Lahore

Three Years Rolling Plan 2010-2013 District Lahore
THREE YEARS ROLLING PLAN

2010-2013
DISTRICT LAHORE
1
Contents
Acronyms ................................................................................................................................................. 4
Executive Summary................................................................................................................................ 5
LAHORE ................................................................................................................................................. 7
SECTION 1: DISTRICT HEALTH PROFILE ............................................................................................ 7
Vision of the District ................................................................................................................................ 7
Background of the District ..................................................................................................................... 7
Map to the District ................................................................................................................................... 8
Demography ........................................................................................................................................... 8
Socio-Economic Indicators .................................................................................................................. 10
Health Indicators .................................................................................................................................... 10
Organizational Structure of District Health Administration ............................................................ 10
Health Resources .................................................................................................................................. 11
1. Health Facilities ......................................................................................................................... 11
a) Public................................................................................................................................... 11
b) Private ................................................................................................................................. 12
2. Human Resource ....................................................................................................................... 12
a) Administrative .................................................................................................................... 12
b) Facility Based ...................................................................................................................... 13
c) Outreach .............................................................................................................................. 18
d) Training Institutions ........................................................................................................... 19
Health Financing................................................................................................................................... 19
Disease Pattern ..................................................................................................................................... 20
Status of Vertical Programs ................................................................................................................. 22
1. National Program for FP & PHC ............................................................................................... 22
2. EPI............................................................................................................................................... 22
3. MNCH Program .......................................................................................................................... 23
4. TB Control Program ................................................................................................................... 23
5. Malaria Control Program .......................................................................................................... 23
6. Hepatitis Control Program ....................................................................................................... 24
7. School Health Services Program .............................................................................................. 24
SECTION 2: PROBLEM ANALYSIS ....................................................................................................... 25
Objectives .............................................................................................................................................. 25
Plan Development Process .................................................................................................................. 25
Problem Identification ......................................................................................................................... 26
Health Problems ................................................................................................................................... 26
Problem Prioritization ........................................................................................................................ 27
Underlying causes of prioritized problems .................................................................................... 29
2
Service delivery/Management problems ........................................................................................... 30

MDGs and MSDS ................................................................................................................................... 31
a) Human Resource .................................................................................................................... 32
DHQ Hospital 1( Mian Munshi) .................................................................................................... 32
THQ Hospital Shahdara ................................................................................................................. 33
b) Equipment .............................................................................................................................. 34
DHQ Hospital-1 Mian Munshi ...................................................................................................... 35
DHQ Hospital Kot Khw. Saeed ..................................................................................................... 40
THQ Hospital Mozang ................................................................................................................... 45
SECTION 3: INTERVENTIONS AND TARGETS ................................................................................... 66
Health Problems ................................................................................................................................... 67
Management Problems ........................................................................................................................ 78
Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned Posts ................ 78
SECTION 4: COSTING AND FINANCING PLAN ................................................................................... 79
Activity based costing .......................................................................................................................... 79
Problem wise costing of Health Problems ............................................................................................. 79
a) Health Problems .................................................................................................................... 80
Problem wise costing of Management Problem .................................................................................... 92
b) Management Problems ......................................................................................................... 93
Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned Posts ................ 93
Financial Outlay .................................................................................................................................... 99
Budget Summary ............................................................................................................................... 99
SECTION 5: MONITORING & EVALUATION ..................................................................................... 100
M&E of Plan......................................................................................................................................... 100
Annex-I ................................................................................................................................................ 103
3
Acronyms
3YRP Three Years Rolling plan
ADB Asian Development Bank
APMO Additional Principal Medical Officer
ARI Acute Respiratory Infections
BHU Basic Health Center
BoD Burden of Dieses
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 Expended 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
4
Executive Summary
Prior to devolution, planning process was carried out at provincial level. Districts were
supposed to implement plans and programs developed/designed at provincial and federal
levels. Devolution brought a paradigm shift where planning became a district responsibility. This
change provided an opportunity to the district at one hand and challenge on other due to their
limited capacity in planning and budgeting. Planning focus also changed from short term to
medium term planning recognizing the flexibility /adaptability it provided. Government
envisions that medium term plan .i.e. 3YRP will be instrumental in using health resources
effectively and efficiently through adapting Minimum Service Delivery Standards (MSDS) as the
strategy to achieve objectives of MDGs.
Districts have been preparing 3YRP (medium term plan) for last few years under the
auspices/patronage of Department of Health (DoH) Government of Punjab through technical
assistance of Punjab Devolved Program Social Services Programme (PDSSP). This year
government of the Punjab through Health Sector Reforms Program (HSRP) with the technical
assistance from a team of consultants (SP09) and wide consultations/inputs from all key stake
holders has established a bench mark in standardization of the format of 3YRP. Capacity
building of the districts has been done on the standardized format.
Current 3 Years Rolling Plan (3YRP) plan is first attempt by the district on that agreed format.
First section of the format (District Health Profile) contains all relevant information on
Geography, Demographic, Socioeconomic and Health indicators of the district. It also takes stock
of health resources in terms of human resource, infrastructure and others. District diseases
pattern compiled from DHIS Primary and Secondary Health Care reports and current status of
vertical /national programs is part of the profile. In fact district profile is a health related fact
sheet of the district and depicts the true picture of health status and health resources/services of
the district. An accurate district health profile provides a sound basis for evidence-based
planning.
3YRP plan has been developed by following the standard planning cycle approach. 3YRP details
the current year activities, physical targets and fiscal targets. Projections of second and third
year physical and financial targets are given. Section Two includes problems identification from
various perspectives, and their 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
5
year. Section Four consists of costing based on additional requirements taking account of
implementation of current status of activities. Best available estimates have been used to
accurately cost the activities. The detailed activity based costing of the Health and Service
Delivery problems has been developed on automated Excel sheets, and annexed for details as
ready reference. Last section of the 3YRP consists of Monitoring and Evaluation of plan to gauge
the progress of different activities and targets of the plan using reliable district data sources.
This permits timely remedial action for smooth implementation of planned activities.
6
LAHORE
_____________________________________________________________________________________________________________
SECTION 1: DISTRICT HEALTH PROFILE

Vision of the District
The District Health Government Lahore is looking to provide efficient “Health Care Delivery
Services “through Primary and Secondary health facilities with the collaboration of Government
and non-government stake holders. The District Health Government is also committed to
improve the “Healthy Life Style” of the people of Lahore district.
Mission of the District
The District Health Government Lahore has been providing promotive, preventive and curative
services through net work of Health Institutions. At present curative services are being utilized
by the population of the District, whereas in preventive programmes achievement of
Department has been 90% of the targets.
Background of the District
Lahore is the 5th largest city in South Asia and 30th largest city in the world. It is also the 2nd
largest as well as 2nd most populous city of Pakistan. The city of Lahore is bounded by
Sheikhupura district in the West and by Wagha on the east, while on South it is surrounded by
the Kasur district on the northern side it is bordered by Ravi River.
Lahore is well connected through a wide Road and rail networks. The city is easily accessible
from different parts of the country and world through air transport.
7
Map to the District
Demography
o Total Population 8190421

o Total Area 2014 square kilometers
o Annual growth rate 5.6%
o Population density 8,200 persons per sq. km
o
Area-wise population
Area Population Percentage
Rural 2076174 25.35%
Urban 6114247 74.65%
Source: Standard Demographic population groups based on DHIS
8
Gender-wise population
Gender Population Percentage
Male 3685690 45%
Female 4504731 55%
Source: Standard Demographic population groups based on DHIS
Population groups
Standard Estimated
Population Groups
Demographic (%) Population
Under 1 year of age 2.7 221141
Under 5 years 13.4 296329
Under 15 years 44 130385
Women in child bearing age (15-49 22 28685
years)
Married Child Bearing age Women 16 38437
Expected pregnancies 3.4 1307
Standard Demographic population groups based on DHIS
Tehsil wise distribution
Tehsil/Town Number of UC Population

972491
NISHTAR TOWN 17
GULBERG TOWN 15 801769
AZIZ BHATTI TOWN 13 684010
ALLAMA IQBAL TOWN 19 1160619
RAVI TOWN 18 1044030
SHALAMAR TOWN 17 868513
SAMNABAD TOWN 19 1039831
WAGAH TOWN 12 655773
DATA GUNJ BUKSH TOWN 18 963385
Languages: Urdu, Punjabi and English are the main languages spoken in the district.
9
Socio-Economic Indicators
Education and Literacy
Literacy rate Male Female

Urban 77.9% 69.9%
Rural ---- ---

Overall District 74 %
Source: EDOH Office Lahore
Health Indicators
 Infant Mortality Rate 50/1000 live births
 Under 5 mortality Rate 68/1000

 Maternal mortality Ratio 236/1000
 Malnutrition (women and children) Male 27%,Female 25% Total=26%
 Life expectancy 63 years approximately.
 Proportion of children under 1 years
 Immunized against measles 92%
Sources: EDO (Health) Lahore
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:
10
ORGANOGRAM
DISTRICT COORDINATION OFFICER
EXECUTIVE DISTRICT OFFICER(HEALTH)
SENIOR DRUG MS
DOH – (HQ) DOH-I DO(PH) DOH-II DOH-III
INSPECTOR/ DHQ/THQ
EDO(H) OFFICE LAHORE LAHORE LAHORE LAHORE
SEC. DQCB HOSPITALS
10 DRUG DDOH Rural Disp.

Estab. Of EDO(H)
INSPECTORS 1.Vacc. Staff (24) DO (Food)
Office 2.Dog Killing Staff
01 FOR EACH 3. Malaria Control Staff
TOWN 4. Death & Birth Reg.
INCLUDING
CANTONMENT 1.Chief Food Insp.
1. Diagnostic Center 2.Food Insp.
2. Dispensaries
3. Unani Shifa Khanas
4. Homeo Dispen.
DO-MCH 5. DHDC
MCH CENTERS
(55)
Health Resources
1. Health Facilities
a) Public
A Detail of physical infrastructure of public health facilities under the administrative control of
EDO (health) in the district is given below.
No. of
Bed
Facility Type Name of Facility Functional Remarks
Strength
Beds
DHQ Hospital Government Mian Munshi

DHQ Hospitals
Hospital- DHQ-I 150 150
required to be up -
Government Kot Khawaja 149 149
graded
Saeed Hospital- DHQ-II
THQ Hospital
Said Mutha Hosptal -THQ-I- 50 50
Mozang Hospital-THQ-II 20 20
RHCs 6 RHC’S 120 120 -----
BHUs 37 74 74
------
MCH Centers 23 --- --- ------
11
Sub Health 2 --- ---

Centers ------
TB Clinics Government infectious

diseases hospital
Health houses 1856 ---- ----- ------
Data source: DHIS/EDOH office
b) Private
The district has town wise exhaustive lists 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. It is not possible to annex at all the lists of private providers working in mega
city of Lahore.
2. Human Resource
The Human resource of district health department has been placed in following
Categories:
a) Administrative
b) Facility based
c) Outreach
d) Training institutions
a) Administrative
Sr. Name of Post Sanctioned Filled

