High maternal mortality 3 3 3 2 3 14 4 Scabies 3 2 3 4 1 13 7 Depression 2 2 3 2 1 10 14 Suspected Malaria 2 1 3 3 1 10 15 Peptic ulcer Disease 3 2 3 2 2 12 8 Diabetes mellitus 2 2 2 2 1 9 19 Asthma 2 2 3 3 1 11 10 Dental Caries 3 2 2 1 1 9 18 Worm Infestations 2 1 3 3 1 10 16 Pulmonary Tuberculosis 2 2 3 2 2 11 9 Road side accident & Injuries 2 3 2 2 1 10 17 Underlying causes of prioritized problems Health problems have their underlying causes. It is important to know the underlying causes of the health problems so that appropriate interventions are developed. There may be a long list of these causes but only few of them are vital ones; and rectifying these causes can resolve the problem to a large extent. Following table gives common causes of the prioritized health problems pertaining to the district. Sr. # Health Problem Causes 1 Diarrheal Diseases
20 Examination 3 3 6 1 2 21 Suction Curette 1 2 2 1 0 22 Infant Resuscitation Trolley (with life saving medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light) 1 1 2 0 1 23 Mother Resuscitation Trolley (with life saving medicines, Laryngoscope, tube, BP Apparatus, Chargeable light) 1 1 2 0 1 24 Cardiac Monitor 1 1 2 1 0 25 Pump Breast Electronic 1 1 1 0 1 26 Vaginal Hysterectomy Set 2 2 4 26.1 Toothed Tissue Forceps (8”) 2 2 4 2 0 26.2 Non-Tooted Tissue Forceps (8”) 2 2 4 2 0 26.3 Dissection Scissors (Curved 7”) 2 2 4 2 0 26.4 Dissection Scissors (Straight 7”) 2 2 4 2 0
27.3 Needle holder 10 10 15 6 4 27.4 Non-toothed tissue forceps 8 inches 10 10 15 6 4 27.5 Toothed tissue forceps 8 inches 10 10 15 0 10 27.6 Sims Speculum single 20 20 30 2 18 27.7 Sims Speculum double 20 20 30 0 20 27.8 Sponge holding forceps 40 40 60 6 34 27.9 Artery forceps 40 40 60 6 34 27.10 Straight clamps (cord) 20 20 30 4 16 27.11 Vacuum Extractor pump 1 1 1 0 1 27.12 Towel clip 40 40 60 6 34 28 Caesarian Section 28.1 Scalpel 6 8 10 4 2 28.2 Artery Forceps Straight 6 inches 24 32 40 24 0 28.3 Artery Forceps Curved 6 inches 24 32 40 24 0 28.4 Artery forceps 8 inches 24 32 40 24 0 28.5 Myoma Scissors straight 7 inches 6 8 10 6 0
Low Socio Economic status Procurement and distribution of ORS ORS packets 200,000 100000 50000 50000 Malnutrition Procurement and distribution of Syp. Zinc Sulfate Syrup 150,000 100,000 50000 50000 Procurement and Distribution of Syp Metronidazole Syrup 30,000 10,000 10,000 Procurement and distribution of IV fluids IV Fluids 150000 10000 10000 2 Acute (upper) respiratory infections Malnutrition Capacity building of health staff in ARI case management Messages on local cable networks Message 12 4 4 4 Air contamination Capacity building of health staff in Integrated Management of Childhood Illnesses (IMNCI) Printing and distribution of IPC material Brochure 300000 150000 100000 50000 Over-crowding/Poor housing facilities Provision of medicines for ARI Training of medics and in IMNCI No. of trainings - - - - Already costed in Diarrhea Lack of proper sanitation Timely referral of complicated cases Procurement and distribution of Antibiotic Amoxicillin Antibiotic (Syrup) 30000 10000 10000 10000 Seasonal variation Procurement and distribution of Antibiotic Co-tri Antibiotic (Syrup) 50000 30000 10000 10000
Lack of awareness and hygienic practices 3 High 5 Mortality Poor antenatal natal and post natal coverage Health awareness/education Message on local cable Message 36 12 12 12 Infections 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 52 52 - - Birth Trauma & Asphyxia Provision of the quality Comprehensive EMONC services at THQH & DHQH Provision of the deficient infrastructure at DHQH Assessment - - - - Prematurity Improvement of feeding and weaning practices Provision of the deficient infrastructure at THQH Assessment - - - - Poor feeding and weaning practices Capacity building of Human Resource dealing child health care Trainings on IMNCI No. of trainings - - - - Already costed in Diarrhea Diarrhea Enhancing EPI coverage Need assessment of food supplements Assessment - - - - ARI Poverty elevation procurement from DGHs office Assessment - - - -
