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					THREE YEARS ROLLING PLAN
       2010-2013
DISTRICT RAHIM YAR KHAN
             Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




Table of Contents
Acronyms ............................................................................................................................................................. 4
Executive Summary............................................................................................................................................ 5
SECTION 1: DISTRICT HEALTH PROFILE......................................................................................................... 7
Vision and Mission of the District ..................................................................................................................... 7
Background of the District ................................................................................................................................. 7
Map of the District .............................................................................................................................................. 8
Demography ....................................................................................................................................................... 8
Socio-Economic Indicators .............................................................................................................................. 10
Health Indicators .............................................................................................................................................. 10
Organizational Structure of District Health Administration ......................................................................... 11
Health Resources .............................................................................................................................................. 13
   1.        Health Facilities .................................................................................................................................... 13
        a.      Public ................................................................................................................................................. 13
        b.      Private ............................................................................................................................................... 14
   2.        Human Resource .................................................................................................................................. 14
        a)      Administrative ................................................................................................................................... 15
        b)      Facility Based .................................................................................................................................... 16
        c)      Outreach ............................................................................................................................................ 20
        d)      Training Institutions ......................................................................................................................... 21
Health Financing............................................................................................................................................... 23
Disease Pattern ................................................................................................................................................. 24
Status of Vertical Programs ............................................................................................................................. 26
   1.        National Program for FP & PHC .......................................................................................................... 26
   2.        EPI.......................................................................................................................................................... 26
   3.        MNCH Program ..................................................................................................................................... 26
   4.        TB Control Program ............................................................................................................................. 26
   5.        Malaria Control Program ..................................................................................................................... 27
   6.        Hepatitis Control Program................................................................................................................... 27
   7.        School Health Services Program ......................................................................................................... 27
SECTION 2: PROBLEM ANALYSIS ................................................................................................................... 28


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             Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




Objectives .......................................................................................................................................................... 28
Plan Development Process .............................................................................................................................. 29
Problem Identification ..................................................................................................................................... 29
Health Problems ............................................................................................................................................... 30
   Problem Prioritization ................................................................................................................................. 30
   Underlying causes of prioritized problems ................................................................................................ 32
Service delivery/Management problems ....................................................................................................... 34
MDGs and MSDS ............................................................................................................................................... 35
   a)        Human Resource .................................................................................................................................. 35
        i.      THQ Hospital ..................................................................................................................................... 36
   b)        Equipment............................................................................................................................................. 36
        i.      Composite List of Gaps of All THQ Hospitals – .................................................................................. 37
SECTION 3: INTERVENTIONS AND TARGETS ............................................................................................... 46
Health Problems ............................................................................................................................................... 47
Management Problems .................................................................................................................................... 61
Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned Posts ............................ 61
SECTION 4: COSTING AND FINANCING PLAN ............................................................................................... 67
Activity based costing ...................................................................................................................................... 67
Problem wise Cost Summary of Health Problems ............................................................................................. 67
   a)        Health Problems ................................................................................................................................... 68
Problem wise cost summary of Management Problems ................................................................................... 82
   b)        Management Problems ........................................................................................................................ 83
Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned Posts ............................ 83
Financial Outlay ................................................................................................................................................ 88
   Budget Summary............................................................................................................................................ 88
SECTION 5: MONITORING & EVALUATION ................................................................................................... 89
M&E of Plan....................................................................................................................................................... 89
Annex-I .............................................................................................................................................................. 92
Annex II ............................................................................................................................................................ 103




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Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




                  Acronyms
      3YRP          Three Years Rolling plan
      ADB           Asian Development Bank
      APMO          Additional Principal Medical Officer
      ARI           Acute Respiratory Infections
      BHU           Basic Health Unit
      BOD           Burden of Diseases
      CDC           Communicable Disease Control
      CDR           Case Detection Rate
      CPR           Contraceptive Prevalence Rate
      DHIS          District Health Information System
      DHQH          District Head Quarter Hospital
      DoH           Department of Health
      DR            Default Rate
      EDO(H)        Executive District Officer Health
      EPI           Expanded Program on Immunization
      HSRP          Health Sector Reforms Program
      IMR           Infant Mortality Rate
      IPC           Interpersonal Communication
      M&E           Monitoring and Evaluation
      M&E           Maintenance and Repair
      MCH           Maternal Child Health
      MMR           Maternal Mortality Ratio
      MNCH          Maternal Newborn and Child Health
      MO            Medical Officer
      MoV           Means of Verification
      MSDS          Minimum Service Delivery Standards
      PDSSP         Punjab Devolved Social Services Program
      PHC           Primary Health Care
      PMO           Principal Medial Officer
      POL           Petrol, Oil and Lubricant
      RHC           Rural Health Center
      SCR           Sputum Conversion Rate
      SHC           Secondary Health Care
      SMO           Senior Medical Officer
      TAMA          Technical Assistance Management Agency
      TB            Tuberculosis
      THQH          Tehsil Head Quarter Hospital
      TNA           Training Need Assessment
      WHO           World Health Organization
      WMO           Women Medical Officer



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        Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




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

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

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

3YRP plan has been developed by following the standard planning cycle approach. 3YRP details the
current year activities, physical targets and fiscal targets. Projections of second and third year physical
and financial targets are given.         Section Two includes problems identification from various
perspectives, and their prioritization by applying WHO prioritization criteria. This section also contains
underlying causes of the prioritized problems. Section Three of the plan relates to developing best
possible interventions/activities and setting physical targets for each year. Section Four consists of

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       Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




costing based on additional requirements taking account of implementation of current status of
activities. Best available estimates have been used to accurately cost the activities. The detailed activity
based costing of the Health and Service Delivery problems has been developed on automated Excel
sheets, and annexed for details as ready reference. Last section or Section Five of the 3YRP consists of
Monitoring and Evaluation of plan to gauge the progress of different activities and targets of the plan
using reliable district data sources. This permits timely remedial action for smooth implementation of
planned activities.




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        Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




DISTRICT RAHIM YAR KHAN
SECTION 1: DISTRICT HEALTH PROFILE
Vision and Mission of the District
The District Health Government has been providing promotive, preventive and curative services
through a net work of health institutions. At present curative services are being adequately utilized by
the population of the District, whereas in preventive programmes achievement of Department has been
80% of the targets.



Background of the District
District Rahim Yar Khan is one of the largest districts of southern Punjab, consisting of four sub-
divisions (Tehsils) i.e. Sadiqabad, Rahim Yar khan, Khanpur and Liaqatpur. The river Indus separates
Rahim Yar Khan from Muzafargarh, Rajanpur, Kashmore & Ghotki districts. The climate is usually hot
and dry.

River Hakra, which used to flow in the district centuries ago eventually dried up, transforming one third
area of the district into desert (Cholistan). The climatic conditions of the district are favorable for
cotton, wheat, sugarcane, mango, orange, lemon, dates and many other abundant crops and fruits.

An airport facility in Rahim Yar Khan links it with other parts of the country. Three FM radio channels
provide amusement, entertainment and information by bringing together a mix of Saraiki and Punjabi
culture. City zoo, sports arenas and parks for families are the recreational spots of the district. The
famous Bhong Mosque is also a major tourist attraction.

Most of the population resides in the rural area, making it an agrarian society, while the socioeconomic
conditions are poor. The high mortality and morbidity indicators like IMR, MMR and Growth rate are
distinctive of the society.

A network of educational institutions like, Islamia University, Sheikh Zayed Medical College, Govt.
Technical College, Degree College for Boys & Girls, Sheikh Zayed Public School, Govt. Army Public
College & School, Bahria Public College & School, Beacon House School system and Al-Huda Grammar


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       Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




School are providing education to the youth and children of the society. A central library named as the
Allama Iqbal Library is a home to precious and unique books.

Map of the District




                                                                                                3




Demography

           o   Total Population                                4578538

           o   Total Area                                      11880 sq.km

           o   Annual Growth Rate                              3.2%

           o   Population Density                              385/square KM

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 Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




Area-wise population

            Area                       Population            Percentage

           Rural                        3754402                 82%

           Urban                         824136                 18%

 Standard Demographic population groups based on DHIS




Gender-wise population

          Gender                       Population           Percentage

            Male                        2197696                 48%

           Female                       2380842                 52%

 Standard Demographic population groups based on DHIS




Population groups

                                      Standard          Estimated Population
    Population Groups              Demographic (%)              2010


 Under 1 year of age                       2.7                123621

 Under 5 years                             13.4               613524

 Under 15 years                            44                 2014557
 Women in child bearing
 age                                       22                 1007278
 (15-49 years)
 Married child bearing age
                                           16                 732566
 women

 Expected pregnancies                      3.4                155670
Standard Demographic population groups based on DHIS



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          Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




      Tehsil wise distribution
                       Tehsil                    Number Of UC                  Population

           Khanpur                                   28                          995728

           Liaqatpur                                 25                          1005625

           Rahim Yar Khan                            40                          1444531

           Sadiqabad                                 29                          1132654



Ethnic groups and languages

The main ethnic groups and spoken languages in the district are Punjabi and Saraiki.

Socio-Economic Indicators

          Education and Literacy


                                Literacy rate*                    Male                Female

                                    Urban                         75.6%                62.6%

                                    Rural                         51.3%                24.4%

            Executive District Officer Literacy and Non formal education RYK

         Per capita income                                     100,000/Annum
         Water and Sanitation                                  Urban (community supply)
                                                                Rural (hands pumps)

Health Indicators
          Infant Mortality Rate                                98/1000 live births
          Under 5 mortality Rate                               148/1000 live births
          Maternal mortality Ratio                             103/100,000 live births*
          Malnutrition (women and children)
          1-Under weight Prevalence (moderate and severe) =39%
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         Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




         2-Stunting Prevalence (moderate and severe)        44%

         3-Wasting Prevalence (moderate and severe)         13%

        Life expectancy                                     64


         Sources: MICS 2007-08 and EDOH Office Rahim Yar Khan


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




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           Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




                                                                               Provincial Health
                                               District
                                             Government
                                                                                 Department
                                                RYK


                                                                            Shiekh Zayed Medical
                        District Coordination Officer
                               Rahimyarkhan
                                                                          College / hospital (DHQ) is
                                                                                 autonomous

                                    Executive District Officer
                                             Health
                                         Rahimyarkhan


   District Health Officer
       Rahimyarkhan                                                 District          Director          District Officer
                                                                     Officer           DHDC               Health -III
                                                                    (MNC H)

  M.S                 04 Deputy District                       Drug             S .M.O        M.O 104
                       Officers (Health)                    Inspectors
 THQ:                                                                          19 RHC :         BHU
                                                            (04) one at
Hospital                                                       Tehsil
                                                                                               Under
                                                                                               PRS P

             N.P C oordinator              E PI C oordinator            TB Dots           AIHC
           Network of L HS & L HW          122-Field teams            C oordinato
                                                                           r


                      M.O                          DS I             C DC Officer          M.O
                                           S anitation Branch
                    04 Blood                                                          02 T.B C linic
                      Bank




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        Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




Health Resources


    1. Health Facilities
   a. Public
Details of physical infrastructure of public health facilities in the district is given in the table below

  Facility type                 Name of facility                Bed            No. of            Remarks
                                                              Strength       Functional
                                                                               Beds

DHQH is a             Sheikh Zayed Hospital Rahim Yar            741             741         Not under the
Teaching Hospital     Khan                                                                   administrative
                                                                                             control of EDOH

Eye Hospital          Tehsil Khanpur                              30              30

THQ Hospital          THQ Hospital Sadiqabad                      60              60

                      THQ Hospital Khanpur                        80              80

                      THQ Hospital Liaqat Pur                     60              60

RHCs                  19 RHCs                                    344             344         RHC Feroza, RHC
                                                                                             Pacca Larran and
                      5 in Tehsil Sadiqabad                                                  RHC Sehja have 8
                      4 in Tehsil Khanpur                                                    beds each.

                      5 in Tehsil Liaqat pur

                      5 in Tehsil Rahim Yar Khan

BHUs                  104 BHUs                                   208             208

                      24 in Tehsil Sadiqabad

                      22 in Tehsil Khanpur

                       28 in Tehsil Liaqat pur

                      30 in Tehsil Rahim Yar Khan

Governmental          56 Rural Dispensaries                        -               -         -
Rural
Dispensaries          13 in Tehsil Sadiqabad

                      15 in Tehsil Khanpur

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        Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




                      12 in Tehsil Liaqat pur

                      16 in Tehsil Rahim Yar Khan

MCH Centers           8 MCH centers                               16             16          As per
                                                                                            DHO/SO RYK
                      2 in Tehsil Sadiqabad

                      1 in Tehsil Khanpur

                      0 in Tehsil Liaqat pur

                      5 in Tehsil Rahim Yar Khan

T.B Clinics           2 T.B Clinics                               4               4         -

                      1 in Tehsil Sadiqabad                       2               2

                      1 in Tehsil Khanpur                         2               2

Health Houses         1851 LHW

Source: DHIS/EDOH office




    b. Private
        The district has provided a list of private service providers including hospitals, clinics,
        laboratories and maternity homes. These private providers are used for providing support in
        preventive programs like Polio and other EPI activities. With the passage of time, role of private
        providers will expand, and there is a need to develop an effective coordination between public
        and private sector. Detailed list of private sector health facilities is attached as Annex-I.


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

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




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     Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




a) Administrative
 Sr.           Name of Post/Designation        Sanctioned   Filled

No.

 1     Executive District Officer Health           1          1

 2     District Officer Health                     1          1

 3     Deputy District Officer Health              4          4

 4     Program Director DHDC                       1          1

 5     District Coordinator National Program       0          1

 6     District Coordinator EPI Surveillance       0          1

 7     District Sanitary Inspector                 1          0

 8     CDC Officer                                 1          0

 9     CDC Inspector                               4          2

10     Drug Inspector                              9          9

11     District Superintendent Vaccination         1          1

12     Assistant Superintendent Vaccination        4          4

13     Tehsil Sanitary Inspector                   4          4

14     Inspector Vaccination                       4          2

15     Senior Microscopist                         1          0

16     Assistant Entomologist                      1          1

17     MREO                                        0          0

18     AIHC                                        1          1




                                                                     15
        Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




   b) Facility Based
 i.   Basic Health Units (104)
     Sr.
                 Name of Post/Designation      Sanctioned   Filled   Vacant
     No.