No.
1 Executive District Officer Health 1 1
2 District Officer Health 5 5
3 Deputy District Officer Health 1 1
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 2 2
10 Drug Inspector 10 10
11 District Superintendent Vaccination 3 3
12 Assistant Superintendent Vaccination 4 0
13 Tehsil Sanitary Inspector 1 1
12
14 Inspector Vaccination 3 3
b) Facility Based
i. Basic Health Unsets (37)
Sr.
Name of Post/Designation Sanctioned Filled Vacant
#
1 Medical Officer 37 37 0
2 School Health & Nutrition Supervisor 37 37 0
9 1
3 Medical Assistant 10
4 Computer Operator 37 - -
5 Medical Technician 34 34 0
6 LHV 33 33 0
7 Dispenser 37 37 0
8 Midwife 37 37 0
37 0
9 N/Qasid 37
10 Chowkidar 37 37 0
11 Sanitary Worker 43 43 0
- No information available
ii. Rural Health Centres (6)
Sr.
#
1 Senior Medical Officers 6 6 0
2 Women Medical Officers 6 6 0
3 Dental Surgeons 6 6 0
4 Medical Officers 7 7 0
5 Charge Nurses 36 36 0
6 Homeo Doctors 3 3 0
7 Hakeems 2 2 0
8 Computer Operators 6 6 0
9 Medical / Technician 4 4 0
13
Sr.
#
10 LHV 12 12 0
11 Lab. Technician 6 6 0
12 Dental Technician 6 6 0
13 29 14 15
R.H.I
14 Junior Clerk 6 6 0
15 Vaccinator 0 0 0
16 Homeo Dispenser 3 3 0
17 Dawasaz 2 2 0
18 Radiographer/X-Ray Asstt. 6 6 0
19 0 0 0
Dresser
20 Anesthesia Assistant 6 6 0
21 O.T.A 6 6 0
22 Dispenser 24 24 0
23 Dental Assistant 0 0 0
24 Laboratory Assistant 6 6 0
25 27 27 0
Midwife
26 Driver 7 7 0
27 T.O 6 6 0
28 Homeo Naib Qasid 3 3 0
29 Dawa Kob 2 2 0
30 Ward Servant 12 12 0
31 24 24 0
Sweepers
32 Sanitary Worker 0 0 0
33 Sanitary Patrol 29 29 0
34 Naib Qasid 18 18 0
35 Mali 6 6 0
36 Cook 6 0 0
37 12 12 0
Chowkidar
38 Water Career/Bhashthi 6 6 0
iii. THQ Hospitals (2)
14
S# Name of post Sanctioned Filled
1 Medical Superintendent 2 2
2 APMO. 3 3
3 APWMO. 2 0
4 Gynecologist 2 2
5 Pediatrician 2 2
6 Surgeon 2 0
18 14
7 MO/CMO
7 5
8 WMO
9 Dental Surgeon 1 1
10 Hospital Pharmacist 2 2
11 Head Nurse 2 1
12 Charge Nurses 21 21
13 Homeo Doctor 0 0
14 Hakim 0 0
15 LHV. 2 2
16 Clerk 4 4
17 Dispenser/Dresser 8 2
18 Homeo Dispenser 0 0
19 Dawasaz 0 0
20 OTA. 3 1
21 Radiographer/X-Ray Assistant 3 2
22 Laboratory Assistant 2 2
23 Dental Assistant 0 0
24 Driver 4 4
25 Tub well operator 1 1
26 Midwife 3 3
27 Ward servant 16 16
28 NQ/Dawakob 10 10
29 Bearer 3 3
30 Dhobi 2 2
31 Gate Keeper 4 4
15
32 Mashki 0 0
33 Baildar 0 0
34 Chowkidar 4 4
35 Cook 2 2
iv. DHQ Hospital (2)
1 Medical Superintendent 2 2
2 Chief Consultant 0 0
3 PMO 0 0
4 PWMO 0 0
5 AMS 1 0
6 APMO 12 5
7 APWMO 9 2
8 Physician 4 4
9 Anesthetist 6 5
10 Cardiologist 4 0
11 Chest specialist 2 0
12 DMS 3 0
SMO 2 1
13 Neuro Surgeon 0 0
14 Nursing Superintendent 5 3
15 Nephrologist 1 1
16 Pediatrician 2 2
17 Pathologist 2 0
18 Radiologist 2 2
19 Surgeon 4 2
20 E.N.T. Specialist 2 0
21 Eye Specialist 2 2
22 Senior Dental Surgeon 1 1
16
23 Urologist 2 0
24 Dental Surgeon 2 2
25 Internees 0 0
26 Medical Officer 117 91
27 Pharmacist 6 6
28 Physiotherapist 2 2
29 W.M.O 40 19
30 Charge Nurses 324 217
31 Head Nurse 16 8
32 Male Nurse 0 0
33 Hakeem 0 0
34 Homeo Doctor 2 2
35 Almoner 1 1
36 Computer Operator 4 4
37 Stenographer 2 2
38 Accountant 2 1
39 E.C.G. Technician 8 6
Haemo Technician 0 0
CT Technician 0 0
40 Senior Clerk 4 2
41 Sanitary Inspector 6 6
42 Junior Clerk 9 9
43 Dawasaz 0 0
44 Dispenser 33 26
45 Homeo Dispenser 2 1
46 Operation Theater Assistant 20 7
47 Physiotherapist Aid 1 1
48 Radiographer 2 2
49 Dental Assistant 0 0
50 Lab. Assistant 8 5
51 Store Keeper 6 5
52 Driver 15 13
17
53 Midwife 2 2
54 Tailor Master 4 4
55 Tube well Operator 5 5
56 Lab. Attendant 9 9
57 O.T. Attendant 14 14
58 X-Ray Attendant 2 2
59 Ambulance Cleaner 0 0
60 Bearer 0 0
61 Baildar 5 5
62 Chowkidar 18 18
63 Cook 8 8
64 Dawakob 0 0
65 Dhobi 8 8
66 Gate Man 18 18
67 Mali 8 8
68 Masalchi 1 1
69 Sanitary Worker 90 90
70 Ward Cleaner 40 40
71 Ward Servant 75 75
72 Water Carrier 0 0
73 Naib Qasid 29 29
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 365 365
CDC Supervisors 37 37
Sanitary Inspectors 45 45
18
d) Training Institutions
A number of training institutions are working in the district which includes the following:
i. DHDC
Post Sanctioned Filled
Programme Director 1 1
MPPT 0 0
LHV Trainer 1 1
Assistant 1 1
Driver 0 0
Naib Qasid 1 1
Chowkidar 1 1
Sanitary Worker 0 0
ii. Community Midwifery School

Currently two midwifery schools are functioning at Public Health Nursing School Montgomery Road
and Lady Aitcheson hospital Lahore.
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 02/2010
Allocation Exp. Allocation Exp. Allocation Exp.
Non-Development 673.061 611.802 836.053 821.332 1060.273 611.891
Development --- --- --- --- --- ---
19
Sub Total 673.061 611.802 836.053 821.332 1060.273 611.891
PHSRP 22.000(B)- 22.000(B)- 8.000(E) 5.738(E) - -

PMDGP - - 78.830 63.834 14.995 2.612
PDSSP 7.683(B) 6.818(B) 2.661(B) 2.022(B) 4.909(E) -
36.884(E) 7.425(E) 37.458(E) 7.121(E)
Provincial Development Funds 3.000(B) 3.000(B) 113.910(B) 101.423(B) 197.147(B) 179.374(B)
(ADP) 8.087(E) 6.650(E)
Grand Total 750.715 657.695 1103.912 1001.470 1277.324 793.877

4.742 - 6.880 - 8.991 -
User charges (like purchi fee, fees
for diagnostic services)
Disease Pattern
The disease pattern is determined through regular and periodic reporting through surveys and
studies. Punjab health department has adopted DHIS as regular reporting mechanism to collect
information on diseases and other variables. Currently, DHIS is in transitional stage, and is
establishing itself as a tool to be used for evidence based planning and management. The
following trend of the diseases has been taken from the consolidated DHIS reports that include
reports from PHC and SHC facilities.
Disease Group Total Percentage

Respiratory disease
1 Acute (upper) respiratory infections 256374 42%
2 Pneumonia < 5 yrs. 3869 1%
3 Pneumonia > 5 yrs. 5667 1%
4 TB Suspects 8222 1%
5 Chronic Obstructive Pulmonary Disease 7188 1%
6 Asthma 15798 3%
Gastro Intestinal Disease
7 Diarrhea / Dysentery < 5 yrs 32046 5%
8 Diarrhea / Dysentery > 5 yrs 28532 5%
9 Enteric / Typhoid Fever 3845 1%
10 Worm Infestations 4878 1%
11 Peptic Ulcer Disease 29017 5%
12 Cirrhosis of Liver 1886 0%
20

Urinary Tract Disease
13 Urinary Tract Infections 12529 2%
14 Nephritis / Nephrosis 382 0%
15 Sexually Transmitted Infections 662 0%
16 Benign Enlargement of Prostrate 735
0%
Other Communicable Diseases

17 Suspected Malaria 6849 1%
18 Suspected Meningitis 1513 0%
19 Fever due to other causes 22801 4%
Vaccine Preventable Disease
20 Suspected Measles 228 0%
21 Suspected Viral Hepatitis 2019 0%
22 Suspected Neonatal Tetanus 322 0%
Cardiovascular Diseases
23 Ischemic heart disease 1017 0%
24 Hypertension 19076 3%
Skin Diseases
25 Scabies 60544 10%
26 Dermatitis 29592 5%
27 Cutaneous Leishmaniasis 51 0%
Endocrine Disease
28 Diabetes Mellitus 21703 4%
Neuro-Psychiatric Diseases
29 Depression 0%
1741
30 Drug Dependence 0%
96
31 Epilepsy 0%
12
Eye & ENT
32 Cataract 1031 0%
33 Trachoma 1110 1%
34 Glaucoma 4335 1%
35 Otitis Media 7839 1%
21

Oral Diseases
36 Dental Caries 12605 2%
Injuries/Poisoning
37 Road traffic accidents 12722 2%
38 Fractures 2117 0%
39 Burns 1660 0%
40 Dog bite 955 0%
41 Snake bite (with signs/symptoms of 6 0%

poisoning)
Miscellaneous Disease
42 Acute Flaccid Paralysis 1737 0%
43 Suspected HIV/AIDS 0 0%
44 Any other Unusual disease (specify) 0% 0%
Total 612589 100%
Source: Compiled from PHC and SHC DHIS Reports
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 program reports.
1. National Program for FP & PHC
 No. of seats allocated for LHWs 2167

 No. of LHWs working 1856
 No. of LHSs working
 Percentage of Population covered by the program 20%
 Important program indicators
o IMR 53 per/1000 live births
o MMR 227 /100000 live births

o CPR 45%
o No. of antenatal visits 30619
2. EPI
 EPI Coverage rate of the district 92%

22
 Fully immunized children 0-23 months 98%

 Pregnant women received TT vaccine TT.I-84%,TTII-74%
 Availability of cold chain equipment Available
3. MNCH Program
LIST OF STAFF MNCH PROGRAM, DISTRICT LAHORE
 PUBLIC HEALTH SPECIALIST 1

 WMOs 5
 CMW TUTOR /CLINICAL TUTOR 1
 SOCIAL ORGANIZER 1
 ACCOUNTS ASSISTANT 1
 LHVs 6
 COMPUTER OPERATORS 2
 DRIVERS 2
 SECURITY GAURDS 4
4. TB Control Program
 CDR all types 56%

 CDR NSS positive 45%
 SCR 95%
 TSR 98%
 DR 2%
5. Malaria Control Program
 No. of slides examined 7919

 No. of positive slides 23
 Slides positively ratio 0.29
 Percentage of plasmodium Falciparum 07%
23
6. Hepatitis Control Program
 No. of hepatitis tests conducted for Hepatitis C 15690
 No. of persons/patients positive for Hepatitis C 1184

 Patients completed treatment for Hepatitis C 520
 Patients under treatment for Hepatitis C 141
 Patients registered/awaiting for Hepatitis C treatment 250
 No. of hepatitis tests conducted for Hepatitis B 15710
 No. of persons/patients positive for Hepatitis B 594

 Patients under treatment for Hepatitis B 95
 Patients registered/awaiting for Hepatitis B treatment 250
7. School Health Services Program
 Total visits to the schools 138

 No. of students examined 5844
 No. of students referred to BHUs 5844
 No. of students treated in BHUs 485
 No. of schools in catchment areas 225
 No. of students 5844
 No. of SH & NS 243
24
SECTION 2: PROBLEM ANALYSIS

The Health sector in Punjab is facing enormous health and service delivery problems. Common
health problems are communicable, non communicable, MNCH related diseases and accident/
trauma. The society is passing through demographic and epidemiological transition. This is due
to changing life style, urbanization, ecological and other factors. Disease pattern is changing
where non communicable diseases are gradually increasing and the communicable diseases are
still posing serious threat. Punjab is practically facing Double Burden of Disease (BOD). Besides,
health problems service delivery/ managerial issues are also hindering the access and quality of
health services to the population. The service delivery/management problems are diverse in
nature, and include shortage of technical human resource, capacity issues, lack of infrastructure
and equipment.
Devolution was introduced during 2001 affecting the administrative and financial set up of the
districts. The devolution also brought political culture in the decision making of the districts in
the shape of Nazims, Naib-Nazims and Councilors. This system is now in the phase of reshaping
and it is not clear what will be future structure and managerial shape when new local bodies
system is put in place. The District Manager and functionaries are in the state of uncertainty and
confusion in this scenario. However, one thing is clear that the district shall remain a hub of all
primary and secondary health services delivery. Despite the source of funding in the future,
either from provincial or district government, health planning at district level shall continue to
play a pivotal role in provision of quality health services.
In view of the above situation the district considers following objectives for developing three
year rolling plan.
Objectives
 Improve health status of the population

 Meeting the requirements of national and provincial health policies
 Achievement of MDGs through MSDS
 Introducing evidence-based planning culture by addressing district specific problems/issues
 Addressing emerging health needs or re-emergence of health problems (e.g. H1N1, HIV-AIDS,
Polio, T.B)
 Ensuring effective inter-sectoral coordination with a view to improving health indicators
The objectives would guide in problem analysis, designing interventions, setting /phasing
the targets, costing and monitoring the plan activities.
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:
25
 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.
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. Diarrheal Diseases 2. Acute respiratory tract 3. Pulmonary Tuberculosis

infections (ARI)
4. Hepatitis 5. High under 5 Mortality 6. Ischemic Heart disease
7. High Maternal Mortality 8. Diabetes mellitus 9. Anemia (including in

pregnancy)
10. Dog Bite 11. Scabies 12. Hypertension
13. Road side accident & 14. Peptic Ulcer Diseases 15. Asthma
Injuries
16. UTI 17. Dental Caries
26
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.
27
Problem Magnitude Severity Vulnerability to Cost Political Total Priority

intervention Effectiveness Expediency Score Number
Diarrheal Diseases 4 3 4 4 2 17 1
ARI (under 5) 4 3 4 4 2 17 2
Pulmonary Tuberculosis 3 1 4 4 3 15 8
Hepatitis 4 3 2 2 4 15 6
High under five mortality 3 4 3 3 3 16 4
Ischemic Heart disease 3 4 2 2 2 13 11
High maternal mortality 3 4 3 3 4 17 3
Diabetes mellitus 3 2 3 3 2 13 9
Anemia ( including in
2 2 4 4 4 16 5
pregnancy)
Dog Bite 1 1 4 4 2 12 13
Scabies 4 2 4 3 2 15 7
Hypertension 2 3 2 3 1 11 15
Road side accident & Injuries 2 3 3 2 2 12 12
Peptic ulcer Disease 2 2 3 2 1 10 16
Asthma 2 2 3 3 1 11 14
Urinary Tract Infections 2 2 3 2 1 10 17
Dental Caries 2 3 3 3 2 13 10
28
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. No. Health Problem Causes
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
 Low Socio Economic status

