HFA District Report - Vehari - POLICY AND STRATEGIC ...pspu.punjab.gov.pk/system/files/HFA-Vehari.pdfTwenty eight (28) health facilities were assessed in district Vehari , including

Health Facility Assessment - Punjab

District Vehari

TRFTechnical Resource

Facility

i

Acknowledgement

TRF acknowledges the cooperation and support of Contech International Health

Consultants, Lahore who worked on the assignment and authored the report. The final

reports were quality assured by Jennifer Sanchos, HLSP Health Systems Consultant, and

Ms. Pamela Sequeira, M&E Specialist TRF.

Disclaimer

This document is issued for the party which commissioned it and for specific purposes

connected with the above-captioned project only. It should not be relied upon by any other

party or used for any other purpose.

We accept no responsibility for the consequences of this document being relied upon by any

other party, or being used for any other purpose, or containing any error or omission which is

due to an error or omission in data supplied to us by other parties.

June 2012

ii

Table of Contents

Acknowledgement ......................................................................................................... i

Acronyms .................................................................................................................... vii

Executive Summary ...................................................................................................... 1

Section 1: Introduction ................................................................................................. 3

Survey objectives ....................................................................................................... 3

Assignment duration .................................................................................................. 3

Scope of HFA ............................................................................................................. 3

Report organisation .................................................................................................... 4

Section 2: District Information ..................................................................................... 5

Administrative setup ................................................................................................... 6

Demographic information ........................................................................................... 6

Socioeconomic and health indicators ......................................................................... 7

Section 3: Assessment of Functional Capacities ....................................................... 8

MNCH services .......................................................................................................... 8

Basic health units (BHUs) .......................................................................................... 9

Rural health centres (RHCs) .................................................................................... 13

Secondary health care (SHC) hospitals .................................................................... 16

Tehsil headquarter (THQ) hospitals.......................................................................... 22

Management basics ................................................................................................. 25

Human resources ................................................................................................ 25

Work coordination and supervision ...................................................................... 30

Management information system......................................................................... 31

Drugs and supplies ............................................................................................. 36

Fee for services ................................................................................................... 37

Infection control ................................................................................................... 41

Death review ....................................................................................................... 42

Facility utilization ...................................................................................................... 43

Well baby clinic ........................................................................................................ 48

Donor contributions .................................................................................................. 48

Clients perspective .................................................................................................. 50

Procurement estimates ........................................................................................... 52

iii

Equipment ........................................................................................................... 52

Civil works ........................................................................................................... 52

Section 4: Key Findings.............................................................................................. 54

Infrastructure ............................................................................................................ 54

Human resources ..................................................................................................... 55

Equipment ................................................................................................................ 55

Drugs and supplies .................................................................................................. 56

Support services ...................................................................................................... 56

Management basics ................................................................................................. 56

Donor contributions .................................................................................................. 57

Clients perspective .................................................................................................. 57

ANNEX 1 ...................................................................................................................... 59

District health department ........................................................................................ 59

ANNEX 2 ...................................................................................................................... 66

Input criteria for MNCH services ............................................................................... 66

ANNEX 3-A .................................................................................................................. 83

Status of surveyed health facilities against the minimal level of inputs ..................... 83

ANNEX 3-B .................................................................................................................. 91

List of items required for hospitals in district Vehari .................................................. 91

ANNEX 4 .................................................................................................................... 107

Scope of civil works required at hospitals ............................................................... 107

iv

List of Tables

Table 1.1: Scope of HFA ................................................................................................ 4

Table 2.1: Demographic profile ....................................................................................... 6

Table 2.2: Population groups .......................................................................................... 6

Table 2.3: Socio-economic and health indicators ............................................................ 7

Table 3.1: Status of assessed infrastructure in BHUs ................................................... 10

Table 3.2: Status of MNCH related staff in BHUs ......................................................... 11

Table 3.3: Status of functional equipment in BHUs ....................................................... 11

Table 3.4: Status of drugs and supplies in BHUs .......................................................... 12

Table 3.5: Status of support services in BHUs .............................................................. 12

Table 3.6: Status of assessed infrastructure in RHCs ................................................... 13

Table 3.7: Status of MNCH related staff in RHCs ......................................................... 14

Table 3.8: Status of functional equipment in RHCs ....................................................... 15

Table 3.9: Status of drugs and supplies in RHCs .......................................................... 15

Table 3.10: Status of support services in RHCs ............................................................ 16

Table 3.11: Status of assessed infrastructure in SHC hospitals .................................... 17

Table 3.12: Status of MNCH related staff in SHC hospitals .......................................... 20

Table 3.13: Status of functional equipment in SHC hospitals ........................................ 21

Table 3.14: Status of drugs and supplies in SHC hospitals ........................................... 21

Table 3.15: Status of support services in SHC hospitals ............................................... 22

Table 3.16: Status of assessed infrastructure in THQHs .............................................. 22

Table 3.17: Status of MNCH related staff in THQHS .................................................... 23

Table 3.18: Status of functional equipment in THQHs .................................................. 24

Table 3.19: Status of drugs and supplies in THQHs ..................................................... 24

Table 3.20: Status of support services in THQHs ......................................................... 24

Table 3.21: Status of HR at SHC hospitals ................................................................... 25

Table 3.22: Status of HR at RHCs ................................................................................ 26

Table 3.23: Status of HR at surveyed BHUs ................................................................. 26

Table 3.24: Reasons for the non-availability of HR 24/7at RHCs .................................. 27

Table 3.25: Reasons for the non-availability of HR 24/7 at SHC hospitals .................... 27

Table 3.26: Capacity building of MNCH related staff..................................................... 28

Table 3.27: Status of work coordination and supervision .............................................. 30

v

Table 3.28: Status of MIS ............................................................................................. 32

Table 3.29: Reasons for running out of stock reported by surveyed facilities ................ 36

Table 3.30: Status of fee for services ........................................................................... 38

Table 3.31: Mechanisms of social protection available ................................................. 39

Table 3.32: Status of infection control & waste management practices......................... 41

Table 3.33: Status of death reviews .............................................................................. 43

Table 3.34: Status of services utilization ...................................................................... 44

Table 3.35: Average monthly MNCH services provided at surveyed facilities ............... 44

Table 3.36: Average monthly family planning services provided at surveyed facilities .. 46

Table 3.37: Status of WBCs established at surveyed facilities ...................................... 48

Table 3.38: Status of donor contributions at surveyed facilities ..................................... 49

Table 3.39: Clients perspective .................................................................................... 50

Table 3.40: Summary of estimated cost for procurement of equipment & civil works .... 53

Table 2.4: Number of public sector health facilities in the district .................................. 59

Table 2.5: Human resources in office of EDO-Health ................................................... 59

Table 2.6: Availability of MNCH services staffing in Vehari ........................................... 60

Table 2.7: Financial allocations in district Vehari .......................................................... 62

Table 2.8: NMNCHP monitoring indicators (Year 2010) ................................................ 63

Table 2.9: Status of CMWs training and deployment ................................................... 65

vi

List of Figures

Figure 1: Map of Vehari .................................................................................................. 5

Figure 2: Comparison of district and provincial indicators ............................................... 7

Figure 3: Range of services that signal fully functional MNCH services.......................... 8

Figure 4: Status of management basics ....................................................................... 27

Figure 5: Level of satisfaction ....................................................................................... 52

Figure 6: Availability of medicines and lab services ...................................................... 52

vii

ACRONYMS

ANC Antenatal Care

AVD Assisted Vaginal Deliveries

BB technician Blood Bank Technician

BHU Basic Health Unit

CBA Child Bearing Age

CEI Client Exit Interview

CH Civil Hospital

CMW Community Midwives

CWAQ Civil Works Assessment Questionnaire

CDC Communicable Disease Control

DCO District Coordination Officer

DDCT District Data Collection Teams

DHO District Health Officer

DHDC District Health Development Centre

DHIS District Health Information System

DHQH District Headquarter Hospital

DLQ District Level Questionnaire

EDOs Executive District Officers

EmONC Emergency Obstetric and Newborn Care

ENC Emergency Newborn Care

EAQ Equipment Assessment Questionnaire

EPI Expanded Programme of Immunisation

FP & PHC Family planning and Primary Health Care

HF Health Facilities

HFA Health Facility Assessments

HID Health Institution Database

HIV Human Immunodeficiency Virus

HMIS Health Management Information System

HR Human Resource

IDI EDOH In-depth Interview of EDO Health

IMNCI Integrated Management of Neonatal and Childhood Illnesses

IMPAC Integrated Management of Pregnancy and Childbirth

JD Job Description

LHS Lady Health Supervisor

LHV Lady Health Visitor

LHW Lady Health Worker

MDGs Millennium Development Goals

M&E Monitoring and Evaluation

MICS Multiple Indicator Cluster Survey

MIS Management Information System

viii

MNCH Maternal, Neonatal and Child Health

MO Medical Officer

NMNCHP National Maternal Newborn and Child Health Programme

NVD Normal Vaginal Deliveries

OBGYN Obstetrics and Gynaecology

OPD Out Patient Department

OT Operation Theatre

PC-1 Planning Commission Proforma 1

PDHS Pakistan Demographic and Health Survey

PNC Post Natal Care

PPHI Peoples Primary Health Care Initiative

PSLM Pakistan Social & Living Standards Measurement Survey

RHC Rural Health Centre

SBA Skilled Birth Attendants

SD&MB Service Delivery and Management Basics

SE Socioeconomic

SHC hospitals Secondary Health Care

SPSS Statistical Package for the Social Sciences

TA Technical Assistance

THQH Tehsil Headquarter hospital

TRF Technical Resource Facility

TT Tetanus Toxoid

WMO Women Medical Officer

WBC Well Baby Clinics

1

Executive Summary

The health facility assessment 2011 (HFA) is aimed at assessing the availability, functioning,

and quality of health care services in the public sector health facilities, with a focus on

maternal, newborn and child health services. This report provides the findings of the HFA for

each surveyed health facility in the district. It is baseline information for the district and the

national maternal newborn and child health programme (NMNCHP), to set performance

benchmarks and realign activities for bridging the gaps existing in maternal newborn and

child health (MNCH) services for achieving the objectives of the programme.

