Area-wise population Area Population Percentage Rural 932407 75% Urban 313769 25% Source: Standard Demographic population groups based on DHIS Gender-wise population Gender Population Percentage Male 585702 47% Female 680474 53% Source: Standard Demographic population groups based on DHIS Population groups Population Groups Standard Demographic (%) Estimated Population Under 1 year of age 2.7 64314 Under 5 years 13.4 319188 15 years 44 1048080 Women in child bearing age (15-49 years) 22 524040 Married Child Bearing age Women 16 381120 Expected pregnancies 3.4 80988 Source: Standard Demographic population groups on DHIS Tehsil wise distribution
Hospital Category Bed Strength DHQ Hospital A 400 and Beds B 251-400 Beds C Up to 250 Beds THQ Hospital A Above 60 Beds B 41-60 Beds C Up to 40 Beds DHQ Hospital Chiniot (Category C) Sr. No. Post Standard as per MSDS Sanctioned Filled Vacancy Gap in relation to sanctioned positions Vacancy Gap in relation to filled positions 1 Gynecologists 3 1 1 2 2 2 Pediatricians 3 1 1 2 2 3 Anesthetists 3 1 0 2 3 4 Medical Officers including SMO,APMO & PMOs 74 12 6 62 68 5 Women Medical Officers including SWMO, APWMO &PMOs 27 5 2 22 25
28.10 Small Retractors 12 16 20 0 12 28.11 Towel Clippers 24 32 40 0 24 28.12 Suction Nozzle 6 8 10 0 6 29 MNCH Related Radiology Equipments 29.1 Ultrasound Machine 1 2 3 2 0 29.2 X-Ray Unit 500 kw 1 1 1 1 0 29.3 Color Doppler 0 1 1 0 0 29.4 Lead Screen for X-Ray Unit 1 1 1 2 0 29.5 0.5 MN Lead Apron. Lead Gloves, Goggles and Thyroid and Gonadal Sheets 1 1 1 0 1 29.6 Safe Light 1 1 1 1 0 29.7 X-RT Film Processing Tank 1 1 1 1 0 29.8 Chest Stand 1 1 1 1 0 29.9 X-Ray film Illuminator 2 2 2 0 2 29.10 X-Ray Film Hangers All 4 4 4 0 4 30 MNCH Related Paediatrics Equipments 30.1 Paediatric Ventilator 1 2 2 0 1
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 referrals protocols - - - - Procurement of Packs 30000 15000 7500 7500 Procurement and distribution of No. of tablets 30000 15000 7500 7500
Procurement and distribution of Anti-D Injection 30 10 10 10 2 High under 5 Mortality Poor antenatal natal and post natal coverage Health awareness/education Message on 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 - - - - Birth Trauma & Asphyxia Provision of the quality Comprehensive EMONC services at THQH & DHQH Provision of the deficient infrastructure at THQ Assessment - - - - Prematurity Improvement of feeding and weaning practices Trainings on IMNCI 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 - - - -
Procurement and distribution of Inj. Cefotaxime Sodium 500gm Injection 30000 10000 10000 Procurement and distribution of Inj. Cefotaxime Sodium 250gm Injection 30000 10000 10000 10000 5 Scabies Lack of awareness Health education & Promotion Messages on local cable networks Message 12 4 4 4 Unhygienic practices Improving water and sanitation Messages through FM channels Message 12 4 4 4 Over-crowding/Poor housing facilities Proper diagnosis and treatment Printing and distribution of IPC material Brochure 500000 200000 150000 150000 Poor water and sanitation Procurement and distribution of Benzyl Benzoate Lotion Lotion 300000 100000 100000 100000 Seasonal variation - - - -
6 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 Awareness raising for behavior change Printing and distribution of IPC material Brochure 400000 200000 100000 100000 Social taboos and norms Awareness raising for behavior change Counseling of pregnant mothers Session - - - - Worm infestation De-worming campaign Procurement of tablets No. of doses 200000 100000 50000 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 Sehat Sahulat Card/health voucher - - - - 7 Hepatitis Poor sanitation Health Education/Promotion Quarterly co-ordination meetings with TMA and agencies Meetings - - - -