 Malnutrition
2 Acute (upper)  Malnutrition
respiratory infections
 Air contamination
 Over-crowding/Poor housing facilities
 Lack of proper sanitation
 Seasonal variation
 Lack of awareness and hygienic practices
3 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
29
4 High under 5 Mortality  Poor antenatal natal and post natal coverage
 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
5 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
6 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
7 TB Suspects  Low socio-economic status

 Lack of proper sanitation
 Lack of awareness and hygienic practices
8 Scabies  Lack of awareness
 Unhygienic practices
 Over-crowding/Poor housing facilities
 Poor water and sanitation
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
30
at provincial or district level has been specifically mentioned. The planning team discussed these
problems in detail and enlisted the main problems as under
Sr.No Problem/cause
1 Shortage of human resource due to:
 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 Deficient facilities for smooth functioning of :

 DHDC
 DHIS Cell
2 Inadequate budget for POL due to:

 Price hikes
 Installation and use of generators
3 Capacity issues of staff related to:

 Financial Management
 Supportive Supervision
 Use of information in decision making
4 Shortage of Vehicles
 Ambulances(7)
 Mobile Clinic Ambulances(2)
 Suzuki Car(800 CC)
5 Shortage of equipment
 General equipment( for various facilities)
 MNCH related
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.
31
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
DHQ Hospital 1( Mian Munshi)

Sr. Post Standard Sanctioned Filled Vacancy Vacancy
No. as per Gap in Gap in
MSDS relation to relation
sanctioned to filled
positions positions
1 Gynaecologist 3 3 3 0 0
2 Paediatricians 3 1 1 2 2
3 Anesthetists 3 2 1 1 2
4 Medical Officers 74 47 31 27 43
including
SMO,APMO & PMOs
5 Women Medical 27 18 11 9 16
Officers including
SWMO, APWMO
&PMOs
6 Lady Health 11 4 3 7 8
Visitors
7 Nurses 75 47 45 28 30
DHQ Hospital 2 (Kot Khawaja Saeed)

positions positions
including
SMO,APMO & PMOs
32

positions positions
Officers including
SWMO, APWMO
&PMOs
Visitors
7 Nurses 75 196 181 0 0
THQ Hospital Shahdara

positions positions
including
SMO,APMO &
PMOs
Officers including
SWMO APWMO
& PMOs
Visitors
7 Nurses 15 5 5 10 10
THQ Hospital Model Town

Sr. No. Post Standard as Sanctioned Filled Vacancy Gap
per MSDS in relation to
sanctioned
positions
1 Gynaecologist 2 2 2 0
2 Paediatricians 2 1 1 1
3 Anesthetists 3 1 1 2
4 Medical Officers 16 11 5
including
SMO,APMO &
PMOs
5 Women Medical 9 5 4
Officers including
SWMO APWMO &
PMOs
33
Sr. No. Post Standard as Sanctioned Filled Vacancy Gap

per MSDS in relation to
sanctioned
positions
6 Lady Health Visitors 8 1 7
7 Nurses 15 11 4
THQ Hospital Said Mittah

MSDS relation to relation to
sanctioned filled posts
posts
including
SMO,APMO & PMOs
Officers including
SWMO APWMO &
PMOs
6 Lady Health Visitors 8 1 1 7 7
7 Nurses 24 12 11 12 13
THQ Hospital Mozang

MSDS relation to relation to
sanctioned filled
positions positions
including
SMO,APMO & PMOs
Officers including
SWMO APWMO &
PMOs
6 Lady Health Visitors 8 1 1 7 7
7 Nurses 15 11 11 4 4
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.
34
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.
DHQ Hospital-1 Mian Munshi
Sr. Equipment Standard as Available Gap Remarks

No. per MSDS
(Qty.)
C B A
1 CTG (Cardiac 1 1 2 2 0
Tocography)
2 Foetal Doppler 3 5 5 5 0
3 Diagnostic Laparoscope 1 1 2 1 0
4 Bulb Sucker 10 20 20 29 0
5 Baby Warmer 3 3 6 2 1
6 Mechanical Sucker 3 3 6 1 2
7 Fetal Stethoscope 4 4 4 2 2
8 Delivery Table 2 2 3 2 0
9 D&C Set 2 3 4 13 0
10 Outlet forceps 4 4 4 11 0
11 Myoma Screw 2 2 2 10 0
12 Kochers forceps 4 4 8 27 0
13 Volselum forceps 6 8 10 23 0
14 Lanes Tissue holding 2 2 4 24 0

forceps
15 Vaginal Retractors 10 10 10 18 0
16 Polypectomy forceps 2 2 2 4 0
17 Sponge holder 10 15 20 30 0
18 Uterine elevator 1 1 1 1 0
19 CosCo Speculum 6 10 10 25 0
Small, Medium, Large
(for each category)
20 Examination light 3 3 6 7 0
21 Suction Curette 1 2 2 5 0
35

No. per MSDS
(Qty.)
C B A
22 Infant Resuscitation 1 1 2 5 0
Trolley (with life saving
medicines, baby
laryngoscope, Endo-
tracheal tube, Infant BP
Apparatus, Chargeable
Light)
23 Mother Resuscitation 1 1 2 0 1
medicines,
Laryngoscope, Endo-
tracheal tube, BP
light)
24 Cardiac Monitor 1 1 2 4 0
25 Pump Breast Electronic 1 1 1 0 1
26 Vaginal Hysterectomy 2 2 4
Set
26.1 Toothed Tissue Forceps 2 2 4 67 0
(8”)
26.2 Non-Tooted Tissue 2 2 4 34 0
Forceps (8”)
26.3 Dissection Scissors 2 2 4 27 0
(Curved 7”)
(Straight 7”)
26.5 Hysterectomy Clamps 8 8 16 6 2
(Straight)
(Curved)
26.7 Uterine Sound 2 2 4 13 0
26.8 Needle Holder (7”) 2 2 4 17 0
26.9 Needle Holder (10”) 2 2 4 67 0
26.10 Artery Forceps (Straight 16 16 32 17 0

6”)
26.11 Artery Forceps (Curved 16 16 32 34 0
6”)
26.12 Allis Forceps 8 8 16 53 0
26.13 Towel Clamps 8 8 16 17 0
26.14 Single blade Sims 4 4 8 7 0

speculum
26.15 Double blade Sims 4 4 8 17 0
speculum
26.16 Sponge holding forceps 8 8 16 35 0
26.17 Volselum forceps 4 4 8 23 0
36

No. per MSDS
(Qty.)
C B A
26.19 Bladder Sound 2 2 4 1 1
27 Delivery Sets 10 10 15
27.1 Episiotomy Scissors 10 10 15 13 0
27.2 Straight Scissors 10 10 15 3 7
27.3 Needle holder 10 10 15 6 4
27.4 Non-toothed tissue 10 10 15 5 5

forceps 8 inches
27.5 Toothed tissue forceps 8 10 10 15 5 5
inches
27.6 Sims Speculum single 20 20 30 7 13
blade
27.7 Sims Speculum double 20 20 30 10 10
blade
27.9 Artery forceps 40 40 60 23 17
27.10 Straight clamps (cord) 20 20 30 12 8
27.11 Vacuum Extractor pump 1 1 1 1 0
27.12 Towel clip 40 40 60 6 34
28 Caesarian Section 6 8 10
28.1 Scalpel 6 8 10 63 0
28.2 Artery Forceps Straight 6 24 32 40 12 12

inches
28.3 Artery Forceps Curved 6 24 32 40 35 0
inches
28.4 Artery forceps 8 inches 24 32 40 2 22
28.5 Myoma Scissors straight 6 8 10 15 0

7 inches
28.6 Dissecting scissors 6 8 10 8 0
(curved) 7 inches
28.7 Green Armtage forceps 8 24 32 40 8 16
inches
28.8 Obstetric outlet forceps 6 8 10 20 0
(pair)
28.9 Doyene’s Retractor 6 8 10 10 0
28.10 Small Retractors 12 16 20 10 2
28.11 Towel Clippers 24 32 40 20 4
28.12 Suction Nozzle 6 8 10 11 0
37

No. per MSDS
(Qty.)
C B A
29 MNCH Related
Radiology Equipments
29.1 Ultrasound Machine 1 2 3 2 0
29.2 X-Ray Unit 500 kw 1 1 1 1 0
29.3 Color Doppler 0 1 1 0 0
29.4 Lead Screen for X-Ray 1 1 1 2 0

Unit
29.5 0.5 MN Lead Apron. Lead 1 1 1 1 0
Gloves, Goggles and
Thyroid and Gonadal
Sheets
29.6 Safe Light 1 1 1 1 0
29.7 X-RT Film Processing 1 1 1 1 0

Tank
29.8 Chest Stand 1 1 1 1 0
29.9 X-Ray film Illuminator 2 2 2 12 0
29.10 X-Ray Film Hangers All 4 4 4 30 0

sizes
30 MNCH Related
Paediatrics
Equipments
30.1 Paediatric Ventilator 1 2 2 0 1
30.2 Incubator 1 1 2 2 0
30.3 Photo Therapy Unit 1 1 1 3 0
30.4 Over-head Radiant 1 1 1 2 0

Warmer
30.5 Infant Length Measuring 2 2 2 1 1
Scale
30.6 Infant Weighing Machine 2 2 2 5 0
30.7 Nebulizer 1 1 2 4 0
30.8 Billiubino-meter 1 1 2 0 1
30.9 Exchange Blood 1 1 2 0 1

Transfusion Set
30.10 Nasal Probe Paed size 2 2 4 0 2
31 Anaesthesia/ICU
31.1 Anaesthesia Machine 1 1 2 5 0
31.2 Ventilators 1 1 1 3 0
31.3 Nebulizer 1 1 1 8 0
38

No. per MSDS
(Qty.)
C B A
31.4 Pulse Oximetry 1 1 1 7 0
31.5 Defibrillator 1 1 1 2 0
31.6 Airway Oral and Nasal 2 3 4 70 0
31.7 Tracheostomy tube 2 2 4 2 0

(adult and paeds)
31.8 Face mask of all sizes 2 2 4 10 0
31.9 Double Cuff Tourniquet 1 2 2 1 0

(for regional block)
31.10 AMBO bag adult 2 2 4 12 0
31.11 AMBO Bag paeds 2 2 4 8 0
31.12 Red Rubber Nasal tubes 4 4 8 5 0

all sizes without cuff
32 Blood Bank
32.1 Blood storage cabinet 1 1 2 2 0

(100 bag capacity)
32.2 Packed cell machine 1 1 1 0 1
32.3 Cell Separator 1 1 1 0 1
32.4 Freezer for Fresh Frozen 1 1 1 0 1

Plasma
32.5 Blood bag shaker 1 1 2 0 1
32.6 RH view box 2 2 4 1 1
32.7 Water bath 2 2 2 2 0
32.8 Micro-pipette 4 6 8 1 3
32.9 Blood grouping tiles 3 3 6 2 1
32.10 Plasma Extractor 1 1 1 0 1
32.11 Platelets agitator 1 1 1 0 1
32.12 Blood thawing bath 1 1 1 1 0
32.13 Microscopes 1 1 2 1 0
33 Gynae & Labour Room

Related Laboratory
Equipment
33.1 Hematology Analyzer 1 1 1 1 0
33.2 Electrolyte Analyzer 1 1 1 0 1
33.3 Analyzer Bio-chemistry 1 1 1 1 0

Semi-automatic
33.4 Glucometer 2 2 2 8 0
39

No. per MSDS
(Qty.)
C B A
33.5 Haemoglobino-meter 2 2 4 1 1
33.6 Centrifuge 1 1 2 2 0
DHQ Hospital Kot Khw. Saeed

No. per MSDS
(Qty.)
C B A
Tocography)
4 Bulb Sucker 10 20 20 6 4
9 D&C Set 2 3 4 14 0

forceps
40

No. per MSDS
(Qty.)
C B A
(for each category)
medicines, baby
laryngoscope, Endo-
Light)
medicines,
Laryngoscope, Endo-
tracheal tube, BP
light)
26 Vaginal Hysterectomy 2 2 4 2
Set
(8”)
Forceps (8”)
(Curved 7”)
(Straight 7”)
(Straight)
(Curved)
26.8 Needle Holder (7”) 2 2 4 0 2
26.9 Needle Holder (10”) 2 2 4 0 2

