Integrated Health Project - Khyber Pakhtunkhwa, Pakistan - PC-I Final Draft Final Version 2020-23

New Integrated Health Project PC-I
“Integration of Health Services Delivery with Special Focus on MNCH, LHW

and Nutrition Program” (Government of Khyber Pakhtunkhwa)
2020-23
Total Cost PKR 7,027.226 Million
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CONTENTS
1. Name of the Project: ....................................................................................................................... 6
2. Location: .......................................................................................................................................... 6
3. Authority responsible for: .............................................................................................................. 6
3.1 Sponsoring: .................................................................................................................................. 6
3.2 Execution: .................................................................................................................................... 6
3.3 Operation and maintenance:...................................................................................................... 6
3.4 Concerned Federal Ministry ...................................................................................................... 6
4.1 Plan Provision: ................................................................................................................................ 6
4.2 Provision in the current year PSDP/ADP: N/A. ........................................................................... 7
5. Project objectives and its relationship with Sectoral Objectives: ............................................... 7
5.1 Goal: ............................................................................................................................................. 7
5.2 Purpose of the Project: ............................................................................................................... 7
5.3 Project Specific Objectives:........................................................................................................ 8
5.4 Relationship with Sectoral Objectives: ..................................................................................... 9
5.5 Relevance of the Project to Health Policy Khyber Pakhtunkhwa (2018-2025) ..................... 9
6 Description, Justification and Technical Parameters: ............................................................... 10
6.1 Project Description: ...................................................................................................................... 10
6.2 Technical Parameters & Broader Scope: ................................................................................... 11
6.3 Strategic Areas/Technical Parameters:....................................................................................... 14
6.3.1 Improvement in MNCH, RH, FP and Nutrition Services: Outreach & facility level: .... 14
6.3.2 To improve Access to RMNCH and Nutrition services of MHSDP at Primary care facility
level by: 15
6.3.3 STRENGTHENING OF BASIC EmONC SERVICES AT THE PRIMARY HEALTH
CARE FACILITIES ............................................................................................................................. 15
6.4 Intervention Matrix .............................................................................................................. 16
6.4.1 Birth Spacing Services:............................................................................................................. 17
6.5 Transfer Grants to PCMC ........................................................................................................... 18
6.6 IMPACT ON SECONDARY AND TERTIARY LEVEL HOSPITALS ......................... 19
6.7 Strengthening and reinforcement of Referral System by introducing Rural Ambulance
Services (RAS) to save lives of Complicated Patients ............................................................................ 19
6.8 Operational. Arrangements: ........................................................................................................ 20
6.9 RAS Dashboard: Daily management through real-time monitoring and supervision ....... 21
6.10 To improve Access to nutrition interventions at Primary & Secondary care level by: .......... 22
6.11 Strengthening of Community Based Services............................................................................. 23
6.12 Improving the services of LHWs ............................................................................................. 23
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6.13 THE SCOPE OF WORK FOR LHW ........................................................................................... 24
6.14 Reform Proposal ....................................................................................................................... 26
6.14.1 Mapping of Existing LHWs Coverage: Geo Mapping....................................................... 26
6.14.2 Management reforms: .......................................................................................................... 27
6.14.3 Recording, reporting and supervision: ............................................................................... 27
6.14.4 Service package ..................................................................................................................... 27
6.14.5 Efficiency and cost effectiveness: ......................................................................................... 28
6.15 Improving the services of CMWs: ....................................................................................... 28
6.15.1 Payment Model of CMWs .................................................................................................... 30
6.15.2 To Strengthen Community Participation and Mobilization in RMNCH activities ............ 32
6.15.3 Improving practices and health seeking behavior for Reproductive, Maternal, New born,
Child Health and Nutrition through BCC ......................................................................................... 32
6.15.4 Toolkit development for standardized key (gender-sensitive) messages for BCC on
MNCH, FP and Nutrition .................................................................................................................... 32
6.15.5 Implantation of district communication strategy.............................................................. 34
The district Social Organizer .................................................................................................................. 34
6.15.6 Stakeholder Participation Strategies and Implementation .............................................. 35
6.16 Governance, Monitoring & Evaluation....................................................................................... 35
6.16.1 Integrate and strengthen programme management at provincial and district level ...... 35
6.16.2 Provincial Project Implementation Unit (PIU) ..................................................................... 36
6.17 Financial Management Unit ..................................................................................................... 36
6.17.1 Fund Flow Mechanism: ....................................................................................................... 36
6.17.2 Reconciliation and Accounting of Funds: ............................................................................... 37
6.17.3 Internal Audit ....................................................................................................................... 37
6.18 Establishment of Anti-Harassment Cell.............................................................................. 37
6.19 District Implementation Unit ................................................................................................... 37
6.22 Institutional arrangements of the Project at Provincial level ............................................... 40
6.22.1 PROJECT STEERING COMMITTEE.............................................................................. 40
6.23 To introduce Technical Management on Provincial and District Level in order to improve
the Quality of Care being provided at a Facility Level...................................................................... 42
6.24 To introduce integrated Monitoring & Evaluation and Surveillance Systems for evidence
based decision making through use of good quality data by: .......................................................... 43
6.25 Monitoring Framework: .................................................................................................................. 44
6.26 Exit Strategy .................................................................................................................................. 48
7 Capital Cost of Project: ................................................................................................................ 48
7.1 Project Approval History: ............................................................................................................ 49
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8. Annual Operating and Maintenance Cost after Completion of the Project ............................ 51
9. Demand and Supply Analysis. ..................................................................................................... 51
9.1 Projected demand for Three years ...................................................................................... 52
10. Financial Plan and Mode of Financing ....................................................................................... 53
10.1 Source of Financing: ................................................................................................................. 53
10.1.1 Equity ..................................................................................................................................... 53
11. Project benefits and analysis. ....................................................................................................... 53
11.1 Financial..................................................................................................................................... 53
11.2 Social benefits with indicators ................................................................................................. 53
11.3 Environmental impact .............................................................................................................. 54
11.4 Quantifiable output of the project ........................................................................................... 54
11.5 Employment generation (direct & Indirect) ........................................................................... 55
11.6 Impact of delays on project cost and viability ........................................................................ 55
12. Implementation schedule.......................................................................................................... 55
13. Management structure and manpower requirements including specialized skills during execution
and operational Phases ............................................................................................................................. 57
14. Additional Projects/Decisions Required to Maximize Socio-Economic Benefits from the Proposed
Project ........................................................................................................................................................ 57
15. Certificate ....................................................................................................................................... 58
PC-1 has been prepared as per instructions for the preparation of PC-1 for social sector Projects. ........... 58
16 List of Acronyms: ........................................................................................................................... 59
17. Logical Framework ......................................................................................................................... 62
18. IHP Financial Summary Cost Sheet............................................................................................ 77
18.1 Output 1 Financial Summary & Physical Activities .................................................................. 78
18.1.1 Annex B-1 Nutrition Commodities & Equipment’s Items & Unit Cost .......................................... 79
18.1.2 Annex B-2 CMWs Birth Station Items & Unit Cost Summary ............................................ 82
18.1.3 Annex B-3 CMWs Kit Bag Items & Unit Cost ....................................................................... 84
18.1.4 Annex B-4 LHWs Kit Bag Items & Unit Cost ........................................................................ 85
18.1.5 Annex B-5 Trainings M&E Frame Work Review Meetings Cost Summary ...................... 86
18.1.6 Annex B-6 Cost of MNCH Schools in Districts ...................................................................... 90
18.1.7 Annex B-7 Cost of Warehousing & Supply Chain ................................................................. 91
18.1.8 Annex B-8 Contraceptives Cost Summary for Health Care Facilities ................................. 92
18.2.1 Annex C-1 Behavior Change Communication Cost Summary............................................. 94
18.3.1 Annex D-1Human Resource Cost Summary PMU & DMU ................................................. 96
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18.3.2 Annex D-2 Operation Cost Summary ..................................................................................... 99
18.3.4 Annex D-4 Procurement of PIU Equipment’s Cost Summary ........................................... 100
18.4 Output 4 Financial Summary & Physical Activities ................................................................ 102
18.4.1 Annex E-1 POL & Repair of Vehicles Cost Summary PMU & DMU ............................... 103
18.4.2 Annex E-2 MIS Tools Cost Summary for LHWs ................................................................. 104
18.4.3 Annex E-3 Monitoring TA/DA Cost Summary PMU & DMU ........................................... 105
18.4.4 Annex E-4 E-Monitoring Cost Summary for CMWs & LHWs & LHSs ........................... 106
19. Procurement Financial & Physical Activities Summary ......................................................... 107
19.1 Justification for New Proposed Human Resource ............................................................... 109
19.2 Integrated Health Project Proposed Human Resource for 2020-23 ....................................... 110
19.3 Integrated Health Project, Staff Comparative Statement (Instant & Previous PC-I)...... 112
19.4 Selection Criteria for PMU & DMU New Staff .................................................................... 116
19.5 Selection Criteria for CMWs ................................................................................................. 119
19.6 Integrated Health Project, Job Descriptions Project Management Unit (PMU) Staff ..... 120
19.7 District Management Unit (DMU) Staff Job Descriptions & TORs .................................. 164
19.7 District Level Field Staff - Health Workers Jobs Description & TORs ............................. 166
20. Pre-PDWP Observation and Annotated Reply ........................................................................ 174
21. Revenue Clearance From Finance Department Khyber Pakhtunkhwa ................................ 194
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1. Name of the Project:
Integration of Health Services Delivery with Special Focus on MNCH, LHW, and
Nutrition Programme (Government of Khyber Pakhtunkhwa) ADP # 816/code 200037
(2020-23)
2. Location:
All Districts of Khyber Pakhtunkhwa
3. Authority responsible for:

3.1 Sponsoring: Government of Khyber Pakhtunkhwa
3.2 Execution: Health Department Khyber Pakhtunkhwa through DGHS

Office
3.3 Operation and maintenance: Health Department Khyber Pakhtunkhwa
through DGHS office
3.4 Concerned Federal Ministry: National Health Services, Regulation &
Coordination (NHSRC)
4.1 Plan Provision:

I. If the project is included in the current Three Year Plan specifies actual allocation. The
scheme is reflected in the Annual Development Plan of Khyber Pakhtunkhwa 2020-21
as “Integration of Health Services Delivery with Special Focus on MNCH, LHW, and
Nutrition Programme”, at a cost of Rs. 8,000 Million (Local share) vide ADP #
816/2020-21.
II. If not included in the current Plan how it is now proposed to be accommodated (Inter/intra
sect-oral adjustments in allocation or other resources may be indicated); N/A
III. If the project is proposed to be financed out of block provision for a program, indicate;
N/A
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4.2 Provision in the current year PSDP/ADP: N/A.
5. Project objectives and its relationship with Sectoral Objectives:
5.1 Goal:
To improve the health outcomes among women, children and newborns by
enhancing coverage and providing access of health and nutrition services to the poor and
vulnerable in rural and less developed urban areas through implementation of the Minimum
health service delivery package (MHSDP) and achievement of Minimum Service Delivery
Standards (MSDS) in both outreach and facility based services.
5.2 Purpose of the Project:
 To improve access to RMNCH and nutrition services of MHSDP at outreach level.

 To improve Access to RMNCH and Nutrition services of MHSDP at Primary care facility
level.
 To improve Access to nutrition interventions at Secondary care level.
 To integrate and strengthen programme management at provincial and district level.
 To introduce E-Monitoring & reporting system for collection of good quality data for
evidence based decision making.
The above objective will contribute towards achievement of the performance

targets envisaged in the Health Policy Khyber Pakhtunkhwa and Health Sector Strategic
Plan.
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5.3 Project Specific Objectives:
Target
PDHS PDHS
Indicators by the end of June 2023
(2012) (2018)
(PC-I)
Maternal 206/100,000 165/100,000 LB

140/ 100,000 LB
Mortality Ratio LB (NIPS 2018)
Neonatal
41/1000 LB 42/1000 LB 35/ 1000 LB
Mortality Rate
Infant Mortality
58/1000 LB 53/1000 LB 45/ 1000 LB
Rate
Under Five
70/1000 LB 64/1000 LB 56/ 1000 LB
Mortality Rate
Contraceptive
Prevalence Rate 28.10 % 30.90% 33%
(Both Methods)
Skilled Birth
48.30% 67.40% >75%
Attendant
Stunting 37.70% 43.30% 40%
Relevance with SDGS:
SDG 3 Indicators Current Status SDG Targets by Project Target

2030 by 2023
3.1.1. Maternal Mortality 165/100,000LB <70 140
Ratio1(per 100,000 live births) NIPs 2019
3.1.2. Skilled Birth Attendance (%) 67.40 >90 >75%
PDHS 2018
3.2.1. Under Five Mortality Rate 64 <25 56
(per 1,000 live births) PDHS 2018
3.2.2. Neonatal Mortality Rate (per 42 <12 35
1,000 live births) PDHS 2018
3.7.1. Contraceptive Prevalence 30.9% >75 33%
Rate (only modern methods, %) PDHS 2018
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Stunting Rate 43.30% 25.98% (40% 39.45%
PDHS 2018 reduction in number
of children under
5 who are stunted
%)
5.4 Relationship with Sectoral Objectives:

The program shall contribute to all health& nutrition sectoral priorities set in the
‘Economic Growth Framework’ of the Planning Commission, i.e.
1: Revamping/management of primary, secondary and tertiary healthcare;
2: Healthcare Financing Reforms; and
3: Governance Reforms in health sector (especially setting quality standards; essential

services package; aid effectiveness, service structure; capacity; access to affordable
medicine; etc.)
5.5 Relevance of the Project to Health Policy Khyber Pakhtunkhwa

(2018-2025)
The Health Department, Khyber Pakhtunkhwa using guidance from Health Policy
Khyber Pakhtunkhwa, Health Sector Strategic Plan 2019-2025, Khyber Pakhtunkhwa
Multi-Sectoral Integrated Nutrition Strategy, Khyber Pakhtunkhwa Protection of Breast
Feeding and Child Nutrition act 2015, Khyber Pakhtunkhwa Sustainable Development
Strategy 2019-2023 and Pakistan Vision 2025. The Health Sector Documents provides
the necessary opportunity and space to the health department for realizing the dream of
having fully functional health systems that is geared at meeting the needs of the
population. Using integrated approach for service delivery, it aims to improve the health
outcomes, especially among women and children, by enhancing coverage and access to
essential health services for the poor and vulnerable by developing and implementing a
Minimum Health Service Delivery Package (MHSDP) at Primary Health Care level for a
measurable reduction in morbidity and mortality.
The instant project will contribute in achieving health outcomes set in Health Policy
Khyber Pakhtunkhwa (2018-2025);
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• To develop actionable plans by Public and Private Health care providers for improving
effectiveness, efficiency, quality, accessibility and equity of healthcare services in
Khyber Pakhtunkhwa
• To improve the health status of target population as part of its effort to achieve SDGs
(SDG 2 & 3) and fulfilling international commitments.
• To facilitate international donors and partners to align their resources for better health
outcomes in the province.
• Develop actionable plans Enhanced coverage and access to minimum health services
especially for the poor and vulnerable.
• A measurable reduction in morbidity and mortality rates due to common preventable

diseases especially among women and children.
• Improved Human resource management.
• Improved Governance and Accountability.
• Improved Regulation and Quality Assurance.
6 Description, Justification and Technical Parameters:
6.1 Project Description:

Health Department, Government of Khyber Pakhtunkhwa while realizing its
commitment to improve health status of its population has embarked on improving its
health system and its strategic direction for achieving better health outcomes for their
population specifically living in the rural area of Khyber Pakhtunkhwa. This integrated
programme is the step towards its implementation.
The instant PC-I is extension of previous IHP project with more focused technical
interventions and with devolved management approach. The role of PMU will be to
provide technical assistance and oversight. Mid-course correction on the basis of available
program data.
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6.2 Technical Parameters & Broader Scope:
The PC-1 has scope of expansion and introduction of community based and facility
based new interventions as well as structural & functional integration with other programs
as follows:
Programme Programme Goals Remarks
National Overall health sector goals of Non salary component of LHWs

Programme for improvement in maternal, new- Program shall be funded through this
Family Planning born& child health and provision program as salary component being
and Primary of Family Planning services funded from current side after the
Health Care, also through extended outreach health regularization of its employees.
known as the services to Rural populations and
Non-Salary Component includes
Lady Health Urban Slum Communities at their
Operational Cost of DMU, Medicines,
Workers door steps through Lady Health
Contraceptives, Equipment, POL and
Programme Workers (LHWs).
Capacity Building.
(LHWP) (est
1994).
Maternal, Improvement of maternal, All components of previous MNCH

Newborn and newborn and child health of the program have been included in this
Child Health population, particularly among PC-1 along with new operational
(MNCH) poor, marginalized and model of CMWs i.e. Deployment of
Programme disadvantaged segments, through: CMWs in Urban Slum. There are
(2006-2012) multiple lacunas in deployment policy
- Strengthening of BEmONC and
of CMWs after attaining diploma from
CEmONC at Primary and
PNC and this policy varies from
Secondary Healthcare facilities
province to province. Previously the
(THQs and DHQs) in terms of
program retained CMWs for two years
capacity building of staff. The
with stipend, then the period was
new initiative of 24/7 BEmONC
increased from 2 to 3 years but in KP
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care services is being launched at deployed CMWs are receiving
selected BHUs & RHCs, through retainer ship stipend for unlimited
separate PC1 from the office of period. However it is linked with
DGHS, The funds will be minimum performance, two verifiable
provided for provision of deliveries per month. It is proposed
additional medicines/ equipment/ that program (IHP) will conduct
additional HR and RR of mapping exercise and geotagging the
infrastructure. The existing CMW station in order to
implementation will be the verify their existence. All CMWs will
responsibility of IHP coordinator. not be entitled to draw stipend for
The field monitoring & more than three years.
supervision of Community and
facility based staff will be under
one umbrella –IHP.
Nutrition These initiatives are being The nutrition interventions are being
interventions proposed for all districts, integrated in PHC at all levels, The
addressing malnutrition including commodities and anthropometric
wasting and stunting through equipment will be purchased from
promotive, preventive and IHP funds.
curative components by
establishing of SCs (DHQs) and
OTPs (BHUs / RHCs), CMAM
and IYCF protocols. These
initiatives are key components in
the proposed IHP PC-1
Preventive/Curative Nutrition
interventions including health
education / awareness and
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screening shall be undertaken at
all levels including community,
Primary and Secondary Health
Facilities
District Health The network of BHUs, RHCs, Resource gaps at PHC health facilities
Management THQ and DHQ hospitals in terms of medicines, supplies like
System managed by the District Health safe delivery kit and capacity building
Department. Governments plays of staff may be done through this
a critical role in provision of program
reproductive, maternal, newborn
and child health services. Some of
the resource gaps related to
MNCH services are proposed to
be filled by the proposed
programme
Functional Functional integration and task- Under the instant PC1 all activities
Integration with sharing with the PWD may be relating to reproductive health will be
Population sought in terms of joint carried out by IHP. Under the program
Welfare procurement and storage of FP coordination mechanisms will be
Department commodities, capacity building of developed with PWD, UNFPA and
relevant RMNCH staff at RTIs of other INGOs for effective
PWD and development of Unified implementation of birth spacing
FP Communication strategy and program.
programs for wider dissemination
through all health and PWD
outlets
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6.3 Strategic Areas/Technical Parameters:
The new Integrated Health project of three years duration FY 2020-2023 envisages
to achieve its goal of improving maternal, newborn and child health through the following
three strategic areas:
The following Three strategic Areas:

1. Improvement in MNCH, RH, FP and Nutrition Services : Outreach & facility level
2. Social Mobilization, Advocacy and Communication
3. Governance, Monitoring and Evaluation
6.3.1 Improvement in MNCH, RH, FP and Nutrition Services:

Outreach & facility level:
a. Sustain the number of Outreach workers i.e. LHW coverage at 61% and CMW
at 37% coverage.
b. Provision of supplies to LHWs and CMWs as per their specified kits. The LHWs
and CMWs will receive regular supply from the health facility including
contraceptives. While LHWs in addition to their routine supplies will receive
micronutrients, MUAC tape and other additional supplies in their kits.
c. Horizontal linkages will be developed between CMWs and LHWs using joint
supervisory model.
d. Increased Community Participation and involvement in health actions by

organizing inter-personal and group sessions, community mobilization through
male and female health committees, community elders and PCMCs,
dissemination of specific messages developed on maternal and child health,
IYCF, exclusive breast feeding, nutrition and immunization using innovative
approaches.
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6.3.2 To improve Access to RMNCH and Nutrition services of MHSDP
at Primary care facility level by:
a. Increased availability of RMNCH and nutrition services of MHSDP against the

approved quality standards by improving efficiency of existing staff that is,
LHWs and CMWs, at the community level.
b. Preventive and promotive services for clients as per MHSDP by conducting

regular meetings on health promotion with PHC/ community groups by health
facility staff and distribution of necessary/ relevant IEC material to the
patient/clients.
c. Training of health facility staff as per MHSDP specially focusing on enhancing

their skills in areas of IYCF, IMNCI, ENC, Pregnancy Childbirth Post Natal
Care (PNC), EmONC, SAM, CMAM, FP counseling, Maternal, Neonatal and
child health, immunization, communication, community mobilization and
communicable disease control.
6.3.3 STRENGTHENING OF BASIC EmONC SERVICES AT THE PRIMARY

HEALTH CARE FACILITIES
According to an estimated figure, 15% of pregnancies undergo complications due
to direct obstetrical causes such as postpartum hemorrhage, sepsis and
complications of abortion are responsible for close to 50% of maternal deaths. A
majority of these maternal and early newborn deaths can be avoided by provision
of prenatal, delivery, postnatal and newborn care services within reasonable travel
distance & travel time. Under two separate ADP Schemes # 200040-
“Rehabilitation of all RHCs across KP & conversion of 50 RHCs into 24/7 facilities
“& 200045- “Strengthening of all BHUs across KP & conversion of 200 BHUs
into 24/7 SBA facilities”. Designated BHUs & RHCs are being upgraded for
provision of 24/7 BEmONC services. The IHP will provide support in
implementation, monitoring and trainings of health care providers.
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6.4 Intervention Matrix
The care will be extended from pre-pregnancy, antenatal period, natal, post-natal
care & immediate care of newborn. The Child care services include, immunization,
prevention and treatment of diarrhea, pneumonia, child growth monitoring and
biannual deworming.
Key interventions for maternal & newborn care at 24/7 (RHCs)
1. Intravenous and intra-muscular administration of medicines such as antibiotics,

oxytocin and anticonvulsants; except assisted vaginal delivery;
2. Manual removal of placenta; manual removal of retained products of an abortion
or miscarriage; and stabilization, referral and transferring the patients of obstetric
emergencies not managed at the basic level to referral facility
3. In terms of newborn care, the required services at the BEmONC facility,
immediate newborn care package will be delivered:
 Resuscitation of newborn in case of birth asphyxia
 prevention from hypothermia
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 management of neonatal infection,
 Very low birth weight infants, complications of birth asphyxia and severe
neonatal jaundice.
 furthermore, skills and supplies for intravenous fluid therapy, thermal
care including radiant warmers,
 kangaroo mother care, oxygen supply
 Parenteral antibiotics, intra-gastric feeding, oral feeding using alternative
methods to breast feeding and breast feeding support.
 Immediate skin to skin contact between mother and newborn with
initiation of breast feeding just after delivery under supervision of health
care provider.
6.4.1 Birth Spacing Services:
Pakistan is committed to increase CPR which is almost static since 2012 and pledged to decrease
annual growth rate in the country. KP The province of Khyber Pakhtunkhwa (including newly
merged districts) with 12.8 % area of Pakistan is occupied by 17.1% of country’s population.
According to the sixth Population and Housing Census 2017, KP’s population stands at 35.5
million. Its population has grown with an inter-censual (1998, 2017) annual growth rate of 2.82%
which is more than national growth rate. High population growth rate was led by a continuously
high birth rate and rapidly declining mortality rate.
Decline in population growth rate has been slow, while contraceptive prevalence of only 31% is
far less than other regional countries. Unmet need for birth spacing is around 21%, and the health
system has to strategize to address this gap.
The IHP aimed to increase CPR from 31% to 33% by 2023. In this regards, project will ensure
the continuous availability of contraceptives at community level (with LHWs & CMWs) and at
all primary & secondary health care facilities to address the unmet need. Monthly quantification
is given below.
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Sr. Quantity Quantity
Unit Name Quantity For Quantity For Quantity
No. For B & For CD &
BHU RHC For D
C SHCs
Oral Pills (No.
1 10 12 15 15 5
of Cycles)
Condom
2 (10 Condoms 100 120 200 200 100
per client
Injection
3 Family 6 4 5 5 2
Planning
4 IUCD 5 15 25 20 2
5 Implant 0 0 3 1 0
6.5 Transfer Grants to PCMC

Government of KP now approved the initiative of PCMC to improve the primary
health care facilities. To run the 24/7 initiative flexible funds would be required for meeting
the day to day requirements. Under instant PC-1, monthly Rs.10,000/- per month per 24/7
BHUs (200) and 24/7 RHC Rs.25,000/- per facility , funds are proposed to be transferred.
Under new initiative the DoH intends to upgrade 200 BHUs and 50 RHCs to provide 24/7
SBA services under two separate PC-Is. The IHP will support in provision of 24/7 services
through efficient monitoring and implementation at the district level. The IHP coordinator
(Previous LHW Coordinator) is proposed to act as focal person at the district level
regarding 24/7 services at BHUs and RHCs across Khyber Pakhtunkhwa. The upgradation
cost of 200 BHUs and 50 RHCs inclusive of, provision of additional equipment’s,
provision of additional HR, provision of additional medicines and disposables, provision
of minor repair of health facilities. However to maintain the functionality index of the
health facilities day to day expenditures would be required i.e. local purchase of essential
medicines, replacement of minor damaged electricity and water accessories etc. The 24/7
services at BHUs and RHCs will contribute in achieving MNCH related indicators of IHP.
The 3 PC-Is, IHP, BHU and RHCs will be implemented in integrated manner under the
leadership of PD IHP and oversight of DGHS. The minor amount @PKR 25,000/- per
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month per RHC and @PKR 10,000/- per month per BHU is proposed. It is submitted that
there is no duplication of cost in BHU and RHC PC-I. The PCMCs will observe the
following parameters in utilization of these funds:
Guidelines For PCMC Funds Utilization;

1 The program may transfer funds in the designated accounts of PCMC committee in
advance on quarterly basis ( Up front only for first time)
2 The committee will upload its expenditure report on quarterly basis
3 The committee based at BHU & RHC will not utilize the funds in hiring of staff on daily
wedges.
4 The funds may be utilized for local purchase of medicines only to recoup the emergency
tray or for labour room.
5 Minor repair and replacement of electricity & water accessories
6 Minor repair of building of the health facility cost not exceeding Rs.25000/- per annum
6 Funds will not be used in giving incentives to staff.
7 Funds may be utilized in organizing integrated health camp.
6.6 IMPACT ON SECONDARY AND TERTIARY LEVEL HOSPITALS

