Bajour

Transcription

Bajour

\
Health Facility Assessment - Federally
Administered Tribal Areas
Agency Bajour
TRF
Technical Resource
Facility
Ack nowledgement
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
i
Table of Contents
Executive Summary ...................................................................................................... 1
Section 1: Introduction ................................................................................................. 4
1.1 Survey Objectives ................................................................................................ 4
1.2 Assignment Duration ............................................................................................ 4
1.3 Scope of HFA ....................................................................................................... 4
1.4 Report Organisation ............................................................................................. 5
Section 2: Agency Information..................................................................................... 6
2.1 Geographical Location ......................................................................................... 6
2.2 Administrative Setup ............................................................................................ 7
2.3 Demographic Information ..................................................................................... 7
2.4 Socioeconomic and Health Indicators .................................................................. 8
Section 3: Health Facility Assessment Survey Findings ............................................ 9
3.1 MNCH Services.................................................................................................... 9
3.1.1 8/6 Preventive MNCH Services at BHUs .................................................... 10
3.1.2 24/7 Basic EmONC Services at RHCs ....................................................... 13
3.1.3 24/7 Comprehensive EmONC Services at the SHC Hospitals .................... 17
3.1.4 24/7 Basic EmONC Services at the Civil Hospital....................................... 23
3.2 Management Basics ........................................................................................... 26
3.2.1 Human Resources...................................................................................... 26
3.2.2 Work Coordination and Supervision ........................................................... 30
3.2.3 Management Information System ............................................................... 30
3.2.4 Drugs and Supplies .................................................................................... 32
3.2.5 Fee for Services ......................................................................................... 33
3.2.6 Infection Control ......................................................................................... 34
3.2.7 Death Review ............................................................................................. 35
3.3 Facility Utilisation ............................................................................................... 36
3.4 Well Baby Clinic ................................................................................................. 38
3.5 Donor Contributions ........................................................................................... 39
3.6 Clients’ Perspective ............................................................................................ 40
3.7 Procurement Estimates ...................................................................................... 42
3.7.1 Equipment .................................................................................................. 42
ii
3.7.2 Civil Works ................................................................................................. 42
Section 4: Key Findings.............................................................................................. 43
4.1 Infrastructure ...................................................................................................... 43
4.2 Human Resources ............................................................................................. 43
4.3 Equipment .......................................................................................................... 44
4.4 Drugs and Supplies ............................................................................................ 44
4.5 Support Services ................................................................................................ 45
4.6 Management Basics ........................................................................................... 45
4.7 Donor Contributions ........................................................................................... 46
4.8 Clients’ Perspective ............................................................................................ 46
ANNEX 1 - Agency Health Department......................................................................... 48
ANNEX 2 - Input Criteria for MNCH Services................................................................ 56
ANNEX 3-A - Status of Surveyed Health Facilities against the Minimal Level of Inputs 76
ANNEX 3-B - List of items required for hospitals in Bajour agency ............................... 83
ANNEX 4 - Scope of civil works required at hospitals ................................................... 93
iii
List of Tables
Table 1.1: Scope of HFA ................................................................................................ 5
Table 2.1: Demographic profile ....................................................................................... 7
Table 2.2: Population groups .......................................................................................... 7
Table 2.3: Socio-economic and health indicators............................................................ 8
Table 3.1: Status of assessed infrastructure in BHUs ................................................... 11
Table 3.2: Status of MNCH related staff in BHUs ......................................................... 12
Table 3.3: Status of functional equipment in BHUs ....................................................... 12
Table 3.4: Status of drugs and supplies in BHUs .......................................................... 12
Table 3.5: Status of support services in BHUs .............................................................. 13
Table 3.6: Status of assessed infrastructure in RHCs ................................................... 13
Table 3.7: Status of MNCH related staff in RHCs ......................................................... 15
Table 3.8: Status of functional equipment in RHCs ....................................................... 15
Table 3.9: Status of drugs and supplies in RHCs.......................................................... 16
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 .......................................... 21
Table 3.13: Status of functional equipment in SHC hospitals ........................................ 22
Table 3.14: Status of drugs and supplies in SHC hospitals........................................... 22
Table 3.15: Status of support services in SHC hospitals............................................... 23
Table 3.16: Status of assessed infrastructure in the CH ............................................... 24
Table 3.17: Status of MNCH related staff in CH............................................................ 25
Table 3.18: Status of functional equipment in the CH ................................................... 25
Table 3.19: Status of drugs and supplies in the CH ...................................................... 25
Table 3.20: Status of support services in the CH .......................................................... 26
Table 3.21: Status of HR at SHC hospitals ................................................................... 26
Table 3.22: Status of HR at RHCs ................................................................................ 27
Table 3.23: Status of HR at surveyed BHUs ................................................................. 27
Table 3.24: Reasons for the non-availability of HR 24/7 at RHCs ................................. 28
Table 3.25: Reasons for the non-availability of HR 24/7 at SHC hospital ...................... 29
Table 3.26: Capacity building of MNCH related staff at the surveyed facilities .............. 29
Table 3.27: Status of coordination and supervision at surveyed facilities ...................... 30
Table 3.28: Status of MIS at surveyed facilities ............................................................ 31
iv
Table 3.29: Reasons for running out of stock reported by surveyed facilities ................ 32
Table 3.30: Status of fee for services at surveyed facilities ........................................... 33
Table 3.31: Mechanisms of social protection available at surveyed facilities ................ 34
Table 3.32: Status of infection control & waste management practices at surveyed
facilities ......................................................................................................................... 35
Table 3.33: Status of death review practices at surveyed facilities................................ 36
Table 3.34: Status of services’ utilisation at surveyed facilities ..................................... 36
Table 3.35: Average monthly MNCH services provided at surveyed facilities ............... 37
Table 3.36: Average monthly family planning services provided at surveyed facilities .. 38
Table 3.37: Status of WBCs established at surveyed facilities ...................................... 38
Table 3.38: Status of donor contributions at surveyed facilities..................................... 39
Table 3.39: Clients’ perspective .................................................................................... 40
Table 3.40: Summary of estimated cost for procurement of equipment & civil works .... 42
Table 2.4: Number of public sector health facilities in the agency ................................. 48
Table 2.5: Human recourses in office of the agency surgeon ....................................... 48
Table 2.6: Availability of MNCH services staffing in Bajour ........................................... 49
Table 2.7: Financial allocations in Bajour agency ......................................................... 51
Table 2.8: NMNCHP monitoring indicators (Year 2010)................................................ 52
Table 2.9: Number of facilities with staff provided by the NMNCHP .............................. 53
Table 2.10: Number of staff trained on delivering MNCH services ................................ 54
Table 2.11: Status of CMWs’ training and deployment ................................................. 55
v
List of Figures
Figure 1: Map of Bajour........................................................................................................ 6
Figure 2: Range of services that signal fully functional MNCH services................................ 9
Figure 3: Status of management basics at surveyed facilities ............................................ 28
Figure 4: Level of satisfaction with examination and attitude of staff .................................. 41
Figure 5: Availability of medicines and lab services ............................................................ 41
vi
ACRONYMS
ANC
Antenatal Care
AVD
BB Technician
Assisted Vaginal Deliveries
BHU
CBA
CEI
CH
CMW
CWAQ
CDC
DCO
DDCT
DHO
DHDC
DHIS
DHQH
DLQ
EDOs
EmONC
ENC
EAQ
Blood Bank Technician
Basic Health Unit
Child Bearing Age
Client Exit Interview
Civil Hospital
Community Midwives
Civil Works Assessment Questionnaire
Communicable Disease Control
District Coordination Officer
District Data Collection Teams
District Health Officer
District Health Development Centre
District Health Information System
District Headquarter Hospital
District Level Questionnaire
Executive District Officers
Emergency Obstetric and Newborn Care
Emergency Newborn Care
EPI
Equipment Assessment Questionnaire
Expanded Programme of Immunisation
FATA
FP & PHC
Federally Administered Tribal Areas
Family Planning and Primary Health Care
HF
Health Facilities
HFA
HID
Health Facility Assessments
HIV
HMIS
HR
IDI – EDOH
IMNCI
IMPAC
JD
LHS
LHV
LHW
MDGs
Health Institution Database
Human Immunodeficiency Virus
Health Management Information System
Human Resources
In-depth Interview of EDO Health
Integrated Management of Neonatal and Childhood Illnesses
Integrated Management of Pregnancy and Childbirth
Job Description
Lady Health Supervisor
Lady Health Visitor
Lady Health Worker
M&E
Millennium Development Goals
Monitoring and Evaluation
MICS
Multiple Indicator Cluster Survey
vii
MIS
MNCH
Management Information System
Maternal, Neonatal and Child Health
MO
NMNCHP
NVD
OBGYN
Medical Officer
National Maternal Newborn and Child Health Programme
Normal Vaginal Deliveries
Obstetrics and Gynaecology
OPD
OT
Out Patient Department
PC-1
PDHS
PNC
PPHI
PSLM
RHC
SBA
SD&MB
SE
SHC hospitals
SPSS
TA
THQH
TRF
TT
WMO
WBC
Operation theatre
Planning Commission Proforma – 1
Pakistan Demographic and Health Survey
Post Natal Care
Peoples Primary Health Care Initiative
Pakistan Social & Living Standards Measurement Survey
Rural Health Centre
Skilled Birth Attendants
Service Delivery and Management Basics
Socioeconomic
Secondary Health Care
Statistical Package for the Social Sciences
Technical Assistance
Tehsil Headquarter Hospital
Technical Resource Facility
Tetanus Toxoid
Women Medical Officer
Well Baby Clinics
viii
Agency Report – Bajour
Executive Summary
The Health Facility Assessment 2011 (HFA) is aimed at assessing the availability,
functioning, and quality of health care services in 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 agency. It is baseline information for the agency 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 completed in May 2011. Contech accomplished the
assignment in a participatory way by maintaining a constant liaison with all of the key
stakeholders.
Eight health facilities were assessed in Bajour agency; including the agency headquarter
(AHQ) hospital, civil hospital (CH), two rural health centres (RHCs) and 4 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 the AHQH and CH were assessed for the availability of 24/7
comprehensive EmONC services. The status of the CH was also presented for its readiness
to deliver 24/7 basic EmONC services. Thus, the CH was assessed against the criteria of
the THQH.
An assessment criteria was formulated to ascertain gaps in the availability of inputs1,
including infrastructure; human resources; drugs and supplies; equipment; and level specific
support services. Summarized HFA findings (detailed findings are given in Section 4) of
HFA, are as follows.
•
Regarding infrastructure, BHU Loesam was found to be completely destroyed by the
floods in 2010. Labour rooms were not available at BHUs Chenagai and Ghani Adda.
Gaps existed in the availability of scrub areas in labour rooms and residences for the
gynaecologists at AHQH Khar and CH Nawagai. A female ward, paediatric nursery and
operation theatres were not available at CH Nawagai
1
Optimal level of inputs are proposed in the Planning Commission Proforma – 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 2’
1
•
The required human resources were not available at BHU Ghani Adda. WMOs and
operation theatre technicians were not available at both of the RHCs. Laboratory
technicians were also not available at RHC Barang. No specialists or staff was available
at CH Nawagai, except for a LHV. At AHQH Khar, the gynaecologist, paediatrician and
operation theatre technician were not available
•
The complete set of required equipment items was not available at any of the surveyed
facilities. Labour room equipment was not available at RHC Pashat. Paediatric nursery
equipment was not available at any of the two SHC hospitals
•
The complete list of tracer drugs, supplies and family planning commodities was not
available at any of the surveyed facilities. Family planning commodities were not
available at RHC Pashat
•
The complete range of inputs required for the delivery of support services was not
available at most of the surveyed facilities. Basic laboratory tests were not available at
BHU Ghani Adda
•
An ambulance service was not available at RHC Barang. Items required for blood
transfusion and radiological services were not available at the AHQH and CH Nawagai
•
AHQH Khar, RHC Barang and BHU Chenagai were found to be performing regular
performance review meetings, but only the AHQH was maintaining their record. Six out
of the 8 facilities participated in the agency’s performance review meetings
•
Monthly supervisory visits were reported by all of the facilities but their feedback was
received by only AHQH Khar and CH Nawagai
•
Bajour agency was practicing the Health Management Information System (HMIS). The
complete range of tools was however not available at any facility
•
No social protection mechanism (such as zakaat, bait-ul-maal and patient welfare
societies) had been introduced at any facility in the agency
•
The complete range of inputs required for infection control practices was deficient at all
of the surveyed facilities. Only the AHQH reported having a waste management plan.
Materials for waste collection, personal protection and waste treatment were not
available at any of the facilities
2
•
The existence of a committee to review maternal and neonatal deaths was reported only
at RHC Pashat, but their records did not suggest any reviews being conducted
•
In the agency, none of the facilities reported having received any donor contributions
In order to assess the perceptions of the clients, a total of 25 client exit interviews were
conducted in the AHQH, CH and RHCs. The clients’ perspective regarding the services
revealed that 90% of the clients were satisfied with the quality of care received at public
health facilities.
The findings of the HFA at all levels revealed significant gaps in the inputs required for the
provision of quality MNCH services. This warrants an immediate need to bridge these gaps
in order to improve the MNCH services.
3
Section 1: Introduction
This section includes the survey objectives, its scope and duration and the organisation of
the agency report.
1.1 Survey Objectives
The HFA 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.
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 agency level
•
To assess the clients’ satisfaction and perception of MNCH services
•
To provide information for systematic planning for procurement and supply of goods
and commodities (listing the medical equipment and instruments which need to be
replaced or purchased)
•
To update and assess the contributions made by the development partners for
improving MNCH and family planning services in the selected agencies
1.2 Assignment Duration
The estimated duration of the assignment was 7 months. The assignment started in October
2010 and completed in May 2011.
1.3 Scope of HFA
The survey included the agency headquarter hospital (AHQH), tehsil/taluka headquarter
hospitals (THQH) / civil hospital (CH), rural health centres (RHCs) and 20% of the basic
health units (BHUs) randomly selected within the agency. 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 AHQH, 5 at the CH and RHCs),
excluding the BHUs. Table 1.1 shows the numbers of health facilities in the agency and the
health facilities surveyed.
4
T ABLE 1.1 : S COPE
OF
HFA
Number of health facilities by type
Bajour Agency
AHQH
CH
RHCs
BHUs
Total
Number of facilities listed by HID
1
1
2
20
24
Number of facilities surveyed
1
1
2
4
8
1.4 Report Organisation
The HFA agency report has been structured in four sections. While the introduction to the
survey, its scope and duration is described in Section 1, Section 2 ‘Agency Information’
contains information collected from the agency health department using the Agency Level
Questionnaire (ALQ), as well as the secondary data sources and it comprises of
demographic, economic and education related information from the agency, as well as the
organisation of the health care delivery system in the agency. This section also includes
information about the monitoring indicators of the National MNCH Programme.
Details of the assessment are contained in Section 3 ‘HFA Findings’. This section presents
information about the NMNCHP analytical framework indicators, status of the MNCH service
availability based on the optimal level of inputs including infrastructure, human resources,
equipment, drugs and supplies and the availability of support 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 the agency level.
It is important to note that section 2 and 3 contain information on human resources, MNCH related training, NMNCHP provided
staff, donor contribution etc., from two different sources and therefore may not necessarily be matching. Where present, it
signifies a disconnect between the information available at the EDOH/DHO office and the surveyed facilities.