6”)
6”)
26.12 Allis Forceps 8 8 16 39 0
26.13 Towel Clamps 8 8 16 130 0

speculum
41

No. per MSDS
(Qty.)
C B A

speculum
27 Delivery Sets 10 10 15 13
27.3 Needle holder 10 10 15 94 0

forceps 8 inches
inches
blade
blade
27.9 Artery forceps 40 40 60 40 0
27.12 Towel clip 40 40 60 0 40
28 Caesarian Section 6 8 10 18
28.1 Scalpel 6 8 10 0 6

inches
inches

7 inches
(curved) 7 inches
inches
(pair)
42

No. per MSDS
(Qty.)
C B A
28.11 Towel Clippers 24 32 40 0 24
29 MNCH Related
29.2 X-Ray Unit 500 kw 1 1 1 0 1

Unit
Gloves, Goggles and
Thyroid and Gonadal
Sheets
29.6 Safe Light 1 1 1 3 0

Tank
29.8 Chest Stand 1 1 1 2 0

sizes
30 MNCH Related
Paediatrics
Equipments
30.2 Incubator 1 1 2 7 0

Warmer
Scale
30.7 Nebulizer 1 1 2 15 0

Transfusion Set
31 Anaesthesia/ICU
43

No. per MSDS
(Qty.)
C B A
31.3 Nebulizer 1 1 1 0 1

(adult and paeds)

31.10 AMBO bag adult 2 2 4 16 0

32 Blood Bank

(100 bag capacity)

Plasma
32.6 RH view box 2 2 4 1 1
32.7 Water bath 2 2 2 1 1

Related Laboratory
Equipment
44

No. per MSDS
(Qty.)
C B A

Semi-automatic
33.4 Glucometer 2 2 2 10 0
THQ Hospital Mozang

No. per MSDS
(Qty.)
C B A
Tocography)
4 Bulb Sucker 10 20 20 20 0
9 D&C Set 2 3 4 18 0

forceps
45

No. per MSDS
(Qty.)
C B A
(for each category)
medicines, baby
laryngoscope, Endo-
Light)
medicines,
Laryngoscope, Endo-
tracheal tube, BP
light)
Set
(8”)
Forceps (8”)
(Curved 7”)
(Straight 7”)
(Straight)
(Curved)
26.8 Needle Holder (7”) 2 2 4 13 0
26.9 Needle Holder (10”) 2 2 4 21 0

6”)
6”)
46

No. per MSDS
(Qty.)
C B A
26.12 Allis Forceps 8 8 16 17 0
26.13 Towel Clamps 8 8 16 12 0

speculum
speculum
27.3 Needle holder 10 10 15 57 0

forceps 8 inches
inches
blade
blade
27.9 Artery forceps 40 40 60 15 35
27.12 Towel clip 40 40 60 12 28
28.1 Scalpel 6 8 10 18 0

inches
inches

7 inches
(curved) 7 inches
47

No. per MSDS
(Qty.)
C B A

inches
(pair)
28.11 Towel Clippers 24 32 40 12 12
29 MNCH Related
29.2 X-Ray Unit 500 kw 1 1 1 1 0

Unit
Gloves, Goggles and
Thyroid and Gonadal
Sheets
29.6 Safe Light 1 1 1 1 0

Tank
29.8 Chest Stand 1 1 1 1 0

sizes
30 MNCH Related
Paediatrics
Equipments
30.2 Incubator 1 1 2 2 0

Warmer
Scale
30.7 Nebulizer 1 1 2 5 0
48

No. per MSDS
(Qty.)
C B A

Transfusion Set
31 Anaesthesia/ICU
31.3 Nebulizer 1 1 1 0 1

(adult and paeds)

31.10 AMBO bag adult 2 2 4 2 0

32 Blood Bank

(100 bag capacity)

Plasma
32.6 RH view box 2 2 4 0 2
32.7 Water bath 2 2 2 0 2
49

No. per MSDS
(Qty.)
C B A

Related Laboratory
Equipment

Semi-automatic
THQ Model Town

No. per MSDS
(Qty.)
C B A
Tocography)
4 Bulb Sucker 5 10 20 0 5
9 D&C Set 2 2 2 1 1

forceps
50

No. per MSDS
(Qty.)
C B A
(for each category)
medicines, baby
laryngoscope, Endo-
Light)
medicines,
Laryngoscope, Endo-
tracheal tube, BP
light)
Set
(8”)
Forceps (8”)
(Curved 7”)
(Straight 7”)
(Straight)
(Curved)
26.8 Needle Holder (7”) 2 2 4 10 0
26.9 Needle Holder (10”) 2 2 2 0 2

6”)
6”)
51

No. per MSDS
(Qty.)
C B A
26.12 Allis Forceps 8 8 8 0 8
26.13 Towel Clamps 8 8 8 0 8

speculum
speculum
27 Delivery Sets 6 6 10
27.3 Needle holder 6 6 10 24 0

forceps 8 inches
inches
blade
blade
27.9 Artery forceps 40 40 40 35 5
27.12 Towel clip 40 40 40 0 40
28.1 Scalpel 4 4 6 0 4

inches
inches

7 inches
(curved) 7 inches
52

No. per MSDS
(Qty.)
C B A

inches
(pair)
28.11 Towel Clippers 16 16 24 0 16
29 MNCH Related
29.2 X-Ray Unit 500 kw 1 1 1 0 1

Unit
Gloves, Goggles and
Thyroid and Gonadal
Sheets
29.6 Safe Light 1 1 1 1 0

Tank
29.8 Chest Stand 1 1 1 2 0

sizes
30 MNCH Related
Paediatrics
Equipments
30.2 Incubator 1 1 1 1 0

Warmer
Scale
30.7 Nebulizer 1 1 1 2 0
53

No. per MSDS
(Qty.)
C B A

Transfusion Set
31 Anaesthesia/ICU
31.3 Nebulizer 1 1 1 0 1

(adult and paeds)


32 Blood Bank

(100 bag capacity)

Plasma
32.6 RH view box 1 2 2 0 1
32.7 Water bath 2 2 2 0 2
54

No. per MSDS
(Qty.)
C B A

Related Laboratory
Equipment

Semi-automatic
THQ Hospital Said Mittah

No. per MSDS
(Qty.)
C B A
Tocography)
4 Bulb Sucker 5 10 20 0 5
9 D&C Set 2 2 2 1 1

forceps
55

No. per MSDS
(Qty.)
C B A
(for each category)
medicines, baby
laryngoscope, Endo-
Light)
medicines,
Laryngoscope, Endo-
tracheal tube, BP
light)
Set
(8”)
Forceps (8”)
(Curved 7”)
(Straight 7”)
(Straight)
(Curved)
26.8 Needle Holder (7”) 2 2 4 0 2
26.9 Needle Holder (10”) 2 2 2 0 2

6”)
6”)
56

No. per MSDS
(Qty.)
C B A
26.13 Towel Clamps 8 8 8 9 0

speculum
speculum

forceps 8 inches
inches
blade
blade
27.9 Artery forceps 40 40 40 0 40
27.12 Towel clip 40 40 40 0 40
28.1 Scalpel 4 4 6 0 4

inches
inches

7 inches
(curved) 7 inches
57

No. per MSDS
(Qty.)
C B A

inches
(pair)
28.11 Towel Clippers 16 16 24 0 16
29 MNCH Related
29.2 X-Ray Unit 500 kw 1 1 1 0 1

Unit
Gloves, Goggles and
Thyroid and Gonadal
Sheets
29.6 Safe Light 1 1 1 1 0

Tank
29.8 Chest Stand 1 1 1 1 0

sizes
30 MNCH Related
Paediatrics
Equipments
30.2 Incubator 1 1 1 0 1

Warmer
Scale
30.7 Nebulizer 1 1 1 1 0
58

No. per MSDS
(Qty.)
C B A

Transfusion Set
31 Anaesthesia/ICU
31.3 Nebulizer 1 1 1 0 1

(adult and paeds)


32 Blood Bank

(100 bag capacity)

Plasma
32.6 RH view box 1 2 2 0 1
32.7 Water bath 2 2 2 0 2
59

No. per MSDS
(Qty.)
C B A

Related Laboratory
Equipment

Semi-automatic
THQ Shahdara

No. per MSDS
(Qty.)
C B A
Tocography)
4 Bulb Sucker 5 10 20 10 0
9 D&C Set 2 2 2 2 0
60

No. per MSDS
(Qty.)
C B A

forceps
(for each category)
medicines, baby
laryngoscope, Endo-
Light)
medicines,
Laryngoscope, Endo-
tracheal tube, BP
light)
26 Vaginal Hysterectomy 2 2 2
Set
(8”)
Forceps (8”)
(Curved 7”)
(Straight 7”)
(Straight)
61

No. per MSDS
(Qty.)
C B A

(Curved)
26.8 Needle Holder (7”) 2 2 4 0 2
26.9 Needle Holder (10”) 2 2 2 0 2

6”)
6”)
26.13 Towel Clamps 8 8 8 0 8

speculum
speculum

forceps 8 inches
inches
blade
blade
27.9 Artery forceps 40 40 40 18 22
27.12 Towel clip 40 40 40 0 40
62

No. per MSDS
(Qty.)
C B A
28.1 Scalpel 4 4 6 0 4

inches
inches

7 inches
(curved) 7 inches
inches
(pair)
28.11 Towel Clippers 16 16 24 0 16
29 MNCH Related
29.2 X-Ray Unit 500 kw 1 1 1 1 0

Unit
Gloves, Goggles and
Thyroid and Gonadal
Sheets
29.6 Safe Light 1 1 1 2 0

Tank
29.8 Chest Stand 1 1 1 1 0

sizes
30 MNCH Related
Paediatrics
Equipments
30.2 Incubator 1 1 1 0 1
63

No. per MSDS
(Qty.)
C B A

Warmer
Scale
30.7 Nebulizer 1 1 1 2 0

Transfusion Set
31 Anaesthesia/ICU
31.3 Nebulizer 1 1 1 2 0

(adult and paeds)


32 Blood Bank

(100 bag capacity)

Plasma
32.6 RH view box 1 2 2 0 1
64

No. per MSDS
(Qty.)
C B A
32.7 Water bath 2 2 2 0 2

Related Laboratory
Equipment

Semi-automatic
65
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.
66
Health Problems
Target Target Target

Plan Activities
Sr. No. Problem Causes Intervention Activities Unit for for for Remarks
Targets
2010-11 2011-12 2012-13
1 Diarrhea  Poor  improvement of  Quarterly co- Meeting 12 4 4 4

sanitation water supply ordination
and sanitation Meeting under the
chairmanship of
DCO 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 Boucher 1,000,000 500,000 250,000 250,000
practices literacy rate distribution of IPC
through material
coordination
with education
department
 Lack of  Proper  Address in school Session 3,800 3,000 800 -
awareness in treatment of assemblies
general Diarrhea
population including ORT
 Lack of  Capacity  Training of No. of 12 6 6 -
awareness building of medics and trainings
among health staff in paramedics in
mothers about Integrated IMNCI
feeding and Management of
weaning Childhood
practices Illnesses
(IMNCI)
 Low Socio  Procurement and ORS packets 80,000 40,000 20,000 20,000
Economic distribution of
status ORS
67

Plan Activities
Targets
2010-11 2011-12 2012-13
 Malnutrition  Procurement and Syrup 80,000 40,000 20,000 20,000

distribution of
Syp. Zinc Sulfate
 Procurement and Syrup 80,000 40,000 20,000 20,000

Distribution of
Syrup
Metronidazole
 Procurement and No. of tablets 300,000 150,000 75,000 75,000

Distribution of
Tablet
Metronidazole
400mg
 Procurement and Injection 70,000 30,000 20,000 20,000

Distribution of Inj.
Metronidazole
100ml
 Procurement and IV Fluids 24,000 8,000 8,000 8,000

distribution of IV
fluids ( Infusion
Ringer Lactate
1000 ml) with
drip set
2 Acute  Malnutrition  Capacity  Messages on local Message 12 4 4 4

(upper) building of cable networks
respiratory health staff in
infections
ARI case
management
68

Plan Activities
Targets
2010-11 2011-12 2012-13
 Air  Capacity  Printing and Brochure 300,000 150,000 100,000 50,000

contamination building of distribution of IPC
health staff in material
Integrated
Management of
Childhood
Illnesses
(IMNCI)
 Over-  Provision of  Training of No. of - - - -
crowding/Poo medicines for medics and para- trainings
r housing ARI medics in IMNCI
facilities
 Lack of proper  Timely referral  Procurement and Antibiotic 150,000 80,000 35,000 35,000
sanitation of complicated distribution of (Syrup)
cases Antibiotic Syrup
Amoxicillin
 Seasonal  Procurement and Antibiotic 100,000 50,000 25,000 25,000

variation distribution of (Syrup)
Antibiotic Syrup
Co-tri
 Lack of  Procurement and Tablet 800,000 400,000 200,000 200,000

awareness distribution of
and hygienic Antibiotic Tab.
practices Co-trimoxazole
BD (Blister Pack)
3 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 350,000 150,000 100,000 100,000
awareness change distribution of IPC
about danger communication material
signs of for Mothers of
pregnancy child bearing age
69

