Three Years Rolling Plan (2010-2013) District Lodhran
THREE YEARS ROLLING PLAN
2010 - 2013
DISTRICT LODHRAN
Table of Contents
Acronyms
Executive Summary
SECTION 1: DISTRICT HEALTH PROFILE
I.Vision of the District
II.Background of the District
III.Map of the District
IV.Demography
V.Socio Economic Indicators
VI.Health Indicators
a)Reproductive Health
VII.Organizational Structure of District Health Administration
VIII.Health Resources
i.Health Facilities
a)Public
b)Private
ii.Human Resource
a)Administrative
b)Facility Based
c)Outreach
d)Training Institutions
iii.Health Financing
IX.Disease Pattern
X.Status of Vertical Programs
i.National Program for FP & PHC
ii.EPI
iii.MNCH Program
iv.TB Control Program
v.Malaria Control Program
vi.Hepatitis Control Program
vii.School Health Services Program
SECTION 2: PROBLEM ANALYSIS
I.Objectives
II.Plan Development Process
a)Problem Identification
i.Health Problems
b)Problem Prioritization
Underlying causes of prioritized problems
ii.Service delivery/Management problems
Underlying causes of Management Problems
III.MDGs and MSDS
a)Human Resource
i.DHQ Hospital
ii.THQ Hospitals
b)Equipment
i.DHQ Hospital
ii.THQ Hospital
SECTION 3: INTERVENTIONS AND TARGETS
I.Health Problems
II.Management Problems
SECTION 4: COSTING AND FINANCING PLAN
I.Activity based costing
a)Health Problems
b)Management Problems
II.Financial Outlay including 3YRP Activities
a)Health Problems
b)Management Problems
III.Summaries
a)Problem-wise Costing
i.Health Problem
ii.Management Problems
b)Activity-wise Costing
i.Health Problems
ii.Management Problems
SECTION 5: MONITORING & EVALUATION
I.M&E of Plan
Annex - I
Annex-II
Acronyms
3YRP / Three Years Rolling planADB / 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 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 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.
District Lodhran
SECTION 1: DISTRICT HEALTH PROFILE
I.Vision of the District
Health Department District Government Lodhran aims to provide to every citizen (1.62 M) regardless of the socio0economic status, an effective, efficient, and most modern health care delivery system, by mean acceptable to them, base on scientific method, at a cost that community and country can afford, in the true spirit of self realize.
II.Background of the District
The foundation of Lodhran city was laid in 1830. The British rule extended to Punjab, district Multan including the area of Lodhran also came under the British rule. At that time district Multan comprised of five pargana (Tehsil) i.e. Multan, Shuja Abad, Lodhran, Malsi and Sarai Sadhu.Settalement operation in tehsil Lodhran was started in 1873 which concluded in April 1875.Kehror Pacca and Dunyapur were the part of tehsil Malsi which were annexed with Lodhran in 1924.
Lodhran District is located on the North side of the river Satluj.On its north are the districts of Multan, Khaniwal and Vehari while Bahawalpur is on its southern side. On the east lies the districts of Vehari and Bahawalpur while district Multan lies on the western side. Lodhran lies between 29° 0 21°, to 29° – 55° latitudes and 71° – 23° to 72° – 11° longitudes.Total area is 2778 square Kilometers or 111105 acres. It is almost rectangular in shape with one arm 34.54 kilometers and other 51.80 kilometers long. It comprises 438 Mauzas.
The climate of the district is hot and dry in summer and cold in winter season. The summer season begins in April and continues till October. The hottest months are May, June and July. The maximum and minimum temperature ranges between 42 028 centigrade respectively. The entire area is smooth plain, almost whole under cultivation through canals and tube wells. The soil is suitable for growing Mangos,
The District Headquarter is connected with its Tehsil Headquarters through Railway line and roads. Lodhran railway station is junction of railway lines. Total metalled raods length is about 853 killometers. The district is linked with Multan, Bahawalpur, Vehari, Khaniwal, Jalapur and Shuja abad through metalled raods. The main ethnic groups are Gujjar, Bhutta, Jam, Mughal, Rajput, Awan, kanjoo, Balouch, Arain and Sandhi.
