ORGANIZATIONAL CHART OF MINISTRY OF HEALTH by miv12499

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									  Annex 1                              ORGANIZATIONAL CHART OF MINISTRY OF HEALTH
                                                                  Federal Minister

                                                                  Minister of State

                                                                  Secretary Health
                                                                          (BS-22)


              SR J. S (Admin)                    SR. J. S (F&D)                    Chief (Health)                                   D. G. (Health)
                   (BS-21)                              (BS-21)                         (BS-20)                                         (BS-21)

                                                                                                              Technical Wing                      Drugs Wing

                                                                                              Nursing Advisor                                          D.C.               Cost Accountant          D.C.
                                                                                                    (BS-20)                                          (L&QC)                   (BS-20)           (Reg&Evol)
                                                                                                                                                      (BS-20)                                     (BS-20)
   D.S. (A)       D.S. (Estt.)     D.S. (Per.)        D.S. (B.)        D.D.G. (P&D)
    (BS-19)         (BS-19)            (BS-19)         (BS-19)           (BS-19)                    D.D.G.                  D.D.G. (PHC)
                                                                                                  (MER/IH/PH)                  (BS-19)             DDG /                       D.D.G.
                                                                                                                                                                 DDG                        D.D.G.         D.D.G.
                                                                                                    (BS-19)                                        CQC                         (E&M)         (Reg)          (D.I)
                                                                                                                                                                 (R&D)
                                                                                                                                                   (QC)         (BS-19)        (BS-19)      (BS-19)        (BS-19)
                                                                                                                                                  (BS-19)
                                                                                                                  H.E.A.
                                                                                                                  (BS-18)                         DDC /         DDC /          DDC /        DDC /         DDC /
                                                                                                                                                  ADC=2         ADG=2          ADG=2        ADG=2         ADG=2
  S.O. =02                                                                                                                     ADG=01             (BS-18)       (BS-18)        (BS-18)      (BS-18)       (BS-18)
  A.D.=02                          S.O. =03                        S.O. =-2          S.O.=01         A.D.G =02
                                  (BS-18/17)
                                                                                                                            C.S.Off. =01
 Librarian=1       S.O. =02                        S.O. =03        R.O. =01          ADG=01         Dy.N.P.D=01                S.T.O.=021
 (BS-18/17)       (BS-18/17)                      (BS-18/17)       St.Off.=01        (BS-18/17)       (BS-18)                                     ADC /         ADC =01
                                                                                                                              (BS-18/17)                                       ADC =01       ADC =03       ADC =2
                                                                   (BS-18/17)                                                                     VCQC=3        S.T.O=01
                                                                                                                                                                               (BS-17)       (BS-17)       (BS-17)
                                                                                                                                                  (BS-17)       A.O. =01
                                                                                                                                                                (BS-17)


                        Pakistan           Directorate of           Federal                 Jinnah             National Institute      Directorate of
Attached Deptt.        Institute of           Malaria             Government             Postgraduate           of Child Health        Central Health           C.Prog.
                     Medical Science         Control,               Services            Medical Centre           (NICH) KHI            Establishment             (BS-17)
                      (PIMS) Isbd           Islamabad.                                  (JPMC) KHI.                                        KHI
                                                                  Hospital Isbd.
                                                                                                                                                                                                  Source: Ministry of Health
Annex 2

                    Organizational Set-up: Provincial Level
                                             MINISTER FOR HEALTH


                                                Secretary Healt


                                                Director General
                                                Health Services




                                               DHS EPI                                         Provincial
             DHS        DHS         DHS                    DHS         DHS     P. Manager
             MC                     D&                     CD          Denta   (HIV/AIDS      Coordinator
                       HQ/BHS
                                                                                            National Pro .



             AD     ADHS        ADH            A -EPI       ADHS        ADHS (TB)   ADHS        ADHS
            (HE)   (Medical)   (MS&DC           -M
                                               4-M         (Malaria)                (F&N        (ORS


                    A        A        HMI        A
    EDO            (Tibb
                       )   (Home)     Cord      (Stat


   Attac
   In
               Provincial Health Development Center, Chemical Examiner, Surgeon Medico legal,
   stiAt
   hed         Transport Management Organization, Health Equipment Maintenance Organization, Govt.
   tu ta
   Instit      Public Analyst, Drug Testing Lab, Women Health Project, Public Health Nursing &
   tioch
   ution       Paramedical School, Secondary Level Hospitals
   ns d

       Source: Inventory of Health and Population Investment in Pakistan, WHO
Annex 3



           Organizational Set-up : District Level
                                                      District Nazim


                                                          DCO

                                  EXECUTIVE DISTRICT OFFICER (Health)



       MS                      MS              DISTRICT OFFICER
   DHQ Hospital            THQ Hospitals                 (Health)
                                                                                                 District Drug
                                                                                                  Inspector


Principal Nursing School
                                CDCO, Entomologist,
                                                                    Program         District
                                                                Director DHDC   Coordinator-NP
                                DSI, DSV, AIHC


                                                         DDHO
                                                         (Tehsil)
Annex 4
                                                        Functions of District Health Departments
PUNJAB                                    SINDH                                       NWFP                                         BALOCHISTAN

1. Prevention and control                 1. Prevention and control of infectious     1. Prevention and control of infections            2. Prevention and control of
    of infectious diseases:               and contagious diseases:                    and contagious diseases.                               infectious and contagious diseases.
   • Tuberculosis:                           • Tuberculosis:                             • Tuberculosis.                             •   Tuberculosis.
   • Eradication/Control of                  • Eradication/Control of Malaria:           • Eradication/Control of                    •   Eradication/Control of Malaria.
     Malaria:                                • Lepers Act                                • Malaria.                                  •   Lepers Act 1898.
   • Lepers Act 1898;                        • Treatment of patients bitten by           • Leprosy Act.                              •   Treatment of patients bitten by rabid
   • Treatment of patients                     rabid animals;                            • Treatment of patients bitten by rabid         animals.
     bitten by rabid animals;                • Adulteration of foodstuff;                  animal.                                   •   Adulteration of food stuffs.
   • Adulteration of foodstuff;              • Government Public Analyst;                • Adulteration of food stuffs.              •   Government Public Analyst.
   • Government Public Analyst;              • Nutrition surveys;                        • Nutrition and publicity in regard to      •   Nutrition surveys.
   • Nutrition surveys;                      • Nutrition and publicity in regard to        surveys.                                  •
   • Nutrition and publicity in regard         food;                                     • Nutrition and publicity in regard to      • Nutrition and publicity in regard to
     to food;                                • Vaccination and inoculation                 food.                                       food.
   • Vaccination and inoculation             • Maternity and Child Welfare               • Vaccinations and inoculation.             • Vaccination and inoculation;
   • Maternity and Child Welfare             • Port Quarantine.                          • Maternity and child welfare.              • Port Quarantine.
   • Port Quarantine.                                                                    • Port Quarantine.
2. Management of health care              2. Management of health care facilities                                                   2. Management of health care facilities and
facilities and provision of health care   and provision of health care services in                                                  provision of health care services in the
services in the district including        the district including District Head                                                      district including maternity and child
DHQ and THQs Hospitals, RHC               Quarters Hospitals, THQ Hospitals,                                                        welfare in the
and BHUs but excluding any                Rural Health Centres (RHCs) and Basic                                                               District Headquarter Hospitals
hospital/Health facility affiliated       Health Units (BHUs) but excluding any                                                               (DHQs)
with the Medical college.                 hospital/Health facility affiliated with    ---                                                     Tehsil Headquarter Hospitals
                                          the Medical College.                                                                                (THQs)
                                                                                                                                              Rural Health Centers (RHCs)
                                                                                                                                              Basic Health Units (BHUs).
                                                                                                                                    excluding any hospital/health facility
                                                                                                                                    affiliated with the Medical College/Tertiary
                                                                                                                                    Hospitals.
3. Audit Cell to undertake financial,     3. Audit Cell to undertake financial,                                                    3. Audit Cell to undertake financial,
   managerial and clinical audit of       managerial and clinical audit of health                                                  managerial and clinical audit of health
                                                                                  --
   health facilities in districts.        facilities in districts.                                                                 facilities in districts.

4. Monitoring and inspection of all       4. Monitoring and inspection of all         2. Plan, Implement, Supervise and 4. Monitoring and inspection of all health
   health care facilities in the          health care facilities in the respective    Monitor Health Programs within district care facilities in the respective district
   respective district.                   district.                                   jurisdiction.
     5. Data collection and                 5. Data collection and compilation     ---                                     5. Data collection and compilation of vital
         compilation of vital health        of vital health statistics.                                                    health statistics.
         statistics.
6. Planning and Development of          6. Planning and Development of health      ---                                     6. Planning and Development of health care
health care services delivery for       care services delivery for improving                                               services delivery for improving health status
improving health status of              health status of population in                                                     of population in accordance with the
population in accordance with the       accordance with the community                                                      community perceived and locally
community perceived and locally         perceived and locally ascertained health                                           ascertained health care needs in order to
ascertained health care needs           care needs in order to pursue the                                                  pursue the “Health for All” goal through
through Primary Health Care (PHC)       “Health for All” goal through Primary                                              Primary Health Care (PHC) approach for
approach.                               Health Care (PHC) approach for                                                     providing equitable health services.
                                        providing equitable health services.


7. Preparation of development           7. Preparation of development              ---                                     7. Preparation of development schemes,
schemes, budget, schedule of new        schemes, budget, schedule of new                                                   budget, schedule of new expenditure and
expenditure and ADP proposals up        expenditure and ADP proposals up to                                                *ADP proposals.
to Rs 5* million                        5* million                                                                         *up to Rs:20 million
*enhanced up to Rs:20 million           *enhanced up to Rs:20 million
8. Service matters except those         8. Service matters except those            3. Carry out all aspects of Personnel   --
entrusted to Health                     entrusted to Health                        Management of the District Cadres in
Department/Services & General           Department/Services & General              Health.
Administration Department in case       Administration & Coordination
of regular employees of the             Department in case of regular
provincial government including         employees of the provincial
BS-17, Recruitment of officers and      government including BS-17,
officials in the district on contract   Recruitment of officers and officials in
basis from time to time under the       the district on contract basis from time
District Government Rules of            to time under the District Government
Business.                               Rules of Business.