5
Section 2: Agency Information
This section includes the agency brief, information on demographic, socioeconomic and
health indicators. It also contains information on health resources and the NMNCHP
indicator compiled at the agency level. The data sources of the information are the EDOH
office using the Agency Level Questionnaire (ALQ) 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 the
survey.
2.1 Geographical Location
Bajaur Agency is an agency in the federally administered tribal areas (FATA). It is the
smallest of all the agencies, with an area of 1290 Sq KM, which is mostly hilly terrain. It is
bounded on the north by Panjkora river, on the west by Kunnar river of Afghanistan and has
a very fertile belt in the Rud Valley. The Bajaur hills are less densely forested and have a
lower elevation than Dir.
F IGUR E 1: M AP
OF
B AJOUR
6
2.2 Administrative Setup
Like the other agencies in FATA, Bajour is headed by a Political Agent (PA), who is
appointed by the provincial government from the Federal or Provincial Civil Service. The PA
coordinates with the agency surgeon and all of the other sector heads of the agency.
2.3 Demographic Information
Demographic information2 is given in the following table.
T ABLE 2.1 : D EMOGR APH IC
PROF ILE
Indicators
Value
Indicators
Value
Total population
738,617
Population of Nawagai
-
Population of Tehsil Khar
-
Urban population
19,943
Population of Tehsil Chamarkand
-
Rural population
718,674
Population of Tehsil Salarzai
-
Population density
(persons per sq.km)
573
Population of Tehsil Uttman Khel
-
Sex ratio (number of males over
100 females) at birth
105
Population of Tehsil Mamond
-
Population annual growth rate*
2.82%
(-) Data not available, *Regional figures for FATA used (Agency specific figures not available)
S OURCE : D IRECTORATE OF HEAL TH SER VICES FATA
T ABLE 2.2 : P OPULAT ION
2
GROUPS
Population
groups
Standard
demographic
(%)
Estimated
population
Under 1 year
2.70
19,943
Population groups
Standard
demographic
(%)
Estimated
population
Women
15-49 years
22.00
162,496
Projected figures for the year 2010.
7
Under 5 years
13.40
98,975
Married women of
child bearing age
(CBAs)
16.00
118,179
Under 15 years
41.97
309,998
Pregnant women
3.40
25,113
Expected births
2.90
21,420
S OURCE : MICS- 2007-08
2.4 Socioeconomic and Health Indicators
Selected socio-economic 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 Immunisation Coverage Evaluation Survey Pakistan (CES)
2006-7.
T ABLE 2.3 : S OC IO - ECONO MIC
AND H EALT H IND ICAT ORS
Indicators
Value
Agency specific figures
www.fata.gov.pk
Literacy rate
15.8 %
Income per capita*
-
Provincial figures
MICS- 2007-8
Infant mortality rate (IMR)
86 per 1000 live births
Under 5 mortality rate (U5MR)
104 per 1000 live births
Indicators
% children<12 months
fully immunized
Value
23% (Ag
Surg Office)
52 % (CES)
Malnutrition (Women)*
-
Maternal mortality ratio
380/100,000
live births
* Data not available
8
Section 3: Health Facility Assessment Survey
Findings
This section describes the HFA findings on status of MNCH service packages against the
assessment criteria and the status of management basics, service utilisation, client
satisfaction, and social protection. In addition, procurement estimates for required
equipments and civil works are also contained in the section.
3.1 MNCH Services
The packages of MNCH services assessed include preventive MNCH services at the BHUs,
basic EmONC services at the RHCs and comprehensive EmONC services at the THQ and
DHQ hospitals3. The range of MNCH services are given below.
F IGUR E 2: R ANG E
OF SERVICES T HAT SIGN AL FU LLY FUNCT IO NAL
BHUs: Facility
available for
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 counseling
· HR (at least one
LHV or Doctor)
RHCs: Facility
available for
24/7 Basic EmONC
Services
· Parenteral
antibiotics
· Parenteral oxytocic
drugs
· Parenteral
anticonvulsants for
pregnancy induced
convulsions (due to
hypertension)
· Manual removal of
placenta
· Removal of
retained products
· Assisted vaginal
delivery (vacuum
extraction, forceps)
· Newborn
resuscitation
+
· Post abortion care
· HR (skilled female
providers-WMO
and LHVs), and
· Preventive MNCH
3
MNCH
SER VIC ES
DHQ/THQ
hospitals: Facility
available for
24/7
Comprehensive
EmONC services
· Surgery (C-section)
· Blood transfusion
· Newborn care
(resuscitation &
incubator)
+
· Gynaecological
care
· Comprehensive
family planning
services including
sterilisation
· HR (skilled staff for
conducting, Csection, Blood
transfusion and
anaesthesia),
and
· Preventive MNCH
and Basic EmONC
NMNCHP PC -1
9
The functional capacity of the health facilities was assessed against 5 specified inputs, which
include:
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 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 bare minimum requirement of the inputs, required for
delivering the package specific MNCH services at the health facilities (Annex 2).
Findings related to minimal level of inputs are given as Annex 3-A.
The following tables present the status of the assessed facilities for the availability of the
optimal level of inputs.
3.1.1 8/6 Pre ve nti ve MNCH Se rvices at BHUs
BHUs operating within Bajour agency were assessed for the provision of preventive MNCH
services available for 8 hours a day, 6 days a week (8/6). Four BHUs were assessed for the
availability of the optimal level of inputs. No inputs were available at BHU Loesam, as the
facility was completely destroyed by the 2010 floods. The findings are 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’s
room and labour room as service provision areas and residences for the accommodation of
required staff. OPD and LHV’s rooms have been assessed as a single room having facilities
for consultation, examination and hand washing; similarly a labour room is also assessed as
a single room having the facilities for delivery, a scrub area and attached toilet facility for the
patient. The findings are presented as the status of building components available and
functional.
10
T ABLE 3.1: S T AT US
OF ASSESSED INFRAST RUCT URE IN
BHU S
Status of building components at surveyed BHUs
Infrastructure
Status
BHU Loesam*
BHU
Chenagai
BHU
Zorbander
BHU Ghani
Adda
A
N
Y
Y
Y
F
N
Y
Y
Y
A
N
Y
Y
Y
F
N
Y
Y
Y
A
N
Y
Y
Y
F
N
Y
Y
Y
A
N
Y
Y
Y
F
N
Y
Y
Y
A
N
Y
Y
Y
F
N
Y
Y
Y
A
N
Y
Y
Y
F
N
Y
Y
Y
A
N
N
Y
N
F
N
N
N
N
A
N
N
N
N
F
N
N
N
N
A
N
N
N
N
F
N
N
N
N
Residence
Doctor
A
N
Y
Y
Y
F
N
N
N
Y
Residence
LHV
A
N
Y
Y
Y
F
N
Y
Y
Y
OPD
1. Consultation area
2. Examination area
3. Hand washing
LHV’s room
2. Examination area
3. Hand washing
Labour room
1. Delivery room
2. Scrub area
3. Patient’s washroom
A=Available, F=Functional
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 (both regular posted and provided by
NMNCHP), against the required number mentioned in PC-1 of NMNCHP is given in Table
3.2.
11
OF
MNCH
RELAT ED ST AFF IN
BHU S
Number of MNCH related staff available at each BHU*
Staff categories
Required
number
BHU Loesam
BHU Chenagai
BHU Zorbander
BHU Ghani Adda
WMO/MO
1
0
1
0
0
LHV
1
0
1
1
0
Equipment items (general items, equipment for OPD and LHV’s room) for BHUs are listed in
PC-1 of NMNCHP. The status of the functional quantity of these items at assessed BHUs is
presented in Table 3.3.
OF FUNCT IONAL EQU IPMENT IN
BHU S
Number of functional equipment items available
at each surveyed BHU
Total items
required at
each BHU
BHU Loesam
BHU Chenagai
BHU Zorbander
BHU Ghani
Adda
General items
3
0
0
0
0
OPD
14
0
9
10
5
LHV’s room
12
0
11
9
7
Equipment
A list of the 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 the surveyed BHUs regarding the available quantity
of tracer items is presented in Table 3.4.
OF DRUGS AND SUPPLIES IN
BHU S
Number of items available at each surveyed BHU
Total items
required at
each BHU
BHU Loesam
BHU Chenagai
BHU Zorbander
BHU Ghani Adda
Supplies
6
0
5
5
2
Drugs
12
0
6
6
4
Item groups
12
Vaccines
5
0
5
5
5
Family planning
commodities
6
0
5
2
6
The facility for basic laboratory tests (test strips and HR) was assessed at surveyed BHUs
and their status is presented in Table 3.5.
OF SUPPORT SER VIC ES IN
Support services
BHU S
Total items
required at
each BHU
BHU Loesam
BHU Chenagai
BHU Zorbander
BHU Ghani
Adda
2
0
1
1
0
Basic lab tests
3.1.2 24/7 Basic EmONC Services at RHCs
RHCs operating within Bajour agency were assessed for the provision of basic EmONC
services available for 24 hours a day, 7 days a week (24/7). Two 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’s 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., as contained in Table 3.6. The findings are presented as status of building components
available and functional:
RHC S
Status of building components at each RHC
Infrastructure
OPD
Status
RHC Bangla Icha
RHC Dajal
A
Y
Y
F
Y
Y
13
Infrastructure
Status
RHC Bangla Icha
RHC Dajal
A
Y
Y
F
Y
Y
A
Y
N
F
Y
N
A
Y
Y
F
N
Y
A
Y
Y
F
N
N
A
Y
Y
F
N
Y
A
N
N
F
N
N
A
Y
Y
F
N
Y
A
Y
Y
F
Y
N
A
Y
Y
F
Y
N
A
Y
Y
F
N
Y
A
Y
Y
F
Y
Y
A
Y
Y
F
Y
Y
A
Y
Y
F
Y
Y
Residence
Doctor
A
Y
Y
F
Y
Y
Residence
LHV
A
Y
Y
F
Y
Y
2. Examination area
3. Hand washing
Female ward
1. Patient area
Labour room
1. Delivery room
2. Scrub area
Clinical laboratory
1. Laboratory room
2. Working area
LHV’s room
2. Examination area
3. Hand washing
(Non-functional refers to facilities requiring major infrastructure repair and may not necessarily mean non-operational)
14
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 the NMNCHP), against the required numbers is presented in Table 3.7.
OF
MNCH
RELAT ED ST AFF IN
Staff categories
RHC S
Required
number at each
RHC
Number of MNCH related staff available at
each RHC
RHC Pashat
RHC Barang
WMO
2
0
0
LHV
2
1
2
Lab technician
1
1
0
Operation theatre technician
1
0
0
Ambulance driver
1
1
0
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.
Equipment
RHC S
Total items
required at each
RHC
Number of functional equipment items
available at each RHC
RHC Pashat
RHC Barang
General items
4
1
0
Female ward
9
1
4
WMO OPD
15
12
9
Labour room
19
0
9
LHV’s room
10
9
9
15
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 the surveyed RHCs regarding the available quantity of
tracer items is presented in Table 3.9.
Item groups
RHC S
Total items
required at each
RHC
Number of items available at each RHC
RHC Pashat
RHC Barang
Supplies
6
5
4
Drugs
18
12
7
Vaccines
5
5
5
Family planning commodities
6
0
3
The facility for support services including basic laboratory tests (space, test strips and
human resources) and ambulance services (a functional vehicle and driver) was assessed at
the surveyed RHCs. The availability status of these services at RHCs is presented in Table
3.10.
Support services
RHC S
Total items
required at each
RHC
RHC Pashat
RHC Barang
Basic lab tests
8
7
6
Ambulance service
2
2
0
16
3.1.3 24/7 Compre hensi ve EmONC Services at the SHC Hospitals
The AHQ and civil hospitals operating within Bajour agency were assessed for the provision
of comprehensive EmONC services available for 24 hours a day, 7 days a week (24/7). A
total of 2 secondary health care (SHC) hospitals including 1 AHQ and 1 civil hospital 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 hospital has been assessed for the availability of an OPD,
indoor wards, LHV’s 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 the respective areas e.g., a consultation area, examination
area and hand washing in the OPD; patient area, nursing station, store rooms and attached
washrooms in the indoor wards, etc., as contained in Table 3.11. The findings are presented
as the status of building components available and functional.
SHC
HOSPIT ALS
Availability of building components
Infrastructure
OPD:
2. Examination area
3. Privacy of examination area
4. Hand washing
Female ward:
1. Patient area
2. Nursing station
4. Store for general items
Status
AHQH Khar
CH Nawagai
A
Y
Y
F
Y
Y
A
N
N
F
N
N
A
N
N
F
N
N
A
N
N
F
N
N
A
Y
N
F
Y
N
A
Y
N
F
Y
N
A
Y
N
F
Y
N
A
Y
N
F
Y
N
17
Infrastructure
5. Store for equipment
Labour room:
1. Delivery room
2. Preparation /stage room
3. Scrub area
4. Staff duty room
6. Staff washroom
Operation theatre:
1. Patient preparation room
2. Operating room
3. Recovery room
4. Scrub area
5. Sterilization area
6. Doctors’ room
7. Support staff duty room
Status
AHQH Khar
CH Nawagai
A
N
N
F
N
N
A
Y
Y
F
Y
Y
A
Y
Y
F
Y
Y
A
N
N
F
N
N
A
Y
Y
F
Y
Y
A
Y
Y
F
Y
Y
A
Y
Y
F
N
Y
A
Y
Y
F
Y
Y
A
N
N
F
N
N
A
Y
N
F
Y
N
A
Y
N
F
Y
N
A
Y
N
F
Y
N
A
Y
N
F
Y
N
A
Y
N
F
Y
N
A
Y
N
F
Y
N
A
Y
N
F
Y
N
A
Y
N
18
Infrastructure
10. Attached washroom for staff
Paediatric ward:
1. Patient area
2. Nursing station
3. Store for general items/drugs or equipment
Paediatric nursery:
1. Patient area
2. Nursing station
4. Change room/area
Clinical laboratory:
1. Laboratory room
2. Working area
3. Doctor’s duty room
4. Store for general reagents or equipment
5. Attached washroom
Blood bank:
1. Blood collection room
Status
AHQH Khar
CH Nawagai
F
Y
N
A
Y
N
F
Y
N
A
Y
N
F
N
N
A
Y
Y
F
Y
Y
A
Y
Y
F
Y
Y
A
Y
Y
F
Y
Y
A
Y
Y
F
N
Y
A
Y
N
F
Y
N
A
Y
N
F
Y
N
A
Y
N
F
Y
N
A
Y
N
F
Y
N
A
Y
Y
F
Y
Y
A
Y
Y
F
Y
Y
A
N
N
F
N
N
A
Y
Y
F
Y
Y
A
Y
Y
F
Y
N
A
Y
Y
F
Y
Y
19
Infrastructure
Status
AHQH Khar
CH Nawagai
A
Y
Y
F
Y
Y
A
Y
Y
F
Y
Y
A
Y
N
F
Y
N
A
Y
Y
F
Y
Y
A
Y
Y
F
Y
Y
A
Y
Y
F
Y
Y
A
N
N
F
N
N
A
Y
Y
F
Y
Y
Ultrasound room:
Examination area
A
Y
N
F
Y
N
Residence:
Gynaecologist
A
N
N
F
N
N
Residence:
Anaesthetist
A
Y
Y
F
Y
Y
Residence:
Paediatrician
A
Y
N
F
Y
N
Residence:
WMO
A
Y
Y
F
Y
Y
Residence:
LHV
A
Y
Y
F
Y
Y
Residence:
Nurses
A
Y
Y
F
Y
Y
Residence
Lab technician
A
Y
Y
F
Y
Y
Residence:
Blood bank technician
A
Y
Y
F
Y
Y
2. Working area
3. Staff duty room
4. Store for general reagents or equipment
LHV’s room:
2. Examination area
3. Privacy for examination
4. Hand washing facility
20
Infrastructure
Status
Residence:
Anaesthesia technician
AHQH Khar
CH Nawagai
A
Y
N
F
Y
N
(Non-functional refers to facilities requiring major infrastructure repair and may not necessarily mean non-operational)
PC-1 of NMNCHP contains the category and number of staff required for comprehensive
EmONC services. The status of the SHC hospital for the availability of human resources
(both regular posted and provided by NMNCHP), against the required numbers is presented
in Table 3.12.
