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Three Years Rolling Plan (2010-2013) District Gujrat
THREE YEARS ROLLING PLAN
DISTRICT GUJRAT
2010-2013
SARDAR AKRAM JAVAIDDISTRICT COORDINATION OFFICERGUJRAT
DR. MUNIR AHMAD EXECUTIVE DISTRICT OFFICER (HEALTH), GUJRAT
DR.AZHAR MEHMOOD CH. DISTRICT OFFICER HEALTH, GUJRAT
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Three Years Rolling Plan (2010-2013) District Gujrat
ContentsAcronyms..............................................................................................................5Executive Summary..............................................................................................7SECTION 1: DISTRICT HEALTH PROFILE...............................................................81. Vision of the District........................................................................................82. Mission of the District......................................................................................83. Background of the District..............................................................................84. Map of the District...........................................................................................95. Demography...................................................................................................96. Socio-Economic Indicators............................................................................117. Health Indicators...........................................................................................118. Organizational Structure of District Health Administration...........................129. Health Resources..........................................................................................139.1. Health Facilities..........................................................................................13
a). Public.......................................................................................................13b). Private......................................................................................................14
9.2. Human Resource........................................................................................149.2.1. Administrative.........................................................................................149.2.2. Facility Based Staff..................................................................................15
9.2.2.1. Basic Health Units...........................................................................159.2.2.2. Rural Health Centres......................................................................159.2.2.3. THQ Hospital Kharian.....................................................................179.2.2.4. DHQ (ABS) Hospital........................................................................18
9.2.3. Outreach Staff.........................................................................................209.2.4. Training Institutions................................................................................21
a) DHDC.......................................................................................................21b) General Nursing & Midwifery School.......................................................21
9.3. Health Financing........................................................................................2210. Disease Pattern..........................................................................................2311. Status of Vertical Programs........................................................................2411.1. National Program for FP & PHC...............................................................2411.2. EPI...........................................................................................................25
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Three Years Rolling Plan (2010-2013) District Gujrat
11.3. MNCH Program........................................................................................2511.4. TB Control Program.................................................................................2511.5. Malaria Control Program..........................................................................2511.6. HIV/AIDS Control Program.......................................................................2511.7. Hepatitis Control Program.......................................................................2511.8. School Health Services Program.............................................................25SECTION 2: PROBLEM ANALYSIS........................................................................27
1. Objectives..................................................................................................272. Plan Development Process.........................................................................282.1. Problem Identification.............................................................................28Health Problems...............................................................................................282.2. Problem Prioritization..............................................................................292.3. Underlying causes of prioritized problems..............................................30Service delivery/Management problems..........................................................31
Underlying causes of Management problems...............................................323. MDGs and MSDS...........................................................................................32
1) Human Resource........................................................................................332) Equipment..................................................................................................34
SECTION 3: INTERVENTIONS AND TARGETS.....................................................44Health Problem...................................................................................................44Management Problems.......................................................................................58SECTION 4: COSTING AND FINANCING PLAN....................................................67I. Activity based costing...................................................................................67
a) Health Problems.........................................................................................67a) Management Problems..............................................................................79
II. Financial Outlay including 3YRP Activities....................................................87a) Health Problems.........................................................................................87b) Management Problems..............................................................................89
III. Summaries.................................................................................................90a) Problem wise Costing.................................................................................90
i. Health Problems......................................................................................90ii. Management Problems............................................................................91
b) Activity-wise costing..................................................................................92Page 3
Three Years Rolling Plan (2010-2013) District Gujrat
i. Health Problems......................................................................................92ii. Management Problems............................................................................98
SECTION 5: Monitoring and Evaluation...........................................................102I. M&E of Plan.................................................................................................102Annex-I..............................................................................................................106
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Three Years Rolling Plan (2010-2013) District Gujrat
Acronyms3YRP Three Years Rolling plan
ADB Asian Development Bank
AE Assistant Entomologist
APMO Additional Principal Medical Officer
ARI Acute Respiratory Infections
ASV Assistant Superintendent Vaccination
BHU Basic Health Center
BoD Burden of Disease
CDC Communicable Disease Control
CDR Case Detection Rate
CPR Contraceptive Prevalence Rate
DC District Coordinator
DHIS District Health Information System
DHQH District Head Quarter Hospital
DoH Department of Health
DR Default Rate
DSV District Superintendent Vaccination
EDO(H) Executive District Officer Health
EPI Expended Program on Immunization
HSRP Health Sector Reforms Program
IMR Infant Mortality Rate
IPC Interpersonal Communication
IV Inspector Vaccination
M & E Monitoring and Evaluation
M & R Maintenance and Repair
MCH Maternal Child Health
MMR Maternal Mortality RatioPage 5
Three Years Rolling Plan (2010-2013) District Gujrat
MNCH Maternal Newborn and Child Health
MO Medical Officer
MoV Means of Verification
MSDS Minimum Service Delivery Standards
PDSSP Punjab Devolved Social Services Program
PHC Primary Health Care
PMO Principal Medial Officer
POL Petrol, Oil and Lubricant
RHC Rural Health Center
SCR Sputum Conversion Rate
SHC Secondary Health Care
SMO Senior Medical Officer
TAMA Technical Assistance Management Agency
TB Tuberculosis
THQH Tehsil Head Quarter Hospital
TNA Training Need Assessment
WHO World Health Organization
WMO Women Medical Officer
Executive Summary
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Three Years Rolling Plan (2010-2013) District Gujrat
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 Social Services Programme (PDSSP). This year government of the Punjab through Health Sector Reforms Program (HSRP) with the 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 first attempt by the district on that agreed format. First section 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 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 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 Gujrat
GUJRAT
SECTION 1: DISTRICT HEALTH PROFILE
1. Vision of the District
Our vision is to ensure effective and efficient use of human and material resources to improve the health status of people primarily focusing on maternal and child health in order to achieve Millennium Development Goals (MDGs).
2. Mission of the District
Our dedicated, devoted and hard working staff will try level best to provide quality health services to people of district Gujrat without discrimination of gender, religion and socio-economic status.
3. Background of the District
Gujrat is a district of Punjab Province in Pakistan. It is an ancient district located in between two famous rivers, the Jhelum and Chenab. Because of its proximity with the rivers the land is good for cultivation with rice and sugar cane as main crops. It is bounded on the northeast by Mirpur, on the northwest by the River Jhelum which separates it from Jhelum District, on the east and southeast by the Chenab River, separating it from the districts of Gujranwala and Sialkot, and on the West by Mandi Bahauddin. District Gujrat is spread over an area of 3,192 square kilometres, and is divided into three tehsils, Gujrat, Kharian, and Sarai Alamgir. There are many historic villages and towns in the district such as Chakdina, Kunjah, Dinga. This district has moderate climate, which is hot in summer and cold in winter. During peak summer, the day temperature shoots up to 50 °C, but the hot spells are comparatively shorter due to proximity of Azad Kashmir Mountains. The winter months are very pleasant and the minimum temperature may fall below 2 °C. The average rainfall on the Kashmir border is over 1000 mm, at Kharian it is 750 mm, at Gujrat 670 mm, and at Dinga 500 mm.
Gujrat has a unique status throughout the Punjab due to some of its manufacturing capabilities and productions. Jalalpur is a large town of Gujrat, where several small and large textile industrial unit have been established. There are many other industrial units and factories engaged in manufacturing of electrical goods (Fan), Electric Motors, Earthen Utensils, Shoes, Rubber Tyre Tube, Sanitary Ware and Rice. The principal tribes of the districts are Syeds, Gujjars, Jats, , Mughals, Rajputs and Kashmiris.
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Three Years Rolling Plan (2010-2013) District Gujrat
4. Map of the District
5. Demography
o Total Population 26,65,399
o Total Area 3192 square kilometers
o Annual growth rate 2.4 %
o Population density 835 persons per sq. km
Area-wise populationArea Population Percentage
Rural 719658 27 %
Urban 1945741 73 %
Source: DCR-1998
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Three Years Rolling Plan (2010-2013) District Gujrat
Gender-wise population
Gender Population Percentage
Male 1330301 49.91 %
Female 1335098 50.09 %
Source: DCR-1998
Population groups
Population GroupsStandard Demographic
(%)Estimated Population
Under 1 year of age 2.7 94,169
Under 5 years 13.4 357164
Under 15 years 44 1172776
Women in child bearing age (15-49 years)
22 586388
Married Child Bearing age Women
16 426464
Expected pregnancies 3.4 90624
Standard Demographic population groups may be based on DHIS
Tehsil wise distribution
Tehsil Number of UC Population
Gujrat 65 1398251
Sarai Alamgir 9 246231
Kharian 43 + (2 Cantt) 1020917
Total 119 2665399
Source: Bureau of Statistics (Census 1998)
Ethnic groups and languages
The main ethnic groups in the district are Punjabi Jat. Punjabi and Urdu are the main languages spoken in the district.
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Three Years Rolling Plan (2010-2013) District Gujrat
6. Socio-Economic Indicators
Education and Literacy Overall district:
10+ years 74% Adult literacy rate 15+ years 71% Adult literacy rate 15-24 years 90
Source: MICS 2007
Housing Ownership of house 89%
Mean household size 6.3
Mean number of persons per room 3.3
Water and Sanitation Access to drinking water 93%
Use of improved drinking water sources 93%
Use of properly treated water 8.1%
Safe drinking water without bacteria 63%
Use of sanitary means of excreta disposal 81%
Use of improved water sources and improved sanitation 76%
Source: MICS 2007
7. Health Indicators
Infant Mortality Rate 70/1000 L.B
Under 5 mortality Rate 100/1000 L.B.
Maternal mortality Ratio 172/100000 L.B
Malnutrition
Underweight prevalence (severe) 5%
Stunting prevalence (severe) 13%
Wasting prevalence (severe) 2.8%
Life expectancy 65 Years
Proportion of children under 1 years immunized 94.5 %
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Three Years Rolling Plan (2010-2013) District Gujrat
against measles
Source: MICS 2007
8. 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:
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EDO (HEALTH)PR. GNSPD DHDCMS THQ
Three Years Rolling Plan (2010-2013) District Gujrat
9. Health Resources
9.1. Health Facilities
a). Public
Details of physical infrastructure of public health facilities in the district
Facility Type No. of Facility Bed Strength
No. of Functional
BedsRemarks
Teaching hospitals - - - -
DHQ Hospital
1 322 322
Declared as Teaching Hospital(70 Bedded ward constructed by Ch. Zahoor Illahi Trust not yet notified.)
THQ Hospital 1 44 44 Kharian
Civil Hospital 1 20 20
Govt. Maternity Hospital
3 62 62
RHCs 9 180 180
BHUs 89 178 178
Govt. Rural Dispensaries
3 - -
MCH Centers 9 - -
Sub Health Centers
34
TB Clinics -
Rural Dispensaries (ZC)
18
City Dispensaries 1
Health house 2176
Data source: DHIS/EDOH office
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Three Years Rolling Plan (2010-2013) District Gujrat
b). Private
Private sector is also contributing in provision of health services in the district. In absence of
any registration and regulatory mechanism, actual situation of private sector is not known.
With the passage of time, role of private health care providers will expand and there is a
need to develop an effective coordination between public and private sector.
