Three Years Rolling Plan 2010-2013 District Khushab
THREE YEARS ROLLING PLAN 2010-2013 DISTRICT KHUSHAB
Table of Contents
Acronyms
EXECUTIVE SUMMARY
SECTION 1: DISTRICT HEALTH PROFILE
Vision of the District
Background of the District
Map of the District
Demography
Socio-Economic Indicators
Health Indicators
Organizational Structure of District Health Administration
Health Resources
1.Health Facilities
a)Public
b)Private
2.Human Resource
a)Administrative
b)Facility Based
c)Outreach
d)Training Institutions
Health Financing
Disease Pattern
Status of Vertical Programs
1.National Program for FP & PHC
2.EPI
3.MNCH Program
4.TB Control Program
5.Malaria Control Program
6.Hepatitis Control Program
SECTION 2: PROBLEM ANALYSIS
Objectives
Plan Development Process
Problem Identification
Health Problems
Problem Prioritization
Underlying causes of prioritized problems
Service delivery/Management problems
MDGs and MSDS
a)Human Resource
i.DHQ Hospital Khushab
ii.THQ Hospital Khushab
iii.THQ Hospital Noorpur Thal
iv.THQ Hospital Nowshera
b)Equipment
i.DHQ Hospital Khushab
ii.THQ Hospital Khushab
iii.THQ Hospital Noorpur Thal
iv.THQ Hospital Nowshera
SECTION 3: INTERVENTIONS AND TARGETS
Health Problems
Management Problems
SECTION 4: COSTING AND FINANCING PLAN
Activity based costing
Problem wise costing summary of Health Problems
a)Health Problems
Problem wise costing summary of Management Problems
b)Management Problems
Financial Outlay
Budget Summary
SECTION 5: MONITORING & EVALUATION
M&E of Plan
Annex-I
Annex II
Acronyms
3YRP / Three Years Rolling planADB / Asian Development Bank
APMO / Additional Principal Medical Officer
ARI / Acute Respiratory Infections
BHU / Basic Health Center
BoD / Burden of Dieses
CDC / Communicable Disease Control
CDR / Case Detection Rate
CPR / Contraceptive Prevalence Rate
DHIS / District Health Information System
DHQH / District Head Quarter Hospital
DoH / Department of Health
DR / Default Rate
EDO(H) / Executive District Officer Health
EPI / Expended Program on Immunization
HSRP / Health Sector Reforms Program
IMR / Infant Mortality Rate
IPC / Interpersonal Communication
M & E / Monitoring and Evaluation
M & E / Maintenance and Repair
MCH / Maternal Child Health
MMR / Maternal Mortality Ratio
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
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 Program 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. Firstsection 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.
DISTRICT KHUSHAB
SECTION 1: DISTRICT HEALTH PROFILE
Vision of the District
The Government Health Department, District Khushab, is very much committed to reduce the maternal mortality and infant mortality as per the developed countries. The department aims at providing essential staff ,equipments / instruments, medicines to the population residing in cities and particularly in rural areas. The department believes in equity, accessibility and availability of all health services to everyone in the district.
Mission of the District
The District Government Health Department, District Khushab will provide high quality services comparable with the best in the country. Their mission statement is as under
“We will work with everyone who wants a better future for our District. We will establish an efficient, effective and accountable District Government, which is committed to respect and uphold basic human rights, responsive towards people's needs, committed to poverty reduction and capable of meeting the challenges of the 21st Century. Our actions will be driven by the concerns of local people”
Background of the District
Khushab is situated between Sargodha and Mianwali, near riverJhelum. The district is full of natural beauty containing Jhelum River,Fields,Mountains (Skaisar) and Thal desert. Its important towns are Quaidabad,Jauharabad, Mitha Twana and Nowshera. District Khushab consists of three tehsils, 51 union councils,and 38 BHUs,five RHCs,three THQ Hospitals and one DHQ Hospital.
- Communication linkages (Roads, Railway):District Khushab is linked with Sargodha and Mianwali by rail as well as roads. However Jhang ,Jhelum and Bhakkar are connected by roads only .
- Source of livelihood:The source of livelihood is agriculture, business and labour.
