Area-wise population Area Population Percentage 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 Population Groups Standard Demographic (%) Estimated Population 2010 1 year of age 2.7 123621 5 years 13.4 613524 Under 15 years 44 2014557 Women in child bearing age (15-49 years) 22 1007278 Married child bearing age women 16 732566 Expected pregnancies 3.4 155670 Standard Demographic population groups on DHIS
Bearer 6 4 2 Sanitary Worker 35 24 11 Naib Qasid 8 6 2 Masalchi 3 2 1 Mali 3 3 0 Gate Keeper 3 2 1 Dhobi 3 3 0 Dawakob 3 3 0 Dai 7 5 2 Cook 6 5 1 Chowkidar 9 9 0 Baildar 6 5 1 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
THQ Hospital (A composite list of gaps with reference to MSDS) Sr. No. Post Standard as per MSDS Sanctioned Filled 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 Equipment Government of Punjab has notified a standard list as 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 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.
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 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
Health Problems Sr. No. Problem Causes Intervention Activities Unit Plan Activities Targets Target for Target for Target for Remarks 1 Poor sanitation improvement of water supply and sanitation Quarterly Meeting with TMA and agencies Meeting 12 4 4 4 Lack of safe drinking water Health Education campaign Messages on local cable network Message 12 4 4 4 Unhygienic practices Improving literacy rate through coordination with education department Printing and distribution of IPC material Brochure 600000 300000 150000 150000 Lack of awareness in general population Proper treatment of Diarrhea including ORT Address in school assemblies Session 5,400 1,800 1,800 1,800
Unsafe drinking 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 3 1 1 1 Ear piercing and tattooing Procurement and supply of Eliza kits Kits 200 100 50 50
3 High 5 Mortality Poor antenatal natal and post natal coverage Health Message on local cable Message 36 12 12 12 Neo-natal 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 74 40 17 17 Birth Trauma & Asphyxia Provision of the quality Comprehensive services at THQH & DHQH Provision of the deficient infrastructure at THQ Assessment Prematurity Improvement of feeding and weaning practices Trainings on IMCI No. of trainings - Poor feeding and weaning practices Capacity building of Resource dealing child health care Need assessment of food supplements Assessment -
Diarrhea Enhancing EPI coverage procurement from DGHs office Assessment - ARI Poverty elevation Distribution of food supplements to mothers & children through LHWs & community mid wives Assessment Lack of capacity of staff for provision of proper child health care (diagnostic and timely referrals) Provision of food supplements Raising income of the poor families through Baitul Mall and Zakat Assessment Low economic status Revising the micro plans of Vaccinators
Malnutrition Lack of spacing Low EPI Coverage 4 High MMR Poor access to healthcare delivery services Health 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 100000 30000 20000 Low coverage Provision of Quality basic EmONC services at BHU & RHC Training of LHWs on BCC No. of trainings 36 12 12 12
Low skilled birth attendance Provision of Quality Comprehensive EmONC services at THQs & DHQs hospital Procurement of vehicles for transportation through CCBs Three delays (seeking health care, and lack of referral services) Improving transportation of the patients Operation and management of vehicles through CCBs Capacity Issues related to maternal care Repair of non functional ambulances for timely transportation of pregnant mothers
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 Implementation of the referrals protocols Procurement of Micro-nutrients Capsule 300000 150000 75000 Procurement and distribution of Calci-D No. of tablets 200000 100000 50000 Procurement and distribution of Anti-D Injection 30 10 10 10
5 Diabetes Mellitus Genetic makeup Health awareness for promoting health life style behaviors Message on local cable Message 12 4 4 4 Obesity Balanced diet Message on FM Message 12 4 4 4 Competitive type A personality Regular walk/exercise Awareness 3 1 1 1 Sedentary life style Screening Camps for high risk population Fast Foods lacking fibers 6 TB Suspects Low status Health Messages on local cable networks Message 12 4 4 4
