccination / immunization for the 18891 month APRIL 2012.

2. National Immunization Days (NIDs) for Polio

Dates of NIDs Target of coverage Actual coverage Percentage of coverage

24th to 28th April 2012 267,597 324924 121%

3. Other Preventive/Promotional Services

S # Service Number 1 Passive Case Detection (PCD) Slides 2 Active Case Detection (ACD) Slides - 3 Visits to Check Sanitation (individual house holds + streets) - 4 Notices issued against Poor Sanitation - 5 Challans sent to Court against Poor Sanitation - 6 Patients Nebulized -

(II) MOTHER, CHILD & REPRODUCTIVE HEALTH During Month under Review

1. Female Health

S # Names of FMOs Ante-Natal Cases Neo-Natal Cases Other OPD Total OPD 1. Dr. Satti jeevat 94 10 12 1166 2. Dr. Shumiala Naz 86 9 162 1065 3. Dr. Shumiala Khan 25 2 52 102 4. Dr. Zohra 74 10 49 67 5. Dr. Amna Hayat 68 2 173 701 6. Dr. Sadaf Choudry 68 24 52 740 7. Dr. Mehreen 110 20 166 191 8. Dr. Amna Fatima 50 0 0 596 9. Dr. Shamim Begam 82 9 97 661 10 Dr. Rizwana Chanar 116 31 135 1118 11 Dr. Zulekha Pari 76 10 79 723 12. Dr. Jai Shree 64 6 168 1235 127

13. Dr. Tasleem Aziz 70 40 250 1308 14. Dr. Hameeda 0 0 15. Dr. Qamurnisa Shumaila 84 4 129 712 16. Dr. Asma Jabeen 49 6 248 662 17. Dr. Nusrat Jameel 94 16 340 1175 18. Dr. Farzana Parven 38 8 21 575 19. Dr. Wajiha Anwar 100 12 62 445 20. Dr. Rukia Chandio 77 22 41 1034 21. Dr. Fozia Soomro 95 0 47 731 22. Dr. Rizwana Khokhar 124 57 174 428 23. Dr. Samena Bhatti 72 9 105 823 24 Dr. Asma 96 8 145 731 25 Dr. Rizwana Shaheen 37 7 75 179 26 Dr. Shazia Sharif 49 9 238 664 27 Dr. Nusrat 37 1 108 635 28 Dr. Hira 121 500 29 Dr. Rukhsana 99 7 71 879

2. Deliveries Assisted

S # Service Number 1 Deliveries Assisted at HFs 44 2 Deliveries Assisted at homes 288

3. Lab/ Diagnostic Tests

S # Test Number 1 Pregnancy Tests 640 2 Blood Sugar Tests 167 3 Hemoglobin Tests 76 4 Ultra Sound Test 0 5 Other (Malaria/HBs/HCv) 1625

9. Important Discussion on Mother and Child and Reproductive Health during MRM During the MRM DSM deeply discussed on the progress of Mother and child and reproductive health and DSM was not satisfied the performance of the different Health facilities regarding the topic, and he also mentioned to improve all the indicators regarding standard demographical charts requirement which is provided to individual each health facility.

10. Provision of Family Planning Services during the Month

S # Name of the Items / Service Number 1 Consultation / Advice 447 2 Oral Pills 194 3 IUCDs 13 4 Injections 201 5 Condom 13 Total 868

1. Number of Male SGs: ------87 Number of Female SGs: ------01

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2. Performance of Social Organizers

Meetings of Support Groups CHSs / SHSs arranged by Names of Social Organizers conducted by him him No. of No. of No. No. Participants Participants Mr. Sultan Ali 3 68 2 52 Mr. Abdul Ghaffar Mr. Faisal 3 62 2 42 Mr.Nadeem Mr.Shahid 4 46 2 40 Total 10 176 6 134

3. School Health Sessions & Community Health Sessions

No.Of School Health No.Of Community Name of Medical Officer Participants Session Participants Health Sessions Male Female Dr. Mohammad Yousif 1 117 1 18 0 Dr. Taj Muhammad 0 0 1 10 15 Dr. Mohammad Mujtaba 1 20 1 20 0 Dr. Muzafar Hussian 1 30 0 0 0 Dr. Ghulam Sarwar 1 50 1 30 20 Dr. Mohammad Farooq(MHM) 0 0 1 30 6 Dr. Ghulam Hyder 0 0 1 25 0 Dr. Amna Hayat 2 103 1 0 100 Dr. Ramzan Wassan 1 20 1 30 0 Dr. Rukhsana Babar 1 33 1 0 16 Dr. Shamim 1 35 2 0 75 Dr. Tasleem Aziz 1 50 1 0 15 Dr. Manzoor Ahmed 1 17 1 17 4 Dr. Fiaz Muhammad 1 35 1 20 0 Dr. Asma 0 0 1 0 30 Dr. Muhammad Sharif 1 70 1 30 0 Dr. Abdul Hameed 1 27 1 11 7 Dr. Asma Jabeen 1 20 2 0 40 Dr. Aftab Ahmed 1 30 1 20 0 Dr. Dilshad 1 15 1 16 0 Dr. Shumaila Naz 1 30 1 0 15 Dr. Zulekha Pari 0 0 1 0 30 Dr. Anwar Adil 1 22 1 6 15 Dr. Turab Ali Shah 1 77 1 20 0 Dr. Rafique Ahmed 1 32 1 55 0 Dr. Satti Jeevat 1 32 1 0 32 Dr. Huq Nawaz Jatoi 1 45 1 8 15 Dr. Gobindram 1 10 1 4 10

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Dr. Mahesh Kumar 0 0 1 29 0 Dr. Mahesh Kumar (Dhilyar) 1 25 1 2 20 Dr. Arjun 1 86 1 2 20 Dr. Pitambar 1 49 0 0 0 Dr. Shamandas 1 15 1 9 2 Dr. Nanad Lal 1 25 1 20 10 Dr. Rizwana Khokhar 0 0 0 0 0 Dr. Santosh Kumar 1 40 1 8 0 Dr. Wajiha Anwar 1 35 1 0 10 Dr. Amna Fatima 0 0 0 0 0 Dr. Shahid Hussian 1 31 1 12 0 Dr. Muhammad Haroon 1 30 1 32 0 Dr. Nusrat Jameel 1 15 1 0 12 Dr. Jay Shiri 1 125 1 0 22 Dr. Rizwana Channar 1 13 1 0 15 Dr. Sayed Tariq 1 14 1 10 0 Dr. Aijaz Beg 1 67 1 15 20 Dr. JayRam 1 30 1 10 6 Dr. Abdul Jabar 1 26 1 3 13 Dr. Babar 1 14 1 10 6 Dr. Aftab (BHU 30-Jamrao 1 42 1 24 18 Dr. Rasool Bux 0 0 1 5 20 Dr. Rizwana Shaheen 1 24 1 0 11 Dr. Bhagwandas 1 20 1 15 7 Dr. Shafiqurehman 0 0 1 50 0 Dr. Qamrunissa Shumaila 2 57 2 0 24 Dr. Rukia Chandio 1 13 1 0 14 Dr. Qamrulhassan 1 80 1 40 0 Dr. Fozia Soomro 1 30 0 0 0 Dr. Kirpal 1 21 0 0 0 Dr. Gul Hassan 1 18 0 0 0 Dr. Sadaf Choudry 1 42 1 0 32 Dr. Jeewat Sunder 1 30 0 0 0 Dr. Naeem Ashraf 1 40 1 6 8 Dr. Agha Asif Ali 1 20 1 2 18 Dr. Attaul Mustafa 1 20 1 27 0 Dr. Bashir Ahmed 1 60 1 25 4 Dr. Kishwar Dass 1 55 1 35 0 Dr. Waheed 1 35 0 0 0 Dr. Bashir Ahmed (Bassi) 1 40 0 0 0 Dr. Hira 1 24 0 0 0 Dr. Shazia Sharif 1 50 1 0 20 Dr. Mehdi Hassan 1 32 0 0 0 Dr. Mohammad Yaqoob Umrani 1 25 1 10 2 Dr. Ihsan Gohar 1 30 0 0 0 130

Dr. Mohammad Aslam(Rahimabad) 1 41 1 9 15 Dr. Tanveer 1 15 0 0 0 Dr. Ali Bahar Rind 1 50 1 5 10 Dr. Moula Bux (Kamil Hingoro) 0 0 1 38 0 Toral 63 1019 48 320 198

4. Important Points during Support Group Meetings. During the community Support group meeting the Important discussions and decisions were that each member of CSG visit the concern health facility randomly in the week, to coordinate with DSU through I/C M.O for the betterment and required items etc,

5. Important Points during SHSs 1. Preventive measure from Malaria. 2. Hand Washing 3. Using Safe and boiled drinking water. 4. Diarrhea diseases in children.

6. Important Points during CHSs 1. Counseling on Family Planning among families. 2. Advantages of neat and clean. 3. Preventive aspects of Hepatitis B&C. 4. Preventive Measures from Swain Flue.

7. Topics for SHSs for the Month

Sr. No. Topics 1 Safe drinking water 2 Hand Washing 3 Personal Hygiene 4 Importance of Child health 5 Self Medication Practice 6 Importance of exercises

8 Topics for CHSs for the Month

S # Topics 1 Prevention from hepatitis B and C 2 Injection safety 3 Identification of T.B Patents 4 Facility of Anti Natal care at heath centers 5 Importance of Child health 6 Importance of Breast Feeding 7 Management / prevention of skin diseases 8 Management of / prevention of Malaria 9 Importance of immunization 10 Management of / prevention of worm infestation 11 Family Planning 12 Safe Blood transfusion 13 Management / prevention of Jaundice

9. Important Discussion on Community Participation during MRM

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The DSM emphasized these health facilities are made to benefit public and public is the owner of that health facility.

10. Health Camps:

11. Measures for improvement / provision of Services by other Department / Agencies

Sr No Description Recommendation To whom sent Present status i Sanitation - - - ii Drainage / sewerage - - - iii ……… drinking water - - - iv Prevention of adulteration - - - v Tree Plantation - - - vi Roads and infrastructure - - - vii Environmental Improvement - - - viii Others - - -

(IV) CURATIVE SERVICES DURING THE MONTH UNDER REVIEW

1. OPD*

New patients treated during Old patients treated during the Total OPD during the month the month month (New + Old) 120,164 1,522 121,686

2. Maximum OPD** Minimum OPD**

S # BHU OPD BHU OPD 1 BHU Hathungo 3452 BHU Awadh 733

3. Top Five Diseases Treated during School Health Sessions/Camps

S # Diseases No. of Patients 1 Allergy

2 Scabies 3 Dandruff 4 Abdominal pain 5 Head ache

*All HFs — BHUs and others. **Reflects OPD at BHUs only — not at other HFs.

4. Top Five Diseases During OPD

S # Disease No. of Patients 1 ARI 19643 2 Maleria 14201 3 Diarrhea 10574 4 Scabies 5958 5 Dysentery 957

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5. ARV / ASV used during the month

No. of Patients Dog bite cases reported 150(448 follow up cases)(Intra dermal vaccination) ARV Administered 211 ARV Available Doses 216(Vials) Snake bite cases reported 0 ASV Vaccine Administered 0 ASV Vaccine Available Doses 53

36. Lab / Diagnostic Tests: Includes Tests Reported at No. (II) (Mother, Child & Reproductive Health) 3. (Lab / Diagnostic Tests)

S # Tests Number 1 Blood Sugar Tests 167 2 Haemoglobin 76 3 X-Rays (if available) 202 4 Ultra Sound 0 5 Others (Malaria/HBs/HCv/PT) 1625

37. B & C SCREENING TESTS

No. of No. of cases No. of cases Total referred Follow up Screening Tests found referred for upto date result Performed positive treatment Hepatitis B 37 1 1 1 - Hepatitis C 42 6 6 6 -

8. TUBERCLOSIS

Patients Receiving Treatment New Cases During Under Diagnosis the Month

9. Referrals

S.No Totals Cases Referred To 1 TB DOT Deliveries Others RHCs THQs DHQs 2 25 25 3 12 10 3

10. Inverse Referrals

S. No Totals Cases Referred from 1 ARV ASV Others RHCs THQs DHQs 2 3 4

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G. MONITORING DURING MONTH UNDER REVIEW

1. Monitoring Visits during the month

DSM Executive Monitoring Other Staff Total 68 103 109 280

2. Important Points/Issues arising from Visits

S # Name of HF Issue Action Remarks BHU Berrani Furniture repair & netting Furniture repaired & 01 provided.

H. AVAILABILITY OF MEDICINES/MEDICAL MATERIALS

1. Medicines available for: 8 Weeks

2. Important Issues raised relating to Medicines, etc. during MRM

I. REPAIR / MAINTENANCE / ELECTRIFICATION OF / AT HFS

Description of Repair / Maintenance S # Name of HFs Status / Remarks incl. Electrification BHU Berrani Furniture repair & netting Furniture repaired & 1 provided.

Inspections / Visits of PPHI HFs

Visitors* Health Facilities Visited Overall Comments

* To reflect only non-PPHI Visitors.

I. REPAIR / MAINTENANCE / ELECTRIFICATION OF / AT HFS

S Description of Repair / Maintenance Name of HFs Status / Remarks # incl. Electrification GD Rawtiani Repair and maintenance of main building 1 including water supply, drainage, electricity, coloring etc. Completed 2 GD Rawtiani ---do--- Completed 3 BHU Rukan Burera ---do--- Completed 4 BHU Chotyarion ---do--- Completed BHU Pritam abad 5 ---do--- Completed 6 BHU Malook Junejo ---do--- Completed 7 BHU Landhi ---do--- Completed 8 BHU Golo Pir ---do--- Completed 9 BHU Moheb Ali Junejo ---do--- Completed 10 DCD Loon Khan ---do--- Completed 11 DCD Bobi Town ---do--- Completed 12 BHU Jia Abad ---do--- Completed

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BHU Perumal 13 ---do--- Completed 14 BHU Khairo Kaloi ---do--- Completed 15 DCD Ali Muhammad Thaheem ---do--- Completed 16 BHU Bago Wadadani ---do--- Completed 17 BHU Karim Dino Wassan ---do--- Completed 18 BHU M.K Rind ---do--- Completed 19 BHU Yameen Hingoro ---do--- Completed 20 BHU Bilawal Hingoro ---do--- Completed 21 BHU Khai ---do--- Completed 22 BHU Gider Aahpan ---do--- Completed 23 BHU Soomar Wassan ---do--- Completed 24 G D Ghundan ---do--- Completed 25 BHU Bassi ---do--- Completed 26 BHU Malook Maher ---do--- Completed 27 BHU Rahimabad ---do--- Completed 28 G.D USAMN NIZAMANI ---do--- Work in Progress 29 G.D Juma Village ---do--- Work in Progress 30 G.D Soomar Faqeer Maher ---do--- Completed 31 G.D Bakir Nizamani ---do--- Work in Progress G.D NASSER KHAN 32 ---do--- JALALANI Work in Progress 33 BHU MAROOF DAHRI ---do--- Completed 34 BHU MEER HASSAN MARI ---do--- Completed G.D DIN MOHD 35 ---do--- KAKEPOTO Work in Progress 36 G.D DALOOR MORI ---do--- Completed 37 BHU QAZI JUMAN DAHRI ---do--- Completed G.D SACHY DINO 38 ---do--- WARYAH Completed 39 BHU ALI MARDAN JAMALI ---do--- Work in Progress BHU PERO FAQEER 40 ---do--- SHORO Completed 41 BHU MULLAN HURMAT ---do--- Completed 42 BHU JEANDO RIND ---do--- Completed 43 BHU MAHER ALI TALPUR ---do--- Completed 44 BHU LUNDO ---do--- Completed 45 DCD MULLAN MAKHAN ---do--- Completed 46 BHU AWADH ---do--- Work in Progress BHU HAMZO HAMZO 47 ---do--- DARS Work in Progress 48 BHU BHIT BHAITI ---do--- Work in Progress BHU DHANI PARTO 49 ---do--- RAJPAR Work in Progress BHU ABDULLAH 50 SANGHRASI Work in Progress

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51 BHU CHAMANDAS Completed

J- DISCUSSION DURING MRM

On Staff Matters: 1. The DSM Sanghar briefed all the participants about the benefit of the monthly progress of PPHI. 2. It was informed to keep a record of referral / inverse referral record. 3. The DSM emphasized to all participants to ensure the availability of staff at their health facilities. 4. The District Support Manager ensured all the participants that; PPHI will provide full support and cooperation in all matters of Incharge of Health facilities. 5. The DSM, PPHI Sanghar once again in this MRM reminded all the in charges of health facilities for their timely submission of HMIS reports, Monthly Medicines Requisition. On Preventive Health: 1. The District Support Manager ensured all the participants that PPHI will extend its full support and cooperation in all vertical Programs related from health. 2. On Curative Health: 1. On Mother, Child & Reproductive Health: Efforts relating to establishment of more MCH centers will be taken.

Other Matters: Date /Time for Next MRM: The Monthly Review Meeting for all the In Charges of Health Facilities shall be held on 10th of every month.

Comments on Targets vs. Achievements (by DSM)

TARGETS

ACHIEVEMENTS

NEGATIVE:

DISTRICT SUPPORT MANAGER CC to: • Programme Director, PSU-PPHI-Sindh, Karachi. • Regional Programme Director, RSU-II, PPHI, Mirpurkhas. • All Participants. • Master File.

DISTRICT SUPPORT MANAGER

MINUTES OF THE (46th ) MONTHLY REVIEW MEETING 136

OF DISTRICT TANDO ALLAHYAR

Monthly Review Meeting (MRM) of District, Tando Allahyar for the Month of April , 2012 was held on 15- 05-2012 . The following officials participated in the meeting:

Sr # Name Designation Place of Posting 1. Dr. Abdul Jaleel Bachani DHO Tando Allahyar 2. Mr. Imran Aziz Siddiqui DSM DSU-Tando Allahyar 3. Dr. Karim Bux Burdi Deputy District Health Officer Tando Allahyar 4. Dr. Aarif Soomro TB DOTS Focal Person Tando Allahyar 5. Mr Raza Ali Baloch Population Welfare Officer Tando Allahyar 6. Dr. Anwar Qadir EPI, Focal Person Tando Allahyar 7. Mr. Khalique Dino officer Hesco , Tando Allahyar 8. Mr. Shafiqu H. Memon Deputy Director 9. Mr. Muhammad Asif Executive M&E DSU-Tando Allahyar 10. Dr. Amir Bux Mughal Sr. Medical officer GD New Mirabad 11. Dr. Danish Hussain Medical officer Gd Bahar Mirjat 12. Dr. Rehan Ali Yusfani Medical officer Bhu Ditto Kalro 13. Dr. Imam Bux Medical officer BHU Kauro Daidano 14. Dr. Abdul Razzaque Medical officer BHU Dinghano Bozdar 15. Dr. Saqib Siddique Medical officer GD Usman Shah Hurri 16. Dr. Irfan Shah Medical officer BHU Shadyoon 17. Dr. Rana M. Akhtar Medical officer BHU Allah Rakhio Pathan 18. Dr. Ghulam Rasool Medical officer GD Mevo Kurkli/Rawat Leghari 19. Dr. Ghulam Nabi Brohi Medical officer BHU Jhando Mari 20. Dr. Ahmed Ali Medical officer BHU Shahnawaz Muhajir 21. Dr. Ariful Hassan Medical officer GD Darya Khan 22. Dr. Zahid Hussain Medical officer GD Lal Faqeer Behrni 23. Dr. Waseem Ahmed Medical officer GD Hakra Mori 24. Dr. Amir Nahyoon Medical officer GD Ghulam Khan Sanjrani 25. Dr. Zohaib Hassan Medical officer GD Khokhar 26. Dr. Noor Ahmed Medical officer GD Bail Sharif/Bachal Pitafi 27. Dr. Hamid Ghousi Medical officer GD Mehroo Khan Lashari 28. Dr. Ashok Kumar Medical officer GD Sachedino Panhwar 29. Dr. Amir Bux Mughal Medical officer GD New Mirabad 30. Dr. Abdul Manan Medical officer BHU Bukera Sharif 31. Dr. Atif Miandad Medical officer GD Sadiq Memon, Wali M 32. Dr. Gulzaib Ahmed Medical officer GD Pak Singhar 33. Dr. Shakeel Ahmed Medical officer GD Mohammad Hassan 34. Dr. Allah Warayo Medical officer GD Mashaikh Hoti 35. Dr. Naveed Memon Medical officer GD Golo Halepoto 36. Dr. Aftab Hyder Medical officer GD Mitho khaskheli 37. Dr. Dharamver Medical officer GD Sobho Rind/Dodo Rind 38. Dr. Muhammad Amir Qazi Medical officer GD Dasoori 39. Dr. Mazhar Hussain Medical officer BHU Sanjar Chang 40. Dr. Ali Khan Medical officer GD Mail Mjori 41. Dr. Waqar Ahmed Medical officer GD Sachedino 42. Dr. Faisal Iqbal Medical officer BHU Tando Soomro 43. Dr. Muhammad Ilyas Baig Medical officer GD Ghani Khan Kaim Khani

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44. Dr. Sumaira Qaimkhani Female Medical officers BHU Allah Rakhio, GD Usman Shah 45. Dr. Tooba Abro Female Medical officers BHU Dinghano Bozdar, GD Lal Faqir 46. Dr. Shazia Parveen Female Medical officers BHU Shadyoon/Missan Nandhi 47. Dr. Samreen Female Medical officers BHU Shahnawaz Muhajir 48. Dr. Quratul Ain Female Medical officers GD Darya Khan /GD Sanjrani 49. Dr. Nazia Jabeen Female Medical officers BHU Tando Soomro, GD Bahar Khan Mirjat 50. Dr. Benish Imran Female Medical officers GD Golo Halepoto/Ghulam Hussain Khokhar 51. Dr. Noor Jahan Female Medical officers BHU Sultanabad Village/ GD Sadique Memon 52. Dr. Samina Naz Female Medical officers BHU Jhando Mari 53. Dr. Sunita Kumari Female Medical officers BHU Tando Soomro/ Dasoori 54. Dr. Fakhra Qureshi Female Medical officers BHU Sanjar Chang 55. Dr. Indra Female Medical officers BHU Ditto, GD Pak Singhar 56. Dr. Shabana Female Medical officers BHU S. Stand, GD Ghani 57. Dr. Farhana Tahir Female Medical officers BHU Sultanabad Stand 58. Dr. Najma Female Medical officers BHU Naseer Khan 59. Dr. Ambreen Memon Female Medical officers GD Sobho Rind 60. Dr. Afshan Bhatti Female Medical officers 61. Dr. Amna Sami Shaikh Sonologist Cluster 62. Dr. Ambar Abbas Sonologist Cluster 63. Dr. Adel Shamshad Medical officer 64. Dr. Zubairuddin Medical officer 65. Dr. Ghulam Sarwar Medical officer 66. Mr. Abdul Hafeez Shar Store Manager PPHI, Tando Allahyar 67.