OF
MNCH
R ELAT ED ST AFF IN
SHC
HOSPIT ALS
Availability at AHQH
Availability at THQHs/CH
Staff categories
Required
number
AHQH Khar
Required
number
CH Nawagai
Gynaecologist
2
0
1
0
Anaesthetist
2
1
1
0
Paediatrician
2
0
1
0
WMOs
6
1
4
0
4
0
4
0
4
3
4
0
Lab technician
3
4
2
0
4
9
4
0
Nurses
20
7
12
0
LHVs
4
1
4
1
Ambulance drivers
4
6
4
0
21
Equipment items for various service components at the SHC hospital 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.
SHC
H OSPIT ALS
Number of functional equipment items available at each SHC hospital
Equipment
Total required items
AHQH Khar
Total required items
CH Nawagai
General items
4
3
4
1
Female ward
19
12
19
10
OPD
12
9
5
4
Paediatric nursery
13
0
13
0
Paediatric ward
10
8
10
0
Labour room
24
10
19
11
Operation theatre
31
21
31
0
Clinical laboratory
5
4
5
2
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 the SHC hospitals regarding the available quantity of tracer
items is presented in Table 3.14.
Item groups
Total items
required at each
SHCH
SHC
HOSPIT ALS
Number of items available at each SHC hospital
AHQH Khar
CH Nawagai
Supplies
9
9
2
Drugs
21
14
6
22
Vaccines
5
5
5
Family planning
commodities
7
6
2
The facility for support services including laboratory tests (space, test strips and human
resources), blood transfusion services (space, supplies and human resources), ambulance
services (a functional vehicle and driver), operation theatre (space, drugs and supplies,
equipment items and human resources) was assessed at the surveyed SHC hospitals. The
availability status of these services at the SHC hospitals is presented in Table 3.15.
Item groups
SHC
Total items
required at each
SHCH
HOSPIT ALS
AHQH Khar
CH Nawagai
Basic laboratory tests
17
14
9
Blood transfusion
5
5
0
Ambulance services
2
2
1
Radiology services
3
2
0
Operation theatre
62
47
3
3.1.4 24/7 Basic EmONC Services at the Ci vil Hospital
The civil hospital was also assessed for its capacity to provide 24/7 basic EmONC services
on similar inputs, as those used for the RHCs. The status of the civil hospital regarding the
availability of inputs to deliver 24/7 basic EmONC services is presented in the Tables 3.16 3.20.
23
OF ASSESSED INFRAST RUCT URE IN T HE
CH
Infrastructure
Status
CH Nawagai
A
Y
F
Y
A
N
F
N
A
N
F
N
A
N
F
N
A
N
F
N
A
Y
F
Y
A
N
F
N
A
Y
F
Y
A
Y
F
Y
A
Y
F
Y
A
Y
F
N
A
Y
F
Y
A
Y
F
Y
A
Y
F
Y
Residence:
WMO
A
Y
F
Y
Residence:
LHV
A
Y
F
Y
OPD:
2. Examination area
3. Hand washing
Female ward:
1. Patient area
Labour room:
1. Delivery room
2. Scrub area
Clinical laboratory:
1. Laboratory room
2. Working area
LHV’s room:
2. Examination area
3. Hand washing facility
24
OF
MNCH
R ELAT ED ST AFF IN
Staff categories
CH
Number of MNCH related staff available at
the CH
Required
number
CH Nawagai
WMOs
2
0
LHV
2
1
Lab technician
1
0
1
0
Ambulance driver
1
0
OF FUNCT IONAL EQU IPMENT IN T HE
CH
Total items
required at
each THQH/CH
Number of functional equipment items
available at the CH
General items
2
1
OPD
3
3
Female ward
6
2
Labour room
14
9
Equipment
OF DRUGS AND SUPPLIES IN T HE
CH Nawagai
CH
Total items
required at
each THQH/CH
Number of items available at the CH
Supplies*
6
1
Drugs*
18
6
Vaccines
5
5
6
2
Item groups
CH Nawagai
25
OF SUPPORT SER VIC ES IN T HE
CH
Total items
required at
each CH
Number of items available at CH
Basic lab tests
8
5
Ambulance service
2
1
Support services
CH Nawagai
3.2 Management Basics
Findings related to facility management basics are presented below:
3.2.1 Human Resources
Information about sanctioned and filled posts of MNCH related staff was collected from the
surveyed facilities and their status is presented in the Tables 3.21 - 3.23. The filled status of
the staff categories, presented in the following tables includes regular postings only, as
reported by the respective facility, on the day of the survey.
OF
HR
AT
SHC
HOSPIT ALS
AHQ Hospital: Khar
CH Nawagai
Staff
Sanctioned
Filled
Sanctioned
Filled
Gynaecologist
1
0
0
0
Anaesthetist
1
1
0
0
Paediatrician
1
0
0
0
WMO
7
1
1
0
0
0
1
0
3
3
0
0
Lab technician
4
4
2
0
9
9
0
0
26
AHQ Hospital: Khar
CH Nawagai
Staff
Sanctioned
Filled
Sanctioned
Filled
Nurses
20
7
0
0
LHV
1
1
1
1
Ambulance drivers
6
6
1
0
OF
HR
AT
RHC S
RHC Pashat
RHC Barang
Staff
Sanctioned
Filled
Sanctioned
Filled
WMO
1
0
1
0
Lab technician
1
1
1
0
Nurses
1
1
0
0
LHV
1
1
2
2
Ambulance driver
1
1
1
0
OF
HR
AT SUR VEYED
BHU S
Number of posts filled at BHUs
Staff
BHU Loesam
S:
BHU Chenagai
BHU Zorbander
BHU Ghani Adda
S*
F*
S
F
S
F
S
F
WMO
0
0
1
1
1
0
1
0
LHV
0
0
1
1
1
1
1
0
Sanctioned,
F:
Filled
The availability of job descriptions, service delivery protocols and staff as per duty roster was
assessed and the findings are presented in Figure 3.
27
F IGUR E 3: S T AT US
OF MANAG EMENT BASICS AT SURVEYED F AC ILIT IES
4
4
Total number
3.5
3
Availability of MNCH related job
descriptions (JDs)
2.5
Presence of duty staff
2
2
Availability of MNCH service
delivery protocols
1.5
1
1
1
1
1
Displayed MNCH service delivery
protocols
1
0.5
0
0
00
DHQH
0000
THQHs
0
00
0 0 0
RHCs
BHUs
The reasons for the non-availability of staff on a 24/7 basis at RHCs and SHCs are provided
in Tables 3.24 and 3.25.
T ABLE 3.24: R EASONS
FOR T HE NON - AVAILABILIT Y OF
HR 24/7
AT
RHC S
Status in RHCs
Reasons for non-availability
WMO
LHV
Ambulance driver
Residence not available
0
0
0
Residence damaged
0
0
0
Security reasons
0
1
1
Lack of basic amenities
0
0
0
28
FOR T HE NON - AVAILABILIT Y OF
HR 24/7
AT
SHC
HOSPIT AL
Status of AHQ hospital
Gynaecologist
Anaesthetist
Paediatrician
Blood bank
technician
Laboratory
technician
WMO
LHV
Gynaecologist
Anaesthetist
Paediatrician
Blood bank
technician
Laboratory
technician
WMO
LHV
Reasons
for nonavailability
Status of THQ hospital
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
1
Lack of
basic
amenities
0
0
0
0
0
0
0
0
0
0
0
0
0
0
The health facilities having staff trained for providing MNCH services are presented in Table
3.26.
T ABLE 3.26: C APAC IT Y
BU ILD ING OF
MNCH
R ELAT ED ST AFF AT T HE SURVEYED FAC ILIT IES
MNCH related training conducted
Health facility
EmONC
ENC
IMNCI
IMPAC
FP
surgical
FP
counselling
Client
centeredness
AHQH Khar
Y
Y
N
N
N
Y
N
CH Nawagai
N
N
N
N
N
N
N
RHC Pashat
N
Y
N
N
N
N
RHC Barang
N
N
N
N
N
N
BHU Loesam
N
N
N
N
N
N
BHU Chenagai
N
Y
N
N
Y
N
BHU Zorbander
N
N
N
N
N
N
BHU Ghani Adda
N
N
N
N
N
N
29
3.2.2 Work Coordi nation a nd Supe rvi sion
Health facilities in the agency were assessed for work coordination and supervisory
activities, including facility staff meetings, the participation of facility in charges in agency
level meetings and conduction of supervisory visits and feedback by the agency health
managers. The findings from each surveyed health facility are presented in Table 3.27.
OF COORDIN AT ION AND SUPER VISION AT SURVEYED F AC ILIT IES
Work coordination and supervision
Health facility
Regular facility PRM*
Meeting
held
Record
maintained
AHQH Khar
Y
Y
CH Nawagai
N
RHC Pashat
Participation
in Agency
PRM**
Monthly supervisory visit
Facility
visited
Facility received visit
feedback
Y
Y
Y
N
Y
Y
Y
N
N
Y
Y
N
RHC Barang
Y
N
Y
Y
N
BHU Loesam
N
N
N
N
N
BHU Chenagai
Y
N
Y
Y
N
BHU Zorbander
N
N
Y
Y
N
BHU Ghani Adda
N
N
N
Y
N
* PRM=Performance Review Meeting
3.2.3 Ma nagement Information System
surveyed facilities were assessed for the availability and maintenance of HMIS tools and
their findings are presented in Table 3.28.
30
OF
MIS
AT SURVEYED F AC ILIT IES
Daily expense register
HMIS monthly report
TB register
Disease early warning
system
DEWS chart
Growth monitoring register
Y
Y
Y
Y
Y
Y
Y
Y
Y
CH Nawagai
Y
Y
Y
Y
Y
Y
Y
N
Y
Y
Y
N
N
N
N
RHC Pashat
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
RHC Barang
N
Y
Y
Y
Y
Y
Y
N
Y
Y
N
N
N
N
N
BHU Loesam
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
BHU Chenagai
Y
Y
Y
Y
Y
Y
Y
N
Y
Y
Y
N
N
N
Y
BHU Zorbander
Y
Y
N
Y
N
N
Y
N
Y
Y
Y
N
N
N
N
BHU Ghani Adda
Y
Y
N
N
N
Y
Y
N
Y
Y
N
N
N
N
N
Meeting register
Y
EPI register
Y
Family planning register
Y
Child health register
Y
Birth register
Y
Mother health register
Y
OPD register
AHQH Khar
Health facility
OPD ticket
medicine stock register
Status of MIS tools
MIS tools – Available
MIS tools – Maintained
AHQH Khar
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
CH Nawagai
Y
Y
Y
Y
N
Y
Y
N
Y
Y
Y
N
N
N
RHC Pashat
Y
Y
N
Y
N
Y
Y
N
Y
Y
N
N
N
N
RHC Barang
N
Y
Y
Y
Y
Y
Y
N
Y
Y
N
N
N
N
BHU Loesam
N
N
N
N
N
N
N
N
N
N
N
N
N
N
BHU Chenagai
Y
Y
Y
Y
Y
Y
Y
N
Y
N
Y
N
N
N
31
OPD register
Mother health register
Birth register
Child health register
Family planning register
EPI register
Meeting register
medicine stock register
Daily expense register
HMIS monthly report
TB register
Disease early warning
system
DEWS chart
BHU Zorbander
Y
Y
N
Y
N
N
Y
N
Y
Y
Y
N
N
N
BHU Ghani Adda
Y
Y
N
N
N
Y
Y
N
Y
Y
N
N
N
N
Health facility
Growth monitoring register
OPD ticket
Status of MIS tools
3.2.4 Drugs and Supplies
The availability of drugs and supplies has been described under the individual MNCH
service packages. The reasons for their non-availability were identified at the surveyed
facilities and are presented in Table 3.29.
FOR RUNN ING OUT OF ST OCK REPORT ED BY SURVEYED F AC ILIT IES
Poor quantification
Delayed demand
submission
Unavailability of
buffer stock
Lack of storage
capacity
Delayed supply
Under supply
No procurement
powers
Insufficient budget
Lack of cold-chain
Reasons for running out of stock
AHQH Khar
Y
N
N
N
N
N
N
Y
N
CH Nawagai
N
N
N
N
Y
N
Y
N
N
RHC Pashat
N
N
N
N
Y
Y
N
N
N
RHC Barang
N
N
N
N
Y
Y
N
N
N
BHU Loesam
N
N
N
N
N
N
N
N
N
BHU Chenagai
Y
N
N
N
Y
N
N
N
N
Health facilities citing
being out of stock
32
Poor quantification
Delayed demand
submission
Unavailability of
buffer stock
Lack of storage
capacity
Delayed supply
Under supply
No procurement
powers
Insufficient budget
Lack of cold-chain
Reasons for running out of stock
BHU Zorbander
N
N
N
N
Y
Y
N
N
N
BHU Ghani Adda
N
N
N
N
Y
Y
N
N
N
Health facilities citing
being out of stock
3.2.5 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 the Tables 3.30 and 3.31.
OF FEE FOR SERVIC ES AT SUR VEYED FAC ILIT IES
Services provided free of cost
OPD ticket
OPD laboratory
OPD ultrasound
OPD X-rays
OPD medicines
Admission fee
Ward bed
Inpatient laboratory
Inpatient ultrasound
Inpatient X-rays
Blood grouping &
cross matching
Inpatient medicines
Health facilities
where services
are charged
Indoor
Ambulance services
OPD
AHQH Khar
N
N
N
N
Y
N
N
N
Y
Y
Y
N
N
CH Nawagai
N
N
N
N
Y
N
N
N
N
N
N
N
N
RHC Pashat
N
N
N
N
Y
N
N
N
N
N
N
N
RHC Barang
N
N
N
N
Y
N
N
N
N
N
N
N
BHU Loesam
N
N
N
BHU Chenagai
N
N
Y
33
Services provided free of cost
T ABLE 3.31: M ECH AN ISMS
Ambulance services
Inpatient medicines
Y
Blood grouping &
cross matching
N
Inpatient X-rays
N
Inpatient ultrasound
BHU Ghani Adda
Inpatient laboratory
Y
Ward bed
N
Admission fee
N
OPD medicines
BHU Zorbander
OPD X-rays
OPD laboratory
Indoor
OPD ticket
Health facilities
where services
are charged
OPD ultrasound
OPD
OF SOC IAL PROT ECT ION AVAILABLE AT SUR VEYED FAC ILIT IES
Health facilities with available
social protection
Social protection mechanism
Bait-ul Maal
Zakaat
Patient welfare society
AHQH Khar
N
N
N
CH Nawagai
N
N
N
RHC Pashat
N
N
N
RHC Barang
N
N
N
BHU Loesam
N
N
N
BHU Chenagai
N
N
N
BHU Zorbander
N
N
N
BHU Ghani Adda
N
N
N
3.2.6 Infection Co ntrol
The health facilities were assessed for practices of infection control and waste management,
and the availability of related material. The findings of individually surveyed facilities are
34
OF INFECT ION CONT ROL
& W AST E
MAN AGEMENT PRACT ICES AT SUR VEYED FAC ILIT IES
Waste collection materials
Personal protection materials
Waste treatment equipment
Functional incinerators
Hand washing practices of HCP
Disinfection of service provision area
Hep B vaccination of staff
Waste segregation
Disposal of waste through burning
Disposal through throwing-away
Disposal through municipal arrangement
Infection control practices
Waste management plan
Availability of materials
AHQH Khar
Y
N
N
N
N
Y
Y
Y
N
N
N
N
CH Nawagai
N
N
N
N
N
N
N
N
N
N
Y
N
RHC Pashat
N
N
N
.
