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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