Map of the District
Demography
- Total Population 11,16,567
- Total Area 6511-square kilometers
- Annual Growth Rate 1.97
- Population Density 171persons per sq. km
Area-wise population
Area / Population / PercentageRural / 8,35,192 / 74.80%
Urban / 2,81,375 / 25.20%
Source: Standard Demographic population groups based on DHIS
Gender-wise population
Gender / Population / PercentageMale / 526252 / 47.14%
Female / 590315 / 52.86%
Source: Standard Demographic population groups based on DHIS
Population groups
Population Groups / Standard Demographic (%) / Estimated PopulationUnder 1 year of age / 2.7 / 30147
Under 5 years / 13.4 / 149620
Under 15 years / 44 / 491289
Women in child bearing age (15-49 years) / 22 / 245645
Married Child Bearing age Women / 16 / 178651
Expected pregnancies / 3.4 / 37963
Source: Standard Demographic population groups based on DHIS
Tehsil wise distribution
Tehsil / Number of UC / PopulationKhushab / 32 / 7,02,163
Noor pur Thal / 10 / 2,14,695
Quidabad / 09 / 1,99,709
Source: Standard Demographic population groups based on DHIS
Ethnic groups and languages
The main ethnic groups in the district are Awan, Baluch, Pathan, Jat, Rajput and Arayen. Saraiki, Punjabi and Urdu are the main languages spoken in the district.
Socio-Economic Indicators
Education and Literacy
Literacy rate / Male / FemaleUrban / 65.41% / 38.32%
Rural / 57.67% / 17.76%
Overall District / 59.8% / 21.8%
Source:EDO Literacy and Non-Formal Education Khushab
- Per capita income Rs. 72,000/-
Health Indicators
- Infant Mortality Rate 95
- Under 5 mortality Rate 108
- Maternal mortality Ratio 300 /1,00,000 live births*
- Malnutrition
Underweight prevalence (severe) 18%
Stunting prevalence (severe) 28%
Wasting prevalence (severe) 13%
- Life expectancy 62years (approx)
Source: MICS 2007-08 and EDO(H) office Khushab
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:
Health Resources
1.Health Facilities
a)Public
Details of physical infrastructure of public health facilities in the district is given in the table below
Facility Type / Name of Facility / Bed Strength / No. of Functional Beds / RemarksDHQ Hospital / DHQ Hospital Khushab / 125 / 125 / ----
THQ Hospital / THQ Hospital Khushab / 100 / 100 / ----
THQ Hospital Nowshera / 60 / 60 / ----
THQ Hospital Noor Pur Thal / 40 / 40 / ----
Civil Hospital / Civil Hospital Quaidabad / 48 / 48
RHCs / RHC Padhrar / 20 / 20 / ----
RHC Khabaki / 20 / 20 / ----
RHC Hadali / 20 / 20 / -----
RHC Roda / 20 / 20 / -----
RHC Mitha Twana / 20 / 20 / -----
BHUs / 38 BHUs in the District / 76 / 76 / ----
Civil Dispensaries / 5 / 0 / 0 / ----
Facility Type / Name of Facility / Bed Strength / No. of Functional Beds / Remarks
MCH Centers / 6 / 0 / 0 / -----
Sub Health Centers / 9 / 0 / 0 / -----
TB Clinics / 0 / 0 / 0 / -----
Health houses / 949 / 0 / 0 / -----
Source: DHIS/EDOH office
b)Private
The district has provided a list of private service providers including hospitals, clinics, laboratories and maternity homes. These private providers are used for providing support in preventive programs like Polio and other EPI activities. With the passage of time, role of private providers will expand, and there is a need to develop an effective coordination between public and private sector. Detailed list of private sector health facilities is attached as Annex-I.
