THREE YEARS ROLLING PLAN
2010-2013
DISTRICT RAHIM YAR KHAN
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Table of Contents
Acronyms ............................................................................................................................................................. 4
Executive Summary............................................................................................................................................ 5
SECTION 1: DISTRICT HEALTH PROFILE......................................................................................................... 7
Vision and Mission of the District ..................................................................................................................... 7
Background of the District ................................................................................................................................. 7
Map of the District .............................................................................................................................................. 8
Demography ....................................................................................................................................................... 8
Socio-Economic Indicators .............................................................................................................................. 10
Health Indicators .............................................................................................................................................. 10
Organizational Structure of District Health Administration ......................................................................... 11
Health Resources .............................................................................................................................................. 13
1.
Health Facilities .................................................................................................................................... 13
a.
Public ................................................................................................................................................. 13
b.
Private ............................................................................................................................................... 14
2.
Human Resource .................................................................................................................................. 14
a)
Administrative ................................................................................................................................... 15
b)
Facility Based .................................................................................................................................... 16
c)
Outreach ............................................................................................................................................ 20
d)
Training Institutions ......................................................................................................................... 21
Health Financing............................................................................................................................................... 23
Disease Pattern ................................................................................................................................................. 24
Status of Vertical Programs ............................................................................................................................. 26
1.
National Program for FP & PHC .......................................................................................................... 26
2.
EPI.......................................................................................................................................................... 26
3.
MNCH Program ..................................................................................................................................... 26
4.
TB Control Program ............................................................................................................................. 26
5.
Malaria Control Program ..................................................................................................................... 27
6.
Hepatitis Control Program................................................................................................................... 27
7.
School Health Services Program ......................................................................................................... 27
SECTION 2: PROBLEM ANALYSIS ................................................................................................................... 28
2
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Objectives .......................................................................................................................................................... 28
Plan Development Process .............................................................................................................................. 29
Problem Identification ..................................................................................................................................... 29
Health Problems ............................................................................................................................................... 30
Problem Prioritization ................................................................................................................................. 30
Underlying causes of prioritized problems ................................................................................................ 32
Service delivery/Management problems ....................................................................................................... 34
MDGs and MSDS ............................................................................................................................................... 35
a)
Human Resource .................................................................................................................................. 35
i.
b)
THQ Hospital ..................................................................................................................................... 36
Equipment............................................................................................................................................. 36
i.
Composite List of Gaps of All THQ Hospitals – .................................................................................. 37
SECTION 3: INTERVENTIONS AND TARGETS ............................................................................................... 46
Health Problems ............................................................................................................................................... 47
Management Problems .................................................................................................................................... 61
Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned Posts ............................ 61
SECTION 4: COSTING AND FINANCING PLAN ............................................................................................... 67
Activity based costing ...................................................................................................................................... 67
Problem wise Cost Summary of Health Problems ............................................................................................. 67
a)
Health Problems ................................................................................................................................... 68
Problem wise cost summary of Management Problems ................................................................................... 82
b)
Management Problems ........................................................................................................................ 83
Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned Posts ............................ 83
Financial Outlay ................................................................................................................................................ 88
Budget Summary............................................................................................................................................ 88
SECTION 5: MONITORING & EVALUATION ................................................................................................... 89
M&E of Plan....................................................................................................................................................... 89
Annex-I .............................................................................................................................................................. 92
Annex II ............................................................................................................................................................ 103
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Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Acronyms
3YRP
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 Unit
Burden of Diseases
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
Expanded 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 Rahim Yar Khan
Executive Summary
Prior to devolution, planning process was carried out at provincial level. Districts were supposed to
implement plans and programs developed/designed at provincial and federal levels. Devolution
brought a paradigm shift where planning became a district responsibility. This change provided an
opportunity to the district at one hand and challenge on other due to their limited capacity in planning
and budgeting. Planning focus also changed from short term to medium term planning recognizing the
flexibility /adaptability it provided. Government envisions that medium term plan i.e. 3YRP will be
instrumental in using health resources effectively and efficiently through adapting Minimum Service
Delivery Standards (MSDS) as the strategy to achieve objectives of MDGs.
Districts have been preparing 3YRP (medium term plan) for last few years under the
auspices/patronage of Department of Health (DoH) Government of Punjab through technical assistance
of Punjab Devolved Program Social Services Programme (PDSSP). This year government of the Punjab
through Health Sector Reforms Program (HSRP) with technical assistance from a team of consultants
(SP09) and wide consultations/inputs from all key stake holders has established a bench mark in
standardization of the format of 3YRP. Capacity building of the districts has been done on the
standardized format.
Current 3 Years Rolling Plan (3YRP) plan is the first attempt by the district on that agreed format.
Section One of the format (District Health Profile) contains all relevant information on Geography,
Demographic, Socioeconomic and Health indicators of the district. It also takes stock of health resources
in terms of human resource, infrastructure and others. District diseases pattern compiled from DHIS
Primary and Secondary Health Care reports and current status of vertical /national programs is part of
the profile. In fact district profile is a health related fact sheet of the district and depicts the true picture
of health status and health resources/services of the district. An accurate district health profile provides
a sound basis for evidence-based planning.
3YRP plan has been developed by following the standard planning cycle approach. 3YRP details the
current year activities, physical targets and fiscal targets. Projections of second and third year physical
and financial targets are given.
Section Two includes problems identification from various
perspectives, and their prioritization by applying WHO prioritization criteria. This section also contains
underlying causes of the prioritized problems. Section Three of the plan relates to developing best
possible interventions/activities and setting physical targets for each year. Section Four consists of
5
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
costing based on additional requirements taking account of implementation of current status of
activities. Best available estimates have been used to accurately cost the activities. The detailed activity
based costing of the Health and Service Delivery problems has been developed on automated Excel
sheets, and annexed for details as ready reference. Last section or Section Five of the 3YRP consists of
Monitoring and Evaluation of plan to gauge the progress of different activities and targets of the plan
using reliable district data sources. This permits timely remedial action for smooth implementation of
planned activities.
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Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
DISTRICT RAHIM YAR KHAN
SECTION 1: DISTRICT HEALTH PROFILE
Vision and Mission of the District
The District Health Government has been providing promotive, preventive and curative services
through a net work of health institutions. At present curative services are being adequately utilized by
the population of the District, whereas in preventive programmes achievement of Department has been
80% of the targets.
Background of the District
District Rahim Yar Khan is one of the largest districts of southern Punjab, consisting of four subdivisions (Tehsils) i.e. Sadiqabad, Rahim Yar khan, Khanpur and Liaqatpur. The river Indus separates
Rahim Yar Khan from Muzafargarh, Rajanpur, Kashmore & Ghotki districts. The climate is usually hot
and dry.
River Hakra, which used to flow in the district centuries ago eventually dried up, transforming one third
area of the district into desert (Cholistan). The climatic conditions of the district are favorable for
cotton, wheat, sugarcane, mango, orange, lemon, dates and many other abundant crops and fruits.
An airport facility in Rahim Yar Khan links it with other parts of the country. Three FM radio channels
provide amusement, entertainment and information by bringing together a mix of Saraiki and Punjabi
culture. City zoo, sports arenas and parks for families are the recreational spots of the district. The
famous Bhong Mosque is also a major tourist attraction.
Most of the population resides in the rural area, making it an agrarian society, while the socioeconomic
conditions are poor. The high mortality and morbidity indicators like IMR, MMR and Growth rate are
distinctive of the society.
A network of educational institutions like, Islamia University, Sheikh Zayed Medical College, Govt.
Technical College, Degree College for Boys & Girls, Sheikh Zayed Public School, Govt. Army Public
College & School, Bahria Public College & School, Beacon House School system and Al-Huda Grammar
7
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
School are providing education to the youth and children of the society. A central library named as the
Allama Iqbal Library is a home to precious and unique books.
Map of the District
3
Demography
o
Total Population
4578538
o
Total Area
11880 sq.km
o
Annual Growth Rate
3.2%
o
Population Density
385/square KM
8
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Area-wise population
Area
Population
Percentage
Rural
3754402
82%
Urban
824136
18%
Standard Demographic population groups based on DHIS
Gender-wise population
Gender
Population
Percentage
Male
2197696
48%
Female
2380842
52%
Standard Demographic population groups based on DHIS
Population groups
Standard
Demographic (%)
Estimated Population
2010
Under 1 year of age
2.7
123621
Under 5 years
13.4
613524
Under 15 years
44
2014557
22
1007278
16
732566
3.4
155670
Population Groups
Women in child bearing
age
(15-49 years)
Married child bearing age
women
Expected pregnancies
Standard Demographic population groups based on DHIS
9
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Tehsil wise distribution
Tehsil
Number Of UC
Population
Khanpur
28
995728
Liaqatpur
25
1005625
Rahim Yar Khan
40
1444531
Sadiqabad
29
1132654
Ethnic groups and languages
The main ethnic groups and spoken languages in the district are Punjabi and Saraiki.
Socio-Economic Indicators
Education and Literacy
Literacy rate*
Male
Female
Urban
75.6%
62.6%
Rural
51.3%
24.4%
Executive District Officer Literacy and Non formal education RYK

Per capita income
100,000/Annum

Water and Sanitation
Urban (community supply)
Rural (hands pumps)
Health Indicators

Infant Mortality Rate
98/1000 live births

Under 5 mortality Rate
148/1000 live births

Maternal mortality Ratio
103/100,000 live births*

Malnutrition (women and children)
1-Under weight Prevalence (moderate and severe) =39%
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Three Years Rolling Plan 2010-2013 District Rahim Yar Khan