N
N
N
N
N
.
N
N
RHC Barang
N
N
N
.
N
N
N
N
N
.
N
Y
BHU Loesam
N
N
N
.
N
N
N
N
N
.
N
N
BHU Chenagai
N
N
N
.
N
N
N
N
N
.
Y
N
BHU Zorbander
N
N
N
.
N
N
N
Y
N
.
Y
N
BHU Ghani Adda
N
N
N
.
N
N
N
N
N
.
Y
N
Health facilities
3.2.7 Death Re view
Findings related to the availability and functioning of death review committees are presented
in Table 3.33.
35
OF DEAT H REVIEW PRACT ICES AT SURVEYED FAC ILIT IES
Status of death review
Health facility
Maternal deaths
Neonatal deaths
Death review
committee
Available
Annual number
Reviewed by
committee
Annual number
Reviewed by
committee
AHQH Khar
N
19
0
75
0
CH Nawagai
N
0
0
1
0
RHC Pashat
Y
0
0
0
0
RHC Barang
N
0
0
0
0
3.3 Facility Utilisation
The findings of services utilisation at the surveyed facilities are given as a monthly aggregate
from July to December 2010, annual utilisation of the year 2010 and a facility-wise average
monthly utilisation are presented in the Tables 3.34, 3.35 and 3.36.
OF SER VIC ES ’ UT ILISAT ION AT SUR VEYED FAC ILIT IES
Monthly utilisation (July to December 2010)
Type of service
Annual
utilisation
(2010)
July
Aug
Sep
Oct
Nov
Dec
1st Antenatal care visits (ANC-1)
338
518
865
893
1,188
894
10,320
Normal vaginal deliveries
209
239
149
237
229
241
2,868
Assisted vaginal deliveries
0
0
0
0
0
0
0
C-sections
0
0
0
0
0
0
0
1st Postnatal care visits (PNC-1)
35
42
74
61
65
64
717
Pregnant women given TT2 vaccine
442
451
519
862
624
337
6,721
36
Monthly utilisation (July to December 2010)
Type of service
Annual
utilisation
(2010)
July
Aug
Sep
Oct
Nov
Dec
Family planning services
2,339
508
900
662
1,036
1,036
11,768
Diarrhoea/Dysentery cases treated
(< 5 years of age)
417
374
347
347
168
170
4,996
Pneumonia cases treated
(< 5 years of age)
25
17
38
52
96
185
942
T ABLE 3.35: A VER AGE
MONT HLY
MNCH
SERVICES PROVID ED AT SURVEYED F AC ILIT IES
Average monthly utilisation
Health facility
Diarrhoea/
ANC -1
NVD
Assisted
VD
C–
Section
PNC -1
TT2
Dysentery
(in <5 yr)
Pneumonia
(in <5 yr)
AHQH Khar
405
194
0
0
28
118
165
26
CH Nawagai
9
4
0
0
1
3
51
3
RHC Pashat
16
3
0
8
37
25
0
RHC Barang
16
4
0
2
66
19
23
BHU Loesam
-
-
-
-
-
-
-
BHU Chenagai
21
1
0
10
47
10
0
BHU Zorbander
84
7
0
7
37
14
0
BHU Ghani Adda
231
5
0
1
231
20
17
37
T ABLE 3.36: A VER AGE
MONT HLY FAMILY PLANN ING SERVICES PRO VID ED AT SUR VEYED FAC ILIT IES
Average monthly utilisation of family planning services
Health facility
COC
POP
DPMA
Net-en
Condoms
IUCDs
Implants
Surgical (Tubal
Ligation +
Vasectomy)
AHQH Khar
4
38
34
0
22
5
0
0
CH Nawagai
0
0
5
0
6
0
0
0
RHC Pashat
7
0
2
0
0
3
0
RHC Barang
0
3
16
0
1
0
0
BHU Loesam
-
-
-
-
-
-
-
BHU Chenagai
9
5
5
0
326
0
0
BHU Zorbander
0
0
3
0
0
0
0
BHU Ghani Adda
104
7
64
0
528
0
0
KEY: COC=Combined Oral Contraceptive, POP=Progesterone-Only Pills, DPMA=Depot Medroxyprogesterone Acetate,
Net-en=Norethisterone enanthate, IUCDs=Intrauterine Contraceptive Devices.
3.4 Well Baby Clinic
The surveyed health facilities were assessed for having an established Well Baby Clinic
(WBC) and the findings are presented in Table 3.37.
OF
W BC S
EST ABLISHED AT SUR VEYED FAC ILIT IES
Name of health facility
WBC established
Name of health facility
WBC established
AHQH Khar
N
BHU Loesam
N
CH Nawagai
N
BHU Chenagai
N
38
RHC Pashat
N
BHU Zorbander
N
RHC Barang
N
BHU Ghani Adda
N
3.5 Donor Contributions
Donor contributions during the last three years were assessed regarding human resources,
infrastructure, equipment including ambulances and drugs and supplies and the findings are
OF DONOR CONT RIBUT ION S AT SURVEYED FAC ILIT IES
Donor contributions
Human resources
Staff incentive
Construction of
new building
Renovation of
existing building
Provision of new
equipment
Provision of new
vehicle/
ambulance
Provision of
medicines
Provision of
consumables
Drugs and
supplies
Capacity building
Equipment
Provision of key
staff
Health facilities
Infrastructure
AHQH Khar
N
N
N
N
N
N
N
N
N
CH Nawagai
N
N
N
N
N
N
N
N
N
RHC Pashat
N
N
N
N
N
N
N
N
N
RHC Barang
N
N
N
N
N
N
N
N
N
BHU Loesam
N
N
N
N
N
N
N
N
N
BHU Chenagai
N
N
N
N
N
N
N
N
N
BHU Zorbander
N
N
N
N
N
N
N
N
N
BHU Ghani Adda
N
N
N
N
N
N
N
N
N
39
3.6 Clients’ Perspective
Client exit interviews (CEIs) were conducted within the scope of the HFA survey to assess
the clients’ perspective on the services provided. The findings of these interviews were
analyzed for assessing their perspective on access, quality and preference for health care
and are presented in Table 3.39 and Figures 4 and 5.
T ABLE 3.39: C LIENT S ’
PERSPECT IVE
No. of interviewed clients (Total: 25)
AHQH
THQHs/CHs
RHCs
Less than 30 minutes
5
4
9
30 minutes to 1 hour
4
1
1
More than 1 hour
1
0
0
Walking
5
2
7
Personal transport
0
1
1
Public transport
5
2
2
Less than 10 minutes
3
1
8
10 minutes to 20 minutes
6
3
2
20 minutes to 30 minutes
1
1
0
More than 30 minutes
0
0
0
Paid fee for services
10
5
10
Received education material
0
0
0
Public health facilities
10
5
10
Private sector
0
0
0
Time to reach facility
Means of transport
Waiting time at facility
Preference for healthcare
Reasons for visiting public health facilities
Close to home
7
3
10
Good quality
6
0
3
Staff attitude
0
0
2
Affordability
3
2
2
40
Lack of choice
1
2
0
Very satisfied
0
0
0
Satisfied
10
3
10
Not satisfied
0
2
0
Overall satisfaction
F IGUR E 4: L EVEL
OF SAT ISF ACT ION W IT H EXAMIN AT ION AND ATT IT UDE OF ST AFF
Communication 0
Attitude of other staff
92
4
8
88
8
Very satisfied
Attitude of care provider 0
92
8
Satisfied
Not satisfied
Clinical Examination 0
0%
F IGUR E 5: A VAILABILIT Y
96
20%
4
40%
60%
80%
100%
OF MED IC IN ES AND LAB SER VIC ES
Lab services 0
100
0
Received (all)
Received (some)
Medicines 0
0%
29
Not received
71
20%
40%
60%
80%
100%
41
3.7 Procurement Estimates
3.7.1 Equipme nt
Based on the information collected, procurement needs for the provision of required
equipment have been identified for individually surveyed facilities to strengthen MNCH
services. A summary of the estimated cost for procurement of the required equipment is
given in Table 3.40. A list of the required equipment for each surveyed facility is presented
as Annex 3-B and details about the cost estimates for individually facilities are given in
Annex 3 B.
3.7.2 Civil Works
A yardstick has been used for assessing the scope of civil works for various MNCH related
building components (Annex 2). The identified scope of work required to complete the
infrastructure needs of the individually surveyed facilities is presented in Annex 4. A
summary of the estimated cost for the execution of civil works including repair and
maintenance, renovation and new construction of missing facilities; is given in Table 3.40
and details about the cost estimates for individual facilities are given in Annex 4.
T ABLE 3.40: S U MMARY
OF EST IMAT ED CO ST FOR PROCUREMENT OF EQUIPMENT
&
C IVIL W ORKS
Estimated cost (PKR in millions)
Procurement
AHQH
CH
RHCs
BHUs
Total
Equipment
16.80
13.58
8.04
2.22
40.64
Civil works
15.57
17.35
18.57
-
-
42
Section 4: Key Findings
A total of 8 health facilities were assessed in Bajour agency, including 4 BHUs, 2 RHCs, a
CH and AHQH. The BHUs were assessed for the availability of 8/6 preventive MNCH
services; RHCs were assessed for the availability of 24/7 basic EmONC services; and the
civil and AHQ hospitals were assessed for the availability of 24/7 comprehensive EmONC
services.
The key findings have been presented based on the availability of specified inputs including,
infrastructure, human resources, equipment, drugs and supplies and support services. The
status of each input has been described at one place for all levels. This is followed by the
key findings on management basics, donor contributions and the clients’ perspective on the
quality of MNCH services.
No inputs could be assessed at BHU Loesam, as the facility was completely destroyed by
the floods in 2010.
4.1 Infrastructure
•
An OPD and residences for the LHVs were available at all of the BHUs, other than at
BHU Loesam. Labour rooms were, however, not available at BHUs Chenagai and Ghani
Adda
•
OPDs, labour rooms, clinical laboratories and staff residences were available at both of
the RHCs (RHCs Bangla Icha and Dajal)
•
Gaps existed in the availability of scrub areas in the labour rooms and residences for the
gynaecologists at AHQH Khar and CH Nawagai. A female ward, paediatric nursery and
operation theatre were not available at CH Nawagai
4.2 Human Resources
•
The required staff was not available at BHU Ghani Adda
43
•
WMOs and operation theatre technicians were not available at both of the RHCs and
laboratory technicians were also not available at RHC Barang
•
No specialists or staff was available at CH Nawagai, except for a LHV. At AHQH Khar,
the gynaecologist, paediatrician and operation theatre technician were not available
•
NMNCHP did not provide support in human resources to any of the facilities at the
agency
•
Security concerns were the most commonly stated reasons for the non-availability of
staff around the clock at the RHCs and SHC hospitals
•
Training on EmONC was provided to the staff at AHQH Khar only. Training on ENC was
provided to the staff at AHQH Khar, RHC Pashat and BHU Chenagai. Training on family
planning counselling was provided to the staff of AHQH and BHU Chenagai
4.3 Equipment
•
The complete set of required equipment items was not available at any of the surveyed
facilities
•
General items were not available at any of the three BHUs
•
Labour room equipment was not available at RHC Pashat
•
Paediatric nursery equipment was not available at any of the two SHC hospitals
4.4 Drugs and Supplies
•
The complete list of tracer drugs, supplies and family planning commodities was not
available at any of the surveyed facilities
•
Family planning commodities were not available at RHC Pashat
•
Vaccines were available at both AHQH Khar and CH Nawagai
•
The most common reasons for running out of the stock of drugs were poor quantification,
delayed and under supply
44
4.5 Support Services
•
The complete range of inputs required for the delivery of support services was not
available at most of the surveyed facilities
•
Basic laboratory tests were not available at BHU Ghani Adda
•
Ambulance services were not available at RHC Barang
•
Items required for blood transfusion and radiological services were not available at the
AHQH and CH Nawagai
4.6 Management Basics
Management basics assessed at the surveyed facilities included availability of job
description and service delivery protocols, work coordination and supervision, MIS, infection
control measures, death reviews of maternal and neonatal deaths, fee for services and
available mechanisms of social protection.
•
AHQH Khar, RHC Barang and BHU Chenagai were conducting regular performance
review meetings but only AHQH was maintaining their record. Six out of the eight
facilities participated in the agency performance review meetings. Monthly supervisory
visits were reported by all of the facilities, but their feedback was only being received by
AHQH Khar and CH Nawagai
•
complete range of tools was however not available at any facility. Tools non-available at
most of the facilities included: the meeting register, T.B anf growth registers and the
DEWS chart. Only 50% of the facilities were sending HMIS reports regularly
•
No social protection mechanism (such as, zakaat, bait-ul-mal and patient welfare
societies) had been introduced at any facility in the agency
•
The complete range of inputs required for infection control practices was deficient at all
of the surveyed facilities. Only the AHQH reported having a waste management plan and
materials for waste collection, personal protection and waste treatment were not
available at any of the facilities
45
•
A record of the maternal and neonatal deaths was well maintained at the AHQH, but a
committee to review maternal and neonatal deaths was reported to have been formed
only at RHC Pashat, but it had never reviewed a single case
Donor contributions for supporting the delivery of MNCH services were assessed at the
surveyed facilities for the provision of human resources, infrastructure, equipment, drugs and
supplies. In the agency, none of the facilities reported having received any such
contributions.
4.8 Clients’ Perspective
Client exit interviews were conducted to assess the clients’ perspective about their
satisfaction with the quality of services at the facility. A total of 25 interviews were conducted
in the agency. Most of the clients preferred public health facilities for being close to their
homes. Ninety percent expressed satisfaction over the quality of care they had received.
46
Annexes
47
ANNEX 1
2.5 Agency Health Department
The public sector agency health system consists of Secondary Health Care (AHQH, CH) and
Primary Health Care (RHCs, BHUs) facilities. The EDOH acts as head of the agency health
department, under the supervision of the DCO.
2.6 Health Resources Agency Surgeon’s Office
2.6.1 Health facilities (Public sector)
Public sector facilities providing MNCH services are given in Table 2.4:
T ABLE 2.4: N U MBER
OF PUBLIC SECT OR HEALT H FAC ILIT IES IN T HE AGENC Y
Type
Number
Bed strength
Teaching hospitals
0
0
Agency headquarter hospital
1
250
Tehsil headquarter hospitals
0
0
Civil hospital
1
50
Rural health centres
2
16
Basic health units
20
0
Govt. rural dispensaries
0
MCH centres
0
Sub health centres
0
S OURCE : HMIS C ELL , A GE NCY S URGEO N ’ S O FFICE
2.6.2 Human Resources at the Age nc y Surgeon Office
Table 2.5 summarises the human resource situation at the agency surgeon’s office.