Plan Activities
Targets
2010-11 2011-12 2012-13
 Low ante-  Provision of  Training of LHWs No. of 77 77 - -

natal coverage Quality basic on BCC trainings
EmONC services
at BHU & RHC
 Low skilled  Provision of  Procurement of - - - -
birth Quality vehicles for
attendance Comprehensive transportation
EmONC services through CCBs
at THQs hospital
 Three delays  Improving  Operation and - - - -
(seeking transportation of management of
health care, the patients vehicles through
transportation CCBs
, and lack of
referral back-
up services)
 Complications  Repair of non - - - -
of pregnancy functional
ambulances for
timely
transportation of
pregnant mothers
 Capacity  Replacement of - - - -
Issues related the non functional
to maternal ambulances for
care timely
transportation of
pregnant mother
 Maternal  Procurement of - - - -
Anemia the MNCH related
equipment and
Instruments
70

Plan Activities
Targets
2010-11 2011-12 2012-13
 Pregnancy  Implementation - - - -
following of the referrals
chronic severe protocols
diseases
 Procurement of Packs 7,000 4,000 1,500 1,500

Micro-nutrients
(Tab. Ferrous
Sulphate )
 Procurement of Packs 20,000 10,000 5,000 5,000

Micro-nutrients
(Tab. Folic Acid)
 Procurement and Injection 300 100 100 100

distribution of
Anti-D
4 High under 5  Poor  Health  Message on local Message 36 12 12 12

Mortality antenatal awareness/educ cable
natal and post ation
natal coverage
 Neo-natal  Provision of the  BCC of mothers Number of - - - -
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 Assessment - - - -

& Asphyxia quality deficient
Comprehensive infrastructure at
EMONC services DHQH
at THQH &
DHQH
71

Plan Activities
Targets
2010-11 2011-12 2012-13
 Prematurity  Improvement of  Provision of the Assessment - - - -

feeding and deficient
weaning infrastructure at
practices THQH
 Poor feeding  Capacity  Trainings on No. of - - - -

and weaning building of IMNCI trainings
practices Human Resource
dealing child
health care
 Diarrhea  Enhancing EPI  Need assessment Assessment - - - -
coverage of food
supplements
 ARI  Poverty  procurement Assessment - - - -

elevation from DGHs office
 Lack of  Provision of food  Distribution of Assessment - - - -

capacity of supplements food supplements
staff for to mothers &
provision of children through
proper child LHWs &
health care community mid
(diagnostic wives
and timely
referrals)
 Low socio  Raising income of Assessment - - - -
economic the poor families
status through Baitul
Mall and Zakat
 Malnutrition  Revising the - - - -

micro plans of
Vaccinators
72

Plan Activities
Targets
2010-11 2011-12 2012-13
 Lack of birth - - - -
spacing
 Low EPI - - - -
Coverage
5 Anemia (  Lack of  Awareness raising  Messages on local Message 12 12 12 1,410,00

including awareness for behavior cable network 0
pregnancy) about balanced change
diet
 Gender  De-worming  Printing and Brochure 150,000 75,000 75,000 450,000
discrimination campaign distribution of IPC
material
 Social taboos  Diagnosis and  Counseling of Session - - - -

and norms treatment of pregnant mothers
infections
 Worm  Strengthening  Procurement of No. of doses 40,000 20,000 20,000 800,000

infestation MNCH Services Syp. Albendazole
10ml. For Children
under 10 years
 Infections  Equity of services  Distribution - - - -

through LHWs and
health facilities
 Poor quality of  Refresher No. of - - - -

MNCH services Trainings of LHWs trainings
on BCC, balanced
diet and provision
of micro-nutrients
73

Plan Activities
Targets
2010-11 2011-12 2012-13
 Poverty/ Low
socio economic
status
6 Hepatitis  Poor sanitation  Health  Quarterly co- Meetings - - - -

Education/Promo ordination
tion meetings with TMA
and other agencies
 Unsafe drinking  Improving water  Messages on local Message 12 12 12 12

water & sanitation cable network
 Sharing of used  Campaign against  Messages on FM Message 12 12 12 12

syringes quackery Radio
 Transfusion of  Strengthening  Printing and Brochure 100,000 50,000 50,000 100,000

unsafe blood blood transfusion distribution of IPC
and blood services for safe material
products transfusions
 Unsafe sexual  Regulatory  Printing and Stickers 2,000 - - 2,000
practices mechanism to pasting of stickers
ensure use of safe at clinics and
instruments by Barber shop
dentists, barbers highlighting use of
etc. new syringes &
Razors
 Ear & Nose  Hepatitis 1 1 1 1

piercing and awareness week (
tattooing walk/display
banners/seminars)
74

Plan Activities
Targets
2010-11 2011-12 2012-13
 Use of  Procurement and Kits 10 10 10 10

unsterilized supply of Eliza kits
equipment by for Hepatitis B
dentists and
barbers
 Procurement and Kits 10 10 10 10

supply of Eliza kits
for Hepatitis C
 Procurement of Syringe - - - -
syringe cutters cutter
 Procurement and Courses 200 150 150 200

distribution of
Interferon Injection
 Procurement and Devices 50,000 50,000 50,000 50,000

supply of HCV
Device

supply of HbsAg
Device

supply of HIV
Device
 Documentation of
expense of
disposable syringes
75

Plan Activities
Targets
2010-11 2011-12 2012-13
 Supportive
supervision to
ensure above
activities
7 Scabies  Lack of  Health education  Messages on local Message 12 4 4 12

awareness & Promotion cable networks
 Unhygienic  Improving water  Printing and Brochure 800,000 400,000 200,000 800,000
practices and sanitation distribution of IPC
material
 Over-  Proper diagnosis  Procurement and Lotion 300,000 150,000 75,000 300,000
crowding/Poor and treatment distribution of
housing Benzyl Benzoate
facilities Lotion
 Poor water and

sanitation
8 TB Suspects  Low socio-  Health  Messages on local Message 36 12 12 12

economic education/promo cable networks
status tion
 Seasonal  Strengthening TB  Printing and Brochure 75,000 25,000 25,000 25,000

variation DOTS program distribution of IPC
through material
involvement of
private sector
 Lack of proper  Involvement of  Procurement of ATT course 600 200 200 200
sanitation private providers drugs to ensure
through public deficiency
private according to
partnership regimen
76

Plan Activities
Targets
2010-11 2011-12 2012-13
 Lack of  Procurement of Packs 50 20 15 15

awareness and reagents for
hygienic notified diagnostic
practices facilities under
DOTS programme
 Trainings on DOTS No. of 11 5 3 3

protocols trainings
77
Management Problems
Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned Posts
Physical Targets
Basic Requirement as per
Sr.No. Name of Post Basic Pay Allowances
Scale Gap
Year I Year II Year III
1 Gynecologist 18 12,910 18,099 1 1 - -
2 Pediatricians 18 12,910 18,099 7 3 2 2
3 Anesthetists 18 12,910 18,099 9 3 3 3
4 MO / WMO 17 9,850 15,345 86 30 30 26
5 Nurses 16 6,060 8,934 42 15 15 12
6 Lady Health Visitors 9 3,820 4,750 58 20 20 18
78
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 Sheet. A moderate estimate of equipment cost has been taken, as there is wide
variation between the minimum and maximum cost. The detailed cost of MNCH equipment
has been annexed as Annex I
The summary of problem and activity wise costing is given below.
Problem wise costing of Health Problems
2010-2011 2011-2012 2012-2013

Sr.
Health Problem Amount Amount Total Cost Rs.
No. Amount (Rs.)
(Rs.) (Rs.)
1 Diarrheal Diseases
8,458,400 4,893,240 4,189,020 17,540,660
2 ARI (under 5)
4,460,000 2,695,000 2,722,500 9,877,500
3 High maternal mortality
3,770,300 2,598,750 2,858,625 9,227,675
4 High under five mortality
1,410,000 1,551,000 1,706,100 4,667,100
Anemia ( including in
5
pregnancy) 2,660,000 2,238,500 2,462,350 7,360,850
6 Hepatitis
9,216,000 8,967,600 9,849,360 28,032,960
7 Scabies
3,920,000 2,414,500 2,655,950 8,990,450
8 Tuberculosis
1,212,000 1,241,680 1,365,848 3,819,528
Total
35,106,700 26,600,270 27,809,753 89,516,723
79
a) Health Problems
Define Financial Targets
Total
Sr. Problem Activity
Year II Year III Cost
Unit Rate Quantity Year I
(10 %) (10 %)
1 Diarrhea  Quarterly co- Meeting 3,000 12 12,000 13,200 14,520 39,720
ordination
Meeting under the
chairmanship of
DCO with TMA
and other
agencies
 Messages on local Message 117,500 12 470,000 517,000 568,700 1,555,700

cable network
 Printing and Brochure 3 1,000,000 1,500,000 825,000 907,500 3,232,500

distribution of IPC
material
 Address in school Session school health & 3,800 - - - -

assemblies nutrition supervisor
gives address to the
school assemblies
 Training of No. of 164,400 12 986,400 1,085,040 - 2,071,440
medics and trainings
paramedics in
IMNCI
 Procurement and ORS packets 6 80,000 240,000 132,000 145,200 517,200

distribution of
ORS
80

Total
(10 %) (10 %)
 Procurement and Syrup 35 80,000 1,400,000 770,000 847,000 3,017,000
distribution of
Syp. Zinc Sulfate
 Procurement and Syrup 12 80,000 480,000 264,000 290,400 1,034,400

Distribution of
Syrp
Metronidazole
 Procurement and No. of tablets 2 300,000 600,000 165,000 181,500 946,500

Distribution of
Tablet
Metronidazole
400mg
 Procurement and Injection 35 70,000 2,450,000 770,000 847,000 4,067,000

Distribution of Inj.
Metronidazole
100ml
 Procurement and IV Fluids 40 24,000 320,000 352,000 387,200 1,059,200

distribution of IV
fluids ( Inje.
Ringer Lactate
1000 ml) with
drip set
8,458,400 4,893,240 4,189,020 17,540,660
81

Total
(10 %) (10 %)
2 Acute (upper)  Messages on local Message 117,500 12 470,000 517,000 568,700 1,555,700
respiratory cable networks
infections
 Printing and Brochure 4 300,000 600,000 440,000 242,000 1,282,000

distribution of IPC
material
 Training of No. of IMNCI Training - - - - -

medics and para- trainings package costed in
medics in IMNCI Diarrhea also
includes
management of ARI
 Procurement and Antibiotic 23 150,000 1,840,000 885,500 974,050 3,699,550
distribution of (Syrup)
Antibiotic Syrup
Amoxicillin
 Procurement and Antibiotic 15 100,000 750,000 412,500 453,750 1,616,250

distribution of (Syrup)
Antibiotic Syrup
Co-tri
 Procurement and Tablet 2 800,000 800,000 440,000 484,000 1,724,000

distribution of
Antibiotic Tab. Co-
trimoxazole DD
(Blister Pack)
4,460,000 2,695,000 2,722,500 9,877,500
82

Total
(10 %) (10 %)
3 High MMR  Messages on local Message 117,500 36 1,410,000 1,551,000 1,706,100 4,667,100
cable network

distribution of IPC
material
 Training of LHWs No. of 13,900 77 1,070,300 - - 1,070,300

on BCC trainings
 Procurement of Costed in service - - - -

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

management of delivery problems
vehicles through
CCBs
 Repair of non Costed in service - - - - -

functional delivery problems
ambulances for
timely
transportation of
pregnant mothers
83

Total
(10 %) (10 %)
 Replacement of Costed in service - - - - -
the non functional delivery problems
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 35 7,000 140,000 57,750 63,525 261,275

Micro-nutrients
(Tab. Ferrous
Sulphate )
 Procurement of Packs 20 20,000 200,000 110,000 121,000 431,000

Micro-nutrients
(Tab. Folic Acid)
 Procurement and Injection 5,000 300 500,000 550,000 605,000 1,655,000

distribution of
Anti-D
3,770,300 2,598,750 2,858,625 9,227,675
84

Total
(10 %) (10 %)
4 High under 5  Message on local Message 117,500 36 1,410,000 1,551,000 1,706,100 4,667,100
Mortality cable
 BCC of mothers Number of Already costed in -

0n promotion of Trainings problem HMM
breast feeding and
weaning practices
through LHWs
 Provision of the Assessment As proposed in MSDS -

deficient Gaps
infrastructure at
DHQH
 Provision of the Assessment As proposed in MSDS -

deficient Gaps
infrastructure at
THQH
 Trainings on No. of As proposed in -

IMNCI trainings Diarrhea
 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
85