9.2. 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
9.2.1. Administrative
Sr. No. Name of Post Sanctioned Filled
1 Executive District Officer Health 1 12 District Officer Health 1 13 Deputy District Officer Health 3 34 Program Director DHDC 1 15 District Coordinator National Program *0 16 District Coordinator Preventive Programs 2 17 District Sanitary Inspector 1 18 CDC Officer 1 19 CDC Inspector 2 2
10 Drug Inspector 3 211 District Superintendent Vaccination 3 312 Assistant Superintendent Vaccination 3 313 Tehsil Sanitary Inspector 2 214 Inspector Vaccination 2 2
*The post is not sanctioned
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Three Years Rolling Plan (2010-2013) District Gujrat
9.2.2. Facility Based Staff
9.2.2.1. Basic Health Units
Sr.# Name of Post/Designation Sanctioned Filled Vacant
1 Medical Officer 89 74 15
2School Health & Nutrition Supervisor
89 7118
3 Medical Assistant 16 12 4
4 Computer Operator 89 46 43
5 Medical Technician 77 62 15
6 LHV 85 79 6
7 Dispenser 85 81 4
8 Midwife 267 113 154
9 Naib Qasid 89 89 0
10 Chowkidar 89 89 0
11 Sanitary Worker 52 52 0
12 Sanitary Inspector 88 42 46
9.2.2.2. Rural Health Centres
Sr.# Name of Post/Designation Sanctioned Filled Vacant
1 Senior Medical Officers 9 9 0
2 Women Medical Officers 9 8 1
3 Woman Medical Officer (MNCH) 9 7 2
4 Dental Surgeons 9 9 0
5 Medical Officers 9 9 0
6 Charge Nurses 54 50 4
7 Homeo Doctors 2 2 0
8 Hakeems 1 1 0
9 Computer Operators 9 1 8
10 Medical /Health Technician 2 2 0
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr.# Name of Post/Designation Sanctioned Filled Vacant
11 LHV 18 18 0
12 LHV (MNCH) 9 9 0
13 Lab. Technician 9 6 3
14 Dental Technician 9 9 0
15 R.H.I 41 41 0
16 Junior Clerk 9 9 0
17 Vaccinator 1 1 0
18 Homeo Dispenser 2 2 0
19 Dawasaz 1 1 0
20 Radiographer/X-Ray Asstt. 10 10 0
21 Dresser 18 18 0
22 Anesthesia Assistant 9 0 9
23 O.T.A 9 3 6
24 Dispenser 9 9 0
25 Dental Assistant 9 9 0
26 Laboratory Assistant 9 9 0
27 Midwife 9 9 0
28 Driver 10 10 0
29 T.O 7 7 0
30 Homeo Naib Qasid 2 2 0
31 Dawa Kob 1 1 0
32 Ward Servant 18 18 0
33 Sweepers 18 18 0
34 Sanitary Worker 18 18 0
35 Sanitary Patrol 41 41 0
36 Naib Qasid 23 23 0
37 Mali 9 9 0
38 Chowkidar 9 9 0
39 Water Carrier 9 9 0
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Three Years Rolling Plan (2010-2013) District Gujrat
9.2.2.3. THQ Hospital Kharian The staff for Sara-i-Alamgir has not yet been sanctioned.
Sr. # Name of Post/ Designation Sanctioned Filled Vacant
01 Medical Superintendent 1 1 0
02 APMO 2 2 0
03 APWMO 1 0 1
04 Gynecologist 2 2 0
05 Physician 1 0 1
06 Pathologist 1 1 0
07 Anesthesia Specialist 1 0 1
08 Eye Specialist 1 1 0
09 Surgeon 1 1 0
10 Pediatrician 1 1 0
11 Medical Officer / CMO 11 7 3
12 WMO 3 1 2
14 Dental Surgeon 1 1 0
15 Pharmacist 1 1 0
16 Head Nurse 0 0 0
17 Male Nurse 0 0 0
18 Charge Nurse 10 7 3
19 Dental Technician 1 1 0
20 ECG Technician 0 0 0
21 Dispenser 5 5 0
22 OTA 2 2 0
23 Radiographer 3 3 0
24 Lab. Assistant 2 2 0
25 Junior Clerk 1 1 0
26 Ward Servant 7 7 0
27 Driver 2 2 0
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. # Name of Post/ Designation Sanctioned Filled Vacant
28 Nurse Dai 0 0 0
29 Peon 3 3 0
30 Cook 0 0 0
31 OT Boy 0 0 0
32 Water Carrier 1 1 0
33 Mali 2 2 0
34 Gateman 1 1 0
35 Ward Barrier 1 1 0
36 Baildar 3 3 0
37 Chowkidar 4 3 1
38 Sweeper 10 10 0
39 Homeo Doctor 1 1 0
40 Homeo Dispenser 1 1 0
41 Hakeem 1 1 0
42 Dawasaz 1 1 0
43 Dawa Kob 1 1 0
9.2.2.4. DHQ (ABS) Hospital
Sr. # Name of Post/Designation Sanctioned Filled Vacant
1 Medical Superintendent 1 1 02 Chief Consultant Surgeon 1 1 03 Chief Consultant Pediatrician 1 1 04 Chief Consultant Pathologist 1 1 0
5Senior Consultant Ophthalmologist
1 0 1
6 Senior Consultant Anesthetist 1 1 07 Senior Consultant 1 0 18 Consultant Surgeon 1 1 09 Consultant Anesthetist 2 0 2
10 Consultant Gynecologist 3 3 011 Consultant Radiologist 1 1 012 Consultant Physicians 2 1 1
13 Consultant Neuro-Surgeon 1 0 1
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. # Name of Post/Designation Sanctioned Filled Vacant
14 Consultant ENT 1 1 015 Consultant Dermatologist 1 0 116 Consultant Cardiologist 1 0 117 Consultant Urologist 1 1 018 Consultant TB/Chest Specialist 1 1 019 Consultant Orthopedic Surgeon 1 1 020 APMO 4 4 021 APWMO 3 3
22 Principal Dental Surgeon 1 1 023 Senior Dental Surgeon 1 1 024 Nursing Superintendent 1 1 025 Hospital Pharmacist 9 7 226 Physiotherapist 1 0 1
27Public Health Nutrition Supervisor
1 0 1
28 CMO 9 0 929 Medical Officers 39 29 1030 Women Medical Officers 8 8 031 Deputy Nursing Superintendent 1 0 132 Budget & Accounts Officer 1 0 133 House Officer 16 15 134 Clinical Nursing Instructor 1 0 135 Head Nurse 13 13 036 Charge Nurses 78 74 0437 Office Superintendent 1 1 038 Refractionist 1 0 139 Hemeo Pathic Doctor 1 1 040 Hakeem 1 1 041 Stenographer 1 1 042 Head Clerk 1 1 043 Accountant 1 1 044 House Keeper 1 1 045 Ophthalmic Technician 4 1 346 Lady Health Visitor 2 2 047 ECG Technician 6 1 548 Dental Technician 2 2 049 Laboratory Technician 4 2 250 Exercise Tolerance Technician 2 0 251 Physiotherapist Aid 1 0 152 ECO Technician 2 0 253 X-Ray Technician 3 0 354 Senior Clerk 1 0 155 Junior Clerk 5 5 0
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. # Name of Post/Designation Sanctioned Filled Vacant
56 Record Keeper 1 1 057 Dresser 1 1 058 Homeo Dispenser 1 1 059 Dispenser 13 13 060 Dawasaz 1 1 061 X-Ray Assistant 4 4 062 Operation Theater Assistant 6 3 363 Store Keeper 2 2 064 Laboratory Assistant 4 2 265 Driver 6 6 066 Midwife 2 2 067 Tubewell Operator 2 0 268 Dai 1 1 069 Bearer 15 12 370 Operation Theater Attendant 4 4 071 Lab Attendant 3 3 072 Water Carrier 2 2 073 Ward Boy 20 19 174 Ward Servant 65 65 075 Chowkidar 10 9 176 Cook 5 3 277 Attendant 3 2 178 Baildar 4 4 079 Dawa Kob 1 1 080 Naib Qasid 8 6 281 Gate Keeper 5 3 282 Ward Cleaner 33 29 483 Sanitary Worker 50 50 084 Mali 4 4 0
9.2.3. Outreach Staff
This information is about outreach program workers such as Vaccinators, CDC
Supervisors and Sanitary Inspectors which are not part of above mentioned health
facilities.
Sr. Post Sanctioned Filled Vacant
1 Vaccinators 112 101 112 CDC Supervisors 72 48 24
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Three Years Rolling Plan (2010-2013) District Gujrat
3 Sanitary Inspectors 87 43 444 Nutrition Supervisor 89 78 115 Social mobilizor NCHD 89 72 176 Sanitary Supervisor 02 01 01
9.2.4. Training Institutions
A number of training institutions are working in the district which include the following:
a) DHDC
b) General Nursing & Midwifery school
a) DHDC
Post Sanctioned Filled Vacant
Programme Director 1 1 0MPPT 1 1 0LHV Trainer 1 1 0Assistant 1 1 0Driver 1 1 0Naib Qasid 1 1 0Chowkidar 2 1 1Sanitary Worker 1 1 0
b) General Nursing & Midwifery School
Name of Post/Designation Sanctioned Filled Vacant
Principal School of Nursing 1 1 0Nursing Instructor 3 3 0House Keeper 3 3 0Sweeper 3 3 0Naib Qasid 2 2 0Chowkidar/Gate Keeper 6 6 0Cook 2 1 1Masalchi 3 0 3Clinical instructor 0 0 0Public Health Nursing Supervisor 0 0 0Stenographer 1 1 0Head clerk 1 0 1Accountant 1 1 0Senior clerk 0 0 0Junior clerk 1 1 0Aya 3 2 1
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Three Years Rolling Plan (2010-2013) District Gujrat
9.3. 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
Source of funding Year
2007-08 2008-09 2009-2010
Allocation Exp. Allocation Exp. Allocation Exp.
Non-Development 328.303 325.917 347.521 346.127 462.871 242.902
Development 350.000 348.000 443.042 423.000 527.000 523.00
Sub Total 678.303 673.917 790.563 769.127 989.871 580.182
PHSRP 95.750 95.750 14.000 14.000 14.000 14.000
PMDGP 0 0 0 0 84.62 58.157
PDSSP 21.232 21.145 23.348 21.955 0 0
Provincial Development Funds (ADP)
0 0 43.000 43.000 0 0
Grand Total 1473.59 1464.73 1661.47 1617.21 2078.36 1418.24
User charges (like parchi fee, fees for diagnostic services)
Year
2007-08 2008-09 July, 2009 To Feb, 2010
Target Remittance Target Remittance Target Remittance
3.000 2.151 3.250 2.500 3.500 2.300
10. 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.
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Three Years Rolling Plan (2010-2013) District Gujrat
Disease Group Percentage of Magnitude
Respiratory Disease1 Acute upper respiratory infection 11.1102 Pneumonia < 5years 0.9933 Pneumonia < 5years 0.7094 TB Suspects 0.4695 Chronic Obstructive Pulmonary Disease 0.4496 Asthma 0.925Gastro Intestinal Disease7 Diarrhea / Dysentery < 5 years 2.5758 Diarrhea / Dysentery < 5 years 2.1039 Enteric / Typhoid Fever 0.20410 Worm infestations 1.97711 Peptic Ulcer 1.55012 Cirrhosis of Liver 0.022Urinary Tract Disease13 Urinary Tract infection 0.82014 Nephritis / Nephrosis 0.05715 Sexually Transmitted Infections 0.04316 Benign Enlargement of Prostrate 0.54Other Communicable Disease17 Suspected Malaria 1.22418 Suspected Meningitis 0.00319 Fever due to other causes 2.567Vaccine Preventable Disease20 Suspected Measles 0.00321 Suspected Viral Hepatitis 0.01822 Suspected Neo-natal Tetanus 0.0004Cardiovascular Disease23 Ischemic Heart disease 0.03324 Hypertension 0.374Skin Disease25 Scabies 4.05926 Dermatitis 0.98827 Cutaneous Leishmaniasis 0.0014Endocrine Disease28 Diabetes Mellitus 0.256Neuro- Psychiatric Disease29 Depression 0.35830 Drug Dependence 0.03931 Epilepsy 0.033Eye & ENT32 Cataract 0.11833 Trachoma 0.079
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Three Years Rolling Plan (2010-2013) District Gujrat
Disease Group Percentage of Magnitude
34 Glaucoma 0.01435 Otitis Media 0.472Oral Disease36 Dental Carries 0.659Injuries / Poisoning37 Road Traffic Accidents 0.59038 Fractures 0.07139 Burns 0.17140 Dog Bites 0.12341 Snake Bites ( with sign/symptoms of
poisoning0.028
Miscellaneous Disease42 Acute Flaccid Paralysis 0.0004543 Suspected HIV/AIDS 18444 Any other unusual disease (specify) 0(Source: DHIS Specific Reports)
11. 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 program reports.
