Three Years Rolling Plan 2010-2013, District Nankana Sahib
THREE YEARS ROLLING PLAN
2010-2013
DISTRICT NANKANA SAHAB
1
Three Years Rolling Plan 2010-2013, District Nankana Sahib
Contents
Acronyms .............................................................................................................................................. 4
Executive Summery.............................................................................................................................. 5
NANKANA SAHIB.................................................................................................................................. 7
SECTION 1: DISTRICT HEALTH PROFILE .......................................................................................... 7
VISION OF THE DISTRICT ..................................................................................................................... 7
BACKGROUND OF THE DISTRICT ....................................................................................................... 7
MAP OF THE DISTRICT ........................................................................................................................ 8
DEMOGRAPHY ...................................................................................................................................... 8
Population groups ................................................................................................................................. 9
SOCIO-ECONOMIC INDICATORS ......................................................................................................... 9
HEALTH INDICATORS ........................................................................................................................ 10
HEALTH RESOURCES ......................................................................................................................... 12
1. HEALTH FACILITIES ............................................................................................................... 12
a)
PUBLIC .............................................................................................................................. 12
b)
Private ............................................................................................................................... 12
2. Human Resource ..................................................................................................................... 13
a)
Administrative .................................................................................................................. 13
b)
Facility Based .................................................................................................................... 14
c)
Outreach ............................................................................................................................ 18
d)
Training Institutions ......................................................................................................... 19
HEALTH FINANCING .......................................................................................................................... 19
STATUS OF VERTICAL PROGRAMS................................................................................................... 22
1. NATIONAL PROGRAM FOR FP & PHC.................................................................................... 22
2. EPI............................................................................................................................................. 22
3. MNCH Program ........................................................................................................................ 23
4. TB CONTROL PROGRAM ......................................................................................................... 23
5. MALARIA CONTROL PROGRAM (February) ......................................................................... 23
6. HIV/AIDS CONTROL PROGRAM ............................................................................................. 23
7. HEPATITIS CONTROL PROGRAM .......................................................................................... 23
8. SCHOOL HEALTH SERVICES PROGRAM ................................................................................ 23
9. ANY OTHER DISTRICT SPECIFIC PROGRAM ........................................................................ 23
SECTION 2: PROBLEM ANALYSIS ..................................................................................................... 24
Objectives ............................................................................................................................................ 24
2
Three Years Rolling Plan 2010-2013, District Nankana Sahib
Plan Development Process ................................................................................................................ 25
Problem Identification ....................................................................................................................... 25
Health Problems ................................................................................................................................. 25
Problem Prioritization ................................................................................................................... 26
Underlying causes of prioritized problems .................................................................................. 28
Service delivery/Management problems ......................................................................................... 30
MDGs and MSDS ................................................................................................................................. 31
Human Resource ............................................................................................................................ 31
i.
DHQ Hospital ........................................................................................................................ 31
Equipment....................................................................................................................................... 32
i.
DHQ Hospital ........................................................................................................................ 32
SECTION 3: INTERVENTIONS AND TARGETS ................................................................................. 39
Health Problems ................................................................................................................................. 39
Management Problems ...................................................................................................................... 49
Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned Posts ....... 49
SECTION 4: COSTING AND FINANCING PLAN ................................................................................. 53
Activity based costing ........................................................................................................................ 53
a)
Health Problems .................................................................................................................. 55
b)
Management Problems ....................................................................................................... 66
Financial Outlay .................................................................................................................................. 69
SECTION 5: MONITORING & EVALUATION ..................................................................................... 70
M&E of Plan......................................................................................................................................... 70
Annex -I ............................................................................................................................................... 73
Annex II ............................................................................................................................................... 76
3
Three Years Rolling Plan 2010-2013, District Nankana Sahib
Acronyms
3YRP
ADB
APMO
ARI
BHU
BoD
CDC
CDR
CPR
DHIS
DHQH
DoH
DR
EDO(H)
EPI
HSRP
IMR
IPC
M&E
M&E
MCH
MMR
MNCH
MO
MoV
MSDS
PDSSP
PHC
PMO
POL
RHC
SCR
SHC
SMO
TAMA
TB
THQH
TNA
WHO
WMO
Three Years Rolling plan
Asian Development Bank
Additional Principal Medical Officer
Acute Respiratory Infections
Basic Health Center
Burden of Dieses
Communicable Disease Control
Case Detection Rate
Contraceptive Prevalence Rate
District Health Information System
District Head Quarter Hospital
Department of Health
Default Rate
Executive District Officer Health
Expended Program on Immunization
Health Sector Reforms Program
Infant Mortality Rate
Interpersonal Communication
Monitoring and Evaluation
Maintenance and Repair
Maternal Child Health
Maternal Mortality Ratio
Maternal Newborn and Child Health
Medical Officer
Means of Verification
Minimum Service Delivery Standards
Punjab Devolved Social Services Program
Primary Health Care
Principal Medial Officer
Petrol, Oil and Lubricant
Rural Health Center
Sputum Conversion Rate
Secondary Health Care
Senior Medical Officer
Technical Assistance Management Agency
Tuberculosis
Tehsil Head Quarter Hospital
Training Need Assessment
World Health Organization
Women Medical Officer
4
Three Years Rolling Plan 2010-2013, District Nankana Sahib
Executive Summery
Prior to devolution, planning process was carried out at provincial level. Districts were
supposed to implement plans and programs developed/designed at provincial and federal
levels. Devolution brought a paradigm shift where planning became a district responsibility.
This change provided an opportunity to the district at one hand and challenge on other due to
their limited capacity in planning and budgeting. Planning focus also changed from short term
to medium term planning recognizing the flexibility /adaptability it provided. Government
envisions that medium term plan .i.e. 3YRP will be instrumental in using health resources
effectively and efficiently through adapting Minimum Service Delivery Standards (MSDS) as the
strategy to achieve objectives of MDGs.
Districts have been preparing 3YRP (medium term plan) for last few years under the
auspices/patronage of Department of Health (DoH) Government of Punjab through technical
assistance of Punjab Devolved Program Social Services Programme (PDSSP). This year
government of the Punjab through Health Sector Reforms Program (HSRP) with the technical
assistance from a team of consultants (SP09) and wide consultations/inputs from all key stake
holders has established a bench mark in standardization of the format of 3YRP. Capacity
building of the districts has been done on the standardized format.
Current 3 Years Rolling Plan (3YRP) plan is first attempt by the district on that agreed format.
First section of the format (District Health Profile) contains all relevant information on
Geography, Demographic, Socioeconomic and Health indicators of the district. It also takes
stock of health resources in terms of human resource, infrastructure and others. District
diseases pattern compiled from DHIS Primary and Secondary Health Care reports and current
status of vertical /national programs is part of the profile. In fact district profile is a health
related fact sheet of the district and depicts the true picture of health status and health
resources/services of the district. An accurate district health profile provides a sound basis for
evidence-based planning.
3YRP plan has been developed by following the standard planning cycle approach. 3YRP details
the current year activities, physical targets and fiscal targets. Projections of second and third
year physical and financial targets are given. Section Two includes problems identification
from various perspectives, and their prioritization by applying WHO prioritization criteria.
This section also contains underlying causes of the prioritized problems. Section Three of the
5
Three Years Rolling Plan 2010-2013, District Nankana Sahib
plan relates to developing best possible interventions/activities and setting physical targets for
each year. Section Four consists of costing based on additional requirements taking account of
implementation of current status of activities. Best available estimates have been used to
accurately cost the activities. The detailed activity based costing of the Health and Service
Delivery problems has been developed on automated Excel sheets, and annexed for details as
ready reference. Last section of the 3YRP consists of Monitoring and Evaluation of plan to
gauge the progress of different activities and targets of the plan using reliable district data
sources. This permits timely remedial action for smooth implementation of planned activities.
6
Three Years Rolling Plan 2010-2013, District Nankana Sahib
NANKANA SAHIB
________________________________________________________________________________
SECTION 1: DISTRICT HEALTH PROFILE
VISION OF THE DISTRICT
Provision of quality Health care services to every human being/ inhabitant of District
especially who are poor and under privileged, without prejudice and bias regarding age,
gender, race, creed & Religion etc through:
 Curative
 Preventive
 Promotive Health Care Services
Primary Health Care is the main tool for provision of Health Care Services to the populations.
The Health Department District Government Nankana Sahib is providing primary health care
throughout the District and secondary health care at District.
BACKGROUND OF THE DISTRICT

Geographical location: District Nankana is surrounded with five Districts i.e. Sheikhupura,
Hafizabad, Faisalabad, Okara & Kasur.

Area.
2719 SqKm

TOTAL POPULATION
1523042
7
Three Years Rolling Plan 2010-2013, District Nankana Sahib
MAP OF THE DISTRICT
DEMOGRAPHY
o
Total Population
1523042
o
Annual growth rate
2.7%
o
Population density
560 People / Sq Km
Area-wise population
Area
Population
Percentage
Rural
1289231
84%
Urban
233811
16%
Source: DHIS Report
Gender-wise population
Gender
Population
Percentage
Male
746290
49%
Female
776751
51%
Source: DHIS Reports
8
Three Years Rolling Plan 2010-2013, District Nankana Sahib
Population groups
Standard Demographic
(%)
Estimated
Population
Under 1 year of age
2.7
41122
Under 5 years
13.4
204088
Under 15 years
44
670138
Women in child bearing age (15-49 years)
22
335069
Married Child Bearing age Women
16
243686
Expected pregnancies
3.4
51783
Population Groups
Standard Demographic population based on DHIS
Tehsil wise distribution
Tehsil
Number of UC
Population
Nankana Sahib.
37
814728
Shahkot
9
207658
Sangla Hill
11
217045
Safdarabad
11
283611
Languages: The main language of the district is Punjabi. Urdu is also spoken and understood.
SOCIO-ECONOMIC INDICATORS
Education and Literacy
Literacy rate
Male
Female
Urban
28%
9%
Rural
11%
7%
Overall District
55%
EDO Literacy and Non Formal Education Nankana
9
Three Years Rolling Plan 2010-2013, District Nankana Sahib
HEALTH INDICATORS

Infant Mortality Rate
140/1000(live births)

Under 5 mortality Rate
59 (live births)

Maternal mortality Ratio
227( Provincial figure)

