HFA District Report - Gawadar

Health Facility Assessment Balochistan
District Gawadar
Acknow ledgement
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 Consultants, and
Ms. Pamela Sequeria, 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
District Report - Gawadar
Table of Contents
List of Tables ................................................................................................................ iv
List of Figures .............................................................................................................. vi
Acronyms .................................................................................................................... vii
Executive Summary ..................................................................................................... 1
Section 1: Introduction ................................................................................................. 3
Survey Objectives ...................................................................................................... 3
Assignment Duration .................................................................................................. 3
Scope of HFA............................................................................................................. 3
Report Organisation ................................................................................................... 4
Section 2: District Information ..................................................................................... 5
Geographical Location ............................................................................................... 5
Administrative Setup .................................................................................................. 6
Demographic Information ........................................................................................... 6
Socioeconomic and Health Indicators ........................................................................ 6
Section 3: Health Facility Assessment Survey Findings............................................ 8
MNCH Services ......................................................................................................... 8
8/6 Preventive MNCH Services at BHU ................................................................. 9
24/7 Basic EmONC Services at RHC .................................................................. 12
24/7 Comprehensive EmONC Services at SHC Hospital .................................... 15
24/7 Basic EmONC Services at THQ Hospital..................................................... 21
Management Basics................................................................................................. 22
Human Resource ................................................................................................ 22
Work Coordination and Supervision .................................................................... 24
Management Information System ........................................................................ 25
Drugs and Supplies ............................................................................................. 26
Fee for Services .................................................................................................. 27
Infection Control .................................................................................................. 29
Death Review ...................................................................................................... 29
Facility Utilisation ..................................................................................................... 30
Well Baby Clinic ....................................................................................................... 32
Donor Contribution ................................................................................................... 32
ii

Clients Perspective .................................................................................................. 33
Procurement Estimates ............................................................................................ 35
Equipment ........................................................................................................... 35
Civil Works .......................................................................................................... 35
Section 4: Key Findings ............................................................................................. 36
Infrastructure ............................................................................................................ 36
Human Resource ..................................................................................................... 36
Equipment ................................................................................................................ 37
Drugs and Supplies .................................................................................................. 37
Support Services ...................................................................................................... 38
Management Basics................................................................................................. 38
Donor Contribution ................................................................................................... 39
Clients Perspective .................................................................................................. 39
Annexes ....................................................................................................................... 40
Annex 1: District Health Department ......................................................................... 41
Annex 2: Input Criteria for MNCH Services ............................................................... 47
Annex 3 - A: Status of Surveyed HF Against Minimal Level of Inputs .................... 60
Annex 3 B: List of Items Required .......................................................................... 66
Annex 4: Scope of Civil Works Required .................................................................. 72
iii
List of Tables
Table 1.1: Scope of HFA ................................................................................................ 4
Table 2.1: Demographic profile ....................................................................................... 6
Table 2.2: Population groups .......................................................................................... 6
Table 2.3: Socio-economic and health indicators............................................................ 7
Table 3.1: Status of assessed infrastructure in BHU ..................................................... 10
Table 3.2: Status of MNCH related staff in BHU ........................................................... 11
Table 3.3: Status of functional equipment in BHU......................................................... 11
Table 3.4: Status of drugs and supplies in BHU............................................................ 11
Table 3.5: Status of support services in BHU................................................................ 12
Table 3.6: Status of assessed infrastructure in RHC..................................................... 12
Table 3.7: Status of MNCH related staff in RHC ........................................................... 14
Table 3.8: Status of functional equipment in RHC ........................................................ 14
Table 3.9: Status of drugs and supplies in RHC ........................................................... 14
Table 3.10: Status of support services in RHC ............................................................. 15
Table 3.11: Status of assessed infrastructure in SHC hospital...................................... 15
Table 3.12: Status of MNCH related staff in DHQ hospital ............................................ 19
Table 3.13: Status of functional equipment in SHC hospital.......................................... 20
Table 3.14: Status of drugs and supplies in SHC hospital ............................................ 21
Table 3.15: Status of support services in SHC hospital ................................................ 21
Table 3.16: Status of HR at DHQ hospital .................................................................... 22
Table 3.17: Status of HR at RHC .................................................................................. 22
Table 3.18: Status of HR at surveyed BHU................................................................... 23
Table 3.19: Reasons of non-availability of HR on 24/7 basis at RHC........................... 23
Table 3.20: Reasons of non-availability of HR on 24/7 basis at SHC hospital ............... 24
Table 3.21: Capacity building of MNCH related staff .................................................... 24
Table 3.22: Status of coordination and supervision ...................................................... 25
Table 3.23: Status of MIS ............................................................................................. 25
Table 3.24: Reasons for stock out reported by surveyed facilities................................. 26
Table 3.25: Status of fee for service ............................................................................. 27
Table 3.26: Mechanisms of social protection available ................................................. 28
Table 3.27: Status of infection control & waste management practices ........................ 29
Table 3.28: Status of death review ............................................................................... 29
iv

Table 3.29: Status of services utilisation ....................................................................... 30
Table 3.30: Average monthly MNCH services provided ................................................ 31
Table 3.31: Average monthly FP services provided ...................................................... 31
Table 3.32: Status of WBC established ........................................................................ 32
Table 3.33: Status of donor contribution ....................................................................... 32
Table 3. 36:Clients perspective ..................................................................................... 33
Table 3.35: Summary of estimated cost for procurement of equipments & civil works .. 35
Table 2.4: Number of public sector health facilities in the district .................................. 41
Table 2.5: Human resource in office of DHO ................................................................ 41
Table 2. 6: Availability of MNCH services staffing in Gwadar ........................................ 42
Table 2.7: Financial allocation in district Gawadar ........................................................ 43
Table 2.8: NMNCHP monitoring indicators (year 2010) ................................................ 44
Table 2.9: Number of facilities with staff provided by the nmnchp ................................. 45
Table 2.10: Number of staff trained on delivering MNCH services ................................ 46
Table 2.11: Status of CMW training and deployment .................................................... 46
i. Status of assessed infrastructure in BHU.................................................................. 60
ii. Status of MNCH related staff in BHU ........................................................................ 60
iii. Status of functional equipment in BHU ..................................................................... 60
iv. Status of drugs and supplies in BHU ........................................................................ 60
V. Status of support services in BHU............................................................................. 61
i. Status of assessed infrastructure in RHC ................................................................. 61
ii. Status of MNCH related staff in RHC ........................................................................ 62
iii. Status of functional equipment in RHC ..................................................................... 62
iv. Status of drugs and supplies in RHC ........................................................................ 62
v. Status of support servicesin RHC ............................................................................. 63
i. Status of assessed infrastructure in dhq hospital ...................................................... 63
ii. Status of MNCH related staff in SHC hospitals ......................................................... 64
iii. Status of functional equipment in dhq hospital.......................................................... 64
iv. Status of drugs and supplies in SHC hospitals ......................................................... 64
v. Status of support services in SHC hospitals ............................................................. 65
List of Figures
Figure 1: Map of Gawadar ............................................................................................. 5