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
a)Administrative
Sr. No. / Name of Post/Designation / Sanctioned / Filled1 / Executive District Officer Health / 01 / 01
2 / District Officer Health / 01 / 01
3 / Deputy District Officer Health / 03 / 01
4 / Program Director DHDC / 01 / 01
5 / District Coordinator National Program / 0* / 01
6 / District Coordinator EPI Surveillance / 0* / 01
7 / District Sanitary Inspector / 1 / 0
8 / CDC Officer / 1 / 0
9 / CDC Inspector / 3 / 1
10 / Drug Inspector / 4 / 4
11 / District Superintendent Vaccination / 1 / 1
12 / Assistant Superintendent Vaccination / 2 / 2
13 / Tehsil Sanitary Inspector / 1 / 1
14 / Inspector Vaccination / 2 / 2
*Posts not yet sanctioned.
b)Facility Based
i.Basic Health Units (38)
Sr. No. / Name of Post/Designation / Sanctioned / Filled / Vacant1 / Medical Officer / 38 / 19 / 19
2 / School Health & Nutrition Supervisor / 38 / 0 / 38
3 / Medical Assistant / 5 / 2 / 3
4 / Computer Operator / 38 / 0 / 38
5 / Medical Technician / 33 / 27 / 6
6 / LHV / 38 / 38 / 0
7 / Dispenser / 38 / 34 / 4
8 / Midwife / 76 / 26 / 50
9 / Naib Qasid / 38 / 38 / 0
10 / Chowkidar / 38 / 37 / 1
11 / Sanitary Worker / 38 / 37 / 1
ii.Rural Health Centers(5)
Sr. No. / Name of Post/Designation / Sanctioned / Filled / Vacant1 / Senior Medical Officers / 5 / 1 / 4
2 / Women Medical Officers / 5 / 3 / 2
3 / Dental Surgeons / 5 / 1 / 4
4 / Medical Officers / 5 / 4 / 1
5 / Charge Nurses / 24 / 20 / 4
6 / Homeo Doctors / 3 / 3 / 0
7 / Hakim / 2 / 2 / 0
8 / Computer Operators / 4 / 1 / 3
9 / Medical /Health Technician / 0 / 0 / 0
10 / LHV / 9 / 9 / 0
11 / Lab. Technician / 4 / 2 / 2
12 / Dental Technician / 4 / 1 / 3
13 / R.H.I / 18 / 3 / 15
14 / Junior Clerk / 5 / 3 / 2
15 / Vaccinator / 0 / 0 / 0
16 / Homeo Dispenser / 4 / 4 / 0
17 / Dawasaz / 2 / 2 / 0
18 / Radiographer/X-Ray Asstt. / 7 / 6 / 1
19 / Dresser / 6 / 3 / 3
20 / Anesthesia Assistant / 4 / 0 / 4
21 / O.T.A / 4 / 1 / 3
22 / Dispenser / 19 / 16 / 3
23 / Dental Assistant / 0 / 0 / 0
24 / Laboratory Assistant / 5 / 2 / 3
25 / Midwife / 21 / 11 / 10
26 / Driver / 6 / 5 / 1
27 / T.O / 4 / 2 / 2
28 / Homeo Naib Qasid / 4 / 4 / 0
29 / Dawakob / 2 / 2 / 0
30 / Ward Servant / 11 / 10 / 1
31 / Sweepers / 18 / 18 / 0
32 / Sanitary Worker / 20 / 18 / 2
33 / Sanitary Patrol / 20 / 18 / 2
34 / Naib Qasid / 13 / 12 / 1
35 / Mali / 5 / 4 / 1
36 / Cook / 3 / 0 / 3
37 / Chowkidar / 9 / 9 / 0
38 / Water Career / 4 / 2 / 2
iii.THQ Hospitals(3)
Sr. No. / Name of post / Sanctioned / FilledMedical Superintendent / 3 / 1
APMO / 8 / 1
APWMO / 3 / 0
Gynecologist / 5 / 1
Pediatrician / 3 / 0
Anesthetist / 3 / 0
Surgeon / 3 / 2
MO/CMO / 30 / 5
WMO / 12 / 4
Dental Surgeon / 3 / 0
Hospital Pharmacist / 2 / 0
Head Nurse / 2 / 0
Charge Nurses / 38 / 23
Homeo Doctor / 2 / 1
Hakim / 2 / 1
LHV / 3 / 3
Clerk / 2 / 1
Dispenser/Dresser / 16 / 15
Homeo Dispenser / 2 / 2
Dawasaz / 2 / 2
OTA / 2 / 2
Radiographer / 5 / 5