T ABLE 2.5: H U MAN
RECOU RSES IN OFF ICE OF T HE AGENC Y SURGEON
Name of post
Sanctioned
Filled
% Filled
Agency surgeon
1
1
100
Deputy agency surgeon
0
0
0
48
Name of post
Sanctioned
Filled
% Filled
Agency coordinator national program for FP & PHC
1
1
100
Agency coordinator EPI surveillance/FSMO*
1
1
100
Agency coordinator NMNCHP
1
1
100
Communicable disease control (CDC) officer
0
0
0
Agency sanitary inspector
1
1
100
Tehsil sanitary inspector
1
1
100
Agency superintendent vaccination
1
1
100
Assistant superintendent vaccination
1
1
100
Inspector vaccination
1
1
100
Total
9
9
100%
*Field Surveillance Medical Officer
S OURCE : A GE NCY S URGEO N ’ S O FFICE
2.6.3 MNCH staff in Bajo ur age nc y
Table 2.6 summarises the status of MNCH staffing in the health facilities including the
AHQH, and all of the CHs, RHCs and BHUs in the agency. The information was collected
from the office of the EDOH/DHO during the survey.
This information may not match with the subsequent tables containing similar information on
human resources collected from the respective surveyed health facilities (No. 3.7, 3.12, 3.17,
3.21 and 3.22).
T ABLE 2.6: A VAILABILIT Y
OF
MNCH
SER VIC ES ST AFFING IN
B AJOUR
Filled
Gynaecologist
1
0
0
0
0
0
0
Paediatrician
1
0
0
0
0
0
0
Posts
% Filled
Sanctioned
Filled posts
AHQH
(1)
CH (1)
R
C
R
C
RHC (2)
R
C
BHU
(20)
R
C
49
Filled
Anaesthetist
1
1
100
1
0
0
0
Radiologist
1
0
0
0
0
0
0
Pathologist
1
0
0
0
0
0
0
Women medical officers (WMOs)
7
2
29
2
0
0
0
0
0
0
0
Medical officers (MOs)
43
24
56
24
0
0
0
0
0
0
0
Blood transfusion officers
0
0
0
0
0
0
0
3
3
100
1
0
2
0
2
2
100
2
0
0
0
-
-
-
-
-
-
LHVs
16
7
44
1
0
1
0
2
0
3
0
Nurses
23
18
50
15
0
2
0
0
0
1
Lady health workers (LHWs)*
-
-
-
Laboratory technician
5
5
100
4
0
1
0
0
0
X-ray technician
6
6
100
5
0
1
0
0
0
Dispenser
86
86
100
61
0
4
0
2
0
Vaccinators
8
5
63
Ambulance drivers
8
6
75
4
0
2
0
0
0
Total
212
165
78%
-
-
-
-
-
-
Posts
R= R EGULAR ,
% Filled
Sanctioned
Filled posts
-
AHQH
(1)
CH (1)
R
C
R
C
BHU
(20)
RHC (2)
R
C
R
C
19
0
-
-
C= O N C ONTRACT
S OURCE : HMIS C ELL , A GE NCY S URGEO N ’ S O FFICE , * C OMMUNITY BASED W ORKER
50
2.7 Financial Allocations
Budgetary allocations and expenditure over the last three years for the agency (in PKR
Million) was supposed to be presented in the following table, but the data was not available
at the office of the agency surgeon.
T ABLE 2.7: F IN ANC IAL
Agency health
budget
(In millions)
ALLOCAT ION S IN
B AJOUR
AG ENCY
2007-08
2008-09
2009-10
Allocation
Expenditure
Allocation
Expenditure
Allocation
Expenditure
Nondevelopment
-
-
-
-
-
-
Development
-
-
-
-
-
-
Total
-
-
-
-
-
-
Information about donor contributions for MNCH services was retrieved from the office of the
agency surgeon, in terms of financial input. It was reported that no donor contributions were
provided to this agency. During the survey, information about donor inputs at the surveyed
health facilities was also collected. None of the health facilities were found to have received
inputs in terms of infrastructure, equipment, human resources etc.
2.9 NMNCH Programme Indicators
Information on NMNCHP indicators is being compiled at the office of the EDOH and this
information has been gathered on the sets of indicators, which is reproduced as such in
the following tables. It is important to note that services utilisation data reported by the
agency office takes into account utilisation of all of the public sector facilities in the agency.
This information may not match with the subsequent tables containing information on drugs
and supplies (No. 3.4, 3.9, 3.14, 3.19 and 3.29) and C-sections (No. 3.34) collected from the
respective health facilities included in the survey.
51
T ABLE 2.8: NMNCHP
MON IT ORING IND ICAT ORS
(Y EAR 2010)
Services management
Number of agency monthly performance review meetings held during last year
6
Number of facilities out of the stock of family planning commodities
-
Number of facilities out of the stock of essential EmONC drugs
-
Support services
Number of facilities with laboratory services available
2
Number of facilities with blood transfusion services available
1
Service utilisation
Antenatal care coverage
8022
Percentage of children <12 months fully vaccinated
23%
TT-2 coverage
2212
Number of deliveries at health facilities
3110
Number of live births at health facilities
3001
Postnatal coverage
609
Number of family planning visits (by type of modern method) at health facilities
-
Number of caesarean sections at comprehensive EmONC facilities
-
Morbidity and mortality
Number of maternal deaths
15
Number of neonatal deaths
109
Number of diarrhoea / dysentery in <5 years age group
7012
Number of pneumonia in <5 years age group
-
Lady health workers (NP FP&PHC)
Number of new pregnant mothers registered
-
Number of SBA deliveries reported
-
Number of maternal deaths reported
-
Number of modern family planning methods users
-
Number of infant deaths reported
-
Community mid-wives (NMNCHP)
Number of first antenatal care visits (ANC 1)
CMWs have not been deployed yet
0
52
Number of ANC revisits
0
Number of TT 2 given
0
Number of deliveries
0
Number of post natal visits
0
Number of family planning visits (both new and follow-up)
0
Number of family planning commodities provided
0
Number of maternal complications referred
0
Number of neonates referred
0
Number of clean/safe delivery kits used
0
Out of the stock of clean/safe delivery kits
0
Out of the stock of family planning commodities
0
Number of pregnant women referred by LHWs
0
Number of maternal deaths
0
Number of neonatal deaths
0
S OURCE : HMIS C ELL , MNCH C ELL , EPI C ELL – A GE NCY S URGE ON O FFICE
2.9.1 Pro vision of Staff by the NMNCHP
The NMNCHP is supposed to provide support in terms of human resources at targeted
health facilities, including specialists, doctors and paramedics. The programme is currently
under implementation and the number of facilities having staff provided by the NMNCHP is
given in Table 2.9.
OF FAC ILIT IES W IT H ST AFF PROVIDED BY T HE
NMNCHP
Number of health facilities
Staff cadre
AHQH
CH
RHCs
BHUs
Gynaecologist
0
0
0
0
Anaesthetist
0
0
0
0
Paediatrician/Neonatologist
0
0
0
0
WMO
0
0
0
0
53
Number of health facilities
Staff cadre
AHQH
CH
RHCs
BHUs
0
0
0
0
0
0
0
0
Lab technician
0
0
0
0
0
0
0
0
Nurses
0
0
0
0
LHVs
0
0
0
0
Ambulance drivers
0
0
0
0
S OURCE : MNCH C ELL – A GE NCY S URGEO N O FFICE
2.9.2 MNCH Staff T raini ng
Part of the mandate of the programme is to build the capacity of MNCH related staff through
conducting skill development training of the staff in standards of service provision,
counselling techniques and client centeredness. Information about the training of MNCH
staff is presented in Table 2.10. It is important to note here that this information collected
from the agency office may not match with the similar information contained in Table no.
3.26 collected from the surveyed facilities.
OF ST AFF T RAINED ON DELIVER ING
MNCH
SERVICES
Number of staff trained (during last three years)
Category of staff
EmONC
ENC
IMNCI
IMPAC
FP
surgical
FP
counselling
Client
centeredness
Gynaecologist
0
0
0
0
0
0
0
Paediatrician
0
0
0
0
0
0
0
Anaesthetist
0
0
0
0
0
0
0
WMO
1
0
0
0
0
0
0
MO
0
0
0
0
0
0
0
54
Number of staff trained (during last three years)
Category of staff
EmONC
ENC
IMNCI
IMPAC
FP
surgical
FP
counselling
Client
centeredness
0
0
0
0
0
0
0
Nurse
4
0
0
0
0
0
0
LHV
4
0
0
0
0
0
0
S OURCE : MNCH C ELL – A GE NCY S URGEO N O FFICE
2.9.3 CMWs’ T raining a nd Deployme nt
Part of the mandate of the programme is to train and deploy community mid-wives for
improving community based MNCH services. The information collected from the agency
NMNCH cell related to the training and deployment of community mid-wives is presented in
Table 2.11.
OF
CMW S ’
T RAIN ING AND DEPLOYMEN T
Training and deployment of community mid-wives (NMNCHP)
Number of selected CMWs verified for their residential status
-
Number of CMWs with completed training
-
Number of CMWs deployed
-
Number of CMW schools where renovation/construction completed
-
CMW’s manual/books available (Number of sets)
-
CMW’s training equipment/models available (Number)
-
Number of CMWs sponsored/supported by partners
-
55
ANNEX 2
Input Criteria for MNCH Services
A. Civil Works Criteria
CIVIL WORKS SCOPE FOR BHUS
OPTIMAL ITEMS
Ob/Gyn OPD or LHV’s room
2. Examination area
3. Hand washing facilities
Labour room
1. Delivery room
2. Scrub area
3. Functional attached washroom for patients
WMO or LHV’s residence
1. Available
2. Good condition
MINIMAL ITEMS
LHV’s room
Available
CIVIL WORKS SCOPE FOR RHCS
OPTIMAL ITEMS
Ob/Gyn OPD
2. Examination area
Ob/Gyn ward
1. Patient area
2. Functional attached washroom
Labour room
1. Delivery room
2. Scrub area
Clinical laboratory
1. Laboratory room
2. Working area
LHV’s room
2. Examination area
Residence - WMO
1. Available
2. Good condition
Residence - LHV
1. Available
2. Good condition
MINIMAL ITEMS
Ob/Gyn OPD
Available
56
CIVIL WORKS SCOPE FOR RHCS
OPTIMAL ITEMS
Ob/Gyn ward
Available
Labour room
Available
LHV’s room
Available
Residence - WMO
1. Available
2. Good condition
Residence - LHV
1. Available
2. Good condition
CIVIL WORKS SCOPE FOR AHQH & THQH
OPTIMAL ITEMS
Ob/Gyn OPD
2. Examination area
Ob/Gyn ward
1. Patient area
2. Nursing station
3. Store for general items/drugs
Labour room
1. Delivery room
2. Preparation/ stage room
3. Scrub area
4. Staff duty room
5.
6.
7.
8.
Store for general items/drugs
Store for equipment
Functional attached washroom for patients
Functional attached washroom for staff
Operation theatre
1. Patient preparation room
2. Operating room
3. Recovery room
4. Scrub area
5.
6.
7.
8.
9.
10.
Sterilization area
Doctors’ room
Support staff duty room
Store for general items/drugs or equipment
Store of equipment
Functional attached washroom for staff
Paediatric ward
1. Patient area
2. Nursing station
Paediatric nursery
1. Patient area
2. Nursing station
4. Change room
57
Clinical laboratory
1. Laboratory room
2. Working area
3. Doctors’ duty room
4. Store for chemical / reagents or equipment
Blood bank
1. Blood collection room
2. Working area
3. Staff duty room
4. Store for equipment / reagents
LHV’s room
2. Examination area
Ultrasound room
Examination area
Residence - Gynaecologist
·
·
Available
Good condition
Residence - Anaesthetist
·
·
Available
Good condition
Residence - Paediatrician
·
·
Available
Good condition
Residence - WMO
·
·
Available
Good condition
Residence - LHV
·
·
Available
Good condition
Residence - Nurse
·
·
Available
Good condition
Residence - Lab technician
·
·
Available
Good condition
Residence - Blood bank technician
·
·
Available
Good condition
Residence - Anaesthesia technician
·
·
Available
Good condition
MINIMAL ITEMS
Ob/Gyn OPD
Available
Ob/Gyn ward
Available
Labour room
Available
Operation theatre
Available
Paediatric ward
Available
Clinical laboratory
Available
58
Residence - Gynaecologist
·
·
Available
Good condition
Residence - Anaesthetist
·
·
Available
Good condition
Residence - Paediatrician
·
·
Available
Good condition
Residence - WMO
·
·
Available
Good condition
Residence - Lab technician
·
·
Available
Good condition
B. Human Resources Crite ria
HUMAN RESOURCES FOR PREVENTIVE EmONC
HUMAN RESOURCES FOR 24/7 BASIC EmONC
OPTIMAL HR FOR BHUS
OPTIMAL HR FOR RHCS
Category
Number
Category
MO, or
1
WMOs
2
LHV
1
1
-
-
Lab technician
1
-
-
LHVs
2
-
-
Ambulance driver
1
MINIMAL HR FOR BHUS
Number
MINIMAL HR FOR RHCS
MO, or
1
WMO
1
LHV
1
Lab technician
1
-
-
LHV
1
-
-
-
-
HUMAN RESOURCES FOR 24/7 COMPREHENSIVE EmONC
OPTIMAL HR FOR AHQH
Category
OPTIMAL HR FOR THQH
Number
Category
Number
Gynaecologist
2
Gynaecologist
1
Anaesthetist
2
Anaesthetist
1
Paediatrician
2
Paediatrician
1
WMOs
6
WMOs
4
4
4
4
4
59
Lab technician
3
Lab technician
2
4
4
Nurses
20
Nurses
12
LHVs
4
LHVs
4
Ambulance drivers
4
Ambulance drivers
4
MINIMAL HR FOR AHQH
MINIMAL HR FOR THQH
Gynaecologist
1
Gynaecologist
1
Anaesthetist
1
Anaesthetist
1
Paediatrician
1
Paediatrician
1
WMOs
4
WMOs
2
1
1
Lab technician
1
Lab technician
1
Nurses
6
Nurses
4
LHVs
1
LHVs
1
C. Equipme nt crite ria
EQUIPMENT FOR BHUS
OPTIMAL ITEMS
General hospital equipment
1. Electric water cooler
2. Water filter
3. Incinerator
OPD / WMO’s office
1. Office / Plain chairs
2. Examination couch
3. Office tables with drawers
4. Steel almirah (Large)
5. Patient’s stool
6. Weighing machine (Adult)
7.
8.
9.
10.
11.
12.
13.
14.
Weighing machine (Infant)
Height measuring board
Height measuring device
B.P apparatus mercury - desk type
Foetal stethoscope
Steam inhaler
Nebulizer
Examination lamp
Lady health visitor’s room
1. Weight scale (Adult)
2. Weight scale (Infant)
3. Height measuring device
4. Height measuring board
5. Disposable syringe cutter
6. D & C instruments set
7.
8.
9.
10.
11.
12.
P.V. examination light
Examination couch
Office chairs
Office tables with drawers
Patient’s stool
Steel almirah (Large)
60
MINIMAL ITEMS
1.
2.
3.
4.
5.
Office chairs
Foetal stethoscope
Weight scale (Adult)
6.