Presently the secondary and tertiary level hospital is taking the load of rural public
both in emergencies, outpatient department, minor surgeries, and MNCH services. By
upgradation, of PHC health facilities in 24/7 BEmONC service provision will directly
decrease the burden on secondary and tertiary level hospitals due to easily accessible
services nearest to communities.
6.7 Strengthening and reinforcement of Referral System by

introducing Rural Ambulance Services (RAS) to save lives of
Complicated Patients
a. A very significant aim of the IHP is to ensure that Maternal Mortality is avoided
and is decreased across KP. For this purpose, it is extremely essential that
CEmONC Facilities are ready and equipped to take in Complicated Patients
from Primary Facilities. Second delay has always been reported as a major
contributor to maternal and neonatal mortality in rural areas. In order to improve
access to health facilities, to encourage women to deliver through a skilled birth
attendant at a properly equipped health facility, and to ensure immediate
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availability of transport in case of a complication, the Government of KP is
launching the Rural Ambulance Service (RAS). An effective outsource model is
being proposed without spending any capital cost. The private sector will be
attracted to provide round the clock patient transfer services in the rural areas of
KP.
b. To assist the transfer of patients, the IHP will operate an outsourced Rural
Ambulance Service that will work on a pay per usage mode.
Retainer ship
Outsourcing Cost of RAS Units fee per vehicle
in PKR
Retainer ship Cost For Light Vehicle

40 40,000
Retainer ship Cost for Heavy Vehicle

20 60,000
Per KM Cost (70 KM per day per
-
vehicle) 44
Per KM Cost HV (70 KM Per Day Per
-
Vehicle) 66
c. Project steering committee will decide the districts where operation of the pilot
will run
d. The project steering committee will decide about who will initiate the
procurement procedure of outsourcing, considering IHP Project, DGHS Office
or office of the Health Foundation or any other institution.
6.8 Operational. Arrangements:

To ensure timely availability of ambulances and to maintain a standard vehicle
maintenance protocol, the task of call response center (emergency helpline xxx) will be
outsourced to any renowned Telecom Operator while the task of provision of vehicle with
drivers & maintenance to any renowned rent-a-car service through open competitive
process. The government will pay out of IHP project to outsource service provider on per
20
km travelled. The CRC will manage the task generation on the call of LHWs or mothers.
The CRC will assign the task to near by ambulance to pick emergency from household to
drop at 24/7 health facility and also pick the patient from 24/7 health facility to any nearby
CEmONC hospital.
6.9 RAS Dashboard: Daily management through real-time monitoring and

supervision
The RAS dashboard will be developed for real time tracking of on-going
emergency cases, real time monitoring of ambulance locations, district level usage reports
and district level snapshots of major indicators. The front dashboard provides a live view
of 4 major indicators; Total tasks handled that day (successful and otherwise), total patients
registered that day, total live health facilities and total number of ambulances. All districts
have access to the ambulance dashboard to monitor their performance on a daily basis and
also to check the real time location of an ambulance through the track ambulance tab.
There will be four types of users of the dashboard, call agent, vehicle service
provider, provincial office and districts. Call agents have access to add a task to the
dashboard, view the facilities, check the live location of ambulances in any district and
21
close a task. They also have access to drivers numbers added on the dashboard by service
provider.
Service provider will have access to “Roster Management” tab of the dashboard
where they can update the drivers. They also have access to the “Maintenance Schedule”
tab to put an ambulance under maintenance.
Provincial office has access to all tabs: reports (emergency task reports USSD
reports, distance report, monthly and daily task count etc.), management of facilities
(adding and updating existing ones), checking live location of ambulances and the
maintenance schedule of vehicles under maintenance.
Districts will have access to check which ambulances are under maintenance in
their district, live location of ambulances, vehicle history, vehicle distance report (KMs
covered), and the reports (to monitor their districts performance).
6.10 To improve Access to nutrition interventions at Primary & Secondary

care level by:
a. DHQ hospital will be supported in establishing Stabilization Centers (SCs) by
providing commodities for treatment of SAM children with complications and provision
of nominal staff which includes 02 staff nurses to ensure its services, round the clock. The
DHQ/THQ/Women & Children (Secondary Care Level where 24/7 qualified Paediatrician
is available) hospital will notify one Medical officer as Focal Person for the nutritional
interventions at the Stabilization Centre of the respective hospital. Currently 250 OTPs are
functional in all aspects but under instant PC1 250 OTPs will be strengthened by providing
anthropometric equipment. In the province 22 stabilization centers are fully functional and
4 new SCs are planned to be established.
b. Procurement of Medicines, Supplies, Stationery, Print material as per

procurement guidelines given by the central procurement cell DGHS office.
1 Malnutrition Currently # of centers to be Total target

Treatment Functional established or strengthen
Centers under new PC1
22
1 # of OTPs 250 250 500
2 # of SC 22 4 26
6.11 Strengthening of Community Based Services

In KP, Community based MNCH, RH and Nutrition services are mainly offered
through Lady Health Workers (LHWs) and Community Midwives. .Multiple gaps in the
services have been identified through extensive assessments & evaluations undertaken by
the Government, international development partners and research bodies. On the basis of
the available evidence, multi-fold consultative dialogues and pilot runs, multiple initiatives
are being proposed in PC-1 to enrich and enhance the services offered at community level
by both LHWs and CMWs. Furthermore, Departmental linkages already proposed in
previous version of PC-1s but not implemented in true spirit shall also be established to
strengthen the networking between LHWs and CMWs as this may lead to:
 Increased number of skilled birth attended deliveries

 Increased number of referrals for pregnancy complications over time
 Identification of cases of malnutrition among women of reproductive age and
children ad timely management and/or referral to nearest OTP/SC
 Increase in number of FP clients and users thus leading to improved CPR
By having an improvement in all the above output/process indicators, there would

be a reduction in maternal and neonatal morbidity and mortality ultimately contributing to
improved health status of population of Khyber Pakhtunkhwa.
6.12 Improving the services of LHWs

The National Program for Family Planning and Primary Health Care, also known
as the Lady Health Workers Program (LHWP), has been working since 1994. The Program
contributes to the overall health sector goals of improvement in maternal, newborn & child
health and provision of Family Planning services. This country wide initiative extended
outreach health services to rural populations and urban slum communities through
23
deployment of over 100,000 Lady Health Workers (LHWs) and contributed to bridge the
gap between health facilities and communities.
6.13 THE SCOPE OF WORK FOR LHW
The scope of work of LHW will be to provide PHC services to the communities in
her catchment area. These include:
1. To register all eligible couples for child spacing interventions i.e., a man married to a
woman of age between 15-49 years, and maintain up to date information of eligible
couples and registration of adolescence girls of kachi abadies/Urban slums;
2. To form women group in her area. She will arrange meetings of these women groups
on fortnightly basis to discuss family planning, immunization, antenatal and postnatal
examination, growth monitoring of children, diarrhea, ARI, iodized salt, tuberculosis,
etc. Preferably one topic will be discussed in one meeting.
3. She will keep close liaison with influential women of her area including lady teachers,
community midwives, traditional birth attendants and satisfied clients.
4. She will visit 7-10 households every day to ensure that all registered households are
visited once every month. During these household visits she will discuss importance
of family planning, immunization, growth monitoring of children, iodized salt,
personal hygiene, better nutrition, sanitation, antenatal and postnatal examination,
prevention from hepatitis and tuberculosis, etc.;
5. To coordinate with community midwives and other skilled birth attendants and local
health facilities for referrals.
6. She will register all pregnant women in her area and will conduct ante natal care as
described in her training and will refer the women to CMW for antenatal care and
preparations for delivery.
7. Act as a liaison between formal health system and her community;
8. As part of their tasks, LHWs will undertake nutritional interventions such as anemia
control, growth monitoring, assessing common risk factors causing malnutrition and
nutritional counseling. They will treat iron deficiency anemia among all women
especially pregnant and lactating mothers as well as anemic young children;
24
9. LHWs will promote nutritional education with emphasis on early initiation of
breastfeeding i.e., within one hour after birth, exclusive breastfeeding for six months,
adequate weaning practices, improving maternal nutrition and preventing
macronutrient malnutrition;
10. To establish vaccination post and to vaccinate children and women in coordination
with area vaccinator.
11. The LHWs shall also participate in various campaigns for immunization against EPI
target diseases e.g. polio, MNT, measles etc. in her catchment’s area only. The LHWs
will be involved in the surveillance activities in her catchment’s area only.
12. To motivate and counsel clients for adoption and continuation of family planning
methods, she will provide condoms, oral pills and administer injectable contraceptives
(second dose), to eligible couples in the community and refer them to CMW and health
facility.
13. To refer clients needing IUD insertions, contraceptive surgery to the nearest
Government health facility preferably to CMW, BHU and RHCs.
14. To carry out prevention and treatment of common ailments e.g. diarrheal disease, acute
respiratory infections, tuberculosis, intestinal parasites, malaria, primary eye care,
scabies. First aid for injuries and other minor diseases using essential drugs. She will
refer cases to nearest centers as per given guidelines. For this purpose a kit of certain
inexpensive basic medicines will be provided to LHW.
15. LHWs will also be involved in TB, AIDS, Hepatitis and Malaria prevention and
control.
16. To attend monthly continuing education session at her base facility to share progress
regarding all activities carried out by her including the home visits, number of family
planning acceptors by methods and stock position of contraceptives. She will also
attend education session, submit her monthly report and collect one month supplies
from the FLCF.
LHWs will not be involved in any other activity without the prior permission from the
DPIU who will seek guidance from PPIU if not already issued on case to case basis.
25
6.14 Reform Proposal
6.14.1 Mapping of Existing LHWs Coverage: Geo Mapping
 Population coverage by LHW needs to be revisited, keeping in view, the population

density & population health needs.
 It is evident that about 30% of the population in the rural areas is devoid of a community
based health package delivered by LHWs in the province and more than 62%
population in the urban slums.
 These uncovered areas have not been geo-mapped at the UC level thus resulting in very
little information being available on where they lie and why they are still uncovered.
This leads to the identification of pockets of uncovered population being spread within
or around the geographical outlay of a UC, areas where there might be high demand
for primary healthcare services.
 The case of urban slums is one such example; the department has not clearly
demarcated urban slums, which are densely populated with high rates of poverty, thus,
making them vulnerable to disease and mass malnutrition.
 In the era of modern technology, satellite imagery could address the issue of
identification of the slum areas.
 Generally, the lack of information on characteristics of the uncovered areas hinders the
department from devising an equitable workforce distribution plan.
 It is proposed that for increasing the outreach services to identify the uncovered
population is required. Moreover the program will devise the strategy to improve the
quality of services rendered by existing LHWs. The TA team will identify the two
major types of gaps in current LHW model which needs to be bridged:
 Lack of universal Geographic coverage
 Quality of outreach services provided in the covered area.
 The cost of exercise is covered in the instant PC-I @PKR 10.00 Million for two
years in Output 1 Annex – B6
26
6.14.2 Management reforms:
Further decentralization & integration at district level is required.

 About 70% time of the LHW is being consumed in polio campaigns, dengue and
immunization coverage in covered and uncovered areas. Due to this primary tasks
regarding MNCH & FP are suffering in their catchment area.
 The Government is resolving the LHW’s issues related to their service structure at low
pace which has created unrest among the LHWs & LHSs. Few LHSs grabbed this
opportunity to fulfil their ulterior motives by forming unions, to collect union funds
from LHWs and on the other hand to blackmail the Management.
6.14.3 Recording, reporting and supervision:
 E-Reporting and recording system may be developed and implemented

 Challenges in implementation of an IT based monitoring
 Gaps in administrative supervision
 Gaps in technical supervision
6.14.4 Service package

 The service package may be revisited i.e. she is unable to conduct WHO protocols of
ANC, PNC and newborn care due to inadequate qualification and training. The service
package may be limited just to educate mothers on identification of danger signs &
early referrals during ANC and post delivery period.
 A decade before, delivery of essential primary health care package by PHC facilities
was not at optimum level. Now more than 90% of the PHC facilities are functional
and out of these 60 % are providing 24/7 MNCH related services, more over
Government of Khyber Pakhtunkhwa is committed to scale up 24/7 initiative at all
viable BHUs. Keeping the current scenario of improvement in PHC delivery model in
the province, the health package delivered by LHWs needs to be revised.
27
6.14.5 Efficiency and cost effectiveness:
 The existing management model of the LHWs failed to deliver results due to inefficient
management, poor mechanisms of accountability, absence of supportive supervision
and long chain of reporting lines. There are questions on cost effectiveness of the
existing LHW model.
 One of the other area of concern affecting their efficiency is relevance of their basic
qualification. The program data shows that the education level varies from middle to
master but still about 50% of the LHWs working in the field are 8th class pass.
6.15 Improving the services of CMWs:
In 2006, the Ministry of Health established the National Maternal Newborn and
Child Health Program (NMNCH) all over Pakistan to meet the targets of maternal,
newborn and child health as set by MDGs. The program introduced community midwives
CMWs as a new cadre of skilled birth attendants who were rural women, hired and trained
from within the same community to serve the approximately 10,000 population cluster.
These CMWs underwent an 18 months long training in antenatal, intra-partum, postnatal
and newborn care and Family Planning. 12 Months Theoretical and 06 Months Clinical
Training. Now the Pakistan Nursing Council (PNC) has enhanced the period of Training
of CMWs from 18 Months to 24 Months. (30% Theoretical and 70% Clinical).
One of the issues being faced by the current MNCH program is the attrition of
CMWs before and after deployment. It has been experienced that the initial model of
CMWs did not work well and is no longer attractive to the CMWs. According to a study
conducted by UNFPA in 2014 “Development of a workforce plan to match demand for
Community Midwives with Supply in Pakistan,” the two years retention period is too short
a time to expect CMWs to start generating enough revenues to sustain their business and
the stipend of Rs. 2,000/- per month is not attractive enough for them to stay on 1.The
1Retention Strategies, Development of a workforce plan to match demand for Community Midwives with Supply in
Pakistan; UNFPA 2014.
28
attrition rate at present is 18% which is a cause for concern because skilled birth attendants
(SBA) are moving out of the system after the government has spent a large amount of
money to train them. Currently in the province the stipend is being paid to CMWs @ of
Rs15000/- per month linked with performance. The CMWs becomes eligible for receiving
monthly stipend if she conducts minimum 2 deliveries per month. The CMWs are eligible
to get stipend till they remain in the program. This is contrary to the basic concept of the
program. The basic concept envisaged at the inception of the program; to train CMWs,
deploy in the community and support in terms of giving stipend for a specified period to
settle her in the community and sustainable to run her own business to generate her
livelihood.
The instant PC-1 proposes the following steps before disbursement of stipends to
deployed CMW and will be paid according to new retention model. It is assumed that
performance linked payment will improve the efficiency of CMWS and after deployment
CMWs will learn the business techniques of establishing their private practices. The
program will not disburse stipend before geo mapping and deleting the ghost CMWs in
payment list. The Department intends to retain CMWs in the community (for flung Rural
areas) to provide services to pregnant women’s.
 Program shall conduct the mapping of CMWs and geotagging of their CMW Birth
stations.
 Stipend may be given for long three years after deployment. During this period along
with other technical trainings, the training on business model will be imparted.
 No CMWs will be eligible to get stipend after 3 years, the name of those CMWs will
be deleted from stipend list who has completed three years period.
 All CMWs will be entitled to receive pack of medicine & disposables after uploading
of monthly report on web portal.
29
6.15.1 Payment Model of CMWs
Payment Model For Year 1 Deployment
Estimate
Cost/vi Total
d client
Services sit payme
visits/mo
PKR nt
nth
Care of pregnant women (ANC) 24 50 1200
Normal vaginal delivery ( one or more) Fixed Cost with

1 1500 1500
medicines & disposables
Care of newborn 2 200 400

Care of lactating women with 0-2 child (PNC, FP,
30 100 3000
childcare and advocacy)
Support group 2 100 200
Immunization day with vaccinator 1 300 300
counselling visit to Newlywed women on FP 4 100 400
Insertion of IUCD 1 500 500

Total 7500
Fixed deployment fee 7500
Total 15000
** The payment of performance will be linked with the documentary proof provided by CMWs.
** Incase in a month if no delivery is conducted by CMWs the fixed amount will be deferred
Estimate
Cost/vi Total
d client
Services sit payme
visits/mo
PKR nt
nth
Normal vaginal delivery ( Minimum - 2) (No payment if

2 1500 3000
less than 3 deliveries)

30 70 2100
30

Total 10000
Total 15000
** The payment of performance will be linked with the documentary proof provided by
CMWs.
** Incase in a month if no delivery is conducted by CMWs the fixed amount will be
deferred
Estimate
Cost/vi Total
d client
Services sit payme
visits/mo
PKR nt
nth
Normal vaginal delivery ( Minimum - 3) (No payment if

3 1500 4500
less than 3 deliveries)

30 70 2100

Total 11500
Total 15000
** The payment of performance will be linked with the documentary proof provided by
CMWs.
** Incase in a month if no delivery is conducted by CMWs the fixed amount will be
deferred
** The report of every CMWs will be re-verified by Provincial Monitors of DGHS Office, IMU,
& M&E Unit IHP. Incase report of any CMWs found fake/Bogus/False the stipend of the CMW
31
will be stop for the next three month as a penalty. The stipend may be revived after submission of
affidavit and positive report from DHO office.
6.15.2 To Strengthen Community Participation and Mobilization in RMNCH

activities
Sociocultural beliefs and practices are one of the most significant aspects that create
hurdles in the uptake of regular checkups and availing medical care pre and post pregnancy.
Furthermore, historical reputation and legacy are one of the major reasons why the
Population chooses to avoid availing Public Sector Facilities for any type of Medical Care.
Evidence based advocacy and social mobilization can play a very strong part in tackling
such misconceptions, and providing important awareness to the Population about the
importance of up-taking proper medical care when required.
6.15.3 Improving practices and health seeking behavior for Reproductive,

Maternal, New born, Child Health and Nutrition through BCC
The Health Department intends to make use of all available channels of
communication to raise awareness and mobilize the community on importance of nutrition,
immunization, family planning, maternal and child health issues using specific themes,
identified either through research based on the policy recommendations that needs to be
addressed, among the general populace as well as specific segments of the society i.e.
religious leaders, opinion leaders and other influencers.
Following are the main activities proposed to be undertaken for advocacy and a
strong social mobilization campaign at all levels including provincial, districts, tehsil, UC
and village level
6.15.4 Toolkit development for standardized key (gender-sensitive) messages

for BCC on MNCH, FP and Nutrition
The Health Communication Specialist at the PMU shall be responsible for development
of;
32
 Key Communication themes (e.g. pregnant & lactating women and shall address
issues like breastfeeding, complementary feeding, use of multiple micronutrients,
& use of iodized salt) and health messages and development of unified standardized
messages
 Communication strategy including use of mass media including print and
electronic media, ATL, BTL etc; local channels, TV, cable, paper, radio , mobile
ring tone
 Tools and materials for communicating the key gender sensitive messages
(documentaries, documentary-dramas, talk shows and cooking shows, IECs etc)
 Guidelines for districts on health promotion and communication strategy.
 Designing and filed testing of IEC material etc.
 Printing of IEC material with information on antenatal, natal and postnatal care,
child health, immunization, Reproductive health, FP, PHC and IYCF, CMAM and
nutrition supplementation
 Collaboration strategy (Education, WASH and other relevant sectors).
 Donor and Development Partner Engagement through Series of advocacy
seminars, meetings and events at Provincial level with Donors, the Media,
Parliamentarians, Senior Bureaucrats, Religious Leaders and the Private Sector.
 Calendar Days identification for celebration such as De-Worming Days during
MCH weeks2, Breastfeeding weeks etc.,
 Periodic MNCH/FP/Nutrition Melas and camps at the HFs
2Sample activities to conduct during MCH week includes:
 Mebandazole tablet distribution to children for deworming

 Community awareness session of mothers on protection from various diseases, ORS preparation, family planning orientation etc
 Vaccination of children with EPI and pregnant women with TT.
 Check-up of Pregnant women and screening of children to identify malnourished children
 Engagement with community elders, especially fathers
33
6.15.5 Implantation of district communication strategy
The district Social Organizer shall be responsible for implementation of District Communication
Strategy.
Outreach workers (LHWs and CMWs) shall be trained to establish health communities in
their catchment areas with strong linkages with Primary Care Management Committees (PCMCs)
of the facility for ensuring both mobilization and participation of the community in achieving
health outcomes. These committees shall have regular monthly meetings, the record and follow-
up of which shall be maintained by the LHWs. Community sessions at the village level by social
organizers and SHNS to enhance acceptance of CMWs and trust on public sector facilities
Socio cultural beliefs and misperception has a tremendous role in devising behavior and
practices of the population. Strong evidence based advocacy and social mobilization can play a
very important role to overcome this issue. Poor health practices of the community can only be
changed if proper communication strategies and social mobilization will be carried out at the
community level. Community based workers need support to build linkages with the community
and Social organizers of the IHP has a very critical role in this regard. It has been proven with
evidence that wherever proper social mobilization campaign was carried out, results were
achieved up to the entire satisfaction. Gender disparities have reflected in poor women and
newborn health. Strategies to enhance women empowerment and their role in decision making
need to be adapted. There is also dire need to coordinate with other sectors like education and
social welfare and also to develop linkages and partnerships with local NGOs and civil society
organization. Role of community support group has been proven very effective and it is clear from
literature review of different countries
Key Interventions:
 Adaption/adaptation of uniform communication messages relevant to RMNCH & LHW
Program and their notification
 Notification of provincial and district level communication core group along with TORs
involving LHWs Program and other stakeholders like PWD, Nutrition and EPI
 Development of provincial and district level communication plans
 Regular social mobilization and advocacy sessions at the provincial, district, tehsil and UC
level according to plan
34
 Seminars and workshops at provincial and district level
 Health Melas at Health Facilities in coordination with donor partners
 Sharing of Progress of the program with EDO (H) and other stakeholders on monthly basis.
 Dissemination of IRMNCH & N P messages using print and electronic media like local
newspapers, cable, FM radio etc.
 Street theatres and announcement with drum beating
 Deployment of CMWs after passing Technical Evaluation by the District Evaluation
Committee (DEC) on working protocols and holding of Deployment Ceremony at district
level
 Introduction of newly deployed CMWs & LHWs through ceremony in community by
District Authorities
 Development of Provincial and District Communication Strategies
 Capacity building of RMNCH & LHW Program field staff on communication skills
6.15.6 Stakeholder Participation Strategies and Implementation

Dissemination of specific messages developed on maternal and child health, IYCF,
exclusive breast feeding, nutrition and immunization using innovative approaches such as seeking
political support (community leaders, government authorities, CSOs/NGOs, journalists, political
leaders, corporate sector players, other stakeholders).
6.16 Governance, Monitoring & Evaluation
6.16.1 Integrate and strengthen programme management at provincial and

district level
Owing to low utilization of public facilities, absenteeism, slow implementation of
projects and programs, poor management, lack of will to undertake or implement reforms, poor
motivation, in adequate information and accountability leads to poor service delivery. To
overcome these issues, following interventions are envisaged in this PC-1:
35
6.16.2 Provincial Project Implementation Unit (PIU)
To ensure effective and efficient implementation of the integrated programme, a Project
Implementation Unit (PIU) is planned in the New PC-1. The PIU will consist of a dedicated team
of experts who will be responsible for the running of the project. The PIU will be headed by a
Project Director, who will be given autonomy to plan and implement activities related to
RMNCH. All employees of previous MNCH & LHW and Nutrition Program will report to PD,
IHP. The PD will be the DDO while Deputy Director Accounts/Account Officer will be the co-
signatory of the project. The PIU will have 04 specialist units with experts in their relevant fields.
This team will initially be selected from the pool of regular government employees which are
available and already working in the health department OR may be hired from open market through
competitive process on market based salary. The existing government employees may participate
in open, transparent competitive process. The 4-5 specialists heading the proposed units, includes
Trainings, Program M&E/Mis, Operation, Procurement.
6.17 Financial Management Unit

Financial Management Unit will be headed by the Deputy Director Accounts. The team is
proposed, Financial Management Specialist, Assistant Accounts Officers and Internal Auditor.
The financial management unit will manage all financial and accounts matters of the integrated
programme. Financial Management Specialist will be hired from market to provide technical
assistance to Project Director and Finance Management Unit.
6.17.1 Fund Flow Mechanism:

Project Director will be the DDO while Deputy Director Accounts will be the co-
signatories of all the Assignment and Designated Accounts of MNCH, LHW and Nutrition
Program.
The funds will flow to the programme through the office of the Secretary Health, where
separate assignment accounts have been opened for ADP share and Donor share if any. The budget
will be released by Finance Department under the object code A03970-others.
All procurement payments will be disbursed from IHP Assignment account to

venders/suppliers through cross cheques.
36
Financial Management Specialist will prepare mechanism for centralized disbursement of
salaries to PMU and DMU staff to their accounts through Bank. DHO office will send claims of
DMU staff salaries on 25th date of every month to Financial Management Unit IHP duly verified
by DHO and Accounts staff in their respective districts and IHP will disbursed salaries directly to
DMU staff through centralized banking system.
6.17.2 Reconciliation and Accounting of Funds:
PD will carry out monthly reconciliation for all the Assignment Accounts of the funds
released / expenditure incurred with Accountant General Office and Banks.
6.17.3 Internal Audit

Internal audit of all spending units would be conducted and in order to strengthen the
internal control system, an internal audit system within the Programme would be established.
It will be the primary duty of the health department to carry out internal audit at all levels
of execution of activities at districts. The function of internal audit is to ensure that public
money is expended in accordance with government rules, regulations and books of accounts
and store stock record have been kept properly and presents true and fair position. The internal
audit reports should be discussed and compliance should be made.
6.18 Establishment of Anti-Harassment Cell
The IHP has a large female work force which might be exposed to a number of risks during
their outreach activities and facility based work. One of the risks is harassment. The proposed
programme intends to establish an Anti-Harassment Cell (AHC) at the PMU level with a dedicated
toll free number. The cell shall be run by in-charge AHC who will be female and directly report to
PD, IHP
6.19 District Implementation Unit

District level management will be strengthened under existing LHWs Coordinator who will
be notified as district coordinator of IHP and all staff of defunct LHWs & MNCH will work under
IHP. The vacant posts of IHP in DMUs will stand abolished.
37
6.20 Provincial Management Unit Organogram
DGHS
Project Diretor
IHP
Incharge Anti- Internal Auditor

Harrasment
Cell
DD DD
DD M&E / DD Operations / Trainings
DD Finance
Procurement
MIS Administration
Training Financial
Social Coordinator Management
Admin Superinten BCC
MIS Organizer Community Specialist
Officer dent Coordinator
Coordinator Based
Training
AAO
District
Coordinator
Computer IHP Logistics
FPOs Programmer / IT Officer
Expert
Focal Person
Training
Facility Based
Assistant
IT Assistants
Data Logistics
Analyst Officer
38
6.21 District Management Unit Organogram
DHO
District Coordinator
(IHP Previous LHW
Coord.)
Social Account Procurement Assistant Computer