Figure 2: Range of services that signal fully functional MNCH services.......................... 8
Figure 3: Status of management basics ....................................................................... 23
Figure 4: Level of satisfaction with examination and attitude of staff ............................ 34
Figure 5: Availability of medicines and lab services ...................................................... 34
vi
ACRONYMS
ANC
AVD
Antenatal Care
Assisted Vaginal Deliveries
BB technician
BHU
CBA
CEI
Blood Bank Technician

Basic Health Unit
CH
CMW
Civil Hospital
Community Midwives
CWAQ
CDC
Civil Works Assessment Questionnaire

Communicable Disease Control
District Coordination Officer
District Data Collection Teams
DCO
DDCT
Child bearing age

Client Exit Interview
DHO
DHDC
DHIS
DHQH
District Health Officer

District Health Development Centre
DLQ
EDOs
EmONC
ENC
EAQ
EPI
FP & PHC
HF
HFA
District Level Questionnaire

Executive District Officers
Emergency Obstetric and Newborn Care
Emergency Newborn Care
Equipment Assessment Questionnaire
Expanded Programme of Immunisation
Family Planning and Primary Health Care
Health Facilities
Health Facility Assessments
Health Institution Database
Human Immunodeficiency Virus
Health Management Information System
HID
HIV
HMIS
HR
IDI EDOH
IMNCI
IMPAC
JD
LHS
LHV
LHW
MDGs
M&E
MICS
District Health Information System

District Headquarter Hospital
Human Resource
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
Millennium Development Goals
Monitoring and Evaluation
Multiple Indicator Cluster Survey
vii

MIS
MNCH
Management Information System

Maternal, Neonatal and Child Health
MO
NMNCHP
Medical Officer
National Maternal Newborn and Child Health Programme
NVD
OBGYN
OPD
OT
Normal Vaginal Deliveries

Obstetrics and Gynaecology
Out Patient Department
Operation Theatre
PC-1
PDHS
PNC
PPHI
Planning Commission Proforma 1

Pakistan Demographic and Health Survey
PSLM
RHC
SBA
SD&MB
Pakistan Social & Living Standards Measurement Survey

Rural Health Centre
Skilled Birth Attendants
Service Delivery and Management Basics
SE
SHC hospitals
SPSS
TA
THQ
TRF
TT
WMO
WBC
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
Post natal care

Peoples Primary Health care Initiative
viii
Executive Summary
Health Facility Assessment 2011 (HFA) was aimed at assessing the availability, functioning,
and quality of health care delivery system in the public sector health facilities (all DHQH,
RHC & 20% of BHU) with a focus on maternal, new-born and child health services. This
district report provides the findings of the HFA for each surveyed health facility in the district.
It is baseline information for the district and the National Maternal Newborn and Child Health
Programme (NMNCHP), to set performance benchmarks and realign activities for bridging
the gaps existing in 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 constant liaison with the entire key
stakeholder. Nine (9) health facilities were assessed in District Gawadar, including 1 DHQ
hospital, 3 RHC and 5 BHU. The BHU were assessed for availability of 8/6 Preventive
MNCH services; RHC were assessed for availability of 24/7 Basic EmONC services; and
DHQ Hospital was assessed for availability of 24/7 Comprehensive EmONC services. An
assessment criterion was formulated to ascertain gaps in availability of inputs1, including
Infrastructure; Human Resource (HR); Drugs and Supplies; Equipment; and Level specific
support services. Summarised HFA findings (detailed findings are given in Section 4) of
HFA, are as follows
In infrastructure, major gaps existed in availability of labour room at BHU; blood bank at
DHQH Gawadar; residence for WMO at RHC Ormara and residences for gynaecologist,
anaesthetist and paediatrician at DHQH Gawadar
Regarding HR, none of the health facility had staff available against optimal level of
inputs and major gaps were related to required number of specialist staff at DHQH and
WMO and technicians of all categories at all level health facilities
The complete set of required equipment items was not available at any of the surveyed
facilities
Drugs, Supplies, Vaccines and FP commodities were assessed using facility specific list
of tracer items for their availability on the day of survey and stock-out status during last
one month. The complete range of items was not available at any of the surveyed
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 1

facilities. The most common reasons for stockout of drugs were poor quantification and
delayed supply
The complete range of required inputs for delivery of support services was not available
at most of the surveyed facilities
In district Gwadar, DHQH and RHC were conducting and maintaining the record of
regular performance review meetings but most of the BHU were not conducting such
meetings
MNCH service delivery protocols and MNCH related job descriptions were not available
District Health Information System (DHIS) was being practiced in the district Gwadar and
DHIS tools were available at all level facilities but not maintained especially at BHU level
Major gaps existed in availability of materials for infection control practices
Review of maternal and neonatal deaths was not being conducted as death review
committee was not functional at any of the surveyed facilities
DHQH Gawadar, RHC Jiwani and RHC Ormara reported donor contribution for
improvement of MNCH services.
In order to assess the perceptions of the clients, a total of 25 Client Exit Interviews were
conducted at DHQH and RHC. Clients perspective on quality of care revealed that majority
of the clients were satisfied with the care provided at the public facilities
Findings of the HFA at all levels revealed significant gaps in the required inputs for provision
of quality MNCH services. This warrants immediate need to bridge these gaps in order to
improve the MNCH services.
Section 1: Introduction
This section includes survey objectives, its scope and duration, and organisation of the
District Report
Survey Objectives
The HFA was aimed at assessing the availability, functioning, and quality of health care
delivery system in the public sector facilities with a focus on maternal, new-born 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 district level
To assess 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 needs to be replaced
or purchased); and
To update and assess the contributions made by the development partners for improving
MNCH and FP services in the selected districts
Assignment Duration
Estimated duration of the assignment was 7 months. The assignment started in October
2010 and completed in May 2011.
Scope of HFA
The survey included District Headquarter Hospital (DHQH), Tehsil Headquarter Hospital
(THQH), Rural Health Centres (RHC) and 20% of Basic Health Units (BHU) randomly
selected within the district. Selection of the BHU was through geographical stratification on
the basis of proportionate distribution. Client exit interviews were conducted at the surveyed
facilities (10 at DHQH, 5 at each THQH and RHC), excluding BHU. Table 1.1 shows the
number of health facilities in the district and health facilities surveyed.