2-Stunting Prevalence (moderate and severe)
44%
3-Wasting Prevalence (moderate and severe)
13%
Life expectancy
64
Sources: MICS 2007-08 and EDOH Office Rahim Yar Khan
Organizational Structure of District Health Administration
There exists a three-tier system in the health sector in the country. At federal level, Federal Secretary of
Health is responsible to administer and supervise the health related activities and programs. Major
function of federal tier is to provide policy guidelines and ensure quality of health care standards
through federal legislation. After the 18th amendment in the constitution, and announcement of
National Finance Award, most of the existing federal level programs will be transferred to the
provincial level. At provincial level, provincial Secretary of Health along with Director General Health
Services is responsible for managing and supervising health care services. The district is still an
administrative entity in the system and EDO (Health) acts as head of the district health department,
under overall supervision of DCO. The organizational structure at district level is as under:
11
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Provincial Health
Department
District
Government
RYK
Shiekh Zayed Medical
College / hospital (DHQ) is
autonomous
District Coordination Officer
Rahimyarkhan
Executive District Officer
Health
Rahimyarkhan
District Health Officer
Rahimyarkhan
M.S
THQ:
Hospital
04 Deputy District
Officers (Health)
N.P C oordinator
Network of L HS & L HW
M.O
04 Blood
Bank
District
Officer
(MNC H)
Drug
Inspectors
(04) one at
Tehsil
E PI C oordinator
122-Field teams
DS I
S anitation Branch
Director
DHDC
S .M.O
19 RHC :
TB Dots
C oordinato
r
C DC Officer
District Officer
Health -III
M.O 104
BHU
Under
PRS P
AIHC
M.O
02 T.B C linic
12
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Health Resources
1. Health Facilities
a. Public
Details of physical infrastructure of public health facilities in the district is given in the table below
Facility type
Name of facility
Bed
Strength
No. of
Functional
Beds
Remarks
DHQH is a
Teaching Hospital
Sheikh Zayed Hospital Rahim Yar
Khan
741
741
Not under the
administrative
control of EDOH
Eye Hospital
Tehsil Khanpur
30
30
THQ Hospital
THQ Hospital Sadiqabad
60
60
THQ Hospital Khanpur
80
80
THQ Hospital Liaqat Pur
60
60
19 RHCs
344
344
208
208
-
-
RHCs
5 in Tehsil Sadiqabad
4 in Tehsil Khanpur
RHC Feroza, RHC
Pacca Larran and
RHC Sehja have 8
beds each.
5 in Tehsil Liaqat pur
5 in Tehsil Rahim Yar Khan
BHUs
104 BHUs
24 in Tehsil Sadiqabad
22 in Tehsil Khanpur
28 in Tehsil Liaqat pur
30 in Tehsil Rahim Yar Khan
Governmental
Rural
Dispensaries
56 Rural Dispensaries
-
13 in Tehsil Sadiqabad
15 in Tehsil Khanpur
13
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
12 in Tehsil Liaqat pur
16 in Tehsil Rahim Yar Khan
MCH Centers
8 MCH centers
16
16
As per
DHO/SO RYK
2 T.B Clinics
4
4
-
1 in Tehsil Sadiqabad
2
2
1 in Tehsil Khanpur
2
2
2 in Tehsil Sadiqabad
1 in Tehsil Khanpur
0 in Tehsil Liaqat pur
5 in Tehsil Rahim Yar Khan
T.B Clinics
Health Houses
1851 LHW
Source: DHIS/EDOH office
b. Private
The district has provided a list of private service providers including hospitals, clinics,
laboratories and maternity homes. These private providers are used for providing support in
preventive programs like Polio and other EPI activities. With the passage of time, role of private
providers will expand, and there is a need to develop an effective coordination between public
and private sector. Detailed list of private sector health facilities is attached as Annex-I.
2. Human Resource
The Human resource of district health department has been placed in following categories:
a)
Administrative
b)
Facility based
c)
Outreach
d)
Training institutions
14
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
a) Administrative
Sr.
Name of Post/Designation
Sanctioned
Filled
No.
1
Executive District Officer Health
1
1
2
District Officer Health
1
1
3
Deputy District Officer Health
4
4
4
Program Director DHDC
1
1
5
District Coordinator National Program
0
1
6
District Coordinator EPI Surveillance
0
1
7
District Sanitary Inspector
1
0
8
CDC Officer
1
0
9
CDC Inspector
4
2
10
Drug Inspector
9
9
11
District Superintendent Vaccination
1
1
12
Assistant Superintendent Vaccination
4
4
13
Tehsil Sanitary Inspector
4
4
14
Inspector Vaccination
4
2
15
Senior Microscopist
1
0
16
Assistant Entomologist
1
1
17
MREO
0
0
18
AIHC
1
1
15
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
b) Facility Based
i.
Basic Health Units (104)
Sr.
Name of Post/Designation
No.
ii.
Sanctioned
Filled
Vacant
84
1
Medical Officer
104
20
2
School Health & Nutrition
Supervisor
104
92
3
Medical Assistant
16
14
02
4
Computer Operator
104
0
104
5
Medical Technician
90
54
36
6
LHV
104
32
72
7
Dispenser
104
73
31
8
Midwife/Dias
208
42
166
9
N/Qasid
104
67
37
10
Chowkidar
104
70
34
11
Sanitary Worker
104
55
49
Sanctioned
Filled
Vacant
12
Rural Health Centers (19)
Sr. No.
Name of Post/ Designation
1.
Senior Medical Officer
19
18
can
1
2.
Medical Officer
19
17
2
3.
WMO
19
09
10
4.
Dental Surgeon
19
13
6
5.
Charge Nurses
114
29
85
6.
Computer Operator
19
4
15
7.
Medical/ Health Technician
0
0
0
16
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr. No.
Name of Post/ Designation
Sanctioned
Filled
Vacant
8.
Senior Clerk
19
18
can
1
9.
Lady Health Visitor
38
30
8
10.
Lab: Technician
19
7
12
11.
Dental Technician / Assistant
19
12
7
12.
Rural Health Inspector
0
0
0
13.
Junior Clerk
7
7
0
14.
Vaccinator
12
12
0
15.
Dispenser
57
57
0
16.
Dresser
19
17
2
17.
Operation Theatre Assistant
19
8
11
18.
Anesthesia Assistant
19
1
18
19.
X-ray Assistant / Radiographer
19
19
0
20.
CDC Supervisor
0
0
0
21.
Lab: Assistant
19
9
10
22.
Driver
23
18
5
23.
Mid-wife
76
29
47
24.
O.T. Attendant
0
0
0
25.
Tube-well Operator
19
16
3
26.
Ward Servant
41
39
2
27.
Sanitary Petrol
76
64
12
28.
Sanitary Worker
73
45
28
29.
Naib Qasid
49
39
10
17
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr. No.
Name of Post/ Designation
Sanctioned
Filled
Vacant
30.
Mali
19
16
can
3
31.
Cook
14
8
6
32.
Chowkidar
36
24
12
33.
Water Carrier
19
18
1
34.
Homeo Doctor
3
1
2
35.
Hakim
2
2
0
36.
Homeo Dispenser
3
3
0
37.
Dawasaz
2
2
0
38.
Dental Assistant
19
12
7
39.
Dawakob
2
2
0
40.
Bearer
0
0
0
41.
Gate Keeper
0
0
0
iii.
THQ Hospitals (3)
Sr. No.
Name of Post/ Designation
Sanctioned
Filled
Vacant
1.
Medical Superintendent
3
2
1
2.
APMO
6
2
4
3.
Senior Medical Officer
12
0
12
4.
Surgeon
3
2
1
5.
Peadiatrician
3
1
2
6.
Anesthetist
4
2
2
7.
Eye Specialist
3
1
2
8.
Dental Surgeon
3
3
0
9.
Medical Officer
32
29
3
18
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr. No.
Name of Post/ Designation
Sanctioned
Filled
Vacant
10.
WMO
14
8
6
11.
Senior Consultant
5
1
4
12.
APWMO's
3
0
3
13.
Physician
3
0
3
14.
Gynecologist
3
1
2
15.
ENT Specialist
3
0
3
16.
Radiologist
4
0
4
17.
Pathologist
5
1
4
18.
Orthopedic Surgeon
1
0
1
19.
Dental Technician / Assistant
3
2
1
20.
Junior Clerk
3
2
1
21.
Radiographer
6
6
0
22.
Homeopathic Dispenser
3
3
0
23.
LHV
3
3
0
24.
Dispenser / Dresser
25
25
0
25.
Store Keeper
3
3
0
26.
Operation Theatre Assistant
4
4
0
27.
Dawasaz
3
3
0
28.
Laboratory Assistant
7
5
2
29.
Driver
6
5
1
30.
Midwife
1
0
1
31.
Tube-well operator
3
3
0
32.
Water Carrier
4
1
3
33.
Ward Servant
28
20
8
19
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr. No.
Name of Post/ Designation
Sanctioned
Filled
Vacant
34.
Bearer
6
4
2
35.
Sanitary Worker
35
24
11
36.
Naib Qasid
8
6
2
37.
Masalchi
3
2
1
38.
Mali
3
3
0
39.
Gate Keeper
3
2
1
40.
Dhobi
3
3
0
41.
Dawakob
3
3
0
42.
Dai
7
5
2
43.
Cook
6
5
1
44.
Chowkidar
9
9
0
45.
Baildar
6
5
1
c) Outreach
This information is about outreach program workers such as Vaccinators, CDC Supervisors and
Sanitary Inspectors which are not part of above mentioned health facilities.
Post
Sanctioned
Filled
Vaccinators
128
128
CDC Supervisor
88
69
Sanitary Inspector
2
0
20
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
d) Training Institutions
A number of training institutions are working in the district, which include the following:
Type of institute
Number
DHDC
1
General Nursing school
1
i.
DHDC
Post
Sanctioned
Filled
Programme Director
1
1
MPPT
1
1
LHV Trainer
1
0
Assistant
1
1
Driver
1
1
Naib Qasid
1
1
Chowkidar
2
2
Sanitary Worker
1
1
Sanctioned
Filled
Principal School of Nursing
1
1
Nursing Instructor
2
1
Clinical Instructor
2
0
House Keeper
1
1
Head Clerk
1
0
Stenographer
1
1
Accountant
1
1
ii.
General Nursing School
Name of Post/Designation
21
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Name of Post/Designation
Sanctioned
Filled
Senior Clerk
1
1
Junior Clerk
1
1
Driver
1
1
Sweeper
1
1
Naib Qasid
2
2
Chowkidar/Gate Keeper
0
0
Cook
1
1
Masalchi
0
0
22
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Health Financing
The provision of financial resources at district level is prime responsibility of district government.
However, keeping in view the budget constraints at the district level, federal and provincial
governments also augment financial resources in form of kind and cash, through different programs.
Financial resources of the district during the last three years out of different sources are given as under:
Rs. Million
Year
Source of funding
2007-08
2008-09
2009-10 up to 03/2010
Allocation
Exp.
Allocation
Exp.
Allocation
Exp.
390.5035
373.786
500.293
387.114
557.458
278.852
0
0
0
0
0
0
390.5035
373.786
500.293
387.114
557.458
278.852
PHSRP
----
----
23.00
0
23.00
0
PMDGP
---
---
155.670
0
155.670
1.7462
PDSSP
32.545
9.595
25.295
0
5.22
13.248
Provincial Development
Funds (ADP)
2.274
0
2.274
1.0026
33.517
0
Grand Total
815.826
757.167
1206.825
775.230 6
1332.323
572.698
User charges (like parchi
fee, fees for diagnostic
services)
3.627
386.476
1214309
392.696
787.973
297.646
Non-Development
Development
Sub Total
23
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Disease Pattern
The disease pattern is determined through regular and periodic reporting through surveys and studies.
Punjab health department has adopted DHIS as regular reporting mechanism to collect information on
diseases and other variables. Currently, DHIS is in transitional stage, and is establishing itself as a tool
to be used for evidence based planning and management. The following trend of the diseases has been
taken from the consolidated DHIS reports that include reports from PHC and SHC facilities.
Sr. No.
Disease Group
Respiratory Diseases
1
Acute (upper) respiratory infections
2
3
4
5
Pneumonia < 5 yrs.
Pneumonia > 5 yrs.
TB Suspects
Chronic Obstructive Pulmonary Disease
6
Asthma
Gastro Intestinal Diseases
7
Diarrhea / Dysentery < 5 yrs
8
Diarrhea / Dysentery > 5 yrs
9
Enteric / Typhoid Fever
10
Worm Infestations
11
Peptic Ulcer Disease
12
Cirrhosis of Liver
Urinary Tract Disease
13
Urinary Tract Infections
14
Nephritis / Nephrosis
15
Sexually Transmitted Infections
16
Benign Enlargement of Prostrate
Other Communicable Diseases
17
Suspected Malaria
18
Suspected Meningitis
19
Fever due to other causes
Vaccine Preventable Diseases
20
Suspected Measles
21
Suspected Viral Hepatitis
22
Suspected Neonatal Tetanus
Cardiovascular Diseases
23
Ischemic heart disease
24
Hypertension
Skin Diseases
% age
30.11%
1.15%
1.00%
1.48%
1.49%
4.03%
5.19%
5.42%
0.92%
1.87%
4.32%
0.10%
2.42%
0.18%
0.06%
0.09%
3.75%
0.08%
8.20%
0.10%
0.27%
0.01%
0.09%
2.57%
24
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr. No.
Disease Group
25
Scabies
26
Dermatitis
27
Cutaneous Leishmaniasis
Endocrine Diseases
28
Diabetes Mellitus
Neuro-Psychiatric Diseases
29
Depression
30
Drug Dependence
31
Epilepsy
Eye & ENT
32
Cataract
33
Trachoma
34
Glaucoma
35
Otitis Media
Oral Diseases
36
Dental Caries
Injuries/Poisoning
37
Road traffic accidents
38
Fractures
39
Burns
40
Dog bite
41
Snake bite (with signs/symptoms of poisoning)
Miscellaneous Diseases
42
Acute Flaccid Paralysis
43
Suspected HIV/AIDS
44
Any other Unusual disease (specify)
Grand Total
Source: Compiled from PHC and SHC DHIS Reports
% age
8.63%
3.62%
0.39%
3.02%
1.16%
0.09%
0.04%
0.21%
0.22%
0.11%
2.45%
2.68%
1.63%
0.16%
0.27%
0.25%
0.03%
0.00%
0.14%
100.00%
25
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Status of Vertical Programs
The following paragraphs depict the current status of the program being implemented in the district.
The indicators and their values have been taken from the respective program reports.
1. National Program for FP & PHC




No. of seats allocated for LHWs
No. of LHWs working
Percentage of Population covered by the program
Important program indicators
o IMR
o MMR
o CPR
o No. of antenatal visits
o TT Coverage of pregnant women
2062
1851
47%
98/1000
103/100,000
38.4 %
2516=83%in February 2010
87%
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
15643

Availability of cold chain equipment
Health Facilities of the District.
Cold Chain is available in all
109%
3.53%(0- 11months)
3.4% (12-23months)
3. MNCH Program



WMO (MNCH)
LHV(MNCH)
CMW
10
16
Under training 84 Deployed 30
4. TB Control Program

CDR all types
70%

CDR NSS Positive
70%

SCR
89%

TSR
93%
26
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan

DR
3%
5. Malaria Control Program




No. of slides examined
No. of positive slides(Plasmodium Vivax)
Slides positively ratio
Percentage of plasmodium Falciparum
6.
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
27276
15
0.001
Nil
3840
763
3654
186
577
7. 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 students referred from BHUs to higher facilities
No. of schools in catchment areas
No. of students
No. of SH & NS
No. of teachers trained
57
1145
422
422
Nil
57
11330
90
27
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
SECTION 2: PROBLEM ANALYSIS
The Health sector in Punjab is facing enormous health and service delivery problems. Common health
problems are communicable, non communicable and MNCH related diseases as well as accidents/
trauma. The society is passing through demographic and epidemiological transition. This is due to
changing life style, urbanization, ecological and other factors. Disease pattern is changing where non
communicable diseases are gradually increasing and the communicable diseases are still posing serious
threat. Punjab is practically facing Double Burden of Disease (BOD). Besides, health problems service
delivery/ managerial issues are also hindering the access and quality of health services to the
population. The service delivery/management problems are diverse in nature, and include shortage of
technical human resource, capacity issues, lack of infrastructure and equipment.
Devolution was introduced during 2001 affecting the administrative and financial set up of the districts.
The devolution also brought political culture in the decision making of the districts in the shape of
Nazims, Naib-Nazims and Councilors. This system is now in the phase of reshaping and it is not clear
what will be future structure and managerial shape when new local bodies system is put in place. The
District Manager and functionaries are in the state of uncertainty and confusion in this scenario.
However, one thing is clear that the district shall remain a hub of all primary and secondary health
services delivery. Despite the source of funding in the future, either from provincial or district
government, health planning at district level shall continue to play a pivotal role in provision of quality
health services.
In view of the above situation the district considers following objectives for developing three year
rolling plan.
Objectives