Organizer Supervisor & logistics Logistics Operators Accountants
MNCH LHWs Assistants Officer MNCH MNCH
IHP
** All Regular employees will draw the salaries from current side
*** No new hiring under the instant PC-I at district level except the Staff Nurses for Stabilization Centers
in DHQs
**** In-case of project vacancy lies vacant, Post will be filled after approval of Project Steering
Committee along with the selection criteria for recruitment.
39
6.22 Institutional arrangements of the Project at Provincial level
6.22.1 PROJECT STEERING COMMITTEE
1. Minister for Health, Government of Khyber Pakhtunkhwa. (Chairman)

2. Secretary, Government of Khyber Pakhtunkhwa, Department of Health (Member)
3. Director General Health Services Khyber Pakhtunkhwa. (Member)
4. Project Director Integrated Health Project Khyber Pakhtunkhwa. (Secretary)
5. Representative of Finance department, Government of Khyber Pakhtunkhwa.
(Member)
6. Representative of Planning and Development department Khyber Pakhtunkhwa.
(Member)
7. HSRU Chief Department of Health Khyber Pakhtunkhwa (Member)
8. Director Independent Monitoring Unit Department of Health Khyber Pakhtunkhwa
(Member)
FUNCTIONS
The project steering committee will:
 the top controlling body of the project which will provide oversight, guidance,
support strategic direction to the project
 ensure the timely completion of the project
 review the operations and achievements of the project on regular basis
 Ensure timely completion of the project
 Be the body to make any change to the project such as change in yearly upscaling
of RHCs, changes in selection of RHCs, substitute, add, or drop an RHC from the
project, decreasing or increasing scope of work etc.
 The project steering committee shall have the power of re-appropriation of the
funds and addition, deletion of costed items within the scope of the PC-I.
40
 In-case of project vacancy lies vacant, Post will be filled after approval of Project Steering
Committee along with the selection criteria for recruitment
 Resolve all the issues related to project
6.22.2 PROJECT MANAGEMENT AND OPERATIONS COMMITTEE
1. Special secretary, Department of health Khyber Pakhtunkhwa (Chairman)

2. Director general health services Khyber Pakhtunkhwa (Member)
3. Director General Provincial Health Services Academy Khyber Pakhtunkhwa.
(Member)
4. Additional Director General Health Services Administration Khyber Pakhtunkhwa
(Member)
5. Project director IHP Khyber Pakhtunkhwa (Secretary)
6. Director Health Services MCH Khyber Pakhtunkhwa (Member)
7. Director Preventive Services Khyber Pakhtunkhwa (Member)
8. Deputy director Reproductive health Khyber Pakhtunkhwa (Member)
FUNCTIONS
 Responsible for all the operations of the project

 Overview and will provide guidance to the physical progress of the project
 Review the functions and will approve course of action
 Recommend changes in the project for placing before the project steering
committee
 Receive planning and monitoring issues and will resolve accordingly
 Report its reviews and recommendation to the project steering committee
6.22.3 QUALITY CARE and Technical COMMITTEE

1. Director General Health Services. (Chairman)
2. Additional Director General Health Services (Member)
3. Project Director IHP (Secretary)
4. Chief HSRU (Member)
41
5. Director IMU Health (Member)
6. Director Health Services (MCH) (Member)
7. Director Health Services (Curative) (Member)
8. Deputy Director Health Services (Reproductive) (Member)
9. Representative of KP health care commission (Member)
10. Professor of Pediatrics (Member)
11. Professor of Gynae & Obstetrics (Member)
12. Representative of UNFPA (Member)
13. Representative of UNICEF (Member)
14. Representative of WHO (Member)
15. Representative of WFP (Member)
16. Any other Co-opted member with the permission of DGHS (Member)
6.23 To introduce Technical Management on Provincial and District Level in

order to improve the Quality of Care being provided at a Facility Level
 Establishment of key technical supervisory posts at Provincial and District Level to

conduct consistent and proper technical supervision of all RMNCH related activities at
Facility and Outreach Level
 Improving inputs in Facilities and maintaining a minimum threshold of key
requirements is one of the more significant aims of the IHP Program. However, it is also
very essential to ensure that in the case of rising load, the quality of care that is provided
to the clients of the Program is of a decent standard. For this purpose, technical
supervisors on a Provincial and District Level will be required to conduct consistent
supervisory checks on the level of care being provide by the Facilities under the
Program.
 The LHW Program has been operating for approximately three decades. It is responsible
for ensuring a wide range of key community activities and is the Department’s most
significant footprints in the Rural Communities. Whereas very consistent investments
are made to uphold the continuity of the Program, a lack of proper technical audit and
mobilization of the LHW Program is losing its effectiveness significantly as expected.
A technical overhaul of the Program can significantly improve its performance and its
links with Communities and Facilities. The program will undertake assessment of
42
community based activities with the support of development partners and in the light of
report program will develop improvement plan for LHWs& CMWS component.
 The key goal of the Program is to increase the utilization of Health Facilities by the
population of KP. The increased utilization is one of the catalysts to improve the Health
Indicators of KP and move the Province towards achieving its SDG commitments.
However, in the absence of a proper technical framework to maintain a minimum
threshold of Quality of Care, it is very possible that the shift in indicators may not be
achieved as required. Hence, addition of tiers of Technical Managers is essential to the
system.
6.24 To introduce integrated Monitoring & Evaluation and Surveillance

Systems for evidence based decision making through use of good quality
data by:
 Improving data availability & data quality: The M&E unit at PIU will develop a robust
monitoring and evaluation framework and an implementation plan. The framework will
capture the requisite information for monitoring of various activities e.g.
implementation status of MHSDP at the outreach level, quality of care, review of routine
reporting data.
 Use of Information for decision making Performance Monitoring and Results
Evaluation Plan
 Functional Maternal, Neonatal and Infant Mortality Surveillance system
 Improved supportive supervision and Supervisory mechanism at various levels of the
programme i.e. LHWs & CMWs by LHSs. Supervision will also be made by facility
staff, DHOs and PIU.
A robust Program management information system shall be introduced at all levels to

record the implementation of programme activities at ground level, preparation of program
performance reports and planning of subsequent activities.
43
6.25 Monitoring Framework:
Proposed Activity Intended Outcomes
Component
Program  Development of an integrated Availability of updated information on
Management data management system RH, MNCH, FP and nutrition enabling
Information using existing DHIS, MNCH robust evaluation of policies in place
System at all MIS and LHW MIS and effective decision-making, that
levels (Program,  Review and updates to health shall monitor the resources invested,
project, district) information system services delivered and outcomes
 Progress tracking on key achieved. Through gap identification it
performance indicators3 shall enable policy bodies to come up
 Monitoring of EPHS with effective targeted solutions on

implementation, BCC effective resource management
implementation and effect on List of reports
health indicators -Program Reports (Quarterly, Annual)
 Comparisons to SDGs -District Reports(Quarterly, Annual)
 Routine data review -KPIs Dashboard(Monthly)
 Operations research
 Incorporation of e-monitoring
and e-reporting
 Data validation
Internal  Resource tracking To systematically and continually
performance  Deliverable monitoring assess the performance of the program
monitoring and  Project Activity beyond the monitoring project inputs,
evaluation Inventory Mapping document the lessons learnt, try new
system  Annual Work plan approaches, introduce corrections and
development
3 To be defined in consensus and consultation with stakeholders
44
 Capacity building of staff improve performance, thereby making
for data documentation, the program client-centric.
analysis and use
 Results-Oriented
Program Activity
Schedule, mapped to
project result,
intermediate result,
performance period, lead
responsibility and status
of the period reported
 Individual Human
Resource work hours
tracking
 Defining evaluation
outline and documenting
baseline for 3rd party
evaluation.
 Introducing clinical
audits in selected district
health facilities.
Functional  Reporting on maternal, Availability of timely local maternal
Maternal, neonatal and infant mortalities and infant mortality data for timely
Neonatal and from communities and health interventions and corrective actions.
Infant Mortality facilities.
Surveillance  Verbal autopsies of select
system reported mortalities by the
health facility staff
 Mortality reviews and death
audits at Health facilities.
45
Improved The monitoring and supervisory To develop a rapid and on-spot
supportive system shall be set up in three corrective mechanism for
supervision and overlapping tiers as follows: CMWs/LHWs, through continuous
Supervisory The First Tier - LHS: Lady supportive supervision through use of
Mechanism at Health Supervisor (LHS) to electronic devices.
various levels of conduct supervisory visit to
the programme CMW/LHWs at least once every
month to:
 Review records being
maintained by the CMWs for
antenatal, postnatal visits,
normal deliveries conducted,
complications referred,
referrals from LHW
entertained, Family Planning
referrals, etc.;
 Inspect logistics i.e., safe
delivery kits, status of
medicines, condition of
equipment;
 Assist CMW in developing
linkages with the LHWs and
the LHV of the health facility;
 Present report to DMU
The Second Tier – Technical
Support and Supervision by
Midwifery manager : The
midwifery tutors to:
 Assess knowledge and skills
of CMW;
46
 Observe CMWs interaction
for antenatal care, postnatal
care and child care and
provide guidance to further
improve her performance;
 On spot technical assistance to
the CMW if performing
delivery;
 Present report to DMU
 Identify training needs for
refreshers
The Third Tier –Support and
Supervision by District &
Provincial Office: The finding
from first and second tiers shall
be consolidated at DMU and
shared with PMU.
E-Monitoring  Provision of tablets/PDAs to  Faster and real time registration of
Lady Health Supervisors and expectant mothers by LHS
select LHWs to record data  Follow-ups with registered mothers
during visits through sms reminders
 Health Communication messages
Establishing  Establishment of a provincial To ensure adequate functioning of
Data level Data Server in MIS Cell programme and desired M&E systems
Center/Server  Development of monthly and in place, such as e-monitoring, e-
Room, E- quarterly report templates reporting, monthly dashboards, real
Monitoring/E-  Level-wise access to managers time data monitoring and Community
Reporting at different level education etc.,
System and A  Level-wise upload portals for
data reporting
47
Web-Based  Integration with data input
Program through SMS, email app etc.
6.26 Exit Strategy

Following the completion of this PC-1, all the activities including
procurement of medicines, supplies, staff hired under the programme both at
provincial and district levels, will be taken on to the recurrent budget and mainstream
in the health department.. In addition, it will be ensured by the Health Department
that activities started under the PC-1, will not only be continued but also enhanced
over time to ensure sustainability and scaling up.
The integration of the key programmes will lead to strengthening of the

overall health systems, which had been undermined and weakened over the years.
Further, the initiative will contribute maximally to strengthening of the health
systems.
7 Capital Cost of Project:
Rs. 7,027.226… Million.
1. Date of estimation: November 01, 2020.
2. Basis of determining the cost: Market survey, previous work done and Government
notifications.
3. Year wise estimates of physical activities:
Cost in PKR
Description
Year-1 Year-2 Year-3 Total
ADP
1,872.712 2,776.285 2,378.228 7,027.226
48
7.1 Project Approval History:
PDWP meeting held on 23-07-2020 under the chairmanship of Additional Chief Secretary
P&D Department Government of Khyber Pakhtunkhwa approved extension in implementation of
the project period 03 Months (July-September, 2020) in local component subject to “No Change
in Scope and Cost of the Project”.
Item wise, year wise allocation, releases, expenditures and physical progress :( PKR in
Millions)
Source Year Allocation Release Actual

Expenditure
ADP 2014-15 250.00 125.00 79.38
2015-16 500.00 125.00 125
2016-17 200.00 200.00 200.00
2017-18 196.00 196.00 192.03
2018-19 300.00 300.00 300.00
2019-20 2000.00 2235.00 2235.00
DFID 2014-15 660.00 613.27 113.442

2015-16 1850.62 540.361 893.204
2016-17 3000.00 1874.00 1332.89
2017-18 3733.00 1603.00 1699.03
2018-19 3000.00 1693.00 1685.00
World Bank 2018-19 3000.00 138.54 11.868

2019-20 400.00 205.60 114.83
49
7.2 Justification for New PC-1 and variation in the scope of Project if
applicable:
Integrated Health Project PC-I closed on 30-06-2020.

• To carry forward the Integration of health services of MNCH, LHW and Nutrition
Programs reflected in ADP # 816/200037 FY 2020-23.
• The Department of health is upgrading 50 RHCs to 24/7 SBA services and provision
of emergency & minor trauma services through separate scheme. However IHP will
provide support in implementation at provincial level to DGHS but lead role at district
level. The district coordinator of IHP (previous LHWs Coordinator) will be responsible in
implementation of 24/7 BHUs & RHCs under supervision of DHO of the concerned
districts.
• Previously the role IHP was as post office, just to transfer the funds to districts &
defunct programs LHWs & MNCH, under instant PC1 financial management unit of the
IHP will be strengthen and restructure. There will be one assignment account of the
project. The deployment retention stipend will be transferred to individual CMW’s
account after due diligence.
• Establishment of IHP MIS i.e. Digitalization of reporting, record keeping, and Web
Access.
• Strengthening of M&E Mechanism at Provincial as well as District levels.
• Recruitment of field staff and PIU staff on essential posts.
• Strengthening and digitalization of Procurement, Supply Chain and Logistics
Management.
• Restructuring of Project Implementation Unit (PIU) at provincial level.
• Development of Behavior Change Communication strategies across the province.
50
8. Annual Operating and Maintenance Cost after Completion of the Project
Annual Operating Cost

1 Expenses/Salary 1,335,961,800
2 E Monitoring 22,596,000
3 Operational cost 121,189,044
4 Drugs & Non Drugs ( Contraceptives) 697,108,992
5 Procurement of stationary & printing / MIS tools of LHWS 22,783,485
6 Procurement of nutrition commodities 220,000,000
7 Cost of warehousing and supply chain 25,868,800
8 Total
2,445,508,121
9. Demand and Supply Analysis.
Public as well as private services focus on curative care, with little attention to promotive,
preventive or rehabilitative care. In addition, there is little known about the community’s
priorities in relation to primary health care services.
Chronic staff shortages and non-availability of essential medicines and equipment is

common and leads to health facilities being underutilized due to shortages of staff and
supplies.
The quality of service provided by public health care providers is variable. Typically
consultations between patient and health worker are short, antibiotics are over-used, poly-
pharmacy, there is poor communication between patient and dispensing staff and inadequate
dispensing techniques. The antibiotics from the kitty of LHWs is withdrawn due to
impending danger of antibiotic resistance. Now she will identify the danger signs of
pneumonia and diarrhea and refer to health facility.
The project’s intended services are needed for the following purpose:
• Access to quality services at the door steps.
• In time provision of desired services is going to be enhanced.
• Effective referral system is going to be strengthened.
51
• Trust over the public sector is going to be improved.
Existing capacity of services and its supply:
The current number of health facilities are neither adequate as per standards set in by the
planning commission nor is the quality of health care services within acceptable limits. A
survey was conducted to find out the quality of health care services against approved
Primary & Secondary Health Care Standards of Khyber Pakhtunkhwa in 2007. Results of
this survey show that the score of Primary Health Care facilities on scale of 1-4 is 1.8 and
that of secondary health care facilities is 1.3 on the same scale.
9.1 Projected demand for Three years

The demand for better health services always exists; it will be there for an infinite time
period. The project is designed to provide better health and nutrition services and improve
the health status of the people of the province.
Capacity of projects being implemented both in the public & private sector
Based on the experience of existing projects there is anecdotal evidence that the public
sector health delivery system is not cost effective where as private sector is also incapable
of delivering in far flung areas due to low return on investment. Therefore initiatives of
public private partnership will be considered for implementation of the project.
National Nutrition Survey 2018 and Multiple Indicator Clusters Survey 2017 (MICS) of
the project show poor health indicators. Supply side further deteriorated due to the recent
Covid-19 Pandemic. With such a bleak picture on the supply side it becomes impossible to
meet the demand side.
On the demand side, there has always been a demand for better health care services in the
selected areas. Demand has increased in the wake of the recent crises.
This project is designed to ensure health care services to meet the existing gaps between
the supply side and increased demand side.
52
10. Financial Plan and Mode of Financing
10.1 Source of Financing:
10.1.1 Equity
The project will be funded by the provincial government of Khyber Pakhtunkhwa, Health
Department, based on the estimated cost of activities.
Provincial Govt. Share: Rs. 7,027.226 Million
TA Support from development partners
11. Project benefits and analysis.

11.1 Financial
 To reduce the burden of disease with special focus on poor & vulnerable community
(Especially PLW, Adolescent girls and Children under 05 age).
 Reduction in disease burden will reduce expenditures by the government on the
health sector
 Poverty reduction by investing in health of women and children
 Cost effective due to economic productivity and growth
 Cost reduction on nutritional intervention
 Generation of employment across health sector
 Women empowerment due to employment of Health workers at community and PHC
level.
11.2 Social benefits with indicators

This project is aimed at increasing the overall quality of life, through decreasing maternal,
newborn and infant mortality, improving availability of services for maternal and child health,
and increasing awareness of the community for safe delivery, nutrition, birth spacing leading
to smaller families, and self-development initiatives. The program aims to work in tandem with
other government initiatives for poverty reduction. The estimated population benefiting from the
programme is approximately 30 million.
Additional social benefits accruing include the reduction of poverty, decreased disease
burden and increased awareness especially in the vulnerable segments of the society i.e. women
53
and children. Increased access to preventive, reproductive health and nutrition services will help
to reduce burden of disease, which will be measured using the following indicators;
 Maternal Mortality Ratio

 Under 5 Mortality Rate
 Infant Mortality Rate
 Population growth Rate
 Total Fertility Rate
 Contraceptive Prevalence Rate
 Prevalence of moderate and severe malnutrition in children <5yrs
 Reduction in Stunting rate
 Service Delivery
The progress on the indicators will be monitored regularly using information from DHIS
and through various national and provincial levels surveys e.g. PDHS, MICS and NNS.
11.3 Environmental impact

With increase in utilization of services due to MHSDP, the project is expected to have
minimum degree of environmental impact due to production of waste from health facilities. It is
expected that initially increased utilization of health services will produce waste, however, at the
same time a reduction of waste from home deliveries at household level is expected, which was
previously improperly disposed. The new policy of the health department for Quality Standards
necessitate proper disposal of waste.
The project, therefore, is unlikely to pose any serious environmental hazards; on the
contrary by promoting healthy behavior and practices, it is likely to contribute towards
improvements in environment with more and more people adopting healthy life styles.
11.4 Quantifiable output of the project

The program will be having four major outputs:
54
1. Improved delivery of maternal, child, family planning and nutrition services under
Essential Package of Health Services
2. Improved practices and health seeking behavior for Reproductive, Maternal, New born and
Child Health and Nutrition
3. Effective management of the Program at provincial and district level
4. Evidence based decision making through improved MIS System, efficient monitoring and
evaluation
Please refer to the Logical Framework (Annex A) of the Programme which includes indicators
for each output along with milestones and targets.
11.5 Employment generation (direct & Indirect)

5832 persons will get direct employment opportunity i.e. Community health workers, PIU,
DMU and support staff.
Indirect employment will be for the people hiring for maintenance of different services like
repair of equipment, machinery, transporters, supply providers and labor at different stages.
11.6 Impact of delays on project cost and viability

 Inflation will increase the cost of program
 Adverse effect on public service delivery
12. Implementation schedule

Starting date: November 01, 2020.
Completion date: June 30, 2023.
Item wise/year wise implementation schedule:
Attached as Annexure –B
Mapping of activities with financial phasing:
Attached as Annexure – B
55
12.1 Implementation Strategies:
The Health Department, Government of Khyber Pakhtunkhwa through the new integrated
PC-1 aims to rollout the Health Policy Khyber Pakhtunkhwa of strengthening the health systems
with the focus on improving not only efficiencies but also effectiveness of the maternal, child
health and nutrition services. The integrated programme aims to improve maternal, neonatal, child
and nutrition outcomes by:
 Sustained existing coverage of LHW at 61% and CMW at 37% at the outreach level.
 Increased awareness about MHSDP through targeted, socially acceptable communication
strategies for enhancing demand and utilization for preventive and curative services.
 Involvement of community in planning of UC level health plans and oversight processes
through constitution and operationalization of Primary care Management committees.
 Enhance comprehensive Family Planning and Nutrition services at outreach and facility
level through WMO, LHVs, CMWs, LHWs and LHSs services.
 Strengthening of Basic and Comprehensive EmONC services and establishment of referral
linkages between outreach workers and levels of health facilities i.e. BHU, RHC, THQ and
DHQ.
 Up-gradation and strengthening of secondary care facilities in respect of establishing
stabilization Centers for treatment of SAM children with complications.
 Improve technical and managerial capacities at all PHC care delivery system and expand
accountability mechanism in health care delivery system.
 Introduction and strengthening of result oriented integrated M&E mechanism at all levels
for enhanced accountability and planning.
 Introduction of client Centered quality services for increased patient satisfaction and
improved health outcomes.
 Strengthening of financial transparency and accountability at all levels of services.
 Inculcating a culture of research for evidence based planning and monitoring.
56
13. Management structure and manpower requirements including specialized
skills during execution and operational Phases
The programme aims to sustained coverage of maternal, neonatal, child health, family
planning and nutrition services at the outreach level through already recruited 3604 LHWs in
previous PC-I and deployed 1300 CMWs. The final figure of deployed CMWs will be determined
after geotagging and verification of functional labour room. To implement the nutrition related
activities in selected health facilities 69 already recruited nutrition assistants from previous PC-I
will be retained.
Further, at the district level the DHO will be responsible for overall execution of the
project. He will be assisted by district coordinator of defunct LHWs program, re-designated as DC
IHP. All other staff of LHWS & MNCH will work under his direct supervision. DGHS office
through its directors will provide technical stewardship.
14. Additional Projects/Decisions Required to Maximize Socio-Economic

Benefits from the Proposed Project
This project is to strengthen the health systems through provision of Community Health
Workers (LHWs & CMWs) for 61% and 37% population coverage respectively. The project intends
to support and supervise the activities related to improvement in MNCH services. The other two projects
of upgradation of BHUs & RHCs should work in collaboration with IHP. The performance of PWD is
directly related in achieving FP targets set in IHP.
57
15. Certificate PC-1 has been prepared as per instructions for the preparation of PC-1 for social sector
Projects.
Prepared by:
___________________________________
(Dr. Haroon Khan),
Project Director,
Integrated Health Project, Khyber Pakhtunkhwa,
(Ph. No. 091-9210342)
Checked by:
___________________________________
(Dr.Niaz Muhammad),
Director General Health Services,
Khyber Pakhtunkhwa,
(Ph. No. 091-9210269)
Recommended by:
___________________________________
(Syed Imtiaz Ali Shah),
Secretary Health,
Govt. Of Khyber Pakhtunkhwa
(091-9210572)
58
16 List of Acronyms:
AGP Auditor General of Pakistan
ANC Antenatal Care
ADC Assistant District Coordinator
BHU Basic Health Unit
CBO Community Based Organization
CDS Comprehensive Development Strategy
CGA Controller General Accounts
CMW Community Midwife
CMAM Community Management of Acute Malnutrition
CPR Contraceptive Prevalence Rate
HD Health Department
HSS Health Sector Strategy
DHIS District Health Information System
DGHS Director General Health Services
DHQ District Head Quarter
EmONC Emergency Obstetric and Newborn Care
ECOSOC Organization for Economic and Social Cooperation
DHO District Health Officer
FP Family Planning
GoKP Government of Khyber Pakhtunkhwa
HSS Health Sector Strategy
ICPD International Conference on Population and Development
59
IEC Information education and Communication
IMNCI Integrated Management of neonatal and child illness
IMR Infant Mortality Rate
IYCF Infant young Child Feeding
LGO Local Government Ordinance
LHS Lady Health Supervisor
LHV Lady Health Visitor
LHW Lady Health Worker
MDG Millennium Development Goals
M&E Monitoring and Evaluation
MIS Management Information System
MMR Maternal Mortality Ratio
MDTF Multi Donor Trust Fund
MNCH Maternal Neonatal and child health
NA Nutrition Assistant
NFP National Finance Commission
NGO Non-Governmental Organization
NNS National Nutrition Survey
OPD Out Patient Department
OTP Out-patient Treatment Point
PCMC Primary Care Management Committee
PHSA Provincial Health Services Academy
PNC Pakistan Nursing Council
POL Petrol Oil Lubrication
60
PC-1 Planning Commission -1
PLW Pregnant Lactating Women
PNC Pakistan Nursing Council
PHC Primary Health Care
RHC Rural Health Centre
RUTF Ready to use therapeutic food
SAM Severe Acute Malnutrition
SBA Skilled Birth Attendant
SOPs Standard Operating Procedure
TA Technical Assistance
THQ Tehsil Head Quarter
TORs Terms of Reference
TSFP Target Supplementary Feeding Program
TBA Traditional Birth Attendant
UC Union Council
WMO Woman Medical Officer
FY Financial Year
61
ANNEXURE A
17. Logical Framework

PROGRAM NAME Strengthening of All BHUs across KP & conversion of 200 BHUs into 24/7 SBA facilities
Milestone
Milestone 1 Milestone 3 Target
GOAL Indicator Baseline 2 Assumptions
2023
2020-21 2021-22 2022-23
To improve maternal, Increased
140/10
new-born and child health 165/100,000 150/100,0 number of SBAs
160/100,000 lb 140/100,000 lb 0,000
in KP especially of the lb 00 lb along with their
lb
poor thereby making capacity building
Maternal Mortality Ratio
progress towards
(MMR) Source; NIPS 2018
achieving health related
SDGs Need based
WB, UNFPA,WHO , MICS, PDHS, &UNICEF provision of
commodities
Enhanced
Mileston
Milestone 1 Milestone 3 Monitoring&
e2
Target Evaluation
Indicator Baseline
2023 Accountability
2020-21 2021-22 2022-23 of the Services
Providers
41/1,000 lb 39 37 35 35
62
Cord Care
(Provision of
(PDHS 18)
Chlorhexidine Gel
Neonatal Mortality Rate and Training of Staff)
(NMR) Latest
Management of
Source; Source; PDHS 2018
Pneumonia and
Diarrhea
Mileston
Indicator Baseline e2
2023
2020-21 2021-22 2022-23
53/1,000 lb
51 49 45 45
(PDHS-18)
Source
Provision of
Infant Mortality Rate Latest FP Services
(IMR) (New Strategies,
PDHS2018 Commodities,
Counseling,
Involvement of MOs
& WMOs)
Mileston Target Training of
Indicator Baseline Milestone 1 Milestone 3
e2 2023 SBAs and other HCPs
63
in HTSP, PPIUCD
&Implanon
2020-21 2021-22 2022-23
Provision of
Tab. IFA, Cal. &
64/1000 lb
Multi-Vitamin to
63 60 56 56 PLWs
Counseling
PDHS-18 regarding PLW diet,
IYCF, WASH etc.
Under 5 Mortality Rate Screening &
Referral of
Source PDHS 2018
Malnourished PLWs
and Infants
Latest
Management of
PDHS
Pneumonia and
Diarrhea
Provision of
Mileston
Milestone 1 Milestone 3 Nut. Commodities&
e2
Target Medicines
Indicator Baseline
2023 Inclusion of
2020-21 2021-22 2022-23 Nut. Indicators in
LHW’s /District’s
64
Monthly Reports
(MIS)
Linkage of
HCFs, OTPs & SCs
Incentives for
4 3.9 3.8 3.7 3.7
Parents of
Total Fertility Rate (TFR) Malnourished
Children
Complete
Source
Immunization
(PDHS 2018)
Mileston
2023
2020-21 2021-22 2022-23
Wasting (moderate &