11.1. National Program for FP & PHC
No. of seats allocated for LHWs 2176
No. of LHWs working 1716
Percentage of Population covered
by the program 62 %
Important program indicators
IMR 42/1000 MMR 170/100000 CPR 41% No. of antenatal visits 91% TT Coverage of pregnant women 95%
11.2. EPI
EPI Coverage rate of the district 94.5% Fully immunized children 0-23 months 94.5% Pregnant women received TT-2 vaccine 95% Availability of cold chain equipment* 98 %
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Three Years Rolling Plan (2010-2013) District Gujrat
*Health Facilities carefully equipped with cold chain while remaining 2 is facing equipment shortage along with repair and maintenance problem
11.3. MNCH Program
CMW Students Admitted 53 Passed 53 Fresh CMWs batch 23
11.4. TB Control Program
CDR all types 72% CDR NSS positive 71% SCR 90% TSR 91% DR 0.5%
11.5. Malaria Control Program
No. of slides examined 60027 No. of positive slides 605 Slides positively ratio 1.008% Percentage of plasmodium falciparum 13.2%
11.6. HIV/AIDS Control Program
Total cases diagnosed 184
11.7. 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
11.8. 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
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Three Years Rolling Plan (2010-2013) District Gujrat
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
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Three Years Rolling Plan (2010-2013) District Gujrat
SECTION 2: PROBLEM ANALYSIS
The Health sector in Punjab is facing enormous health and service delivery problems. Common health problems are communicable, non communicable, MNCH related diseases and accident/ 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.
1. 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) 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.
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Three Years Rolling Plan (2010-2013) District Gujrat
2. 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 SP-09 team at divisional headquarter. The main components of the trainings were: (i) developing a three-year 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
2.1. 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. Health Problems, and Health Service Delivery or Management Problems. In the initial stage an exhaustive list of these problems was prepared. The enlisted health and service delivery problems of the district are given in the following tables.
Health ProblemsThe 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.
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Three Years Rolling Plan (2010-2013) District Gujrat
1. Diarrhea
2. Accidents and Injuries
3. Hepatitis (B&C)
4. Diabetes
5. Malaria
6. Scabies
7. Complications of pregnancy
8. Drug Addiction
9. Pulmonary tuberculosis
10. Hypertension
2.2. 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
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Three Years Rolling Plan (2010-2013) District Gujrat
problems. A cut-off point was decided, to establish the priority health problems of the district.
These problems will be addressed in the three years rolling plan.
Problem Magnitude Severity Vulnerability to
intervention
Cost Effectiveness
Political Expediency
Total Score
Priority Number
Diarrhea 4 4 4 4 4 20 1
Hepatitis (B&C) 4 4 3 2 3 16 3
Accidents and Injuries
4 3 4 3 3 17 2
Diabetes 3 3 3 4 2 15 4
Hypertension 3 3 2 3 2 13 8
Scabies 3 3 4 3 1 14 6
Malaria 3 2 4 3 2 14 5
Drug Addiction 3 2 3 2 2 12 9
Complications of pregnancy
3 3 3 3 2 14 7
2.3. 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 and selected service delivery problems pertaining to the district.
Sr. # Health Problem Causes
1 Diarrhoeal Diseases Poor hygiene and sanitation Lack of safe drinking water Unhygienic practices Lack of awareness among mothers about feeding and
weaning practices2 Accidents and injuries Lack of traffic sense
Poor maintenance of vehicles Poor road conditions Lack of safety measures at work place Fire-arm injuries Domestic accidents Burns Bomb blasts/terrorist activities Natural calamities like flood
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. # Health Problem Causes
Lack of tolerance in the society 3 Hepatitis (B&C) Poor sanitation
Unsafe drinking water Sharing of used syringes Transfusion of unsafe/unscreened blood and blood products Unsafe sexual practices Ear piercing and tattooing Use of unsterilized equipment by dentists and barbers
4 Diabetes Obesity Inactive life style Lack of health awareness in Diabetes Genetics and Infections
5 Resistant Malaria (Falciparum)
Breeding places for mosquitoes Injudicious use of anti-malarial by GPs and HCPs Lack of awareness for prevention
6 Scabies Overcrowding in schools and homes Low socio-economic conditions Poor Health Education
7 Complications of pregnancy
Low access to appropriate health services Lack of awareness about danger signs of pregnancy Three delays (seeking health care, transportation, and lack
of referral back-up services) Lack of skilled birth attendants
Service delivery/Management problemsThis 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 which need to be addressed:
1. Shortage of skilled (MNCH
2. Inadequate medicines and supplies
3. Inadequate budget for POL
4. Inadequate MNCH elated equipment
5. Deficient logistic support
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Three Years Rolling Plan (2010-2013) District Gujrat
Underlying causes of Management problemsSr. # Service Causes
1. Shortage of skilled (MNCH)
Non-availability of trained staff Non-sanctioning of staff according to MSDS Lack of permanent postings Lack of incentivized and differential pay package Frequent transfer postings Job insecurity Lack of basic amenities at workplace Lack of conducive environment including insecurity and
transport of children for education Political and media interference
2. Inadequate medicines and supplies
Less budget allocation for medicines Frequent increase in drug prices
3. Inadequate budget for POL
Generator provision for back-up of electricity supply Less budget allocation Frequent increase in prices
4. Inadequate MNCH related equipment
Deficient equipment to cater basic and comprehensive EmONC at primary and secondary level of care
Old and un-serviceable equipment Shortage of regular budget for M&R Frequent cuts on M&R budget
5. Shortage of functional vehicles
Provision of inadequate funds for purchase of vehicles Ban on procurement of vehicles by the government Complicated procedure for purchase of new vehicles
3. 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
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Three Years Rolling Plan (2010-2013) District Gujrat
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.
1) 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 Category Bed Strength
DHQ Hospital A 400 and above BedsB 251-400 BedsC Up to 250 Beds
THQ Hospital A Above 60 BedsB 41-60 BedsC Up to 40 Beds
ABS Hospital DHQ (B)
Sr. No.
Post Standard as per MSDS
Sanctioned Filled Vacancy Gap*
1 Gynaecologist 3 3 3 02 Paediatricians 3 1 1 23 Anesthetists 5 1 1 44 MO/SMO/APMO/PMO 104 16 6 15 SMO/SWMO 39 5 2 186 Charge Nurses 114 78 69 217 Lady Health Visitors 11 1 1 10
*Vacancy Gap in relation to Sanctioned Posts and MSDS
THQ Hospital Kharian (Category C)
Sr. Post Standard as per MSDS
Sanctioned Filled Vacancy Gap*
1. Gynaecologist 2 2 2 02. Pediatricians 2 1 1 1
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. Post Standard as per MSDS
Sanctioned Filled Vacancy Gap*
3. Anesthetists 4 1 0 44. Physician 2 1 1 15. Surgeon 2 1 1 16. Eye Specialist 1 1 1 07. APMO/APWMO 2 3 3 08. SMO/SWMO 5 0 0 59. Medical Officers 15 7 7 8
10. CMO 4 3 3 1 11. Lady Health Visitors 8 1 1 7 12. Nurses 75 10 7 65
*Vacancy Gap in relation to Sanctioned Posts and MSDS
Rural Health Centers
Sr. No.
Post Standard as per MSDS
Sanctioned Filled Vacancy Gap*
1 Senior Medical Officers 9 9 9 02 Medical Officers 18 13 12 143 Women Medical Officers 9 13 12 14 Nurses 54 78 65 135 LHV 26 26 26 0
*Vacancy Gap in relation to Sanctioned Posts and MSDS
Basic Health Units
Sr. Post Standard as per MSDS
Sanctioned Filled Vacancy Gap*
1 Medical Officer 89 71 69 22 H & N Supervisor 89 71 68 33 L HVs 89 71 69 2
*Vacancy Gap in relation to Sanctioned Posts and MSDS
2) EquipmentGovernment 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
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Three Years Rolling Plan (2010-2013) District Gujrat
Management/Service delivery problems. Detailed costing of equipment gaps according to MSDS is attached as Annex-I.
i. DHQ Hospital
Sr. No. Equipment Standard as per MSDS(Qty.)
Available Gap
C B A
1 CTG (Cardiac Tocography) 1 1 2 1 02 Foetal Doppler 3 5 5 1 23 Diagnostic Laparoscope 1 1 2 1 04 Bulb Sucker 10 20 2
010 0
5 Baby Warmer 3 3 6 1 26 Mechanical Sucker 3 3 6 3 07 Fetal Stethoscope 4 4 4 4 08 Delivery Table 2 2 3 2 09 D&C Set 2 3 4 2 0
10 Outlet forceps 4 4 4 4 011 Myoma Screw 2 2 2 2 012 Kochers forceps 4 4 8 4 013 Volselum forceps 6 8 1
06 0
14 Lanes Tissue holding forceps 2 2 4 2 015 Vaginal Retractors 10 10 1
010 0
16 Polypectomy forceps 2 2 2 2 017 Sponge holder 10 15 2
010 0
18 Uterine elevator 1 1 1 1 019 CosCo Speculum
Small, Medium, Large (for each category)
6 10 10
6 0
20 Examination light 3 3 6 3 021 Suction Curette 1 2 2 1 0
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No. Equipment Standard as per MSDS(Qty.)
Available Gap
C B A
22 Infant Resuscitation Trolley (with life saving medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light)
1 1 2 1 0
23 Mother Resuscitation Trolley (with life saving medicines, Laryngoscope, Endo-tracheal tube, BP Apparatus, Chargeable light)
1 1 2 1 0
24 Cardiac Monitor 1 1 2 1 025 Pump Breast Electronic 1 1 1 1 026 Vaginal Hysterectomy Set 2 2 4 2 0
26.1 Toothed Tissue Forceps (8”) 2 2 4 2 026.2 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
26.5 Hysterectomy Clamps (Straight)
8 8 16
8 0
26.6 Hysterectomy Clamps (Curved)
8 8 16
8 0
26.7 Uterine Sound 2 2 4 2 026.8 Needle Holder (7”) 2 2 4 2 026.9 Needle Holder (10”) 2 2 4 2 0
26.10 Artery Forceps (Straight 6”) 16 16 32
16 0
26.11 Artery Forceps (Curved 6”) 16 16 32
16 0
26.12 Allis Forceps 8 8 16
8 0
26.13 Towel Clamps 8 8 16
8 0
26.14 Single blade Sims speculum 4 4 8 4 026.15 Double blade Sims speculum 4 4 8 4 026.16 Sponge holding forceps 8 8 1
68 0
26.17 Volselum forceps 4 4 8 4 0
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No. Equipment Standard as per MSDS(Qty.)
Available Gap
C B A
26.18 Uterine Sound 2 2 4 2 026.19 Bladder Sound 2 2 4 2 0
27 Delivery Sets 10 10 15
10 0
27.1 Episiotomy Scissors 10 10 15
10 0
27.2 Straight Scissors 10 10 15
10 0
27.3 Needle holder 10 10 15
10 0
27.4 Non-toothed tissue forceps 8 inches
10 10 15
10 0
27.5 Toothed tissue forceps 8 inches
10 10 15
10 0
27.6 Sims Speculum single blade 20 20 30
20 0
27.7 Sims Speculum double blade 20 20 30
20 0
27.8 Sponge holding forceps 40 40 60
40 0
27.9 Artery forceps 40 40 60
40 0
27.10 Straight clamps (cord) 20 20 30
20 0
27.11 Vacuum Extractor pump 1 1 1 1 027.12 Towel clip 40 40 6
040 0
28 Caesarian Section 6 8 10
6 0
28.1 Scalpel 6 8 10
6 0
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
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No. Equipment Standard as per MSDS(Qty.)