The following could not attend the meeting for the reasons stated against each:-

S # Names/Designation Reasons S # Names/Designation Reasons 1 DC, Tando Allahyar In meeting 2 Dr, Hakeem Mal, MO Leave 3 Dr. Dildar Hussain Mughal, MO On leave 4 Dr. Ali Khan Leave 5 Dr. Afshan Bhati Leave

K. HFs WITH PPHI

BHUs: 13 Dispensaries: 32 MCHCs: ______Others:______TOTAL: 45 B. Population of the Catchments Area: 563018

W. STAFF STRENGTH

HR POSITION Sr Name of Post Sanctioned Posts (Govt.) PPHI Govt Total 1 Medical officers 15 36 4 39 2 Female Medical officers - 16 - 16 3 Ultrasound Specialist - 2 - 2 4 Dispensers 21 26 4 30

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Health Technicians 5 26 11 13 24 (Male/Female) 6 Lady Health Visitors 12 6 7 13

X. CLUSTERS OF HFs

WITH ONE MO

WITH ONE FMO

Previous Month Total Month under Review Total Clusters of 5 HFs 2 (U/S) Clusters of 5 HFs 2 (U/S) Clusters of 4 HFs Clusters of 4 HFs Clusters of 3 HFs Clusters of 3 HFs Clusters of 2 HFs Clusters of 2 HFs 12 Single HFs Single HFs 4

E. CAPACITY BUILDING 1. First Session: During MRM :

• Resource person: Dr. Arif Soomro • Topic: TB

2. Second Session:

• Resource person: Dr. Naveed Memon • Topic: BLS

Capacity Building of LHVs / Dispensers During Month under Review

Names of the Resource Persons No. of Date Venue Topic with dates Participants Dr. Irfan Shah 02-04-2012 BHU Shadyoon ARI 32 BHU Naseer Khan Hepatitis Dr. Dildar Hussain 02-04-2012 Leghari BHU Shahnawaz Dr. Ahmed Ali Panhwar 16-04-2012 Polio 20 Muhajir BHU Sultanabad Dr. Lajpat Rai 16-04-2012 Malaria 12 Stand BHU Bukera Dr. Abdul Manan 02-04-2012 Routine Vaccine 20 Sharif

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BHU Dhingano Dr. Abdul Razaq Abro 03-04-2012 Malaria 20 Bozdar

Dr. Rehan Yusfani 02-04-2012 BHU Ditto Kalro EPI 12

GD Darya khan Dr.Arif Hassan Dahri TB 28-04-2012 4 Hingoro BHU Tando Dr. Faisal Memon 02-04-2012 Malaria 20 Soomro BHU Kauro Role of Paramedic in Dr. Imam bux Unnar 10-04-2012 6 Daidano primary Health Care BHU Kauro Dr. Imam bux Unnar 13-04-2012 Hepatitis 6 Daidano Dr. Naveed Ahmed Memon 17-04-2012 GD Golo halepoto Pharingitis 6

Dr. Mazhar Hussain 02-05-2012 BHU Sanjar Chang Acute Gastroenteritis 10

Dr. Ghulam Nabi Brohi 18-04-2012 BHU Jhando Mari Routine Vaccine 16 BHU Allah Rakhio Dr. Rana Mohd Akhtar 03-05-2012 Malaria 7 Pathan BHU Sultanabad Dr. Hakeem Mal 02-04-2012 Routine Immunization 14 Village BHU Allah Rakhio Hypertension in Dr. Sumaira 27-04-2012 10 Pathan pregnancy GD Darya khan Dr. Quratulain Memon Scabies 3 Hingoro BHU sultanabad Dr. Noor Jehan 21-04-2012 Village/GD Scabies 4 Sadique Memon BHU Tando Pelvic Inflammatory Dr. Nazia Jabeen 6-4-2012 20 Soomro Disease PID BHU Kauro Dr. Shumaila Muqadas Antenatal care 16 Daidano BHU Shahnawaz Pregnancy Induced Dr. Samreen 02-04-2012 14 Muhajir hypertension BHU Naseer khan Dr. Beenish Imran 02-04-2012 Polio 9 leghari Dr. Fakhra 18-04-2012 BHU Sanjar Chang IUCD 10 BHU Sultanabad Dr. Shbana Qureshi 18-04-2012 Diarrhea 3 Stand Dr. Samina Akram 02-04-2012 BHU Jhando Mari Polio 12 BHU Dhingano Dr. Tooba Abro Contraceptive 22 Bozdar BHU Bukera Dr. Sunnita 3-04-2012 Anemia in Pregnancy 19 Sharif

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Dr. Shazia Parveen 17-04-2012 BHU Shadyoon Scabies 11

F. REVIEW OF THE PERFORMANCE (I) PREVENTIVE HEALTHCARE During Month under Review 1. Vaccination / Immunization

No. of Doses of Immunization Administered to Children at Health Facilities. 3018 No. of TT vaccines provided to pregnant / Child Bearing Age Women at Health Facilities. 586 No. of Immunization & Vaccination Administered by outreach EPI Teams -

2. National Immunization Days (NIDs) for Measles

Dates of NIDs Target of coverage Actual coverage Percentage of coverage 23, 24, 25 April, 2012

3. Other Preventive/Promotional Services

S # Service Number 1 Passive Case Detection (PCD) Slides - 2 Active Case Detection (ACD) Slides - 3 Visits to Check Sanitation (individual households + streets) - 4 Notices issued against Poor Sanitation - 5 Challans sent to Court against Poor Sanitation - 6 Patients Nebulized 669

(II) MOTHER, CHILD & REPRODUCTIVE HEALTH During Month under Review • Female Health

S # Names of FMOs Ante-Natal Cases Neo-Natal Cases Other OPD Total OPD 1 Dr. Noor Jahan 153 42 751 946 2 Dr. Tooba Abro 237 16 820 1073 3 Dr. Indra 28 6 755 789 4 Dr. Benish Imran 70 9 1008 1087 5 Dr. Quratul Ain 47 2 1215 1264 6 Dr. Sumera Qaimkhani 117 6 596 719 7 Dr. Samreen 288 16 1199 1503 8 Dr. Shazia Parveen 47 687 734 9 Dr. Nazia Jabeen 135 11 1016 1162 10 Dr. Samina Naz 89 13 505 607 11 Dr. Sunita Kumari 125 14 597 736 12 Dr. Fakhra Qureshi 28 14 1788 1830 13 Dr. Shabana Qureshi 300 25 701 1026 TOTAL 1664 174 11638 13476

2. Deliveries Assisted

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S # Service Number 1 Deliveries Assisted at HFs 35 2 Deliveries Assisted at Homes -

3. Lab/ Diagnostic Tests

S # Test Number 1 Pregnancy Tests 330 2 Blood Sugar Tests 646 3 Hemoglobin Tests 199 4 Ultra Sound Test 1000 5 Other 921

29. Important Discussion on Mother and Child and Reproductive Health during MRM

DSM directed the FMOs to ensure immunization of children, pregnant women and child bearing age women and also ensure that they should bring immunization and Ante-Natal card each time they visit HFs.

30. Provision of Family Planning Services during the Month

S # Name of the Items / Service Number 1 Consultation / Advice 422 2 Oral Pills 204 3 IUCDs 1 4 Injections 147 5 Others 225 Total 999

(III) COMMUNITY PARTICIPATION During Month under Review

1. Number of Male Support Groups: 43 Number of Female SGs: 20 (Total 63)

2. Performance of Social Organizers

Meetings of Support Groups CHSs/SHSs arranged by him conducted by him Names of Social Organizers No. of No. of Male Female No. Participants Participants Dr. Muhammad Azam 11 - 122 4 60 Mr. Riaz Hussain 12 2 194 5 40 Mr. Gandhi 15 3 160 6 70 Total 38 5 476 15 170

3. School Health Sessions & Community Health Sessions

Sr Names of MO / FMOs/Paramedics Community Health Sessions School Health Sessions Sessions Sessions Children Children

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Participants Examined Treated

1 Dr. Noor Jahan 2 64 2 120 64 2 Dr. Tooba Abro 2 46 2 117 2 3 Dr. Indra 2 50 0 0 0 4 Dr. Benish Imran 3 70 2 82 71 5 Dr. Quratul Ain 2 43 2 11 6 6 Dr. Sumera Qaimkhani 1 25 1 17 17 7 Dr. Samreen 2 36 1 10 2 8 Dr. Shazia Parveen 2 15 2 25 16 9 Dr. Nazia Jabeen 2 27 2 65 35 10 Dr. Samina Naz 1 13 1 23 23 11 Dr. Sunita Kumari 1 10 1 70 2 12 Dr. Fakhra Qureshi 2 41 2 121 49 13 Dr. Shabana Qureshi 1 10 2 45 25 Total 23 450 20 706 312 1 Dr. Waseem Ahmed 1 18 1 10 2 2 Dr. Zahid Hussain 2 26 1 5 11 3 Dr. Gulzaib Ahmed 1 13 1 17 10 4 Dr. Hakim Mal 1 20 1 12 4 5 Dr. Amir Nahyoon 2 26 2 32 18 6 Dr. Danish Hussain 1 11 1 11 3 7 Dr. Imam Bux 2 19 3 80 28 8 Dr. Rehan Yusfani 2 19 1 50 30 9 Dr. Abdul Razzak 2 28 2 24 2 10 Dr. Ghulam Rasool 2 28 2 35 10 11 Dr. Faisal Iqbal 1 18 1 13 3 12 Dr. Abdul Manan 3 41 3 80 28 13 Dr. Abdul Hussain 2 42 2 23 13 14 Dr. Irfan Shah 2 27 1 4 2 15 Dr. Ariful Hassan 2 14 2 6 3 16 Dr. Saqib Siddique 1 11 1 0 0 17 Dr. Adil Shamshad 1 11 1 20 8 18 Dr. Hafiz Zohaib Hassan Memon 0 0 0 0 0 19 Dr. Allah Warayo 1 20 1 12 8 20 Dr. Hamid Ghousi 1 8 0 0 0 21 Dr. Ashok Kumar 2 26 2 26 7 22 Dr. Shakeel Ahmed 1 18 1 3 3 23 Dr. Rana Muhammad Akhtar 1 10 1 6 1 24 Dr. Zulfiquar Ali Jamali 0 0 0 0 0 25 Dr. Atif Miandad 1 14 1 10 2 26 Dr. Naveed Memon 1 14 1 25 0 27 Dr. Aftab Hyder 1 12 1 3 4 28 Dr. Dharamver 2 36 2 21 8 29 Dr. Muhammad Amir Qazi 0 0 1 0 0 30 Dr. Mazhar Hussain 2 45 2 17 7 31 Dr. Dildar Hussain Mughal 1 13 1 10 5 32 Dr. Ali Khan 1 17 1 18 3 33 Dr. Noor Ahmed Pahore 2 22 2 44 21 34 Dr. Ahmed Ali 4 51 1 6 2 35 Dr. Amir Bux 1 11 1 25 5 36 Dr. Ghulam Nabi 1 17 1 20 11 143

37 Dr. Laj Pat 1 13 1 6 4 Total 52 719 47 674 266

4. Important Points during Support Group Meetings. • Polio campaign and refusals cover • Provision of building (where not available) • R & R of newly taken over GDs • Provision of Ambulances

5. Important Points during SHSs • Personal Hygiene

6. Important Points during CHSs • Sanitation

7. Topics for SHSs for the Month

Sr. No. Topics Education about health and Hygiene , tooth brushing, scabies, Polio, Immunization, Oral hygiene , 1 Nutrition, Malaria and its prevention, Hepatitis, ARI, Hazards of chewing tobacco, importance of Iodine Salt in food, eye infection , worm 2 infestation in children, dog bite

8. Topics for CHSs for the Month

S # Topics 1 Epilepsy Diabetic Mellitus Ante Natal care, Post natal care, Immunization, Iodine deficiency , Polio, Scabies, weaning, family planning Neo Natal care, Malaria and its prevention 2 common cold, dog bite, Hazards of chewing tobacco, Nutrition, RTI, Gastro, Preparation of ORS at home. Hepatitis , water borne disease, pulmonary tuberculosis , water purification, hypertension

9. Important Discussion on Community Participation during MRM

DSM, DHO and officials raised their concern about polio refusals cases in the District and emphasized the need of community sensitization through CHS, SHS, & CSG meetings. It was also decided that all PPHI HFs will serve as a Fix point during upcoming polio campaign and they will submit their daily reports to nearby BHU in the same UC or DSU Tando Allahyar on the same day.

10. Health Camps: Number Held: Number of Patients: ------

11. Measures for improvement / provision of Services by other Department / Agencies

Sr No Description Recommendation To whom sent Present status I Sanitation Ii Drainage / sewerage iii ……… drinking water Iv Prevention of adulteration V Tree Plantation vi Roads and infrastructure vii Environmental Improvement

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viii Others

(IV) CURATIVE SERVICES DURING THE MONTH UNDER REVIEW 1. OPD*

New patients treated Old patients treated Total OPD during the during the month during the month month (New + Old) 67045 3262 70346

2. Maximum OPD** Minimum OPD**

S # BHU OPD BHU OPD 1 Shahnawaz Rajput 3014 Ditto Kalro 1169

3. Top Five Diseases Treated during School Health Sessions/Camps

S # Diseases No. of Patients 1 RTI 812

2 GIT 812

3 Dermatological problems 423

4 Malaria 141 5 ENT 136 *All HFs — BHUs and others. **Reflects OPD at BHUs only — not at other HFs.

4. Top Five Diseases During OPD

S # Disease No. of Patients 1 Respiratory 11983 2 Dermatological Problems 5165 3 Fever 3183 4 Susp: Malaria 3252 5 Gastro Intestinal Disease 2158

31. ARV / ASV used during the month

No. of Patients Dog bite cases reported 193 ARV Administered 154 (Vials) ARV Available Doses Snake bite cases reported - ASV Vaccine Administered - ASV Vaccine Available Doses -

38. Lab / Diagnostic Tests: Includes Tests Reported at No. (II) (Mother, Child & Reproductive Health) 3. (Lab / Diagnostic Tests)

S # Tests Number

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1 Pregnancy Tests 330 2 Blood Sugar Tests 646 3 Hemoglobin 199 4 X-Rays (if available) - 5 Ultra Sound 1000 6 Others (please specify) 921

39. Hepatitis B & C SCREENING TESTS

No. of Tests No. of cases No. of cases referred Total referred Follow up Screening Performed found positive for treatment upto date result 198 198 15 15 - -

40. TUBERCLOSIS

Patients New Cases During Under Diagnosis Receiving Treatment the Month 31 0 -

9. Referrals

Cases Referred To S.No Total TB DOT Deliveries Others RHCs THQs DHQs 1 83 83 - -

10. Inverse Referrals

Cases Referred from S.No Totals ARV ASV Others RHCs THQs DHQs 1 - 0

G. MONITORING DURING MONTH UNDER REVIEW

12. Monitoring Visits during the month

DSM Executive Monitoring Other Staff Total 45 48 152 245

2. Important Points/Issues arising from Visits

S # Name of HF Issue Action Remarks

DO BUILDING MEETING WITH 1 GD Usaman Shah Hurri BUILDINGS INCOMPLETE BUILDINGS DEPTT VISITED DO ELECTRIC CITY MEETING WITH 2 GD MAIL MORI BUILDINGS NOT AVAILABLE BUILDINGS DEPTT VISITED 146

REQUEST RE FOR 3 BHU SANJAR CHANG NEED OF R&R RE VISITED ESTIMATE

H. AVAILABILITY OF MEDICINES/MEDICAL MATERIALS

1. Medicines available for ( 32 ) Weeks

2. Important Issues raised relating to Medicines, etc. during MRM • Issues regarding Newly taken over GDs:-

Sr# Name HF ISSUES

1 GD Mehro Khan Lashari Electricity , Fans, meter, grill, drainage system, Motor 2 GD Hakra Mori meter, drainage system 3 GD Pak Singhar Electricity , Fans, meter, grill, drainage system, motor 4 GD Mithoo Khaskheli Electricity , Fans, meter, grill, drainage system, motor 5 GD Ghani Khan Kaim Khani Three phase meter connection required, grill, motor 6 GD Dodo Rind Masonry & plumbing work, motor 7 GD Sobho Rind Electricity , plumbing work, motor Electricity , meter, grill, carpenter work, drainage system, 8 GD Ghulam Hussain Lund motor 9 GD Saleh Arisar Electricity , drainage system, plumbing work, motor 10 GD Sachedino Panhwar Electricity , motor 11 GD Muhammad Hassan Dal drainage system 12 GD Saeed Khan Leghari Electricity , meter, drainage system, motor 13 GD Mashaikh Hoti Carpenter work, meter, grill, drainage system 14 GD Mail Mori Electricity , meter, drainage system, plumbing work

I. REPAIR / MAINTENANCE / ELECTRIFICATION OF / AT HFS

Description of Repair / S # Name of HFs Status / Remarks Maintenance incl. Electrification M.B recorded & Sent to 1 BHU-Allah Rakhio Pathan 100% Completed P.S.U. M.B recorded & Sent to 2 BHU Ditto Kalroo 100% Completed P.S.U. M.B recorded & Sent to 3 GD M Sadiq Memon 100% Completed P.S.U. M.B recorded & Sent to 4 BHU-Jhando Mari 100% Completed P.S.U. M.B recorded & Sent to 5 BHU-Shadyoon 100% Completed P.S.U.

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M.B recorded & Sent to 6 BHU-Sultanabad stand 100% Completed P.S.U. M.B recorded & Sent to 7 BHU-Sultanabad Village 100% Completed P.S.U. M.B recorded & Sent to 8 GD-Dassori 100% Completed P.S.U. M.B recorded & Sent to 9 B.H.U Bukera Sharif 100% Completed P.S.U. M.B recorded & Sent to 10 B.H.U Kauro Daidaanoo 100% Completed P.S.U. M.B recorded & Sent to 11 B.H.U Tando Soomro 100% Completed P.S.U. M.B recorded & Sent to 12 B.H.U Shahnwaz Muhajir 100% Completed P.S.U. M.B recorded & Sent to 13 BHU-Naseer Khan Leghari 100% Completed P.S.U. M.B recorded & Sent to 14 BHU-Sanjar chang 100% Completed P.S.U. M.B recorded & Sent to 15 GD-Ghulam Khan Sanjrani 100% Completed P.S.U. M.B recorded & Sent to 16 BHU-Dhingano Bozdar 100% Completed P.S.U. M.B recorded & Sent to 17 GD-Ghulam Hussain Khokhar 100% Completed P.S.U. Quarter of BHU Shahnawaz MB needs to be 18 100% completed Muhajir recorded MB needs to be 19 Quarter of BHU Jhando Mari 100% completed recorded MB needs to be 20 Quarter of BHU Bukera 100% completed recorded MB needs to be 21 GD Lal Faqir Behrani 100% completed recorded MB needs to be 22 GD Golo Halepoto 100% completed recorded

Inspections / Visits of PPHI HFs

Visitors* Health Facilities Visited Overall Comments

* To reflect only non-PPHI Visitors.

Health Indicators and performance/target at DSU-PPHI-TAY on quality basis Total Catchment Population of District Tandoallahyar 563018

S.# Description Number Remarks Monthly Achievement %age Targets for 148

Targets Achieved Next Month The popn of villages Total Catchment seeking 1 Population 563,018 Facility from Center 48% of Female Catchment 2 Catchment Population 270,249 Population 2 visist per Facility Utilization by 3 person per 93,836 70,307 75% 93836 all (Total OPD) 1,126,036 year Facility Utilization by 2 visist per

4 Female (Total Female female per 45,042 13,476 30% 15000 450,498 OPD) year 3.4% of

5 Pregnant Women Catchment 1,595 19,143 Population Equal to # A.N Check ups (at least of a 1,595 1,664 104% 1664 1) 19,143 pregnant women Twice # of A.N Check ups (at least b pregnant 3,190 2) 38,286 women 3.1% of

6 Deliveries Catchment 1,455 35 24% 45 174,554 Population Equal to #

7 P.N check ups of 1,455 174 12% 200 174,554 Deliveries 16% of 8 F.P clients total 7,507 577 8% 1,200 90,083 population Fully Immunized 5% of total 2346 711 30% 750 9 Children 28151 population

DISCUSSION DURING MRM

Date /Time for Next MRM: To be decided later

Comments on Targets Achievements (by DSM)

¾ Every MO shall conduct at least 4 Health sessions. ¾ MO’s & FMO’s have to be actively involved in NID’s, SNIDs and during NIDs they are bound to ask every mother and her children for Immunization and prepare a list of children not vaccinated on daily basis and report to DSM /DHO office. ¾ Target population and actual coverage in NIDs, SNIDs must be submitted with monthly HMIS report. ¾ Every MO must conduct five minutes meeting with vaccinators at the start of the day and ask him about performance, progress and targets for the day.

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¾ During NID days all UC focal person / I/C MOs will monitor the field teams and fix points and report to DSM/DHO/DC on daily basis. ¾ Due to low production and high cost of IV fluids injection lactate, it is advice to the MOs to minimize the use of ringer lactate injection. In case of mild dehydration/diarrhea the ORS /normal saline should be use instead of injection ringer lactate. ¾ The utilization of Zinc sulfate should be increase. ¾ The schedule of vaccinator should be monitor by the I/C MO and a certificate mentioning that the schedule been followed properly by the vaccinator should be given by MO in every month.

MINUTES OF THE (40th) MONTHLY REVIEW MEETING OF DISTRICT UMERKOT

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Monthly Review Meeting (MRM) of District, Umerkot for the Month of April, 2012 was held on 10th May, 2012 at Darbar Hall, DC Office, Umerkot. Written invitations to participate were sent to the DC, the DHO, the DO (F&P), D.O Population Welfare Department, District In charge, National Program, EPI, HANDS, TRDP, AWARE, Sami Foundation, Medical officers & Female Medical Officers as usual. The list of participants is as follows:

List of Participants:

Sr. Names Designation Sr. Names Designation 1 Ashique Hussain Chandio DSM PPHI U.K 29 Dr Shanker Malhi MO PPHI 2 Dr Javed Bhuto MNCH, WHO 30 Dr Ashok Kumar MO PPHI 3 Dr Ali Raza Qadri PC, Save the Children 31 Dr. Gobind Ram MO PPHI 4 Duarka Das TRDP 32 Dr. Mohan Bhoopani MO PPHI 5 Abdul Jabar Sami Foundation 33 Dr Devi das MO PPHI 6 Dr Mahboob Ali Samejo ADSM, PPHI,UK 34 Dr Malook Oad MO PPHI 7 Mohammad Yousif Ex F & A 35 Dr Mansoor Ali Shah MO PPHI 8 Dr Talib Mangrio MO Govt 36 Dr Nasrullah MO PPHI 9 Dr Chetan Malhi MO Govt 37 Dr Mohan Lal MO PPHI 10 Dr Eassar Das MO Govt 38 Dr Nadir Ali MO PPHI 11 Dr Nand Lal MO Govt 39 Dr Ghandi Lal MO PPHI 12 Dr Qazi Samejo MO Govt 40 Dr Chetan Kolhi MO PPHI 13 Dr Shankar MO Govt 41 Dr. Mukesh Kumar MO PPHI 14 Dr Jeevraj MO Govt 42 Dr Kanji Mal MO PPHI 15 Dr Metha Ram MO Govt 43 Dr Gomoon Mal MO PPHI 16 Dr Khushal Das MO Govt 44 Dr Bhawani Shanker MO PPHI 17 Dr Ghansham Das MO Govt 45 Dr Hussna Bhatti FMO PPHI 18 Dr Vijay Kumar MO PPHI 46 Dr Shazia Asif FMO PPHI 19 Dr Bahadur Singh MO PPHI 47 Dr Naheed Akhtar FMO PPHI 20 Dr Teekam Das MO PPHI 48 Dr Devi Jagdesh FMO PPHI 21 Dr Santosh Kumar MO PPHI 49 Dr Anila Rawal FMO PPHI 22 Dr Mohammad Yousif MO PPHI 50 Dr Tahreem FMO PPHI 23 Dr Dalpat Rai MO PPHI 51 Dr Rana Shah FMO PPHI 24 Dr M Naeem MO PPHI 52 Dileep Kumar S.O 25 Dr Naresh Kumar MO PPHI 53 Abdul Rehman S.O 26 Dr Parshotam MO PPHI 54 Mohmmad Usman S.O 27 Dr Jai Parkash MO PPHI 55 Zulfiqar Ali Asst: Admn 28 Dr Vasdev MO PPHI 56 Hosh Mohammad Asst:

The following could not attend the meeting for the reasons stated against each:-

S # Names/Designation Reasons S # Names/Designation Reasons 1 Dr Sarwan Kumar C/L 2 Dr Madhan Rathi L.W.P

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L. HFs WITH PPHI

BHUs: 30 Dispensaries: 11 MCHCs: 01 Others: 0

TOTAL: 42

B. Population of the Catchments Area: 622,536

Y. STAFF STRENGTH

Sanctioned Government PPHI Vacant Working Posts (Govt.) Employees Contract (Sanc-Govt) Mos 39 11 28 43 32 WMO 0 0 0 FMOs 18 07 0 07 13 LHVs 31 39 10 29 21 Male 37 27 0 MTs/MAs 64 37 Female 0 0 0 Dispensers 2 32 0 32 2

Z. CLUSTERS OF HFs WITH ONE MO

WITH ONE FMO

Previous Month Total Month under Review Total Clusters of 5 HFs Clusters of 5 HFs Clusters of 4 HFs Clusters of 4 HFs Clusters of 3 HFs 01 Clusters of 3 HFs Clusters of 2 HFs 04 Clusters of 2 HFs 05 Single HFs 02 Single HFs 02

E. CAPACITY BUILDING

3. Sessions: During MRM

1st Session: Dr Ali Raza Qadri conducted session on “ANTENATAL CARE” and focused on the following points:-

• General Objective • Importance of Antenatal Care • Recommended Schedule for Antenatal Visits • Nutritional needs in pregnancy

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• Essentials of antenatal care • History Taking • Examination • Investigations • Assess Fetal Well Being • The Three Delays resulting in Maternal Deaths At 37 WEEKS • Key Messages

32. Capacity Building of LHVs / Dispensers During Month under Review

No. of Names of the Resource Persons with dates Date Venue Topic Participants

F. REVIEW OF THE PERFORMANCE (I) PREVENTIVE HEALTHCARE During Month under Review

1. Vaccination / Immunization

No. of Doses of Immunization Administered to Children at Health Facilities. No. of TT vaccines provided to pregnant / Child Bearing Age Women at Health Facilities. No. of Immunization & Vaccination Administered by outreach EPI Teams ---- Total vaccination / immunization for the month January 2012

2. National Immunization Days (`s) for Polio

Dates of NIDs Target of coverage Actual coverage Percentage of coverage

3. Other Preventive/Promotional Services

S # Service Number 1 Passive Case Detection (PCD) Slides 00 2 Active Case Detection (ACD) Slides 00 3 Visits to Check Sanitation (individual house holds + streets) -- 4 Notices issued against Poor Sanitation -- 5 Challans sent to Court against Poor Sanitation -- 6 Patients Nebulized --

(II) MOTHER, CHILD & REPRODUCTIVE HEALTH

During Month under Review

1. Female Health

S # Names of FMOs Ante-Natal Cases Neo-Natal Cases Other OPD Total OPD 1 Dr. Husna Bhatti 96 12 1182 1290

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2 Dr Naheed Akhtar 141 90 1191 1422 3 Dr Devi Jagdesh 467 34 1478 1979 4 Dr Anila Rawal 0 0 266 (ultrasound) 266 5 Dr Tahreem 63 25 352 440 6 Dr Rana Shah 128 13 1461 1602 Total 895 174 5930 6999

2. Deliveries Assisted

S # Service Number 1 Deliveries Assisted at HFs 79 2 Deliveries Assisted at Homes 00

3. Lab/ Diagnostic Tests

S # Test Number 1 Pregnancy Tests 196 2 Blood Sugar Tests 437 3 Hemoglobin Tests 263 4 Ultra Sound Test 266 5 Other (Sputum) 07

33. Important Discussion on Mother and Child and Reproductive Health during MRM

It was unanimously agree up that PHC services revolve around the mother & child healthcare. It was reiterated that all possible efforts would be taken to improve delivery in this area.