TABLE 1. 1: SCOPE OF HFA
District Gawadar
Number of Health Facilities by type

DHQH
THQH
RHC
BHU
Total
Number of facilities listed by HID
20
27
Number of facilities surveyed
Report Organisation
HFA District Report has been structured in four sections. While the introduction to the
survey, its scope and methodology is described in Section 1, Section 2 District Information
contains information collected from the District Health Department using DLQ as well as the
secondary data sources and it comprises of demographic, economic and education related
information of the district as well as the organisation of health care delivery system in the
district. This section also includes information about the monitoring indicators of National
MNCH Programme.
Details of the assessment are contained in Section 3 HFA Findings. This section presents
information about NMNCHP analytical framework indicators, status of the MNCH service
availability based on optimal level of inputs including infrastructure, human resource,
equipment, drugs and supplies and 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 snapshot in time of the surveyed health facilities.
At the end information about the satisfaction and perspective of the clients on the MNCH
services provided at the public sector health facilities. Section 4 comprises of key findings of
HFA at district level.
Section 2: District Information

This section includes district brief, information on demographic, socioeconomic and health
indicators. It also contains information on health resources and NMNCHP indicator compiled
at district level. The data sources of the information are DHO office using District Level
Questionnaire (DLQ) and published documents. The information collected from DHO office
may not match with subsequent tables containing similar information collected from
respective health facilities included in survey
Geographical Location
District Gawadar having 12,637 area km2 is situated on the north coastline along the Arabian
Sea. Gawadar was made a district in July 1997; previously it was one of three Tehsils (sub
districts) of Makran Division. It consists mostly of barren land and hills, with the exception of
the Dasht River, which passes through Gawadar District on its way to the Arabian Sea from
Mirani Dam in Kech District north of Gawadar. It is Gawadar is linked by road with 700 km
Makran Coastal Highway. The road links Karachi with several ports along the coast including
Ormara and Pasni. The other highway is Gawadar-Quetta-Chaman and is linked to adjacent
districts and the provincial capital through a network of roads and rail.
FIGURE 1: MAP OF GWADAR
Administrative Setup
Like other districts in the province, Gawadar is headed by Deputy Commissioner (DC)
assisting the Divisional Commissioner and is accountable to him. The DC is appointed by
the provincial government from the Federal or Provincial Civil Service.
Demographic Information
TABLE 2. 1: DEMOGRAPHIC PROFILE
Indicators
Value
Indicators
Value
Total Population
248,440
Urban Population
54%
Population of Tehsil Gawadar
100,790
Rural Population
46%
Population of Tehsil Jiwani
51,543
Population of Tehsil Pasni
78,981
Population of Tehsil Ormara
26,161
Population density (persons

per sq.km)
Sex ratio (number of males
over 100 females) at birth
20
115
S OURCE : DHIS C ELL DHO O FFICE
TABLE 2. 2: POPULATION GROUPS
Population
groups
Standard
demographic
(%)
Estimated
population
Standard
demographic
(%)
Estimated
population
Under 1 year
2.70
6,708
Under 5 years
Under 15
years
13.40
33,291
Women 15-49
years
Married CBA
22.00
54,657
16.00
39,750
41.97
104,270
Pregnant women
3.40
8,447
Expected births
2.9
7,205
Population
groups
S OURCE : PDHS 2006-07
Socioeconomic and Health Indicators

Selected Socio-Economic (SE) and health indicators are given in the table 2.3. The sources
include, Pakistan Demographic and Health Survey (PDHS) 2006-7, Immunisation Coverage
Evaluation Survey Pakistan (CES) 2006-7, District EPI Cell.

TABLE 2. 3: SOCIO-ECONOMIC AND HEALTH INDICATORS
Indicators
Value
District figures
63% (DHO)
67.3(CES)
Provincial figures
PDHS 2006-07
Literacy rate
25 %
Infant Mortality Rate
49/1000 live births
Under 5 Mortality Rate
59/1000 live births
Maternal Mortality Ratio
785/100,000 live births
S OURCE : PDHS 2006-07, DISTRICT EPI C ELL D EVELOPMENT S TATISTICS OF B ALUCHISTAN
2009
% children<12 months fully immunised
Section 3: Health Facility Assessment Survey

Findings
MNCH Services
The packages of MNCH services assessed include Preventive MNCH services at BHU,
Basic EmONC services at RHC and Comprehensive EmONC services at THQ and DHQ
hospitals2.The range of MNCH services are given below.
FIGURE 2: RANGE OF SERVICES THAT SIGNAL FULLY FUNCTIONAL MNCH SERVICES
BHU: 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)
RHC: 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 LHV), and
Preventive MNCH
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

Functional capacity of health facilities were assessed against 5 specified inputs, which
include:
1. Infrastructure
2. Human Resource
3. Drugs and Supplies
4. Equipment
5. Level specific support services
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 provision of level
specific package of MNCH services(Annex 1).
Optimal level of inputs provides a strategic norm upon which gaps are identified and
up-gradation are proposed for improving accessibility of quality MNCH services
through development and implementation of an integrated and sustainable MNCH
programme at all levels of the health care delivery system.
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. Findings related
to minimal level of inputs are given as Annex 2.
Following tables present the status of assessed facilities for availability of the optimal level of
inputs.
8/6 Preventive MNCH Services at BHU

BHU operating within District Gawadar were assessed for provision of Preventive MNCH
services available for 8 hours a day, 6 days a week (8/6). Five BHU were assessed for
availability of optimal level of inputs as summarised in Tables 3.1 - 3.5 by individual BHU.
Infrastructure of the BHU has been assessed for availability of OPD, LHV room and labour
room as service provision areas and residences for accommodation of required staff. OPD
and LHV rooms have been assessed as single room having facilities for consultation,
examination and hand washing; similarly labour room also assessed as single room having
facility for delivery, scrub area and attached toilet facility for patient. Findings are presented
as status of building components available and functional in table 3.1.
9