Improve health status of the population

Meeting the requirements of national and provincial health policies

Achievement of MDGs through MSDS

Introducing evidence-based planning culture by addressing district specific problems/issues

Addressing emerging health needs or re-emergence of health problems (e.g. H1N1, HIV-AIDS,
Polio, T.B)
28
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan

Ensuring effective inter-sectoral coordination with a view to improving health indicators
The objectives would guide in problem analysis, designing interventions, setting /phasing the
targets, costing and monitoring the plan activities.
Plan Development Process
Plan development has been a systematic and consultative process. A core planning team consisting of
EDO (H), DOH, MS DHQ and THQs, Statistical officer, and Budget and Accounts Officer, was designated
by Director General Health Services Punjab. This team received three days customized training from SP09 team at divisional headquarters. The main components of the trainings were: (i) developing a threeyear rolling health sector plan using the standard three year rolling plan format; (ii) costing of the plan;
(iii) preparing related budget projections; (iv) accounting procedures; (v) preparing adequate financial
reports on the use of funds.
The district planning team adopted the following steps for the preparation of three years rolling plan:

Problem identification

Prioritization of identified problems

Identifying underlying causes of prioritized problems

Developing interventions and activities

Setting targets

Determining resource requirements, costing and budgeting

Preparing action plans

Preparing monitoring plan
Problem Identification
This step involved assessment of the current situation from various perspectives to establish the actual
health situation in terms of health and service delivery/management problems. Problem identification
is based on the district health profile, review of previous plans, MIS (DHIS, Program reports and
periodic reports etc.), District specific surveys (MICS), MSDS, and national and provincial policy
guidelines.
The district planning team held meetings and started with identification of problem using the training
received from SP-09 team and consulting the above mentioned documents. The problems identified
were broadly divided into two categories i.e.
29
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
a) Health Problems
b) Health Service Delivery or Management Problems
Health Problems
The district specific health problems identification process started during the three years rolling
plans workshop. The planning team in the initial stage prepared a long list of the health problems.
The identification of health problems was based on various information sources including DHIS,
and district specific reports. The enlisted health problems of the district are given in the following
table.
1. Acute respiratory tract
infections (ARI)
4. Anemia
2. Diarrheal Diseases
3. Hepatitis
5. Scabies
6. Enteric Fever
7. Pulmonary Tuberculosis
8. Worm infestation
9. Road side accident & injuries
10. Diabetes Mellitus
12. High Maternal Mortality rate
13. Arthritis
11. High under 5
Mortality rate
14. Cataract
16. Hypertension
17. Dental Caries
15. Suspected Malaria
Problem Prioritization
WHO has developed standard criteria for prioritization of health problems; which is based on the
following five elements:





Magnitude
Severity/danger
Vulnerability to intervention (feasibility)
Cost-effectiveness of the intervention
Political expediency
Each element has been assigned a score from 1 to 4 depending upon grade/scale of that element i.e.
Very High=4, High=3, Medium=2 and Low=1.
Elements of the prioritization criteria were applied to each of the enlisted health problems. The
aggregate of individual scores assigned to the elements of the prioritization criteria gave the total score
for a health problem. This total score was then used to prioritize the health problems. A cut-off point of
was decided, to establish the priority health problems of the district. These problems will be addressed
in the three years rolling plan.
30
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Problem
Magnitude
Severity
Vulnerability
to
Intervention
Cost
Effectiveness
Political
Expediency
Total
Score
Priority
Number
Diarrheal
Diseases
4
3
4
4
1
16
1
ARI (under 5)
3
3
3
3
1
13
7
Hepatitis
3
4
3
2
3
15
2
Pulmonary
Tuberculosis
3
3
3
2
2
13
6
Anemia (
including in
pregnancy)
4
2
2
3
2
13
8
Scabies
2
1
3
3
1
10
13
Enteric Fever
3
2
2
2
1
10
14
High maternal
mortality
2
3
3
3
3
14
4
High under five
mortality
3
3
3
2
3
14
3
Accidents &
Injuries
2
2
2
2
2
10
15
Diabetes Mellitus
3
3
3
3
2
14
5
Worm infestation
3
2
3
3
1
12
10
Dental Caries
3
2
3
1
1
10
11
STI
2
1
3
2
2
10
12
Cataract
2
3
4
3
1
13
9
Suspected
Malaria
1
2
2
2
1
8
17
Hypertension
2
2
2
2
1
9
16
31
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Underlying causes of prioritized problems
Health problems have their underlying causes. It is important to know the underlying causes of the
health problems so that appropriate interventions are developed. There may be a long list of these
causes but only few of them are vital ones; and rectifying these causes can resolve the problem to a
large extent. Following table gives common causes of the prioritized health problems pertaining to the
district.
Sr.
No.
Health Problem
1
Diarrheal Diseases
2
Hepatitis
3
High under 5
Mortality
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
Poor sanitation
Unsafe drinking water
Sharing of used syringes
Transfusion of unsafe blood and blood products
Unsafe sexual practices
Ear & Nose piercing and tattooing
Use of unsterilized equipment by dentists and
barbers
Poor antenatal natal and post natal coverage
Neo-natal Infections
Birth Trauma & Asphyxia
Prematurity
Poor feeding and weaning practices
Diarrhea
ARI
Lack of capacity of staff for provision of proper
child health care (diagnostic and timely referrals)
Low socio economic status
Malnutrition
Lack of birth spacing
Low EPI Coverage
32
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr.
No.
4
Health Problem
High MMR
Causes









Poor access to healthcare delivery services
Lack of awareness about danger signs of pregnancy
Low ante-natal coverage
Low skilled birth attendance
Three delays (seeking health care, transportation, and
lack of referral back-up services)
Complications of pregnancy
Capacity Issues related to maternal care
Maternal Anemia
Pregnancy following chronic severe diseases
5
Diabetes Mellitus





Genetic makeup
Obesity
Competitive type A personality
Sedentary life style
Fast Foods lacking fibers
6
TB Suspects