Source
severe) prevalence
National Nutrition survey 2018
Mileston
2023
2020-21 2021-22 2022-23
40% 39% 38% 37% 37%
Stunting (moderate &
Source
severe) prevalence
National Nutrition survey 2018
65
Mile
Milestone 1 Milestone 2 ston
Target
PURPOSE Indicator Baseline e3 Assumptions
2023
2022
2020-21 2021-22
-23
Provision of
commodities.
30.9% - PDHS 2017-18 31% 32% 33% 33%
Contraceptive Prevalence Uninterrupted logistic
rate (Both methods) supply system.
Source
To improve access to PDHS 2018
quality Reproductive Milest
Milestone 1 Milestone 2
health, Child health and one 3 Target
Indicator Baseline
Nutrition services 2022- 2023
2020-21 2021-22
especially for the poor 23
67.4 70% 72% 75% >75%
Skilled Birth Attendance
Source
(SBA)
PDHS 2017-18,
Milestone Milesto Target
Indicator Baseline Milestone 2
1 ne 3 2023
66
2022-
2020-21 2021-22
23
Transfer Grants
to all BHU's Through
Health Council (For
62% 65% 68% 70% 70% Non 24/7 BHU's @
Rs.100,000& for 24/7
BHU's @ Rs.150,000
per year).
Performance
Institutional deliveries Evaluation of LHWs
Source; PDHS 2018 etc. through number
of referrals to CMWs
& HF
Enhanced
Monitoring of SBAs
PDHS through Field, District
and Provincial
Monitors
Milesto Target
Indicator Baseline Milestone 1 Milestone 2
ne 3 2023
67
2022-
2020-21 2021-22
23
5 10 15 15
(DHIS-KP) 0
Average number of
Source
deliveries at per 24/7
Training of
BHUs per month
DHIS – KP SBAs and other HCPs
on IYCF
Milestone 1 Milestone 2 Milestone 3 Target
Indicator Baseline
2020-21 2021-22 2022-23 2023
60.80% 62% 63% 64% 64%
Exclusive breastfeeding Source
till age of 6 months PDHS 2018,
Survey Data/MICS
Milest
Milestone 1 Milestone 2
one 3 Target
OUTPUT 1 Indicator 1.1 Baseline Assumptions
2022- 2023
2020-21 2021-22
23
Improved delivery of Increased and sustained
maternal, child, family Average number of IUCD political commitment to
planning and nutrition insertion per month at 1 3 5 8 8 reproductive, maternal
services under Essential 24/7 BHUs and child health service
Package of Health Services delivery reflect
68
increased government
investment in health
sector
Funding support from

federal government
Source; DHIS continues/ enhanced
and fiduciary risks
mitigated
Provincial funding and
donor assistance is
District Health Information System (DHIS)
available to fill the
funding gaps
Source
DHIS 2020
Milesto
Indicator 1.3 Baseline ne 3
2023
2020-21 2021-22 2022-23
Number of 24/7 BHUs 75 200
0 25 BHUs 100 BHUs
providing Basic EmONC BHUs BHUs
services (4 signal Source
functions except forceps Third party validation for functionality of established facilities, Program Management
delivery) Information System
69
Miles
Milestone 1 Milestone 2 tone
Target
Indicator 1.5 Baseline 3
2023
2022-
2020-21 2021-22
23
249 249 500 500 500

Number of OTP sites Source
Programme database
Miles
Target
Indicator 1.6 Baseline 3
2023
2022-
2020-21 2021-22
23
15 15 20 30 30
Increase in number of
Source
NVD at 24/7 RHCs
DHIS
Miles
Target
OUTPUT 2 Indicator 2.1 Baseline 3 Assumptions
2023
2022-
2020-21 2021-22
23
Improved practices and Early initiation of 46.9% 52% 54% 55% 55% Increased and
health seeking behaviour for breastfeeding Source sustained political
70
Reproductive, Maternal, NNS 2018 commitment to
New born and Child Health Miles reproductive,
and Nutrition Milestone 1 Milestone 2 tone maternal and child
Target
Indicator 2.2 Baseline 3 health service delivery
2023
2022- reflect increased
2020-21 2021-22
23 government
29.2% 30% 35% 40% 40% investment in demand
Source side interventions.

Human resources
(particular women)
required available,
deployed and
retained. Private
sector facilitates the
Percentage of children
public sector in
receiving age appropriate
creating awareness
complimentary feeding NNS2018
and changing
behaviors related with
RCN. Effective
coordination between
program and projects
for coordinated
communication
interventions. System
71
of regular monitoring/
assessment functional.
Miles
Target
OUTPUT 3 Indicator 3.1 Baseline 3 Assumptions
2023
2022-
2020-21 2021-22
23
Strong strategic
leadership at
provincial and district
10 15 15 15 15 level reflected through
performance of
Key posts at PMU filled
steering committee
and performance
and DHMTs
indicators measured at six
Effective management of the Source
month intervals
Program at provincial and Required competent
district level health managers/ staff
Administrative data available and
deployed at
appropriate level
Milesto
Indicator 3.2 Baseline ne 3
2023
2020-21 2021-22 2022-23
1 per annum 2 3 3 3
72
Project Steering Source
committee meeting held
Administrative data
to track progress
Miles
3 Target
Indicator 3.2 Baseline
2023 Ownership of district
2022-
2020-21 2021-22 health department and
23
PHFMC available
Days out of stock for 3 100% 50% 30% 15% 15%
contraceptive methods, Source
oxytocin, Magnesium
Sulphate, Mesoprostol
Program database
and Safe Delivery Kit at
24/7 BHUs
Milesto
Indicator 3.3 Baseline ne 3 Assumptions
2023
2020-21 2021-22 2022-23
Strong commitment at
Days out of stock for 4
provincial level to
contraceptive methods,
100% 50% 30% 15% 15% integrate health
Iron, Folic Acid, ORS,
information systems
Amoxylsyp/DT,
with strong leadership
73
Injgentamycin 40mg and Availability of
Zinc at 24/7 BHU level effective
organizations able to
Source
produce quality
evidence and
influencing policies
Effective strategic
partnership among
development partners
Program database and the government to
generate demand and
provision of quality
RCN services
Security situation
Mileston conducive to research
OUTPUT 4 Indicator 4.1 Baseline e3 and advocacy in all
2023
provinces/ areas.
2020-21 2021-22 2022-23
Monthly Monthly Monthly
Monthly Review
Performance review of Review Review Review
Meetings
districts conducted at Meetings Meetigns Meetings
Quarterly review held
Evidence based decision provincial level using KPI Annual Annual
Annual Annual
making through efficient system/ road map report performanc performance
performa performa
monitoring and evaluation e review review
74
nce nce
review review
Annual Annual
Annual
District District
District
Annual District performa performa Equipments available,
performanc
performance nce nce capacity of the firm/
e
disseminated dissemin dissemin company / HISDU /
disseminate
through DOH ated ated PITB to resolve
d through
website through through trouble shooting
DOH
DOH DOH
website
website website
Source
KPI dashboard
Milesto
Indicator 4.2 Milestone 1 Milestone 2 Target
Baseline ne 3
2023
2020-21 2021-22 2022-23
External
review 200 PHFs
Review of the system
EMR System emplaced at and EMR
50 PHFs 100 PHFs held in first quarter in
zero health facility expansi Functionin
Improved quality of data Year 1
on in g
200
Source
Validation results
75
Milesto
Indicator 4.3 Baseline Milestone 1 Milestone 2 Target
ne 3
2023
2020-21 2021-22 2022-23
36
districts
20 districts having
having function All
36 districts having
functional al districts
functional system
system ( system ( having
( regular bi-
regular bi- regular functional
monthly meeting)
monthly bi- system
Verbal autopsy system Irregular implementation
meeting) monthly
functional for maternal &
meeting
newborn deaths
)
Annual
Annual Annual
provinci
provincial Annual provincial provincial
al report
report report published report
publishe
published published
d
Source
Verbal autopsy reports
76
Annexure B
18. IHP Financial Summary Cost Sheet

Integration of Health Service Delivery with Special Focus on MNCH, LHW & Nutrition Program Summary Cost Sheet FY (2020-
2023)
Sr
Description FY 2020-21 FY 2021-22 FY 2022-23 Total Cost
No
1 HR cost 879,083,420 1,388,549,800 1,264,756,200 3,532,389,420
2 HR training Cost 41,898,000 79,466,700 107,002,000 228,366,700
Medicine and Supplies/equipment/contraceptives
3 732,543,792 754,963,041 701,122,416 2,188,629,249
(LHW/CMW/PMU)
4 E-Monitoring 12,546,000 23,676,000 24,156,000 60,378,000
5 POL 77,559,600 81,160,080 84,468,084 243,187,764
6 TA/DA 36,720,960 36,720,960 36,720,960 110,162,880
7 Operations cost (PMU & DMU) 8,651,800 9,339,000 9,840,450 27,831,250
8 Nutrition Commodities//Equipment - 239,634,000 - 239,634,000
9 Purchase of Vehicle - 11,500,000 - 11,500,000
10 Procurement of PIU Equipment 6,585,000 4,100,000 300,000 10,985,000
11 BCC Cost 7,000,000 17,000,000 18,100,000 42,100,000
12 Transfer Grant to PCMC of 50 24/7 RHCs - 15,000,000 15,000,000 30,000,000
13 Transfer Grant to PCMC of 200 24/7 BHUs 12,000,000 24,000,000 24,000,000 60,000,000
14 Cost of Warehousing and Supply Chain 22,170,100 44,424,200 44,512,400 111,106,700
15 Operating Cost of MNCH School 6,000,000 15,300,000 15,300,000 36,600,000
16 Procurement of Contraceptives for Primary & 29,954,220 31,451,931 32,949,642 94,355,793

Secondary Care Health Facilities
Total Cost 1,872,712,892 2,776,285,712 2,378,228,152 7,027,226,756
77
18.1 Output 1 Financial Summary & Physical Activities
Output 1: Improved delivery of maternal, child, family planning and nutrition services under essential package of health services
Sr. Unit Worki Physical Targets Financial Cost - PKR

No Unit No. of Total Cost - ng Yea Year Year Total Cost -
. Activity Details Defined Cost Items PKR Note rI II III Year I Year II Year III PKR
Carton N
Procurement of Nutrition 23,12
1.1 Commodit 23,120 0 0 208,376,00 208,376,000
Commodities (F-75, F-100, RUTF) 208,376,000 0 - -
ies 0
Procurement of Multimicronutrient
Pack of 30 100,0
1.2 sprinkles for children 6-23 months 125 100,000 0 0 12,500,000
Sachet 12,500,000 00 - 12,500,000 -
of age B-1
Equipment
1.3 Procurement of OTP Equipments 68,000 251 0 251 0 17,068,000
s 17,068,000 - 17,068,000 -
Procurement of Stabilization Center Equipment

1.4 65,000 26 0 26 0 1,690,000
Equipments s 1,690,000 - 1,690,000 -
Procurement of Equipments,
1.5 Instruments & FF ( Deployment CMW 91,044 1,204 B-2 604 600 0 54,990,57 109,616,976
109,616,976 54,626,400 -
Cost) for CMWs 6
Purchase of drugs, non-drugs &

contraceptives for CMWs (Units
1.6 CMW 3,274 54,000 B-3 1300 1300 1900 51,066,60 74,635,800 176,769,000
4500 * 12 Months = 54000*Unit 176,769,000 51,066,600
0
cost 3244)
Medicines (Drug/Non Drug 15,4 15,41 15,41 1,879,459,84

1.7 LHW's 40,644 46,242 1,879,459,84 B-4 626,486,6 626,486,61 626,486,61
items)for LHW's 14 4 4 8
8 16 6 6
Double Cabin 4*4 (3000 cc) for 7,000,0
1.8 Number 1 0 1 0 7,000,000
Project Director 00 7,000,000 Vehicl - 7,000,000 -
2,250,0 es
1.9 Car (1300 cc) for Deputy Directors Number 2 0 2 0 4,500,000
00 4,500,000 - 4,500,000 -
1.1
Trainings & Review Meetings Trainings B-6 0 0 0 41,898,00 107,002,00 228,366,700
2 228,366,700 79,466,700
0 0
1.1 Operating
Cost of MNCH Schools B-7 1 1 1 36,600,000
3 Cost 36,600,000 6,000,000 15,300,000 15,300,000
78
Cost of
1.1 Cost of Warehousing and Supply Cost of
Wareho B-8 1 1 1 22,170,10
4 Chain Warehouse 111,106,700 44,424,200 44,512,400 111,106,700
use 0
Procuremengt of Contraceptives for

1.1 1,75
Primary & Secondar Care Health B-9 1,757 1,757 29,954,22
5 94,355,793 7 31,451,931 32,949,642 94,355,793
Facilities 0
Total Cost of Procurement 832,566,11 1,153,956,44

2,887,409,017 900,886,458 2,887,409,017
2 7
18.1.1 Annex B-1 Nutrition Commodities & Equipment’s Items & Unit Cost
Provision of OTP supplies and equipment Unit Price Quantity Centres Total
Medical Equipment/Supplies (prices inclusive of taxes, freight, handling &

transportation)
Scale, electornic, mother/child 150Kgx100g 25,000 1 1 25,000

Scale, electornic, baby, 10Kgx<5g> for SCs 25,000 1 1 25,000
Portable Baby /Child/Adult Length and Height Measuring System 14,200 1 1 14,200
IEC/Registration Material (OPT Card, Ration Card, Referal Slip to SC, Treatment
2,700 1 1 2,700
Protocols etc.)
MAUC Tape Child 11.5 Red (Pack of 50) 500 1 1 500

MAUC Tape Adult without color code (Pack of 50) 500 1 1 500
Thermometer 100 1 1 100
Total Cost 68,000
Total Unit Cost in million 68,000
Provision of SC supplies and equipment Unit Price Quantity Centres Total

Office Equipment/Supplies
79
Computer 80,000 - 1 -
Printer (Laser) 35,000 - 1 -
UPS 25,000 - 1 -
Office Table 30,000 - 1 -
Office Chair 10,000 - 1 -
Visitor Chair 4,000 - 1 -
Almirah 5,000 - 1 -
Jug/Cups 1,500 - 1 -
Chiller/Water Dispenser 8,000 - 1 -
Sub-total -
Medical Equipment/Supplies (prices inclusive of taxes, freight, handling &

transportation)
Scale, electornic, mother/child 150Kgx100g 25,000 1 1 25,000

Scale, electornic, baby, 10Kgx<5g> for SCs 25,000 1 1 25,000
Portable Baby /Child/Adult Length and Height Measuring System 14,400 1 1 14,400
IEC/Registration Material (OPT Card, Ration Card, Referal Slip to SC etc) 2,700 - 1 -
MAUC Tape Child 11.5 Red (Pack of 50) 500 1 1 500

MAUC Tape Adult without color code (Pack of 50) 1,000 - 1 -
Thermometer 100 1 1 100
Sub-total 65,000
Total Cost 65,000
80
Procurement and distribution of F75 Unit Price Quantity Total
Annual Requirement (Cartons containing 24 Cans)
Yr 1 11,500 - -
Yr 2 11,500 1,872 21,528,000
Yr 3 11,500 - -
Total Cost 21,528,000
Total Cost (in million) 11,500 21,528,000
Procurement and distribution of F100 Unit Price Quantity Total
Annual Requirement (Cartons containing 24 Cans)
Yr 1 13,500 - -
Yr 2 13,500 1,248 16,848,000
Yr 3 13,500 - -

81
Procurement and distribution of Ready to use therapeutic food
Annual Requirement (Cartons containing 150 sachets) Unit Price Quantity Total
Yr 1 8,500 - -
Yr 2 8,500 20,000 170,000,000
Yr 3 8,500 - -
Grand Total 208,376,000
18.1.2 Annex B-2 CMWs Birth Station Items & Unit Cost Summary
Unit Cost for Newly Deployed CMW's Birth Station
Sr. No. Unit Name Qty Rate Unit Cost

A CMWs Kit
1 Episiotomy Scissors
2 Small Artery Forceps
3 Medium Artery Forceps
4 Allis forceps
1 2,000 2,000
5 Non Toothed forceps
6 Needle Holder
7 Fetoscope
8 Vaginal Speculums
9 Kidney Tray
10 Instrument Tray with Lid
1 1,325 1,325
11 Bowl 10”
12 Bowl6”
82
13 CMW Kit Bag 1 1,500 1,500
4,825
B CMWs Equipment & Instrument
1 Syringe Cutter 1 350 350
2 Safety Box 1 70 70
3 Haemoglobin meter 1 8,375 8,375
4 AMBU Bag (adult) 1 3,154 3,154
5 AMBU BAG (BABY) 1 3,154 3,154
6 CMW sign Board (standard size) 1 2,800 2,800
17,903
C Instrument Kit for CMW
1 BP Apparatus 2 2,300 2,300
2 Stethoscope 2 500 1,000
3 Weighing Machine Adult 1 3,600 3,600
4 Baby Weighing Machine 1 4,660 4,660
5 Measuring tape 1 18 18
6 Sterilizer 1 2,650 2,650
7 Bulb Sucker 1 88 88
8 Instrument Cabinet Wall mounted 1 8,000 8,000
9 Delivery Table 1 40,000 45,000
10 Clinic Stool (Steel) 1 1,000 1,000
68,316
Unit Cost of (A+B+C) 91,044
83
18.1.3 Annex B-3 CMWs Kit Bag Items & Unit Cost
Cost of CMWs Kit Bag
Disposable supplies for delivery Qty Unit Cost T.Cost/ Delivery
1 Disposable syringes 5cc 2 13 26

I/V Cannula, with injection Port and Integrated Closing Cone Size 20 1 46 46
2 G
3 Cotton roll (500gm) 0.5 50 25
4 Surgical gauze 1 17 17
5 Surgical tape 1 15 15
6 Gloves Surgical 1 45 45
7 Sanitizer 1 10 10
8 Mask 1 7 7
Cat Gut No 1 with non-cutting, round body needle, 40 mm Box of 36 1 100 100
9 or less
0.1 10 1
10 Cord Clamp plastic (Disposable). Standard Size. Pack of 10
Total Disposables 292
Medicines Cost Per delivery

1 Cap / Tab Amoxicillin (500 mg) 9 8 72
2 Metronidazole tablets (400 mg) 9 2 18
3 Clotrimazole cream / Gel (vaginal) 2 % 35 gm 0.5 110 55
4 Inj. Ringers lactate IL 9 % 500ml 1 70 70
5 Injection Magnesium Sulphate 0.2 17 3
6 Tablet Misoprostol 200 mcg 6 6 36
7 Tablet Paracetamol (10 Tablets) 2 10 20
8 Pyodine Antiseptic 450 ML solution 0.1 170 17
9 Injection Oxytocin/ syntocinon 4 6 24
84
10 Injection Cepro4500mg 1 170 170
11 Antiseptic cream (Polyfax) 1 20 20
12 Tab. Clotrimazole 500 mg with applicator 1 30 30
13 4% CHX (Chlorhexidine) 10mg 1 40 40
14 Oral Pills 2 21 42
15 Condoms 50 5 250
16 Injectibles with syringes 2 75 150
1017.4
Total Cost Per Delivery 1309.4
Monthly expected Monthly Cost per
Sr No Description Cost per month
deliveries per month CMWs
1 Total monthly Cost per CMWs 2.5 1309.4 3274
18.1.4 Annex B-4 LHWs Kit Bag Items & Unit Cost
Requirement of drugs/non drugs & contraceptives for LHWs
Monthly consumption per

S. No Name of Item Unit Unit Cost Monthly Cost Annual Cost
LHW
1 Paracetamol Tablets Tablets 200 1.5 300 3600

2 Paracetamol Syrup Bottle 5 40 200 2400
3 Ferrous Fumerate+ Folic Acid Tablets 1000 0.5 500 6000
4 Antiseptic Lotion 1.5% Bottle 1 39 39 468
5 Sticking Plaster/Zinc Oxide 1.5 M Roll 1 115 115 1380
6 Cotton Wool (non-sterile) Roll 1 130 130 1560
7 Cotton Bandage 4 x 3 m Pack of 12 1 210 210 2520
8 Low osmolarity ORS (20.5 gm) Sachet 8 8 64 768
9 Zinc Sulphate Syrup Bottle 5 30 150 1800
10 Mabendazole Tablets Tablets 20 5 100 1200
85
11 Benzyle Benzoate Lotion Bottle 2 39 78 936
12 LHW Kit bags Piece 0.5 2000 1000 1000
13 Thermometers Piece 2 120 240 2880
14 Scissors Piece 1 300 300 3600
15 MUAC Tape Tape 4 12 48 576
16 Oral Pills Cycles 3 21 63 756
17 Condoms Piece 100 5 500 6000
18 Salter Scale Piece 1 500 500 500
19 DMPA Injections with syringes Vial 3 75 225 2700
Total 3651 4762 40644
18.1.5 Annex B-5 Trainings M&E Frame Work Review Meetings Cost Summary
Trainings M&E Frame Work & Review Meetings
All Figs in (Rs.)
Unit Physical Target Financial Targets
S. FY FY FY
Activities Total
No. (2020- (2021- (2022- FY FY FY
Defined Cost 21) 22) 23) (2020-21) (2021-22) (2022-23)
Development of M&E System
1 Develop M&E Tools Consultancy

1,000,000 1 - - 1,000,000 - - 1,000,000
Review of MIS/Integration of
2 Consultancy
Information System development 2,500,000 1 - - 2,500,000 - - 2,500,000
Geo Mapping of Existing CMWs &

3 Consultancy
Updation of Data in MIS 4,000,000 1 - - 4,000,000 - - 4,000,000
Geo Mapping of LHWs Coverage at

UC level: Identifiy Numbers of LHWs
4 Consultancy
required to achieve Universal 4,500,000 1 1 - 4,500,000 4,500,000 - 9,000,000
Coverage
86
Service Rendered by Others (Short
5 Consultant LumpSum
Term Services) 1 1 1 2,000,000 5,000,000 5,000,000 12,000,000
Sub Total
5 2 - 14,000,000 9,500,000 5,000,000 28,500,000
Operations Research
Annual Assessments/Third Party

1 Validation/ Third party evaluation of Consultancy
20,000,000 1 - - 20,000,000 - - 20,000,000
CMW Program
Review meetings of IHP at provincial

3 Meeting
level with 90 participants 2,000,000 1 2 2 2,000,000 4,000,000 4,000,000 10,000,000
Sub Total
2 2 2 22,000,000 4,000,000 4,000,000 30,000,000
Detail calculations of Training related clumped activities Nutrition
Training of stabiliztion
1 center (SC) staff at each Training
316,900 - - - 3,802,800 - 3,802,800
district
12
TOT 75 master trainiers (25x3) on

2 on Comprehensive package on Training
799,100 - - - 799,100 - 799,100
Nutrition treatment Provincial
1
3 Refresher Training of LHWS Training

156,200 10 450 1,562,000.000 31,240,000 70,290,000 103,092,000
200
Hands on Training of LHVs
working at 24/7 on BEmNOC at
4 Training
Category A,B, C hospital at 603,200 3,619,200.000 26,540,800 24,128,000 54,288,000
district 6 44 40
Training on Comprehensive
5 Training
package on Nutrition at district 358,400 2 10 716,800.000 3,584,000 3,584,000 7,884,800
10
Sub Total
5,898,000.000 65,966,700 98,002,000 169,866,700
Grand Total 41,898,000 79,466,700 107,002,000 228,366,700
87
Training of stabiliztion center (SC) staff at each district
Unit Price Quantity Days Total
Supplies per participant 200 14 1 2,800

Meal & teas per participant 700 14 5 49,000
Facilitator (03)
Daily Lecture's allowance 3000 2 5 30,000
Average travel cost per facilitator 3000 9 5 135,000
Average daily allowance per participant = 2560 2560 7 5 89,600
Meal & teas per facilitator 700 3 5 10,500
Venue/Hall charges 10000 316,900

TOT 75 master trainiers (25x3) on treatment protocol of CMAM

(OTP, IFA, Sprinkles) Provincial

Facilitator (03)
Average daily allowance per participant = 2560 x 5 2560 2 5 25,600
Out-station participants
Average travel cost per participant 4,000 25 2 200,000
Average daily allowance per participant = 2560 x 5 2,560 25 5 320,000
Venue/Hall charges 10000 1 5 50,000
799,100
88
Training on Comprehensive package on Nutrition at district

Facilitator (02)
Average daily allowance per participant = 2560 x 5 2050 2 3 12,300
Participants
Average travel cost per participant 300 25 3 22,500
Venue/Hall charges 10000 1 3 30,000
358,400
358,400
Refresher Training of LHWS

Facilitator (03)
Average daily allowance per participant 600 20 6 72,000
Participants
89
156,200
156,200
Hands on Training on BEmNOC at Category A,B, C hospital at

district
Supplies per participant with training Manual 500 10 1 5,000
Facilitator (02)
Participants
Average travel cost per participant 1,200 10 14 168,000
603,200
Per Participant Cost 60,320
18.1.6 Annex B-6 Cost of MNCH Schools in Districts

Cost of MNCH Schools in Districts
All Figs in (Rs.)
S.
N Activities FY FY Total
Annu Annual FY
o. BPS (2021- (202
al Increas (2020-21) FY FY FY
22) 2-23)
Defined Cost e (2020-21) (2021-22) (2022-23)
1 Programme Staff
Provincial Staff (Project
Implementation Unit)
1. Principals for CMW Person

- 240,0
1 Schools (on incentive basis) year - - 10 10 - 2,400,000 2,400,000 4,800,000
00
90
1. Tutors for CMW Schools Person
- 180,0
2 (on incentive basis) year - - 30 30 - 5,400,000 5,400,000 10,800,000
00
Sub Total 7,800,000 7,800,000 15,600,000

2 Strengthening CMW
Schools (24)
2.
Operating expenses Annu
1 10 10 10 - 6,000,000 6,000,000 6,000,000 18,000,000
m 600,000
Per
2.
Accreditation Exam fee CM
2 300 300 - - 1,500,000 1,500,000 3,000,000
W 5,000
Sub Total
- 6,000,000 7,500,000 7,500,000 21,000,000
GRAND TOTAL 6,000,000 15,300,000 15,300,000 36,600,000
18.1.7 Annex B-7 Cost of Warehousing & Supply Chain