Seasonal variation Strengthening TB DOTS program through involvement of private sector Printing and distribution of IPC material Brochure 75000 25000 25000 25000 Lack of proper sanitation Involvement of private providers through public private partnership Procurement of to ensure deficiency according to regimen ATT course 600 200 200 200 Lack of awareness and hygienic practices 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 7 Acute (upper) respiratory infections Malnutrition Capacity building of health in ARI case management Messages on local cable networks Message 12 4 4 12
Air Capacity building of health staff in Integrated Management of Childhood Illnesses (IMCI) Messages through FM radio channels Message 12 4 4 12 housing facilities Provision of medicines for ARI Printing and distribution of IPC material Brochure 300,000 100,000 100,000 300,000 Lack of proper sanitation Timely referral of complicated cases Training of medics and in IMCI No. of trainings - - Seasonal variation Procurement and distribution of Antibiotic Syrup Amoxycillin Antibiotic (Syrup) 150,000 50,000 50,000 150,000 Lack of awareness and hygienic practices
8 Aneamia ( including pregnancy) Lack of awareness about balanced diet Awareness raising for behaviour change Messages on cable network Message 12 4 4 4 Gender 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 300,000 100,000 100,000 100,000 Infections Diagnosis and treatment of infections Distribution through LHWs and health facilities
· Poor quality of MNCH services Strengthening MNCH Services ·Refresher Trainings of LHWs on BCC, balanced diet and provision of micro-nutrients No. of trainings Poverty/ Low socio economic status Equity of services Provision of Sahulat Card/health voucher
Sr. No. Problem Causes Intervention Activities Unit Plan Activities Targets Target for Target for Target for Remarks 1 Shortage of skilled staff Vacant positions Filling of the vacant Temporary Filling of the vacant posts of medics and the paramedics through existing recruitment committees Recruitment - - - - 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, Health Education officers etc T A - - - - Lack of basic amenities at workplace Provision of staff Residences Availability of recreation, education and 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 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 264,387 Liters 264,387 Less allocation for POL budget 3 Capacity issues of the staff Delay release and utilization of funds due to non-clarity of financial procedures Advocacy for keeping health department on higher priority Pursuance of EDO ( F&P) for timely release of funds - - - -
Inability of subordinate staff to carry out activity and in accordance with protocols Pursuance to the competent authority for timely release of funds Conducting Financial Management workshops No. of trainings 3 1 1 1 Inability of staff to convert data into information for management, planning and decision making 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
Health Problems Sr. Problem Activity Define Financial Targets Total Cost Unit Rate Quantity Year I Year II (10 %) Year III (10 %) 1 Diarrhea Quarterly 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 165,600 13 662,400 546,480 601,128 1,810,008
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 - - - - - - - - 4,530,000 2,678,500 2,946,350 10,154,850
3 High under 5 Mortality 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 - - - - -
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 poverty pregnant mother through LHWs and providing them food supplement through DGHS & Financial support from BaitulMall & Zakat - - - - -
Distribution of food supplements to mothers & children through LHWs & community mid wives Assessment Assessing 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 - - - - -
1,496,000 1,230,680 1,353,748 4,080,428 4 High MMR 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 - - - - -