9.Health Equipment Maintenance          10.Health Equipment Maintenance                                                    10.Health Equipment Maintenance (HEM)
(HEM) for ensuring availability of      (HEM) for ensuring availability of state                                           for ensuring availability of state of the art &
state of the art & functional bio       of the art & functional bio medical                                                functional bio medical technology.
medical technology.                     technology.
                                                                                   ---
11.Transport maintenance as an         11.Transport maintenance as an                                                        11.Transport maintenance as an essential
essential component of speedy          essential component of speedy                                                         component of speedy provision of outreach
provision of outreach health care      provision of outreach health care                                                     health care services.
services                               services.
                                                                                   ---




12.District Quality Control Board      12.District Quality Control Board for       4.Control of Medical drugs, poisons and   12.District Quality Control Board (DQCB)
(DQCB) under the overall technical     ensuring supply & availability of quality   dangerous drugs (Drug Act and Rules)      under the overall technical support from the
support from the Provincial Quality    medicines in line with the National                                                   Provincial Quality Control Board (PQCB)
Control Board (PQCB) for ensuring      Health Policy                                                                         for ensuring supply & availability of quality
supply & availability of quality                                                                                             medicines in line with the National Health
medicines in line with the National                                                                                          Policy.
Health Policy


13.Technical scrutiny,                 13.Technical scrutiny, standardization                                                13.Full powers for purchase of medicines in
standardization and purchase of        and purchase of stores and capital                                                    accordance with their budget allocations as
stores and capital goods and bio       goods and bio medical equipment for                                                   per specification and policies fixed by the
medical equipment for each health      each health facility in respective                                                    Provincial Government.
facility in respective districts.      districts.                                  ---




14.Government Medical Stores           14.Government Medical Stores Depot                                                    14.Government Medical Stores Deport.
Depot (MSD) at each district for       (MSD) at each district for ensuring                                                   (MSD) at appropriate quantity of reserves
ensuring availability of appropriate   availability of appropriate quantity of                                               and timely distribution of routine and
quantity of reserves and timely        reserves and timely distribution of                                                   incidental drugs to all health care facilities.
distribution of routine and            routine and incidental drugs to all
incidental drugs to all health care    health care facilities.
facilities.                                                                        ---
15.Surgeon Medico-legal Office and      15.Surgeon Medico-legal Office and its                                                   15.Surgeon Medico-legal Office and its
its functions relating to the           functions relating to the constitution of                                                functions relating to the constitution of
constitution of Medico -legal           Medico -legal examination.                                                               Medico -legal examination.
examination.                                                                        ---



16.All Administrative and related   16.All Administrative and related
matters of Nursing Cadres up to BS- matters of Nursing Cadres up to BS-17.
17                                                                         ---                                                   ---


17.Formulation and implementation       17.Formulation and implementation of 5. Levy of fees by Medical Officers.                17.Formulation and implementation of
of policies pertaining to institution   policies pertaining to institution of user                                               policies pertaining to institution of user
of user charges and levy of related     charges and levy of related and                                                          charges and levy of related and subsequent
and subsequent fee by Medical           subsequent fee by Medical Officers in                                                    fee by Medical Officers in districts.
Officers in districts                   districts.

                                                                                                                                 18.In a time span ranging over 5 years the
18.In a time span ranging over 5        18.In a time span ranging over 5 years                                                   office of the Chief Chemical Examiner will
years the office of the Chief           the office of the Chief Chemical                                                         be transferred and its responsibilities thereof
Chemical Examiner will be               Examiner will be transferred and its                                                     will be entrusted to the districts.
transferred and its responsibilities    responsibilities thereof will be
thereof will be entrusted to the        entrusted to the district.                                                         ---
districts




                                                                                          6. Medical attendance of
---                                     ---                                               Government servants.                   ---

                                                                                    7. Matters related to prevention and
---                                     ---                                         control of AIDS and viral Hepatitis          ---

                                                                                          8. Health Management Information
                                                                                             System.
---                                     ---                                                                                      ---
                                                                              9. Primary Health Care.
---                                   ---                                                                                    ---

                                                                              10. Expanded Programme on
---                                   ---                                     Immunization (EPI).                            ---

                                                                              11. Communicable Disease Control
---                                   ---                                     (CDC).
                                                                                      12. Rural Health.
---                                   ---                                                                                    ---

                                                                             13. Mother Child Health and Family
---                                   ---                                        Planning.                                   ----

                                                                              14. Public Sector Hospitals in the district.
---                                   ---                                                                                    ----

      Source: JICA Study team for improvement of health information system
  Annex-5                 UTILIZATION OF HEALTH SERVICES

  Table-2: Institutions Reporting and Number of Reports Received during 1998-2000.
                            1998                        1999                        2000
    Province     Institutions                Institutions                Institutions
                               Tot Reports                 Tot Reports                 Tot Reports
                  Reporting                   Reporting                   Reporting
   Punjab
                       3200         30227          3346         35568          3338         36459
   Sindh
                       1061         11251          1089         11261          1400         13289
   NWFP
                       1293          9867          1452         13967          1413          9980
   Balochistan
                        976          8604          1042          8216          1066          8173
   AJK
                        528          6101           526          6092           527          6098
   NAs
                        220          2118           233          2226           272          2470
   ICT
                         17           204            17           201            17            99
   Pakistan            7295         68372          7705         77531          8033         76568


Table-3:   A Summary of the Utilization of Health Institutions By Province
       Province           Year       Total new cases       Tot Rpt       Patients/ day
                      1998               12807286             28582           18
    Punjab            1999               18442661             34125           22
                      2000               25700921             34972           29
                      1998                 7261745            10922           27
    Sindh             1999                 7728410            10817           29
                      2000                 9434416            10380           36
                      1998                 4843801             8809           22
    NWFP              1999                 5990216            12579           19
                      2000                 7285573            13085           22
                      1998                 3586812             8170           18
    Balochistan       1999                 3287439             7797           17
                      2000                 3625324             7794           19
                      1998                 3250678             3923           33
    AJK               1999                 3626395             3934           37
                      2000                 3739836             3951           38
                      1998                  657246             1145           23
    NAs               1999                  815424             1193           27
                      2000                 1039209             1351           31
                      1998                  119018              204           23
    ICT               1999                  141853              201           28
                      2000                  106671               99           43
                      1998               32526586             61755           21
    Pakistan          1999               40032398             70646           23
                      2000               50931950             71632           28
Graph-1                                                                   Utilization of Health Institutions by Province (All FLCFs)

                                                          50
                                                                            Year 1998         Year 1999        Year 2000
                               Mean Patients/ day

                                                          40

                                                          30

                                                          20

                                                          10

                                                           0
                                                                 Punjab          Sindh          NWFP      Balochistn        AJK    NAs    ICT



 Graph-2                                                                                   Utilization of Basic Health Units


                                                          35                Year 1998         Year 1999       Year 2000
                                                          30
                                 Mean patients/ day




                                                          25
                                                          20
                                                          15
                                                          10
                                                          5
                                                          0
                                                                 Punjab          Sindh          NWFP      Balochistn       AJK    NAs    ICT




Graph-3                                                                                  Utilization of Rural Health Centers

                                                      100                  Year 1998         Year 1999       Year 2000
                                                       90
                     Mean Patients/ day




                                                       80
                                                       70
                                                       60
                                                       50
                                                       40
                                                       30
                                                       20
                                                       10
                                                        0
                                                                 Punjab          Sindh          NWFP      Balochistn       AJK    NAs    ICT




Graph-4                                                                                     Utilization of Dispensaries

                                           25                              Year 1998         Year 1999       Year 2000

                                           20
     Mean Patients/ day




                                           15


                                           10


                                                      5


                                                      0
                                                               Punjab          Sindh           NWFP       Balochistn       AJK    NAs     ICT




                                                                                                                                                1
                                                                                Utilization of MCH Centers
       Graph-5
                                            16              Year 1998            Year 1999      Year 2000
                      Mean Patients/ day    14
                                            12
                                            10
                                             8
                                             6
                                             4
                                             2
                                             0
                                                 Punjab             Sindh         NWFP       Balochistn     AJK         NAs         ICT




     Graph-6                                                                Utilization of Hospitals (OPDs only)


                                           300              Year 1998            Year 1999      Year 2000

                                           250
          Mean patients/ day




                                           200

                                           150

                                           100

                                           50

                                            0
                                                 Punjab             Sindh          NWFP      Balochistn      AJK         NAs           ICT




Table-4:                                         Utilization of Health Institutions in Pakistan (By month)
                                                           1998                                 1999                            2000
    Month                                                              Patient/                           Patient/                           Patient/
                                           Tot NC         Tot Rpt        day        Tot NC Tot Rpt          day      Tot NC    Tot Rpt         day
    Jan                                    1885530         5036         14.98       2287467 5825           15.71     3323513    6364          20.89
    Feb                                    2169699         5193         16.71       2897305 5985           19.36     4006192    6270          25.56
    Mar                                    2558358         5109         20.03       2856960 5807           19.68     3832954    6204          24.71
    Apr                                    2472853         5288         18.71       2944140 5916           19.91     4127041    6242          26.45
    May                                    2616162         5329         19.64       3461693 6062           22.84     4612411    6224          29.64
    Jun                                    2783401         5365         20.75       3544701 6000           23.63     4579977    6194          29.58
    Jul                                    3175621         5260         24.15       3853380 5892           26.16     4972819    6041          32.93
    Aug                                    3479662         5136         27.10       4100734 5970           27.48     5570764    6108          36.48
    Sep                                    3275083         5063         25.87       3832887 6014           25.49     5144061    5892          34.92
    Oct                                    3134820         5085         24.66       3714411 6015           24.70     4477182    5784          30.96
    Nov                                    2565900         4967         20.66       3317882 5748           23.09     3712459    5607          26.48
    Dec                                    2414137         4949         19.51       3259645 5487           23.76     2756155    4944          22.30