The HFA started in October 2010 and ended in May 2011. Contech accomplished the

assignment in a participatory way by maintaining a constant liaison with all the key

stakeholders. Twenty eight (28) health facilities were assessed in district Vehari, including 1

district headquarter (DHQH) hospital, 2 tehsil headquarter (THQH) hospitals, 10 rural health

centres (RHCs) and 15 basic health units (BHUs).

The BHUs were assessed for the availability of 8/6 preventive MNCH services; RHCs were

assessed for the availability of 24/7 basic emergency obstetric and newborn care (EmONC)

services; and DHQ and THQ hospitals were assessed for the availability of 24/7

comprehensive EmONC services.

The health facilities were also assessed for the availability of enabling factors necessary for

the delivery of MNCH services. An assessment criteria was formulated to ascertain gaps in

the availability of inputs 1 , including infrastructure; human resources (HR); drugs and

supplies; equipment; and level specific support services. Summarized HFA findings are

given in Section 3 of the HFA.

In order to assess the perceptions of the clients, a total of 70 client exit interviews were

conducted in the DHQH, THQH and RHCs. The clients perspective on the quality of care

revealed that all of the clients were satisfied with the care provided at the public facilities.

Regarding infrastructure, the majority of the building components were available and

functional and major gaps existed in the availability of labour rooms at BHUs and RHCs; a

paediatric ward and blood bank at THQH Burewala and an operation theatre at THQH

Mailsi.

1 Optimal level of inputs are proposed in the Planning Commission Proforms 1 (PC-1) of NMNCHP required to

deliver level specific MNCH services; Minimal level of inputs, are bare minimum requirement of the inputs for delivering

level specific MNCH services. More explanation of these inputs has been provided at the start of Section 3 of the report

and contents of the criteria are given in Annexure 1

2

The complete set of required equipment items was not available at the majority of the

surveyed facilities.

All of the health facilities were conducting regular performance review meetings; and a

record of the meetings was being maintained at 15 out of the 28 facilities.

The district health information system (DHIS) was operational in district Vehari and the

available DHIS tools were being maintained at the surveyed facilities.

The complete range of inputs required for infection control practices was deficient at all of

the surveyed facilities

A review of maternal and neonatal deaths through a death review committee was only being

conducted at the DHQH Vehari.

3

Section 1: Introduction

This section includes the survey objectives, its scope and duration and the organisation of

the district report.

Survey objectives

The health facility assessment was aimed at assessing the availability, functioning and

quality of the health care delivery system, in the public sector facilities with a focus on

maternal, newborn and child health services.

Some of the specific objectives of the HFA were:

To assess the health facility status and quality of MNCH services (comprehensive

and basic EmONC, preventive MNCH and family planning) at the district level;

To assess the clients satisfaction and perception of MNCH services;

To provide information for the systematic planning for procurement and supply of

goods and commodities (listing the medical equipment and instruments which need

to be replaced or purchased); and

To update and assess the contributions made by the development partners for

improving MNCH and family planning services in the selected districts.

Assignment duration

Estimated duration of the assignment was 7 months. The assignment started in October

2010 and ended in May 2011.

Scope of HFA

The survey included the district headquarter hospital (DHQH), tehsil/taluka headquarter

hospitals (THQHs), rural health centres (RHCs) and 20% of the basic health units (BHUs)

randomly selected from within the district. The selection of the BHUs was done through

geographical stratification, on the basis of proportionate distribution. Client exit interviews

were conducted at the surveyed facilities (10 at DHQH, 5 at each THQH and RHC),

excluding the BHUs.

Table 1.1 shows the numbers of health facilities in the district and health facilities surveyed.

4

TABLE 1.1 : SCOPE OF HFA

District Vehari Number of health facilities by type

DHQH THQH RHC BHU Total

Number of facilities 1 2 10 77 90

Number of facilities surveyed 1 2 10 15 28

Report organisation

The HFA district report has been structured in five sections. While the introduction to the

survey, its scope and duration is described in Section 1, Section 2 District Information

contains information collected from the district health department, using the district level

questionnaire (DLQ) as well as secondary data sources. It comprises of demographic,

economic and education related information.

Section 3: This section presents information about enabling factors that are essential for the

maintenance of quality MNCH service availability, across all the levels of health care

institutions. The health facilities were assessed against the availability of 5 specified inputs

including infrastructure, human resources, equipment, drugs and supplies and the availability

of support services, (which would enable them to perform their level-specific services).

Information on management basics like work coordination, MIS etc., is also contained in this

section. The information presented in this section gives a snapshot in time, of the surveyed

health facilities. At the end, there is information about the satisfaction and perspective of the

clients, on the MNCH services provided at the public sector health facilities.

Section 4 comprises of the key findings of the HFA at district level and recommendations for

rectifying the deficiencies or discrepancies that were identified during the assessment.

5

Section 2: District Information

This section includes the district brief, information on demographic, socioeconomic and

health indicators. It also contains information on health resources and the NMNCHP

indicator compiled at district level. The data sources of the information are the EDOH office,

using the district level questionnaire (DLQ) and published documents. The information

collected from the EDOH office, may not match with subsequent tables containing similar

information, collected from respective health facilities included in survey. It is recommended

that the discrepancy should be investigated by the competent authority.

Vehari district is situated in the southern part of the Punjab province, having its district

headquarters at Vehari city. Vehari was declared as a district in 1976; previously it was a

tehsil of district Multan. The district lies along the right bank of the river Sutlej which forms its

southern boundary. The district is surrounded by the Sahiwal, Pakpattan, Bahawalpur,

Khanewal, Lodhran and Bahawalnagar districts. The area of district is 4364 Sq Km.

District Vehari is linked to the adjacent districts and the provincial capital through roads and

a railway network. Its distance from Lahore is 325km.

FIGURE 1: MAP OF VEHARI

6

Administrative setup

Like other the districts in the province, district Vehari is headed by a district coordination

officer (DCO), assisting the divisional commissioner and is accountable to him. The DCO is

appointed by the provincial government from the federal or provincial civil service. The DCO

coordinates with executive district officers (EDOs), who head each of the district offices

including health2.

Demographic information

Demographic information3 is given in the following tables.

TABLE 2.1 : DEMOGRAPHIC PROFILE

Indicators Value Indicators Value

Total population 2.8 million Urban population 460,467

Population of tehsil Vehari 901,757 Rural population 2,417,449

Population of tehsil Burewala 970,373 Population density (persons per

sq.km) 659

Population of tehsil Mailsi 1,005,785 Sex ratio (number of males over

100 females) at birth 96

- - Population annual growth rate 2.7%

SOURCE: DHIS CELL EDOH OFFICE

TABLE 2.2 : POPULATION GROUPS

Population

groups

Standard

demographic

(%)

Estimated

population

Population

groups

Standard

demographic

(%)

Estimated

population

Under 1 year 2.70 77,703 Women 15-49

years 22.00 633,141

Under 5 years 13.40 385,641

Married women of

child bearing age

(CBAs)

16.00 460,467

Under 15

years 41.97 1,207,861 Pregnant women 3.40 97,849

Expected births 2.90 83,459

SOURCE: PDHS 2006-07

2 www.paiman.org.pk

3 Projected figures for the year 2010.

7

Socioeconomic and health indicators

Selected socio-economic (SE) and health indicators are given in Table 2.3. The sources

include the multiple cluster indicators survey (MICS) 2008, Pakistan demographic and health

survey (PDHS) 2006-7 and the immunisation coverage evaluation survey Pakistan (CES)

2006-7.

TABLE 2. 3 : SOCIO-ECONOMIC AND HEALTH INDICATORS

Indicators Value Indicators Value

District specific figures MICS 2007-08

Literacy rate 50% Malnutrition 47%

Income per capita* -

Infant mortality rate (IMR) 82 per 1000 live births % children

8

Section 3: Assessment of Functional Capacities

MNCH services

The packages of MNCH services assessed include preventive MNCH services at BHUs,

basic EmONC services at RHCs and comprehensive EmONC services at the THQ and DHQ

hospitals4. The range of MNCH services are given below.