TABLE 3.1: STATUS OF ASSESSED INFRASTRUCTURE IN BHU
Status of building components at Surveyed BHU

Infrastructure
OPD
1. Consultation area
Status
BHU
Pishkan
BHU
Nagor
Sharif
BHU Ganz
BHU Basool
BHU
Kolanch
Kocho
2. Examination area
3. Hand washing
LHV Room
1. Consultation
area
2. Examination
area
3. Hand washing
Labour room
1. Delivery room
2. Scrub area
3. Patient wash
room
Residence
Doctor
Residence
LHV
10

Doctor or LHV is required for provision of Preventive MNCH Services.Status of assessed
BHU for availability of Human Resource (HR) (both regular posted and provided by
NMNCHP),against the required number mentioned in PC-1 of NMNCHP is presented in
table 3.2.
TABLE 3.2: STATUS OF MNCH RELATED STAFF IN BHU
Number of MNCH related staff available at each

BHU
Staff categories
Required
number at
each RHC
BHU
Pishkan
BHU
Nagor
Sharif
BHU
Ganz
BHU
Basool
BHU
Kolanch
Kocho
MO/WMO
LHV
Equipment items (general items, equipment for OPD and LHV room) for BHU are listed in
PC-1 of NMNCHP. Status of functional quantity of these items at assessed BHU is
presented in table 3.3.
TABLE 3.3: STATUS OF FUNCTIONAL EQUIPMENT IN BHU
Equipment
Total Items
required at
each BHU
Number of functional equipment items available at

each surveyed BHU
BHU
Pishkan
BHU
Nagor
Sharif
BHU
Ganz
BHU
Basool
BHU
Kolanch
Kocho
General items
OPD
14
LHV Room
12
List of essential drugs and supplies for MNCH services is contained in PC-1 of NMNCHP.
Tracer items were selected from the list (Annex 1) for assessing their availability at surveyed
facilities. Status of surveyed BHU regarding available quantity of tracer items is presented in
table 3.4.
TABLE 3.4: STATUS OF DRUGS AND SUPPLIES IN BHU
Item groups
Total Items
required at
each BHU
Supplies
Number of items available at each surveyed BHU

BHU
Pishkan
BHU
Nagor
Sharif
BHU
Ganz
BHU
Basool
BHU
Kolanch
Kocho
Drugs
12
11
10
Vaccines
FP Commodities
11

Facility for basic laboratory tests (test strips and HR) was assessed at surveyed BHU and
their status is presented in table 3.5.
TABLE 3.5: STATUS OF SUPPORT SERVICES IN BHU
Support services
Total
Items
required
at each
BHU
Basic lab tests

BHU
Pishkan
BHU
Nagor
Sharif
BHU
Ganz
BHU
Basool
BHU
Kolanch
Kocho
24/7 Basic EmONC Services at RHC

RHC operating within District Gawadar were assessed for provision of Basic EmONC
services available for 24 hours a day, 7 days a week (24/7). Three RHC were assessed for
availability of optimal level of inputs as summarised in Tables 3.6 - 3.10.
Infrastructure of the RHC has been assessed for availability of OPD, indoor ward, LHV room,
labour room and clinical laboratory as service provision areas and residences for
accommodation of required staff. Service provision areas have been assessed as single
room having facilities like consultation, examination and hand washing etc., as contained in
table 3.6. Findings are presented as status of building components available and functional:
TABLE 3.6: STATUS OF ASSESSED INFRASTRUCTURE IN RHC
Status of building components at each RHC

Infrastructure
OPD
Status
RHC Jiwani
RHC Ormara
RHC Pasni
2. Examination area
3. Hand washing
Female ward
1. Patient area
2. Patient wash room
12
Status of building components at each RHC

Infrastructure
Labour Room
1. Delivery room
Status
RHC Jiwani
RHC Ormara
RHC Pasni
2. Scrub area
Clinical lab.
1. Laboratory room
2. Working area
3. Pt. wash room
LHV Room
2. Examination area
3. Hand washing
Residence
Doctor
Residence
LHV
PC-1 of NMNCHP contains category and number of staff required for Basic EmONC
services. Status of RHC for availability of HR (both regular posted and provided by
NMNCHP), against required numbers is presented in table 3.7.
13

TABLE 3.7: STATUS OF MNCH RELATED STAFF IN RHC
Staff categories
Required
number at each
RHC
Number of MNCH related staff available at

each RHC
RHC Jiwani
RHC Ormara
RHC Pasni
WMO
LHV
Lab technician
OT technician
Ambulance driver
Equipment items for various service components at RHC are listed in PC-1 of NMNCHP.
Status of functional quantity of these items at RHC, is presented in the table 3.8.
TABLE 3.8: STATUS OF FUNCTIONAL EQUIPMENT IN RHC
Equipment
Total Items
required at each
RHC
General items
Number of functional equipment items

available at each RHC
RHC Jiwani
RHC Ormara
RHC Pasni
Female ward
WMO OPD
15
13
Labour room
19
11
15
LHV Room
10
facilities. Status of surveyed RHC regarding available quantity of tracer items is presented in
table 3.9.
TABLE 3.9: STATUS OF DRUGS AND SUPPLIES IN RHC
Item groups
Total Items
required at each
RHC
Supplies
Number of items available at each RHC

RHC Jiwani
RHC Ormara
RHC Pasni
Drugs
18
16
16
15
Vaccines
FP Commodities
14
Facility for support services including basic laboratory tests (space, test strips and HR) and
ambulanceservices (functional vehicle and driver) was assessed at surveyed RHC.
Availability status of these services at RHC is presented 3.10.
TABLE 3.10: STATUS OF SUPPORT SERVICES IN RHC
Support services
Total Items
required at each
RHC
RHC Jiwani
RHC Ormara
RHC Pasni
Basic lab tests
Ambulance service
24/7Comprehensive EmONC Services at SHC Hospital

DHQ Hospital operating within District Gawadar was assessed for provision of
Comprehensive EmONC services available for 24 hours a day, 7 days a week (24/7). DHQ
Hospital was assessed for availability of optimal level of inputs as summarised in Tables
3.11 - 3.15.
Infrastructure of the DHQ hospital has been assessed for availability of OPD, indoor wards,
LHV room, labour room, operation theatre, paediatric nursery, blood bank, ultrasound room
and clinical laboratory as service provision areas and residences for accommodation of
required staff. Service provision areas have been assessed for availability of essential space
in respective areas e.g., consultation area, examination area and hand washing in OPD;
patient area, nursing station, store rooms and attached washrooms in indoor wards, etc., as
contained in table 3.13. Findings are presented as status of building components available
and functional.
TABLE 3.11: STATUS OF ASSESSED INFRASTRUCTURE IN SHC HOSPITAL
Availability of building components