        1       Medical Officer                   104        20       84

                School Health & Nutrition                             12
        2                                         104        92
                Supervisor

        3       Medical Assistant                 16         14       02

        4       Computer Operator                 104         0       104

        5       Medical Technician                90         54       36

        6       LHV                               104        32       72

        7       Dispenser                         104        73       31

        8       Midwife/Dias                      208        42       166

        9       N/Qasid                           104        67       37

        10      Chowkidar                         104        70       34

        11      Sanitary Worker                   104        55       49



ii.     Rural Health Centers (19)

      Sr. No.      Name of Post/ Designation   Sanctioned   Filled   Vacant

        1.      Senior Medical Officer            19         18       can
                                                                       1

        2.      Medical Officer                   19         17        2

        3.      WMO                               19         09       10

        4.      Dental Surgeon                    19         13        6

        5.      Charge Nurses                     114        29       85

        6.      Computer Operator                 19          4       15

        7.      Medical/ Health Technician         0          0        0


                                                                              16
  Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




Sr. No.      Name of Post/ Designation     Sanctioned   Filled   Vacant

  8.      Senior Clerk                        19         18       can
                                                                   1

  9.      Lady Health Visitor                 38         30        8

  10.     Lab: Technician                     19          7       12

  11.     Dental Technician / Assistant       19         12        7

  12.     Rural Health Inspector               0          0        0

  13.     Junior Clerk                         7          7        0

  14.     Vaccinator                          12         12        0

  15.     Dispenser                           57         57        0

  16.     Dresser                             19         17        2

  17.     Operation Theatre Assistant         19          8       11

  18.     Anesthesia Assistant                19          1       18

  19.     X-ray Assistant / Radiographer      19         19        0

  20.     CDC Supervisor                       0          0        0

  21.     Lab: Assistant                      19          9       10

  22.     Driver                              23         18        5

  23.     Mid-wife                            76         29       47

  24.     O.T. Attendant                       0          0        0

  25.     Tube-well Operator                  19         16        3

  26.     Ward Servant                        41         39        2

  27.     Sanitary Petrol                     76         64       12

  28.     Sanitary Worker                     73         45       28

  29.     Naib Qasid                          49         39       10



                                                                          17
     Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




   Sr. No.       Name of Post/ Designation   Sanctioned    Filled   Vacant

     30.      Mali                               19         16        can
                                                                       3

     31.      Cook                               14          8         6

     32.      Chowkidar                          36         24        12

     33.      Water Carrier                      19         18         1

     34.      Homeo Doctor                        3          1         2

     35.      Hakim                               2          2         0

     36.      Homeo Dispenser                     3          3         0

     37.      Dawasaz                             2          2         0

     38.      Dental Assistant                   19         12         7

     39.      Dawakob                             2          2         0

     40.      Bearer                              0          0         0

     41.      Gate Keeper                         0          0         0


iii.    THQ Hospitals (3)
    Sr. No.    Name of Post/ Designation     Sanctioned   Filled    Vacant

     1.      Medical Superintendent              3          2         1

     2.      APMO                                6          2         4

     3.      Senior Medical Officer             12          0        12

     4.      Surgeon                             3          2         1

     5.      Peadiatrician                       3          1         2

     6.      Anesthetist                         4          2         2

     7.      Eye Specialist                      3          1         2

     8.      Dental Surgeon                      3          3         0

     9.      Medical Officer                    32         29         3

                                                                             18
   Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




Sr. No.      Name of Post/ Designation    Sanctioned   Filled   Vacant

   10.    WMO                                14          8        6

   11.    Senior Consultant                   5          1        4

   12.    APWMO's                             3          0        3

   13.    Physician                           3          0        3

   14.    Gynecologist                        3          1        2

   15.    ENT Specialist                      3          0        3

   16.    Radiologist                         4          0        4

   17.    Pathologist                         5          1        4

   18.    Orthopedic Surgeon                  1          0        1

   19.    Dental Technician / Assistant       3          2        1

   20.    Junior Clerk                        3          2        1

   21.    Radiographer                        6          6        0

   22.    Homeopathic Dispenser               3          3        0

   23.    LHV                                 3          3        0

   24.    Dispenser / Dresser                25         25        0

   25.    Store Keeper                        3          3        0

   26.    Operation Theatre Assistant         4          4        0

   27.    Dawasaz                             3          3        0

   28.    Laboratory Assistant                7          5        2

   29.    Driver                              6          5        1

   30.    Midwife                             1          0        1

   31.    Tube-well operator                  3          3        0

   32.    Water Carrier                       4          1        3

   33.    Ward Servant                       28         20        8

                                                                         19
    Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




Sr. No.       Name of Post/ Designation         Sanctioned            Filled   Vacant

   34.    Bearer                                     6                  4        2

   35.    Sanitary Worker                            35                24        11

   36.    Naib Qasid                                 8                  6        2

   37.    Masalchi                                   3                  2        1

   38.    Mali                                       3                  3        0

   39.    Gate Keeper                                3                  2        1

   40.    Dhobi                                      3                  3        0

   41.    Dawakob                                    3                  3        0

   42.    Dai                                        7                  5        2

   43.    Cook                                       6                  5        1

   44.    Chowkidar                                  9                  9        0

   45.    Baildar                                    6                  5        1



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

                     Post                                Sanctioned            Filled

Vaccinators                                                 128                 128

CDC Supervisor                                              88                  69

Sanitary Inspector                                           2                   0




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         Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




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

                   Type of institute                                     Number
   DHDC                                                                      1
   General Nursing school                                                    1


  i.     DHDC
                Post                           Sanctioned                            Filled

Programme Director                                   1                                  1

MPPT                                                 1                                  1

LHV Trainer                                          1                                  0

Assistant                                            1                                  1

Driver                                               1                                  1

Naib Qasid                                           1                                  1

Chowkidar                                            2                                  2

Sanitary Worker                                      1                                  1



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

Principal School of Nursing                          1                                  1

Nursing Instructor                                   2                                  1

Clinical Instructor                                  2                                  0

House Keeper                                         1                                  1

Head Clerk                                           1                                  0

Stenographer                                         1                                  1

Accountant                                           1                                  1

                                                                                                 21
         Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




  Name of Post/Designation        Sanctioned              Filled

Senior Clerk                          1                     1

Junior Clerk                          1                     1

Driver                                1                     1

Sweeper                               1                     1

Naib Qasid                            2                     2

Chowkidar/Gate Keeper                 0                     0

Cook                                  1                     1

Masalchi                              0                     0




                                                                      22
            Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




  Health Financing
  The provision of financial resources at district level is prime responsibility of district government.
  However, keeping in view the budget constraints at the district level, federal and provincial
  governments also augment financial resources in form of kind and cash, through different programs.
  Financial resources of the district during the last three years out of different sources are given as under:



                                                                                                  Rs. Million



                                                                       Year

    Source of funding                   2007-08                   2008-09             2009-10 up to 03/2010

                              Allocation          Exp.    Allocation          Exp.   Allocation        Exp.


Non-Development               390.5035        373.786      500.293        387.114     557.458        278.852


Development                       0                 0         0                0         0              0

Sub Total                     390.5035        373.786     500.293        387.114     557.458         278.852

PHSRP                            ----              ----     23.00              0       23.00            0

PMDGP                             ---              ---     155.670             0      155.670        1.7462

PDSSP                           32.545            9.595    25.295              0       5.22          13.248

Provincial Development
                                2.274               0       2.274         1.0026      33.517            0
Funds (ADP)

Grand Total                      815.826      757.167     1206.825       775.230 6   1332.323        572.698

User charges (like parchi
fee, fees for diagnostic        3.627         386.476     1214309         392.696     787.973        297.646
services)




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       Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




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

           Sr. No.                      Disease Group                                 % age
           Respiratory Diseases
              1     Acute (upper) respiratory infections                             30.11%
              2       Pneumonia < 5 yrs.                                              1.15%
              3       Pneumonia > 5 yrs.                                              1.00%
              4       TB Suspects                                                     1.48%
              5       Chronic Obstructive Pulmonary Disease                           1.49%
              6      Asthma                                                           4.03%
           Gastro Intestinal Diseases
              7      Diarrhea / Dysentery < 5 yrs                                     5.19%
              8      Diarrhea / Dysentery > 5 yrs                                     5.42%
              9      Enteric / Typhoid Fever                                          0.92%
             10      Worm Infestations                                                1.87%
             11      Peptic Ulcer Disease                                             4.32%
             12      Cirrhosis of Liver                                               0.10%
           Urinary Tract Disease
             13      Urinary Tract Infections                                         2.42%
             14      Nephritis / Nephrosis                                            0.18%
             15      Sexually Transmitted Infections                                  0.06%
             16      Benign Enlargement of Prostrate                                  0.09%
           Other Communicable Diseases
             17      Suspected Malaria                                                3.75%
             18      Suspected Meningitis                                             0.08%
             19      Fever due to other causes                                        8.20%
           Vaccine Preventable Diseases
             20      Suspected Measles                                                0.10%
             21      Suspected Viral Hepatitis                                        0.27%
             22      Suspected Neonatal Tetanus                                       0.01%
           Cardiovascular Diseases
             23      Ischemic heart disease                                           0.09%
             24      Hypertension                                                     2.57%
           Skin Diseases
                                                                                                         24
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




   Sr. No.                       Disease Group              % age
     25     Scabies                                         8.63%
     26     Dermatitis                                      3.62%
     27     Cutaneous Leishmaniasis                         0.39%
  Endocrine Diseases
     28     Diabetes Mellitus                               3.02%
  Neuro-Psychiatric Diseases
     29     Depression                                      1.16%
     30     Drug Dependence                                 0.09%
     31     Epilepsy                                        0.04%
  Eye & ENT
     32     Cataract                                        0.21%
     33     Trachoma                                        0.22%
     34     Glaucoma                                        0.11%
     35     Otitis Media                                    2.45%
  Oral Diseases
     36     Dental Caries                                   2.68%
  Injuries/Poisoning
     37     Road traffic accidents                          1.63%
     38     Fractures                                       0.16%
     39     Burns                                           0.27%
     40     Dog bite                                        0.25%
     41     Snake bite (with signs/symptoms of poisoning)   0.03%
  Miscellaneous Diseases
     42     Acute Flaccid Paralysis                         0.00%
     43     Suspected HIV/AIDS                              0.14%
     44     Any other Unusual disease (specify)
            Grand Total                                     100.00%
Source: Compiled from PHC and SHC DHIS Reports




                                                                      25
       Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




Status of Vertical Programs
The following paragraphs depict the current status of the program being implemented in the district.
The indicators and their values have been taken from the respective program reports.

  1. National Program for FP & PHC
      No. of seats allocated for LHWs                              2062
      No. of LHWs working                                          1851
      Percentage of Population covered by the program              47%
      Important program indicators
          o IMR                                                     98/1000
          o MMR                                                     103/100,000
          o CPR                                                     38.4 %
          o No. of antenatal visits                                 2516=83%in February 2010
          o TT Coverage of pregnant women                           87%


  2. EPI
      EPI coverage rate of the district
           o Based on program information                           109%
           o Based on third party validation                        -
      Fully immunized children 0-23 months                         3.53%(0- 11months)
                                                                    3.4% (12-23months)

      Pregnant women received TT vaccine                           15643
      Availability of cold chain equipment                         Cold Chain is available in all
       Health Facilities of the District.



  3. MNCH Program
      WMO (MNCH)                                                   10
      LHV(MNCH)                                                    16
      CMW                                                          Under training 84 Deployed 30

  4. TB Control Program
      CDR all types                                                70%

      CDR NSS Positive                                             70%

      SCR                                                          89%

      TSR                                                           93%

                                                                                                       26
     Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




    DR                                                        3%



5. Malaria Control Program
    No. of slides examined                                    27276
    No. of positive slides(Plasmodium Vivax)                  15
    Slides positively ratio                                   0.001
    Percentage of plasmodium Falciparum                       Nil

6.   Hepatitis Control Program
    No. of hepatitis tests conducted                          3840
    No. of positive cases detected                            763
    No. of persons vaccinated against Hepatitis B             3654
    No. of cases treated for Hepatitis B                      186
    No. of cases treated for Hepatitis C                      577



7. School Health Services Program
    Total visits to the schools                               57
    No. of students examined                                  1145
    No. of students referred to BHUs                          422
    No. of students treated in BHUs                           422
    No. of students referred from BHUs to higher facilities   Nil
    No. of schools in catchment areas                         57
    No. of students                                           11330
    No. of SH & NS                                            90
    No. of teachers trained




                                                                       27
        Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




SECTION 2: PROBLEM ANALYSIS

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

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

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

Objectives
       Improve health status of the population
       Meeting the requirements of national and provincial health policies
       Achievement of MDGs through MSDS
       Introducing evidence-based planning culture by addressing district specific problems/issues
       Addressing emerging health needs or re-emergence of health problems (e.g. H1N1, HIV-AIDS,
        Polio, T.B)
                                                                                                        28
       Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




      Ensuring effective inter-sectoral coordination with a view to improving health indicators

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

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

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

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

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

The district planning team held meetings and started with identification of problem using the training
received from SP-09 team and consulting the above mentioned documents. The problems identified
were broadly divided into two categories i.e.

                                                                                                         29
         Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




    a) Health Problems
    b) Health Service Delivery or Management Problems

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

         1. Acute respiratory tract             2. Diarrheal Diseases   3. Hepatitis
            infections (ARI)
         4. Anemia                              5. Scabies              6. Enteric Fever

         7. Pulmonary Tuberculosis              8. Worm infestation     9. Road side accident & injuries

         10. Diabetes Mellitus                  11. High under 5        12. High Maternal Mortality rate
                                                    Mortality rate
         13. Arthritis                          14. Cataract            15. Suspected Malaria

         16. Hypertension                       17. Dental Caries

Problem Prioritization
WHO has developed standard criteria for prioritization of health problems; which is based on the
following five elements:

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

Each element has been assigned a score from 1 to 4 depending upon grade/scale of that element i.e.
Very High=4, High=3, Medium=2 and Low=1.
Elements of the prioritization criteria were applied to each of the enlisted health problems. The
aggregate of individual scores assigned to the elements of the prioritization criteria gave the total score
for a health problem. This total score was then used to prioritize the health problems. A cut-off point of
was decided, to establish the priority health problems of the district. These problems will be addressed
in the three years rolling plan.