Total
(10 %) (10 %)
 procurement from Assessment Assessing below - - - -
DGHs office poverty pregnant
mother through
LHWs and providing
them food
supplement through
DGHS & Financial
support from Baitul
Mal & Zakat
 Distribution of Assessment Assessing below - - - -
food supplements poverty pregnant
to mothers & mother through
LHWs and providing
children through
them food
LHWs & supplement through
community mid DGHS & Financial
wives support from Baitul
Mal & Zakat
 Raising income of Assessment Assessing below - - - -
the poor families poverty pregnant
through Baitul mother through
LHWs and providing
Mall and Zakat
them food
supplement through
DGHS & Financial
support from Baitul
Mal & Zakat
 Revising the - - - -
micro plans of
Vaccinators
1,410,000 1,551,000 1,706,100 4,667,100
86

Total
(10 %) (10 %)
5 Anemia (  Messages on local Message 117,500 36 1,410,000 1,551,000 1,706,100 4,667,100
including cable network
pregnancy)
 Printing and Brochure 3 300,000 450,000 247,500 272,250 969,750

distribution of IPC
material
 Counseling of Session LHWs are - - - -

expected to
pregnant mothers
conduct counseling
session on
behavior change
during their visit to
pregnant ladies
 Procurement of No. of doses 20 80,000 800,000 440,000 484,000 1,724,000
Syp. Albendazole
10ml. For Children
under 10 years
 Distribution Already - - -
distributed
through LHWs and
health facilities
 Refresher No. of Already costed in - - -

trainings problem High
Trainings of LHWs
Maternal Mortality
on BCC, balanced
diet and provision
of micro-nutrients
2,660,000 2,238,500 2,462,350 7,360,850
87

Total
(10 %) (10 %)
6 Hepatitis  Quarterly co- Meetings Costed in - - - -
ordination diarrhoeal
meetings with TMA disease
and other agencies
 Messages on local Message 117,500 36 1,410,000 1,551,000 1,706,100 4,667,100

cable network
 Messages on FM Message 28,000 36 336,000 369,600 406,560 1,112,160

Radio
 Printing and Brochure 4 200,000 400,000 220,000 242,000 862,000

distribution of IPC
material
 Printing and Stickers 50 2,000 100,000 - - 100,000

pasting of stickers
at clinics and
Barber shop
highlighting use of
new syringes &
Razors
 Hepatitis Lump sum 3 150,000 150,000 150,000 450,000

awareness week (
walk/display
banners/seminars)
 Procurement and Kits 10,000 30 100,000 110,000 121,000 331,000

for Hepatitis B
88

Total
(10 %) (10 %)
 Procurement and Kits 10,000 30 100,000 110,000 121,000 331,000
for Hepatitis C
 Procurement of Syringe cutter Available - - - - -

syringe cutters
 Procurement and Courses 15,000 500 3,000,000 2,475,000 2,722,500 8,197,500

distribution of
Interferon Injection
 Procurement and Devices 32 150,000 1,600,000 1,760,000 1,936,000 5,296,000
supply of HCV
Device
 Procurement and Devices 32 150,000 1,600,000 1,760,000 1,936,000 5,296,000

supply of HbsAg
Device
 Procurement and Devices 42 30,000 420,000 462,000 508,200 1,390,200
supply of HIV
Device
 Documentation of
expense of
disposable syringes
 Supportive
supervision to
ensure above
activities
89

Total
(10 %) (10 %)
9,216,000 8,967,600 9,849,360 28,032,960
7 Scabies  Messages on local Message 117,500 12 470,000 517,000 568,700 1,555,700

cable networks
 Printing and Brochure 3 800,000 1,200,000 660,000 726,000 2,586,000

distribution of IPC
material
 Procurement and Lotion 15 300,000 2,250,000 1,237,500 1,361,250 4,848,750

distribution of
Benzyl Benzoate
Lotion
3,920,000 2,414,500 2,655,950 8,990,450
8 Tuberculosis  Messages on local Message 42,000 36 504,000 554,400 609,840 1,668,240

cable networks

distribution of IPC
material
 Procurement of ATT course To be procured from 600 - - - -

drugs to ensure the PTP
deficiency
according to
regimen
90

Total
(10 %) (10 %)
 Procurement of Packs To be procured from 50 - - - -
reagents for the PTP
notified diagnostic
facilities under
DOTS programme
 Trainings on DOTS No. of 41,600 11 208,000 137,280 151,008 496,288

protocols trainings
1,212,000 1,241,680 1,365,848 3,819,528
91
Problem wise costing of Management Problem
FYI FY II FY III Total Cost

Sr. No. Management Problem
Amount Amount Amount Rs.
(Rs.) (Rs.) (Rs.)
Human Resource Plan (Senction
1
of Posts against MSDS Gaps) 16,430,676 35,328,850 55,477,014 107,236,540
2 POL
2,000,000 - - 2,000,000
3 Capacity Issues of Staff

102,600 102,600 102,600 307,800
4 Deficient Infrastructure
4,620,500 - - 4,620,500
5 Shortage of Vehicles
22,250,000 10,200,000 - 32,450,000
Lack of General Hospital

6
Equipment 66,450,000
7 MNCH Related Equipment

121,161,615 - - 121,161,615
Total
233,015,391 45,631,450 55,579,614 267,776,455
92
b) Management Problems
Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned Posts
Financial Targets
Year I Year II Year III

Basic Basic Requirement
Sr.No. Name of Post Allowances
Scale Pay as per Gap
Pay of Pay of
Pay of Pay of Pay of Pay of
other Allowances other Allowances Allowances
Officers Officers Officers other staff
staff staff
1 Gynecologist 18 12,910 18,099 1 154,920 - 217,188 170,412 238,907 187,453 262,797
2 Pediatricians 18 12,910 18,099 7 464,760 - 651,564 852,060 1,194,534 1,312,172 1,839,582
3 Anesthetists 18 12,910 18,099 9 464,760 - 651,564 1,022,472 1,433,441 1,687,079 2,365,177
4 MO / WMO 17 9,850 15,345 86 3,546,000 - 5,524,200 7,801,200 12,153,240 12,299,892 19,161,608
5 Nurses 16 6,060 8,934 42 1,090,800 - 1,608,120 2,399,760 3,537,864 3,695,630 5,448,311
6 Lady Health 9 3,820 4,750 58 916,800 1,140,000 2,016,960 2,508,000 3,217,051 4,000,260
Visitors
5,721,240 916,800 9,792,636 12,245,904 2,016,960 21,065,986 19,182,227 3,217,051 33,077,736
93

Total
(10 %) (10 %)
1 Shortage of  Temporary Filling of the Recruitment - - - No Cost activities

skilled staff vacant posts of medics and
the paramedics through
existing recruitment
committees
 Demand generation and Plan 1 1 1

request to the Department
of Health by the districts
for recruitment through
PSC against vacant posts
 Districts to prepare the Pay Package 1 1 1

incentivized pay package
with consultation of all
stockholders
 Consensus building Meeting 1 1 1

between the districts for
uniform incentivized pay
package for all categories
and levels staff
 Request to the Provincial Plan 1 1 1

Government for approval
and implementation of
agreed pay packages
94

Total
(10 %) (10 %)
 Review and revise the TA

career structure of medics,
paramedics and technical
staff, Health Education
officers etc
 Availability of recreation, Plan EDOH 1 1 1

education and other
facilities for children of
staff working in rural areas
 Construction of the Requirement 1 1 1

residences for the staff Plan
 provision of recreation Plan EDOH 1 1 1

facilities (Parks/Play
area/common rooms)
 Provision of the transport Plan EDOH 1 1 1

of staff children for the
education purposes
 Capacity and need TNA

assessment of the medics
and the paramedics
 Prepare training programs Plan 1 1 1

for providing higher
professional education
based on TNA
95

Total
(10 %) (10 %)
2 Inadequate  Assessing additional need

budget for POL for POL
 Costing & Submission the POL 76 26,316 2,000,000 2,000,000

additional Demand for POL
2,000,000 2,000,000
3 Capacity issues  Financial Management No. of 39000 3 39,000 39,000 39,000 117,000
of the staff workshops trainings
 Supportive supervision No. of 31800 3 31,800 31,800 31,800 95,400

training workshops trainings
 Workshops on Use of No. of 31800 3 31,800 31,800 31,800 95,400

information trainings
- 102,600 102,600 102,600 307,800
4 Lack of  Up gradation of DHDC Up gradation Detail 1 4,246,500 4,246,500

infrastructure Annexed
96

Total
(10 %) (10 %)
 Strengthening of DHIS Cell Up gradation Detail 1 374,000 - - 374,000

Annexed
- 4,620,500 - - 4,620,500
5 Shortage of  Purchase of Ambulances Vehicle 3,400,000 7 13,600,000 10,200,000 - 23,800,000

Vehicles for different Filter clinics
mentioned in workings
 Purchase of 2 Ambulances Vehicle 4,000,000 2 8,000,000 - - 8,000,000

for Mobile Clinics
 Purchase of Suzuki Car for Vehicle 650,000 1 650,000 - - 650,000

DHIS Co-Coordinator
- 22,250,000 10,200,000 - 32,450,000
6 Deficient Purchase of necessary Equipment Detail Annex - 8,500,000 - - 8,500,000

General Equipment at DHQH Kot
Equipment Khawaja Saeed
Purchase of necessary Equipment Detail Annex - 57,950,000 - - 57,950,000

equipment at various health
facilities
- 66,450,000 - - 66,450,000
97

Total
(10 %) (10 %)
7 Deficient  Purchase of MNCH related Equipment Detail - 12,147,260 - - 12,147,260

equipment Equipment at DHQH Mian Annexed
(with reference Munshi
to notified list)
at DHQHs and
THQHs
 Purchase of MNCH related Equipment Detail - 19,842,130 - - 19,842,130
Equipment at DHQH Kot Annexed
Khawaja Saeed

Equipment at THQH Annexed
Mazang

Equipment at THQH Said Annexed
Mittah

Equipment at THQH Annexed
Shahdara

Equipment at THQH Model Annexed
Town
121,161,615 121,161,615
98
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-II. Overall
financial outlay of the plan is as under:
Budget Summary
2010-2011 2011-2012 2012-2013
Regular Budget 1,255,874,944 1,490,214,136 1,713,746,256
Proposed additional
budget based on 268,122,091 72,231,720 83,389,367
problem identification
Total 1,523,997,035 1,562,445,856 1,797,135,624
99
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 During 1st register/visit
services (on year book/Attendance
rotational basis) of register
essential specialties
(Physician,
Surgeon,
Pediatrician and
Gynecologist)
% of health 100% Stock Register EDOH/ DOH/ 6 monthly
facilities with During 1st MSs
availability of year
essential MNCH
related equipment
(level specific)
Availability of 100% Stock Register EDOH/ Quarterly
relevant (MNCH) During 1st DOH/MSs,
laboratory year Store keeper
equipment at
appropriate level of
care
% facilities with 100% Stock Register EDOH/ DOH/ Monthly
availability of During 1st MSs, Store
essential medicines year keeper
% of functional 100% Log Book EDOH/DOH/ Quarterly
ambulances in the (DHQH/ Transport
district THQH/ officer
RHCs)
100

Achievement of
monitoring
% utilization of 100% of Quarterly Reports EDOH/ DOH/ Quarterly
sanctioned budget yearly MSs/
budget Accounts
officer
% of facilities with 100% Supervisory visit EDOH/DoH/ Quarterly
availability of basic (50% report DDOH
EmONC during 1st
year)
% of DHQ/THQ 100% in 3 Supervisory visit EDOH/DoH/ Quarterly
hospitals with years report DDOH
Comprehensive (50%
EmONC services during 1st
year)
% of facilities with 100% in 3 Supervisory visit EDOH/DoH/ Quarterly
availability of years (50% report DDOH
separate or during 1st
partitioned room year)
reserved
exclusively for
delivery
% of targeted Target DHIS Report EDOH/ Quarterly
pregnant women according Statistical
newly registered by to Officer
LHW population
% of targeted Target DHIS Report EDOH/ DHIS Quarterly
pregnant women according Coordinator/
received TT-2 to Statistical
vaccine population Officer
Delivery conducted 60 % DHIS Report EDOH/ DHIS Quarterly
by or under During 1st Coordinator/
supervision of year Statistical
skilled persons Officer
reported
%of target children Target DHIS Report EDOH/ DHIS Quarterly
between 18 - 23 according Coordinator/
months of age fully to Statistical
immunized population Officer
% of referred cases 100% DHIS Report/ EDOH/ DHIS Quarterly
attended LHWs monthly Coordinator/
report Statistical
Officer
101

Achievement of
monitoring
% of targeted Target LHW’s monthly/ EDOH/ Quarterly
eligible couples according quarterly report Statistical
provided to Officer
knowledge and population /Coordinator
information on NP-FP&PHC
Family Planning
methods
No. of meetings 12 Minutes of EDOH/ Focal Quarterly
with participation meetings meetings person/s
from other sectors per year
102
Annex-I
Cost of MNCH related equipment gaps for DHQ and THQ
Hospitals
DHQ Mian Munshi Hospital
Unit
Sr. No. Equipment Gap Total cost(Rs.)
Cost
5 Baby Warmer 1 850000
850,000.00
23 Mother Resuscitation Trolley (with life saving medicines, 1 110000
Laryngoscope, Endo-tracheal tube, BP Apparatus, Chargeable 110,000.00
light)
25 Pump Breast Electronic 1 250000