Available Gap
C B A
28.6 Dissecting scissors (curved) 7 inches
6 8 10
6 0
28.7 Green Armtage forceps 8 inches
24 32 40
24 0
28.8 Obstetric outlet forceps (pair) 6 8 10
6 0
28.9 Doyene’s Retractor 6 8 10
6 0
28.10 Small Retractors 12 16 20
12 0
28.11 Towel Clippers 24 32 40
24 0
28.12 Suction Nozzle 6 8 10
6 0
29 MNCH Related Radiology Equipments
29.1 Ultrasound Machine 1 2 3 1 029.2 X-Ray Unit 500 kw 1 1 1 1 029.3 Color Doppler 0 1 1 1 029.4 Lead Screen for X-Ray Unit 1 1 1 1 029.5 0.5 MN Lead Apron. Lead
Gloves, Goggles and Thyroid and Gonadal Sheets
1 1 1 1 0
29.6 Safe Light 1 1 1 1 029.7 X-RT Film Processing Tank 1 1 1 1 029.8 Chest Stand 1 1 1 1 029.9 X-Ray film Illuminator 2 2 2 2 0
29.10 X-Ray Film Hangers All sizes 4 4 4 4 030 MNCH Related Paediatrics
Equipments30.1 Paediatric Ventilator 1 2 2 1 030.2 Incubator 1 1 2 1 030.3 Photo Therapy Unit 1 1 1 1 030.4 Over-head Radiant Warmer 1 1 1 1 030.5 Infant Length Measuring Scale 2 2 2 2 030.6 Infant Weighing Machine 2 2 2 2 030.7 Nebulizer 1 1 2 1 030.8 Billiubino-meter 1 1 2 1 030.9 Exchange Blood Transfusion
Set1 1 2 1 0
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No. Equipment Standard as per MSDS(Qty.)
Available Gap
C B A
30.10 Nasal Probe Paed size 2 2 4 2 031 Anaesthesia/ICU
31.1 Anaesthesia Machine 1 1 2 1 031.2 Ventilators 1 1 1 1 031.3 Nebulizer 1 1 1 1 031.4 Pulse Oximetry 1 1 1 1 031.5 Defibrillator 1 1 1 1 031.6 Airway Oral and Nasal 2 3 4 2 031.7 Tracheostomy tube (adult and
paeds)2 2 4 2 0
31.8 Face mask of all sizes 2 2 4 2 031.9 Double Cuff Tourniquet (for
regional block)1 2 2 1 0
31.10 AMBO bag adult 2 2 4 2 031.11 AMBO Bag paeds 2 2 4 2 031.12 Red Rubber Nasal tubes all
sizes without cuff4 4 8 4 0
32 Blood Bank32.1 Blood storage cabinet (100
bag capacity)1 1 2 1 0
32.2 Packed cell machine 1 1 1 0 132.3 Cell Separator 1 1 1 0 132.4 Freezer for Fresh Frozen
Plasma1 1 1 1 0
32.5 Blood bag shaker 1 1 2 1 032.6 RH view box 2 2 4 2 032.7 Water bath 2 2 2 2 032.8 Micro-pipette 4 6 8 4 032.9 Blood grouping tiles 3 3 6 3 0
32.10 Plasma Extractor 1 1 1 0 132.11 Platelets agitator 1 1 1 0 132.12 Blood thawing bath 1 1 1 1 032.13 Microscopes 1 1 2 1 0
33 Gynae & Labour Room Related Laboratory Equipment
33.1 Hematology Analyzer 1 1 1 1 033.2 Electrolyte Analyzer 1 1 1 1 0
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No. Equipment Standard as per MSDS(Qty.)
Available Gap
C B A
33.3 Analyzer Bio-chemistry Semi-automatic
1 1 1 1 0
33.4 Glucometer 2 2 2 2 033.5 Haemoglobino-meter 2 2 4 2 033.6 Centrifuge 1 1 2 1 0
ii. THQ Hospital KharianSr. Equipment Standard
as per MSDS
(Qty.)
Available Gap
C B A
1 CTG (Cardiac Tocography) 1 1 1 0 1
2 Foetal Doppler 2 2 3 0 2
3 Diagnostic Laparoscope 1 1 1 1 0
4 Bulb Sucker 5 10
20 5 0
5 Baby Warmer 2 2 3 2 0
6 Mechanical Sucker 3 3 3 3 0
7 Fetal Stethoscope 2 3 4 2 0
8 Delivery Table 2 2 2 2 0
9 D&C Set 2 2 2 2 0
10 Outlet forceps 4 4 4 4 0
11 Myoma Screw 2 2 2 2 0
12 Kochers forceps 4 4 4 4 0
13 Volselum forceps 4 4 6 4 014 Lanes Tissue holding forceps 2 2 2 2 015 Vaginal Retractors 4 4 6 4 016 Polypectomy forceps 2 2 2 2 017 Sponge holder 10 1
015 10 0
18 Uterine elevator 1 1 1 1 0
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. Equipment Standard as per MSDS
(Qty.)
Available Gap
C B A
19 CosCo Speculum Small, Medium, Large (for each category)
4 6 6 4 0
20 Examination light 3 3 3 3 021 Suction Curette 1 1 2 1 022 Infant Resuscitation Trolley
(with life saving medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light)
1 1 1 1 0
23 Mother Resuscitation Trolley (with life saving medicines, Laryngoscope, Endo-tracheal tube, BP Apparatus, Chargeable light)
1 1 1 1 0
24 Cardiac Monitor 1 1 1 1 025 Pump Breast Electronic 1 1 1 1 026 Vaginal Hysterectomy Set
26.1 Toothed Tissue Forceps (8”) 2 2 2 2 026.2 Non-Tooted Tissue Forceps
(8”)2 2 2 2 0
26.3 Dissection Scissors (Curved 7”)
2 2 2 2 0
26.4 Dissection Scissors (Straight 7”)
2 2 2 2 0
26.5 Hysterectomy Clamps (Straight)
8 8 8 8 0
26.6 Hysterectomy Clamps (Curved)
8 8 8 8 0
26.7 Uterine Sound 2 2 2 2 026.8 Needle Holder (7”) 2 2 4 2 026.9 Needle Holder (10”) 2 2 2 2 0
26.10 Artery Forceps (Straight 6”) 16 16
16 16 0
26.11 Artery Forceps (Curved 6”) 16 16
16 16 0
26.12 Allis Forceps 8 8 8 8 026.13 Towel Clamps 8 8 8 8 0
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. Equipment Standard as per MSDS
(Qty.)
Available Gap
C B A
26.14 Single blade Sims speculum 4 4 4 4 026.15 Double blade Sims speculum 4 4 4 4 026.16 Sponge holding forceps 8 8 8 8 026.17 Volselum forceps 4 4 4 4 026.18 Uterine Sound 2 2 2 2 026.19 Bladder Sound 2 2 2 2 0
27 Delivery Sets27.1 Episiotomy Scissors 6 6 10 6 027.2 Straight Scissors 6 6 10 6 027.3 Needle holder 6 6 10 6 027.4 Non-toothed tissue forceps 8
inches6 6 10 6 0
27.5 Toothed tissue forceps 8 inches
6 6 10 6 0
27.6 Sims Speculum single blade 12 12
20 12 0
27.7 Sims Speculum double blade 12 12
20 12 0
27.8 Sponge holding forceps 40 40
40 40 0
27.9 Artery forceps 40 40
40 30 10
27.10 Straight clamps (cord) 20 20
30 15 5
27.11 Vacuum Extractor pump 1 1 1 1 027.12 Towel clip 40 4
040 30 10
28 Caesarian Section28.1 Scalpel 4 4 6 4 028.2 Artery Forceps Straight 6
inches16 1
624 16 0
28.3 Artery Forceps Curved 6 inches
16 16
24 16 0
28.4 Artery forceps 8 inches 16 16
24 16 0
28.5 Myoma Scissors straight 7 inches
4 4 6 4 0
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. Equipment Standard as per MSDS
(Qty.)
Available Gap
C B A
28.6 Dissecting scissors (curved) 7 inches
4 4 6 4 0
28.7 Green Armtage forceps 8 inches
16 16
24 16 0
28.8 Obstetric outlet forceps (pair) 4 4 6 4 028.9 Doyene’s Retractor 4 4 6 4 0
28.10 Small Retractors 8 8 12 8 028.11 Towel Clippers 16 1
624 16 0
28.12 Suction Nozzle 4 4 6 4 029 MNCH Related Radiology
Equipments29.1 Ultrasound Machine 1 1 2 1 029.2 X-Ray Unit 500 kw 1 1 1 1 029.3 Color Doppler 0 0 0 0 029.4 Lead Screen for X-Ray Unit 1 1 1 1 029.5 0.5 MN Lead Apron. Lead
Gloves, Goggles and Thyroid and Gonadal Sheets
1 1 1 1 0
29.6 Safe Light 1 1 1 1 029.7 X-RT Film Processing Tank 1 1 1 1 029.8 Chest Stand 1 1 1 1 029.9 X-Ray film Illuminator 2 2 2 2 0
29.10 X-Ray Film Hangers All sizes 4 4 4 4 030 MNCH Related Paediatrics
Equipments30.1 Paediatric Ventilator 1 1 2 1 030.2 Incubator 1 1 1 1 030.3 Photo Therapy Unit 1 1 1 1 030.4 Over-head Radiant Warmer 1 1 1 1 030.5 Infant Length Measuring
Scale2 2 2 2 0
30.6 Infant Weighing Machine 2 2 2 2 030.7 Nebulizer 1 1 1 1 030.8 Billiubino-meter 1 1 1 1 030.9 Exchange Blood Transfusion
Set1 1 1 1 0
30.10 Nasal Probe Paed size 1 2 2 1 0
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. Equipment Standard as per MSDS
(Qty.)
Available Gap
C B A
31 Anaesthesia/ICU31.1 Anaesthesia Machine 1 1 1 1 031.2 Ventilators 1 1 1 1 031.3 Nebulizer 1 1 1 1 031.4 Pulse Oximetry 1 1 1 1 031.5 Defibrillator 1 1 1 1 031.6 Airway Oral and Nasal 1 2 2 1 031.7 Tracheostomy tube (adult
and paeds)1 2 2 1 0
31.8 Face mask of all sizes 1 2 2 1 031.9 Double Cuff Tourniquet (for
regional block)1 1 1 1 0
31.10 AMBO bag adult 1 2 2 1 031.11 AMBO Bag paeds 2 2 2 2 031.12 Red Rubber Nasal tubes all
sizes without cuff4 4 4 4 0
32 Blood Bank32.1 Blood storage cabinet (100
bag capacity)1 1 1 1 0
32.2 Packed cell machine 1 1 1 1 032.3 Cell Separator 1 1 1 1 032.4 Freezer for Fresh Frozen
Plasma1 1 1 1 0
32.5 Blood bag shaker 1 1 1 1 032.6 RH view box 1 2 2 1 032.7 Water bath 2 2 2 2 032.8 Micro-pipette 4 4 6 4 032.9 Blood grouping tiles 3 3 3 3 0
32.10 Plasma Extractor 1 1 1 1 032.11 Platelets agitator 1 1 1 1 032.12 Blood thawing bath 1 1 1 1 032.13 Microscopes 1 1 1 1 0
33 Gynae & Labour Room Related Laboratory Equipment
33.1 Hematology Analyzer 1 1 1 1 033.2 Electrolyte Analyzer 1 1 1 1 0
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. Equipment Standard as per MSDS
(Qty.)