                                                                                                         30
               Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




    Problem         Magnitude   Severity   Vulnerability        Cost        Political   Total   Priority
                                                to         Effectiveness   Expediency   Score   Number
                                           Intervention

Diarrheal              4           3            4               4              1         16        1
Diseases

ARI (under 5)          3           3            3               3              1         13        7

Hepatitis              3           4            3               2              3         15        2

Pulmonary              3           3            3               2              2         13        6
Tuberculosis

Anemia (               4           2            2               3              2         13        8
including in
pregnancy)

Scabies                2           1            3               3              1         10       13

Enteric Fever          3           2            2               2              1         10       14

High maternal          2           3            3               3              3         14        4
mortality

High under five        3           3            3               2              3         14        3
mortality

Accidents &            2           2            2               2              2         10       15
Injuries

Diabetes Mellitus      3           3            3               3              2         14        5

Worm infestation       3           2            3               3              1         12       10

Dental Caries          3           2            3               1              1         10       11

STI                    2           1            3               2              2         10       12

Cataract               2           3            4               3              1         13        9

Suspected              1           2            2               2              1         8        17
Malaria

Hypertension           2           2            2               2              1         9        16




                                                                                                 31
        Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




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

  Sr.        Health Problem                                   Causes
  No.

    1       Diarrheal Diseases      Poor sanitation
                                    Lack of safe drinking water
                                    Unhygienic practices
                                    Lack of awareness in general population
                                    Lack of awareness among mothers about feeding and weaning
                                    practices Economic status
                                     Low Socio
                                    Malnutrition
    2       Hepatitis               Poor sanitation
                                    Unsafe drinking water
                                    Sharing of used syringes
                                    Transfusion of unsafe blood and blood products
                                    Unsafe sexual practices
                                    Ear & Nose piercing and tattooing
                                    Use of unsterilized equipment by dentists and
                                     barbers
    3       High under 5            Poor antenatal natal and post natal coverage
            Mortality               Neo-natal Infections
                                    Birth Trauma & Asphyxia
                                    Prematurity
                                    Poor feeding and weaning practices
                                    Diarrhea
                                    ARI
                                    Lack of capacity of staff for provision of proper
                                     child health care (diagnostic and timely referrals)
                                    Low socio economic status
                                    Malnutrition
                                    Lack of birth spacing
                                    Low EPI Coverage




                                                                                                   32
      Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




Sr.     Health Problem                                    Causes
No.

4      High MMR                Poor access to healthcare delivery services
                               Lack of awareness about danger signs of pregnancy
                               Low ante-natal coverage
                               Low skilled birth attendance
                               Three delays (seeking health care, transportation, and
                                lack of referral back-up services)
                               Complications of pregnancy
                               Capacity Issues related to maternal care
                               Maternal Anemia
                               Pregnancy following chronic severe diseases

5      Diabetes Mellitus       Genetic makeup
                               Obesity
                               Competitive type A personality
                               Sedentary life style
                               Fast Foods lacking fibers
6      TB Suspects             Low socio-economic status
                               Seasonal variation
                               Lack of proper sanitation
                               Lack of awareness and hygienic
                                practices
7      Acute (upper)           Malnutrition
       respiratory             Air contamination
       infections              Over-crowding/Poor housing
                               facilities
                                Lack of proper sanitation
                               Seasonal variation
                             Lack of awareness and hygienic
                              practices
8      Anemia ( including    Lack of awareness about balanced diet
       pregnancy)            Gender discrimination
                             Social taboos and norms
                             Worm infestation
                             Infections
                             Poor quality of MNCH services
                             Poverty/ Low socio economic status




                                                                                         33
         Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




Service delivery/Management problems
This segment entails the district specific management problems. Management problems are result of
deficiency/lack of resources; these problems range from administrative to financial issues, and cause
hindrance in the smooth delivery of health services in the district. It was observed that solution of some
of these problems lies with the provincial government; whereas remaining can be addressed at the
district level. While proposing the interventions, their action at provincial or district level has been
specifically mentioned. The planning team discussed these problems in detail and enlisted the main
problems as under:




     1       Shortage of staff
              Ban on permanent postings
              Non availability of incentivized pay package and career structure
              Medico-legal work for WMOs
              Non sanctioning of posts according to MSDS



     2       Capacity issues of Management staff in:
             Financial management
             Supportive Supervision
             Use of information

     3
             Shortage of equipment MNCH related equipment at THQHS
     4       Inadequate budget for POL
              Price hikes
              Installation and use of generators
              Inadequate budget for POL




                                                                                                       34
       Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




MDGs and MSDS

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

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




   a) Human Resource
       With regard to MSDS gap analysis for human resource, the difference between the standards
       proposed in MSDS and filled posts has been calculated as the vacancy gap. The hospitals have
       been categorized based on their bed strength as follows:




              Hospital                     Category                        Bed Strength

                                               A                        400 and above Beds
             DHQ Hospital                      B                           251-400 Beds

                                               C                           Up to 250 Beds
                                               A                           Above 60 Beds

             THQ Hospital                      B                            41-60 Beds
                                               C                           Up to 40 Beds




                                                                                                      35
       Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




  i.   THQ Hospital
       (A composite list of gaps with reference to MSDS)

        Sr. No.         Post        Standard Sanctioned Filled        Vacancy        Vacancy
                                      as per                           Gap in         Gap in
                                      MSDS                           relation to    relation to
                                                                     sanctioned        filled
                                                                      positions      positions

          1        Gynaecologist        7           3           1          4             6

          2        Paediatricians       7           3           1          4             6

          3        Anesthetists        10           4           2          3             5

          4        Medical             60           50         31         10            29
                   Officers
                   including
                   SMO,APMO &
                   PMOs

          5        Women               31           17          8         14            23
                   Medical
                   Officers
                   including
                   SWMO,
                   APWMO
                   &PMOs

          6        Lady Health         24           3           3          0            21
                   Visitors

          7        Nurses              78           14         38          4            40



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

Gaps in relation to the MNCH related equipment have been identified taking into account the equipment
purchased or under process of purchase from all funds including PMDGP funds allocated/sanctioned to
the district. The cost of equipment gap has been included in the equipment portion of the
Management/Service delivery problems.


                                                                                                  36
      Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




i.    Composite List of Gaps of All THQ Hospitals –

     Sr.         Equipment          Standard as        Available   Gap   Remarks
     No.                             per MSDS

                                         (Qty.)

                                    C      B      A

     1     CTG (Cardiac             1     1       2       2         2
           Tocography)

     2     Foetal Doppler           3     5       5       9         6

     3     Diagnostic Laparoscope   1     1       2       1         3

     4     Bulb Sucker              10    20      20      50       10

     5     Baby Warmer              3     3       6       8         4

     6     Mechanical Sucker        3     3       6       9         3

     7     Fetal Stethoscope        4     4       4       3         9

     8     Delivery Table           2     2       3       5         2

     9     D&C Set                  2     3       4       7         3

     10    Outlet forceps           4     4       4       2        10

     11    Myoma Screw              2     2       2       0         6

     12    Kochers forceps          4     4       8       6        10

     13    Volselum forceps         6     8       10      16       10

     14    Lanes Tissue holding     2     2       4       2         6
           forceps

     15    Vaginal Retractors       10    10      10      20       10

     16    Polypectomy forceps      2     2       2       0         6

     17    Sponge holder            10    15      20      30       20

     18    Uterine elevator         1     1       1       0         3


                                                                                   37
 Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




Sr.           Equipment            Standard as       Available   Gap   Remarks
No.                                 per MSDS

                                       (Qty.)

                                   C     B      A

19     CosCo Speculum              6    10      10      0        18

       Small, Medium, Large
       (for each category)

20     Examination light           3    3       6       9         3

21     Suction Curette             1    2       2       3         3

22     Infant Resuscitation        1    1       2       1         3
       Trolley (with life saving
       medicines, baby
       laryngoscope, Endo-
       tracheal tube, Infant BP
       Apparatus, Chargeable
       Light)

23     Mother Resuscitation        1    1       2       0         3
       Trolley (with life saving
       medicines,                                       4
       Laryngoscope, Endo-
       tracheal tube, BP
       Apparatus, Chargeable
       light)

24     Cardiac Monitor             1    1       2       4         0

25     Pump Breast Electronic      1    1       1       0         3

26     Vaginal Hysterectomy        2    2       4
       Set

26.1   Toothed Tissue Forceps      2    2       4       3         5
       (8”)

26.2   Non-Tooted Tissue           2    2       4       3         5
       Forceps (8”)


                                                                                 38
  Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




Sr.           Equipment            Standard as        Available   Gap   Remarks
No.                                 per MSDS

                                        (Qty.)

                                   C      B      A

26.3    Dissection Scissors        2     2       4       3         5
        (Curved 7”)

26.4    Dissection Scissors        2     2       4       4         4
        (Straight 7”)

26.5    Hysterectomy Clamps        8     8       16      26        6
        (Straight)

26.6    Hysterectomy Clamps        8     8       16      26        6
        (Curved)

26.7    Uterine Sound              2     2       4       5         3

26.8    Needle Holder (7”)         2     2       4       2         6

26.9    Needle Holder (10”)        2     2       4       2         6

26.10   Artery Forceps (Straight   16    16      32      34       30
        6”)

26.11   Artery Forceps (Curved     16    16      32      34       30
        6”)

26.12   Allis Forceps              8     8       16      12       20

26.13   Towel Clamps               8     8       16      14       18

26.14   Single blade Sims          4     4       8       6        10
        speculum

26.15   Double blade Sims          4     4       8       6        10
        speculum

26.16   Sponge holding forceps     8     8       16      17       15

26.17   Volselum forceps           4     4       8       6        10

26.18   Uterine Sound              2     2       4       5         3

                                                                                  39
  Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




Sr.           Equipment           Standard as        Available   Gap   Remarks
No.                                per MSDS

                                       (Qty.)

                                  C      B      A

26.19   Bladder Sound             2     2       4       2         6

 27     Delivery Sets             10    10      15

27.1    Episiotomy Scissors       10    10      15      20       15

27.2    Straight Scissors         10    10      15      20       15

27.3    Needle holder             10    10      15      35        -

27.4    Non-toothed tissue        10    10      15      20       15
        forceps 8 inches

27.5    Toothed tissue forceps    10    10      15      20       15
        8 inches

27.6    Sims Speculum single      20    20      30      40       30
        blade

27.7    Sims Speculum double      20    20      30      40       30
        blade

27.8    Sponge holding forceps    40    40      60      60       80

27.9    Artery forceps            40    40      60      60       80

27.10   Straight clamps (cord)    20    20      30      0        80

27.11   Vacuum Extractor          1     1       1       3         0
        pump

27.12   Towel clip                40    40      60                -

 28     Caesarian Section         6     8       10

28.1    Scalpel                   6     8       10      16       10

28.2    Artery Forceps Straight   24    32      40      89       15
        6 inches


                                                                                 40
  Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




Sr.           Equipment            Standard as        Available   Gap   Remarks
No.                                 per MSDS

                                        (Qty.)

                                   C      B      A

28.3    Artery Forceps Curved 6 24       32      40      74       30
        inches

28.4    Artery forceps 8 inches    24    32      40      74       30

28.5    Myoma Scissors             6     8       10      16       10
        straight 7 inches

28.6    Dissecting scissors        6     8       10      16       10
        (curved) 7 inches

28.7    Green Armtage forceps      24    32      40      74       30
        8 inches

28.8    Obstetric outlet forceps   6     8       10      16       10
        (pair)

28.9    Doyene’s Retractor         6     8       10      16       10

28.10   Small Retractors           12    16      20      37       15

28.11   Towel Clippers             24    32      40     104        0

28.12   Suction Nozzle             6     8       10      16       10

 29     MNCH Related
        Radiology Equipments

29.1    Ultrasound Machine         1     2       3       7         0

29.2    X-Ray Unit 500 kw          1     1       1       1         2

29.3    Color Doppler              0     1       1       3         0

29.4    Lead Screen for X-Ray      1     1       1       0         3
        Unit




                                                                                  41
  Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




Sr.           Equipment          Standard as      Available   Gap   Remarks
No.                               per MSDS

                                     (Qty.)

                                 C     B      A

29.5    0.5 MN Lead Apron.       1    1       1      3         3
        Lead Gloves, Goggles
        and Thyroid and
        Gonadal Sheets

29.6    Safe Light               1    1       1      0         3

29.7    X-RT Film Processing     1    1       1      0         3
        Tank

29.8    Chest Stand              1    1       1      -3        6

29.9    X-Ray film Illuminator   2    2       2      6

29.10   X-Ray Film Hangers All   4    4       4      2        10
        sizes

 30     MNCH Related
        Paediatrics Equipments

30.1    Paediatric Ventilator    1    2       2      3         3

30.2    Incubator                1    1       2      4

30.3    Photo Therapy Unit       1    1       1      1         2

30.4    Over-head Radiant        1    1       1      0         3
        Warmer

30.5    Infant Length            2    2       2      0         6
        Measuring Scale

30.6    Infant Weighing          2    2       2      1         5
        Machine

30.7    Nebulizer                1    1       2      1         3

30.8    Billiubino-meter         1    1       2      1         3


                                                                              42
  Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




Sr.           Equipment          Standard as      Available   Gap   Remarks
No.                               per MSDS

                                     (Qty.)

                                 C     B      A

30.9    Exchange Blood           1    1       2      1         3
        Transfusion Set

30.10   Nasal Probe Paed size    2    2       4      2         6

 31     Anaesthesia/ICU

31.1    Anaesthesia Machine      1    1       2      4         0

31.2    Ventilators              1    1       1      0         3

31.3    Nebulizer                1    1       1      2         1

31.4    Pulse Oximetry           1    1       1      2         1

31.5    Defibrillator            1    1       1      1         2

31.6    Airway Oral and Nasal    2    3       4      4         6

31.7    Tracheostomy tube        2    2       4      2         6
        (adult and paeds)

31.8    Face mask of all sizes   2    2       4      2         6

31.9    Double Cuff Tourniquet   1    2       2      3         3
        (for regional block)

31.10   AMBO bag adult           2    2       4      3         5

31.11   AMBO Bag paeds           2    2       4      2         6

31.12   Red Rubber Nasal tubes   4    4       8      4        12
        all sizes without cuff


 32     Blood Bank

32.1    Blood storage cabinet    1    1       2      1         3
        (100 bag capacity)


                                                                              43
  Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




Sr.           Equipment          Standard as      Available   Gap   Remarks
No.                               per MSDS

                                     (Qty.)

