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					Three Years Rolling Plan

     2010-2013


  District Jhelum
                             Three Year Rolling Plan (2010 – 2013) District Jhelum



Table of Contents
Acronyms ................................................................................................................................................ 5
Executive Summary................................................................................................................................. 7
SECTION 1: DISTRICT HEALTH PROFILE ............................................................................ 9
I.         Vision of the District ................................................................................................................ 9
II.              Background of the District ................................................................................................. 9
III.             Map of the District .............................................................................................................. 10
IV.              Demography .......................................................................................................................... 10
V.               Socio-Economic Indicators............................................................................................... 12
VI.              Heath Indicators .................................................................................................................. 12
VII.             Organizational Structure of District Health Administration ................................. 13
VIII.               Health Resources ............................................................................................................ 14
      1.         Health Facilities ................................................................................................................... 14
           a). Public ..................................................................................................................................... 14
           b). Private ................................................................................................................................... 14
      2.         Human Resource ................................................................................................................. 15
      a.         Administrative ...................................................................................................................... 15
      b.         Facility Based Staff ............................................................................................................. 15
           i.       Basic Health Units (45) ................................................................................................. 15
           ii.      Rural Health Centers (5) ............................................................................................... 16
           iii.         THQ Hospitals (2) ........................................................................................................ 17
           iv.          DHQ Hospital Jhelum ............................................................................................... 18
      c.         Outreach Staff ...................................................................................................................... 20
      d.         Training Institutions .......................................................................................................... 20
           i.       DHDC .................................................................................................................................. 20
           ii.      General Nursing & Midwifery School........................................................................ 21
           iii.         Para- medical School Jhelum ................................................................................. 21
      3.         Health Financing ................................................................................................................. 23
IX.              Disease Pattern .................................................................................................................... 24
X.               Status of Vertical Programs ............................................................................................. 25
      1.         National Program for FP & PHC ..................................................................................... 25
      2.         EPI ............................................................................................................................................ 26


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                         Three Year Rolling Plan (2010 – 2013) District Jhelum



   3.         MNCH Program .................................................................................................................... 26
   4.         TB Control Program............................................................................................................ 26
   5.         Malaria Control Program .................................................................................................. 26
   6.         Hepatitis Control Program ............................................................................................... 27
SECTION 2: PROBLEM ANALYSIS ............................................................................................ 28
   I.         Objectives............................................................................................................................... 29
   II.           Plan Development Process ........................................................................................... 29
   1.         Problem Identification........................................................................................................ 30
        A-           Health Problems .......................................................................................................... 30
   2.         Problem Prioritization ........................................................................................................ 31
   3.         Underlying causes of prioritized health problems .................................................... 32
   III.          MDGs and MSDS ............................................................................................................ 35
        1)       Human Resource ............................................................................................................. 35
        i.       DHQ Hospital ................................................................................................................... 36
        ii.      THQ Hospitals .................................................................................................................. 37
        2)       Equipment ......................................................................................................................... 37
SECTION 3: INTERVENTIONS AND TARGETS ..................................................................... 56
Health Problems .............................................................................................................................. 56
        Management Problems .......................................................................................................... 70
SECTION 4: COSTING & FINANCING PLAN........................................................................... 77
   I.         Activity based costing ........................................................................................................ 77
   a)         Health Problems .................................................................................................................. 78
   b)         Management Problems ...................................................................................................... 88
   II.           Financial outlay including 3YRP activities ............................................................. 95
   a)         Health Problems .................................................................................................................. 95
   b)         Management Problems ...................................................................................................... 97
   III.          Summaries ........................................................................................................................ 98
   1.         Problem-wise costing ......................................................................................................... 98
        a)       Health Problems .............................................................................................................. 98
        b)       Management Problems .................................................................................................. 98
   2.         Activity-wise Costing .......................................................................................................... 99
        a)       Health Problems .............................................................................................................. 99


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                       Three Year Rolling Plan (2010 – 2013) District Jhelum



       b)      Management Problems ................................................................................................ 106
SECTION 5: MONITORING & EVALUATION ........................................................................ 109
   M&E of Plan ................................................................................................................................ 109
Annex-I ................................................................................................................................................ 113
Annex-II ............................................................................................................................................... 117




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           Three Year Rolling Plan (2010 – 2013) District Jhelum



Acronyms
3YRP             Three Years Rolling plan

ADB              Asian Development Bank

AE               Assistant Entomologist

APMO             Additional Principal Medical Officer

ARI              Acute Respiratory Infections

ASV              Assistant Superintendent Vaccination

BHU              Basic Health Center

BoD              Burden of Disease

CDC              Communicable Disease Control

CDR              Case Detection Rate

CPR              Contraceptive Prevalence Rate

DC               District Coordinator

DHIS             District Health Information System

DHQH             District Head Quarter Hospital

DoH              Department of Health

DR               Default Rate

DSV              District Superintendent Vaccination

EDO(H)           Executive District Officer Health

EPI              Expended Program on Immunization

HSRP             Health Sector Reforms Program

IMR              Infant Mortality Rate

IPC              Interpersonal Communication

IV               Inspector Vaccination

M&E              Monitoring and Evaluation

M&E              Maintenance and Repair



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          Three Year Rolling Plan (2010 – 2013) District Jhelum



MCH             Maternal Child Health

MMR             Maternal Mortality Ratio

MNCH            Maternal Newborn and Child Health

MO              Medical Officer

MoV             Means of Verification

MSDS            Minimum Service Delivery Standards

PDSSP           Punjab Devolved Social Services Program

PHC             Primary Health Care

PMO             Principal Medial Officer

POL             Petrol, Oil and Lubricant

RHC             Rural Health Center

SCR             Sputum Conversion Rate

SHC             Secondary Health Care

SMO             Senior Medical Officer

TAMA            Technical Assistance Management Agency

TB              Tuberculosis

THQH            Tehsil Head Quarter Hospital

TNA             Training Need Assessment

WHO             World Health Organization

WMO             Women Medical Officer




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                 Three Year Rolling Plan (2010 – 2013) District Jhelum



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

Districts have been preparing 3YRP (medium term plan) for last few years under
the auspices/patronage of Department of Health (DoH) Government of Punjab
through technical assistance of Punjab Devolved Program Social Services
Programme (PDSSP). This year government of the Punjab through Health Sector
Reforms Program (HSRP) with the technical assistance from a team of consultants
(SP09) and wide consultations/inputs from all key stake holders has established a
bench mark in standardization of the format of 3YRP. Capacity building of the
districts has been done on the standardized format.

Current 3 Years Rolling Plan (3YRP) plan is first attempt by the district on that
agreed format. First section of the format (District Health Profile) contains all
relevant information on Geography, Demographic, Socioeconomic and Health
indicators of the district. It also takes stock of health resources in terms of human
resource, infrastructure and others. District diseases pattern compiled from DHIS
Primary and Secondary Health Care reports and current status of vertical /national
programs is part of the profile. In fact district profile is a health related fact sheet of
the   district    and   depicts   the   true   picture   of   health   status   and   health
resources/services of the district. An accurate district health profile provides a
sound basis for evidence-based planning.

3YRP plan has been developed by following the standard planning cycle approach.
3YRP details the current year activities, physical targets and fiscal targets.
Projections of second and third year physical and financial targets are given.
Section Two includes problems identification from various perspectives, and their

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            Three Year Rolling Plan (2010 – 2013) District Jhelum



prioritization by applying WHO prioritization criteria. This section also contains
underlying causes of the prioritized problems. Section Three of the plan relates to
developing best possible interventions/activities and setting physical targets for
each year. Section Four consists of costing based on additional requirements taking
account of implementation of current status of activities. Best available estimates
have been used to accurately cost the activities. The detailed activity based costing
of the Health and Service Delivery problems has been developed on automated
Excel sheets, and annexed for details as ready reference. Last section of the 3YRP
consists of Monitoring and Evaluation of plan to gauge the progress of different
activities and targets of the plan using reliable district data sources. This permits
timely remedial action for smooth implementation of planned activities.




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            Three Year Rolling Plan (2010 – 2013) District Jhelum



                          District Jhelum

SECTION 1: DISTRICT HEALTH PROFILE

 I.   Vision of the District
      Our vision is to ascertain a healthy society, both mentally and physically,
      through provision of improved health care services to district population
      without any discrimination.



II.   Background of the District
      Jhelum was known as Jalham. “Jal” means pure water and “Ham” means
      iced water referring to the iced water of Jhelum River from the snowy peaks
      of the Himalayas. District Jhelum was constituted under the British regime
      on 23rd March 1849. In 1850, the district headquarters was shifted from
      Pind Dadan Khan to Jhelum.

      This district is situated in the northeastern part of Pakistan and was one of
      the four districts of former Rawalpindi division. The district consists of four
      major towns i.e. Jhelum city, Dina, Pind Dadan Khan and Sohawa. The
      district is bounded on the north by district of Rawalpindi on the east by river
      Jhelum, districts of Gujrat and Mirpur of AJK, on the south by the river
      Jhelum and districts of Mandi Bahauddin and Sargodha and on the west by
      the districts of Chakwal and Khushab.

      Total area of the district is 3587 sq. kilometers. Geographically, district
      Jhelum is divided into three regions and are called riverine, upland and
      plateau. Riverine region possesses alluvial soil and is situated between river
      Jhelum and hills in the southern part of the district. Upland region is a tract
      lying between hill ranges. Jhelum Tehsil primarily consists of highland
      region.




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                Three Year Rolling Plan (2010 – 2013) District Jhelum



III.    Map of the District




IV.     Demography
            o   Total Population                           1226031

            o   Annual growth rate                         1.89%

            o   Population density                         3587 Sq. Km

    1. Rural-urban population

                         Area                 Population                 Percentage

                Rural                     840651                   70

                Urban                     360280                   30

                    Source: DCR-1998

    2. Male-female population

                        Gender                Population                 Percentage

                Male                      652248                   53%

                Female                    573783                   47%

                       Source: DCR-1998

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             Three Year Rolling Plan (2010 – 2013) District Jhelum



   3. Population groups

                                               Standard        Estimated
         Population Groups
                                          Demographic (%)      Population

Under 1 year of age                               2.7            32425

Under 5 years                                    13.4           160924

Under 15 years                                    44            528402

Women in child bearing age (15-49                 22            246420
years)

Married Child Bearing age Women                   16            192149

Expected pregnancies                              3.4            40832

Source: Standard Demographic population groups based on DHIS



   4. Tehsil wise distribution

                 Tehsil                      Number of UC      Population

                 Jhelum                           19             401912

                  Dina                            09             230689

                Sohawa                            10             190786

          Pind Dadan Khan                         16             333968

Source: Bureau of Statistics (Census 1998)




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                 Three Year Rolling Plan (2010 – 2013) District Jhelum



V.     Socio-Economic Indicators
       Education and Literacy

             Age                                  Percentage

                 Age 10+ yrs                          77

                 Adult 15+ yrs                        74

                 Adult 15-24 yrs                      93

       Source: MICS 2007-2008


           Housing

                        Mean Household Size:                              6.1 persons
                        Person / housing unit (ownership of House)            90%
                        Percentage of Households who own three or more        98%
                         possessions
                         Source: MICS 2007-2008




VI.    Heath Indicators


      Infant Mortality Rate                                    51 /1000 L.B*

      Neonatal mortality Rate                                  18/1000 L.B

      Under 5 mortality Rate                                   69/1000*

      Maternal Mortality Rate                                 176/100000 L.B

      Malnutrition children less then 5yrs*

                 Underweight prevalence moderate and severe           26%

                 Underweight prevalence severe                        71%

      Life expectancy                                                65 yrs

      Proportion of children under 2 years immunized                 96%




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             Three Year Rolling Plan (2010 – 2013) District Jhelum



VII.    Organizational Structure of District Health Administration


There exists a three-tier system in the health sector in the country. At federal level,
Federal Secretary of Health is responsible to administer and supervise the health
related activities and programs. Major function of federal tier is to provide policy
guidelines and ensure quality of health care standards through federal legislation.
After the 18th amendment in the constitution, and announcement of National
Finance Award, most of the existing federal level programs will be transferred to the
provincial level. At provincial level, provincial Secretary of Health along with
Director General Health Services is responsible for managing and supervising
health care services. The district is still an administrative entity in the system and
EDO (Health) acts as head of the district health department, under overall
supervision of DCO. The organizational structure at district level is as under:




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                Three Year Rolling Plan (2010 – 2013) District Jhelum



VIII.    Health Resources


    1. Health Facilities

    a). Public
      Details of physical infrastructure of public health facilities in the district

                                                                 No. of
                                                 Bed
  Facility Type         No. of Facility                        Functional        Remarks
                                               Strength
                                                                 Beds
 DHQ Hospital                  1                    260            260                 --
 THQ Hospital                  2                    100            100                 --
 RHCs                          5                    100            100                 --
 BHUs                          45                   90              90
 Govt. Rural
                               8                    --              --                 --
 Dispensaries
 MCH Centers                   5                    --              --                 --
 Sub Health
                               1                    --              --                 --
 Centers
 TB Clinics                    1
 Rural
 Dispensaries                  11
 (ZC)
 City
                               1                    --              --                 --
 Dispensaries
 Health house                 992                   --              --                 --
 Data source: DHIS/EDOH office

    b). Private


        Private sector is also contributing in provision of health services in the district.
        In absence of any registration and regulatory mechanism, actual situation of
        private sector is not known. According to available information total number of
        private hospitals and clinics are 50. With the passage of time, role of private
        health care providers will expand and there is a need to develop an effective
        coordination between public and private sector. Detailed list of private sector
        health facilities is attached as Annex-I.




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            Three Year Rolling Plan (2010 – 2013) District Jhelum



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

  a)    Administrative
  b)    Facility based
  c)    Outreach
  d)        Training institutions




  a. Administrative


      Sr.                  Name of Post            Sanctioned        Filled
      No.
       1  Executive District Officer Health             1              1
       2  District Officer Health                       1              1
       3  Deputy District Officer Health                4              4
       4  Program Director DHDC                         1              1
       5  District Coordinator National                *0              1
          Program
    6     District Coordinator EPI Surveillance        *0              1
    7     District Sanitary Inspector                   1              1
    8     CDC Officer                                   1              1
    9     CDC Inspector                                 4              1
    10    Drug Inspector                                5              3
    11    District Superintendent Vaccination           1              0
    12    Assistant Superintendent                      4              1
          Vaccination
    13    Tehsil Sanitary Inspector                     4              2
    14    Inspector Vaccination                         4              0
  *The post is not sanctioned


  b. Facility Based Staff
 i.     Basic Health Units (45)
      Sr.          Name of
                                      Sanctioned     Filled         Vacant
       #      Post/Designation
       1    Medical Officer               45           35             10
            School Health &                                           2
       2                                  45           42
            Nutrition Supervisor

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           Three Year Rolling Plan (2010 – 2013) District Jhelum



       3    Medical Assistant          15             8              7
       4    Computer Operator          50             43             7
       5    Medical Technician
       6    LHV                         45            43            2
       7    Dispenser                   45            37            8
       8    Midwife                    135           110            25
       9    N/Qasid                     45            45            0
      10    Chowkidar                   45            45            0
      11    Sanitary Worker             45            45            0




ii.     Rural Health Centers (5)
      Sr.         Name of
                                   Sanctioned       Filled         Vacant
       #      Post/Designation
       1   Senior Medical               5             1              4
           Officers
       2   Women Medical                5             3              2
           Officers
       3   Woman Medical                5             1              4
           Officer (MNCH)
       4   Dental Surgeons             5              5             0
       5   Medical Officers            6              5             1
       6   Charge Nurses               30             17            13
       7   Homeo Doctors               3              3             0
       8   Hakeems                     2              1             1
       9   Computer Operators          5              4             1
      11   LHV                         10             6             4
      12   LHV (MNCH)                  5              4             1
      13   Lab. Technician             5              4             1
      14   Dental Technician           5              1             4
      15   R.H.I                       21             0             21
      16   Junior Clerk                5              5             0
      18   Homeo Dispenser             3              3             0
      19   Dawasaz                     2              2             0
      20   Radiographer/X-Ray          5              4             1
           Asstt.
      21   Dresser                     5              5              0
      22   Anesthesia Assistant        5              3              2
      23   O.T.A                       5              3              2
      24   Dispenser                   20             20             0
      26   Laboratory Assistant        5              5              0
      27   Midwife                     23             21             2

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             Three Year Rolling Plan (2010 – 2013) District Jhelum



       Sr.           Name of
                                     Sanctioned       Filled         Vacant
        #       Post/Designation
       28     Driver                     5              4              1
       29     T.O                        5              5              0
       32     Ward Servant               10             10             0
       33     Sweepers/ Sanitary         20             18             2
              Worker
       35     Sanitary Patrol            25             25             0
       36     Naib Qasid                 15             15             0
       37     Mali                       5              5              0
       38     Cook                       4              4              0
       39     Chowkidar                  10             10             0
       40     Water Career               5              5              0


iii.     THQ Hospitals (2)


                 Name of Post/
       Sr.                           Sanctioned       Filled         Vacant
                  Designation
             Medical
         1.                               2             2              0
             Superintendent
         2. APMO                         4              0              4
         3. APWMO                        2              0              2
         4. Gynecologist                 4              0              4
         5. Physician                    2              0              2
         6. Pathologist                  2              0              2
         7. Anesthesia Specialist        2              1              1
         8. Eye Specialist               2              0              2
         9. Surgeon                      2              1              1
         10. Pediatrician                2              1              1
         11. Medical Officer / CMO       18             10             8
         12. WMO                         7              5              2
              Senior Dental
         13.                              2             2              0
             Surgeon
         14. Pharmacist                  2              2              0
         15. Head Nurse                  2              2              0
         16. Male Nurse                  2              1              1
         17. Charge Nurse                22             16             6
         18. Dispenser                   10             8              2
         19. Radiographer                4              4              0
         20. Lab. Assistant              4              4              0
         21. Junior Clerk                2              2              0
         22. Ward Servant                5              5              0

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            Three Year Rolling Plan (2010 – 2013) District Jhelum



        23. Driver                       4             4              0
        24. Naib Qasid                   5             5              0
        25. Cook                         1             1              0
        26. Ward boy                     5             5              0
        27. Water Carrier                2             2              0
        28. Mali                         2             2              0
        29. Gatekeeper                   2             2              0
        30. Baildar                      2             2              0
        31. Chowkidar                    2             2              0
            Ward Cleaner/
        32.                             12             10             2
            Sweeper
        33. Homeo Doctor                 2             2              0
        34. Homeo Dispenser              2             1              1
        35. Hakeem                       1             1              0
        36. Dawasaz                      1             1              0


iv.     DHQ Hospital Jhelum


      Sr.          Name of
                                     Sanctioned      Filled         Vacant
       #      Post/Designation
            Medical
        1.                               1             1              0
            Superintendent
        2. Physician                     1             1              0
            Chief Consultant
        3.                               1             1              0
            Physician
        4. Surgeon                       2             2              0
        5. Radiologist                   2             1              1
        6. Pathologist                   1             1              0
             Senior Consultant
        7.                               1             1              0
            Pediatrician
            Chief Consultant ENT
        8.                               1             1              0
            Specialist
        9. Ophthalmologist               1             1              0
        10. Anesthetist                  3             2              1
        11. Senior Dental Surgeon        1             1              0
            Principal Dental
        12.                              1             1              0
            Surgeon
        13. Cardiologist                2              1             1
        14. Senior Medical Officer      15             2             13
            Senior Woman
        15.                              9             0              9
            Medical Officer
        16. Gynecologist                 3             3              0

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       Three Year Rolling Plan (2010 – 2013) District Jhelum