2
Graph-7                                 Utilization of Health Services, by Month (Pakistan)
                                                    Year 1998         Year 1999              Year 2000


            100
             90
             80
             70
Case/ day




             60
             50
             40
             30
             20
             10
              0
                              Jan     Feb     Mar      Apr      May       Jun      Jul       Aug         Sep      Oct     Nov      Dec




Graph-8
                                    Utilization of Health Facilities by Month and Health Problems
                                                   Year-1998-2000 (Aggregated Data)
                                                    Diarrhea       Fever          Dysentry          ARI
                          6
                          5
                          4
             Cases/ day




                          3
                          2
                          1
                          0
                                Jan     Feb    Mar      Apr     May   Jun       Jul      Aug       Sep      Oct     Nov    Dec




Table-5                         Utilization of Health Institutions by Age
                                      1998                                 1999                                     2000
  Age
(years)                                Tot     Patients                      Tot      Patients                        Tot       Patients
                          Tot NC       Rpt      / day           Tot NC      Rpt        / day             Tot NC      Rpt         / day
<1                        2228829     61755       1.444         2731170    70646         1.546           3392896    71632          1.895
<5                        4832125     61755       3.130         5849309    70646         3.312           7368732    71632          4.115
< 15                      6400450     61755       4.146         7525635    70646         4.261           9870209    71632          5.512
< 45                      12990344    61755       8.414        16102393    70646         9.117           20428512   71632        11.407
> 45                      6222792     61755       4.031         7841233    70646         4.440           9806619    71632          5.476




                                                                                                                                   3
                                                                      Utilizaiton of Health Institutions by Age
    Graph-9                                                         (Not Controled for age group %age in the Population)
                                                                         Year 1998                Year 1999                   Year 2000


                                                           12
                                                           10
                                     Mean Cases/ day



                                                            8
                                                            6
                                                            4
                                                            2
                                                            0
                                                                        <1           <5              < 15             < 45          > 45
                                                                                                     Age



                                                             Utilization of Health Institutions by Age (%age)
                                                                            (During 1998 - 2000)

                                                                                                            <1
                                                                        > 45
     Graph-10                                                           19%
                                                                                                            7%
                                                                                                                  <5
                                                                                                                 15%




                                                                                                                       < 15
                                                                                                                       19%


                                                                          < 45
                                                                          40%




                                                                       Utilization of Facilities by Age & by Year
                                                                              (Controlled for % in the Pop.)
     Graph-11                                                            Year 1998                   Year 1999                   Year 2000

                                                           3000
                           Adjusted No. of Patients/ day




                                                           2500

                                                           2000

                                                           1500

                                                           1000

                                                           500

                                                                0
                                                                          0..4            5..14              15..44              45.. A
                                                                                                  Age Category




Table-6 :        Utilization of Health Institutions by Sex
   Age                1998                                                                      1999                                               2000
 (years)        Male       Female                                                         Male       Female                                  Male       Female
<1                0.769       0.674                                                         0.817       0.730                                  0.989       0.906
<5                1.664       1.466                                                         1.757       1.555                                  2.165       1.949
< 15              2.100       2.046                                                         2.153       2.108                                  2.790       2.721
< 45              3.331       5.083                                                         3.565       5.552                                  4.427       6.980
> 45              1.978       2.052                                                         2.160       2.280                                  2.633       2.843




4
 Graph-12                                              Utilization of Health Institutions by Age (%age)
                                                                   Male (During 1998 - 2000)



                                                                                  <1
                                                      > 45                        8%
                                                      20%

                                                                                          <5
                                                                                         17%




                                                                                         < 15
                                                       < 45                              21%
                                                       34%




                                                       Utilization of Health Institutions by Age (%age)
                                                                 Female (During 1998 - 2000)

 Graph-13
                                                                                <1
                                                       > 45                     6%
                                                       18%                              <5
                                                                                       13%




                                                                                               < 15
                                                                                               18%




                                                             < 45
                                                             45%




Graph-14                                          Utilization of Health Institutions By Sex
                                    Male
                         80
                                    Female
                         70

                         60
    Mean Patients/ day




                         50

                         40

                         30

                         20

                         10

                          0
                              Basic Health Unit     Rural Health         Dispensery                   MCH Centers   Hospitals
                                                      Centers




                                                                                                                                5
Graph-15
                                                                 Utilization of Rural Health Centers by Sex and Province

                                             70           Male
                                                          Female
                                             60

                                             50
     Mean Patient/ day




                                             40

                                             30

                                             20

                                             10

                                             0
                                                      Punjab          Sindh       NWFP        Balochistn         AJK           NAs               ICT




                                                          A Comparison Between Utilization of Curative Vs Preventive Services
    Graph-16                                                                  (by Province and Year) .

                                              14                                                               1998
         Preventive as % of Curative Cases




                                              12                                                               1999
                                              10                                                               2000

                                                  8
                                                  6
                                                  4
                                                  2
                                                  0
                                                          Punjab         Sindh    NWFP         B'chistan          AJK              NAs           ICT


                                                               A Comparison Between Utilization of Curative Vs Preventive Services
       Graph-17                                                      (Preventive as %age of curative services Urban Vs Rural)
                                                                                  FLCFs of Tehsil Faisalabad Vs Tehsil Samundari

                                                                                      Urban                    Rural
                                                      9                                                                             9
                                                                     9
                                                      8
                                                                                                 8
                                                      7
                                                      6
                                              % age




                                                                                                                                             6
                                                      5
                                                      4
                                                                              4
                                                      3
                                                                                                           3
                                                      2
                                                      1
                                                      0
                                                                    Yr 1998                     Yr 1999                            Yr 2000




6
Table-7: A Comparison Between Utilization of Curative Vs Preventive Services
                             1998                  1999                           2000
    Province
                   Curative Preventive % Curative Preventive    % Curative    Preventive       %
 Punjab            12807286 1420095 10 18442661 1950123         10 25700921    2540809         9
 Sindh              7261745 696499 9 7728410        721295      9  9434416      835698         8
 NWFP               4843801 424132 8 5990216        503214      8  7285573      607850          8
 B'chistan          3586812 107503 3 3287439        112583       3  3625324     125547          3
 AJK                3250678 130675 4 3626395        144596       4  3739836     149902          4
 NAs                 657246     22466     3 815424   28134       3  1039209      33028          3
 ICT                 119018     18344 13 141853      22011      13  106671       15945         13
%age = (Preventive/ (Curative + Preventive)) * 100




 Source: National Health information cell. Ministry of Health




                                                                                           7
Annex 6                 NATIONAL ESSENTIAL DRUGS LIST

                                     THIRD REVISION

PREFACE

After the second World War the development and emergence of miracle drugs like antibiotics
brought a revolution in the medical care. The obvious effectiveness of these new pharmaceuticals
and intensive marketing efforts combined to catalyze wide spread use of modern medicine. A
rapidly growing and profitable industry, together with an enthusiastic but largely uninformed
audience and an unregulated market, resulted in excess of promotion and consumption
alowgwith inflated level of expenditure. However, by 1970s it had become clear that least
advantageous nations were not even meeting the basic needs of their people for essential life
saving and health promoting drugs. As a result gradually a number of countries started
concentrating on the development of a basic list of reliable drugs to meet the most vital basic
needs of their people.

A World Health Organization (WHO) Committee of Experts met in 1977 to determine the number
of drugs, which were actually needed to ensure a reasonable level of health care for as many
people as possible. Consequently, the first Model List of Essential Drugs was finalized in the same
year. This list is being updated regularly by the WHO and is intended to be used as a guideline
and provide basis for member countries to identify their own priorities and make their own
selection. Through 1970s and 1980s the WHO started promotion of the concept of Essential
Drugs Program in order to redress this imbalance. The program aimed at reduction in the
number of drugs purchased/used by the hospitals/institutions to a minimum possible level in
order to make best use of limited public funds.

Essential drugs as defined by WHO are those that satisfy the health care needs of majority of the
population. They should therefore be available at all times in adequate amounts and in the
appropriate dosage forms.

The National Essential Drugs List (NEDL) of Pakistan was first prepared in 1994 in consultation
with relevant experts. The list was previously reviewed in 1995 and 2000. The present list is the
third revision containing 452 drugs of different pharmacological classes.

The health sector in general and public health sector in particular is expected to seriously
consider adopting this list. The provincial health departments can play a pivotal role to encourage
the hospitals/institutions for making bulk purchases from within this list. We hope that this list
will find more acceptance among health care professionals.

                                                       Maj. Gen. ® Mohammad Aslam HI (M)

                                                                       Director General Health
EXPLANATORY NOTES

Letters in parentheses following drug names indicate: (P) for Primary, (S) for Secondary and (T)
for Tertiary.

1.           Classification of drugs for use at various levels of Health Services is as follows:


       (P)         PRIMARY: For use at the Primary Health Care Level including Basic Health Units
               and Rural Health Centers.

       (S)          SECONDARY: For use at the Secondary Health Center Level i.e; hospitals.

       (T)        TERTIARY: For use at the specialized and sub-specialized levels for specific
               expertise diagnostic precision or special equipment required for proper use.

II.          Drugs subject to international controls under :


       (1)          Single Convention on Narcotic drugs 1961:

       (2)          Convention on Psychotropic Substances 1971; and

       (3)          Convention on Illicit Traffic in Narcotic Drugs and Psychotropic     Substances 1988.

III.     Special considerations ;


       (4)          In renal insufficiency, contraindicated or dosage adjustments       necessary;

       (5)          To improve compliance;

       (6)          Special pharmacokinetic properties;

       (7)          Adverse effects diminish benefit/risk ratio;

       (8)          Limited indications or narrow spectrum of activity;

       (9)          For epidural anaesthesia;

       (10) Specific expertise, diagnostic precision, individualization of dosage or special
            equipment required for proper use;

       (11) Monitoring of therapeutic concentrations in plasma can improve safety and efficacy;

       (12) COMPLEMENTARY DRUGS: Choice to be made on the basis of cost effectiveness.