                                 C     B      A

32.2    Packed cell machine      1    1       1      0         3

32.3    Cell Separator           1    1       1      0         3

32.4    Freezer for Fresh        1    1       1      0         3
        Frozen Plasma

32.5    Blood bag shaker         1    1       2      1         3

32.6    RH view box              2    2       4      5         3

32.7    Water bath               2    2       2      0         6

32.8    Micro-pipette            4    6       8      10       10

32.9    Blood grouping tiles     3    3       6      6         6

32.10   Plasma Extractor         1    1       1      0         3

32.11   Platelets agitator       1    1       1      0         3

32.12   Blood thawing bath       1    1       1      0         3

32.13   Microscopes              1    1       2      2         2



 33     Gynae & Labour Room
        Related Laboratory
        Equipment

33.1    Hematology Analyzer      1    1       1      0         3

33.2    Electrolyte Analyzer     1    1       1      0         3

33.3    Analyzer Bio-chemistry   1    1       1      0         3
        Semi-automatic

33.4    Glucometer               2    2       2      0         6


                                                                              44
 Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




Sr.          Equipment      Standard as      Available   Gap   Remarks
No.                          per MSDS

                                (Qty.)

                            C     B      A

33.5   Haemoglobino-meter   2    2       4      5         3

33.6   Centrifuge           1    1       2      2         2




                                                                         45
       Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




SECTION 3: INTERVENTIONS AND TARGETS

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




                                                                                                       46
                                     Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




Health Problems

                                                                                                              Target   Target   Target
     Sr.                                                                                    Plan Activities    for      for      for
            Problem       Causes          Intervention         Activities           Unit                                                 Remarks
     No.                                                                                       Targets        2010-    2011-    2012-
                                                                                                                11       12       13
      1    Diarrhea    Poor             improvement of    Quarterly co-       Meeting          12            4        4        4
                        sanitation        water supply       ordination
                                          and sanitation     Meeting with
                                                             TMA and other
                                                             agencies

                       Lack of safe     Health            Messages on local   Message          12            4        4        4
                        drinking          Education          cable network
                       water
                        Unhygienic       campaign
                                          Improving         Printing and        Brochure      600000         300000   150000   150000
                        practices         literacy rate      distribution of
                                          through            IPC material
                                          coordination
                                          with education
                                          department
                       Lack of          Proper            Address in school   Session        5,400         1,800    1,800    1,800
                        awareness in      treatment of       assemblies
                        general           Diarrhea
                        population        including ORT




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                                 Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




                                                                                                           Target   Target   Target
Sr.                                                                                      Plan Activities    for      for      for
       Problem        Causes          Intervention           Activities         Unit                                                  Remarks
No.                                                                                         Targets        2010-    2011-    2012-
                                                                                                             11       12       13

                   Lack of          Capacity            Training of       No. of            13           13
                    awareness         building of          medics and        trainings
                    among             health staff in      paramedics in
                    mothers           Integrated           IMCI
                    about feeding     Management of
                    and weaning       Childhood
                    practices         Illnesses (IMCI)
                   Low Socio                             Procurement and   ORS            250000         100000   60000    40000
                    Economic                               distribution of   packets
                    status                                 ORS

                   Malnutrition                          Procurement and   Syrup          150000         70,000   40000    40000
                                                           distribution of
                                                           Syp. Zink
                                                           Sulphate

                                                          Procurement and   Syrup          150000         70,000   40,000   40,000
                                                           Distribution of
                                                           Syp.
                                                           Metronidazole

2     Hepatitis    Poor             Health              Quarterly co-     Meetings
                    sanitation        Education/Pro        ordination
                                      motion               meetings with
                                                           TMA and other
                                                           agencies



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                             Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




                                                                                                              Target    Target   Target
Sr.                                                                                         Plan Activities    for       for      for
      Problem       Causes           Intervention             Activities            Unit                                                  Remarks
No.                                                                                            Targets        2010-     2011-    2012-
                                                                                                                11        12       13
                 Unsafe            Improving            Messages on local     Message          36            12       12       12
                  drinking           water &               cable network
                  water              sanitation

                 Sharing of        Campaign             Printing and          Brochure      200,000        100,000   50,000   50,000
                  used syringes      against               distribution of
                                     quackery              IPC material

                 Transfusion of    Strengthening        Printing and          Stickers                      5,000      -        -
                  unsafe blood       blood                 pasting of
                  and blood          transfusion           stickers at clinics
                  products           services for safe     and Barber shop
                                     transfusions          highlighting use
                                                           of new syringes &
                                                           Razors

                 Unsafe sexual     Regulatory           Hepatitis                              3             1         1        1
                  practices          mechanism to          awareness week
                                     ensure use of         ( walk/display
                                     safe                  banners/seminar
                                     instruments by        s)
                                     dentists,
                                     barbers etc.
                 Ear piercing                            Procurement and       Kits            200           100       50       50
                  and tattooing                            supply of Eliza
                                                           kits




                                                                                                                                                    49
                             Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




                                                                                                  Target   Target   Target
Sr.                                                                             Plan Activities    for      for      for
      Problem       Causes        Intervention       Activities         Unit                                                 Remarks
No.                                                                                Targets        2010-    2011-    2012-
                                                                                                    11       12       13
                 Use of                          Procurement of     Syringe       1,200          600      300      300
                  unsterilized                     syringe cutters   cutter
                  equipment by
                  dentists and
                  barbers
                                                  Procurement and   Courses         200           100      50       50
                                                   distribution of
                                                   Interferon
                                                   Injection

                                                  Documentation
                                                   of expense of
                                                   disposable
                                                   syringes

                                                  Supportive
                                                   supervision to
                                                   ensure above
                                                   activities

                                                  Procurement and
                                                   distribution of
                                                   Interferon
                                                   Injection




                                                                                                                                       50
                                 Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




                                                                                                                 Target   Target   Target
Sr.                                                                                            Plan Activities    for      for      for
       Problem          Causes           Intervention            Activities          Unit                                                   Remarks
No.                                                                                               Targets        2010-    2011-    2012-
                                                                                                                   11       12       13
3     High under     Poor              Health              Message on local     Message           36           12       12       12
      5 Mortality     antenatal          awareness/educ       cable
                      natal and post     ation
                      natal
                      coverage
                     Neo-natal         Provision of the    BCC of mothers       Number of         74           40       17       17
                      Infections         quality basic        0n promotion of     Trainings
                                         EMONC services       breast feeding
                                         at BHU & RHC         and weaning
                                                              practices through
                                                              LHWs

                     Birth Trauma      Provision of the    Provision of the
                      & Asphyxia         quality              deficient           Assessment
                                         Comprehensive        infrastructure at
                                         EMONC services       THQ
                                         at THQH &
                                         DHQH
                     Prematurity       Improvement of      Trainings on         No. of                                            -
                                         feeding and          IMCI                trainings
                                         weaning
                                         practices
                     Poor feeding      Capacity            Need assessment                                                        -
                      and weaning        building of          of food             Assessment
                      practices          Human                supplements
                                         Resource
                                         dealing child
                                         health care
                                                                                                                                                      51
                             Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




                                                                                                        Target   Target   Target
Sr.                                                                                   Plan Activities    for      for      for
      Problem       Causes         Intervention        Activities           Unit                                                   Remarks
No.                                                                                      Targets        2010-    2011-    2012-
                                                                                                          11       12       13
                 Diarrhea        Enhancing EPI    procurement                                                            -
                                   coverage          from DGHs office    Assessment


                 ARI             Poverty          Distribution of
                                   elevation         food                Assessment
                                                     supplements to
                                                     mothers &
                                                     children through
                                                     LHWs &
                                                     community mid
                                                     wives

                 Lack of         Provision of     Raising income of
                  capacity of      food              the poor families   Assessment
                  staff for        supplements       through Baitul
                  provision of                       Mall and Zakat
                  proper child
                  health care
                  (diagnostic
                  and timely
                  referrals)
                 Low socio                         Revising the
                  economic                           micro plans of
                  status                             Vaccinators




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                               Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




                                                                                                           Target   Target   Target
Sr.                                                                                      Plan Activities    for      for      for
       Problem       Causes           Intervention          Activities          Unit                                                  Remarks
No.                                                                                         Targets        2010-    2011-    2012-
                                                                                                             11       12       13
                  Malnutrition




                  Lack of birth
                   spacing



                 Low EPI
                   Coverage


4     High MMR    Poor access to    Health            Messages on local   Message           36           12       12       12
                   healthcare         education/prom     cable network
                   delivery           otion
                   services
                  Lack of           Behaviour         Printing and        Brochure       100000         50000    30000    20000
                   awareness          change             distribution of
                   about danger       communication      IPC material
                   signs of           for Mothers of
                   pregnancy          child bearing
                                      age
                  Low ante-         Provision of      Training of LHWs    No. of            36           12       12       12
                   natal              Quality basic      on BCC              trainings
                   coverage           EmONC services
                                      at BHU & RHC




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                             Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




                                                                                                      Target   Target   Target
Sr.                                                                                 Plan Activities    for      for      for
      Problem       Causes           Intervention          Activities        Unit                                                Remarks
No.                                                                                    Targets        2010-    2011-    2012-
                                                                                                        11       12       13
                 Low skilled       Provision of       Procurement of
                  birth              Quality             vehicles for
                  attendance         Comprehensive       transportation
                                     EmONC services      through CCBs
                                     at THQs & DHQs
                                     hospital
                 Three delays      Improving          Operation and
                  (seeking           transportation      management of
                  health care,       of the patients     vehicles through
                  transportatio                          CCBs
                  n, and lack of
                  referral back-
                  up services)
                 Capacity                              Repair of non
                  Issues related                         functional
                  to maternal                            ambulances for
                  care                                   timely
                                                         transportation of
                                                         pregnant
                                                         mothers




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                             Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




                                                                                                    Target   Target   Target
Sr.                                                                               Plan Activities    for      for      for
      Problem       Causes         Intervention       Activities           Unit                                                Remarks
No.                                                                                  Targets        2010-    2011-    2012-
                                                                                                      11       12       13
                 Maternal                         Replacement of
                  Anemia                            the non
                                                    functional
                                                    ambulances for
                                                    timely
                                                    transportation of
                                                    pregnant mother

                 Capacity                         Procurement of
                  Issues related                    the MNCH related
                  to maternal                       equipment and
                  care                              Instruments

                                                   Implementation
                                                    of the referrals
                                                    protocols

                                                   Procurement of                   300000         150000   75000    75000
                                                    Micro-nutrients     Capsule


                                                   Procurement and                  200000         100000   50000    50000
                                                                         No. of
                                                    distribution of
                                                                        tablets
                                                    Calci-D




                                                                                                                                         55
                                 Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




                                                                                                                 Target   Target   Target
Sr.                                                                                            Plan Activities    for      for      for
       Problem          Causes           Intervention            Activities           Unit                                                  Remarks
No.                                                                                               Targets        2010-    2011-    2012-
                                                                                                                   11       12       13
                                                              Procurement and                       30           10       10       10
                                                               distribution of     Injection
                                                               Anti-D


5     Diabetes       Genetic           Health               Message on local    Message           12            4        4        4
      Mellitus        makeup             awareness for         cable
                                         promoting
                                         health life style
                                         behaviors
                     Obesity           Balanced diet        Message on FM       Message           12            4        4        4
                                                               Radio


                     Competitive       Regular              Awareness                             3             1        1        1
                      type A             walk/exercise         walk/Banners/Se
                      personality                              minars/Poster

                     Sedentary life                          Screening Camps
                      style                                    for high risk
                                                               population

                     Fast Foods
                      lacking fibers


6     TB Suspects    Low socio-        Health               Messages on local   Message           12            4        4        4
                      economic           education/prom        cable networks
                      status             otion

                                                                                                                                                      56
                               Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




                                                                                                         Target   Target   Target
Sr.                                                                                    Plan Activities    for      for      for
      Problem       Causes          Intervention          Activities         Unit                                                   Remarks
No.                                                                                       Targets        2010-    2011-    2012-
                                                                                                           11       12       13
                 Seasonal         Strengthening     Printing and       Brochure         75000         25000    25000    25000
                  variation         TB DOTS            distribution of
                                    program            IPC material
                                    through
                                    involvement of
                                    private sector
                 Lack of          Involvement of    Procurement of     ATT course        600           200      200      200
                  proper            private            drugs to ensure
                  sanitation        providers          deficiency
                                    through public     according to
                                    private            regimen
                                    partnership
                 Lack of                             Procurement of     Packs              50           20       15       15
                  awareness                            reagents for
                  and hygienic                         notified
                  practices                            diagnostic
                                                       facilities under
                                                       DOTS
                                                       programme

                                                     Trainings on DOTS     No. of            14            6        4        4
                                                           protocols      trainings




                                                                                                                                              57
                                  Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




                                                                                                               Target    Target    Target
Sr.                                                                                          Plan Activities    for       for       for
       Problem          Causes         Intervention            Activities          Unit                                                      Remarks
No.                                                                                             Targets        2010-     2011-     2012-
                                                                                                                 11        12        13
7     Acute          Malnutrition    Capacity            Messages on local   Message            12            4         4         12
      (upper)                          building of          cable networks
      respiratory                      health staff in
      infections                       ARI case
                                       management
                     Air             Capacity            Messages            Message            12            4         4         12
                      contaminatio     building of          through FM radio
                      n                health staff in      channels
                                       Integrated
                                       Management of
                                       Childhood
                                       Illnesses (IMCI)
                     Over-           Provision of        Printing and        Brochure        300,000        100,000   100,000   300,000
                      crowding/Poo     medicines for        distribution of
                      r housing        ARI                  IPC material
                      facilities
                     Lack of         Timely referral     Training of         No. of              -                                 -
                      proper           of complicated       medics and para-    trainings
                      sanitation       cases                medics in IMCI

                     Seasonal                             Procurement and     Antibiotic      150,000        50,000    50,000    150,000
                      variation                             distribution of     (Syrup)
                                                            Antibiotic Syrup
                                                            Amoxycillin




                                                                                                                                                       58
                                Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




                                                                                                                Target    Target    Target
Sr.                                                                                           Plan Activities    for       for       for
       Problem         Causes          Intervention           Activities          Unit                                                        Remarks
No.                                                                                              Targets        2010-     2011-     2012-
                                                                                                                  11        12        13
                     Lack of
                     awareness
                     and hygienic
                     practices