Provision of Family Planning Services during the Month

S # Name of the Items / Service Number 1 Consultation / Advice 566 2 Oral Pills 3 IUCDs 4 Injections 5 Others Total 566

(III) COMMUNITY PARTICIPATION During Month under Review

1. Number of Male SGs: 41 Number of Female SGs: 06

2. Performance of Social Organizers

Meetings of Support Groups CHSs/SHSs arranged by him Names of Social Organizers conducted by him Total No. of No. of Male Female No. Participants Participants Dileep Kumar 07 105 08 155 Abdul Rehman 08 112 07 133 Mohammad Usman 08 118 08 145 154

Total 23 335 23 433

4. School Health Sessions & Community Health Sessions

Community Health Session School Health Session Names of MO / Session Participants Children FMOs/Paramedics Session Examined Treated Dr Bahadur Singh 1 20 1 7 5 Dr Mukesh Kumar 1 16 1 0 0 Dr Easar Das 2 50 1 0 0 Dr Shanker Kumar 0 0 0 0 0 Dr Chetan Kolhi 1 29 1 0 0 Dr Gomoon 1 8 1 0 0 Dr Shanker 0 0 1 0 0 Dr Khushahal Das 1 30 1 0 0 Dr Talib Mangrio 1 30 1 0 0 Dr Chetan Kumar 1 19 1 0 0 Dr Parshotam Das 0 0 0 0 0 Dr Vijay Kumar 1 10 1 36 36 Dr Nandlal 1 30 1 0 0 Dr Qazi Samejo 1 26 1 0 0 Dr Gobind Ram, 1 12 1 3 3 Dr Ghansham 1 15 1 0 0 Dr Vasdev 1 31 1 0 0 Dr Metharam 2 36 1 0 0 Dr Bhawani Shanker 1 22 1 0 0 Dr Dalpat Rai 1 20 1 0 0 Dr Nasrullah 1 10 1 15 5 Dr Jeev raj 1 19 1 0 0 Dr Madhan Rathi 2 39 1 0 0 Dr Naresh Kumar 1 7 1 0 0 Dr Sarwan Kumar 1 30 1 0 0 Dr Teekam Das 0 0 1 8 5 Dr Gandhi 1 28 1 15 5 Dr Jai Parkash 1 3 1 8 8 Dr Naeem 1 10 1 0 0 Dr Kanji 1 22 1 10 7 Dr Naresh Kumar 2 13 1 0 0 Dr Mohan Bhoopani 1 10 1 10 10 Dr Santosh Kumar 1 12 1 0 0 Dr Ashok Kumar 1 20 1 23 10 Dr Mansoor Shah 4 71 1 0 0 Dr Devidas 1 12 1 0 0 Dr Nadir Ali 0 0 0 0 0 Dr Malook Oad 1 22 1 0 0 Dr M Yousif 1 26 1 0 0 Dr Mohan Rathore 1 11 1 0 0 Dr Shazia Asif 0 0 0 0 0 Dr Naheed Akhtar 1 16 1 23 2 Dr Anila Rawal 0 0 0 0 0

155

Dr Tahreem 4 116 0 0 0 Dr Devi Jagdesh 1 17 1 0 0 49 932 40 158 96

4. Important Points during Support Group Meetings.

• FMO, LHV & Dai needed • Vaccinator & Pathology Laboratory required • Ultra Sound facility be provided • Progress of Health Facility

5. Important Points during CHSs • Skin Disease • Malaria Prevention • Diarrhea Prevention • Water Diseases • Breast feeding is important for newly born baby. • Importance of EPI

34. Topics for SHSs for the Month

Sr. No. Topics 1

8 Topics for CHSs for the Month

S # Topics 1 Scabies 2 ARI 3 Measles 4 Polio

9. Important Discussion on Community Participation during MRM

10. Health Camps: Number Held: 0 Number of Patients: 0

11. Measures for improvement / provision of Services by other Department / Agencies

Sr No Description Recommendation To whom Present sent status I Sanitation ------Ii Drainage / sewerage ------Iii ……… drinking water ------Iv Prevention of adulteration ------V Tree Plantation ------Vi Roads and infrastructure ------Vii Environmental Improvement ------Viii Others ------

(IV) CURATIVE SERVICES DURING THE MONTH UNDER REVIEW

1. OPD* 156

New patients treated Old patients treated Total OPD during the during the month during the month month (New + Old) 59217 1518 60735

2. Maximum OPD** Minimum OPD**

S # BHU OPD BHU OPD

1 BHU Shadi Palli 4352 BHU Siddique Abro 579 2 BHU Mendre jo Par 3285 BHU Dilawar Hussain 698 3 BHU Ghulam Nabi Shah 2979 BHU Sanwan Rajar 739 4 BHU Saleh Banbhro 2261 GD Ahmedabad 755 5 GD Muzafar 2152 BHU Fateh M Rajar 764

3. Top Five Diseases Treated during School Health Sessions/Camps

S # Diseases No. of Patients 1

*All HFs — BHUs and others. **Reflects OPD at BHUs only — not at other HFs.

4. Top Five Diseases During OPD

S # Disease No. of Patients 1 ARI 10551 2 Fever 5299 3 Diarrhea 4510 4 Pneumonia 2997 5 Scabies 2674

35. ARV / ASV used during the month

No. of Patients Dog bite cases reported 130 ARV Administered 130 ARV Available Doses 163 (Patients) Snake bite cases reported 00 ASV Vaccine Administered 00 ASV Vaccine Available Doses 00

41. Lab / Diagnostic Tests: Includes Tests Reported at No. (II) (Mother, Child & Reproductive Health) 3. (Lab / Diagnostic Tests)

S # Tests Number

157

1 Pregnancy Tests 196 2 Blood Sugar Tests 437 3 Hemoglobin 263 4 X-Rays (if available) N/A 5 Ultra Sound 266 6 Sputum 7 7 Others (Lab test) 1135

42. B & C SCREENING TESTS

No. of No. of cases No. of cases Total referred Follow up Screening Tests found referred for upto date result Performed positive treatment Hepatitis B N/A N/A N/A N/A N/A Hepatitis C N/A N/A N/A N/A N/A

43. TUBERCLOSIS

Patients New Cases During Under Diagnosis Receiving Treatment the Month 51 08 00

9. Referrals

Sr. Totals Cases Referred To 1 TB DOT Deliveries Others RHCs THQs DHQs 2 0 0 00 0 0 0 0

10. Inverse Referrals

Sr. Totals Cases Referred from 1 ARV ASV Others RHCs THQs DHQs 2 00 00 0 0 00 00 00

G. MONITORING DURING MONTH UNDER REVIEW

13. Monitoring Visits during the month

DSM ADSM/ Executive Monitoring Other Staff Total 35 53 161 249

2. Important Points/Issues arising from Visits

S # Name of HF Issue Action Remarks 1

H. AVAILABILITY OF MEDICINES/MEDICAL MATERIALS

1. Medicines available for 43 Weeks

158

2. Important Issues raised relating to Medicines, etc. during MRM • Monthly medicine supplied at all the health Facilities • Health facility wise, monthly medicine consumption and per patients cost were shared with doctors.

I. REPAIR / MAINTENANCE / ELECTRIFICATION OF / AT HFS

Description of Repair / Maintenance incl. Status / S # Name of HFs Electrification Remarks Tiles Work, Colour, Repair, Carpenter, Plumbering & 1 BHU Rana Jagir Complete Electrification Tiles Work, Co lour, Repair, Carpenter, Pulmbering 2 BHU Aahori Farm Complete & Electrification 3 BHU Kharoro Syed Tiles Work, Co lour, Repair, Carpenter & Pulmbering Complete Tiles Work, Co lour, Repair, Carpenter, Pulmbering 4 BHU Moula Bux Rajar Complete & Electrification Tiles Work, Co lour, Repair, Carpenter, Pulmbering 5 MCH Umerkot Complete & Electrification 6 BHU Digu Co lour, Repair, Carpenter & Pulmbering Complete 7 BHU Samaro Road Co lour, Repair, Carpenter & Pulmbering Complete Tile work, Co lour, Repair, Carpenter, Pulmbering & 8 BHU Kunri Memon Complete Electrification 9 BHU Sanwan Rajar Tile work, Co lour, Repair, Carpenter & Pulmbering Complete Tile work, Co lour, Repair, Carpenter, Pulmbering & 10 BHU Pir Sarhandi Complete Electrification 11 BHU Faqir Ali Bux Halepoto Tile work, Co lour, Repair, Carpenter & Pulmbering Complete 12 GD Muzafer Hussain Shah Tile work, Co lour, Repair, Carpenter & Pulmbering Complete 13 GD Amin Rajar Tile work, Co lour, Repair, Carpenter & Pulmbering Complete 14 BHU Nabisar Thar Tile work, Co lour, Repair, Carpenter & Pulmbering Complete 15 BHU Fateh M.Rajar Tile work, Co lour, Repair, Carpenter & Pulmbering Complete 16 BHU Toban Veri Tile work, Co lour, Repair, Carpenter &n Pulmbering Complete 17 BHU Haji Pir Shah Tile work, Co lour, Repair, Carpenter & Pulmbering Complete 18 BHU Siddique Abro New Roof, Co lour, Repair, Carpenter & Pulmbering Complete 19 BHU Saleh Bhanbhro Co lour, Repair, Carpenter & Pulmbering Complete Work started Tile work, Co lour, Repair, Carpenter & 20 BHU Mehinry Jo Par Complete Pulmbering 21 BHU Abdul Hakim Aresar Repair, Tile work, Plumbering & Colour Complete 22 BHU Nawaz Ali Shah Repair, Tile work, Plumbering & Colour Complete 23 BHU Mohd. Hussain Gujrati Repair, Plumbering & Colour Complete 24 GD Sajan Khan Chandio Repair, Tile work, Plumbering & Colour Complete 25 G.D Moosa Jan Sarhandi Repair, Tile work, Plumbering & Colour Complete 26 BHU Araro Bhurgri Repair, Tile work, Plumbering & Colour Complete Co lour, Repair, Carpenter, Pulmbering & 27 BHU Dilawar Hussain Shah Complete Electrification 28 GD Noor Mohammad Mangrio Colour, Repair, Tile, Carpenter & Pulmbering. Complete Colour, Repair, Tile, Carpenter & Pulmbering & 29 GD Ismail Nohri Complete Electrification Colour, Repair, Tile, Carpenter & Pulmbering & 30 BHU Darelo Complete Electrification Colour, Repair, Tile, Carpenter & Pulmbering & 31 BHU Padheri Farm Complete Electrification 32 GD Maghan Khan Chandio Tiles Work, Colour, Repair, Carpenter & Plumbering complete 159

33 BHU Talhi Tiles Work, Colour, Repair, Carpenter & Plumbering complete 34 BHU Ghulam Nabi Shah Tiles Work, Colour, Repair, Carpenter & Plumbering Revised 35 BHU Shadi Pali New Roof, Co lour, Repair, Carpenter & Pulmbering Revised 36 GD Ahmedabad In Progress Revised Work In Progress 37 BHU Okraro Chanio In Progress Incomplete 38 BHU Mir Din Mohd In Progress Incomplete

Inspections / Visits of PPHI HFs

Visitors* Health Facilities Visited Overall Comments ------

* To reflect only non-PPHI Visitors.

J- DISCUSSION DURING MRM

On Staff Matters: • Health Facilities Timings should be followed strictly. On Preventive Health: • School Health Sessions, Community Health Sessions & CSG meetings will continuously be monitored by Monitoring staff. On Curative Health: • The chair emphasized the importance the presence of the doctor at the health facility which will ensure the provision of curative service in the true sense of the word. • Mother, Child & Reproductive Health: • It was shared with the participants that inclusion of quite a few female technical staff has further strengthened the human resource present at the health facility for provision of healthcare services to the female segment of the population .moreover, conversion of three health facilities into the 24 hour running MCHCs has also started picking the pace towards alleviating the sufferings of female folk. Other Matters:

Date /Time for Next MRM: June 08, 2012 at 10:00 am

Comments on Targets vs. Achievements (by DSM) • R & R work of two more health facilities will be completed soon.

160

MINUTES OF THE (45th ) MONTHLY REVIEW MEETING OF DISTRICT LARKANA

Monthly Review Meeting (MRM) of PPHI, District Larkana for the month of April, 2012 was held on 12th May, 2012 at hotel Bar B.Q Tonight. Written invitations to participate were sent to the DCO, EDO (H), EDO (F&P), Distt. Population Welfare Officer, WHO representative, Dy.Dir. Malaria and District In charges of EPI, LHW and all other National Programs. The list of participants is as follows:

List of Participants:

S # Names/Designation S # Names/Designation

1 Mr. Ghulam Abbas Detho, RPD-III 2 Mr. Abdul Hafeez Mahesar, DSM- Lrk

3 Mr. Ashfaque Hyder Abbasi, DPWO 4 Dr.Mohammad Idress MO (HQ) 5 Dr. Mohammad Ali MO. 6 Mr. Gada Hussain Chachar, SO I. 7 Mr. Khalid Hussain, SO. II 8 Mr.Sarfraz Ahmed Asstt: F&A 9 Mr. Amir Ali, Asstt: Store 10 Mr. Farhan Ahmed, Asstt: Admin 11 Dr. M. Younis khuhro, MO 12 Mr. Mohammad Ali, SO III 13 Dr. Abdul Matab Jatoi, MO 14 Dr. Farman ali Abro , MO 15 Dr. Attahullah Jagirani, MO 16 Dr. Mumtaz Ali Bhutto, MO 17 Dr. Asadullah Gopang, MO 18 Dr. M.Hanif Dhamraho, MO 19 Dr. Jamil ahmed Brohi, MO 20 Dr. Ahsanullah Bugti, MO 21 Dr. S Baleegh Din Rashidi, MO 22 Dr. Bashir Ahmed Wagan, MO 23 Dr. M. Afzal Odho, MO 24 Dr. Abdul Razaque Rahujo, MO 25 Dr. M.Hanif Mashori , MO 26 Dr. Badar Din Channo, MO 27 Dr.Mahesh Kumar , MO 28 Dr. Jai Kumar , MO 29 Dr. Baqa Muhammad , MO 30 Dr. Ganesh Lal , MO 31 Dr. Imdad Hussain Lashari, MO 32 Dr. Zafar Ali Tunio, MO 33 Dr. M.Ali shaikh, MO 34 Dr. Mukhtiar Ali Chann, MO o 35 Dr. Raj Kumar , MO 36 Dr. Aijaz Ali sheikh, MO 37 Dr. Khuda Bux Soom, MO 38 Hakeem Razakat Ali, MO 39 Dr. Abdullah Arijo, MO 40 Dr. Altaf Khokhar , MO 41 Dr. Nisar Kandhro, MO 42 Dr. Nabi Dino Bludi, MO 43 Dr. Altaf Abro, MO 44 Dr. Tarique Altaf Jatoi, MO 45 Dr. Abdul Aziz Siyal, MO 46 Dr. Shamsdin Sohu, MO 47 Dr. Abdul Rehman Shaikh, MO 48 Dr. Amanullah Abro , MO 49 Dr. Muzafar Ali Bhutto , MO 50 Dr. Mushtaque Ahmed , MO 51 Dr. Maqsood Wadho, MO 52 Dr. M.Aslam Soomro , MO 53 Dr. Zafar Ali Morio, MO 54 Dr. Rahim Bux Soomro, MO 55 Dr. Salma Soomro , FMO 56 Dr. Afroz Memon , FMO 57 Dr. Dur-e- Najaf , FMO 58 Dr. Kashifa Ayaz, FMO 59 Dr. Qurtlain Soomro , FMO 60 Dr. Bilqees Khokhar , FMO 61 Dr. Raksana Bughio, FMO 62 Dr. Noor Jahan Abasi, FMO 63 Dr. Shazia Ambreen , FMO 64 Dr. Zaib Nisa Bhutto, FMO 65 Dr. Farzana Shaikh, FMO 66 Dr. Aziz Akhtar , FMO 67 Dr. Sanam Asia , FMO 68 Dr. Farzana Tunio, FMO 69 Dr. Shazia Rehman , FMO 70 Dr. Rozina Shah , FMO 71 Dr. Aneeta Raj, FMO 72 Dr. Musrat Sandano, FMO 73 Dr. Hajira Nadeem , FMO 74 Dr. Farzana Balouch, FMO 75 Dr. Haseena shaikh, FMO 76 Dr. Seeema kousar , FMO

161

77 Mst. Rani, LHV 78 Mst. Noor Shaheen , LHV 79 Mst. Rashida solangi, LHV 80 Mst. Shahida Lashari, LHV 81 Mst. Humera parveen, LHV 82 Mst. Habiba Bughio, LHV 83 Mst. Samina Bhutto, LHV 84 Mst. Rozina Brohi, LHV 85 Mst. Mehtab Mangi, LHV 86 Mst. Shazia Khuhro , LHV 87 Mst. Bashira chandio, LHV 88 Mst. Sajida Bhutto , LHV 89 Mst. Shabana , LHV 90 Mst. Saima Shah , LHV

The following could not attend the meeting for the reasons stated against each:-

S # Names/Designation Reasons S # Names/Designation Reasons 1 Dr. Zakir Hussain Khoso, MO C/L 2 Dr. Sabeen Naz, FMO Absent 3 Dr. Jawahar Sheeraz, FMO C/L 4 Dr. Nusrat Wagan,FMO C/L 5 Dr. Khadeja Makkiah, FMO C/L 6 Dr. Asma Abbasi C/L 7 Ms. Zubeda Mugheri-LHV Absent 8 Ms. Rohee Bano-LHV Absent 9 Ms. Yasmeen Shaik-LHV Absent 10 Mst. Feroza Pirzado, LHV LWP 11 Mst. Sumera Kanwal,LHV Absent 12 Ms. Nuzhat Qazi Absent 13 Ms. Azra Kanasri-LHV Absent 14 Mst. Rehana Brohi, LHV LWP 15 Ms. Nafees Fatima -LHV Absent 16 Mst. Benazir Junejo-LHV Absent 17 Mst. Saima Maryam, LHV Absent 18 Mst. NAveeda , LHV Absent 19 Mst. Zahida Magsi, LHV Absent 20 Mst. Tasleem, LHV Absent 21 Mst. Saima Mughal, LHV Absent 22 Mst. Razia Begum, LHV Absent

M. HFs WITH PPHI

BHUs: 27 Dispensaries: 19 MCHCs: 00 Others: 01

TOTAL: 47 B. Population of the Catchments Area:

S # Name of Health Facility Population 1 BHU SAJAN SANGI 32,034 2 BHU AKIL 21,300 3 BHU SHAH ABAD 33,280 4 BHU BEERO CHANDIO 26,500 5 BHU MASOODERO 15,200 6 BHU KHAN WAH 20,000 7 BHU IZAT JI WANDH 7,836 8 BHU LASHARI 24,000 9 BHU WARIS DINO MACHI 9,484 10 BHU JUMO AGHAM 15,000 11 BHU PATHAN 29,000 12 BHU NEW GUD 45,000 13 BHU BAKHAR KARIRA 12,710 14 BHU SONO JATOI 55,000 15 BHU KOTHI 30,000 16 BHU PIR BUX BHUTTO 24,800 17 BHU SAIDUDERO 12,250 18 BHU WASAYO BHUTTO 9,135

162

19 BHU VEEHAR 30,000 20 BHU KARANI 31,000 21 BHU MAD BAHOO 26,355 22 BHU DHAMRAH 38,341 23 BHU HAJI DHADHRO 5,000 24 BHU FATEHPUR 15,000 25 BHU MOEN JO DARO 34,713 26 BHU SEEHAR 23,316 27 BHU USMAN KALHORO 23,119 28 GD RASHID WAGAN 23,418 29 GD BAQAPUR 14,000 30 GD KANGA 17,409 31 GD AGHANI 12,240 32 GD DODO SANHERI 5,000 33 GD AREEJA 10,000 34 GD PANJODERO 25,200 35 GD ABAD BHUTTO 4,666 36 GD KOT BHUTTO 10,500 37 GD KETI MUMTAZ 2,000 38 GD SHAHANI 3,080 39 GD KHAIRODERO 10,000 40 GD MEHAR BURIRO 4,300 41 GD GUJHAR 4,078 42 GD LAL BUX SHAIKH 34,731 43 GD TATRI 41,500 44 GD MANGRIA 18,000 45 GD HESSAB CHANDIO 30,000 46 GD BAHMAN 1,550 47 GD MAHOTA 18,155 Total: 9,39,200

AA. STAFF STRENGTH

Sanctioned Government PPHI Vacant Working Posts (Govt.) Employees Contract (Sanc-Govt) MOs 45 16 30 52 07 WMO 0 0 0 FMOs 28 24 0 24 4 LHVs 42 32 8 25 11 Male 9 9 0 MTs/MAs 33 24 Female 0 0 0 Dispensers 52 42 28 25 10

BB. CLUSTERS OF HFs

163

WITH ONE MO

WITH ONE FMO

Previous Month Total Month under Review Total Clusters of 5 HFs Clusters of 5 HFs Clusters of 4 HFs Clusters of 4 HFs Clusters of 3 HFs Clusters of 3 HFs Clusters of 2 HFs 18 Clusters of 2 HFs 18 Single HFs 06 Single HFs 06

E. REVIEW OF THE PERFORMANCE (I) PREVENTIVE HEALTHCARE During Month under Review

1. Vaccination / Immunization

No. of Doses of Immunization Administered to Children at Health Facilities. 396 No. of TT vaccines provided to pregnant / Child Bearing Age Women at Health Facilities. 60 No. of Immunization & Vaccination Administered by the outreach EPI Teams 0 Total vaccination / immunization for the month November 456

2. National Immunization Days (NIDs) for Polio

Actual Percentage of Dates of NIDs Target of coverage coverage coverage Nil Nil Nil Nil

3. Other Preventive/Promotional Services

S # Service Number 1 Passive Case Detection (PCD) Slides -- 2 Active Case Detection (ACD) Slides -- 3 Visits to Check Sanitation (individual house holds + streets) -- 4 Notices issued against Poor Sanitation -- 5 Challans sent to Court against Poor Sanitation -- 6 Patients Nebulized --

(II) MOTHER, CHILD & REPRODUCTIVE HEALTH

During Month under Review

164

1. Female Health

S.No Name of FMOs Antenatal Post Natal Other Total OPD 1 Dr. Kashafa Ayaz 50 9 171 224 2 Dr. Afroz Memon 44 23 18 85 3 Dr. Farzana Tunio 13 40 32 85 4 Dr. Shazia Abbasi 213 58 148 419 5 Dr. Qurtlain Soomro 96 30 177 303 6 Dr. Zaib Nisa Bhutto 17 11 30 58 7 Dr. Nusrat Wagan 61 14 45 120 8 Dr. Sanam Asia 91 30 300 421 9 Dr. Khadeja Makkiah 108 25 100 233 10 Dr. Aneeta Raj 42 0 90 132 11 Dr. Sabeen Naz 29 8 323 360 12 Dr. Shazia Rehman 40 20 43 103 13 Dr. Farzana Balouch 91 5 356 452 14 Dr. Bilqees 15 5 250 270 15 Dr. Seema Kousar 15 6 93 114 16 Dr. Jawahar Sheeraz 73 7 430 510 17 Dr. Aziz Akhtar 178 21 29 228 18 Dr. Dur-e- Najaf 73 8 55 136 19 Dr. Farzana Shaikh 131 3 150 266 20 Dr. Ruksana Bughio 100 75 0 175 21 Dr. Musrat Nazir 210 10 30 250 22 Dr. Asma Abbasi 63 10 200 273 23 Dr. Rozina Shah 32 0 0 32 24 Dr. Salma Soomro 40 13 32 85 Total: 2058 927 3134 5334

2. Deliveries Assisted

S # Service Number 1 Deliveries Assisted at HFs 80 2 Deliveries Assisted at Homes 00

3. Lab/ Diagnostic Tests

S # Test Number 1 Pregnancy Tests 508 2 Blood Sugar Tests 1089 3 Hemoglobin Tests 314 4 Ultra Sound Test 3258 5 Other (Malaria) 00

36. Important Discussion on Mother and Child and Reproductive Health during MRM

Discussions were carried out by the participants with the guest speakers.

