Three Years Rolling Plan (2010-2013) District Narowal
THREE YEARS ROLLING PLAN
2010-2013
DISTRICT NAROWAL
Table of Contents
Acronyms
Executive Summary
SECTION 1: DISTRICT HEALTH PROFILE
1.Vision of the District
2.Background of the District
3.Map of the District
4.Demography
5.Socio-Economic Indicators
6.Health Indicators
7.Organizational Structure of District Health Administration
8.Health Resources
a)Health Facilities
i.Public
ii.Private
2.Human Resource
a)Administrative
a)Facility Based
ii.Rural Health Centres
iii.THQ Hospitals
iv.DHQ Hospital
b)Outreach
c)Training Institutions
3.Health Financing
9.Disease Pattern
10.Status of Vertical Programs
SECTION 2: PROBLEM ANALYSIS
1.Objectives
2.Plan Development Process
i.Problem Identification
a)Health Problems
ii.Problem Prioritization
iii.Underlying causes of prioritized problems
b)Service delivery/Management problems
Underlying causes of Management Problems
3.MDGs and MSDS
a)Human Resource
i.DHQ Hospital
ii.THQ Hospital
b)Equipment
c)DHQ Hospital
d)THQ Hospital
SECTION 3: INTERVENTIONS AND TARGETS
Health Problems
Management Problems
SECTION 4: COSTING AND FINANCING PLAN
7.Activity based costing
a)Health Problems
b)Management Problems
8.Financial Outlay including 3YRP Activities
a)Health Problems
b)Management Problems
9.Summaries
I.Problem-wise Costing
a)Health Problems
b)Management Problems
II.Activity-wise Costing
a)Health Problems
b)Management Problems
SECTION 5: MONITORING & EVALUATION
M&E of Plan
ANNEXURES
Annex-I
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
Acronyms
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. 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 Narowal
SECTION 1: DISTRICT HEALTH PROFILE
1.Vision of the District
District Health Department Narowal is committed to provide quality health services to all. Our staff will work sincerely for efficient utilization of available resources specifically for maternal and child health care.
2.Background of the District
Narowal is a city in the north-east of the Punjab province of Pakistan. The city is the capital of Narowal District and tehsil. The city is situated at the bank of Ravi River about 4-5km from the Indian border.District Narowal came into existence on 1 July 1991. Although no documentary background of the district is available in the history yet certain indications as well as guideline regarding its creation as per aphorism of the eminent of the area is available. About 500 years ago in the era of Sikandar Lodhi in the year 1488, Hindus belonging to the Aror tribe of District Multan embraced Islam in the hands of Habibullah Shah, a saint of the area. Nar Singh of the said tribe met Shah Shamash Tabraiz as per direction of the said saint. Nar Singh being desirous to build a new city requested Shah Shamash Tabraiz to pray for the completion of his desire and noble task. Shah Shamash Tabraiz sent his own son along with said Nar Singh towards Narowal. The tribe of said Nar Singh stationed permanently in the vicinity of Narowal. Later on the city was gradually known as Narowal. During British Rule Narowal was a town of the Raya Tehsil of Sialkot District, after independence from Britain in 1947 Narowal became tehsil headquarters - in 1991 the district of Sialkot was bifurcated, Narowal then became the capital of the newly formed Narowal District.
This is the historical place where Jagat Guru Nanak Ji departed from this world on 23rd Assu, Samvat 1596 (22 September 1529 AD). It is also called Dera Nanak Baba. Dera Sahib railway station, on Lahore-Narowal section, serves this place. The Shrine is located by the River Ravi within a distance of nine kilometers from the railway station. The present building was built at a cost of Rs.1,35,600, donated by Sardar Popindar Singh, the Maharaja of Patiala. It was repaired by the Govt of Pakistan in 1995 incurring expenditure in lakhs of rupees. It has a spacious and beautiful building. Its location beside a forest and River Ravi makes its care difficult.