7.
8.
9.
10.
Weight scale (Infant)
D & C instruments set
Examination couch
EQUIPMENT FOR RHCS
OPTIMAL ITEMS
General hospital
1. Ambulance
3. Water filter
4. Incinerator
Female ward items
1. Fowler bed (Iron)
2. Attendant's bench
3. Bed side locker
4. Overhead food trolley
5.
6.
7.
8.
9.
Dust bin (Stainless steel)
Screen folding (Complete)
Baby cot
Stethoscope
1. Office chairs
2. Plain chairs
6. Patient’s stool
8.
9.
10.
11.
12.
13.
14.
15.
Weighing machine (Infant)
Foetal stethoscope
Steam inhaler
Nebulizer
Examination lamp
Labour room
1. UPS power supply system (2000W)
2. Suction machine (Electric)
3. Infant weighing machine
4. Foetal stethoscope
5. Electric instrument sterilizer (12”x6”)
6. Jar for forceps
7. Spring type dressing forceps (S.s)
8. Sim’s speculum (Right angle, small)
9. Sim’s speculum (Right angle, medium)
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
Sim’s speculum (Right angle, large)
Sponge forceps
Artery forceps (Long, straight)
Uterine sound
Vulsellum forceps
Scissors (Dissecting, blunt pointed)
Artery forceps
Blunt-ended scissors
Infant ambo bag
61
EQUIPMENT FOR RHCS
OPTIMAL ITEMS
2. Weight scale (Infant)
3. Height measuring device
4. Height measuring board
5. P.V. examination light
6.
7.
8.
9.
10.
Examination couch
Office chairs
Patient’s stool
MINIMAL ITEMS
Female ward items
2. B.P apparatus mercury - desk type
3. Stethoscope
1. Office chairs
5. B.P apparatus mercury - desk type
Labour room
3. Sponge forceps
4. Uterine sound
5.
6.
7.
8.
Vulsellum forceps
Artery forceps
1. Office chairs
4.
5.
6.
7.
Weight scale (Infant)
Examination couch
EQUIPMENT FOR AHQ HOSPITAL
OPTIMAL ITEMS
General hospital
1. Ambulance
2. Defibrillator
3. Desktop computer with monitor and
accessories
62
OPTIMAL ITEMS
Gynae/Obs. ward items
1. Cabinet instrument (Large)
4. Bed side locker
5. Screen folding (Complete)
7. Artery forceps (7 inch)
8. B P apparatus mercury – desk type
9. Dissecting forceps (Plain, 7 inch)
10.
11.
12.
13.
14.
15.
16.
Scissors (Curved, 5 inch)
Scissors (Sharp, 5 inch, straight)
Chital forceps
Kidney tray (S.s 10 inch)
Jar for forceps
Infusion / drip stands
Foetal monitor (Foetal doppler - desk
type)
17. Infant B.P apparatus
19. Baby cot
OPD / Gynaecologist’s office
4. Ultrasound machine
5. Examination lamp
6.
7.
8.
9.
10.
11.
12.
Stethoscope (Adult size)
B.P apparatus - desktop type
Office chair
Office table with drawers
Patient’s stool
Patient waiting bench
Examination couch
Paediatric nursery
1. Air ways 2 size
2. Infant ambo bag
3. Infant laryngoscope set
4. Suction apparatus: electrically operated
5. Infant incubators
6.
7.
8.
9.
10.
11.
12.
13.
Phototherapy unit
Baby warmer
Infant B.P apparatus (Cuff 2.5 cm)
Room thermometer
Baby cot
Steam inhaler
Oxygen cylinder complete with trolley
Paediatric ward
1. Suction machine
2. Infant B.P apparatus (Cuff 2.5 cm)
3. Stethoscope - Paediatric Littman type
4. Nebulizer
5. Oxygen cylinder complete with trolley
6.
7.
8.
9.
10.
Emergency medicine trolley
Patient's attendant bench
Fowler bed (Iron)
Bed side locker (S.s top)
63
OPTIMAL ITEMS
Labour room
3. Jar for forceps
7. Sim’s speculum (Right angle, large)
8. Sponge forceps
9. Artery forceps (Long, straight)
10. Uterine sound
11. Vulsellum forceps
12. Scissors (Dissecting, blunt pointed)
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
Operation theatre
1. Needle holder
2. Stitch scissors
3. Dissecting forceps (Toothed)
4. Sim’s speculum (Large)
5. Sim’s speculum (Medium)
6. Vacuum extractor
7. Obstetric forceps
8. Rectangular instrument tray & lids
9. Towel clips
10. Sponge forceps (22.5 cm)
11. Artery forceps (Straight,16 cm)
12. Uterine homeostasis forceps (20 cm)
13. Hysterectomy forceps (Straight, 22.5 cm)
14. Mosquito forceps (12.5 cm)
15. Tissue forceps (19 cm)
16. Needle holder (Straight, 17.5 cm)
17. Surgical knife handle # 3
19. Abdominal retractors, double-ended
(Richardson)
20. Curved operating scissors, blunt pointed
(Mayo), 17 cm
21. Straight operating scissors, blunt pointed
(Mayo), 17 cm
22. Aesthetic face masks (3 sizes)
23. Anaesthesia machine
24. Laryngoscopes
25. X-Ray illuminator
26. Gynae instrument set
27. General instrument set
28. Adult ambo bag and mask
30. Myomectomy screw
31. Air conditioners
Laboratory
1. Spin machine
2. Chemistry analyzer
3. Counter (Hand tally differential)
5. Lab cabinet
Artery forceps
Episiotomy instruments set (Complete)
D&C instruments set (Complete)
Delivery forceps set
Infant ambo bag
Portable light & rechargeable batteries
Sterilizing drum
Vacuum extractor
Delivery table
MINIMAL ITEMS
64
OPTIMAL ITEMS
2. Examination lamp
3. Stethoscope (Adult size)
4.
5.
6.
7.
Paediatric nursery
1. Air ways 2 size
2. Infant ambo bag
6. Phototherapy unit
Paediatric ward
2. Nebulizer
Labour room
5. Sponge forceps
6.
7.
8.
9.
10.
11.
Operation theatre
2. Laryngoscopes
B.P apparatus - desktop type
Office chair
Office table with drawers
Examination couch
Uterine sound
Vulsellum forceps
D&C instruments set (Complete)
Delivery table
EQUIPMENT FOR THQ HOSPITAL
OPTIMAL ITEMS
General hospital
1. Ambulance
2. Defibrillator
3. Desktop computer with monitor and
accessories
65
OPTIMAL ITEMS
1. Cabinet instrument (Large)
2. Fowler bed (Iron )
4. Bed side locker
7. Artery forceps (7 inch)
9. Dissecting forceps (Plain, 7 inch)
10.
11.
12.
13.
14.
15.
16.
Scissors (Curved, 5 inch)
Scissors (Sharp, 5 inch, straight)
Chital forceps
Kidney tray (S.s 10 inch)
Jar for forceps
Foetal monitor (Foetal doppler - desk
type)
17. Infant B.P apparatus
19. Baby cot
4. Ultrasound machine
5. Examination lamp
Paediatric nursery
1. Air ways 2 size
2. Infant ambo bag
6.
7.
8.
9.
10.
11.
12.
13.
Phototherapy unit
Baby warmer
Room thermometer
Baby cot
Steam inhaler
Paediatric ward
1. Suction machine
2. Infant B.P apparatus (Cuff 2.5 cm)
4. Nebulizer
6.
7.
8.
9.
10.
Fowler bed (Iron)
Labour room
3. Jar for forceps
8. Sponge forceps
9. Artery forceps (Long, straight)
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
Uterine sound
Vulsellum forceps
Artery forceps
Infant ambo bag
Portable light & rechargeable batteries
Sterilizing drum
Vacuum extractor
66
OPTIMAL ITEMS
Operation theatre
1. Needle holder
2. Stitch scissors
3. Dissecting forceps (Toothed)
4. Sim’s speculum (Large)
5. Sim’s speculum (Medium)
6. Vacuum extractor
7. Obstetric forceps
8. Rectangular instrument tray & lids
9. Towel clips
10. Sponge forceps (22.5 cm)
11. Artery forceps (Straight,16 cm)
12. Uterine homeostasis forceps (20 cm)
13. Hysterectomy forceps (Straight, 22.5 cm)
14. Mosquito forceps (12.5 cm)
15. Tissue forceps (19 cm)
16. Needle holder (Straight, 17.5 cm)
19. Abdominal retractors, double-ended
(Richardson)
20. Curved operating scissors, blunt pointed
(Mayo), 17 cm
21. Straight operating scissors, blunt pointed
(Mayo), 17 cm
22. Aesthetic face masks (3 sizes)
24. Laryngoscopes
25. X-Ray illuminator
27. General instrument set
28. Adult ambo bag and mask
30. Myomectomy screw
31. Air conditioners
Laboratory
1. Spin machine
2. Chemistry analyzer
3. Counter (Hand tally differential)
5. Lab cabinet
MINIMAL ITEMS
2. Examination lamp
Paediatric nursery
1. Air ways 2 size
2. Infant ambo bag
6. Phototherapy unit
Paediatric ward
2. Nebulizer
Labour room
4.
5.
6.
7.
Operation theatre
2. Laryngoscopes
Sponge forceps
Uterine sound
Vulsellum forceps
67
D. Drugs and Supplies Crite ria
DRUGS & SUPPLIES FOR BHUS
OPTIMAL ITEMS
Supplies
1. Gloves
2. Clean / Safe delivery kit
3. Disposable/ Auto disable syringes
4. Reagents/ strips for routine lab tests
5. Surgical spirit
6. Oral Rehydration Salt – ORS
Tracer drugs
1. Capsule Amoxicillin
2. Syrup Amoxicillin
3. Tablet Metronidazole
4. Syrup Metronidazole
5. Tablet Iron
6. Tablet Folic acid
7.
8.
9.
10.
11.
12.
Vaccines
1. BCG
2. OPV
3. Penta-valent
4. Measles
5. TT
1. Condoms
2. COC
3. POP
4. IUCDs
5. Injection DMPA
6. Injection Net-En
Tetracycline ointment
Injection Oxytocin
IV solutions
Syrup Salbutamol
Syrup Chloroquine
Syrup Zinc Sulphate
MINIMAL ITEMS
Supplies
Tracer drugs
1. Tablet Iron
Vaccines
1. BCG
2. OPV
3. Penta-valent
4. Measles
5. TT
Family planning commodities (any three)
1. Condoms
2. IUCDs
3. COC or POP
4. Injection DMPA or Net-En
68
DRUGS & SUPPLIES FOR RHCS
OPTIMAL ITEMS
Supplies
1. Gloves
5. Surgical spirit
6. Oral Rehydration Salt – ORS
Tracer drugs
1. Injection Dexamethasone
2. Injection Adrenaline
3. Injection Atropine
4. Injection Ampicillin
9. Tablet Iron
10.
11.
12.
13.
14.
15.
16.
17.
18.
Vaccines
1. BCG
2. OPV
3. Penta-valent
4. Measles
5. TT
1. Condoms
2. COC
3. POP
4. IUCDs
5. Injection DMPA
6. Injection Net-En
Tablet Folic acid
Injection Oxytocin
Injection Magnesium Sulphate
IV solutions
Syrup Salbutamol
Syrup Chloroquine
Syrup Zinc Sulphate
Injection Diclofenac Sodium
MINIMAL ITEMS
Supplies
Tracer drugs
2. Injection Oxytocin
3. Injection Magnesium Sulphate
Vaccines
1. BCG
2. OPV
3. Penta-valent
4. Measles
5. TT
1. Condoms
2. IUCDs
3. COC or POP
69
DRUGS & SUPPLIES FOR AHQH & THQH
OPTIMAL ITEMS
Supplies
1. Gloves
5.
6.
7.
8.
9.
Screening kits for Hep B,C & HIV
Blood grouping reagents
Blood bags with transfusion sets
Surgical spirit
Oral Rehydration Salt – ORS
Tracer drugs
9. Tablet Iron
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Injection Oxytocin
IV solutions
Syrup Salbutamol
Syrup Chloroquine
Syrup Zinc Sulphate
Injection Thiopentone Sodium
Injection Neostigmine
Injection Propofol
Vaccines
1. BCG
2. OPV
3. Penta-valent
4. Measles
5. TT
1. Condoms
2. COC
3. POP
4.
5.
6.
7.
IUCDs
Injection DMPA
Injection Net-En
Implants
MINIMAL ITEMS
Supplies
1. Gloves
5. Screening kits for Hep B,C & HIV
6. Blood grouping reagents
Tracer drugs
5.
6.
7.
8.
9.
Vaccines
1. BCG
2. OPV
3. Penta-valent
4. Measles
5. TT
1. Condoms
2. IUCDs
3. COC or POP
5. Implants
Injection Oxytocin
Injection Thiopentone Sodium
Injection Neostigmine
Injection Propofol
70
E. Support Se rvices Criteria
SUPPORT SERVICES FOR BHUS
SUPPORT SERVICES FOR RHCS
OPTIMAL CRITERIA
OPTIMAL CRITERIA
Basic lab tests
1. Space
2. Doctor or LHV or laboratory technician
3. Reagents and strips
Basic lab tests
1. Doctor or LHV
Ambulance services
1. Functional ambulance
2. Ambulance driver
MINIMAL CRITERIA FOR BHUS
MINIMAL CRITERIA FOR RHCS
Basic lab tests
1. Space
2. Doctor or LHV or laboratory technician
Basic lab tests
1. Doctor or LHV
SUPPORT SERVICES CRITERIA FOR SHC HOSPITALS
OPTIMAL CRITERIA
Basic lab tests
1. Space
2. Laboratory technician
4. Laboratory equipment
Blood transfusion services
1. Blood bank technician or laboratory
technician
2. Screening strips for Hep B, C & HIV
Radiology services
1. Space
2. Ultrasound equipment
Operation theatre services
1. Space
2. Anaesthetist
3. Operation theatre technician
4. Anaesthesia technician
5. Operation theatre equipment
Ambulance services
2. Ambulance driver
MINIMAL CRITERIA
Basic lab tests
1. Space
2. Laboratory technician
Blood transfusion services
1. Laboratory or blood bank technician
2. Screening strips for Hep B, C & HIV
71
Radiology services
1. Space
2. Ultrasound equipment
Operation theatre services
1. Space
2. Anaesthetist or Anaesthesia technician
3. Operation theatre equipment
F. Infection Co ntrol & Waste Ma nagement Crite ria
ASSESSMENT CRITERIA
Infection control – Hand washing
1. Hand washing basin with running water
2. Soap
3. Towel
4. Gloves
Personal protection materials
1. Face masks
2. Safety goggles
3. Heavy duty leather gloves
4. Gowns
5. Industrial boots
Waste collection materials
1. Safety boxes
2. Colour-coded plastic bags
Waste treatment equipment
1. Autoclave for waste treatment
2. Autoclave test strips
Disinfection of service provision areas
1. Cleaning materials
2. Chemical disinfectant
G. Input Criteria fo r Basic EmONC servi ces at T HQ hospital
G.1 - Civil works
CIVIL WORKS SCOPE
OPD
2. Examination area
Female ward
1. Patient area
72
Labour room
1. Delivery room
2. Scrub area
Clinical laboratory
1. Laboratory room
2. Working area
LHV’s room
2. Examination area
Residence - WMO
·
·
Available
Good condition
Residence - LHV
·
·
Available
Good condition
G.2 - Human Resources
HUMAN RESOURCES
Category
Number
WMOs
2
1
Lab technician
1
LHVs
2
Ambulance drivers
1
G. 3 - Equipme nt
EQUIPMENT
General hospital
1. Ambulance
Female ward
3. Bed side locker
6. Baby cot
OPD
3. Examination lamp
73
Labour room
3. Jar for forceps
8.