III.Map of the District
IV.Demography
Total Population 16, 20, 795 persons
Annual growth rate2.0 %
Population density 422 persons per sq. km
Areawise population
Area / Population / PercentageRural / 13, 90, 795 / 85.80%
Urban / 2, 30, 00 / 14.20%
Source: DCR 1998 (Projected population)
Genderwise population
Gender / Population / PercentageMale / 8, 42, 813 / 52%
Female / 7, 77, 982 / 48%
Source: DCR 1998 (Projected population)
Population groups
Population Groups / Standard Demographic (%) / Estimated PopulationUnder 1 year of age / 2.7 / 43, 761
Under 5 years / 13.4 / 2, 17, 186
Under 15 years / 44 / 7, 13, 149
Women in child bearing age (15-49 years) / 22 / 3, 56, 574
Married Child Bearing age Women / 16 / 2, 59, 327
Expected pregnancies / 3.4 / 55, 107
Source: Bureau of Statistics (Projected from Census 1998)
V.SocioEconomic Indicators
Education and Literacy
Age / Literacy Rate10+yrs / 45%
Adult 15+yrs / 41%
Adult 15024yrs / 60%
Literacy rate / Rural / Urban / Male / Female / Overall District
%age / 26.8% / 47.7% / 26.8 / 16.0 / 29.9
Source: MICS 2070208
Per capita income
875 $/Annum
Housing
Ownership of house 76%
Mean household size 6.8
Mean number of persons per room 3.7
Total Housing Units 861437
Pacca Housing Units 504369
Electrified 183988
Piped water supply 21510
Gas for Cooking 2500
Mean household size
Overall district 6.8 persons
Tehsil Lodhran 6.7 persons
Tehsil Dunya Pur 6.9 persons
Tehsil Kehror Pacca 7.0 persons
Water and Sanitation
Physical access to drinking water (within dwelling) 93 %
Use of improved drinking water sources 99 %
Use of properly treated water 1.5 %
Safe drinking water without bacteria 32 %
Use of sanitary means of excreta disposal 58 %
Use of improved water sources and improved Sanitation 58 %
Proper disposal of ;
Waste water 24 %
Solid waste 4.3 %
Hand washing adequately;
Before meal 48%
After using latrine 52 %
VI.Health Indicators
Infant Mortality Rate 71.9/100
Neonatal mortality Rate 45/100
Under 5 mortality Rate 94/1000 Live births
Maternal mortality Ratio 222/100,000
Life expectancy 65 years
Proportion of children under 1 years immunized 85%
against measles
a)Reproductive Health
Contraception
- Use of contraceptives (any method) 23%
- Contraceptive drop out 3.6%
- Unwilling pregnancy 27%
Maternal and newborn health
- Antenatal care (ANC) 46%
- Skilled attendant at delivery 31%
- Institutional deliveries 28%
- Postnatal care (PNC) 29%
Source: MICS 2007-2008
VII.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:
VIII.Health Resources
i.Health Facilities
a)Public
Details of physical infrastructure of public health facilities in the district is given in the table below
Facility Type / No. of Facility / Bed Strength / No. of Functional Beds / RemarksTeaching hospitals / 0 / 0 / 0 / 0
DHQ Hospital / 1 / 40 / 40 / New DHQ of 125 Beds is under construction
THQ Hospital / 2 / 40 / 28 / 12 more beds are required
RHCs / 4 / 32 / 24 / RHC 53 M is 8 bedded
BHUs / 48 / 96 / 96
Govt. Rural Dispensaries / 1 / 0 / 0 / 0
MCH Centers / 0 / 0 / 0 / 0
Sub Health Centers / 0 / 0 / 0 / 0
TB Clinics / 0 / 0 / 0 / 0
Rural Dispensaries (ZC) / 0 / 0 / 0 / 0
City Dispensaries / 0 / 0 / 0 / 0
Health house / 1011 / 0 / 0 / 0
Data 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.