         Senior Consultant
     17.                            1             1            0
         Gynecologist
     18. Medical Officers          12             5            7
         Woman Medical
     19.                            4             2            2
         Officers
     20. Chest Specialist           1             1            0
     21. APMO                       5             4            1
     22. APWMO                      4             3            1
         Causality Medical
     23.                            9             4            5
         Officer
     24. Pharmacist                2              2            0
     25. Nursing Instructor        1              0            1
     26. Head Nurse                7              5            2
     27. Homeo Doctor              1              1            0
     28. Hakeem                    1              1            0
     29. Charge Nurse              58             48           10
     30. ECG Technician            2              1            1
     31. Dental Technician         1              1            0
     32. Lady Health Visitor       2              2            0
     33. House Keeper              1              1            0
     34. Sr. Clerk                 1              1            0
     35. Dispenser                 8              8            0
     36. Stretcher Bearer          2              2            0
     37. Dresser                   2              2            0
     38. Homeo Dispenser           1              1            0
     39. Dawa Saz                  1              0            1
     40. OTA                       3              3            0
     41. Radiographer              3              3            0
     42. Store Keeper              1              1            0
     43. Junior Clerk              4              3            1
     44. Lab Assistant             3              3            0
     45. Khateeb                   1              1            0
     46. Driver                    4              4            0
     47. Midwife                   2              2            0
     48. Lab Attendant             3              3            0
     49. X-Ray Attendant           2              2            0
     50. Ward Servant              39             39           0
     51. Dhobi                     2              2            0
     52. Dawa Kob                  1              1            0
     53. Naib Qasid                6              6            0
     54. Ward Cleaner              47             47           0
     55. Cook                      2              2            0
     56. Chowkidar                 6              6            0

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             Three Year Rolling Plan (2010 – 2013) District Jhelum



           57. Mali                              3                3                 0
           58. Baildar                           3                3                 0
           59. Water Carrier                     3                3                 0


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

       Sr.                     Post                  Sanctioned             Filled

       1       Vaccinators                              48                     47
       2       CDC Supervisors                          38                     15
       3       Sanitary Inspectors                      45                     13
       4       Nutrition Supervisor                     45                     43
       5       Social mobilizer NCHD                    45                     42
       6       Sanitary Supervisor                       5                     2



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

              i.          DHDC
              ii.         General Nursing & Midwifery school

              iii         Para-medical school Jhelum

  i.       DHDC


                   Post                    Sanctioned                 Filled

Programme Director                              1                       1
MPPT                                            1                       1
LHV Trainer                                     1                       0
Assistant                                       1                       1
Driver                                          1                       1
Naib Qasid                                      1                       1
Chowkidar                                       2                       2
Sanitary Worker                                 1                       1


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           Three Year Rolling Plan (2010 – 2013) District Jhelum



  ii.   General Nursing & Midwifery School
        Name of Post/Designation          Sanctioned           Filled

Principal School of Nursing                   1                  1
Nursing Instructor                            4                  1
House Keeper                                  2                  2
Sweeper                                       2                  2
Naib Qasid                                    2                  2
Chowkidar/Gate Keeper                         2                  2
Cook                                          3                  3
Masalchi                                      1                  1
Clinical instructor                           1                  0
Public Health Nursing Supervisor              1                  0
Stenographer                                  1                  0
Head clerk                                    1                  1
Accountant cum Cashier                        1                  1
Senior clerk                                  1                  1
Junior clerk                                  1                  0
Aya                                           2                  2
LHV                                           2                  1
Driver                                        1                  0
ANI                                           2                  2




 iii.   Para- medical School Jhelum
           The vacancy position of the Paramedical School Jhelum is as under:

Staff                     Sanctioned          Filled            Vacant

Principal                          1              1                  0
Head Clerk                         1              1                  0
Senior Clerk                       1              1                  0
Accountant                         1              0                  1
Junior Clerk                       2              2                  0
Warden                             1              1                  0
Audio –visual                      1              0                  1
Operator
Museum cum                         1              0                  1
librarian
Dispenser Tutor                    2              2                  0
Laboratory Assistant               2              2                  0
Tutor
Laboratory Assistant               1              1                  0
Radiographer Tutor                 2              2                  0
OTA Tutor                          2              1                  1

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         Three Year Rolling Plan (2010 – 2013) District Jhelum



Chokidar                   3                 3                   0
Mali                       2                 2                   0
Baildar                    2                 2                   0
Cook                       2                 2                   0
Bearer                     2                 2                   0
Naib Qasid                 6                 6                   0
Sweeper                    6                 6                   0
Water Carrier              1                 1                   0




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               Three Year Rolling Plan (2010 – 2013) District Jhelum



     3. Health Financing

     The provision of financial resources at district level is prime responsibility of
     district government. However, keeping in view the budget constraints at the
     district level, federal and provincial governments also augment financial
     resources in form of kind and cash, through different programs. Financial
     resources of the district during the last three years out of different sources are
     given as under:
                                                                             Rs. Million
                                                            Year
                                                                              2009-10 upto
 Source of funding             2007-08                 2008-09
                                                                                03/2010
                       Allocation     Exp.       Allocation        Exp.    Allocation      Exp.

Non-Development        242.606       240.08      252.694       352.935     277.650         236.0


Development            9.120          3.537        7.698           7.039      Nil           Nil

Sub Total              251.726      243.617      260.392       359.974     277.650         236.0

                                                                                          12.181
PHSRP                    60.33        15.70        59.61           33.78    25.864         uptill
                                                                                         28/2/10
PMDGP                                             81.650       12.978       62.671        41.131
PDSSP                   14.640       14.255       16.377       9.251
Provincial
Development Funds          0             0        31.095       19.865       10.118         5.679
(ADP)
Grand Total              74.97       29.955      188.732       75.874       98.653       58.991

                                                            Year
User charges (like                                                         July, 2009 To April,
                               2007-08                  2008-09
parchi fee, fees for                                                              2010
diagnostic services)     Target     Remittance     Target     Remittance    Target      Remittance
                         3.000        2.191         3.30           3.042     3.65          3-36




      23
            Three Year Rolling Plan (2010 – 2013) District Jhelum



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



Disease Group                                       Percentage of Magnitude
Respiratory disease
1    Acute (upper) respiratory infections                         19%
2    Pneumonia < 5 yrs.                                          0.38%
3    Pneumonia > 5 yrs.                                          0.26%
4    TB Suspects                                                 0.80%
5    Chronic Obstructive Pulmonary Disease                       0.38%
6    Asthma                                                      1.63%
Gastro Intestinal Disease
7    Diarrhea / Dysentery < 5 yrs                                1.96%
8    Diarrhea / Dysentery > 5 yrs                                2.26%
9    Enteric / Typhoid Fever                                     0.20%
10   Worm Infestations                                           0.82%
11   Peptic Ulcer Disease                                        4.58%
12   Cirrhosis of Liver                                          0.02%
Urinary Tract Disease
13   Urinary Tract Infections                                    1.82%
14   Nephritis / Nephrosis                                       0.05%
15   Sexually Transmitted Infections                             0.07%
16   Benign Enlargement of Prostrate                             0.01%
Other Communicable Diseases
17   Suspected Malaria                                           1.27%
18   Suspected Meningitis                                        0.01%
19   Fever due to other causes                                    2%
Vaccine Preventable Disease
20   Suspected Measles                                           0.01%
21   Suspected Viral Hepatitis                                   0.13%
22   Suspected Neonatal Tetanus                                  0.00%
Cardiovascular Diseases
23   Ischemic heart disease                                      0.24%
24   Hypertension                                                2.12%

      24
              Three Year Rolling Plan (2010 – 2013) District Jhelum



Disease Group                                    Percentage of Magnitude
Skin Diseases
25    Scabies                                                3.62%
26    Dermatitis                                             1.42%
27    Cutaneous Leishmaniasis                                0.00%
Endocrine Disease
28    Diabetes Mellitus                                      1.28%
Neuro-Psychiatric Diseases
29    Depression                                             0.88%
30    Drug Dependence                                        0.08%
31    Epilepsy                                               0.09%
Eye & ENT
32    Cataract                                               0.25%
33    Trachoma                                               0.06%
34    Glaucoma                                               0.05%
35    Otitis Media                                           0.84%
Oral Diseases
36    Dental Caries                                          1.95%
Injuries/Poisoning
37    Road traffic accidents                                 0.78%
38    Fractures                                              0.19%
39    Burns                                                  0.12%
40    Dog bite                                               0.22%
41    Snake bite (with signs/symptoms of                     0.02%
      poisoning)
Miscellaneous Disease
42    Acute Flaccid Paralysis                                0.01%
43    Suspected HIV/AIDS                                     0.00%
44    Any other Unusual disease (specify)
 (Source: DHIS Specific Reports)


X.    Status of Vertical Programs


     1. National Program for FP & PHC
             No. of seats allocated for LHWs                  1100

             No. of LHWs working                              996

             No of Lady Health Supervisors                    44

             No of LHS working                                37

             Vehicles for LHS                                 40
     25
             Three Year Rolling Plan (2010 – 2013) District Jhelum



        Functional Vehicles                                         32

        Important program indicators
            o IMR                                              38/1000
            o MMR                                              176/100000
            o CPR                                              39%
            o No. of antenatal visits                          15322
            o TT Coverage of pregnant women                    94%

2. EPI
            EPI Coverage rate of the district

               Fully immunized children 0-23 months                         96%

            Pregnant women received TT vaccine      ( TT-2)         61%

            Availability of cold chain equipment                 62 facilities fully

                                                                Equipped, while

                                                    Remaining are facing deficiency

3. MNCH Program
            CMW Students Admitted                                     74

            Passed                                                    39

            Fresh CMWs batch                                         23+13= 36


4. TB Control Program
    CDR all types                                                    70%

    CDR NSS positive                                                 7%

    SCR                                                              92%

    TSR                                                              85%

    DR                                                               1%

5. Malaria Control Program
              No. of slides examined                                18068

              No. of positive slides                                 2

              Slides positively ratio                                 0.01%

              Percentage of plasmodium falciparum                     0

26
         Three Year Rolling Plan (2010 – 2013) District Jhelum



6. Hepatitis Control Program


    No. of hepatitis tests conducted Hepatitis B           17660

    No. of positive cases detected Hepatitis B             870

    No. of hepatitis tests conducted Hepatitis C           17660

    No. of positive cases detected Hepatitis C             1830

    No. of persons vaccinated against Hepatitis B          2895

    No. of cases treated for Hepatitis B                   214

    No. of cases treated for Hepatitis C                   211




27
             Three Year Rolling Plan (2010 – 2013) District Jhelum



SECTION 2: PROBLEM ANALYSIS


The Health sector in Punjab is facing enormous health and service delivery
problems. Common health problems are communicable, non communicable,
MNCH related diseases and accident/ trauma. The society is passing
through demographic and epidemiological transition. This is due to
changing life style, urbanization, ecological and other factors. Disease
pattern is changing where non communicable diseases are gradually
increasing and the communicable diseases are still posing serious threat.
Punjab is practically facing Double Burden of Disease (BOD).               Besides,
health problems service delivery/ managerial issues are also hindering the
access and quality of health services to the population. The service
delivery/management problems are diverse in nature, and include shortage
of technical human resource, capacity issues, lack of infrastructure and
equipment.

Devolution was introduced during 2001 affecting the administrative and
financial set up of the districts. The devolution also brought political culture
in the decision making of the districts in the shape of Nazims, Naib-Nazims
and Councilors. This system is now in the phase of reshaping and it is not
clear what will be future structure and managerial shape when new local
bodies system is put in place. The District Manager and functionaries are in
the state of uncertainty and confusion in this scenario. However, one thing
is clear that the district shall remain a hub of all primary and secondary
health services delivery. Despite the source of funding in the future, either
from provincial or district government, health planning at district level shall
continue to play a pivotal role in provision of quality health services.

In view of the above situation the district considers following objectives for
developing three year rolling plan.




   28
            Three Year Rolling Plan (2010 – 2013) District Jhelum



 I.    Objectives
      Improve health status of the population
      Meeting the requirements of national and provincial health policies
      Achievement of MDGs through MSDS
      Introducing evidence-based planning culture by addressing district
       specific problems/issues
      Addressing emerging health needs or re-emergence of health problems
       (e.g. H1N1, HIV-AIDS, Polio, T.B)
      Ensuring effective inter-sectoral coordination with a view to improving
       health indicators

   The objectives would guide in problem analysis, designing interventions,
   setting /phasing the targets, costing and monitoring the plan activities.




II.    Plan Development Process



Plan development has been a systematic and consultative process. A core
planning team consisting of EDO (H), DOH, MS DHQ and THQs, Statistical
officer, and Budget and Accounts Officer, was designated by Director
General Health Services Punjab. This team received three days customized
training from SP-09 team at divisional headquarters. The main components
of the trainings were: (i) developing a three-year rolling health sector plan
using the standard three year rolling plan format; (ii) costing of the plan; (iii)
preparing related budget projections; (iv) accounting procedures; (v)
preparing adequate financial reports on the use of funds.

The district planning team adopted the following steps for the preparation
of three years rolling plan:

      Problem identification
      Prioritization of identified problems

      29
            Three Year Rolling Plan (2010 – 2013) District Jhelum



      Identifying underlying causes of prioritized problems
      Developing interventions and activities
      Setting targets
      Determining resource requirements, costing and budgeting
      Preparing action plans
      Preparing monitoring plan




   1. Problem Identification



This step involved assessment of the current situation from various
perspectives to establish the actual health situation in terms of health and
service delivery/management problems. Problem identification is based on
the district health profile, review of previous plans, MIS (DHIS, Program
reports and periodic reports etc.), District specific surveys (MICS), MSDS,
and national and provincial policy guidelines.

The district planning team held meetings and started with identification of
problem using the training received from SP-09 team and consulting the
above mentioned documents. The problems identified were broadly divided
into two categories i.e. Health Problems, and Health Service Delivery or
Management Problems. In the initial stage an exhaustive list of these
problems was prepared. The enlisted health and service delivery problems
of the district are given in the following tables.




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

   30
            Three Year Rolling Plan (2010 – 2013) District Jhelum



and district specific reports. The enlisted health problems of the district are
given in the following table.

                         1.   Diarrhea
                         2.   Accidents and Injuries
                         3.   Hepatitis (B&C)
                         4.   Hypertension/CVDs
                         5.   Diabetes
                         6.   Resistant Malaria
                              (Falciparum)
                         7.   Scabies
                         8.   Complications of pregnancy



   2. Problem Prioritization
Prioritization is making decisions on how limited resources could be best
allocated/utilized to priority health problems or needs. The health problems
given above have been prioritized keeping in view the WHO criteria of:

           Magnitude
           Severity/danger
           Vulnerability to intervention (feasibility)
           Cost-effectiveness of the intervention
           Political expediency



Elements of the prioritization criteria were applied to each of the enlisted
health problems. The aggregate of individual scores assigned to the elements
of the prioritization criteria gave the total score for a health problem. This
total score was then used to prioritize the health problems. A cut-off point
was decided to establish the priority health problems of the district. These
problems will be addressed in the three years rolling plan.



   31
                 Three Year Rolling Plan (2010 – 2013) District Jhelum



 The health problems prioritized by the district are given in the following
 table:

  Problem         Magnitude   Severity       Vulnerability       Cost         Political   Total   Priority
                                                  to         Effectiveness   Expedienc    Score   Number
                                             intervention                         y

Diarrhea             4           4                4               4              4         20        1

Hepatitis            4           4                3               2              3         16        3
(B&C)
Accidents &          4           3                4               3              3         17        2
injuries
Diabetes             3           3                3               4              2         15        5

Hypertension         4           3                3               3              2         15        4

Scabies              3           3                3               3              1         13        7

Malaria              3           2                4               3              2         14        6

Drug                 3           2                2               2              2         11        9
Addiction
Complications        2           2                3               3              2         12        8
of pregnancy



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


   Sr. #        Health Problem                                         Causes

     1        Diarrhoeal Diseases            Poor sanitation
                                             Lack of safe drinking water
                                             Unhygienic practices
                                             Lack of awareness among mothers about feeding
                                              and weaning practices


      32
           Three Year Rolling Plan (2010 – 2013) District Jhelum



Sr. #     Health Problem                                  Causes

                                Low EPI coverage
 2      Accidents and            Lack of traffic sense
        injuries                Poor maintenance of vehicles
                                 Poor road conditions
                                Lack of safety measures at work place
                                Fire-arm injuries
                                Domestic accidents
                                Burns
                                Bomb blasts/terrorist activities
                                Lack of tolerance in the society
 3      Hepatitis (B&C)          Poor sanitation
                                Unsafe drinking water
                                Sharing of used syringes
                                Transfusion of unsafe/unscreened blood and blood
                                 products
                                Unsafe sexual practices
                                Ear piercing and tattooing
                                Use of unsterilized equipment by dentists and
                                 barbers
 4      Hypertension/ CVDs      Obesity
                                Inactive life style
                                Lack of recreational sites
                                Genetics

 5      Diabetes                Obesity
                                Inactive life style
                                Lack of recreational sites
                                Genetics

 6      Resistant Malaria       Breeding places for mosquitoes
        (Falciparum)            Decline area of district
                                Lack of awareness for prevention
 7      Scabies                 Overcrowding in schools and homes
                                Low socio-economic conditions
                                Poor Health Education
                                Incomplete treatment (poor compliance)
 8      Complications of        Low access to appropriate health services
        pregnancy               Lack of awareness about danger signs of pregnancy
                                Three delays (seeking health care, transportation,


  33
                Three Year Rolling Plan (2010 – 2013) District Jhelum



Sr. #         Health Problem                                Causes

                                      and lack of referral back-up services)
                                     Lack of skilled birth attendants



        B- Service delivery/Management problems


       1.      Shortage of MNCH related staff
       2.      Inadequate budget for POL
       3.      Political interference
       4.      Outdated/Inadequate equipment for MNCH services at secondary
               level
       5.      Shortage of functional vehicles including ambulances


Underlying causes of Management Problems


Sr. #             Service                                   Causes

  1.        Shortage of skilled      Vacant positions
            (MNCH) staff             Non-sanctioning of staff according to MSDS
                                     Lack of permanent postings
                                     Lack of incentivized and differential pay package
                                     Frequent transfer postings
                                     Job insecurity
                                      Lack of basic amenities at workplace
                                      Lack of conducive environment including insecurity
                                      and transport of children for education
                                     Political interference
  2.        Inadequate budget          Frequent increase in prices of POL
            for POL                    Less allocation for POL budget

  3.        Political                 Undue pressure from local political figures
            interference              especially in medico-legal cases



  4.        Outdated/                Shortage of equipment as per as MSDS
            inadequate               Debilitated condition of existing infra-structure
            equipment for            Lack of repair and maintenance

  34
               Three Year Rolling Plan (2010 – 2013) District Jhelum



            MNCH services at         Inadequate infrastructure for Emergency, Operation
            secondary level           Theatre, OPD and Inpatients, residences for staff at
                                      THQ and DHQ hospitals
                                      Lack of blood transfusion services especially at THQ
                                     Lack of back-up electrical power facilities
   5.       Shortage of              Provision of inadequate funds for purchase of
            functional vehicles       vehicles
            including                Ban on procurement of vehicles by the government
            ambulances               Complicated procedure for purchase of new vehicles
                                     Poor maintenance of vehicles




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

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




    1) Human Resource
       With regard to MSDS gap analysis for human resource, the difference
        between the standards proposed in MSDS and filled posts has been


       35
             Three Year Rolling Plan (2010 – 2013) District Jhelum



       calculated as the vacancy gap. The hospitals have been categorized based on
       their bed strength as follows:




         Hospital                       Category                 Bed Strength

       DHQ Hospital                        A                  400 and above Beds

                                           B                     251-400 Beds

                                           C                    Up to 250 Beds

       THQ Hospital                        A                    Above 60 Beds

                                           B                      41-60 Beds

                                           C                    Up to 40 Beds



        i.    DHQ Hospital
              (Category B)

Sr.          Post       Standard        Sanctioned   Filled    Vacancy    Vacancy
No.                      as per                                 Gap in      Gap in
                         MSDS                                 relation to  relation
                                                              Sanctioned to Filled
                                                               Positions  Positions
  1. Gynecologist            3              3          3           0           0
  2. Pediatricians           3              1          1           2           2
  3. Anesthetists            5              3          2           2           3
  4. Medical
     officers
     including             104             32         11          72            93
     SMO, APMO,
     and PMOs
  5. Women
     Medical
     Officers
     including              39             17          5          22            34
     SWMO,
     APWMO, and
     PWMO

  36
                Three Year Rolling Plan (2010 – 2013) District Jhelum



       6. Nurses               114           65           53         49           61
       7. Lady Health           11           2            2           9           9
          Visitors




ii.    THQ Hospitals
       (Category B and C)

       There are two THQ hospitals in the district; THQ hospital Sohawa belongs to
       Category C, while THQ hospital Pind Dadan Khan belongs to category B. the
       following table is a composite list of MSDS gap analysis for both these hospitals

Sr.            Post          Standard    Sanctioned     Filled    Vacancy    Vacancy
No.                           as per                               Gap in     Gap in
                              MSDS                               relation to relation
                                                                 Sanctioned to Filled
                                                                  Positions Positions
      1.  Gynaecologist          4             4          0           0          4
      2.  Pediatricians          4             2          1           2          3
      3.  Anesthetists           6             2          1           4          5
      4.  Medical Officers
          including SMO,        35            22          10         13            25
          APMO, and PMO
       5. Women Medical
          Officers
          including             19             9          5          10            14
          SWMO,
          APMWO, PWMO
       6. Nurses                39            24          18         15            21
      7 Lady Health             16             2           2         14            14
          Visitors




2) Equipment
  Government of Punjab has notified a standard list as yard-stick of MNCH related
  equipment to provide comprehensive EmONC services in the DHQ and THQ
  hospitals. Provision of comprehensive EmONC services is essentially required to
  decrease the high MMR and IMR prevailing in the province.