Infrastructure
Status
DHQH Gawadar
OPD:
2. Examination area
3. Privacy of examination area
15
4. Hand washing
Female ward:
1. Patient area
2. Nursing station
4. Store for general items
5. Store for equipment
Labour room:
1. Delivery room
2. Preparation /stage room
3. Scrub area
4. Staff duty room
6. Staff wash room
8. Store for equip.
Operation theatre:
1. Patient preparation room
16
2. Operating room
3. Recovery room
4. Scrub area
5. Sterilisation area
6. Doctors room
7. Support staff duty room

9. Store for equipment
10. Attached washroom for staff
Paediatrics ward:
1. Patient area
2. Nursing station
3. Store for general items/drugs or

equip.
Paediatric nursery:
1. Patient area
2. Nursing station
3. Store for general items/drugs or
17

equip.
4. Change room/area
Clinical lab.:
1. Laboratory room
2. Working area
3. Doctors duty room
4. Store for general reagents or equip.
5. Attached wash room
Blood bank:
1. Blood collection room
2. Working area
3. Staff duty room
4. Store for general reagents or equip.
5. Attached wash room
LHV Room:
2. Examination area
3. Privacy for examination
4. Hand washing facility
18
Ultrasound room:
Examination area
Residence:
Gynaecologist
Residence:
Anaesthetist
Residence:
Paediatrician
Residence:
WMO
Residence:
LHV
Residence:
Nurses
Residence
Lab technician
Residence:
BB technician
Residence:
Anaesthesia technician
PC-1 of NMNCHP contains category and number of staff required for Comprehensive
EmONC services. Status of DHQ hospital for availability of HR (both regular posted and
provided by NMNCHP), against required numbers is presented in table 3.12.
TABLE 3.12: STATUS OF MNCH RELATED STAFF IN DHQ HOSPITAL
Availability at DHQH Gawadar

Staff categories
Required number
Available number
Gynaecologist
Anaesthetist
19
Paediatrician
WMO
OT technician
BB technician
Lab technician
Nurses
20
LHV
Ambulance drivers
Equipment items for various service components at DHQ hospital are listed in PC-1 of
NMNCHP. Status of functional quantity of these items at SHC hospitals, is presented in the
table 3.13.
TABLE 3.13: STATUS OF FUNCTIONAL EQUIPMENT IN SHC HOSPITAL
Equipment

available at DHQH Gawadar
Total required Items
Available items
General items
Female ward
19
15
OPD
12
10
Paediatric nursery
13
11
Paediatric ward
10
Labour room
24
16
Operation theatre
31
26
Clinical laboratory
20

facilities. Status of DHQ hospital regarding available quantity of tracer items is presented in
the table 3.14.
TABLE 3.14: STATUS OF DRUGS AND SUPPLIES IN SHC HOSPITAL
Item groups
Total Items
Number of items
available at
DHQH Gawadar
Supplies
Drugs
21
Vaccines
FP Commodities
Facility for support services including laboratory tests (space, test strips and HR), blood
transfusion services (space, supplies and HR), ambulance services (functional vehicle and
driver), operation theatre (space, drugs and supplies, equipment items and HR) was
assessed at surveyed DHQ hospital. Availability status of these services at SHC hospitals is
presented in table 3.15.
TABLE 3.15: STATUS OF SUPPORT SERVICES IN SHC HOSPITAL
Item groups
Total Items
Number of items
available at
DHQH Gawadar
Basic laboratory tests
17
11
Blood transfusion
Ambulance services
Radiology services
Operation theatre
62
36
24/7 Basic EmONC Services at THQ Hospital

There is no THQ Hospital in Gawadar
21
Management Basics
Findings related to facility management basics are presented below:
Human Resource
Information about sanctioned and filled posts of MNCH related staff was collected from the
surveyed facilities;and their status is presented in table 3.16 - 3.18. Filled status of staff
categories presented in following tables,include regular posting only,as reported by the
respective facility on the day of survey.
TABLE 3.16: STATUS OF HR AT DHQ HOSPITAL
Status of HR at SHC Hospitals

Staff
DHQH Gawadar
Gynaecologist
S
1
F
1
Anaesthetist
Paediatrician
WMO
OT technician
BB technician
Lab technician
Nurses
LHV
Ambulance drivers
TABLE 3.17: STATUS OF HR AT RHC
Number of posts sanctioned and filled at each RHC

Staff
RHC Jiwani
RHC Ormara
RHC Pasni
WMO
Lab technician
Nurse
LHV
Ambulance drivers
22

TABLE 3.18: STATUS OF HR AT SURVEYED BHU
Number of posts sanctioned and filled at each RHC

Staff
BHU Pishkan
F
WMO
S
0
LHV
BHU Nagor
Sharif
F
S
0
BHU Ganz
F
S
0
BHU Basool
F
S
1
BHU Kolanch
Kocho
F
S
0
Availability
ity of job descriptions,
descriptions service delivery protocols and staff as per duty roster was
assessed and their findings are presented in the Figure 3.
FIGURE 3: STATUS OF MANAGEMENT BASICS
5
4.5
Total number
4
3.5
3
2.5
2
1.5
1
0.5
0
Availability of MNCH related job

descriptions (JDs)
Presence of duty staff
Availability of MNCH service

delivery protocols
Displayed MNCH service
delivery protocols
1 1
0 0 0
0 0 0 0
0 0 0 0
DHQH
RHCs
BHUs
Reasons for non-availability

availability of staff on 24/7 basis at RHC and SHC are provided in Table
3.19 and 3.20.
TABLE 3.19: REASONS OF NON-AVAILABILITY OF HR ON 24/7 BASIS AT RHC
Reasons of non-availability
availability
Status in RHC
Residence not available
WMO
0
LHV
0
Ambulance Driver
0
Residence damaged
Security reasons
Lack of basic amenities
23