8     Aneamia (     Lack of          Awareness          Messages on local   Message              12            4         4         4
      including      awareness         raising for         cable network
      pregnancy)     about             behaviour
                     balanced diet     change

                    Gender           Awareness          Printing and        Brochure          150,000        50,000    50,000    50,000
                     discriminatio     raising for         distribution of
                     n                 behavior change     IPC material

                    Social taboos    Awareness          Counseling of       Session                             -         -         -
                     and norms         raising for         pregnant
                                       behavior change     mothers

                    Worm             Deworming          Procurement of      No. of doses      300,000        100,000   100,000   100,000
                     infestation       campaign            de-worming
                                                           tablets




                                                                                                                                                        59
                               Three Years Rolling Plan 2010-2013 District Rahim Yar Khan




                                                                                                         Target   Target   Target
Sr.                                                                                    Plan Activities    for      for      for
      Problem       Causes           Intervention        Activities           Unit                                                  Remarks
No.                                                                                       Targets        2010-    2011-    2012-
                                                                                                           11       12       13
                 Infections        Diagnosis and    Distribution
                                     treatment of      through LHWs
                                     infections        and health
                                                       facilities

                 · Poor quality    Strengthening    ·Refresher           No. of
                  of MNCH            MNCH Services     Trainings of        trainings
                  services                             LHWs on BCC,
                                                       balanced diet and
                                                       provision of
                                                       micro-nutrients

                 Poverty/ Low      Equity of        Provision of
                  socio              services          Sehat Sahulat
                  economic                             Card/health
                  status                               voucher




                                                                                                                                              60
                                  Three Years Rolling Plan 2010-2013 District Rahim Yar khan


Management Problems


Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned Posts


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

   1       Gynaecologist                 18       12,910      18,099               0                -             -           -


   2       Paediatricians                18       12,910      18,099               3                1             1           1


   3       Anesthetists                  18       12,910      18,099               5                2             2           1


   4       MO / WMO                      17       9,850       15,345               7                3             2           2


   5       Nurses                        16       6,060        8,934              22                8             8           6


   6       Lady Health Visitors           9       3,820        4,750              21                7             7           7




                                                                                                                                  61
                                          Three Years Rolling Plan 2010-2013 District Rahim Yar khan


                                                                                                                        Plan         Target      Target      Target
Sr.
          Problem         Causes              Intervention                     Activities                  Unit       Activities   for 2010-   for 2011-   for 2012-   Remarks
No.
                                                                                                                       Targets         11          12          13

1     Shortage of      Vacant             Filling of the vacant    Temporary Filling of the          Recruitment       -            -           -           -
      skilled staff     positions           posts                     vacant posts of medics and
                                                                      the paramedics through
                                                                      existing recruitment
                                                                      committees
                       Non-               Sanctioning of           Demand generation and             Plan              -            -           -           -
                        sanctioning of      positions according       request to the Department of
                        staff according     to MSDS                   Health by the districts for
                        to MSDS                                       recruitment through PSC
                                                                      against vacant posts
                       Lack of            Recruitment              Districts to prepare the          Pay Package       -            -           -           -
                        permanent           through Public            incentivized pay package
                        postings            Service                   with consultation of all
                                            Commission on             stockholders
                                            regular basis
                       Lack of            Incentivized pay         Consensus building between        Meeting           -            -           -           -
                        incentives and      package at all            the districts for uniform
                        differential        levels                    incentivized pay package for
                        pay packages                                  all categories and levels staff
                       Frequent           Well defined career      Request to the Provincial         Plan              -            -           -           -
                        transfer            structure including       Government for approval
                        postings            opportunities for         and implementation of
                                            higher education          agreed pay packages




                                                                                                                                                                       62
                                   Three Years Rolling Plan 2010-2013 District Rahim Yar khan


                                                                                                               Plan         Target      Target      Target
Sr.
      Problem       Causes             Intervention                    Activities                   Unit     Activities   for 2010-   for 2011-   for 2012-   Remarks
No.
                                                                                                              Targets         11          12          13

                 Job insecurity    Conducive working       Review and revise the career     TA                -            -           -           -
                                     environment              structure of medics,
                                                              paramedics and technical
                                                              staff, Health Education
                                                              officers etc
                 Lack of basic     Provision of staff      Availability of recreation,      Plan EDOH         -            -           -           -
                  amenities at       Residences               education and other facilities
                  workplace                                   for children of staff working
                                                              in rural areas
                 Lack of           High level political    Construction of the              Requirement       -            -           -           -
                  conducive          commitment for           residences for the staff         Plan
                  environment        providing
                  including          protection to
                  insecurity and     staff working in
                  transport of       health facilities
                  children for
                  education
                 Political &                                provision of recreation          Plan EDOH         -            -           -           -
                  Media                                       facilities (Parks/Play
                  Interference                                area/common rooms)
                 Deficient                                  Provision of the transport of    Plan EDOH         -            -           -           -
                  transparent                                 staff children for the
                  accountability                              education purposes




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                                            Three Years Rolling Plan 2010-2013 District Rahim Yar khan


                                                                                                                Plan         Target      Target      Target
Sr.
          Problem            Causes             Intervention                Activities                 Unit   Activities   for 2010-   for 2011-   for 2012-   Remarks
No.
                                                                                                               Targets         11          12          13

                         Shortage of                              Capacity and need               TNA           -            -           -           -
                          the residences                            assessment of the medics
                                                                    and the paramedics
                         Medico-legal                             Prepare training programs       Plan          -            -           -           -
                          work specially                            for providing higher
                          for Females                               professional education based
                                                                    on TNA
2      Inadequate        Installation of    Rational increase    Assessing additional need for                 -            -           -           -
      budget for POL      the Generator       in POL Budget         POL
                          for back up
                          electricity
                          supply
                         Frequent                                 Costing & Submission the        POL       264,387      264,387
                          increase in                               additional Demand for POL
                                                                                                                Liters
                          prices of POL


                         Less allocation
                          for POL
                          budget
3     Capacity issues    Delay release      Advocacy for         Pursuance of EDO ( F&P) for                   -            -           -           -
      of the staff        and utilization     keeping health        timely release of funds
                          of funds due to     department on
                          non-clarity of      higher priority
                          financial
                          procedures

                                                                                                                                                               64
                                   Three Years Rolling Plan 2010-2013 District Rahim Yar khan


                                                                                                   Plan         Target      Target      Target
Sr.
      Problem       Causes            Intervention                Activities             Unit    Activities   for 2010-   for 2011-   for 2012-   Remarks
No.
                                                                                                  Targets         11          12          13

                 Inability of      Pursuance to the     Conducting Financial      No. of          3           1           1           1
                  subordinate        competent             Management workshops      trainings
                  staff to carry     authority for
                  out activity       timely release of
                  and in             funds
                  accordance
                  with protocols
                 Inability of      Capacity building    Conducting supportive     No. of          3           1           1           1
                  staff to           of DDOs and other     supervision training      trainings
                  convert data       related staff in      workshops
                  into               financial
                  information        management,
                  for                supportive
                  management,        supervision & use
                  planning and       of information
                  decision
                  making
                                                          Conduction workshops on   No. of          3           1           1           1
                                                           Use of information        trainings




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                                         Three Years Rolling Plan 2010-2013 District Rahim Yar khan


                                                                                                             Plan         Target      Target      Target
Sr.
         Problem           Causes            Intervention                  Activities             Unit     Activities   for 2010-   for 2011-   for 2012-   Remarks
No.
                                                                                                            Targets         11          12          13

4     Deficient         Deficient        Make up the             Purchase of MNCH related   Equipment       -            -           -           -            -
      infrastructure     equipment to      deficiencies against     equipment at all THQHs
      for MNCH           cater basic       standards specified
      services at        and               in MSDS
      THQHs              comprehensiv
                         e EmONC at
                         primary and
                         secondary
                         level of care




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        Three Years Rolling Plan 2010-2013 District Rahim Yar khan




SECTION 4: COSTING AND FINANCING PLAN

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



                   Problem wise Cost Summary of Health Problems
                                              2010-2011        2011-2012       2012-2013
Sr.                                                                                            Total Cost
                Health Problem                                  Amount          Amount
No.                                          Amount (Rs.)                                         Rs.
                                                                 (Rs.)           (Rs.)

 1     Diarrheal Diseases
                                                 6,240,400        4,086,280      4,373,908     14,700,588

 2     Hepatitis
                                                 4,530,000        2,678,500      2,946,350     10,154,850

 3     High under five mortality
                                                 1,496,000        1,230,680      1,353,748      4,080,428

 4     High maternal mortality
                                                 1,490,000        1,331,000      1,415,700      4,236,700

 5     Diabetes Mellitus
                                                   642,000          681,200        642,000      1,965,200

 6     Tuberculosis
                                                 1,248,400        1,058,160      1,148,976      3,455,536

 7     ARI (under 5)
                                                 1,892,000        2,081,200      2,289,320      6,262,520

 8     Anemia ( including in pregnancy)
                                                 3,030,000        3,333,000      3,666,300     10,029,300

       Total
                                             20,568,800       16,480,020       17,836,302     54,885,122




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                            Three Years Rolling Plan 2010-2013 District Rahim Yar khan




a) Health Problems


                                                    Define                          Financial Targets
                                                                                                                    Total
 Sr.   Problem          Activity                                                        Year II         Year III
                                           Unit     Rate     Quantity    Year I                                      Cost
                                                                                        (10 %)          (10 %)
  1    Diarrhea    Quarterly co-       Meeting     2,000      12        8,000           8,800           9,680      26,480
                    ordination
                    Meeting with
                    TMA and other
                    agencies
                   Messages on local   Message    70,000      12       280,000         308,000         338,800    926,800
                    cable network


                   Message on FM       Message      5       600000     1,500,000       825,000         907,500    3,232,500
                    Radio

                   Printing and        Brochure              5,400         -              -               -           -
                    distribution of
                    IPC material

                   Address in school   Sessions   165,600     13       662,400         546,480         601,128    1,810,008
                    Assemblies




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                         Three Years Rolling Plan 2010-2013 District Rahim Yar khan


                                                  Define                          Financial Targets
                                                                                                                    Total
Sr.   Problem        Activity                                                         Year II          Year III
                                        Unit      Rate     Quantity    Year I                                        Cost
                                                                                      (10 %)           (10 %)
                 Training of       No. of         5       250000      500,000        330,000          242,000    1,072,000
                  medics and        Trainings
                  paramedics in
                  MNCH
                 Procurement and   ORS Packets    35      150000     2,450,000      1,540,000        1,694,000   5,684,000
                  distribution of
                  ORS

                 Procurement and   Syrup          12      150000      840,000        528,000          580,800    1,948,800
                  Distribution of
                  Syp. Zink
                  Sulphate
                 Procurement and   Syrup         2,000      12         8,000          8,800            9,680       26,480
                  Distribution of
                  Syp.
                  Metronidazole


                                                                      6,240,400      4,086,280        4,373,908   14,700,588




                                                                                                                               69
                            Three Years Rolling Plan 2010-2013 District Rahim Yar khan


                                                           Define                               Financial Targets
                                                                                                                                 Total
Sr.   Problem           Activity                                                                    Year II         Year III
                                              Unit          Rate           Quantity   Year I                                      Cost
                                                                                                    (10 %)           (10 %)
2     Hepatitis    Quarterly co-         Meetings   Costed in diarrheal      -          -             -                -
                    ordination                       disease
                    meetings with
                    TMA and other
                    agencies

                   Messages on local     Message          70,000            36       840,000       924,000         1,016,400   2,780,400
                    cable network


                   Printing and          Brochure           6             200,000    600,000       330,000         363,000     1,293,000
                    distribution of
                    IPC material

                   Printing and          Stickers           50               -       250,000          -                -       250,000
                    pasting of stickers
                    at clinics and
                    Barber shop
                    highlighting use
                    of new syringes &
                    Razors

                   Hepatitis                        Lump sum                 3       250,000          -                -       250,000
                    awareness week (
                    walk/display
                    banners/seminar
                    s)


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                         Three Years Rolling Plan 2010-2013 District Rahim Yar khan


                                                   Define                          Financial Targets
                                                                                                                   Total
Sr.   Problem        Activity                                                          Year II         Year III
                                            Unit   Rate     Quantity    Year I                                      Cost
                                                                                       (10 %)          (10 %)
                 Procurement and    Kits          10000      200      1,000,000       550,000         605,000    2,155,000
                  supply of Eliza
                  kits

                 Procurement of     Syringe        150      1,200      90,000         49,500          54,450     193,950
                  syringe cutters    cutter


                 Procurement and    Courses       15,000     200      1,500,000       825,000         907,500    3,232,500
                  distribution of
                  Interferon
                  Injection

                 Documentation of                             -           -              -               -           -
                  expense of
                  disposable
                  syringes

                 Supportive                                   -           -              -               -
                  supervision to
                  ensure above
                  activities

                 Procurement and                    -         -           -              -               -           -
                  distribution of
                  Interferon
                  Injection


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                             Three Years Rolling Plan 2010-2013 District Rahim Yar khan


                                                             Define                            Financial Targets
                                                                                                                                 Total
Sr.     Problem           Activity                                                                 Year II          Year III
                                              Unit           Rate       Quantity    Year I                                        Cost
                                                                                                   (10 %)           (10 %)
                                                               -           -       4,530,000      2,678,500        2,946,350   10,154,850



3     High under     Message on local    Message           70,000        36        840,000        924,000         1,016,400   2,780,400
      5 Mortality     cable


                     BCC of mothers      Number of         16,400        74        656,000        306,680          337,348    1,300,028
                      0n promotion of     Trainings
                      breast feeding
                      and weaning
                      practices through
                      LHWs
                     Provision of the    Assessment   As proposed in      -           -              -                -           -
                      deficient                        MSDS Gaps
                      infrastructure at
                      THQ
                     Trainings on IMCI    No. of      As proposed in      -           -              -                -           -
                                          trainings    Diarrhea




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                         Three Years Rolling Plan 2010-2013 District Rahim Yar khan