       37
             Three Year Rolling Plan (2010 – 2013) District Jhelum




Gaps in relation to the MNCH related equipment have been identified taking into
account the equipment purchased or under process of purchase from all funds
including PMDGP funds allocated/sanctioned to the district. The cost of
equipment      gap   has       been   included       in       the   equipment    portion   of   the
Management/Service delivery problems. The detailed costing of equipment gaps
for DHQ and THQ hospitals is attached as Annex-II.

i.     DHQ Hospital
     Sr.          Equipment                      Standard            Available       Gap
     No.                                             as per
                                                     MSDS
                                                     (Qty.)
                                                 C        B    A
      1    CTG (Cardiac Tocography)              1        1    2        1             0
      2    Foetal Doppler                        3        5    5        3             2
      3    Diagnostic Laparoscope                1        1    2        0             2
      4    Bulb Sucker                           10 20 20               2             18
      5    Baby Warmer                           3        3    6        1             5
      6    Mechanical Sucker                     3        3    6        0             6
      7    Fetal Stethoscope                     4        4    4        4             0
      8    Delivery Table                        2        2    3        2             1
      9    D&C Set                               2        3    4        1             3
     10    Outlet forceps                        4        4    4        0             4
     11    Myoma Screw                           2        2    2        2             0
     12    Kochers forceps                       4        4    8        4             4
     13    Volselum forceps                      6        8    10       3             7
     14    Lanes Tissue holding forceps          2        2    4        2             2
     15    Vaginal Retractors                    10 10 10               5             5
     16    Polypectomy forceps                   2        2    2        1             1
     17    Sponge holder                         10 15 20               4             16
     18    Uterine elevator                      1        1    1        1             0




     38
         Three Year Rolling Plan (2010 – 2013) District Jhelum



 Sr.               Equipment               Standard          Available   Gap
 No.                                           as per
                                               MSDS
                                               (Qty.)
                                           C     B      A
 19    CosCo Speculum                      6    10 10           3         7
       Small, Medium, Large (for each
       category)
 20    Examination light                   3    3       6       2         4
 21    Suction Curette                     1    2       2       2         0
 22    Infant Resuscitation Trolley        1    1       2       0         2
       (with life saving medicines, baby
       laryngoscope, Endo-tracheal
       tube, Infant BP Apparatus,
       Chargeable Light)
 23    Mother Resuscitation Trolley        1    1       2       0         2
       (with life saving medicines,
       Laryngoscope, Endo-tracheal
       tube, BP Apparatus, Chargeable
       light)
 24    Cardiac Monitor                     1    1       2       0         2
 25    Pump Breast Electronic              1    1       1       0         1
 26    Vaginal Hysterectomy Set
26.1   Toothed Tissue Forceps (8”)         2    2       4       2         2
26.2   Non-Tooted Tissue Forceps (8”)      2    2       4       2         2
26.3   Dissection Scissors (Curved 7”)     2    2       4       0         4
26.4   Dissection Scissors (Straight 7”)   2    2       4       0         4
26.5   Hysterectomy Clamps (Straight )     8    8       16      3        13
26.6   Hysterectomy Clamps (Curved)        8    8       16      3        13
26.7   Uterine Sound                       2    2       4       2         2
26.8   Needle Holder (7”)                  2    2       4       2         2
26.9   Needle Holder (10”)                 2    2       4       2         2
26.10 Artery Forceps (Straight 6”)         16 16 32             6        26

39
         Three Year Rolling Plan (2010 – 2013) District Jhelum



 Sr.               Equipment              Standard          Available   Gap
 No.                                          as per
                                              MSDS
                                              (Qty.)
                                          C     B      A
26.11 Artery Forceps (Curved 6”)          16 16 32             3        29
26.12 Allis Forceps                       8    8       16      4        12
26.13 Towel Clamps                        8    8       16      0        16
26.14 Single blade Sims speculum          4    4       8       2         6
26.15 Double blade Sims speculum          4    4       8       2         6
26.16 Sponge holding forceps              8    8       16      4        12
26.17 Volselum forceps                    4    4       8       2         6
26.18 Uterine Sound                       2    2       4       0         4
26.19 Bladder Sound                       2    2       4       0         4
 27    Delivery Sets
27.1   Episiotomy Scissors                10 10 15             2        13
27.2   Straight Scissors                  10 10 15             4        11
27.3   Needle holder                      10 10 15             2        13
27.4   Non-toothed tissue forceps 8       10 10 15             3        12
       inches
27.5   Toothed tissue forceps 8 inches    10 10 15             2        13
27.6   Sims Speculum single blade         20 20 30             2        28
27.7   Sims Speculum double blade         20 20 30             2        28
27.8   Sponge holding forceps             40 40 60             5        55
27.9   Artery forceps                     40 40 60             2        58
27.10 Straight clamps (cord)              20 20 30             2        28
27.11 Vacuum Extractor pump               1    1       1       1         0
27.12 Towel clip                          40 40 60             6        54
 28    Caesarian Section
28.1   Scalpel                            6    8       10      8         2
28.2   Artery Forceps Straight 6 inches   24 32 40             6        34
28.3   Artery Forceps Curved 6 inches     24 32 40             4        36


40
         Three Year Rolling Plan (2010 – 2013) District Jhelum



 Sr.                Equipment             Standard          Available   Gap
 No.                                          as per
                                              MSDS
                                              (Qty.)
                                          C     B      A
28.4   Artery forceps 8 inches            24 32 40             6        34
28.5   Myoma Scissors straight 7 inches   6    8       10      3         7
28.6   Dissecting scissors (curved) 7     6    8       10      1         9
       inches
28.7   Green Armtage forceps 8 inches     24 32 40             10       30
28.8   Obstetric outlet forceps (pair)    6    8       10      0        10
28.9   Doyene’s Retractor                 6    8       10      2         8
28.10 Small Retractors                    12 16 20             2        18
28.11 Towel Clippers                      24 32 40             6        36
28.12 Suction Nozzle                      6    8       10      2         8
 29    MNCH Related Radiology
       Equipments
29.1   Ultrasound Machine                 1    2       3       2         1
29.2   X-Ray Unit 500 kw                  1    1       1       1         0
29.3   Color Doppler                      0    1       1       0         1
29.4   Lead Screen for X-Ray Unit         1    1       1       1         0
29.5   0.5 MN Lead Apron. Lead Gloves,    1    1       1       1         0
       Goggles and Thyroid and
       Gonadal Sheets
29.6   Safe Light                         1    1       1       1         0
29.7   X-RT Film Processing Tank          1    1       1       0         1
29.8   Chest Stand                        1    1       1       1         0
29.9   X-Ray film Illuminator             2    2       2       1         1
29.10 X-Ray Film Hangers All sizes        4    4       4       2         2
 30    MNCH Related Paediatrics
       Equipments
30.1   Paediatric Ventilator              1    2       2       0         2



41
         Three Year Rolling Plan (2010 – 2013) District Jhelum



 Sr.               Equipment             Standard         Available   Gap
 No.                                         as per
                                             MSDS
                                             (Qty.)
                                         C     B      A
30.2   Incubator                         1    1       2      2         0
30.3   Photo Therapy Unit                1    1       1      1         0
30.4   Over-head Radiant Warmer          1    1       1      1         0
30.5   Infant Length Measuring Scale     2    2       2      2         0
30.6   Infant Weighing Machine           2    2       2      2         0
30.7   Nebulizer                         1    1       2      1         1
30.8   Billiubino-meter                  1    1       2      1         1
30.9   Exchange Blood Transfusion Set    1    1       2      1         1
30.10 Nasal Probe Paed size              2    2       4      2         2
 31    Anaesthesia/ICU
31.1   Anaesthesia Machine               1    1       2      1         1
31.2   Ventilators                       1    1       1      1         0
31.3   Nebulizer                         1    1       1      1         0
31.4   Pulse Oximetry                    1    1       1      1         0
31.5   Defibrillator                     1    1       1      1         0
31.6   Airway Oral and Nasal             2    3       4      3         1
31.7   Tracheostomy tube (adult and      2    2       4      3         1
       paeds)
31.8   Face mask of all sizes            2    2       4      4         0
31.9   Double Cuff Tourniquet (for       1    2       2      2         0
       regional block)
31.10 AMBO bag adult                     2    2       4      2         2
31.11 AMBO Bag paeds                     2    2       4      2         2
31.12 Red Rubber Nasal tubes all sizes   4    4       8      4         4
       without cuff
 32    Blood Bank




42
         Three Year Rolling Plan (2010 – 2013) District Jhelum



 Sr.                Equipment            Standard         Available   Gap
 No.                                         as per
                                             MSDS
                                             (Qty.)
                                         C     B      A
32.1   Blood storage cabinet (100 bag    1    1       2      1         1
       capacity)
32.2   Packed cell machine               1    1       1      1         0
32.3   Cell Separator                    1    1       1      1         0
32.4   Freezer for Fresh Frozen Plasma   1    1       1      1         0
32.5   Blood bag shaker                  1    1       2      1         1
32.6   RH view box                       2    2       4      2         2
32.7   Water bath                        2    2       2      2         0
32.8   Micro-pipette                     4    6       8      6         2
32.9   Blood grouping tiles              3    3       6      3         3
32.10 Plasma Extractor                   1    1       1      1         0
32.11 Platelets agitator                 1    1       1      1         0
32.12 Blood thawing bath                 1    1       1      1         0
32.13 Microscopes                        1    1       2      1         0
 33    Gynae & Labour Room Related
       Laboratory Equipment
33.1   Hematology Analyzer               1    1       1      1         0
33.2   Electrolyte Analyzer              1    1       1      0         1
33.3   Analyzer Bio-chemistry Semi-      1    1       1      1         0
       automatic
33.4   Glucometer                        2    2       2      0         2
33.5   Haemoglobino-meter                2    2       4      2         2
33.6   Centrifuge                        1    1       2      1         1




43
             Three Year Rolling Plan (2010 – 2013) District Jhelum



ii.    THQ Hospital Sohawa
      Sr.          Equipment                 Standard         Available   Gap
      No.                                        as per
                                                 MSDS
                                                 (Qty.)
                                             C     B      A
       1    CTG (Cardiac Tocography)         1    1       1      0         1
       2    Foetal Doppler                   2    2       3      1         1
       3    Diagnostic Laparoscope           1    1       1      0         1
       4    Bulb Sucker                      5    10 20          1         4
       5    Baby Warmer                      2    2       3      1         1
       6    Mechanical Sucker                3    3       3      1         2
       7    Fetal Stethoscope                2    3       4      1         1
       8    Delivery Table                   2    2       2      1         1
       9    D&C Set                          2    2       2      1         1
      10    Outlet forceps                   4    4       4      0         4
      11    Myoma Screw                      2    2       2      0         2
      12    Kochers forceps                  4    4       4      2         2
      13    Volselum forceps                 4    4       6      1         3
      14    Lanes Tissue holding forceps     2    2       2      0         2
      15    Vaginal Retractors               4    4       6      0         4
      16    Polypectomy forceps              2    2       2      0         2
      17    Sponge holder                    10 10 15            2         8
      18    Uterine elevator                 1    1       1      0         1
      19    CosCo Speculum                   4    6       6      0         4
            Small, Medium, Large (for each
            category)
      20    Examination light                3    3       3      3         0
      21    Suction Curette                  1    1       2      1         0




      44
         Three Year Rolling Plan (2010 – 2013) District Jhelum



 Sr.              Equipment                 Standard         Available   Gap
 No.                                            as per
                                                MSDS
                                                (Qty.)
                                            C     B      A
 22    Infant Resuscitation Trolley (with   1    1       1      0         1
       life saving medicines, baby
       laryngoscope, Endo-tracheal tube,
       Infant BP Apparatus, Chargeable
       Light)
 23    Mother Resuscitation Trolley         1    1       1      0         1
       (with life saving medicines,
       Laryngoscope, Endo-tracheal
       tube, BP Apparatus, Chargeable
       light)
 24    Cardiac Monitor                      1    1       1      0         1
 25    Pump Breast Electronic               1    1       1      0         1
 26    Vaginal Hysterectomy Set
26.1   Toothed Tissue Forceps (8”)          2    2       2      2         0
26.2   Non-Tooted Tissue Forceps (8”)       2    2       2      2         0
26.3   Dissection Scissors (Curved 7”)      2    2       2      0         2
26.4   Dissection Scissors (Straight 7”)    2    2       2      2         0
26.5   Hysterectomy Clamps (Straight)       8    8       8      0         8
26.6   Hysterectomy Clamps (Curved)         8    8       8      0         8
26.7   Uterine Sound                        2    2       2      2         0
26.8   Needle Holder (7”)                   2    2       4      2         0
26.9   Needle Holder (10”)                  2    2       2      2         0
26.10 Artery Forceps (Straight 6”)          16 16 16            6        10
26.11 Artery Forceps (Curved 6”)            16 16 16            6        10
26.12 Allis Forceps                         8    8       8      3         5
26.13 Towel Clamps                          8    8       8      2         6
26.14 Single blade Sims speculum            4    4       4      4         0
26.15 Double blade Sims speculum            4    4       4      4         0

45
         Three Year Rolling Plan (2010 – 2013) District Jhelum



 Sr.               Equipment              Standard          Available   Gap
 No.                                          as per
                                              MSDS
                                              (Qty.)
                                          C     B      A
26.16 Sponge holding forceps              8    8       8       2         6
26.17 Volselum forceps                    4    4       4       2         2
26.18 Uterine Sound                       2    2       2       1         1
26.19 Bladder Sound                       2    2       2       2         0
 27    Delivery Sets
27.1   Episiotomy Scissors                6    6       10      4         2
27.2   Straight Scissors                  6    6       10      1         5
27.3   Needle holder                      6    6       10      1         5
27.4   Non-toothed tissue forceps 8       6    6       10      2         4
       inches
27.5   Toothed tissue forceps 8 inches    6    6       10      1         5
27.6   Sims Speculum single blade         12 12 20             1        11
27.7   Sims Speculum double blade         12 12 20             1        11
27.8   Sponge holding forceps             40 40 40             2        38
27.9   Artery forceps                     40 40 40             8        32
27.10 Straight clamps (cord)              20 20 30             0        20
27.11 Vacuum Extractor pump               1    1       1       0         1
27.12 Towel clip                          40 40 40             0        40
 28    Caesarian Section
28.1   Scalpel                            4    4       6       4         0
28.2   Artery Forceps Straight 6 inches   16 16 24             2        14
28.3   Artery Forceps Curved 6 inches     16 16 24             2        14
28.4   Artery forceps 8 inches            16 16 24             4        12
28.5   Myoma Scissors straight 7 inches   4    4       6       4         0
28.6   Dissecting scissors (curved) 7     4    4       6       1         3
       inches
28.7   Green Armtage forceps 8 inches     16 16 24             1        15



46
         Three Year Rolling Plan (2010 – 2013) District Jhelum



 Sr.                Equipment            Standard          Available   Gap
 No.                                         as per
                                             MSDS
                                             (Qty.)
                                         C     B      A
28.8   Obstetric outlet forceps (pair)   4    4       6       2         2
28.9   Doyene’s Retractor                4    4       6       1         3
28.10 Small Retractors                   8    8       12      4         4
28.11 Towel Clippers                     16 16 24             4        12
28.12 Suction Nozzle                     4    4       6       0         4
 29    MNCH Related Radiology
       Equipments
29.1   Ultrasound Machine                1    1       2       1         0
29.2   X-Ray Unit 500 kw                 1    1       1       1         0
29.3   Color Doppler                     0    0       0       0         0
29.4   Lead Screen for X-Ray Unit        1    1       1       1         0
29.5   0.5 MN Lead Apron. Lead Gloves,   1    1       1       1         0
       Goggles and Thyroid and Gonadal
       Sheets
29.6   Safe Light                        1    1       1       1         0
29.7   X-RT Film Processing Tank         1    1       1       1         0
29.8   Chest Stand                       1    1       1       1         0
29.9   X-Ray film Illuminator            2    2       2       0         2
29.10 X-Ray Film Hangers All sizes       4    4       4       4         0
 30    MNCH Related Paediatrics
       Equipments
30.1   Paediatric Ventilator             1    1       2       0         1
30.2   Incubator                         1    1       1       1         0
30.3   Photo Therapy Unit                1    1       1       1         0
30.4   Over-head Radiant Warmer          1    1       1       1         0
30.5   Infant Length Measuring Scale     2    2       2       2         0
30.6   Infant Weighing Machine           2    2       2       1         1



47
         Three Year Rolling Plan (2010 – 2013) District Jhelum



 Sr.                 Equipment           Standard         Available   Gap
 No.                                         as per
                                             MSDS
                                             (Qty.)
                                         C     B      A
30.7   Nebulizer                         1    1       1      1         0
30.8   Billiubino-meter                  1    1       1      0         1
30.9   Exchange Blood Transfusion Set    1    1       1      0         1
30.10 Nasal Probe Paed size              1    2       2      0         1
 31    Anaesthesia/ICU
31.1   Anaesthesia Machine               1    1       1      1         0
31.2   Ventilators                       1    1       1      0         1
31.3   Nebulizer                         1    1       1      1         0
31.4   Pulse Oximetry                    1    1       1      1         0
31.5   Defibrillator                     1    1       1      0         1
31.6   Airway Oral and Nasal             1    2       2      0         1
31.7   Tracheostomy tube (adult and      1    2       2      0         1
       paeds)
31.8   Face mask of all sizes            1    2       2      0         1
31.9   Double Cuff Tourniquet (for       1    1       1      1         0
       regional block)
31.10 AMBO bag adult                     1    2       2      1         1
31.11 AMBO Bag paeds                     2    2       2      1         1
31.12 Red Rubber Nasal tubes all sizes   4    4       4      0         4
       without cuff
 32    Blood Bank
32.1   Blood storage cabinet (100 bag    1    1       1      1         0
       capacity)
32.2   Packed cell machine               1    1       1      0         1
32.3   Cell Separator                    1    1       1      0         1
32.4   Freezer for Fresh Frozen Plasma   1    1       1      0         1
32.5   Blood bag shaker                  1    1       1      0         1



48
                Three Year Rolling Plan (2010 – 2013) District Jhelum



        Sr.                Equipment             Standard         Available   Gap
        No.                                          as per
                                                     MSDS
                                                     (Qty.)
                                                 C     B      A
       32.6   RH view box                    1         2      2       0        1
       32.7   Water bath                     2         2      2       2        0
       32.8   Micro-pipette                  4         4      6       4        0
       32.9   Blood grouping tiles           3         3      3       3        0
       32.10 Plasma Extractor                1         1      1       1        0
       32.11 Platelets agitator              1         1      1       1        0
       32.12 Blood thawing bath              1         1      1       1        0
       32.13 Microscopes                     1         1      1       1        0
        33    Gynae & Labour Room Related
              Laboratory Equipment
       33.1   Hematology Analyzer            1         1      1       1        0
       33.2   Electrolyte Analyzer           1         1      1       1        0
       33.3   Analyzer Bio-chemistry Semi-   1         1      1       1        0
              automatic
       33.4   Glucometer                     2         2      2       0        2
       33.5   Haemoglobino-meter             1         1      1       0        1
       33.6   Centrifuge                     1         1      1       1        0



iii.     THQ Hospital Pind Dadan Khan
        Sr.                                  Standard
        No.                                          as per
                           Equipment                 MSDS         Available   Gap
                                                     (Qty.)
                                             C         B      A
         1    CTG (Cardiac Tocography)       1         1      1      0         1
         2    Foetal Doppler                 2         2      3      1         1
         3    Diagnostic Laparoscope         1         1      1      0         1