TABLE 3.20: REASONS OF NON-AVAILABILITY OF HR ON 24/7 BASIS AT SHC HOSPITAL
Status of DHQ Hospital

Gynaecologist
Anaesthetist
Paediatrician
Blood Bank
Technician
Laboratory
Technician
WMO
LHV
Residence not available
Residence damaged
Security reasons
Lack of basic amenities
Reasons of nonavailability
Health facilities having staffed trained for providing MNCH services is presented in the Table
3.21.
TABLE 3.21: CAPACITY BUILDING OF MNCH RELATED STAFF
MNCH related training conducted

Health Facility
EmONC
ENC
IMNCI
IMPAC
FP
surgical
FP
counselling
Client
centeredness
DHQH
Gawadar
RHC Jiwani
RHC Ormara
RHC Pasni
BHU Basool
BHU Ganz
BHU Kolanch
Kocho
BHU Nagor
Sharif
BHU Pishkan
Work Coordination and Supervision

Health facilities in the district were assessed for work coordination and supervisory activities,
including facility staff meetings, participation of facility in charges in district level meetings
and conduction of supervisory visits and feedbacks by district health managers. Findings of
each surveyed health facility are presented in Table 3.22.
24

TABLE 3.22: STATUS OF COORDINATION AND SUPERVISION
Work Coordination and Supervision

Regular facility PRM*
Monthly Supervisory Visit
Health facility
Participation in
district PRM**
Facility
visited
Facility
received visit
feedback
RHC Pasni
BHU Basool
BHU Ganz
BHU Kolanch Kocho
BHU Nagor Sharif
BHU Pishkan
Meeting
held
Record
maintained
DHQH Gawadar
RHC Jiwani
RHC Ormara
* PRM=Performance Review Meeting
Management Information S ystem

District Gawadar was practicing District Health Information System (DHIS). Surveyed
facilities were assessed for availability and maintenance of DHIS tools and their findings are
presented in Table 3.23.
TABLE 3.23: STATUS OF MIS
Status of MIS Tools

Medicine Stock
register
Daily expense
register
DHIS monthly
report
TB register
Disease Early
Warning System
DEWS chart
Growth Monitoring
Register
RHC Jiwani
RHC Ormara
RHC Pasni
BHU Basool
Meeting register
EPI register
Family Planning
register
Child health
register
Birth register
Mother health
register
OPD register
OPD ticket
DHQH
Gawadar
Health
Facility
MIS Tools Available
25

Status of MIS Tools
Health
Facility
OPD ticket
OPD register
Mother health
register
Birth register
Child health
register
Family Planning
register
EPI register
Meeting register
Medicine Stock
register
Daily expense
register
DHIS monthly
report
TB register
Disease Early
Warning System
DEWS chart
Growth Monitoring
Register
BHU Ganz
BHU Kolanch
Kocho
BHU Nagor
Sharif
BHU Pishkan
MIS TOOLS MAINTAINED

DHQH
Gawadar
RHC Jiwani
RHC Ormara
RHC Pasni
BHU Basool
BHU Ganz
BHU Kolanch
Kocho
BHU Nagor
Sharif
BHU Pishkan
Drugs and Supplies

Availability of drugs and supplies has been described under individual MNCH service
packages. The reasons of their non-availability were identified at the surveyed facilities and
presented in the Table 3.24.
TABLE 3.24: REASONS FOR STOCK OUT REPORTED BY SURVEYED FACILITIES
Reasons for stock out

Delayed demand
submission
Unavailability of
buffer stock
Lack of storage
capacity
Delayed supply
Under supply
No procurement
powers
Insufficient budget
Lack of cold-chain
DHQH Gawadar
Poor quantification
Health facilities
citing stock out
26

Reasons for stock out
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
RHC Jiwani
RHC Ormara
RHC Pasni
BHU Basool
BHU Ganz
BHU Kolanch Kocho
BHU Nagor Sharif
BHU Pishkan
Health facilities
citing stock out
Fee for Services

Fee for MNCH services and availability of social protection mechanisms for the poor were
assessed at surveyed facilities and their findings are presented in Table 3.25 and 3.26.
TABLE 3.25: STATUS OF FEE FOR SERVICE
Services provided free of cost

OPD
Indoor
OPD X-rays
OPD Medicines
Admission fee
Ward bed
Inpatient laboratory
Inpatient
Ultrasound
Inpatient X-rays
RHC Jiwani
RHC Ormara
RHC Pasni
BHU Basool
BHU Ganz
BHU Kolanch
Kocho
Ambulance services
OPD Ultrasound
Inpatient medicines
OPD Laboratory
Blood grouping &

cross matching
OPD Ticket
DHQH Gawadar
Health facilities
where service are
charged
27

Services provided free of cost
OPD
Ambulance services
Inpatient medicines
Blood grouping &

cross matching
Inpatient X-rays
Inpatient
Ultrasound
BHU Pishkan
Inpatient laboratory
Ward bed
Admission fee
OPD Medicines
BHU Nagor Sharif
OPD X-rays
OPD Laboratory
OPD Ultrasound
OPD Ticket
Health facilities
where service are
charged
Indoor
TABLE 3.26: MECHANISMS OF SOCIAL PROTECTION AVAILABLE
Social Protection Mechanism

Health facilities with available
social protection
Bait-ul-Maal
Zakat
Patient Welfare
Society
DHQH Gawadar
RHC Jiwani
RHC Ormara
RHC Pasni
BHU Basool
BHU Ganz
BHU Kolanch Kocho
BHU Nagor Sharif
BHU Pishkan
28
Infection Control
Health facilities were assessed for practices of infection control and waste management, and
availability of related material. Findings of individual surveyed facilities are presented in table
3.27.
TABLE 3.27: STATUS OF INFECTION CONTROL & WASTE MANAGEMENT PRACTICES
Availability of Materials
RHC Ormara
RHC Pasni
BHU Basool
BHU Ganz
BHU Kolanch
Kocho
BHU Nagor Sharif
BHU Pishkan
Disposal through
Municipal Arrangement
Disposal through
Throwing-away
Health facilities
Disposal of waste
through burning
Waste segregation
Hep B Vaccination of
Staff
RHC Jiwani
Disinfection of service
provision area
Hand washing practices

of HCP
Personal protection
materials
Functional Incinerators
Waste collection
materials
Waste treatment
equipment
Waste management plan
DHQH Gawadar
Infection Control Practices
Death Review
Findings related to availability and functioning of death review committees are presented in
the Table 3.28.
TABLE 3.28: STATUS OF DEATH REVIEW
Status of Death Review