IV.      When the strength of a drug is specified in terms of a selected salt or ester, this is
mentioned in brackets; when it refers to the active moiety, the name of the salt or ester in
brackets is preceded by the word ‘as’.
1.   ANAESTHETICS


1.1 General Anaesthetics and Oxygen


                         diazepam (P), (S), (T), (2)          10mg/2ml inj.
                         ether, anaesthetic (P), (S), (T),    liquid for inhalation
                         (3,10)
                         halothane (T) (10)                   liquid for inhalation
                         ketamine (S), (T), (10)              50 mg/ml inj.(as hydrochloride)
                         nitrous oxide (T), (10)              gas for inhalation
                         (*propofol                           10 mg/ml inj)
                         thiopental (T), (10)                 500 mg powder for inj. (as
                                                              sodium salt)
                         (*only in exceptional cases on the basis of cost effectiveness).




1.2 Local Anaesthetics


                         bupivacaine (T),(9), (10)            0.25% & .5% (as hydrochloride)
                                                              inj.
                         ephedrine hydrochloride (S), (T),    50 mg/ml Inj.
                         (3)
                         lignocaine (S), (T)                  1% & 2% inj. (as hydrochloride)
                                                              5% (as hydrochloride) inj. for
                                                              spinal anaesthesia
                                                              2% & 4% (hydrochloride) topical
                                                              solution
                                                              2% (hydrochloride) gel.
                         lignocaine + epinephrine (S), (T)    1% (hydrochloride) +
                                                              epinephrine
                                                              1:100 000 inj.
                                                              2% (hydrochloride) +
                                                              epinephrine
                                                              1:200 000 inj.
                                                              2% (hydrochloride) +
                                                              epinephrine

                                                              1:80 000 dental cartridge


1.3 Neuromuscular Blocking Agents.


                         atracurium (T)                       25&50 mg inj. (as besylate)
                         pancuronium (T)                      4 mg inj. (as bromide)
                         suxamethonium (T), (10)              100 mg inj. (as chloride)
1.4 Miscellaneous


                         atropine (P), (S), (T)                     1mg inj. (as sulfate)
                         oxygen (P), (S), (T)                        gas for inhalation.




2:    ANALGESICS, ANTI TIPYRETICS, NON-STEROIDAL


ANTI-INFLAMMATORY DRUGS AND DRUGS USED TO TREAT GOUT.


2.1 Opioid Analgesics


                         morphine (P), (S), (T), (1)                10mg & 30mg slow release tab.
                                                                    10mg/ml inj. (as sulfate or
                                                                    hydrochloride).
                         pethidine (P), (S), (T), (1,4)             50 mg/ml inj. (as hydrochloride)




2.2   Non-Opioid Analgesics and NSAIDS


                    acetylsalicylic acid (P), (S), (T)       300 mg tab.


                    diclofenac (T)                          75 mg / 3 ml inj. (as sodium)


                    ibuprofen (P),(S),(T)                   200,400 and 600 mg tab.


                    indomethacin (P),(S),(T)                25 mg cap or tab.


                    paracetamol (P),(S), (T)                500 mg tab.


2.3   Local Analgesics


                         choline salicylate (P), (S), (T)          8.7% gel for local use.




2.4   Drugs used to treat Gout


                         allopurinol (S), (T), (7)                  100 & 300 mg tablet
                         colchicine (S), (T), (4)                   0.5 mg tab
3:    ANTIALLERGICS AND DRUGS USED IN


      ANAPHYLAXIS


                          adrenaline (P), (S), (T)            1mg inj. (as hydrochloride)
                          chlorpheniramine (P), (S), (T)      4mg tablet (as maleate),
                                                              2mg/5ml syrup (as maleate)
                          dexamethasone (P), (S), (T)         0.5mg tab


                                                              4&20mg inj.(as sodium
                                                              phosphate)
                          hydrocortisone (P),(S),(T)          100 mg inj.(as sodium succinate)
                          prednisolone (P), (S), (T)          5 mg tablet
                          promethazine (P), (S), (T)          10 & 25mg tab. (as
                                                              hydrochloride)
                                                              5mg/5ml elixir or syrup


                                                              (as hydrochloride)


                                                              25mg inj. (as hydrochloride)




4:    ANTI-EPILEPTICS


                                 carbamazepine (P), (S),      200 mg tab. Syp.
                 (T)                 (11)
                                 diazepam (P), (S), (T) (2)   10 mg/2ml injection.
                                 ethosuximide (T)             250 mg capsule/tab. 250 mg/5ml
                                                              syrup.
                                 phenobarbitone (P), (S),     30 mg tab. 200 mg/ml inj.
                 (T),                 (2,11)
                                 phenytoin (P), (S), (T),     100mg tab./capsule (as
                 (7,11)
                                                              sodium)
                                 phenytoin sodium (S), (T),   30mg/5ml syrup (as sodium)
                                 (7,11)
                                 valproate sodium             200 mg tab. 200 mg/5ml syrup.
                 (T),(7,11)
                                 valproic acid (T), (7,11)    125 mg, 250 mg & 500 mg tab
                                                              250 mg/5ml syrup).



5:    ANTI-INFECTIVE DRUGS.


5.1   Anthelmintics


                              albendazole (P), (S), (T)       200 mg tab. 100 mg/5ml susp.
                              levamisole (T), (8)             40 mg tablet (as hydrochloride)
                                                              40 mg/5ml syrup.
                              mebendazole (P), (S), (T)       100 mg tab. 100 mg/5ml susp.
                          niclosamide(P), (S), (T)        500 mg tab.
                          pyrantel (P), (S), (T)          250 mg tab. (as pamoate)
                                                          250 mg/5ml susp.(as pamoate).




5.2 Antibacterials


                     amoxicillin (P), (S), (T,), (4)      250 & 500 mg capsule/tablet (as
                                                          trihydrate).

                                                          125 & 250 mg/5ml syrup (as trihydrate)
                     ampicillin (P), (S), (T), (4)        250 & 500mg tab/cap (as anhydrous/trihydrate)


                                                          125 mg/5ml syrup (as
                                                          anhydrous/trihydrate)

                                                          500mg inj.(as sodium salt).
                     amikacin (T)                         250 & 500 mg inj. (as sulphate)
                     benzylpenicillin (P), (S), (T)       100.44 gm inj. (benzathine)


                                                          600 mg (1 million IU) inj.


                                                          (sodium/potassium)
                     cefazolin (T)                        250,500mg & 1gm inj.(as sodium salt)
                     cefatazidime (T)                     500 mg & 1 gm inj.
                     ceftriaxone (T)                      250,500&1gm inj(as sodium salt)
                     ceftizoxime (T)                      250, 500mg & 1gm inj.(as sodium salt).
                     cefixin (T)                          100 mg cap.
                     cefuroxime (T)                       125,250 mg tab. (as axetil)


                                                          250 and 750 mg inj. (as sodium)
                     cephalexin (T)                       250 & 500 mg cap.


                                                          125 mg/5ml & 250mg/5ml syrup.
                     cephradine (T)                       250 & 500 mg cap.


                                                          125 mg/5ml & 250 mg / 5ml syrup


                                                          250, 500 mg & 1 gm inj.
                     chloramphenicol (P), (S), (T), (7)   250 mg capsule


                                                          125mg/5ml syrup (as palmitate)


                                                          1 gm inj. (as sodium succinate)
                     ciprofloxacin (P), (S),(T)           250 mg tab.(as hydrochloride)
                     clindamycin (T), (8)                 300 & 600 mg inj. (as hydrochloride)
                          cloxacillin (T)                       250 mg cap. (as sodium)


                                                                125 mg/5ml syrup (as sodium),


                                                                250 mg inj. (as sodium)
                          co-trimoxazole (P), (S), (T)          400mg+80mg & 800mg+160mg tab.
                          (sulphamethoxazole+                   200 mg+40 mg/5ml suspension
        trimethoprim), (4)
                                                                800mg+160mg/3 ml injection.
                          doxycycline (T), (5,6)                100 mg cap / tablets (as hyclate/hydrochloride)
                          erythromycin (P), (S), (T)            250 & 500mg tablet (as stearate)
                                                                200mg/5ml suspension (as ethyl succinate)
                                                                500mg inj. (as lactobionate).
                          gentamicin (P), (S,), (T,),           40 & 80 mg inj. (as sulfate)
        (4,7,10,11)
                          metronidazole (P), (S), (T), (8)      200, 400 mg tab.
                                                                200 mg/5ml suspension (as benzoate)

                                                                500 mg/100ml vial.
                          nalidixic acid (P), (S), (T)          500 mg tablet
                                                                300 mg / 5ml syrup.


                                                                5000,000 IU tab
                                                                100,000 IU/ml drops
                                                                100,000 IU pessaries
                          nitrofurantoin (P), (4,8)             100 mg
                          nystatin (S), (T)                     200 mg tab. (as hydrochloride)
                          pefloxacin (T)                        400 mg/5ml inj.
                          phenoxymethylpenicillin (P), (S),     250 & 500mg tab. (as potassium salt) 125
        (T)                                                     mg/5ml syrup.
                          procaine benzylpenicillin (P), (S),   1 & 3 million IU inj.
        (T)
                          sulphasalazine (S), (T)               500 mg tab.
                          tinidazole (S), (T)                   300 & 500 mg tab.
                          trimethoprim (S),                     300 mg tab.
        (T), (8)




5.3 Anti-Tuberculosis Drugs


                       ethambutol (P), (S), (T), (4)            400mg tab.(hydrochloride)
                       isoniazid (P), (S), (T)                  50, 100 & 300 mg tab. Syrup.
                       isoniazid + ethambutol                   150 mg +400 mg
     (P),(S),(T),(5)
                      pyrazinamide (P), (S), (T)               500 mg tab.
                      rifampicin (P), (S), (T)                 150, 300, 450 & 600 mg tab/cap syrup.
                      rifampicin + isoniazid (P),(S),(T)       150 mg + 100 mg tab./cap.
                                                               300 mg + 150 mg tab./cap.
                                                               450 mg + 300 mg tab./cap.
                      rifampicin + isoniazid + pyrazinamide    150 mg + 75 mg + 400 mg
                      (P),(S),(T), (5)
                      rifampicin + isoniazid + pyrazinamide    150 mg + 75 mg + 400 mg + 275 mg
      +                 ethambutol (P),(S),(T)
                      streptomycin (P), (4)                    1g inj. (as sulphate).
                      thioacetazone (P), (S), (T)              50mg tab.
                      thioacetazone + isoniazid (P), (S),      (50 mg + 100 mg) tab. (150 mg + 300 mg) tab
      (T), (7)


5.4   Anti-Fungal Drugs


                      amphotericin B (T), (4)                  50 & 100 mg tab.
                      griseofulvin (T), (7,8)                  125 & 500 mg tab.
                      ketoconazole (T)                         200 mg tab. 100 mg/5ml oral suspension
                      nystatin (P), (S), (T)                   500 000 IU tablets
                                                               100 000 IU/ml oral drops
                                                               100 000 IU pessary


5.5   Anti-Amoebic Drugs


                         chloroquine (P), (S), (T)              150mg tab (as sulphate or phosphate)
                                                                50 mg/5ml syrup, 200 mg inj.
                         diloxanide (P), (S), (T)               500 mg tablet (as furoate).
                         metronidazole (P), (S), (T)            200 & 400 mg tab.
                                                                200 mg (as benzoate)/5ml suspension.