Lack of capacity of staff for provision of proper child health care (diagnostic and timely referrals) Provision of food supplements Distribution of food supplements to mothers & children through LHWs & community mid wives Assessment - - - - Low economic status Raising income of the poor families through Baitul Mal and Assessment - - - - Malnutrition Revising the micro plans of Vaccinators - - - - Lack of birth spacing Low EPI Coverage 4 High MMR Poor access to healthcare delivery services Health education/promotion Messages on local cable network Message 36 12 12 12 Lack of awareness about danger signs of pregnancy Behaviour change communication for Mothers of bearing age Printing and distribution of IPC material Brochure 150000 50000 50000 Low coverage Provision of Quality EmONC services at BHU & RHC Training of LHWs on BCC No. of trainings - - - - Low skilled birth attendance Provision of Quality Comprehensive services at THQs hospital Procurement of vehicles for transportation through CCBs - - - -
Three delays (seeking health care, transportation, and lack of referral services) Improving transportation of the patients Operation and management of vehicles through CCBs - - - - Complications of pregnancy Repair of non functional ambulances for timely transportation of pregnant mothers - - - - Capacity Issues related to maternal care Replacement of the non functional ambulances for timely transportation of pregnant mother - - - - Maternal Anemia Procurement of the MNCH related equipment and Instruments - - - - Pregnancy following chronic severe diseases Implementation of the referral protocols - - - - Procurement of (Tab. Ferrous Sulphate ) Packs 7000 4000 1500 1500 Procurement of (Tab. Folic Acid) Packs 40000 20000 10000 10000 Procurement and distribution of Calci-D Packs 10000 5000 5000
Procurement and distribution of Anti-D Injection 20 10 5 5 5 Anemia (including pregnancy) Lack of awareness about balanced diet Awareness raising for behavior change Messages on local cable network Message 36 12 12 12 Gender discrimination De-worming campaign Printing and distribution of IPC material Brochure 250,000 150000 50000 Social taboos and norms Diagnosis and treatment of infections Counseling of pregnant mothers Session - - - - Worm infestation Strengthening MNCH Services Procurement of de-worming tablets ( Tab. De-worm) No. of 50,000 10000 Infections Equity of services Distribution through LHWs and health facilities - - - - Already distributed by LHWs Poor quality of MNCH services Refresher Trainings of LHWs on BCC, balanced diet and provision of micro-nutrients No. of trainings - - - - Poverty/ Low socio economic status 6 Hepatitis Poor sanitation Health Education/Promotion Quarterly co-ordination meetings with TMA and other agencies Meetings - - - - Costed in Diarrhea
Supportive supervision to ensure above activities 7 Scabies Lack of awareness Health education & Promotion Messages on local cable networks Message 12 4 4 4 Unhygienic practices Improving water and sanitation Printing and distribution of IPC material Brochure 600000 200000 200000 200000 Over-crowding/Poor housing facilities Proper diagnosis and treatment Procurement and distribution of Benzyl Benzoate Lotion Lotion 100000 25000 Poor water and sanitation Seasonal variation 8 Road accident & Injuries Lack of traffic sense Coordination with police department to improve traffic sense and ensuring observance of traffic rules Quarterly co-ordination meetings with Traffic Police department Meeting 12 4 4 4 Poor maintenance of vehicles Advocacy for improving the condition of roads Quarterly co-ordination meetings with Highway department Meeting 12 4 4 4 Poor road conditions Health education/promotion to prevent domestic accidents Preparation of Disaster Management Plan including the Patient Management protocols Plan 1 1
Lack of safety measures at work place Ensure enforcement of safety laws at work places Training of the medics and the paramedics - - - - Fire-arm injuries Provision of emergency kits for blast victims Kits 800 400 200 200 Domestic accidents Burns Bomb blasts/terrorist activities Lack of tolerance in the society