Death
Review
Committee
Available
Annual
Number
Reviewed by
committee
Annual
Number
Reviewed by
committee
DHQH Gawadar
RHC Jiwani
RHC Ormara
Health facility
Maternal Deaths
Neonatal Deaths
29

Status of Death Review
Death
Review
Committee
Available
Annual
Number
Reviewed by
committee
Annual
Number
Reviewed by
committee
RHC Pasni
BHU Basool
BHU Ganz
BHU Kolanch Kocho
BHU Nagor Sharif
BHU Pishkan
Health facility
Maternal Deaths
Neonatal Deaths
Facility Utilisation
Findings of services utilisation at surveyed facilities are given as monthly aggregate from
July to December 2010, annual utilisation of year 2010 and facility-wise average monthly
utilisation are presented in Tables 3.29, 3.30 and 3.31.
TABLE 3.29: STATUS OF SERVICES UTILISATION
July
Aug
Sep
Oct
Nov
Dec
1st Antenatal Care visits (ANC-1)
186
126
121
137
110
119
Annual
utilisation
(2010)
2,604
Normal vaginal deliveries
74
63
29
61
54
78
719
Assisted vaginal deliveries
33
C-sections
1st Postnatal Care visits (PNC-1)
50
38
16
37
43
46
1,103
155
173
150
225
143
166
2,217
815
832
505
767
779
867
9,306
648
658
644
666
365
668
5,732
589
249
650
578
190
864
5,614
Monthly utilisation (July to December 2010)

Type of service
Pregnant women given TT2

vaccine
FP services
Diarrhoea/Dysentery cases treated
(< 5 years of age)
Pneumonia cases treated
(< 5 years of age)
30

TABLE 3.30: AVERAGE MONTHLY MNCH SERVICES PROVIDED
Average Monthly Utilisation

Health
facility
ANC 1
NVD
Assisted
VD
C
Section
PNC 1
TT2
Diarrhoea/
Dysentery
(in <5 yr)
Pneumonia
(in <5 yr)
DHQH
Gawadar
31
37
16
18
162
249
RHC Jiwani
17
13
12
34
116
202
RHC Ormara
11
31
RHC Pasni
63
100
41
BHU Basool
55
60
BHU Ganz
38
28
16
133
BHU Kolanch
Kocho
BHU Nagor
Sharif
BHU Pishkan
TABLE 3.31: AVERAGE MONTHLY FP SERVICES PROVIDED
Average Monthly Utilisation of FP Services

Health
facility
COC
POP
DPMA
Net-en
Condoms
IUCDs
Implants
Surgical
FP
DHQH
Gawadar
692
244
136
252
RHC Jiwani
33
RHC
Ormara
RHC Pasni
21
BHU Basool
BHU Ganz
BHU
0
0
0
0
0
0
0
Kolanch
Kocho
BHU Nagor
0
0
0
0
0
0
0
Sharif
BHU
13
5
2
2
3
0
0
Pishkan
KEY: COC=Combined Oral Contraceptive, POP=Progesterone-Only Pills, DPMA=Depot
Medroxyprogesterone Acetate, Net-en=norethisterone enanthate, IUCDs=Intrauterine Contraceptive
Devices
31
Well Baby Clinic

Surveyed health facilities were assessed for established Well Baby Clinic (WBC) and its
findings are presented in Table 3.32.
TABLE 3.32: STATUS OF WBC ESTABLISHED
Name of health facility
WBC Established
Name of health facility
WBC Established
DHQH Gawadar
BHU Ganz
RHC Jiwani
BHU Kolanch Kocho
RHC Ormara
BHU Nagor Sharif
RHC Pasni
BHU Pishkan
BHU Basool
Donor Contribution
Donor Contribution during last three years was assessed regarding human resource,
infrastructure, equipment including ambulances, and drugs and supplies and findings are
presented in Table 3.33.
TABLE 3.33: STATUS OF DONOR CONTRIBUTION
Donor Contribution
Human Resource
Infrastructure
Equipment
Drugs and
Supplies
Health facilities
Provision of
key staff
Capacity
building
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
DHQH Gawadar
RHC Jiwani
RHC Ormara
RHC Pasni
BHU Basool
BHU Ganz
BHU Kolanch Kocho
32

Donor Contribution
Human Resource
Infrastructure
Drugs and
Supplies
Equipment
Health facilities
Provision of
key staff
Capacity
building
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
BHU Nagor Sharif
BHU Pishkan
Clients Perspective
Client Exit Interviews (CEI) was conducted within the scope of the HFA Survey to assess
clients perspective on provided services. Findings of these interviews were analysed for
assessing their perspective on access, quality and preference for health care and are
presented in Table 3.34 and Figures 4 and 5.
TABLE 3. 1: CLIENTS PERSPECTIVE
No of interviewed clients (Total:25)

DHQH
RHC
Less than 30 minutes
30 minutes to 1 hour
More than 1 hour
Walk
Personal transport
13
Public transport
Less than 10 minutes
10 minutes to 20 minutes
20 minutes to 30 minutes
More than 30 minutes
Paid fee for services
10
Received Education Material
Public HF
10
14
Private sector
Time to reach facility
Means of transport
Waiting time at facility
Preference for healthcare
33
Reasons for visiting public HF

Close to home
Good quality
Staff attitude
Affordability
Lack of choice
Very satisfied
Satisfied
13
Not satisfied
Overall satisfaction
FIGURE 4: LEVEL OF SATISFACTION WITH EXAMINATION AND ATTITUDE OF STAFF
Communication
Attitude of other staff
24
68
92
4
Very satisfied
Attitude of care provider
28
72
Satisfied
Not satisfied
Clinical Examination
8
0%
84
20%
40%
8
60%
80%
100%
FIGURE 5: AVAILABILITY OF MEDICINES AND LAB SERVICES
Lab services
90
10 0
Received (all)
Received (some)
Medicines
83
0%
20%
40%
60%
80%
Not received
17
100%
34
Procurement Estimates
Equipment
Based on the information collected, procurement needs for provision of required equipment
have been identified for individual surveyed facilities to strengthen MNCH services.
Summary of estimated cost for procurement of required equipment is given below. List of
required equipment for each surveyed facility is presented as Annex 3A and details about
cost estimates for individual facilities is given in Annex 3 B.
Civil Works
A yardstick has been used for assessing the scope of civil works of various MNCH related
building components (Annex 1). Identified scope of work to complete the infrastructure
needs of the individual surveyed facilities is presented in Annex 4. Summary of estimated
cost for execution of civil works including repair and maintenance, renovation and new
construction of missing facilities; is given in table below and details about cost estimates for
individual facilities is given in Annex 4.
TABLE 3.35: SUMMARY OF ESTIMATED COST FOR PROCUREMENT OF EQUIPMENTS & CIVIL
WORKS
Estimated Cost (PKR in Millions)