3.Map of the District
4.Demography
- Total Population1.566 Million
- Annual growth rate 1.96 %
- Population density666 persons per sq. km
a)Area-wise population
Area / Population / PercentageRural / 1.378 / 88%
Urban / 0.188 / 12%
Source: DCR 1998 (Projected population)
b) Gender-wise population
Gender / Population / PercentageMale / 0.751 / 48%
Female / 0.815 / 52%
Source: DCR 1998 (Projected population)
c) Population groups
Population Groups / Standard Demographic (%) / Estimated PopulationUnder 1 year of age / 2.7 / 42290
Under 5 years / 13.4 / 209883
Under 15 years / 44 / 689168
Women in child bearing age (15-49 years) / 22 / 3445832
Married Child Bearing age Women / 16 / 250606
Expected pregnancies / 3.4 / 53254
d)Tehsil wise distribution
Tehsil / Number of UC / PopulationNarowal / 39 / 751819
Shakargarh / 35 / 814470
Total=2 / 74 / 1566289
Source: Bureau of Statistics (Projected from Census 1998)
5.Socio-Economic Indicators
a)Education and Literacy
Age / Literacy Rate10+yrs / 69%
Adult 15+yrs / 63%
Adult 15-24yrs / 86%
Literacy rate / Male / Female
Overall District / 70% / 41%
Source: MICS 2007-2008
b)Housing
- Ownership of house 92 %
- Mean household size 7.3
- Mean number of persons per room 4.2
c)Water and Sanitation
- Access to drinking water 98%
- Use of improved drinking water sources 100%
- Use of properly treated water 0.6%
- Safe drinking water without bacteria 77%
- Use of sanitary means of excreta disposal 65%
- Use of improved water sources and improved sanitation 65%
- Proper disposal of:
- Waste water 58%
- Solid waste 2%
6.Health Indicators
- Infant Mortality Rate 82/1000
- Under 5 mortality Rate 120/1000 Live births
- Maternal mortality Ratio 320/100000
- Malnutrition
Underweight prevalence (severe) 14%
Stunting prevalence (severe) 27%
Wasting prevalence (severe) 10.2%
- Life expectancy 64 years
- Proportion of children under 1 years immunized 74
against measles
- Contraception
- Use of contraceptives (any method) 26 %
- Contraceptive drop out 12.8%
- Unwilling pregnancy 24%
- Maternal and newborn health
- Antenatal care (ANC) 64%
- Skilled attendant at delivery 45%
- Institutional deliveries 66%
- Postnatal care (PNC) 43%
(Source: MICS 2007-08)
7.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:
8.Health Resources
a)Health Facilities
i.Public
Details of physical infrastructure of public health facilities in the district are given in the table below:
Facility Type / Name/Number of Facility / Bed Strength / No. of Functional Beds / RemarksDHQ Hospital / 1 / 40 / 40 / ------
THQ Hospital / 1 / 40 / 40 / ------
RHCs / 7 / 140 / 140 / ------
BHUs / 56 / 112 / 112 / ------
Government Rural Dispensaries / 2 / 0 / 0 / ------
MCH Centers / 4 / 0 / 0 / ------
Sub Health Centers / 3 / 0 / 0 / ------
TB Clinics/ Hospital / 1 / 0 / 0 / ------
TB Clinic / 1208 / 0 / 0 / ------
Data source: DHIS/EDOH office
ii.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.