Cost of Warehousing and Supply Chain
Sr No Warehousing Cost Unit Cost/Salary Annual Cost Y1 Y2 Y3 Total
1 Warehouse manager 60,000
360,000 756,000 793,800 1,909,800
1 720,000
2 Warehouse Assistant 40,000
480,000 1,008,000 1,058,400 2,546,400
2 960,000
3 Rent of Warehouse (Monthly rent / Sq.ft) 33
5,940,000 11,880,000 11,880,000 29,700,000
30,000 11,880,000
Per
pack Annual Number Annual
Sr No Supply Chain cost Y1 Y2 Y3 Total
Supply frequency of sdp Cost
Cost
1 LHWs (Box of 15kg) 3 12,400,575 24,801,150 24,801,150 62,002,875
550 15,031 24,801,150
2 CMWs (Box of 15kg) 4 1,540,000 3,080,000 3,080,000 7,700,000
550 1,400 3,080,000
3 Health Facilities(BHU/RHC/DHQ) (Box of 15 kg) 3 1,449,525 2,899,050 2,899,050 7,247,625
550 1,757 2,899,050
Total 42,660,200 22,170,100 44,424,200 44,512,400 111,106,700
91
18.1.8 Annex B-8 Contraceptives Cost Summary for Health Care Facilities
Procurement of Contraceptives for Primary & Secondary Care Health Facilities
Provision of contraceptives for FY 2020-23
Per annum - Cost

Unit No of
Sr. No. LHW's/CMW's/Facilities Name Strength
Cost Months Year I Year II Year III Total
BHUs 9,233,496 9,695,171 10,156,846

1 514 1,497 12 29,085,512
Civil Dispensries 10,347,960 10,865,358 11,382,756
2 970 889 12 32,596,074
MCH Centers 1,041,912 1,094,008 1,146,103
3 58 1,497 12 3,282,023
sub health centers 256,032 268,834 281,635
4 24 889 12 806,501
RHCs 1,562,820 1,640,961 1,719,102
5 61 2,135 12 4,922,883
Catogory B + A Hospitals ( Non
1,770,000 1,858,500 1,947,000
6 MTI, Non teaching ) 20 7,375 12 5,575,500
Catogory C Hospitals 1,409,400 1,479,870 1,550,340

7 27 4,350 12 4,439,610
Cat D Hospitals 4,332,600 4,549,230 4,765,860
8 83 4,350 12 13,647,690
Total Cost 29,954,220 31,451,931 32,949,642
1,757 94,355,793
Unit Cost For Contraceptive Per Month

Unit Cost For BHU ( Unit Cost For RHC
Unit Cost For B Unit Cost For C & D Unit cost per CD & SHC
Normal) & MCH center (Normal)
Sr.
Unit Name Quantity Quantity Quantity Quantity
No. Unit Unit Unit Quantity Unit
For Rate For Rate For B & Rate Rate For Rate Unit Cost
Cost Cost Cost For D Cost
BHU RHC C BHU
Oral Pills (No.
1 10 12 15 15 5 105
of Cycles) 21 210 21 252 21 315 21 315 21
Condom
2 (10 Condoms 100 120 200 200 100 500
5.00 500 5.00 600 5.00 1,000 5.00 1,000 5.00
per client
92
Injection
3 Family 6 4 5 5 2 154
77 462 77 308 77 385 77 385 77
Planning
4 IUCD 5 15 25 20 2 130
65 325 65 975 65 1,625 65 1,300 65
5 Implant 0 0 3 1 0 -
1,350 - 1,350 - 1,350 4,050 1,350 1,350 1,350
Total Unit Cost Total Unit Cost Total Unit Cost Total Unit Cost
For BHU 24/7 1,497 For RHC 2,135 For THQ 7,375 For THQ 4,350 889
Output 2: Improved Practices and Health Seeking Behavior for Reproductive, Maternal, Newborn and Child Health and Nutrition
Unit Physical Targets Financial Cost - PKR

Sr. Total Cost Working
Activity Details Unit Total Cost
No. Defined - PKR Note Year I Year II Year III Year I Year II Year III
Cost
Cost of developing
Basic Communication
Package (BCP) on
maternal and child
health, IYCF, exclusive
breast feeding,
1 Year 1,000,000 3 0 1 1
nutrition, Deworming 3,000,000 - 3,000,000 3,300,000 6,300,000
of Children and
Pregnant Women,
immunization using
print and electronic
C-1
media and radio.
Cost of disseminating
Basic Communication
Package (BCP) on
maternal and child
health, IYCF, exclusive
2 Year 1,000,000 1 1 1
breast feeding, 6,000,000 6,000,000 6,000,000 6,600,000 18,600,000
nutrition, Deworming
of Children and
Pregnant Women,
immunization using
93
social media & Mobile
ring tone
Support in conducting
3 MCH, Nutrition and Year 2,000,000 0 1 1
2,000,000 - 2,000,000 2,200,000 4,200,000
Deworming Week
Development of
Communication
4 Year 1,000,000 1 0 0
Package (Short videos 1,000,000 1,000,000 - - 1,000,000
etc)
MCH Week Special
5 Focus on Deworming Year 6,000,000 0 1 1
6,000,000 - 6,000,000 6,000,000 12,000,000
in School Children
Total Cost of Output 2 12,000,000 7,000,000 17,000,000 18,100,000 42,100,000
18.2.1 Annex C-1 Behavior Change Communication Cost Summary

Behavior Change Communication (Annexed-C)
Improved Practices and Health Seeking Behavior for Reproductive, Maternal, Newborn and Child Health and Nutrition
Unit Physical Targets Financial Cost - PKR
Sr. Total Cost
Activity Details Cost - Year Year Year Total Cost
No. Defined Number - PKR Year I Year II Year III
PKR I II III
Cost of developing Basic
Communication Package (BCP) on
maternal and child health, IYCF,
exclusive breast feeding, nutrition,
1 Year 1,000,000 3 1 1
Deworming of Children and 6,300,000 - 3,000,000 3,300,000 6,300,000
Pregnant Women, immunization
using print and electronic media
and radio.
Cost of disseminating Basic
Communication Package (BCP) on
maternal and child health, IYCF,
exclusive breast feeding, nutrition,
2 Year 1,000,000 18 1 1 1
Deworming of Children and 18,600,000 6,000,000 6,000,000 6,600,000 18,600,000
Pregnant Women, immunization
using social media & Mobile ring
tone
94
Support in conducting MCH,
3 Year 2,000,000 2 0 1 1
Nutrition and Deworming Week 4,200,000 - 2,000,000 2,200,000 4,200,000
Development of Communication
4 Year 1,000,000 1 1 0 0
Package (Short videos etc) 1,000,000 1,000,000 - - 1,000,000
MCH Week Special Focus on
5 Year 6,000,000 2 0 1 1
Deworming in School Children 12,000,000 - 6,000,000 6,000,000 12,000,000
Total Cost of Output 2
42,100,000 7,000,000 17,000,000 18,100,000 42,100,000
Output 3: Effective Management of the Programme at Provincial and District Level
Sr. Unit Total Cost - Working Physical Targets Financial Cost - PKR
Activity Details
No. Defined Unit Cost PKR Note Year I Year II Year III Year I Year II Year III TOTAL
See
Provision for payment of
3.1 notes Misc D-I 37
salaries to PMU staff 89,739,320 37 37 22,657,420 32,979,100 34,102,800
(S) 89,739,320
3.2 Operation Cost Month Misc D-2 27,831,250
27,831,250 8,651,800 9,339,000 9,840,450
Transfer Grants to PCMC
3.3 200 60,000,000
BHUs 200 200 12,000,000 24,000,000 24,000,000
D-3
Transfer Grants to PCMC
3.4 Annual Misc 25 30,000,000
RHC 25 25 3,000,000 12,000,000 15,000,000
Procurement of PIU
3.5 Month Misc D-4 - - 10,985,000
Equipments 10,985,000 - 6,585,000 4,100,000 300,000
Provision for payment of
Mon-
3.6 salaries & Stipends to Misc D-I 5,277 3,442,650,100
Year 3,442,650,100 5,623 5,848 856,426,000 1,355,570,700 1,230,653,400
DMU staff
Total Cost of Output 3 3,571,205,670 909,320,220 1,437,988,800 1,313,896,650 3,661,205,670
95
18.3.1 Annex D-1Human Resource Cost Summary PMU & DMU
Human Resource Staff Cost Provincial & District IHP (PIU & DIU Office)
Annexed-A All Figs in (Rs.)
S. FY FY FY
Activities Annual Annual FY FY FY Total
No. BPS (2020- (2021- (2022-
Defined Cost Increase (2020-21) (2021-22) (2022-23)
21) 22) 23)
1 Programme Staff
Provincial Staff
(Project
Project Director (By
Transfer from DGHS / Person
1.1
open competative process 20 year 6,000,000 300,000 1 1 1 6,000,000 6,300,000 6,600,000 18,900,000
from market)
Deputy Director M&E /
MIS By Transfer from
Person
1.2 DGHS (He will be 18 / 19
year 480,000 - 1 1 1 480,000 480,000 480,000 1,440,000
entitled to draw project
allowance)
Deputy Director
Training By Transfer
Person
1.3 from DGHS (He will be 18 / 19
year 480,000 - 1 1 1 480,000 480,000 480,000 1,440,000
allowance)
Deputy Director
Operations By Transfer
from DGHS (He will be Person
1.4 18 / 19
entitled to draw project year 480,000 - 1 1 1 480,000 480,000 480,000 1,440,000
allowance or Deputation
Allowance)
Deputy Director Finance Person
1.5 (AG Staff by Deputation) 18 year 2,100,000 105,000 1 1 1 1,400,000 2,205,000 2,310,000 5,915,000
Deputy Director
Procurement By Transfer
Person
1.6 from DGHS (He will be
18 year 360,000 - 1 1 1 360,000 360,000 360,000 1,080,000
allowance)
Financial Management Person
1.70
Specialist (Open 19 year 2,100,000 105,000 1 1 1 1,050,000 2,205,000 2,315,000 5,570,000
96
Competative Process
from market on Contract)
Computer Programmer / Person
1.8
IT Expert (Project Staff) 17 Year 1,194,000 59,700 1 1 1 796,000 1,253,700 1,313,400 3,363,100
Provincial Logistics Person
1.9
Officer (Project Staff) 17 year 1,194,000 59,700 1 1 1 796,000 1,253,700 1,313,400 3,363,100
Assistant Accounts
Person
1.10 Officer (AG Staff by
17 year 1,194,000 59,700 1 1 1 796,000 1,253,700 1,313,400 3,363,100
Deputation)
Admin Officer ((By
Transfer from DGHS / Person
1.11
open competative process 17 Year 1,194,000 59,700 1 1 1 796,000 1,253,700 1,313,400 3,363,100
from market)
Data Analyst (Project Person
1.12
Staff) 17 year 1,080,000 54,000 2 2 2 1,431,100 2,160,000 2,160,000 5,751,100
Office Superientendent
Person
1.13 (Deputation Staff from
16 year 1,194,000 59,700 1 1 1 796,000 1,253,700 1,313,400 3,363,100
Secreteriat)
BCC Coordinator Person
1.14
(Project Staff) 17 year 1,080,000 54,000 1 1 1 540,000 1,134,000 1,188,000 2,862,000
Training Coordinator Person
1.15
(Project Staff) 17 year 1,080,000 54,000 1 1 1 540,000 1,134,000 1,188,000 2,862,000
Internal Auditor (BPS
16) Deputation from Person
1.16
AG/Auditor General 16 year 720,000 36,000 1 1 1 720,000 756,000 792,000 2,268,000
Office
Assistant Logistic Officer Person
1.17
(Project Staff) 16 year 780,000 39,000 2 2 2 1,040,000 1,599,000 1,638,000 4,277,000
IT Assistant/ Computer Person
1.18 16
Operators (Project Staff) year 720,000 36,000 8 8 8 2,880,000 5,320,000 5,320,000 13,520,000
Receptionist/Telephone
Operator / Incharge Anti- Person
1.19 BPS-4
Harrashment Cell year 480,000 24,000 1 1 1 480,000 504,000 532,800 1,516,800
(Project Staff Female)
Sub Total
28 28 28 21,861,100 31,385,500 32,410,800 85,657,400
Support Staff Provincial
Driver For New Person
1.20 BPS-4
Vehicles year 264,000 - 3 3 3 316,320 585,600 614,880 1,516,800
Person
1.21 Chowkidar BPS-3
year 264,000 - 4 4 4 288,000 604,800 624,960 1,517,760
97
Naib Qasid ( Regular
Person
1.22 Employees from MNCH -
year 216,000 - - - - - - - -
& LHW)
Person
1.23 Sanitary Worker BPS-1
year 216,000 - 2 2 2 192,000 403,200 452,160 1,047,360
Sub Total
9 9 9 796,320 1,593,600 1,692,000 4,081,920
Total PMU Cost
37 37 37 22,657,420 32,979,100 34,102,800 89,739,320
District Staff (District
WMOs to provide Basic
Person
1.24 EmONC facilities 17
year 1,080,000 54,000 13 13 13 1,170,000 9,132,000 9,360,000 19,662,000
(Project Staff)
03 Staff Nurse /
Person
1.25 Stabilization Center 16
year 720,000 36,000 52 52 52 18,720,000 37,476,000 37,512,000 93,708,000
(Project Staff)
Procurement & Logistics Person
1.26 14
Assistant (Project Staff) year 480,000 24,000 11 11 11 5,280,000 5,304,000 5,328,000 15,912,000
Nutrition Assistant Person
1.27 12
(Project Staff) year 360,000 18,000 69 69 69 16,560,000 24,858,000 24,876,000 66,294,000
LHVs to provide Basic
Person
1.28 EmONC facilities 12
year 390,000 19,500 30 30 30 7,800,000 14,419,500 14,439,000 36,658,500
(Project Staff)
Lady Health Supervisors Person
1.29 7
(LHS) (Project Staff) year 288,000 14,400 221 221 221 42,432,000 63,662,400 63,676,800 169,771,200
Lady Health Worker Person
1.30 5
(LHW) (Project Staff) year 240,000 12,000 3,604 3,604 3,604 576,640,000 864,972,000 864,984,000 2,306,596,000
Stipends for Students Person
1.31 Stipend
CMW year 180,000 - - 300 300 54,000,000 54,000,000 108,000,000
Community Mid Wife
Person
1.32 (CMW) (Stipend for Stipend
year 180,000 - 1,300 1,300 604 156,000,000 234,000,000 108,720,000 498,720,000
deployed CMW)
Drivers for LHS vehicles Person
1.33 4
(Project Staff) year 216,000 10,800 221 221 221 31,824,000 47,746,800 47,757,600 127,328,400
DMU Sub-Total
5,623 5,848 5,277 856,426,000 1,355,570,700 1,230,653,400 3,442,650,100
Grand Total
5,667 5,892 5,321 879,083,420 1,388,549,800 1,264,756,200 3,532,389,420
98
18.3.2 Annex D-2 Operation Cost Summary
OPERATION COST
Annexed-F All Figs in (Rs.)
S. No. Activities
Annual FY FY FY FY FY FY Total
Operations Defined Cost
Increase (2020-21) (2021-22) (2022-23) (2020-21) (2021-22) (2022-23)
PIU (Operations &
Maintenance Cost)
1 Rent of Building of PIU Office Monthly 400,000 40,000 12 12 12 4,800,000 5,280,000 5,760,000 15,840,000
2 Repair of Equipments Annual 100,000 5,000 1 1 1 100,000 105,000 110,250 315,250
3 Electricity charges Annual 630,000 - 1 1 1 532,600 630,000 630,000 1,792,600
4 Gas Charges Annual 200,000 - 1 1 1 69,600 200,000 200,000 469,600
Broad Band Internet Services
5 Annual 120,000 - 2 2 2 69,600 200,000 200,000 469,600
(Charges)
6 Stationary & Expendable Items Annual 150,000 7,500 1 1 1 200,000 110,000 115,500 425,500
7 Postages and courier Annual 180,000 9,000 1 1 1 180,000 109,000 114,450 403,450
8 Printing of office material Annual 100,000 5,000 1 1 1 100,000 105,000 110,250 315,250
9 Costs for Advertisement Annual 1,000,000 - 1 1 1 1,000,000 1,000,000 1,000,000 3,000,000
10 Mis./Other Cost Annual 1,000,000 - 1 1 1 1,000,000 1,000,000 1,000,000 3,000,000
11 Law charges Annual 600,000 - 1 1 1 600,000 600,000 600,000 1,800,000
8,651,800 9,339,000 9,840,450 27,831,250
99
18.3.3 Annex D-3 PCMC Grants Cost Summary (BHUs & RHCs)
Funds to be transferred to PCMC of RHCs/ BHUs

HFs Annual Grant # of units Year 1 Year 2 Year 3 Total Annual Cost
24/7
RHCs 300,000 50 3,000,000 12,000,000 15,000,000 30,000,000
24/7
BHUs 120,000 200 12,000,000 24,000,000 24,000,000 60,000,000
420,000 15,000,000 36,000,000 39,000,000 90,000,000
18.3.4 Annex D-4 Procurement of PIU Equipment’s Cost Summary

Procurement of PIU Equipments
All Figs in (Rs.)
S. No. Activities FY FY FY Total
FY FY FY
Defined Cost (2020-21) (2021-22) (2022-23) (2020-21) (2021-22) (2022-23)
Procurement
of Supplies &
1
Equipments
PIU
Development of
Online
1 Database, Number 1,000,000 1 1 1 1,000,000 1,000,000
Website &
Android Apps
Desktop 2,800,000
Computers
2 Number 100,000 28 - - - 2,800,000
(Provincial &
Districts)
Heavy Duty 1,200,000
Scanners for
3 Number 300,000 4 - - - - 1,200,000
Digitalization
of Record
4 Printers (Laser) Number 40,000 28 - - 1,120,000 - - 1,120,000
5 Laptops Number 120,000 5 - - 600,000 - - 600,000
Multimedia HD 400,000
6 Number 400,000 1 - - - - 400,000
LED Smart TV
100
55" for
Conference
Room
Licensed 500,000
Computer
Software
(Windows for
Server,
7 Software 500,000 1 - - - - 500,000
Computers,
Anti-virus)
(Corporate
Editions for 100
users)
Telephone 100,000
Exchange for 5
8 lines (35 Number 100,000 1 - - - - 100,000
extensions)
with installation
9 Telephone Sets Number 3,000 15 - - 45,000 - - 45,000
Computer 300,000
accessories
(flash drives,
10 Lumpsum 300,000 1 1 1 300,000 300,000 900,000
external HDD,
Toners for
Printers, etc.)
Photocopying 500,000
11 Machine - Number 500,000 1 - - - - 500,000
heavy duty
Air conditioner 500,000
12 (Split Wall Number 100,000 5 - - - - 500,000
Mounted)
Chillers/Water 30,000
13 Number 30,000 1 - - - - 30,000
Dispensers
Heavy Duty 500,000
14 Generator for Number 500,000 1 - - - - 500,000
PIU Office
Sub Total 3,993,000 93 2 2 5,795,000 4,100,000 300,000 10,195,000
Furniture
Office tables 250,000
15 Number 50,000 5 - - - - 250,000
(Officer)
Office tables 120,000
16 Number 30,000 4 - - - - 120,000
(Staff)
17 Reception Desk Number 50,000 1 - - 50,000 - - 50,000
Office Chairs 200,000
(Officers) -
18 Number 20,000 10 - - - - 200,000
Revolving
Hydraulic
101
Computer 100,000
19 Number 25,000 4 - - - - 100,000
tables
Sofa Set (five 70,000
seater) for
20 Number 70,000 1 - - - - 70,000
Programme
Manager
Sub Total 25 - - 790,000 - - 790,000
Grand Total 6,585,000 4,100,000 300,000 10,985,000
Output 4: Evidence Based Decision Making through Efficient Monitoring and Evaluation
Sr. Unit Physical Targets Financial Cost - PKR

Activity Total Cost Worki
No Unit Year
Details Defined - PKR ng Note Year I Year II Year I Year II Year III Total
. Cost III
POL and
4.1 See notes 211,751,034
FTA 211,751,034 - - - 67,587,600 70,689,480 73,473,954
E-I
Repair of
4.3 See notes 31,436,730
Vehicle 31,436,730 - - - 9,972,000 10,470,600 10,994,130
MIS Tools LHW/Ye
4.4 E-2 22,783,425
for LHWS ar 22,783,425 - - - - 22,783,425 -
TA/DA
4.5 See notes E-3 110,162,880
(Monitoring) 110,162,880 - - - 36,720,960 36,720,960 36,720,960
4.6 E-Monitoring See notes E-4 60,378,000
60,378,000 - - - 12,546,000 23,676,000 24,156,000
Total Cost of Output 4 436,512,069 126,826,560 164,340,465 145,345,044 436,512,069
- - -
102
18.4.1 Annex E-1 POL & Repair of Vehicles Cost Summary PMU & DMU
POL, Repair of Vehicle Cost for FY 2020-23 (Annexed-D 1)
No. of Vehicles/ Quantity Per Rate

Sr. Detail of No. of
Required For Strength of Month per Year I Year II Year III Total
No. Expenditure Month
FPO's, So's Required Unit
Project Director
1 400
Vehicle 12 110 528,000 554,400 582,120 1,664,520
Deputy Director
1 350
M&E / MIS 12 110 462,000 485,100 509,355 1,456,455
Deputy Director
1 150
Admin 12 110 198,000 207,900 218,295 624,195
Deputy Director
1 150
Finance 12 110 198,000 207,900 218,295 624,195
Deputy Director
1 150
Procurement 12 110 198,000 207,900 218,295 624,195
POL Deputy Director
1 1 150
Training 12 110 198,000 207,900 218,295 624,195
Logistics Vehicle 1 150
12 110 198,000 207,900 218,295 624,195
POL for PIU
1 300
Generator 12 110 396,000 415,800 436,590 1,248,390
POL for FPOs 10 240
12 110 3,168,000 3,326,400 3,492,720 9,987,120
POL for Regular &
IHP LHS having 514 70
12 110 47,493,600 49,868,280 52,361,694 149,723,574
Vehicle
FTA for Regular &
IHP LHS without 194
12 6,250 14,550,000 15,000,000 15,000,000 44,550,000
Vehicle
Total POL Cost
67,587,600 70,689,480 73,473,954 211,751,034
Project Director
1
Vehicle 12 9,000 108,000 113,400 119,070 340,470
Deputy Director
1
M&E / MIS 12 8,000 96,000 100,800 105,840 302,640
Repair of Deputy Director
2 1
Vehicle Admin 12 8,000 96,000 100,800 105,840 302,640
Deputy Director
1
Finance 12 8,000 96,000 100,800 105,840 302,640
Deputy Director
1
Procurement 12 8,000 96,000 100,800 105,840 302,640
103
Deputy Director
1
Training 12 8,000 96,000 100,800 105,840 302,640
Logistics Vehicle 1
12 5,000 60,000 63,000 66,150 189,150
Generator Repair 1
12 6,000 72,000 75,600 79,380 226,980
Regular & IHP
514
LHS having Vehicle 12 1,500 9,252,000 9,714,600 10,200,330 29,166,930
1 9,972,000 10,470,600 10,994,130 31,436,730
Total Cost
77,559,600 81,160,080 84,468,084 243,187,764
18.4.2 Annex E-2 MIS Tools Cost Summary for LHWs

MIS Tools for LHWs
Total Annual Cost of Printing per LHW
S.No Items Requirement/LHW/LHS Unit Cost in PKR Total LHWs/LHSs Annual Cost in PKR / LHW
1 Register Khandaan 1 300 15414 4,624,200

2 Register Curative & FP & Stock Register 1 325 15414 5,009,550
3 monthly Report for LHW 25 pages 1 50 15414 770,700
4 Facility Monthly Report 1 200 15414 3,082,800
5 Community Chart (Urdu) 10 10 15414 1,541,400
6 Growth cards for LHW 30 3 15414 1,387,260
7 Referral Pad 1 55 15414 847,770
8 Movement register for vehicles 1 200 705 141,000
9 Checklist & feedback report for Supervisor 1 40 705 28,200
10 Monthly Report for Supervisor 1 125 705 88,125
104
11 Diary for LHW for 2 years 1 300 15414 4,624,200
12 Diary for Supervisor 1 298 705 210,090
13 Jaiza Karkardagi of LHW 1 170 705 119,850
14 Maternal Mortality Proforma, 20 pages 1 20 15414 308,280
Total 22,783,425
18.4.3 Annex E-3 Monitoring TA/DA Cost Summary PMU & DMU
TA/DA Cost Sheet for FY 2020-23 (Annexed-D 2)
DA & Lodging No. of

Sr. No. of DA No. of
Detail BPS TA Rate Per Day (Equal Days per Year I Year II Year III Total
No. Positions Rate Months
to five dailies) month
A PMU Staff
Project Director (By
1 Transfer from DGHS) 20 1 10 12
3,280 16,400 2,361,600 2,361,600 2,361,600 7,084,800
Deputy Director M&E
2 / MIS (By Transfer 19 1 10 12
3,280 16,400 2,361,600 2,361,600 2,361,600 7,084,800
from DGHS)
Deputy Director
3 Training (By Transfer 19 1 4 12
3,280 16,400 944,640 944,640 944,640 2,833,920
from DGHS)
Deputy Director
4 Admin (By Transfer 19 1 4 12
3,280 16,400 944,640 944,640 944,640 2,833,920
from DGHS)
Deputy Director Tours will be
5 Finance (AG Staff by 18 1 conducted on Govt 2 12
2,560 12,800 368,640 368,640 368,640 1,105,920
Deputation) Vehicles or PKR
Deputy Director 10/KM
6 Procurement (By 18 1 2 12
2,560 12,800 368,640 368,640 368,640 1,105,920
Transfer from DGHS)
Computer Programmer
7 / IT Expert (Project 17 1 2 12
2,560 12,800 368,640 368,640 368,640 1,105,920
Staff)
Provincial Logistics
8 17 1 2 12
Officer (Project Staff) 2,560 12,800 368,640 368,640 368,640 1,105,920
Assistant Accounts
9 Officer (AG Staff by 17 1 2 12
2,560 12,800 368,640 368,640 368,640 1,105,920
Deputation)
Admin Officer (Project
10 17 1 2 12
Staff) 2,560 12,800 368,640 368,640 368,640 1,105,920
105
Financial Management
11 Specialist (Project 19 1 2 12
2,560 12,800 368,640 368,640 368,640 1,105,920
Staff)
Data Analyst (Project
12 17 2 2 12
Staff) 2,560 12,800 737,280 737,280 737,280 2,211,840
Office Superintendent
13 (Deputation Staff from 17 1 2 12
2,560 12,800 368,640 368,640 368,640 1,105,920
Secretariat)
BCC Coordinator
14 17 1 1 12
(Project Staff) 2,560 12,800 184,320 184,320 184,320 552,960
Training Coordinator
15 17 1 1 12
(Project Staff) 2,560 12,800 184,320 184,320 184,320 552,960
Internal Auditor (BPS
16 16 1 1 12
16) 1,440 7,200 103,680 103,680 103,680 311,040
Assistant Logistics
17 16 2 1 12
Officer 1,440 7,200 207,360 207,360 207,360 622,080
IT Assistant/ Computer
18 Operators (Project 16 10 1 12
1,440 7,200 1,036,800 1,036,800 1,036,800 3,110,400
Staff)
19 FPOs 17 10 12 12
2,560 12,800 22,118,400 22,118,400 22,118,400 66,355,200
20 Drivers 6 7 7 12
880 4,400 2,587,200 2,587,200 2,587,200 7,761,600
Total PMU TA/DA
36,720,960 36,720,960 36,720,960 110,162,880
* If it is considered necessary for program activities, any other cadre staff can be moved for district visits with the premission of Program Director and TA/DA will be paid to him within available
budget
18.4.4 Annex E-4 E-Monitoring Cost Summary for CMWs & LHWs & LHSs
E-Monitoring/Reporting Cost
Type of Activity Year Wise Strength Unit Year wise Cost
Sr.
Cost per
No. Year -I Year -II Year -III Year -I Year -II Year -III
month. Total Cost
LHSs will use these SIMs to report neonatal/maternal
death SMS.
1 LHSs will also use these SIMs to report through
Program's Android Monitoring App for LHWs field 740 740 740 200 888,000 1,776,000 1,776,000 4,440,000
monitoring activities.
LHWs will use these SIMs .