37. Provision of Family Planning Services during the Month

165

S # Name of the Items / Service Number 1 Consultation / Advice 1168 2 Oral Pills 5964 3 IUCDs 00 4 Injections 00 5 Others (Condoms) 450 Total 7582

(III) COMMUNITY PARTICIPATION During Month under Review

1. Number of Male SGs: 47 Number of Female SGs: 00

2. Performance of Social Organizers

Names of Social Meetings of Support Groups CHSs/SHSs arranged by him Organizers conducted by him Total No. of No. of Male Female No. Participants Participants Mr. Gada Hussain Chachar 03 0 90 02 85 Mr. Khalid Hussain 02 0 65 03 112 Abro Mohammad Ali 02 0 45 07 152 Total 07 0 200 12 349

2. School Health Sessions & Community Health Sessions

Community Health Session School Health Session TOTA NAME OF S.No NO: TOTAL TOTAL NO: L TOTAL FMOs/MOs SESSIO PARTICIPA OPD/TREA SESSIO PARTI OPD/TRE N NTS TMENT N CIPAN ATMENT TS 1 Dr. Khadeja Makkiah 1 60 45 0 0 0 2 Dr. Bilqees Khokhar 2 50 5 0 0 0 3 Dr. Musrat Nazir 1 22 11 1 30 0 4 Dr. Dur-e-Najaf 2 105 72 2 100 42 5 Dr. Shamsdin Sohu 1 40 16 1 70 50 6 Dr. Farzana Shaikh 3 85 45 0 0 0 7 Dr. Shazia Rehman 1 8 0 1 18 0 8 Dr. Asma Abbasi 2 58 28 2 53 12 9 Dr. Qurtlain Soomro 1 15 0 2 94 0 10 Dr. Sabeen Naz 2 45 0 1 30 0 11 Dr. Nusrat Wagan 2 41 20 2 35 18 12 Dr. Aziz Akhtar 2 107 60 2 135 45 13 Dr. Shazia Abbasi 2 61 50 2 46 10 14 Dr. Zaib Nisa Bhutto 2 60 32 2 120 55 15 Dr. Ruksana Bughio 2 65 18 0 0 0

166

16 Dr.Jawahr Sheeraz 2 35 0 0 0 0 17 Dr. Farzana Balouch 1 28 19 1 113 70 18 Dr. Afroz Memon 1 30 20 2 60 30 19 Dr. Seema Kousar 2 57 51 2 52 25 20 Dr. Farazana Tunio 2 21 5 2 36 14 21 Dr. Rozina Shah 2 65 20 2 90 70 22 Dr. Sanam Asia 2 105 30 2 144 12 23 Dr. Kashifa Ayaz 2 52 13 2 33 10 24 Dr. Aneeta Raj 0 00 00 1 132 0 25 Dr. Nabi Dino Bluudi 0 00 00 2 67 21 26 Dr. Ahsanullah Bugti 0 00 00 1 30 0 40 1215 560 35 1488 484

4. Important Points during Support Group Meetings. • Polio Campaign discussed • Diagnostic Laboratory • Medicine quality and quantity. • EPI Coverage were discussed • Ultra sound facility days • FMO days at HFs also discussed • Security and ownership of community.

38. Important Points during SHSs • Scabies • Cough • Diarrhea • Influenza Virus • Nutrition • Respiratory trait Infection and Asthma • Personal Hygiene • Pneumonia • Malaria

39. Important Points during CHSs • Dysfunctional Uterine Bleeding DUB • Scabies • Rabies virus Tuberculosis • Antenatal Care • Pelvic Inflammatory Diseases • Importance of Vaccinations • Conjunctivitis (Red Eye) • Low Birth weight Newborn • Family Planning • Diet in Pregnancy • U/S Examination During Pregnancy • Lactating Mother • Postpartum Hemorrhage.

167

• Urine Tract Infection • Vomiting • Anemia • Intestinal Tuberculosis • Constipation • Vomiting • Cough • Acute Diarrhea • Influenza Virus • Nutrition • Respiratory trait Infection and Asthma • Personal Hygiene. • Pneumonia • Malaria.

7. Topics for SHSs for the Month

Sr. No. Topics 1 Scabies 2 Malaria 3 Importance of Vaccinations 4 Acute Diarrhea 5 Nutrition 6 Personal Hygien 7 Cough

8. Topics for CHSs for the Month

S.No Topics 1 Dysfunctional Uterine Bleeding DUB 2 Scabies 3 Rabies virus Tuberculosis 4 Antenatal Care 5 Pelvic Inflammatory Diseases 6 Importance of Vaccinations 7 Conjunctivitis (Red Eye) 8 Low Birth weight Newborn 9 Family Planning 10 Diet in Pregnancy 11 U/S Examination During Pregnancy 12 Lactating Mother 13 Postpartum Haemorrage 14 Urine Tract Infection 15 Vomiting 16 Anemia 17 Intestinal Tuberculosis 18 Constipation

168

19 Vomiting 20 Cough 21 Acute Diarrhea 22 Influenza Virus 23 Nutrition 24 Respiratory trait Infection and Asthma 25 Personal Hygiene 26 Pneumonia 27 Malaria

9. Important Discussion on Community Participation during MRM

• Most of the Participants acknowledged PPHI role to provide basic health facilities in rural areas for poor community at free of cost. • Community participation through community support groups also the role model of PPHI. • Repair and Renovation of Health facilities and other facilities provided at Health facilities by PPHI also appreciated by participants.

10. Health Camps: Number Held: 00. Number of Patients: 00.

11. Measures for improvement / provision of Services by other Department / Agencies

Sr No Description Recommendation To whom Present sent status I Sanitation N/A N/A N/A Ii Drainage / sewerage N/A N/A N/A Iii ……… drinking water N/A N/A N/A Iv Prevention of adulteration N/A N/A N/A V Tree Plantation N/A N/A N/A Vi Roads and infrastructure N/A N/A N/A Vii Environmental Improvement N/A N/A N/A Viii Others N/A N/A N/A

(IV) CURATIVE SERVICES DURING THE MONTH UNDER REVIEW

1. OPD*

New patients treated Old patients treated Total OPD during the during the month during the month month (New + Old) 107248 0 107248

2. Maximum OPD** Minimum OPD**

S # BHU/GD OPD BHU/GD OPD 1 BHU Pir Bux Bhutto 3604 GD Keti Mumtaz 704 2 BHU Pathan 3346 GD Areeja 800 3 BHU Dhamrah 3354 BHU Wasayo Bhutto 1322 4 GD Tatri 3168 BHU Khan Wah 1326 5 BHU Veehar 3101 BHU Haji Dhadhro 1501

169

3. Top Five Diseases Treated during School Health Sessions/Camps

S # Diseases No. of Patients 1 Scabies 512 152 2 Malaria 3 ARI 25 4 Diarrhea 55 5 Cough 30

*All HFs — BHUs and others. **Reflects OPD at BHUs only — not at other HFs.

4. Top Five Diseases during OPD

S # Disease No. of Patients 1 Fever (Clinical Malaria) 2564 2 Acute Respiratory Infections 13943 3 Scabies 8210 4 Diarrhea 512 5 Dysentery 12

3. ARV / ASV used during the month

No. of Patients Dog bite cases reported 235 ARV Administered 235 ARV Available Doses 112 Snake bite cases reported 0 ASV Vaccine Administered 0 ASV Vaccine Available Doses 50

44. Lab / Diagnostic Tests: Includes Tests Reported at No. (II) (Mother, Child & Reproductive Health) 3. (Lab / Diagnostic Tests)

S # Tests Number 1 Pregnancy Tests 69 2 Blood Sugar Tests 21 3 Hemoglobin 23 4 X-Rays (if available) 00 5 Ultra Sound 3258 6 Others (Malaria) 13

45. B & C SCREENING TESTS

No. of Tests No. of cases No. of cases referred Total referred Follow up Screening Performed found positive for treatment upto date result Hepatitis B 50 01 01 01 No 50 10 10 10 No Hepatitis C

170

8. TUBERCLOSIS

Patients New Cases During Under Diagnosis Receiving Treatment the Month 02 0 07

9. REFERRALS

S.No Totals Cases Referred To 1 TB DOT Deliveries Others RHCs THQs DHQs 2 No No No No No No No 3 No No No No No No No 4 No No No No No No No

10. Inverse Referrals

S.No Totals Cases Referred from 1 ARV ASV Others RHCs THQs DHQs 2 No No No No No No No 3 No No No No No No No

G. MONITORING DURING MONTH UNDER REVIEW

1. Monitoring Visits during the month

DSM Executive Monitoring Other Staff Total 45 40 138 223

2. Important Points/Issues arising from Visits

S # Name of HF Issue Action Remarks N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

H. AVAILABILITY OF MEDICINES/MEDICAL MATERIALS

1. Medicines available for 30 Weeks

2. Important Issues raised relating to Medicines, etc. during MRM

I. REPAIR / MAINTENANCE / ELECTRIFICATION OF / AT HFS

Description of Repair / S # Name of HFs Status / Remarks Maintenance incl. Electrification Repair of Electric Motor/ 03 Ceiling Working condition. 1 BHU Beero Chandio fans. 2 BHU Sono jatoi Repair/winding electric motor. Working condition.

171

3 GD Aghani Repaired of Hand pump/ Water tank. ======4 BHU/MCHC Dhamrah Repair of two iron beds. ======5 BHU Veehar Repair of Electricity 6 BHU Usman Kalhoro Repair of Electricity.

Inspections / Visits of PPHI HFs

Visitors* Health Facilities Visited Overall Comments N/A N/A N/A N/A N/A N/A * To reflect only non-PPHI Visitors.

J- DISCUSSION DURING MRM

On Staff Matters: • All the staff members of BRHF’ were once again reminded to observe timings in their health facilities. • Always wear aprons/ uniforms which have been already provided. • Observe/ ensure cleanliness in their health facilities. • Maintenance of proper record keeping • Ensure availability of all essential medicines. • Ensure availability of instruments in working condition. • Submitted DHIS reports timely. • Submitted Medicine position/Stock position timely.

On Preventive Health: • All the Medical Officers/ Female Medical Officers were informed that Family Planning material / medicine are available in abundant quantity and they should promote its usage. • It was also requested that ensure availability of T. B DOTS medicine and wherever there is shortage, inform DSU immediately. On Curative Health:

All the Medical Officers were informed that there is sufficient stock of medicines available in DSU store and they should report immediately for any kind of shortage

On Mother, Child & Reproductive Health: N/A

Other Matters:

Matters regarding supply of medicines, repair of buildings, provision of uniforms, and other items were also discussed during the monthly meeting.

Date /Time for Next MRM:

Next MRM will be held on first week of June, 2012

Comments on Targets vs Achievements (by DSM) All the targets/goals and assignments from time to time are being achieved for successful continuation of this program and for the satisfaction of the community.

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MINUTES OF THE 22th MONTHLY REVIEW MEETING OF DISTRICT GHOTKI @ MIRPUR MATHELO

Monthly Review Meeting of District, Ghotki @ Mirpur Mathelo for the Month of April, 2012 was held on 10th May, 2012 at DC Committee Hall Mirpur Mathelo. Written invitations to participate were sent to the DC, the DHO, the EDO (F&P) and District Incharge of EPI, LHW and all other National Programs as usual. The list of participants follows:

List of Participants:

S # Names Designation Names Designation 1 Mr. Danish Afzal DSM Dr. Imtiaz Ahmed Mirani M.O 2 Mr. Muhammad Ilyas Executive (M&E) Dr Ghulam Mujtaba MO 3 Mr. Ahsan Masood Executive (F&A) Dr. Fassiuddin M.O 4 Dr. Tulsi Das Makhija Cardiologist Dr Altaf hussain Dental Surgeon 5 Dr. Zakir Hussain Cardiologist Dr. Majid Rahim M.O 6 Dr. Suresh Kumar Ultrasound Specialist Dr. Amna FMO 7 Dr Raj Batra Anesthetist Dr Ihsan Ali M.O 8 Dr Qadeer Anesthetist Dr Nazir Ahmed Malik M.O 9 Dr Qadir Bux General Surgeon Dr. Mukesh Kumar ENT Specialist 10 Dr. Asma Samreen Dental Surgeon Dr Suneel Kumar M.O 11 Dr Shazia Shakeel Dental Surgeon Dr Pershotam Dental Surgeon 12 Dr.Irfan Baloch Orthopedic Surgeon Dr Altaf Dental Surgeon 13 Dr. Abdul Latif M.O Dr. Imtiaz Shaikh General Surgeon 14 Dr. Nazir Ahmed M.O Dr. Mumtaz Ahmed Peadiatrician 15 Dr. Ghulam Rasool M.O Dr. Qurat-ul-Ain Shahani Gynecologist 16 Dr. Nisar Ahmed Soomro M.O Dr. Afsana Zulfiqar FMO 17 Dr. Shah Pasand Mahar M.O Dr. Sania FMO 18 Dr Sajjad Hussain M.O Dr Hina FMO 19 Dr. Umesh Kumar M.O Dr Samina Shaikh Sonologist 20 Dr. Amar Lal M.O Dr Shanker Lal MO 21 Dr. Sanaullah Kolachi M.O 22 Dr. Moizuddin Jatoi M.O 23 Dr. Zulfiqar Ali Shah M.O 24 Dr. Parshotam Lal M.O 25 Dr. Imran Hussain M.O 26 Dr. Bashir Ahmed Bhutto M.O 27 Dr. Amanullah Mahar M.O 28 Dr. Gh. Sarwar Mahar M.O 29 Dr. Asif Hakeem M.O 30 Dr. Sadia Nisar Memon FMO 31 Dr. Yasmeen Chachar FMO 32 Dr. Samina Asif FMO 33 Dr. Atiya Zafar FMO 34 Dr. Rashida Shaikh FMO 35 Dr. Salma Qureshi FMO 36 Dr. Roopa FMO 37 Dr. Rabia Raheem FMO 38 Dr. Rahat Shakeel FMO 39 Dr Rabia Rahim FMO

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All the MOs / WMOs / FMOs attended the meeting, except the following, for reasons mentioned against each: Designation Reasons for S # Names absence 1 Raj Kumar Anesthetist 2 Dr Yakoob Maher MO 3 Dr Zakir Baloch Cardiologist 4 Dr. Rafique Ahmed Shaikh M.O 5 Dr Shazia Shakeel Dental Surgeon

A. HFs WITH PPHI BHUs: 31 Dispensaries: 10 RHC: 03 DCDs: 7 TOTAL: 51

B. Population of the Catchment Area: 10,97,544

CC. STAFF STRENGTH

Government PPHI Sanctioned Posts Working Vacant Employees Contract MOs 45 27 1 26 19 W/FMOs 45 13 0 13 32 LHVs 10 12 3 9 1 MTs/HTs 70 62 50 12 8 Dispensers 24 5 5 0 19

DD. CLUSTERS OF HFs

WITH ONE MO

Previous Month Month under Review Total at Present Clusters of 6 HFs - Clusters of 6 HFs - Clusters of 5 HFs - Clusters of 5 HFs - Clusters of 4 HFs - Clusters of 4 HFs - Clusters of 3 HFs - Clusters of 3 HFs - Clusters of 2 HFs 04 Clusters of 2 HFs 04 Single HFs 22 Single HFs 22

WITH ONE FMO

Previous Month Month under Review Total at Present Clusters of 5 HFs - - Clusters of 6 HFs ( Ultrasound) Clusters of 4 HFs - Clusters of 4 HFs - Clusters of 3 HFs - Clusters of 3 HFs - Clusters of 2 HFs 9 Clusters of 2 HFs 07 Single HFs 4 Single HFs 06

E. CAPACITY BUILDING

1. First Session: During MRM

174

Dr:Tulsi Das (Cadiologist) conducted the session on the topic the management of cardio patient after Open Heart Surgery.

2. Second Session: During MRM Nil

40. Capacity Building of LHVs / Dispensers During Month under Review

No. of Names of the Resource Persons with dates Date Venue Topic Participants Nil Nil Nil Nil Nil

F. REVIEW OF THE PERFORMANCE (I) PREVENTIVE HEALTHCARE During Month under Review

1. Vaccination / Immunization

No. of Doses of Immunization Administered to Children at Health Facilities. 2659 No. of TT vaccines provided to pregnant / Child Bearing Age Women at Health Facilities. 1152 No. of Immunization & Vaccination Administered by outreach EPI Teams 6098 Total vaccination / immunization for the month December -2011 9909

2. National Immunization Days (NIDs) for Polio

Percentage of Dates of NIDs Target of coverage Actual coverage coverage 21,22,23 April - - -

3. Other Preventive/Promotional Services

S # Service Number 1 Passive Case Detection (PCD) Slides 10 2 Active Case Detection (ACD) Slides 0 3 Visits to Check Sanitation (individual house holds + streets) 27 4 Notices issued against Poor Sanitation - 5 Challans sent to Court against Poor Sanitation 10 6 Patients Nebulized 368

(II) MOTHER, CHILD & REPRODUCTIVE HEALTH During Month under Review

S # Names of FMOs Ante-Natal Cases Neo-Natal Cases Other OPD Total OPD 1 Dr. Rabia Raheem 172 0 919 1091 2 Dr. Roopa 5 0 836 841 3 Dr. Rashida Shaikh 100 2 1231 1333 4 Dr. Afsana Zulfikar 113 0 557 670 5 Dr. Atia Zafar 89 0 873 962 6 Dr Nusrat Noor 18 0 207 225 7 Dr. Sannia Akram 68 6 532 606

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8 Dr. Salma Qureshi 37 0 473 510 9 Dr. Yasmeen 15 0 443 458 10 Dr. Amna Khokhar 21 0 628 649 11 Dr Samina Asif 112 2 967 1081 12 Dr Sadia Nisar Memon 69 2 1094 1165 13 Sr. Rahat Shakeel 12 0 317 329 Total 831 12 9077 9903

1. Female Health

2. Deliveries Assisted

S # Service Number 1 Deliveries Assisted at HFs 12 2 Deliveries Assisted at Homes 27

3. Lab/ Diagnostic Tests

S # Test Number 1 Pregnancy Tests 297 2 Blood Sugar Tests 709 3 Hemoglobin Tests 71 4 Ultra Sound Test 139 5 Malarial Parasites Test -

41. Important Discussion on Mother and Child and Reproductive Health during MRM

Nil

42. Provision of Family Planning Services during the Month

S # Name of the Items / Service Number 1 Consultation / Advice 663 2 Oral Pills 299 3 IUCDs 5 4 Injections 196 5 Others 83 Total 1246

(III) COMMUNITY PARTICIPATION During Month under Review

1. Number of Male SGs: 48 Number of Female SGs: ______

2. Performance of Social Organizers

Meetings of Support Groups CHSs/SHSs arranged conducted by him by him Names of Social Organizers Total No. No. of Male Female of No. Participants Participants 176

Mr. Tarique Hakeem 01 0 16 18 234 Mr. Abdul Rasheed 03 0 31 21 294 Mr. Muhammad Usman 02 0 29 23 334 Total

3. School Health Sessions & Community Health Sessions

Names of MO / Community Health Sessions School Health Sessions FMOs/Paramedics Sessions Participants Sessions Children Children Examined Treated Dr. Rabia Raheem 1 50 1 25 15 Dr. Roopa 2 40 1 30 20 Dr. Rashida Shiakh 3 105 3 20 20 Dr Nusrat 1 12 1 22 8 Dr. Afsana Zulfikar 2 53 0 0 0 Dr. Sannia Akram 1 18 1 18 25 Dr. Atia Zafar 0 0 1 21 17 Dr. Sadia Nisar Memon 2 29 1 27 12 Dr. Samina Asif 2 85 0 0 0 Dr.Rahat Shakeel 2 34 2 14 14 Dr.Amna Khokhar 3 50 4 84 84 Dr. Salma Qureshi 2 105 2 40 12 Dr. Umesh Kumar 1 50 1 40 40 Dr. Nisar Ahmed Soomro 1 35 1 25 20 Dr. Nazir Ahmed Malik 0 0 0 0 0 Dr. Sanaullah 2 63 1 0 0 Dr. Bashir Ahmed Bhutto 3 173 1 8 6 Dr. Zulfikar Ali Shah 2 40 0 0 0 Dr. Asif Hakeem 2 29 1 0 0 Dr. Imtiaz Ahmed 1 30 1 30 23 Dr. Gh: Rasool 2 27 1 28 14 Dr. Rafique Ahmed Shaikh 0 0 0 0 0 Dr. Imran Hussain 1 25 1 20 7 Dr. Gh: Sarwar Mahar 1 40 1 10 5 Dr Sajjad Hussain 3 78 2 17 2 Dr Amar Lal 0 0 1 200 176 Dr Ahsan Ali 1 10 1 20 8 Dr Amanullah 0 0 0 0 0 Dr. Abdul Latif Naich 2 47 2 49 41 Dr. Majid Rahim 2 80 1 25 10 Dr. Shah Pasand Khan 1 36 1 25 15 Dr. Moizuddin Jatoi 1 25 1 15 7

177

Dr. Tauqeer Ahmed 0 0 0 0 0 Dr Mohammad Yakob 1 15 2 5 0

4. Important Points during Support Group Meetings.

Non availability of PT strips, Glucometer strips and Malaria test kit

5. Important Points during SHSs

Nil

6. Important Points during CHSs

Issue for Ultrasonologist should be at BHU level, Viability of vaccination at their door step demanded, vaccination according to EPI schedule in villages

7. Topics for SHSs for the Month

Sr. No. Topics 1 Hand wash, Diarrhea prevention, Prevention from cold 2 Personal Hygiene, Acute Respiratory Infection 3 Scabies, Skin Infection

8. Topics for CHSs for the Month

S # Topics 1 Antenatal and post natal care, Personal Hygiene, 2 Hepatitis, Family planning, 3 Scabies, Diarrhea,

9. Important Discussion on Community Participation during MRM

Nil

10. Health Camps: Number Held: _____ . Number of Patients: _____.

11. Measures for improvement / provision of Services by other Department / Agencies

Sr No Description Recommendation To whom Present sent status i Sanitation Nil Nil Nil ii Drainage / sewerage Nil Nil Nil iii ……… drinking water Nil Nil Nil iv Prevention of adulteration Nil Nil Nil v Tree Plantation Nil Nil Nil vi Roads and infrastructure Nil Nil Nil vii Environmental Improvement Nil Nil Nil viii Others Nil Nil Nil

(IV) CURATIVE SERVICES DURING THE MONTH UNDER REVIEW

178

1. OPD*

New patients treated Old patients treated Total OPD during the during the month during the month month (New + Old) 51002 2414 53416

2. Maximum OPD** Minimum OPD**

S # BHU OPD BHU OPD 1 BHU Umer Daho 2961 BHU Mohammad Yakob Maher 282 2 BHU Hasoo Daho 1944 DCD Rang Ali Shah 529 3 BHU Sangheri 71782 BHU Bago Daho 544 4 BHU Qadirpur 1787 DCD Chatokot 607 5 BHU Jahanpur 1752 BHU Syedpur 648

3. Top Five Diseases Treated during School Health Sessions/Camps

S # Diseases No. of Patients 1 ARI 67 2 Fever for other cause 55

3 Suspected Malaria 39

4 Scabies 38

5 Gastro Intestinal Disease 28

*All HFs — BHUs and others. **Reflects OPD at BHUs only — not at other HFs.