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 / Sanctioned / Filled1 / Executive District Officer Health / 1 / 1
2 / District Officer Health / 1 / 1
3 / Deputy District Officer Health / 2 / 2
4 / Program Director DHDC / 1 / 1
5 / District Sanitary Inspector / 1 / 1
6 / District Coordinator National Program / 1 / 1
7 / Drug Inspector / 1 / 1
8 / District Superintendent Vaccination / 1 / 1
a)Facility Based
i.Basic Health Units
Sr. No. / Name of Post/Designation / Sanctioned / Filled / Vacant1 / Medical Officer / 56 / 22 / 34
2 / School Health & Nutrition Supervisor / 56 / 55 / 1
3 / Medical Assistant / 12 / 8 / 4
4 / Computer Operator / 56 / 0 / 56
5 / Medical Technician / 44 / 32 / 12
6 / LHV / 56 / 55 / 1
7 / Dispenser / 56 / 55 / 1
8 / Midwife / 112 / 75 / 37
9 / N/Qasid / 56 / 56 / 0
10 / Chowkidar / 56 / 56 / 0
11 / Sanitary Worker / 56 / 54 / 2
ii.Rural Health Centres
Sr.# / Name of Post/Designation / Sanctioned / Filled / Vacant
1 / Senior Medical Officers / 7 / 3 / 4
2 / Women Medical Officers / 7 / 5 / 2
3 / Dental Surgeons / 7 / 4 / 3
4 / Medical Officers / 7 / 7 / 0
5 / Charge Nurses / 42 / 40 / 2
6 / Homeo Doctors / 5 / 4 / 1
7 / Hakeems / 1 / 1 / 0
8 / Computer Operators / 7 / 0 / 7
10 / LHV / 14 / 14 / 0
11 / Lab. Technician / 7 / 0 / 7
12 / Dental Technician / 7 / 1 / 6
13 / R.H.I / 33 / 0 / 33
14 / Junior Clerk / 7 / 7 / 0
16 / Homeo Dispenser / 5 / 5 / 0
17 / Dawasaz / 1 / 1 / 0
18 / Radiographer/X-Ray Asstt. / 7 / 7 / 0
19 / Dresser / 7 / 6 / 1
20 / Anesthesia Assistant / 7 / 2 / 5
21 / O.T.A / 7 / 7 / 0
22 / Dispenser / 28 / 28 / 0
24 / Laboratory Assistant / 7 / 6 / 1
25 / Midwife / 33 / 31 / 2
26 / Driver / 8 / 7 / 1
27 / T.O / 7 / 7 / 0
28 / Homeo Naib Qasid / 5 / 5 / 0
29 / Dawa Kob / 1 / 1 / 0
30 / Ward Servant / 14 / 13 / 1
31 / Sanitary Worker / 28 / 28 / 0
33 / Sanitary Patrol / 35 / 34 / 1
34 / Naib Qasid / 14 / 14 / 0
35 / Mali / 7 / 7 / 0
36 / Cook / 7 / 7 / 0
37 / Chowkidar / 14 / 14 / 0
38 / Water Career / 7 / 7 / 0
iii.THQ Hospitals
S# / Name of post / Sanctioned / Filled1 / Medical Superintendent / 1 / 1
2 / APMO. / 2 / 1
3 / APWMO. / 1 / 0
4 / Gynecologist / 2 / 0
5 / Pediatrician / 1 / 1
6 / Surgeon / 1 / 1
7 / MO/CMO / 8 / 4
8 / WMO / 3 / 2
9 / Dental Surgeon / 1 / 1
10 / Hospital Pharmacist / 1 / 1
12 / Charge Nurses / 10 / 9
13 / Homeo Doctor / 1 / 1
14 / Hakim / 1 / 1
15 / LHV. / 1 / 1
16 / Clerk / 1 / 1
17 / Dispenser/Dresser / 7 / 7
18 / Homeo Dispenser / 1 / 1
19 / Dawasaz / 1 / 1
20 / OTA. / 1 / 0
21 / Radiographer / 1 / 1
22 / Laboratory Assistant / 2 / 2
23 / Dental Technician / 1 / 0
24 / Driver / 2 / 2
25 / Tub well operator / 1 / 1
26 / Dai / 1 / 1
27 / Ward servant / 6 / 6