                                                        Define                            Financial Targets
                                                                                                                         Total
Sr.   Problem        Activity                                                                 Year II         Year III
                                        Unit            Rate          Quantity   Year I                                  Cost
                                                                                              (10 %)          (10 %)
                 Need assessment    Assessment   Assessing below        -         -             -               -         -
                  of food                         poverty pregnant
                  supplements                     mother through
                                                  LHWs and
                                                  providing them
                                                  food supplement
                                                  through DGHS &
                                                  Financial support
                                                  from Baitul Mal &
                                                  Zakat

                 procurement        Assessment   Assessing below        -         -             -               -         -
                  from DGHs office                poverty pregnant
                                                  mother through
                                                  LHWs and
                                                  providing them
                                                  food supplement
                                                  through DGHS &
                                                  Financial support
                                                  from BaitulMall &
                                                  Zakat




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                         Three Years Rolling Plan 2010-2013 District Rahim Yar khan


                                                         Define                            Financial Targets
                                                                                                                          Total
Sr.   Problem        Activity                                                                  Year II         Year III
                                         Unit            Rate          Quantity   Year I                                  Cost
                                                                                               (10 %)          (10 %)
                 Distribution of     Assessment   Assessing below        -         -             -               -         -
                  food supplements                 poverty pregnant
                  to mothers &                     mother through
                  children through                 LHWs and
                  LHWs &                           providing them
                  community mid                    food supplement
                  wives                            through DGHS &
                                                   Financial support
                                                   from BaitulMall &
                                                   Zakat

                 Raising income of   Assessment   Assessing below        -         -             -               -         -
                  the poor families                poverty pregnant
                  through Baitul                   mother through
                  Mall and Zakat                   LHWs and
                                                   providing them
                                                   food supplement
                                                   through DGHS &
                                                   Financial support
                                                   from BaitulMall &
                                                   Zakat

                 Revising the                                            -         -             -               -         -
                  micro plans of
                  Vaccinators



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                           Three Years Rolling Plan 2010-2013 District Rahim Yar khan


                                                         Define                               Financial Targets
                                                                                                                                Total
Sr.    Problem         Activity                                                                   Year II          Year III
                                           Unit          Rate          Quantity    Year I                                       Cost
                                                                                                  (10 %)           (10 %)
                                                                                  1,496,000      1,230,680        1,353,748   4,080,428



4     High MMR    Messages on local   Message          70,000           36        840,000        924,000         1,016,400   2,780,400
                   cable network


                  Printing and        Brochure            4           100000      200,000        132,000          96,800      428,800
                   distribution of
                   IPC material
                  Training of LHWs     No. of     Costed in High         -           -              -                -           -
                   on BCC              trainings   under 5 M


                  Procurement of                  Costed in service      -           -              -                -           -
                   vehicles for                    delivery problems
                   transportation
                   through CCBs
                  Operation and                   Costed in service      -           -              -                -           -
                   management of                   delivery problems
                   vehicles through
                   CCBs




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                         Three Years Rolling Plan 2010-2013 District Rahim Yar khan


                                                      Define                             Financial Targets
                                                                                                                         Total
Sr.   Problem        Activity                                                                Year II         Year III
                                         Unit         Rate          Quantity   Year I                                    Cost
                                                                                             (10 %)          (10 %)
                 Repair of non                 Costed in service      -          -             -               -          -
                  functional                    delivery problems
                  ambulances for
                  timely
                  transportation of
                  pregnant mothers
                 Replacement of                Costed in service      -          -             -               -          -
                  the non                       delivery problems
                  functional
                  ambulances for
                  timely
                  transportation of
                  pregnant mother
                 Procurement of                Costed in service      -          -             -               -          -
                  the MNCH related              delivery problems
                  equipment and
                  Instruments
                 Implementation                Costed in MSDS         -          -             -               -          -
                  of the referrals              Gaps
                  protocols
                 Procurement of      Packs             2           300000     300,000       165,000         181,500    646,500
                  Micro-nutrients




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                          Three Years Rolling Plan 2010-2013 District Rahim Yar khan


                                                             Define                             Financial Targets
                                                                                                                                  Total
Sr.    Problem        Activity                                                                      Year II          Year III
                                          Unit               Rate        Quantity    Year I                                       Cost
                                                                                                    (10 %)           (10 %)
                  Procurement and    No. of tablets          1          200000      100,000        55,000           60,500      215,500
                   distribution of
                   Calci-D
                  Procurement and    Injection              5000          30        50,000         55,000           60,500      165,500
                   distribution of
                   Anti-D
                                                                                    1,490,000      1,331,000        1,415,700   4,236,700



5     Diabetes    Message on local   Message               70,000         12        280,000        308,000          280,000     868,000
      Mellitus     cable



                  Message on FM      Message               28000          12        112,000        123,200          112,000     347,200
                   Radio


                  Awareness                           Lump sum             3        250,000        250,000          250,000     750,000
                   walk/Banners/S
                   eminars/Poster

                  Screening Camps                     At THQH level        -           -              -                -           -
                   for high risk                       Screening camps
                   population                          with the help
                                                       donor Agencies


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                             Three Years Rolling Plan 2010-2013 District Rahim Yar khan


                                                            Define                          Financial Targets
                                                                                                                             Total
Sr.    Problem           Activity                                                               Year II         Year III
                                            Unit            Rate       Quantity    Year I                                    Cost
                                                                                                (10 %)          (10 %)
                                                                                  642,000      681,200          642,000    1,965,200



6                    Messages on                          70,000        12       280,000       308,000         338,800     926,800
      TB Suspects
                      local cable        Message
                      networks

                     Printing and                            6         75000     150,000       150,000         150,000     450,000
                      distribution of    Brochure
                      IPC material

                     Procurement of                  To be procured     600         -             -               -           -
                      drugs to ensure                 from the PTP
                      deficiency         ATT course
                      according to
                      regimen

                     Procurement of                  To be procured     50          -             -               -           -
                      reagents for                    from the PTP
                      notified
                      diagnostic         Packs
                      facilities under
                      DOTS
                      programme




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                              Three Years Rolling Plan 2010-2013 District Rahim Yar khan


                                                            Define                               Financial Targets
                                                                                                                                   Total
Sr.     Problem           Activity                                                                   Year II          Year III
                                              Unit          Rate          Quantity    Year I                                       Cost
                                                                                                     (10 %)           (10 %)
                     Trainings on         No. of          136400           14        818,400        600,160          660,176    2,078,736
                      DOTS protocols      trainings

                                                                                     1,248,400      1,058,160        1,148,976   3,455,536



7     Acute          Messages on local   Message          70,000           12        280,000        308,000          338,800     926,800
      (upper)         cable networks
      respiratory
      infections


                     Messages through    Message          28,000           12        112,000        123,200          135,520     370,720
                      FM radio
                      channels
                     Printing and        Brochure            5           300,000     500,000        550,000          605,000    1,655,000
                      distribution of
                      IPC material
                     Training of          No. of     IMCI Training          -           -              -                -           -
                      medics and para-    trainings   package costed in
                      medics in IMCI                  Diarrhea also
                                                      includes
                                                      management of
                                                      ARI



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                             Three Years Rolling Plan 2010-2013 District Rahim Yar khan


                                                              Define                                Financial Targets
                                                                                                                                      Total
Sr.    Problem           Activity                                                                       Year II          Year III
                                             Unit             Rate           Quantity    Year I                                       Cost
                                                                                                        (10 %)           (10 %)
                    Procurement and      Antibiotic            20           150,000    1,000,000      1,100,000        1,210,000   3,310,000
                     distribution of     (Syrup)
                     Antibiotic Syrup
                     Amoxycillin
                                                                -               -       1,892,000      2,081,200        2,289,320   6,262,520



8     Anemia (      Messages on local   Message             70,000             -        280,000        308,000          338,800     926,800
      including      cable network
      pregnancy)

                    Printing and        Brochure               5                        250,000        275,000          302,500     827,500
                     distribution of
                     IPC material
                    Counseling of       Session        LHWs are                -           -              -                -           -
                     pregnant mothers                   expected to
                                                        conduct
                                                        counseling session
                                                        on behavior
                                                        change during
                                                        their visit to
                                                        pregnant ladies

                    Procurement of      No. of doses           25              -       2,500,000      2,750,000        3,025,000   8,275,000
                     de-worming
                     tablets
                                                                                                                                                80
                         Three Years Rolling Plan 2010-2013 District Rahim Yar khan


                                                         Define                               Financial Targets
                                                                                                                                Total
Sr.   Problem         Activity                                                                    Year II          Year III
                                           Unit          Rate          Quantity    Year I                                        Cost
                                                                                                  (10 %)           (10 %)
                 Distribution                                            -           -              -                -
                  through LHWs
                  and health
                  facilities
                 Refresher             No. of     IMCI Training          -           -              -                -           -
                  Trainings of         trainings   package costed in
                  LHWs on BCC,                     Diarrhea also
                  balanced diet and                includes
                  provision of                     management of
                  micro-nutrients                  ARI

                 Provision of Sehat                                      -           -              -                -           -
                  Sahulat
                  Card/health
                  voucher
                                                                                  3,030,000      3,333,000        3,666,300   10,029,300




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                    Three Years Rolling Plan 2010-2013 District Rahim Yar khan




                           Problem wise cost summary of Management Problems


                                                                 2010-2011      2011-2012      2012-2013
Sr. No.                         Problems                                                                     Total Cost Rs.
                                                                Amount (Rs.)   Amount (Rs.)   Amount (Rs.)
  1       Human Resource Plan (Sanction of Posts against MSDS    4,182,648       8,869,252     13,565,673     26,617,573
          Gaps)


  2       POL                                                    19,829,000          -              -         19,829,000



  3       Delays in Release of Fund                               102,600        102,600        102,600        307,800



  4       MNCH Related Equipment                                 66,827,685          -              -         66,827,685



          Total                                                  90,941,933      8,971,852     13,668,273    113,582,058




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                                         Three Years Rolling Plan 2010-2013 District Rahim Yar khan


        b) Management Problems
      Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned Posts


                                                                                                                 Financial Targets

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

1     Gynaecologist     18     12,910     18,099          0            -          -           -           -                          -          -                          -


2     Paediatricians    18     12,910     18,099          3        154,920        -       217,188     340,824                   477,814     562,360                  788,392


3     Anesthetists      18     12,910     18,099          5        309,840        -       434,376     681,648                   955,627     937,266                  1,313,987


4     MO / WMO          17     9,850      15,345          7        354,600        -       552,420     650,100                  1,012,770    1,001,154                1,559,666


5     Nurses            16     6,060      8,934          22        581,760        -       857,664     1,279,872                1,886,861    1,935,806                2,853,877


6     Lady Health       9      3,820      4,750          21                    320,880    399,000                  705,936      877,800                 1,164,794    1,448,370
      Visitors

                                                                   1,401,120   320,880    2,460,648   2,952,444     705,936     5,210,872   4,436,586   1,164,794    7,964,293



                                                                                                                                                                      83
                                   Three Years Rolling Plan 2010-2013 District Rahim Yar khan


                                                                 Define                       Financial Targets
                                                                                                                             Total
Sr.       Problem              Activity
                                                                                                   Year II        Year III   Cost
                                                          Unit   Rate     Quantity   Year I
                                                                                                   (10 %)         (10 %)
1     Shortage of      Temporary Filling of the   Recruitment    -          -         -              -              -         -
      skilled staff     vacant posts of medics
                        and the paramedics
                        through existing
                        recruitment committees
                       Demand generation and      Plan           -          -         -              -              -         -
                        request to the
                        Department of Health
                        by the districts for
                        recruitment through
                        PSC against vacant posts
                       Districts to prepare the   Pay Package    -          -         -              -              -         -
                        incentivized pay
                        package with
                        consultation of all
                        stockholders

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



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             Three Years Rolling Plan 2010-2013 District Rahim Yar khan


 Request to the              Plan          -   -        -        -       -   -
  Provincial Government
  for approval and
  implementation of
  agreed pay packages
 Review and revise the       TA            -   -        -        -       -   -
  career structure of
  medics, paramedics and
  technical staff like Sos,
  Health Education
  officers etc
 Availability of             Plan EDOH     -   -        -        -       -   -
  recreation, education
  and other facilities for
  children of staff
  working in rural areas
 Construction of the         Requirement   -   -        -        -       -   -
  residences for the staff    Plan


 provision of recreation     Plan EDOH     -   -        -        -       -   -
  facilities (Parks/Play
  area/common rooms)
 Provision of the            Plan EDOH     -   -        -        -       -   -
  transport of staff
  children for the
  education purposes




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                                Three Years Rolling Plan 2010-2013 District Rahim Yar khan


                     Capacity and need        TNA           -        -          -          -        -          -
                      assessment of the
                      medics and the
                      paramedics
                     Prepare training         Plan          -        -          -          -        -          -
                      programs for providing
                      higher professional
                      education based on TNA
2    Inadequate      Assessing additional                   -        -          -          -        -          -
    budget for        need for POL
    POL


                     Costing & Submission     POL          75     264,387   19,829,000                     19,829,000
                      the additional Demand
                      for POL
                                                             -        -      19,829,000     -        -      19,829,000

                                                                                 -                              -

3   Capacity         Conducting Financial     No. of      39000     3        39,000      39,000   39,000    117,000
    issues of the     Management               trainings
    staff             workshops



                     Conducting supportive    No. of      31800     3        31,800      31,800   31,800    95,400
                      supervision training     trainings
                      workshops




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                                   Three Years Rolling Plan 2010-2013 District Rahim Yar khan


                       Conduction workshops       No. of      31800   3      31,800     31,800    31,800      95,400
                        on Use of information      trainings


                                                                             102,600     102,600   102,600    307,800



4   Deficient          Purchase of MNCH           Equipment                66,827,685                       66,827,685
    equipment for       related equipment at all
    MNCH                THQHs
    services at
    secondary
    care facilities




                                                                            66,827,685                       66,827,685




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        Three Years Rolling Plan 2010-2013 District Rahim Yar khan


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

       Budget Summary
                                          2010-2011               2011-2012               2012-2013

         Regular district budget            735,210,840             813,496,309             894,845,940

         Additional budget based
         on problem                         111,510,733               25,451,872              31,504,575
         identification

         Total                              846,721,573             838,948,181             926,350,515




                                                                                                        88
        Three Years Rolling Plan 2010-2013 District Rahim Yar khan



SECTION 5: MONITORING & EVALUATION

The monitoring and evaluation targets and indicators mentioned below will be used to gauge the
progress of implementation of the plan. Monitoring and evaluation of the three years rolling plan would
be carried out through the proposed indicators, targets and means of verifications, by the district health
authorities.