4. Top Five Diseases During OPD

S # Disease No. of Patients 1 ARI 8619 2 Fever for other cause 5121 3 Suspected Malaria 3731 4 Scabies 2722 5 Gastro Intestinal Disease 2267

43. ARV / ASV used during the month

No. of Patients Dog bite cases reported 77 ARV Administered 5 ARV Available Doses 0 Snake bite cases reported 0 ASV Vaccine Administered 0 ASV Vaccine Available Doses 0

46. 47. Lab / Diagnostic Tests: Includes Tests Reported at No. (II) (Mother, Child & Reproductive Health)

179

S # Tests Number 1 Pregnancy Tests 297 2 Blood Sugar Tests 709 3 Haemoglobin 71 4 X-Rays (if available) 0 5 Ultra Sound 139 6 Others (please specify) 0

48. B & C SCREENING TESTS

No. of No. of cases No. of cases Total referred Follow up Screening Tests found referred for upto date result Performed positive treatment Hepatitis B Nil Nil Nil Nil Nil Hepatitis C Nil Nil Nil Nil Nil

49. TUBERCLOSIS

Patients New Cases During Under Diagnosis Receiving Treatment the Month 22 2 19

9. Referrals

S.No Totals Cases Referred To TB DOT Deliveries Others RHCs THQs DHQs HFs 1 344 22 0 322 0 241 103 -

10. Inverse Referrals

S.No Totals Cases Referred from ARV ASV Others RHCs THQs DHQsHFs 1 29 32 0 3 0 5 32 0

G. MONITORING DURING MONTH UNDER REVIEW

1. Monitoring Visits during the month

DSM Executive Monitoring Other Staff Total 52 59 190 301

2. Important Points/Issues arising from Visits

S # Name of HF Issue Action Remarks 1 Nil Nil Nil Nil

H. AVAILABILITY OF MEDICINES/MEDICAL MATERIALS

1. Medicines available for 15 Weeks

14. Important Issues raised relating to Medicines, etc. during MRM DSM discussed with all MOs regarding medicine consumption and control on misuse of medicine.

180

I. REPAIR / MAINTENANCE / ELECTRIFICATION OF / AT HFS

Description of Repair / S # Name of HFs Status / Remarks Maintenance incl. Electrification 1 BHU Bago Bhutto R&R 100% 2 BHU Dad Laghari R&R 100% 3 BHU Ahmed Ali Pitafi R&R 100% 4 BHU Ali Mahar R&R 100% 5 BHU Ayoub Lakhan R&R 100% 6 BHU Darwaish Naich R&R 100% 7 BHU Hasso Daho R&R 100% 8 BHU Hussain Beli R&R 100% 9 BHU Jahanpur Sharief R&R 100% 10 BHU Kamo Shaheed R&R 100% 11 BHU Lohi R&R 100% 12 BHU Noor Abad R&R 100% 13 BHU Qadirpur R&R 100% 14 BHU Saleh Mahar R&R 100% 15 BHU Soi Sharief R&R 100% 16 BHU Syed Pur R&R 100% 17 BHU Taj Muhammad Ruk R&R 100% 18 BHU Umer Deho R&R 100% 19 GD Khadwari R&R 100% 20 GD Muhammadpur R&R 100% 21 BHU Sangri R&R 100% 22 GD Qazi Badal R&R 100% 23 GD Hayat Pitafi R&R 100% 24 BHU Rounti R&R 100% 25 BHU Ghulam Hyder Leghari R&R 100% 26 GD Chunglani R&R 100% 27 BHU Abdul Sattar R&R 100% 28 GD Sajawal Dandhu R&R 95% 29 BHU Hasso Daho(Boundary) R&R 100% 30 GD Pir Goth R&R 95% 31 GD Chak Shahbaz R&R 80% 32 BHU Bago Daho R&R 15%

Inspections / Visits of PPHI HFs

Visitors* Health Facilities Visited Overall Comments

J- DISCUSSION DURING MRM

¾ Monitor the performance of Vaccinators by checking their registers and field visit reports in case any irregularity informed to EDOH. ¾ Visit to villages and meeting with community regarding sanitation.

181

¾ Conduct School and Health Sessions on regular basis, if any fake report found serious action will be taken. ¾ Conduct meetings Community Support Group Members and submit minutes of meeting to DSU. ¾ FMOs Ane-Natal performance was poor. Increase / conduct Health Sessions. ¾ FMOs Meeting with LHWs and conduct capacity building sessions. ¾ Expedite in R&R work. ¾ Timely submission of reports specially DEWS on weekly report. ¾ Hard Area Allowances Cheque distributed.

Expected Date for Next MRM: ___12____June -2012

Comments on Targets vs Achievements (by DSM) Nil

182

MINUTES OF THE (43rd) MONTHLY REVIEW MEETING OF DISTRICT JACOBABAD

Monthly Review Meeting (MRM) of District, Jacobabad for the Month of April 2012 was held on 07th May 2012, at Zila Nazim council Hall Jacobabad. Written invitations were sent to the DC, EDO (H), DPWO, DSO (WHO), SO (DEWS)-WHO, SO UNICEF), and District In charge of EPI, LHW, Distt Coordinator, TB DOTS, HMIS and all other National Programs as usual. The list of participants follows:

List of Participants:

1. Mr. Ghulam Ali Soomro District Support Manager Jacobabad 2. Dr. Wajid Hussain Bhutto District Coordinator TB Dots 3. Dr. Ashok Khetpal DC-NPFP&PHC Jacobabad 4. Mr. Mushtaq Ali Leghari Ex.O(M&E) 5. Mr.Muhammad Iqrar Veesar S.M DSU Jcd. 6. Mr.Haq Nawaz Lashari S.M DSU Jcd. 7. Dr.Abdul Jabar Thahim M.O H/Q DSU Jcd. 8. Dr.Sajjad Ahmed Burriro I/C M.O G.M Jakhrani 9. Dr.Habib ul Rehman Khoso I/C M.O Abdullah Lashari 10. Dr.Shoukat Ali Soomro I/C M.O Jumo Dasti 11. Dr.Ghulam Mohammad Talani I/C M.O Madadpur 12. Dr.Kishor Kumar M.O MCHC Jafferabad,Jcd 13. Muhammad Ishaque Malik I/C M.O Mouladad 14. Dr.Mohammad Aslam Abbasi M.O Noor Mohammad Pathan 15. Dr.Ghulam Mohammad Dasti I/C M.O Karim Bux Khoso 16. Dr.Nusrat Soomro FMO Welfare Dispensary Ahmed Mian Soomro 17. Dr.Fozia Khoso FMO MCHC Jaffarabad 18. Dr.Farzana Khoso FMO MCHC Jaffarabad 19. Dr.Naila Soomro FMO GD Abad / BHU Mubarakpur 20. Dr. Farida Qureshi FMO GD Police Head Quarter 21. Dr. Rukkaya Abro FMO BHU N.M Pathan / BHU S.K Rind 22. Dr. Resham Naseer Soomro FMO GD Jumo Dasti 23. Dr. Shazia Jamali FMO Welfare Disp Ahmed Mian Soomro 24. Dr. Sheerin Soomro FMO GD Adam Khan 25. Dr. Saima Patujo FMO BHU Madadpur / BHU Bahadurpur 26. Dr. Saeeda Solangi FMO MCHC Jaffarabad 27. Dr. Veer Singh I/C M.O GD Shabirabad 28. Dr. Fazalullah Brohi I/C M.O Muhammad Pur Odho 29. Dr.Aziz Ahmed Soomro I/C M.O BHU Udi 30. Dr.Muzafar Khaskheli I/C M.O BHU Hashmatabad 31. Dr.Naeem Ahmed Sarki I/C M.O GD Naseer Khan Bhangar 32. Dr. Zulfiqar Ali Golo M.O BHU Bachro 33. Dr.Abdul Fattah Khoso ` I/C M.O BHU Bachro 34. Dr.Abdul Ghafar Babar I/C M.O Dodapur 35. Dr. Baqa Muhammad Panhwar I/C M.O Banlow Syedan 36. Dr.Kashif Ali Pahore I/C M.O BHU Joungal

183

37. Dr. Nabi Bux Soomro GD Imam Bux Kehar 38. Dr.Azizullah Talani I/C M.O GD Police H/Q 39. Dr.Inayatullah Dayo I/C M.O BHU Sheranpur 40. Dr. Safiullah Bhutto I/C M.O BHU Mubarakpur 41. Dr. Ihtasham ul Haq I/C M.O BHU A.R Suhendero 42. Dr. Zafar Ali Pathan I/C M.O GD Abad 43. Dr. Ashok Kumar Sangitiani I/C M.O BHU Karim Bux Khoso 44. Dr. Amar Lal M.O BHU Karim Bux 45. Dr. Irfan Ahmed Khoso I/C M.O BHU Bangul 46. Dr. Kishore Kumar M.O MCHC Jaffarabad 47. Dr. Saeed Ahmed Odhano I/C M.O DCD Abdul Rasool Khoso 48. Mr. Nadeem Ahmed Dispenser BHU Bahoo Khoso 49. Mr. Jan Muhammad Dispenser BHU Piyaro Khoso 50. Mr.Ghulam Hussain Assistant Accounts 51. Mr. Mehmood Ali Roongho Sub-Engineer PPHI 52. Mr.Shehryar Abro Assistant/Computer Operator 53. Mr.Shuhab Ali Sehto Store Manager 54. Mr.Asif Ali Assistant Store Manager 55. Mr.Abdul Wahid Bhayo Assistant Admin

The following could not attend the meeting for the reasons stated against each:-

S # Names/Designation Reasons S # Names/Designation Reasons 1 Dr. Aqeela Ghaffar illness 2 Dr. Abdul Basit Death of close relative 3 4 5

N. HFs WITH PPHI

BHUs: __24____ Govt Dispensaries: ___09____ MCHCs: ___01____ Others:__ 03

TOTAL: __37__

B. Population of the Catchments Area: 723,473

EE. STAFF STRENGTH

Sanctioned Government PPHI Vacant Working Posts (Govt.) Employees Contract (Sanc-Govt) Mos 42 37 7 30 5 WMO 0 0 0 0 FMOs 20 14 1 13 6 LHVs 20 02 1 1 18 Male 09 07 07 0 MTs/MAs 02 Female 0 0 0 0 Dispensers 65 57 28 29 8

FF. CLUSTERS OF HFs

184

WITH ONE MO

WITH ONE FMO

Previous Month Total Month under Review Total Clusters of 5 HFs Clusters of 5 HFs Clusters of 4 HFs Clusters of 4 HFs Clusters of 3 HFs Clusters of 3 HFs 01 Clusters of 2 HFs 05 Clusters of 2 HFs 05 Single HFs 08 Single HFs 08

E. CAPACITY BUILDING

1. First Session: During MRM Dr. Muhammad Aslam Abbasi, MO BHU Noor Muhammad Pathan Delivered detailed lecture of Basic Life Support (BLS). He discussed following points in his session: • Basic Tools • CPR • ABCD of CPR • Process of Rescue

2. Second Session: During MRM

Dr. Wajid Hussain Bhutto, Coordinator TB Dot Program District Jacobabad discussed the progress of TB DOTS Program and status of suspected TB cases referred from BHUs.

44. Capacity Building of LHVs / Dispensers During Month under Review

No. of Names of the Resource Persons with dates Date Venue Topic Participants 0 0 0

F. REVIEW OF THE PERFORMANCE (I) PREVENTIVE HEALTHCARE During Month under Review

1. Vaccination / Immunization

No. of Doses of Immunization Administered to Children at Health Facilities. 6647 No. of TT vaccines provided to pregnant / Child Bearing Age Women at Health Facilities. 2777 No. of Immunization & Vaccination Administered by outreach EPI Teams 1412 Total vaccination / immunization for the month 10836

185

2. National Immunization Days (NIDs) for Polio

Percentage of Dates of NIDs Target of coverage Actual coverage coverage 23rd to 26th April 2012 161942 182827 112%

3. Other Preventive/Promotional Services

(II) MOTHER, CHILD & REPRODUCTIVE HEALTH During Month under Review 1. Female Health

S.No Name of FMO Ante Natal Cases Natal Cases Other OPD Total OPD 1 DR. FARIDA QURESHI 239 17 1544 1800 2 DR. HASEENA JAAN 621 3 722 1346 3 DR. RUQAYA ABRO 106 4 1140 1250 4 DR. SHEERIN SOOMRO 112 7 1059 1178 5 DR. NUSRAT SOOMRO 132 1 963 1096 6 DR. SHAZIA JAMALI 113 3 864 980 7 DR. ASYA SOLANGI 200 7 699 906 8 DR. SAIMA PATUJO 132 3 726 861 9 DR. FARZANA KHOSO 135 7 680 822 10 DR. NAILA MAJID SOOMRO 273 1 542 816 11 DR. SAEEDA SOLANGI 225 8 573 806 12 DR. RESHAM NASEER 47 0 433 480 13 DR. AQEELA GHAFFAR 5 7 26 38 14 DR. FOUZIA KHOSO WORKING AS SONOLOGIST TOTAL 2340 68 9971 12379

2. Deliveries Assisted

S # Service Number 1 Deliveries Assisted at HFs 151 2 Deliveries Assisted at Homes 11

3. Lab/ Diagnostic Tests

S # Test Number 1 Pregnancy Tests 714 186

2 Blood Sugar Tests 36 3 Hemoglobin Tests 52 4 Ultra Sound Test 1536 5 Other 10

45. Important Discussion on Mother and Child and Reproductive Health during MRM

Following points were discussed:

• Deliveries & D&Cs (during the month) conducted by FMOs / LHVs / CMWs- name wise evaluation. • Contraceptive clients-FMO wise. • School Health Sessions / Community Health Sessions. • Ultrasounds examinations by FMOs.

46. Provision of Family Planning Services during the Month

S # Name of the Items / Service Number Consultation / Advice 857 Oral Pills (clients) 121 IUCDs 8 Injections 100 Others 45 Total 1131

(III) COMMUNITY PARTICIPATION During Month under Review

1. Number of Male SGs: ------37------Number of Female SGs: ------

2. Performance of Social Organizers

Meetings of Support Groups CHSs/SHSs arranged by him Names of Social Organizers conducted by him Total No. of No. of Male Female No. Participants Participants M.Iqrar Veesar 01 0 14 36 968 Haq Nawaz Lashari 02 0 24 39 1161 Total 03 0 38 75 2129

3. School Health Sessions & Community Health Sessions

CHS SHS S.No Name of M.O / F.M.O Children Children Sessions Participants Sessions Examined Treated 1 Dr. Muhammad Aslam Abbasi 4 120 0 0 0 2 Dr. Inayatullah Dayo 1 25 2 40 22 3 Dr. Zafar pathan 1 25 1 22 9 4 Dr. G.M Dasti 2 80 0 0 0

187

5 Dr. Veer Bhan 2 104 0 0 0 6 Dr. Tara Chand 2 117 0 0 0 7 Dr. Ghulam Muhammad Talani 1 20 1 12 5 8 Dr. Abdul Ghaffar Babbar 2 36 0 0 0 9 Dr. Ashok Kumar Sangitiani 2 53 0 0 0 10 Dr. Nabi Bux Soomro 1 37 1 40 25 11 Dr. Baqa Muhammad 1 52 1 20 20 12 Dr. Rukkaya 2 25 0 0 0 13 Dr. Saeeda 2 44 0 0 0 14 Dr. Farzana 2 33 0 0 0 15 Dr. Asya 2 42 0 0 0 16 Dr. Sheerin Soomro 1 27 1 20 15 17 Dr. Nusrat Soomro 2 49 0 0 0 18 Dr. Kashif Pahore 1 23 1 6 4 19 Dr. Wahid Bux Laghari 2 60 0 0 0 20 Dr. Naila Soomro 2 43 0 0 0 21 Dr. Shazia Jamali 2 52 0 0 0 22 Dr. Aqeela 1 5 1 6 4 23 Dr. Resham 2 44 0 0 0 24 Dr. Ishaque Malik 2 21 0 0 0 25 Dr. Irfan Khoso 1 30 1 60 30 26 Dr. Rano Mal 1 16 1 37 12 27 Dr. Abdul Basit 1 45 1 48 15 28 Dr. Amar Lal 2 120 0 0 0 29 Dr. Saima 2 115 0 0 0 30 Dr. Aziz Ahmed 1 28 0 0 0 31 Dr. Saeed Odhano 1 18 0 0 0 32 Dr. Shoakat Soomro 0 0 1 10 4 33 Dr. Safiullah 1 34 0 0 0 34 Dr. Sajjad Buriro 1 12 0 0 0 35 Dr. Muzaffar Khaskheli 1 23 0 0 0 36 Dr. Ihtasham ul Haq 0 0 1 60 12 37 Dr. Zulfiqar Golo 0 0 1 15 15 38 Dr. Abdul Fattah Khoso 1 55 0 0 0 39 Dr. Habib Khoso 0 0 1 23 5 40 Dr. Azim Shah 1 22 0 0 0 41 Dr. Veer Singh 0 0 1 10 6 42 Dr. Sajjad Soomro 1 13 0 0 0 43 Dr. Haseena Jaan 1 32 0 0 0 44 Dr. Fazalullah Brohi 0 0 0 0 0 Total 58 1700 17 429 203

4. Important Points during Support Group Meetings.

• Progress Review of R/R work where it was in progress. • Importance of community Health Sessions in catchment areas of the H.F. • Participation of CSG members during special Polio campaign. • Importance of immunization of children.

188

5. Important Points during SHSs

• Diarrhea • ARI • Scabbies

6. Important Points during CHSs

• Diarrhea • ARI • Scabbies

7. Topics for SHSs for the Month

Sr. No. Topics 1 Malaria 2 ARI 3 Importance of Immunization

8. Topics for CHSs for the Month

S # Topics 1 Malaria 2 ARI 3 Importance of Immunization

9. Important Discussion on Community Participation during MRM

10. Health Camps: Number Held: ------0------. Number of Patients: ------0-----.

11. Measures for improvement / provision of Services by other Department / Agencies

Sr No Description Recommendation To whom Present sent status I Sanitation Ii Drainage / sewerage Iii ……… drinking water Iv Prevention of adulteration V Tree Plantation Vi Roads and infrastructure Vii Environmental Improvement Viii Others

(IV) CURATIVE SERVICES DURING THE MONTH UNDER REVIEW

1. OPD*

New patients treated Old patients treated Total OPD during the during the month during the month month (New + Old) 67213 2318 69531

189

2. Maximum OPD** Minimum OPD**

S # BHU OPD BHU OPD 1 MCH Center Jaffarabad Jcd 7258 BHU GM Jakhrani 357 2 W.D Ahmed Mian Soomro 6910 GD Shabirabad 510 3 GD Police Dispensary 4202 DCD Miranpur Buriro 707 4 BHU Mubarakpur 3191 GD Naseer Bhangar 799

3. Top Five Diseases Treated during School Health Sessions/Camps

S # Diseases No. of Patients 1. Scabies 331 2. ARI 162

3. Malaria 26

4. Unexplained fever 11

5. Fever (Clinical Malaria) 7 *All HFs — BHUs and others. **Reflects OPD at BHUs only — not at other HFs.

4. Top Five Diseases During OPD

S # Disease No. of Patients 1 Fever (Clinical Malaria) 12458 2 ARI 12076 3 Scabbies 9306 4 Diarrhea 7384 5 Cough 1426

47. ARV / ASV used during the month

No. of Patients Dog bite cases reported 304 ARV Administered (vials) 196 ARV Available Doses 965 Snake bite cases reported 0 ASV Vaccine Administered 0 ASV Vaccine Available Doses 19

50. Lab / Diagnostic Tests: Includes Tests Reported at No. (II) (Mother, Child & Reproductive Health) 3. (Lab / Diagnostic Tests)

S # Tests Number 1 Pregnancy Tests 758 2 Blood Sugar Tests 132 3 Hemoglobin 59 4 X-Rays (if available) 20 5 Ultra Sound 1536 Others (please specify) 6 341 Malaria-Rapid Diagnostic Tests 190

51. B & C SCREENING TESTS

No. of No. of cases No. of cases Total referred Follow up Screening Tests found referred for upto date result Performed positive treatment Hepatitis B 127 06 06 37 0 Hepatitis C 131 47 47 238 0

52. TUBERCLOSIS

Patients New Cases During Under Diagnosis Receiving Treatment the Month 60 68 18

9. Referrals

Cases Referred To S.No Totals TB DOT Deliveries Others BHU/RHCs THQs DHQs 1 397 139 0 258 10 03 384 2 3

10. Inverse Referrals

Cases Referred from S.No Totals ARV ASV Others RHCs THQs DHQs 1 102 102 0 0 0 10 92 2 3

G. MONITORING DURING MONTH UNDER REVIEW

15. Monitoring Visits during the month

DSM Executive Monitoring Other Staff Total 71 81 92 244

2. Important Points/Issues arising from Visits

S # Name of HF Issue Action Remarks 1 GD Admam Khan OPD Register was not MO has been warned to Panhwer maintained by MO. All maintain OPD register by entries were made by the himself as required by Dispenser on the basis of protocal OPD slips. 2 MCHC Jafferabad Maternal Register was not FMOs have been illustrated properly maintained. the method of Maternal Yearly No. was not filled. Register. 3 BHU Sheranpur Expense Register was not Dispenser has been trained properly maintained. now to make proper entries. Erroneously entries of bin

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cards were mentioned in daily expense register

H. AVAILABILITY OF MEDICINES/MEDICAL MATERIALS

1. Medicines available for …10.6…. Weeks 16. Important Issues raised relating to Medicines, etc. during MRM

I. REPAIR / MAINTENANCE / ELECTRIFICATION OF / AT HFS

Description of Repair / Maintenance S # Name of HFs Status / Remarks incl. Electrification Service wire was required at DCD Abdul Provided and electricity 1 DCD Abdul Rasool Khoso Rasool Khoso for main connection. made functional.