28 / NQ/Dawakob / 2 / 1
29 / Bearer / 1 / 1
30 / Dhobi / 1 / 1
31 / Gate Keeper / 1 / 1
32 / Mashki / 1 / 1
33 / Baildar / 4 / 4
34 / Chowkidar / 3 / 3
35 / Cook / 3 / 3
36 / Sweeper / 9 / 9
iv.DHQ Hospital
S# / Name of post / Sanctioned / FilledMedical Superintendent / 1 / 1
APMO/ APWMO / 7 / 0
Physician / 1 / 1
Anesthetist / 1 / 0
Cardiologist / 1 / 0
E.N.T Specialist / 1 / 0
Radiologist / 1 / 0
Pathologist / 1 / 0
Orthopedic Surgeon / 1 / 0
Pediatrician / 1 / 1
Surgeon / 1 / 1
Gynaecologist / 3 / 0
Eye Specialist / 1 / 1
Senior Dental Surgeon / 1 / 0
Dental Surgeon / 1 / 1
Medical Officer / 5 / 4
Pharmacist / 1 / 1
Physiotherapist / 1 / 0
W.M.O / 3 / 2
Charge Nurses / 7 / 7
Head Nurse / 1 / 1
Hakeem / 1 / 1
Homeo Doctor / 1 / 1
Stenographer / 1 / 1
Accountant / 1 / 1
Senior Clerk / 2 / 1
Junior Clerk / 3 / 3
Dawasaz / 1 / 1
Dispenser / 5 / 5
Homeo Dispenser / 1 / 1
Operation Theater Assistant / 1 / 1
Physiotherapist / 1 / 0
Radiographer / 2 / 2
Dental technician / 1 / 1
Lab. Assistant / 2 / 2
Store Keeper / 1 / 1
Driver / 5 / 5
Aya / 1 / 1
Dai / 1 / 1
Tailor Master / 1 / 1
Tube well Operator / 1 / 1
Lab. Attendant / 1 / 1
Ambulance Cleaner / 1 / 1
Bearer / 1 / 1
Baildar / 2 / 2
Chowkidar / 3 / 3
Cook / 3 / 3
Dawakob / 1 / 1
Dhobi / 1 / 1
Gate Keeper / 1 / 1
Mali / 1 / 1
Sanitary Worker / 9 / 9
Ward Servant / 6 / 61
Water Carrier / 1 / 1
Naib Qasid / 3 / 3
b)Outreach
This information is about outreach program workers such as Vaccinators, CDC Supervisors and Sanitary Inspectors which are not part of above mentioned health facilities.
Post / Sanctioned / Filled / VacantVaccinators / 66 / 65 / 1
CDC Supervisors / 59 / 32 / 27
Sanitary Inspectors / 56 / 48 / 8
c)Training Institutions
A number of training institutions are working in the district, which include the following:
Type of institute / Number- DHDC
- General Nursing school
i.DHDC
Sr.No. / Post / Sanctioned / FilledProgram Director / 1 / 1
MPPT / 1 / 0
LHV Trainer / 1 / 0
Assistant / 1 / 1
Driver / 1 / 1
Naib Qasid / 1 / 1
Chowkidar / 1 / 1
Sanitary Worker / 1 / 1
ii.General Nursing School
Sr.No / Name of Post/Designation / Sanctioned / FilledPrincipal School of Nursing / 1 / 1
Nursing Instructor / 3 / 1
Assistant Nursing Instructor / 1 / 1
P.H.N/Supervisor / 2 / 0
Stenographer / 1 / 0
Accountant / 1 / 1
Librarian / 1 / 1
Driver / 1 / 1
House Keeper / 1 / 0
Sweeper / 2 / 2
Naib Qasid / 1 / 1
Chowkidar/Gate Keeper / 2 / 2
Cook / 2 / 2
Aya / 2 / 2
Mali / 3 / 3
Bearer / 2 / 2
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. in Millions
Source of funding / Year2007-08 / 2008-09 / 2009-10 up to 01/2010
Allocation / Exp. / Allocation / Exp. / Allocation / Exp.