Unsafe drinking water Improving & 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 500000 200000 200000 100000 Transfusion of unsafe blood and blood products Strengthening transfusion services for safe transfusions Printing and pasting of stickers at clinics and Barber shop highlighting use of new syringes & Razors Stickers 1500 1500 - - Unsafe sexual practices Regulatory mechanism to ensure use of safe instruments by dentists, barbers etc. Hepatitis awareness week ( walk/display banners/seminars) 1 1 - - Ear & Nose piercing and tattooing Procurement & Distribution of HCV Device Kits 15000 5000 5000 5000 Use of unsterilized equipment by dentists and barbers Procurement & Distribution of BSAG Device Kits 15000 5000 5000 5000 Procurement & Distribution of HIV Device Kits 15000 5000 5000 5000 Procurement and supply of HCV Eliza kits Kits 20 10 5 5
Procurement and supply of HBV Eliza kits Kits 15 5 5 5 Procurement of syringe cutters Syringe cutter 1000 500 250 250 Procurement and distribution of Interferon Injection Courses 150 50 50 50 Documentation of expense of disposable syringes - - - - Procurement & Distribution of SGPT kits Kits 18 6 6 6 Procurement & Distribution of SGOT kits Kits 18 6 6 6 8 T B Low socio-economic status Health education/promotion Messages on local cable networks Message 36 12 12 12 Seasonal variation Strengthening TB DOTS program through involvement of private sector Printing and distribution of IPC material Brochure 500000 200000 200000 100000 Lack of proper sanitation Involvement of private providers through public private partnership Procurement of drugs to ensure deficiency according to regimen ATT course 1000 500 250 250
Lack of awareness and hygienic practices Procurement of reagents for notified diagnostic facilities under DOTS programme 20 15 15 Trainings on DOTS protocols No. of trainings 5 3 2 - 9 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 - - - - Lack of safety measures at work place Ensure enforcement of safety laws at work places Provision of emergency kits for blast victims Emergency. Kits 300 100 100 100 Fire-arm injuries Procurement of equipments / instruments / various splints and Plaster casts - - - - Domestic accidents - - - -
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 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 staff Requirement Plan - - - - Political & Media Interference provision of recreation facilities area/common rooms) Plan EDOH - - - - Deficient transparent accountability Provision of the transport of staff 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 33,816 33,816 Less allocation for POL budget - - - -
Construction of the Residence DDOH Chiniot Construction 1 1 - - Construction of the essential staff residence of DDOH Chiniot Construction 1 - 1 - Construction of the Residence DDOH Lalian Construction 1 1 - - Construction of the essential residence of DDOH Lalian Construction 1 - 1 - Construction of the Residence DDOH Bhawana Construction 1 1 - - Construction of the essential staff residence of DDOH Bhawana Construction 1 - 1 - 4 Deficient equipment (with reference to notified list) at all levels of care Debilitated condition of existing infra-structure Make up the deficiencies against standards specified in MSDS Purchase of MNCH related Equipment at DHQH Equipment 1 1 - - Lack of repair and maintenance Developing a transparent accountability mechanism - - - -
Inadequate infrastructure for Emergency, Operation Theatre, OPD and Inpatients, residences for staff at THQ and DHQ hospitals Make up the deficiencies against standards specified in MSDS - - - - Lack of blood transfusion services especially at THQ Devise appropriate mechanisms for repair and maintenance - - - - Lack of back-up electrical power facilities Provision of infrastructure at THQ and DHQ according to the MSDS - - - - - Deficient equipment to basic and comprehensive EmONC at primary and secondary level of care Provision of blood transfusion services at all THQ and DHQ hospitals - - - - - Old and un-serviceable equipment Provision of back-up electricity power especially in ICU, and Operation Theatres. - - - - - Shortage of regular budget for M&R - - - - - Frequent cuts on M&R budget
8 T B 1,136,600 1,170,840 629,200 2,936,640 9 Road Accident & Injuries 575,100 632,610 695,871 1,903,581 TOTAL 18,564,300 16,023,810 15,974,541 48,492,151 Health Problems Sr. Problem Activity Define Financial Targets Total Cost Unit Rate Quantity Year I Year II (10 %) Year III (10 %) 1 High MMR Messages on cable network Message 10,000 36 120,000 132,000 145,200 397,200 Printing and distribution of IPC material Brochure 4 300000 400,000 440,000 484,000 1,324,000 Training of LHWs on BCC No. of trainings 9,300 36 334,800 - - 334,800