7
Acute (upper)
respiratory
infections





Low socio-economic status
Seasonal variation
Lack of proper sanitation
Lack of awareness and hygienic
practices
Malnutrition
Air contamination
Over-crowding/Poor housing
facilities
Lack
of proper sanitation
Seasonal variation
8
Anemia ( including
pregnancy)
 Lack of awareness and hygienic
practices
 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
33
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Service delivery/Management problems
This segment entails the district specific management problems. Management problems are result of
deficiency/lack of resources; these problems range from administrative to financial issues, and cause
hindrance in the smooth delivery of health services in the district. It was observed that solution of some
of these problems lies with the provincial government; whereas remaining can be addressed at the
district level. While proposing the interventions, their action at provincial or district level has been
specifically mentioned. The planning team discussed these problems in detail and enlisted the main
problems as under:
1
Shortage of staff
 Ban on permanent postings
 Non availability of incentivized pay package and career structure
 Medico-legal work for WMOs
 Non sanctioning of posts according to MSDS
2
Capacity issues of Management staff in:
Financial management
Supportive Supervision
Use of information
3
4
Shortage of equipment MNCH related equipment at THQHS
Inadequate budget for POL
 Price hikes
 Installation and use of generators
 Inadequate budget for POL
34
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
MDGs and MSDS
The government is committed to achieve the MDGs targets. For this purpose, the government of Punjab
has decided to adopt Minimum Service Delivery Standards (MSDS) as strategy to achieve the MDGs
within the province. Health Department of Punjab is especially focusing on MNCH related component of
MSDS for which substantial resources are coming from Asian Development Program funded Punjab
Millennium Development Goal Program (PMDGP). MSDS entails a level-specific service delivery package
(for primary and secondary health care) along with their standards and system specifications including
human, infrastructure, equipment, medical supplies, medicine and other consumables.
In order to achieve the MDGs, the government of Punjab has adopted MSDS as strategic framework.
During the development of three years rolling plans, gaps under MSDS focusing on MNCH interventions
have been identified. Most essential areas for which gaps have been identified are human resource and
equipment of DHQ and THQ hospitals, as per lists notified by the government in accordance with MSDS
standards.
a) Human Resource
With regard to MSDS gap analysis for human resource, the difference between the standards
proposed in MSDS and filled posts has been calculated as the vacancy gap. The hospitals have
been categorized based on their bed strength as follows:
Hospital
DHQ Hospital
THQ 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
35
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
i.
THQ Hospital
(A composite list of gaps with reference to MSDS)
Sr. No.
Post
Standard Sanctioned Filled
as per
MSDS
Vacancy
Gap in
relation to
sanctioned
positions
Vacancy
Gap in
relation to
filled
positions
1
Gynaecologist
7
3
1
4
6
2
Paediatricians
7
3
1
4
6
3
Anesthetists
10
4
2
3
5
4
Medical
Officers
including
SMO,APMO &
PMOs
60
50
31
10
29
5
Women
Medical
Officers
including
SWMO,
APWMO
&PMOs
31
17
8
14
23
6
Lady Health
Visitors
24
3
3
0
21
7
Nurses
78
14
38
4
40
b) Equipment
Government of Punjab has notified a standard list as yard-stick of MNCH related equipment to provide
comprehensive EmONC services in the DHQ and THQ hospitals. Provision of comprehensive EmONC
services is essentially required to decrease the high MMR and IMR prevailing in the province.
Gaps in relation to the MNCH related equipment have been identified taking into account the equipment
purchased or under process of purchase from all funds including PMDGP funds allocated/sanctioned to
the district. The cost of equipment gap has been included in the equipment portion of the
Management/Service delivery problems.
36
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
i.
Composite List of Gaps of All THQ Hospitals –
Sr.
No.
Equipment
Standard as
per MSDS
Available
Gap
Remarks
(Qty.)
C
B
A
1
CTG (Cardiac
Tocography)
1
1
2
2
2
2
Foetal Doppler
3
5
5
9
6
3
Diagnostic Laparoscope
1
1
2
1
3
4
Bulb Sucker
10
20
20
50
10
5
Baby Warmer
3
3
6
8
4
6
Mechanical Sucker
3
3
6
9
3
7
Fetal Stethoscope
4
4
4
3
9
8
Delivery Table
2
2
3
5
2
9
D&C Set
2
3
4
7
3
10
Outlet forceps
4
4
4
2
10
11
Myoma Screw
2
2
2
0
6
12
Kochers forceps
4
4
8
6
10
13
Volselum forceps
6
8
10
16
10
14
Lanes Tissue holding
forceps
2
2
4
2
6
15
Vaginal Retractors
10
10
10
20
10
16
Polypectomy forceps
2
2
2
0
6
17
Sponge holder
10
15
20
30
20
18
Uterine elevator
1
1
1
0
3
37
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr.
No.
Equipment
Standard as
per MSDS
Available
Gap
Remarks
(Qty.)
19
CosCo Speculum
C
B
A
6
10
10
0
18
Small, Medium, Large
(for each category)
20
Examination light
3
3
6
9
3
21
Suction Curette
1
2
2
3
3
22
Infant Resuscitation
Trolley (with life saving
medicines, baby
laryngoscope, Endotracheal tube, Infant BP
Apparatus, Chargeable
Light)
1
1
2
1
3
23
Mother Resuscitation
Trolley (with life saving
medicines,
Laryngoscope, Endotracheal tube, BP
Apparatus, Chargeable
light)
1
1
2
0
3
24
Cardiac Monitor
1
1
2
4
0
25
Pump Breast Electronic
1
1
1
0
3
26
Vaginal Hysterectomy
Set
2
2
4
26.1
Toothed Tissue Forceps
(8”)
2
2
4
3
5
26.2
Non-Tooted Tissue
Forceps (8”)
2
2
4
3
5
4
38
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr.
No.
Equipment
Standard as
per MSDS
Available
Gap
Remarks
(Qty.)
C
B
A
26.3
Dissection Scissors
(Curved 7”)
2
2
4
3
5
26.4
Dissection Scissors
(Straight 7”)
2
2
4
4
4
26.5
Hysterectomy Clamps
(Straight)
8
8
16
26
6
26.6
Hysterectomy Clamps
(Curved)
8
8
16
26
6
26.7
Uterine Sound
2
2
4
5
3
26.8
Needle Holder (7”)
2
2
4
2
6
26.9
Needle Holder (10”)
2
2
4
2
6
26.10
Artery Forceps (Straight
6”)
16
16
32
34
30
26.11
Artery Forceps (Curved
6”)
16
16
32
34
30
26.12
Allis Forceps
8
8
16
12
20
26.13
Towel Clamps
8
8
16
14
18
26.14
Single blade Sims
speculum
4
4
8
6
10
26.15
Double blade Sims
speculum
4
4
8
6
10
26.16
Sponge holding forceps
8
8
16
17
15
26.17
Volselum forceps
4
4
8
6
10
26.18
Uterine Sound
2
2
4
5
3
39
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr.
No.
Equipment
Standard as
per MSDS
Available
Gap
2
6
Remarks
(Qty.)
C
B
A
26.19
Bladder Sound
2
2
4
27
Delivery Sets
10
10
15
27.1
Episiotomy Scissors
10
10
15
20
15
27.2
Straight Scissors
10
10
15
20
15
27.3
Needle holder
10
10
15
35
-
27.4
Non-toothed tissue
forceps 8 inches
10
10
15
20
15
27.5
Toothed tissue forceps
8 inches
10
10
15
20
15
27.6
Sims Speculum single
blade
20
20
30
40
30
27.7
Sims Speculum double
blade
20
20
30
40
30
27.8
Sponge holding forceps
40
40
60
60
80
27.9
Artery forceps
40
40
60
60
80
27.10
Straight clamps (cord)
20
20
30
0
80
27.11
Vacuum Extractor
pump
1
1
1
3
0
27.12
Towel clip
40
40
60
Caesarian Section
6
8
10
28.1
Scalpel
6
8
10
16
10
28.2
Artery Forceps Straight
6 inches
24
32
40
89
15
28
-
40
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr.
No.
Equipment
Standard as
per MSDS
Available
Gap
Remarks
(Qty.)
C
B
A
28.3
Artery Forceps Curved 6 24
inches
32
40
74
30
28.4
Artery forceps 8 inches
24
32
40
74
30
28.5
Myoma Scissors
straight 7 inches
6
8
10
16
10
28.6
Dissecting scissors
(curved) 7 inches
6
8
10
16
10
28.7
Green Armtage forceps
8 inches
24
32
40
74
30
28.8
Obstetric outlet forceps
(pair)
6
8
10
16
10
28.9
Doyene’s Retractor
6
8
10
16
10
28.10
Small Retractors
12
16
20
37
15
28.11
Towel Clippers
24
32
40
104
0
28.12
Suction Nozzle
6
8
10
16
10
29
MNCH Related
Radiology Equipments
29.1
Ultrasound Machine
1
2
3
7
0
29.2
X-Ray Unit 500 kw
1
1
1
1
2
29.3
Color Doppler
0
1
1
3
0
29.4
Lead Screen for X-Ray
Unit
1
1
1
0
3
41
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr.
No.
Equipment
Standard as
per MSDS
Available
Gap
Remarks
(Qty.)
C
B
A
29.5
0.5 MN Lead Apron.
Lead Gloves, Goggles
and Thyroid and
Gonadal Sheets
1
1
1
3
3
29.6
Safe Light
1
1
1
0
3
29.7
X-RT Film Processing
Tank
1
1
1
0
3
29.8
Chest Stand
1
1
1
-3
6
29.9
X-Ray film Illuminator
2
2
2
6
29.10
X-Ray Film Hangers All
sizes
4
4
4
2
10
30
MNCH Related
Paediatrics Equipments
3
30.1
Paediatric Ventilator
1
2
2
3
30.2
Incubator
1
1
2
4
30.3
Photo Therapy Unit
1
1
1
1
2
30.4
Over-head Radiant
Warmer
1
1
1
0
3
30.5
Infant Length
Measuring Scale
2
2
2
0
6
30.6
Infant Weighing
Machine
2
2
2
1
5
30.7
Nebulizer
1
1
2
1
3
30.8
Billiubino-meter
1
1
2
1
3
42
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr.
No.
Equipment
Standard as
per MSDS
Available
Gap
Remarks
(Qty.)
C
B
A
30.9
Exchange Blood
Transfusion Set
1
1
2
1
3
30.10
Nasal Probe Paed size
2
2
4
2
6
31
Anaesthesia/ICU
31.1
Anaesthesia Machine
1
1
2
4
0
31.2
Ventilators
1
1
1
0
3
31.3
Nebulizer
1
1
1
2
1
31.4
Pulse Oximetry
1
1
1
2
1
31.5
Defibrillator
1
1
1
1
2
31.6
Airway Oral and Nasal
2
3
4
4
6
31.7
Tracheostomy tube
(adult and paeds)
2
2
4
2
6
31.8
Face mask of all sizes
2
2
4
2
6
31.9
Double Cuff Tourniquet
(for regional block)
1
2
2
3
3
31.10
AMBO bag adult
2
2
4
3
5
31.11
AMBO Bag paeds
2
2
4
2
6
31.12
Red Rubber Nasal tubes
all sizes without cuff
4
4
8
4
12
1
1
2
1
3
32
32.1
Blood Bank
Blood storage cabinet
(100 bag capacity)
43
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr.
No.
Equipment
Standard as
per MSDS
Available
Gap
Remarks
(Qty.)
C
B
A
32.2
Packed cell machine
1
1
1
0
3
32.3
Cell Separator
1
1
1
0
3
32.4
Freezer for Fresh
Frozen Plasma
1
1
1
0
3
32.5
Blood bag shaker
1
1
2
1
3
32.6
RH view box
2
2
4
5
3
32.7
Water bath
2
2
2
0
6
32.8
Micro-pipette
4
6
8
10
10
32.9
Blood grouping tiles
3
3
6
6
6
32.10
Plasma Extractor
1
1
1
0
3
32.11
Platelets agitator
1
1
1
0
3
32.12
Blood thawing bath
1
1
1
0
3
32.13
Microscopes
1
1
2
2
2
33
Gynae & Labour Room
Related Laboratory
Equipment
33.1
Hematology Analyzer
1
1
1
0
3
33.2
Electrolyte Analyzer
1
1
1
0
3
33.3
Analyzer Bio-chemistry
Semi-automatic
1
1
1
0
3
33.4
Glucometer
2
2
2
0
6
44
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr.
No.
Equipment
Standard as
per MSDS
Available
Gap
Remarks
(Qty.)
C
B
A
33.5
Haemoglobino-meter
2
2
4
5
3
33.6
Centrifuge
1
1
2
2
2
45
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
SECTION 3: INTERVENTIONS AND TARGETS
After enlisting the vital causes of prioritized health problems, team proposed appropriate interventions
to tackle the problems. Once interventions and activities had been identified, next task the planning
team performed was to set the number and quality of specific activities (targets) that have to be carried
out. It is pertinent to mention over here that the plan envisages additional activities along with routine
activities under regular budget.
46
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Health Problems
Sr.
No.
1
Problem
Diarrhea
Causes
Intervention
Activities
Unit
Plan Activities
Targets
Target
for
201011
Target
for
201112
Target
for
201213
 Poor
sanitation
 improvement of
water supply
and sanitation
 Quarterly coordination
Meeting with
TMA and other
agencies
Meeting
12
4
4
4
 Lack of safe
drinking
water
 Unhygienic
practices
 Health
Education
campaign
 Improving
literacy rate
through
coordination
with education
department
 Proper
treatment of
Diarrhea
including ORT
 Messages on local
cable network
 Printing and
distribution of
IPC material
Message
12
4
4
4
Brochure
600000
300000
150000
150000
 Address in school
assemblies
Session
5,400
1,800
1,800
1,800
 Lack of
awareness in
general
population
Remarks
47
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr.
No.
2
Problem
Hepatitis
Causes
Intervention
 Lack of
awareness
among
mothers
about feeding
and weaning
practices
 Capacity
building of
health staff in
Integrated
Management of
Childhood
Illnesses (IMCI)
Activities
Unit
Plan Activities
Targets