FIGURE 3: RANGE OF SERVICES THAT SIGNAL FULLY FUNCTIONAL MNCH SERVICES

4 NMNCHP PC -1

BHUs: Facilities

available for

RHCs: Facilities

available for

DHQ/THQ

hospitals:

Facilities available

for

8/6 Preventive

MNCH Services

1. Antenatal

checkup

2. Lab (Anemia,

Malaria,

pregnancy test,

urine test for

sugar & Protein)

3. Normal delivery

Family planning

services (at least 3

metho

8/6 Preventive

MNCH Services

Antenatal

checkup

Lab (Anemia,

Malaria,

pregnancy test,

urine test for

sugar & Protein)

Normal delivery

Family planning

services (at least 3 methods)

TT immunisation

EPI vaccination

Growth

monitoring

Nutrition

24/7 Basic EmONC

Services

1. Parenteral

antibiotics

2. Parenteral

oxytocic drugs

3. Parenteral

anticonvulsants

for pregnancy

induced

convulsions (due

to hypertension)

4. Manual removal

of placenta

5. Removal of

retained products

6. Assisted vaginal

delivery (vacuum

/ forceps

extraction,)

7. Newborn

resuscitation

8. Post abortion

care

9. HR (skilled

female providers-

WMO and LHVs),

10. Preventive

MNCH

24/7 Comprehensive

EmONC services

1. Surgery (C-

section)

2. Blood

transfusion

3. Newborn care

(resuscitation &

incubator)

4. Gynaecological

care

5. Comprehensive

family planning

services

including

sterilisation

6. HR (skilled staff

for conducting,

C-section,

Blood

transfusion and

anaesthesia)

7. Preventive

MNCH

+

8. Basic EmONC

9

The health facilities were assessed against the availability of 5 specified inputs which would

enable them to perform their level-specific services, including:

1. Infrastructure.

2. Human resources.

3. Drugs and supplies.

4. Equipment.

5. Level specific support services.

The health facilities assessment findings are presented against two levels of inputs

including:

1. Optimal level of inputs, these are those proposed in the PC-1 of the national MNCH

programme, required to make a health facility fully functional for the provision of the

level specific package of MNCH services (Annex 2).

2. Minimal level of inputs, which are the bare minimum requirement of the inputs, required

for delivering the package specific MNCH services at the health facilities (Annex 1). The

findings related to the minimal level of inputs are given as Annex 2.

The following tables present the status of assessed facilities for availability of the optimal

level of inputs.

Basic health units (BHUs)

BHUs operating within district Vehari were assessed for the provision of preventive MNCH

services available for 8 hours a day, 6 days a week (8/6). Fifteen BHUs were assessed for

the availability of the optimal level of inputs as summarised in Tables 3.1 3.5 by individual

BHU.

The infrastructure of the BHUs has been assessed for the availability of an OPD, LHV room

and labour room as service provision areas and residences for the accommodation of

required staff. OPD and LHV rooms have been assessed as a single room, having facilities

for consultation, examination and hand washing. Similarly a labour room has also assessed

been as a single room having the facilities for delivery, a scrub area and an attached toilet

facility for patient. The findings are presented as status of building components available and

functional, in Table 3.1.

10

TABLE 3.1: STATUS OF ASSESSED INFRASTRUCTURE IN BHUS

Infrastructure

Sta

tus

Status of building components at surveyed BHUs

BH

U C

hak 1

48-E

B

BH

U C

hak 1

99-E

B

BH

U C

hak 2

31-E

B

BH

U C

hak 3

17-E

B

BH

U C

hak 4

09-E

B

BH

U K

ikri

Ka

lan

BH

U K

ikri

Kh

urd

BH

U L

alip

ur

BH

U M

itro

o

BH

U C

hak 1

22-W

B

BH

U C

hak 1

68-E

B

BH

U C

hak 2

2-W

B

BH

U C

hak 4

1-W

B

BH

U C

hak 5

2-W

B

BH

U C

hak 5

69-W

B

OPD 1. Consultation

area

A Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y

F Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y

2. Examination area

A N Y Y Y N Y Y Y Y Y N N Y Y Y

F N Y Y Y N Y Y Y Y Y N N Y Y Y

3. Hand washing A Y N N N N Y N N N N N N N N N

F Y N N N N Y N N N N N N N N N

LHVs room 1. Consultation

area

A Y Y Y Y N Y Y Y N Y Y Y Y Y Y

F Y Y Y Y N Y Y Y N Y Y Y Y Y Y

2. Examination area

A Y N Y N N Y Y Y N Y Y Y Y Y Y

F Y N Y N N Y Y Y N Y N Y Y Y Y

3. Hand washing A N N N N N N N N N N N N N N N

F N N N N N N N N N N N N N N N

Labour room 1. Delivery room

A N Y N N Y N N N N N N N N N N

F N Y N N Y N N N N N N N N N N

2. Scrub area A N N N N N N N N N N N N N N N


3. Patients washroom

A N N N N N N N N N N N N N N N


Residence Doctor


F N N N N N Y Y Y Y Y N N Y N Y

Residence LHV


F N N Y N N N N N Y N Y N N N N

Key: A=Available, F=Functional

11

A doctor or LHV is required for the provision of preventive MNCH services. The status of the

assessed BHUs for the availability of human resources (HR) (both regular posted and

provided by NMNCHP), against the required number mentioned in PC-1 of NMNCHP is

presented in Table 3.2.

TABLE 3.2: STATUS OF MNCH RELATED STAFF IN BHUS

Staff

categories

Required

number

Number of MNCH related staff available at each BHU

BH

U C

hak 1

48-E

B

BH

U C

hak 1

99-E

B

BH

U C

hak 2

31-E

B

BH

U C

hak 3

17-E

B

BH

U C

hak 4

09-E

B

BH

U K

ikri

Ka

lan

BH

U K

ikri

Kh

urd

BH

U L

alip

ur

BH

U M

itro

o

BH

U C

hak 1

22-W

B

BH

U C

hak 1

68-E

B

BH

U C

hak 2

2-W

B

BH

U C

hak 4

1-W

B

BH

U C

hak 5

2-W

B

BH

U C

hak 5

69-W

B

WMO/MO 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

LHV 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

The equipment items (general items, equipment for OPD and LHV room) for BHUs are listed

in PC-1 of NMNCHP. The status of the functional quantity of these items at assessed BHUs

is presented Table 3.3.

TABLE 3.3: STATUS OF FUNCTIONAL EQUIPMENT IN BHUS

Equipment

Total items

required at

each BHU

Number of functional equipment items available at each surveyed

BHU

BH

U C

hak 1

48-E

B

BH

U C

hak 1

99-E

B

BH

U C

hak 2

31-E

B

BH

U C

hak 3

17-E

B

BH

U C

hak 4

09-E

B

BH

U K

ikri

Ka

lan

BH

U K

ikri

Kh

urd

BH

U L

alip

ur

BH

U M

itro

o

BH

U C

hak 1

22-W

B

BH

U C

hak 1

68-E

B

BH

U C

hak 2

2-W

B

BH

U C

hak 4

1-W

B

BH

U C

hak 5

2-W

B

BH

U C

hak 5

69-W

B

General

items 3 0 0 0 0 0 1 1 0 1 0 0 0 2 0 0

OPD 14 6 9 7 6 5 7 6 6 7 7 5 5 8 6 4

LHVs

room 12 9 6 7 6 6 8 7 6 5 6 7 9 8 4 7

A list of essential drugs and supplies for MNCH services is contained in PC-1 of NMNCHP.

Tracer items were selected from the list (Annex 2) for assessing their availability at the

surveyed facilities. The status of surveyed BHUs regarding the available quantity of tracer

items is presented in Table 3.4.

12

TABLE 3.4: STATUS OF DRUGS AND SUPPLIES IN BHUS

Item groups

Total

items

required

at each

BHU

Number of items available at each surveyed BHU

BH

U C

hak 1

48-E

B

BH

U C

hak 1

99-E

B

BH

U C

hak 2

31-E

B

BH

U C

hak 3

17-E

B

BH

U C

hak 4

09-E

B

BH

U K

ikri

Ka

lan

BH

U K

ikri

Kh

urd

BH

U L

alip

ur

BH

U M

itro

o

BH

U C

hak 1

22-W

B

BH

U C

hak 1

68-E

B

BH

U C

hak 2

2-W

B

BH

U C

hak 4

1-W

B

BH

U C

hak 5

2-W

B

BH

U C

hak 5

69-W

B

Supplies 6 4 4 4 4 4 4 4 4 3 5 4 3 4 2 4

Drugs 12 2 11 10 10 10 9 10 10 10 9 6 8 9 6 4

Vaccines 5 4 4 4 4 4 5 5 4 4 5 5 1 5 4 5

Family

planning

commodities

6 2 4 4 5 5 4 4 2 4 4 5 4 2 4 3

The facilities for basic laboratory tests (test strips and HR) were assessed at the surveyed

BHUs and their status is presented in Table 3.5.