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 referrals protocols Costed in MSDS Gaps - - - - - Procurement of Micro-nutrients Packs 35 30000 525,000 288,750 317,625 1,131,375 Procurement and distribution of Cali-D No. of tablets 20 30000 300,000 165,000 181,500 646,500 Procurement and distribution of Anti-D Injection 5000 30 50,000 55,000 60,500 165,500 1,729,800 1,080,750 1,188,825 3,999,375 2 High 5 Mortality Message on local cable Message 36 10,000 120,000 132,000 145,200 397,200
BCC of mothers 0n promotion of breast feeding and weaning practices through LHWs Number of Trainings - LHWs training on BCC of mothers on promotion of breast feedings - - - - Provision of the deficient infrastructure at THQ Assessment As proposed in management problems - - - - Trainings on IMNCI No. of trainings - IMNCI Training package costed in Diarrhoea below - - - - Need assessment of food supplements Assessment - Assessing below poverty pregnant mother through LHWs and providing them food supplement through DGHS & Financial support from & Zakat - - - No cost activity
Address in school Assemblies Sessions School Health & Nutrition Supervisors did this task 4920 - - - Training of medics and paramedics in MNCI No. of Trainings 140,200 7 560,800 462,660 - 1,023,460 Procurement and distribution of ORS ORS Packets 5 150000 250,000 275,000 302,500 827,500 Procurement and Distribution of Syrp Zink Sulphate Syrup 35 150000 1,750,000 1,925,000 2,117,500 5,792,500 Procurement and Distribution of Syp. Metronidazole Syrup 15 150000 750,000 825,000 907,500 2,482,500
Procurement and Distribution of Inj. Metronidazole Injection 60 20000 600000 330,000 363,000 300,000 Procurement and distribution of IV fluids Injection 50 15000 750000 275,000 302,500 250,000 5,636,800 4,121,260 4,024,460 12,982,520 4 Acute (upper) respiratory infections Messages on local cable networks Message 10,000 12 40,000 44,000 48,400 132,400 Messages through FM radio channels Message 28,000 12 112,000 123,200 135,520 370,720 Printing and distribution of IPC material Brochure 4 300000 600,000 330,000 363,000 1,293,000
6 Anemia ( including pregnancy) Messages on local cable network Message 10,000 36 120,000 132,000 145,200 397,200 Printing and distribution of IPC material Brochure 4 400000 800,000 440,000 484,000 1,724,000 Counseling of pregnant mothers Session LHWs are expected to conduct counseling session on behavior change during visit to pregnant ladies - - - No cost activity Procurement of tablets No. of doses 7 200000 700,000 385,000 423,500 1,508,500 Distribution through LHWs and health facilities - - - - - -
Printing and distribution of IPC material Brochure 4 500000 800,000 880,000 484,000 2,164,000 Printing and pasting of stickers at clinics and Barber shop highlighting use of new syringes & Razors Stickers 50 1500 75,000 - - 75,000 Hepatitis awareness week ( walk/display banners/seminars) Lump sum 1 300,000 300,000 Procurement & Distribution of HCV Device Kits 30 15000 150000 165,000 181,500 496,500 Procurement & Distribution of BSAG Device Kits 30 15000 150000 165,000 181,500 496,500 Procurement & Distribution of HIV Device Kits 30 15000 150000 165,000 181,500 496,500
Procurement and supply of HCV kits Kits 10000 20 100,000 55,000 60,500 215,500 Procurement and supply of HBV Eliza kits Kits 8000 15 40000 44,000 48,400 132,400 Procurement of syringe cutters Syringe cutter 150 1000 75,000 41,250 45,375 161,625 Procurement and distribution of Interferon Injection Courses 15000 150 750,000 825,000 907,500 2,482,500 Documentation of expense of disposable syringes - - - Procurement & Distribution of SGPT Kits 7000 18 42,000 46,200 50,820 139,020 Procurement & Distribution of SGOT Kits 7000 18 46,200 50,820 139,020