Laboratory Assistant / 5 / 4
Dental Assistant / 1 / 0
Driver / 5 / 5
Tube well operator / 3 / 2
Dai / 2 / 1
Ward servant / 17 / 17
Naib Qasid/Dawakob / 2 / 2
Bearer / 3 / 3
Dhobi / 2 / 2
Gate Keeper / 7 / 7
Mashki / 1 / 0
Baildar / 4 / 3
Chowkidar / 5 / 5
Cook / 2 / 1
Sweeper / 19 / 17
iv.DHQ Hospital
Sr. No. / Name of post / Sanctioned / FilledMedical Superintendent / 1 / 1
Chief Consultant / 1 / 1
PMO / 0 / 0
PWMO / 0 / 0
AMS / 0 / 0
APMO / 4 / 2
APWMO / 3 / 1
Physician / 1 / 0
Anesthetist / 1 / 1
Cardiologist / 1 / 1
Chest specialist / 0 / 0
DMS / SMO / 2 / 2
Neuro Surgeon / 0 / 0
Nursing Superintendent / 0 / 0
Nephrologist / 0 / 0
Gynecologist / 3 / 1
Pediatrician / 1 / 1
Pathologist / 1 / 0
Radiologist / 1 / 0
Surgeon / 2 / 1
E.N.T. Specialist / 1 / 0
Eye Specialist / 1 / 1
Senior Dental Surgeon / 1 / 0
Urologist / 0 / 0
Dental Surgeon / 3 / 2
Internees / 0 / 0
Medical Officer / 5 / 5
Pharmacist / 1 / 1
Physiotherapist / 1 / 0
W.M.O / 3 / 0
Charge Nurse / 19 / 15
Head Nurse / 2 / 0
Male Nurse / 0 / 0
Hakim / 1 / 1
Homeo Doctor / 1 / 1
Almoner / 0 / 0
Computer Operator / 0 / 0
Stenographer / 0 / 0
Accountant / 0 / 0
E.C.G. Haemo & CT Technician / 1 / 1
Senior Clerk / 1 / 1
Sanitary Inspector / 0 / 0
Junior Clerk / 2 / 1
Dawasaz / 1 / 1
Dispenser / 10 / 10
Homeo Dispenser / 1 / 1
Operation Theater Assistant / 1 / 1
Physiotherapist Aid / 1 / 0
Radiographer / 3 / 3
Dental Assistant / 0 / 0
Lab. Assistant / 3 / 3
Store Keeper / 1 / 0
Driver / 2 / 2
Midwife / 2 / 2
Tailor Master / 1 / 0
Tube well Operator / 2 / 1
Lab. Attendant / 0 / 0
O.T. Attendant / 0 / 0
X-Ray Attendant / 0 / 0
Ambulance Cleaner / 0 / 0
Bearer / 3 / 2
Baildar / 3 / 3
Chowkidar / 4 / 3
Cook / 1 / 0
Dawakob / 1 / 1
Dhobi / 2 / 0
Gate Man / 10 / 10
Mali / 1 / 1
Masalchi / 0 / 0
Sanitary Worker / 18 / 18
Ward Cleaner / 0 / 0
Ward Servant / 14 / 8
Water Carrier / 4 / 4
Naib Qasid / 3 / 3
c)Outreach
This information is about outreach program workers such as Vaccinators, CDC Supervisors and Sanitary Inspectors which are not part of above mentioned health facilities.
Post / Sanctioned / FilledVaccinators / 47 / 47
CDC Supervisors / 35 / 34
Sanitary Inspectors / 39 / 30
d)Training Institutions
A number of training institutions are working in the district,which include the following:
Type of institute / NumberDHDC / 1
General Nursing school / 1
i.DHDC
Post / Sanctioned / FilledProgramme Director / 1 / 1
MPPT / 1 / 0
LHV Trainer / 1 / 0
Assistant / 1 / 1
Driver / 1 / 1
Naib Qasid / 1 / 1
Chowkidar / 2 / 2
Sanitary Worker / 1 / 1
ii.General Nursing School
Name of Post/Designation / Sanctioned / FilledPrincipal School of Nursing / 1 / 0
Nursing Instructor / 3 / 1
House Keeper / 1 / 1
Sweeper / 3 / 2
Naib Qasid / 1 / 1
Chowkidar/Gate Keeper / 4 / 2
Cook / 2 / 0
Masalchi / 0 / 0
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
/ Year2007-08 / 2008-09 / 2009-10 up to 03/2010
Allocation / Exp. / Allocation / Exp. / Allocation / Exp.