TABLE 3.5: STATUS OF SUPPORT SERVICES IN BHUS

Support

services

Total

items

required

at each

BHU

Number of items available at each surveyed BHU

BH

U C

hak 1

48-E

B

BH

U C

hak 1

99-E

B

BH

U C

hak 2

31-E

B

BH

U C

hak 3

17-E

B

BH

U C

hak 4

09-E

B

BH

U K

ikri

Ka

lan

BH

U K

ikri

Kh

urd

BH

U L

alip

ur

BH

U M

itro

o

BH

U C

hak 1

22-W

B

BH

U C

hak 1

68-E

B

BH

U C

hak 2

2-W

B

BH

U C

hak 4

1-W

B

BH

U C

hak 5

2-W

B

BH

U C

hak 5

69-W

B

Basic lab

tests 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

13

Rural health centres (RHCs)

RHCs operating within district Vehari were assessed for the availability of the essential

inputs and allied services necessary for the provision of basic EmONC services, available for

24 hours a day, 7 days a week (24/7). Ten RHCs were assessed for the availability of the

optimal level of inputs as summarised in Tables 3.6 3.10 by individual RHC.

The infrastructure of the RHCs has been assessed for the availability of an OPD, indoor

ward, LHV room, labour room and clinical laboratory, as service provision areas and

residences for the accommodation of required staff. Service provision areas have been

assessed as a single room having facilities like consultation, examination and hand washing,

etc. The findings are presented as the status of building components available and functional

in Table 3.6.

TABLE 3.6: STATUS OF ASSESSED INFRASTRUCTURE IN RHCS

Infrastructure

Sta

tus

Status of building components at each RHC

RH

C C

ha

k 2

22-E

D

RH

C C

ha

k 5

6-W

B

RH

C C

ha

k 8

7-W

B

RH

C G

ag

go

RH

C J

all

ah

Je

em

RH

C L

ud

de

n

RH

C M

ac

hiw

al

RH

C M

ou

za S

hara

f

RH

C S

ah

uk

a

RH

C T

ibb

a S

ult

an

Pu

r

OPD 1. Consultation area

A Y Y Y Y Y Y Y Y Y Y

F Y Y Y Y Y Y Y Y Y Y

2. Examination area A Y Y Y N Y N Y Y Y Y

F Y Y Y N Y N Y Y N Y

3. Hand washing A N Y N N Y Y N N N N

F N Y N N Y Y N N N N

Female ward 1. Patient area



2. Patients washroom A Y Y N Y Y Y Y Y Y Y

F Y Y N Y Y N Y Y Y Y

Labour room 1. Delivery room

A Y Y N Y Y Y Y N Y Y

F Y Y N Y Y Y Y N Y Y

2. Scrub area A Y N N N N N N N N N

F Y N N N N N N N N N

3. Patients washroom A Y Y N N Y Y Y N Y Y

F Y Y N N Y N Y N Y Y

Clinical lab 1. Laboratory room



14

Infrastructure

Sta

tus

Status of building components at each RHC

RH

C C

ha

k 2

22-E

D

RH

C C

ha

k 5

6-W

B

RH

C C

ha

k 8

7-W

B

RH

C G

ag

go

RH

C J

all

ah

Je

em

RH

C L

ud

de

n

RH

C M

ac

hiw

al

RH

C M

ou

za S

hara

f

RH

C S

ah

uk

a

RH

C T

ibb

a S

ult

an

Pu

r

2. Working area A N Y N N N Y Y N N N

F N Y N N N Y Y N N N

3. Patients washroom A N Y N N Y Y N Y Y N

F N Y N N N Y N Y Y N

LHVs room 1. Consultation area

A Y Y N Y Y Y Y Y Y Y

F Y Y N Y Y Y Y Y Y Y

2. Examination area A N Y N N N N Y Y N N

F N Y N N N N Y Y N N

3. Hand washing A N Y N N N Y N N Y N

F N Y N N N Y N N Y N

Residence Doctor


F Y N Y Y N N Y N N Y

Residence LHV

A N Y Y Y Y Y Y Y Y Y

F N Y Y Y Y Y Y Y Y Y


PC-1 of NMNCHP contains the category and number of staff required for basic EmONC

services. The status of RHCs for the availability of human resources (both regular posted

and provided by NMNCHP), against the required numbers is presented in Table 3.7.

TABLE 3.7: STATUS OF MNCH RELATED STAFF IN RHCS

Staff

categories

Required

number at

each RHC

Number of MNCH related staff available at each RHC*

RH

C C

ha

k

22

2-E

D

RH

C C

ha

k

56-W

B

RH

C C

ha

k

87-W

B

RH

C G

ag

go

RH

C J

all

ah

Je

em

RH

C L

ud

de

n

RH

C M

ac

hiw

al

RH

C M

ou

za

Sh

ara

f

RH

C S

ah

uk

a

RH

C T

ibb

a S

ult

an

Pu

r

WMO 2 1 1 2 1 1 1 2 0 0 2

LHV 2 2 3 3 3 3 3 3 3 1 3

Lab technician 1 0 0 1 0 0 0 0 0 0 1

15

OT technician 1 0 0 0 0 0 0 0 0 0 0

Ambulance

driver 1 1 1 1 1 1 1 1 1 1 1

The equipment items for various service components at RHCs are listed in PC-1 of

NMNCHP. The status of the functional quantity of these items at RHCs is presented in Table

3.8.

TABLE 3.8: STATUS OF FUNCTIONAL EQUIPMENT IN RHCS

Equipment

Total items

required at

each RHC

Number of functional equipment items available at each RHC

RH

C C

ha

k

222-E

D

RH

C C

ha

k

56-W

B

RH

C C

ha

k

87-W

B

RH

C G

ag

go

RH

C J

all

ah

Je

em

RH

C L

ud

de

n

RH

C M

ac

hiw

al

RH

C M

ou

za S

hara

f

RH

C S

ah

uk

a

RH

C T

ibb

a S

ult

an

Pu

r

General items 4 0 2 1 3 3 1 1 1 2 2

Female ward 9 7 6 6 7 2 6 5 3 3 7

WMO OPD 15 6 11 5 9 5 12 10 6 7 8

Labour room 19 8 7 12 10 9 13 6 7 3 10

LHVs room 10 6 6 2 6 6 6 4 2 5 5


Tracer items were selected from the list (Annex 2) for assessing their availability at the

surveyed facilities. The status of the surveyed RHCs regarding the available quantity of

tracer items is presented in Table 3.9.

TABLE 3.9: STATUS OF DRUGS AND SUPPLIES IN RHCS

Item groups

Total items

required at

each RHC

Number of items available at each RHC

RH

C C

ha

k

222-E

D

RH

C C

ha

k

56-W

B

RH

C C

ha

k

87-W

B

RH

C G

ag

go

RH

C J

all

ah

Je

em

RH

C L

ud

de

n

RH

C M

ac

hiw

al

RH

C M

ou

za S

hara

f

RH

C S

ah

uk

a

RH

C T

ibb

a S

ult

an

Pu

r

Supplies 6 6 6 4 5 6 5 3 4 6 5

16

Drugs 18 11 15 10 10 5 6 8 7 9 10

Vaccines 5 4 5 4 4 4 3 3 4 4 3

Family

planning

commodities

6 4 1 6 2 2 5 4 3 0 2

The facilities for support services including basic laboratory tests (space, test strips and HR)

and ambulance services (a functional vehicle and driver) were assessed at the surveyed

RHCs. The availability status of these services at RHCs is presented in Table 3.10.

TABLE 3.10: STATUS OF SUPPORT SERVICESIN RHCS

Support

services

Total items

required at

each RHC

Number of items available at each RHC R

HC

Ch

ak

222-E

D

RH

C C

ha

k

56-W

B

RH

C C

ha

k

87-W

B

RH

C G

ag

go

RH

C J

all

ah

Je

em

RH

C L

ud

de

n

RH

C M

ac

hiw

al

RH

C M

ou

za S

hara

f

RH

C S

ah

uk

a

RH

C T

ibb

a S

ult

an

Pu

r

Basic lab tests 8 3 8 4 3 4 8 6 6 5 4

Ambulance

service 2 1 2 1 2 2 2 2 2 2 2

Secondary health care (SHC) hospitals

The THQ and DHQ hospitals operating within district Vehari were assessed for the

availability of inputs for functioning as a comprehensive EmONC facility; 24 hours a day, 7

days a week (24/7). A total of 3 secondary health care (SHC) hospitals including 1 DHQ and

2 THQ hospitals were assessed for the availability of the optimal level of inputs as

summarised in Tables 3.11 3.15 by individual SHC hospital.

The infrastructure of the SHC hospitals has been assessed for the availability of an OPD,

indoor wards, LHV room, labour room, operation theatre, paediatric nursery, blood bank,

ultrasound room and clinical laboratory, as service provision areas and residences for the

accommodation of required staff. Service provision areas have been assessed for the

availability of essential space in respective areas e.g., consultation area, examination area

and hand washing in the OPD; patient area, nursing station, store rooms and attached

17

washrooms in indoor wards, etc. The findings are presented as the status of building

components available and functional, in Table 3.11.