9.
10.
11.
12.
13.
14.
Sponge forceps
Artery forceps (Long, straight)
Uterine sound
Vulsellum forceps
Artery forceps
G.4 - Drugs and Supplies
DRUGS & SUPPLIES
Supplies
1. Gloves
5. Screening kits for Hep B,C & HIV
6. Blood grouping reagents
Tracer drugs
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Vaccines
1. BCG
2. OPV
3. Penta-valent
4. Measles
5. TT
1. Condoms
2. COC
3. POP
4. IUCDs
5. Injection DMPA
6. Injection Net-En
Tablet Iron
Tablet Folic acid
Injection Oxytocin
IV solutions
Syrup Salbutamol
Syrup Chloroquine
Syrup Zinc Sulphate
74
G.5 - Support services
SUPPORT SERVICES
Laboratory services
1. Basic laboratory tests
Ambulance services
2. Ambulance driver
75
ANNEX 3-A
Status of Surveyed Health Facilities against the Minimal
Level of Inputs
A. Status of BHUs
i.
STATUS OF ASSESSED INFRASTRUCTURE IN BHU S
Status of building components at surveyed BHUs
Infrastructure
BHU Loesam
BHU Chenagai
BHU Zorbander
BHU Ghani Adda
LHV’s room - Available
N
Y
Y
Y
LHV’s room - Functional
N
Y
Y
Y
ii.
STATUS OF MNCH RELATED STAFF IN BHU S
Availability of MNCH related staff at surveyed BHUs*
Staff categories
WMO/MO or LHV
Required
number
1
BHU Loesam
BHU Chenagai
BHU Zorbander
BHU Ghani
Adda
0
2
1
0
* Available staff includes regular and NMNCHP provided staff
iii.
STATUS OF FUNCTIONAL EQUIPMENT IN BHU S
Equipment
Assessed items
Availability of functional equipment items at
surveyed BHUs
Total items
10
BHU Loesam
BHU Chenagai
BHU Zorbander
BHU Ghani
Adda
0
9
8
5
76
iv.
STATUS OF DRUGS AND SUPPLIES IN BHU S
Total items
required at
each BHU
BHU Loesam
BHU Chenagai
BHU
Zorbander
BHU Ghani Adda
Supplies*
3
0
2
2
0
Drugs*
2
0
2
2
2
Vaccines
5
0
5
5
5
Family planning
commodities
4
0
4
1
4
Item groups
* Tracer items were selected for assessment from list provided in the PC-1 NMNCHP
v.
STATUS OF SUPPORT SERVICES IN BHU S
Support services
Basic lab tests*
Total items
required at
each BHU
BHU Loesam
BHU Chenagai
BHU
Zorbander
BHU Ghani
Adda
2
0
1
1
0
*Includes facility for tests of pregnancy, haemoglobin, urine for protein and sugar, and malaria.
B. 24/7 Basic EmO NC Services at RHCs
i.
STATUS OF ASSESSED INFRASTRUCTURE IN RHC S
Infrastructure
OPD
Female ward
Status
RHC Pashat
RHC Barang
A
Y
Y
F
Y
Y
A
Y
Y
F
N
Y
77
Labour room
LHV’s room
Residence - Doctor
Residence - LHV
ii.
A
Y
Y
F
N
Y
A
Y
Y
F
Y
Y
A
Y
Y
F
Y
Y
A
Y
Y
F
Y
Y
STATUS OF MNCH RELATED STAFF IN RHC S
Staff categories
Required
number at
each RHC
Number of MNCH related staff available at each RHC*
RHC Pashat
RHC Barang
WMO
1
0
0
LHV
1
1
2
Lab technician
1
1
0
*Available staff includes regular and NMNCHP provided staff
iii.
STATUS OF FUNCTIONAL EQUIPMENT IN RHC S
Equipment
Total items
required at
each RHC
Number of functional equipment items available at
each RHC
RHC Pashat
RHC Barang
Female ward
3
1
3
WMO OPD
5
5
4
Labour room
8
0
4
LHV’s room
7
6
7
78
iv.
STATUS OF DRUGS AND SUPPLIES IN RHC S
Item groups
Total items
required at
each RHC
RHC Pashat
RHC Barang
Supplies*
3
2
1
Drugs*
3
2
1
Vaccines
5
5
5
Family planning
commodities
4
0
3
v.
STATUS OF SUPPORT SERVICES IN RHC S
Basic lab tests*
Total items
required at
each RHC
RHC Pashat
RHC Barang
Basic lab tests*
4
4
3
Ambulance service
2
2
0
C. 24/7 Compre hensi ve EmO NC Service s at SHC Hospitals
i.
STATUS OF ASSESSED INFRASTRUCTURE IN SHC HOSPITALS
Status of building components in SHCs
Infrastructure
Gynae OPD
Gynae ward
Labour room
Status
AHQH Khar
CH Nawagai
A
Y
Y
F
Y
Y
A
Y
N
F
Y
N
A
Y
Y
F
Y
Y
79
Operation theatre
Paediatric ward
Laboratory
Residences - Gynaecologist
Anaesthetist
Paediatrician
WMO
Lab technician
ii.
A
Y
N
F
Y
N
A
Y
Y
F
Y
Y
A
Y
Y
F
Y
Y
A
N
N
F
N
N
A
Y
Y
F
Y
Y
A
Y
N
F
Y
N
A
Y
Y
F
Y
Y
A
Y
Y
F
Y
Y
STATUS OF MNCH RELATED STAFF IN SHC HOSPITALS
Availability* at AHQH
Availability* at THQH
Staff categories
Required number
AHQH Khar
Required number
CH Nawagai
Gynaecologist
1
0
1
0
Anaesthetist
1
1
1
0
Paediatrician
1
0
1
0
WMOs
4
1
2
0
1
0
1
0
Lab technician
1
4
1
0
Nurses
6
7
4
0
LHVs
1
1
1
1
* Available staff includes regular and NMNCHP provided staff
80
iii.
STATUS OF FUNCTIONAL EQUIPMENT IN SHC HOSPITALS
Availability at AHQH
Availability at THQH/CH
Equipment
Total items
AHQH Khar
Total items
CH Nawagai
Female ward
1
0
1
0
OPD
7
5
2
2
Paediatric nursery
6
0
6
0
Paediatric ward
4
3
4
0
Labour room
11
5
7
2
Operation theatre
4
4
4
0
iv.
STATUS OF DRUGS AND SUPPLIES IN SHC HOSPITALS
Item groups
Total
items
AHQH Khar
CH Nawagai
Supplies*
6
6
1
Drugs*
9
4
1
Vaccines
5
5
5
5
4
2
81
v.
STATUS OF SUPPORT SERVICES IN SHC HOSPITALS
Item groups
Total
items
AHQH Khar
CH Nawagai
Basic laboratory tests*
9
8
4
Blood transfusion
5
5
0
Ambulance services
2
2
1
Radiology services
3
2
0
Operation theatre
16
13
3
82
ANNEX 3-B
Each item is assessed against the standard quantity in different assessed components of the
service provision areas. The standard quantity of the same item may vary in each
component. Annexed tables include the aggregate quantity of each item in all of the
surveyed components. Therefore, the table may show the requirement of an item despite
having the same aggregate quantity with respect to standard, available and functional, as
explained in the following table. Annexed tables show the aggregate quantities of each
assessed item, therefore, the requirement may arise even though the overall standard
quantity is available and functional in the facility.
Quantity of an item
Component
STD*
AVL*
FUNC*
RQRD*
OPD
2
3
3
0
Ward
4
3
3
1
Aggregate
6
6
6
1
* STD: Standard, AVL: Available, FUNC: Functional, RQRD:
Required
A. List of items required for AHQ a nd THQH/CH i n Bajo ur age nc y
AHQH Khar, Bajour - FATA
Item quantities
Item name
Abdominal retractors, double-ended
(Richardson)
Adult ambo bag and mask
Air conditioner (Split) 1.5 Ton (with heating
system)
Air ways 2 size
Ambulance
Anaesthesia machine
Anaesthetic face masks (3 sizes)
Artery forceps (7”)
Attendant's bench
Auto-clave for treatment of hospital waste
B P apparatus mercury – desk type
Baby cot
Baby warmer
Standard
Available
Functional
Required
12
1
1
11
2
1
0
2
10
1
1
9
1
1
2
2
8
30
1
4
21
2
0
4
1
1
7
15
1
3
0
0
0
4
1
0
7
15
1
3
0
0
1
0
1
2
6
15
0
1
21
2
83
C.T.G. machine
Cabinet instrument (Large)
Chemistry analyzer
Chital forceps
Counter (Hand tally differential)
Curved operating scissors, blunt pointed
(Mayo), 17 cm
Defibrillator
Delivery table
Desktop computer with monitor and accessories
Dissecting forceps (Plain, 7”)
Dissecting forceps (Toothed)
ECG machine
Electric instrument sterilizer (12”x6”)
Electric water cooler
Examination couch
Foetal monitor (Foetal doppler - desk type)
Foetal stethoscope
Fowler bed (Iron)
General instrument set
Glucometer
Gynae instrument set
Haematology analyzer
Hysterectomy forceps (Straight, 22.5 cm)
Incinerator (50kg)
Infant ambo bag
Infant laryngoscope set
Infant weighing machine
Infusion pump
Jar for forceps
Kidney tray (S.s 10”)
Lab cabinet
Lab incubator
Laryngoscopes set (Adult)
LaserJet printer
Artery forceps (Long, straight,10”)
Mosquito forceps (12.5 cm)
Myomectomy screw
Nebulizer
Needle holder (Straight, 17.5 cm)
60
6
1
2
1
2
2
70
1
0
1
1
2
1
70
1
0
0
1
2
1
5
5
1
2
0
0
1
6
1
1
5
6
1
1
2
4
2
4
30
1
2
2
1
4
2
1
4
60
1
2
2
1
18
1
2
5
1
5
18
2
4
2
2
5
4
4
3
36
2
2
12
1
1
1
2
5
1
2
1
0
1
1
2
0
1
2
1
40
1
0
2
2
2
1
0
15
0
1
7
0
16
2
0
1
2
2
0
1
1
1
1
1
0
1
2
5
1
2
1
0
1
1
2
0
1
2
1
40
1
0
2
0
1
0
0
15
0
1
7
0
16
2
0
1
1
0
0
1
1
1
1
5
1
0
0
1
1
2
29
1
1
1
0
4
1
0
3
30
0
2
0
1
17
1
2
4
1
4
15
2
1
0
2
4
3
4
3
35
1
1
11
84
Needle holder (Straight,8”)
Obstetric forceps
Office chair
Ophthalmoscope
Overhead food trolley
Oxygen cylinder complete with trolley &
regulator
Patient’s stool
Patient waiting bench
Phototherapy unit
Portable light & rechargeable batteries (OT)
Power generator 50 Kva (Diesel)
Pulse oximeter
Rectangular instrument tray & lids
Refrigerator (10 cuft)
Room thermometer
Scissors (Curved 5”)
Scissors (Sharp, 5” straight)
Shredder (500 litre)
Sim’s speculum (Large)
Sim’s speculum (Medium)
Sim’s speculum (Right angle, medium)
Sim’s speculum (Right angle, small)
Spin machine (centrifuge)
Sponge forceps (22.5 cm)
Spring type dressing forceps (S.s)
Steam inhaler
Sterilizing drum
Stethoscope - Paediatric Littman type
Stitch scissors
Artery forceps (Straight,16 cm)
Straight operating scissors, blunt pointed
(Mayo), 17 cm
Suction apparatus: electrically operated
Surgical knife handle # 3
Tissue forceps (19 cm)
Towel clips
Ultrasound machine
UPS for computer
UPS power supply system (2000W)
4
2
2
2
1
30
0
1
2
1
0
0
0
1
2
1
0
0
4
1
0
1
1
30
9
21
4
5
3
2
2
30
1
1
1
3
3
3
1
2
3
2
10
1
4
4
3
3
3
1
7
2
4
2
4
2
4
4
36
0
2
2
20
0
0
1
0
1
6
0
1
0
1
2
0
0
1
1
0
0
7
5
0
0
2
0
1
0
2
2
0
2
2
20
0
0
1
0
1
4
0
0
0
0
2
0
0
1
1
0
0
3
5
0
0
2
0
1
0
2
2
3
0
0
10
1
1
0
3
2
0
1
2
3
2
8
1
4
3
2
3
3
0
2
2
4
0
4
1
4
2
34
6
0
0
6
4
3
3
36
36
1
4
4
2
4
0
1
0
0
0
0
1
4
0
1
0
0
0
0
3
0
3
35
36
1
4
4
85
Uterine homeostasis forceps (20 cm)
Uterine sound
Vacuum extractor
Vulsellum forceps
Water distillation unit
Water filter
Weighing machine (Adult)
X-Ray illuminator
Total quantities
18
2
2
3
1
2
2
1
0
0
1
0
1
0
2
1
0
0
0
0
1
0
1
1
18
2
2
3
0
2
1
0
766
326
287
551
CH Nawagai, Bajour - FATA
Item name
Abdominal retractors, double-ended (Richardson)
Adult ambo bag and mask
Air conditioner (Split) 1.5 Ton (with heating
system)
Air ways 2 size
Ambulance
Anaesthesia machine
Anaesthetic face masks (3 sizes)
Attendant's bench
Auto-clave for treatment of hospital waste
Baby cot
Baby warmer
C.T.G. machine
Cabinet instrument (Large)
Chemistry analyzer
Chital forceps
Clean delivery kits
Counter (Hand tally differential)
Curved operating scissors, blunt pointed (Mayo),
17 cm
Defibrillator
Desktop computer with monitor and accessories
Disposable syringe cutter
Dissecting forceps (Plain, 7”)
Dissecting forceps (Toothed)
Item quantities
Standard
Available
Functional
Required
2
2
0
0
0
0
2
2
5
3
3
2
2
1
1
2
14
10
1
2
10
2
20
6
1
1
1
2
100
1
0
1
0
0
7
6
0
1
0
0
0
4
0
0
1
1
40
0
0
1
0
0
7
6
0
1
0
0
0
4
0
0
1
1
40
0
2
0
1
2
7
4
1
1
10
2
20
2
1
1
0
1
60
1
2
0
0
2
2
1
3
2
2
2
0
0
0
0
1
0
0
0
0
0
1
0
2
1
3
2
1
2
86
ECG machine
Foetal monitor (Foetal doppler - desk type)
Foetal stethoscope
Fowler bed (Iron)
Glucometer
Gynae instrument set
Haematology analyzer
Hysterectomy forceps (Straight, 22.5 cm)
Incinerator (50kg)
Infant ambo bag
Infant laryngoscope set
Infusion pump
Jar for forceps
Kidney tray (S.s 10”)
Lab cabinet
Lab incubator
Laryngoscopes set (Adult)
LaserJet printer
Mosquito forceps (12.5 cm)
Myomectomy screw
Nebulizer