       49
        Three Year Rolling Plan (2010 – 2013) District Jhelum



Sr.                                        Standard
No.                                            as per
                  Equipment                    MSDS         Available   Gap
                                               (Qty.)
                                           C     B      A
 4    Bulb Sucker                          5    10 20          0        10
 5    Baby Warmer                          2     2      3      0         2
 6    Mechanical Sucker                    3     3      3      3         0
 7    Fetal Stethoscope                    2     3      4      0         3
 8    Delivery Table                       2     2      2      2         0
 9    D&C Set                              2     2      2      2         0
10    Outlet forceps                       4     4      4      3         1
11    Myoma Screw                          2     2      2      2         0
12    Kochers forceps                      4     4      4      2         2
13    Volselum forceps                     4     4      6      2         2
14    Lanes Tissue holding forceps         2     2      2      2         0
15    Vaginal Retractors                   4     4      6      0         4
16    Polypectomy forceps                  2     2      2      0         2
17    Sponge holder                        10 10 15            2         8
18    Uterine elevator                     1     1      1      0         1
19    CosCo Speculum                       4     6      6      2         4
      Small, Medium, Large (for each
      category)
20    Examination light                    3     3      3      0         3
21    Suction Curette                      1     1      2      1         0
22    Infant Resuscitation Trolley (with   1     1      1      1         0
      life saving medicines, baby
      laryngoscope, Endo-tracheal
      tube, Infant BP Apparatus,
      Chargeable Light)




50
         Three Year Rolling Plan (2010 – 2013) District Jhelum



 Sr.                                       Standard
 No.                                           as per
                  Equipment                    MSDS         Available   Gap
                                               (Qty.)
                                           C     B      A
 23    Mother Resuscitation Trolley        1     1      1      1         0
       (with life saving medicines,
       Laryngoscope, Endo-tracheal
       tube, BP Apparatus, Chargeable
       light)
 24    Cardiac Monitor                     1     1      1      1         0
 25    Pump Breast Electronic              1     1      1      0         1
 26    Vaginal Hysterectomy Set
26.1   Toothed Tissue Forceps (8”)         2     2      2      0         2
26.2   Non-Tooted Tissue Forceps (8”)      2     2      2      0         2
26.3   Dissection Scissors (Curved 7”)     2     2      2      0         2
26.4   Dissection Scissors (Straight 7”)   2     2      2      0         2
26.5   Hysterectomy Clamps (Straight)      8     8      8      0         8
26.6   Hysterectomy Clamps (Curved)        8     8      8      0         8
26.7   Uterine Sound                       2     2      2      0         2
26.8   Needle Holder (7”)                  2     2      4      0         2
26.9   Needle Holder (10”)                 2     2      2      0         2
26.10 Artery Forceps (Straight 6”)         16 16 16            0        16
26.11 Artery Forceps (Curved 6”)           16 16 16            0        16
26.12 Allis Forceps                        8     8      8      0         8
26.13 Towel Clamps                         8     8      8      0         8
26.14 Single blade Sims speculum           4     4      4      0         4
26.15 Double blade Sims speculum           4     4      4      0         4
26.16 Sponge holding forceps               8     8      8      0         8
26.17 Volselum forceps                     4     4      4      0         4
26.18 Uterine Sound                        2     2      2      0         2
26.19 Bladder Sound                        2     2      2      0         2



51
         Three Year Rolling Plan (2010 – 2013) District Jhelum



 Sr.                                      Standard
 No.                                          as per
                   Equipment                  MSDS          Available   Gap
                                              (Qty.)
                                          C     B      A
 27    Delivery Sets
27.1   Episiotomy Scissors                6     6      10      2         4
27.2   Straight Scissors                  6     6      10      1         5
27.3   Needle holder                      6     6      10      2         4
27.4   Non-toothed tissue forceps 8       6     6      10      0         6
       inches
27.5   Toothed tissue forceps 8 inches    6     6      10      0         6
27.6   Sims Speculum single blade         12 12 20             0        12
27.7   Sims Speculum double blade         12 12 20             3         9
27.8   Sponge holding forceps             40 40 40             0        40
27.9   Artery forceps                     40 40 40             6        34
27.10 Straight clamps (cord)              20 20 30             0        30
27.11 Vacuum Extractor pump               1     1      1       0         1
27.12 Towel clip                          40 40 40             0        40
 28    Caesarian Section
28.1   Scalpel                            4     4      6       0         4
28.2   Artery Forceps Straight 6 inches   16 16 24             10        6
28.3   Artery Forceps Curved 6 inches     16 16 24             6        10
28.4   Artery forceps 8 inches            16 16 24             0        16
28.5   Myoma Scissors straight 7 inches   4     4      6       0         4
28.6   Dissecting scissors (curved) 7     4     4      6       1         3
       inches
28.7   Green Armtage forceps 8 inches     16 16 24             4        12
28.8   Obstetric outlet forceps (pair)    4     4      6       2         2
28.9   Doyene’s Retractor                 4     4      6       2         2
28.10 Small Retractors                    8     8      12      1         7
28.11 Towel Clippers                      16 16 24             6        10



52
         Three Year Rolling Plan (2010 – 2013) District Jhelum



 Sr.                                     Standard
 No.                                         as per
                    Equipment                MSDS         Available   Gap
                                             (Qty.)
                                         C     B      A
28.12 Suction Nozzle                     4     4      6      0         4
 29    MNCH Related Radiology
       Equipments
29.1   Ultrasound Machine                1     1      2      1         0
29.2   X-Ray Unit 500 kw                 1     1      1      1         0
29.3   Color Doppler                     0     0      0      0         0
29.4   Lead Screen for X-Ray Unit        1     1      1      1         0
29.5   0.5 MN Lead Apron. Lead Gloves,   1     1      1      1         0
       Goggles and Thyroid and Gonadal
       Sheets
29.6   Safe Light                        1     1      1      1         0
29.7   X-RT Film Processing Tank         1     1      1      1         0
29.8   Chest Stand                       1     1      1      1         0
29.9   X-Ray film Illuminator            2     2      2      2         0
29.10 X-Ray Film Hangers All sizes       4     4      4      4         0
 30    MNCH Related Paediatrics
       Equipments
30.1   Paediatric Ventilator             1     1      2      0         1
30.2   Incubator                         1     1      1      1         0
30.3   Photo Therapy Unit                1     1      1      0         1
30.4   Over-head Radiant Warmer          1     1      1      0         1
30.5   Infant Length Measuring Scale     2     2      2      0         2
30.6   Infant Weighing Machine           2     2      2      2         0
30.7   Nebulizer                         1     1      1      1         0
30.8   Billiubino-meter                  1     1      1      1         0
30.9   Exchange Blood Transfusion Set    1     1      1      0         1
30.10 Nasal Probe Paed size              1     2      2      0         2



53
         Three Year Rolling Plan (2010 – 2013) District Jhelum



 Sr.                                     Standard
 No.                                         as per
                   Equipment                 MSDS         Available   Gap
                                             (Qty.)
                                         C     B      A
 31    Anaesthesia/ICU
31.1   Anaesthesia Machine               1     1      1      1         0
31.2   Ventilators                       1     1      1      0         1
31.3   Nebulizer                         1     1      1      1         0
31.4   Pulse Oximetry                    1     1      1      1         0
31.5   Defibrillator                     1     1      1      1         0
31.6   Airway Oral and Nasal             1     2      2      0         2
31.7   Tracheostomy tube (adult and      1     2      2      2         0
       paeds)
31.8   Face mask of all sizes            1     2      2      2         0
31.9   Double Cuff Tourniquet (for       1     1      1      0         1
       regional block)
31.10 AMBO bag adult                     1     2      2      1         1
31.11 AMBO Bag paeds                     2     2      2      0         2
31.12 Red Rubber Nasal tubes all sizes   4     4      4      0         4
       without cuff
 32    Blood Bank
32.1   Blood storage cabinet (100 bag    1     1      1      1         0
       capacity)
32.2   Packed cell machine               1     1      1      0         1
32.3   Cell Separator                    1     1      1      0         1
32.4   Freezer for Fresh Frozen Plasma   1     1      1      0         1
32.5   Blood bag shaker                  1     1      1      0         1
32.6   RH view box                       1     2      2      0         2
32.7   Water bath                        2     2      2      0         2
32.8   Micro-pipette                     4     4      6      0         4
32.9   Blood grouping tiles              3     3      3      0         3



54
         Three Year Rolling Plan (2010 – 2013) District Jhelum



 Sr.                                  Standard
 No.                                      as per
                    Equipment             MSDS         Available   Gap
                                          (Qty.)
                                      C     B      A
32.10 Plasma Extractor                1     1      1      0         1
32.11 Platelets agitator              1     1      1      0         1
32.12 Blood thawing bath              1     1      1      0         1
32.13 Microscopes                     1     1      1      0         1
 33    Gynae & Labour Room Related
       Laboratory Equipment
33.1   Hematology Analyzer            1     1      1      0         1
33.2   Electrolyte Analyzer           1     1      1      0         1
33.3   Analyzer Bio-chemistry Semi-   1     1      1      1         0
       automatic
33.4   Glucometer                     2     2      2      1         1
33.5   Haemoglobino-meter             1     1      1      1         0
33.6   Centrifuge                     1     1      1      1         0




55
                                       Three Years Rolling Plan (2010-2013) District Jehlum


SECTION 3: INTERVENTIONS AND TARGETS


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


Health Problems



                                                                                      Plan
                                                                                                 Target for   Target for   Target for
     Problem            Causes         Intervention         Activity        Unit    Activities
                                                                                                  2010-11      2011-12      2012-13
                                                                                     Targets


                                     Coordination with   Quarterly co-
                                     TMA for             ordination
1. Diarrhea under   Poor Hygiene &
                                     improvement of      meetings with   Meetings      12            4            4            4
   5 children       sanitation
                                     water supply and    TMA and other
                                     sanitation          agencies


                                                         Messages on
                    Lack of safe     Awareness                           Monthly
                                                         local cable                   36           12           12           12
                    drinking water   raising campaign                    Telecast
                                                         network




        56
                       Three Years Rolling Plan (2010-2013) District Jehlum


                     Proper treatment     Printing and
     Unhygienic
                     of Diarrhea          distribution of    Brochure   200,000     100,000   50,000    50,000
     practices
                     including ORT        IPC material



                                          Conduction of
                     Health awareness
                                          HES in the         Session     2,000       1,000     500       500
                     in the community
                                          community
     Lack of
     awareness
     among mothers
     about feeding
     and weaning     Capacity building
     practices       of health staff in   Training of
                     Integrated           medics and
                                                             Batch         60         20        20        20
                     Management of        paramedics in
                     Childhood            IMCI
                     Illnesses (IMCI)



                                          Procurement
                                          and distribution    ORS
                                                                        2,550,000   850,000   850,000   850,000
                                          of ORS and Zinc    packets
                                          Sulphate


                                          Procurement
                                          and distribution
                                                             Syrup      1,200,000   400,000   400,000   400,000
                                          of Zinc
                                          Sulphate




57
                                          Three Years Rolling Plan (2010-2013) District Jehlum



                                                                                      Plan
                                                                                                 Target for   Target for   Target for
   Problem          Causes         Intervention         Activity         Unit       Activities
                                                                                                  2010-11      2011-12      2012-13
                                                                                     Targets



                                  Coordination
                                                    Quarterly co-
                                  with police
                                                    ordination
2. Accident &   Lack of traffic   department to
                                                    meetings with     Meetings         12            4            4            4
   Injuries     sense             improve traffic
                                                    Traffic Police
                                  sense and
                                                    department
                                  ensuring
                                  observance of
                                  traffic rules
                                                    Quarterly co-
                                  Advocacy for
                Poor                                ordination
                                  improving the
                maintenance                         meetings with     Meetings         12            4            4            4
                                  condition of
                of vehicles                         Highway
                                  roads
                                                    department
                                                    Preparation of
                                  Health
                                                    Disaster
                                  education/pro
                                                    Management Plan
                Poor road         motion to
                                                    including the                       -            -
                conditions        prevent
                                                    Patient
                                  domestic
                                                    Management
                                  accidents
                                                    protocols
                                                    Training of the
                                  Ensure
                Lack of safety                      medics and the    Training in
                                  enforcement of
                measures at                         paramedics in     Batch for        24           16            4            4
                                  safety laws at
                work place                          first aid and     25 trainees
                                  work places
                                                    emergency
                                  Provision of      Provision of
                Fire-arm
                                  emergencies       emergency kits    Kits            3,000        1,000        1,000        1,000
                injuries
                                  medicines         for victims




        58
                       Three Years Rolling Plan (2010-2013) District Jehlum

                              Procurement of
                              equipments /
     Domestic
                              instruments /                  -          -         -         -
     accidents
                              various splints
                              and Plaster casts


     Burns                    Drugs               Drugs   300,000    100,000   100,000   100,000


     Bomb
                              Disaster
     blasts/terroris
                              management plan
     t activities

     Natural
     calamities
     flood

     Lack of
     tolerance in
     the society




59
                                               Three Years Rolling Plan (2010-2013) District Jehlum




                                                                                                Plan
                                                                                                           Target for   Target for   Target for
     Problem           Causes           Intervention               Activity         Unit      Activities
                                                                                                            2010-11      2011-12      2012-13
                                                                                               Targets




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

                                                                                   Monthly
                                                                                   Package
                 Unsafe drinking     Campaign against        Messages on local
                                                                                                   -             -             -            -
                 water               quackery                cable network




                                                             Printing and
                                     Strengthening blood
                 Sharing of used                             distribution of IPC
                                     transfusion services                          Brochure   275,000       100,000      100,000      75,000
                 syringes                                    and hepatitis
                                     for safe transfusions
                                                             awareness material



                 Transfusion of
                                                             Procurement and
                 unsafe/unscreened   Campaign against
                                                             supply of screening     Kits     300,000       100,000      100,000      100,000
                 blood and blood     drug addiction
                                                             kits
                 products




           60
                                      Three Years Rolling Plan (2010-2013) District Jehlum

                            Regulatory
                            mechanism to ensure
     Unsafe sexual                                   Procurement of         Syringe
                            use of safe                                                 1,000   500     250     250
     practices                                       safety boxes           cutter
                            instruments by
                            dentists, barbers etc.



                                                     Procurement of drugs
     Ear piercing and
                                                     for treatment of       Injection   6,000   2,000   2,000   2,000
     tattooing
                                                     Hepatitis patients




                                                     Develop and
     Use of unsterilized
                                                     implement SOPs for
     equipment by
                                                     sterilization of
     dentists and barbers
                                                     equipment
                                                                                          -




61
                                                    Three Years Rolling Plan (2010-2013) District Jehlum


                                                                                                            Plan
                                                                                                                       Target for   Target for   Target for
     Problem             Causes          Intervention                      Activity                Unit   Activities
                                                                                                                        2010-11      2011-12      2012-13
                                                                                                           Targets



                                         Health Education
                                                                   Health educational
4.    CVDs        Sedentary Life Style   campaign regarding                                    Seminar       50           20           15           15
                                                                   sessions in community
                                         healthy life style



                  Lack of Awareness      Strengthening clinical
                                                                   Printing and distribution
                  regarding dietary      diagnostic services for
                                                                   of Health Education         Brochure   150,000       50,000       50,000       50,000
                  habits and regular     early detection of
                                                                   material
                  walks                  problems



                                                                   Demand generation and
                                                                   request submission for
                  Excess smoking         Genetic counseling        approval of establishing
                                                                   CCU at district and
                                                                   tehsil level



                                                                   Temporary positioning
                                         Establishment and
                                                                   of qualified medical and
                  Genetics               Strengthening of
                                                                   paramedical staffs in
                                         coronary care unit
                                                                   the specialty




                  Stressful life




             62
                                           Three Years Rolling Plan (2010-2013) District Jehlum




                                                                                                        Plan
                                                                                                      Activities   Target for   Target for   Target for
 Problem               Causes           Intervention               Activity                    Unit
                                                                                                       Targets      2010-11      2011-12      2012-13




                Obesity               Health Education      Health educational
                                      campaign              sessions in community
5.   Diabetes                         regarding healthy                                 Seminar           6            2            2            2
                                      life style

                Inactive life style   Strengthening         Printing and distribution
                                      diagnostic services   of Health Education
                                      for early detection   material
                                                                                        Brochure



                Lack of health
                awareness on                                Provision of lab
                Diabetes                                    equipment/ reagents         glucometer
                                                                                                         55           35           10           10
                                                                                        with Sticks


                Genetics &
                Infections
                                                            Provision of medicines      Drug          202,290       67,430       67,430       67,430




     63
                                             Three Years Rolling Plan (2010-2013) District Jehlum




                                                                                                            Plan
                                                                                                                       Target for   Target for   Target for
    Problem           Causes             Intervention               Activity                 Unit         Activities
                                                                                                                        2010-11      2011-12      2012-13
                                                                                                           Targets



6. Resistant                                                Printing and distribution
                Breeding places for   Public awareness
 Malaria                                                    of Health Education         Poster             75,000       40,000       20,000       15,000
                mosquitoes            campaign
 (Falciparum)                                               material



                In judious use of     Strengthening
                                                            Provision of lab            Microscope ,
                anti malarial by      Malaria eradication                                                      59           59            -           -
                                                            equipment/reagents          allied kit
                GPs And HCPs          program



                                                            Training of health care
                Lack of awareness
                                                            providers / GPs on Roll     Training               60           20           20          20
                for prevention
                                                            back malaria




                                                            Antimalarial drugs          Tablet (Pack of
                                                                                                            1,500        1,000          300         200
                                                            aursonate tablets,          100)




                                                            Antimalarial drugs          Tablet (Pack of
                                                                                                            5,000        3,000        1,000        1,000
                                                            Primaquin,                  100)




         64
     Three Years Rolling Plan (2010-2013) District Jehlum


               Antimalarial drugs         Tablet (Pack of
                                                            150,000   75,000   45,000   30,000
               Chloroquin                 100)




               Fogging Machine            Machine                6        6        -        -




               Purchase of diesel for
                                          Litre               9,000   3,000    3,000    3,000
               fogging




               Spray Pumps                pumps                100       50       25       25




               Uniform for spray man      Uniform              100      100        -        -




               Glasses/ gloves, Bucket,
                                          Misc                  25       25        -        -
               soap



               Purchase of insecticide
               delta methrine (Powder             Kg          8,000   4,000    2,000    2,000
               5 % WDP)




65
     Three Years Rolling Plan (2010-2013) District Jehlum


               Purchase of insecticide
               delta methrine (Liquid         Litre     6,000   2,000   2,000   2,000
               1.5 % )



               Purchase of larvicidal
               Drug (Phenthion                 Kg       4,000   2,000   1,000   1,000
               Granules)



               Purchase of larvicidal
               Drug ( Temiphos)               Litre     1,500    500     500     500
               Liquid



                                         4 Squad of 6
               Spray man                 persons x 25     12       4       4       4
                                         days



               Purchase of motor cycle
                                         Motor cycle      65      35      15      15
               for CDCSs




                POL for motor cycles          litre     27000   6300    9000    11700




66
                                           Three Years Rolling Plan (2010-2013) District Jehlum



                                                                                             Plan Activities   Target for   Target for   Target for
Problem              Causes            Intervention             Activity             Unit
                                                                                                Targets         2010-11      2011-12      2012-13



               Overcrowding in      Awareness raising   Community health
7.   Scabies                                                                      HES              600             200          200          200
               schools and homes    campaign            education sessions



               Low socio-economic   Provision of        Printing & Distribution
                                                                                  Brochure     150,000          50,000       50,000       50,000
               conditions           medicines           of IPC Material



               Poor Health                              Supply of anti scabies
                                                                                  drug         100,000          50,000       30,000       20,000
               Education                                drugs




      67
                                                Three Years Rolling Plan (2010-2013) District Jehlum


                                                                                                            Plan Activities   Target for   Target for   Target for
      Problem               Causes              Intervention              Activity              Unit
                                                                                                               Targets         2010-11      2011-12      2012-13



                         Low access to        Behavior Change
8.   Complication of                                                 Messages on local        Monthly
                       appropriate health     Communication                                                         -              -            -           -
     Pregnancy                                                        cable network           Package
                           services               (BCC)


                                                 Improving
                       Lack of awareness                                Printing and
                                              transportation to
                       about danger signs                            distribution of IPC      Brochure         200,000        100,000       50,000      50,000
                                             appropriate level of
                         of pregnancy                                      material
                                                    care