Available Gap
C B A
33.3 Analyzer Bio-chemistry Semi-automatic
1 1 1 1 0
33.4 Glucometer 2 2 2 2 033.5 Haemoglobino-meter 1 1 1 1 033.6 Centrifuge 1 1 1 1 0
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Three Years Rolling Plan (2010-2013) District 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 UnitPlan
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 co-ordination 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
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Three Years Rolling Plan (2010-2013) District Gujrat
Problem Causes Intervention Activity UnitPlan
Activities Targets
Target for 2010-11
Target for 2011-12
Target for 2012-13
Remarks
Unhygienic practices
Proper 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
Conduction 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
- - Procurement and distribution of ORS and Zinc
ORS packets 3,600,000 2,400,000 1,200,000 1,200,000
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Three Years Rolling Plan (2010-2013) District Gujrat
Problem Causes Intervention Activity UnitPlan
Activities Targets
Target for 2010-11
Target for 2011-12
Target for 2012-13
Remarks
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 co-ordination meetings with Traffic Police department
Meetings 12 8 4 4
Poor maintenance of vehicles
Advocacy for improving the condition of roads
· Quarterly co-ordination meetings with Highway department
Meetings 12 8 4 4
Poor road conditions
Health education/promotion to prevent domestic accidents
· Preparation of Disaster Management Plan
- - - - -
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Three Years Rolling Plan (2010-2013) District Gujrat
Problem Causes Intervention Activity UnitPlan
Activities Targets
Target for 2010-11
Target for 2011-12
Target for 2012-13
Remarks
including the Patient Management protocols
Lack of safety measures at work place
Ensure enforcement of safety laws at work places
· Training of the medics and the paramedics in first aid and emergency
Training in Batch for 25 trainees
20 10 5 5
Fire-arm injuries
Provision of emergencies medicines
· Provision of emergency kits for victims
Kits 1,500 1,000 500 500
Domestic accidents
· Procurement of equipments / instruments / various splints and
- - - - -
Page 49
Three Years Rolling Plan (2010-2013) District Gujrat
Problem Causes Intervention Activity UnitPlan
Activities Targets
Target for 2010-11
Target for 2011-12
Target for 2012-13
Remarks
Plaster casts
Burns ·Drugs Drugs 1,500 1,000 500 500
3 Hepatitis B & C Poor sanitation
Health Education/Promotion
·Quarterly co-ordination meetings with TMA and other agencies
- - - - -
Unsafe drinking water
Campaign against quackery
·Messages on local cable network
Monthly Package
- - - -
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
Campaign against drug
·Procureme
Kits 300,000 200,000 100,000 100,000
Page 50
Three Years Rolling Plan (2010-2013) District Gujrat
Problem Causes Intervention Activity UnitPlan
Activities Targets
Target for 2010-11
Target for 2011-12
Target for 2012-13
Remarks
unsafe/unscreened blood and blood products
addiction nt and supply of screening kits
Unsafe sexual practices
Regulatory mechanism to ensure use of safe instruments by dentists, barbers etc.
·Procurement of safety boxes
Syringe cutter
600 400 200 200
Ear piercing and tattooing
·Procurement of drugs for treatment of Hepatitis patients
Injection 9,000 6,000 3,000 3,000
4 Diabetes Obesity Health Education campaign regarding healthy life style
Health educational sessions in community
Seminar - - - -
Inactive life Strengthening Printing Brochure 150,000 100,000 50,000 50,000
Page 51
Three Years Rolling Plan (2010-2013) District Gujrat
Problem Causes Intervention Activity UnitPlan
Activities Targets
Target for 2010-11
Target for 2011-12
Target for 2012-13
Remarks
style diagnostic services for early detection
and distribution of Health Education material
Lack of health awareness on Diabetes
Provision of lab equipment/reagents
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 equipment/reagents
Microscope , allied kit
100 - - -
Page 52
Three Years Rolling Plan (2010-2013) District Gujrat
Problem Causes Intervention Activity UnitPlan
Activities Targets
Target for 2010-11
Target for 2011-12
Target for 2012-13
Remarks
· 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 - - -
Page 53
Three Years Rolling Plan (2010-2013) District Gujrat
Problem Causes Intervention Activity UnitPlan
Activities Targets
Target for 2010-11
Target for 2011-12
Target for 2012-13
Remarks
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
Litre 6,000 4,000 2,000 2,000
Page 54
Three Years Rolling Plan (2010-2013) District Gujrat
Problem Causes Intervention Activity UnitPlan
Activities Targets
Target for 2010-11
Target for 2011-12
Target for 2012-13
Remarks
methrine (Liquid 1.5 % )
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
Page 55
Three Years Rolling Plan (2010-2013) District Gujrat
Problem Causes Intervention Activity UnitPlan
Activities Targets
Target for 2010-11
Target for 2011-12
Target for 2012-13
Remarks
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 socio-economic 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
Improving transportation to appropriate level of care
Printing and distribution of IPC
Brochure 200,000 100,000 50,000 50,000
Page 56
Three Years Rolling Plan (2010-2013) District Gujrat
Problem Causes Intervention Activity UnitPlan
Activities Targets
Target for 2010-11
Target for 2011-12
Target for 2012-13
Remarks
pregnancy material
Three delays (seeking health care, transportation, and lack of referral back-up services)
Strengthening healthcare facilities
Activation and use of Health Committees and women 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 mid-wives in their catchment area
- - - - -
Repair of non
Ambulance 4 - - -
Page 57
Three Years Rolling Plan (2010-2013) District Gujrat
Problem Causes Intervention Activity UnitPlan
Activities Targets
Target for 2010-11
Target for 2011-12
Target for 2012-13
Remarks
functional ambulances for timely transportation of pregnant mothers
Replacement of non functional ambulances for timely transportation of pregnant mothers
Ambulance 12 6 4 2
POL for ambulances
Litre 28,800 24,000 9,600 14,400
Page 58
Three Years Rolling Plan (2010-2013) District Gujrat
Management Problems
Human resource plan to bridge gap between MSDS and Existing sanctioned posts
Page 59
Sr. No. Name of PostBasic Scale
Basic Pay AllowancesRequirement
as per Gap
Physical Targets
Year I Year II Year III
1 Gynaecologist 18 12,910 18,099 - - - -
2 Paediatricians 18 12,910 18,099 2 1 1 2
3 Anesthetists 18 12,910 18,099 4 2 1 1
4 MO / WMO 17 9,850 15,345 107 53 26 26
5 Nurses 16 6,060 8,934 23 11 6 6
6 Lady Health Visitors 9 3,820 4,750 10 5 3 2
Three Years Rolling Plan (2010-2013) District Gujrat
Problem Causes Intervention Activity UnitPlan
Activities Targets
Target for 2010-11
Target for 2011-12
Target for 2012-13
Remarks
1. Shortage of skilled staffs MNCH related
·Non-availability of trained staff
·Filling of the vacant posts
·Filling of the vacant posts of medics and the paramedics through existing recruitment committees
- - - - - Recruitment
·Non-sanctioning of staff according to MSDS
·Sanctioning of trained staffs according to MSDS
Temporary filling of vacant positions on contract
- - - - - Recruitment
·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
Lack of Well defined ·Orientation Batch 6 4 1 1 -
Page 60
Three Years Rolling Plan (2010-2013) District Gujrat
Problem Causes Intervention Activity UnitPlan
Activities Targets
Target for 2010-11
Target for 2011-12
Target for 2012-13 Remarks
incentivized and differential pay package
career structure including opportunities for higher education
trainings of the recruited staffs
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
·Review and revise the career
- - - - - Technical assistance
Page 61
Three Years Rolling Plan (2010-2013) District Gujrat
Problem Causes Intervention Activity UnitPlan
Activities Targets
Target for 2010-11
Target for 2011-12
Target for 2012-13 Remarks
workplace structure of medics and paramedics
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
Page 62
Three Years Rolling Plan (2010-2013) District Gujrat
Problem Causes Intervention Activity UnitPlan
Activities Targets
Target for 2010-11
Target for 2011-12
Target for 2012-13 Remarks
·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 assessment
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
Page 63
Three Years Rolling Plan (2010-2013) District Gujrat
Problem Causes Intervention Activity UnitPlan
Activities Targets
Target for 2010-11
Target for 2011-12
Target for 2012-13 Remarks
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
Deficient equipment to
· Provision of the equipment
Procurement of equipments for
- - - - - Detail attached
Page 64
Three Years Rolling Plan (2010-2013) District Gujrat
Problem Causes Intervention Activity UnitPlan
Activities Targets
Target for 2010-11
Target for 2011-12
Target for 2012-13 Remarks
MNCH related Equipment
cater basic and comprehensive EmONC at primary and secondary level of care
in accordance with the notified equipment list
THQ and DHQ hospitals based on the gaps between MSDS and existing available
Old and un-serviceable equipment
· Provision of adequate budget for maintenance and repair
Allocation of enhanced amount for M&R of equipments
- - - - - Submission 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
Page 65
Three Years Rolling Plan (2010-2013) District Gujrat
Problem Causes Intervention Activity UnitPlan
Activities Targets
Target for 2010-11
Target for 2011-12
Target for 2012-13 Remarks
- ·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 submission
- ·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 submission
· Procurement of supervisory vehicles at DHQ
vehicles 1 1 - - -
Page 66
Three Years Rolling Plan (2010-2013) District Gujrat
Problem Causes Intervention Activity UnitPlan
Activities Targets
Target for 2010-11
Target for 2011-12
Target for 2012-13 Remarks
·Poor maintenance of vehicles
- - - - - - - NO COST ACTIVITY
· Procurement of supervisory vehicles at THQ
vehicles 8 4 2 2 -
SECTION 4: COSTING AND FINANCING PLAN
I. Activity based costingThe 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 with the plan as Annex-II and Annex-III. A moderate estimate of equipment cost has been taken, as there is
wide variation between the minimum and maximum cost. The summary of activity and problem wise costing is given below.
Page 67
Three Years Rolling Plan (2010-2013) District Gujrat
a) Health ProblemsSr. No.
Problem Activity Define Financial Targets Total Cost Remarks
Unit Rate Quantity Year I Year II Year III
1 Diarrhoeal diseases
Quarterly co-ordination meetings with TMA and other agencies
Meetings 3,000 12 12,000 54,240 14,520 39,720 -
Messages on local cable network
Monthly Telecast
35,000 36 420,000 1,898,400 508,200 1,390,200 -
Printing and distribution of IPC material
Brochure 5 300,000 500,000 2,260,000 605,000 1,655,000 -
Conduction of HES in the community
Session 2,000 240 160,000 723,200 193,600 529,600 -
Training of medics and paramedics in IMCI
Training 245,000 8 980,000 2,704,800 592,900 2,111,900 -
Page 68
Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No.
Problem Activity Define Financial Targets Total Cost Remarks
Unit Rate Quantity Year I Year II Year III
Procurement and distribution of ORS and Zinc Sulphate
ORS packets
5 3,600,000 6,000,000 27,120,000 7,260,000 19,860,000 -
- Syrup 60 300,000 6,000,000 27,120,000 7,260,000 19,860,000 -
2 Accidents And Injuries
· Quarterly co-ordination meetings with Traffic Police department
Meetings 5,000 12 20,000 90,400 24,200 66,200 -
· Quarterly co-ordination 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
- - - - - - - Plan
Page 69
Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No.
Problem Activity Define Financial Targets Total Cost Remarks
Unit Rate Quantity Year I Year II Year III
protocols
· 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 of equipments / instruments / various splints and Plaster casts
- - - - - - - Plan
· Drugs Drugs 300 1,500 150,000 678,000 181,500 496,500 -
3 Hepatitis B & C
· Quarterly co-ordination meetings with TMA and other
- - - - - - - Integrated activity
Page 70
Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No.
Problem Activity Define Financial Targets Total Cost Remarks
Unit Rate Quantity Year I Year II Year III
agencies
· Messages on local cable network
Monthly Package
- - - - - - Integrated activity
· Printing and distribution of IPC and hepatitis awareness material
Brochure 30 30,000 300,000 1,356,000 363,000 993,000 -
· 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 36,000,000
162,720,000
43,560,000 119,160,000 -
Page 71
Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No.
