SCR 90% TSR 91% DR 0.5% Malaria Control Program No. of slides examined 60027 No. of positive slides 605 Slides positively ratio 1.008% Percentage of plasmodium falciparum 13.2% HIV/AIDS Control Program Total cases diagnosed 184 Hepatitis Control Program No. of hepatitis tests conducted 24256 No. of positive cases detected 1812 No. of persons vaccinated against Hepatitis B 3195 No. of cases treated for Hepatitis B 31 No. of cases treated for Hepatitis C 490 School Health Services Program The school health services program is functional in the district. Regular visits are being conducted by the medical officers of School Health Services (SHS) program. The detail of program activities is as under: Total Visits to the School 2616 No. Students Examined 24164 No of students referred to BHUs 9366 No. Students Treated at BHU 22071 No. of Students referred from BHU to higher facilities 30841 No. of Schools in catchment Areas 2120 ( 923 Girls+1197 boys) No. of Students 314578 No of Teachers Trained 5307 ( 6490) No of SH & NS 69 Source: DHDC Gujrat
SECTION 3: INTERVENTIONS AND TARGETS After enlisting the vital causes of prioritized health problems, team proposed appropriate interventions to tackle the problems. Once interventions and activities had been identified, next task the planning team performed was to set the number and quality of specific activities (targets) that have to be carried out. It is pertinent to mention over here that the plan envisages additional activities along with routine activities under regular budget. Health Problem Problem Causes Intervention Activity Unit Plan Activities Targets Target for 2010-11 Target for 2011-12 Target for 2012-13 Remarks 1 Diarrhoeal diseases Poor Hygiene & sanitation Coordination with TMA for improvement of water supply and sanitation Quarterly meetings with TMA and other agencies Meetings 12 8 4 4 Lack of safe drinking water Awareness raising campaign Messages on local cable network Monthly Telecast 36 24 12 12
Unhygienic practices treatment of Diarrhoea including ORT Printing and distribution of IPC material Brochure 300,000 200,000 100,000 100,000 Lack of awareness among mothers about feeding and weaning practices Health awareness in the community of HES in the community Session 240 160 80 80 - Capacity building of health staff in Integrated Management of Childhood Illnesses (IMCI) Training of medics and paramedics in IMCI Training 8 4 2 2 - - and distribution of ORS and ORS packets 3,600,000 2,400,000 1,200,000 1,200,000
Zinc Sulphate Syrup 300,000 200,000 100,000 100,000 2 Accidents And Injuries Lack of traffic sense Coordination with police department to improve traffic sense and ensuring observance of traffic rules · Quarterly meetings with Traffic Police department Meetings 12 8 4 4 Poor maintenance of vehicles Advocacy for improving the condition of roads · Quarterly meetings with Highway department Meetings 12 8 4 4
Sharing of used syringes Strengthening blood transfusion services for safe transfusions ·Printing and distribution of IPC and hepatitis awareness material Brochure 30,000 20,000 10,000 10,000 Transfusion of blood and blood products Campaign against drug addiction and supply of screening kits Kits 300,000 200,000 100,000 100,000 Unsafe sexual practices Regulatory mechanism to ensure use of safe instruments by dentists, barbers etc. of safety boxes Syringe cutter 600 400 200 200 Ear piercing and tattooing of drugs for treatment of Injection 9,000 6,000 3,000 3,000
Hepatitis patients 4 Diabetes Obesity Health Education campaign regarding healthy life style Health educational sessions in community Seminar - - - - Inactive life style Strengthening diagnostic services for early detection Printing and distribution of Health Education material Brochure 150,000 100,000 50,000 50,000 Lack of health awareness on Diabetes Provision of lab glucometer with Sticks 400 200 100 100 · Genetics & Infections Provision of medicines Drug 60,000 40,000 20,000 20,000
5 Malaria Breeding places for mosquitoes Public awareness campaign Printing and distribution of Health Education material Poster 60,000 40,000 20,000 20,000 In judicious use of anti malarial by GPs And HCPs Strengthening Malaria eradication program Provision of lab Microscope , allied kit 100 - - - · Lack of awareness for prevention Training of health care providers / GPs on Roll back malaria Training 8 4 2 2 Antimalarial drugs aursonate tablets, Tablet (Pack of 100) 2,000 1,000 500 500