5.6 Antiviral Drugs


                        acyclovir (T), (8)                    200 mg tab 250mg inj. (as sodium)

5.7 Antimalarial Drugs and Prophylactics


                       chloroquine (P), (S), (T)              150mg tab (as sulphate orphosphate)
                                                              50mg/5ml syrup&200 mg inj.
                       primaquine (P), (S), (T)               7.5 mg tab.
                       quinine (P), (S), (T)                  200 mg tab. (as sulphate)
                                                              300 mg tab. (as bisulphate)
                       quinine dihydrochloride (S),(T)        600mg inj
                       sulphadoxine + pyrimethamine           500 mg + 25 mg tab.
                       (P), (S), (T)
5.8 Antileishmanial Drugs


                      sodium stibogluconate (S)           100 mg inj.


6:   ANTIMIGRAINE DRUGS


                      ergotamine (P), (S), (T), (7)       1mg tab. (as tartarate)


                                                          0.5mg inj.


7: ANTIPARKINSONISM DRUGS


                        biperiden (P), (S), (T)           2 & 5 mg inj. (as lactate)
                        carbidopa+levodopa (T),(5,6)      25 mg + 250 mg tab.
                        procyclidine (S), (T)             5 mg. tab.
                        selegiline (T)                    5 mg tab.


8:   DRUGS AFFECTING BLOOD


8.1 Antianaemic Drugs


                        ferrous salt (P), (S), (T)        eq.to 60 mg iron tab. eq.to
                                                          25mg iron/ml syrup (as sulfate).
                        folic acid (P), (S), (T), (10)    1 & 5mg tab.
                        iron dextran (P), (S), (T), (5)   eq. to 50mg iron/ml inj.


8.2 Drugs Affecting Coagulation


                        heparin (S), (T)                   1000, 5000 & 20,000 IU inj.


                                                           (as sodium)
                        phytomenadione (S), (T)            10 mg inj. 10mg tab.
                        tranexamic acid (S),(T)            250mg cap. 250 mg inj.
                        warfarin (S),(T), (6,10)           1 & 5 mg tab. (as sodium)


9:   BLOOD PRODUCTS AND PLASMA SUBSTITUTES


                        albumin (human) (T)               5% & 25% solution for inj.
                        dextran 40 (P), (S),(T)           40% w/w for infusion.
                        factor VIII concentrate (T),      inj.
                        (8,10)
                        factor IX complex                 inj.
                        conc. USP (T)
                        immune human serum (T)            inj.
                        platelets human (T)               inj.
                 polygeline (T)                       35% inj.


10: CARDIOVASCULAR DRUGS


                 acetylsalicylic acid(P), (S), (T)    150 mg, 300 mg tab.
                 amiodarone (T)                       200 mg tab.
                 amlodipine (S), (T)                  5 mg tab.
                 atenolol (S), (T)                    50 & 100 mg tab.
                 captopril (T)                        25 & 50 mg tab.
                 digoxin (P), (S), (T), (4)           500 mcg inj. 250 mcg tab.
                                                      50 mcg/ml oral solution.
                 diltiazem (T)                        30, 60, 90 & 180 mg tab.
                                                      (as hydrochloride) 10 & 50 mg
                                                      inj.
                 dobutamine (T)                       250 mg inj.
                 dopamine (S), (T)                    200 & 800 mg


                                                      inj. (as hydrochloride)
                 (enalapril (S), (T)                  5 & 10 mg tab), 100 mg inj).
                 esmolol (T)                          100 mg inj.
                 gemfibrozil (T)                      300 mg cap.
                 hydralazine (T)                      25 mg tab. 20 mg inj.
                 isoprenaline (S), (T)                30 mg tab. 1mg inj.
                 isosorbide dinitrate (P), (S), (T)   5mg tab (sublingual).


                                                      10mg tab.
                 labetolol (T)                        100 & 200 mg tab. (as
                                                      hydrochloride)
                                                      5mg/ml inj. (as hydrochloride).
                 lignocaine (P), (S), (T)             1% & 2% inj. (as hydrochloride).
                 (lisinopril                          5, 10 & 20 mg tab)
                 losartan (S), (T)                    25 mg tab.
                 methyldopa (P), (S), (T), (7)        250 & 500 mg tab.
                                                      250 mg inj.
                 nicotinic acid (S), (T)              50mg tab.
                 (nitroglycerin (P), (S), (T)         500 mcg tablet (sublingual)
                                                      2.6 & 6.4 mg tab.
                                                      5&10 mg patches)
                                                      1mg/ml I.V. infusion (T)
                 phenytoin (S), (T)                   30 mg/5ml susp.
                                                      25 mg cap. (sodium)
                                                      250 mg inj.
                 prazosin (P), (S), (T)               1 & 2 mg tab.
                 procainamide (T)                     250 mg tab. 100 mg inj.
                  propranolol (P), (S), (T)            10, 40, 80 & 160 mg tab.
                                                       1mg inj.
                  quinidine (T)                        200 mg tab. (as sulphate)
                  sodium nitroprusside (T), (8,10)     50 mg inj.
                  verapamil (S), (T), (8,10)           40, 80 & 240 mg tab. 5mg inj.
                                                       (T)


11: DERMATOLOGICAL DRUGS (TOPICAL)


                  benzoic acid + salicylic acid (P),   6% + 3% ointment or cream
                  (S), (T)
                  benzoyl peroxide (T)                 5% & 10% gel
                  benzyl benzoate (P), (S), (T)        25% lotion
                  betamathosone (S), (T)               0.1% oint/cream/lotion
                  betamathosone + neomycin (S),        0.1+0.5% oint/cream/lotion
                  (T)
                  benzophenones (T)                    cream/lotion/gel
                  calamine powder (P), (S), (T)        for 15% calamine lotion
                  clotrimazole (P), (S), (T)           1% cream/oint/solution
                  coaltar liquid (P), (S), (T)         for 7.5% lotion.
                  gammabenzene hexachloride (S),       1% cream
                  (T)
                  gentian violet (P), (S), (T)         0.5% aq. solution
                  hydrocortisone (P), (S), (T)         1% cream/oint (as acetate)
                  hydrocolloid methoxasalen (S),       dressings
                  (T)
                                                       10 mg tab.
                                                       0.75% oint./cream/lotion.
                  neomycin+bacitracin (P), (S), (T)    5mg neomycin sulfate
                                                       +500 IU bactitracin zinc/g




                  neomycin (P), (S), (T)               0.5% oint/cream
                  nystatin (P), (S), (T)               100,000 iu/gm oint/cream
                  polymyxin + zinc bacitracin (P),     ointment.
                  (S), (T)
                  permethrin (T)                       1% & 5% cream
                  salicylic acid (P), (S), (T)         5% topical solution/ lotion/gel.
                  silver sulphadiazine (P), (S), (T)   1% cream
                  sodium thiosulfate (P), (S), (T)     15% solution
                  zinc oxide (P), (S), (T)             25% cream/ointment
12: DIURETICS


                  amiloride (S),(T), (4,7,8)            5 mg tab. (hydrochloride)
                  furosemide (P), (S), (T)              20 & 40 mg tab. 10mg inj.
                  hydrochlorthiazide (S), (T)           50 mg tab.
                  mannitol (T)                          10% & 20% inj.
                  spironolactone (S), (T), (8)          25 & 100 mg tab.




13: GASTROINTESTINAL DRUGS


                  aluminium hydroxide (P), (S), (T)     500mg tablet
                                                        320 mg/5ml oral suspension
                  aluminium hydroxide +                 400 + 400 mg tab.
                  magenesium hydroxide (P), (S),        200 + 200 mg/5ml susp.
                  (T)
                  atropine sulphate (P), (S), (T)       1 mg tab. & 0.5mg inj.
                  bisacodyl (P), (S), (T)               5mg tab
                  cimetidine (P), (S), (T)              200 & 400mg tab. 200mg inj
                  cyclizine (P), (S), (T)               50mg tab. 12.5 mg/5ml syrup.
                                                        50mg inj.
                  hyoscine butylbromide (P), (S),       10 mg tab & 20 mg inj.
                  (T)
                  ispaghulla husk (P), (S), (T)         for solution
                  lactulose (T)                         50% syrup
                  magnesium hydroxide (P), (S),         550 mg/10ml susp. 400 mg tab.
                  (T)
                  metoclopramide (P), (S), (T)          10 mg tab. 10mg inj.