                          Three delays
                                                                     Activation and use
                         (seeking health
                                                                         of Health
                              care,            Strengthening
                                                                      Committees and                                -
                       transportation, and   healthcare facilities
                                                                      women groups
                         lack of referral
                                                                       under LHWs
                        back-up services)


                                                                      Training of TBAs
                                                                                             Batch of 25
                        Lack of skilled      Refresher courses for    with specific focus
                                                                                             TBAs for 2              8             4             2           2
                        birth attendants            TBAs             on safe delivery and
                                                                                            days Training
                                                                         danger signs



                                                Deployment of        Placement of mid-
                                                 community             wives in their
                                                  midwives            catchment area


                                                                        Repair of non
                                                                         functional
                                                                       ambulances for
                                                                                             Ambulance              20            10             5           5
                                                                           timely
                                                                      transportation of
                                                                      pregnant mothers

         68
     Three Years Rolling Plan (2010-2013) District Jehlum

                 Replacement of non
                     functional
                   ambulances for
                                      Ambulance      4        2       1     1
                       timely
                  transportation of
                  pregnant mothers



                                                  10800     2400   3600   4800
                 POL for ambulances     Liter




69
                                     Three Years Rolling Plan (2010-2013) District Jehlum




Management Problems



                  Human Resource Plan to bridge gap between MSDS proposed and Sanctioned posts




                                                                                         Physical Targets


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



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

              2       Paediatricians        18    12,910     18,099         4        2    1           1

              3       Anesthetists          18    12,910     18,099         6        3    2           1

              4       MO / WMO              17    9,850      15,345         38      20    10          8

              5       Nurses                16    6,060      8,934          98      50    24          24

              6       LHVs                  9     3,820      4,750          23      10    7           6



      70
                                                 Three Years Rolling Plan (2010-2013) District Jehlum



                                                                                                                    Plan
                                                                                                                               Target for   Target for   Target for
    Problem              Causes                  Intervention                    Activity                Unit     Activities
                                                                                                                                2010-11      2011-12      2012-13
                                                                                                                   Targets


                 Non-availability of        Filling of the vacant      Filling of the vacant posts            -        -             -            -            -
                 trained staff              posts                      of medics and the
1. Shortage of                                                         paramedics through
Skilled Staff                                                          existing recruitment
                                                                       committees
                 Non-sanctioning of staff   Sanctioning of trained     Temporary filling of vacant            -        -                          -            -
                 according to MSDS          staffs according to        positions on contract
                                            MSDS
                 Lack of permanent          Incentivized pay package   Demand generation and                  -        -             -            -            -
                 postings                   at all levels              request to the Department
                                                                       of Health by the districts
                                                                       for recruitment through
                                                                       PSC against vacant posts
                 Lack of incentivized and   Well defined career        Orientation trainings of the   Batch          16              8            4            4
                 differential pay package   structure including        recruited staffs
                                            opportunities for higher
                                            education

                                            High level political       Consensus building
                                            commitment for             between the districts for
                                            providing protection to    uniform incentivized pay
                 Frequent transfer
                                            staff working in health    package for all categories
                 postings
                                            facilities                 and levels staff


                                                                       Request to the Provincial
                                                                       Government for approval
                 Job insecurity
                                                                       and implementation of
                                                                       agreed pay packages




           71
                                 Three Years Rolling Plan (2010-2013) District Jehlum



                                               Review and revise the
     Lack of basic amenities
                                               career structure of medics
     at workplace
                                               and paramedics



     Lack of conducive
     environment including
                                                                            Posts   146   75   37   34
     insecurity and transport
     of children for education



                                               Filling of Human Resource
                                                                            Posts   23    10    7    6
                                                    gaps as per MSDS




     Political and media
                                                                            HR      169   85   44   40
     interference




                                               Capacity and need
                                               assessment of the medics
                                               and the paramedics



                                               Prepare training programs
                                               for providing higher
                                               professional education
                                               based on TNA




72
                                                        Three Years Rolling Plan (2010-2013) District Jehlum




                                                                                                                          Plan
                                                                                                                                      Target for    Target for    Target for
      Problem                      causes                     Intervention              Activity            Unit        Activities
                                                                                                                                       2010-11       2011-12       2012-13
                                                                                                                         Targets


2.Inadequate                                             Rational increase in POL   Assessment of
district health budget    Generator provision for        budget                     additional
for POL                  backup of electricity supply                              requirement


                         Less budget allocation                                    Costing and
                                                                                    submission of
                                                                                    additional
                                                                                    demand
                         Frequent increase in prices                                Provision of POL   36000 Liter       36,000      12,000        12,000        12,000
                                                                                    budget for
                                                                                    supervisory
                                                                                    vehicles
                                                                                    Provision of POL    32400 liter       32,400      10,800        10,800        10,800
                                                                                    budget for EPI
                                                                                    vehicles




                                                                                    Provision of POL    54000 liter   54000          18000         18000         18000
                                                                                    budget for
                                                                                    Generator




          73
                                         Three Years Rolling Plan (2010-2013) District Jehlum



                                                                                                     Plan
                                                                                                                Target for Target for Target for
    Problem            Causes                Intervention               Activity           Unit    Activities
                                                                                                                 2010-11    2011-12    2012-13
                                                                                                    Targets

3. Political   Undue pressure from        High level political       Formulation of
interference   local political figures    commitment to              the Health
               especially in medico-      provide protection to      committees
               legal cases                the health staff against
                                          undue political
                                          interference

                                          Advocacy at higher         Meetings with
                                          political level            political leaders




                                                                      Advocacy           Meeting   12           4          4          4
                                                                     seminars




         74
                                                Three Years Rolling Plan (2010-2013) District Jehlum




                                                                                                             Plan Activities   Target for   Target for   Target for
    Problem                 Causes                    Intervention                   Activity         Unit
                                                                                                                Targets         2010-11      2011-12      2012-13


4.Outdated         Deficient equipment to       Provision of the equipment    Costing of equipment
/inadequate        cater basic and              in accordance with the       for THQ and DHQ
equipment for      comprehensive Emmons         notified equipment list      hospitals based on the
MNCH services at   at primary and secondary                                  gaps between MSDS
secondary level    level of care                                             and existing available

                   Old and un-serviceable       Adequate budget for           Allocation of the
                   equipment                    maintenance and repair       budget


                   Shortage of regular budget   Capacity building of staff    Procurement of
                   for M&R                      regarding maintenance of     equipments
                                                log books of equipment
                    Frequent cuts on M&R        Provision of the workshop    Enhance amount for
                   budget                       at all district levels for   M&R in the budget
                                                repair and maintenance
                                                 Advocacy for provision of   Establishing district
                                                sufficient budget for M&R    level bio-equipment
                                                                             workshop


                                                                             Condemnation of the
                                                                             old and off-road
                                                                             vehicles




         75
                                            Three Years Rolling Plan (2010-2013) District Jehlum



                                                                                                 Plan Activities   Target for   Target for   Target for
   Problem               Causes                 Intervention               Activity       Unit
                                                                                                    Targets         2010-11      2011-12      2012-13




5.Shortage of   Provision of inadequate   Provision of sufficient   Condemnation of the
functional      funds for purchase of     funds for purchase of     old and off-road
vehicles        vehicles                  vehicles                  vehicles



                Ban on procurement of     Seeking exemptions for
                                                                    Demand submission
                vehicles by the           procurement of specific
                                                                    for replacement
                government                vehicle



                Complicated procedure
                                          Expedite the              Demand for fund for
                for purchase of new
                                          procurement procedure     repair
                vehicles



                                          Demand sufficient funds
                Poor maintenance of       for repair and            Procurement of the
                Vehicles                  maintenance of vehicles   vehicles
                                          and expedite the repair




         76
                                    Three Years Rolling Plan (2010-2013) District Jehlum




SECTION 4: COSTING & FINANCING PLAN


I.   Activity based costing
     The planning team has used the best available data sources, for calculation of estimates for the intervention/activities.
     It is pertinent to mention that the costing of the plan is based on additional needs and activities. The detailed activity
     based costing of the Health and Service Delivery problems has been performed on automated Excel sheets, which are
     annexed with the plan as Annex-III and Annex-IV. A moderate estimate of equipment cost has been taken, as there is
     wide variation between the minimum and maximum cost. The summary of activity and problem wise costing is given
     below.




      77
                                                    Three Years Rolling Plan (2010-2013) District Jehlum




     a) Health Problems


  1.      Diarrhoeal Disease

                                                                 Define                                  Financial Targets


                  Activity                                                                                                                     Total Cost
                                               Unit             Rate           Quantity        Year I          Year II          Year III



Quarterly co-ordination meetings with TMA                3,000            12              12,000          13,200             14,520        39,720
and other agencies

Messages on local cable network             Monthly      35,000           36              420,000         462,000            508,200       1,390,200
                                            Telecast

Printing and distribution of IPC material   Brochure     5                200,000         500,000         275,000            302,500       1,077,500



Conduction of HES in the community          Session      2000             2,000           2,000,000       1,100,000          1,210,000     4,310,000




Training of medics and paramedics in IMCI   Batch            75000                60         1,500,000       1,650,000         1,815,000       4,965,000




             78
                                                    Three Years Rolling Plan (2010-2013) District Jehlum



Procurement and distribution of ORS and    ORS
                                                             5        2,550,000    4,250,000    4,675,000    5,142,500     14,067,500
Zinc Sulphate                             packets




Procurement and distribution of Zinc
                                          Syrup              60       1,200,000    24,000,000   26,400,000   29,040,000    79,440,000
Sulphate




Total                                                                                                                     105,289,920




            79
                                                 Three Years Rolling Plan (2010-2013) District Jehlum


2. Accidents and Injuries

                                                     Define                                   Financial Targets

            Activity                     Unit          Rate       Quantity       Year I          Year II           Year III       Total Cost


Quarterly co-ordination           Meetings       5,000        12             20,000       22,000              24,200          66,200
meetings with Traffic Police
department

Quarterly co-ordination           Meetings       5,000        12             20,000       22,000              24,200          66,200
meetings with Highway
department
Preparation of Disaster                                       -              -            -                   -               -
Management Plan including the
Patient Management protocols
Training of the medics and the    Training in    50,000       24             800,000      220,000             242,000         1,262,000
paramedics in first aid and       Batch for 25
emergency                         trainees

Provision of emergency kits for   Kits           3,000        3,000          3,000,000    3,300,000           3,630,000       9,930,000
victims
Procurement of equipments /                      -            -              -            -                   -               -
instruments / various splints
and Plaster casts

Drugs                             Drugs          300          300,000        30,000,000   33,000,000          36,300,000      99,300,000


Disaster management plan                                                     -            -                   -               -


Total                                                                                                                         110,624,400




          80
                                               Three Years Rolling Plan (2010-2013) District Jehlum




3. Hepatitis

                                                  Define                             Financial Targets



            Activity                                                                                                   Total Cost
                                       Unit        Rate      Quantity      Year I      Year II            Year III



Quarterly co-ordination                               -          -             -            -                   -            -
meetings with TMA and other
agencies
Messages on local cable network    Monthly            -          -             -            -                   -            -
                                   Package

Printing and distribution of IPC    Brochure
and hepatitis awareness
material
Procurement and supply of           Kits             50      300,000    5,000,000    5,500,000           6,050,000    16,550,000
screening kits

Procurement of safety boxes         Syringe         500       1,000       250,000      137,500             151,250      538,750
                                   cutter

Procurement of drugs for           Injection      12,000      6,000     24,000,000   26,400,000          29,040,000   79,440,000
treatment of Hepatitis patients

Develop and implement SOPs for                                   -             -            -                   -            -
sterilization of equipment


Total                                                                                                                  96,528,750



          81
                                              Three Years Rolling Plan (2010-2013) District Jehlum


   4. Cardio-Vascular Diseases

                                                Define                             Financial Targets


            Activity                                                                                                 Total Cost
                                       Unit      Rate     Quantity      Year I          Year II        Year III


Health educational sessions in     Seminar       10,000       50        200,000         165,000        181,500         546,500
community

Printing and distribution of       Brochure               150,000
Health Education material

Demand generation and request                                               -                -              -               -
submission for approval of
establishing CCU at district and
tehsil level

Temporary positioning of                                                    -                -              -               -
qualified medical and
paramedical staffs in the
specialty

Total
                                                                                                                  546,500




          82
                                                 Three Years Rolling Plan (2010-2013) District Jehlum


   5. Diabetes

                                                     Define                                       Financial Targets



             Activity                                                                                                                         Total Cost
                                          Unit            Rate       Quantity        Year I          Year II                   Year III




                                   Seminar        10,000         6              20,000        22,000                  24,200              66,200
  Health educational sessions in
community
                                   Brochure                                     -             -                       -                   -
  Printing and distribution of
Health Education material

                                   Glucometer     7,000          55             245,000       77,000                  84,700              406,700
  Provision of lab                 with Sticks
equipment/reagents

Provision of medicines             Drug           4,800          202,290        323,664,000   356,030,400             391,633,440         1,071,327,840



Total
                                                                                                                                          1,071,800,740




           83
                                                        Three Years Rolling Plan (2010-2013) District Jehlum


   6. Malaria

                                                            Define                              Financial Targets

            Activity                                                                                                                Total Cost
                                              Unit               Rate   Quantity       Year I        Year II            Year III

Printing and distribution of Health   Poster                            75,000
Education material

Provision of lab                      Microscope , allied   60,000      59         3,540,000    -                   -              3,540,000
equipment/reagents                    kit

Training of health care providers /   Training              75,000      60         1,500,000    1,650,000           1,815,000      4,965,000
GPs on Roll back malaria

Antimalarial drugs aursonate          Tablet (Pack of       2,000       1,500      2,000,000    660,000             484,000        3,144,000
tablets,                              100)
Antimalarial drugs Primaquin,         Tablet (Pack of       1,000       5,000      3,000,000    1,100,000           1,210,000      5,310,000
                                      100)

Antimalarial drugs Chloroquin         Tablet (Pack of       50          150,000    3,750,000    2,475,000           1,815,000      8,040,000
                                      100)

Fogging Machine                       Machine               90,000      6          540,000      -                   -              540,000

Purchase of disel for fogging         Litre                 76          9,000      228,000      250,800             275,880        754,680


Spray Pumps                           pumps                 7,000       100        350,000      192,500             211,750        754,250




           84
                                              Three Years Rolling Plan (2010-2013) District Jehlum


Uniform for spray man           Uniform             500      100        50,000        -              -           50,000



Glasses/ gloves, Backet, soap   Mis                 1,000    25         25,000        -              -           25,000


Purchase of insecticide delta   Kg                  800      8,000      3,200,000     1,760,000      1,936,000   6,896,000
methrine (Powder 5 % WDP)

Purchase of insecticide delta   Litre               1,200    6,000      2,400,000     2,640,000      2,904,000   7,944,000
methrine (Liquid 1.5 % )

Purchase of larvicidal Drug     Kg                  500      4,000      1,000,000     550,000        605,000     2,155,000
(Phenthion Granules)

Purchase of larvicidal Drug (   Litre               2,000    1,500      1,000,000     1,100,000      1,210,000   3,310,000
Temiphos) Liquid

Spray man                       4 Squad of 6        65,000   12         260,000       286,000        314,600     860,600
                                persons x 25 days

Purchase of motor cycle for     Motor cycle         60,000   65         2,100,000     990,000        1,089,000   4,179,000
CDCSs

POL for motor cycles            litre               75       27000      472,500       742,500        1,061,775   2,276,775

Total                                                                                                            54,744,305




          85
                                                     Three Years Rolling Plan (2010-2013) District Jehlum


   7. Scabies

                                                                        Define                                       Financial Targets

                   Activity                                                                                                                             Total Cost
                                                       Unit            Rate           Quantity         Year I             Year II        Year III

Community health education sessions                  HES          2,000              600             400,000           440,000       484,000         1,324,000


Printing & Distribution of IPC Material              Brochure                        150,000


Supply of anti scabies drugs                         drug         50                 100,000         2,500,000         1,650,000     1,210,000       5,360,000

Total                                                                                                                                                6,684,000


   8. Complications of pregnancy

                                                                Define                                           Financial Targets

             Activity                                                                                                                                       Total Cost
                                              Unit               Rate             Quantity         Year I              Year II            Year III

Messages on local cable network           Monthly Package   -                 -                -                 -                   -                  -



Printing and distribution of IPC          Brochure                            200,000
material




           86
                                                    Three Years Rolling Plan (2010-2013) District Jehlum


Activation and use of Health                              -           -          -             -               -                   -
Committees and women groups under
LHWs

Training of TBAs with specific focus    Batch of 25       50,000      8          200,000       110,000         121,000             431,000
on safe delivery and danger signs       TBAs for 2 days
                                        Training
Placement of mid-wives in their                                                  -             -               -                   -
catchment area

Repair of non functional ambulances     Ambulance         50,000      20         500,000       275,000         302,500             1,077,500
for timely transportation of pregnant
mothers

Replacement of non functional           Ambulance         1,500,000   4          3,000,000     1,650,000       1,815,000           6,465,000
ambulances for timely transportation
of pregnant mothers

POL for ambulances                      Litre             76          10800          182,400         300,960             441,408       924,768



Total
                                                                                                                                   53,911,316




           87
                                                      Three Years Rolling Plan (2010-2013) District Jehlum


      b) Management Problems
                         Human Resource Plan to bridge gap between proposed MSDS and Sanctioned posts
                                                                                                             Financial Targets



                                                                               Year I                             Year II                               Year III
                                                         Require
Sr.                       Basic   Basic
        Name of Post                       Allowances    ment as
No.                       Scale    Pay
                                                         per Gap
                                                                                                                                                          Pay
                                                                               Pay of                              Pay of
                                                                    Pay of                             Pay of                                Pay of        of
                                                                               other    Allowances                 other    Allowances                             Allowances
                                                                   Officers                           Officers                              Officers     other
                                                                                staff                               staff
                                                                                                                                                         staff

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


2       Paediatricians     18     12,910     18,099        4        309,840      -       434,376      511,236                    716,720    749,813                1,051,190


3       Anesthetists       18     12,910     18,099        6        464,760      -       651,564      852,060                1,194,534     1,124,719               1,576,785

4       MO / WMO           17     9,850      15,345        38      2,364,000     -      3,682,800    3,900,600               6,076,620     5,434,836               8,466,757

5       Nurses             16     6,060      8,934         98      3,636,000     -      5,360,400    5,919,408               8,726,731     8,623,138               12,712,725


6       Lady Health        9      3,820      4,750         23       458,400              570,000      857,208                1,065,900     1,275,727               1,586,310
        Visitors


           Total                                                   7,233,000     -      10,699,140   12,040,512      -      17,780,506     17,208,233      -       25,393,767




           88
                                                        Three Years Rolling Plan (2010-2013) District Jehlum


1. Shortage of skilled staff

                                                                 Define                             Financial Targets

                  Activity                                                                                                           Total Cost
                                                  Unit           Rate      Quantity      Year I       Year II           Year III

Filling of the vacant posts of medics and the             -        -            -             -            -                   -            -
paramedics through existing recruitment
committees
Temporary filling of vacant positions on                  -        -            -             -            -                   -            -
contract

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

Orientation trainings of the recruited staffs   Batch          175,000         16       1,400,000     770,000             847,000     3,017,000


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

Request to the Provincial Government for                                                      -            -                   -            -
approval and implementation of agreed pay
packages
Review and revise the career structure of                                                     -            -                   -            -
medics and paramedics

Filling of Human Resource gaps as per           Posts                         146       6,774,600   11,183,304          15,932,506   33,890,410
MSDS




            89
                                                     Three Years Rolling Plan (2010-2013) District Jehlum


                                             Posts                          23        458,400      857,208    1,275,727       2,591,335


                                             HR                            169      10,699,140   17,780,506   25,393,767     53,873,412


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


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



Total                                                                                                                      93,372,157




          90
                                                  Three Years Rolling Plan (2010-2013) District Jehlum


2. Inadequate district health budget for POL

                                                           Define                               Financial Targets

              Activity                                                                                                                  Total Cost
                                           Unit            Rate      Quantity        Year I          Year II            Year III

Assessment of additional requirement                                                        -                  -                   -               -

Costing and submission of additional                                                        -                  -                   -               -
demand

Provision of POL budget for             36000 Litre   76            36,000      912,000          1,003,200          1,103,520          3,018,720
supervisory vehicles


                                        32400 litre   76            32,400      820,800          902,880            993,168            2,716,848
Provision of POL budget for EPI
vehicles