Problem Activity Define Financial Targets Total Cost Remarks
Unit Rate Quantity Year I Year II Year III
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 -
Provision of lab equipment/reagents
Glucometer with Sticks
7,000 400 1,400,000 3,864,000 847,000 3,017,000 -
Provision of medicines
Drug 4,800 60,000 96,000,000
433,920,000
116,160,000 317,760,000 -
5 Malaria Printing and distribution of Health Education material
Poster 25 60,000 500,000 2,260,000 605,000 1,655,000 -
Page 72
Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No.
Problem Activity Define Financial Targets Total Cost Remarks
Unit Rate Quantity Year I Year II Year III
Provision of lab equipment/reagents
Microscope , allied kit
60,000 100 6,000,000 6,000,000 - 6,000,000 -
Training of health care providers / GPs on Roll back malaria
Training 50,800 8 203,200 560,832 122,936 437,896 -
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 -
Page 73
Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No.
Problem Activity Define Financial Targets Total Cost Remarks
Unit Rate Quantity Year I Year II Year III
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 -
Spray Pumps pumps 7,000 150 350,000 1,582,000 423,500 1,158,500 -
Uniform for spray man
Uniform 500 150 75,000 75,000 - 75,000 -
Glasses/ gloves, Bucket, soap
Misc 1,000 150 50,000 226,000 60,500 165,500 -
Page 74
Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No.
Problem Activity Define Financial Targets Total Cost Remarks
Unit Rate Quantity Year I Year II Year III
Purchase of insecticide delta methrine (Powder 5 % WDP)
Kg 800 10,000 3,200,000 10,592,000 1,936,000 8,656,000 -
Purchase of insecticide delta methrine (Liquid 1.5 % )
Litre 1,200 6,000 2,400,000 10,848,000 2,904,000 7,944,000 -
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 -
Page 75
Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No.
Problem Activity Define Financial Targets Total Cost Remarks
Unit Rate Quantity Year I Year II Year III
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 -
Page 76
Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No.
Problem Activity Define Financial Targets Total Cost Remarks
Unit Rate Quantity Year I Year II Year III
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 -
Activation and use of Health Committees and women groups under LHWs
- - - - - - - Plan
Training of TBAs with specific focus on safe delivery and danger signs
Batch of 25 TBAs for 2 days Training
51,000 20 510,000 1,407,600 308,550 1,099,050 -
Placement of mid-wives in their catchment area
- - - - - - - placement in progress
Page 77
Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No.
Problem Activity Define Financial Targets Total Cost Remarks
Unit Rate Quantity Year I Year II Year III
Repair of non functional ambulances for timely transportation of pregnant mothers
Ambulance
25,000 4 100,000 100,000 - 100,000 -
Replacement of non functional ambulances for timely transportation of pregnant mothers
Ambulance
3,800,000 12 22,800,000
57,912,000 9,196,000 48,716,000 -
POL for ambulances
Litre 76 28,800 364,800 3,815,808 1,324,224 2,491,584 -
Page 78
Three Years Rolling Plan (2010-2013) District Gujrat
a) Management ProblemsHuman Resource plan to bridge gap between MSDS and existing sanctioned positions
Sr. No.
Name of Post BS
Basi
c Pa
y
Allo
wan
ces Requi
rement as per Gap
Financial Targets
Year I Year II Year III
Pay of Officers
Pay of other staff
Allowances
Pay of Officers
Pay of other staff
Allowances
Pay of Officers
Pay of other staff
Allowances
1 Gynaecologist 18 12,910
18,099 - - - - - - - - - -
2 Paediatricians 18 12,910
18,099 2 154,920 - 217,188 340,824 - 477,814 749,813 - 1,051,190
3 Anesthetists 18 12,910
18,099 4 309,840 - 434,376 511,236 - 716,720 749,813 - 1,051,190
4 MO / WMO 17 9,850 15,345 107 6,264,600 - 9,759,420 10,271,580 - 16,001,766 15,017,310 - 23,394,987
5 Nurses 16 6,060 8,934 23 799,920 - 1,179,288 1,359,864 - 2,004,790 2,023,798 - 2,983,599
6 Lady Health Visitors
9 3,820 4,750 10 - 229,200 285,000 - 403,392 501,600 - 554,664 689,700
Grand Total 7,529,280 229,200 11,875,272 12,483,504 403,392 19,702,690 18,540,733 554,664 29,170,665
Page 79
Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No.
Problem Activity Define Financial Targets Total Cost Remarks
Unit Rate Quantity Year I Year II Year III
1 Shortage of skilled MNCH related staff
· Filling of the vacant posts of medics and the paramedics through existing recruitment committees
- - - - - - - Recruitment
Temporary filling of vacant positions on contract
- - - - - - - Recruitment
· Demand generation and request to the Department of Health by the districts for recruitment through PSC against vacant posts
- - - - - - - Plan
Page 80
Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No.
Problem Activity Define Financial Targets Total Cost Remarks
Unit Rate Quantity Year I Year II Year III
· Orientation trainings of the recruited staffs
Batch 350,500 6 1,402,000
385,550 424,105 2,211,655 -
· Consensus building between the districts for uniform incentivized pay package for all categories and levels staff
- - - - - - - Meeting
· Request to the Provincial Government for approval and implementation of agreed pay packages
- - - - - - - Plan
· Review and revise the career structure of medics and paramedics
- - - - - - - Technical assistance
Page 81
Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No.
Problem Activity Define Financial Targets Total Cost Remarks
Unit Rate Quantity Year I Year II Year III
· Filling of Human Resource gaps as per MSDS
Posts - 136 7,529,280
12,483,504
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 11,875,272
19,702,690
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
Page 82
Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No.
Problem Activity Define Financial Targets Total Cost Remarks
Unit Rate Quantity Year I Year II Year III
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
Page 83
Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No.
Problem Activity Define Financial Targets Total Cost Remarks
Unit Rate Quantity Year I Year II Year III
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 14,850,000
16,335,000
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
Page 84
Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No.
Problem Activity Define Financial Targets Total Cost Remarks
Unit Rate Quantity Year I Year II Year III
available
Allocation of enhanced amount for M&R of equipments
- - - - - - - Submission of demand
Orientation of staffs in maintenance of logos for equipments
- - - - - - - Plan
5 Deficient logistic support
· Condemnation of the old and off-road vehicles
- - - - - - - As per demand by district
· Preparation and submission of demand for replacement five ambulances at RHC
- - - - - - - Demand submission
Page 85
Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No.
Problem Activity Define Financial Targets Total Cost Remarks
Unit Rate Quantity Year I Year II Year III
· Procurement of ambulances
Ambulance
- - - - - - Addressed in health problem no. 07
· Demand submission for replacement four supervisory vehicles at HQ AND THQ
- - - - - - - Demand submission
· Procurement of supervisory vehicles at DHQ
vehicles 3,800,000 1 3,800,000 - - 3,800,000 -
- - - - - - - - NO COST ACTIVITY
· Procurement of supervisory vehicles at THQ
vehicles 900,000 8 3,600,000 1,980,000 2,178,000 7,758,000 -
Page 86
Three Years Rolling Plan (2010-2013) District Gujrat
II. Financial Outlay including 3YRP ActivitiesThe 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. Overall financial outlay of the plan is as under:
a) Health Problems
Object Classification
2010-2011 2011-2012 2012-2013
Regular Additional Total Regular Additional Total Regular Additional Total
A03907 5,750 420,000 425,750 6,613 462,000 468,613 7,604 508,200 515,804
A03902 5,750 2,300,000 2,305,750 6,613 2,255,000 2,261,613 7,604 2,480,500 2,488,104
A03820 - 52,000 52,000 - 57,200 57,200 - 62,920 62,920
A03927 - 166,950,000 166,950,000 - 177,100,000
177,100,000
- 192,269,000
192,269,000
A13101 5,750 - 5,750 6,613 - 6,613 7,604 - 7,604
A09501 - 24,900,000 24,900,000 - 17,710,000 17,710,000 - 9,922,000 9,922,000
A09601 - 530,000 530,000 - 385,000 385,000 - 423,500 423,500
A03903 - 320,000 320,000 - 352,000 352,000 - 387,200 387,200
A03801 - 2,193,200 2,193,200 - 1,206,260 1,206,260 - 1,326,886 1,326,886
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Three Years Rolling Plan (2010-2013) District Gujrat
Object Classification
2010-2011 2011-2012 2012-2013
Regular Additional Total Regular Additional Total Regular Additional Total
A09601 - - - - - - - - -
A09404 - 14,000,000 14,000,000 - 8,030,000 8,030,000 - 8,833,000 8,833,000
A03807 - 1,065,300 1,065,300 - 1,795,860 1,795,860 - 2,580,204 2,580,204
A03906 - 75,000 75,000 - - - - - -
A09802 - 50,000 50,000 - 55,000 55,000 - 60,500 60,500
A01277 - 325,000 325,000 - 357,500 357,500 - 393,250 393,250
A13001 - 100,000 100,000 - - - - - -
Total 17,250 213,280,500 213,297,750 19,838 209,765,820 209,785,658 22,813 219,247,160 219,269,973
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Three Years Rolling Plan (2010-2013) District Gujrat
b) Management Problems
Object Classification
2010-2011 2011-2012 2012-2013
Regular Additional Total Regular Additional Total Regular Additional Total
A03801 - 1,402,000 1,402,000 - 385,550 385,550 - 424,105 424,105
A01101 - 7,529,280 7,529,280 - 12,483,504 12,483,504 - 18,540,733 18,540,733
A01270 678,854 11,875,272 12,554,126 780,682 19,702,690 20,483,372 897,785 29,170,665 30,068,450
A09501 - 7,400,000 7,400,000 - 1,980,000 1,980,000 - 2,178,000 2,178,000
A03807 - 17,694,000 17,694,000 - 19,463,400 19,463,400 - 21,409,740 21,409,740
A09601 - 9,727,000 9,727,000 - 2,692,845 2,692,845 - - -
A01102 - 229,200 229,200 - 403,392 403,392 - 554,664 554,664
Total 678,854 55,856,752 56,535,606 780,682 57,111,381 57,892,063 897,785 72,277,908 73,175,692
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Three Years Rolling Plan (2010-2013) District Gujrat
III. Summaries
a) Problem wise Costing
i. Health Problems
Sr. No. ProblemFY I FY II FY III Total Cost Rs.
Amount (Rs.) Amount (Rs.) Amount (Rs.) Amount (Rs.)
1 Diarrhoeal diseases 14,072,000 14,940,200 16,434,220 45,446,420
2 Accidents And Injuries 2,190,000 2,134,000 2,347,400 6,671,400
3 Hepatitis B & C 41,400,000 45,540,000 50,094,000 137,034,000
4 Diabetes 97,650,000 106,645,000 117,309,500 321,604,500
5 Malaria 28,283,700 17,852,560 16,897,166 63,033,426
6 Scabies 5,410,000 4,576,000 5,033,600 15,019,600
7 Complication of pregnancy 24,274,800 18,078,060 11,131,274 53,484,134
Total 213,280,500 209,765,820 219,247,160 642,293,480
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Three Years Rolling Plan (2010-2013) District Gujrat
ii. Management Problems
Sr. No. Problem
FY I FY II FY III Total Cost Rs.
Amount (Rs.) Amount (Rs.)Amount
(Rs.)Amount (Rs.)