Malnutrition (women and children)
55%

Life expectancy
64 Years

Proportion of children 0-23 months immunized
89%
Source: MICS 2007-08 and EDO(Health) Nankana Sahib.
10
Three Years Rolling Plan 2010-2013, District Nankana Sahib
Organizational Structure of District Health Administration
There exists a three-tier system in the health sector in the country. At federal level, Federal
Secretary of Health is responsible to administer and supervise the health related activities and
programs. Major function of federal tier is to provide policy guidelines and ensure quality of
health care standards through federal legislation. After the 18th amendment in the constitution,
and announcement of National Finance Award, most of the existing federal level programs will
be transferred to the provincial level. At provincial level, provincial Secretary of Health along
with Director General Health Services is responsible for managing and supervising health care
services. The district is still an administrative entity in the system and EDO (Health) acts as
head of the district health department, under overall supervision of DCO. The organizational
structure at district level is as under:
Secretary Health
Zila Nazim
District
Coordination
Officer
Director General
Health Services
Executive District
Officer Health
Medical
Superintendent
DHQ Hospital
Director Health
Services
District Officer
Health
Incharges of
Health Facilities
DDOHs
Drug Inspector
04
District
Coordinators
District
Supervisors
RHCs 09
National
Programme
DSV 01
DSI 01
CDCO 01
BHUs 61
T.B DOTS
ASV 02
TSI 01
CDCI 00
GRDs 02
District
Surveillance
IV 03
SI 48
CDC Supervisor
44
MCH 06
EPI Focal
Person
Vaccinator 85
RD 19
CDC Focal
Person
MNCH
Coordinato
r
11
Three Years Rolling Plan 2010-2013, District Nankana Sahib
HEALTH RESOURCES
1. HEALTH FACILITIES
a) PUBLIC
Details of physical infrastructure of public health facilities in the district is given below
Bed
Strength
No. of
Functional
Beds
100
100
No THQH is functional so for
-
-
RHCs
09
20 each RHC
20 each RHC
BHUs
61
02 each BHU
02 each BHU
Govt. Rural
Dispensaries
02
Nil
Nil
MCH Centers
06
Nil
Nil
Sub Health
Centers
19
Nil
Nil
Health houses
843
40
Nil
Facility Type
DHQ Hospital
THQ Hospital
Name of Facility
DHQ Hospital Nankana Sahib
Remarks
DHQ Hospital
requires upgraduation
Functioning of
THQHs is urgently
required
Data source: DHIS/EDOH office
b) Private
The district has provided a list of private service providers including hospitals, clinics,
laboratories and maternity homes. These private providers are used for providing
support in preventive programs like Polio and other EPI activities. With the passage of
time, role of private providers will expand, and there is a need to develop an effective
coordination between public and private sector. Detailed list of private sector health
facilities is attached as Annex-I.
12
Three Years Rolling Plan 2010-2013, District Nankana Sahib
2. Human Resource
The Human resource of district health department has been placed in following categories:
a)
b)
c)
d)
Administrative
Facility based
Outreach
Training institutions
a) Administrative
Sr.
No.
1
Name of Post
Sanctioned
Filled
Executive District Officer Health
01
01
2
District Officer Health
01
01
3
Deputy District Officer Health
04
03
4
Program Director DHDC
0
0
5
District Coordinator National Program
1
01
6
District Coordinator EPI Surveillance
01
01
7
District Sanitary Inspector
01
01
8
CDC Officer
01
01
9
CDC Inspector
01
0
10
Drug Inspector
01
01
11
District Superintendent Vaccination
01
01
12
Assistant Superintendent Vaccination
03
02
13
Tehsil Sanitary Inspector
01
01
14
Inspector Vaccination
03
03
13
Three Years Rolling Plan 2010-2013, District Nankana Sahib
b) Facility Based
i.
Basic Health Units (61)
Name of Post/Designation
Sr
Sanctioned
Filled
Vacant
1
Medical Officer
61
4
57
2
School Health & Nutrition Supervisor
61
58
03
3
Medical Assistant
4
3
1
4
Computer Operator
61
4
57
5
Medical Technician
61
47
14
6
LHV
61
50
11
7
Dispenser
61
61
0
8
Midwife
61
23
38
9
N/Qasid
61
60
01
10
Chowkidar
61
57
04
11
Sanitary Worker
61
19
42
ii.
Sr.
#
1
Rural Health Centres (09)
Name of Post/Designation
Sanctioned
Filled
Vacant
Senior Medical Officers
09
02
07
2
Women Medical Officers
09
05
04
3
Dental Surgeons
09
08
01
4
Medical Officers
09
04
05
5
Charge Nurses
54
44
10
6
Homeo Doctors
09
02
07
7
Hakeems
09
01
08
8
Computer Operators
09
01
08
9
Medical /Health Technician
2
2
0
10
LHV
18
16
02
11
Lab. Technician
09
01
08
12
Dental Technician
09
03
06
14
Three Years Rolling Plan 2010-2013, District Nankana Sahib
Sr.
#
13
Name of Post/Designation
Sanctioned
Filled
Vacant
R.H.I
26
26
-
14
Junior Clerk
09
08
01
15
Vaccinator
09
09
0
16
Homeo Dispenser
09
04
05
17
Dawasaz
09
09
0
18
Radiographer/X-Ray Asstt.
09
09
-
19
Dresser
09
09
-
20
Anesthesia Assistant
09
0
09
21
O.T.A
09
01
08
22
Dispenser
36
36
-
23
Dental Assistant
09
0
0
24
Laboratory Assistant
09
06
03
25
Midwife
36
34
02
26
Driver
18
09
09
27
T.O
09
09
0
28
Homeo Naib Qasid
0
0
0
29
Dawa Kob
09
09
0
30
Ward Servant
18
18
-
31
Sweepers
09
09
0
32
Sanitary Worker
36
16
20
33
Sanitary Patrol
44
44
-
34
Naib Qasid
18
18
-
35
Mali
09
08
01
36
Cook
09
04
05
37
Chowkidar
18
11
07
38
Water Career
09
09
-
15
Three Years Rolling Plan 2010-2013, District Nankana Sahib
iii.
THQ Hospitals
No THQ Hospital is functioning in the District at this stage
iv.
DHQ Hospital (1)
S#
Name of post
Sanctioned
Filled
1
Medical Superintendent
1
1
2
Chief Consultant
0
0
3
PMO
0
0
4
PWMO
0
0
5
AMS
0
0
6
APMO
3
0
7
APWMO
01
0
8
Physician
1
0
9
Anesthetist
3
0
10 Cardiologist
02
0
11 Chest specialist
1
0
12 DMS
01
0
13 SMO
01
0
14 Neuro Surgeon
0
0
14 Nursing Superintendent
1
0
15 Nephrologist
0
0
16 Pediatrician
2
1
17 Pathologist
1
0
18 Radiologist
1
1
19 Surgeon
2
1
20 E.N.T. Specialist
1
0
21 Eye Specialist
01
0
22 Senior Dental Surgeon
1
0
23 Urologist
01
0
16
Three Years Rolling Plan 2010-2013, District Nankana Sahib
S#
Name of post
Sanctioned
Filled
24 Dental Surgeon
2
0
25 Internees
0
0
26 Medical Officer
12
5
27 Pharmacist
1
1
28 Physiotherapist
1
0
29 W.M.O
04
01
30 Charge Nurses
33
25
31 Head Nurse
4
0
32 Male Nurse
0
0
33 Hakeem
1
0
34 Homeo Doctor
01
01
35 Almoner
0
0
36 Computer Operator
01
0
37 Stenographer
01
0
38 Accountant
1
0
39 E.C.G. Haemo & CT Technician
2
1
40 Senior Clerk
1
1
41 Sanitary Inspector
01
0
42 Junior Clerk
3
3
43 Dawasaz
1
1
44 Dispenser
8
8
45 Homeo Dispenser
1
1
46 Operation Theater Assistant
3
0
47 Physiotherapist Aid
01
0
48 Radiographer
4
4
49 Dental Assistant
01
0
50 Lab. Assistant
4
3
51 Store Keeper
2
1
52 Driver
4
2
53 Midwife
2
0
17
Three Years Rolling Plan 2010-2013, District Nankana Sahib
S#
Name of post
Sanctioned
Filled
54 Tailor Master
1
0
55 Tube well Operator
2
0
56 Lab. Attendant
2
2
57 O.T. Attendant
2
0
58 X-Ray Attendant
0
0
59 Ambulance Cleaner
0
0
60 Bearer
1
1
61 Baildar
2
1
62 Chowkidar
3
1
63 Cook
3
1
64 Dawakob
1
1
65 Dhobi
3
1
66 Gate Man
2
1
67 Mali
2
0
68 Masalchi
02
02
69 Sanitary Worker
6
6
70 Ward Cleaner
9
0
71 Ward Servant
10
6
72 Water Carrier
1
1
73 Naib Qasid
3
1
c) Outreach
This information is about outreach program workers such as Vaccinators, CDC Supervisors and Sanitary
Inspectors which are not part of above mentioned health facilities.
Post
Sanctioned
Filled
Vaccinators
88
84
CDC Supervisors
47
43
Sanitary Inspectors
61
43
18
Three Years Rolling Plan 2010-2013, District Nankana Sahib
d) Training Institutions
Nankana Sahib is newly created district so no training institutions is fully functional.
HEALTH FINANCING
Rs. Million
Year
Source of funding
2007-08
Allocation
Non-Development
2008-09
Exp.
Allocation
Exp.
209.123
208.110
221.439
--
--
--
209.123
208.110
PHSRP
-
PMDGP
PDSSP
Development
Sub Total
Provincial Development
Funds (ADP)
Grand Total
2009-10 up to 01/2010
Allocation
220.336
Exp.
214.760
-
--
--
221.439
-220.336
214.760
-
-
20
12.2
-
-
-
-
59.620
38
-
-
--
-
-
-
25.392
3.540
24.288
15.420
410.536
24.385
420.036
36.845
233.411
223.53
711.595
294.921
660.188
40.385
19
Three Years Rolling Plan 2010-2013, District Nankana Sahib
DISEASE PATTERN
Disease Group
Respiratory disease
1
Acute (upper) respiratory infections
2
Pneumonia < 5 yrs.
Magnitude
Percentage
269880
2616
31.350%
0.303%
2449
0.285%
10044
1.1667%
3161
.3671%
6
Asthma
Gastro Intestinal Disease
26973
3.1332%
7
Diarrhea / Dysentery < 5 yrs
32205
3.7410%
8
Diarrhea / Dysentery > 5 yrs
37772
4.3877%
9
Enteric / Typhoid Fever
2294
.2664%
10
Worm Infestations
5437
0.6315%
11
Peptic Ulcer Disease
22000
2.5556%
12
Cirrhosis of Liver
295
0.0342%
31689
3.681%
3
Pneumonia > 5 yrs.
4
TB Suspects
5
Chronic Obstructive Pulmonary Disease
Urinary Tract Disease
13
Urinary Tract Infections
14
Nephritis / Nephrosis
15
Sexually Transmitted Infections
607
0.0705%
16
Benign Enlargement of Prostrate
214
0.02485%
8691
-1.009%
4
0.0004%
96378
11.195%
Other Communicable Diseases
17
Suspected Malaria
18
Suspected Meningitis
19
Fever due to other causes
-
20
Three Years Rolling Plan 2010-2013, District Nankana Sahib
Disease Group
Magnitude
Percentage
Vaccine Preventable Disease
20
Suspected Measles
21
Suspected Viral Hepatitis
22
Suspected Neonatal Tetanus
3482
-
Cardiovascular Diseases
23
Ischemic heart disease
24
Hypertension
Skin Diseases
25
Scabies
26
Dermatitis
27
Cutaneous Leishmaniasis
Endocrine Disease
28
Diabetes Mellitus
Neuro-Psychiatric Diseases
29
Depression
0.4044%
194
0.0225%
21774
2.5293%
172451
20.0326%
42309
4.9147%
11935
1.386%
4667
.5421%
68
.00789%
-
30
Drug Dependence
31
Epilepsy
222
0.0257%
Eye & ENT
32
Cataract
787
0.0914%
33
Trachoma
598
0.06946%
34
Glaucoma
125
0.0145%
35
Otitis Media
4312
0.5008
23201
2.6951%
16427
1.9082%
3677
0.4271%
912
0.1059%
75
0.0881%
Oral Diseases
36
Dental Caries
Injuries/Poisoning
37
Road traffic accidents
38
Fractures
39
Burns
40
Dog bite
21
Three Years Rolling Plan 2010-2013, District Nankana Sahib
Disease Group
41
Magnitude
Snake bite (with signs/symptoms of poisoning)
51
.0059%
191
0.0221%
860167
100
Miscellaneous Disease
42
Acute Flaccid Paralysis
43
44
Suspected HIV/AIDS
Any other Unusual disease (specify)
TOTAL
Percentage
-
Source: Compiled from PHC and SHC DHIS Reports
STATUS OF VERTICAL PROGRAMS
The following paragraphs depict the current status of the program being implemented in the
district. The indicators and their values have been taken from the program reports
1. NATIONAL PROGRAM FOR FP & PHC