TABLE 3.11: STATUS OF ASSESSED INFRASTRUCTURE IN SHC HOSPITALS

Infrastructure Status

Availability of building components

DHQH Vehari THQH Burewala THQH Mailsi

OPD:

1. Consultation area

A Y Y Y

F Y Y Y

2. Examination area A Y N Y

F Y N Y

3. Privacy of examination area A Y N Y

F Y N Y

4. Hand washing A Y N Y

F Y N Y

Female ward:

1. Patient area

A Y Y Y

F Y Y Y

2. Nursing station A Y Y Y

F Y Y Y

3. Patients washroom A Y Y Y

F Y Y Y

4. Store for general items A Y N Y

F Y N Y

5. Store for equipment A Y N N

F Y N N

Labour room:

1. Delivery room

A Y Y Y

F Y Y Y

2. Preparation /stage room A Y N Y

F Y N Y

3. Scrub area A Y N N

F Y N N

4. Staff duty room A Y Y N

F Y Y N

5. Patients washroom A Y Y N

F Y Y N

6. Staff washroom A Y Y Y

F Y Y Y

7. Store for general items A Y N Y

F Y N Y

8. Store for equipment A Y N Y

F Y N Y

18




Operation theatre:

1. Patient preparation room

A Y Y N

F Y Y N

2. Operating room A Y Y N

F Y Y N

3. Recovery room A Y Y N

F Y Y N

4. Scrub area A Y Y N

F Y Y N

5. Sterilization area A Y Y N

F Y Y N

6. Doctors room A Y Y Y

F Y Y Y

7. Support staff duty room A Y Y N

F Y Y N

8. Store for general items A Y Y Y

F Y Y Y

9. Store for equipment A Y Y N

F Y Y N

10. Attached washroom for staff A Y Y N

F Y Y N

Paediatric ward:

1. Patient area

A Y N Y

F Y N Y

2. Nursing station A Y N Y

F Y N Y

3. Store for general items/drugs or

equipment

A Y N Y

F Y N Y

4. Patients washroom A Y N Y

F Y N Y

Paediatric nursery:

1. Patient area

A Y Y Y

F Y Y Y

2. Nursing station A Y Y Y

F Y Y Y

3. Store for general items/drugs or

equipment

A Y Y Y

F Y Y Y

4. Change room/area A Y N Y

F Y N Y

Clinical lab:

1. Laboratory room

A Y Y Y

F Y Y Y

19




2. Working area A Y N Y

F Y N Y

3. Doctors duty room A Y N N

F Y N N

4. Store for general reagents or

equipment

A Y Y Y

F Y Y Y

5. Attached washroom A Y Y Y

F Y Y Y

Blood bank:

1. Blood collection room

A Y N Y

F Y N Y

2. Working area A Y N Y

F Y N Y

3. Staff duty room A Y N Y

F Y N Y

4. Store for general reagents or

equipment

A Y N N

F Y N N

5. Attached washroom A Y N Y

F N N Y

LHVs room:


A Y N Y

F Y N Y

2. Examination area A Y N Y

F Y N Y

3. Privacy for examination A Y N Y

F Y N Y

4. Hand washing facility A Y N Y

F Y N Y

Ultrasound room:

Examination area

A Y N Y

F Y N Y

Residence:

Gynaecologist

A Y N Y

F Y N Y

Residence:

Anaesthetist

A Y Y Y

F Y Y Y

Residence:

Paediatrician

A Y Y Y

F Y Y Y

Residence:

WMO

A Y N Y

F Y N Y

Residence: A Y Y Y

20




LHV F Y Y Y

Residence:

Nurses

A Y Y Y

F Y Y Y

Residence

Lab technician

A N N N

F N N N

Residence:

Blood bank technician

A Y N N

F Y N N

Residence:

Anaesthesia technician

A N N N

F N N N


PC-1 of NMNCHP contains category and number of staff required for comprehensive

EmONC services. The status of SHC hospitals for the availability of human resources (both

regular posted and provided by NMNCHP), against the required numbers is presented in

Table 3.12.

TABLE 3.12: STATUS OF MNCH RELATED STAFF IN SHC HOSPITALS

Staff categories

Availability at DHQH Availability at THQHs

Required

number DHQH Vehari

Required

number THQH Burewala THQH Mailsi

Gynaecologist 2 3 1 0 2

Anaesthetist 2 1 1 0 0

Paediatrician 2 2 1 1 1

WMOs 6 4 4 2 4

OT technician 4 0 4 0 0

Blood bank technician 4 0 4 0 0

Lab technician 3 1 2 0 0

Anaesthesia technician 4 0 4 0 0

Nurses 20 39 12 16 14

LHVs 4 2 4 1 1

Ambulance drivers 4 2 4 2 1

21

The equipment items for various service components at SHC hospitals are listed in PC-1 of

NMNCHP. The status of the functional quantity of these items at SHC hospitals is presented

in Table 3.13.

TABLE 3.13: STATUS OF FUNCTIONAL EQUIPMENT IN SHC HOSPITALS

Equipment

Availability of functional equipment items

Total

required

items

DHQH Vehari

Total

required

items

THQH Burewala THQH Mailsi

General items 4 2 4 3 3

Female ward 19 18 19 15 12

OPD 12 11 5 4 3

Paediatric nursery 13 13 13 11 9

Paediatric ward 10 10 10 7 5

Labour room 24 17 19 11 14

Operation theatre 31 30 31 29 29

Clinical laboratory 5 5 5 3 4


Tracer items were selected from the list (Annex 2) for assessing their availability at surveyed

facilities. The status of the SHC hospitals regarding the available quantity of tracer items is


TABLE 3.14: STATUS OF DRUGS AND SUPPLIES IN SHC HOSPITALS

Item groups Total items

Number of items available at each SHC hospital


Supplies 9 8 8 7

Drugs 21 9 13 8

Vaccines 5 4 4 4

Family planning

commodities 7 6 5 0

22

The facilities for support services including laboratory tests (space, test strips and HR), blood

transfusion services (space, supplies and HR), ambulance services (functional vehicle and

driver), operation theatre (space, drugs and supplies, equipment items and HR) were

assessed at the surveyed SHC hospitals. The availability status of these services at SHC

hospitals is presented in Table 3.15.

TABLE 3.15: STATUS OF SUPPORT SERVICES IN SHC HOSPITALS

Item groups Total items

Number of items available at each SHC hospital


Basic laboratory tests 17 17 10 13

Blood transfusion 5 4 3 2

Ambulance services 2 2 2 2

Radiology services 3 3 1 3

Operation theatre 62 56 54 36

Tehsil headquarter (THQ) hospitals

THQ hospitals were also assessed for their capacity to provide 24/7 basic EmONC services

on similar inputs, as those used for RHCs. The status of THQ hospitals regarding the

availability of inputs to deliver 24/7 basic EmONC services is presented in Tables 3.16 -

3.20.

TABLE 3.16: STATUS OF ASSESSED INFRASTRUCTURE IN THQHS


Availability of building components at each THQH


OPD:


A Y Y

F Y Y

2. Examination area A N Y

F N Y

3. Hand washing A N Y

F N Y

Female ward:

1. Patient area

A Y Y

F Y Y

2. Patients washroom A Y Y

23


Availability of building components at each THQH


F Y Y

Labour room:

1. Delivery room

A Y Y

F Y Y

2. Scrub area A N N

F N N

3. Patients washroom A Y N

F Y N

Clinical lab:

1. Laboratory room

A Y Y

F Y Y

2. Working area A N Y

F N Y

3. Attached washroom A Y Y

F Y Y

LHVs room:


A N Y

F N Y

2. Examination area A N Y

F N Y

3. Hand washing facility A N Y

F N Y

Residence - WMO A N Y

F N Y

Residence - LHV A Y Y

F Y Y


TABLE 3.17: STATUS OF MNCH RELATED STAFF IN THQHS

*Available staff includes regular and NMNCHP provided staff

Staff categories Required

number

Number of MNCH related staff available at THQHs*


WMOs 2 2 4

LHV 2 1 1

Lab technician 1 0 0

OT technician 1 0 0

Ambulance driver 1 2 1

24

TABLE 3.18: STATUS OF FUNCTIONAL EQUIPMENT IN THQHS

TABLE 3.19: STATUS OF DRUGS AND SUPPLIES IN THQHS

* Tracer items were selected for assessment from list provided in the PC-1 NMNCHP

TABLE 3.20: STATUS OF SUPPORT SERVICESIN THQHS

*Includes facility for tests of pregnancy, haemoglobin, urine for protein and sugar, and malaria

Equipment

Total items

required at each

THQH

Number of items available at THQHs


General items 2 2 2

OPD 3 2 1

Female ward 6 4 4

Labour room 14 8 12

Item groups

Total items

required at each

THQH



Supplies* 6 5 5

Drugs* 18 13 7

Vaccines 5 4 4

Family planning commodities 6 5 0

Support services

Total items

required at each

THQH



Basic lab tests* 8 5 7

Ambulance service 2 2 2

25

Management basics

The findings related to facility management basics are presented below:

Human resources

The filled posts of MNCH related staff at the surveyed facilities were assessed against the

sanctioned posts, provided in notified yard sticks of the provincial health department. Posts

for medical officers (MOs) and women medical officers (WMOs) are collectively sanctioned

with a ratio of 3:1 for posting in clinical disciplines at the DHQH. Accordingly, a gap in the

filled positions of WMOs could be inferred at the DHQH.