2,794,000 2,564,650 2,337,115 7,695,765 8 T B Messages on cable networks Message 10,000 36 120,000 132,000 145,200 397,200 Printing and distribution of IPC material Brochure 4 500000 800,000 880,000 484,000 2,164,000 Procurement of to ensure deficiency according to regimen ATT course To be procured from the PTP 1000 - - - - Procurement of reagents for notified diagnostic facilities DOTS programme Packs To be procured from the PTP - - - - Trainings on DOTS protocols No. of trainings 72,200 5 216,600 158,840 - 375,440 1,136,600 1,170,840 629,200 2,936,640
9 Road accident & Injuries Quarterly meetings with Traffic Police department Meeting 3000 12 12000 12000 12000 36000 Quarterly meetings with Highway department Meeting 4000 12 16,000 17,600 19,360 52,960 Preparation of Disaster Management Plan including the Patient Management protocols Plan EDO/DOH & MS 1 1 No cost acivity Provision of emergency kits for blast victims Emergency Kits 5591 300 559,100 615,010 676,511 1,850,621 Procurement of equipments / instruments / various splints and Plaster 591,100 650,210 715,231 1,956,541
Problem wise cost summary of Management Problems Sr. No. Problem F Y I FY II FY III Total Cost Rs. Amount (Rs.) Amount (Rs.) Amount (Rs.) 1 HR Plan 14,453,460 31,401,770 48,463,288 94,318,518 2 POL for newly installed Generators 2,570,000 - - 2,570,000 3 Deficient Infrastructure 131,845,000 94,723,000 - 281,968,000 4 Lack of MNCH related Machinery & Equipment 14,749,490 - - 14,749,490 5 Shortage of Vehicles 9,800,000 6,600,000 3,100,000 19,500,000 Total 173,417,950 132,724,770 51,563,288 413,106,008
Prepare training programs for providing higher professional education based on TNA Plan - - - - 2 Inadequate budget for POL Assessing additional need for POL - - - - Costing & Submission the additional Demand for POL P O L 76 33,816 2,570,000 - - 2,570,000 2,570,000 - - 2,570,000 3 Lack of infrastructure construction of 250 Bedded Hospital Construction Detail Annex 1 48600000 40,150,000 44,165,000 132,915,000 Construction of 60 Bedded Hosptial Construction Detail Annex 1 25,200,000 20,790,000 22,869,000 68,859,000 Construction of the EDOH office Construction Detail Annex 1 11,500,000 - - 11,500,000
5 Shortage of Vehicles Purchase of Vehicle for EDOH Office Vehicle 3,800,000 1 3,800,000 - - 3,800,000 Purchase of Vehicle for DOH Office Vehicle 3,800,000 1 3,800,000 - - 3,800,000 Purchase of Vehicle for DDOH office Vehicle 2,200,000 1 2,200,000 - - 2,200,000 Purchase of Vehicle for DHDC Office Vehicle 4,400,000 1 - 4,840,000 - 4,840,000 Purchase of Vehicle for DSI/CDCO office Vehicle 2,200,000 1 - 2,420,000 - 2,420,000 Purchase of Vehicle for DSV(EPI) office Vehicle 2,200,000 1 - - 2,662,000 2,662,000 Purchase of Vehicle for MS DHQ Hospital Vehicle 900,000 1 - - 1,089,000 1,089,000 9,800,000 7,260,000 3,751,000 20,811,000
% of planned supervisory visits conducted 50 visits /year Inspection register EDOH/DOH/ DDOH/Dist. Monitoring officer Quarterly % of RHCs with availability of services (on rotational basis) of essential specialties (Physician, Surgeon, Pediatrician and Gynecologist) 100% During 1st year Movement register/visit register EDOH / DOH Quarterly % of health facilities with availability of essential MNCH related equipment 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, 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 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 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 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 sectors 12 meetings per year Minutes of meetings EDOH/ Focal person/s Quarterly Private Health Facilities in District Chiniot
Sr. No Name of Clinics/Private Hospitals Name of Islamia Hospital Chiniot Anjuman Islamia Hospital CHiniot Haji Gulzar Al Hospital Chiniot Dr.Irfan Munir Ali Hospital Dr.Javaid Iqbal Khair Ul Bashar Hospital Malik Munir Ahmad Subhan Hospital Dr.Shaheen Aziz Chiniot General Hospital Dr.Raees Bajwa Al Mansoor Hospital Dr.Mansoor Ali Children Clinic Dr.Abid Yaseen Dr.Irshad Clinic Dr.Irshad Dr.Yaqoob Clinic Dr.Yaqoob Dr.R.M Yaseen Clinic Dr.R.M Yaseen Dr.Hamid Surgeon Clinic Dr.Hamid Dr.Ahmad Amin Clinic Dr.Ahmad Amin Dr.Jamshaid Zaidi Clinic Dr.Jamshaid Zaidi Dr.Fiaz Clinic Dr.Fiaz Dr.Naeem Gulzar Clinic Dr.Naeem Gulzar Dr.Mushtaq Bashir Clinic Dr.Mushtaq Bashir Dr.Munir Ahmad Clinic Dr.Munir Ahmad