Non-Development / 230.918 / - / 246.275 / - / 311.401 / 138.994
Development / 4.151 / 0.749 / 13.446 / - / 17.467 / 3.103
Sub Total / 235.07 / 0.749 / 259.73 / - / 328.87 / 142.10
PHSRP / - / - / 10.000 / - / 10.000 / 0.881
PMDGP / - / - / 96.150 / 1.096 / 95.026 / 28.229
PDSSP / 13.109 / 11.629 / 17.628 / - / - / 0.075
Provincial Development Funds (ADP) / 30.659 / 30.659 / 12.865 / 12.865 / 35.050 / 19.453
Grand Total / 278.84 / 43.04 / 396.38 / 13.97 / 468.95 / 190.74
User charges (like parchi fee, fees for diagnostic services) / 4.451 / - / 5.493 / - / 1.869 / -
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.
Disease Group / Total / %ageRespiratory Diseases
1 / Acute (upper) respiratory infections / 108906 / 28.36
2 / Pneumonia < 5 yrs. / 5712 / 1.49
3 / Pneumonia > 5 yrs. / 7000 / 1.82
4 / TB Suspects / 6500 / 1.69
5 / Chronic Obstructive Pulmonary Disease / 19786 / 5.15
6 / Asthma / 7442 / 1.94
Gastro Intestinal Disease
7 / Diarrhea / Dysentery < 5 yrs / 11494 / 2.99
8 / Diarrhea / Dysentery > 5 yrs / 10288 / 2.68
9 / Enteric / Typhoid Fever / 4064 / 1.06
10 / Worm Infestations / 6256 / 1.63
11 / Peptic Ulcer Disease / 30272 / 7.88
12 / Cirrhosis of Liver / 1154 / 0.30
Urinary Tract Diseases
13 / Urinary Tract Infections / 18064 / 4.70
14 / Nephritis / Nephrosis / 530 / 0.14
15 / Sexually Transmitted Infections / 222 / 0.06
16 / Benign Enlargement of Prostrate / 666 / 0.17
Other Communicable Diseases
17 / Suspected Malaria / 9566 / 2.49
18 / Suspected Meningitis / 110 / 0.06
19 / Fever due to other causes / 23610 / 6.15
Vaccine Preventable Diseases
20 / Suspected Measles / 208 / 0.05
21 / Suspected Viral Hepatitis / 436 / 0.11
22 / Suspected Neonatal Tetanus / 60 / 0.02
Cardiovascular Diseases
23 / Ischemic heart disease / 1332 / 0.35
24 / Hypertension / 12194 / 3.18
Skin Diseases
25 / Scabies / 36778 / 9.58
26 / Dermatitis / 7944 / 2.07
27 / Cutaneous Leishmaniasis / 316 / 0.08
Endocrine Disease
28 / Diabetes Mellitus / 6290 / 1.64
Neuro-Psychiatric Diseases
29 / Depression / 10682 / 2.78
30 / Drug Dependence / 968 / 0.25
31 / Epilepsy / 346 / 0.09
Eye & ENT Diseases
32 / Cataract / 4968 / 1.29
33 / Trachoma / 926 / 0.24
34 / Glaucoma / 548 / 0.14
35 / Otitis Media / 5624 / 1.46
Oral Diseases
36 / Dental Caries / 8252 / 2.15
Injuries/Poisoning
37 / Road traffic accidents / 8774 / 2.28
38 / Fractures / 2112 / 0.55
39 / Burns / 1670 / 0.43
40 / Dog bite / 1572 / 0.41
41 / Snake bite (with signs/symptoms of poisoning) / 310 / 0.08
Miscellaneous Diseases
42 / Acute Flaccid Paralysis / 36 / 0.01
43 / Suspected HIV/AIDS / 0 / 0
44 / Any other Unusual disease (specify) / 0 / 0
Total / 383498 / 100
Source: Compiled from PHC and SHC DHIS Reports
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 respective program reports.