Target
for
201011
Target
for
201112
Target
for
201213
 Training of
medics and
paramedics in
IMCI
No. of
trainings
13
13
 Low Socio
Economic
status
 Procurement and
distribution of
ORS
ORS
packets
250000
100000
60000
40000
 Malnutrition
 Procurement and
distribution of
Syp. Zink
Sulphate
Syrup
150000
70,000
40000
40000
 Procurement and
Distribution of
Syp.
Metronidazole
Syrup
150000
70,000
40,000
40,000
 Quarterly coordination
meetings with
TMA and other
agencies
Meetings
 Poor
sanitation
 Health
Education/Pro
motion
Remarks
48
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr.
No.
Problem
Causes
Intervention
Activities
Unit
Plan Activities
Targets
Target
for
201011
Target
for
201112
Target
for
201213
 Unsafe
drinking
water
 Improving
water &
sanitation
 Messages on local
cable network
Message
36
12
12
12
 Sharing of
used syringes
 Campaign
against
quackery
 Printing and
distribution of
IPC material
Brochure
200,000
100,000
50,000
50,000
 Transfusion of
unsafe blood
and blood
products
 Strengthening
blood
transfusion
services for safe
transfusions
 Printing and
pasting of
stickers at clinics
and Barber shop
highlighting use
of new syringes &
Razors
Stickers
5,000
-
-
 Unsafe sexual
practices
 Regulatory
mechanism to
ensure use of
safe
instruments by
dentists,
barbers etc.
 Hepatitis
awareness week
( walk/display
banners/seminar
s)
3
1
1
1
200
100
50
50
 Ear piercing
and tattooing
 Procurement and
supply of Eliza
kits
Kits
Remarks
49
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr.
No.
Problem
Causes
 Use of
unsterilized
equipment by
dentists and
barbers
Intervention
Activities
Unit
Plan Activities
Targets
Target
for
201011
Target
for
201112
Target
for
201213
 Procurement of
syringe cutters
Syringe
cutter
1,200
600
300
300
 Procurement and
distribution of
Interferon
Injection
Courses
200
100
50
50
Remarks
 Documentation
of expense of
disposable
syringes
 Supportive
supervision to
ensure above
activities
 Procurement and
distribution of
Interferon
Injection
50
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Unit
Plan Activities
Targets
Target
for
201011
Target
for
201112
Target
for
201213
 Message on local
cable
Message
36
12
12
12
 Provision of the
quality basic
EMONC services
at BHU & RHC
 BCC of mothers
0n promotion of
breast feeding
and weaning
practices through
LHWs
Number of
Trainings
74
40
17
17
 Provision of the
quality
Comprehensive
EMONC services
at THQH &
DHQH
 Improvement of
feeding and
weaning
practices
 Capacity
building of
Human
Resource
dealing child
health care
 Provision of the
deficient
infrastructure at
THQ
Sr.
No.
Problem
Causes
Intervention
Activities
3
High under
5 Mortality
 Poor
antenatal
natal and post
natal
coverage
 Neo-natal
Infections
 Health
awareness/educ
ation
 Birth Trauma
& Asphyxia
 Prematurity
 Poor feeding
and weaning
practices
Remarks
Assessment
 Trainings on
IMCI
No. of
trainings
 Need assessment
of food
supplements
Assessment
-
-
51
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr.
No.
Problem
Causes
 Diarrhea
 ARI
 Lack of
capacity of
staff for
provision of
proper child
health care
(diagnostic
and timely
referrals)
 Low socio
economic
status
Intervention
Activities
Unit
 Enhancing EPI
coverage
 procurement
from DGHs office
Assessment
 Poverty
elevation
 Distribution of
food
supplements to
mothers &
children through
LHWs &
community mid
wives
 Provision of
food
supplements
 Raising income of
the poor families
through Baitul
Mall and Zakat
Plan Activities
Targets
Target
for
201011
Target
for
201112
Target
for
201213
Remarks
-
Assessment
Assessment
 Revising the
micro plans of
Vaccinators
52
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr.
No.
Problem
Causes
Unit
Plan Activities
Targets
Target
for
201011
Target
for
201112
Target
for
201213
Intervention
Activities
 Health
education/prom
otion
 Messages on local
cable network
Message
36
12
12
12
 Behaviour
change
communication
for Mothers of
child bearing
age
 Provision of
Quality basic
EmONC services
at BHU & RHC
 Printing and
distribution of
IPC material
Brochure
100000
50000
30000
20000
 Training of LHWs
on BCC
No. of
trainings
36
12
12
12
Remarks
 Malnutrition
 Lack of birth
spacing
Low EPI
Coverage
4
High MMR
 Poor access to
healthcare
delivery
services
 Lack of
awareness
about danger
signs of
pregnancy
 Low antenatal
coverage
53
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr.
No.
Problem
Causes
 Low skilled
birth
attendance
 Three delays
(seeking
health care,
transportatio
n, and lack of
referral backup services)
 Capacity
Issues related
to maternal
care
Intervention
 Provision of
Quality
Comprehensive
EmONC services
at THQs & DHQs
hospital
 Improving
transportation
of the patients
Activities
Unit
Plan Activities
Targets
Target
for
201011
Target
for
201112
Target
for
201213
Remarks
 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
54
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr.
No.
Problem
Causes
Intervention
Activities
 Maternal
Anemia
 Replacement of
the non
functional
ambulances for
timely
transportation of
pregnant mother
 Capacity
Issues related
to maternal
care
 Procurement of
the MNCH related
equipment and
Instruments
Unit
Plan Activities
Targets
Target
for
201011
Target
for
201112
Target
for
201213
300000
150000
75000
75000
200000
100000
50000
50000
Remarks
 Implementation
of the referrals
protocols
 Procurement of
Micro-nutrients
 Procurement and
distribution of
Calci-D
Capsule
No. of
tablets
55
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr.
No.
Problem
Causes
Intervention
Activities
 Procurement and
distribution of
Anti-D
5
Diabetes
Mellitus
 Genetic
makeup
 Obesity
 Competitive
type A
personality
Unit
Plan Activities
Targets
Target
for
201011
Target
for
201112
Target
for
201213
30
10
10
10
Injection
 Health
awareness for
promoting
health life style
behaviors
 Balanced diet
 Message on local
cable
Message
12
4
4
4
 Message on FM
Radio
Message
12
4
4
4
 Regular
walk/exercise
 Awareness
walk/Banners/Se
minars/Poster
3
1
1
1
12
4
4
4
 Sedentary life
style
Remarks
 Screening Camps
for high risk
population
 Fast Foods
lacking fibers
6
TB Suspects
 Low socioeconomic
status
 Health
education/prom
otion
 Messages on local
cable networks
Message
56
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr.
No.
Problem
Causes
 Seasonal
variation
 Lack of
proper
sanitation
 Lack of
awareness
and hygienic
practices
Intervention
 Strengthening
TB DOTS
program
through
involvement of
private sector
 Involvement of
private
providers
through public
private
partnership
Activities
Unit
Plan Activities
Targets
Target
for
201011
Target
for
201112
Target
for
201213
75000
25000
25000
25000
 Printing and
distribution of
IPC material
Brochure
 Procurement of
drugs to ensure
deficiency
according to
regimen
ATT course
600
200
200
200
 Procurement of
reagents for
notified
diagnostic
facilities under
DOTS
programme
Packs
50
20
15
15
Trainings on DOTS
protocols
No. of
trainings
14
6
4
4
Remarks
57
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr.
No.
7
Problem
Acute
(upper)
respiratory
infections
Causes
Intervention
Activities
Unit
Plan Activities
Targets
Target
for
201011
Target
for
201112
Target
for
201213
 Malnutrition
 Capacity
building of
health staff in
ARI case
management
 Messages on local
cable networks
Message
12
4
4
12
 Air
contaminatio
n
 Capacity
building of
health staff in
Integrated
Management of
Childhood
Illnesses (IMCI)
 Provision of
medicines for
ARI
 Messages
through FM radio
channels
Message
12
4
4
12
 Printing and
distribution of
IPC material
Brochure
300,000
100,000
100,000
300,000
 Timely referral
of complicated
cases
 Training of
medics and paramedics in IMCI
No. of
trainings
-
 Procurement and
distribution of
Antibiotic Syrup
Amoxycillin
Antibiotic
(Syrup)
150,000
 Overcrowding/Poo
r housing
facilities
 Lack of
proper
sanitation
 Seasonal
variation
Remarks
-
50,000
50,000
150,000
58
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr.
No.
Problem
Causes
Intervention
Activities
Unit
Plan Activities
Targets
Target
for
201011
Target
for
201112
Target
for
201213
Remarks
Lack of
awareness
and hygienic
practices
8
Aneamia (
including
pregnancy)
 Lack of
awareness
about
balanced diet
 Awareness
raising for
behaviour
change
 Messages on local
cable network
Message
12
4
4
4
 Gender
discriminatio
n
 Awareness
raising for
behavior change
 Printing and
distribution of
IPC material
Brochure
150,000
50,000
50,000
50,000
 Social taboos
and norms
 Awareness
raising for
behavior change
 Counseling of
pregnant
mothers
Session
-
-
-
 Worm
infestation
 Deworming
campaign
 Procurement of
de-worming
tablets
No. of doses
100,000
100,000
100,000
300,000
59
Three Years Rolling Plan 2010-2013 District Rahim Yar Khan
Sr.
No.
Problem
Causes
Intervention
Activities
 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
 Poverty/ Low
socio
economic
status
 Equity of
services
 Provision of
Sehat Sahulat
Card/health
voucher
Unit
Plan Activities
Targets
Target
for
201011
Target
for
201112
Target
for
201213
Remarks
No. of
trainings
60
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Management Problems
Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned Posts
Physical Targets
Sr. No.
Name of Post
Basic
Scale
Basic Pay
Allowances
Requirement as per Gap
Year I
Year II
Year III
1
Gynaecologist
18
12,910
18,099
0
-
-
-
2
Paediatricians
18
12,910
18,099
3
1
1
1
3
Anesthetists
18
12,910
18,099
5
2
2
1
4
MO / WMO
17
9,850
15,345
7
3
2
2
5
Nurses
16
6,060
8,934
22
8
8
6
6
Lady Health Visitors
9
3,820
4,750
21
7
7
7
61
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Sr.
No.
1
Problem
Shortage of
skilled staff
Causes
Intervention
Activities
Unit
Plan
Activities
Targets
Target
for 201011
Target
for 201112
Target
for 201213
 Vacant
positions
 Filling of the vacant
posts
 Temporary Filling of the
vacant posts of medics and
the paramedics through
existing recruitment
committees
Recruitment
-
-
-
-
 Nonsanctioning of
staff according
to MSDS
 Sanctioning of
positions according
to MSDS
 Demand generation and
request to the Department of
Health by the districts for
recruitment through PSC
against vacant posts
Plan
-
-
-
-
 Lack of
permanent
postings
 Recruitment
through Public
Service
Commission on
regular basis
 Incentivized pay
package at all
levels
 Districts to prepare the
incentivized pay package
with consultation of all
stockholders
Pay Package
-
-
-
-
 Consensus building between
the districts for uniform
incentivized pay package for
all categories and levels staff
Meeting
-
-
-
-
 Well defined career
structure including
opportunities for
higher education
 Request to the Provincial
Government for approval
and implementation of
agreed pay packages
Plan
-
-
-
-
 Lack of
incentives and
differential
pay packages
 Frequent
transfer
postings
Remarks
62
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Sr.
No.
Problem
Unit
Plan
Activities
Targets
Target
for 201011
Target
for 201112
Target
for 201213
Causes
Intervention
Activities
 Job insecurity
 Conducive working
environment
 Review and revise the career
structure of medics,
paramedics and technical
staff, Health Education
officers etc
TA
-
-
-
-
 Lack of basic
amenities at
workplace
 Provision of staff
Residences
 Availability of recreation,
education and other facilities
for children of staff working
in rural areas
Plan EDOH
-
-
-
-
 Lack of
conducive
environment
including
insecurity and
transport of
children for
education
 High level political
commitment for
providing
protection to
staff working in
health facilities
 Construction of the
residences for the staff
Requirement
Plan
-
-
-
-
 Political &
Media
Interference
 provision of recreation
facilities (Parks/Play
area/common rooms)
Plan EDOH
-
-
-
-
 Deficient
transparent
accountability
 Provision of the transport of
staff children for the
education purposes
Plan EDOH
-
-
-
-
Remarks
63
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Sr.
No.
2
Problem
Inadequate
budget for POL
Causes
Intervention
Capacity issues
of the staff
Unit
Target
for 201011
Target