Antimalarial drugs Primaquin, Tablet (Pack of 100) 7,000 4,000 2,000 2,000 Antimalarial drugs Chloroquin Tablet (Pack of 100) 200,000 100,000 50,000 50,000 Fogging Machine Machine 2 - - - Purchase of diesel for fogging Litre 9,000 6,000 3,000 3,000 Spray Pumps pumps 150 100 50 50 Uniform for spray man Uniform 150 - - -
Glasses/ gloves, Bucket, soap Misc 150 100 50 50 Purchase of insecticide delta methrine (Powder 5 % WDP) Kg 10,000 6,000 4,000 2,000 Purchase of insecticide delta methrine (Liquid 1.5 % ) Litre 6,000 4,000 2,000 2,000 Purchase of larvicidal Drug (Phenthion Granules) Kg 5,000 3,000 2,000 1,000
Purchase of larvicidal Drug ( Temiphos) Liquid Litre 1,600 1,000 500 500 Spray man 4 Squad of 6 persons x 25 days 15 10 5 5 Purchase of motor cycle for CDCSs Motor cycle 60 25 15 10 POL for motor cycles litre 26,100 19,800 9,000 10,800 6 Scabies Overcrowding in schools and homes · Awareness raising campaign Community health education sessions HES 240 160 80 80
Low conditions · Provision of medicines Printing & Distribution of IPC Material Brochure 150,000 100,000 50,000 50,000 Poor Health Education - Supply of anti scabies drugs drug 250,000 150,000 75,000 75,000 7 Complication of pregnancy Low access to appropriate health services Behaviour Change Communication (BCC) Messages on local cable network Monthly Package - - - - Lack of awareness about danger signs of pregnancy Improving transportation to appropriate level of care Printing and distribution of IPC material Brochure 200,000 100,000 50,000 50,000 Three delays (seeking health care, and lack of Strengthening healthcare facilities Activation and use of Health Committees and women - - - - - transportation
referral services) groups under LHWs Lack of skilled birth attendants Refresher courses for TBAs Training of TBAs with specific focus on safe delivery and danger signs Batch of 25 TBAs for 2 days Training 20 10 5 5 Deployment of community midwives Placement of in their catchment area - - - - - Repair of non functional ambulances for timely Ambulance 4 - - -
of pregnant mothers of non functional ambulances for timely of pregnant mothers Ambulance 12 6 4 2 POL for ambulances Litre 28,800 24,000 9,600 14,400 Management Problems Sr. No. Name of Post Basic Scale Basic Pay Allowances Requirement as per Gap Physical Targets
Problem Causes Intervention Activity Unit Plan Activities Targets Target for 2010-11 Target for 2011-12 Target for 2012-13 Remarks 1. Shortage of skilled staffs MNCH related of trained staff ·Filling of the vacant posts ·Filling of the vacant posts of medics and the paramedics through existing recruitment committees - - - - - of staff according to MSDS ·Sanctioning of trained staffs according to MSDS Temporary filling of vacant positions on contract - - - - - ·Lack of permanent postings ·Incentivized pay package at all levels ·Demand generation and request to the Department of Health by the districts for recruitment through PSC against vacant posts - - - - - Plan availability
Lack of incentivized and differential pay package Well defined career structure including opportunities for higher education ·Orientation trainings of the recruited staffs Batch 6 4 1 1 - Frequent transfer postings High level political commitment for providing protection to staff working in health facilities ·Consensus building between the districts for uniform incentivized pay package for all categories and levels staff - - - - - Meeting Job insecurity ·Request to the Provincial Government for approval and implementation of agreed pay packages - - - - - Plan
Lack of basic amenities at workplace ·Review and revise the career structure of medics and paramedics - - - - - Technical assistance Lack of conducive environment including insecurity and transport of children for education · Filling of Human Resource gaps as per MSDS Posts 136 67 34 35 Detail HR plan is attached Posts 10 5 3 2 Detail HR plan is attached Political and media interference HR 146 72 37 37 Detail HR plan is attached