The filled status of staff categories, presented in the following tables, includes regular

posting only, as reported by the respective facility, on the day of survey. The status of HR

availability at each surveyed facility is given in the Tables 3.21, 3.22 and 3.23.

TABLE 3.21: STATUS OF HR AT SHC HOSPITALS

Staff

Status of HR at DHQH Status of HR at THQHs

DHQH Vehari S


S F F F

Gynaecologist 1 3 1 0 2

Anaesthetist 2 1 1 0 0

Paediatrician 1 2 1 1 1

WMO 64 4 2 2 4

OT technician 0 0 0 0 0

Blood bank technician 0 1 0 0 0

Lab technician 1 1 1 0 0

Anaesthesia technician 0 0 0 0 0

Nurses 25 39 14 16 14

LHV 4 2 1 1 1

Ambulance drivers 4 2 2 2 1

Key: S= Sanctioned, F=Filled

26

TABLE 3.22: STATUS OF HR AT RHCS

Staff

Sanctioned

posts (at

each RHC)

Number of posts filled at RHCs

RH

C C

ha

k 2

22-E

D

RH

C C

ha

k

56-W

B

RH

C C

ha

k

87-W

B

RH

C G

ag

go

RH

C J

all

ah

Je

em

RH

C L

ud

de

n

RH

C M

ac

hiw

al

RH

C M

ou

za S

hara

f

RH

C S

ah

uk

a

RH

C T

ibb

a S

ult

an

Pu

r

WMO 1 1 1 1 0 1 0 1 0 0 1

Lab technician 1 0 0 1 0 0 0 0 0 0 1

Nurse 2 1 3 4 6 6 6 6 5 6 6

LHVs 1 2 2 2 2 2 2 2 2 0 2

Ambulance

drivers 2 1 1 1 1 1 1 1 1 1 1

TABLE 3.23: STATUS OF HR AT SURVEYED BHUS

Staff

Sanctioned

posts (at

each BHU)

Number of posts filled at BHUs

BH

U C

ha

k 1

48-E

B

BH

U C

ha

k 1

99-E

B

BH

U C

ha

k 2

31-E

B

BH

U C

ha

k 3

17-E

B

BH

U C

ha

k 4

09-E

B

BH

U K

ikri

Ka

lan

BH

U K

ikri

Kh

urd

BH

U L

alip

ur

BH

U M

itro

o

BH

U C

ha

k 1

22-W

B

BH

U C

ha

k 1

68-E

B

BH

U C

ha

k 2

2-W

B

BH

U C

ha

k 4

1-W

B

BH

U C

ha

k 5

2-W

B

BH

U C

ha

k 5

69-W

B

WMO/MO 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

LHV 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

The availability of job descriptions, service delivery protocols and staff as per duty roster was

assessed and the findings are presented in Figure 4.

27

FIGURE 4: STATUS OF MANAGEMENT BASICS

The reasons for the non-availability of staff on a 24/7 basis at RHCs and SHCs are provided

in Table 3.24 and 3.25.

TABLE 3.24: REASONS FOR THE NON-AVAILABILITY OF HR 24/7AT RHCS

Reasons of non-availability Status in RHCs

WMO LHV Ambulance driver

Residence not available 0 0 0

Residence damaged 0 0 0

Security reasons 0 0 0

Lack of basic amenities 0 0 0

TABLE 3.25: REASONS FOR THE NON-AVAILABILITY OF HR 24/7 AT SHC HOSPITALS

Reasons for non-

availability

Status of DHQ hospital Status of THQ hospitals

Gyn

aec

olo

gis

t

An

ae

sth

eti

st

Pae

dia

tric

ian

Blo

od

ban

k

tec

hn

icia

n

Lab

ora

tory

tec

hn

icia

n

W M

O

L H

V

Gyn

aec

olo

gis

t

An

ae

sth

eti

st

Pae

dia

tric

ian

Blo

od

ban

k

tec

hn

icia

n

Lab

ora

tory

tec

hn

icia

n

W M

O

L H

V

Residence not

available 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Residence damaged 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Security reasons 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0

5

10

15

DHQHTHQHs

RHCsBHUs

1 2

10

15

1

0

3

14

0 1

1012

00

00

00

00

Total number

Availability of MNCH related job

descriptions (JDs)

Presence of duty staff

Availability of MNCH service

delivery protocols

Displayed MNCH service

delivery protocols

28

Reasons for non-

availability

Status of DHQ hospital Status of THQ hospitals

Gyn

aec

olo

gis

t

An

ae

sth

eti

st

Pae

dia

tric

ian

Blo

od

ban

k

tec

hn

icia

n

Lab

ora

tory

tec

hn

icia

n

W M

O

L H

V

Gyn

aec

olo

gis

t

An

ae

sth

eti

st

Pae

dia

tric

ian

Blo

od

ban

k

tec

hn

icia

n

Lab

ora

tory

tec

hn

icia

n

W M

O

L H

V

Lack of basic

amenities 0 0 0 0 0 0 0 0 0 0 0 0 0 0

The details of health facilities having staff trained for providing MNCH services are presented

in Table 3.26 below.

TABLE 3.26: CAPACITY BUILDING OF MNCH RELATED STAFF

Health facility

MNCH related training conducted

EmONC ENC IMNCI IMPAC FP

surgical

FP

counselling

Client

centreedness

DHQH Vehari Y Y Y N Y Y N

THQH

Burewala Y N Y N N N N

THQH Mailsi N Y Y N N N N

RHC Chak

222-ED N N Y N N N

RHC Chak

56-WB Y N N N N N

RHC Chak

87-WB Y Y Y N N N

RHC Gaggo N N Y N Y N

RHC Jallah

Jeem N Y Y N N N

RHC Ludden Y Y Y N Y Y

RHC Machiwal Y N Y N N N

RHC Mouza

Sharaf N Y N N N N

29

Health facility

MNCH related training conducted

EmONC ENC IMNCI IMPAC FP

surgical

FP

counselling

Client

centreedness

RHC Sahuka Y N N N N N

RHC Tibba

Sultan Pur Y N Y N Y N

BHU Chak

148-EB N N N N N Y

BHU Chak

199-EB N N N Y N N

BHU Chak

231-EB N N N Y N N

BHU Chak

317-EB N N N N N N

BHU Chak

409-EB N N N N N Y

BHU Kikri

Kalan N N N N N Y

BHU Kikri

Khurd N N Y N Y N

BHU Lalipur N N Y N N N

BHU Mitroo N N N N N Y

BHU Chak

122-WB N N N N N Y

BHU Chak

168-EB N N Y N N N

BHU Chak

22-WB N N N N N Y

BHU Chak

41-WB N N Y N N N

BHU Chak

52-WB N N N N Y N

BHU Chak

569-WB N N N N N Y

30

Work coordination and supervision

The health facilities in the district were assessed for work coordination and supervisory

activities, including facility staff meetings, the participation of facility in-charges in district

level meetings and the conduction of supervisory visits and feedback by district health

managers. The findings from each surveyed health facility are presented in Table 3.27.

TABLE 3.27: STATUS OF WORK COORDINATION AND SUPERVISION

Health facility


Regular facility PRM*

Participation in

district PRM*

Monthly supervisory visit

Meeting

held

Record

maintained

Facility

visited

Facility received visit

feedback

DHQH Vehari Y Y Y N N

THQH Burewala Y N Y Y Y

THQH Mailsi Y Y Y Y Y

RHC Chak 222-ED Y N Y Y Y

RHC Chak 56-WB Y Y Y Y Y

RHC Chak 87-WB Y Y Y Y Y

RHC Gaggo Y Y Y Y Y

RHC Jallah Jeem Y Y Y Y Y

RHC Ludden Y Y Y Y Y

RHC Machiwal Y N Y Y Y

RHC Mouza Sharaf Y Y Y Y Y

RHC Sahuka Y Y Y Y Y

RHC Tibba Sultan Pur Y N Y Y Y

BHU Chak 148-EB Y Y Y Y N

BHU Chak 199-EB Y N Y Y Y

BHU Chak 231-EB Y Y Y Y Y

BHU Chak 317-EB Y Y Y Y N

31

Health facility


Regular facility PRM*

Participation in

district PRM*

Monthly supervisory visit

Meeting

held

Record

maintained

Facility

visited

Facility received visit

feedback

BHU Chak 409-EB Y N Y Y N

BHU Kikri Kalan Y N Y Y N

BHU Kikri Khurd Y Y Y Y Y

BHU Lalipur Y N Y Y Y

BHU Mitroo Y Y Y Y Y

BHU Chak 122-WB Y Y Y Y N

BHU Chak 168-EB Y N Y Y N

BHU Chak 22-WB Y N Y Y Y


BHU Chak 52-WB Y N Y Y N


* PRM = Performance Review Meeting

Management information system

District Vehari was practicing the district health information system (DHIS). The surveyed

facilities were assessed for the availability and maintenance of DHIS tools. The findings are