Provision of POL budget for Generator   54000 litre   76            54000       1,368,000        1,504,800          1,655,280          4,528,080



Total                                                                                                                                  10,263,648




          91
                                                 Three Years Rolling Plan (2010-2013) District Jehlum




3. Political Interference


                                                        Define                                 Financial Targets

               Activity                                                                                                               Total Cost
                                          Unit          Rate      Quantity            Year I          Year II          Year III



Formulation of the Health committees                                                    -                  -                -               -

Meetings with political leaders                                              -                    -                -              -


 Advocacy seminars                     Meeting       20000       12          80,000               88,000           96,800         264,800



Total                                                                                                                                  264,800




           92
                                                   Three Years Rolling Plan (2010-2013) District Jehlum




4. Outdated /inadequate equipment for MNCH services at secondary level


                                                          Define                              Financial Targets

               Activity                                                                                                              Total Cost
                                            Unit          Rate      Quantity         Year I          Year II          Year III


Costing of equipment for THQ and DHQ
hospitals based on the gaps between
MSDS and existing available

Allocation of the budget                                                       -                -                 -              -


Procurement of equipments                             -                        16,602,260       15,548,204        -              32,150,464

Enhance amount for M&R in the budget                                           -                -                 -              -

Establishing district level bio-equipment                                      -                -                 -              -
workshop


Condemnation of the old and off-road                                           -                -                 -              -
vehicles




           93
                                              Three Years Rolling Plan (2010-2013) District Jehlum


Total
                                                                                                                                    32,150,464




5. Shortage of functional vehicles




                                                        Define                               Financial Targets

               Activity                                                                                                              Total Cost
                                           Unit        Rate          Quantity       Year I        Year II            Year III


Condemnation of the old and off-road   Plan                                     -             -                  -              -
vehicles


Demand submission for replacement      Demand                                   -             -                  -              -
                                       Submission

Demand for fund for repair              Demand                                  -             -                  -              -
                                       submission

Procurement of the vehicles            Vehicle      3800000      1              3800000       -                  -              38000000



Procurement of the vehicles            Vehicle      900000       2              900OOO        990000             -              1890000




          94
                                          Three Years Rolling Plan (2010-2013) District Jehlum



 II.     Financial outlay including 3YRP activities
         The costing of the plan includes routine recurring budget with 15% price escalation for subsequent years and additional
         cost involved on the basis of health and management problems; which is essentially required to bring visible improvement
         in the health system. Other financial resources expected from provincial level through ADP and PMDGP are also part of
         this plan. Overall financial outlay of the plan is as under:

                a) Health Problems
    Object                        2010-2011                                    2011-2012                                    2012-2013
 Classification
                   Regular       Additional          Total      Regular       Additional          Total      Regular       Additional          Total
A03907              212,750         420,000          632,750     244,663         462,000          706,663     281,362         508,200          789,562

A03902              379,500        5,500,000        5,879,500    436,425        4,950,000        5,386,425    501,889        4,386,250        4,888,139

A03820                       -       52,000            52,000             -       57,200            57,200             -       62,920            62,920

A03927                       -   424,764,000                              -                                            -
                                                  424,764,000                 458,440,400      458,440,400                 502,529,940      502,529,940

A13101              126,500                   -      126,500     145,475                   -      145,475     167,296                   -      167,296

A09501                       -     5,100,000        5,100,000             -     2,640,000        2,640,000             -     2,904,000        2,904,000

A09601                       -      890,000          890,000              -      192,500          192,500              -      211,750          211,750

A03903                       -     2,620,000        2,620,000             -     1,727,000        1,727,000             -     1,899,700        1,899,700

A03801                       -     4,000,000        4,000,000             -     3,630,000        3,630,000             -     3,993,000        3,993,000



           95
                                           Three Years Rolling Plan (2010-2013) District Jehlum


    Object                        2010-2011                                        2011-2012                                       2012-2013
 Classification
                   Regular        Additional          Total        Regular         Additional          Total        Regular        Additional          Total
A09601                       -                 -              -               -                 -              -              -                 -              -

A09404                       -    12,035,000        12,035,000                -     9,014,500         9,014,500               -     9,915,950         9,915,950

A03807            4,617,250          791,700         5,408,950    5,309,838         1,093,620         6,403,458    6,106,313        1,448,007         7,554,320

A03906                       -        50,000            50,000                -                 -              -              -                 -              -

A09802                       -        25,000            25,000                -                 -              -              -                 -              -

A01277                       -       260,000          260,000                 -       286,000          286,000                -       314,600           314,600

A13001              729,100          500,000         1,229,100      838,465           275,000         1,113,465      964,235          302,500         1,266,735

     Total        6,065,100      457,007,700       463,072,800    6,974,865       482,768,220       489,743,085    8,021,095      528,476,817       536,497,912




          96
                                              Three Years Rolling Plan (2010-2013) District Jehlum


                 b) Management Problems


   Object                        2010-2011                                   2011-2012                                 2012-2013
Classification        Regular    Additional        Total           Regular   Additional       Total          Regular   Additional           Total

A03801            -              1,400,000      1,400,000      -             770,000       770,000       -             847,000          847,000

A01102            98,165,150     458,400        98,623,550     112,889,923   857,208       113,747,131   129,823,411   1,275,727        131,099,138

A01101            73,399,900     6,774,600      80,174,500     84,409,885    11,183,304    95,593,189    97,071,368    15,932,506       113,003,873

A01270            109,259,200    10,699,140     119,958,340    125,648,080   17,780,506    143,428,586   144,495,292   25,393,767       169,889,059

A03820            -              80,000         80,000         -             88,000        88,000        -             96,800           96,800

A03807            4,617,250      3,100,800      7,718,050      5,309,838     3,410,880     8,720,718     6,106,313     3,751,968        9,858,281

A09501                           3800000        3800000                      1890000       1890000                     -

A09601            -              16,602,260     16,602,260     -             15,548,204    15,548,204    -             -                -

    Total          285,441,500    42,915,200     324,556,700   328,257,725    51,528,102   377,895,826   377,496,384       47,297,768   424,794,151




            97
                       Three Years Rolling Plan (2010-2013) District Jehlum


    III.     Summaries


           1. Problem-wise costing
        a) Health Problems
Sr. No.   Problem                             FY I           FY II          FY III        Total Cost Rs.

                                              Amount (Rs.)   Amount         Amount        Amount (Rs.)
                                                             (Rs.)          (Rs.)
1           Diarrhoeal diseases                 32,682,000    34,575,200     38,032,720    105,289,920

2           Accidents And Injuries              33,840,000    36,564,000     40,220,400    110,624,400

3           Hepatitis B & C                     32,250,000    35,337,500     37,963,750    105,551,250

4           Cardiovascular Diseases CVD          450,000       440,000        484,000       1,374,000

5           Diabetes                           323,929,000   356,129,400    391,742,340   1,071,800,740

6           Malaria                             26,415,500    14,946,800     15,385,755     56,748,055

7           Scabies                             3,150,000      2,365,000     1,996,500      7,511,500

8           Complication of pregnancy           4,382,400      2,610,960     2,982,408      9,975,768
Total                                          457,098,900   482,968,860    528,807,873   1,468,875,633




           b) Management Problems
                                                     FY I        FY II         FY III     Total Cost Rs.
Sr. No.                Problem                                                Amount
                                              Amount (Rs.)   Amount (Rs.)                  Amount (Rs.)
                                                                                (Rs.)
1           Shortage of skilled staffs         19,332,140     30,591,018     43,448,999     93,372,157

2           Inadequate budget POL               3,100,800     3,410,880       3,751,968     10,263,648

3           Political interference               80,000         88,000         96,800        264,800
4           Outdated/ inadequate               16,602,260     15,548,204             -      32,150,464
            equipment
5           Shortage of functional vehicles           -              -               -           -


            Total
                                                                                          136,051,069




               98
                                      Three Years Rolling Plan (2010-2013) District Jehlum



    2. Activity-wise Costing


    a) Health Problems
                                                                                                               Costing (Rs.)
 Sr.
 No.     Health Problem                      Activity                         FY-I        FY-II       FY-III          Total
1      Diarrheal diseases   Quarterly co-ordination meetings with TMA
                            and other agencies                             12,000       13,200       14,520          39,720

                            Messages on local cable network
                                                                          420,000      462,000      508,200       1,390,200

                            Printing and distribution of IPC material
                                                                          500,000      275,000      302,500       1,077,500

                            Conduction of HES in the community
                                                                         2,000,000    1,100,000    1,210,000      4,310,000

                            Training of medics and paramedics in IMCI
                                                                         1,500,000    1,650,000    1,815,000      4,965,000

                            Procurement and distribution of ORS and
                            Zinc Sulphate                                4,250,000    4,675,000    5,142,500     14,067,500

                             Procurement and distribution of Zinc
                            Sulphate                                    24,000,000   26,400,000   29,040,000     79,440,000

2      Accidents And        Quarterly co-ordination meetings with
       Injuries             Traffic Police department                      20,000       22,000       24,200          66,200

        99
                                   Three Years Rolling Plan (2010-2013) District Jehlum


                                                                                                             Costing (Rs.)
Sr.
No.     Health Problem                    Activity                          FY-I        FY-II       FY-III          Total
                         Quarterly co-ordination meetings with
                         Highway department                              20,000       22,000       24,200          66,200

                          Preparation of Disaster Management Plan                                                        -
                         including the Patient Management protocols            -            -            -

                          Training of the medics and the paramedics
                         in first aid and emergency                     800,000      220,000      242,000       1,262,000

                         Provision of emergency kits for victims
                                                                       3,000,000    3,300,000    3,630,000      9,930,000

                         Procurement of equipments / instruments /                                                       -
                         various splints and Plaster casts                     -            -            -

                         Drugs
                                                                      30,000,000   33,000,000   36,300,000     99,300,000

                         Disaster management plan                                                                        -
                                                                               -            -            -

3     Hepatitis B & C    Quarterly co-ordination meetings with TMA                                                       -
                         and other agencies                                    -            -            -

                         Messages on local cable network                                                                 -
                                                                               -            -            -

                         Printing and distribution of IPC and


      100
                                   Three Years Rolling Plan (2010-2013) District Jehlum


                                                                                                               Costing (Rs.)
Sr.
No.    Health Problem                    Activity                            FY-I        FY-II        FY-III          Total
                        hepatitis awareness material                    3,000,000    3,300,000    2,722,500       9,022,500

                        Procurement and supply of screening kits
                                                                        5,000,000    5,500,000    6,050,000      16,550,000

                        Procurement of safety boxes
                                                                         250,000      137,500      151,250          538,750

                        Procurement of drugs for treatment of
                        Hepatitis patients                             24,000,000   26,400,000   29,040,000      79,440,000

                         Develop and implement SOPs for                                                                    -
                        sterilization of equipment                              -            -             -

4     Cardiovascular    Health educational sessions in community
      Diseases (CVD)                                                     200,000      165,000      181,500          546,500

                        Printing and distribution of Health
                        Education material                               250,000      275,000      302,500          827,500

                         Demand generation and request submission                                                          -
                        for approval of establishing CCU at district            -            -             -
                        and tehsil level

                        Temporary positioning of qualified medical                                                         -
                        and paramedical staffs in the speciality                -            -             -

5     Diabetes          Health educational sessions in community


      101
                                   Three Years Rolling Plan (2010-2013) District Jehlum


                                                                                                               Costing (Rs.)
Sr.
No.    Health Problem                     Activity                         FY-I         FY-II         FY-III          Total
                                                                         20,000        22,000        24,200          66,200

                        Printing and distribution of Health                                                                -
                        Education material                                     -             -             -

                        Provision of lab equipment/reagents
                                                                        245,000        77,000        84,700         406,700

                        Provision of medicines
                                                                     323,664,000   356,030,400   391,633,440   1,071,327,840

6     Malaria           Printing and distribution of Health
                        Education material                             1,000,000      550,000       453,750       2,003,750

                        Provision of lab equipment/reagents
                                                                       3,540,000             -             -      3,540,000

                        Training of health care providers / GPs on
                        Roll back malaria                              1,500,000     1,650,000     1,815,000      4,965,000

                        Antimalarial drugs aursonate tablets,
                                                                       2,000,000      660,000       484,000       3,144,000

                        Antimalarial drugs Primaquin,
                                                                       3,000,000     1,100,000     1,210,000      5,310,000

                        Antimalarial drugs Chloroquin
                                                                       3,750,000     2,475,000     1,815,000      8,040,000


      102
                                   Three Years Rolling Plan (2010-2013) District Jehlum


                                                                                                          Costing (Rs.)
Sr.
No.    Health Problem                     Activity                      FY-I         FY-II       FY-III          Total
                        Fogging Machine
                                                                    540,000               -           -        540,000

                        Purchase of diesel for fogging
                                                                    228,000       250,800      275,880         754,680

                        Spray Pumps
                                                                    350,000       192,500      211,750         754,250

                        Uniform for spray man
                                                                     50,000               -           -         50,000

                        Glasses/ gloves, Bucket, soap
                                                                     25,000               -           -         25,000

                         Purchase of insecticide delta methrine
                        (Powder 5 % WDP)                           3,200,000     1,760,000    1,936,000      6,896,000

                         Purchase of insecticide delta methrine
                        (Liquid 1.5 % )                            2,400,000     2,640,000    2,904,000      7,944,000

                        Purchase of larvicidal Drug (Phenthion
                        Granules)                                  1,000,000      550,000      605,000       2,155,000

                        Purchase of larvicidal Drug ( Temiphos)
                        Liquid                                     1,000,000     1,100,000    1,210,000      3,310,000

                        Spray man


      103
                                    Three Years Rolling Plan (2010-2013) District Jehlum


                                                                                                            Costing (Rs.)
Sr.
No.     Health Problem                     Activity                         FY-I       FY-II       FY-III          Total
                                                                         260,000     286,000     314,600         860,600

                         Purchase of motor cycle for CDCSs
                                                                        2,100,000    990,000    1,089,000      4,179,000

                         POL for motor cycles
                                                                         472,500     742,500    1,061,775      2,276,775

7     Scabies            Community health education sessions
                                                                         400,000     440,000     484,000       1,324,000

                         Printing & Distribution of IPC Material
                                                                         250,000     275,000     302,500         827,500

                         Supply of anti scabies drugs
                                                                        2,500,000   1,650,000   1,210,000      5,360,000

8     Complication of    Messages on local cable network                                                                -
      pregnancy                                                                 -           -           -

                         Printing and distribution of IPC material
                                                                         500,000     275,000     302,500       1,077,500

                         Activation and use of Health Committees                                                        -
                         and women groups under LHWs                            -           -           -

                         Training of TBAs with specific focus on safe
                         delivery and danger signs                       200,000     110,000     121,000         431,000


      104
                                  Three Years Rolling Plan (2010-2013) District Jehlum


                                                                                                                  Costing (Rs.)
Sr.
No.    Health Problem                    Activity                            FY-I         FY-II          FY-III          Total
                        Placement of mid-wives in their catchment                                                            -
                        area                                                    -             -               -

                         Repair of non functional ambulances for
                        timely transportation of pregnant mothers        500,000        275,000        302,500       1,077,500

                         Replacement of non functional ambulances
                        for timely transportation of pregnant           3,000,000     1,650,000       1,815,000      6,465,000
                        mothers

                        POL for ambulances
                                                                          91,200        100,320        110,352         301,872

      Total
                                                                    1,468,252,737 1,468,252,737   1,468,252,737 1,468,252,737




      105
                                    Three Years Rolling Plan (2010-2013) District Jehlum


b) Management Problems
                                                                                                  Costing (Rs.)
  Sr.        Management
  No.           Problems                           Activity                       FY-I         FY-II         FY-III        Total
  1       Shortage of skilled   Filling of the vacant posts of medics and                -             -              -            -
         staffs                 the paramedics through existing
                                recruitment committees

                                Temporary filling of vacant positions on                 -             -              -            -
                                contract

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

                                Orientation trainings of the recruited staffs    1,400,000     770,000       847,000       3,017,000

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

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

                                Review and revise the career structure of                -             -              -            -
                                medics and paramedics

                                Filling of Human Resource gaps as per           17,932,140   29,821,018    42,601,999     90,355,157


   106
                                   Three Years Rolling Plan (2010-2013) District Jehlum


                                                                                          Costing (Rs.)
Sr.      Management
No.       Problems                              Activity                   FY-I        FY-II       FY-III       Total
                               MSDS

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

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

2     Inadequate budget        Assessment of additional requirement               -            -            -           -
      POL

                               Costing and submission of additional               -            -            -           -
                               demand

3     Political interference   Provision of POL budget for supervisory     912,000    1,003,200    1,103,520    3,018,720
                               vehicles

                               Provision of POL budget for EPI vehicles    820,800     902,880      993,168     2,716,848

                               Provision of POL budget for Generator      1,368,000   1,504,800    1,655,280    4,528,080

                               Formulation of the Health committees               -            -            -           -

                               Meetings with political leaders                    -            -            -           -

                                Advocacy seminars                           80,000      88,000       96,800      264,800



107
                                Three Years Rolling Plan (2010-2013) District Jehlum


                                                                                          Costing (Rs.)
Sr.       Management
No.        Problems                           Activity                    FY-I         FY-II       FY-III         Total
4      Outdated/            Costing of equipment for THQ and DHQ                 -             -            -             -
      inadequate            hospitals based on the gaps between MSDS
      equipment             and existing available

                            Allocation of the budget                             -             -            -             -

                            Procurement of equipments                   16,602,260   15,548,204             -   32,150,464

                            Enhance amount for M&R in the budget                 -             -            -             -

5      Shortage of          Establishing district level bio-equipment            -             -            -             -
      functional vehicles   workshop

                            Condemnation of the old and off-road                 -             -            -             -
                            vehicles

                            Condemnation of the old and off-road                 -             -            -             -
                            vehicles

                            Demand submission for replacement                    -             -            -             -

                            Demand for fund for repair                           -             -            -             -

                            Procurement of the vehicles                  4,700,000      990,000             -     5,690,000

              Total                                                     43,815,200   50,628,101             -   141,741,069




108
                        Three Years Rolling Plan (2010-2013) District Jehlum



      SECTION 5: MONITORING & EVALUATION


      The proposed monitoring and evaluation targets and indicators will be used to
      gauge the progress of implementation of the plan. This will be done through:

              Developing indicators
              Identifying means of verification (MoV); and
              Plan for monitoring and evaluation of the district health plan


      M&E of Plan


  Indicators       Target          %           MoV        Responsibility   Frequency    Remarks
                              Achievement                                      of
                                                                           monitoring

% of planned      60 visits                  Inspection   EDOH             Quarterly
supervisory        /year                        Book
visits
conducted             100                                 DOH              Monthly
                     visits
                     /year

                      120                                 DDOH             Monthly
                     visits
                     /year

% of                 100%                   Pay Roll      EDOH / DOH       6 monthly    Posts       of
DHQ/THQs                                                                                essential
with               During                                                               specialists at
availability of    1st year                                                             RHCs        is
specialists of                                                                          under
essential                                                                               consideration
specialties
(Physician,
Surgeon,
Paediatrician
and
Gynaecologist)




               109
                           Three Years Rolling Plan (2010-2013) District Jehlum


  Indicators         Target           %            MoV        Responsibility   Frequency    Remarks
                                 Achievement                                       of
                                                                               monitoring

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

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

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

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

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

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

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




                   110
                        Three Years Rolling Plan (2010-2013) District Jehlum


  Indicators      Target           %            MoV        Responsibility   Frequency    Remarks
                              Achievement                                       of
                                                                            monitoring

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

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

% of pregnant         60%                   DHIS           EDOH/            Monthly
women newly                                 /MNCH          Statistical
registered for        65%                   /PHSRP         Officer
ANC-1by SBAs                                Report
                      70%

% of targeted         75%                   DHIS           EDOH/ DHIS       Quarterly
pregnant                                    Report         Coordinator/
women                 90%                                  Statistical
received TT-2                                              Officer
vaccine               100%

Delivery                                    DHIS           EDOH/ DHIS       Quarterly
conducted by                                Report         Coordinator/
or under              55%                                  Statistical
supervision of                                             Officer
                      65%
skilled persons
reported              75%

%of target            90%                   DHIS           EDOH/ DHIS       Quarterly
children                                    Report/ EPI    Coordinator/
between 18 -          95%                   Reports        Statistical
23 months of                                               Officer
                      98%
age fully
immunized