·Capacity and need assessment of the medics and the paramedics - - - - - NO COST ACTIVITY ·Prepare training programs for providing higher professional education based on TNA - - - - - TNA 2. Inadequate medicine and supply Less budget allocation for medicines Need-based demand for provision of sufficient budget for medicines and supplies ·Inclusion of enhanced amount for medicines and supplies in the proposed annual budget according to the needs - - - - - Need
Frequent increase in price Demand generation for medicine. - - - - - Demand generation Procurement of essential drugs on the basis of allocated budget - - - - - Already addressed in health problems 3. Inadequate budget for POL · Generator provision for backup of electricity supply Rational increase in POL budget Assessment of additional requirement - - - - - NO COST ACTIVITY · Less budget allocation Costing and submission of additional demand - - - - - - · Frequent increase in prices · Provision of POL budget for supervisory vehicles for DHQ litre 39,600 13,200 13,200 13,200 -
· Provision of POL budget for supervisory vehicles for THQ litre 74,160 24,720 24,720 24,720 - · Provision of POL budget for generator litre 594,000 198,000 198,000 198,000 - 4. Inadequate MNCH related Equipment Deficient equipment to cater basic and comprehensive EmONC at primary and secondary level of care · Provision of the equipment in accordance with the notified equipment list Procurement of equipments for THQ and DHQ hospitals based on the gaps between MSDS and existing available - - - - - Detail attached Old and equipment · Provision of adequate budget for maintenance and repair Allocation of enhanced amount for M&R of equipments - - - - - of demand
· Shortage of regular budget for M&R · Capacity building of staff regarding maintenance of log books of each equipment Orientation of staffs in maintenance of logos for equipments - - - - - Plan 5. Deficient logistic support ·Provision of inadequate funds for purchase of vehicles · Provision of sufficient funds for purchase of vehicles · Condemnation of the old and off-road vehicles - - - - - As per demand by district - ·Ban on procurement of vehicles by the government · Seeking exemptions for procurement of specific vehicle · Preparation and submission of demand for replacement five ambulances at RHC - - - - - Demand - ·Complicated procedure for purchase of new vehicles · Expedite the procurement procedure · Procurement of ambulances Ambulance - - - - Addressed in health problem no. 07
· Demand sufficient funds for repair and maintenance of vehicles and expedite the repair · Demand submission for replacement four supervisory vehicles at HQ AND THQ - - - - - Demand · Procurement of supervisory vehicles at DHQ vehicles 1 1 - - - ·Poor maintenance of vehicles - - - - - - - NO COST ACTIVITY · Procurement of supervisory vehicles at THQ vehicles 8 4 2 2 -
department · Quarterly meetings with Highway department Meetings 5,000 12 20,000 90,400 24,200 66,200 - · Preparation of Disaster Management Plan including the Patient Management protocols - - - - - - - Plan · Training of the medics and the paramedics in first aid and emergency Training in Batch for 25 trainees 50,000 20 500,000 1,380,000 302,500 1,077,500 Including medics and paramedics · Provision of emergency kits for victims Kits 3,000 1,500 1,500,000 6,780,000 1,815,000 4,965,000 -
· Procurement and supply of screening kits Kits 50 300,000 5,000,000 22,600,000 6,050,000 16,550,000 - · Procurement of safety boxes Syringe cutter 500 600 100,000 452,000 121,000 331,000 - · Procurement of drugs for treatment of Hepatitis patients Injection 12,000 9,000 43,560,000 119,160,000 - 4 Diabetes Health educational sessions in community Seminar - - - - - - Integrated Activity Printing and distribution of Health Education material Brochure 5 150,000 250,000 1,130,000 302,500 827,500 -
Antimalarial drugs aursonate tablets, Tablet (Pack of 100) 2,000 2,000 2,000,000 5,520,000 1,210,000 4,310,000 - Antimalarial drugs Primaquin, Tablet (Pack of 100) 1,000 7,000 3,000,000 10,040,000 2,420,000 7,620,000 - Antimalarial drugs Chloroquin Tablet (Pack of 100) 50 200,000 5,000,000 13,800,000 3,025,000 10,775,000 - Fogging Machine Machine 90,000 2 180,000 180,000 - 180,000 - Purchase of diesel for fogging Litre 76 9,000 228,000 1,030,560 275,880 754,680 -