                                                        5mg / 5 ml syrup
                  omeprazole (P), (S), (T)              20 mg cap.
                  oral rehydration salt (P), (S), (T)   components to reconstitute 1
                                                        litre
                                                        glucose/electrolyte solution:
                                                        sodium chloride 3.5g, trisodium
                                                        citrate dihydrate 2.9g, potassium
                                                        chloride 1.5g, glucose 20g.
                  potassium chloride (P), (S), (T)      7.4% inj
                  prochlorperazine (S), (T)             5 mg tab. 12.5 mg inj.
                  promethazine (P), (S), (T)            10 & 25mg tablet. 1 mg/ml
                                                        elixir. 25 mg/ml inj.
                  sulphasalazine (S), (T)               500 mg tab.
14: HORMONES, OTHER ENDOCRINE DRUGS AND CONTRACEPTIVES


                   bromocriptine (T)                   2.5 mg tab.
                   carbimazole                         5mg tab.
                   clomifene (T,8)                     50 mg tablet
                   condoms with or without
                   spermicide (nonoxinol) (P), (S),
                   (T)
                   conjugated estrogen (S), (T)        0.625 mg / gm cream
                   dexamethasone (P), (S), (T)         0.5mg tab. 4 & 20 mg inj.
                   diaphragms with spermicide
                   (nonoxinol) (P), (S), (T)
                   ethynylestradiol + levonorgestrol   0.03 mg + 0.15 mg tab.
                   (S), (T)
                   ethynylestradiol + norethisterone   (0.05 mg + 0.5 mg), (35 mcg +
                   (P), (S)                            1mg) tab.
                   glibenclamide (P), (S), (T)         5 mg tab.
                   human chorionic                     1000 & 5000 iu inj.
                   gonadotrophic hormone (T)
                   hydrocortisone (S), (T)             100 & 250 mg inj.
                   17-hydroxyprogesterone              250 & 500 mg inj.
                   caproate (S), (T)
                   insulin comp.                       S100 IU/inj.
                   zinc or isophane (P), (S), (T)
                   insulin Regular (P), (S) , (T)      100 IU.
                   intrauterine device copper T (P),
                   (S), (T)
                   levonorgesterol (P), (S)            0.75 mg tab.
                   metformin (P), (S), (T)             500 mg tab. (as hydrochloride)
                   norethisterone (S), (T)             5 mg tab. 200 mg inj. (as
                                                       enanthate)
                   oxytocin (S), (T)                   10 units /ml; 1ml ampoule
                   potassium iodide (P), (S), (T)      60 mg tablet
                   prednisolone (S), (T)               5mg tablet
                   propylthiouracil (T)                50 & 100 mg tab.
                   thyroxine (T)                       50mcg tab. (as sodium
                                                       anhydrous)
                   vasopressin/ADH (T)                 20 IU/ inj.


15: IMMUNOLOGICALS


15.1 Diagnostics


                   tuberculin PPD (T)                  inj.
15.2 Sera and Immunologicals


                       anti-D immunoglobulin (T)             inj.
                       antiscorpian sera (P), (S), (T)       inj.
                       antivenom sera (P), (S), (T)          inj.
                       diphtheria antitoxin inj. (P), (S),   inj.
                       (T)
                       hepatitis B immunoglobulin (T)        inj.
                       tetanus antitoxin (P), (S), (T)       inj.
                       tetanus toxid (P), (S), (T)           inj


15.3 Vaccine for Universal Immunization


                       BCG (dried) vaccine (P), (S), (T)     inj
                       diptheria-pertussis tetanus           inj.
                       vaccine (P), (S), (T)
                       dipatheria-tetanus vaccine (P),       inj.
                       (S), (T)
                       measles-mumps-rubella
                       vaccine (P), (S), (T)                 inj.
                       measles vaccine (P), (S), (T)         inj.
                       poliomyelitis vaccine                 oral solution
                       (live attenuated) P), (S), (T)
                       tetanus vaccine (P), (S), (T)         inj.


15.4 Vaccines for Specific Use.


                       hepatitis B vaccine (T)               inj.
                       meningococcal vaccine (T)             inj.
                       rabies vaccine (P), (S), (T)          inj.
                       rubella vaccine (T)                   inj
                       yellow fever vaccine (T)              inj


15.5 Immunosuppressents.


                       cyclosporin (T), (10)                 50 mg/ml inj.
                                                             25 & 100 mg cap


16: MUSCLE RELAXANTS (PERIPHERALLY ACTING) AND CHOLINESTERASE INHIBITORS


                       pyridostigmine (S), (T),              60 mg tab.
                       (8,10)
17: OPHTHALMOLOGICAL PREPARATIONS


17.1 Anti-Infective Agents


                       acyclovir (T)                       3% eye oint.
                       chloramphenicol (P), (S), (T)       1% eye oint. 0.5% drops
                       gentamicin (S), (T)                 0.3% eye drops/eye oint.
                       ketoconazole (T)                    2 mg/ml eye drops
                       polymixin B sulphate + bacitracin   10,000 IU + 500 IU/gm oint.
                       zinc (S),(T)
                       sulfacetamide (P), (S), (T)         10%, 20% & 30% eye drops,
                                                           10% eye oint.
                       tetracycline (P), (S), (T)          ointment.


17.2 Miotics and Antiglaucoma Drugs.


                       dipivefrin (T)                      0.1% eye drops
                       (levobunalol                        0.5% eye drops)
                       pilocarpine (S)                     1%, 2% & 4% eye drops.

17.3 Mydriatics and Cycloplegics Drugs


                       atropine (S), (T)                   1% & 2% eye drops
                       homatropine (S), (T)                2% eye drops
                       phenylepherine (T)                  0.12% eye drops
                       tropicamide (S), (T)                1% eye drops


17.4 Corticosteroids


                       prednisolone (T)                    0.2% eye drops


17.5 Non-steroidal Antiallergic/Decongestants


                       antazoline (S), (T)                 eye drops
                       (naphazoline (S), (T)               eye drops)
                       pheniramine maleate (S), (T)        eye drops
                       zinc sulphate + boric acid (P),     0.46% + 1.6% eye drops
                       (S), (T)


17.6 Topical Anaesthetics


                       oxybuprocaine (S), (T)              0.4% eye drops
                       proparacaine (S), (T)               eye drops
 17.7 Others


                  artficial tears (T)                 eye drops
                  flourescine sodium (S), (T)         eye drops


18: OXYTOCICS AND ANTIOXYTOCICS


                  ergometrine (P), (S), (T), (7)      0.25mg tab. (hydrogen maleate)
                                                      200 mg inj.


19: PERITONEAL DIALYSIS SOLUTION


                  intraperitonial dialysis parental
                  solution
                  (of appropriate composition) (T)


20: PSYCHOTHERAPEUTIC DRUGS


                  amitryptyline (S), (T)              10, 25 & 50 mg tab.
                  chloral hydrate(S), (T)             1 g / 5ml syrup
                  chlorpromazine(S), (T)              10, 25, 50 &100 mg tab.
                                                      25 mg/5ml syrup. 50 mg inj.
                  clomipramine (T)                    10 & 25 mg cap.(as
                                                      hydrochloride)
                  diazepam (P,2), (S), (T)            2, 5 & 10 mg tab. 10mg inj
                  fluoxetine (S), (T)                 20 mg cap.
                  fluphenazine (S), (T)               25 mg inj (as decanoate)
                  haloperidol (P), (S), (T)           0.25, 1.25 & 5 mg tab


                                                      5mg inj. 2mg/ml oral drops
                  imipramine (S)                      25 mg tab.
                  lithium carbonate (T)               400 mg tab.
                  resperidone (S), (T)                1 mg, 2 mg, 3 mg tab.
                  trifluperazine (P), (S), (T)        5 mg tab.


21: DRUGS ACTING ON THE RESPIRATORY TRACT


                  aminophylline (P), (S), (T), (10)   100 & 200 mg tab. 250 mg inj.
                  baclomethasone (S), (T)             250 mcg aerosol(as
                                                      dipropionate)
                  cromoglycate (T)                    1mg/dose aerosol (as disodium)
                                                      20 mg cap. (as disodium)
                  dextromethorphan compound           Syrup
                  (P), (S), (T)
                  epinephrine (P), (S), (T)           1 mg inj.
                  salbutamol (P), (S), (T), (10)     2 & 4 mg tab. 2mg/5ml syrup,100
                                                     mcg/dose aerosol(T), 50mcg/5ml
                                                     inj.
                                                     5mg (as sulfate)/ml respirator
                                                     solution for use in nebulizers,
                  theophylline (P), (S), (T), (11)   180 & 270 mg tab. 350 mg tab.


                                                     (S.R) 120 mg/5ml syrup.


22: SOLUTIONS CORRECTING WATER, ELECTROLYTE AND ACID BASE DISTURBANCES


                  dextrose + saline (P), (S), (T)    10% + 0.9% IV solution, 5% +
                                                     0.45% IV solution, 4.3% +
                                                     0.18% IV solution, 3% + 0.3%
                                                     IV solution
                  dextran 40 (P), (S), (T)           IV solution
                  dextrose (P), (S), (T)             5%, 10% & 25% IV solution
                  normal saline (P), (S), (T)        0.9% & 0.45% IV solution
                  potassium chloride (P), (S), (T)   500 mg tab. 7.4% IV solution
                  ringer’s lactate (P), (S), (T)     IV solution
                  sodium bicarbonate (P), (S), (T)   0.7% IV solution
                  water for inj. (P), (S), (T)