for 201112
Target
for 201213
 Shortage of
the residences
 Capacity and need
assessment of the medics
and the paramedics
TNA
-
-
-
-
 Medico-legal
work specially
for Females
 Prepare training programs
for providing higher
professional education based
on TNA
Plan
-
-
-
-
-
-
-
-
264,387
264,387
-
-
 Installation of
the Generator
for back up
electricity
supply
 Rational increase
in POL Budget
 Less allocation
for POL
budget
 Delay release
and utilization
of funds due to
non-clarity of
financial
procedures
 Assessing additional need for
POL
 Costing & Submission the
additional Demand for POL
 Frequent
increase in
prices of POL
3
Activities
Plan
Activities
Targets
 Advocacy for
keeping health
department on
higher priority
 Pursuance of EDO ( F&P) for
timely release of funds
POL
Remarks
Liters
-
-
64
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Sr.
No.
Problem
Causes
 Inability of
subordinate
staff to carry
out activity
and in
accordance
with protocols
 Inability of
staff to
convert data
into
information
for
management,
planning and
decision
making
Intervention
Activities
Unit
Plan
Activities
Targets
Target
for 201011
Target
for 201112
Target
for 201213
 Pursuance to the
competent
authority for
timely release of
funds
 Conducting Financial
Management workshops
No. of
trainings
3
1
1
1
 Capacity building
of DDOs and other
related staff in
financial
management,
supportive
supervision & use
of information
 Conducting supportive
supervision training
workshops
No. of
trainings
3
1
1
1
 Conduction workshops on
Use of information
No. of
trainings
3
1
1
1
Remarks
65
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Sr.
No.
4
Problem
Deficient
infrastructure
for MNCH
services at
THQHs
Causes
Intervention
 Deficient
equipment to
cater basic
and
comprehensiv
e EmONC at
primary and
secondary
level of care
 Make up the
deficiencies against
standards specified
in MSDS
Activities
 Purchase of MNCH related
equipment at all THQHs
Unit
Equipment
Plan
Activities
Targets
Target
for 201011
Target
for 201112
Target
for 201213
Remarks
-
-
-
-
-
66
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
SECTION 4: COSTING AND FINANCING PLAN
Activity based costing
The planning team has used the best available data sources, for calculation of estimates for the
intervention/activities. It is pertinent to mention that the costing of the plan is based on additional
needs and activities. The detailed activity based costing of the Health and Service Delivery
problems has been performed on automated Excel sheets, which are hyperlinked as H & M sheets.
A moderate estimate of equipment cost has been taken, as there is wide variation between the
minimum and maximum cost. The detailed Cost of MCNH related equipment has been annexed as
Annex II The summary of problem and activity wise costing is given below.
Problem wise Cost Summary of Health Problems
2010-2011
Sr.
No.
Health Problem
1
Diarrheal Diseases
2
Hepatitis
3
High under five mortality
4
High maternal mortality
5
Diabetes Mellitus
6
Tuberculosis
7
ARI (under 5)
8
Anemia ( including in pregnancy)
Total
Amount (Rs.)
2011-2012
Amount
(Rs.)
2012-2013
Amount
(Rs.)
Total Cost
Rs.
6,240,400
4,086,280
4,373,908
14,700,588
4,530,000
2,678,500
2,946,350
10,154,850
1,496,000
1,230,680
1,353,748
4,080,428
1,490,000
1,331,000
1,415,700
4,236,700
642,000
681,200
642,000
1,965,200
1,248,400
1,058,160
1,148,976
3,455,536
1,892,000
2,081,200
2,289,320
6,262,520
3,030,000
3,333,000
3,666,300
10,029,300
17,836,302
54,885,122
20,568,800
16,480,020
67
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
a) Health Problems
Define
Sr.
1
Problem
Diarrhea
Financial Targets
Activity
Total
Year II
Year III
(10 %)
(10 %)
Cost
Unit
Rate
Quantity
Year I
 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
70,000
12
280,000
308,000
338,800
926,800
 Message on FM
Radio
Message
5
600000
1,500,000
825,000
907,500
3,232,500
 Printing and
distribution of
IPC material
Brochure
5,400
-
-
-
-
 Address in school
Assemblies
Sessions
13
662,400
546,480
601,128
1,810,008
165,600
68
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Define
Sr.
Problem
Financial Targets
Activity
Unit
Rate
Quantity
Year I
Total
Year II
Year III
(10 %)
(10 %)
Cost
 Training of
medics and
paramedics in
MNCH
No. of
Trainings
5
250000
500,000
330,000
242,000
1,072,000
 Procurement and
distribution of
ORS
ORS Packets
35
150000
2,450,000
1,540,000
1,694,000
5,684,000
 Procurement and
Distribution of
Syp. Zink
Sulphate
Syrup
12
150000
840,000
528,000
580,800
1,948,800
 Procurement and
Distribution of
Syp.
Metronidazole
Syrup
2,000
12
8,000
8,800
9,680
26,480
6,240,400
4,086,280
4,373,908
14,700,588
69
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Define
Sr.
Problem
Activity
Unit
2
Hepatitis
Financial Targets
Rate
Quantity
Year I
Total
Year II
Year III
(10 %)
(10 %)
Cost
 Quarterly coordination
meetings with
TMA and other
agencies
Meetings
Costed in diarrheal
disease
-
-
-
-
 Messages on local
cable network
Message
70,000
36
840,000
924,000
1,016,400
2,780,400
 Printing and
distribution of
IPC material
Brochure
6
200,000
600,000
330,000
363,000
1,293,000
 Printing and
pasting of stickers
at clinics and
Barber shop
highlighting use
of new syringes &
Razors
Stickers
50
-
250,000
-
-
250,000
Lump sum
3
250,000
-
-
250,000
 Hepatitis
awareness week (
walk/display
banners/seminar
s)
70
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Define
Sr.
Problem
Financial Targets
Activity
Unit
Total
Year II
Year III
(10 %)
(10 %)
Cost
Rate
Quantity
Year I
10000
200
1,000,000
550,000
605,000
2,155,000
 Procurement and
supply of Eliza
kits
Kits
 Procurement of
syringe cutters
Syringe
cutter
150
1,200
90,000
49,500
54,450
193,950
 Procurement and
distribution of
Interferon
Injection
Courses
15,000
200
1,500,000
825,000
907,500
3,232,500
 Documentation of
expense of
disposable
syringes
-
-
-
-
-
 Supportive
supervision to
ensure above
activities
-
-
-
-
-
-
-
-
 Procurement and
distribution of
Interferon
Injection
-
-
71
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Define
Sr.
Problem
Activity
Unit
3
High under
5 Mortality
Financial Targets
Total
Year II
Year III
(10 %)
(10 %)
Cost
Rate
Quantity
Year I
-
-
4,530,000
2,678,500
2,946,350
10,154,850
 Message on local
cable
Message
70,000
36
840,000
924,000
1,016,400
2,780,400
 BCC of mothers
0n promotion of
breast feeding
and weaning
practices through
LHWs
Number of
Trainings
16,400
74
656,000
306,680
337,348
1,300,028
 Provision of the
deficient
infrastructure at
THQ
Assessment
As proposed in
MSDS Gaps
-
-
-
-
-
 Trainings on IMCI
No. of
trainings
As proposed in
Diarrhea
-
-
-
-
-
72
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Define
Sr.
Problem
Financial Targets
Activity
Unit
Rate
Quantity
Year I
Total
Year II
Year III
(10 %)
(10 %)
Cost
 Need assessment
of food
supplements
Assessment
Assessing below
poverty pregnant
mother through
LHWs and
providing them
food supplement
through DGHS &
Financial support
from Baitul Mal &
Zakat
-
-
-
-
-
 procurement
from DGHs office
Assessment
Assessing below
poverty pregnant
mother through
LHWs and
providing them
food supplement
through DGHS &
Financial support
from BaitulMall &
Zakat
-
-
-
-
-
73
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Define
Sr.
Problem
Financial Targets
Activity
Unit
Rate
Quantity
Year I
Total
Year II
Year III
(10 %)
(10 %)
Cost
 Distribution of
food supplements
to mothers &
children through
LHWs &
community mid
wives
Assessment
Assessing below
poverty pregnant
mother through
LHWs and
providing them
food supplement
through DGHS &
Financial support
from BaitulMall &
Zakat
-
-
-
-
-
 Raising income of
the poor families
through Baitul
Mall and Zakat
Assessment
Assessing below
poverty pregnant
mother through
LHWs and
providing them
food supplement
through DGHS &
Financial support
from BaitulMall &
Zakat
-
-
-
-
-
-
-
-
-
-
 Revising the
micro plans of
Vaccinators
74
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Define
Sr.
Problem
Activity
Unit
4
High MMR
Financial Targets
Rate
Quantity
Total
Year II
Year III
(10 %)
(10 %)
1,496,000
1,230,680
1,353,748
4,080,428
Year I
Cost
 Messages on local
cable network
Message
70,000
36
840,000
924,000
1,016,400
2,780,400
 Printing and
distribution of
IPC material
Brochure
4
100000
200,000
132,000
96,800
428,800
 Training of LHWs
on BCC
No. of
trainings
Costed in High
under 5 M
-
-
-
-
-
 Procurement of
vehicles for
transportation
through CCBs
Costed in service
delivery problems
-
-
-
-
-
 Operation and
management of
vehicles through
CCBs
Costed in service
delivery problems
-
-
-
-
-
75
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Define
Sr.
Problem
Financial Targets
Activity
Unit
Total
Year II
Year III
(10 %)
(10 %)
Cost
Rate
Quantity
Year I
 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
Costed in MSDS
Gaps
-
-
-
-
-
300000
300,000
165,000
181,500
646,500
 Procurement of
Micro-nutrients
Packs
2
76
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Define
Sr.
5
Problem
Diabetes
Mellitus
Financial Targets
Activity
Total
Year II
Year III
(10 %)
(10 %)
Cost
Unit
Rate
Quantity
Year I
 Procurement and
distribution of
Calci-D
No. of tablets
1
200000
100,000
55,000
60,500
215,500
 Procurement and
distribution of
Anti-D
Injection
5000
30
50,000
55,000
60,500
165,500
1,490,000
1,331,000
1,415,700
4,236,700
 Message on local
cable
Message
70,000
12
280,000
308,000
280,000
868,000
 Message on FM
Radio
Message
28000
12
112,000
123,200
112,000
347,200
 Awareness
walk/Banners/S
eminars/Poster
Lump sum
3
250,000
250,000
250,000
750,000
 Screening Camps
for high risk
population
At THQH level
Screening camps
with the help
donor Agencies
-
-
-
-
-
77
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Define
Sr.
Problem
Activity
Unit
6
TB Suspects
Financial Targets
 Messages on
local cable
networks
Message
 Printing and
distribution of
IPC material
Brochure
 Procurement of
drugs to ensure
deficiency
according to
regimen
 Procurement of
reagents for
notified
diagnostic
facilities under
DOTS
programme
Rate
Quantity
Total
Year II
Year III
(10 %)
(10 %)
642,000
681,200
642,000
1,965,200
Year I
Cost
70,000
12
280,000
308,000
338,800
926,800
6
75000
150,000
150,000
150,000
450,000
To be procured
from the PTP
600
-
-
-
-
To be procured
from the PTP
50
-
-
-
-
ATT course
Packs
78
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Define
Sr.
Problem
Activity
Unit
 Trainings on
DOTS protocols
7
Acute
(upper)
respiratory
infections
Financial Targets
No. of
trainings
Total
Year II
Year III
(10 %)
(10 %)
Cost
Rate
Quantity
Year I
136400
14
818,400
600,160
660,176
2,078,736
1,248,400
1,058,160
1,148,976
3,455,536
 Messages on local
cable networks
Message
70,000
12
280,000
308,000
338,800
926,800
 Messages through
FM radio
channels
Message
28,000
12
112,000
123,200
135,520
370,720
 Printing and
distribution of
IPC material
Brochure
5
300,000
500,000
550,000
605,000
1,655,000
 Training of
medics and paramedics in IMCI
No. of
trainings
-
-
-
-
-
IMCI Training
package costed in
Diarrhea also
includes
management of
ARI
79
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Define
Sr.
Problem
Activity
Unit
 Procurement and
distribution of
Antibiotic Syrup
Amoxycillin
8
Anemia (
including
pregnancy)
Financial Targets
Antibiotic
(Syrup)
Total
Year II
Year III
(10 %)
(10 %)
Cost
Rate
Quantity
Year I
20
150,000
1,000,000
1,100,000
1,210,000
3,310,000
-
-
1,892,000
2,081,200
2,289,320
6,262,520
-
280,000
308,000
338,800
926,800
250,000
275,000
302,500
827,500
 Messages on local
cable network
Message
70,000
 Printing and
distribution of
IPC material
Brochure
5
 Counseling of
pregnant mothers
Session
 Procurement of
de-worming
tablets
No. of doses
LHWs are
expected to
conduct
counseling session
on behavior
change during
their visit to
pregnant ladies
-
-
-
-
-
25
-
2,500,000
2,750,000
3,025,000
8,275,000
80
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Define
Sr.
Problem
Financial Targets
Activity
Unit
Rate
 Distribution
through LHWs
and health
facilities
 Refresher
Trainings of
LHWs on BCC,