She will also use these SIMs for EDD registration of
2 9,600,00
new Pregnant women & daily work report through 16,000 16,000 16,000 100 19,200,000 19,200,000 48,000,000
0
USSD.
106
LHVs will use these SIMs to submit Check-In Check-
out message, Daily Status Reports etc.
3 These SIMs will also be used for Program's Android 100 300 500 200 120,000 720,000 1,200,000 2,040,000
Reporting App.
Field Program Officers & SO will use these SIMs for
Program's Android App for field Monitoring. They may
4 also be connected with LHWs, LHSs, LHVs through 35 35 35 200 42,000 84,000 84,000 210,000
Calling User Groups.
WMO at RHC will use these SIMs for Program's
Android App for field Monitoring. They may also be
7 connected through LHWs, LHSs, LHVs, Ambulance 50 50 50 200 120,000 120,000 120,000 360,000
Service drivers through Calling User Groups.
CMWs will use these SIMs .
She will also use these SIMs for EDD registration of
8 new Pregnant women & daily work report through 1,560,00
1,300 1,300 1,300 100 1,560,000 1,560,000 4,680,000
USSD. 0
District Coordinators will use these SIMs for Android

App for field Monitoring. They may also be connected
9 through LHWs, LHSs, LHVs, through Calling User 36 36 36 500 216,000 216,000 216,000 648,000
Groups.
12,546,0
Total 00 23,676,000 24,156,000 60,378,000
19.Procurement Financial & Physical Activities Summary
Procurement of Medicines, Contraceptives, Nutrition Commodities, CMW Workstation & Printing etc
Annexed-B All Figs in Million (Rs.)
S.
Activities
No. FY FY FY Total
Annual FY FY FY
Defined (2020- (2021- (2022-
Annexure Cost (2020-21) (2021-22) (2022-23)
21) 22) 23)
2 Procurement
Procurements For LHWs
107
Annual purchase of drugs,
2.1 non-drugs & contraceptives LHW/Year
40,644 15,414 15,414 15,414 626,486,616 626,486,616 626,486,616 1,879,459,848
for Regular & IHP LHWs
Annexed-
MIS Tools for LHWS
B2 22,783,425 - 15,414 - 22,783,425 - 22,783,425
Procurement for CMWS
-
Procurement of Equipments,
CMW/ Annexed-
Instruments & FF (
Year B3 91,044 604 600 - 54,990,576 54,626,400 - 109,616,976
Deployment Cost) CMWs
Purchase of drugs, non-drugs CMWs
2.2
& contraceptives for CMWs Kit Bag 3,274 1,300 1,300 1,900 51,066,600 51,066,600 74,635,800 176,769,000
Nutrition
Procurement of Nutrition
Annexed-
2.3 Commodities (F-75, F-100, Cartons
B1 23,120 - 23,120 - - 208,376,000 - 208,376,000
RUTF)
Procurement of
Multimicronutrient sprinkles Pack of 30
2.6
for children 6-23 months of Sachet 125 - 100,000 - - 12,500,000 - 12,500,000
age
Procurement of OTP Annexed-
2.8 Equipments
Equipments B1 68,000 - 251 - - 17,068,000 - 17,068,000
Procurement of Stabilization Annexed-
2.9 Equipments
Center Equipments B1 65,000 - 26 - - 1,690,000 - 1,690,000
Procurement For PIU/
DMUs
Double Cabin 4*4 (3000 cc)
2.10 Number
for Project Director 7,000,000 1 - - 7,000,000 - 7,000,000
Car (1000 cc) for Deputy
2.11 Number
Directors 2,250,000 2 - - 4,500,000 - 4,500,000
Procurement of PIU Annexed-

2.14 Lumpsum Annex A
Equipments B4 - - - 6,585,000 4,100,000 300,000 10,985,000
Total
739,128,792 1,010,197,041 701,422,416 2,450,748,249
108
19.1 Justification for New Proposed Human Resource
03 New Position has been proposed in the new IHP PC-I (Financial Management Specialist, Behavior Change Communication (BCC)
Coordinator and Training Coordinator)
S. No New Position Justification for New Position
1 Financial Management Specialist Financial Management Specialist position has been added in this PC-I
as it was previously support from TRF+ (DFID Funds) for 02 Year and
01 Year from The World Bank fund to Integrated Health Project. This
PC-I needs to add this position as the donor support has been stopped
and no allocation has been made from foreign aid. Allocated cost for this
PC-I is PKR 8.00 Billion and the traditional staff from AG can handle
accounts but not financial management. Moreover in future this project
is expecting support from donors in term of Financial and technical
which needs well experienced Financial Management Specialist with
project from Market on market salary to assist donor.
2 Behavior Change Communication (BCC) Behavior Change Communication Coordinator position has been added
Coordinator in PC-I as the project has allocated PKR 42.10 million for Mass Media
Campaign. BCC coordinator will create messages and prepare TORs for
the BCC and needs to change community behavior towards facility.
3 Training Coordinator Three programs MNCH, LHW and Nutrition has been integrated in this
PC-I and Training Coordinator will conduct training of the three
programs. PKR 208 Million has been allocated for training in the
proposed PC-I and training coordinator is recruited in previous PC-I.
Specialized training coordinator needs to be recruited from market to
conduct these trainings of MNCH, LHW and Nutrition components.
109
19.2 Integrated Health Project Proposed Human Resource for 2020-23
Total PMU Staff

S. No. Integrated Health Project Staff Details (PMU)
BPS No of Staff
Provincial Staff (Project Implementation Unit)

1.1 Project Director (By Transfer from DGHS / open competitive process from market) BPS 20 1
1.2 Deputy Director M&E / MIS By Transfer from DGHS (He will be entitled to draw project BPS 18/19 1
allowance)
1.3 Deputy Director Training By Transfer from DGHS (He will be entitled to draw project BPS 18/19 1
allowance)
1.4 Deputy Director Operations By Transfer from DGHS (He will be entitled to draw project BPS 18 1
allowance)
1.5 Deputy Director Accounts (AG Staff by Deputation) BPS 18 1

1.6 Deputy Director Procurement By Transfer from DGHS (He will be entitled to draw project BPS 18 1
allowance)
1.7 Computer Programmer / IT Expert (Project Staff) BPS 17 1
1.8 Provincial Logistics Officer (Project Staff) BPS 17 1
1.9 Assistant Accounts Officer (AG Staff by Deputation) BPS 17 1
1.10 Admin Officer (Project Staff) BPS 17 1
1.11 Financial Management Specialist (Market Expert) (open competitive process from market on BPS-19 1
Contract)
110
1.12 Data Analyst (Project Staff) BPS 17 2
1.13 Office Superintendent (Deputation Staff from Secretariat) BPS 16/17 1
1.14 BCC Coordinator (Project Staff New Position) BPS 17 1
1.15 Training Coordinator (Project Staff New Position) BPS 17 1
1.16 Internal Auditor (BPS 16) BPS 16 1
1.17 Assistant Logistic Officer (Project Staff) BPS 16 2
1.18 IT Assistant/ Computer Operators (Project Staff) BPS 16 8
1.19 Receptionist/Telephone Operator (Project Staff) BPS 04 1
1.20 Warehouse Manager BPS 16 1
1.21 Warehouse Assistant BPS 14 1
Total PMU Staff 30
1.22 Driver For New Vehicles BPS 4 3
1.23 Chowkidar BPS 3 4
1.24 Naib Qasid ( Regular Employees from MNCH & LHW) Transfer from
MNCH, LHW
1.25 Sanitary Worker BPS 1 2
Sub Total 9
District Staff (District Implementation Unit) BPS No of Staff

1.26 WMOs to provide Basic EmONC facilities (Project Staff) BPS 17 13
02 Staff Nurse / Stabilization Center (Project Staff New Position not Recruited in old
1.27 BPS 16 52
IHP PC-I)
1.28 Procurement & Logistics Assistant (Project Staff) BPS 14 11
1.29 Nutrition Assistant (Project Staff) BPS 12 69
111
1.30 LHVs to provide Basic EmONC facilities (Project Staff) BPS 12 30
1.31 Lady Health Supervisors (LHS) (Project Staff) BPS 07 221
1.32 Lady Health Worker (LHW) (Project Staff) BPS 05 3604
1.33 Stipends for Students CMW Stipend 300

1.34 Community Mid Wife (CMW) (Stipend for deployed CMW) Stipend 1300
1.35 Drivers for LHS vehicles (Project Staff) BPS 04 221
Total DMU Staff 5832
19.3 Integrated Health Project, Staff Comparative Statement (Instant & Previous PC-I)
Integrated Health Project

Staff Comparative Statement of Previous & Instant PC-I
Previous
PC-I New PC-I Remarks
Sr. BP No. of BP No. of
Name of Post
No S Posts S Posts
PIU
1 Project Director 20 1 20 1
Sub Total 1 1
Technical Unit
18/
2 Deputy Director MNCH 19 1
19 1 Replaced as Deputy Director Operation
18/
3 Deputy Director LHW 19 1
19 1 Replaced as Deputy Director M&E / MIS
18/
4 Deputy Director EPI 19 1
19 1 Replaced as Deputy Director Training
112
Deputy Director
5 19 1
Nutrition 18 1 Replaced as Deputy Director Procurement
Provincial Nutrition
6 17 1
Officer Post Deleted
7 BCC Coordinator 17 1 New Post Included
8 Training Coordinator 17 1 New Post Included
Sub Total 5 6
Procurement Unit
9 Logistics Officer 17 1 17 1 Project Post Retained
Assistant Logistic
10 16 2 16 2
Officer Project Post Retained
Sub Total 3 3
Financial Management Unit
Post deleted and Replaced as Financial Management Specialist Position and
11 Finance Manager 19 1
19 1 will be recruited from market on an open competitive process.
12 Accounts officer 18 1 18 1 Replaced as Deputy Director Accounts from AG Office
Assistant Accounts
13 17 2
Officer 17 1 One post retained and 1 deleted
14 Internal Auditor 16 1 16 1 Post Retained
Sub Total 5 4
Monitoring & Evaluation and
Health Education Unit
Deputy Director
Monitoring &
15 19 1
Evaluation and Health
Education Replaced in above
Monitoring &
16 17 2
Evaluation Officer Post deleted
17 Field Monitoring officer 17 8 Salary not included in Project
Computer
18 Programmer/IT 17 1 17 1
Specialist Project Post Retained
19 Data Analyst 16 3 16 2 02 Project Post retained and 1 deleted
113
Sub Total 15 3
Support Staff
20 Administrative Officer 17 1 17 1 Project Post Retained
21 Office Superintendent 16/ 1 16/ 1

17 17 Secretariat Staff Retained.
IT Assistant/ Computer
22 15 10 8
Operators 16 8 Project Post Retained and 02 deleted
Receptionist/Telephone
23 04 1 1
Operator 04 Post Retained for In charge Anti-Harassment Cell
24 Driver 4 16 04 3 Will be recruited on Project Policy
25 Chowkidar 3 3 03 4 02 for IHP Office and 02 for IHP Warehouse
26 Naib Qasid 1 8 Transfer MNCH and LHW regular Staff to IHP Office
27 Sanitary Worker 1 3 01 2 02 Post retained and 01 deleted
Sub Total 43 20
MN
CH
28 CMW Deployed 1640 1300 1300 Post Retained
CMWs recruited and
29 1440
under two years Training 300 300 Will be recruited
30 WMOs 17 46 17 13 13 Project Staff Retained and 33 Post deleted
31 LHVs 12 92 12 30 30 Project Staff Retained and 33 Post deleted.
Sub Total 3,218 1643
LH
W
32 Lady Health Workers 5 3,926 5 3604 3604 Project Post Retained & 322 post deleted.
Recruitment of Lady
33 Health Supervisors 7 254 7 221
(LHS) 221 Project Post Retained & 33 Post deleted
Recruitment of Drivers
34 4 254 4 221
for LHS vehicles 221 Project Post Retained & 33 Post deleted
114
35 Account supervisor 7 14 Post Deleted
36 LHWs under trainings 5 2418 5 Post deleted no new recruitment will be made
Sub Total 6,866 4046
EPI
PHC Technician Multi
37 purpose (EPI 12 500
Technician) 0 Transferred to EPI current side
Sub Total 500 0
Nutr
ition
District Coordinator Post Deleted and IHP Coordinator (Previous LHW Coordinator) will be
38 17 25
Nutrition responsible
Staff Nurses for 26
39 Stabilization Centres (03 16 78
per centre) 16 52 52 Post Retained and 26 Post deleted
Nutrition Assistants
40 12 99
Female (New recruits) 12 69 69 Project Post Retained and 30 Post Deleted
Sub Total 202 121
District Strengthening
Coordinators for DHO
41 17 8
Office 0 Post Deleted
42 WMOs for CEmONC 17 44 0 Post Deleted
43 LHVs for CEmONC 12 44 0 Post Deleted
Assistant Accounts
44 17 25
Officer for DHO office 0 Post Deleted
Procurement and
45 14 25
Logistics Assistant 11 11 Project Post Retained and 14 Post Deleted
46 Driver 4 25 0 Post Deleted
Sub Total 171 11
Grand Total 11,029 5858
115
19.4 Selection Criteria for PMU & DMU New Staff
Recruitment Procedures for Provincial and District Level Appointments
At the provincial level, the health department will undertake recruitments in compliance to Project Policy notified by
Government of Khyber Pakhtunkhwa for all contract employees/on MP Scale. The Project Director, in line with the
Government’s approved recruitment procedures will invite applications against the vacant post in a transparent manner through
open advertisement in local and national dailies; carry out short listing according to approved job descriptions, share the short
list with the members of the selection committee, arrange for conduct of interviews giving notice of minimum seven days for
local and two weeks for out station candidates and ensure timely appointment of selected candidates.
COMPOSITION OF SELECTION COMMITTEES

Recruitment of the project post shall be made on the recommendations of Selection Committees. Composition of Selection
Committees for appointment to post in different pay scales or equivalent posts will be as under:-
a) For posts in BS-19 and above or equivalent post.
1) Additional Chief Secretary, Khyber Pakhtunkhwa Chairman

2) Secretary Establishment or his nominee not below the rank of Additional Secretary Member
3) Secretary Finance or his nominee not below the rank of Additional Secretary Member
4) For Technical Posts, an expert from Technical Departments or Public Sector Member
University may be associated with the committee
5) Representative of P&D not below the rank of Additional Secretary Member
6) Secretary of the concerned sponsoring Department Member / Secretary
b) For posts in BS-17 up to BS-18
116
1) Secretary of the Department Chairman
2) Representative of the Establishment or his nominee not below the rank of Deputy Member
Secretary
3) Representative of the Finance or his nominee not below the rank of Deputy Member
Secretary
4) In case of technical posts, an expert from Technical Departments or Public Sector Member
University may be associated with the committee
5) Representative of P&D not below the rank of Deputy Secretary Member
6) Project Director / Additional Secretary or Deputy Secretary, if there is no Member / Secretary
Additional Secretary in the Department
c) For posts in BS-1 to 16
1) Project Director Chairman

2) Additional Secretary or Deputy Secretary of the concerned sponsoring Department Member
3) Representative of Establishment Department Member
4) Representative of Finance Department Member
5) Representative of Project Director Secretary
SHORTLISTING COMMITTEE
a) To facilitate the Selection Committee a Short-Listing Committee with the following composition will shortlist the
candidates on the basis of their academic qualification, past experience, age limits and other conditions advertised for
the post:-
i. For the post of Project Director
1) Administrative Secretary Concerned Chairman

2) Additional/Deputy Secretary of Concerned Department Member
3) Representative of the Establishment Department not below the rank of Deputy Member
Secretary
4) Representative of the Finance Department not below the rank of Deputy Secretary Member
117
5) Representative of the P&D not below the rank of Deputy Secretary Member
ii. For other posts.
1) Project Director Chairman

2) Additional Secretary or Deputy Secretary of the Department Concerned Member
3) Representative of the Establishment Department not below the rank of Deputy Member
Secretary
4) Representative of the Finance Department not below the rank of Deputy Secretary Member
5) Representative of the P&D not below the rank of Deputy Secretary Member
Departmental Selection Committee
1. The Departmental Selection Committee shall consist of the following:-
(1) Secretary Health Chairman

(2) Representative of the Finance department Member
(3) Representative of P&D department Member
(4) Representative of Establishment Department Member
(5) Director General Health Services Member
(6) Project Director Secretary
2. The Committee shall also make recommendations for appointment by promotion or transfer to all posting Basic Pay
Scale 18 and above and shall also assess fitness/suitability of candidates in light of the approved job descriptions.
118
19.5 Selection Criteria for CMWs
Community Midwives (CMWs)
Selection will be made at district level after advertisement in at-least three widely circulated newspapers.
a. Selection Criteria
The community midwives shall be selected only from the rural areas and urban slums.DHO will be the final appointing
authority.
The selection criteria of Community Midwives are as under:

 Female, preferably married.
 Should be 18 – 35 years of age.
 Permanent resident of the area, for which she is applying.
Minimum qualification should be at least Matriculate with Science subjects obtaining 45% marks.
 Have experience of working in the community.
b. Selection Committee
o District Health Officer Chairman
o District Coordinator LHW Program Secretary
o District Coordinator MNCH/PH Specialist Member
o A representative of District Government (Preferably female) Member
o Principal of Midwifery School(Where training is to take place) Member
o Medical Superintendent of the concerned hospital Member
 Verification of the residential status shall be done through the Lady Health Supervisors, and third party
monitors/provincial representative.
119
 The selection committee will also send the matriculation certificate for verification to the concerned board.
However, if the candidate fulfills all other requirements will be allowed to start training without waiting for the confirmation
from the board.
Staff ANNEXURE-D
19.6 Integrated Health Project, Job Descriptions Project Management Unit (PMU) Staff
S Designation &Pay Eligibility Criteria ToRs / Responsibilities

No scale
1 Project Director Medical doctor with post graduate qualification in The Project Director (IHP) reporting to the DG
(IHP) public health. Health Khyber Pakhtunkhwa, and as head of
provincial programme management unit, is
BPS 20 As per Project At least 15 years of experience at mid and senior
responsible for overall management, planning
Policy or Open level positions including 5 years of project
and successful implementation of the
Competitive process management experience for implementation of
programme.
from Market field based projects.
He will be employed through as per project
The Department will send a pannel of three
policy or an open competitive recruitment
eligible candidates of BPS-20 to Recruitment
process.
Committee for the selection of Project Director.
1. He will provide all necessary management
and technical skills to the project as may be
120
No scale
required by the project management unit

for all programme components.
2. He will supervise the PIU in the
implementation and Monitoring of
activities.
3. He will provide leadership in planning,
technical, and Financial Management,
disbursement, and auditing issues arising
from implementation of the various project
activities.
4. He may associate with other, for example
management consultants. Trainers, contract
management or others fields relating to
management and supervision to provide the
full range of services and interdisciplinary
topics.
5. Ensuring effective communication and
consultations with all stakeholders.
6. Monitoring and facilitating all programme
components within the implementation,
121
No scale
legal financial and technical requirements

of the project.
7. undertaking the monitoring and evaluation
of performance indicators and outcomes
against the targets, as agreed with the
development partners and Primary &
Secondary Healthcare Department
8. Prepare the periodic reports for
Government and Donors as required.
9. He shall gather and record information
about progress and results of
subcomponents and other components.
10. He will prepare detailed reports to compare
actual result with plan, highlight difficult
problems in implementing subproject and
suggest solutions.
11. A key activity of the Project Director will
be the transfer of knowledge so as to leave
the PMU of the project with a cadre of
trained staff, having the necessary
122
No scale
experience, and appropriate skills, to enable

them to be capable of managing the later
stage of the subproject and similar future
projects.
12. This transfer of knowledge and skills will
be both through working closely with PMU
staff as day to day tasks are carried out,
formal training (e.g. small classes,
workshops, etc.) and regularly reviews of
duties of PMU staff and their
implementation.
13. Review, development and testing of new
intervention of the Programme.
14. Supervise monthly meetings of project
officers and quarterly meeting of provincial
project coordinators.
15. Supervise and monitor the recruitment
process, capacity building and training of
staff.
123
No scale
16. Monthly update of Programme activities

and publication of quarterly, biannual and
annual reports.
17. Matters related to research activities
including new research initiatives.
18. Perform other functions required for
implementation of project objectives.
2 Deputy Director A medical doctor with post graduate qualification Deputy Director (Operations) reporting to the
(Operations) BPS 18/19 in public health PD, shall be responsible for affairs related to
by transfer from DGHS human resource, Districts Operations and
At least 10 years of experience at mid and senior
Khyber Pakhtunkhwa assignments given by the PD if and when
level positions including 5 years of project
required.
management experience for implementation of
field based projects He will be assisted by a team of Operations, one
for each of the major tasks.
3 Deputy Director A medical doctor with post graduate qualification Deputy Director (Training) (Community &
(Training) BPS 18/19 in public health Facility based interventions), reporting to the
by transfer from DGHS PD, shall be responsible for affairs related to
124
No scale
At least 10 years of experience at mid and senior community based and facility based operations
level positions including 5 years of project and assignments given by the PD if and when
management experience for implementation of required.
field basedprojects
He will be assisted by a team of training
coordinator, one for each of the major tasks.
4 Deputy Director A medical doctor with post graduate qualification Deputy Director (Monitoring / MIS), reporting
(Monitoring / MIS) in public health to the PD, shall be responsible for affairs
BPS 18/19 by transfer related to MNCH, LHW and Nutrition
from DGHS At least 10 years of experience at mid and senior activities, and assignments given by the PD if
level positions including 5 years of project and when required.
management experience for implementation of
He will be employed through
field based projects
transfer/deputation from Health Department. In
case Health Department not depute any officer
within six months after the requisition by this
office and repeated requests the officer may be
appointed on contract basis through open
competition.
125
No scale
5 Deputy Director The potential candidate should have a post The Deputy Director (procurement) reporting
(Procurement) BPS 18 graduate degree (MBA Finance or Supply Chain to the PD shall be responsible for the affairs
by transfer from DGHS Management). related to all procurements by the programme.
Minimum of 4 years of practical experience, She/he shall manage each step of the
preferably in health sector in procurement of procurement cycle, supply chain management,
goods, works and routine services and warehousing and distribution systems.
consultancy services and conductions of related
She/he shall develop procurement documents
trainings.
(Procurement Plan, SBDs, RFP, IFB,
Evaluation Criteria, Prequalification
documents etc) and transfer her/his knowledge
and offer formal and on-the-job skills training
in procurement to the programme staff.
She/he shall ensure that all procurements are

done in accordance with Khyber Pakhtunkhwa
Procurement Rules
She/he will be employed through transfer from

DGHS, Health Department.
126
No scale
6 Deputy Director An Accounts professional, with a relevant degree The Deputy Director Accounts, reporting to the
(Accounts) (BPS-18) in accounting and finance or commerce graduate PD, shall be responsible for managing
by transfer from DoH / with PIPFA / SAS. programme finances and assignments given by
AG KP or Open the PD if and when required.
At least 6 years of experience of working at mid
Competition
and senior level positions in public sector To fill this post an Audit / Accounts Officer
organization (BPS-18) will be hired preferably from Health
Department, AG Office through transfer /
deputation. In case Health Department does not
transfer/appoint an suitable officer within 4
months, the post may be filled on contract basis
through open competition.
7 Financial Management  ACCA or BBA (Hons) / with atleast 06 years  Carry the overall responsibility for all
Specialist (Market experience. the Financial Management functions at
Salary) Open project level.
 Preference will be given to MBA Finance
Competative Process  Preparing management briefs on the
 Experience 03 years with Health / Donors
from Market on basis of financial reports that highlight
Project on Managerial or same level position
Contract variance, achievements and also
will be given advantage.
provide recommendations to improve
performance.
127
No scale
 The Financial Management Specialist shall  Get well acquainted with the SAP based
assist the Project Director Integrated Health Government Accounting and Reporting
Project in execution of financial management System and Government of Khyber
activities of the Project effectively and Pakhtunkhwa Financial Rules, and
efficiently in compliance with agreed reporting reporting and disbursements
protocols with the Financial Guidelines of requirements.
Government and Donors.  Liaise and coordinate with the Project
Director and Deputy Director
 He / She will report directly to Project Director.
Accounts.
 Appointment will be made on contract.
 Provide overall financial oversight of
Age limit 25 to 35 Years the project, including developing,
guiding and directing financial
management and accounting systems to
support tracking of funds – ensuring
‘value for money’ through efficiency
and effectiveness in the delivery of
outputs required to achieve the
objectives of the project.
128
No scale
 Contribute to the development of the

Annual Work Plan & Cash Plan,
ensuring alignment with Project’s
strategies, agreement on annual targets
and inclusion of M&E activities in the
work plan with budgeting.
 Maintain and update the project
financial management system to track
and report on project resources and
expenditures, and generate the
necessary reports on timely basis
including monthly bank reconciliation
statements of all bank accounts of the
project.
 Maintenance of budget records,

preparation and processing of revised
budget documents preparation of
budget re-appropriation requests and
129
No scale
presentation to relevant authority for

approval.
 Manage financial aspects of the

contracts under administration,
including payment terms, purchase
orders, variation orders.
 Ensure compliance with all prevailing

statutory laws including Income Tax
and Sales Tax Laws.
 Apply pre-audit checks on all payments
to the service providers before
disbursement out of the project’s funds.
 Facilitate the external auditors and
responds adequately and in timely
manners to audit queries.
 Any other task assigned by the Project
Director from time to time.
130
No scale
He/she will be recruited/appointed through

contract basis on Market Salary through open
competition.
8 Computer  Master degree in Computer science/BSc (04  Management of IT Infrastructure of the