Needle holder (Straight, 17.5 cm)
Needle holder (Straight,8”)
Obstetric forceps
Ophthalmoscope
Oxygen cylinder complete with trolley & regulator
Phototherapy unit
Portable light & rechargeable batteries (OT)
Power generator 50 Kva (Diesel)
Pulse oximeter
Rectangular instrument tray & lids
Refrigerator 10 cuft
Room thermometer
Scissors (Curved 5”)
Scissors (Sharp, 5” straight)
10
1
1
2
1
4
1
2
20
1
2
2
1
2
1
3
4
1
5
10
1
3
2
1
2
1
3
3
2
2
3
2
2
1
1
10
6
2
10
1
1
1
2
2
2
1
2
3
2
0
1
0
0
0
0
0
1
0
0
0
0
1
0
0
1
0
0
4
4
0
3
1
0
1
0
0
2
0
0
0
0
0
0
0
4
0
1
0
0
0
1
0
0
2
0
0
1
0
0
1
0
0
0
0
0
1
0
0
0
0
1
0
0
1
0
0
4
4
0
3
1
0
1
0
0
2
0
0
0
0
0
0
0
4
0
1
0
0
0
1
0
0
2
0
0
1
0
10
0
1
2
1
4
1
1
20
1
2
2
0
2
1
2
4
1
1
6
1
0
1
1
1
1
3
1
2
2
3
2
2
1
1
6
6
1
10
1
1
0
2
2
0
1
2
2
2
87
Shredder 500 litre
Sim’s speculum (Large)
Sim’s speculum (Medium)
Spin machine (centrifuge)
Steam inhaler
Sterilizing drum
Stethoscope - Paediatric Littman type
Stitch scissors
Artery forceps (Straight,16 cm)
Straight operating scissors, blunt pointed (Mayo),
17 cm
Tissue forceps (19 cm)
Towel clips
Ultrasound machine
UPS for computer
Uterine homeostasis forceps (20 cm)
Uterine sound
Vacuum extractor
Vulsellum forceps
Water distillation unit
Water filter
X-Ray illuminator
Total items
16
1
2
2
3
3
3
1
5
2
3
1
4
2
2
2
2
0
0
0
2
1
1
0
0
0
1
1
2
0
0
0
2
0
0
0
2
1
1
0
0
0
1
1
2
0
0
0
14
1
2
2
1
2
2
1
5
2
2
0
2
2
2
2
2
0
0
2
2
2
2
2
2
1
3
4
2
3
2
3
1
2
3
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
2
2
2
2
2
1
3
4
2
3
2
3
1
2
1
1
437
105
105
332
88
B. List of items required for RHCs i n Bajour agenc y
Available
Functional
Required
Item quantities
Required
1
4
20
2
4
20
2
100
2
1
20
1
1
2
2
20
1
2
2
1
1
3
1
2
1
6
2
20
2
2
2
2
2
2
2
2
2
2
Item quantities
Functional
Ambulance
Attendant's bench
Baby cot
Clean delivery kits
Examination couch
Foetal stethoscope
Fowler bed (Iron)
Incinerator (50kg)
Infant ambo bag
Jar for forceps
Nebulizer
Office chair
Patient’s stool
Plain chairs
Standard
quantity
RHC Pashat, Bajour
- FATA
Available
Item name
RHC Barang, Bajour
- FATA
0
2
12
2
0
12
1
20
1
0
0
0
0
2
1
0
0
1
2
0
0
3
1
1
0
6
2
0
1
3
0
0
0
2
0
0
1
0
0
1
12
2
0
12
1
20
1
0
0
0
0
2
1
0
0
1
2
0
0
3
1
1
0
6
2
0
0
3
0
0
0
1
0
0
1
0
1
3
8
0
4
8
1
80
1
1
20
1
1
0
1
20
1
1
0
1
1
0
0
1
1
0
0
20
2
0
2
2
2
1
2
2
1
2
1
0
0
1
0
0
0
0
0
1
0
0
0
2
1
0
0
2
0
0
0
2
0
0
0
17
2
0
2
2
0
0
0
0
0
0
0
0
1
0
0
1
0
0
0
0
0
1
0
0
0
2
1
0
0
2
0
0
0
2
0
0
0
17
2
0
2
2
0
0
0
0
0
0
0
0
0
4
20
1
4
20
2
100
2
0
20
1
1
0
1
20
1
0
2
1
1
1
1
2
1
0
0
20
0
0
2
2
2
2
2
2
2
2
89
Steam inhaler
Uterine sound
Vulsellum forceps
Water filter
1
2
1
1
1
2
2
1
2
0
2
1
0
0
0
0
0
2
0
2
1
0
0
0
0
0
2
1
0
0
1
1
2
2
1
0
1
2
1
0
0
0
0
0
2
1
2
1
0
0
0
0
0
2
0
0
0
1
1
2
2
1
0
Total
277
81
78
200
39
39
249
C. List of items required for BHUs i n Bajour agenc y
Item quantities
Required
Available
Functional
Required
Total
Item quantities
Standard
quantity
Functional
B P apparatus mercury – desk
type
Clean delivery kits
Examination couch
Foetal stethoscope
Incinerator (50kg)
Nebulizer
Office chair
Patient’s stool
Plain chairs
Steam inhaler
Water filter
BHU Zorbander, Bajour
- FATA
Available
Item name
BHU Loesam, Bajour FATA
1
0
0
1
1
1
0
50
1
1
1
2
1
2
2
1
2
1
4
2
2
2
4
1
2
1
2
0
0
0
0
2
0
0
0
0
2
0
4
2
1
2
3
0
1
0
2
0
0
0
0
2
0
0
0
0
1
0
4
2
0
2
3
0
1
0
2
50
1
1
1
0
1
2
2
1
1
1
0
0
2
0
1
1
1
1
0
12
1
1
0
2
1
1
0
0
2
0
9
2
1
2
0
0
9
0
2
12
1
1
0
2
1
1
0
0
2
0
9
2
1
2
0
0
6
0
2
38
0
0
1
0
0
1
2
1
0
1
0
0
1
0
4
1
0
1
0
85
19
17
68
46
43
51
90
Item quantities
Required
Available
Functional
Required
Total
Item quantities
Standard
quantity
Functional
B P apparatus mercury – desk
type
Clean delivery kits
Examination couch
Foetal stethoscope
Incinerator (50kg)
Nebulizer
Office chair
Patient’s stool
Plain chairs
Steam inhaler
Water filter
BHU K. Lars Din,
Bajour - FATA
Available
Item name
BHU Ghani Adda,
Bajour - FATA
1
0
0
1
1
1
0
50
1
1
1
2
1
2
2
1
2
1
4
2
2
2
4
1
2
1
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
50
1
1
1
2
1
2
2
1
2
1
4
2
2
2
4
1
2
1
2
0
0
0
0
2
1
2
0
0
2
0
6
2
1
4
0
0
2
0
2
0
0
0
0
2
1
2
0
0
2
0
6
2
1
4
0
0
2
0
2
50
1
1
1
0
0
0
2
1
0
1
1
0
1
0
4
1
0
1
0
85
0
0
85
25
25
65
91
D. Estimated cost of requi red equipment at s urve yed facilities
Health facility
Estimated cost
(in PKR)
Health facility
Estimated cost
(in PKR)
AHQH Khar
16,807,426
BHU Loesam
616,496
CH Nawagai
13,582,894
BHU Chenagai
445,255
RHC Pashat
6,386,207
BHU Zorbander
718,046
RHC Barang
1,662,637
BHU Ghani Adda
449,516
92
ANNEX 4
A. Scope of civil works requi red at SHC Hospitals
Rough cost estimate for improvement / renovation
AHQH Khar, Bajour Agency
Description
Boundary wall
Repair of boundary wall
Unit
Qty
Rate
Amount
Sft
10,250
127
1,296,625
Sft
Sft
Sft
Sft
Sft
Sft
11,645
19,504
9,475
121,020
96
427
15
13,492
5,093
66
22
66
11
550
550
22,000
55
55
768,552
429,083
625,337
1,331,224
52,800
234,850
330,000
742,050
280,121
Sft
Sft
228
8,925
77
77
17,518
687,225
Rft
646
385
248,806
Rft
291
385
111,939
1,650
2,219,250
66
22
66
11
550
550
22,000
55
55
35,904
72,600
201,960
188,760
79,200
585,200
154,000
273,353
168,218
Hospital
Main building
Repair
Restoration of roof tiles
Restoration of plaster work
Restoration of floor
Restoration of distempering
Restoration of almirah
Restoration of doors/windows
Tile work in bathrooms
Restoration of toilets
Restoration of electric components
Covered
area
36925
External development
Repair
Approach road
Internal roads (Tuff Pavers)
Sewerage system ( 9 “ dia ) including
manholes
Water supply system ( 3” dia)
New construction
1345
Sft
Residence
Repair
12234
Sft
Sft
Sft
Sft
Sft
Sft
544
3,300
3,060
17,160
144
1,064
7
4,970
3,059
93
New construction
2688
Sft
1,650
Total
15,569,774
Total without new construction
8,915,324
4,435,200
Civil Hospital Nawagai, Bajour Agency
Description
Boundary wall
Unit
Qty
Rate
Amount
Sft
3,000
127
379,500
Sft
Sft
Sft
Sft
Sft
4,183
1,906
21,516
96
428
9
1,516
1,044
22
66
11
550
550
22,000
55
55
92,021
125,813
236,676
52,800
235,400
198,000
83,385
57,402
Sft
Sft
500
925
77
77
38,500
71,225
Rft
271
385
104,335
Rft
109
385
41,869
1,650
8,611,350
66
22
66
11
550
550
17,952
56,870
227,568
99,365
79,200
327,800
Hospital
Main building
Repair
Covered
area
3955
Repair
Approach road
manholes
New construction
5219
Sft
Residence
Repair
8940
Sft
Sft
Sft
Sft
Sft
Sft
272
2,585
3,448
9,033
144
596
94
New construction
20
4,470
2,608
3264
Sft
22,000
55
55
440,000
245,850
143,413
1,650
5,385,600
Total
17,351,892
3,354,942
B. Scope of civil works requi red at RHCs
RHC Pashat, Bajour Agency
Description
Boundary wall
Unit
Qty
Rate
Amount
Sft
4,275
127
540,788
Sft
Sft
Sft
Sft
Sft
Sft
152
15,499
14,655
69,084
168
220
10
1,785
1,275
66
22
66
11
550
550
22,000
55
55
10,007
340,978
967,255
759,928
92,400
121,000
220,000
98,175
70,125
Sft
Sft
150
2,400
77
77
11,550
184,800
Rft
180
385
69,300
Rft
73
385
28,201
1,650
4,392,300
Hospital
Main building
Repair
Covered
area
4080
Repair
Approach road
manholes
New construction
2662
Sft
95
Residence
Repair
5868
Sft
Sft
Sft
Sft
Sft
Sft
544
1,089
1,360
5,808
96
456
3
2,567
1,834
66
22
66
11
550
550
22,000
55
55
Total
8,731,972
4,339,672
35,904
23,958
89,760
63,888
52,800
250,800
66,000
141,199
100,856
RHC Barong, Bajour Agency
Description
Boundary wall
Unit
Qty
Rate
Amount
Sft
8,750
127
1,106,875
Cft
Sft
Sft
Sft
Sft
Sft
Sft
4,641
3,234
6,452
43
35,242
72
246
5
3,047
2,539
132
66
22
66
11
550
550
22,000
55
55
612,563
213,413
141,933
2,812
387,660
39,600
135,300
110,000
167,571
139,643
Sft
Sft
210
6,600
77
77
16,170
508,200
Rft
200
385
76,808
Rft
110
385
42,158
1,650
3,368,475
Hospital
Main building
Repair
Restoration of brick work
Covered
area
8705
Repair
Approach road
manholes
New construction
2041.5
Sft
96
Residence
Repair
4776
New construction
Cft
Sft
Sft
Sft
Sft
Sft
Sft
1088
714
544
952
1,514
5,258
72
474
4
2,786
2,388
Sft
132
66
22
66
11
550
550
22,000
55
55
94,199
35,904
20,933
99,891
57,838
39,600
260,700
88,000
153,230
131,340
1,650
1,795,200
Total
9,846,013
4,682,338
C. Scope of civil works requi red at BHUs
BHU Chenagai, Bajour Agency
Description
Boundary wall
Unit
Qty
Rate
Amount
Sft
1,440
127
182,160
Sft
Sft
Sft
Sft
Sft
1,275
124
10,769
24
64
2
1,103
788
66
22
11
550
550
22,000
55
55
84,150
2,723
118,459
13,200
35,200
44,000
60,638
43,313
Sft
180
77
13,860
Hospital
Main building
Repair
Repair
Approach road
Covered
area
3150
97
manholes
New construction
1222
Sft
2,040
77
157,080
Rft
138
385
52,938
Rft
65
385
25,025
1,650
2,016,300
132
66
22
66
11
550
550
22,000
55
55
102,366
55,440
22,748
146,784
45,496
26,400
180,400
88,000
152,900
122,320
Sft
Residence
Repair
4448
Cft
Sft
Sft
Sft
Sft
Sft
Sft
776
840
1,034
2,224
4,136
48
328
4
2,780
2,224
Total
3,791,898
1,775,598
BHU Zor Bandar, Bajour Agency
Description
Boundary wall
Unit
Qty
Rate
Amount
Sft
1,875
127
237,188
Sft
Sft
Sft
Sft
Sft
Sft
191
2,471
1,258
13,675
144
94
5
1,031
656
66
22
66
11
550
550
22,000
55
55
12,585
54,353
83,026
150,427
79,200
51,700
110,000
56,719
36,094
Hospital
Main building
Repair
Covered
area
2625
98
Repair
Approach road
manholes
New construction
667
Sft
Sft
175
1,050
77
77
13,475
80,850
Rft
142
385
54,766
Rft
79
385
30,319
1,650
1,100,550
66
22
66
11
550
550
22,000
55
55
48,263
21,296
84,167
42,592
26,400
159,500
66,000
130,213
104,170
Sft
Residence
Repair
3788
Sft
Sft
Sft
Sft
Sft
Sft
731
968
1,275
3,872
48
290
3
2,368
1,894
Total
2,833,852
1,733,302
BHU Ghani Adda, Bajour Agency
Description
Boundary wall
Unit
Qty
Rate
Amount
Sft
1,463
127
185,006
Sft
Sft
Sft
Sft
2,076
11,345
72
48
5
907
777
22
11
550
550
22,000
55
55
45,678
124,799
39,600
26,400
110,000
49,858
42,735
Hospital
Main building
Repair
Covered
area
2590
99
Repair
Approach road
manholes
New construction
1360
Sft
Sft
195
2,820
77
77
15,015
217,140
Rft
125
385
48,125
Rft
88
385
33,688
1,650
2,244,000
132
22
66
11
550
550
22,000
55
55
58,262
20,933
80,949
41,866
26,400
227,700
66,000
194,838
155,870
Sft
Residence
Repair
5668
Cft
Sft
Sft
Sft
Sft
Sft
441
952
1,227
3,806
48
414
3
3,543
2,834
Total
4,054,860
1,810,860
D. Estimated cost for execution of ci vil works at surveyed
facilities
Health facility
Estimated cost
(in PKR)
Health facility
Estimated cost
(in PKR)
AHQH Khar
15,569,774
BHU Loesam
-
CH Nawagai
17,351,892
BHU Chenagai
3,791,898
RHC Pashat
8,731,972
BHU Zorbander
2,833,852
RHC Barang
9,846,013
BHU Ghani Adda
4,054,860
100
TRF is funded by UKaid from the Department for International Development and AusAID, and managed by HLSP

Bajour

Transcription

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