M&E of Plan

       Indicators            Target           %                MoV            Responsibility     Frequency    Remarks
                                         Achievement                                                 of
                                                                                                 monitoring

% of planned                50 visits                      Inspection         EDOH/DOH/         Quarterly
supervisory visits           /year                      Book/Attendance       DDOH/Dist.
conducted                                                   register          Monitoring
                                                                              officer

% of RHCs with               100%                      Movement               EDOH / DOH        Quarterly
availability of services                               register/visit
(on rotational basis) of   During 1st                  book/Attendance
essential specialties        year                      register
(Physician, Surgeon,
Paediatrician and
Gynaecologist)

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

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




                                                                                                       89
        Three Years Rolling Plan 2010-2013 District Rahim Yar khan


       Indicators              Target           %               MoV            Responsibility      Frequency    Remarks
                                           Achievement                                                 of
                                                                                                   monitoring

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

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

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

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

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

% of facilities with         100% in 3                   Supervisory      visit EDOH/DoH/         Quarterly
availability of separate    years (50%                   report                 DDOH
or partitioned room          during 1st
reserved exclusively           year)
for delivery

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

% of targeted pregnant         Target                    DHIS Report           EDOH/ DHIS Quarterly
women received TT-2         according to                                       Coordinator/
vaccine                      population                                        Statistical
                                                                               Officer




                                                                                                         90
       Three Years Rolling Plan 2010-2013 District Rahim Yar khan


       Indicators           Target           %                 MoV       Responsibility   Frequency    Remarks
                                        Achievement                                           of
                                                                                          monitoring

Delivery conducted by       60 %                      DHIS Report        EDOH/ DHIS Quarterly
or under supervision      During 1st                                     Coordinator/
of skilled persons          year                                         Statistical
reported                                                                 Officer

%of target children         Target                    DHIS Report        EDOH/ DHIS Quarterly
between 18 - 23          according to                                    Coordinator/
months of age fully       population                                     Statistical
immunized                                                                Officer

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

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

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




                                                                                                91
  Three Years Rolling Plan 2010-2013 District Rahim Yar khan




                                                                   Annex-I
Private Health Facilities in District Rahim Yar
                     Khan