250,000.00
26.5 Hysterectomy Clamps (Straight) 2 150
300.00
26.19 Bladder Sound 1 1500
1,500.00
27.2 Straight Scissors 7 360
2,520.00
27.3 Needle holder 4 135
540.00
27.4 Non-toothed tissue forceps 8 inches 5 100
500.00
27.5 Toothed tissue forceps 8 inches 5 100
500.00
27.6 Sims Speculum single blade 13 275
3,575.00
27.7 Sims Speculum double blade 10 250
2,500.00
27.8 Sponge holding forceps 31 250
7,750.00
27.9 Artery forceps 17 275
4,675.00
27.1 Straight clamps (cord) 8 175
1,400.00
27.12 Towel clip 34 125
4,250.00
28.2 Artery Forceps Straight 6 inches 12 125
1,500.00
28.4 Artery forceps 8 inches 22 175
3,850.00
28.7 Green Armtage forceps 8 inches 16 300
4,800.00
28.1 Small Retractors 2 300
600.00
28.11 Towel Clippers 4 125
500.00
30.1 Paediatric Ventilator 1 1200000
1,200,000.00
30.5 Infant Length Measuring Scale 1 5000
5,000.00
30.8 Billiubino-meter 1 36000
103
Unit
Cost
36,000.00
30.9 Exchange Blood Transfusion Set 1 2000
2,000.00
30.1 Nasal Probe Paed size 2 7000
14,000.00
32.2 Packed cell machine 1 600000
600,000.00
32.3 Cell Separator 1 5225000
5,225,000.00
32.4 Freezer for Fresh Frozen Plasma 1 1150000
1,150,000.00
32.5 Blood bag shaker 1 10000
10,000.00
32.6 RH view box 1 1000
1,000.00
32.8 Micro-pipette 3 8000
24,000.00
32.9 Blood grouping tiles 1 3000
3,000.00
32.1 Plasma Extractor 1 1000000
1,000,000.00
32.11 Platelets agitator 1 1000000
1,000,000.00
33.2 Electrolyte Analyzer 1 625000
625,000.00
33.5 Haemoglobino-meter 1 1000
1,000.00
Total cost of equipment 12,147,260.00
DHQ Kot Khawaja Hospital
Unit
cost
3 Diagnostic Laparoscope 1 1200000 1,200,000.00
4 Bulb Sucker 4 45 180.00
104
Unit
cost
5 Baby Warmer 1 850000 850,000.00
11 Myoma Screw 2 320 640.00
12 Kochers forceps 4 235 940.00
13 Volselum forceps 6 235 1,410.00
15 Vaginal Retractors 4 350 1,400.00
17 Sponge holder 10 300 3,000.00
18 Uterine elevator 1 150 150.00
23 Mother Resuscitation Trolley (with life saving medicines, 1 110000 110,000.00
Laryngoscope, Endo-tracheal tube, BP Apparatus, Chargeable
light)
25 Pump Breast Electronic 1 250000 250,000.00

26.1 Toothed Tissue Forceps (8”) 2 55 110.00
26.2 Non-Tooted Tissue Forceps (8”) 2 55 110.00
26.3 Dissection Scissors (Curved 7”) 2 150 300.00
26.4 Dissection Scissors (Straight 7”) 2 150 300.00
26.7 Uterine Sound 2 90 180.00
26.8 Needle Holder (7”) 2 150 300.00
26.9 Needle Holder (10”) 2 300 600.00
26.1 Artery Forceps (Straight 6”) 4 110 440.00
26.14 Single blade Sims speculum 4 275 1,100.00
26.15 Double blade Sims speculum 4 250 1,000.00
26.19 Bladder Sound 2 1500 3,000.00
27.2 Straight Scissors 10 360 3,600.00
27.4 Non-toothed tissue forceps 8 inches 10 100 1,000.00
27.5 Toothed tissue forceps 8 inches 10 100 1,000.00
27.6 Sims Speculum single blade 20 275 5,500.00
27.7 Sims Speculum double blade 20 250 5,000.00
27.8 Sponge holding forceps 40 250 10,000.00
27.1 Straight clamps (cord) 10 175 1,750.00
27.12 Towel clip 40 125 5,000.00
28.1 Scalpel 6 50 300.00
28.2 Artery Forceps Straight 6 inches 24 125 3,000.00
28.4 Artery forceps 8 inches 24 175 4,200.00
28.5 Myoma Scissors straight 7 inches 6 150 900.00
28.7 Green Armtage forceps 8 inches 18 300 5,400.00
28.8 Obstetric outlet forceps (pair) 6 900 5,400.00
28.1 Small Retractors 12 300 3,600.00
28.11 Towel Clippers 24 125 3,000.00
29.2 X-Ray Unit 500 kw 1 6000000 6,000,000.00
105
Unit
cost
30.1 Paediatric Ventilator 1 1200000 1,200,000.00
30.4 Over-head Radiant Warmer 1 910000 910,000.00
30.5 Infant Length Measuring Scale 2 5000 10,000.00
30.8 Billiubino-meter 1 36000 36,000.00
30.9 Exchange Blood Transfusion Set 1 2000 2,000.00
30.1 Nasal Probe Paed size 2 7000 14,000.00
31.3 Nebulizer 1 165000 165,000.00
31.7 Tracheostomy tube (adult and paeds) 2 1000 2,000.00
31.8 Face mask of all sizes 2 1000 2,000.00
31.9 Double Cuff Tourniquet (for regional block) 1 320 320.00
31.12 Red Rubber Nasal tubes all sizes without cuff 4 1000 4,000.00
32.2 Packed cell machine 1 600000 600,000.00
32.3 Cell Separator 1 5225000 5,225,000.00
32.4 Freezer for Fresh Frozen Plasma 1 1150000 1,150,000.00
32.6 RH view box 1 1000 1,000.00
32.7 Water bath 1 3000 3,000.00
32.8 Micro-pipette 3 8000 24,000.00
32.9 Blood grouping tiles 2 3000 6,000.00
32.1 Plasma Extractor 1 1000000 1,000,000.00
32.11 Platelets agitator 1 1000000 1,000,000.00
32.12 Blood thawing bath 1 3000 3,000.00
33.5 Haemoglobino-meter 1 1000 1,000.00
Total cost of equipment 19,842,130
THQ Mazang Hospital
Sr. No. Equipment Gap Unit Total cost(Rs.)

cost
3 Diagnostic Laparoscope 1 1200000 1,200,000
106

cost
5 Baby Warmer 2 850000 1,700,000

10 Outlet forceps 2 900 1,800
11 Myoma Screw 1 320 320
15 Vaginal Retractors 8 350 2,800
16 Polypectomy forceps 2 750 1,500
17 Sponge holder 2 300 600
18 Uterine elevator 1 150 150
21 Suction Curette 1 95 95
23 Mother Resuscitation Trolley (with life saving medicines, 1 110000 110,000
light)
25 Pump Breast Electronic 1 250000 250,000

26.18 Uterine Sound 2 1500 3,000
26.19 Bladder Sound 2 1500 3,000
27.6 Sims Speculum single blade 6 275 1,650
27.7 Sims Speculum double blade 11 250 2,750
27.9 Artery forceps 35 275 9,625
27.1 Straight clamps (cord) 12 175 2,100
27.12 Towel clip 28 125 3,500
28.2 Artery Forceps Straight 6 inches 4 125 500
28.5 Myoma Scissors straight 7 inches 3 150 450
28.7 Green Armtage forceps 8 inches 2 300 600
28.8 Obstetric outlet forceps (pair) 4 900 3,600
28.9 Doyene’s Retractor 4 200 800
28.1 Small Retractors 10 300 3,000
28.11 Towel Clippers 12 125 1,500
28.12 Suction Nozzle 3 250 750
30.1 Paediatric Ventilator 1 1200000 1,200,000
30.4 Over-head Radiant Warmer 1 910000 910,000
30.5 Infant Length Measuring Scale 2 5000 10,000
30.8 Billiubino-meter 1 36000 36,000
30.9 Exchange Blood Transfusion Set 1 2000 2,000
30.1 Nasal Probe Paed size 2 7000 14,000
31.2 Ventilators 1 525000 525,000
31.3 Nebulizer 1 165000 165,000
31.6 Airway Oral and Nasal 2 500 1,000
31.7 Tracheostomy tube (adult and paeds) 2 1000 2,000
31.9 Double Cuff Tourniquet (for regional block) 1 320 320
31.12 Red Rubber Nasal tubes all sizes without cuff 4 1000 4,000
107

cost
32.1 Blood storage cabinet (100 bag capacity) 1 812000 812,000

32.2 Packed cell machine 1 600000 600,000
32.3 Cell Separator 1 5225000 5,225,000
32.4 Freezer for Fresh Frozen Plasma 1 1150000 1,150,000
32.5 Blood bag shaker 1 10000 10,000
32.6 RH view box 2 1000 2,000
32.7 Water bath 2 3000 6,000
32.9 Blood grouping tiles 3 3000 9,000
32.1 Plasma Extractor 1 1000000 1,000,000
32.11 Platelets agitator 1 1000000 1,000,000
32.12 Blood thawing bath 1 3000 3,000
33.2 Electrolyte Analyzer 1 425000 425,000
33.5 Haemoglobino-meter 1 1000 1,000
Total cost of equipment
16,416,410
DHQ Said Mittah Hospital
Unit Total
Sr. No. Equipment Gap
cost cost(Rs.)
1 CTG (Cardiac Tocography) 1 285000 285,000.00
2 Foetal Doppler 2 10000 20,000.00
3 Diagnostic Laparoscope 1 1200000 1,200,000.00
4 Bulb Sucker 5 45 225.00
5 Baby Warmer 2 850000 1,700,000.00
6 Mechanical Sucker 3 28000 84,000.00
7 Fetal Stethoscope 2 1500 3,000.00
8 Delivery Table 1 17500 17,500.00
9 D&C Set 1 2100 2,100.00
10 Outlet forceps 3 900 2,700.00
11 Myoma Screw 2 320 640.00
12 Kochers forceps 4 235 940.00
13 Volselum forceps 4 235 940.00
14 Lanes Tissue holding forceps 2 400 800.00
15 Vaginal Retractors 4 350 1,400.00
16 Polypectomy forceps 2 750 1,500.00
17 Sponge holder 10 300 3,000.00
18 Uterine elevator 1 150 150.00
19 CosCo Speculum 4 550 2,200.00
Small, Medium, Large (for each category) -
108
20 Examination light 1 18000 18,000.00

21 Suction Curette 1 95 95.00
22 Infant Resuscitation Trolley (with life saving medicines, baby 1 95000 95,000.00
laryngoscope, Endo-tracheal tube, Infant BP Apparatus,
Chargeable Light)
23 Mother Resuscitation Trolley (with life saving medicines, 1 110000 110,000.00

light)
24 Cardiac Monitor 1 500000 500,000.00

25 Pump Breast Electronic 1 250000 250,000.00
26.1 Toothed Tissue Forceps (8”) 2 55 110.00
26.2 Non-Tooted Tissue Forceps (8”) 2 55 110.00
26.3 Dissection Scissors (Curved 7”) 2 150 300.00
26.4 Dissection Scissors (Straight 7”) 2 150 300.00
26.5 Hysterectomy Clamps (Straight) 8 150 1,200.00
26.6 Hysterectomy Clamps (Curved) 8 175 1,400.00
26.7 Uterine Sound 2 90 180.00
26.8 Needle Holder (7”) 2 150 300.00
26.9 Needle Holder (10”) 2 300 600.00
26.1 Artery Forceps (Straight 6”) 16 110 1,760.00
26.11 Artery Forceps (Curved 6”) 14 125 1,750.00
26.12 Allis Forceps 7 230 1,610.00
26.14 Single blade Sims speculum 4 275 1,100.00
26.15 Double blade Sims speculum 4 250 1,000.00
26.17 Volselum forceps 4 250 1,000.00
26.18 Uterine Sound 2 1500 3,000.00
26.19 Bladder Sound 2 1500 3,000.00
27.1 Episiotomy Scissors 6 125 750.00
27.2 Straight Scissors 6 360 2,160.00
27.3 Needle holder 6 135 810.00
27.4 Non-toothed tissue forceps 8 inches 6 100 600.00
27.5 Toothed tissue forceps 8 inches 6 100 600.00
27.6 Sims Speculum single blade 12 275 3,300.00
27.7 Sims Speculum double blade 12 250 3,000.00
27.9 Artery forceps 40 275 11,000.00
27.1 Straight clamps (cord) 20 175 3,500.00
27.11 Vacuum Extractor pump 1 19000 19,000.00
27.12 Towel clip 40 125 5,000.00
28.1 Scalpel 4 50 200.00
109
28.2 Artery Forceps Straight 6 inches 16 125 2,000.00