1 Shortage of skilled Vacant positions Filling of the vacant posts Temporary Filling of the vacant posts of medics and the paramedics through existing recruitment committees Recruitment Non-sanctioning 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 Districts to prepare the incentivized pay package with consultation of all stockholders Pay Package Lack of incentives and differential pay packages Incentivized pay package at all levels Consensus building between the districts for uniform incentivized pay package for all categories and levels staff Meeting Frequent transfer postings Well defined career structure including opportunities for higher education Request to the Provincial Government for approval and implementation of agreed pay packages Plan Job insecurity Conducive working environment Review and revise the career structure of medics, paramedics and technical staff like SOs, Health Education officers etc T A Lack of basic amenities at workplace Provision of 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 Requirement Plan Political & Media Interference provision of recreation facilities area/common rooms) Plan EDOH Deficient transparent accountability Provision of the transport of children for the education purposes Plan EDOH 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 2 Inadequate budget for POL Installation of the Generator for back up electricity supply Rational increase in POL Budget Assessing additional need for POL Frequent increase in prices of POL Costing & Submission the additional Demand for POL P O L 210,907 Liters 210,907 _ _ Less allocation for POL budget 3 Lack of infrastructure Residence for EDOH Provision of the deficient infrastructure Up-gradation of DHDC Up-gradation 1 1
Residence for DOH Establishment of e-Library Up-gradation 1 1 - - DDOH residence Establishment of Training Room at DHDC Hostel Training Room 1 1 - - Residence for PD DHDC Up-gradation of Nursing School ( detail Annex) Up-gradation 1 1 - - Up-gradation of Nursing School Establishment of DHIS Office Establishment of Office 1 1 - - Construction of Residences ( EDOH, DOH, PD DHDC,DDOH,D/inspector & Other staff) Construction 1 1 1 - 4 Shortage of Vehicles Required for field/Educational visit of nursing students A.C Vehicles 35 seaters according to basic Nursing curriculum of P.N.C. Provision of vehicle Coaster 25 Seated A.C. Purchase of Vehicle Vehicle 1 1 - - Required for EDOH supervisory visits ( Double cabin Toyota Hilux) Provision of vehicle Double Cabin Toyota Hilux) Purchase of Vehicle Vehicle 1 1 - - 5 Deficient equipment (with reference to notified list) at all levels of care Deficient equipment to basic and comprehensive EmONC at primary and secondary level of care Provision of equipments in accordance with identified gaps with MNCH notified list Purchase of equipments for DHQH Pakpattan and THQH Arifwala Equipment 1 1 - - Old and un-serviceable equipment
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 poverty pregnant mother through LHWs and providing them food supplement through DGHS & Financial support from BaitulMall & Zakat - - - - - Revising the micro plans of Vaccinators - - - - - 4 High MMR Messages on local cable network Message 8,000 36 96,000 105,600 116,160 317,760 Printing and distribution of IPC material Brochure 4 150000 200,000 220,000 242,000 662,000
Training of LHWs on BCC No. of trainings Already costed in problem High 5 Mortality - - - - - Procurement of vehicles for transportation through CCBs Costed in service delivery problems - - - - - Operation and management of vehicles through CCBs Costed in service delivery problems - - - - - Repair of non functional ambulances for timely transportation of pregnant mothers Costed in service delivery problems - - - - - Replacement of the non functional ambulances for timely transportation of pregnant mother Costed in service delivery problems - - - - - Procurement of the MNCH related equipment and Instruments Costed in service delivery problems - - - - -
Implementation of the referral protocols Costed in MSDS Gaps - - - - - Procurement of Micro-nutrients (Tab. Ferrous Sulphate ) Packs 35 7000 140,000 57,750 63,525 261,275 Procurement of Micro-nutrients (Tab. Folic Acid) Packs 20 40000 400000 220,000 242,000 862,000 Procurement and distribution of Packs 15 150,000 82,500 90,750 323,250 Procurement and distribution of Anti-D Injection 5000 20 50,000 27,500 30,250 107,750 1,036,000 713,350 784,685 2,534,035 5 Anemia (including pregnancy) Messages on cable network Message 8,000 36 96,000 105,600 116,160 317,760 Printing and distribution of IPC material Brochure 6 250,000 900,000 330,000 363,000 1,593,000