1 Shortage of skilled staffs MNCH related
21,035,752 32,975,136 48,690,168 102,701,055
2 Inadequate medicine and supply - - - -
3 Inadequate budget POL 17,694,000 19,463,400 21,409,740 58,567,140
4 Inadequate MNCH related Equipment
9,727,000 2,692,845 - 12,419,845
5 Deficient logistic support 7,400,000 1,980,000 2,178,000 11,558,000
Total 55,856,752 57,111,381 72,277,908 185,246,040
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Three Years Rolling Plan (2010-2013) District Gujrat
b) Activity-wise costing
i. 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
20,000 22,000 24,200 66,200
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No. Problem Activity FY-I FY-II FY-III Total
department
· 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 network
- - - -
· Printing and distribution of IPC 300,000 330,000 363,000 993,000
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No. Problem Activity FY-I FY-II FY-III Total
and hepatitis awareness material
· Procurement and supply of screening kits
5,000,000 5,500,000 6,050,000 16,550,000
· Procurement of safety boxes 100,000 110,000 121,000 331,000
· Procurement of drugs for treatment of Hepatitis patients
36,000,000 39,600,000 43,560,000 119,160,000
4 Diabetes Health educational sessions in community
- - - -
Printing and distribution of Health Education material
250,000 275,000 302,500 827,500
Provision of lab equipment/reagents
1,400,000 770,000 847,000 3,017,000
Provision of medicines 96,000,000 105,600,000
116,160,000
317,760,000
5 Malaria Printing and distribution of Health Education material
500,000 550,000 605,000 1,655,000
Provision of lab equipment/reagents
6,000,000 - - 6,000,000
Training of health care providers / GPs on Roll back
203,200 111,760 122,936 437,896
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No. Problem Activity FY-I FY-II FY-III Total
malaria
Antimalarial drugs aursonate tablets,
2,000,000 1,100,000 1,210,000 4,310,000
Antimalarial drugs Primaquin, 3,000,000 2,200,000 2,420,000 7,620,000
Antimalarial drugs Chloroquin 5,000,000 2,750,000 3,025,000 10,775,000
Fogging Machine 180,000 - - 180,000
Purchase of disel for fogging 228,000 250,800 275,880 754,680
Spray Pumps 350,000 385,000 423,500 1,158,500
Uniform for spray man 75,000 - - 75,000
Glasses/ gloves, Bucket, soap 50,000 55,000 60,500 165,500
Purchase of insecticide delta methrine (Powder 5 % WDP)
3,200,000 3,520,000 1,936,000 8,656,000
Purchase of insecticide delta methrine (Liquid 1.5 % )
2,400,000 2,640,000 2,904,000 7,944,000
Purchase of larvicidal Drug (Phenthion Granules)
1,000,000 1,100,000 605,000 2,705,000
Purchase of larvicidal Drug ( Temiphos) Liquid
1,200,000 1,100,000 1,210,000 3,510,000
Spray man 325,000 357,500 393,250 1,075,750
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No. Problem Activity FY-I FY-II FY-III Total
Purchase of motor cycle for CDCSs
2,100,000 990,000 726,000 3,816,000
POL for motor cycles 472,500 742,500 980,100 2,195,100
6 Scabies Community health education sessions
160,000 176,000 193,600 529,600
Printing & Distribution of IPC Material
250,000 275,000 302,500 827,500
Supply of anti scabies drugs 5,000,000 4,125,000 4,537,500 13,662,500
7 Complication of pregnancy Messages on local cable network
- - - -
Printing and distribution of IPC material
500,000 275,000 302,500 1,077,500
Activation and use of Health Committees and women groups under LHWs
- - - -
Training of TBAs with specific focus on safe delivery and danger signs
510,000 280,500 308,550 1,099,050
Placement of mid-wives in - - - -
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No. Problem Activity FY-I FY-II FY-III Total
their catchment area
Repair of non functional ambulances for timely transportation of pregnant mothers
100,000 - - 100,000
Replacement of non functional ambulances for timely transportation of pregnant mothers
22,800,000 16,720,000 9,196,000 48,716,000
POL for ambulances 364,800 802,560 1,324,224 2,491,584
Total 13,280,500 09,765,820 19,247,160 42,293,480
ii. Management Problems
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No. Problem Activity Costing (Rs.)
FY-I FY-II FY-III Total
1 Shortage of skilled staffs MNCH related
· Filling of the vacant posts of medics and the paramedics through existing recruitment committees
- - - -
Temporary filling of vacant positions on contract
- - - -
· Demand generation and request to the Department of Health by the districts for recruitment through PSC against vacant posts
- - - -
· Orientation trainings of the recruited staffs
1,402,000 385,550 424,105 2,211,655
· Consensus building between the districts for uniform incentivized pay package for all categories and levels staff
- - - -
· Request to the Provincial Government for approval and implementation of agreed pay packages
- - - -
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No. Problem Activity Costing (Rs.)
FY-I FY-II FY-III Total
· 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 medicine.
- - - -
Procurement of essential drugs - - - -
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No. Problem Activity Costing (Rs.)
FY-I FY-II FY-III Total
on the basis of allocated budget
3 Inadequate budget POL Assessment of additional requirement
- - - -
Costing and submission of additional demand
- - - -
· Provision of POL budget for supervisory vehicles for DHQ
990,000 1,089,000 1,197,900 3,276,900
· Provision of POL budget for supervisory vehicles for THQ
1,854,000 2,039,400 2,243,340 6,136,740
· Provision of POL budget for generator
14,850,000 16,335,000 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 available
9,727,000 2,692,845 - 12,419,845
Allocation of enhanced amount for M&R of equipments
- - - -
Orientation of staffs in maintenance of logos for equipments
- - - -
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Three Years Rolling Plan (2010-2013) District Gujrat
Sr. No. Problem Activity Costing (Rs.)
FY-I FY-II FY-III Total
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
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Three Years Rolling Plan (2010-2013) District Gujrat
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.
I. M&E of Plan
Indicators Target % Achievemen
t
MoV Responsibility
Frequency of
monitoring
Remarks
% of planned supervisory visits conducted
50 visits /year
Inspection Book
EDOH/DOH/ DDOH
Quarterly
% of RHCs with availability 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
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Three Years Rolling Plan (2010-2013) District Gujrat
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 populatio
n
DHIS Report
EDOH/ Statistical Officer
Quarterly
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Three Years Rolling Plan (2010-2013) District Gujrat
% of targeted pregnant women received TT-2 vaccine
Target according
to populatio
n
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 populatio
n
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 populatio
n
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
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Three Years Rolling Plan (2010-2013) District Gujrat
Annex-I
Costing of Equipment gaps for DHQ and THQ Hospitals
DHQ HOSPITAL GUJRAT
Sr. No.
Equipment Standard as per MSDS Available Gap Cost/Unit
Total Cost(Qty.)
C B A1 CTG (Cardiac
Tocography)1 1 2 1 0 285000 0
2 Foetal Doppler 3 5 5 1 2 101000 2020003 Diagnostic Laparoscope 1 1 2 1 0 1200000 04 Bulb Sucker 10 20 20 10 0 45 05 Baby Warmer 3 3 6 1 2 850000 17000006 Mechanical Sucker 3 3 6 3 0 28000 07 Fetal Stethoscope 4 4 4 4 0 1500 08 Delivery Table 2 2 3 2 0 17500 09 D&C Set 2 3 4 2 0 2100 0
10 Outlet forceps 4 4 4 4 0 900 011 Myoma Screw 2 2 2 2 0 320 012 Kochers forceps 4 4 8 4 0 235 013 Volselum forceps 6 8 10 6 0 235 014 Lanes Tissue holding
forceps2 2 4 2 0 400 0
15 Vaginal Retractors 10 10 10 10 0 350 016 Polypectomy forceps 2 2 2 2 0 750 017 Sponge holder 10 15 20 10 0 300 018 Uterine elevator 1 1 1 1 0 150 0
19 CosCo Speculum 6 10 10 6 0 550 020 Examination light 3 3 6 3 0 18000 021 Suction Curette 1 2 2 1 0 95 022 Infant Resuscitation
Trolley (with life saving medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light)
1 1 2 1 0 95000 0
23 Mother Resuscitation Trolley (with life saving medicines, Laryngoscope, Endo-tracheal tube, BP Apparatus, Chargeable light)
1 1 2 1 0 110000 0
24 Cardiac Monitor 1 1 2 1 0 500000 0
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Three Years Rolling Plan (2010-2013) District Gujrat
25 Pump Breast Electronic 1 1 1 1 0 250000 026 Vaginal Hysterectomy
Set2 2 4 2 0 30000 0
26.1 Toothed Tissue Forceps (8”)
2 2 4 2 0 55 0
26.2 Non-Tooted Tissue Forceps (8”)
2 2 4 2 0 55 0
26.3 Dissection Scissors (Curved 7”)
2 2 4 2 0 150 0
26.4 Dissection Scissors (Straight 7”)
2 2 4 2 0 150 0
26.5 Hysterectomy Clamps (Straight)
8 8 16 8 0 150 0
26.6 Hysterectomy Clamps (Curved)
8 8 16 8 0 175 0
26.7 Uterine Sound 2 2 4 2 0 90 026.8 Needle Holder (7”) 2 2 4 2 0 150 026.9 Needle Holder (10”) 2 2 4 2 0 300 026.1 Artery Forceps (Straight
6”)16 16 32 16 0 110 0
26.11
Artery Forceps (Curved 6”)
16 16 32 16 0 125 0
26.12
Allis Forceps 8 8 16 8 0 230 0
26.13
Towel Clamps 8 8 16 8 0 125 0
26.14
Single blade Sims speculum
4 4 8 4 0 275 0
26.15
Double blade Sims speculum
4 4 8 4 0 250 0
26.16
Sponge holding forceps 8 8 16 8 0 200 0
26.17
Volselum forceps 4 4 8 4 0 250 0
26.18
Uterine Sound 2 2 4 2 0 1500 0
26.19
Bladder Sound 2 2 4 2 0 1500 0
27 Delivery Sets 10 10 15 10 0 027.1 Episiotomy Scissors 10 10 15 10 0 125 027.2 Straight Scissors 10 10 15 10 0 360 027.3 Needle holder 10 10 15 10 0 135 027.4 Non-toothed tissue
forceps 8 inches10 10 15 10 0 100 0
27.5 Toothed tissue forceps 8 inches
10 10 15 10 0 100 0
27.6 Sims Speculum single blade
20 20 30 20 0 275 0
27.7 Sims Speculum double blade
20 20 30 20 0 250 0
27.8 Sponge holding forceps 40 40 60 40 0 250 0
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Three Years Rolling Plan (2010-2013) District Gujrat
27.9 Artery forceps 40 40 60 40 0 275 027.1 Straight clamps (cord) 20 20 30 20 0 175 027.1
1Vacuum Extractor pump 1 1 1 1 0 19000 0
27.12
Towel clip 40 40 60 40 0 125 0
28 Caesarian Section 6 8 10 6 0 028.1 Scalpel 6 8 10 6 0 50 028.2 Artery Forceps Straight 6
inches24 32 40 24 0 125 0
28.3 Artery Forceps Curved 6 inches
24 32 40 24 0 125 0
28.4 Artery forceps 8 inches 24 32 40 24 0 175 028.5 Myoma Scissors straight 7
inches6 8 10 6 0 150 0
28.6 Dissecting scissors (curved) 7 inches
6 8 10 6 0 270 0
28.7 Green Armtage forceps 8 inches
24 32 40 24 0 300 0
28.8 Obstetric outlet forceps (pair)
6 8 10 6 0 900 0
28.9 Doyene’s Retractor 6 8 10 6 0 200 028.1 Small Retractors 12 16 20 12 0 300 028.1
1Towel Clippers 24 32 40 24 0 125 0
28.12
Suction Nozzle 6 8 10 6 0 250 0
29 MNCH Related Radiology Equipments
0
29.1 Ultrasound Machine 1 2 3 1 0 575000 029.2 X-Ray Unit 500 kw 1 1 1 1 0 6000000 0
29.3 Color Doppler 0 1 1 1 0 5750000 029.4 Lead Screen for X-Ray
Unit1 1 1 1 0 30000 0
29.5 0.5 MN Lead Apron. Lead Gloves, Goggles and Thyroid and Gonadal Sheets
1 1 1 1 0 100000 0
29.6 Safe Light 1 1 1 1 0 5000 029.7 X-RT Film Processing
Tank1 1 1 1 0 5000 0
29.8 Chest Stand 1 1 1 1 0 4500 029.9 X-Ray film Illuminator 2 2 2 2 0 4000 029.1 X-Ray Film Hangers All
sizes4 4 4 4 0 4000 0
30 MNCH Related Paediatrics Equipments
0
30.1 Paediatric Ventilator 1 2 2 1 0 1200000 030.2 Incubator 1 1 2 1 0 1500000 030.3 Photo Therapy Unit 1 1 1 1 0 22000 0
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Three Years Rolling Plan (2010-2013) District Gujrat
30.4 Over-head Radiant Warmer
1 1 1 1 0 910000 0
30.5 Infant Length Measuring Scale
2 2 2 2 0 5000 0
30.6 Infant Weighing Machine 2 2 2 2 0 3100 030.7 Nebulizer 1 1 2 1 0 22000 030.8 Billiubino-meter 1 1 2 1 0 36000 030.9 Exchange Blood
Transfusion Set1 1 2 1 0 2000 0
30.1 Nasal Probe Paed size 2 2 4 2 0 7000 031 Anaesthesia/ICU 0
31.1 Anaesthesia Machine 1 1 2 1 0 321000 031.2 Ventilators 1 1 1 1 0 525000 031.3 Nebulizer 1 1 1 1 0 165000 031.4 Pulse Oximetry 1 1 1 1 0 21000 031.5 Defibrillator 1 1 1 1 0 500000 031.6 Airway Oral and Nasal 2 3 4 2 0 500 031.7 Tracheostomy tube (adult
and paeds)2 2 4 2 0 1000 0
31.8 Face mask of all sizes 2 2 4 2 0 1000 031.9 Double Cuff Tourniquet
(for regional block)1 2 2 1 0 320 0
31.1 AMBO bag adult 2 2 4 2 0 2450 031.1
1AMBO Bag paeds 2 2 4 2 0 3000 0
31.12
Red Rubber Nasal tubes all sizes without cuff
4 4 8 4 0 1000 0
32 Blood Bank 032.1 Blood storage cabinet
(100 bag capacity)1 1 2 1 0 812000 0
32.2 Packed cell machine 1 1 1 0 1 600000 60000032.3 Cell Separator 1 1 1 0 1 5225000 522500032.4 Freezer for Fresh Frozen
Plasma1 1 1 1 0 1150000 0
32.5 Blood bag shaker 1 1 2 1 0 10000 032.6 RH view box 2 2 4 2 0 1000 032.7 Water bath 2 2 2 2 0 3000 032.8 Micro-pipette 4 6 8 4 0 8000 032.9 Blood grouping tiles 3 3 6 3 0 3000 032.1 Plasma Extractor 1 1 1 0 1 1000000 100000032.1
1Platelets agitator 1 1 1 0 1 1000000 1000000
32.12
Blood thawing bath 1 1 1 1 0 3000 0
32.13
Microscopes 1 1 2 1 0 115000 0
33 Gynae & Labour Room Related Laboratory Equipment
0
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Three Years Rolling Plan (2010-2013) District Gujrat
33.1 Hematology Analyzer 1 1 1 1 0 425000 033.2 Electrolyte Analyzer 1 1 1 1 0 625000 033.3 Analyzer Bio-chemistry
Semi-automatic1 1 1 1 0 690000 0
33.4 Glucometer 2 2 2 2 0 2500 033.5 Haemoglobino-meter 2 2 4 2 0 1000 033.6 Centrifuge 1 1 2 1 0 133000 0
Total 9727000
THQ KHARIAN
Sr. No.