Purchase of larvicidal Drug (Phenthion Granules) Kg 500 5,000 1,000,000 3,310,000 605,000 2,705,000 - Purchase of larvicidal Drug ( Temiphos) Liquid Litre 2,000 1,600 1,200,000 4,720,000 1,210,000 3,510,000 - Spray man 4 Squad of 6 persons x 25 days 65,000 15 325,000 1,469,000 393,250 1,075,750 - Purchase of motor cycle for CDCSs Motor cycle 60,000 60 2,100,000 4,542,000 726,000 3,816,000 - POL for motor cycles litre 75 26,100 472,500 3,175,200 980,100 2,195,100 -
6 Scabies Community health education sessions HES 2,000 240 160,000 723,200 193,600 529,600 - Printing & Distribution of IPC Material Brochure 5 150,000 250,000 1,130,000 302,500 827,500 - Supply of anti scabies drugs drug 50 250,000 5,000,000 18,200,000 4,537,500 13,662,500 - 7 Complication of pregnancy Messages on local cable network Monthly Package - - - - - - Integrated Activity Printing and distribution of IPC material Brochure 5 200,000 500,000 1,380,000 302,500 1,077,500 -
· Filling of Human Resource gaps as per MSDS Posts - 136 7,529,280 18,540,733 38,553,517 Detail HR plan is attached - Posts - 10 229,200 403,392 554,664 1,187,256 Detail HR plan is attached - HR - 146 29,170,665 60,748,627 Detail HR plan is attached · Capacity and need assessment of the medics and the paramedics - - - - - - - NO COST ACTIVITY · Prepare training programs for providing higher professional education based on TNA - - - - - - - TNA
2 Inadequate medicine and supply · Inclusion of enhanced amount for medicines and supplies in the proposed annual budget according to the needs - - - - - - - Need assessment Demand generation for medicine. - - - - - - - Demand generation Procurement of essential drugs on the basis of allocated budget - - - - - - - Already addressed in health problems 3 Inadequate budget POL Assessment of additional requirement - - - - - - - NO COST ACTIVITY
Costing and submission of additional demand - - - - - - - - · Provision of POL budget for supervisory vehicles for DHQ litre 75 39,600 990,000 1,089,000 1,197,900 3,276,900 - · Provision of POL budget for supervisory vehicles for THQ litre 75 74,160 1,854,000 2,039,400 2,243,340 6,136,740 - · Provision of POL budget for generator litre 75 594,000 17,968,500 49,153,500 - 4 Inadequate MNCH related Equipment Procurement of equipments for THQ and DHQ hospitals based on the gaps between MSDS and existing - - - 9,727,000 2,692,845 - 12,419,845 Detail attached
Activity-wise costing Health Problems Sr. No. Problem Activity FY-I FY-II FY-III Total 1 Diarrhoeal diseases Quarterly co-ordination meetings with TMA and other agencies 12,000 13,200 14,520 39,720 Messages on local cable network 420,000 462,000 508,200 1,390,200 Printing and distribution of IPC material 500,000 550,000 605,000 1,655,000 Conduction of HES in the community 160,000 176,000 193,600 529,600 Training of medics and paramedics in IMCI 980,000 539,000 592,900 2,111,900 Procurement and distribution of ORS and Zinc Sulphate 6,000,000 6,600,000 7,260,000 19,860,000 - 6,000,000 6,600,000 7,260,000 19,860,000
2 Accidents And Injuries · Quarterly co-ordination meetings with Traffic Police department 20,000 22,000 24,200 66,200 · Quarterly co-ordination meetings with Highway department 20,000 22,000 24,200 66,200 · Preparation of Disaster Management Plan including the Patient Management protocols - - - - · Training of the medics and the paramedics in first aid and emergency 500,000 275,000 302,500 1,077,500 · Provision of emergency kits for victims 1,500,000 1,650,000 1,815,000 4,965,000 · Procurement of equipments / instruments / various splints and Plaster casts - - - - · Drugs 150,000 165,000 181,500 496,500 3 Hepatitis B & C · Quarterly co-ordination meetings with TMA and other agencies - - - - · Messages on local cable - - - -
implementation of agreed pay packages · Review and revise the career structure of medics and paramedics - - - - Filling of Human Resource gaps as per MSDS 7,529,280 12,483,504 18,540,733 38,553,517 229,200 403,392 554,664 1,187,256 11,875,272 19,702,690 29,170,665 60,748,627 · Capacity and need assessment of the medics and the paramedics - - - - · Prepare training programs for providing higher professional education based on TNA - - - - 2 Inadequate medicine and supply · Inclusion of enhanced amount for medicines and supplies in the proposed annual budget according to the needs - - - - Demand generation for - - - -