23: VITAMINS AND MINERALS


                  ascorbic acid (P), (S), (T)        100 mg tab.
                  calcium gluconate (P), (S), (T)    100 mg/ml inj.
                  calcium lactate (P)¸ (S), (T)      10 mg tab.
                  D – 3 (S), (T)                     300000 & 600000 Units
                  erogocalciferol (P), (S), (T)      1.25 mg (50 000 IU)
                                                     capsule/tablet, 250 ug/ml (10
                                                     000 IU/ml) oral solution
                  hexavitamin USP (P), (S), (T)      tab. each tab. contains not less
                                                     than: Vitamin A 5000IU, Vitamin
                                                     D 400IU Ascorbic Acid 75mg,
                                                     Thiamine Hydrochloride 2mg,
                                                     Riboflavin 3mg, Nicotinamide 20
                                                     mg.
                  nicotinamide (P), (S), (T)         50 mg tab.
                  pyridoxin (P), (S), (T)            25 mg tab. (as hydrochloride)
                  retinol (P), (S), (T)              10000 IU tab. 100,000 IU inj.
                  thiamine (P), (S), (T)             100mg/ml inj. (as hydrochloride)
                                                     100mg tab. (as hydrochloride)
24: E.N.T. PREPARATIONS


                     boroglycerine (P)¸ (S), (T)          40%
                     clotrimazole (T)                     1% topical solution
                     ephedrine nasal drops (P), (S),      0.5%
                     (T)
                     gentamycin + hydrocortisone (T)      3% + 0.1%
                     gentian violet (P), (S), (T)         0.5%
                     ichthamol glycerin BPC (P), (S),
                     (T)
                     polymyxin B sulphate +               10,000 IU + 50mg/ml ear drops
                     lignocaine hydrochloride (P), (S),
                     (T)
                     prednisolone (T)                     nasal drops. 5mg tab.
                     prochlorperazine (P), (S), (T)       5 mg tab.
                     promethazine (P), (S), (T)           10 & 25 mg tab.
                                                          1mg/ml elixir. 25mg inj.
                     pseudoephedrine                      tab/syrup
                     compound (S),(3)
                     soda glycrine BPC (P), (S), (T)
                     xylocaine (P), (S), (T)              2% inj. 4% topical solution, 2%
                                                          topical gel
                     xylocaine + adrenaline (T)           2% + 1:80,000, 2% + 1:200,000
                     xylometazoline (P), (S), (T)         0.1% nasal drops


25: ANTISEPTICS AND DIS-INFECTANTS


25.1 Antiseptics


                     chlorhexidine gluconate (P), (S),    1.5% solution
                     (T)
                     chloroxylenol (P), (S), (T)          4.8% solution
                     glutaraldehyde (T)                   10% solution
                     glutoral                             2% solution)
                     hydrogen peroxide BP.(P), (S),       solution
                     (T)
                     povidone iodine (P), (S), (T)        7.5% solution
                     tincture benzoin co. BP (P), (S),
                     (T)
                     tincture iodine (P), (S), (T)


25.2 Disinfectants


                     calcium hypochlorite (T)             powder for solution
26: DENTAL PREPARATIONS (T)


                    acidulated phosphate fluoride gel
                    calcium hydroxide paste
                    camphorated monochlorophenol.
                    eugenol, also with fillers
                    formocresol (formaldehyde 19% cresol 35% and glycerol 15%)
                    iodoform compound paint
                    mercury
                    silver alloys
                    sodium flouride drop/rinse/tab
                    tannic acid powder
                    triamcinolone acetonide paste
                    zinc oxide + magnesium oxide in polyacrylic 40% cement.


27: DISPENSARY ITEMS: (P), (S), (T)


                    coal tar
                    cresol
                    emulsifying wax
                    formaldehyde
                    gentian violet
                    glucose
                    glycerin
                    hexylresorcinol throat paint
                    hydrogen peroxide
                    iodine
                    kaolin
                    linolic acid
                    liquid paraffin
                    magnesium sulphate
                    methylated spirit
                    paraffin, hard
                    paraffin, yellow
                    pectin
                    peppermint oil
                    potassium chloride
                    potassium permanganate
                    salicylic acid
                    sodium acid citrate
                    sodium bicarbonate
                    soft paraffin wax
                    sulfer sublime
                    tannic acid
                         tragacanth
                         trisodium citrate dehydrate
                         turpentine oil
                         wool fat
                         zinc oxide powder
                         zinc undeconate


28: DRUGS FOR LOCAL PURCHASE


                         Drugs in the following groups are required occasionally. Therefore
                         drugs in these groups can be made available through local purchase
                         by hospitals. Some of the illustrative drugs in these groups are
                         mentioned below:-


28.1 ANTIDOTES AND OTHER SUBSTANCES USED IN POISONING


                         atropine (P), (S), (T)              2mg/ml inj. (as sulfate)
                         charcoal, activated (P), (S), (T)   powder
                         desferrioxamine (S), (T)            500mg inj. (as mesylate)
                         dimercaprol (S), (T)                100 mg inj.
                         flumazenil (P), (S), (T)            500 mcg inj.
                         magnesium sulphate (S,T)            50% inj.
                         methionine (S), (T)                 250 mg tab. (as racemate)
                         naloxone (P), (S), (T)              0.04 & 0.4 mg inj. (as
                                                             hydrochloride)
                         neostigmine (T)                     15 mg tab. (as bromide) 0.5mg
                                                             inj. (methyl sulphate)
                         obidoxime (T)                       250 mg inj. (as chloride)
                         penicillamine (T)                   125 & 250 mg capsule or tablet,
                         physostigmine (T)                   1 mg inj. (salicylate)
                         pralidoxime (T)                     200 mg/ml Inj.
                         protamine (T)                       10 mg inj. (as sulphate)
                         prussian blue (T)                   powder for topical use
                         sodium calcium edetate (T)          1 gm inj.
                         sodium nitrite (T)                  300 mg inj.
                         sodium thiosulfate (T)              500mg/ml inj. in 50 ml ampoule.


28.2 Antileprosy Drugs


                         clofazimine (T)                      100 mg cap.
                         dapsone (T)                          50 mg tab.


28.3 ANTI-NEOPLASTICS, IMMUNOSUPPRESSIVES AND DRUGS USED IN PALLIATIVE CARE


28.3.1   Immunosuppressive Drugs
asparaginase (T), (10)             10,000 iu inj.
aminogluthemide                    tab.
anastrazole(T)                     1 mg tab.
azathioprine (S), (T), (10)        50 mg tablet
                                   100 mg inj. (as sodium salt)
bleomycin (T), (10)                15 mg inj. (as sulphate).
busulphan (T)                      0.5mg tab.
calcium folinate (T), (10)         15 mg tablet, 30 mg inj.
carboplatin (T)                    150 mg & 450 mg inj.
chlorambucil (S), (T), (10)        2 mg tab.
chlormethine (T), (10)             10 mg inj. (as hydrochloride)
cisplatin (T), (10)                10, 25 & 50 mg inj.
cyclophosphamide (T), (10)         50 mg tablet 200, 500 mg & 1 gm
                                   inj.
cyproterone acetate (T)            50 mg tab.
cytarabine (T), (10)               100 mg inj.
dacarbazine (T), (10)              200 mg inj.
dactinomycin (T), (10)             0.5mg inj
di-ethylstilboestrol diphosphate   1mg tab.
sodium (S),(T)
doxorubicin (T), (10)              10 & 50 mg inj.
etoposide (T)                      100mg cap.
                                   100mg inj.
flutamide (S), (T), (10)           250 mg tab
5-fluorouracil (T)                 250 mg inj.
hydroxyurea (S), (T)               500 mg cap.
ifosfamide (T)                     inj.
lomustine (T)                      cap.
medroxyprogesterone (T)            100 mg tab. 150 mg inj.
megesterol acetate                 2mg tab.
mesna (T)                          400 mg inj.
melphalan (T)                      100 mg inj.
mercaptopurine (T), (10)           50mg tablet
methotrexate (T), (10)             2.5, 5 & 10 mg tab. 5, 50 & 500 mg
                                   inj.
mitomycin (T)                      inj
mitozantrone (T)                   inj
procarbazine (T)                   50mg cap. (as hydrochloride)
tamoxifen (S), (T)                 10 & 20 mg tab
6 thioguanine (T)                  40 mg tab.
vincristine (T), (10)              1 & 5 mg inj. (as sulfate)
vinblastine (T), (10)              inj
vinorelbine (T)                    10 & 50 mg inj.
28.4 DIAGNOSTIC AGENTS


                      barium sulphate (S), (T)       powder for oral use
                      iodinated poppy
                      iodipamide (T)                 50% inj.
                      iohexol (T)                    180 & 300 mg/ml inj
                      iophendylate (T)               30.5% inj.
                      iothalamate (T)                60% aqueous solution
                      meglumine diatrizoate BP/USP   inj.
                      (T)
                      meglumine diatrizoate+         66% + 10% inj
                      sodium diatrizoate (T)
                      meglumine iotroxenate (T)      0.105% & 1.26% solution for
                                                     inj.
                      meglumine ioxagalate           39% + 19.65% inj.
                      +sodium ioxagalate (T)
                      propyliodone (T)               10 gm inj
                      seed oil (T)                   inj.
                      sodium acetrizoate (T)         40% inj
                      sodium ipodate (T)             500 mg cap.


29:   DRUGS FOR SPECIALIZED CENTERS


29.1 Antiretroviral drugs


                      didanosine (DDI), (T)          buffered chewable, dispersible
                                                     tablets 25mg, 50mg, 100mg,
                                                     150mg, 200mg, buffered powder
                                                     for oral solution 100mg, 167mg,
                                                     250mg packets, unbuffered
                                                     enteric coated capsule 125mg,
                                                     200mg, 250mg, 400mg.
                      efavirenz (T)                  capsule 50mg, 100mg, 200mg,
                                                     oral solution 150mg/5ml
                      indinavir (T)                  capsule 200mg, 333mg, 400mg,
                                                     (as sulfate)
                      lamivudine (3TC), (T)          tablet 150mg, oral solution
                                                     50mg/5ml
                      nelfinavir (T)                 tablet 250mg (as mesilate)
                      nevirapine (T)                 tablets 200mg, oral suspension
                                                     50mg/5ml
                      ritonavir (T)                  capsule 100mg, oral solution
                                                     400mg/5ml
                      saquinavir (T)                 capsule 200mg
stavudine (D4T), (T)     capsule 15mg, 20mg, 30mg,
                         40mg, powder for oral solution
                         5mg/5ml
zalcitabine (DDC), (T)   tablets 0.375mg, 0.75mg
zidovudine (ZDV), (T)    tablet 300 mg, capsule 100mg,
                         oral solution or syp. 50mg/5ml
                         solution, for IV infusion injection
                         10mg/ml in 20ml vial.
Annex 7

       Essential Services Packages at the Community, Primary and Mid-level Health Facilities and Secondary Hospital

  Community Level
  Task (Objective)                     Task Description                                                                 Personnel or Agency
  Family Planning                      Supply of oral contraceptives to continuing users; supply of condoms;            LHW, Private providers trained by
  (To reduce unmet need by providing   Injectable contraceptive services, follow-up service and referral of women       MoPW; male workers of MoPW.
  FP services at doorstep)             having side effects and problems to higher level.