Programmer/IT Expert year) in Computer Science Project.
 05 year of work experience in the respective  Designing and Planning for expanding
field existing and developing new softwares.
 Age limit 25 to 35 years  Work in close liaision with management to
implement new systems.
 Plan, Organize, Control and evaluate data
operations.
 Manage IT Staff by recruiting, training, and
coaching employees.
 Design, develop, implement and coordinate
systems, policies, and procedures
 Act in Alignment with user needs and
system functionality to contribute to
organizational policy
131
No scale
Any other task assigned by PD from time to

time.
9 Logistic officer  MBA/M Com / M Sc Economics  Logistic officer will report to PD and will
 Two years’ experience in procurement and develop logistics plan, budget requirements
logistics management, preferably in public and deployment timelines for new
sector operations.
 Should be computer literate  Develop logistical plans for current
 Acquaintance and knowledge of operations and logistics contingency plans.
PPRA/KPPRA and GFR would be given  Prepare plans for liquidation and
preference. downsizing.
 Preference will be given to the employees  Develop and execute tools and
having experience in LHW program methodologies to enable effective
 Age limit 25 to 35 years implementation of logistic plans.
 Design and develop standard operating
methods to manage logistics operations
efficiently.
 Ensure all supervised staff members are
trained as well as cross-trained adequately.
132
No scale
 Identify added logistic training

requirements to attain high working
standards.
 Develop and execute logistics support
policy, processes and methodologies to
general benefit of PIU and at District level.
 Develop reports on material and personnel
movements and various operational
logistics problems.
time.
10 Internal Auditor  BS/B.com degree in Accounting or  Internal Auditor will report to PD and
Finance will perform and control the full audit
 5years working experience as Internal cycle including risk management and
Auditor control management over operations’
 Advanced computer skills on MS Office, effectiveness, financial reliability and
accounting software and databases compliance with all applicable
directives and regulations
133
No scale
 Ability to manipulate large amounts of  Determine internal audit scope and

data and to compile detailed reports develop annual plans
 Proven knowledge of auditing standards  Obtain, analyse and evaluate
and procedures, laws, rules and accounting documentation, previous
regulations reports, data, flowcharts etc
 High attention to detail and excellent  Prepare and present reports that reflect
analytical skills audit’s results and document process
 Sound independent judgments  Act as an objective source of
independent advice to ensure validity,
legality and goal achievement
 Identify loopholes and recommend risk
aversion measures and cost savings
 Maintain open communication with
management and audit committee
 Document process and prepare audit
findings memorandum
 Conduct follow up audits to monitor
management’s interventions
 Engage to continuous knowledge
development regarding government
134
No scale
rules, regulations, best practices, tools,

techniques and performance standards
time.
11 Data Analyst  Bachelor degree in Mathematics/  Interpret data, analyze results using
Economics/Statistics statistical techniques and provide ongoing
 Three (03) years experience in related field reports
 Strong knowledge of and experience with  Develop and implement data collection
reporting packages strategies that optimize statistical efficiency
 Knowledge of statistics and experience using and data quality
statistical packages for analysing large datasets  Acquire data from primary or secondary
(Excel, SPSS, SAS etc) data sources and maintain databases/data
 Strong analytical skills with the ability to systems
collect, organise, analyse, and disseminate  Identify, analyze, and interpret trends or
significant amounts of information with patterns in complex data sets
attention to detail and accuracy  Filter and “clean” data, and review computer
 Skilled at queries, report writing and reports, printouts, and performance
presenting findings
135
No scale
 Age limit 25 to 35 years indicators to locate and correct or point out

missing values or incorrect entries
 Work closely with management to prioritize
project needs
 Locate and define new process improvement
opportunities
 Quarterly carry out surveys and program
reviews and create reports to provide
management facts based understanding of
project activities and performance
time.
12 Admin Officer  Master degree in management sciences (MBA  To supervise and coordinate activities of
HR/Administration, MPA etc) administrative staff
 Three (03) experience in related field  To maintain management information
 Well versed with MS-office suite (Word, Excel system (manual/computerized)
& Power point)  To provide and maintain office premises and
 To work cooperatively and patiently other facilities
136
No scale
 Age limit 25 to 35 years  To review and answer internal and external

correspondence
 To provide secretarial or executive services
for committees
 To make purchases related to office
equipment, furniture and stationery etc.
 To assist PD in administrative affairs

time.
13 Assistant Accounts  M Com / MBA (Finance) with PIPFA  To assist the Financial Management
Officer  5 year experience in Accounting / Auditing / Specialist and Deputy Director
Public Finance in Govt/Semi Govt/Reputable Accounts.
Private Organization  All the accounts and finance related
Age limit 25 to 35 years activities.
time.
137
No scale
14 Assistant Logistics  BBA (Hons) Finance/BSc Finance.  Assist in Developing / preparation of

Officer  Minimum 3 years’ experience in bidding documents.
transport/shipping/insurance/freight/forwarding  Procurement of drugs and medical
 procurement Work experience in the equipment, contraceptive, vehicles,
humanitarian field will be an added advantage printed / training material and other office
 To be responsible for the activities carried out equipment in accordance with the
by the Logistics Officer in his absence Government as well as World Bank
Age limit 25 to 35 years Procurement procedures.
 Pre and post-delivery inspections at the
premises of firms.
 Warehousing and Inventory Central
Management.
138
No scale
 Transportation / distribution of Logistic

from the point of production to the point
of consumption.
 Monitoring and evaluation of Logistic
System up to districts and facility level.
time.
15 Procurement and  BA/BSc form HEC recognized University  Maintains receiving, warehousing, and
Logistics Assistant  Preference will be given to candidates distribution operations by initiating,
having relevant experience. coordinating, and enforcing program,
operational, and personnel policies and
OR procedures
 Keeping stock register up-to-date
 Intermediate or equivalent Responsible to carry out physical audit of
 2 years relevant experience in Transport, store stock.
Logistics & Warehouse management  Planning, organizing and controlling of
Age limit 25 to 35 years stores over-all operations.
139
No scale
 Issue Inventory report, IN/OUT status

report, dead stock report, goods age
report, consumption report.
 Recording of inventory / stock.
 Coordination with Provincial Logistics
& Procurement unit. Chain.
 Documentation of all supplies inward &
outward.
 Recording & Maintaining vouchers,
receipts, quotations and soft data.
 Documentation of fuel expense (if any).
 Coordination with concerned staff
members in district office for supplies
and deliveries related to IHP.
 Assisting concerned district immediate
supervisor in day to affairs related to
Logistics & Procurement related to IHP
 Preparing & follow up stock requisition
and approvals.
140
No scale
 Monthly Logistics related report

submission to quarter concerned.
 Any other task assigned by Project
Director from time to time.
16 IT Assistant /Computer  Bachelor’s degree in Computer sciences  To assist IT Officer in keeping database
Operators  At least two year experience of working in operational.
similar position in Govt/semi Govt/private  To maintain and ensure upkeep of data
sector organization networks.
 Age limit 25 to 35 years  Effective data storage, maintenance and
utilization.
 Ensure data validation/reconciliation
 Familiar with RDBMS, SQL and MS
Office Tools.
 Able to do preliminary hardware testing
and troubleshooting
time.
141
No scale
17 Nutrition Assistant  BA/B.Sc preferably having experience in nutrition or  To adopt measures for the implementation
health sciences and local resident of CMAM, community management of
 Domiciled in the province of Khyber acute malnutrition and IYCF, Infant and
Pakhtunkhwa Young Child Feeding.
 Proficiency in Urdu, Pashto and other local  To carryout Anthropometric Measurements
languages of all target beneficiaries (children 6-59
 Age limit 25 to 35 years months and Pregnant/Lactating Women) as
per CMAM guidelines and maintain records of
the measurements.
 To register the identified severe and
moderate acute malnourished children and
Pregnant/Lactating women in SFP/OTP
programs as per CMAM National
Guidelines and ensure follow-ups of the
142
No scale
registered beneficiaries through LHWs or

any other means.
 To ensure that all mothers
(pregnant/lactating) attending the facility
are properly educated on best practices of
Infant and Young Child Feeding and
properly counseled on breastfeeding and
lactation management.
 Maintain records of the nutrition supplies
received from the district warehouse and
keep records of all distribution completed
on the stock registers.
 Provide monthly data for
computerization/compilation and onward
submission.
time.
143
No scale
18 Training Coordinator She/he is a public health professional, a medical Training coordinator reporting to the Program
doctor with postgraduate qualification in public Director, is responsible for overall
BPS 17
health. S/he has at least 03 years of relevant management, planning and successful
experience of working. conduction of the trainings in program.
Age limit 25 to 35 Years. Any other task assigned by PD from time to

time
S/he will be employed through

transfer/deputation and an open competitive
recruitment process.
The remuneration for this position will be

equivalent to grade 17 officer as admissible
under the Government rules.
19 Monitoring/ FPOs 1. MBBS (additional score for MPH)  To assist and participate in the
2. Masters in sociology/social work implementation, supervision and
BPS 17
3. Preferably females monitoring of the Program’s interventions
4. Experience in public health/social sector and promote health services through
5. Computer literate fieldwork, community involvement for
health development, in a sustainable basis.
144
No scale
 To assist in the training activities for

different categories of health personnel at
provincial, district and sub-district staff and
Lady Health Workers.
 To undertake extensive field visits to

FLCFs and the areas under the National
Program ensuring necessary leadership and
coordination to:
o Support and supervise the Training

Program.
o Monitor the process of selection of

LHWs and use of resources.
o Ensure proper reporting of the

activities of the program.
o Monitor supplies and logistics.
 To liaise between district, provincial PIUs

for the effective coordination of the
145
No scale
activities of the program under the

supervision and technical guidance of
Provincial Coordinator.
 To promote the required district and sub-

district inter-sectoral collaboration in
support of the Program ensuring the
necessary leadership and coordination
skills.
 The remuneration for this position will be

equivalent to grade 17 officer with a project
allowance as admissible under the
Government rules
146
No scale
20 Provincial BCC Essential  Undertake background research for evidence

Coordinator based BCC programming for all
 Master degree in Social and Behavioral
programmes of IHP.
Sciences or Public Health.
 Design and develop BCC plans, materials
 Five year experience of managing a BCC
and products with appropriate branding and
intervention in an international or national
compliance with respective institutional
NGO / Government including minimum 3
regulations and guidelines.
years “hands on” direct implementation at
 Organize BCC Training of Trainers (ToTs)
grassroots level.
for Implementing Partners (IP) staff and
 Sound experience of working with partner
oversight to replication of trainings at
organizations (NGOs or local government).
district levels as well as regular technical
 Excellent project management skills
guidance and support for smooth
implementation of the project.
Desirable  Ensure that monitoring system tools,
 Sensitive to culture, gender issues, equity and checklists, indicators, reporting formats are
accessibility issues in place to track immediate results/outputs
 Excellent expertise of behavior change and impact/outcomes against planned
communication (BCC) initiatives.
 Capacity-building skills
147
No scale
 Ability to work independently as well as  Undertake field visits to partners to oversee

collaboratively with multi-stakeholders implementation and provide on-site
 Excellent interpersonal skills feedback for required improvements, and
 Excellent written and verbal communication / generate field visit reports with timely and
presentation skills appropriate follow up on action points.
 Excellent computer skills including MS office  Conduct periodic project reviews and
 Age limit 25 to 35 Years prepare project reports for management and
outside as and when required.
 Lead the advocacy and influencing
component of the project using field
evidence as well as coordination and
representation of IHP at different forums and
platforms.

time.
He / She will be appointed on Contract through

open competition from Market
148
No scale
21 Staff Nurse for SCs  Bachelor of Nursing with 02 years’ experience  Effectively following the SC protocols for
 Preference will be given to experience in the medical care of the SAM cases with
Nutrition related activities. complications.
 Excellent spoken and written Local and
English languages with good interpersonal  Work closely with SC and Pediatric staff to
&Communication Skills ensure all SC protocols are understood and
 Age limit 25 to 35 Years. agreed and appropriate referrals take place to
and from the OTP.
 Prepare plan of action for effective SC

implementation in consultation with the SC
Focal Person and Pediatrician.
 Ensure all criteria are documented, including

admission, discharge and transfer to and
from the SC.
 Ensure comprehensive health checks,

checking Vitals, frequent medicines and
149
No scale
feed administration and treatment according

to the protocols.
 Ensure timely therapeutic preparation,

provision and monitoring.
 Completing and updating the patient file to

ensure a track of patient progress.
 Ensure adequate availability of all medical

and therapeutic feed supply and ensure stock
is pre-positioned as planned by discussing
with logistics.
 Follow-up and provide feedback to the SC

Supervisor on the amount and quality of the
treatment supplies if it does not comply with
specified quality standards.
150
No scale
 Ensure cases not meeting admission criteria

return home or referred to the appropriate
programme as early as possible and counsel
the family why their child is not admitted.
 Through liaison with the community

mobilizers and nutrition volunteers, provide
effective follow up of default cases.

time.
He/She will be employed appointed on contract
basis through open competition.
151
No scale
23 Women Medical  Bachelor of Medicine & Bachelor of  As a Woman Medical Officer, the incumbent
Officer (WMO) Surgery (MBBS) or Doctor of Medicines will be responsible for patients care during
(MD) from any recognized university.
 Registered with Pakistan Medical & routine OPD checkups and keep record of
Dental Council (PMDC). each patient; conduct ante natal & post-natal
 At Least 2 years’ experience after House
clinics; appropriate referrals of patients and
Job from any Govt. Hospital.
 Ability to work in hard to access remote follow up; coordinate with Field office
areas. regularly and provide reports on daily
 Age limit 25 to 35 years
activities to the management; provide
immediate report/s of suspected epidemic
diseases; examine patients to determine
medical problem, utilize physical findings
and patient's statements for better care and
proper treatment; provide monthly report of
program activities to the management;
acceptable behavior with the patients, staff
and others; perform other related
duties assigned by supervisor.
152
No scale
24 Office Supridentent  Second class Bachelor Degree from  A Superintendent who normally holds
(By Deputation from recognized university charge of a Branch under the control of an
Secreteriat)  Five Years of office working experience Administrative Officer shall be responsible
 Age 25 to 35 Years for ensuring that the work is conducted
properly and that there is tidiness and
discipline in his Branch;
 (The Superintendent shall be personally
responsible for the accurate sorting of Dak
Section‐wise, and shall further ensure that
 The Receipt Clerk submits the receipts
at least twice daily to the appropriate
Section/Office along with dairy;
 letters are dispatched on the date of
receipt and office copies returned
promptly to the Section/Office
concerned
 That confidential/secret
communications are treated in the
153
No scale
manner as prescribed by the

Government
 The Superintendent should open all covers
other than those sealed and addressed by
name to any particular office/officer in the
Department and to;
 Make sure that each envelope is
completely emptied
 Check enclosure and make note of
omissions, if any, in the margin of the
communication
 Separate receipts section‐wise and
place them in the labelled
compartments
 Obtain, in case of disputed receipts,
orders of the Project Director or of
an officer authorized for the purpose
 Any other task assigned by PD from time to
time.
154
No scale
25 Warehouse Manager  BBA (Hons) Finance, BSc Finance or Supply  Looking after operation of
(BPS-16) Chain Management. Warehousing and Distribution unit to
 Minimum of 5 years of experience in public ensure commodity security at each level
sector management with experience in Public of supply chain
procurements and Supply chain management.  Take measures to improve district level
 Age Limit 25 to 35 Years. storage conditions including capacity
building of district relevant staff,
ensuring implementation of Good
Storage Practices and Standard
Operating Procedures (SoPs) for
smooth warehousing operations at all
levels
 Warehouse Management System
implementation at all levels of supply
chain
 Implementation of warehousing
manuals including standard operating
procedures, health and safety
155
No scale
guidelines, monitoring checklist and

job descriptions
 Identifying HR deficiencies if any
 Periodic capacity building of
warehouse staff on inventory
management and SoPs/guidelines
 Ensure timely distribution of
commodities to the last mile
 Presentation of warehousing and
distribution issues at the relevant
forums
 Provide regular written and verbal
reports and updates, by email or in
person, to the supervisor, on planned
and actual activities, site visits,
progress, constraints, and related issues
 To prepare Annual Procurement Plan
for outsourcing of services
156
No scale
 To prepare RFPs for procurement of

outsourced services
 To prepare draft bid evaluation reports
and other outsourcing related
documents including technical and
financial reports after comprehensive
due diligence.
 To design workable, cost effective and
vibrant business models for outsourcing
of services.
 To carefully design, execute and
implement contracts of outsourcing of
services.
 To ensure the quality of outsourced
services through effective quality
controls.
 To develop and implement effective
monitoring and evaluation controls for
157
No scale
outsourced services through contract

management.
 To process invoices of outsourced
services submitted by service providers
 To always have a reliable market
survey of rates of services to be
procured to not only ensure cost
effective procurements but also to have
value for money.
 To run an effective post contract
management regime.
 To ensure timely start of quality
outsourced services in warehousing,
transportation and logistics.
 Any other Task assigned by PD from
time to time.
158
No scale
26 Warehouse Assistant  BA/BSc form HEC recognized University  Move inventory and materials across
(BPS-14)  Preference will be given to candidates facilities
having relevant experience in Warehouse  Process inventory for delivery
and Supply Chain Management for 02  Sort, organize and store inventory in
the proper location
Years..
 Package items and label correctly
 Age Limit 25 to 35 Years.
 Scan delivered items and ensure
quality
 Report damaged or missing inventory
to supervisors
 Stack and organize large bulk items
 Remove inventory from trucks or
shipping and delivery to proper
location
 Update logs and documentation for
inventory processing
 Move materials from facilities to
workstations, pick-up locations, or
other locations
 Ensure workspace is free of debris and
remove safety hazards from aisles
159
No scale
 Work as an active team member to

complete team goals
 Prepare documentation and inventory
for audits
 Any other task assigned by PD from
time to time.
25 Receptionist/Telephone  FA/F.Sc  Attend all visitors and forward to

Operator  02 Years relevant Experience concerned section on request
 Age limit 20 to 30 Years  Keep records of calls placed and

received
 Preferably Female
 Listen to callers requests, referring to
alphabetical or geographical directories
to answer questions and provide
telephone information
 Monitor automated systems for placing
collect calls and intervene for a callers
needing assistance
 Set up conference calls in different
locations and time zones
 Update directory information
160
No scale

time to time.
27 Driver  Middle Pass The drivers shall perform the following duties;
 Having valid LTV driving license
 To enter the official tours/mileage
 02 years of working experience as driver with
covered in the log book of the vehicles;
government or private organization
 Should check up the Fuel, M/Oil and
 Age 18 to 30 Years
Radiator Water and Battery before
starting the vehicle;
 To acquaint himself with Traffic Rules
and road‐senses;
 Should look‐after the general up‐keep
of vehicles;
161
No scale
 Should drive the vehicle with utmost

care and keeping in view all the traffic
rules etc
time to time.
28 Chowkidar  Middle Pass  Chowkidar is responsible to keep and

 02 years of working experience as Chowkidar watch and ward during and after office
with government or private organization hours.
 Age 18 to 30 Years  He will responsible to take
precautionary measures relating to
prevention of fire and damage to
Govt. property.
 To prepare entry of all visitors and
office staff In and out timing
time to time
162
No scale
29 Sanitary Worker  Middle Pass  To sweep Govt. office and Public place
 02 years of working experience as Sanitary and to clean Govt. lavatories.
Worker with government or private  Sweeper is responsible to sweep, clean
organization and mope the rooms, corridors,
 Age 18 to 30 Years verandahs and compound.
 He will responsible to clean the
lavatories, Urinals, Bath, Wash basins
etc daily and properly.
 He will also responsible to collect and
dispose off all waste in the office
 He is responsible to light the stoves /
Angithies and to perform the allied
work relating to this job
time to time
163
19.7 District Management Unit (DMU) Staff Job Descriptions & TORs
Designation & Pay

Eligibility Requirement Roles & Responsibilities
scale
1 District Coordinator Medical doctor with post graduation in The District Coordinator, reporting to the Executive District
(IHP/LHW) public health or MNCH or DCH Officer Health of the district and the Programme Director at
(BPS-18) At least 7 years of experience in public PMU, and as head of district programme management unit,
by transfer / health with at least three years is responsible for overall management, planning and
Deputation experience at mid/senior level successful implementation of the programme in the district.
from DOH / Initial management position
Recruitment
2 Social Masters in Social Sciences with Three Monitoring and Evaluation of outreach and facility based
Organiser/MNCH years Experience in any Public Health programme activities
(BPS-17) Programme/ Organization
Coordination of programme with EDO and PMU
by transfer /
Deputation Social Mobilization
from DOH / Initial
Recruitment Verbal Autopsy
Initially all existing incumbents working as social

organizers will continue their services as Monitoring &
Evaluation Officer.
164
Designation & Pay
Eligibility Requirement Roles & Responsibilities
scale
3 CMW Tutor As per criteria of General Nursing CMW Training

BPS-17 Council Technical Monitoring of CMWs
by transfer / S/he will be employed through open competition/Tranfer/
Deputation Deputation.
from DOH / Initial
Recruitment
4 Accountants MNCH Bachelor’s degree in Coommrece District Accounts Assistant shall report to the District
BS-16 having 3 years experience in a reputable Programme Manager and will be responsible for preparation
by transfer / organization. of budget, release of funds, reconciliation with District
Deputation Accounts Office, pre and post audit of bills and preparation
from DOH / Initial of statement of expenditure.
Recruitment S/he will be employed through an open competitive process
/ transfer / deputation.
Initially all existing incumbents working as Accounts

Assistants will continue their services as Accounts
Assistant.
165
19.7 District Level Field Staff - Health Workers Jobs Description & TORs
Designation & Pay Eligibility Requirement Roles & Responsibilities

scale
1 Medical Officer (MO) Medical doctor with at least 3 Medical Officer will be the overall in-charge of the unit and will be
stabilization centre - years of clinical experience responsible for clinical management of children admitted in the
DHQH preferably in management of Stablization Centre.
malnourished children.
The MO will examine each patient every day and will attend to
emergency calls as per the need.
2 Nursing staff (for Diploma in Nursing with at The nurses posted in the unit will be responsible for nursing care
DHQH Nutrition) least 3 years of clinical including weight record; measure, mix and dispense feed; give oral
experience preferably in drugs; supervise intra venous fluids; assess clinical signs and record
management of malnourished the routine information.
children.
The nurse will also counsel mothers/caregivers on the emotional
needs of her child and encourage them to give sensory stimulation.
3 Woman Medical Medical doctor with at least 3 Ensure smooth operation of all MNCH services in cooperation and
Officer (WMO) for years of clinical experience in under the supervision of district programme manager
RHCs obstetrics and gynaecology Ensure high level of clinical care to woman and children attending the
 Age limit 25 to 35 years RHC for their health needs
166
Conduct deliveries at the RHCs
Prepare training lectures and provide training to LHVs, LHWs and

CMWs
4 Nutrition Assistant Qualified LHV registered with Work closely with district and facility staff to ensure all aspects of the
OTP (LHV) PNC with 2 years of work programme are understood and agreed and appropriate referrals take
experience with 1 year place to and from the OTP and the programme is well integrated into
working in CMAM the health systems.
Supervise the activities of the CMAM team (LHW and CMW)
Work closely with the teams to ensure all children are screened
correctly
Ensure comprehensive health checks and treatment according to the
protocols.
Enusre correct clinical diagnosis at the time of assessment so that the
patient receives appropriate treament in the relavant program.
Timely identification of complications, non responder, and referrals
to the SC.
5 Lady Health  Female • To carry-out extensive supervision and monitoring of the field
activities of LHWs. She should visit the Health House of
Supervisor (LHS)  Age: 22-45
every LHW under her supervision at least twice a month.
BPS-07  Education: (In order • Provide supportive supervision and on the job training to
of preference) LHV LHWs under her supervision and provide verbal and written
167
or Graduate or LHW feedback to LHWs. She may act as trainer in the refresher
with Intermediate training as and when required by the DPIU.
with one year • To attend the continued education sessions in all the relevant
experience as LHW health facilities.
after completion of
full training or • Carry out Verbal Autopsy of Infant Deaths reported by her
Intermediate with LHWs.
preferably one-year • To assist the DPIU in the preliminary scanning for verification
relevant experience of LHWs.
(in exceptional cases • To attend the District Program Monthly Review
with prior approval of (DPMR) at DPIU.
PPIU) • To liaise between district and FLCF for the effective
coordination of the activities of the program.
 Local resident of the
• To execute the above duties and functions under the
area (permanently
supervision and technical guidance of DPIU, FMO and FLCF
residing in the area)
In charge.
• To ensure regular maintenance of vehicle (if allotted) and
its movement register/Log Book.
• To provide administrative supervision to the CMWs in her
catchment area.
The Lady Health Supervisor, at the time of recruitment, will be

required to provide a notarized affidavit stating that she
would perform her duties to the satisfaction of her
supervisors for at least one year after the completion of
their training failing which they will have to return the
salaries she has received.
168
6 LHV (24/7 BHU) Qualified LHV registered with Provide ANC and PNC care to pregnant and lactating women
PNC with 2 years of work Provide safe delivery services for pregnant women
experience
Give health and hygiene education to women of reproductive age
Ensure cleaning, sterilization and disinfection of all MNCH related
material
Supervise outreach staff (CMW & LHW)
Collect data on regular basis
7 LHW ( BPS 5)  Female, Preferably married The scope of work of LHW will be to provide PHC
 Permanent resident of the services to the communities in her catchment area. These
area for which she is include:
recruited  To register all eligible couples for child spacing interventions
 Minimum 8 years of i.e., a man married to a woman of age between 15-49 years,
schooling preferably and maintain up to date information of eligible couples and
Matriculate registration of adolescence girls of kachi abadies/Urban
 Should be between 18 to 45 slums;
years. (for unmarried 20-45
 To form women group in her area. She will arrange meetings
years)
of these women groups on fortnightly basis to discuss family
 Preference will be given to
planning, immunization, antenatal and postnatal examination,
women with past
growth monitoring of children, diarrhea, ARI, iodized salt,
169
experience in community tuberculosis, etc. Preferably one topic will be discussed in one
development meeting.
 She should be willing to  She will keep close liaison with influential women of her area
carry out the services from including lady teachers, community midwives, traditional
her home ( which will be birth attendants and satisfied clients.
designated a “Health
 She will visit 7-10 households every day to ensure that all
House”) ensuring effective
registered households are visited once every month. During
linkage between the
these household visits she will discuss importance of family
community and the public
planning, immunization, growth monitoring of children,
health care delivery system.
iodized salt, personal hygiene, better nutrition, sanitation,
antenatal and postnatal examination, prevention from
hepatitis and tuberculosis, etc.;
 To coordinate with community midwives and other skilled

birth attendants and local health facilities for referrals.
 She will register all pregnant women in her area and will
conduct ante natal care as described in her training and will
refer the women to CMW for antenatal care and preparations
for delivery.
 Act as a liaison between formal health system and her

community;
170
 As part of their tasks, LHWs will undertake nutritional
interventions such as anemia control, growth monitoring,
assessing common risk factors causing malnutrition and
nutritional counseling. They will treat iron deficiency anemia
among all women especially pregnant and lactating mothers
as well as anemic young children;
 LHWs will promote nutritional education with emphasis on

early initiation of breastfeeding i.e., within one hour after
birth, exclusive breastfeeding for six months, adequate
weaning practices, improving maternal nutrition and
preventing macronutrient malnutrition;
 To establish vaccination post and to vaccinate children and

women in coordination with area vaccinator.
 The LHWs shall also participate in various campaigns for

immunization against EPI target diseases e.g. polio, MNT,
measles etc. in her catchment’s area only. The LHWs will be
involved in the surveillance activities in her catchment’s area
only.
 To motivate and counsel clients for adoption and continuation

of family planning methods, she will provide condoms, oral
pills and administer injectable contraceptives (second dose),
171
to eligible couples in the community and refer them to CMW
and health facility.
 To refer clients needing IUD insertions, contraceptive surgery

to the nearest Government health facility preferably to CMW,
BHU and RHCs.
 To carry out prevention and treatment of common ailments

e.g. diarrheal disease, acute respiratory infections,
tuberculosis, intestinal parasites, malaria, primary eye care,
scabies. First aid for injuries and other minor diseases using
essential drugs. She will refer cases to nearest centers as per
given guidelines. For this purpose a kit of certain inexpensive
basic medicines will be provided to LHW.
 LHWs will also be involved in TB, AIDS, Hepatitis and