Inspections / Visits of PPHI HFs

Visitors* Health Facilities Visited Overall Comments

* To reflect only non-PPHI Visitors.

J- DISCUSSION DURING MRM

• OPD BHU wise. Comparison of OPDs of February in corresponding years ie 2006, 2007, 2008, 2009, 2010, 2011 & 2012. • ARV cases during the month. • Various tests during the month under review i.e Blood sugar, malaria, pregnancy test, hemoglobin test HBs HCV etc. • Ultrasounds cases / X-Ray cases. • EPI-performance BHU wise. Issues relating to cold chain maintenance. Shortage of BCG at EPI centers throughout the month. • TB referrals during the month. • Monthly progress of FMOs, deliveries, D&Cs, FP cases, ANC registrations etc. • School Health Sessions / Community Health Sessions. • Community Support Group meetings. • Repair & renovation of BHUs. • Contraceptive material. • Increase in NVDs On Mother, Child & Reproductive Health:

Date /Time for Next MRM: 6th June, 2012 will be the tentative dates. Comments on Targets vs Achievements (by DSM) DSM discussed that whereas ANC coverage had been almost 75% but at the same time CPR had been just 1.54 % in March which has improved to 3.07% in April. He gave target to FMOs to enhance it to 6% in May 2012. DSM said that PPHI should bring CPR to at least 20% within next six months. To this effect FMOs complained that FP material had been received in March 2012 after lapse of more than nine months. DSM explained that supply of FP material from Population Welfare Department had always been irregular hence CPR had gone done to even 1% in last couple of months. He expected that supply of FP material would be continuous in future as committed by Population Welfare Department at highest level.

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MINUTES OF THE (44th) MONTHLY REVIEW MEETING OF DISTRICT KAMBER-SHAHDADKOT

Monthly Review Meeting (MRM) of District, Kamber-Shahdadkot for the Month of April, 2012 was held on 10 May, 2012 at DSU Kamber Shahdadkot. Written invitations to participate were sent to the DCO, the EDO(H), the EDO(F&P) and District Incharge of EPI, Surveillance Officer WHO, T.B Dot Programme, EDO (Education), and all other National Programs as usual.

The list of participants follows:

S.No. Name of Officer’s 1 Mr Habibul Rehman Jamot (DSM Kamber Shahdadkot) 2 Mr Abdul Latif Malik (Executive M&E) 3 Dr Ghulam Abbas Keheri (I/C M.O BHU Ghathar) 4 Dr Gutam Kumar (W.H.O) 5 Dr Mumtaz Ali Sheikh ( EDO Health Representative) 6 Dr Zahida Keheri (FMO BHU Khairpur Jooso & BHU Ghogaro) 7 Dr Sanaullah Wagan (I/C M.O BHU Datu Teewna) 8 Dr Surya Lashari (BHU Ghazi Khan Khuhawar & BHU Thoof Chosool) 9 Dr Abdul Karim Memon(BHU Ziaudin Isran) 10 Dr Fozia Soomro (FMO BHU Arzi Bhutto) 11 Dr Safia Jamali (FMO BHU Deera & Wadho Kalhoro) 12 Dr Farzana Soomro (FMO MCH Shahdadkot) 13 Dr Reehana Chandio (FMO MCH Nasirabad) 14 Dr Shahid Nabi Shah (BHU Thoof Chusool 15 Dr Tahira Memon (BHU Gathar & GD Chajjra) 16 Dr Najamuddin Shaikh (I/C M.O MCHC Shahdadkot) 17 Dr Samina Shah (FMO BHU Lalu Raunk & BHU Thori Bijar 18 Dr Noor Mohammad Memon 19 Dr Shamshad (FMO BHU Datu Tiwna & BHU K.B Wahocho) 20 Dr Ameer Rahojo (I/C BHU Khuda Bux Wahoocho) 21 Dr Ambreen Bhutto ( BHU Bambho Khan Chandio / BHU Ghulam Ali Magsi) 22 Mr Riaz Ahmed Tunio (S.O) 23 Mr Imran Ahmed Laghari (S.O) 24 Dr Ravi Kumar ( GD Abdul Wahab Khoso) 25 Dhani Bux Makool (Dawa Saz Unani Shafa Khana) 26 Dr Nisar Ahmed Mugheri ( BHU Mohammad Ali Gurhmani) 27 Dr Barkat Makool (BHU Kot Ghulam Shah) 28 Dr Munwar Chandio ( BHU Googharo) 29 Dr Ghaulam Farid Khuhawar( BHU Khandu) 30 Dr Suneel Kumar ( BHU Aitbar Khan Chandio) 31 Dr Parkash Lal Advani ( BHU Chakiyani) 32 Dr Abdul Manan Sheikh (BHU Wadho Kalhoro) 33 Dr Noor Khatoon (BHU Deera/BHU Wadho Kalhoro) 34 Dr Mansoor Depar ( BHU Gaji Khuhawar) 35 Dr Allah Bux Soomro(BHU ARZI BHU Arzi Bhutto) 36 Dr Khalid Hussain Burirro( BHU Gazi Khan Khuhawar) 37 Dr Abdul Ghaffar Chandio( BHU Bambho Khan Chandio) 38 Dr Subhan Ali Lakho ( BHU Hamal) 39 Dr Nadeem Akhtar Sheikh( GD Chhajjra)

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The following could not attend the meeting for the reasons stated against each:-

S # Names/Designation Reasons Concerned Health Facility 01 Dr Fareeda Sheikh On leave MCH Shahdadkot BHU Aitbar Khan 02 Dr Shahla Sattar Absent Chandio/Chakiyani

O. HFs WITH PPHI

TOTAL: 27 BHUs: 22 Dispensaries: 02 MCHCs: 02 Others: 01

B. Population of the Catchments Area: 1375398

GG. STAFF STRENGTH

Sanctioned Government PPHI Vacant Working Posts (Govt.) Employees Contract (Sanc-Govt) MO 24 24 8 16 16 W/FMOs 02 15 2 13 00 LHVs 26 12 07 05 19 Male - - - MTs/MAs - - Female - - - Dispensers 03 25 05 20 00

HH. CLUSTERS OF HFs

WITH ONE MO

Previous Month Total Month under Review Total Clusters of 6 HFs - Clusters of 6 HFs - Clusters of 5 HFs - Clusters of 5 HFs - Clusters of 4 HFs - Clusters of 4 HFs - Clusters of 3 HFs - Clusters of 3 HFs - Clusters of 2 HFs - Clusters of 2 HFs - Single HFs 24 Single HFs 24

WITH ONE FMO

Previous Month Total Month under Review Total Clusters of 5 HFs Clusters of 5 HFs Clusters of 4 HFs Clusters of 4 HFs Clusters of 3 HFs Clusters of 3 HFs Clusters of 2 HFs 11 Clusters of 2 HFs 11 Single HFs 04 Single HFs 04

E. CAPACITY BUILDING

1. First Session: During MRM

. Review Performance Of all health facilities

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F. REVIEW OF THE PERFORMANCE (I) PREVENTIVE HEALTHCARE During Month under Review

1. Vaccination / Immunization

No. of Doses of Immunization Administered to Children at Health Facilities. 2582 No. of TT vaccines provided to pregnant / Child Bearing Age Women at Health Facilities. 581 No. of Immunization & Vaccination Administered by outreach EPI Teams _ Total vaccination / immunization for the month ------3163

2. National Immunization Days (NIDs) for Polio

Percentage of Dates of NIDs Target of coverage Actual coverage coverage 23/4/2012 TO 25/4/2012 233852 287139 99 %

3. Other Preventive/Promotional Services

S # Service Number 1 Passive Case Detection (PCD) Slides Nil 2 Active Case Detection (ACD) Slides Nil 3 Visits to Check Sanitation (individual house holds + streets) - 4 Notices issued against Poor Sanitation - 5 Challans sent to Court against Poor Sanitation - 6 Patients Nebulized 307

(II) MOTHER, CHILD & REPRODUCTIVE HEALTH During Month under Review 1. Female Health

Neo- Ante-Natal Other Total S # Names of FMOs Natal Cases OPD OPD Cases

01 Dr Samina Shah 134 3 2115 2252

02 Dr Tahira Memon 76 1 1796 1873

03 Dr Umbrin Bhutto 162 7 2666 2835

04 Dr Surya Lashari 33 1 2378 2412 05 Dr Fozia Soomro 76 0 741 817 06 Dr Noor Khatoon 57 2 1007 1066 07 Dr Rehana Chandio 98 17 4015 4130 08 Dr Safia Jamali 83 0 3418 3501 09 Dr Farzana Soomro 81 5 501 587 10 Dr Zahida Khaeri 50 0 1521 1571 11 Dr Shamshad Begum 54 0 1450 1504 12 Dr Farida Shaikh 150 11 571 732 13 Dr Hakimzadi 112 11 300 423 14 Dr Reehana Tunio 39 9 2649 2697 15 Dr Shahla Sattar 78 0 1004 1082 TOTAL 1283 75 26124 27482

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2. Deliveries Assisted

S # Service Number 1 Deliveries Assisted at HFs 87 2 Deliveries Assisted at Homes -

3. Lab/ Diagnostic Tests

S # Test Number 1 Pregnancy Tests 567 2 Blood Sugar Tests 262 3 Hemoglobin Tests 9 4 Ultra Sound Test 0 5 Other 7482

48. Important Discussion on Mother and Child and Reproductive Health during MRM

DSM stressed on all MOs, especially FMOs to provide better services to the people for mother and reproductive health.

49. Provision of Family Planning Services during the Month

S # Name of the Items / Service Number Consultation / Advice 381 Oral Pills 123 IUCDs 6 Injections 165 Others 250 Total 925

(III) COMMUNITY PARTICIPATION During Month under Review

1. Number of Male SGs: 27 Number of Female SGs: 01

2. Performance of Social Organizers

Names of Social Meetings of Support Groups conducted by CHSs/SHSs arranged by Organizers him him Male Female Total No. of Participants No. No. of Participants Mr Imran Ahmed Leghari On Leave Mr Riaz Ahmed Tunio 13 1 203 24 273 Total 13 1 203 24 273

3. School Health Sessions & Community Health Sessions

Community Health Sessions School Health Sessions Names of MO / Children Children FMOs/Paramedics Sessions Participants Sessions Examined Treated Dr Samina Shah 2 31 2 24 9 Dr Tahira Memon 3 56 1 18 9

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Dr Umbrin Bhutto 2 36 2 31 10 Dr Surya Lashari 2 24 2 19 11 Dr Fozia Soomro 2 39 2 24 12 Dr Noor Khatoon 2 33 2 21 8 Dr Safia Jamali 2 41 2 18 9 Dr Zahida Kaheri 3 54 1 16 11 Dr Shamshad Begum 2 26 2 21 7 Dr Farzana Soomro 3 51 1 25 7 Dr Rehana Tunio 2 29 2 23 12 Dr Rehana Chandio 4 83 0 0 0 Dr Shahla Sattar 1 16 1 16 9 Dr Khalid Sheikh 1 18 1 14 7 Dr Abdul Karim 2 27 2 20 6 Dr Nadim Akhtar 2 29 1 19 7 Dr Subhan Lakho 1 24 1 14 6 Dr Heeranand 1 22 1 17 8 Dr Abdul Ghaffar 1 14 1 14 9 Dr Khalid Buriro 2 34 1 16 7 Dr Ravi Kumar 1 19 1 13 7 Dr Sanaullah Wagan 2 28 1 17 6 Dr Ameer Rahojo 1 24 1 13 8 Dr Suneel Kumar 1 15 1 18 6 Dr Shahid Nabi Shah 2 33 1 16 11 Dr Mansoor Depar 1 13 1 18 7 Dr Nisar Ahmed Mugheri 1 18 1 16 11 Dr Allah Bux Soomro 2 23 1 21 8 Dr Parkash 2 28 1 16 9 Dr Shabir Ahmed Wagan 1 16 1 14 7 Dr Ghulam Abbas Kaheri 1 14 1 13 6 Dr Abdul Manan Sheikh 1 18 1 16 5 Totals 56 936 40 561 254

4. Important Points during Support Group Meetings. 1. Electricity problem 2. Supply of ARV 3. Supply of medicines

5. Important Points during SHSs 1. To create awareness in children about cleanliness 2. To create awareness in children to personal hygiene 3. To create awareness in children about physical fitness 6. Important Points during CHSs 1. Awareness in community about prevalent diseases. 2. Counseling to pregnant women. 3. Awareness in community how to protect from heat & sun stroke.

7. Topics for SHSs for the Month Sr. No. Topics 1 Malaria 2 Cough 3 Hygiene 4 Fever

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8. Topics for CHSs for the Month

S # Topics 1 Dengue Fever 2 Meningitis 3 Viginal discharge 4 Tuber Closes

9. Important Discussion on Community Participation during MRM

Community to help at centers for tree plantation etc.

10. Health Camps: Nil

11. Measures for improvement / provision of Services by other Department / Agencies

Sr No Description Recommendation To whom sent Present status i Sanitation Nil Nil ii Drainage / sewerage Nil Nil iii Drinking water Nil Nil iv Prevention of adulteration Nil Nil v Tree Plantation Nil Nil vi Roads and infrastructure Nil Nil vii Environmental Improvement Nil Nil viii Others Nil Nil

(IV) CURATIVE SERVICES DURING THE MONTH UNDER REVIEW 1. OPD*

New patients treated Old patients treated Total OPD during the during the month during the month month (New + Old) 67372 1152 68524

2. Maximum OPD** Minimum OPD**

S # BHU OPD BHU OPD 1 Lalu Rounk 8254 Ghulam Ali Magsi 1327 2 Bambho khan chandio 4583 Gathar 1355 3 Googharo 3695 Chakiyani 1420 4 Ziaudin Isran 3417 Hamal 1472 5 Behram 3208 Aitbar Khan Chandio 1546

3. Top Five Diseases Treated during School Health Sessions/Camps

S # Diseases No. of Patients 1 Fever (Clinical Malaria 103 2 A.R.I 86 3 Scabies 73 4 Diaherrea 41

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*All HFs — BHUs and others. **Reflects OPD at BHUs only — not at other HFs.

4. Top Five Diseases During OPD

S # Disease No. of Patients 1 A.R.I 8781 2 Scabies 5372 3 Fever clinical Malaria 4183 4 Diarrhea 3271

50. ARV / ASV used during the month

No. of Patients Dog bite cases reported 208 ARV Administered 208 ARV Available Doses 431( Vials) Snake bite cases reported Nil ASV Vaccine Administered Nil ASV Vaccine Available Doses 08

53. Lab / Diagnostic Tests: Includes Tests Reported at No. (II) (Mother, Child & Reproductive Health) 3. (Lab / Diagnostic Tests) S # Tests Number 1 Pregnancy Tests 567 2 Blood Sugar Tests 262 3 Hemoglobin 9 4 X-Rays (if available) _ 5 Ultra Sound _ 6 Others (please specify) 7482 8320

54. B & C SCREENING TESTS

No. of cases No. of cases No. of Tests Total referred Follow up Screening found referred for Performed upto date result positive treatment Hepatitis B Nil - Nil Nil - Hepatitis C Nil - Nil Nil -

55. TUBERCLOSIS

Patients New Cases During Under Diagnosis Receiving Treatment the Month 34 _ - 9. Referrals

S.No Totals Cases Referred To 1 TB DOT Deliveries Others RHCs THQs DHQs

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2 6 - - - - 6 3 4

10. Inverse Referrals

S.No Totals Cases Referred from ARV ASV Others RHCs THQs DHQs 1 Nil Nil Nil Nil Nil Nil Nil 2 3

G. MONITORING DURING MONTH UNDER REVIEW

17. Monitoring Visits during the month

DSM Executive Monitoring Other Staff Total 52 39 41 132

2. Important Points/Issues arising from Visits

S # Name of HF Issue Action Remarks 01 N/A N/A N/A N/A 02 N/A N/A N/A N/A 03 N/A N/A N/A N/A 04 N/A N/A N/A N/A

H. AVAILABILITY OF MEDICINES/MEDICAL MATERIALS

1. Medicines available for 88 Weeks

2. Important Issues raised relating to Medicines, etc. during MRM

As such no issue was discussed.

I. REPAIR / MAINTENANCE / ELECTRIFICATION OF / AT HFS

Description of Repair / S # Name of HFs Status / Remarks Maintenance incl. Electrification 01 BHU Khairpur Jooso Work completed MB recorded 02 BHU Datu Teewna -do- -do- 03 BHU Ghazi Khan Khuhawar -do- -do- 04 BHU Aitbar Khan Chandio -do- -do- 05 BHU Gathar -do- -do- 06 BHU Bhambo Khan Chandio -do- -do- 07 BHU Mohammad Ali Gurmani -do- -do- 08 BHU Thori Bijar -do- -do- 09 BHU Chakyani -do- -do- 10 BHU Kot Ghulam Shah -do- -do- 11 BHU Behram d-o- -do- 12 BHU Lalu Raunk -do- -do-

200

13 BHU Ghogharo -do- -do- 14 BHU Ghulam Ali Magsi -do- -do- 15 BHU Arzi Bhutto -do- -do- 16 BHU Thoof Chosool -do- -do- 17 BHU Deera -do- MB recorded 18 BHU Wadho Kalhoro -do- MB recorded 19 BHU Khuda Bux Wahocho -do- MB recorded 20 BHU Gaji Khuhawar -do- MB recorded 21 BHU Khandu -do- MB recorded 22 Unani Shifakhana Gul Buriro work completed MB recorded

Inspections / Visits of PPHI HFs

Visitors* Health Facilities Visited Overall Comments

- - -

* To reflect only non-PPHI Visitors.

J- DISCUSSION DURING MRM

On Staff Matters:

I On the puctualty of staff at health facility..

On Preventive Health:

It was decided to conduct more and more CHSs and utilize the services of vaccinators and outreach staff in order to prevent diseases, and to establish rapport in all the national programs.

On Curative Health:

1. To run OPDs properly at all HFs. 2. To properly provide the services to the people. 3. To ensure availability of essential medicines at HFs

On Mother, Child & Reproductive Health:

FMOs as well MOs were asked by the DSM to properly attend all the ante-natal & neo-natal cases.

Other Matters:

Date /Time for Next MRM:

08-06-2012 @ 09.30 am

Comments on Targets vs Achievements (by DSM)

1. R&R Target of all the HFs / schemes completed.

201

MINUTES OF THE (40th) MONTHLY REVIEW MEETING OF DISTRICT KASHMORE

Monthly Review Meeting (MRM) of District, Kashmore for the Month of April-2012 was held on 10th May-, 2012 at District Government Complex Kandhkot. Written invitations to participate in the MRM were sent to the Deputy Commissioner Kashmore, Additional Deputy Commissioner-1 Kashmore, the EDO (Health) and District In charge of EPI, LHW and all other National Programs.

List of Participants:

S # Names/Designation Designation S # Names/Designation Designation 1 Mr. Ghulam Abbas Detho DSM 24 Manzoor Ali H.T Executive 2 Abdul Razaque Junejo Officer(M&E) 25 Abdul Ghani H.T 3 Abdul Waheed Soomro Executive (F&A) 4 Dr. Vijay Kumar MO 5 Dr. Zain Malik MO 26 Dr. Aneel MO 6 Dr. Mansoor Malik MO 27 Dr. Shagufta FMO 28 Dr. Muqeem MO 7 Dr. Zulfiqar Ali MO 29 Dr. Hazoor Bux MO 8 Badardin M.T 30 Dr. Yougesh MO 9 Qutub Din M.T 31 Abdul Razaque M.T 10 Gulsher Ahmed M.T 32 Shamas Din M.T 11 Dr. Shishpal Das MO 33 Abdul Ghani SO 12 Liaqat Ali SO 34 Dr. Javed MO 13 Abdul Khaliq Malik M.T 35 Dr. Anwar Ali MO 14 Mohammad Rafiq SO 36 Dr. Nirmal Das DHIS Trainer 15 Inamullah Sub-engineer 37 Dr. Zubair SO WHO 16 Israr Ahmed SO 17 Dr. Asadullah MO 18 Dr. Gulab din MO 19 Dr. Irshad Ahmed MO 20 Dr. Mumtaz Malik FMO 21 Dr. Aftab Ahmed MO 22 Dr. Abdul ghafoor MO 23 Abdul Bais M.T

The following could not attend the meeting for the reasons stated against each:-

S # Names/Designation Reasons S # Names/Designation Reasons 1 Dr. Maqbool Ahmed Absent 2 Dr. Hafeezullah Absent 3 Dr. Rukhsana Absent 4 Ghulam Mujtaba Absent 5 Nazeer Ahmed (M.T) Absent 6 Dilijan (M.T) Absent

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P. HFs WITH PPHI

BHUs: 21 Dispensaries: 16 MCHCs: 1 Others: 1

TOTAL: 39

B. Population of the Catchments Area: Approximately One Million

II. STAFF STRENGTH

Sanctioned Government PPHI Vacant Working Posts (Govt.) Employees Contract (Sanc-Govt) MOs 18 1 19 22 2 WMO 0 3 0 FMOs 17 4 0 4 13 LHVs 8 4 0 4 4 Male 48 23 25 MTs/MAs/Dispenser 48 0 Female

JJ. CLUSTERS OF HFs

WITH ONE MO

Previous Month Total Month under Review Total Clusters of 6 HFs 0 Clusters of 6 HFs 0 Clusters of 5 HFs 0 Clusters of 5 HFs 0 Clusters of 4 HFs 0 Clusters of 4 HFs 0 Clusters of 3 HFs 0 Clusters of 3 HFs 2 Clusters of 2 HFs 11 Clusters of 2 HFs 10 Single HFs 9 Single HFs 9

WITH ONE FMO

Previous Month Total Month under Review Total Clusters of 5 HFs 0 Clusters of 5 HFs 0 Clusters of 4 HFs 0 Clusters of 4 HFs 0 Clusters of 3 HFs 0 Clusters of 3 HFs 0 Clusters of 2 HFs 3 Clusters of 2 HFs 3 Single HFs 1 Single HFs 1

E. CAPACITY BUILDING

1. First Session: During MRM

EPI rep shared his experiences about the last polio campaign and appreciate the performance, commitment of PPHI team who actively steered the whole campaign. PPHI monitoring team and Doctors also expressed their experience, reservations especially about the lethargic attitude of government staff and health department and discuss various gaps left unfilled by the DHO health side.

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2. Second Session: During MRM

Dr. Nirmal presented a well prepared presentation on the DHIS and. After this PowerPoint presentation a detailed question /answer session was held, in which doctors and participants took keen interest. 3. The Medical Officers requested during the MRM to RPD RSU III Larkana that we want the changing in HFs timing and Honorable RPD RSU III allowed to all IMOs for timing of HFs opening and closing will be 08:00 AM to 02:00 PM in official days.