Non-Development / 198.478 / 86.822 / 234.599 / 220.101 / 251.987 / 106.713
Development
PHSRP / 4.2 / 2.0 / 17.0 / 7.032
PMDGP / 68.541 / 68.541 / 0.3
PDSSP / 18.228 / 18.228 / 17.658 / 20.0
Provincial Development Funds (ADP) / 133.304 / 118.149 / 75.736 / 60.0 / 70.700 / 50.307
Other Sources HSRP / 95.0 / 95.0 / 89.800 / 28.500
Grand Total / 449.21 / 206.971 / 509.104 / 394.591 / 439.728 / 157.32
User charges (like parchi fee, fees for diagnostic services) / 1.796 / 1.854 / 1.210
9.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 / Percentage of MagnitudeRespiratory disease
1 / Acute (upper) respiratory infections / 52%
2 / Pneumonia < 5 yrs. / 1.47%
3 / Pneumonia > 5 yrs. / 1.4%
4 / TB Suspects / 1.86%
5 / Chronic Obstructive Pulmonary Disease / 0.94%
6 / Asthma / 4.6%
Gastro Intestinal Disease
7 / Diarrhea / Dysentery < 5 yrs / 5.2%
8 / Diarrhea / Dysentery > 5 yrs / 5.46%
9 / Enteric / Typhoid Fever / 0.54%
10 / Worm Infestations / 1.73%
11 / Peptic Ulcer Disease / 6.68%
12 / Cirrhosis of Liver / 0.42%
Urinary Tract Disease
13 / Urinary Tract Infections / 2%
14 / Nephritis / Nephrosis / 0.08%
15 / Sexually Transmitted Infections / 0.03%
16 / Benign Enlargement of Prostrate / 0.10%
Other Communicable Diseases
17 / Suspected Malaria / 2.13%
18 / Suspected Meningitis / 0.04%
19 / Fever due to other causes / 2.4%
Vaccine Preventable Disease
20 / Suspected Measles / 0.05%
21 / Suspected Viral Hepatitis / 0.24%
22 / Suspected Neonatal Tetanus / 0.01%
Cardiovascular Diseases
23 / Ischemic heart disease / 1.16%
24 / Hypertension / 6.4%
Skin Diseases
25 / Scabies / 13.06%
26 / Dermatitis / 6.26%
27 / Cutaneous Leishmaniasis / 0.24%
Endocrine Disease
28 / Diabetes Mellitus / 4.4%
Neuro-Psychiatric Diseases
29 / Depression / 0.53%
30 / Drug Dependence / 0.02%
31 / Epilepsy / 0.02%
Eye & ENT
32 / Cataract / 0.6%
33 / Trachoma / 0.13%
34 / Glaucoma / 0.06%
35 / Otitis Media / 2.26%
Oral Diseases
36 / Dental Caries / 3.73%
Injuries/Poisoning
37 / Road traffic accidents / 3.46%
38 / Fractures / 0.50%
39 / Burns / 0.29%
40 / Dog bite / 0.38%
41 / Snake bite (with signs/symptoms of poisoning) / 0.01%
Miscellaneous Disease
42 / Acute Flaccid Paralysis / 0.0022%
43 / Suspected HIV/AIDS / 0.04%
44 / Any other Unusual disease (specify)
Source: DHIS Reports
10.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.
a)NATIONAL PROGRAM FOR FP & PHC
- No. of seats allocated for LHWs 1446
- No. of LHWs working 1208
- Percentage of Population covered by the program 72.5%
- Important program indicators
- IMR 42/1000
- MMR 186/100000
- CPR 38%
- No. of antenatal visits 85%
- TT Coverage of pregnant women 91%
b)EPI