642,000 681,200 642,000 1,965,200 6 TB Suspects Messages on local cable networks Message 70,000 12 280,000 308,000 338,800 926,800 Printing and distribution of IPC material Brochure 6 75000 150,000 150,000 150,000 450,000 Procurement of drugs to ensure deficiency according to regimen ATT course To be procured from the PTP 600 - - - - Procurement of reagents for notified diagnostic facilities under DOTS programme Packs To be procured from the PTP 50 - - - -
Trainings on DOTS protocols No. of trainings 136400 14 818,400 600,160 660,176 2,078,736 1,248,400 1,058,160 1,148,976 3,455,536 7 Acute (upper) respiratory infections Messages on 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 in IMCI No. of trainings IMCI Training package costed in Diarrhea also includes management of ARI - - - - -
Procurement and distribution of Antibiotic Syrup Amoxycillin Antibiotic (Syrup) 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 8 Anemia ( including pregnancy) Messages on local cable network Message 70,000 - 280,000 308,000 338,800 926,800 Printing and distribution of IPC material Brochure 5 250,000 275,000 302,500 827,500 Counseling of pregnant mothers Session LHWs are expected to conduct counseling session on behavior change during their visit to pregnant ladies - - - - - Procurement of de-worming tablets No. of 25 - 2,500,000 2,750,000 3,025,000 8,275,000
Distribution through LHWs and health facilities - - - - Refresher Trainings of LHWs on BCC, balanced diet and provision of No. of trainings IMCI Training package costed in Diarrhea also includes management of ARI - - - - - Provision of Sehat Sahulat Card/health voucher - - - - - 3,030,000 3,333,000 3,666,300 10,029,300
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 like Sos, Health Education officers etc T A - - - - - - Availability of recreation, education and 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 - - - - - -
102,600 102,600 102,600 307,800 4 Deficient equipment for MNCH services at secondary care facilities Purchase of MNCH related equipment at all THQHs Equipment 66,827,685 66,827,685 66,827,685 66,827,685
% 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 report EDOH/DoH/ DDOH Quarterly % of targeted pregnant women newly registered by LHW Target according to DHIS Report EDOH/ Statistical Officer Quarterly % of targeted pregnant women received TT-2 vaccine Target according to DHIS Report EDOH/ DHIS Coordinator/ Statistical Officer Quarterly
Delivery conducted by or under supervision of skilled persons reported 60 % 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 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 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/ person/s Quarterly
30 Photo Therapy Unit 2 22,000 44,000 30 Over-head Radiant Warmer 3 910,000 2,730,000 31 Infant Length Measuring Scale 6 5,000 30,000 31 Infant Weighing Machine 5 3,100 15,500 31 Nebulizer 3 22,000 66,000 31 3 36,000 108,000 31 Exchange Blood Transfusion Set 3 2,000 6,000 30 Nasal Probe Paed size 6 7,000 42,000 31 Anesthesia/ICU - 31 Anesthesia Machine - 321,000 - 31 Ventilators 3 525,000 1,575,000 31 Nebulizer 1 165,000 165,000 31 Oximetry 1 21,000 21,000 32 Defibrillator 2 500,000 1,000,000 32 Airway Oral and Nasal 6 500 3,000 32 Tracheostomy tube (adult and paeds) 6 1,000 6,000 32 Face mask of all sizes 6 1,000 6,000 32 Double Cuff Tourniquet (for regional block) 3 320 960 31 AMBO bag adult 5 2,450 12,250 31 AMBO Bag paeds 6 3,000 18,000 31 Red Rubber Nasal tubes all sizes without cuff 12 1,000 12,000 32 Blood Bank - 32 Blood storage cabinet (100 bag capacity) 3 812,000 2,436,000 32 Packed cell machine 3 600,000 1,800,000 32 Cell Separator 3 5,225,000 15,675,000 32 Freezer for Fresh Frozen Plasma 3 1,150,000 3,450,000
33 Blood bag shaker 3 10,000 30,000 33 RH view box 3 1,000 3,000 33 Water bath 6 3,000 18,000 33 10 8,000 80,000 33 grouping tiles 6 3,000 18,000 32 Plasma Extractor 3 1,000,000 3,000,000 32 Platelets agitator 3 1,000,000 3,000,000 32 thawing bath 3 3,000 9,000 32 Microscopes 2 115,000 230,000 33 & Labour Room Related Laboratory Equipment - 33 Hematology Analyzer 3 425,000 1,275,000 33 Electrolyte Analyzer 3 625,000 1,875,000 33 Analyzer Bio-chemistry Semi-automatic 3 690,000 2,070,000 33 Glucometer 6 2,500 15,000 34 Haemoglobino-meter 3 1,000 3,000 34 Centrifuge 2 133,000 266,000 Grand Total 66,827,685