51. Capacity Building of LHVs / Dispensers During Month under Review

No. of Names of the Resource Persons with dates Date Venue Topic Participants ------

F. REVIEW OF THE PERFORMANCE (I) PREVENTIVE HEALTHCARE During Month under Review

1. Vaccination / Immunization

No. of Doses of Immunization Administered to Children at Health Facilities. 138 No. of TT vaccines provided to pregnant / Child Bearing Age Women at Health Facilities. 42 No. of Immunization & Vaccination Administered by outreach EPI Teams 73 Total vaccination / immunization for the month April 2012 253

(II) MOTHER, CHILD & REPRODUCTIVE HEALTH During Month under Review

1. Female Health

Other Total S # Names of FMOs Ante-Natal Cases Neo-Natal Cases OPD OPD 1 Mrs: Shazia Kalwar (LHV) 0 4 0 0 2 Miss Haseena (LHV) 0 4 0 0 3 Dr. Shagufta 130 3 656 789 4 Dr. Mumtaz Malik 45 2 499 546 5 Dr. Rukhsana 73 0 295 368 Total 248 13 1450 1703

2. Deliveries Assisted

S # Service Number 1 Deliveries Assisted at HFs 13 2 Deliveries Assisted at Homes 0

3. Lab/ Diagnostic Tests

S # Test Number 1 Pregnancy Tests 121 204

2 Blood Sugar Tests 168 3 Hemoglobin Tests 1 4 Ultra Sound Test 284 5 Other 114

52. Provision of Family Planning Services during the Month

S # Name of the Items / Service Number 1 Consultation / Advice 18 2 Oral Pills 10 3 IUCDs 0 4 Injections 6 5 Others 0 Total 34

(III) COMMUNITY PARTICIPATION During Month under Review

1. Number of Male SGs: ------39------Number of Female SGs: ------00----

2. Performance of Social Organizers

Names of Social Meetings of Support Groups CHSs/SHSs arranged by him Organizers conducted by him Total No. of No. of Male Female No. Participants Participants Abdul Razaque Junejo 6 0 110 2/0 37/0 Abdul Ghani Panhyar 4 0 76 4/2 68/84 Muhammad Rafique Khoso 4 0 86 3/4 48/72 Israr Malik 5 0 95 2/2 45/32 Liaqat Ali Bahalkani 0 0 0 0 0/0 Total 22 0 424 11/8 198/188

CGS meetings conducted by SOs lacked effectiveness and coherence; they were warned to conduct session more interactively and with specific time line

3. School Health Sessions & Community Health Sessions

Community Health Sessions School Health Sessions Names of MO / S.no Children Children FMOs/Paramedics Sessions Participants Sessions Examined Treated 1 Dr. Gulab Din 1 50 1 140 0 2 DR ZAIN MALIK 2 24 2 13 6 3 Dr. Abdul Ghafoor 2 38 2 16 0 4 Dr. Irshad Ahmed Langah 2 57 2 16 0 5 DR SALEEM KHOSO 4 73 2 10 2 6 Bais Khoso (M.T) 1 14 1 0 0 7 DR ZULFIQAR 2 14 2 25 10 8 Dr. Hazoor Bux 1 16 1 15 10 9 Dr. Javed Ahmed 1 12 1 15 5 10 Dr. Mansoor Malik 2 24 1 4 2

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11 Dr. Asadullah Noonari 1 25 1 20 12 12 DR AFTAB SOOMRO 4 77 2 50 22 13 Dr. Rukhsana 1 15 1 0 0 14 Dr. Shagufta 2 32 1 15 5 15 Dr. Yougesh Kumar 1 15 1 5 3 16 M.T Abdul Khalique 1 19 1 6 2 17 Dr Maqbool Ahmed 1 10 1 3 3 18 Abdul Razaque (M.T) 1 11 1 25 10 19 Badardin (M.T) 1 22 1 15 10 20 Shamas Din Khoso (M.T) 1 8 1 12 5 21 Dr. Anwar Ali 1 15 1 4 4 22 Dr. Aneel Kumar 1 12 0 0 0 23 Dr. Shishpal 1 8 0 0 0 24 Dr. Mumtaz Malik 2 35 0 0 0 25 Dr HAFEEZULLAH 0 0 0 0 0 26 Dr. Mohammad Muqeem 0 0 0 0 0 27 DR VIJAY 0 0 0 0 0 28 Dr. Sajida Gul 0 0 0 0 0 29 Mr. Qutub Din (M.T) 0 0 0 0 0 30 Total 37 626 27 409 111

4. Important Points during Support Group Meetings.

The following issues were discussed during the support Group Meetings:

• EPI centre facility • Water Supply & Electricity Problem • Repair and Renovation work. • Staff shortage at health facilities • Female Staff appointed at health facilities

5. Important Points during SHS’s

• Safe Drinking Water • diahorrea • Malaria • Gastro • Scabies

6. Important Points during CHS’s

• Antenatal Checkup • RTI • Boil Water • Prevention of Scabies • Personal Hygiene

7. Topics for SHSs for the Month

Sr. No. Topics 1 Diahorrea / Dysentry

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2 Malaria 3 Scabies

8 Topics for CHSs for the Month

S # Topics 1 Family Planning 2 Skin Infection 3 Diarrhea 4 Water born diseases 5 Safe Drinking Water 6 Pneumonia 7 Malaria, its causes, effects , and remedies 8 T.B

9. Important Discussion on Community Participation during MRM

• Realizing community of the responsibility to feel ownership of their health facility. • Effective communication with the PPHI staff, cooperating with the monitoring staff and with the staff of health facility and responding to the various initiatives introduced by the PPHI for the betterment of the health facility and its functioning. • To impart feelings of ownership to the community, it was decided to make useful interaction and communication through social organizers and MOs. • It was also discussed to invite some CSG members to MRM to make them abreast of PPHI role in primary health care and also to have an interaction on larger scale to address general issues. • Various methods were discussed to make community more interested in the maintenance of their HF through frequent visits and close interaction with the Doctors. • It was also decided to apprise community through CSG meetings about the recent trends in primary health care and various tools/methods to promote healthy habits which ultimately would lead to healthy society. • Apprising community of the various interventions being made by the PPHI and the difference made in the functioning of the HFs after the PPHI takeover.

10. Health Camps: Number Held: ------0------. Number of Patients: ----00------.

11. Measures for improvement / provision of Services by other Department / Agencies

Sr No Description Recommendation To whom Present sent status I Sanitation - - - Ii Drainage / sewerage - - - Iii ……… drinking water - - - Iv Prevention of adulteration - - - V Tree Plantation - - - Vi Roads and infrastructure - - - Vii Environmental Improvement - - - Viii Others - - -

(IV) CURATIVE SERVICES DURING THE MONTH UNDER REVIEW

1. OPD* 207

New patients treated Old patients treated Total OPD during the during the month during the month month (New + Old) 20543 448 20991

2. Maximum OPD** Minimum OPD**

S # BHU OPD BHU OPD 1 Bhu Dari 1188 Gd Mehrab mazari 326 2 Gd Kashmore colony 1071 Bhu Sher Mohammad 302 3 Bhu PEER JAN 963 Bhu Rasaldar 248 4 Mchc Kashmore (M) 934 Gd Ghous bux bangwar 228 5 Bhu D.M.KOSH 757 Gd Jamsuharo 16

3. Top Five Diseases Treated during School Health Sessions/Camps

S # Diseases No. of Patients 1 ARI 0 0 2 Fever (clinical Malaria) 3 Diarrhea 0 4 Scabies 0 5 Dysentery 0 *All HFs — BHUs and others. **Reflects OPD at BHUs only — not at other HFs.

4. Top Five Diseases During OPD

S # Disease No. of Patients 1 ARI 2056 2 Scabies/Skin 2025 3 Diahhrea 1962 4 Malaria 1906 5 Pneumonia 372

53. ARV / ASV used during the month

No. of Patients Dog bite cases reported 124 ARV Administered 76 ARV Available Doses 608 Snake bite cases reported 0 ASV Vaccine Administered 0 ASV Vaccine Available Doses 7

56. Lab / Diagnostic Tests: Includes Tests Reported at No. (II) (Mother, Child & Reproductive Health) 3. (Lab / Diagnostic Tests)

S # Tests Number 1 Pregnancy Tests 121

208

2 Blood Sugar Tests 168 3 Hemoglobin 1 4 X-Rays (if available) 0 5 Ultra Sound 284 6 Others (please specify) 114

57. B & C SCREENING TESTS

No. of Tests No. of cases No. of cases referred Total referred Follow up Screening Performed found positive for treatment upto date result Hepatitis B - - - - - Hepatitis C - - - - -

58. TUBERCLOSIS

Patients New Cases During Under Diagnosis Receiving Treatment the Month 2 0 0

9. Referrals

S.No Totals Cases Referred To 1 TB DOT Deliveries Others RHCs/HFTHQs DHQs 2 0 0 0 0 0 0 0 3 ------4 ------

10. Inverse Referrals

S.No Totals Cases Referred from 1 ARV ASV Others RHCs/HF THQs DHQs 2 124 124 0 0 120 4 0 3 ------4 ------

G. MONITORING DURING MONTH UNDER REVIEW

18. Monitoring Visits during the month

DSM Executive Monitoring Other Staff Total 8 70 222 300

2. Important Points/Issues arising from Visits

S # Name of HF Issue Action Remarks 1 GD Kashmore Colony Sanitation 2 GD 27 mile Need Repair Building of HF 3 GD Azim Golo Need Repair Building of HF 3 BHU Sardarabad Hand pump 4 GD Mehrab Mazari Boundary Wall 5 BHU Malguzar Suhryani Boundary Wall 6 GD Hafeezullah Repair and Renovation 209

7 GD Elahi Bux Khoso Repair and Renovation 8 BHU Dari Boundry Wall 9 BHU Zorgarh Boundry wall

Action:- Sanitation work would be completed before the next MRM at 9 HFs. Approval has been sought from the program director to do sanitation work. Similarly R & R work would be given priority as soon as PC-1 stage of those HFs reached.

H. AVAILABILITY OF MEDICINES/MEDICAL MATERIALS

1. Medicines available for ……………55…………. Weeks

2. Important Issues raised relating to Medicines, etc. during MRM

• Non clearance of DTL of some items • Extra Supply of Capsule Amoxicillin and Syrup Calpol • Shortage of essential items • Shortage of Equipments (B.P Apparatus, Thermometer, Stethoscope, baby weight scale, Nebulizer, etc. • Proper maintenance of store at Health facility • Shortage of FMO and paramedics

I. REPAIR / MAINTENANCE / ELECTRIFICATION OF / AT HFS

Description of Repair / Maintenance Status / S # Name of HFs incl. Electrification Remarks MCHC Kashmore Tiles Work, Co lour, Repair, Carpenter, 1 Completed Plumbering, Electrification. BHU Sher Muhammad Bijarani Tiles Work, Co lour, Repair, Carpenter, Completed 2 Plumbering, Electrification. BHU Pir Jan Bajkani Tiles Work, Co lour, Repair, Carpenter, Completed 3 Plumbering, Electrification. GD Ghous Bux Bangwar Tiles Work, Co lour, Repair, Carpenter, Completed 4 Plumbering, Electrification. GD Kashmore Colony-I Tiles Work, Co lour, Repair, Carpenter, Completed 5 Plumbering, Electrification. GD Nasrullah Bijarani Tiles Work, Co lour, Repair, Carpenter, Completed 6 Plumbering, Electrification. BHU Gullanpur Tiles Work, Co lour, Repair, Carpenter, Completed 7 Plumbering, Electrification. GD Mehrab Mazari Tiles Work, Co lour, Repair, Carpenter, Completed 8 Plumbering, Electrification. BHU Khewali Tiles Work, Co lour, Repair, Carpenter, Completed 9 Plumbering, Electrification. BHU Dari Tiles Work, Co lour, Repair, Carpenter, Completed 10 Plumbering, Electrification. GD Sardaroo Khoso Tiles Work, Co lour, Repair, Carpenter, Completed 11 Plumbering, Electrification. BHU Sardarbabad Tiles Work, Co lour, Repair, Carpenter, Completed 12 Plumbering, Electrification. BHU M.K Mazari Tiles Work, Co lour, Repair, Carpenter, Completed 13 Plumbering, Electrification.

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BHU Diyani Tiles Work, Co lour, Repair, Carpenter, Completed 14 Plumbering, Electrification. BHU Badani Tiles Work, Co lour, Repair, Carpenter, Completed 15 Plumbering, Electrification. BHU Din Muhammad Kosh Tiles Work, Co lour, Repair, Carpenter, Completed 16 Plumbering, Electrification.

Inspections / Visits of PPHI HFs

Visitors* Health Facilities Visited Overall Comments

- - -

J- DISCUSSION DURING MRM

On Staff Matters:

YES

On Preventive Health:

YES

On Curative Health:

YES

On Mother, Child & Reproductive Health:

YES

Other Matters:

YES

Date /Time for Next MRM:

7th June - 2012, 10.am

Comments on Targets v/s Achievements (by DSM)

• OPD challan fee and its timely deposit. • Doctor’s responsibility to prepare medicine indent by themselves. • Stock register and proper store maintenance of store data. • Hard area allowance • Proper store keeping • Attendance/absenteeism • Importance of MRM in the overall working of PPHI

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• Realizing staff of the importance of their attachment with an institution like PPHI, a motivated and functional organization in the health sector unlike the dormant public sector. • Emphasis on community session and school sessions

Though the shortage of FMOs is chronically an old issue but its importance cannot be overemphasized. After making all efforts to recruit and attract new lady doctors for the HFs of DSU Kashmore and experiencing little success in this endeavor, now we are shifting our emphasis to the recruitment of Staff nurses, LHVs/Midwives, so we could provide primary services to the poor women of the area as MCH issue is of very important nature and cannot be ignored anymore owing to the want of FMOs.

We are having acute shortage of funds as we are intervening warmly in the provision of primary health care to all the people of community, but our share of total health budget is mere 16 %, while we are managing 85 % of total district health facilities. Paucity of funds always is a great hurdle in the execution of ours progressive approach to upgrade community health. I hope sanity will prevail and people who are at the helm of affairs, especially at the ministry of finance, will realize the services being provided by the PPHI in the remote and backward areas of the district where public health sector never imagined and intended to reach out.

(Abdul Ghafar Surhio) District Support Manager DSU PPHI Kashmore.

Cc: 1. The Secretary Health, Government of Sindh. 2. The Programme Director, PPHI Sindh 3. The Regional Program Director, RSU Larkana. 4. The D. G (Health), Hyderabad. 5. The DC Kashmore. 6. The ADC-1 Kashmore. 7. EDO (Health) Kashmore. 8. All Participants

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MINUTES OF MONTHLY REVIEW MEETING (31st) OF DISTRICT SHIKARPUR

Monthly Review Meeting (MRM) of District, Shikarpur for the Month of April , 2012 was held on 10 th May, 2012 at DC Office (Darbar Hall) Shikarpur . Written invitations for participation were sent to the DC , DHO, DO (R), DO(F&P) and District In charge of EPI, District Coordinator National Program District Officer Population Welfare and representative of WHO.

The participants list is given below.

S S # Names/Designation Names/Designation # 1 Mr. Javed Ahmed Abro DSM 2 Dr. Kishore Kumar DO (P/H) 3 Mr. Mohammad Ramzan Ex: M&E 4 Dr. Waqar Ahmed Mangi S Manager 5 Dr. Akhtar Memon MO 6 Mr. Zia Ahmed Jalbani Ex (F&A) 7 Dr. Rahim Bux Bhutto MO 8 Mr. Tariq Hussain Mahar SO 9 Dr. Aijaz Hussain Soomro SMO 10 Dr. Abdul Hafeez Jakhro MO 11 Dr. Israr Daudpoto MO 12 Dr. Waseem Lohar MO 13 Dr. Fayyaz Lohar MO 14 Dr. Tanveer Memon Sonologist 15 Dr. Imdad Ali Mahar MO 16 Dr. Zulfiqar Mahar MO 17 Dr. Saiqa Soomro FMO 18 Dr. Shahjahan Malik MO 19 Dr. Tahmina Memon FMO 20 Dr. Maida Siddiqi FMO 21 Dr. Hafeezullah Shah MO 22 Dr. Saima Hajano FMO 23 Dr. Anmanullah Soomro MO 24 Mr. Khalil Ahmed Sohu SO 25 Dr Akbar Soomro MO 26 Dr. Allah Bux Sanjrani MO 27 Dr. Abid Hussain Shah MO 28 Mr. Salahuddin Soomro A/A 29 Dr. Faiza Kanwal FMO 30 Dr. Antonia Maria FMO 31 Dr. Majid Soomro MO 32 Dr. Saifullah Mahar SMO 33 Dr. Sahib Khan Brohi MO 34 Dr. Faiza Bano FMO 35 Dr. Reshman Shaikh FMO 36 Dr. Rafat Khalil FMO 37 Dr. Naeem Ahmed Pathan MO 38 Dr. Nisar Ahmed Brohi MO 39 Dr. Wajahat Ara FMO 40 Mr. Farhan Shaikh A/A 41 Dr. Deepa Dileep FMO 42 Dr. Naseema Mangi FMO 43 Mr. Himayatullah Naich Ex: Construction 44 Dr. Marvi Qazi FMO 45 Dr. Ghulam Murtaza MO 46 Mr. Mohammad Shujah HR Assistant 47 Dr Latif Dino MO

Q. HFs WITH PPHI

BHUs: 19 Dispensaries: 07 MCHCs: ___Nil___ others: ___Nil___

TOTAL: ___26____

B. Population of the Catchments Area:

KK. STAFF STRENGTH

Sanctioned Government PPHI Vacant Working Posts (Govt.) Employees Contract (Sanc-Govt) MOs 26 11 15 29 3 WMO 0 0 0 213

FMOs 15 14 0 14 1 LHVs 19 17 3 14 2 Male - - - MTs/MAs 15 0 Female 15 7 8 Dispensers - 5 2 3 0

LL. CLUSTERS OF HFs

WITH ONE MO

WITH ONE FMO

Previous Month Total Month under Review Total Clusters of 5 HFs Clusters of 5 HFs Clusters of 4 HFs Clusters of 4 HFs Clusters of 3 HFs Clusters of 3 HFs Clusters of 2 HFs 8 Clusters of 2 HFs 8 Single HFs 5 Single HFs 5

E. CAPACITY BUILDING

1. First Session: IMPROVEMENT OF HEALTH CARE SERVICES AT HF

Mr. Javed Ahmed Abro, DSM PPHI DSU Shikarpur briefly discussed the achievements and targets Health Facility wise and directed MOs and FMOs to achieve their targets according to catchment area population by providing best health care services in their respective areas. He directed MOs concerned to ensure early completion of repair and renovation work with their personal interest to achieve development at their HFs.

2. Second Session: ANTINATAL SERVICES

54. Capacity Building of LHVs / Dispensers During Month under Review

No. of Names of the Resource Persons with dates Date Venue Topic Participants 2/4/2012 BHU Hamayoon Family planning Dr. Nadar Panhwar 12 & EPI 2/4/2012 BHU Abdoo Family planning Dr. Rahim Bux Bhutto 10 & EPI 2/4/2012 BHU Jahan Family planning Dr. Israr Daudpoto 10 Khan & EPI Dr. Fayaz Lohar 3/4/2012 BHU Wazirabad Family planning 13 & EPI

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3/4/2012 BHU Soomar Family planning Dr. Aijaz Soomro 11 Goth & EPI 4/4/2012 GD Chodhio Family planning Dr. Naeem Pathan 09 Sadhayo & EPI 4/4/2012 BHU Rustam Family planning Dr. Saifullah Mahar 12 & EPI

F. REVIEW OF THE PERFORMANCE (I) PREVENTIVE HEALTHCARE During Month under Review 1. Vaccination / Immunization

No. of Doses of Immunization Administered to Children at Health Facilities. 4550 No. of TT vaccines provided to pregnant / Child Bearing Age Women at Health Facilities. 1020 No. of Immunization & Vaccination Administered by outreach EPI Teams 0 Total vaccination / immunization for the month ______5570

2. National Immunization Days (NIDs) for Polio

Percentage of Dates of NIDs Target of coverage Actual coverage coverage N/A N/A N/A N/A N/A N/A N/A N/A

3. Other Preventive/Promotional Services

S # Service Number 1 Passive Case Detection (PCD) Slides N/A 2 Active Case Detection (ACD) Slides N/A 3 Visits to Check Sanitation (individual house holds + streets) 09 4 Notices issued against Poor Sanitation N/A 5 Challans sent to Court against Poor Sanitation N/A 6 Patients Nebolizer N/A

MOTHER, CHILD & REPRODUCTIVE HEALTH During Month under Review 1. Female Health S # Names of FMOs Ante-Natal Cases Neo-Natal Cases Other OPD Total OPD 1 Dr. Saima Hajano 210 05 3257 3472 2 Dr. Faiza Kanwal 284 14 1567 1865 3 Dr. Saiqa Soomro 62 3 1172 1237 4 Dr. Tahmina Memon 113 6 1537 1656 5 Dr. Maida Siddiqi 66 5 1464 1535 6 Dr. Rafat Khalil 76 1 1053 1130 7 Dr. Antonia Maria 97 1 887 985 8 Dr. Fozia Bano 61 1 1359 1421 9 Dr. Naseema Mangi 60 2 1255 1317 10 Dr. Deepa Dileep 99 1 1713 1813 11 Wajahat Ara 67 0 845 912 12 Dr. Reshman Shaikh 165 0 1089 1254 13 Dr. Marvi Qazi 72 0 570 642 Total 1432 39 17768 19239

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2. Deliveries Assisted

S # Service Number 1 Deliveries Assisted at HFs 39 2 Deliveries Assisted at Homes 00

3. Lab/ Diagnostic Tests

S # Test Number 1 Pregnancy Tests 321 2 Blood Sugar Tests 920 3 Hemoglobin Tests 338 4 Ultra Sound Test 691 5 Other (MP) & (Nebulizer) 821

55. Important Discussion on Mother and Child and Reproductive Health during MRM

FMOs were directed to improve their working in mother and child health care and reproductive health by DSM. He observed that while it is matter of pride that BHUs and GDs under administrative control of PPHI are providing services continuously at such far flung areas of the district but a lot of work remains to be done. FMOs can extend antenatal and postnatal cover by educating visiting women of its importance.

56. Provision of Family Planning Services during the Month

S # Name of the Items / Service Number 1 Consultation / Advice 462 2 Oral Pills 120 3 IUCDs 6 4 Injections 167 5 Others 6 Total 761

(III) COMMUNITY PARTICIPATION

During Month under Review

1. Number of Male SGs: ------26------Number of Female SGs: -----Nil------

2. Performance of Social Organizers

Meetings of Support Groups CHSs/SHSs arranged by him Names of Social Organizers conducted by him Total No. of No. of Male Female No. Participants Participants Mr. Tariq Hussain Mahar 7 N/A 119 43 1419 Mr. Khalil Ahmed Sohu 5 N/A 89 47 1572 Total 12 208 90 2991

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3. School Health Sessions & Community Health Sessions

Community Health Sessions School Health Sessions Names of MO / Children Children FMOs/Paramedics Sessions Participants Sessions Examined Treated Dr. Saiqa Soomro 2 19 2 47 4 Dr. Saima Hajano 2 35 1 17 3 Dr. Faiza Kanwal 1 12 1 12 3 Dr. Tahmina 1 10 1 14 2 Dr. Marvi Qazi 2 68 2 57 6 Dr. Rashman 1 14 1 12 2 Dr. Fozia Bano 1 24 0 0 0 Dr. Naseema 2 35 0 0 0 Dr. Wajahat Ara 2 42 0 0 0 Dr. Deepa Dileep 2 55 1 22 3 Dr. Antonia Maria 2 45 1 45 2 Dr. Rafat Khalil 1 18 0 0 0 Dr. Maida Siddiqi 1 15 1 11 3 Dr. Athar Hussain Shah 1 18 1 22 3 Dr. Aijaz Soomro 2 28 1 18 2 Dr. Shahjan Malik 1 15 1 17 3 Dr. Akber Ali 0 0 2 32 3 Dr. Allah Bux Sanjrani 2 41 1 19 2 Dr. Saifullah Mahar 0 0 0 0 0 Dr. Waseem Lohar 1 19 1 15 3 Dr. Fayyaz Lohar 1 18 1 13 2 Dr. Zulifqar Mahar 1 15 1 18 3 Dr. Abid Hussain 1 19 1 11 2 Dr. Rahim Bux Bhutto 1 13 1 16 3 Dr. Nadar Ali Pahnwar 1 17 1 21 4 Dr. Majid Soomro 1 21 1 13 4 Dr. Murtaza Seelro 1 9 2 31 12 Dr. Fida Hussain 2 46 1 35 2 Sahib Khan Brohi 2 21 0 0 0

4. Important Points during Support Group Meetings.

5. Important Points during SHSs

6. Important Points during CHSs

Community members demanded the Sugar free Syrups, Multi Vitamin Injections.