Equipment Standard as per MSDS Available
Gap Cost/Unit Total Cost(Qty.)
C B A1 CTG (Cardiac
Tocography)1 1 1 0 1 285000 101000
2 Foetal Doppler 2 2 3 0 2 101000 24000003 Diagnostic
Laparoscope1 1 1 1 0 1200000 0
4 Bulb Sucker 5 10 20 5 0 45 05 Baby Warmer 2 2 3 2 0 850000 06 Mechanical
Sucker3 3 3 3 0 28000 0
7 Fetal Stethoscope 2 3 4 2 0 1500 08 Delivery Table 2 2 2 2 0 17500 09 D&C Set 2 2 2 2 0 2100 0
10 Outlet forceps 4 4 4 4 0 900 011 Myoma Screw 2 2 2 2 0 320 012 Kochers forceps 4 4 4 4 0 235 013 Volselum forceps 4 4 6 4 0 235 014 Lanes Tissue
holding forceps2 2 2 2 0 400 0
15 Vaginal Retractors
4 4 6 4 0 350 0
16 Polypectomy forceps
2 2 2 2 0 750 0
17 Sponge holder 10 10 15 10 0 300 018 Uterine elevator 1 1 1 1 0 150 0
19 CosCo Speculum 4 6 6 4 0 550 020 Examination light 3 3 3 3 0 95 021 Suction Curette 1 1 2 1 0 95000 0
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Three Years Rolling Plan (2010-2013) District Gujrat
22 Infant Resuscitation Trolley (with life saving medicines, baby laryngoscope, Endo-tracheal tube, Infant BP Apparatus, Chargeable Light)
1 1 1 1 0 110000 0
23 Mother Resuscitation Trolley (with life saving medicines, Laryngoscope, Endo-tracheal tube, BP Apparatus, Chargeable light)
1 1 1 1 0 500000 0
24 Cardiac Monitor 1 1 1 1 0 250000 025 Pump Breast
Electronic1 1 1 1 0 30000 0
26 Vaginal Hysterectomy Set
2 2 2 55 0
26.1 Toothed Tissue Forceps (8”)
2 2 2 2 0 55 0
26.2 Non-Tooted Tissue Forceps (8”)
2 2 2 2 0 150 0
26.3 Dissection Scissors (Curved 7”)
2 2 2 2 0 150 0
26.4 Dissection Scissors (Straight 7”)
2 2 2 2 0 150 0
26.5 Hysterectomy Clamps (Straight)
8 8 8 8 0 175 0
26.6 Hysterectomy Clamps (Curved)
8 8 8 8 0 90 0
26.7 Uterine Sound 2 2 2 2 0 150 026.8 Needle Holder
(7”)2 2 4 2 0 300 0
26.9 Needle Holder (10”)
2 2 2 2 0 110 0
26.1 Artery Forceps (Straight 6”)
16 16 16 16 0 125 0
26.11 Artery Forceps (Curved 6”)
16 16 16 16 0 230 0
26.12 Allis Forceps 8 8 8 8 0 125 026.13 Towel Clamps 8 8 8 8 0 275 0
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Three Years Rolling Plan (2010-2013) District Gujrat
26.14 Single blade Sims speculum
4 4 4 4 0 250 0
26.15 Double blade Sims speculum
4 4 4 4 0 200 0
26.16 Sponge holding forceps
8 8 8 8 0 250 0
26.17 Volselum forceps 4 4 4 4 0 1500 026.18 Uterine Sound 2 2 2 2 0 1500 026.19 Bladder Sound 2 2 2 2 0 0
27 Delivery Sets 6 6 10 4 2 125 72027.1 Episiotomy
Scissors6 6 10 6 0 360 0
27.2 Straight Scissors 6 6 10 6 0 135 027.3 Needle holder 6 6 10 6 0 100 027.4 Non-toothed
tissue forceps 8 inches
6 6 10 6 0 100 0
27.5 Toothed tissue forceps 8 inches
6 6 10 6 0 275 0
27.6 Sims Speculum single blade
12 12 20 12 0 250 0
27.7 Sims Speculum double blade
12 12 20 12 0 250 0
27.8 Sponge holding forceps
40 40 40 40 0 275 0
27.9 Artery forceps 40 40 40 30 10 175 19000027.1 Straight clamps
(cord)20 20 30 15 5 19000 625
27.11 Vacuum Extractor pump
1 1 1 1 0 125 0
27.12 Towel clip 40 40 40 30 10 50028 Caesarian
Section4 4 6 4 0 50 0
28.1 Scalpel 4 4 6 4 0 125 028.2 Artery Forceps
Straight 6 inches16 16 24 16 0 125 0
28.3 Artery Forceps Curved 6 inches
16 16 24 16 0 175 0
28.4 Artery forceps 8 inches
16 16 24 16 0 150 0
28.5 Myoma Scissors straight 7 inches
4 4 6 4 0 270 0
28.6 Dissecting scissors (curved) 7 inches
4 4 6 4 0 300 0
28.7 Green Armtage forceps 8 inches
16 16 24 16 0 900 0
28.8 Obstetric outlet forceps (pair)
4 4 6 4 0 200 0
28.9 Doyene’s Retractor
4 4 6 4 0 300 0
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Three Years Rolling Plan (2010-2013) District Gujrat
28.1 Small Retractors 8 8 12 8 0 125 028.11 Towel Clippers 16 16 24 16 0 250 028.12 Suction Nozzle 4 4 6 4 0 0
29 MNCH Related Radiology Equipments
575000 0
29.1 Ultrasound Machine
1 1 2 1 0 6000000 0
29.2 X-Ray Unit 500 kw
1 1 1 1 0 0
29.3 Color Doppler 0 0 0 0 0 5750000 029.4 Lead Screen for
X-Ray Unit1 1 1 1 0 30000 0
29.5 0.5 MN Lead Apron. Lead Gloves, Goggles and Thyroid and Gonadal Sheets
1 1 1 1 0 100000 0
29.6 Safe Light 1 1 1 1 0 5000 029.7 X-RT Film
Processing Tank1 1 1 1 0 5000 0
29.8 Chest Stand 1 1 1 1 0 4500 029.9 X-Ray film
Illuminator2 2 2 2 0 4000 0
29.1 X-Ray Film Hangers All sizes
4 4 4 4 0 4000 0
30 MNCH Related Paediatrics Equipments
0
30.1 Paediatric Ventilator
1 1 2 1 0 1200000 0
30.2 Incubator 1 1 1 1 0 1500000 030.3 Photo Therapy
Unit1 1 1 1 0 22000 0
30.4 Over-head Radiant Warmer
1 1 1 1 0 910000 0
30.5 Infant Length Measuring Scale
2 2 2 2 0 5000 0
30.6 Infant Weighing Machine
2 2 2 2 0 3100 0
30.7 Nebulizer 1 1 1 1 0 22000 030.8 Billiubino-meter 1 1 1 1 0 36000 030.9 Exchange Blood
Transfusion Set1 1 1 1 0 2000 0
30.1 Nasal Probe Paed size
1 2 2 1 0 7000 0
31 Anaesthesia/ICU 031.1 Anaesthesia
Machine1 1 1 1 0 321000 0
31.2 Ventilators 1 1 1 1 0 525000 031.3 Nebulizer 1 1 1 1 0 165000 0
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Three Years Rolling Plan (2010-2013) District Gujrat
31.4 Pulse Oximetry 1 1 1 1 0 21000 031.5 Defibrillator 1 1 1 1 0 500000 031.6 Airway Oral and
Nasal1 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 031.11 AMBO Bag paeds 2 2 2 2 0 3000 031.12 Red Rubber Nasal
tubes all sizes without cuff
4 4 4 4 0 1000 0
32 Blood Bank 032.1 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 032.4 Freezer for Fresh
Frozen Plasma1 1 1 1 0 1150000 0
32.5 Blood bag shaker 1 1 1 1 0 10000 032.6 RH view box 1 2 2 1 0 1000 032.7 Water bath 2 2 2 2 0 3000 032.8 Micro-pipette 4 4 6 4 0 8000 032.9 Blood grouping
tiles3 3 3 3 0 3000 0
32.1 Plasma Extractor 1 1 1 1 0 1000000 032.11 Platelets agitator 1 1 1 1 0 1000000 032.12 Blood thawing
bath1 1 1 1 0 3000 0
32.13 Microscopes 1 1 1 1 0 115000 033 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 Bio-chemistry Semi-automatic
1 1 1 1 0 690000 0
33.4 Glucometer 2 2 2 2 0 2500 0
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