32

TABLE 3.28: STATUS OF MIS

Health

facility

Status of MIS tools

OP

D t

icke

t

OP

D r

eg

iste

r

Mo

ther

he

alt

h r

eg

iste

r

Bir

th r

eg

iste

r

Ch

ild

he

alt

h r

eg

iste

r

Fa

mil

y p

lan

nin

g r

eg

iste

r

EP

I re

gis

ter

Meeti

ng

reg

iste

r

Med

icin

e s

toc

k r

eg

iste

r

Dail

y e

xp

en

se

reg

iste

r

DH

IS m

on

thly

re

po

rt

TB

re

gis

ter

Dis

eas

e e

arl

y w

arn

ing

sy

ste

m

DE

WS

ch

art

Gro

wth

m

on

ito

rin

g

reg

iste

r

MIS tools - Available

DHQH Vehari Y Y N Y N Y Y Y Y Y Y Y Y Y Y

THQH

Burewala Y Y Y Y Y Y Y Y Y Y Y Y Y Y N

THQH Mailsi Y Y Y Y Y Y Y Y Y Y Y Y Y Y N

RHC Chak

222-ED Y Y Y Y Y Y Y Y Y Y Y Y Y N Y

RHC Chak

56-WB Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y

RHC Chak

87-WB Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y

RHC Gaggo Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y

RHC Jallah

Jeem Y Y Y Y N Y Y Y Y Y Y Y Y N N

RHC Ludden Y Y Y Y Y Y Y Y Y Y Y Y Y N Y

RHC

Machiwal Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y

RHC Mouza

Sharaf Y Y Y Y N Y Y Y Y Y Y Y Y N N

RHC Sahuka Y Y Y Y Y Y Y Y Y Y Y Y N N Y

RHC Tibba

Sultan Pur Y Y Y Y Y Y Y Y Y Y Y Y N N Y

33

Health

facility

Status of MIS tools

OP

D t

icke

t

OP

D r

eg

iste

r

Mo

ther

he

alt

h r

eg

iste

r

Bir

th r

eg

iste

r

Ch

ild

he

alt

h r

eg

iste

r

Fa

mil

y p

lan

nin

g r

eg

iste

r

EP

I re

gis

ter

Meeti

ng

reg

iste

r

Med

icin

e s

toc

k r

eg

iste

r

Dail

y e

xp

en

se

reg

iste

r

DH

IS m

on

thly

re

po

rt

TB

re

gis

ter

Dis

eas

e e

arl

y w

arn

ing

sy

ste

m

DE

WS

ch

art

Gro

wth

m

on

ito

rin

g

reg

iste

r

BHU Chak

148-EB Y Y Y Y Y Y Y Y Y Y Y Y N N N

BHU Chak

199-EB Y Y Y Y Y Y Y Y Y Y Y Y Y Y N

BHU Chak

231-EB Y Y Y Y Y Y Y Y Y Y N Y Y Y N

BHU Chak

317-EB Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y

BHU Chak

409-EB Y Y Y Y Y Y Y Y Y Y Y Y Y N Y

BHU Kikri

Kalan Y Y Y Y Y Y Y Y Y Y Y Y Y N Y

BHU Kikri

Khurd Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y

BHU Lalipur Y Y Y Y Y Y Y Y Y Y Y Y Y N Y

BHU Mitroo Y Y Y Y Y Y Y Y Y Y Y Y Y Y N

BHU Chak

122-WB Y Y Y Y Y Y Y Y Y Y Y Y Y N Y

BHU Chak

168-EB Y Y Y Y Y Y Y N Y Y Y Y Y Y Y

BHU Chak

22-WB Y Y Y Y Y Y N Y Y Y Y Y Y N Y

BHU Chak


BHU Chak

52-WB Y Y Y Y Y Y Y Y Y Y Y Y Y N N

34

Health

facility

Status of MIS tools

OP

D t

icke

t

OP

D r

eg

iste

r

Mo

ther

he

alt

h r

eg

iste

r

Bir

th r

eg

iste

r

Ch

ild

he

alt

h r

eg

iste

r

Fa

mil

y p

lan

nin

g r

eg

iste

r

EP

I re

gis

ter

Meeti

ng

reg

iste

r

Med

icin

e s

toc

k r

eg

iste

r

Dail

y e

xp

en

se

reg

iste

r

DH

IS m

on

thly

re

po

rt

TB

re

gis

ter

Dis

eas

e e

arl

y w

arn

ing

sy

ste

m

DE

WS

ch

art

Gro

wth

m

on

ito

rin

g

reg

iste

r

BHU Chak


MIS tools Maintained

DHQH Vehari Y Y N Y N Y Y Y Y Y Y Y Y N

THQH

Burewala Y Y N N N Y Y N Y Y Y Y Y N

THQH Mailsi Y Y Y Y Y Y Y Y Y Y Y Y Y N

RHC Chak

222-ED Y Y Y Y Y Y Y Y Y Y Y Y Y N

RHC Chak

56-WB Y Y Y Y Y Y Y Y Y Y Y Y N Y

RHC Chak

87-WB Y Y Y Y Y Y Y Y Y N Y Y N Y

RHC Gaggo Y Y Y Y Y Y Y Y Y Y Y Y Y Y

RHC Jallah

Jeem Y Y Y Y N Y Y Y Y Y Y Y Y N

RHC Ludden Y Y Y Y Y Y Y Y Y Y Y Y Y N

RHC

Machiwal Y Y Y Y Y Y Y Y Y Y Y Y Y Y

RHC Mouza

Sharaf Y Y Y Y N Y Y Y Y N Y Y N N

RHC Sahuka Y Y Y Y Y Y Y Y Y Y Y Y N N

RHC Tibba

Sultan Pur Y Y Y Y N Y Y N Y Y Y Y N N

35

Health

facility

Status of MIS tools

OP

D t

icke

t

OP

D r

eg

iste

r

Mo

ther

he

alt

h r

eg

iste

r

Bir

th r

eg

iste

r

Ch

ild

he

alt

h r

eg

iste

r

Fa

mil

y p

lan

nin

g r

eg

iste

r

EP

I re

gis

ter

Meeti

ng

reg

iste

r

Med

icin

e s

toc

k r

eg

iste

r

Dail

y e

xp

en

se

reg

iste

r

DH

IS m

on

thly

re

po

rt

TB

re

gis

ter

Dis

eas

e e

arl

y w

arn

ing

sy

ste

m

DE

WS

ch

art

Gro

wth

m

on

ito

rin

g

reg

iste

r

BHU Chak

148-EB Y Y Y Y Y Y Y N Y Y Y Y N N

BHU Chak

199-EB Y Y Y Y N Y Y N Y Y Y Y Y N

BHU Chak

231-EB Y Y N N N N N Y Y Y N Y N N

BHU Chak

317-EB Y Y Y Y Y Y Y N Y Y Y Y Y Y

BHU Chak

409-EB Y Y Y N Y Y Y Y Y Y N Y Y N

BHU Kikri

Kalan Y Y Y Y Y Y Y N Y Y Y Y N N

BHU Kikri

Khurd Y Y Y Y Y Y Y Y Y Y Y Y N N

BHU Lalipur Y Y Y Y N Y Y N Y Y Y Y N N

BHU Mitroo Y Y Y N N Y Y Y Y Y Y Y Y Y

BHU Chak

122-WB Y Y N N Y Y Y Y Y Y Y Y N N

BHU Chak

168-EB Y Y Y N N Y Y N Y Y Y Y Y N

BHU Chak

22-WB Y Y Y Y Y Y N N Y Y Y Y Y N

BHU Chak

41-WB Y Y Y Y Y Y Y N Y Y Y Y N N

BHU Chak

52-WB Y Y Y Y N Y Y N Y Y Y Y Y N

BHU Chak

569-WB Y Y Y Y N Y Y N Y Y Y Y N N

36

Drugs and supplies

The availability of drugs and supplies has been described under individual MNCH service

packages. The reasons for their non-availability were identified at the surveyed facilities and

are presented in Table 3.29.