7. Topics for SHSs for the Month

Sr. No. Topics 1 Chest infection 2 Skin Infection 3 Malaria 4 Mal Nutrition

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8. Topics for CHSs for the Month

S # Topics 1 Post Natal Visits & its importance 2 Skin Infection 3 Malaria 4 Malaria & its prevention

9. Important Discussion on Community Participation during MRM

10. Health Camps: Number Held: ------1-----. Number of Patients: --561--.

11. Measures for improvement / provision of Services by other Department / Agencies

Sr No Description Recommendation To whom Present sent status i Sanitation 0 0 0 ii Drainage / sewerage 0 0 0 iii ……… drinking water 0 0 0 iv Prevention of adulteration 0 0 0 v Tree Plantation 0 0 0 vi Roads and infrastructure 0 0 0 vii Environmental Improvement 0 0 0 viii Others 0 0 0

(IV) CURATIVE SERVICES DURING THE MONTH UNDER REVIEW

1. OPD*

New patients treated Old patients treated Total OPD during the during the month during the month month (New + Old) 2890 55246 58136

2. Maximum OPD** Minimum OPD**

S # BHU OPD BHU OPD 1 BHU Wazirabad 5,505 BHU Jahangir Thahim 1,511 2 BHU Jahan Khan 4,544 BHU Darwesh Kakepoto 1,397 3 BHU Jhali Kalwari 2,783 BHU Nim Sharif 1,240

3. Top Five Diseases Treated during School Health Sessions/Camps

S # Diseases No. of Patients 1 Scabies 11 2 Malaria 8 3 ARI 13 4 Diarrhea 6

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5 Dysentery 4

*All HFs — BHUs and others. **Reflects OPD at BHUs only — not at other HFs.

4. Top Five Diseases during OPD

S # Disease No. of Patients 1 ARI 10,476 2 Sussp: Malaria 2,725 3 Diarrhea 3,609 4 Skin Infection 2,866 5 Dysentery 4,55

7. ARV / ASV used during the month

No. of Patients Dog bite cases reported 63 ARV Administered 63 ARV Available Doses 921 Snake bite cases reported 0 ASV Vaccine Administered 0 ASV Vaccine Available Doses 0

59. Lab / Diagnostic Tests: Includes Tests Reported at No. (II) (Mother, Child & Reproductive Health) 3. (Lab / Diagnostic Tests)

S # Tests Number 1 Pregnancy Tests 321 2 Blood Sugar Tests 920 3 Hemoglobin 338 4 X-Rays (if available) 0 5 Ultra Sound 691 6 Others (please specify) 821

60. B & C SCREENING TESTS

No. of No. of cases No. of cases Total referred Follow up Screening Tests found referred for upto date result Performed positive treatment Hepatitis B 346 20 20 0 0

219

Hepatitis C 346 26 26 0 0

61. TUBERCLOSIS

Patients New Cases During Under Diagnosis Receiving Treatment the Month 24 02 5

9. Referrals

S.No Totals Cases Referred To 1 TB DOT Deliveries Others RHCs THQs DHQs 2 39 29 0 0 15 9 5 3 0 0 0 0 0 0 0 4 0 0 0 0 0 0 0

10. Inverse Referrals

S.No Totals Cases Referred from 1 ARV ASV Others RHCs THQs DHQs 2 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 4 0 0 0 0 0 0 0

G. MONITORING DURING MONTH UNDER REVIEW

19. Monitoring Visits during the month

DSM Executive Monitoring Other Staff Total 39 75 123 237

2. Important Points/Issues arising from Visits

S # Name of HF Issue Action Remarks 1 - - - - 2 - - - -

H. AVAILABILITY OF MEDICINES/MEDICAL MATERIALS

1. Medicines available for 16 Weeks

2. Important Issues raised relating to Medicines, etc. during MRM

I. REPAIR / MAINTENANCE / ELECTRIFICATION OF / AT HFs

Description of Repair / S # Name of HFs Status / Remarks Maintenance incl. Electrification 1 GD Chodhio Sadhayo 99% Work in progress 2 BHU Ali Khan 50% Work in progress 3 BHU Nabi Shah Waggan 15% Work in progress 4 GD Khadim Hussain Jatoi 00% Work to be started

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Inspections / Visits of PPHI HFs

Visitors* Health Facilities Visited Overall Comments ------* To reflect only non-PPHI Visitors.

J- DISCUSSION DURING MRM

Punctuality: DSM asked MOs & FMOs to ensure punctuality of the time during the HF working hours in the interest of the patients.

On Preventive Health: Malaria preventive measures discussed.

On Curative Health: Scabies, Hand Wash

On Mother, Child & Reproductive Health:

Other Matters: It was also decided to organize Hepatitis B /C Screening Camps at all the HFs managed by PPHI after polio round.

Date /Time for Next MRM: 10 May 2012

Comments on Targets vs Achievements (by DSM) R&R work completion within given deadline

DSM directed the Executive Construction, MOs , M&E & SO concerned to ensure early start R&R work of BHU Nabi Shah Wagan , BHU Ali Khan & GD Khadim Hussain Jatoi.

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MINUTES OF THE (45) MONTHLY REVIEW MEETING OF DISTRICT SUKKUR

Monthly Review Meeting (MRM) of District, Sukkur for the Month of April, 2012 was held on 11th May, 2012 at DSU PPHI Sukkur. Written invitations to participate were sent to the DCO, the EDO(H), the EDO(F&P) and District Incharge of EPI, LHW, and all other National Programs as usual. The list of participants follows:

List of Participants:

S # Names/Designation S # Names/Designation 1 NASIMDDIN MIRANI DSM Sukkur 36 Dr.Shazia Mangi 2 Syed Haider Ali Shah EO (M&E) 37 Dr.Rizwana Parveen 3 Shazia Rasool EO (F&A) 38 Dr. Zakia Mahar 4 Mohammad Idress DO EDOH 39 Dr.Zaib-nisa 5 Asif Nazeer Kalwar SO 40 Dr.Shaista Mahar 6 Zubair Ahmed SO 41 Dr. Saira Kalwar 7 Dr. Shumaila SO DEWS WHO 42 Dr. Musarat Qureshi 8 Dr. Ghulam Murtaza 43 Dr. Shazia Amir 9 Dr. Abdul Aziz Sheikh 44 Dr. Bisharat Ali Sheikh 10 Dr. Abdul Wahab 45 Dr. Farzana Sheikh 11 Dr. Muhammad Javed Baloch 46 Dr.Farzana chachar 12 Dr. Mumtaz Bullo 47 Dr. Suneel Kumar 13 Dr. Saifullah Qureshi 48 Dr.Kaneez Fatima 14 Dr. Ahsanullah Dayo 49 Dr. Rasool Bux Shah 15 Dr. Abdul Sami Sheikh 50 Dr. Illahi Bux 16 Dr. Abdul Gaffar Khoso 51 Faisal Sheikh Assistant Admin 17 Dr. Abdul Waheed Simair 52 Dr.Khadim Soomro 18 Dr. Bashir Ahmed 53 Dr. Arshad Qazi 19 Dr. Nizam Shah 54 Dr. Jalees Fatima 20 Dr. Khurram Hayat 55 Dr. Farzana Naz 21 Dr. Ghulam Rasool 56 Dr. Shahid Shahni 22 Dr. Noor Ahmed Soomro 57 Dr. Afshan soomro 23 Dr. Girdhari Mal 58 Dr. Sanam Qazi 24 Dr. Tahir Hussain Abbassi 59 Dr. Nusrat Dharejo 25 Dr. Munawar Kalwar 60 Dr. Abida Gillani 26 Dr. Ghulam Qadir 61 Dr.Abida Simair 27 Dr. Zahid Mahar 62 Dr. Ghulam zuhra 28 Dr. Salahuddin Shah 63 Dr. Sanam Qazi 29 Dr. Meer Parveez 64 Ghulam Hussain Mahar DDPWO 30 Dr. Nadeem Ahmed 65 222

31 Dr. Ghulam Muhammad 66 32 Dr. Abdul Hakeem Faisal 67 33 Dr. Amanullah 68 34 Dr. Mohammad Naqi

The following could not attend the meeting for the reasons stated against each:-

S # Names/Designation Reasons S # Names/Designation Reasons 1 Dr. Aneela Haseja Leave 3 Dr. Javed Ahmed Absent 2 Dr. Mushtaque Ahmed Leave

R. HFs WITH PPHI

BHUs: ___26____ Dispensaries: ___7____ MCHCs: ___1____ Others:__1____

TOTAL: ___35____

B. Population of the Catchments Area:

MM. STAFF STRENGTH

Sanctioned Government PPHI Vacant Working Posts (Govt.) Employees Contract (Sanc-Govt) MOs 35 13 23 58 23 WMO 0 0 0 FMOs 22 18 0 18 5 LHVs 45 42 27 13 3 Male 2 2 0 MTs/MAs 2 0 Female 0 0 0 Dispensers/HT 52 52 35 17 0

NN. CLUSTERS OF HFs

WITH ONE MO

WITH ONE FMO

Previous Month Total Month under Review Total Clusters of 5 HFs Clusters of 5 HFs Clusters of 4 HFs Clusters of 4 HFs Clusters of 3 HFs Clusters of 3 HFs Clusters of 2 HFs 14 Clusters of 2 HFs 12

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Single HFs 4 Single HFs 6

E. CAPACITY BUILDING

57. Capacity Building of LHVs / Dispensers During Month under Review

No. of Names of the Resource Persons with dates Date Venue Topic Participants NIL NIL NIL NIL NIL

Behavior Presented By: Dr. Abdul Aziz Shaikh

DEFINATION ` The Way We Act Towards Others.

BEHAVIOR ` Depends on the Attitude of the person , which derives from their background, knowledge, and life experiences. ` It changes according to the situation.

Shaped by:

` Belief : An idea thought to be true by an individual that may or may not be supported by facts.

` Value: An opinion or standard that is important to an individual. Values are formed or influenced by religious, educational, and cultural factors or grow from personal experience.

Attitude: A view or opinion that is formed from a person’s beliefs and values, which in turn shapes behavior.

TYPES:

` Passive/non-aggressive. ` Aggressive. ` Assertive.

` Passive/non-aggressive: A person tries to avoid conflict and unpleasant and risky situations, has low self-esteem, is apologetic and hesitant.

` Aggressive:

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A person shows a tendency to put others down, ignore the right of others, dominates, attacks, blames, and shows hostility and anger.

` Assertive: A person is appropriately honest, is empathetic, respect the right of others, listens to others, has positive feelings about him/herself.

` One person can show different behavior in different situations. ` One should try to exhibit assertive behavior at all the time.

F. REVIEW OF THE PERFORMANCE (I) PREVENTIVE HEALTHCARE During Month under Review 1. Vaccination / Immunization

Descriptions Number Doses of Immunization Administered to Children at HFs. 2381 TT vaccines administered to pregnant women at HFs. 1136 Immunization & Vaccination Administered by outreach EPI Teams 5882 Total Vaccination / Immunization for the Month April 2012 9399

2. National Immunization Days (NIDs) for Polio

Percentage of Dates of NIDs Target of coverage Actual coverage coverage 0 0 0 0

3. Other Preventive/Promotional Services

(II) MOTHER, CHILD & REPRODUCTIVE HEALTH During Month under Review 1. Female Health

S # Names of FMOs Ante-Natal Cases Neo-Natal Cases Other OPD Total OPD 1 Dr. Kaneez Fatima 287 9 1374 1670 2 Dr. Ghulam Zuhra 384 21 764 1169 3 Dr. Nusrat Dharejo 440 11 496 947 4 Dr. Shazia Mangi 190 7 1125 1322 5 Dr. Afshan Shahid 114 3 734 851 6 Dr. Najma Shah 391 5 1365 1761 7 Dr. Abida Simair 292 8 1428 1728 8 Dr. Shazia Aamir 327 4 2039 2370 9 Dr. Anila Hasija 189 4 1257 1450

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10 Dr. Jalees Fatima 117 3 856 976 11 Dr. Zaibunisa 94 2 709 805 12 Dr. Sanam Qazi 231 1 931 1163 13 Dr. Shaista Mahar 234 1 1134 1369 14 Dr. Rizwana 161 2 1048 1211 15 Dr. Zakia Mahar 133 1 791 925 16 Dr. Farzana Riaz 20 0 394 414 17 Dr.Sahira Kalwar 115 0 1004 1119 18 Dr. Farzana 113 0 688 801 Total 3832 82 18137 22051

2: Deliveries Assisted

S # Service Number 1 Deliveries Assisted at HFs 79 2 Deliveries Assisted at Homes 44

3. Lab/ Diagnostic Tests

S # Test Number 1 Pregnancy Tests 561 2 Blood Sugar Tests 731 3 Hemoglobin Tests 516 4 Ultra Sound Test 2092 5 Other 26

58. Important Discussion on Mother and Child and Reproductive Health during MRM No new thing was discussed on this issue.

59. Provision of Family Planning Services during the Month

S # Name of the Items / Service Number Consultation / Advice 260 Oral Pills 206 IUCDs 10 Injections 268 Others 202 Total 946 8 (III) COMMUNITY PARTICIPATION During Month under Review

1. Number of Male SGs: -----34------Number of Female SGs: ----02------

2. Performance of Social Organizers

Meetings of Support Groups CHSs/SHSs arranged by him Names of Social Organizers conducted by him Total No. of No. of Male Female No. Participants Participants Nasimddsin Mirani DSM 1 0 20 0/0 0/0

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Syed Haider Ali Shah EO M&E 66 2/0 70/0 4 0 One Meeting Along with DSM Zubair Ahmed Sahto 2 0 20 2/2 65/120 Asif Nazeer 2 0 20 02/02 75/80 Total 8 0 126 6/4 210/200

3. School Health Sessions & Community Health Sessions

Community Health Sessions School Health Sessions Names of MO / Children Children FMOs/Paramedics Sessions Participants Sessions Examined Treated Dr. Sahira 2 35 1 74 Dr. Afshan Shahid 0 0 2 160 52 Dr. Nusrat Dharejo 2 110 1 17 6 Dr. Kaneez Fatima 2 50 1 10 6 Dr. Ghulam Zuhra 2 40 1 11 0 Dr. Shazia Mangi 2 60 1 00 Dr. Najma Shah 2 76 1 13 2 Dr. Shazia amir 2 35 2 58 0 Dr. Zaibunisa 2 25 0 00 Dr. Abida Simair 3 40 0 00 Dr. Anila Hasija 2 59 1 18 12 Dr. Farzana Riaz 0 0 Sanam Qazi 2 39 2 25 8 Dr. Zakia Mahar 2 38 0 00 Dr. Jalees Fatima 1 20 2 40 0 Dr. Rizwana 4 120 2 32 7 Dr. Shaista Mahar 4 60 1 26 19 Dr. Farzana 2 62 2 67 8 Dr. Girdhari 2 50 2 14 7 Dr. Shahid Hafeez 0 0 1 15 2 Dr. Zahid Mahar 2 32 2 46 40 Dr. Basheer Ahmed 1 35 1 30 5 Dr. Salahuddin Shah 2 28 1 13 3 Dr. Ghulam Rasool 2 37 1 13 5 Dr. Nizam Shah 0 0 1 55 16 Dr. Kadim 1 16 1 92 Dr. Arshad Qazi 2 70 2 20 20 Dr. Mumtaz Bullo 1 35 0 00 Dr. Fezan shah 0 0 0 0 0 Dr. Aziz Sheikh 2 36 2 20 6 Dr. Meer Parveez 1 35 1 53 Dr. wahab 1 35 1 12 4 Dr. Ghaffar Khoso 0 0 0 0 0 Dr. Munwar 2 80 0 00 Dr. rasool Bux 0 0 0 00 Dr. Saifullah 2 74 2 35 12 Dr. Waheed 2 22 1 20 4 Dr Khuram 2 64 2 55 33 Dr. Ghulam Qadir 1 15 1 10 5 Dr. Tahir Abbasi 2 31 2 40 24 Dr. Noor Ahmed 1 10 1 30 0 227

Dr.. Ghulam 1 30 1 20 5 Muhammad Dr. Mushtaq Mahar 1 10 2 30 15 Dr. Faisal Qazi 1 10 2 25 21 Ghulam Mrtaza 1 16 16 10 5 Dr. Ahasan Dayo 1 25 1 20 10 Dr. Javeed Baloch 1 19 2 16 3 Dr. Sami Sheikh 1 12 1 72 Dr. M Hasan 1 30 0 00 Dr. Nadeem Mangi 1 9 1 10 2 Dr. amanullah 1 69 1 30 30 Dr. Sunil Kumar 1 25 1 20 13 Total 76 1829 73 1114 421

4. Important Points during Support Group Meetings. Community Support group members are suggested to conduct jointly health session with IMO & FMO at there respective areas. It was planned that next month all MO and FMO will conduct session in the catchments area of their HFs.

5. Important Points during SHSs

The focused topic for the month of April 2012. So all participant are educate about the Importance of extra curriculum activities in school

6. Important Points during CHSs

The preventions were discussed with the participants; The Doctors shared the causes of ARI and Malaria and also insisted to the participants that you have to follow the preventions to avoid the diseases.

7. Topics for SHSs for the Month

Sr. No. Topics 1 Hygiene & its importance. 2 Asthma and its prevention. 3 ARI and its prevention. 4 Extra curriculum activities & its role in development

8. Topics for CHSs for the Month

S # Topics 1 ARI Infections & its prevention. 2 Diarrhea types & its prevention 3 Health Awareness and its importance 4 Quakes & its effects on society 5 Obstetric problems and its complications. 6 Skin infection & its prevention (Scabies). 7 Poliomyelitis its complication & preventions. 8 Vaccination & its importance. 9 Malaria its complications& its prevention. 10 Heat Stroke and its prevention.

9. Important Discussion on Community Participation during MRM Not discussed. 228

10. Health Camps: Number Held: ------. Number of Patients: ------.

11. Measures for improvement / provision of Services by other Department / Agencies

(IV) CURATIVE SERVICES DURING THE MONTH UNDER REVIE

1. OPD*

New patients treated Old patients treated Total OPD during the during the month during the month month (New + Old) 84888 4362 89250

2. Maximum OPD** Minimum OPD**

S # BHU OPD BHU OPD 1 BHU Newpind 7531 GD FM Jatoi 1583 2 BHU Dadloi 6290 BHU Samo Chachar 1443 3 BHU Qasimpur 5102 GD Riazabad 1122 4 BHU Tando Nouraja 4230 BH Dubar 1056 5 BHU Patni 3967 GD Village Sehta 966

3. Top Five Diseases Treated during School Health Sessions/Camps

S # Diseases No. of Patients 1 ARI 0 0 2 Suspected Malaria 3 Diarrhea 0 4 Scabies 0 *All HFs — BHUs and others. **Reflects OPD at BHUs only — not at other HFs.

4. Top Four Diseases during OPD

S # Disease No. of Patients 1 ARI 15713 2 Malaria 9130 3 Diarrhea 10046

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4 Skin Diseases 6319

60. ARV / ASV used during the month

No. of Patients Dog bite cases reported 166 ARV Administered 166 ARV Available Doses at HF 29 Snake bite cases reported 0 ASV Vaccine Administered 0 ASV Vaccine Available Doses 0

62. Lab / Diagnostic Tests: Includes Tests Reported at No. (II) (Mother, Child & Reproductive Health) 3. (Lab / Diagnostic Tests)

S # Tests Number 1 Pregnancy Tests 561 2 Blood Sugar Tests 731 3 Hemoglobin 516 4 X-Rays (if available) 26 5 Ultra Sound 2092 6 Others (please specify) 0

63. B & C SCREENING TESTS

No. of No. of cases No. of cases Total referred Follow up Screening Tests found referred for upto date result Performed positive treatment Hepatitis B 0 0 0 0 0 Hepatitis C 0 0 0 0 0

64. TUBERCLOSIS

Patients New Cases During Under Diagnosis Receiving Treatment the Month 106 18 68

9. Referrals

S.No Totals Cases Referred To 1 TB DOT Deliveries Others RHCs/HFTHQs DHQs 2 102 34 01 67 05 50 47 3 4

S.No Totals Cases Referred from 1 ARV ASV Others RHCs/HF THQs DHQs/DSU 2 71 62 0 9 0 0 71 3 4

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G. MONITORING DURING MONTH UNDER REVIEW

20. Monitoring Visits during the month

DSM EX: M&E Other Staff Total 39 73 105 217

2. Important Points/Issues arising from Visits

S # Name of HF Issue Action Remarks Nil Nil Nil Nil

H. AVAILABILITY OF MEDICINES/MEDICAL MATERIALS

1. Medicines available for …………60……………. Weeks

2. Important Issues raised relating to Medicines, etc. during MRM

I. REPAIR / MAINTENANCE / ELECTRIFICATION OF / AT HFS

Description of Repair / S # Name of HFs Status / Remarks Maintenance incl. Electrification 1 BHU Patni 100% Completed 2 BHU New pind 100% Completed 3 BHU Salehpat 100% Completed 4 BHU Qasimpur 100% Completed 5 BHU Arore 100% Completed 6 BHU Nouraja 100% Completed 7 BHU Dadloi 100% Completed 8 BHU Dubar 100% Completed 9 BHU Hingoro 100% Completed 10 BHU Tando Thatti 100% Completed 11 BHU Gagro 100% Completed 12 BHU Darawhan 100% Completed 13 BHU Kandowahan 100% Completed 14 BHU Sultan pur 100% Completed 15 GD Mubarkpur 100% Completed 16 BHU Cheechro 100% Completed 17 BHU Haji Khan Chachar 100% Completed 18 BHU Thikratho 100% Completed 19 GD Naseerabad 100% Completed 20 BHU Nirch 100% Completed 21 BHU Abad 100% Completed 22 BHU Faqeerabad 100% Completed 23 BHU Thariri 100% Completed 24 BHU Lutaf Ali Jagrani 100% Completed 25 BHU Hussain Kalwar 100% Completed 231

26 BHU Samo Chachar 100% Completed 27 BHU Dodanko 100% Completed 28 BHU Kandri 100% Completed 29 GD Ali Wahan 100% Completed 30 GD Riazabad 100% Completed

Inspections / Visits of PPHI HFs

Visitors* Health Facilities Visited Overall Comments NIL NIL NIL

* To reflect only non-PPHI Visitors.

J- DISCUSSION DURING MRM

On Staff Matters: • Most Male Medical Officers are not conducting Community and School Health Sessions • Referral Register not maintained properly. • Most of the columns of PPHI profarma empty. • Suspected cases of TB were not mentioned in DHIS report. • Most of MO & FMO came late at HF. • Leave procedure may strictly be follow. • Requisition for medical equipments, furniture & other must be submitted every month. • The Ratio of Immunization & Family Planning Services are reduced during last month • F.M.O Report & DHIS Report is not match with each other.

On Preventive Health:

• Punctuality and performance of all vaccinators may be monitored strictly as special direction received from wordy Program Director. • Report of Immunization (EPI) was submitted on weekly bases by I/C MO at DSU Sukkur for further submission to PSU.

On Curative Health: • The ARI was the top diagnostic diseases for the month of April and it may further increase in next month so more medicine of ARI will be provided to the HFs. On Mother, Child & Reproductive Health:

Total 79 NVDs were conducted by PPHI staff during the month of April 2012 which is not a good sign. The contraceptive material is Available, while antenatal and postnatal cases are increased. Other Matters: Date /Time for Next MRM: 10/06/2012 Comments on Targets vs Achievements (by DSM)

Achievements:

232

1: Three portable Generators were provided to Ultrasonlogist.

2: Survey of damaged HFs.

3: Shared un available medicine namely (amoxicillin Drops, stitching Material, Sugar pricker, Cotton roll) from other DSUs

Targets: 1: Increase the ratio of CSG meetings.

2: Target for TT vaccination, Family planning, & Deliveries services should be increased.

3.TS will be submitted to PSU

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