balanced diet and
provision of
micro-nutrients
 Provision of Sehat
Sahulat
Card/health
voucher
No. of
trainings
IMCI Training
package costed in
Diarrhea also
includes
management of
ARI
Total
Year II
Year III
(10 %)
(10 %)
Cost
Quantity
Year I
-
-
-
-
-
-
-
-
-
-
-
-
-
-
3,030,000
3,333,000
3,666,300
10,029,300
81
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Problem wise cost summary of Management Problems
Sr. No.
Problems
2010-2011
2011-2012
2012-2013
Amount (Rs.)
Amount (Rs.)
Amount (Rs.)
Total Cost Rs.
1
Human Resource Plan (Sanction of Posts against MSDS
Gaps)
4,182,648
8,869,252
13,565,673
26,617,573
2
POL
19,829,000
-
-
19,829,000
3
Delays in Release of Fund
102,600
102,600
102,600
307,800
4
MNCH Related Equipment
66,827,685
-
-
66,827,685
Total
90,941,933
8,971,852
13,668,273
113,582,058
82
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
b) Management Problems
Human Resource Plan to bridge the Gaps between MSDS Proposed and Sanctioned Posts
Financial Targets
Sr.
No.
Name of Post
Basic
Scale
Basic
Pay
Allowances
Year I
Requirement
as per Gap
Year II
Pay of
Officers
Pay of
other
staff
Allowances
Pay of
Officers
Pay of
other
staff
Year III
Allowances
Pay of
Officers
Pay of
other
staff
Allowances
1
Gynaecologist
18
12,910
18,099
0
-
-
-
-
-
-
-
2
Paediatricians
18
12,910
18,099
3
154,920
-
217,188
340,824
477,814
562,360
788,392
3
Anesthetists
18
12,910
18,099
5
309,840
-
434,376
681,648
955,627
937,266
1,313,987
4
MO / WMO
17
9,850
15,345
7
354,600
-
552,420
650,100
1,012,770
1,001,154
1,559,666
5
Nurses
16
6,060
8,934
22
581,760
-
857,664
1,279,872
1,886,861
1,935,806
2,853,877
6
Lady Health
Visitors
9
3,820
4,750
21
320,880
399,000
320,880
2,460,648
1,401,120
2,952,444
705,936
877,800
705,936
5,210,872
4,436,586
1,164,794
1,448,370
1,164,794
7,964,293
83
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Define
Sr.
1
Problem
Shortage of
skilled staff
Financial Targets
Activity
Year III
(10 %)
Total
Cost
Unit
Rate
Quantity
Year I
Year II
(10 %)
 Temporary Filling of the
vacant posts of medics
and the paramedics
through existing
recruitment committees
Recruitment
-
-
-
-
-
-
 Demand generation and
request to the
Department of Health
by the districts for
recruitment through
PSC against vacant posts
Plan
-
-
-
-
-
-
 Districts to prepare the
incentivized pay
package with
consultation of all
stockholders
Pay Package
-
-
-
-
-
-
 Consensus building
between the districts
for uniform incentivized
pay package for all
categories and levels
staff
Meeting
-
-
-
-
-
-
84
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
 Request to the
Provincial Government
for approval and
implementation of
agreed pay packages
Plan
-
-
-
-
-
-
 Review and revise the
career structure of
medics, paramedics and
technical staff like Sos,
Health Education
officers etc
TA
-
-
-
-
-
-
 Availability of
recreation, education
and other facilities for
children of staff
working in rural areas
Plan EDOH
-
-
-
-
-
-
 Construction of the
residences for the staff
Requirement
Plan
-
-
-
-
-
-
 provision of recreation
facilities (Parks/Play
area/common rooms)
Plan EDOH
-
-
-
-
-
-
 Provision of the
transport of staff
children for the
education purposes
Plan EDOH
-
-
-
-
-
-
85
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
2
Inadequate
budget for
POL
 Capacity and need
assessment of the
medics and the
paramedics
TNA
-
-
-
-
-
-
 Prepare training
programs for providing
higher professional
education based on TNA
Plan
-
-
-
-
-
-
-
-
-
-
-
-
75
264,387
19,829,000
-
-
19,829,000
 Assessing additional
need for POL
 Costing & Submission
the additional Demand
for POL
POL
19,829,000
-
-
3
Capacity
issues of the
staff
19,829,000
-
 Conducting Financial
Management
workshops
No. of
trainings
39000
3
39,000
39,000
39,000
117,000
 Conducting supportive
supervision training
workshops
No. of
trainings
31800
3
31,800
31,800
31,800
95,400
86
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
 Conduction workshops
on Use of information
4
Deficient
equipment for
MNCH
services at
secondary
care facilities
 Purchase of MNCH
related equipment at all
THQHs
No. of
trainings
Equipment
31800
3
31,800
31,800
31,800
95,400
102,600
102,600
102,600
307,800
66,827,685
66,827,685
66,827,685
66,827,685
87
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Financial Outlay
The costing of the plan includes routine recurring budget with 15% price escalation for subsequent
years and additional cost involved on the basis of health and management problems; which is
essentially required to bring visible improvement in the health system. Other financial resources
expected from provincial level through ADP and PMDGP are also part of this plan. Details of the
financial estimates for three years rolling plan are attached as Annex-III. Overall financial outlay of the
plan is as under:
Budget Summary
2010-2011
Regular district budget
2011-2012
2012-2013
735,210,840
813,496,309
894,845,940
111,510,733
25,451,872
31,504,575
846,721,573
838,948,181
926,350,515
Additional budget based
on problem
identification
Total
88
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
SECTION 5: MONITORING & EVALUATION
The monitoring and evaluation targets and indicators mentioned below will be used to gauge the
progress of implementation of the plan. Monitoring and evaluation of the three years rolling plan would
be carried out through the proposed indicators, targets and means of verifications, by the district health
authorities.
M&E of Plan
Indicators
% of planned
supervisory visits
conducted
% of RHCs with
availability of services
(on rotational basis) of
essential specialties
(Physician, Surgeon,
Paediatrician 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
Target
50 visits
/year
100%
During 1st
year
100%
%
Achievement
MoV
Responsibility
Inspection
Book/Attendance
register
EDOH/DOH/
DDOH/Dist.
Monitoring
officer
Quarterly
Movement
register/visit
book/Attendance
register
EDOH / DOH
Quarterly
Stock Register
EDOH/
MSs
Stock Register
EDOH/
DOH/MSs,
Store keeper
During 1st
year
100%
During 1st
year
Frequency
of
monitoring
DOH/ 6 monthly
Quarterly
89
Remarks
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Indicators
Target
% facilities with
availability of essential
medicines
100%
%
of
functional
ambulances in the
district
% utilization of
sanctioned budget
% of facilities with
availability of basic
EmONC
%
Achievement
MoV
Responsibility
Stock Register
EDOH/
MSs,
keeper
Log Book
EDOH/DOH/
Transport
officer
Quarterly Reports
EDOH/ DOH/ Quarterly
MSs/ Accounts
officer
During 1st
year
100%
(DHQH/
THQH/
RHCs)
100% of
yearly
budget
100%
(50%
during 1st
year)
Frequency
of
monitoring
DOH/ Monthly
Store
Quarterly
Supervisory
report
visit EDOH/DoH/
DDOH
Quarterly
Supervisory
report
visit EDOH/DoH/
DDOH
Quarterly
visit EDOH/DoH/
DDOH
Quarterly
% of DHQ/THQ
hospitals with
Comprehensive
EmONC services
100% in 3
years
% of facilities with
availability of separate
or partitioned room
reserved exclusively
for delivery
100% in 3
years (50%
during 1st
year)
Supervisory
report
% of targeted pregnant
women newly
registered by LHW
Target
according to
population
DHIS Report
EDOH/
Statistical
Officer
% of targeted pregnant
women received TT-2
vaccine
Target
according to
population
DHIS Report
EDOH/ DHIS Quarterly
Coordinator/
Statistical
Officer
(50%
during 1st
year)
Quarterly
90
Remarks
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Indicators
Target
%
Achievement
MoV
Delivery conducted by
or under supervision
of skilled persons
reported
60 %
During 1st
year
DHIS Report
EDOH/ DHIS Quarterly
Coordinator/
Statistical
Officer
%of target children
between 18 - 23
months of age fully
immunized
Target
according to
population
DHIS Report
EDOH/ DHIS Quarterly
Coordinator/
Statistical
Officer
% of referred cases
attended
100%
DHIS
LHWs
report
Responsibility
Frequency
of
monitoring
Report/ EDOH/ DHIS Quarterly
monthly Coordinator/
Statistical
Officer
% of targeted eligible
couples provided
knowledge and
information on Family
Planning methods
Target
according to
population
LHW’s
monthly/ EDOH/
quarterly report
Statistical
Officer
/Coordinator
NP-FP&PHC
No. of meetings with
participation from
other sectors
12 meetings
per year
Minutes
meetings
Quarterly
of EDOH/ Focal Quarterly
person/s
91
Remarks
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Annex-I
Private Health Facilities in District Rahim Yar
Khan
Sr. No.
Name of Hospital/Clinic-Address
1.
Ali Clinic, Baba Gharib Shah
2.
Tariq Sir-jee Centre, Adda Khanpur RYKhan
3.
Jamila Welfare Eye Hosp: Adda Khanpur (RYKhan)
4.
Kamran Clinic, Iqbal Nagar
5.
Tariq Hospital, Iqbal Nagar
6.
Ahmed Hassan Dentist Care
7.
Talha Clinic Iqbal Nagar
8.
Barkat Hospital, Iqbal Nagar
9.
Hazifa Clinic, Iqbal Nagar
10.
Qureshi Medical Store, Iqbal Nagar
11.
Al-Aziz Medical Store, -do-
12.
Abu-Hafeeza Dental Clinic, Adda Khanpur (RYKhan)
13.
Al-Shahab Dental Clinic, Khanpur Road, Near P/S Sadar
14.
Chishtee Homeo Clinic, KNP: Road
15.
Ismail Shafa Khana, Near P/S Sadar
16.
Darul-Sehat, Near, P/S Sadar
92
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Sr. No.
Name of Hospital/Clinic-Address
17.
Darul-Shafa, Clinic,(Dental)-do-
18.
Al-Saeed general Clinic, Gulshan Iqbal, Rahimyarkhan
19.
Fatima Clinic, Gulshan Iqbal
20.
Mian Jee, Homeo Clinic, --do-
21.
Hassan Homeo Clinic, Iqbal Nagar
22.
Safeer Homeo Clinic, -do-
23.
Gosha-e-Tibb, -do-
24.
Al-Khalil Clinic, Ittihad Clinic
25.
Al-Hayyat Hospital, Hosp:Road,RYK
26.
Sajid Surgical Hosp: -do-
27.
Hafeez Eye Hosp: -do-
28.
Abdullah Surgical Hosp: -do-
29.
Shahzad Qadri Hosp: -do-
30.
Hamza Medi-Care
-do-
31.
Masood E.N.T clinic,
-do-
32.
Dr. Babar Clinic,
-do-
33.
Darshani Clinic
-do-
34.
Al-shafa. Phsio Theraphy Clinic Hospital, Road, Rahimyarkhan
35.
Usman Children Hosp: -d-
36.
Al-Noor Hospital, -do-
37.
Zaka Clinic,
38.
Niaz Clinic, Near City Park
39.
Dr,Major Barkat Clinic, Hosp:Road
40.
Dr. Mukhtar Clinic, City Park
41.
Faiz Eye Hosp:
-do-
-do93
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Sr. No.
Name of Hospital/Clinic-Address
42.
Ayasha Clinic, Model Town, RYK
43.
Al-Karam Hospital, -do-
44.
Sana Clinic,
45.
Sirajia Darul Shafa, Fire brigade Road
46.
Chaudhery Clinic, School Bazar
47.
Khalid Homeo Clinic, Hosp: Road
48.
Hayyat Homeo Store, -do-
49.
Hakeem Muhammad Ashraf –do-
50.
Aiman Hosp: Hosp: Road, RYK
51.
Imran Clinic, -do-
52.
Azam Clinic, -do-
53.
Dr. Navid Rehmat, Dental Clinic
54.
Al-Shafa & National Hosp: -do-
55.
Navid Clinic, Abu Dhabi Road,RYK
56.
Zainab Clinic, Jail Road, RYK
57.
Hamdani Hosp: Abu Dahbi Road
58.
Bhukhari Hospital, -do-
59.
Ahmed Clinic,
-do-
60.
Umer Hospital,
-do-
61.
Tariq Clinic, Habib Colony
62.
Imtiaz Clinic, Jugnuo Clinic
63.
Ebad Clinic, -do-
64.
Dr. Irshad-Ul-Haq, Clinci -do-
65.
Naqash Homeo Clinic, Jinnah Park.
66.
Dr. Perveez Clinic, Abu Dhabi Road
-do-
94
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Sr. No.
Name of Hospital/Clinic-Address
67.
Dr.Shahid Naeem, Abu Dhabi Road.
68.
Rehman Homeo Clinic -do-
69.
Fauji Dental Clinci,
70.
Al-Ayisha Dental complex –do-
71.
Usman Clinic,
72.
Ali Raza Unani, Disp: -do-
73.
Jabbar Hameed, Homeo Clinic,Sadiq Town.
74.
Iftikhar Homeo clinic, -do-
75.
Ali Clinic
76.
Dr.Muhammad Tariq Sabir –do-
77.
Al-Saeed Clinic, Satellite town
78.
Nasir Hospital Adda Gulmerg
79.
Dr. Ijaz Cheema Hafiz Colony Chowk
80.
Dr. Iftikhar Khan Homeo Sakhi Sarwar Colony.
81.
Dr. Bilal Ahmed Basti Elam Din
82.
Dr. Muhammad Ashraf Jinnah Hosp:
83.
Dr. Ghulam Rabbani Adda Gulmerg
84.
Dr. Ansir Jameel Hassan Colony
85.
Dr. Sajida Perveen Hassan Colony
86.
Dr. Abdul Jabbar Homeio Dastgir Colony
87.
Dr. Khadim Hussain Saeedi -Do-
88.
Sheikh Mujeeb Ahsan Hospital Warless Pull RYKhan
89.
Tehseen Hospital
90.
Salman Hospital Usman Park RYK
91.
Maryyam Maternity Hospital -do-
-do-
-do-
-do-
-do-
95
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Sr. No.
Name of Hospital/Clinic-Address
92.
Nishtar General Hospital RYK
93.
Amina Clinic Circular Road RYK
94.
Arif homeopathic Akbar Road RYK
95.
Darul Shifa Muhallah Saddat