                111
                       Three Years Rolling Plan (2010-2013) District Jehlum


  Indicators       Target          %           MoV       Responsibility   Frequency    Remarks
                              Achievement                                     of
                                                                          monitoring

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

% of targeted      200000/                  LHW’s        EDOH/            Quarterly
eligible couples     year                   monthly/     Statistical
provided                                    quarterly    Officer
knowledge and                               report       /Coordinator
information on                                           NP-FP&PHC
Family
Planning
methods

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




               112
                 Three Years Rolling Plan (2010-2013) District Jehlum


                                                                                      Annex-I

    List of Private Sector Health Facilities in District Jhelum


                                                                                         Category of
          Contact       Name of Health
Sr.                                                   Addresses             Contact        Health
          Persons          Centers
                                                                                           Centers
                                     District: Jhelum; Town: Jhelum
      Dr. Shahida       Al - Ghani                                                      Maternity
1                                            Civil Line Jhelum            3051
      Arshad            Hospital                                                        Home
                                                                                        Maternity
2     Dr. Alia Niaz     Fazal Hospital       356 Civil Lines              2184
                                                                                        Home
      Dr. Nazira                             5-Kazim Kamal Rd Jhelum                    Maternity
3                       Nazira's Hospital                                 622236
      Mehdi                                  Cantt                                      Home
      Dr. Rukhsana      Afzal Hospital                                    625646        Maternity
4                                            Machine Mohallah Jhelum
      Abid                                                                624646        Home
                                             Nai Abadi Dhok Abdullah
      Khalida           Ahmed Clinic                                                    Maternity
5                                            Near Haji Shifa Khana Dhok   613299
      Parveen                                                                           Home
                                             Jumma
                                                                                        Maternity
6     Zahida Iqbal      Bismillah Clinic     Phulray Syeedan
                                                                                        Home
                                                                                        Maternity
7     Najma             Ali Clinic           Kala Gujran Gt Road          622171
                                                                                        Home
                                                                                        Maternity
8     Mrs. Riffat Ara   Mughal Clinic        Tana Wala Tallian            612413
                                                                                        Home
                        Tipu Clinic &                                     0631966,      Maternity
9     Mrs. Shanaz                            Opp. High School GT Road
                        Maternity Home                                    630535        Home
                        Bassi Wala Clinic    Ramdin Bazar, Sardar                       Maternity
10    Mrs. Riaz Abid                                                      623958
                        & MH                 Chowk                                      Home
                                             Quarter#1 C/O Sajad
                                                                                        Maternity
11    Ghazala Farhat    Nukhba Clinic        Mehmood Kiyani Bhu
                                                                                        Home
                                             Sohan
      Mrs. Munawar                           Street 10, Machine                         Maternity
12                      Hammad Clinic
      Sultana                                Mohallah No. 3                             Home
                        Al-Hafeez Clinic
      Dr. Naheed                             Machine Mohalla # 2, B Iv-
13                      & Maternity                                       0541-623-8,   Clinic
      Abdul Hafeez                           I-S-93, Jehlum
                        home
      Dr. Fauzia        Women Clinic &       Maj. Akram Shaheed Road,                   Maternity
14                                                                        621287
      Kazmi             Maternity home       Mohammdi Chowk, Jehlum                     Home
15    Dr. Tayyeba       Khan                 Machine Mohallah # 1 ,       628088        Clinic

       113
                Three Years Rolling Plan (2010-2013) District Jehlum


                                                                                       Category of
         Contact      Name of Health
Sr.                                                Addresses                Contact      Health
         Persons         Centers
                                                                                         Centers
      Aziz           Mohammad             Jehlum
                     Hospital
      Dr. Shazana
      Imtiaz         Al-Qasim Clinic &    Civil Lines Opp. Nazam's         0541-
16                                                                                    Clinic
      Dr. Saeeda     Matern               Off. Jehlum                      621622,
      Afzal
      Dr. Nabeela    Dr. Nabeela's        10-A, Civil Lines , Professor'   0541-
17                                                                                    Clinic
      Butt           Clinic               Colony, Jehlum                   622978
      Dr. Fareeda    Noor-Un-Nisa         Gts Chowk, Cantt Area,           627094
18                                                                                    Hospital
      Yasmin         Hospital             Jehlum

                                 District: Jhelum, Town: Sohawa
19    Zubia Yasir     Kashif Clinic        Sohawa Post Office Sagral                  Clinic
                              District: Jhelum , Town: Dina-Mangla
      Dr. Rubina      Al - Karam
20                                         Mangla Road, Dina Jhelum        630816     Hospital
      Khawaja         Hospital
      Dr. Rehana      Dr. Rehana's                                                    Maternity
21                                         GT Road, Dina                   630354
      Yasin           Maternity Home                                                  Home
      Dr. Taveer      Al-Kausar                                            635892,
22                                         GT Road, Dina                              Hospital
      Saleeha         Hospital                                             636892
      Dr. Gulnaz
23                    Al-Shafi Hospital   G.T. Road, Dina                  632549     Hospital
      Chatta
                            District: Jhelum; Town: Pind Dadan Khan
      Mrs. Farzana    Agha Khan                                       0458-
24                                        Pind Dadan Khan                             Clinic
      Akbar           Health Cente                                    210454P
                          List of Family Physicians working in Jhelum
      Dr. Ahsan
25                           -            Civil Line Jhelum                     -     Hospital
      Ullaha
      Dr. Saeeda                                                                -
26                           -            Civil Line Jhelum                           Hospital
      Ahsan
      Dr. Farrukh                                                               -
27                           -            Civil Line Jhelum                           Hospital
      Ahsan
      Dr. Khalid                                                                -
28    Manzoor                -            Civil Line Jhelum                           Clinic
      Khwaja
      Dr. Munir                                                                 -
29                           -            Civil Line Jhelum                           Clinic
      Azam
      Dr. Imtiaz                                                                -
30                           -            Nia Mohallaha, Jhelum                       Clinic
      Sarfraz


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                Three Years Rolling Plan (2010-2013) District Jehlum


                                                                                Category of
          Contact        Name of Health
Sr.                                                 Addresses        Contact      Health
          Persons           Centers
                                                                                  Centers
      Dr. Saleem                                                        -
31                                -        Model Colony, Jhelum                Clinic
      Chowdhry
32    Dr. Iqbal Rana              -        Ram Din Bazar, Jhelum        -      Clinic
      Dr. Mazar                                                         -
33                                -        Ram Din Bazar, Jhelum               Clinic
      Shibli
      Dr. Col.                                                          -
34                                -        Civil Lines, Jhelum                 Clinic
      Shabbir,
35    Dr. Nasir Jamil             -        Medan- Pakistan, Jhelum      -      Clinic
      Dr. Abdul                                                         -
36                                -        Medan- Pakistan, Jhelum             Clinic
      Shakoor
      Dr. Maj. Yousaf                                                   -
37                                -        MM# 1 Jhelum                        Clinic
      Akhter
      Dr. Abdul                                                         -
38                                -        MM#2 Jhelum                         Clinic
      Shakoor Malik
      Dr. Amir                                                          -
39    Zammurad, Dr.               -        MM# 3 Jhelum                        Clinic
      Faisal
40    Dr. Sabir Khalil            -        MM# 3 Jhelum                 -      Clinic

      Dr. Tariq                                                         -
41                       Rahim Clinic,     Taliahanwala, Jhelum                Clinic
      Raheem
      Dr. Capt. Abdul                                                   -
42                                         Civil Lines, Jhelum                 Clinic
      Rasheed
      Dr. Capt.                                                         -
43                       Family Hospital   Dina                                Clinic
      Arshad,
      Dr. Zafar                                                         -
44                       Zafar Hospital,   Dina                                Clinic
      Mughal
      Dr.                                                               -
45    Mohammad           Data Road,        Dina                                Clinic
      Ishaq
46    Dr. Nadir Jalal,            -        Thatti Mughalan, Jhelum      -      Clinic
      Dr. Sajid                                                         -
47    Mahmood                     -        Kala Gujran, Jhelum                 Clinic
      Khawaja,
      Dr. Abdul                                                         -
48                                -        Jhelum                              Clinic
      Rasool Qureshi,
      Dr. Imtiaz H.                                                     -
49                       Al-Qasim,         Civil Lines, Jhelum                 Clinic
      Shah,
50    Dr. Khalid         Poly Clinic       Jada Jhelum                  -      Clinic


       115
               Three Years Rolling Plan (2010-2013) District Jehlum


     Saeed Akhtar
     Dr. Habib-Ur-                                             -
51                      Poly Clinic        Jada Jhelum                Clinic
     Rehman
52   Dr. Shirafat       Near Poly Clinic   Jada Jhelum         -      Clinic
53   Dr. Aslam                  -          Jada Road, Jhelum   -      Clinic
54   Dr. Nimat Ullah            -          Near D.H.O Jhelum   -      Clinic
55   Dr. Ejaz Butt-             -          Sohawa              -      Clinic
     Dr. Aftab
56                               -         Sohawa              -      Clinic
     Ahmad
     L/Dr. Saeeda
57                               -         PD Khan             -      Clinic
     Nisar
58   Dr. Javaid Iqbal            -         PD Khan             -      Clinic
59   Dr. Qasim                   -         PD Khan             -      Clinic




      116
             Three Years Rolling Plan (2010-2013) District Jehlum


                                                                             Annex-II
Costing of Equipment Gaps for DHQ and THQ Hospitals

                           DHQ Hospital Jehlum

 Sr.     Equipment        Standard as per   Available   Gap      Cost/Unit    Total Cost
 No.                           MSDS
                              (Qty.)
                          C     B     A
 1    CTG (Cardiac          1     1       2    1         0         285000         0
      Tocography)
 2    Foetal Doppler        3     5      5      3        2         101000     202000
 3    Diagnostic            1     1      2      0        2        1200000     2400000
      Laparoscope
 4    Bulb Sucker         10     20    20       2       18             45       810
 5    Baby Warmer          3      3     6       1       5          850000     4250000
 6    Mechanical           3      3     6       0       6           28000     168000
      Sucker
 7    Fetal Stethoscope     4     4     4       4        0           1500        0
 8    Delivery Table        2     2     3       2        1          17500      17500
 9    D&C Set               2     3     4       1        3           2100       6300
 10   Outlet forceps        4     4     4       0        4            900       3600
 11   Myoma Screw           2     2     2       2        0            320        0
 12   Kochers forceps       4     4     8       4        4            235       940
 13   Volselum forceps      6     8    10       3        7            235       1645
 14   Lanes Tissue          2     2     4       2        2            400       800
      holding forceps
 15   Vaginal             10     10    10       5        5            350       1750
      Retractors
 16   Polypectomy           2     2      2      1        1            750        750
      forceps
 17   Sponge holder       10     15    20       4       16            300       4800
 18   Uterine elevator     1      1     1       1       0             150        0
   19 CosCo Speculum       6     10    10           3        7        550       3850
 20   Examination light    3      3     6       2        4          18000      72000
 21   Suction Curette      1      2     2       2        0             95        0




       117
               Three Years Rolling Plan (2010-2013) District Jehlum


 22     Infant                1    1    2     0       2       95000   190000
        Resuscitation
        Trolley (with life
        saving medicines,
        baby
        laryngoscope,
        Endo-tracheal
        tube, Infant BP
        Apparatus,
        Chargeable Light)
 23     Mother                1    1    2     0       2      110000   220000
        Resuscitation
        Trolley (with life
        saving medicines,
        Laryngoscope,
        Endo-tracheal
        tube, BP
        Apparatus,
        Chargeable light)
 24     Cardiac Monitor       1    1    2     0       2      500000   1000000
 25     Pump Breast           1    1    1     0       1      250000   250000
        Electronic
 26     Vaginal               2    2    4                     30000     0
        Hysterectomy
        Set
26.1    Toothed Tissue        2    2    4     2       2          55    110
        Forceps (8”)
26.2    Non-Tooted            2    2    4     2       2          55    110
        Tissue Forceps
        (8”)
26.3    Dissection            2    2    4     0       4         150    600
        Scissors (Curved
        7”)
26.4    Dissection            2    2    4     0       4         150    600
        Scissors (Straight
        7”)
26.5    Hysterectomy          8    8   16     3       13        150    1950
        Clamps (Straight
        )
26.6    Hysterectomy          8    8   16     3       13        175    2275
        Clamps (Curved)
26.7    Uterine Sound         2    2    4     2       2          90    180
26.8    Needle Holder         2    2    4     2       2         150    300
        (7”)
26.9    Needle Holder         2    2    4     2       2         300    600
        (10”)
26.1    Artery Forceps       16   16   32     6       26        110    2860
        (Straight 6”)
26.11   Artery Forceps       16   16   32     3       29        125    3625
        (Curved 6”)
26.12   Allis Forceps         8    8   16     4       12        230    2760

        118
              Three Years Rolling Plan (2010-2013) District Jehlum


26.13   Towel Clamps         8    8   16     0       16        125   2000
26.14   Single blade Sims    4    4    8     2       6         275   1650
        speculum
26.15   Double blade         4    4    8     2       6         250   1500
        Sims speculum
26.16   Sponge holding       8    8   16     4       12        200   2400
        forceps
26.17   Volselum forceps     4    4    8     2       6         250   1500
26.18   Uterine Sound        2    2    4     0       4        1500   6000
26.19   Bladder Sound        2    2    4     0       4        1500   6000
 27     Delivery Sets       10   10   15                              0
27.1    Episiotomy          10   10   15     2       13        125   1625
        Scissors
27.2    Straight Scissors   10   10   15     4       11        360   3960
27.3    Needle holder       10   10   15     2       13        135   1755
27.4    Non-toothed         10   10   15     3       12        100   1200
        tissue forceps 8
        inches
27.5    Toothed tissue      10   10   15     2       13        100   1300
        forceps 8 inches
27.6    Sims Speculum       20   20   30     2       28        275   7700
        single blade
27.7    Sims Speculum       20   20   30     2       28        250   7000
        double blade
27.8    Sponge holding      40   40   60     5       55        250   13750
        forceps
27.9    Artery forceps      40   40   60     2       58        275   15950
27.1    Straight clamps     20   20   30     2       28        175    4900
        (cord)
27.11   Vacuum               1    1    1     1       0       19000     0
        Extractor pump
27.12   Towel clip          40   40   60     6       54        125   6750
 28     Caesarian            6    8   10                              0
        Section
28.1    Scalpel              6    8   10     8       2          50   100
28.2    Artery Forceps      24   32   40     6       34        125   4250
        Straight 6 inches
28.3    Artery Forceps      24   32   40     4       36        125   4500
        Curved 6 inches
28.4    Artery forceps 8    24   32   40     6       34        175   5950
        inches
28.5    Myoma Scissors       6    8   10     3       7         150   1050
        straight 7 inches
28.6    Dissecting           6    8   10     1       9         270   2430
        scissors (curved)
        7 inches
28.7    Green Armtage       24   32   40    10       30        300   9000
        forceps 8 inches


        119
             Three Years Rolling Plan (2010-2013) District Jehlum


28.8  Obstetric outlet     6    8    10     0       10          900     9000
      forceps (pair)
28.9 Doyene’s              6    8    10     2       8           200     1600
      Retractor
28.1 Small Retractors     12   16    20     2       18          300     5400
28.11 Towel Clippers      24   32    40     6       36          125     4500
28.12 Suction Nozzle       6    8    10     2       8           250     2000
 29   MNCH Related                                                       0
      Radiology
      Equipments
29.1 Ultrasound            1    2     3     2       1        575000    575000
      Machine
 29.2 X-Ray Unit 500       1    1     1         1        0   6000000     0
      kw
29.3 Color Doppler         0    1     1     0       1        5750000   5750000
29.4 Lead Screen for       1    1     1     1       0          30000      0
      X-Ray Unit
29.5 0.5 MN Lead           1    1     1     1       0        100000      0
      Apron. Lead
      Gloves, Goggles
      and Thyroid and
      Gonadal Sheets
29.6 Safe Light            1    1     1     1       0          5000      0
29.7 X-RT Film             1    1     1     0       1          5000     5000
      Processing Tank
29.8 Chest Stand           1    1     1     1       0          4500      0
29.9 X-Ray film            2    2     2     1       1          4000     4000
      Illuminator
29.1 X-Ray Film            4    4     4     2       2          4000     8000
      Hangers All sizes
 30   MNCH Related
      Paediatrics
      Equipments
30.1 Paediatric            1    2     2     0       2        1200000   2400000
      Ventilator
30.2 Incubator             1    1     2     2       0        1500000     0
30.3 Photo Therapy         1    1     1     1       0          22000     0
      Unit
30.4 Over-head             1    1     1     1       0        910000      0
      Radiant Warmer
30.5 Infant Length         2    2     2     2       0          5000      0
      Measuring Scale
30.6 Infant Weighing       2    2     2     2       0          3100      0
      Machine
30.7 Nebulizer             1    1     2     1       1         22000    22000
30.8 Billiubino-meter      1    1     2     1       1         36000    36000
30.9 Exchange Blood        1    1     2     1       1          2000     2000
      Transfusion Set


       120
               Three Years Rolling Plan (2010-2013) District Jehlum


30.1    Nasal Probe Paed     2    2     4     2       2        7000   14000
        size
 31     Anaesthesia/ICU                                                 0
31.1    Anaesthesia          1    1     2     1       1      321000   321000
        Machine
31.2    Ventilators          1    1     1     1       0      525000     0
31.3    Nebulizer            1    1     1     1       0      165000     0
31.4    Pulse Oximetry       1    1     1     1       0       21000     0
31.5    Defibrillator        1    1     1     1       0      500000     0
31.6    Airway Oral and      2    3     4     3       1         500    500
        Nasal
31.7    Tracheostomy         2    2     4     3       1        1000    1000
        tube (adult and
        paeds)
31.8    Face mask of all     2    2     4     4       0        1000     0
        sizes
31.9    Double Cuff          1    2     2     2       0         320     0
        Tourniquet (for
        regional block)
31.1    AMBO bag adult       2    2     4     2       2        2450    4900
31.11   AMBO Bag paeds       2    2     4     2       2        3000    6000
31.12   Red Rubber Nasal     4    4     8     4       4        1000    4000
        tubes all sizes
        without cuff
 32     Blood Bank                                                      0
32.1    Blood storage        1    1     2     1       1      812000   812000
        cabinet (100 bag
        capacity)
32.2    Packed cell          1    1     1     1       0      600000     0
        machine
32.3    Cell Separator       1    1     1     1       0     5225000     0
32.4    Freezer for Fresh    1    1     1     1       0     1150000     0
        Frozen Plasma
32.5    Blood bag shaker     1    1     2     1       1       10000   10000
32.6    RH view box          2    2     4     2       2        1000    2000
32.7    Water bath           2    2     2     2       0        3000     0
32.8    Micro-pipette        4    6     8     6       2        8000   16000
32.9    Blood grouping       3    3     6     3       3        3000    9000
        tiles
32.1    Plasma Extractor     1    1     1     1       0     1000000     0
32.11   Platelets agitator   1    1     1     1       0     1000000     0
32.12   Blood thawing        1    1     1     1       0        3000     0
        bath
32.13   Microscopes          1    1     2     1       0      115000     0
 33     Gynae & Labour                                                  0
        Room Related
        Laboratory
        Equipment

        121
             Three Years Rolling Plan (2010-2013) District Jehlum


33.1   Hematology            1        1   1          1           0            425000        0
       Analyzer
33.2   Electrolyte           1        1   1          0           1            625000      625000
       Analyzer
33.3   Analyzer Bio-         1        1   1          1           0            690000        0
       chemistry Semi-
       automatic
33.4   Glucometer            2        2   2          0           2              2500       5000
33.5   Haemoglobino-         2        2   4          2           2              1000       2000
       meter
33.6   Centrifuge            1        1   2          1           1        133000   133000
                                                                      Grand Total 19714835