No. of seats allocated for LHWs
1015
No. of LHWs working
784
Percentage of Population covered by the program
52%
Important program indicators
o IMR
59
o MMR
27
o CPR
45%
o No. of antenatal visits
47%
o TT Coverage of pregnant women
TT.I-84%,TTII-74%
2. EPI



EPI Coverage rate of the district
o Based on program information
o Based on third party validation
Fully immunized children 0-23 months
Pregnant women received TT vaccine
92%
92%
Nil
98%
TT.I-84%,TTII-74%

Availability of cold chain equipment
43%
22
Three Years Rolling Plan 2010-2013, District Nankana Sahib
3.
MNCH Program
Training of Community Midwives
60 Trained
4. TB CONTROL PROGRAM





CDR all types
CDR NSS positive
SCR
TSR
DR
71%
68%
97%
94%
02%
5. MALARIA CONTROL PROGRAM (February)




No. of slides examined
No. of positive slides
Slides positively ratio
Percentage of plasmodium Falciparum
22915
130
0.57
07%
6. HIV/AIDS CONTROL PROGRAM




No. of HIV/AIDS tests conducted
No. of positive cases detected
No. of HIV/AIDS patients treated
No. of sentinel centers
1002
Nil
Nil
Nil
7. HEPATITIS CONTROL PROGRAM





No. of hepatitis tests conducted
No. of positive cases detected
No. of persons vaccinated against Hepatitis B
No. of cases treated for Hepatitis B
No. of cases treated for Hepatitis C
1991
259
10,000
20
170
8. SCHOOL HEALTH SERVICES PROGRAM








Total visits to the schools
No. of students examined
No. of students referred to BHUs
No. of students treated in BHUs
No. of schools in catchment areas
No. of students
No. of SH & NS
No. of teachers trained
1450
16047
2182
611
793
18904
58
40% (one from each School)
9. ANY OTHER DISTRICT SPECIFIC PROGRAM
Universal Salt Iodization Program: District Nankana Sahib stood 1st In the Punjab in
2009& 2010.
23
3YRP 2010-2013, District Nankana Sahib
SECTION 2: PROBLEM ANALYSIS
The Health Sector in Punjab is facing enormous health and service delivery problems, and in
general the problems are common in nature. However, there are variations in districts with
regard to the problems due to geographic situation, cultural norms, and health seeking
behaviors, socio-economic conditions, political environment and insufficient skilled human
resource.
Common health problems are communicable, non communicable, MNCH related diseases and
accident/ trauma. The society is passing through demographic and epidemiological transition.
This is due to changing life style, urbanization, ecological and other factors. Disease pattern is
changing where non communicable diseases are gradually increasing and the communicable
diseases are still posing serious threat. Punjab is practically facing Double Burden of Disease
(BOD). Besides, health problems service delivery/ managerial issues are also hindering the
access and quality of health services to the population.
Devolution was introduced during 2001 affecting the administrative and financial set up of the
districts. The devolution also brought political culture in the decision making of the districts in
the shape of Nazims, Naib-Nazims and Councilors. This system is now in the phase of reshaping
and it is not clear what will be future structure and managerial shape when new local bodies
system is put in place. The District Manager and functionaries are in the state of uncertainty
and confusion in this scenario. However, one thing is clear that the district shall remain a hub
of all primary and secondary health services delivery. Despite the source of funding in the
future, either from provincial or district government, health planning at district level shall
continue to play a pivotal role in provision of quality health services.
In view of the above situation the district considers following objectives for developing three
year rolling plan.
Objectives






Improve health status of the population
Meeting the requirements of national and provincial health policies
Achievement of MDGs through MSDS
Introducing evidence-based planning culture by addressing district specific
problems/issues
Addressing emerging health needs or re-emergence of health problems (e.g. H1N1, HIVAIDS, Polio, T.B)
Ensuring effective inter-sectoral coordination with a view to improving health
indicators
The objectives would guide in problem analysis, designing interventions, setting /phasing
the targets, costing and monitoring the plan activities.
24
3YRP 2010-2013, District Nankana Sahib
Plan Development Process
Plan development has been a systematic and consultative process. A core planning team
consisting of EDO (H), DOH, MS DHQ and THQs, Statistical officer, and Budget and Accounts
Officer, was designated by Director General Health Services Punjab. This team received three
days customized training from SP-09 team at divisional headquarter. The main components of
the trainings were: (i) developing a three-year rolling health sector plan using the standard
three year rolling plan format; (ii) costing of the plan; (iii) preparing related budget
projections; (iv) accounting procedures; (v) preparing adequate financial reports on the use of
funds.
The district planning team adopted the following steps for the preparation of three years
rolling plan:
 Problem identification
 Prioritization of identified problems
 Identifying underlying causes of prioritized problems
 Developing interventions and activities
 Setting targets
 Determining resource requirements, costing and budgeting
 Preparing action plans
 Preparing monitoring plan
Problem Identification
This step involved assessment of the current situation from various perspectives to establish
the actual health situation in terms of health and service delivery/management problems.
Problem identification is based on the district health profile, review of previous plans, MIS
(DHIS, Program reports and periodic reports etc.), District specific surveys (MICS), MSDS, and
national and provincial policy guidelines.
The district planning team held meetings and started with identification of problem using the
training received from SP-09 team and consulting the above mentioned documents. The
problems identified were broadly divided into two categories i.e.
a) Health Problems
b) Health Service Delivery or Management Problems
Health Problems
The district specific health problems identification process started during the three years
rolling plans workshop. The planning team in the initial stage prepared a long list of the
health problems. The identification of health problems was based on various information
sources including DHIS, and district specific reports. The enlisted health problems of the
district are given in the following table.
25
3YRP 2010-2013, District Nankana Sahib
1. Acute respiratory tract
infections (ARI)
4. Urinary Tract Infections
2. Diarrheal Diseases
3. Scabies
5. Asthma
6. Dental Caries
7. Acid Peptic disease
8. Hypertension
9. Road side accident & injuries
10. Diabetes Mellitus
11. Skin Diseases
12. Anemia
13. Hepatitis
15. High under 5 Mortality rate
16. Worm infestation
14. High Maternal
Mortality rate
17. Arthritis
19. Suspected Malaria
20. Entire Fever
21. Psychiatric disorder
22. Drug Dependence
23. Epilepsy
24. Cataract
25. Dog Bite
26. Measles
27. Ischemic heart disease
18. Tuberculosis
28. Arthritis
Problem Prioritization
WHO has developed standard criteria for prioritization of health problems; which is based on
the following five elements:





Magnitude
Severity/danger
Vulnerability to intervention (feasibility)
Cost-effectiveness of the intervention
Political expediency
Each element has been assigned a score from 1 to 4 depending upon grade/scale of that
element i.e. Very High=4, High=3, Medium=2 and Low=1.
Elements of the prioritization criteria were applied to each of the enlisted health problems. The
aggregate of individual scores assigned to the elements of the prioritization criteria gave the
total score for a health problem. This total score was then used to prioritize the health
problems. A cut-off point of was decided, to establish the priority health problems of the
district. These problems will be addressed in the three years rolling plan.
26
3YRP 2010-2013, District Nankana Sahib
Problem
Magnitude
Severity
Vulnerability
to
intervention
Cost
Effectiveness
Political
Expediency
Total
Score
Priority
Number
Diarrheal
Diseases
ARI (under 5)
3
3
4
4
1
15
1
4
3
4
3
1
15
2
Tuberculosis
3
2
4
3
1
13
7
Suspected
Malaria
Anemia
2
2
3
3
1
11
10
3
2
4
4
1
14
4
High maternal
mortality
High under
five mortality
Asthma
2
3
4
3
3
15
3
2
2
4
3
3
14
5
2
2
1
1
1
7
25
Accidents &
Injuries
Hepatitis
1
2
2
2
1
8
21
3
4
2
2
3
14
6
Scabies
3
1
3
3
2
12
8
Skin Diseases
2
1
3
2
1
9
20
Urinary Tract
Infections
Acid peptic
Disease
Dental Caries
2
1
3
2
1
9
16
2
2
2
2
1
9
17
2
2
1
1
1
7
24
Hypertension
2
2
2
2
1
9
15
Diabetes
Mellitus
Worm
infestation
Drug
Dependence
Psychiatric
disorder
Epilepsy
1
2
2
2
2
9
14
3
2
3
3
1
12
9
2
2
2
1
2
9
18
1
1
2
1
1
6
26
2
1
2
2
1
8
22
Cataract
3
2
2
2
2
11
12
Dog Bite
2
2
2
2
2
10
13
Measles
2
2
3
3
2
12
11
Arthritis
2
2
1
2
1
8
23
Ischemic
heart disease
2
3
2
1
1
9
19
27
3YRP 2010-2013, District Nankana Sahib
Underlying causes of prioritized problems
Health problems have their underlying causes. It is important to know the underlying causes of
the health problems so that appropriate interventions are developed. There may be a long list
of these causes but only few of them are vital ones; and rectifying these causes can resolve the
problem to a large extent. Following table gives common causes of the prioritized health
problems and selected service delivery problems pertaining to the district.
HEALTH PROBLEMS
Sr. No.
1
Health Problem
Diarrhea
Causes
 Poor sanitation
 Lack of safe drinking water
 Unhygienic practices
 Lack of awareness in general population
 Lack of awareness among mothers about feeding and weaning practices
 Low Socio Economic status
 Malnutrition
2
Anemia ( including
pregnancy)
 Lack of awareness about balanced diet
 Gender discrimination
 Social taboos and norms
 Worm infestation
 Infections
 ·Poor quality of MNCH services
 Poverty/ Low socio economic status
3
Acute (upper) respiratory
infections
 Malnutrition
 Air contamination
 Over-crowding/Poor housing facilities
 Lack of proper sanitation
 Seasonal variation
 Lack of awareness and hygienic practices
4
TB Suspects
 Low socio-economic status
 Seasonal variation
 Lack of proper sanitation
 Lack of awareness and hygienic practices
5
Hepatitis
 Poor sanitation
 Unsafe drinking water
 Sharing of used syringes
 Transfusion of unsafe blood and blood products
 Unsafe sexual practices
 Ear piercing and tattooing
 Use of unsterilized equipment by dentists and barbers
28
3YRP 2010-2013, District Nankana Sahib
Sr. No.
6
Health Problem
Accident & Injuries
Causes
 Lack of traffic sense
 Poor maintenance of vehicles
 Poor road conditions
 Lack of safety measures at work place
 Fire-arm injuries
 Domestic accidents
 Burns
 Bomb blasts/terrorist activities
 Lack of tolerance in the society
7
High MMR
 Poor access to healthcare delivery services
 Lack of awareness about danger signs of pregnancy
 Low ante-natal coverage
 Low skilled birth attendance
 Three delays (seeking health care, transportation, and lack of referral
back-up services)
 Capacity
Issues related to maternal care
 Maternal Anemia
 Capacity Issues related to maternal care
 Poor access to healthcare delivery services
8
High under Five Mortality
 Poor antenatal natal and post natal services
 Poor access and quality of health care services
 Lack of birth spacing
 Lack of capacity of staff for provision of proper child health care (diagnostic
timely referrals)
 and
Infections
 Malnutrition
 Poor feeding and weaning practices
 Low socio economic status
29
3YRP 2010-2013, District Nankana Sahib
Service delivery/Management problems
This segment entails the district specific management problems. Management problems are
result of deficiency/lack of resources; these problems range from administrative to financial
issues, and cause hindrance in the smooth delivery of health services in the district. It was
observed that solution of some of these problems lies with the provincial government; whereas
remaining can be addressed at the district level. While proposing the interventions, their action
at provincial or district level has been specifically mentioned. The planning team discussed
these problems in detail and enlisted the main problems as under:
Sr.No
1
2
3
4
Service Delivery / Management Problems
Shortage of skilled staff due to:




Ban on permanent postings
Non availability of incentivized pay package and career structure
Medico-legal work for WMOs
Non sanctioning of posts according to MSDS
Deficient MNCH related equipment (with reference to standard notified list) at:


DHQH
THQHs
Capacity issues related to:



Financial Management
Supportive Supervision and
Use of information
Inadequate budget for POL due to:


Price hikes
Installation and use of generators
30
3YRP 2010-2013, District Nankana Sahib
MDGs and MSDS
The government is committed to achieve the MDGs targets. For this purpose, the government
of Punjab has decided to adopt Minimum Service Delivery Standards (MSDS) as strategy to
achieve the MDGs within the province. Health Department of Punjab is especially focusing on
MNCH related component of MSDS for which substantial resources are coming from Asian
Development Program funded Punjab Millennium Development Goal Program (PMDGP). MSDS
entails a level-specific service delivery package (for primary and secondary health care) along
with their standards and system specifications including human, infrastructure, equipment,
medical supplies, medicine and other consumables.
Human Resource
Hospital
Category
Bed Strength
A
400 and above Beds
B
251-400 Beds
C
Up to 250 Beds
A
Above 60 Beds
B
41-60 Beds
C
Up to 40 Beds
DHQ Hospital
THQ Hospital
i.
DHQ Hospital
(Category C)
Sr.
No.
Post
Standard as per
MSDS
Sanctioned
Filled
1
Gynecologist
3
1
1
Vacancy
Gap in
relation to
sanctioned
positions
2
2
Pediatricians
3
2
1
1
2
3
Anesthetists
3
3
0
0
3
4
Medical Officers
including SMO and
APMO
74
5 MOs
58
69
6
27
5
1
22
26
8
Women Medical
Officers including
SWMO and APWMO
Lady Health Visitors
11
3
8
8
9
Nurses
75
38
37
50
3(APMO/
1 (SMO)
12 MOs
25
Vacancy
Gap in
relation
to filled
positions
2
31
3YRP 2010-2013, District Nankana Sahib
Equipment
Government of Punjab has notified a standard list as yard-stick of MNCH related equipment to
provide comprehensive EmONC services in the DHQ and THQ hospitals. Provision of
comprehensive EmONC services is essentially required to decrease the high MMR and IMR
prevailing in the province.
Gaps in relation to the MNCH related equipment have been identified taking into account the
equipment purchased or under process of purchase from all funds including PMDGP funds
allocated/sanctioned to the district. The cost of equipment gap has been included in the
equipment portion of the Management/Service delivery problems
i.
Sr. No.
1
DHQ Hospital
Equipment
Standard as
per MSDS
C (Qty.)
B
A
Available
Gap
1
1
2
1
-
2
CTG (Cardiac
Tocography)
Foetal Doppler
3
5
5
3
-
3
Diagnostic Laparoscope
1
1
2
1
-
4
Bulb Sucker
10
20
20
10
-
5
Baby Warmer
3
3
6
3
-
6
Mechanical Sucker
3
3
6
3
7
Fetal Stethoscope
4
4
4
4
-
8
Delivery Table
2
2
3
2
7
9
D&C Set
2
3
4
2
1
10
Outlet forceps
4
4
4
4
-
11
Myoma Screw
2
2
2
2
1
12
Kochers forceps
4
4
8
4
-
13
Volselum forceps
6
8
10
6
-
Remarks
32
3YRP 2010-2013, District Nankana Sahib
Sr. No.
14
Equipment
Standard as
per MSDS
C (Qty.)
B
A
Available
Gap
2
2
4
2
-
15
Lanes Tissue holding
forceps
Vaginal Retractors
10
10
10
10
10
16
Polypectomy forceps
2
2
2
2
2
17
Sponge holder
10
15
20
10
7
18
Uterine elevator
1
1
1
1
1
19
CosCo Speculum
Small, Medium, Large
(for each category)
6
10
10
6
-
20
Examination light
3
3
6
3
1
21
Suction Curette
1
2
2
1
1
22
Infant Resuscitation
Trolley (with life saving
medicines, baby
laryngoscope, Endotracheal tube, Infant BP
Apparatus, Chargeable
Light)
Mother Resuscitation
Trolley (with life saving
medicines,
Laryngoscope, Endotracheal tube, BP
Apparatus, Chargeable
light)
1
1
2
1
1
1
1
2
1
1
24
Cardiac Monitor
1
1
2
1
-
25
Pump Breast Electronic
1
1
1
1
1
26
Vaginal Hysterectomy
Set
Toothed Tissue Forceps
(8”)
Non-Tooted Tissue
Forceps (8”)
Dissection Scissors
(Curved 7”)
Dissection Scissors
(Straight 7”)
2
2
4
2
2
2
2
4
2
-
2
2
4
2
-
2
2
4
2
-
2
2
4
2
-
23
26.1
26.2
26.3
26.4
Remarks
33
3YRP 2010-2013, District Nankana Sahib
Sr. No.
26.5
Equipment
Standard as
per MSDS
C (Qty.)
B
A
Available
Gap
8
8
16
8
6
8
8
16
8
6
26.7
Hysterectomy Clamps
(Straight)
Hysterectomy Clamps
(Curved)
Uterine Sound
2
2
4
2
1
26.8
Needle Holder (7”)
2
2
4
2
-
26.9
Needle Holder (10”)
2
2
4
2
2
26.10
16
16
32
16
-
16
16
32
16
-
26.12
Artery Forceps (Straight
6”)
Artery Forceps (Curved
6”)
Allis Forceps
8
8
16
8
-
26.13
Towel Clamps
8
8
16
8
-
26.14
4
4
8
4
4
4
4
8
4
4
26.16
Single blade Sims
speculum
Double blade Sims
speculum
Sponge holding forceps
8
8
16
8
8
26.17
Volselum forceps
4
4
8
4
4
26.18
Uterine Sound
2
2
4
2
2
26.19
Bladder Sound
2
2
4
2
2
27
Delivery Sets
10
10
15
10
4
27.1
Episiotomy Scissors
10
10
15
10
-
27.2
Straight Scissors
10
10
15
10
4
27.3
Needle holder
10
10
15
10
10
27.4
Non-toothed tissue
forceps 8 inches
Toothed tissue forceps 8
inches
Sims Speculum single
blade
10
10
15
10
10
10
10
15
10
10
20
20
30
20
20
26.6
26.11
26.15
27.5
27.6
Remarks
34
3YRP 2010-2013, District Nankana Sahib
Sr. No.
27.7
Equipment
Standard as
per MSDS
C (Qty.)
B
A
Available
Gap
20
20
30
20
20
27.8
Sims Speculum double
blade
Sponge holding forceps
40
40
60
40
40
27.9
Artery forceps
40
40
60
40
40
27.10
Straight clamps (cord)
20
20
30
20
20
27.11
Vacuum Extractor pump
1
1
1
1
-
27.12
Towel clip
40
40
60
40
40
Caesarian Section
6
8
10
6
3
28.1
Scalpel
6
8
10
6
-
28.2
Artery Forceps Straight 6 24
inches
Artery Forceps Curved 6 24
inches
Artery forceps 8 inches
24
32
40
24
24
32
40
24
24
32
40
24
24
6
8
10
6
6
6
8
10
6
6
24
32
40
24
16
6
8
10
6
6
28.9
Myoma Scissors straight
7 inches
Dissecting scissors
(curved) 7 inches
Green Armtage forceps 8
inches
Obstetric outlet forceps
(pair)
Doyene’s Retractor
6
8
10
6
3
28.10
Small Retractors
12
16
20
12
6
28.11
Towel Clippers
24
32
40
24
24
28.12
Suction Nozzle
6
8
10
6
4
29.1
MNCH Related
Radiology Equipments
Ultrasound Machine
1
2
3
1
-
29.2
X-Ray Unit 500 kw
1
1
1
1
-
28
28.3
28.4
28.5
28.6
28.7
28.8
29
Remarks
35
3YRP 2010-2013, District Nankana Sahib
Sr. No.
Equipment
Standard as
per MSDS
C (Qty.)
B
A
Available
Gap
29.3
Color Doppler
0
1
1
0
-
29.4
1
1
1
1
-
29.5
Lead Screen for X-Ray
Unit
0.5 MN Lead Apron. Lead
Gloves, Goggles and
Thyroid and Gonadal
Sheets
1
1
1
1
-
29.6
Safe Light
1
1
1
1
-
29.7
1
1
1
1
-
29.8
X-RT Film Processing
Tank
Chest Stand
1
1
1
1
-
29.9
X-Ray film Illuminator
2
2
2
2
-
29.10
X-Ray Film Hangers All
sizes
MNCH Related
Paediatrics
Equipments
4
4
4
4
-
30.1
Paediatric Ventilator
1
2
2
1
-
30.2
Incubator
1
1
2
1
-
30.3
Photo Therapy Unit
1
1
1
1
-
30.4
Over-head Radiant
Warmer
1
1
1
1
-
30.5
2
2
2
2
-
30.6
Infant Length Measuring
Scale
Infant Weighing Machine
2
2
2
2
-
30.7
Nebulizer
1
1
2
1
-
30.8
Billiubino-meter
1
1
2
1
-
30.9
Exchange Blood
Transfusion Set
Nasal Probe Paed size
1
1
2
1
-
2
2
4
2
-
30
30.10
31
31.1
Anaesthesia/ICU
Anaesthesia Machine
Remarks
1
1
2
1
-
36
3YRP 2010-2013, District Nankana Sahib
Sr. No.
Equipment
Standard as
per MSDS
C (Qty.)
B
A
Available
Gap
31.2
Ventilators
1
1
1
1
-
31.3
Nebulizer
1
1
1
1
-
31.4
Pulse Oximetry
1
1
1
1
-
31.5
Defibrillator
1
1
1
1
-
31.6
Airway Oral and Nasal
2
3
4
2
-
31.7
Tracheostomy tube
(adult and paeds)
2
2
4
2
-
31.8
Face mask of all sizes
2
2
4
2
-
31.9
Double Cuff Tourniquet
(for regional block)
1
2
2
1
-
31.10
AMBO bag adult
2
2
4
2
-
31.11
AMBO Bag paeds
2
2
4
2
-
31.12
Red Rubber Nasal tubes
all sizes without cuff
4
4
8
4
-
32
32.1
Blood Bank
Remarks
1
1
2
1
-
32.2
Blood storage cabinet
(100 bag capacity)
Packed cell machine
1
1
1
1
-
32.3
Cell Separator
1
1
1
1
-
32.4
1
1
1
1
-
32.5
Freezer for Fresh Frozen
Plasma
Blood bag shaker
1
1
2
1
-
32.6
RH view box
2
2
4
2
-
32.7
Water bath
2
2
2
2
-
32.8
Micro-pipette
4
6
8
4
-
32.9
Blood grouping tiles
3
3
6
3
-
37
3YRP 2010-2013, District Nankana Sahib
Sr. No.
Equipment
Standard as
per MSDS
C (Qty.)
B
A
Available
Gap
32.10
Plasma Extractor
1
1
1
1
-
32.11
Platelets agitator
1
1
1
1
-
32.12
Blood thawing bath
1
1
1
1
-
32.13
Microscopes
1
1
2
1
-
33
Remarks
Gynae & Labour Room
Related Laboratory
Equipment
33.1
Hematology Analyzer
1
1
1
1
-
33.2
Electrolyte Analyzer
1
1
1
1
-
33.3
1
1
1
1
-
33.4
Analyzer Bio-chemistry
Semi-automatic
Glucometer
2
2
2
2
-
33.5
Haemoglobino-meter
2
2
4
2
-
33.6
Centrifuge
1
1
2
1
-
38
3YRP 2010-2013, District Nankana Sahib
SECTION 3: INTERVENTIONS AND TARGETS
After enlisting the vital causes of prioritized health problems, team proposed appropriate interventions to tackle the problems. Once interventions
and activities had been identified, next task the planning team performed was to set the number and quality of specific activities (targets) that have to