28.3 Artery Forceps Curved 6 inches 16 125 2,000.00
28.4 Artery forceps 8 inches 16 175 2,800.00
28.5 Myoma Scissors straight 7 inches 4 150 600.00
28.6 Dissecting scissors (curved) 7 inches 4 270 1,080.00
28.7 Green Armtage forceps 8 inches 16 300 4,800.00
28.8 Obstetric outlet forceps (pair) 4 900 3,600.00
28.9 Doyene’s Retractor 4 200 800.00
28.1 Small Retractors 8 300 2,400.00
28.11 Towel Clippers 16 125 2,000.00
28.12 Suction Nozzle 4 250 1,000.00
29.2 X-Ray Unit 500 kw 1 6000000 6,000,000.00
29.4 Lead Screen for X-Ray Unit 1 30000 30,000.00
29.5 0.5 MN Lead Apron. Lead Gloves, Goggles and Thyroid and 1 100000 100,000.00
Gonadal Sheets
30.1 Paediatric Ventilator 1 1200000 1,200,000.00

30.2 Incubator 1 1500000 1,500,000.00
30.3 Photo Therapy Unit 1 22000 22,000.00
30.4 Over-head Radiant Warmer 1 910000 910,000.00
30.5 Infant Length Measuring Scale 2 5000 10,000.00
30.6 Infant Weighing Machine 1 3100 3,100.00
30.8 Billiubino-meter 1 36000 36,000.00
30.9 Exchange Blood Transfusion Set 1 2000 2,000.00
30.1 Nasal Probe Paed size 1 7000 7,000.00
31.1 Anaesthesia Machine 1 321000 321,000.00
31.2 Ventilators 1 525000 525,000.00
31.3 Nebulizer 1 165000 165,000.00
31.4 Pulse Oximetry 1 21000 21,000.00
31.5 Defibrillator 1 500000 500,000.00
31.6 Airway Oral and Nasal 1 500 500.00
31.7 Tracheostomy tube (adult and paeds) 1 1000 1,000.00
31.8 Face mask of all sizes 1 1000 1,000.00
31.9 Double Cuff Tourniquet (for regional block) 1 320 320.00
31.1 AMBO bag adult 1 2450 2,450.00
31.11 AMBO Bag paeds 2 3000 6,000.00
31.12 Red Rubber Nasal tubes all sizes without cuff 4 1000 4,000.00
32.1 Blood storage cabinet (100 bag capacity) 1 812000 812,000.00
32.2 Packed cell machine 1 600000 600,000.00
32.3 Cell Separator 1 5225000 5,225,000.00
32.4 Freezer for Fresh Frozen Plasma 1 1150000 1,150,000.00
32.5 Blood bag shaker 1 10000 10,000.00
110
32.6 RH view box 1 1000 1,000.00

32.7 Water bath 2 3000 6,000.00
32.8 Micro-pipette 3 8000 24,000.00
32.9 Blood grouping tiles 3 3000 9,000.00
32.1 Plasma Extractor 1 1000000 1,000,000.00
32.11 Platelets agitator 1 1000000 1,000,000.00
32.12 Blood thawing bath 1 3000 3,000.00
33.1 Hematology Analyzer 1 425000 425,000.00
33.2 Electrolyte Analyzer 1 625000 625,000.00
33.3 Analyzer Bio-chemistry Semi-automatic 1 690000 690,000.00
33.4 Glucometer 2 2500 5,000.00
THQ Shah Dara Hospital
Sr. No. Equipment Gap Unit cost Total cost(Rs.)
1 CTG (Cardiac Tocography) 1 285000 285,000

2 Foetal Doppler 2 10000 20,000
5 Baby Warmer 2 850000 1,700,000
6 Mechanical Sucker 2 28000 56,000
7 Fetal Stethoscope 2 1500 3,000
8 Delivery Table 1 17500 17,500
12 Kochers forceps 4 235 940
13 Volselum forceps 4 235 940
14 Lanes Tissue holding forceps 2 400 800
17 Sponge holder 8 300 2,400
19 CosCo Speculum 4 550 2,200
20 Examination light 2 18000 36,000
22 Infant Resuscitation Trolley (with life saving medicines, baby 1 95000 95,000
Chargeable Light)
111

light)
24 Cardiac Monitor 1 500000 500,000

26.1 Toothed Tissue Forceps (8”) 2 55 110
26.2 Non-Tooted Tissue Forceps (8”) 2 55 110
26.3 Dissection Scissors (Curved 7”) 2 150 300
26.5 Hysterectomy Clamps (Straight) 8 150 1,200
26.6 Hysterectomy Clamps (Curved) 8 175 1,400
26.7 Uterine Sound 2 90 180
26.8 Needle Holder (7”) 2 150 300
26.9 Needle Holder (10”) 2 300 600
26.1 Artery Forceps (Straight 6”) 4 110 440
26.11 Artery Forceps (Curved 6”) 10 125 1,250
26.12 Allis Forceps 8 230 1,840
26.13 Towel Clamps 8 125 1,000
26.14 Single blade Sims speculum 3 275 825
26.15 Double blade Sims speculum 4 250 1,000
26.16 Sponge holding forceps 6 200 1,200
26.17 Volselum forceps 4 250 1,000
26.18 Uterine Sound 2 1500 3,000
26.19 Bladder Sound 2 1500 3,000
27.1 Episiotomy Scissors 4 125 500
27.2 Straight Scissors 2 360 720
27.3 Needle holder 5 135 675
27.4 Non-toothed tissue forceps 8 inches 6 100 600
27.5 Toothed tissue forceps 8 inches 6 100 600
27.11 Vacuum Extractor pump 1 19000 19,000
27.12 Towel clip 40 125 5,000
28.1 Scalpel 4 50 200
28.2 Artery Forceps Straight 6 inches 16 125 2,000
28.3 Artery Forceps Curved 6 inches 16 125 2,000
28.4 Artery forceps 8 inches 16 175 2,800
112

28.6 Dissecting scissors (curved) 7 inches 4 270 1,080
28.7 Green Armtage forceps 8 inches 16 300 4,800
28.11 Towel Clippers 16 125 2,000
28.12 Suction Nozzle 4 250 1,000
29.4 Lead Screen for X-Ray Unit 1 30000 30,000
30.2 Incubator 1 1500000 1,500,000
30.3 Photo Therapy Unit 1 22000 22,000
30.6 Infant Weighing Machine 1 3100 3,100
31.1 Anaesthesia Machine 1 321000 321,000
31.2 Ventilators 1 525000 525,000
31.4 Pulse Oximetry 1 21000 21,000
31.5 Defibrillator 1 500000 500,000
31.6 Airway Oral and Nasal 1 500 500
31.1 AMBO bag adult 1 2450 2,450
31.11 AMBO Bag paeds 2 3000 6,000
32.3 Cell Separator 1 5225000 5,225,000
32.5 Blood bag shaker 1 10000 10,000
32.6 RH view box 1 1000 1,000
32.7 Water bath 2 3000 6,000
32.8 Micro-pipette 4 8000 32,000
113

33.1 Hematology Analyzer 1 425000 425,000
33.4 Glucometer 2 2500 5,000
THQ Model Town Hospital
Total
Sr. No. Equipment Gap Unit cost
cost(Rs.)
1 CTG (Cardiac Tocography) 1 285000 285,000
2 Foetal Doppler 1 10000 10,000
4 Bulb Sucker 5 45 225
5 Baby Warmer 1 850000 850,000
6 Mechanical Sucker 3 28000 84,000
9 D&C Set 1 2100 2,100
12 Kochers forceps 4 235 940
13 Volselum forceps 4 235 940
14 Lanes Tissue holding forceps 2 400 800
17 Sponge holder 5 300 1,500
19 CosCo Speculum 4 550 2,200
22 Infant Resuscitation Trolley (with life saving medicines, baby 1 95000 95,000
Chargeable Light)

light)
24 Cardiac Monitor 1 500000 500,000

26.1 Toothed Tissue Forceps (8”) 2 55 110
26.2 Non-Tooted Tissue Forceps (8”) 2 55 110
114
Total
cost(Rs.)
26.3 Dissection Scissors (Curved 7”) 2 150 300
26.4 Dissection Scissors (Straight 7”) 2 150 300
26.5 Hysterectomy Clamps (Straight) 8 150 1,200
26.6 Hysterectomy Clamps (Curved) 8 175 1,400
26.7 Uterine Sound 1 90 90
26.9 Needle Holder (10”) 2 300 600
26.1 Artery Forceps (Straight 6”) 8 110 880
26.11 Artery Forceps (Curved 6”) 10 125 1,250
26.12 Allis Forceps 8 230 1,840
26.13 Towel Clamps 8 125 1,000
26.14 Single blade Sims speculum 4 275 1,100
26.15 Double blade Sims speculum 4 250 1,000
26.17 Volselum forceps 4 250 1,000
26.18 Uterine Sound 1 1500 1,500
26.19 Bladder Sound 2 1500 3,000
27.1 Episiotomy Scissors 6 125 750
27.4 Non-toothed tissue forceps 8 inches 6 100 600
27.5 Toothed tissue forceps 8 inches 6 100 600
27.11 Vacuum Extractor pump 1 19000 19,000
27.12 Towel clip 40 125 5,000
28 Caesarian Section -
28.1 Scalpel 4 50 200
28.2 Artery Forceps Straight 6 inches 16 125 2,000
28.3 Artery Forceps Curved 6 inches 16 125 2,000
28.4 Artery forceps 8 inches 16 175 2,800
28.6 Dissecting scissors (curved) 7 inches 4 270 1,080
28.7 Green Armtage forceps 8 inches 16 300 4,800
28.11 Towel Clippers 16 125 2,000
28.12 Suction Nozzle 4 250 1,000
115
Total
cost(Rs.)
29.2 X-Ray Unit 500 kw 1 6000000 6,000,000
29.4 Lead Screen for X-Ray Unit 1 30000 30,000
29.5 0.5 MN Lead Apron. Lead Gloves, Goggles and Thyroid and 1 100000 100,000
Gonadal Sheets

30.6 Infant Weighing Machine 1 3100 3,100
31.1 Anaesthesia Machine 1 321000 321,000
31.2 Ventilators 1 525000 525,000
31.3 Nebulizer 1 165000 165,000
31.5 Defibrillator 1 500000 500,000
31.8 Face mask of all sizes 1 1000 1,000
31.11 AMBO Bag paeds 1 3000 3,000
32.3 Cell Separator 1 5225000 5,225,000
32.5 Blood bag shaker 1 10000 10,000
32.6 RH view box 1 1000 1,000
32.7 Water bath 2 3000 6,000
32.8 Micro-pipette 4 8000 32,000
32.13 Microscopes 1 115000 115,000
33.1 Hematology Analyzer 1 425000 425,000
33.3 Analyzer Bio-chemistry Semi-automatic 1 690000 690,000
33.4 Glucometer 2 2500 5,000
116
117

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Three Years Rolling Plan 2010-2013 District Lahore

THREE YEARS ROLLING PLAN

Service delivery/Management problems ........................................................................................... 30

SECTION 1: DISTRICT HEALTH PROFILE

Mission of the District

Background of the District

Map to the District

o Total Population 8190421

Tehsil wise distribution

Tehsil/Town Number of UC Population

GULBERG TOWN 15 801769

AZIZ BHATTI TOWN 13 684010

ALLAMA IQBAL TOWN 19 1160619

RAVI TOWN 18 1044030

SHALAMAR TOWN 17 868513

SAMNABAD TOWN 19 1039831

WAGAH TOWN 12 655773

DATA GUNJ BUKSH TOWN 18 963385

Education and Literacy

Literacy rate Male Female

Rural ---- ---

 Infant Mortality Rate 50/1000 live births

 Under 5 mortality Rate 68/1000

Sources: EDO (Health) Lahore

Organizational Structure of District Health Administration

EXECUTIVE DISTRICT OFFICER(HEALTH)

10 DRUG DDOH Rural Disp.

DHQ Hospital Government Mian Munshi

RHCs 6 RHC’S 120 120 -----

MCH Centers 23 --- --- ------

Sub Health 2 --- ---

TB Clinics Government infectious

Sr. Name of Post Sanctioned Filled

i. Basic Health Unsets (37)

2 School Health & Nutrition Supervisor 37 37 0

ii. Rural Health Centres (6)

2 Women Medical Officers 6 6 0

28 Homeo Naib Qasid 3 3 0

iii. THQ Hospitals (2)

S# Name of post Sanctioned Filled

25 Tub well operator 1 1

S# Name of post Sanctioned Filled

iv. DHQ Hospital (2)

S# Name of post Sanctioned Filled

22 Senior Dental Surgeon 1 1

26 Medical Officer 117 91

30 Charge Nurses 324 217

46 Operation Theater Assistant 20 7

55 Tube well Operator 5 5

Post Sanctioned Filled

ii. Community Midwifery School

The provision of financial resources at district level is prime responsibility of district

Development --- --- --- --- --- ---

Sub Total 673.061 611.802 836.053 821.332 1060.273 611.891

PHSRP 22.000(B)- 22.000(B)- 8.000(E) 5.738(E) - -

Grand Total 750.715 657.695 1103.912 1001.470 1277.324 793.877

Disease Group Total Percentage

Disease Group Total Percentage