ii.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 / Post / Sanctioned / FilledExecutive District Officer Health / 1 / 1
District Officer Health / 1 / 1
Deputy DOH Lodhran / 1 / 1
Drug Inspector / 1 / 1
Assistant Entomologist / 1 / 1
CDC Officer / 1 / 1
Statistical Officer / 1 / 1
Office Superintendent / 1 / 1
District Sanitary Inspector / 1 / 1
Assistant / 1 / 0
Head Clerk / 1 / 1
Statistical Assistant / 1 / 1
Assistant Superintendent Vaccination / 1 / 1
Assistant Inspectoress Health Centers / 1 / 0
Tehsil Sanitary Inspector / 1 / 0
Senior Clerk / 4 / 4
Junior Clerk / 5 / 3
Accountant / 1 / 0
Drivers / 3 / 3
Insect Collector / 2 / 2
Naib Qasid / 7 / 7
Chowkidar / 5 / 5
Ward Cleaner / 1 / 1
b)Facility Based
Basic Health Units
Sr.No / Post / Sanctioned / FilledMedical Officer / 48 / 48
Nutrition Supervisors / 48 / 48
Computer Operator / 48 / 0
Deputy Medical Officer / 4 / 2
Medical Technician / 44 / 44
Lady Health Visitor / 48 / 48
Sanitary Inspectors / 48 / 48
Dispenser / 48 / 48
Midwife / 44 / 44
Naib qasid / 48 / 48
Chowkidar / 48 / 48
Ward Cleaner / 30 / 30
Rural Health Centres
Sr.No / Post / Sanctioned / FilledSenior Medical Officer / 4 / 4
Medical Officer / 4 / 3
Woman Medical Officer / 4 / 4
Dental Surgeon / 4 / 4
Charge Nurses / 24 / 6
Homeopathic Healer / 2 / 2
Homeopathic Dispenser / 2 / 2
Hakeem / 2 / 2
Dawasaz / 2 / 2
Dispenser / 16 / 15
Dresser / 8 / 7
Lady Health Visitor / 8 / 8
Computer Operator / 4 / 0
Dental Technician / 4 / 0
Laboratory Technician / 4 / 1
Radiographer / 4 / 4
Senior Clerk / 4 / 4
Junior Clerk / 4 / 0
Laboratory Assistant / 4 / 4
Midwife / 16 / 0
Driver / 4 / 4
Naib Qasid / 8 / 8
Chowkidar / 8 / 8
Mali / 4 / 0
Water Carrier / 4 / 0
Ward Servant (M&F) / 12 / 0
Sweepers / 16 / 16
Dawakoob / 2 / 2
WMO MNCH / 4 / 1
LHV MNCH / 4 / 4
THQ Hospitals
Sr. No. / Nomenclature of Post / Sanctioned / Filled / Vacancy Gap1 / Medical Superintendent / 2 / 2 / 0
2 / Additional MS / 0 / 0 / 0
3 / D.M.S / 0 / 0 / 0
4 / Physician / 2 / 1 / 1
5 / Surgeon / 2 / 2 / 0
6 / Gynecologist / 2 / 2 / 0
7 / Pediatrician / 2 / 2 / 0
8 / Anesthetist / 2 / 1 / 1
9 / Opthathmologist / 2 / 2 / 0
10 / ENT Specialist / 2 / 0 / 2
11 / Pathologist / 0 / 0 / 0
12 / Radiologist / 0 / 0 / 0
13 / Orthopedic Surgeon / 0 / 0 / 0
14 / Clinical Psychologist / 0 / 0 / 0
15 / Emergency Specialist / 0 / 0 / 0
16 / Trauma Surgeon / 0 / 0 / 0
17 / Forensic Expert / 0 / 0 / 0
18 / Urologist / 0 / 0 / 0
19 / Cardiologist / 0 / 0 / 0
20 / Neurosurgeon / 0 / 0 / 0
21 / Psychiatrist / 0 / 0 / 0
22 / TB & Chest Specialist / 0 / 0 / 0
23 / Dermatologist / 0 / 0 / 0
24 / Pediatric Surgeon / 0 / 0 / 0