be carried out. It is pertinent to mention over here that the plan envisages additional activities along with routine activities under regular budget.
Health Problems
Sr.
No.
1
Problem
Diarrhea
Causes
Intervention
Activities
Unit
Plan
Activities
Targets
Target for
2010-11
Target for
2011-12
Target for
2012-13
 Poor sanitation
 improvement of water supply
and sanitation
 Quarterly co-ordination
Meeting with TMA and
other agencies
Meeting
12
4
4
4
 Lack of safe drinking
water
 Health Education campaign
 Messages on local cable
network
Message
12
4
4
4
 Unhygienic practices
 Improving literacy through
coordination with education
department
 Printing and
distribution of IPC
material
Boucher
100,000
40,000
30,000
30,000
 Lack of awareness in
general population
 Proper treatment of Diarrhoea
including ORT
 Address in school
assemblies
Session
2,200
725
750
725
 Lack of awareness
among mothers about
feeding and weaning
practices
 Capacity building of health staff
in Integrated Management of
Childhood Illnesses (IMCI)
 Training of medics and
paramedics in IMCI
No. of
trainings
7
3
2
2
Remarks
39
3YRP 2010-2013, District Nankana Sahib
Sr.
No.
2
Problem
Anemia (
including
pregnancy)
Causes
Intervention
Activities
Unit
Plan
Activities
Targets
Target for
2010-11
Target for
2011-12
Target for
2012-13
 Low Socio Economic
status
 Procurement and
distribution of ORS
ORS packets
150,000
50,000
50,000
50,000
 Malnutrition
 Procurement and
distribution of Syp. Zink
Sulphate
Syrup
100,000
50,000
30,000
20,000
 Procurement and
Distribution of Syrup
Metronidazole
Syrup
100,000
50,000
30,000
20,000
36
12
12
12
100,000
40,000
30,000
30,000
-
-
-
100,000
35,000
35,000
30,000
-
-
-
-
37
37
-
-
 Lack of awareness
about balanced diet
 Awareness raising for behavior
change
 Messages on local cable
network
Message
 Gender discrimination
 Awareness raising for behavior
change
 Printing and
distribution of IPC
material
Boucher
 Social taboos and
norms
 Awareness raising for behavior
change
 Counseling of pregnant
mothers
Session
 Worm infestation
 De-worming campaign
 Procurement of deworming tablets
No. of doses
 Infections
 Diagnosis and treatment of
infections
 Distribution through
LHWs and health
facilities
 · Poor quality of MNCH
services
 Strengthening MNCH Services
 ·Refresher Trainings of
LHWs on BCC, balanced
diet and provision of
micro-nutrients
No. of
trainings
Remarks
40
3YRP 2010-2013, District Nankana Sahib
Sr.
No.
3
Problem
Acute (upper)
respiratory
infections
Causes
Intervention
Activities
Unit
Plan
Activities
Targets
Target for
2010-11
Target for
2011-12
Target for
2012-13
36
12
12
12
-
-
-
-
100000
40000
30000
30000
 Poverty/ Low socio
economic status
 Equity of services
 Provision of Sehat
Suhlat Card/health
voucher
Message
 Malnutrition
 Capacity building of health staff
in ARI case management
 Messages on local cable
networks
Message
 Air contamination
 Capacity building of health staff
in Integrated Management of
Childhood Illnesses (IMCI)
 Messages through FM
radio channels
 Over-crowding/Poor
housing facilities
 Provision of medicines for ARI
 Printing and
distribution of IPC
material
Boucher
 Lack of proper
sanitation
 Timely referral of complicated
cases
 Training of medics and
para-medics in IMCI
No. of
trainings
-
-
-
-
 Procurement of drugs
Antibiotic
(Syrup)
90000
30000
30000
30000
Message
36
12
12
12
Boucher
50000
20000
20000
10000
 Seasonal variation
Remarks
 Lack of awareness and
hygienic practices
4
TB Suspects
 Low socio-economic
status
 Health education/promotion
 Messages on local cable
networks
 Seasonal variation
 Strengthening TB DOTS program
through involvement of private
sector
 Printing and
distribution of IPC
material
41
3YRP 2010-2013, District Nankana Sahib
Sr.
No.
Problem
Causes
 Lack of proper
sanitation
Intervention
 Involvement of Private
Practitioners through Public
Private Partnership(PPP)
 Lack of awareness and
hygienic practices
Activities
 Procurement of drugs to
ensure deficiency
according to regimen
 Procurement of
reagents for notified
diagnostic facilities
under DOTS programme
 Trainings on DOTS
protocols
5
Hepatitis
 Poor sanitation
 Provision of safe drinking water
 Quarterly co-ordination
meetings with TMA and
other agencies
 Unsafe drinking water
 Health Education/Promotion
 Messages on local cable
network
 Sharing of used
syringes
 Campaign against quackery
 Printing and
distribution of IPC
material
 Transfusion of unsafe
blood and blood
products
 Strengthening blood transfusion
services for safe transfusions
 Address in School
Assemblies
 Unsafe sexual practices
 Campaign against drug addiction
 Hepatitis awareness
week ( walk/display
banners/seminars)
Plan
Activities
Targets
Target for
2010-11
Target for
2011-12
Target for
2012-13
ATT course
600
200
200
200
Packs
50
20
15
15
No. of
trainings
4
4
-
-
-
-
-
-
Message
36
12
12
12
Boucher
60000
30000
15000
15000
-
-
-
-
3
1
1
1
Unit
Remarks
Meetings
-
42
3YRP 2010-2013, District Nankana Sahib
Sr.
No.
Problem
Causes
 Ear piercing and
tattooing
 Use of unsterilized
equipment by dentists
and barbers
Plan
Activities
Targets
Target for
2010-11
Target for
2011-12
Target for
2012-13
500
200
150
150
Kits
30000
10000
10000
10000
Kits
30000
10000
10000
10000
Kits
30000
10000
10000
10000
 Procurement and supply
of HCV Eliza kits
Kits
18
6
6
6
 Procurement and supply
of HBV Eliza kits
Kits
9
3
3
3
Syringe
cutter
1800
600
600
600
Courses
1200
400
400
400
Intervention
Activities
 Regulatory mechanism to ensure
use of safe instruments by
dentists, barbers etc.
 Printing and pasting of
stickers at clinics and
Barber shop
highlighting use of new
syringes & Razors
 Procurement &
Distribution of HCV
Device
 Procurement &
Distribution of BSAG
Device
 Procurement &
Distribution of HIV
Device
 Procurement of syringe
cutters
 Procurement and
distribution of
Interferon Injection
Unit
Sticker
Remarks
43
3YRP 2010-2013, District Nankana Sahib
Sr.
No.
Problem
Causes
Intervention
Activities
Unit
Plan
Activities
Targets
Target for
2010-11
Target for
2011-12
Target for
2012-13
Remarks
 Documentation of
expense of disposable
syringes
 Procurement &
Distribution of SGPT
Kits
36
12
12
12
 Procurement &
Distribution of SGOT
Kits
36
12
12
12
Meeting
12
4
4
4
Meeting
12
4
4
4
Prepared by
EDOH
1
1
 Documentation of
expense of disposable
syringes
 Supportive Supervision
to ensure above
activities
6
Accident &
Injuries
 Lack of traffic sense
 Coordination with police
department to improve traffic
sense and ensuring observance of
traffic rules
 Quarterly co-ordination
meetings with Traffic
Police department
 Poor maintenance of
vehicles
 Advocacy for improving the
condition of roads
 Quarterly co-ordination
meetings with Highway
department
 Poor road conditions
 Health education/promotion to
prevent domestic accidents
 Preparation of Disaster
Management Plan
including the Patient
Management protocols
44
3YRP 2010-2013, District Nankana Sahib
Sr.
No.
Problem
Causes
 Lack of safety measures
at work place
Intervention
 Ensure enforcement of safety
laws at work places
Activities
Unit
 Training of the medics
and the paramedics
 Fire-arm injuries
 Provision of emergency
kits for blast victims
 Domestic accidents
 Procurement of
equipments /
instruments / various
splints and Plaster casts
Kits
Plan
Activities
Targets
Target for
2010-11
Target for
2011-12
Target for
2012-13
-
-
-
-
300
150
150
-
36
12
12
12
100000
50000
30000
20000
-
-
-
-
Remarks
 Burns
 Bomb blasts/terrorist
activities
 Lack of tolerance in the
society
7
High MMR
 Poor access to
healthcare delivery
services
 Health education/promotion
 Messages on local cable
network
 Lack of awareness
about danger signs of
pregnancy
 Behaviour change
communication for Mothers of
child bearing age
 Printing and
distribution of IPC
material
 Low ante-natal
coverage
 Provision of Quality basic
EmONC services at BHU & RHC
 Training of LHWs on
BCC
Message
Boucher
45
3YRP 2010-2013, District Nankana Sahib
Sr.
No.
Problem
Causes
 Low skilled birth
attendance
 Three delays (seeking
health care,
transportation, and
lack of referral back-up
services)
 Capacity Issues related
to maternal care
 Maternal Anemia
 Capacity Issues related
to maternal care
Intervention
Activities
 Provision of Quality
Comprehensive EmONC services
at THQs & DHQs hospital
 Activate and use of
Health Committees and
women groups under
LHWs
 Improving transportation of the
patients
 Procurement of vehicles
for transportation
through CCBs
 Operation and
management of vehicles