Malaria prevention and control.
 To attend monthly continuing education session at her base

facility to share progress regarding all activities carried out by
her including the home visits, number of family planning
acceptors by methods and stock position of contraceptives.
She will also attend education session, submit her monthly
report and collect one month supplies from the FLCF.
172
 LHWs will not be involved in any other activity without the
prior permission from the DPIU who will seek guidance from
PPIU if not already issued on case to case basis.
173
20. Pre-PDWP Observation and Annotated Reply
Pre PDWP Observation Annotated Reply
1. Health Department to include LHW mapping exercise Advice well taken and added in the scope of the project on page #.
in the scope of the project? 25
7.14.1 Mapping of Existing LHWs Coverage: Geo

Mapping
 Population coverage by LHW needs to be revisited,

keeping in view, the population density & population
health needs.
 It is evident that about 36% of the population in the rural
areas is devoid of a community based health package
delivered by LHWs in the province and more than 50%
population in the urban slums.
 These uncovered areas have not been geo-mapped at the
UC level thus resulting in very little information being
available on where they lie and why they are still
uncovered. This leads to the identification of pockets of
uncovered population being spread within or around the
geographical outlay of a UC, areas where there might be
high demand for primary healthcare services.
174
 The case of urban slums is one such example; the
department has not clearly demarcated urban slums, which
are densely populated with high rates of poverty, thus,
making them vulnerable to disease and mass malnutrition.
 In the era of modern technology, satellite imagery could
address the issue of identification of the slum areas.
 Generally, the lack of information on characteristics of the
uncovered areas hinders the department from devising an
equitable workforce distribution plan.
 It is proposed that for increasing the outreach services to
identify the uncovered population is required. Moreover
the program will devise the strategy to improve the quality
of services rendered by existing LHWs. The TA team will
identify the two major types of gaps in current LHW
model which needs to be bridged:
 Lack of universal Geographic coverage
 Quality of outreach services provided in the
covered area.
 The cost of exercise is covered in the instant PC-I
@PKR 10.00 Million for two years in Output 1
Annex – B6 on page 85 in PC-I
175
2. As per Health Policy DOH will focus on provision of Birth Spacing Services:
Health facilities network and community based Lady Pakistan is committed to increase CPR which is almost static since
Health Workers and Community Midwives.
2012 and pledged to decrease annual growth rate in the country. KP
Therefore, Health Department may also needs to
include family planning services interventions in the The province of Khyber Pakhtunkhwa (including newly merged
PC-I for secondary care hospitals.
districts) with 12.8 % area of Pakistan is occupied by 17.1% of
country’s population. According to the sixth Population and Housing
Census 2017, KP’s population stands at 35.5 million. Its population
has grown with an inter-censual (1998, 2017) annual growth rate of
2.82% which is more than national growth rate. High population
growth rate was led by a continuously high birth rate and rapidly
declining mortality rate.
Decline in population growth rate has been slow, while
contraceptive prevalence of only 31% is far less than other regional
countries. Unmet need for birth spacing is around 21%, and the
health system has to strategize to address this gap.
The IHP aimed to increase CPR from 31% to 33% by 2023. In this
regards, project will ensure the continuous availability of
contraceptives at community level (with LHWs & CMWs) and at all
primary & secondary health care facilities to address the unmet
need. Monthly quantification is given below. And also added in the
scope of the project 6.4.1: under Birth Spacing Services at page no
16-17
S
Quant
r. Unit Quantit Quantit Quant Quant
ity
N Name y For y For ity ity
For B
o. BHU RHC For D For
&C
176
CD &
SHCs
Oral Pills
1 (No. of 10 12 15 15 5
Cycles)
Condom
(10
2 100 120 200 200 100
Condoms
per client
Injection
3 Family 6 4 5 5 2
Planning
4 IUCD 5 15 25 20 2
5 Implant 0 0 3 1 0
The program proposed allocation is Rs 94.3 Million for the
procurement contraceptives for primary & secondary health. The
detail cost sheet is annexed at page # 91-92 Annex-B-8
3. What is status of MHSDP? Whether it is an approved Minimum Health Service Delivery Package was developed by the
Department of Health with the assistance of DFID and wider
document.
consultation of stakeholders. The document was approved by the
Department of Health.
4. Non salary component of regular LHWs have been It is submitted that current PC-I is the extension of previous IHP PC-
I, the current PC-I includes the previous and new interventions. The
included. Health Department to justify.
DOH made its efforts to improve the modalities of technical
interventions at community as well as facility level to improve the
health status of women and children in the province. In this regards
LHWs are key service provider at community level. Without
inclusion of non-salary component of LHWs the stated objectives of
the program could not be achieved. The shifting of proposed cost of
non-salary component of the LHWs will cause delay in
177
implementation of the whole project. However this cost would be
shifted on current side after completion of the project.
5. On what basis targets of the project (MMR, NMR, The overall objective of the project is to achieve SDGs target to fulfill
international commitments. The project targets are determined on the
IMR, CPR etc.) have been determined. How it will be
basis of annual reduction rate to reach at destination by 2030. The
measured. Health department to include proper baseline is adopted from PDHS 2018 and end line will be from PDHS
2023-24. The below given table showing achieving SDGs is added in
indicators for evaluating the performance of the
the digest component of the PC-I on page 07-08.
project by steering committee.
SDG 3 Indicators Current Status SDG Targets by 2030 Project Targe
by 2023
3.1.1. Maternal Mortality Ratio1(per 165/100,000LB <70 140
100,000 live births) NIPs 2019
3.1.2. Skilled Birth Attendance (%) 67.40 >90 >75%
PDHS 2018
3.2.1. Under Five Mortality Rate (per 64 <25 56
1,000 live births) PDHS 2018
3.2.2. Neonatal Mortality Rate (per 1,000 42 <12 35
live births) PDHS 2018
3.7.1. Contraceptive Prevalence Rate 30.9% >75 33%
(only modern methods, %) PDHS 2018
Stunting Rate 43.30% 25.98% (40% 39.45%
PDHS 2018 reduction in number
of children under
5 who are stunted %)
The steering committee or implementation committee will review the

progress of the project on the basis of following output indicators or
process indicators;
1 increase in score of functionality index of 24/7 BHUs & RHCs
2 Increase in ANC cases per health facilities per month
3 Increase in # of normal vaginal deliveries per health facilities per month
4 Increase in PNC cases per health facilities per month
178
5 Stock availability of minimum 2 contraceptives out of 4
6 Stock availability of ORS & Zinc syp
7 # of posts vacant at service delivery level
6. Why the Health Department has retained stipends for Under previous PC-I the CMWs were paid @PKR 15000/- per month
CMWs after attaining diploma from PNC. as deployment fee for unlimited period subject to submission of
monthly report and no of 02 deliveries per month by previous MNCH
program. In instant PC-I it is proposed that CMWs will be paid as
deployment fee for maximum periods of 3 years on the basis pay for
performance model. It is just to incentives them to establish and run
their midwifery home in the community. The pay for performance
model is proposed and placed at page no 28-30. The program will
conduct the geo mapping of all CMWs in order to update eligible
payment list. The program will not disburse stipend before geo
mapping and deleting the ghost CMWs in payment list. The
Department intends to retain CMWs in the community (for flung
Rural areas) to provide services to pregnant womens.
7. Health Department to appraise the forum regarding Procurement of Nutrition Commodities in previous PC-I:
status of nutrition commodities purchased under the 1- Nutrition Supplements Procured in Previous PC-I
Quantity Quantity Quantity
previous PC-I. Name of Quantity
S/No. Procured received issued
Supplements Available
(Cartons) at Store from Store
1 F-75 988 988 188 646
2 F-100 912 912 112 617
179
Consignment
3 56159 56159 20333 35829
of RUTF
Micro
5 Nutrient 4000 4000 0 3940
Sachet
Distribution plan of nutrition commodity is hear by attached below

at the end of the observation
8. Staff comparative statement of new and old PC-I may In previous PC-I the No of Post were 42 at PMU level. The posts were
rationalize and in instant PC-I the post are 28. The new post of
be provided.
Financial Management Specialist, BCC Coordinator, and Training
Coordinator are included in 28 total posts. The detail comparison is
given at page no 112-120. The staff comparative sheet is attached
below the table:
9. Transfer of grants to PCMC may be justified in light Under new initiative the DoH intends to upgrade 200 BHUs and 50
RHCs to provide 24/7 SBA services under two separate PC-Is. The
of other projects of BHUs and RHCs.
IHP will support in provision of 24/7 services through efficient
monitoring and implementation at the district level. The IHP
coordinator (Previous LHW Coordinator) is proposed to act as focal
person at the district level regarding 24/7 services at BHUs and RHCs
across Khyber Pakhtunkhwa. The upgradation cost of 200 BHUs and
50 RHCs inclusive of, provision of additional equipment’s, provision
of additional HR, provision of additional medicines and disposables,
provision of minor repair of health facilities. However to maintain the
functionality index of the health facilities day to day expenditures
would be required i.e. local purchase of essential medicines,
replacement of minor damaged electricity and water accessories etc.
The 24/7 services at BHUs and RHCs will contribute in achieving
180
MNCH related indicators of IHP. The 3 PC-Is, IHP, BHU and RHCs
will be implemented in integrated manner under the leadership of PD
IHP and oversight of DGHS. The minor amount @PKR 25,000/- per
month per RHC and @PKR 10,000/- per month per BHU is proposed.
It is submitted that there is no duplication of cost in BHU and RHC
PC-I. The PCMCs will observe the following parameters in utilization
of these funds:
Guidelines For PCMC Funds Utilization;
1 The program may transfer funds in the designated accounts of PCMC
committee in advance on quarterly basis ( Up front only for first time)
2 The committee will upload its expenditure report on quarterly basis
3 The committee based at BHU & RHC will not utilize the funds in hiring of staf
on daily wedges.
4 The funds may be utilized for local purchase of medicines only to recoup th
emergency tray or for labour room.
5 Minor repair and replacement of electricity & water accessories
6 Minor repair of building of the health facility cost not exceeding Rs.25000/- pe
annum
6 Funds will not be used in giving incentives to staff.
8 Funds may be utilized in organizing integrated health camp.
*The Guidelinees for PCMCs are also given in digest part of the
PC-I 6.5 at page No 19
10. Rural Ambulance services mechanism needs further Second delay has always been reported as a major contributor to
elaboration basis for retainer ship units and costs may maternal and neonatal mortality in rural areas. In order to improve
be provided. Health department may provide the access to health facilities, to encourage women to deliver through a
criteria for selection of districts. skilled birth attendant at a properly equipped health facility, and to
ensure immediate availability of transport in case of a complication,
the Government of KP intends to decrease MMR in the province. An
effective outsource model of Rural Ambulance Services is being
181
proposed to be piloted in 10 districts of KP. The beauty of the
proposed model is launching of the initiative without any capital cost.
The private sector will be attracted to provide round the clock patient
transfer services in the rural areas of KP.
Costing Model
Retainer ship
Outsourcing Cost of RAS Units fee per vehicle
in PKR
Retainer ship Cost For Light Vehicle per
month 40 40,000
Retainer ship Cost for Heavy Vehicle per
month 20 60,000
Per KM Cost -
44
Per KM Cost HV -
66
Project steering committee will decide the districts where operation
of the pilot will run on the following guidelines:
1 # of 24/7 health facilities
2 Equity based regional distribution
3 Initially few districts where operation of the pilot is easy to
run to attract the vendor
4 Districts where SBA rate is low
182
Operation Outlines
The task of call response center (emergency helpline 1122) will be
outsourced to any renowned Telecom Operator while the task of
provision of vehicle with drivers, POL, insurance & maintenance to
1122 may be given the task the funds may be transferred to 1122 to
provide designated services in the rural areas to reduce maternal
mortality. The task will be generated by LHWs / CMWs the CRC will
manage insertion of trackers in all vehicles and will generate task on
the call of LHWs or mothers. The CRC will assign the task to near
by ambulance to pick emergency from household to drop at 24/7
health facility and also pick the patient from 24/7 health facility to
any nearby CEmONC hospital.
183
The detail is given at Sr. No 6.7 at page no 18-20 Strengthening and
reinforcement of Referral System by introducing Rural Ambulance
Services (RAS) to save lives of Complicated Patients.
11. Whether LHWs have been trained in all areas reflected LHWs have been trained time to time to provide services in the area
of MNCH. However in the instant PC-I few trainings of the LHWs
under the scope for LHW in the PC-I.
on Integrated Nutrition package and MNCH related knowledge and
skills has been allocated.
12. Performance evaluation of the existing District Social The performance evaluation of the Social Organizer is being
conducted annually on routine performance evaluation contained in
Organizer may be provided.
ACR form. However the performance of District Social Organizers
will be linked with the performance of the project and it will be
evaluated on quarter basis
184
13. PIU – which existing staff has been retained? List attached as below:
Total PMU Staff

S. Integrated Health Project Staff Details
No. (PMU)
BPS No of
Staff
Provincial Staff (Project Implementation Unit)
1.1 Project Director (By Transfer from DGHS / BPS 20 1
open competitive process from market)
1.2 Deputy Director M&E / MIS By Transfer from BPS 1

DGHS (He will be entitled to draw project 18/19
allowance)
1.3 Deputy Director Training By Transfer from BPS 1
allowance)
1.4 Deputy Director Operations By Transfer from BPS 1
allowance)
1.5 Deputy Director Accounts (AG Staff by BPS 18 1
Deputation)
1.6 Deputy Director Procurement By Transfer BPS 18 1
from DGHS (He will be entitled to draw project
allowance)
185
1.7 Computer Programmer / IT Expert (Project BPS 17 1
Staff)
1.8 Provincial Logistics Officer (Project Staff) BPS 17 1
1.9 Assistant Accounts Officer (AG Staff by BPS 17 1
Deputation)
1.10 Admin Officer (Project Staff) BPS 17 1
1.11 Financial Management Specialist (Market 19 1

Expert) (open competitive process from market
on Contract)
1.12 Data Analyst (Project Staff) BPS 17 2
1.13 Office Superintendent (Deputation Staff from BPS 1
Secretariat) 16/17
1.14 BCC Coordinator (Project Staff New Position) BPS 17 1
1.15 Training Coordinator (Project Staff New BPS 17 1
Position)
1.16 Internal Auditor (BPS 16) BPS 16 1
1.17 Assistant Logistic Officer (Project Staff) BPS 16 2
1.18 IT Assistant/ Computer Operators (Project BPS 16 8
Staff)
1.19 Receptionist/Telephone Operator (Project BPS 4 1
Staff)
Total PMU Staff 30
1.20 Driver For New Vehicles BPS 04 3
1.21 Chowkidar BPS 03 4
186
1.23 Naib Qasid ( Regular Employees from Transfe 0
MNCH & LHW) r from
MNCH,
LHW
1.24 Sanitary Worker BPS 01 2
Sub Total 9
14. Staff nurse for stabilization centers in DHQ, their roles The stabilization centers to treat Severely Acute Malnourished
(SAM) Children with complication are established at 22 centers and
need to be determined.
will be established 04 new centers at secondary care hospital. The two
staff nurses will be provided from the project and two other staff
nurses will be provided by the hospital to run 24/7 Stabilization
Centers.
15. The Steering Committee cannot add items which has Advice well taken. However steering committee can add some
essential items regarding purchase of medicines or instruments
not been covered in the PC-I.
within the scope of the project and without exceeding the cost of the
total project.
16. Heath Department to provide assets details of the IHP Table Attached Below
Project and their status.
17. Inclusion of vehicles, computers under the project is The project submitted the justification for the procurement of new IT
equipment’s and vehicles to Finance Department via Revenue
not justified.
Clearance meeting. FD accordingly rationalize the quantity and cost
of the items to be procured. The 26 Desktop will be procured for IHP
Coordinators and 02 for PMU Office. 03 Vehicles were procured in
the previous PC-I in 2014 and currently working at the disposal of
DGHS and DOH.
18. What will be the working relation with LHW program The proposed LHWs business model is hybrid. At the district level
overall in charge of the LHW will be DHO and Immediate supervisor
on current side? Whether they will be report to PMU
will be IHP Coordinator (Previously LHW Coordinator).
or DGHS.
187
19. Recruitment of staff needs to be made as per project Advice well taken. The composition of the selection committees
have been amended in compliance to project policy of the
policy.
Government of Khyber Pakhtunkhwa.
20. Independent Project Director may be appointed. The Project Director will be appointed through open competitive
process. Appointment will be made on Project Policy.
21. IMU Health may be involved in M&E of the project. The role of IMU will be crucial in the project monitoring and
explained at page No. 29. The project will be reviewed on monthly
on the basis of the report submitted by IMU to department. The IMU
will act as third party monitor of the project as well as 24/7 services
of BHUs and RHCs.
Assets Details of IHP Project and their status:
INTEGRATED HEALTH PROJECT

LIST OF IHP INVENTORY
PURCHASED In
S.NO DESCRIPTION Stock Remarks
QUANTITY use
CANON FAX MACHINE

Total Quantity
1 2
Procured Out of 2 Fax Machine Procured 1 is with DGHS office. Therefore
Working requested 2 more Fax machine for the Project
2 Issued 2
Condition
2 2 0
HP LAPTOP WITHOUT BAG

Total Quantity
1 7
Procured
188
Working
2 Issued 4
Condition Out of 7 Laptops Procured 3 is
Not in not in working condition also out of 4 ,2 laptops are with DGHS office.
3 Issued 3 Working Therefore requested 7 laptops for the project
Condition
TOSHIBA DIGITAL PHOTOCOPIER
Total Quantity
1
Procured 2 Out of 2 Photocopier Procured 1 is with DGHS office. Therefore
Working requested 2 more Photocopier machine for the Project
2 Issued 2
Condition
HP SCANNER 5590
Total Quantity
1 2
Procured Heavy duty Scanner is requetsed as needed for digitalization of record.
Working The prsent one with IHP is of normal use
2 Issued 2
Condition
LASER JET HP PRINTER
Total Quantity
1 7
Procured
Working
2 Issued 5
Condition
Not in
3 Issued 2 Working
Condition
MICROWAVE
Total Quantity
1 1
Procured
Not requested in new PC-1
Working
2 Issued
1 Condition
OFFICE STAFF TABLE
Total Quantity Out of 11 office table Procured 3 are issued to DGHS office and 4 are
1 11
Procured damaged. Therefore requested 5 more office table for the Project
189
Working
2 Issued 7
condition
3 Issued 4 Damaged
OFFICER WOODEN TABLE

Total Quantity
1 15
Procured
Working Out of 15 office table Procured 6 are issued to DGHS office and 3 are
2 Issued 12
Condition damaged. Therefore requested 4 more office table for the Project
3 Issued 3 Damaged
COMPUTER TABLE
Total Quantity
1 22
Procured
Working Out of 2 Computer tables Procured 8 are issued to DGHS office and 5 are
2 Issued 17
Condition damaged. Therefore requested 5 more office table for the Project
3 Issued 5 Damaged
COMPUTER CHAIR REVOLVING

Total Quantity
1 22
Procured
Working
2 Issued 14 Not requested in new PC-1
Condition
3 Issued 8 Damaged
OFFICE CHAIR VISITER

Total Quantity
1 60
Procured
Working
Condition
3 Issued 22 Damaged
190
SOFA THREE SEATER
Total Quantity
1 6
Procured
Working
Condition
3 Issued 1 Damaged
SOFA FIVE SEATER

Total Quantity
1 5
Procured
Working Out of 5 Sofa seat Procured 2 were issued to DGHS office and 1 is
2 4
Issued Condition damaged. Therefore requested 1 more Sofa seat for the Project
3 1 Damaged
Issued
UPS 1000 VOLT FOR DESKTOP
Total Quantity
1 17
Procured
2 Issued 3 Working Not requested in new PC-1
3 Issued 14 Damaged
17 17 0
OFFICE REVOLVING CHAIR

Total Quantity
1 18
Procured
2 Issued 10 Working Out of 18 Revolving chair Procured 5 are issued to DGHS office and 8 are
damaged. Therefore requested 10 more Office revolving chair for the
3 Issued 8 Damaged Project
18 18 0
191
TELEPHONE SET
Total Quantity
1 15
Procured
Working
2 Issued 12 Out of 15 Telephone sets Procured 5 are issued to DGHS office and 3 are
Condition
damaged. Therefore requested 15 more Telephone sets for the Project
3 Issued 3 Damaged
DESK TOP COMPUTER

Total Quantity
1 19
Procured
Working Out of 19 Desktop computers Procured 6 were issued to DGHS office and
2 Issued 11
condition 8 are damaged. Therefore requested 30 more Desktop computers for the
Project PMU and Field offices.
3 Issued 8 Damaged
AIR CONDITIONER
Total Quantity
1 10
Procured
Working
2 Issued 7
condition
Out of 10 ACs Procured 1 was issued to DGHS office and 3 are damaged.
3 Issued 3 Damaged
Therefore requested 6 more Air Cons for the Project.
TELEPHONE EXCHANGE (2 lines)
Total Quantity Currently installed Telephone exchange is of 2 lines. Therefore requested
1 1
Procured 5 line exchange for the Project.
Working
2 Issued 1
condition
Distribution Plan of Nutrition Commodities:
ESTIMATED DISTRIBUTION PLAN FOR NUTRITION COMMODITES TO THE DISTRICT OF KHYBER PAKTUNKHWA
Total Carton RUTF =20333
192
Monthly Consumption of RUTF Per District
Name of District Number of OTP Sites
Sr. No November December January February March April May June Total
1 Abbottabad 29 174 174 174 174 174 174 174 174 1392
2 Bannu 18 108 108 108 108 108 108 108 108 864
3 Battagram 16 96 96 96 96 96 96 96 96 768
4 Buner 14 84 84 84 84 84 84 84 84 672
5 Chitral 16 96 96 96 96 96 96 96 96 768
6 Charsadda 25 150 150 150 150 150 150 150 150 1200
7 Dir Upper 18 108 108 108 108 108 108 108 108 864
8 Dir Lower 19 114 114 114 114 114 114 114 114 912
9 D.I.khan 19 114 114 114 114 114 114 114 114 912
10 Hangu 8 48 48 48 48 48 48 48 48 384
11 Haripur 25 150 150 150 150 150 150 150 150 1200
12 Kohistan Upper 8 48 48 48 48 48 48 48 48 384
13 Kohat 15 90 90 90 90 90 90 90 90 720
14 Karak 15 90 90 90 90 90 90 90 90 720
15 Lakki Marwat 18 108 108 108 108 108 108 108 108 864
16 Manshera 31 186 186 186 186 186 186 186 186 1488
17 Malakand 16 96 96 96 96 96 96 96 96 768
18 Mardan 31 186 186 186 186 186 186 186 186 1488
19 Nowshera 22 132 132 132 132 132 132 132 132 1056
20 Peshawar 31 186 186 186 186 186 186 186 186 1488
21 Swat 27 162 162 162 162 162 162 162 162 1296
22 Shangla 12 72 72 72 72 72 72 72 72 576
23 Swabi 29 174 174 174 174 174 174 174 174 1392
24 Tank 12 72 72 72 72 72 72 72 72 576
Total 474 2844 2844 2844 2844 2844 2844 2844 2844 22752
193
21.Revenue Clearance From Finance Department Khyber Pakhtunkhwa
194

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Integrated Health Project - Khyber Pakhtunkhwa, Pakistan - PC-I Final Draft Final Version 2020-23

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New Integrated Health Project PC-I

“Integration of Health Services Delivery with Special Focus on MNCH, LHW

Total Cost PKR 7,027.226 Million

3. Authority responsible for:

3.2 Execution: Health Department Khyber Pakhtunkhwa through DGHS

4.1 Plan Provision:

5.2 Purpose of the Project:

 To improve access to RMNCH and nutrition services of MHSDP at outreach level.

The above objective will contribute towards achievement of the performance

Maternal 206/100,000 165/100,000 LB

Stunting 37.70% 43.30% 40%

Relevance with SDGS:

SDG 3 Indicators Current Status SDG Targets by Project Target

5.4 Relationship with Sectoral Objectives:

1: Revamping/management of primary, secondary and tertiary healthcare;

2: Healthcare Financing Reforms; and

3: Governance Reforms in health sector (especially setting quality standards; essential

5.5 Relevance of the Project to Health Policy Khyber Pakhtunkhwa

• A measurable reduction in morbidity and mortality rates due to common preventable

• Improved Human resource management.

• Improved Governance and Accountability.

• Improved Regulation and Quality Assurance.

6 Description, Justification and Technical Parameters:

6.1 Project Description:

Programme Programme Goals Remarks

National Overall health sector goals of Non salary component of LHWs

Maternal, Improvement of maternal, All components of previous MNCH

The following Three strategic Areas:

6.3.1 Improvement in MNCH, RH, FP and Nutrition Services:

d. Increased Community Participation and involvement in health actions by

a. Increased availability of RMNCH and nutrition services of MHSDP against the

b. Preventive and promotive services for clients as per MHSDP by conducting

c. Training of health facility staff as per MHSDP specially focusing on enhancing

6.3.3 STRENGTHENING OF BASIC EmONC SERVICES AT THE PRIMARY

Key interventions for maternal & newborn care at 24/7 (RHCs)

1. Intravenous and intra-muscular administration of medicines such as antibiotics,

6.4.1 Birth Spacing Services:

6.5 Transfer Grants to PCMC

Guidelines For PCMC Funds Utilization;

6.6 IMPACT ON SECONDARY AND TERTIARY LEVEL HOSPITALS

6.7 Strengthening and reinforcement of Referral System by

Retainer ship Cost For Light Vehicle

Retainer ship Cost for Heavy Vehicle

6.8 Operational. Arrangements:

6.9 RAS Dashboard: Daily management through real-time monitoring and

6.10 To improve Access to nutrition interventions at Primary & Secondary

b. Procurement of Medicines, Supplies, Stationery, Print material as per

1 Malnutrition Currently # of centers to be Total target

6.11 Strengthening of Community Based Services

 Increased number of skilled birth attended deliveries

By having an improvement in all the above output/process indicators, there would

6.12 Improving the services of LHWs

6.13 THE SCOPE OF WORK FOR LHW

 Population coverage by LHW needs to be revisited, keeping in view, the population

Further decentralization & integration at district level is required.

6.14.3 Recording, reporting and supervision:

 E-Reporting and recording system may be developed and implemented

6.14.4 Service package

6.15 Improving the services of CMWs:

Normal vaginal delivery ( one or more) Fixed Cost with

Care of newborn 2 200 400

counselling visit to Newlywed women on FP 4 100 400

Insertion of IUCD 1 500 500