TABLE 3.29: REASONS FOR RUNNING OUT OF STOCK REPORTED BY SURVEYED FACILITIES

Health facilities citing

being out of stock

Reasons for running out of stock

Po

or

qu

an

tifi

cati

on

Dela

ye

d d

em

an

d

su

bm

issio

n

Un

av

ail

ab

ilit

y o

f

bu

ffer

sto

ck

Lac

k o

f s

tora

ge

cap

acit

y

Dela

ye

d s

up

ply

Un

der

su

pp

ly

No

pro

cu

rem

en

t

po

wers

Ins

uff

icie

nt

bu

dg

et

Lac

k o

f c

old

-ch

ain

DHQH Vehari N N Y N N N Y Y N

THQH Burewala N N N N Y N N Y N

THQH Mailsi N N Y N N N Y Y N

RHC Chak 222-ED N N N N N Y Y N N

RHC Chak 56-WB N N N N Y N Y N N

RHC Chak 87-WB N N N Y Y N N Y N

RHC Gaggo N N N Y N N N Y N

RHC Jallah Jeem Y Y N N N N Y N N

RHC Ludden N N Y N Y N Y N N

RHC Machiwal Y N Y Y N Y N Y N

RHC Mouza Sharaf Y N N N Y Y N N N

RHC Sahuka N Y N N Y N N N N

RHC Tibba Sultan Pur Y N N Y N N N Y N

BHU Chak 148-EB N N N Y Y Y N N N

BHU Chak 199-EB N N N N N Y Y N N

BHU Chak 231-EB Y N N N N Y N Y N

BHU Chak 317-EB N N N Y Y N N N N

37

Health facilities citing

being out of stock

Reasons for running out of stock

Po

or

qu

an

tifi

cati

on

Dela

ye

d d

em

an

d

su

bm

issio

n

Un

av

ail

ab

ilit

y o

f

bu

ffer

sto

ck

Lac

k o

f s

tora

ge

cap

acit

y

Dela

ye

d s

up

ply

Un

der

su

pp

ly

No

pro

cu

rem

en

t

po

wers

Ins

uff

icie

nt

bu

dg

et

Lac

k o

f c

old

-ch

ain

BHU Chak 409-EB N N N N N Y N Y N

BHU Kikri Kalan N N N N Y Y N N N

BHU Kikri Khurd N N N N Y Y N Y N

BHU Lalipur Y N N N Y Y N N N

BHU Mitroo Y N N N Y Y N N N

BHU Chak 122-WB N N N N Y Y N N N

BHU Chak 168-EB N N N N Y Y N N N

BHU Chak 22-WB N N Y N N N N N N

BHU Chak 41-WB N N N N Y Y N N N

BHU Chak 52-WB N N Y N Y Y Y N N

BHU Chak 569-WB N N N N Y Y N Y N

Fee for services

The charging of a fee for MNCH services and the availability of social protection

mechanisms for the poor were assessed at surveyed facilities and the findings are presented

in Tables 3.30 and 3.31.

38

TABLE 3.30: STATUS OF FEE FOR SERVICES

Health facilities

where services

are charged

Services provided free of cost at surveyed health facilities

OPD Indoor

Am

bu

lan

ce s

erv

ices

OP

D t

icke

t

OP

D la

bo

rato

ry

OP

D u

ltra

so

un

d

OP

D X

-ra

ys

OP

D m

ed

icin

es

Ad

mis

sio

n f

ee

Ward

be

d

Inp

ati

en

t la

bo

rato

ry

Inp

ati

en

t u

ltra

so

un

d

Inp

ati

en

t X

-ray

s

Blo

od

gro

up

ing

& c

ros

s

matc

hin

g

Inp

ati

en

t m

ed

icin

es

DHQH Vehari N N N N Y N Y N N N N Y N

THQH Burewala N N N N Y N Y Y Y Y Y Y N

THQH Mailsi N N N N Y N Y Y N N N N N

RHC Chak 222-ED N N N N Y N N N N N Y N

RHC Chak 56-WB N N N N Y N Y Y N N Y N

RHC Chak 87-WB N N N N Y N Y N N N Y N

RHC Gaggo N N N N Y N Y Y N N Y N

RHC Jallah Jeem N N N N Y N Y N N N Y N

RHC Ludden N N N N Y N Y Y Y Y Y N

RHC Machiwal N N N N Y N Y Y N Y Y N

RHC Mouza Sharaf N Y N N Y N Y Y N N Y N

RHC Sahuka N N N N Y N Y Y N Y Y N

RHC Tibba Sultan

Pur N N N N Y N Y Y Y Y Y N

BHU Chak 148-EB N N Y




BHU Chak 409-EB N Y Y

39

Health facilities

where services

are charged

Services provided free of cost at surveyed health facilities

OPD Indoor

Am

bu

lan

ce s

erv

ices

OP

D t

icke

t

OP

D la

bo

rato

ry

OP

D u

ltra

so

un

d

OP

D X

-ra

ys

OP

D m

ed

icin

es

Ad

mis

sio

n f

ee

Ward

be

d

Inp

ati

en

t la

bo

rato

ry

Inp

ati

en

t u

ltra

so

un

d

Inp

ati

en

t X

-ray

s

Blo

od

gro

up

ing

& c

ros

s

matc

hin

g

Inp

ati

en

t m

ed

icin

es

BHU Kikri Kalan N N Y

BHU Kikri Khurd N N Y

BHU Lalipur N N Y

BHU Mitroo N N Y

BHU Chak122-WB N N Y

BHU Chak168-EB N Y Y

BHU Chak 22-WB N N Y




TABLE 3.31: MECHANISMS OF SOCIAL PROTECTION AVAILABLE

Health facilities with available

social protection

Social protection mechanism

Bait-ul Maal Zakaat Patient welfare society

DHQH Vehari Y Y Y

THQH Burewala N Y Y

THQH Mailsi N Y N

RHC Chak 222-ED N N N

RHC Chak 56-WB N N N

40

Health facilities with available

social protection

Social protection mechanism

Bait-ul Maal Zakaat Patient welfare society

RHC Chak 87-WB N N N

RHC Gaggo N N N

RHC Jallah Jeem N N N

RHC Ludden N N N

RHC Machiwal N N N

RHC Mouza Sharaf N N N

RHC Sahuka N N N

RHC Tibba Sultan Pur N N N

BHU Chak 148-EB N N N





BHU Kikri Kalan N N N

BHU Kikri Khurd N N N

BHU Lalipur N N N

BHU Mitroo N N N

BHU Chak 122-WB N N N






41

Infection control

The health facilities were assessed for the availability of practices of infection control and

waste management and the availability of related material. The findings from the individually

surveyed facilities are presented in Table 3.32.

TABLE 3.32: STATUS OF INFECTION CONTROL & WASTE MANAGEMENT PRACTICES

Health facilities

Availability of materials Infection control practices

Wa

ste

man

ag

em

en

t p

lan

Wa

ste

co

lle

cti

on

ma

teri

als

Pers

on

al p

rote

cti

on

mate

rials

Wa

ste

tre

atm

en

t eq

uip

men

t

Fu

ncti

on

al

incin

era

tors

Han

d w

ash

ing

pra

cti

ce

s

of

HC

P

Dis

infe

cti

on

of

serv

ice

pro

vis

ion

are

a

Hep

B V

acc

inati

on

of

sta

ff

Wa

ste

se

gre

gati

on

Dis

po

sal

of

Was

te t

hro

ug

h

bu

rnin

g

Dis

po

sal th

rou

gh

th

row

ing

-

aw

ay

Dis

po

sal th

rou

gh

mu

nic

ipal

arr

an

ge

me

nt

DHQH Vehari Y Y N N Y N Y Y Y N N Y

THQH Burewala Y Y N N Y N Y N Y N N Y

THQH Mailsi Y N N N N N Y Y Y Y N N

RHC Chak 222-ED Y N N . N N Y N Y N N

RHC Chak 56-WB Y N N . N N Y Y Y N N

RHC Chak 87-WB Y N N . N N Y N Y N N

RHC Gaggo Y N N . N N Y N Y N N

RHC Jallah Jeem Y N N . N N Y N N N N

RHC Ludden Y N N . N N N N N N N

RHC Machiwal Y N N . N N Y Y N N N

RHC Mouza Sharaf Y N N . N N Y N N N N

RHC Sahuka Y N N . N N Y N N N N

RHC Tibba Sultan Pur Y N N . N N Y Y Y N Y

BHU Chak 148-EB Y N N . N N N N N N N

BHU Chak 199-EB Y N N . N N N N Y Y N

42

Health facilities

Availability of materials Infection control practices

Wa

ste

man

ag

em

en

t p

lan

Wa

ste

co

lle

cti

on

ma

teri

als

Pers

on

al p

rote

cti

on

mate

rials

Wa

ste

tre

atm

en

t eq

uip

men

t

Fu

ncti

on

al

incin

era

tors

Han

d w

ash

ing

pra

cti

ce

s

of

HC

P

Dis

infe

cti

on

of

serv

ice

pro

vis

ion

are

a

Hep

B V

acc

inati

on

of

sta

ff

Wa

ste

se

gre

gati

on

Dis

po

sal

of

Was

te t

hro

ug

h

bu

rnin

g

Dis

po

sal th

rou

gh

th

row

ing

-

aw

ay

Dis

po

sal th

rou

gh

mu

nic

ipal

arr

an

ge

me

nt

BHU Chak 231-EB Y N N . N N N Y N N N

BHU Chak 317-EB Y N N . N N N Y Y N N


BHU Kikri Kalan Y N N . N N N Y N N N

BHU Kikri Khurd Y N N . N N N Y Y N N

BHU Lalipur Y N N . N N N Y N N N

BHU Mitroo Y N N . N N Y N N N N

BHU Chak 122-WB Y N N . N N N Y N N N


BHU Chak 22-WB Y N N . N N N N N N N

BHU Chak 41-WB Y N N . N N Y Y N N Y

BHU Chak 52-WB Y N N . N N N Y N N N

BHU Chak 569-WB Y N N . N N N N N N N

Death review

The findings related to the availability and functioning of death review committees are

Documents

HFA District Report - Vehari - POLICY AND STRATEGIC ...pspu.punjab.gov.pk/system/files/HFA-Vehari.pdfTwenty eight (28) health facilities were assessed in district Vehari , including