through CCBs
 Repair of non functional
ambulances for timely
transportation of
pregnant mothers
 Replacement of the non
functional ambulances
for timely
transportation of
pregnant mother
 Procurement of the
MNCH related
equipment and
Instruments
Unit
Plan
Activities
Targets
Target for
2010-11
Target for
2011-12
Target for
2012-13
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Remarks
 Implementation of the
referrals protocols
46
3YRP 2010-2013, District Nankana Sahib
Sr.
No.
8
Problem
High under
Five Mortality
Causes
Intervention
Activities
Unit
 Procurement of Micronutrients
Capsule
 Procurement and
distribution of Calci-D
No. of tablets
 Procurement and
distribution of Anti-D
Injection
 Poor antenatal natal
and post natal services
 Health awareness/education
 Message on local cable
Message
 Poor access and quality
of health care services
 Capacity building of Human
Resource dealing child health
care
 BCC for mothers
through LHWs
Boucher
 Lack of birth spacing
 Strengthening infrastructure as
per MNCH standards
 Trainings on IMCI
No. of
trainings
 Provision of food supplements
 Need assessment of
food supplements
 Lack of capacity of staff
for provision of proper
child health care
(diagnostic and timely
referrals)
 Infections
 Improvement of feeding and
weaning practices
 procurement from
DGHs office
Plan
Activities
Targets
Target for
2010-11
Target for
2011-12
Target for
2012-13
200000
100000
50000
50000
150000
50000
50000
50000
30
10
10
10
36
12
12
12
100,000
50,000
30,000
20,000
-
-
-
-
-
-
-
-
-
-
-
-
Remarks
Assessment
47
3YRP 2010-2013, District Nankana Sahib
Sr.
No.
Problem
Causes
 Malnutrition
 Poor feeding and
weaning practices
 Low socio economic
status
Intervention
 Poverty elevation
 Enhancing EPI coverage
Activities
Unit
 Distribution of food
supplements to mothers
& children through
LHWs & community mid
wives
Plan
 Raising income of the
poor families through
Baitul Mall and Zakat
Plan
 Revising the micro plans
of Vaccinators
Plan
Plan
Activities
Targets
Target for
2010-11
Target for
2011-12
Target for
2012-13
-
-
-
-
-
-
-
-
-
-
-
-
Remarks
48
3YRP 2010-2013, District Nankana Sahib
Management Problems
Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned Posts
Physical Targets
Sr.No.
Name of Post
Basic
Scale
Basic
Pay
Allowances
Requirement
as per Gap
Year Year
I
II
1
Gynaecologist
18
12,910
18,099
2
1
1
-
2
Paediatricians
18
12,910
18,099
1
1
-
-
3
Anesthetists
18
12,910
18,099
0
-
-
-
4
MO / WMO
17
9,850
15,345
80
30
25
25
5
Nurses
16
6,060
8,934
37
15
11
11
6
Lady Health
Visitors
9
3,820
4,750
8
3
3
2
Year
III
49
3YRP 2010-2013, District Nankana Sahib
Sr.
No
1
Problem
Shortage of
skilled staff
Causes
Intervention
 Vacant positions
 Filling of the vacant posts
 Non-availability of staff
according to MSDS
 Incentivized pay package at all levels
 Lack of permanent
postings
 Well defined career structure including
opportunities for higher education
 Lack of incentivized and
differential pay package
 Conducive working environment
 Frequent transfer postings
 Provision of staff in accordance with
MSDS
 Job insecurity
 Lack of basic amenities at
workplace
 High level political commitment for
providing protection to staff working
in health facilities
Activities
 Filling of the vacant posts
of medics and the
paramedics through
existing recruitment
committees
 Temporary filling of
vacant positions on
contract
Unit
Plan Activities
Targets
Target
for
2010-11
Target
for
2011-12
Target
for
2012-13
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Remarks
50
3YRP 2010-2013, District Nankana Sahib
Sr.
No
Problem
Causes
Intervention
Activities
 Lack of conducive
environment including
insecurity and transport of
children for education
Unit
Plan Activities
Targets
Target
for
2010-11
Target
for
2011-12
Target
for
2012-13
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Remarks
 Political interference
 Lack of supportive
supervision
 Deficient transparent
accountability
2
Capacity
issues of
Managemen
t and
Technical
staff
 Late transfer of funds from
provincial finance
department to the districts
 Advocacy for keeping health
department on higher priority
 Pursuance of EDO ( F&P)
for timely release of
funds
 Lack of capacity in
financial management at
the district level
 Pursuance to the competent authority
for timely release of funds
 Financial Management
workshops
No. of
trainings
1
1
 Less priority of districts
for health services
 Capacity building of DDOs and other
related staff in financial management
 Training on Use of
Information
No. of
trainings
1
1
51
3YRP 2010-2013, District Nankana Sahib
Sr.
No
Problem
Causes
Intervention
Activities
 Training on Supportive
supervision
3
Inadequate
budget for
POL
 Installation of the
Generator for back up
electricity supply
 Rational increase in POL Budget
 Frequent increase in
prices of POL
Unit
No. of
trainings
Plan Activities
Targets
Target
for
2010-11
1
1
57,643
57,643
Target
for
2011-12
Target
for
2012-13
Remarks
 Assessing additional need
for POL
 Costing & Submit ion the
additional Demand for
POL
POL
 Purchase of MNCH
related equipment at
DHQ Hospital
Sheikhupura
Equipment
 Less allocation for POL
budget
 Increase in Vehicles
4
Deficient
equipment
(with
reference to
notified list)
at all levels
of care
 Deficient equipment to
cater basic and
comprehensive EmONC at
primary and secondary
level of care
 Make up the deficiencies against
standards specified in MSDS
52
3YRP 2010-2013, District Nankana Sahib
SECTION 4: COSTING AND FINANCING PLAN
Activity based costing
The planning team has used the best available data sources, for calculation of estimates for
the intervention/activities. It is pertinent to mention that the costing of the plan is based on
additional needs and activities. The detailed activity based costing of the Health and
Service Delivery problems has been performed on automated Excel sheets, which are
hyperlinked as H and M sheets with the plan . A moderate estimate of equipment cost has
been taken, as there is wide variation between the minimum and maximum cost. The
detailed cost of MNCH related equipment has been annexed as Annex II. The summary of
problem and activity wise costing is given below.
53
3YRP 2010-2013, District Nankana Sahib
Problem wise costing summary of Health Problems
Sr. No.
Problem
FYI
Amount
(Rs.)
FY II
Amount
(Rs.)
FY III
Amount
(Rs.)
Total Cost
Rs.
1
Diarrheal Diseases
3,385,200
2,456,080
2,132,988
7,974,268
2
Anemia ( including in pregnancy)
1,588,480
1,232,000
1,234,200
4,054,680
3
ARI (under 5)
1,080,000
1,122,000
1,234,200
3,436,200
4
Suspected Tuberculosis
425,600
396,000
363,000
1,184,600
5
Hepatitis
7,822,000
8,337,450
9,171,195
25,330,645
6
Road side accident & Injuries
854,650
940,115
19,360
1,814,125
7
High maternal mortality
840,000
682,000
677,600
2,199,600
8
High under five mortality
540,000
462,000
435,600
1,437,600
16,535,930
15,627,645
15,268,143
47,431,718
Total
54
3YRP 2010-2013, District Nankana Sahib
a) Health Problems
Define
Sr.
Problem
Unit
1
Diarrhea
Financial Targets
Activity
Rate
Quantity
Year I
Year II
(10 %)
Total
Year III
(10 %)
Cost
 Quarterly coordination Meeting
with TMA and other
agencies
Meeting
2,000
12
8,000
8,800
9,680
26,480
 Messages on local
cable network
Message
20,000
12
80,000
88,000
96,800
264,800
 Printing and
distribution of IPC
material
Broacher
6
100,000
240,000
198,000
217,800
655,800
 Address in school
assemblies
Sessions
2,200
-
-
-
-
 Training of medics and
paramedics in IMCI
No. of
Trainings
152,400
7
457,200
335,280
368,808
1,161,288
 Procurement and
distribution of ORS
ORS Packets
5
150,000
250,000
275,000
302,500
827,500
55
3YRP 2010-2013, District Nankana Sahib
Define
Sr.
Problem
Activity
Unit
2
Anemia (
including
pregnancy)
Financial Targets
Rate
Quantity
Year I
Year II
(10 %)
Total
Year III
(10 %)
Cost
 Procurement and
distribution of Syp.
Zink Sulphate
Syrup
35
100,000
1,750,000
1,155,000
847,000
3,752,000
 Procurement and
Distribution of Syrup
Metronidazole
Syrup
12
100,000
600,000
396,000
290,400
1,286,400
3,385,200
2,456,080
2,132,988
7,974,268
 Messages on local
cable network
Message
20,000
36
240,000
264,000
290,400
794,400
 Printing and
distribution of IPC
material
Boucher
6
100,000
240,000
198,000
217,800
655,800
 Counseling of pregnant
mothers
Session
LHWs are expected to
conduct counseling
session on behavior
change during their visit
to pregnant ladies
-
-
-
-
 Procurement of deworming tablets
No. of doses
700,000
770,000
726,000
2,196,000
-
-
-
-
 Distribution through
LHWs and health
facilities