25 / Neurologist / 0 / 0 / 0
26 / Epidemiologist / 0 / 0 / 0
27 / Medical Officer / 6 / 6 / 0
28 / APMO / 3 / 3 / 0
29 / APWMO / 0 / 0 / 0
30 / EMO / 4 / 4 / 0
31 / WMO Labor Room / 6 / 6 / 0
32 / MO Intensive care / 4 / 4 / 0
33 / BTO / 0 / 0 / 0
34 / Dental Surgeon / 2 / 2 / 0
35 / Charge Nurse / 20 / 20 / 0
36 / Head Nurse / 2 / 2 / 0
37 / Nursing Superintendent / 0 / 0 / 0
38 / Budget & Accounts Officer / 0 / 0 / 0
39 / Accountant / 0 / 0 / 0
40 / Social Welfare Officer / 0 / 0 / 0
41 / Bio Medical Engineer / 0 / 0 / 0
42 / Pharmacist / 0 / 0 / 0
43 / Health & NutritionSupervisor / 0 / 0 / 0
44 / Speech Therapist / 0 / 0 / 0
45 / StatisticalSpecialist / 0 / 0 / 0
46 / Radiographer / 4 / 4 / 0
47 / Dental Technician / 0 / 0 / 0
48 / Lab Technician / 0 / 0 / 0
49 / Lab Assistant / 4 / 4 / 0
50 / Dispenser / 8 / 8 / 0
51 / Eye Refractions / 0 / 0 / 0
52 / Ophthalmic Technician / 0 / 0 / 0
53 / Bio Medical Technician / 0 / 0 / 0
54 / ECG Technician / 0 / 0 / 0
55 / OT Technician / 6 / 0 / 6
56 / LHV / 2 / 2 / 0
57 / Dresser / 2 / 2 / 0
58 / Midwifes / 0 / 0 / 0
59 / Store keeper / 2 / 2 / 0
60 / Computer Operator / 0 / 0 / 0
61 / Naib Qasid / 6 / 6 / 0
62 / Chowkidar / 6 / 6 / 0
63 / Senior Clerk / 0 / 0 / 0
64 / Driver / 4 / 4 / 0
65 / Water Carrier / 0 / 0 / 0
66 / Cashier / 0 / 0 / 0
67 / Junior Clerk / 2 / 2 / 0
68 / Head Clerk / 0 / 0 / 0
69 / Baildar / 0 / 0 / 0
70 / Car Painter / 0 / 0 / 0
71 / Cook / 2 / 2 / 0
72 / Plumber / 0 / 0 / 0
73 / Almoner / 0 / 0 / 0
74 / Gate Keeper / 0 / 0 / 0
75 / Dental Assistant / 2 / 2 / 0
76 / Telephone Operator / 0 / 0 / 0
77 / Physiotherapy/ Aids Technician / 0 / 0 / 0
78 / Structure Bearer / 0 / 0 / 0
79 / Projectionist / 0 / 0 / 0
80 / St. Assistant / 0 / 0 / 0
81 / OTA / 2 / 2 / 0
82 / Sanitary Inspector / 0 / 0 / 0
83 / Lab Attendant / 0 / 0 / 0
84 / Gardner/ Mali / 4 / 4 / 0
85 / Sanitary Worker / 14 / 14 / 0
86 / Ward Servant / 14 / 14 / 0
87 / Electrician / 0 / 0 / 0
88 / Tailor / 0 / 0 / 0
89 / Dhobi/ Washer Man / 2 / 0 / 2
90 / A.C Mechanic / 0 / 0 / 0
91 / Tube Well Operator / 2 / 2 / 0
DHQ Hospital
Sr.No / Post / Sanctioned / FilledMedical Superintendent / 1 / 1
Physician / 1 / 0
Surgeon / 1 / 1
Gynecologist / 1 / 1
Pediatrician / 1 / 1
Anestheseist / 1 / 0
Ophthalmologist / 1 / 1
ENT Specialist / 1 / 0
Pathologist / 1 / 0
Radiologist / 1 / 0
Orthopedic Surgeon / 1 / 1
Cardiologist / 1 / 1
Psychiatrist / 1 / 0
Medical Officer / 3 / 3
APMO / 5 / 2
APWMO / 3 / 0
EMO / 6 / 6
WMO Labour Room / 2 / 2
MO Intensive Care / 3 / 3
Blood Transfusion Officer / 1 / 0
Dental Surgeon / 2 / 1
Head Nurse / 2 / 0
Charge Nurse / 13 / 13