96.
Kamran Clinic Muhallah Kanjoan
97.
Asia Homeopathic Clinic & Store Bano Bazar
98.
Tamour Homeo Clinic & Store -do-
99.
Al-Khalid Homeo Clinic store, -do-
100.
Muhammad Nazir Muslim Homeo store, -do-
101.
Tahir Homeo Store,
102.
Mansoor Clinic and Maternity Home
103.
Usmania Surgico Diagnostic -doi-
104.
Sirajia Dawakhana, Spay Bazar
105.
Jadeed Shafakhana
106.
Al-Habib Shafa Khana, Shopping cente.
107.
Daud Homeo Clinic, Railway Road
108.
Awami Hospital, Railway Road,
109.
Al-Shafa Homeo Clinic, Bano Bazar
110.
Matab Tib-Ul-Arab, Bano Bazar
111.
Super Homeo Store, -do-
112.
B.J Homeo Store,
113.
Matab Sh: Nasee-ud-Din Sadar Bazar
114.
Zia Dental Clinic.Railway Raod
115.
Ghouri Dental Clinic
116.
Javid Dental Clinc
-do-
-do-
-do-
-do-do96
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Sr. No.
Name of Hospital/Clinic-Address
117.
Hassan Amjad, Dentist
118.
National clinic, Airport Road
119.
Paracha Clinic, -do-
120.
Hamza Clinic
121.
Maqsood Medicose & Hom: Clinic –do-
122.
Hamid Medicose, Airport Road,
123.
Waseem Dental Clinic,
-do-
124.
Naeem Homeo Clinic
-do-
125.
Waheed Medicose, Akbar Road
126.
Aslam Clinic,Main Road, Noor e wali
127.
Javid Clinic,
128.
Al-madina Homeo Clinic, -do-
129.
Azam Medicose
-do-
130.
Hamid Medicose,
-do-
131.
Wajid Clinic, Tibbi Laran
132.
Shah Naqshband Clinic, Chak 72/NP
133.
Al-Masoom Shahpur Road, -do-
134.
Dr.Masood Jahangir
-do-
135.
Dr. Akhtar Bilal
-do-
136.
Unani Dawakhana,
-do-
137.
Al-Aziz Hospital,
-do-
138.
Punjab Medicose, Noor e wali
139.
Dr.Abid Hussain Qadri, Shahbazpur Road
140.
Al-Rehmat Children Hosp: -do-
141.
Tahir Clinic, Chowk Pathanistan,
-do-
-do-
97
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Sr. No.
Name of Hospital/Clinic-Address
142.
Muslim Homeo Clinic, -do-
143.
Al-Riaz Homeo Clinic
-do-
144.
Awaisia Shafa Khana,
-do-
145.
Zaki Children Hosp:
146.
China Dental Clinic,
147.
Faisal Clinic, Gulshan Usman
148.
Azhar Homeo clinic Kacha Sadiqabad Road
149.
Aiysha Maternity Hosp: -do-
150.
Amina Clinia, Islamia colony
151.
Al-Ebad,Clinic Noor-e-Wali
152.
First Aid Medical, Lever estate
153.
Factory Sir-jee, Lever Hosp:
154.
Ferozai Shafa Khana, Pathanistan, Chowk.
155.
Al-Azhari, Clinic,Lever marriage Halll
156.
Al-Falah Hospital, Mud Darbari
157.
Al-Khalid Hosp: Shahbaz pur Road
158.
Majid Hospital,
159.
Rehmat Hospital, Bheel Nagar
160.
Shahzad Clinic,
161.
Ikram Children Hosp: Thalli Chowk
162.
Rehman Children Hosp: -do-
163.
Barkat Clinic,
164.
Ali Clinic, Tareen Colony
165.
Tareen Clinic
166.
Najam Clinic, Railway Road,
-do-
-do-
-do-
-do-
-do-
98
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Sr. No.
Name of Hospital/Clinic-Address
167.
Afzal Clinic. Shahi Road,
168.
Shahzad Clinic, Shahi Road
169.
Ahmed Clinic
170.
Dr. Shabbir Clinic, School Bazar
171.
Dr. Shakeel Homeo Wahi Shah Mohd:
172.
Rafahi Dispensar, Dr. Abdul Razzaq
173.
Dr. Javid Iqbal Anjum Taj Garh Road
174.
Farooq Ahmed,. Homeo Head Amingarh
175.
Malik Ijaz, Homeo Clinic -do-
176.
Rashid Minhas -do- Gharib Shah
177.
Abdul Sattar Hakeem -do-
178.
Ghulam Yasin, Homeo Wahi Rahim
179.
Dr. Abdullah Adda Chak Abbas
180.
Qadira Clinic Baba Gharib Shah
181.
Homeo Dr. Mumtaz Ahmed
182.
Homeo Dr. M. Arshad Kamboo
183.
Homeo Dr. M. Ashraf Bagga Chowk
184.
Dr. Cop:Abdul Rauf Chowk Bahadar
185.
Hakeem Sy: Zulfiqar Ali Shah
186.
Lady Dr. Naseem Akhtar F.P.Punjab
187.
Dr. Jamal Anwar Iqbalabad
188.
Dr. Ali Raza Zaidi Taj Garh
189.
Dr. Fateh Muhammad
190.
Hakeem Faiz Ullah
191.
Dr. Muhammad Tahir Akram
-do-
99
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Sr. No.
Name of Hospital/Clinic-Address
192.
Dr. Naseem Akhtar
193.
Dr. Mazhar Faiz
194.
Dr. Ghulam Rasul
195.
Dr. Khalid Javid Kot samaba Road
196.
Dr. Hakeem Muhammad Din,Rajanpur Kalan
197.
Hakeem Muhammad Iqbal -do-
198.
Abdul Hafeez, Homeo Clinic –do-
199.
Khalid Majeed, -do-
200.
Hakeem Masood,
201.
Hakeem Ishfaq, Qaisar Chohan
202.
Dr.Abdul Hameed Raja, Adda Sh:Wahn.
203.
Dr. Muhammad Wasim
204.
Hakeem Ilahi Bux Bhutta Kot
205.
Dr.Muhammad Saleem, Bhugwela
206.
Dr.Sarfraz Homeo, Abadpur
207.
Dr. Atta Muhammad, Pul Girri
208.
Dr. Malik Irshad, Pul Girri
209.
Hakeem Manzoor Ahmed, Palu Shah
210.
Dr.Tariq Mehmood, Manthar
211.
Dr. Ghulam Ali Mahar
212.
Dr.Muhammad Imran –do-
213.
Hakeem Abdul Rasheed -do-
214.
Dr.Muhammad Arif, Homeo,Metla Wali.
215.
Dr.Muhammad Akram, Homeo, 112/P
216.
Dr.Muhammad Akram , 249/P
-do-do-
-do-
100
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Sr. No.
Name of Hospital/Clinic-Address
217.
Kazmi Clinic, Pul Palace
218.
Al-Shahfa Clinic, Pul Sunni
219.
Zafar Clinic,
220.
Mehboob Clinic, Pul Palace
221.
Awami Hospital,
222.
Pervaiz Clinic, Chak No.52/P
223.
Arshad Clinic, Chak No.51/P
224.
Dr. Zafar Sattar, Pul Suuni
225.
Dr. Aslam Pervaiz, -do-
226.
Dr.Muhammad Shahid -do-
227.
Boota Dental Clinic, Chak No.100/P
228.
Dr. Abdul Kareem, Chak No.99/P
229.
Bashir Hospital, Chak No.87/P
230.
Adnan Qadeer, Homeo, Basti Kahoor
231.
Dr.Nisar Ahmed, Homeo –do-
232.
Dr. Shaukat Ali, Homeo 103/P
233.
Dr.Saeed Ahmed, Homeo, -do-
234.
Dr.Asmat Kazmi, Pul Palace
235.
Ab-e-Hayyat Hosp: -do-
236.
Dr.Muhammad Amin, Homeo, 91/P
237.
Dr.Muhammad Tariq, Homeo, 88/P
238.
Dr.Muhammad Aslam, Homeo 89/P
239.
Dr.Muhammad Sadiq, Homeo 106/P
240.
Dr. Khalid, Mueenabad, Jetha Bhutta
241.
Shaukat Homeo Clinic, Chachran Road.
-do-
-do-
101
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Sr. No.
Name of Hospital/Clinic-Address
242.
Shamim Homeo Clinic -do-
243.
Musa Clinic, Bismillah colony
244.
Al-Wazir Hosp:, Chowk Z.Peer
245.
Dr. Mansha Clinic -do-
246.
Dr. Zia Ullah Jatoi -do-
247.
Dr. Zia Ul-Hassan Khan -do-
248.
Dr. Sharif Clinic, Chachran Road
249.
Dr. Rubina Akhtar, Chowk Z.Peer
250.
Shafa Clinic,
251.
Abdul Kareem Clinic -do-
252.
Ahmadani Clinic
253.
Dr. Abdul Jabbar, N.Kot
254.
Ikram Clinic, Sehja Adda
255.
Usman Clinic
256.
Usman Clinic, Dr.Najeeb Alam
257.
Joya Homeo Clinic, Chowk Azim Shah.
258.
Hassan Clinic, Bagho-o-Bahar
259.
Ikhlaq Clinic,
260.
Shafaq Homeo Clinic, -do-
261.
Tayyab Clinic, Chak No.45/P
262.
Mubarik Homeo Clinic -do-
263.
Ramzan Clinic, Chachran Sharif
264.
Ashraf Clinic, Fateh pur kamal
265.
Decent Medicose, -do-
266.
Abbasi Clinic, -do-
-do-
-do-
-do-
102
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Sr. No.
Name of Hospital/Clinic-Address
267.
Murad Dawakhana, Kotla Pathan
268.
Al-Siraj Hospital, Khanpur
Annex II
Costing of MNCH related equipment gaps for DHQ and THQ Hospitals
Sr. No.
Equipment
Gap
Unit cost
1
CTG (Cardiac Tocography)
2
2
Foetal Doppler
6
3
Diagnostic Laparoscope
3
4
Bulb Sucker
5
Baby Warmer
4
6
Mechanical Sucker
9
10
285,000
10,000
Total cost
570,000
60,000
3,600,000
1,200,000
45
850,000
450
3,400,000
252,000
28,000
7
Fetal Stethoscope
3
4,500
1,500
8
Delivery Table
2
9
D&C Set
3
17,500
35,000
6,300
10
Outlet forceps
10
2,100
900
11
Myoma Screw
6
320
1,920
12
Kochers forceps
10
235
2,350
13
Volselum forceps
10
235
2,350
14
Lanes Tissue holding forceps
6
400
2,400
15
Vaginal Retractors
10
350
3,500
16
Polypectomy forceps
6
750
4,500
17
Sponge holder
20
300
6,000
18
Uterine elevator
3
150
450
19
CosCo Speculum
Small, Medium, Large (for each category)
18
550
9,900
-
20
Examination light
21
Suction Curette
3
3
9,000
54,000
18,000
95
285
103
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Sr. No.
22
Equipment
Gap
Unit cost
Infant Resuscitation Trolley (with life saving
medicines, baby laryngoscope, Endo-tracheal
tube, Infant BP Apparatus, Chargeable Light)
3
23
Mother Resuscitation Trolley (with life saving
medicines, Laryngoscope, Endo-tracheal tube,
BP Apparatus, Chargeable light)
3
24
Cardiac Monitor
Total cost
285,000
95,000
110,000
-
330,000
500,000
25
Pump Breast Electronic
3
26
Vaginal Hysterectomy Set
26
Toothed Tissue Forceps (8”)
5
55
275
26
Non-Tooted Tissue Forceps (8”)
5
55
275
26
Dissection Scissors (Curved 7”)
5
150
750
26
Dissection Scissors (Straight 7”)
4
150
600
27
Hysterectomy Clamps (Straight)
6
150
900
27
Hysterectomy Clamps (Curved)
6
175
1,050
27
Uterine Sound
3
90
270
27
Needle Holder (7”)
6
150
900
27
Needle Holder (10”)
6
300
1,800
26
Artery Forceps (Straight 6”)
30
110
3,300
26
Artery Forceps (Curved 6”)
30
125
3,750
26
Allis Forceps
20
230
4,600
26
Towel Clamps
18
125
2,250
26
Single blade Sims speculum
10
275
2,750
26
Double blade Sims speculum
10
250
2,500
26
Sponge holding forceps
15
200
3,000
26
Volselum forceps
10
250
2,500
26
Uterine Sound
250,000
750,000
-
3
4,500
1,500
26
Bladder Sound
6
27
Delivery Sets
27
Episiotomy Scissors
15
125
1,875
27
Straight Scissors
15
360
5,400
27
Needle holder
-
135
-
27
Non-toothed tissue forceps 8 inches
15
100
1,500
28
Toothed tissue forceps 8 inches
15
100
1,500
28
Sims Speculum single blade
30
275
8,250
28
Sims Speculum double blade
30
250
7,500
1,500
9,000
-
104
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Sr. No.
Equipment
Gap
Unit cost
Total cost
28
Sponge holding forceps
80
250
20,000
28
Artery forceps
80
275
22,000
27
Straight clamps (cord)
80
175
14,000
27
Vacuum Extractor pump
27
Towel clip
28
Caesarian Section
28
Scalpel
10
50
500
28
Artery Forceps Straight 6 inches
15
125
1,875
28
Artery Forceps Curved 6 inches
30
125
3,750
28
Artery forceps 8 inches
30
175
5,250
29
Myoma Scissors straight 7 inches
10
150
1,500
29
Dissecting scissors (curved) 7 inches
10
270
2,700
29
Green Armtage forceps 8 inches
30
300
9,000
29
Obstetric outlet forceps (pair)
10
900
9,000
29
Doyene’s Retractor
10
200
2,000
28
Small Retractors
15
300
4,500
28
Towel Clippers
-
-
-
28
Suction Nozzle
10
250
2,500
29
MNCH Related Radiology Equipments
29
Ultrasound Machine
29
X-Ray Unit 500 kw
29
Color Doppler
29
Lead Screen for X-Ray Unit
3
-
19,000
-
57,000
-
-
575,000
2
12,000,000
6,000,000
-
-
-
3
90,000
30,000
30
0.5 MN Lead Apron. Lead Gloves, Goggles and
Thyroid and Gonadal Sheets
3
30
Safe Light
3
30
X-RT Film Processing Tank
3
300,000
100,000
5,000
15,000
15,000
5,000
30
Chest Stand
3
30
X-Ray film Illuminator
6
29
X-Ray Film Hangers All sizes
30
MNCH Related Pediatrics Equipments
30
Pediatric Ventilator
13,500
4,500
10
4,000
4,000
24,000
40,000
-
3
1,200,000
3,600,000
105
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Sr. No.
30
Equipment
Incubator
Gap
Unit cost
-
Total cost
-
1,500,000
30
Photo Therapy Unit
2
30
Over-head Radiant Warmer
3
31
Infant Length Measuring Scale
6
31
Infant Weighing Machine
5
31
Nebulizer
3
31
Billiubino-meter
3
31
Exchange Blood Transfusion Set
3
30
Nasal Probe Paed size
6
44,000
22,000
910,000
5,000
2,730,000
30,000
15,500
3,100
22,000
36,000
66,000
108,000
6,000
2,000
42,000
7,000
31
Anesthesia/ICU
31
Anesthesia Machine
-
321,000
31
Ventilators
3
1,575,000
525,000
31
Nebulizer
1
31
Pulse Oximetry
1
32
Defibrillator
2
32
Airway Oral and Nasal
6
32
Tracheostomy tube (adult and paeds)
6
165,000
21,000
165,000
21,000
1,000,000
500,000
500
3,000
6,000
1,000
32
Face mask of all sizes
6
32
Double Cuff Tourniquet (for regional block)
3
31
AMBO bag adult
5
31
AMBO Bag paeds
6
6,000
1,000
320
960
12,250
2,450
18,000
3,000
31
Red Rubber Nasal tubes all sizes without cuff
12
32
Blood Bank
32
Blood storage cabinet (100 bag capacity)
3
32
Packed cell machine
3
1,000
12,000
-
812,000
600,000
2,436,000
1,800,000
106
Three Years Rolling Plan 2010-2013 District Rahim Yar khan
Sr. No.
32
Equipment
Cell Separator
Gap
Unit cost
3
Total cost
15,675,000
5,225,000
32
Freezer for Fresh Frozen Plasma
3
33
Blood bag shaker
3
33
RH view box
3
33
Water bath
6
33
Micro-pipette
33
Blood grouping tiles
6
32
Plasma Extractor
3
32
Platelets agitator
3
3,450,000
1,150,000
10,000
1,000
30,000
3,000
18,000
3,000
10
8,000
3,000
80,000
18,000
3,000,000
1,000,000
3,000,000
1,000,000
32
Blood thawing bath
3
32
Microscopes
2
33
Gynae & Labour Room Related Laboratory
Equipment
33
Hematology Analyzer
3,000
115,000
9,000
230,000
-
3
1,275,000
425,000
33
Electrolyte Analyzer
3
1,875,000
625,000
33
Analyzer Bio-chemistry Semi-automatic
3
33
Glucometer
6
34
Haemoglobino-meter
3
690,000
2,500
2,070,000
15,000
3,000
1,000
34
Centrifuge
Grand Total
2
133,000
266,000
66,827,685
107