20
plan
100,000
56
3YRP 2010-2013, District Nankana Sahib
Define
Sr.
Problem
Financial Targets
Activity
Unit
 Refresher Trainings of
LHWs on BCC,
balanced diet and
provision of micronutrients
No. of trainings
Total
Rate
Quantity
Year I
Year II
(10 %)
Year III
(10 %)
Cost
11,040
37
408,480
-
-
408,480
1,588,480
1,232,000
1,234,200
4,054,680
 Provision of Sehat
Suhlat Card/health
voucher
3
Acute (upper)
respiratory
infections
 Messages on local
cable networks
Message
 Messages through FM
radio channels
 Printing and
distribution of IPC
material
Boucher
 Training of medics and
para-medics in IMCI
No. of trainings
 Procurement of drugs
Antibiotic
(Syrup)
20,000
36
240,000
264,000
290,400
794,400
-
-
-
-
-
-
6
100000
240,000
198,000
217,800
655,800
IMCI Training package
costed in Diarrhoea also
includes management of
ARI
-
-
-
-
-
20
90000
600,000
660,000
726,000
1,986,000
57
3YRP 2010-2013, District Nankana Sahib
Define
Sr.
Problem
Activity
Unit
4
5
TB Suspects
Hepatitis
Financial Targets
Rate
Quantity
Total
Year I
Year II
(10 %)
Year III
(10 %)
Cost
1,080,000
1,122,000
1,234,200
3,436,200
 Messages on local
cable networks
Message
20,000
36
240,000
264,000
290,400
794,400
 Printing and
distribution of IPC
material
Boucher
6
50000
120,000
132,000
72,600
324,600
 Procurement of drugs
to ensure deficiency
according to regimen
ATT course
To be procured from
the PTP
600
-
-
-
-
 Procurement of
reagents for notified
diagnostic facilities
under DOTS
programme
Packs
To be procured from
the PTP
50
-
-
-
-
 Trainings on DOTS
protocols
No. of trainings
4
65,600
-
-
65,600
425,600
396,000
363,000
1,184,600
-
-
-
-
 Quarterly coordination meetings
with TMA and other
agencies
Meetings
16400
Costed in diarrhoeal
disease
0
58
3YRP 2010-2013, District Nankana Sahib
Define
Sr.
Problem
Financial Targets
Activity
Unit
Rate
Quantity
Year I
Year II
(10 %)
Total
Year III
(10 %)
Cost
 Messages on local
cable network
Message
20000
36
240,000
264,000
290,400
794,400
 Printing and
distribution of IPC
material
Boucher
6
60000
180,000
99,000
108,900
387,900
-
-
-
-
3
150,000
-
-
150,000
 Address in School
Assemblies
Proposed activity for
School H&N Supervisor
 Hepatitis awareness
week ( walk/display
banners/seminars)
Lump sum
 Printing and pasting
of stickers at clinics
and Barber shop
highlighting use of
new syringes &
Razors
Sticker
50
500
10,000
8,250
9,075
27,325
 Procurement &
Distribution of HCV
devices
Kits
30
30000
300000
330,000
363,000
993,000
 Procurement &
Distribution of BSAG
Devices
Kits
30
30000
300000
330,000
363,000
993,000
59
3YRP 2010-2013, District Nankana Sahib
Define
Sr.
Problem
Financial Targets
Activity
Unit
Rate
Quantity
Year I
Year II
(10 %)
Total
Year III
(10 %)
Cost
 Procurement &
Distribution of HIV
Devices
Kits
30
30000
300000
330,000
363,000
993,000
 Procurement and
supply of HCV Eliza
kits
Kits
10000
18
60,000
66,000
72,600
198,600
 Procurement and
supply of HBV Eliza
kits
Kits
8000
9
24000
26,400
29,040
79,440
 Procurement of
syringe cutters
Syringe cutter
150
1800
90,000
99,000
108,900
297,900
 Procurement and
distribution of
Interferon Injection
Courses
15000
1200
6,000,000
6,600,000
7,260,000
19,860,000
-
-
-
 Documentation of
expense of
disposable syringes
 Procurement &
Distribution of SGPT
Kits
7000
36
84,000
92,400
101,640
278,040
 Procurement &
Distribution of SGOT
Kits
7000
36
84000
92,400
101,640
278,040
60
3YRP 2010-2013, District Nankana Sahib
Define
Sr.
Problem
Financial Targets
Activity
Unit
Rate
Quantity
Total
Year I
Year II
(10 %)
Year III
(10 %)
Cost
7,822,000
8,337,450
9,171,195
25,330,645
 Documentation of
expense of
disposable syringes
 Supportive
supervision to
ensure above
activities
6
Accident &
Injuries
 Quarterly coordination meetings
with Traffic Police
department
Meeting
2,000
12
8,000
8,800
9,680
26,480
 Quarterly coordination meetings
with Highway
department
Meeting
2,000
12
8,000
8,800
9,680
26,480
 Preparation of Disaster
Management Plan
including the Patient
Management protocols
Prepared by
EDOH
-
-
-
-
-
-
-
-
 Training of the medics
and the paramedics
1
-
61
3YRP 2010-2013, District Nankana Sahib
Define
Sr.
Problem
Financial Targets
Activity
Unit
 Provision of
emergency kits for
blast victims
Kits
Total
Rate
Quantity
Year I
Year II
(10 %)
Year III
(10 %)
Cost
5591
300
838,650
922,515
-
1,761,165
854,650
940,115
19,360
1,814,125
 Procurement of
equipments /
instruments / various
splints and Plaster
casts
7
High MMR
 Messages on local
cable network
Message
20,000
36
240,000
264,000
290,400
794,400
 Printing and
distribution of IPC
material
Boucher
6
100000
300,000
198,000
145,200
643,200
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
 Training of LHWs on
BCC
As proposed in Anemia
 Activate and use of
Health Committees and
women groups under
LHWs
Costed in service
delivery problems
 Procurement of
vehicles for
transportation through
CCBs
Costed in service
delivery problems
62
3YRP 2010-2013, District Nankana Sahib
Define
Sr.
Problem
Financial Targets
Activity
Unit
Rate
 Operation and
management of
vehicles through CCBs
Costed in service
delivery problems
 Repair of non
functional ambulances
for timely
transportation of
pregnant mothers
Costed in service
delivery problems
 Replacement of the
non functional
ambulances for timely
transportation of
pregnant mother
Costed in service
delivery problems
 Procurement of the
MNCH related
equipment and
Instruments
Costed in service
delivery problems
 Implementation of the
referrals protocols
Worked on EDOH
Total
Quantity
Year I
Year II
(10 %)
Year III
(10 %)
Cost
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
 Procurement of Micronutrients
Capsule
2
200000
200,000
110,000
121,000
431,000
 Procurement and
distribution of Calci-D
No. of tablets
1
150000
50,000
55,000
60,500
165,500
 Procurement and
distribution of Anti-D
Injection
5000
30
50,000
55,000
60,500
165,500
63
3YRP 2010-2013, District Nankana Sahib
Define
Sr.
Problem
Activity
Unit
8
High under
Five Mortality
Financial Targets
Rate
Quantity
Total
Year I
Year II
(10 %)
Year III
(10 %)
Cost
840,000
682,000
677,600
2,199,600
 Message on local cable
Message
20,000
36
240,000
264,000
290,400
794,400
 BCC for mothers
through LHWs
Boucher
6
100,000
300,000
198,000
145,200
643,200
 Trainings on IMCI
No. of trainings
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
462,000
435,600
 Need assessment of
food supplements
As proposed in
Diarrhoea
Assessment
 procurement from
DGHs office
 Distribution of food
supplements to
mothers & children
through LHWs &
community mid wives
Plan
 Raising income of the
poor families through
Baitul Mall and Zakat
Plan
 Revising the micro
plans of Vaccinators
Plan
540,000
1,437,600
64
3YRP 2010-2013, District Nankana Sahib
Problem wise costing summary of Management Problems
Sr. No.
Problems
2010-2011
2011-2012
2012-2013
Amount
(Rs.)
Amount
(Rs.)
Amount
(Rs.)
12,821,856
25,344,211
39,668,132
77,834,199
4,323,225
-
-
4,323,225
Total Cost Rs.
1
Human Resource Plan (Sanction
of Posts against MSDS Gaps)
2
POL
3
Capacity Issues of the Staff
102,600
-
-
102,600
4
MNCH Related Equipment
11,436,535
-
-
11,436,535
28,684,216 25,344,211
39,668,132
93,696,559
Total
65
3YRP 2010-2013, District Nankana Sahib
b) Management Problems
Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned
Financial Targets
Sr.No.
Name of Post
Basic
Scale
Basic
Pay
Allowances
Year I
Requirement
as per Gap
Year II
1
Gynaecologist
18
12,910
18,099
2
154,920
Pay of
other
staff
-
2
Paediatricians
18
12,910
18,099
1
154,920
-
217,188
170,412
238,907
187,453
262,797
3
Anesthetists
18
12,910
18,099
0
-
-
-
-
-
-
-
4
MO / WMO
17
9,850
15,345
80
3,546,000
-
5,524,200
7,151,100
11,140,470
11,441,760
17,824,752
5
Nurses
16
6,060
8,934
37
1,090,800
-
1,608,120
2,079,792
3,066,149
3,255,674
4,799,702
6
Lady Health
Visitors
9
3,820
4,750
8
137,520
171,000
137,520
7,737,696
Pay of
Officers
4,946,640
Allowances
Pay of
Officers
217,188
Pay of
other
staff
Year III
Pay of
other
staff
Allowances
Pay of
Officers
340,824
477,814
374,906
525,595
9,742,128
302,544
376,200
302,544
15,299,539
15,703,525
Allowances
443,731
551,760
413,820
23,964,607
66
3YRP 2010-2013, District Nankana Sahib
Define
Sr.
1
Problem
Activity
 Filling of the vacant posts of
medics and the paramedics
through existing recruitment
committees
Shortage of
skilled staff
Capacity
issues of
Managemen
t and
Technical
staff
Rate
Quantity
Year I
Year II
(10 %)
Year III
(10 %)
-
-
-
-
-
-
-
-
-
-
-
-
39000
1
39,000
-
-
39,000
31800
1
31,800
-
-
-
-
-
-
 Financial Management
workshops