Orientation of staffs in maintenance of logos for equipments - - - - 5 Deficient logistic support · Condemnation of the old and off-road vehicles - - - - · Preparation and submission of demand for replacement five ambulances at RHC - - - - · Procurement of ambulances - - - - · Demand submission for replacement four supervisory vehicles at HQ AND THQ - - - - · Procurement of supervisory vehicles at DHQ 3,800,000 - - 3,800,000 · Procurement of supervisory vehicles at THQ 3,600,000 1,980,000 2,178,000 7,758,000 55,856,752 7,111,381 2,277,908 185,246,040
SECTION 5: Monitoring and Evaluation The monitoring and evaluation targets and indicators mentioned below will be used to gauge the progress of implementation of the plan. Monitoring and evaluation of the three years rolling plan would be carried out through the proposed indicators, targets and means of verifications, by the district health authorities. M&E of Plan Indicators Target % Achievement MoV Responsibility Frequency of monitoring Remarks % of planned supervisory visits conducted 50 visits /year Inspection Book EDOH/DOH/ DDOH Quarterly % of RHCs with of specialists of essential specialties (Physician, Surgeon, Paediatrician and Gynaecologist) 100% During 1st year Pay Roll EDOH / DOH 6 monthly % of health facilities with availability of essential MNCH related equipment (level specific) 100% During 1st year Stock Register EDOH/ DOH/ MSs 6 monthly Availability of relevant (MNCH) laboratory equipment at appropriate level of care 100% During 1st year Stock Register EDOH/ DOH/MSs, Store keeper Quarterly
% facilities with availability of essential medicines 100% During 1st year Stock Register EDOH/ DOH/ MSs, Store keeper Monthly % of functional ambulances in the district 100% (DHQH/ THQH/ RHCs) Log Book EDOH/DOH/ Transport officer Quarterly % utilization of sanctioned budget 100% of yearly budget Quarterly Reports EDOH/ DOH/ MSs/ Accounts officer Quarterly % of facilities with availability of basic EmONC 100% (50% during 1st year) Supervisory visit report EDOH/DoH/ DDOH Quarterly % of DHQ/THQ hospitals with Comprehensive EmONC services 100% in 3 years (50% during 1st year) Supervisory visit report EDOH/DoH/ DDOH Quarterly % of facilities with availability of separate or partitioned room reserved exclusively for delivery 100% in 3 years (50% during 1st year) Supervisory visit report EDOH/DoH/ DDOH Quarterly % of targeted pregnant women newly registered by LHW Target according to population DHIS Report EDOH/ Statistical Officer Quarterly % of targeted pregnant women received TT-2 vaccine Target according to population DHIS Report EDOH/ DHIS Coordinator/ Statistical Officer Quarterly
Delivery conducted by or under supervision of skilled persons reported 90% (…. % During 1st year) DHIS Report EDOH/ DHIS Coordinator/ Statistical Officer Quarterly %of target children between 18 - 23 months of age fully immunized Target according to population DHIS Report EDOH/ DHIS Coordinator/ Statistical Officer Quarterly % of referred cases attended 100% DHIS Report/ LHWs monthly report EDOH/ DHIS Coordinator/ Statistical Officer Quarterly % 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
31.6 Airway Oral and Nasal 1 2 2 1 0 500 0 31.7 Tracheostomy tube (adult and paeds) 1 2 2 1 0 1000 0 31.8 Face mask of all sizes 1 2 2 1 0 1000 0 31.9 Double Cuff Tourniquet (for regional block) 1 1 1 1 0 320 0 31.1 AMBO bag adult 1 2 2 1 0 2450 0 31.11 AMBO Bag paeds 2 2 2 2 0 3000 0 31.12 Red Rubber Nasal tubes all sizes without cuff 4 4 4 4 0 1000 0 32 Blood Bank 0 32.1 Blood storage cabinet (100 bag capacity) 1 1 1 1 0 812000 0 0 Packed cell machine 1 1 1 1 0 600000 0 32.3 Cell Separator 1 1 1 1 0 5225000 0 32.4 Freezer for Fresh Frozen Plasma 1 1 1 1 0 1150000 0 32.5 Blood bag shaker 1 1 1 1 0 10000 0 32.6 RH view box 1 2 2 1 0 1000 0 32.7 Water bath 2 2 2 2 0 3000 0 32.8 Micro-pipette 4 4 6 4 0 8000 0 32.9 Blood grouping tiles 3 3 3 3 0 3000 0 32.1 Plasma Extractor 1 1 1 1 0 1000000 0 32.11 Platelets agitator 1 1 1 1 0 1000000 0 32.12 Blood thawing bath 1 1 1 1 0 3000 0 32.13 Microscopes 1 1 1 1 0 115000 0 33 Gynae & Labour Room Related Laboratory Equipment 0 33.1 Hematology Analyzer 1 1 1 1 0 425000 0 33.2 Electrolyte Analyzer 1 1 1 1 0 625000 0 33.3 Analyzer 1 1 1 1 0 690000 0 33.4 Glucometer 2 2 2 2 0 2500 0 33.5 1 1 1 1 0 1000 0