 Sr. No.   Name of Hospital/Clinic-Address

    1.     Ali Clinic, Baba Gharib Shah

    2.     Tariq Sir-jee Centre, Adda Khanpur RYKhan

    3.     Jamila Welfare Eye Hosp: Adda Khanpur (RYKhan)

    4.     Kamran Clinic, Iqbal Nagar

    5.     Tariq Hospital, Iqbal Nagar

    6.     Ahmed Hassan Dentist Care

    7.     Talha Clinic Iqbal Nagar

    8.     Barkat Hospital, Iqbal Nagar

    9.     Hazifa Clinic, Iqbal Nagar

   10.     Qureshi Medical Store, Iqbal Nagar

   11.     Al-Aziz Medical Store, -do-

   12.     Abu-Hafeeza Dental Clinic, Adda Khanpur (RYKhan)

   13.     Al-Shahab Dental Clinic, Khanpur Road, Near P/S Sadar

   14.     Chishtee Homeo Clinic, KNP: Road

   15.     Ismail Shafa Khana, Near P/S Sadar

   16.     Darul-Sehat, Near, P/S Sadar



                                                                        92
 Three Years Rolling Plan 2010-2013 District Rahim Yar khan


Sr. No.   Name of Hospital/Clinic-Address

  17.     Darul-Shafa, Clinic,(Dental)-do-

  18.     Al-Saeed general Clinic, Gulshan Iqbal, Rahimyarkhan

  19.     Fatima Clinic, Gulshan Iqbal

  20.     Mian Jee, Homeo Clinic, --do-

  21.     Hassan Homeo Clinic, Iqbal Nagar

  22.     Safeer Homeo Clinic, -do-

  23.     Gosha-e-Tibb, -do-

  24.     Al-Khalil Clinic, Ittihad Clinic

  25.     Al-Hayyat Hospital, Hosp:Road,RYK

  26.     Sajid Surgical Hosp: -do-

  27.     Hafeez Eye Hosp: -do-

  28.     Abdullah Surgical Hosp: -do-

  29.     Shahzad Qadri Hosp: -do-

  30.     Hamza Medi-Care         -do-

  31.     Masood E.N.T clinic,     -do-

  32.     Dr. Babar Clinic,        -do-

  33.     Darshani Clinic         -do-

  34.     Al-shafa. Phsio Theraphy Clinic Hospital, Road, Rahimyarkhan

  35.     Usman Children Hosp: -d-

  36.     Al-Noor Hospital, -do-

  37.     Zaka Clinic,     -do-

  38.     Niaz Clinic, Near City Park

  39.     Dr,Major Barkat Clinic, Hosp:Road

  40.     Dr. Mukhtar Clinic, City Park

  41.     Faiz Eye Hosp:       -do-


                                                                         93
 Three Years Rolling Plan 2010-2013 District Rahim Yar khan


Sr. No.   Name of Hospital/Clinic-Address

  42.     Ayasha Clinic, Model Town, RYK

  43.     Al-Karam Hospital, -do-

  44.     Sana Clinic,     -do-

  45.     Sirajia Darul Shafa, Fire brigade Road

  46.     Chaudhery Clinic, School Bazar

  47.     Khalid Homeo Clinic, Hosp: Road

  48.     Hayyat Homeo Store, -do-

  49.     Hakeem Muhammad Ashraf –do-

  50.     Aiman Hosp: Hosp: Road, RYK

  51.     Imran Clinic, -do-

  52.     Azam Clinic, -do-

  53.     Dr. Navid Rehmat, Dental Clinic

  54.     Al-Shafa & National Hosp: -do-

  55.     Navid Clinic, Abu Dhabi Road,RYK

  56.     Zainab Clinic, Jail Road, RYK

  57.     Hamdani Hosp: Abu Dahbi Road

  58.     Bhukhari Hospital, -do-

  59.     Ahmed Clinic,        -do-

  60.     Umer Hospital,       -do-

  61.     Tariq Clinic, Habib Colony

  62.     Imtiaz Clinic, Jugnuo Clinic

  63.     Ebad Clinic, -do-

  64.     Dr. Irshad-Ul-Haq, Clinci -do-

  65.     Naqash Homeo Clinic, Jinnah Park.

  66.     Dr. Perveez Clinic, Abu Dhabi Road


                                                              94
 Three Years Rolling Plan 2010-2013 District Rahim Yar khan


Sr. No.   Name of Hospital/Clinic-Address

  67.     Dr.Shahid Naeem, Abu Dhabi Road.

  68.     Rehman Homeo Clinic -do-

  69.     Fauji Dental Clinci,     -do-

  70.     Al-Ayisha Dental complex –do-

  71.     Usman Clinic,             -do-

  72.     Ali Raza Unani, Disp: -do-

  73.     Jabbar Hameed, Homeo Clinic,Sadiq Town.

  74.     Iftikhar Homeo clinic, -do-

  75.     Ali Clinic             -do-

  76.     Dr.Muhammad Tariq Sabir –do-

  77.     Al-Saeed Clinic, Satellite town

  78.     Nasir Hospital Adda Gulmerg

  79.     Dr. Ijaz Cheema Hafiz Colony Chowk

  80.     Dr. Iftikhar Khan Homeo Sakhi Sarwar Colony.

  81.     Dr. Bilal Ahmed Basti Elam Din

  82.     Dr. Muhammad Ashraf Jinnah Hosp:

  83.     Dr. Ghulam Rabbani Adda Gulmerg

  84.     Dr. Ansir Jameel Hassan Colony

  85.     Dr. Sajida Perveen Hassan Colony

  86.     Dr. Abdul Jabbar Homeio Dastgir Colony

  87.     Dr. Khadim Hussain Saeedi -Do-

  88.     Sheikh Mujeeb Ahsan Hospital Warless Pull RYKhan

  89.     Tehseen Hospital        -do-

  90.     Salman Hospital Usman Park RYK

  91.     Maryyam Maternity Hospital -do-


                                                              95
 Three Years Rolling Plan 2010-2013 District Rahim Yar khan


Sr. No.   Name of Hospital/Clinic-Address

  92.     Nishtar General Hospital RYK

  93.     Amina Clinic Circular Road RYK

  94.     Arif homeopathic Akbar Road RYK

  95.     Darul Shifa Muhallah Saddat

  96.     Kamran Clinic Muhallah Kanjoan

  97.     Asia Homeopathic Clinic & Store Bano Bazar

  98.     Tamour Homeo Clinic & Store -do-

  99.     Al-Khalid Homeo Clinic store, -do-

 100.     Muhammad Nazir Muslim Homeo store, -do-

 101.     Tahir Homeo Store,            -do-

 102.     Mansoor Clinic and Maternity Home

 103.     Usmania Surgico Diagnostic -doi-

 104.     Sirajia Dawakhana, Spay Bazar

 105.     Jadeed Shafakhana      -do-

 106.     Al-Habib Shafa Khana, Shopping cente.

 107.     Daud Homeo Clinic, Railway Road

 108.     Awami Hospital, Railway Road,

 109.     Al-Shafa Homeo Clinic, Bano Bazar

 110.     Matab Tib-Ul-Arab, Bano Bazar

 111.     Super Homeo Store, -do-

 112.     B.J Homeo Store,     -do-

 113.     Matab Sh: Nasee-ud-Din Sadar Bazar

 114.     Zia Dental Clinic.Railway Raod

 115.     Ghouri Dental Clinic   -do-

 116.     Javid Dental Clinc     -do-


                                                              96
 Three Years Rolling Plan 2010-2013 District Rahim Yar khan


Sr. No.   Name of Hospital/Clinic-Address

 117.     Hassan Amjad, Dentist

 118.     National clinic, Airport Road

 119.     Paracha Clinic, -do-

 120.     Hamza Clinic        -do-

 121.     Maqsood Medicose & Hom: Clinic –do-

 122.     Hamid Medicose, Airport Road,

 123.     Waseem Dental Clinic,             -do-

 124.     Naeem Homeo Clinic                -do-

 125.     Waheed Medicose, Akbar Road

 126.     Aslam Clinic,Main Road, Noor e wali

 127.     Javid Clinic,              -do-

 128.     Al-madina Homeo Clinic, -do-

 129.     Azam Medicose               -do-

 130.     Hamid Medicose,             -do-

 131.     Wajid Clinic, Tibbi Laran

 132.     Shah Naqshband Clinic, Chak 72/NP

 133.     Al-Masoom Shahpur Road, -do-

 134.     Dr.Masood Jahangir                 -do-

 135.     Dr. Akhtar Bilal                  -do-

 136.     Unani Dawakhana,                  -do-

 137.     Al-Aziz Hospital,                 -do-

 138.     Punjab Medicose, Noor e wali

 139.     Dr.Abid Hussain Qadri, Shahbazpur Road

 140.     Al-Rehmat Children Hosp: -do-

 141.     Tahir Clinic, Chowk Pathanistan,


                                                              97
 Three Years Rolling Plan 2010-2013 District Rahim Yar khan


Sr. No.   Name of Hospital/Clinic-Address

 142.     Muslim Homeo Clinic, -do-

 143.     Al-Riaz Homeo Clinic          -do-

 144.     Awaisia Shafa Khana,          -do-

 145.     Zaki Children Hosp:

 146.     China Dental Clinic,          -do-

 147.     Faisal Clinic, Gulshan Usman

 148.     Azhar Homeo clinic Kacha Sadiqabad Road

 149.     Aiysha Maternity Hosp: -do-

 150.     Amina Clinia, Islamia colony

 151.     Al-Ebad,Clinic Noor-e-Wali

 152.     First Aid Medical, Lever estate

 153.     Factory Sir-jee, Lever Hosp:

 154.     Ferozai Shafa Khana, Pathanistan, Chowk.

 155.     Al-Azhari, Clinic,Lever marriage Halll

 156.     Al-Falah Hospital, Mud Darbari

 157.     Al-Khalid Hosp: Shahbaz pur Road

 158.     Majid Hospital,        -do-

 159.     Rehmat Hospital, Bheel Nagar

 160.     Shahzad Clinic,   -do-

 161.     Ikram Children Hosp: Thalli Chowk

 162.     Rehman Children Hosp: -do-

 163.     Barkat Clinic,                -do-

 164.     Ali Clinic, Tareen Colony

 165.     Tareen Clinic             -do-

 166.     Najam Clinic, Railway Road,


                                                              98
 Three Years Rolling Plan 2010-2013 District Rahim Yar khan


Sr. No.   Name of Hospital/Clinic-Address

 167.     Afzal Clinic. Shahi Road,

 168.     Shahzad Clinic, Shahi Road

 169.     Ahmed Clinic     -do-

 170.     Dr. Shabbir Clinic, School Bazar

 171.     Dr. Shakeel Homeo Wahi Shah Mohd:

 172.     Rafahi Dispensar, Dr. Abdul Razzaq

 173.     Dr. Javid Iqbal Anjum Taj Garh Road

 174.     Farooq Ahmed,. Homeo Head Amingarh

 175.     Malik Ijaz, Homeo Clinic -do-

 176.     Rashid Minhas -do- Gharib Shah

 177.     Abdul Sattar Hakeem -do-

 178.     Ghulam Yasin, Homeo Wahi Rahim

 179.     Dr. Abdullah Adda Chak Abbas

 180.     Qadira Clinic Baba Gharib Shah

 181.     Homeo Dr. Mumtaz Ahmed

 182.     Homeo Dr. M. Arshad Kamboo

 183.     Homeo Dr. M. Ashraf Bagga Chowk

 184.     Dr. Cop:Abdul Rauf Chowk Bahadar

 185.     Hakeem Sy: Zulfiqar Ali Shah

 186.     Lady Dr. Naseem Akhtar F.P.Punjab

 187.     Dr. Jamal Anwar Iqbalabad

 188.     Dr. Ali Raza Zaidi Taj Garh

 189.     Dr. Fateh Muhammad

 190.     Hakeem Faiz Ullah

 191.     Dr. Muhammad Tahir Akram


                                                              99
 Three Years Rolling Plan 2010-2013 District Rahim Yar khan


Sr. No.   Name of Hospital/Clinic-Address

 192.     Dr. Naseem Akhtar

 193.     Dr. Mazhar Faiz

 194.     Dr. Ghulam Rasul

 195.     Dr. Khalid Javid Kot samaba Road

 196.     Dr. Hakeem Muhammad Din,Rajanpur Kalan

 197.     Hakeem Muhammad Iqbal -do-

 198.     Abdul Hafeez, Homeo Clinic –do-

 199.     Khalid Majeed, -do-           -do-

 200.     Hakeem Masood,                -do-

 201.     Hakeem Ishfaq, Qaisar Chohan

 202.     Dr.Abdul Hameed Raja, Adda Sh:Wahn.

 203.     Dr. Muhammad Wasim            -do-

 204.     Hakeem Ilahi Bux Bhutta Kot

 205.     Dr.Muhammad Saleem, Bhugwela

 206.     Dr.Sarfraz Homeo, Abadpur

 207.     Dr. Atta Muhammad, Pul Girri

 208.     Dr. Malik Irshad, Pul Girri

 209.     Hakeem Manzoor Ahmed, Palu Shah

 210.     Dr.Tariq Mehmood, Manthar

 211.     Dr. Ghulam Ali Mahar

 212.     Dr.Muhammad Imran –do-

 213.     Hakeem Abdul Rasheed -do-

 214.     Dr.Muhammad Arif, Homeo,Metla Wali.

 215.     Dr.Muhammad Akram, Homeo, 112/P

 216.     Dr.Muhammad Akram , 249/P


                                                              100
 Three Years Rolling Plan 2010-2013 District Rahim Yar khan


Sr. No.   Name of Hospital/Clinic-Address

 217.     Kazmi Clinic, Pul Palace

 218.     Al-Shahfa Clinic, Pul Sunni

 219.     Zafar Clinic,     -do-

 220.     Mehboob Clinic, Pul Palace

 221.     Awami Hospital,     -do-

 222.     Pervaiz Clinic, Chak No.52/P

 223.     Arshad Clinic, Chak No.51/P

 224.     Dr. Zafar Sattar, Pul Suuni

 225.     Dr. Aslam Pervaiz, -do-

 226.     Dr.Muhammad Shahid -do-

 227.     Boota Dental Clinic, Chak No.100/P

 228.     Dr. Abdul Kareem, Chak No.99/P

 229.     Bashir Hospital, Chak No.87/P

 230.     Adnan Qadeer, Homeo, Basti Kahoor

 231.     Dr.Nisar Ahmed, Homeo –do-

 232.     Dr. Shaukat Ali, Homeo 103/P

 233.      Dr.Saeed Ahmed, Homeo, -do-

 234.     Dr.Asmat Kazmi, Pul Palace

 235.     Ab-e-Hayyat Hosp: -do-

 236.     Dr.Muhammad Amin, Homeo, 91/P

 237.     Dr.Muhammad Tariq, Homeo, 88/P

 238.     Dr.Muhammad Aslam, Homeo 89/P

 239.     Dr.Muhammad Sadiq, Homeo 106/P

 240.     Dr. Khalid, Mueenabad, Jetha Bhutta

 241.     Shaukat Homeo Clinic, Chachran Road.


                                                              101
 Three Years Rolling Plan 2010-2013 District Rahim Yar khan


Sr. No.   Name of Hospital/Clinic-Address

 242.     Shamim Homeo Clinic -do-

 243.     Musa Clinic, Bismillah colony

 244.     Al-Wazir Hosp:, Chowk Z.Peer

 245.     Dr. Mansha Clinic -do-

 246.     Dr. Zia Ullah Jatoi -do-

 247.     Dr. Zia Ul-Hassan Khan -do-

 248.     Dr. Sharif Clinic, Chachran Road

 249.     Dr. Rubina Akhtar, Chowk Z.Peer

 250.     Shafa Clinic,         -do-

 251.     Abdul Kareem Clinic -do-

 252.     Ahmadani Clinic        -do-

 253.     Dr. Abdul Jabbar, N.Kot

 254.     Ikram Clinic, Sehja Adda

 255.     Usman Clinic

 256.     Usman Clinic, Dr.Najeeb Alam

 257.     Joya Homeo Clinic, Chowk Azim Shah.

 258.     Hassan Clinic, Bagho-o-Bahar

 259.     Ikhlaq Clinic,   -do-

 260.     Shafaq Homeo Clinic, -do-

 261.     Tayyab Clinic, Chak No.45/P

 262.     Mubarik Homeo Clinic -do-

 263.     Ramzan Clinic, Chachran Sharif

 264.     Ashraf Clinic, Fateh pur kamal

 265.     Decent Medicose, -do-

 266.     Abbasi Clinic, -do-


                                                              102
    Three Years Rolling Plan 2010-2013 District Rahim Yar khan


   Sr. No.             Name of Hospital/Clinic-Address

    267.               Murad Dawakhana, Kotla Pathan

    268.               Al-Siraj Hospital, Khanpur




                                                             Annex II
  Costing of MNCH related equipment gaps for DHQ and THQ Hospitals

Sr. No.                          Equipment               Gap       Unit cost   Total cost

      1      CTG (Cardiac Tocography)                          2                  570,000
                                                                     285,000
      2      Foetal Doppler                                    6                   60,000
                                                                      10,000
      3      Diagnostic Laparoscope                            3                3,600,000
                                                                   1,200,000
      4      Bulb Sucker                                   10             45          450
      5      Baby Warmer                                       4                3,400,000
                                                                     850,000
      6      Mechanical Sucker                                 9                  252,000
                                                                      28,000
      7      Fetal Stethoscope                                 3                    4,500
                                                                       1,500
      8      Delivery Table                                    2                   35,000
                                                                      17,500
      9      D&C Set                                           3                    6,300
                                                                       2,100
    10       Outlet forceps                                10            900        9,000
    11       Myoma Screw                                       6         320        1,920
    12       Kochers forceps                               10            235        2,350
    13       Volselum forceps                              10            235        2,350
    14       Lanes Tissue holding forceps                      6         400        2,400
    15       Vaginal Retractors                            10            350        3,500
    16       Polypectomy forceps                               6         750        4,500
    17       Sponge holder                                 20            300        6,000
    18       Uterine elevator                                  3         150          450
    19       CosCo Speculum                                18            550        9,900
             Small, Medium, Large (for each category)                                   -
    20       Examination light                                 3                   54,000
                                                                      18,000
    21       Suction Curette                                   3          95          285

                                                                                            103
    Three Years Rolling Plan 2010-2013 District Rahim Yar khan



Sr. No.                       Equipment                     Gap       Unit cost   Total cost

    22     Infant Resuscitation Trolley (with life saving         3                  285,000
          medicines, baby laryngoscope, Endo-tracheal                    95,000
          tube, Infant BP Apparatus, Chargeable Light)
    23    Mother Resuscitation Trolley (with life saving          3                  330,000
          medicines, Laryngoscope, Endo-tracheal tube,                  110,000
          BP Apparatus, Chargeable light)
    24    Cardiac Monitor                                     -                                -
                                                                        500,000
    25    Pump Breast Electronic                                  3                  750,000
                                                                        250,000
    26    Vaginal Hysterectomy Set                                                             -
    26    Toothed Tissue Forceps (8”)                             5          55          275
    26    Non-Tooted Tissue Forceps (8”)                          5          55          275
    26    Dissection Scissors (Curved 7”)                         5         150          750
    26    Dissection Scissors (Straight 7”)                       4         150          600
    27    Hysterectomy Clamps (Straight)                          6         150          900
    27    Hysterectomy Clamps (Curved)                            6         175        1,050
    27    Uterine Sound                                           3          90          270
    27    Needle Holder (7”)                                      6         150          900
    27    Needle Holder (10”)                                     6         300        1,800
    26    Artery Forceps (Straight 6”)                        30            110        3,300
    26    Artery Forceps (Curved 6”)                          30            125        3,750
    26    Allis Forceps                                       20            230        4,600
    26    Towel Clamps                                        18            125        2,250
    26    Single blade Sims speculum                          10            275        2,750
    26    Double blade Sims speculum                          10            250        2,500
    26    Sponge holding forceps                              15            200        3,000
    26    Volselum forceps                                    10            250        2,500
    26    Uterine Sound                                           3                    4,500
                                                                          1,500
    26    Bladder Sound                                           6                    9,000
                                                                          1,500
    27    Delivery Sets                                                                        -
    27    Episiotomy Scissors                                 15            125        1,875
    27    Straight Scissors                                   15            360        5,400
    27    Needle holder                                       -             135                -
    27    Non-toothed tissue forceps 8 inches                 15            100        1,500
    28    Toothed tissue forceps 8 inches                     15            100        1,500
    28    Sims Speculum single blade                          30            275        8,250
    28    Sims Speculum double blade                          30            250        7,500
                                                                                               104
    Three Years Rolling Plan 2010-2013 District Rahim Yar khan



Sr. No.                      Equipment                  Gap       Unit cost       Total cost

    28    Sponge holding forceps                          80            250           20,000
    28    Artery forceps                                  80            275           22,000
    27    Straight clamps (cord)                          80            175           14,000
    27    Vacuum Extractor pump                               3                       57,000
                                                                     19,000
    27    Towel clip                                      -               -                    -
    28    Caesarian Section                                                                    -
    28    Scalpel                                         10             50              500
    28    Artery Forceps Straight 6 inches                15            125            1,875
    28    Artery Forceps Curved 6 inches                  30            125            3,750
    28    Artery forceps 8 inches                         30            175            5,250
    29    Myoma Scissors straight 7 inches                10            150            1,500
    29    Dissecting scissors (curved) 7 inches           10            270            2,700
    29    Green Armtage forceps 8 inches                  30            300            9,000
    29    Obstetric outlet forceps (pair)                 10            900            9,000
    29    Doyene’s Retractor                              10            200            2,000
    28    Small Retractors                                15            300            4,500
    28    Towel Clippers                                  -                   -                -
    28    Suction Nozzle                                  10            250            2,500
    29    MNCH Related Radiology Equipments                                                    -
    29    Ultrasound Machine                              -                                    -
                                                                    575,000
    29    X-Ray Unit 500 kw                                   2                   12,000,000
                                                                  6,000,000
    29    Color Doppler                                   -               -                    -
    29    Lead Screen for X-Ray Unit                          3                       90,000
                                                                     30,000
    30    0.5 MN Lead Apron. Lead Gloves, Goggles and         3                      300,000
          Thyroid and Gonadal Sheets                                100,000
    30    Safe Light                                          3                       15,000
                                                                      5,000
    30    X-RT Film Processing Tank                           3                       15,000
                                                                      5,000
    30    Chest Stand                                         3                       13,500
                                                                      4,500
    30    X-Ray film Illuminator                              6                       24,000
                                                                      4,000
    29    X-Ray Film Hangers All sizes                    10                          40,000
                                                                      4,000
    30    MNCH Related Pediatrics Equipments                                                   -
    30    Pediatric Ventilator                                3                    3,600,000
                                                                  1,200,000
                                                                                               105
    Three Years Rolling Plan 2010-2013 District Rahim Yar khan



Sr. No.                      Equipment                    Gap       Unit cost   Total cost

    30    Incubator                                         -                                -
                                                                    1,500,000
    30    Photo Therapy Unit                                    2                   44,000
                                                                       22,000
    30    Over-head Radiant Warmer                              3                2,730,000
                                                                      910,000
    31    Infant Length Measuring Scale                         6                   30,000
                                                                        5,000
    31    Infant Weighing Machine                               5                   15,500
                                                                        3,100
    31    Nebulizer                                             3                   66,000
                                                                       22,000
    31    Billiubino-meter                                      3                  108,000
                                                                       36,000
    31    Exchange Blood Transfusion Set                        3                    6,000
                                                                        2,000
    30    Nasal Probe Paed size                                 6                   42,000
                                                                        7,000
    31    Anesthesia/ICU                                                                     -
    31    Anesthesia Machine                                -                                -
                                                                      321,000
    31    Ventilators                                           3                1,575,000
                                                                      525,000
    31    Nebulizer                                             1                  165,000
                                                                      165,000
    31    Pulse Oximetry                                        1                   21,000
                                                                       21,000
    32    Defibrillator                                         2                1,000,000
                                                                      500,000
    32    Airway Oral and Nasal                                 6         500        3,000
    32    Tracheostomy tube (adult and paeds)                   6                    6,000
                                                                        1,000
    32    Face mask of all sizes                                6                    6,000
                                                                        1,000
    32    Double Cuff Tourniquet (for regional block)           3         320          960
    31    AMBO bag adult                                        5                   12,250
                                                                        2,450
    31    AMBO Bag paeds                                        6                   18,000
                                                                        3,000
    31    Red Rubber Nasal tubes all sizes without cuff     12                      12,000
                                                                        1,000
    32    Blood Bank                                                                         -
    32    Blood storage cabinet (100 bag capacity)              3                2,436,000
                                                                      812,000
    32    Packed cell machine                                   3                1,800,000
                                                                      600,000
                                                                                             106
    Three Years Rolling Plan 2010-2013 District Rahim Yar khan



Sr. No.                        Equipment           Gap       Unit cost   Total cost

    32    Cell Separator                                 3                15,675,000
                                                             5,225,000
    32    Freezer for Fresh Frozen Plasma                3                 3,450,000
                                                             1,150,000
    33    Blood bag shaker                               3                   30,000
                                                                10,000
    33    RH view box                                    3                    3,000
                                                                 1,000
    33    Water bath                                     6                   18,000
                                                                 3,000
    33    Micro-pipette                              10                      80,000
                                                                 8,000
    33    Blood grouping tiles                           6                   18,000
                                                                 3,000
    32    Plasma Extractor                               3                 3,000,000
                                                             1,000,000
    32    Platelets agitator                             3                 3,000,000
                                                             1,000,000
    32    Blood thawing bath                             3                    9,000
                                                                 3,000
    32    Microscopes                                    2                  230,000
                                                               115,000
    33    Gynae & Labour Room Related Laboratory                                      -
          Equipment
    33    Hematology Analyzer                            3                 1,275,000
                                                               425,000
    33    Electrolyte Analyzer                           3                 1,875,000
                                                               625,000
    33    Analyzer Bio-chemistry Semi-automatic          3                 2,070,000
                                                               690,000
    33    Glucometer                                     6                   15,000
                                                                 2,500
    34    Haemoglobino-meter                             3                    3,000
                                                                 1,000
    34    Centrifuge                                     2                  266,000
                                                               133,000
          Grand Total                                                    66,827,685




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