Total
Cost
Unit
 Temporary filling of vacant
positions on contract
2
Financial Targets
Trainings on Use of
Information
No. of trainings
Training on Supportive
supervision
No. of trainings
31800
1
31,800
31,800
102,600
31,800
102,600
67
3YRP 2010-2013, District Nankana Sahib
Define
Sr.
Problem
Total
Activity
Unit
3
Inadequate
budget for
POL
Financial Targets
Rate
Quantity
 Assessing additional need
for POL
 Costing & Submission the
additional Demand for POL
POL
75
57,643
Year I
Year II
(10 %)
Year III
(10 %)
-
-
-
4,323,225
4,323,225
4
Deficient
equipment
(with
reference to
notified list)
at THQHs
and DHQH

Purchase of MNCH related
equipment at DHQ Hospital
Nankana Sahib
Cost
4,323,225
-
-
-
-
4,323,225
Equipment
Detail Annexed
21,813,280
-
-
21,813,280
Equipment
Detail Annexed
25,319,780
-
-
25,319,780
47,133,060
-
-
47,133,060
68
3YRP 2010-2013, District Nankana Sahib
Financial Outlay
The costing of the plan includes routine recurring budget with 15% price escalation for
subsequent years and additional cost involved on the basis of health and management
problems; which is essentially required to bring visible improvement in the health system.
Other financial resources expected from provincial level through ADP and PMDGP are also part
of this plan. Details of the financial estimates for three years rolling plan are attached as
Annex-III. Overall financial outlay of the plan is as under:
Budget Summary
2010-2011
Regular budget
Proposed additional
budget
Total
2011-2012
2012-2013
373,252,898
468,212,713
538,444,620
45,220,146
40,971,856
54,936,275
418,473,044
509,184,569
593,380,895
69
3YRP 2010-2013, District Nankana Sahib
SECTION 5: MONITORING & EVALUATION
The monitoring and evaluation targets and indicators mentioned below will be used to gauge
the progress of implementation of the plan. Monitoring and evaluation of the three years
rolling plan would be carried out through the proposed indicators, targets and means of
verifications, by the district health authorities.
M&E of Plan
Indicators
% of planned
supervisory
visits
conducted
% of RHCs with
availability of
services (on
rotational
basis) of
essential
specialties
(Physician,
Surgeon,
Pediatrician
and
Gynaecologist)
% of health
facilities with
availability of
essential
MNCH related
equipment
(level specific)
Availability of
relevant
(MNCH)
laboratory
equipment at
appropriate
level of care
% facilities
with
availability of
essential
medicines
Target
50 visits
/year
%
Achievement
MoV
Responsibility
Frequency
of
monitoring
Inspection
EDOH/DOH/
Book/Attendance DDOH/Dist.
register
Monitoring
officer
Movement
EDOH / DOH
register/visit
book/Attendance
register
Quarterly
100%
During 1st
year
Stock Register
EDOH/
DOH/ MSs
6
monthly
100%
During 1st
year
Stock Register
EDOH/
DOH/MSs,
Store keeper
Quarterly
100%
During 1st
year
Stock Register
EDOH/
DOH/ MSs,
Store keeper
Monthly
100%
During 1st
year
Remarks
Quarterly
70
3YRP 2010-2013, District Nankana Sahib
Indicators
% of functional
ambulances in
the district
% utilization of
sanctioned
budget
% of facilities
with
availability of
basic EmONC
% of DHQ/THQ
hospitals with
Comprehensive
EmONC
services
% of facilities
with
availability of
separate or
partitioned
room reserved
exclusively for
delivery
% of targeted
pregnant
women newly
registered by
LHW
% of targeted
pregnant
women
received TT-2
vaccine
Delivery
conducted by
or under
supervision of
skilled persons
reported
%of target
children
between 18 23 months of
age fully
immunized
Target
%
Achievement
MoV
Responsibility
Frequency
of
monitoring
100%
(DHQH/
THQH/
RHCs)
100% of
yearly
budget
Log Book
EDOH/DOH/
Transport
officer
Quarterly
Quarterly
Reports
Quarterly
100%
(50%
during 1st
year)
100% in 3
years
(50%
during 1st
year)
100% in 3
years
(50%
during 1st
year)
Supervisory visit
report
EDOH/
DOH/ MSs/
Accounts
officer
EDOH/DoH/
DDOH
Supervisory visit
report
EDOH/DoH/
DDOH
Quarterly
Supervisory visit
report
EDOH/DoH/
DDOH
Quarterly
Target
according
to
population
DHIS Report
EDOH/
Statistical
Officer
Quarterly
Target
according
to
population
DHIS Report
EDOH/ DHIS Quarterly
Coordinator/
Statistical
Officer
60 %
During 1st
year
DHIS Report
EDOH/ DHIS Quarterly
Coordinator/
Statistical
Officer
Target
according
to
population
DHIS Report
EDOH/ DHIS Quarterly
Coordinator/
Statistical
Officer
Remarks
Quarterly
71
3YRP 2010-2013, District Nankana Sahib
Indicators
Target
%
Achievement
MoV
% of referred
cases attended
100%
DHIS Report/
LHWs monthly
report
% of targeted
eligible couples
provided
knowledge and
information on
Family
Planning
methods
No. of meetings
with
participation
from other
sectors
Target
according
to
population
LHW’s monthly/
quarterly report
12
meetings
per year
Minutes of
meetings
Responsibility
Frequency
of
monitoring
Remarks
EDOH/ DHIS Quarterly
Coordinator/
Statistical
Officer
EDOH/
Quarterly
Statistical
Officer
/Coordinator
NP-FP&PHC
EDOH/ Focal
person/s
Quarterly
72
3YRP 2010-2013, District Nankana Sahib
Private Health Facilities in District Nankana Sahib
Annex -I
___________________________________________________________________________________________________________
TEHSIL NANKANA SAHIB.
SR. NO.
NAME OF DOCTOR
ADDRESS
QUALIFICATION
1.
Dr. Muhammad Naeem
Warburton
M.B.B.S
2.
Dr. Abdul Ghaffar Khan
Warburton
M.B.B.S
3.
Dr. Shabbir
United Hospital Warburton
M.B.B.S,MPH,MHM,
4.
Dr. Usman
United Hospital Warburton
M.B.B.S,DMRD,FRCR,
5.
Dr. Sakina Malik
United Hospital Warburton
M.B.B.S,MCPS,
6.
Dr. Ashiq
United Hospital Warburton
M.B.B.S,DOMS,MS,
7.
Dr. Babar Shehzad
Guru Bazar Nankana Sahib.
M.B.B.S
8.
Dr. Sheikh Shoukat Ali
Guru Bazar Nankana Sahib.
M.B.B.S
9.
Dr. Manzoor Awais
Guru Bazar Nankana Sahib.
M.B.B.S
10.
Dr. Azhar Naeem
Guru Bazar Nankana Sahib.
M.B.B.S,DCH,
11.
Dr. Iqbal Hussain Wattoo
Guru Bazar Nankana Sahib.
M.B.B.S,MPH,MMCH,
12.
Dr. Allia Ejaz
Guru Bazar Nankana Sahib.
M.B.B.S
13.
Dr. Razia Afzal
Guru Bazar Nankana Sahib.
M.B.B.S
14.
Dr. Afzal
Guru Bazar Nankana Sahib.
M.B.B.S
15.
Dr. Muhammad Yaqoob
Syedwala
M.B.B.S
16.
Dr. Riaz Ali Ch.
Syedwala
M.B.B.S
17.
Dr. Abdul Majeed
Syedwala
M.B.B.S
18.
Dr. Abdul Qadoos
Syedwala
M.B.B.S
19.
Dr. Muhammad Afzal
Bara Garh
M.B.B.S
20.
Dr. Manzoor
Bucheki
M.B.B.S
21.
Dr. Talat Iqbal
Bucheki
M.B.B.S
22.
Dr. Syed Yousaf
Bucheki
M.B.B.S
23.
Dr. Azhar Amin
Bucheki
M.B.B.S
24.
Dr. Sarwar Ahmad
More Khunda
M.B.B.S
25.
Dr. Usman
More Khunda
M.B.B.S
73
3YRP 2010-2013, District Nankana Sahib
SR. NO.
NAME OF DOCTOR
ADDRESS
QUALIFICATION
26.
Dr. Javed
More Khunda
M.B.B.S
27.
Dr. Khalid Nadeem
More Khunda
M.B.B.S
28.
Dr. Ateeq
More Khunda
M.B.B.S
29.
Dr. Asif
More Khunda
M.B.B.S,MPH,
30.
Dr. Abdur Razzaq
Head Baloki More Khunda
M.B.B.S
31.
Dr. Shoukat Ali
Mandi Faizabad
M.B.B.S
32.
Dr. Anayat Ali
Mandi Faizabad
M.B.B.S
33.
Dr.Ijaz Mahmood
Nankana Sahib.
M.B.B.S,F.C.P.S
TEHSIL SAFDARABAD.
SR. NO.
NAME OF DOCTOR
ADDRESS
QUALIFICATION
1.
Dr. Muhammad Ali Shamim
Safdarabad
M.B.B.S
2.
Dr. Ahmad Saddain Bin Khalid
Safdarabad
M.B.B.S
3.
Dr. Nasir Mehmood
Safdarabad
Surgeon, M.B.B.S
4.
Dr. Ibrahim
Safdarabad
M.B.B.S
5.
Dr. Sami-ul-Allah
Safdarabad
M.B.B.S
6.
Dr. Abdul Razzaq
Safdarabad
M.B.B.S
7.
Dr. M Saeed Akhtar
Safdarabad
M.B.B.S
8.
Dr. Asif Mehmood Ch.
Safdarabad
M.B.B.S
9.
Dr. Ghafar Alam
Safdarabad
M.B.B.S
10.
Dr. Muhammad Fayyaz
Safdarabad
M.B.B.S
TEHSIL SHAHKOT.
SR. NO.
NAME OF DOCTOR
ADDRESS
QUALIFICATION
1.
Dr. Rabia
Manawala
M.B.B.S
2.
Dr. Imtiaz Hussain Gill
Manawala
M.B.B.S
3.
Dr. Asif
Manawala
M.B.B.S
4.
Dr. Muhammad Nawaz
Manawala
M.B.B.S
5.
Dr. Islam Din Khambo
Manawala
M.B.B.S
6.
Dr. Khalid
Manawala
M.B.B.S
74
3YRP 2010-2013, District Nankana Sahib
SR. NO.
NAME OF DOCTOR
ADDRESS
QUALIFICATION
7.
Dr. Iftikhar Ch.
Manawala
M.B.B.S
8.
Dr. Rashid
Shahkot
M.B.B.S
9.
Dr. Ashraf
Shahkot
M.B.B.S
10.
Dr. Uzma
Shahkot
M.B.B.S
11.
Dr. Tariq
Shahkot
M.B.B.S
12.
Dr. Dastgir
Shahkot
M.B.B.S
13.
Dr. Farhat
Shahkot
M.B.B.S
14.
Dr. Ashraf
Shahkot
M.B.B.S
15.
Dr. Yasmeen
Shahkot
M.B.B.S
16.
Dr. Shahid Latif
Shahkot
M.B.B.S
17.
Dr. Mustafa
Shahkot
M.B.B.S
18.
Dr. Shamshad
Shahkot
M.B.B.S
19.
Dr. Wajeer Ali
Shahkot
M.B.B.S
20.
Capt. Dr. Mushtaq
Shahkot
M.B.B.S
21.
Dr. Gazanfar Ali
Shahkot
M.B.B.S
22.
Dr. Naveed Mazhar
Shahkot
M.B.B.S
23.
Dr. M Khalid Saleemi
Shahkot
M.B.B.S
24.
Dr. Shakeel Ahmad
Shahkot
M.B.B.S
NAME OF DOCTOR
ADDRESS
QUALIFICATION
1.
Dr. Imtiaz Ahmad
Sangla Hill
M.B.B.S
2.
Cpt. Dr. Khalid Saleem
Sangla Hill
M.B.B.S
3.
Dr. Abdul Ghafar
Sangla Hill
M.B.B.S
4.
Dr. Zahoor Ahmad
Sangla Hill
M.B.B.S
5.
Dr. Muzaffar
Sangla Hill
M.B.B.S
6.
Dr. Shahid Fahad
Sangla Hill
M.B.B.S
TEHSIL SANGLA HILL
SR. NO.
75
3YRP 2010-2013, District Nankana Sahib
Annex II
Costing of MNCH related equipment gaps for DHQ and THQ Hospitals
DHQ Hospital Nankana Sahib
Sr. No.
Equipment
Gap
Unit cost
Total
cost(Rs.)
7
Fetal Stethoscope
3
15,000
45,000
9
D&C Set
1
2,100
2,100
11
Myoma Screw
1
320
320
15
Vaginal Retractors
10
350
3,500
16
Polypectomy forceps
2
750
1,500
17
Sponge holder
7
300
2,100
18
Uterine elevator
1
150
150
20
Examination light
1
18,000
18,000
21
Suction Curette
1
95
95
22
Infant Resuscitation Trolley (with life saving medicines,
baby laryngoscope, Endo-tracheal tube, Infant BP
Apparatus, Chargeable Light)
1
95,000
95,000
23
Mother Resuscitation Trolley (with life saving medicines,
Laryngoscope, Endo-tracheal tube, BP Apparatus,
Chargeable light)
1
110,000
110,000
25
Pump Breast Electronic
1
250,000
250,000
26.5
Hysterectomy Clamps (Straight)
6
150
900
26.6
Hysterectomy Clamps (Curved)
6
175
1,050
26.7
Uterine Sound
1
90
90
26.9
Needle Holder (10”)
2
300
600
26.14
Single blade Sims speculum
4
275
1,100
26.15
Double blade Sims speculum
4
250
1,000
26.16
Sponge holding forceps
8
200
1,600
26.17
Volselum forceps
4
250
1,000
26.18
Uterine Sound
2
1,500
3,000
26.19
Bladder Sound
2
1,500
3,000
27.2
Straight Scissors
4
360
1,440
27.3
Needle holder
10
135
1,350
27.4
Non-toothed tissue forceps 8 inches
10
100
1,000
27.5
Toothed tissue forceps 8 inches
10
100
1,000
27.6
Sims Speculum single blade
20
275
5,500
76
3YRP 2010-2013, District Nankana Sahib
Sr. No.
Equipment
Gap
Unit cost
Total
cost(Rs.)
27.7
Sims Speculum double blade
20
250
5,000
27.8
Sponge holding forceps
40
250
10,000
27.9
Artery forceps
40
275
11,000
27.1
Straight clamps (cord)
20
175
3,500
27.12
Towel clip
40
125
5,000
28.2
Artery Forceps Straight 6 inches
24
125
3,000
28.3
Artery Forceps Curved 6 inches
24
125
3,000
28.4
Artery forceps 8 inches
24
175
4,200
28.5
Myoma Scissors straight 7 inches
6
150
900
28.6
Dissecting scissors (curved) 7 inches
6
270
1,620
28.7
Green Armtage forceps 8 inches
16
300
4,800
28.8
Obstetric outlet forceps (pair)
6
900
5,400
28.9
Doyene’s Retractor
3
200
600
28.1
Small Retractors
6
300
1,800
28.11
Towel Clippers
24
125
3,000
28.12
Suction Nozzle
4
250
1,000
30.1
Paediatric Ventilator
1
1,200,000
1,200,000
30.9
Exchange Blood Transfusion Set
1
2,000
2,000
31.9
Double Cuff Tourniquet (for regional block)
1
320
320
32.2
Packed cell machine
1
600,000
600,000
32.3
Cell Separator
1
5,225,000
5,225,000
32.4
Freezer for Fresh Frozen Plasma
1
1,150,000
1,150,000
32.5
Blood bag shaker
1
10,000
10,000
32.7
Water bath
2
3,000
6,000
32.1
Plasma Extractor
1
1,000,000
1,000,000
32.11
Platelets agitator
1
1,000,000
1,000,000
32.12
Blood thawing bath
1
3,000
3,000
33.2
Electrolyte Analyzer
1
625,000
625,000
Total cost of equipment
11,436,535
77