Counseling of pregnant mothers Session LHWs are expected to conduct counseling session on behavior change during visit to pregnant ladies - - - - 317,760 Procurement of tablets ( Tab. Deform) No. of doses 7 50,000 210,000 77,000 84,700 371,700 Distribution through LHWs and health facilities Already distributed - - - - - Refresher Trainings of LHWs on BCC, balanced diet and provision of No. of trainings Already costed in problem High under 5. - - - - - 1,206,000 512,600 563,860 2,600,220 6 Hepatitis Quarterly meetings with TMA and other agencies Meetings Costed in diarrheal disease - - - - - Messages on local cable network Message 8000 36 96,000 105,600 116,160 317,760
Documentation of expense of disposable syringes - - - - - - - Supportive supervision to ensure above activities - - - - - - - 2,130,000 1,353,000 1,488,300 4,971,300 7 Scabies Messages on local cable networks Message 8,000 12 32,000 35,200 38,720 105,920 Printing and distribution of IPC material Brochure 4 600000 800,000 880,000 968,000 2,648,000 Procurement and distribution of Benzyl Benzoate Lotion Lotion 15 100000 750,000 412,500 453,750 1,616,250 1,582,000 1,327,700 1,460,470 4,370,170
8 Road accident & Injuries Quarterly meetings with Traffic Police department Meeting 3,000 12 12,000 13,200 14,520 39,720 Quarterly meetings with Highway department Meeting 3,000 12 12,000 13,200 14,520 39,720 Preparation of Disaster Management Plan including the Patient Management protocols Plan MS of the respective Hospital, EDO & DOH will prepare the Plan 1 - - - - Training of the medics and the paramedics - - - - - Provision of emergency kits for blast victims Kits 5591 800 2,236,400 1,230,020 1,353,022 4,819,442 2,260,400 1,256,420 1,382,062 4,898,882
Sr. Problem Activity Define Financial Targets Cost Unit Rate Quantity Year I Year II (10 %) Year III (10 %) 1 Inadequate budget for POL Assessing ,Costing & Submission the additional Demand for POL P O L 75 210,907 Liters 15,818,000 - - 15,818,000 - - 15,818,000 - - 15,818,000 2 Lack of infrastructure Up gradation of DHDC Up gradation 2,100,000 1 2,100,000 - - 2,100,000 Establishment of e-Library Establishment 520000 1 520,000 - - 520,000 Establishment of Training Room at DHDC Hostel Training Room 492000 1 492,000 - - 492,000 Up gradation of Nursing School ( detail Annex) Up gradation 1,925,000 1 1,925,000 - - 1,925,000 Establishment of DHIS Office Establishment of Office 278000 1 278,000 - - 278,000 Construction of Residences ( EDOH, DOH, PD DHDC,DDOH,D/inspector & Other staff) Construction 16,700,000 1 6,680,000 5,010,000 5,010,000 16,700,000 11,995,000 5,010,000 5,010,000 22,015,000
4 Shortage of Vehicles Purchase of Vehicle Nursing Students Vehicle 2,800,000 1 2,800,000 - - 2,800,000 Purchase of Supervisory Vehicle for EDOH Vehicle 3200000 1 3,200,000 - - 3,200,000 Purchase of Vehicle for Statistical Officer Vehicle 600000 1 600000 600000 6,000,000 600,000 - 6,600,000 5 Deficient equipment (with reference to notified list) at SHC Purchase of MNCH related equipment at DHQ Hospital Pakpatan Equipment Detailed Annexed 24,514,470 - - 24,514,470 Purchase of MNCH related equipment at THQ Hospital Arifwala Equipment Equipment 16,564,100 - - 16,564,100 41,078,570 - - 41,078,570
% of targeted eligible couples provided knowledge and information on Family Planning methods Target according to population LHW’s monthly/ quarterly report EDOH/ Statistical Officer /Coordinator NP-FP&PHC Quarterly No. of meetings with participation from other sectors 12 meetings per year Minutes of meetings EDOH/ Focal person/s Quarterly
Annex-1 Private Health Facility in District Pakpattan Sr. No Name of Hospital/Clinic Name of Doctors/ Specialist 1 Ghaffar Clinic Purana Town Pakpattan Dr. Abdul Ghaffar Ghaffar 2 Meraj Clinic Near Dr. Tanveer Hospital Pakpattan Dr. Muhammad Meraj 3 Yaqoob Clinic Railway Road Pakpattan Dr. Muhammad Yaqoob 4 Akram Clinic Railway Road Pakpattan Dr. Muhammad Akram 5 Jalil Clinic Mandi Bazar Pakpattan Dr. M.A. Jalil 6 Jamil Clinic Mandi Bazar Pakpattan Dr. Bhutta 7 Anwar Clinic Mandi Bazar Pakpattan Dr. Muhammad Anwar 8 Al-Seraj Hospital Karkhana Bazar Pakpattan Dr. Younas Rana Dr. Mrs. Nabeela Rana 9 Tahir Clinic College Road Pakpattan Dr. Muhammad Tahir Dr. Salma Iqbal 10 Sabria Clinic College Road Pakpattan Dr. Azfar Hadi