  IEEC                                 Information and education for empowerment and change (IEEC) through              LHW, C-SBA, community
  (To provide information and          support groups or other participatory methods, using culturally adapted          volunteers
  education in MNH)                    pictorial booklets and audiocassettes on pre-defined locally needed range of
                                       MNH topics.

  Prenatal risk assessment             Prenatal risk assessment using instruments to flag high-risk pregnancies         LHW, C-SBA
  (To identify high risk pregnancy)    (parity of 0 or 5+, age <18 or >34 years, poor obstetric history, severe
                                       anemia, jaundice and/or high fever in pregnancy)

  Referral in pregnancy                Referral of high risk pregnancies flagged through above method, or identified    LHW, C-SBA
                                       during prenatal care examination, to primary level for lab work

  Prenatal care                        Prenatal care for low risk women after screening through risk assessment         LHW, C-SBA
  (To provide home-based prenatal      instruments: monitoring weight-gain; taking blood pressure; checking for
  care)                                anemia, jaundice, swelling, fever; iron-folic acid / micro-nutrient
                                       supplements; nutrition information and counseling; prevention and treatment
                                       of malaria.

  Birth preparedness                   Prenatal birth and newborn care preparedness information package and             LHW, in consultation with TBA or
  (To prepare woman and family for     emergency kit: IEEC regarding obstetric and newborn danger signs; provision      C-SBA
  birth and newborn care)              of sealed emergency kit (containing sterilized gauze and other materials to be
                                       used in case of emergency) to be returned if unused for full refund.

  Skilled birth attendance             Skilled birth attendance (SBA) at home, where available: Recommended for         CMW, LHV or C-SBA, assisted by
  (To provide safe home delivery by    all high-risk pregnancies. SBA and LHW to ensure preemptive availability of      LHW
  skilled birth attendant)             transport for obstetric or newborn emergency, directly to Secondary level;
                                         SBA to be fully equipped and skilled to recognize, stabilize and refer (RSR)
                                         obstetric and newborn emergencies.

Safe delivery by TBA                     For low-risk pregnancies, and/or where SBA not available/ delivery by                 TBA, assisted by LHW
(To ensure safe and clean delivery by    traditional birth attendant: ensure reliable referral and transport/telecom links
traditional attendant)                   with Secondary care EmONC facility. TBA and LHW to ensure preemptive
                                         availability of transport for obstetric or newborn emergency, directly to
                                         Secondary level.

Safe delivery by family member           Under unavoidable circumstances, ONLY for low risk pregnancy, and when                Family birth attendant, assisted by
(To ensure safe and clean delivery by    neither SBA nor trained TBA are available: Family birth attendant to be               LHW
a family member, where                   oriented by LHW in clean delivery and RSR. LHW to ensure preemptive
unavoidable)                             availability of transport for obstetric or newborn emergency, directly to
                                         Secondary level.

Referral of high-risk women to           Advice to woman and family for delivering at primary or middle level facility         LHW, C-SBA
primary/middle health facility for       when classified as high-risk and arrangements for emergency transportation
normal delivery                          unreliable; facilitating transportation and stay at facility for required period of
(To ensure easy and prompt access to     time.
EmONC)
Consultation with SBA                    Direct access of the family to skilled birth attendant nearby (LHV, C-SBA),           LHW
 (To ensure family’s direct access to    regardless of choice of first birth attendant; woman, husband and family to
SBA)                                     have correct address of SBA, referral slip from LHW, arrangement of
                                         transport, and an idea of total anticipated costs.

Newborn care                             Routine newborn care, including immediate onset of breastfeeding,                     C-SBA
(To ensure routine newborn care)         promoting use of colostrums, warmth and bonding, cord care, delayed
                                         bathing, proper conditions for bathing,

Newborn RSR                              Newborn resuscitation, neonatal examination, identification of problems,              C-SBA
(To ensure emergency care to             prompt referral in case of illness or abnormality.
newborn)
Postpartum care                          Routine postpartum care visits at prescribed intervals (on second, third, sixth,      TBA, C-SBA, LHW
 (To ensure proper postpartum care       tenth and 20th day of delivery) for postpartum examination including history
and referral in cases of complication)   of bleeding, discharge, weakness, fatigue, breastfeeding, breast care, fever,
                                         anemia, jaundice, etc., and prompt referral of complications to adequate level.

Easy and organized access to             Referral links and access to emergency transportation services to Secondary           LHW, TBA, C-SBA and village
EmONC services                           Hospital; protocols for emergency referral; community resource mobilization           health committee
                                         for facilitating transportation and expenses;
Primary Level Health Facility (The Proposed Community Health Center)
Task (Objective)                          Task Description                                                                  Personnel/Agency
Family planning                           Provision of hormonal contraceptives (prescription and supply), insertion and     LHV, visiting Medical Officer
 (To provide FP services and follow-      removal of IUD, treatment of side effects, referral of problem cases to next
up, and support to community level)       level of care. Counseling and advice.

                                          Support and supervision of community level family planning services;
                                          training of LHWs in family planning.

Prenatal care                             Complete range of prenatal care, including lab work (all routine blood and        LHV, visiting Medical Officer
(To provide prenatal care to high and     urine tests), counseling and advice; referral to next level of care.
low risk pregnant women)
                                          Support and supervision of community level prenatal care services; training
                                          of LHW in prenatal care.

Nutritional advice and                    Advice and counseling on adequate nutritional requirements of pregnant            LHV, visiting Medical Officer
supplements                               women, to women and husbands; provision of iron-folic acid and other
(To ensure proper nutrition during        nutritional supplements;
pregnancy and lactation)
                                          Supply of nutrition supplements to LHW and community volunteers for
                                          distribution among pregnant and lactating women.

Normal delivery of high-risk              Provision of facility-based normal delivery, particularly to pregnant women       LHV, C-SBA
pregnant women                            identified as high risk at community level; link with secondary care for timely
(To ensure timely referral of obstetric   referral for EmONC; transport and telecom services
and/or newborn emergencies)

Basic minimum curative care to            Diagnostic services including lab work for: malaria, upper respiratory            LHV, supported by visiting
women and newborns                        infection, mild to moderate anemia, diarrhea, nausea and other minor              Medical Officer
(To provide diagnosis and treatment       ailments.
of common illnesses among pregnant
and lactating women, newborn
babies)
Mid-level Health Facility (Proposed Integrated Rural Health Complex)
Task (Objective)                       Task Description                                                             Personnel/Agency
Basic EmONC                            Provision of basic EmONC services (including post-abortion care)             Male or female medical doctor
(To provide basic EmONC services       comprising the following:                                                    having training in basic EmONC;
24 hrs/day)                            • Induction of labor using oxytocin under competent supervision              consultant obs/gyne and
                                       • Assisted vaginal delivery                                                  pediatrician on call from
                                       • Intravenous and intra-muscular administration of sedatives and             Secondary Hospital; support staff.
                                           antibiotics
                                       • Intravenous plasma expanders
                                       • Oxygen
                                       • Blood typing and cross-matching with voluntary donors
                                       • Newborn resuscitation
                                       • Diagnosis and treatment of neonatal asphyxia, infections
Supervision of LHWs, TBAs              Linkages with community workers in the following areas:                      Male or female Trainers (Visiting
primary level facility staff in        • RSR                                                                        Medical Officers trained in
obstetric and newborn first-aid        • CPR                                                                        education techniques); LHVs,
(To provide technical and managerial   • Newborn resuscitation                                                      senior CMWs.
support, supervision and backup to     • Use of oxygen and plasma expanders to prevent shock in PPH
community level workers)               • Handling and referral of obstetric and newborn emergencies
                                       • Treatment of malaria
Immunization                           Routine immunizations, including:                                            LHV, supported by Visiting
(To ensure 100% coverage,              • Tetanus immunization reproductive age/pregnant women                       Medical Officer; working with
particularly against tetanus and       • Hepatitis B vaccination where applicable                                   LHWs and TBAs.
hepatitis)
Nutrition supplementation              Provision of Vitamin A, Iron-folic acid, special food supplements, etc.      LHV
(To provide micro-nutrient             Vitamin A supplementation on routine basis;
supplementation; To ensure full
coverage of pregnant and lactating
women)
Family planning services               Provision and prescription of all contraceptive methods after examination;   LHV; Visiting Medical Officer
(To ensure full coverage of            provision of supplies to community workers; making appointments for          (trained in CS); or MSU of MoPW
population with family planning; To    contraceptive surgery for Mobile Services Units of MoPW; treatment of side   to visit periodically.
address the unmet need of FP in        effects; counseling; training of community workers in contraceptive
served population)                     technology.
Secondary Hospital

Task (Objective)                     Task Description                                                                 Personnel/Agency
Comprehensive EmONC                  Provision of full EmONC services (including post-abortion care) comprising the   Ob/Gyn specialists, and/or male or
 (To provide comprehensive EmONC     following:                                                                       female medical doctors having
services 24 hrs/day)                 • All elements of basic EmONC, plus                                              training in EmONC, including C-
                                     • Cesarean section and other obstetric surgery                                   section and blood transfusion;
                                     • Complete blood transfusion services, with screening for HIV and Hepatitis B    Anesthetist or MO trained in
                                     • Neonatal special care units                                                    anesthesia; support staff; full
                                     • Diagnosis and treatment of all common obstetric and neonatal complications     laboratory staff; LHVs and/or Nurses
                                                                                                                      in EmoNC triage services; PG
                                                                                                                      students in final year of training from
                                                                                                                      teaching hospitals on rotation.
Training and supervision of staff,   Training of the Trainers including the following areas:                          Non doctor Master trainers; PG
and referral links with Mid-level    • RSR; CPR, Newborn resuscitation                                                students in final year;
health facilities                    • Use of oxygen/plasma expanders in PPH; Handling and referral of obstetric
                                          and newborn emergencies
                                     • Contraceptive Technology
                                     • Treatment of malaria
All other services provided at       e.g., routine immunization, provision of micro-nutrients and food                LHV, Medical Officers
primary and mid-level facilities     supplementation, Family planning etc.

								
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