                            THQ Pind Dadan Khan
Sr.     Equipment        Standard as per MSDS      Available     Gap          Cost/Unit      Total
No.                             (Qty.)                                                       Cost
                           C      B       A
1   CTG (Cardiac             1     1      1              0           1          285000      285000
    Tocography)
2   Foetal Doppler           2    2       3              1           1          101000     101000
3   Diagnostic               1    1       1              0           1         1200000     1200000
    Laparoscope
4   Bulb Sucker              5   10       20             0           10             45       450
5   Baby Warmer              2   2         3             0           2          850000     1700000
6   Mechanical               3   3         3             3           0           28000        0
    Sucker
7   Fetal Stethoscope        2    3       4              0           3            1500       4500
8   Delivery Table           2    2       2              2           0           17500         0
9   D&C Set                  2    2       2              2           0            2100         0
10 Outlet forceps            4    4       4              3           1             900        900
11 Myoma Screw               2    2       2              2           0             320         0
12 Kochers forceps           4    4       4              2           2             235        470
13 Volselum forceps          4    4       6              2           2             235        470
14 Lanes Tissue              2    2       2              2           0             400         0
    holding forceps
15 Vaginal                   4    4       6              0           4             350       1400
    Retractors
16 Polypectomy               2    2       2              0           2             750       1500
    forceps
17 Sponge holder            10   10       15             2           8             300       2400
18 Uterine elevator          1   1         1             0           1             150        150
 19 CosCo Speculum           4        6        6             2            4        550       2200

       122
                Three Years Rolling Plan (2010-2013) District Jehlum


20     Examination light     3   3      3        0       3       18000      54000
21     Suction Curette       1   1      2        1       0          95        0
22     Infant                1   1      1        1       0       95000        0
       Resuscitation
       Trolley (with life
       saving medicines,
       baby
       laryngoscope,
       Endo-tracheal
       tube, Infant BP
       Apparatus,
       Chargeable Light)
23     Mother                1   1      1        1       0      110000        0
       Resuscitation
       Trolley (with life
       saving medicines,
       Laryngoscope,
       Endo-tracheal
       tube, BP
       Apparatus,
       Chargeable light)
24     Cardiac Monitor       1   1      1        1       0      500000        0
25     Pump Breast           1   1      1        0       1      250000      250000
       Electronic
26     Vaginal               2   2      2                        30000        0
       Hysterectomy
       Set
26.1   Toothed Tissue        2   2      2        0       2             55    110
       Forceps (8”)
26.2   Non-Tooted            2   2      2        0       2             55    110
       Tissue Forceps
       (8”)
26.3   Dissection            2   2      2        0       2         150       300
       Scissors (Curved
       7”)
26.4   Dissection            2   2      2        0       2         150       300
       Scissors (Straight
       7”)
26.5   Hysterectomy          8   8      8        0       8         150       1200
       Clamps (Straight)
26.6   Hysterectomy          8   8      8        0       8         175       1400
       Clamps (Curved)
26.7   Uterine Sound         2   2      2        0       2          90       180
26.8   Needle Holder         2   2      4        0       2         150       300
       (7”)
26.9   Needle Holder         2   2      2        0       2         300       600
       (10”)
26.1   Artery Forceps       16   16     16       0       16        110       1760
       (Straight 6”)



       123
               Three Years Rolling Plan (2010-2013) District Jehlum


26.1   Artery Forceps      16   16     16       0       16        125   2000
       (Curved 6”)
26.1   Allis Forceps        8   8      8        0       8         230   1840
26.1   Towel Clamps         8   8      8        0       8         125   1000
26.1   Single blade Sims    4   4      4        0       4         275   1100
       speculum
26.2   Double blade         4   4      4        0       4         250   1000
       Sims speculum
26.2   Sponge holding       8   8      8        0       8         200   1600
       forceps
26.2   Volselum forceps     4   4       4       0       4         250   1000
26.2   Uterine Sound        2   2       2       0       2        1500   3000
26.2   Bladder Sound        2   2       2       0       2        1500   3000
 27    Delivery Sets        6   6      10                                 0
27.1   Episiotomy           6   6      10       2       4         125    500
       Scissors
27.2   Straight Scissors    6   6      10       1       5         360   1800
27.3   Needle holder        6   6      10       2       4         135    540
27.4   Non-toothed          6   6      10       0       6         100    600
       tissue forceps 8
       inches
27.5   Toothed tissue       6   6      10       0       6         100    600
       forceps 8 inches
27.6   Sims Speculum       12   12     20       0       12        275   3300
       single blade
27.7   Sims Speculum       12   12     20       3       9         250   2250
       double blade
27.8   Sponge holding      40   40     40       0       40        250   10000
       forceps
27.9   Artery forceps      40   40     40       6       34        275   9350
27.1   Straight clamps     20   20     30       0       30        175   5250
       (cord)
27.1   Vacuum Extractor     1   1      1        0       1       19000   19000
       pump
27.1   Towel clip          40   40     40       0       40        125   5000
 28    Caesarian            4   4       6       0       4                0
       Section
28.1   Scalpel              4   4       6       0       4          50    200
28.2   Artery Forceps      16   16     24      10       6         125    750
       Straight 6 inches
28.3   Artery Forceps      16   16     24       6       10        125   1250
       Curved 6 inches
28.4   Artery forceps 8    16   16     24       0       16        175   2800
       inches
28.5   Myoma Scissors       4   4      6        0       4         150    600
       straight 7 inches
28.6   Dissecting           4   4      6        1       3         270    810
       scissors (curved)
       7 inches

       124
              Three Years Rolling Plan (2010-2013) District Jehlum


28.7 Green Armtage        16   16       24       4       12          300     3600
     forceps 8 inches
28.8 Obstetric outlet      4   4        6        2       2           900     1800
     forceps (pair)
28.9 Doyene’s              4   4        6        2       2           200      400
     Retractor
28.1 Small Retractors      8   8        12       1       7           300     2100
28.1 Towel Clippers       16   16       24       6       10          125     1250
28.1 Suction Nozzle        4   4         6       0       4           250     1000
 29 MNCH Related                                                              0
     Radiology
     Equipments
29.1 Ultrasound            1   1        2        1       0        575000      0
     Machine
29.2 X-Ray Unit 500        1        1        1       1        0   6000000     0
     kw
29.3 Color Doppler         0   0        0        0       0        5750000     0
29.4 Lead Screen for X-    1   1        1        1       0          30000     0
     Ray Unit
29.5 0.5 MN Lead           1   1        1        1       0        100000      0
     Apron. Lead
     Gloves, Goggles
     and Thyroid and
     Gonadal Sheets
29.6 Safe Light            1   1        1        1       0          5000      0
29.7 X-RT Film             1   1        1        1       0          5000      0
     Processing Tank
29.8 Chest Stand           1   1        1        1       0          4500      0
29.9 X-Ray film            2   2        2        2       0          4000      0
     Illuminator
29.1 X-Ray Film            4   4        4        4       0          4000      0
     Hangers All sizes
 30 MNCH Related                                                              0
     Paediatrics
     Equipments
30.1 Paediatric            1   1        2        0       1        1200000   1200000
     Ventilator
30.2 Incubator             1   1        1        1       0        1500000      0
30.3 Photo Therapy         1   1        1        0       1          22000    22000
     Unit
30.4 Over-head             1   1        1        0       1        910000    910000
     Radiant Warmer
30.5 Infant Length         2   2        2        0       2          5000     10000
     Measuring Scale
30.6 Infant Weighing       2   2        2        2       0          3100      0
     Machine
30.7 Nebulizer             1   1        1        1       0         22000      0
30.8 Billiubino-meter      1   1        1        1       0         36000      0



       125
               Three Years Rolling Plan (2010-2013) District Jehlum


30.9   Exchange Blood       1   1      1        0       1        2000    2000
       Transfusion Set
30.1   Nasal Probe Paed     1   2      2        0       2        7000    14000
       size
 31    Anaesthesia/ICU                                                    0
31.1   Anaesthesia          1   1      1        1       0      321000     0
       Machine
31.2   Ventilators          1   1      1        0       1      525000   525000
31.3   Nebulizer            1   1      1        1       0      165000     0
31.4   Pulse Oximetry       1   1      1        1       0       21000     0
31.5   Defibrillator        1   1      1        1       0      500000     0
31.6   Airway Oral and      1   2      2        0       2         500    1000
       Nasal
31.7   Tracheostomy         1   2      2        2       0        1000     0
       tube (adult and
       paeds)
31.8   Face mask of all     1   2      2        2       0        1000     0
       sizes
31.9   Double Cuff          1   1      1        0       1         320     320
       Tourniquet (for
       regional block)
31.1   AMBO bag adult       1   2      2        1       1        2450    2450
31.1   AMBO Bag paeds       2   2      2        0       2        3000    6000
31.1   Red Rubber Nasal     4   4      4        0       4        1000    4000
       tubes all sizes
       without cuff
 32    Blood Bank                                                         0
32.1   Blood storage        1   1      1        1       0      812000     0
       cabinet (100 bag
       capacity)
32.2   Packed cell          1   1      1        0       1      600000   600000
       machine
32.3   Cell Separator       1   1      1        0       1     5225000   5225000
32.4   Freezer for Fresh    1   1      1        0       1     1150000   1150000
       Frozen Plasma
32.5   Blood bag shaker     1   1      1        0       1       10000    10000
32.6   RH view box          1   2      2        0       2        1000    2000
32.7   Water bath           2   2      2        0       2        3000    6000
32.8   Micro-pipette        4   4      6        0       4        8000    32000
32.9   Blood grouping       3   3      3        0       3        3000    9000
       tiles
32.1   Plasma Extractor     1   1      1        0       1     1000000   1000000
32.1   Platelets agitator   1   1      1        0       1     1000000   1000000
32.1   Blood thawing        1   1      1        0       1        3000    3000
       bath
32.1   Microscopes          1   1      1        0       1      115000   115000



       126
              Three Years Rolling Plan (2010-2013) District Jehlum


33     Gynae & Labour                                                                   0
       Room Related
       Laboratory
       Equipment
33.1   Hematology             1        1        1        0       1        425000     425000
       Analyzer
33.2   Electrolyte            1        1        1        0       1        625000     625000
       Analyzer
33.3   Analyzer Bio-          1        1        1        1       0        690000        0
       chemistry Semi-
       automatic
33.4   Glucometer             2        2        2        1       1          2500       2500
33.5   Haemoglobino-          1        1        1        1       0          1000        0
       meter
33.6   Centrifuge             1        1       1         1       0        133000        0
                                      Grand Total                                    16602260




                                       THQ Sohawa
 Sr.       Equipment        Standard as per MSDS Available       Gap     Cost/Unit    Total Cost
 No.                               (Qty.)
                              C      B       A
  1     CTG (Cardiac            1       1      1    0                1     285000      285000
        Tocography)
  2     Foetal Doppler            2         2        3       1       1     101000     101000
  3     Diagnostic                1         1        1       0       1    1200000     1200000
        Laparoscope
  4     Bulb Sucker               5        10       20       1       4         45       180
  5     Baby Warmer               2         2        3       1       1     850000      850000
  6     Mechanical                3         3        3       1       2      28000      56000
        Sucker
  7     Fetal Stethoscope         2         3        4       1       1       1500       1500
  8     Delivery Table            2         2        2       1       1      17500      17500
  9     D&C Set                   2         2        2       1       1       2100       2100
 10     Outlet forceps            4         4        4       0       4        900       3600
 11     Myoma Screw               2         2        2       0       2        320       640
 12     Kochers forceps           4         4        4       2       2        235       470
 13     Volselum forceps          4         4        6       1       3        235       705
 14     Lanes Tissue              2         2        2       0       2        400       800
        holding forceps
 15     Vaginal                   4         4        6       0       4        350       1400
        Retractors
 16     Polypectomy               2         2        2       0       2        750       1500
        forceps

       127
              Three Years Rolling Plan (2010-2013) District Jehlum


17     Sponge holder        10    10    15      2       8          300      2400
18     Uterine elevator      1     1     1      0       1          150      150
 19    CosCo Speculum        4     6     6          0       4      550      2200
20     Examination light     3     3     3      3       0        18000       0
21     Suction Curette       1     1     2      1       0           95       0
22     Infant                1     1     1      0       1        95000     95000
       Resuscitation
       Trolley (with life
       saving medicines,
       baby
       laryngoscope,
       Endo-tracheal
       tube, Infant BP
       Apparatus,
       Chargeable Light)
23     Mother                1     1     1      0       1       110000     110000
       Resuscitation
       Trolley (with life
       saving medicines,
       Laryngoscope,
       Endo-tracheal
       tube, BP
       Apparatus,
       Chargeable light)
24     Cardiac Monitor       1     1     1      0       1       500000     500000
25     Pump Breast           1     1     1      0       1       250000     250000
       Electronic
26     Vaginal
       Hysterectomy
       Set
26.1   Toothed Tissue        2     2     2      2       0            55      0
       Forceps (8”)
26.2   Non-Tooted            2     2     2      2       0            55      0
       Tissue Forceps
       (8”)
26.3   Dissection            2     2     2      0       2            150    300
       Scissors (Curved
       7”)
26.4   Dissection            2     2     2      2       0            150     0
       Scissors (Straight
       7”)
26.5   Hysterectomy          8     8     8      0       8            150    1200
       Clamps (Straight)
26.6   Hysterectomy          8     8     8      0       8            175    1400
       Clamps (Curved)
26.7   Uterine Sound         2     2     2      2       0             90     0
26.8   Needle Holder         2     2     4      2       0            150     0
       (7”)
26.9   Needle Holder         2     2     2      2       0            300     0
       (10”)

       128
              Three Years Rolling Plan (2010-2013) District Jehlum


26.1    Artery Forceps      16    16    16      6       10           110   1100
        (Straight 6”)
26.11   Artery Forceps      16    16    16      6       10           125   1250
        (Curved 6”)
26.12   Allis Forceps        8     8     8      3       5            230   1150
26.13   Towel Clamps         8     8     8      2       6            125   750
26.14   Single blade Sims    4     4     4      4       0            275    0
        speculum
26.15   Double blade         4     4     4      4       0            250     0
        Sims speculum
26.16   Sponge holding       8     8     8      2       6            200   1200
        forceps
26.17   Volselum forceps     4     4     4      2       2         250      500
26.18   Uterine Sound        2     2     2      1       1        1500      1500
26.19   Bladder Sound        2     2     2      2       0        1500       0
  27    Delivery Sets        6     6    10                                  0
 27.1   Episiotomy           6     6    10      4       2            125   250
        Scissors
27.2    Straight Scissors    6     6    10      1       5            360   1800
27.3    Needle holder        6     6    10      1       5            135   675
27.4    Non-toothed          6     6    10      2       4            100   400
        tissue forceps 8
        inches
27.5    Toothed tissue       6     6    10      1       5            100    500
        forceps 8 inches
27.6    Sims Speculum       12    12    20      1       11           275   3025
        single blade
27.7    Sims Speculum       12    12    20      1       11           250   2750
        double blade
27.8    Sponge holding      40    40    40      2       38           250   9500
        forceps
27.9    Artery forceps      40    40    40      8       32           275   8800
27.1    Straight clamps     20    20    30      0       20           175   3500
        (cord)
27.11   Vacuum               1     1     1      0       1       19000      19000
        Extractor pump
27.12   Towel clip          40    40    40      0       40           125   5000
 28     Caesarian            4     4     6                                  0
        Section
28.1    Scalpel              4     4     6      4        0            50    0
28.2    Artery Forceps      16    16    24      2       14           125   1750
        Straight 6 inches
28.3    Artery Forceps      16    16    24      2       14           125   1750
        Curved 6 inches
28.4    Artery forceps 8    16    16    24      4       12           175   2100
        inches
28.5    Myoma Scissors       4     4     6      4       0            150     0
        straight 7 inches
28.6    Dissecting           4     4     6      1       3            270    810

        129
              Three Years Rolling Plan (2010-2013) District Jehlum


       scissors (curved)
       7 inches
 28.7 Green Armtage        16     16    24      1       15           300    4500
       forceps 8 inches
 28.8 Obstetric outlet      4      4     6      2       2            900    1800
       forceps (pair)
 28.9 Doyene’s              4      4     6      1       3            200    600
       Retractor
 28.1 Small Retractors      8      8    12      4        4           300    1200
28.11 Towel Clippers       16     16    24      4       12           125    1500
28.12 Suction Nozzle        4      4     6      0        4           250    1000
  29   MNCH Related                                                          0
       Radiology
       Equipments
 29.1 Ultrasound            1      1     2      1       0        575000      0
       Machine
  29.2 X-Ray Unit 500       1      1     1          1        0   6000000     0
       kw
 29.3 Color Doppler         0      0     0      0       0        5750000     0
 29.4 Lead Screen for       1      1     1      1       0          30000     0
       X-Ray Unit
 29.5 0.5 MN Lead           1      1     1      1       0        100000      0
       Apron. Lead
       Gloves, Goggles
       and Thyroid and
       Gonadal Sheets
 29.6 Safe Light            1      1     1      1       0          5000      0
 29.7 X-RT Film             1      1     1      1       0          5000      0
       Processing Tank
 29.8 Chest Stand           1      1     1      1       0          4500      0
 29.9 X-Ray film            2      2     2      0       2          4000     8000
       Illuminator
 29.1 X-Ray Film            4      4     4      4       0          4000      0
       Hangers All sizes
  30   MNCH Related                                                          0
       Paediatrics
       Equipments
 30.1 Paediatric            1      1     2      0       1        1200000   1200000
       Ventilator
 30.2 Incubator             1      1     1      1       0        1500000     0
 30.3 Photo Therapy         1      1     1      1       0          22000     0
       Unit
 30.4 Over-head             1      1     1      1       0        910000      0
       Radiant Warmer
 30.5 Infant Length         2      2     2      2       0          5000      0
       Measuring Scale
 30.6 Infant Weighing       2      2     2      1       1          3100     3100
       Machine
 30.7 Nebulizer             1      1     1      1       0         22000      0


      130
               Three Years Rolling Plan (2010-2013) District Jehlum


30.8    Billiubino-meter     1      1     1      0       1       36000      36000
30.9    Exchange Blood       1      1     1      0       1        2000       2000
        Transfusion Set
30.1    Nasal Probe Paed     1      2     2      0       1        7000       7000
        size
 31     Anaesthesia/ICU                                                       0
31.1    Anaesthesia          1      1     1      1       0      321000        0
        Machine
31.2    Ventilators          1      1     1      0       1      525000      525000
31.3    Nebulizer            1      1     1      1       0      165000        0
31.4    Pulse Oximetry       1      1     1      1       0       21000        0
31.5    Defibrillator        1      1     1      0       1      500000      500000
31.6    Airway Oral and      1      2     2      0       1         500       500
        Nasal
31.7    Tracheostomy         1      2     2      0       1        1000       1000
        tube (adult and
        paeds)
31.8    Face mask of all     1      2     2      0       1        1000       1000
        sizes
31.9    Double Cuff          1      1     1      1       0            320     0
        Tourniquet (for
        regional block)
 31.1   AMBO bag adult       1      2     2      1       1        2450       2450
31.11   AMBO Bag paeds       2      2     2      1       1        3000       3000
31.12   Red Rubber Nasal     4      4     4      0       4        1000       4000
        tubes all sizes
        without cuff
 32     Blood Bank                                                            0
32.1    Blood storage        1      1     1      1       0      812000        0
        cabinet (100 bag
        capacity)
32.2    Packed cell          1      1     1      0       1      600000      600000
        machine
32.3    Cell Separator       1      1     1      0       1     5225000      5225000
32.4    Freezer for Fresh    1      1     1      0       1     1150000      1150000
        Frozen Plasma
32.5    Blood bag shaker     1      1     1      0       1       10000      10000
32.6    RH view box          1      2     2      0       1        1000       1000
32.7    Water bath           2      2     2      2       0        3000        0
32.8    Micro-pipette        4      4     6      4       0        8000        0
32.9    Blood grouping       3      3     3      3       0        3000        0
        tiles
 32.1   Plasma Extractor     1      1     1      1       0     1000000        0
32.11   Platelets agitator   1      1     1      1       0     1000000        0
32.12   Blood thawing        1      1     1      1       0        3000        0
        bath
32.13   Microscopes          1      1     1      1       0      115000        0
 33     Gynae & Labour                                                        0

        131
             Three Years Rolling Plan (2010-2013) District Jehlum


       Room Related
       Laboratory
       Equipment
33.1   Hematology          1      1     1      1       0        425000       0
       Analyzer
33.2   Electrolyte         1      1     1      1       0        625000       0
       Analyzer
33.3   Analyzer Bio-       1      1     1      1       0        690000       0
       chemistry Semi-
       automatic
33.4   Glucometer          2      2     2      0       2          2500      5000
33.5   Haemoglobino-       1      1     1      0       1          1000      1000
       meter
33.6   Centrifuge          1      1     1      1       0        133000        0
                                                           Grand Total=   12849755




       132

				
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