Accountant / 1 / 1
Pharmacist / 1 / 1
Radiographer / 3 / 3
Dental Technician / 1 / 1
Laboratory Assistant / 3 / 2
Dispenser / 8 / 8
Lady Health Visitor / 2 / 2
Head Clerk / 1 / 1
Senior Clerk / 2 / 2
Junior Clerk / 4 / 2
Dental Assistant / 1 / 1
Store Keeper / 2 / 1
OTA / 1 / 1
Dresser / 3 / 3
Midwife / 3 / 2
Naib Qasid / 9 / 9
Chowkidar / 5 / 4
Driver / 9 / 9
Baildar / 2 / 2
Cook / 3 / 3
Gate Keeper / 1 / 1
Gardener / 2 / 2
Sanitary Worker / 14 / 13
Ward Servant / 12 / 12
Dhobi / 1 / 1
Tube well Operator / 1 / 1
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 / FilledVaccinator / 55 / 54
CDC Supervisor / 40 / 37
Sanitary Inspector / 48 / 22
d)Training Institutions
A number of training institutions are working in the district, which include the following:
Type of institute / NumberDHDC / Nil
General Nursing school / 1
DHDC
DHDC in Lodhran is still to be established. All types of trainings are being arranged in the existing EDO(H) office building at District Complex 10 M chak. DOH is officiating the job of Program Director DHDC. It is requested that the appropriate measures must be taken for the DEVELOPMENT of District Health Development Center. Thefollowing posts are require to be sanctioned for DHDC Lodhran along with the standard DHDC building.
General Nursing School
Sr.No / Post / Sanctioned / FilledPrincipal / 1 / 1
Instructor / 3 / 2
Assistant Instructor / 1 / 1
Public Health Supervisor / 2 / 0
Librarian / 1 / 1
House Keeper / 1 / 1
Stenographer / 1 / 0
Senior Clerk / 1 / 1
Accountant / 1 / 1
Junior Clerk / 1 / 1
Naib Qasid / 1 / 1
Chowkidar / 4 / 4
Cook / 1 / 1
Bearer / 2 / 2
Mali / 3 / 2
Aya Female / 2 / 2
Sweeper / 3 / 3
Driver / 1 / 1
Computer Operator MNCH / 1 / 0
Instructor Midwifery MNCH / 2 / 0
Clinical Supervisor MNCH / 1 / 0
Driver MNCH / 1 / 1
Security Guard MNCH / 1 / 0
iii.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 / Year20708 / 20809 / 209010
Allocation / Exp. / Allocation / Exp. / Allocation / Exp.
Developmental / 111.00 / 67.00 / 202.914 / 135.645 / 148.269 / 62.00
Nondevelopmental / 199.522 / 173.563 / 206.583 / 212.187 / 302.464 / 194.638
Sub-Total / 30.522 / 240.563 / 409.497 / 347.832 / 450.733 / 256.638
PHRSP / 23.976 / 0 / 44.576 / 5.232 / 39.344 / 0
PMDGP / 0 / 0 / 73.720 / 0 / 73.720 / 21.30
PDSSP / 18.151 / 0 / 18.151 / 15.287 / 24.260 / 2.864
Provincial development budget / --- / ---- / ---- / ---- / ---- / ----
Other sources (CM initiative) / 0 / 0 / 1.440 / 0 / 1.440 / 0.920
Total / 42.127 / 0 / 137.887 / 20.519 / 138.764 / 25.084
Grand Total / 342.649 / 240.563 / 547.384 / 368.351 / 589.497 / 281.722
IX.Disease Pattern