Procurement
DHQH
RHC
BHU
Total
Equipment
17
10
30
Civil Works
32
29
23
84
35
Section 4: Key Findings

In district Gawadar, total of 9 health facilities were assessed including 5 BHU, 3 RHC and 1
DHQH. The BHU were assessed for availability of 8/6 Preventive MNCH services; RHC
were assessed for availability of 24/7 Basic EmONC services; and DHQ Hospital was
assessed for availability of 24/7 Comprehensive EmONC services.
The key findings have been presented based on the availability of specified inputs including,
Infrastructure, Human Resource, Equipment, Drugs and Supplies, and Support services.
Status of each input has been described at one place for all levels. This is followed by key
findings on Management basics, Donor contribution and Clients perspective on the quality of
MNCH services.
Infrastructure
OPD was available at all BHU while labour rooms were not available at all BHU except
BHU Pishkan. LHV residences were available at BHU Pishkan, BHU Basool and BHU
Kolanch Kocho but was in good condition at BHU Pishkan
OPD, female ward, labour room and clinical laboratory were available at all the three
RHC; whereas residence for WMO was available at RHC Jiwani and RHC Pasni but was
not in good condition at RHC Pasni
OPD, female ward, labour room, operation room, paediatric ward, paediatric nursery and
clinical laboratory were available at DHQH Gawadar City, whereas blood bank was not
available. Further, Residences were not available for gynaecologist, anaesthetist and
paediatrician at DHQH Gawadar City
Human Resource
The required staff was available at BHU Pishkan and BHU Basool
WMO was not available at RHC Jiwani and RHC Ormara. Required number of LHV were
available at RHC Ormara and RHC Pasni; Laboratory technician and OT technician were
not available at RHC Pasniwhile ambulance driver and OT technician were not available
at RHC Jiwani
36
All the specialist staff was available,although not in required number at DHQH Gawadar.
No Anaesthesia technician and ambulance drivers were available at DHQH
Staff of RHC Ormara and RHC Pasni received training on FP counselling only and
IMNCI
Equipment
The complete set of required equipment items was not available at any of the surveyed
facilities
General equipment items were not available at any of the surveyed BHU, while LHV
room equipment items were not available at BHU Pishkan, BHU Basool and BHU
Kolanch Kocho
No Labour room equipment,General equipment items and Female ward items were
available at RHC Jiwani
Required number of equipment items were not available at DHQH Gawadar.
Drugs and Supplies
The complete list of tracer drugs and family planning were not available at any of the
surveyed facilities
All the vaccines were available only at BHU Pishkan. while FP commodities were not
available at BHU Basool and BHU Kolanch Kocho
The complete range of Vaccines was available at all RHC.Similarly the required number
of supplies was available at RHC Ormara
Required number of drugs and supplies were no available at DHQH Gawadar
The most common reasons for stockout of drugs werepoor quantification and delayed
supply
37
Support Services
The complete range of required inputs for delivery of support services was not available
at most of the surveyed facilities
Inputs required for provision of basic laboratory tests were available only at BHU Pishkan
Ambulance service was not available at RHC Jiwani
Blood transfusion services and radiology services were available at DHQH Gawadar
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:
Five out of nine health facilities were conducting regular performance review meetings
but its record was maintained at only 4 of the surveyed facilities. Similarly five facility incharges reported regular participation in district level performance review meetings
Except BHU Basool, all the facilities reported supervisory visits of district health
managers and its feedback was also received at all the facilities.
District Health Information System (DHIS) was being practiced in district Gawadar.
Regarding DHIS tools, complete range of tools was not available at any of the facility,
specifically non-availability of TB Registe, Disease early warning system and DEWS
chart
Social protection mechanisms for the poor (including Zakaat, Bait-ul Maal and patient
welfare societies) were not found at any of the surveyed facility
Complete range of inputs required for infection control practices were deficient at all the
surveyed facilities. All the facilities except RHC Ormara reported non-availability of waste
management plan but materials for waste collection, personal protection and waste
treatment were not available at any of the facility
Death review committee was not available for review of maternal and neonatal deaths at
any of the surveyed facilities
38
Donor Contribution
Donor contribution for supporting delivery of MNCH was assessed at the surveyed facilities
for provision of human resource, infrastructure, equipment, drugs and supplies. In the district
Gawadar, DHQH, RHC Jiwani and RHC Ormara reported such contribution in the form of
new vehicle/ambulance.
Clients Perspective
Client exit interviews were conducted to assess clients perspective about their satisfaction
with the services utilised at the facility. Total of 25 interviews were conducted in the district
and findings concluded that 8% of the clients were very satisfied and 84% were satisfied and
8% were not satisfied with the availed services.
39
Annexes
40
Annex 1: District Health Department

Public sector district health system consists of Secondary Health Care (DHQH) and Primary
Health Care (RHC, BHU) facilities. DHO acts as head of the district health department.
Health Resources
Health facilities (Public sector)
Public sector facilities providing MNCH services are given in table below:
TABLE 2.4: NUMBER OF PUBLIC SECTOR HEALTH FACILITIES IN THE DISTRICT
Type
Number
Bed strength
Teaching hospitals
DHQ Hospital
45
THQ Hospital
RHC
58
BHU
20
23
Govt. Rural Dispensaries
24
MNCH Centres
Sub Health Centres
S OURCE : DHIS C ELL , DHO OFFICE
Human Resource DHO Office

Table 2.5 summarises the HR situation at the DHO office.
TABLE 2.5: HUMAN RESOURCE IN OFFICE OF DHO
Name of Post
Sanctioned
Filled
% Filled
District Health Officer
100
Deputy District Officer Health
100
District Coordinator National Program for FP & PHC
100
District Coordinator EPI Surveillance
100
District Coordinator NMNCHP
100
District Sanitary Inspector
Communicable Disease Control Officer
CDC Inspector
Drug Inspector
District Superintendent Vaccination
100
Assistant Superintendent Vaccination
100
Tehsil Sanitary Inspector
41
Name of Post
Sanctioned
Filled
% Filled
10
90
Inspector Vaccination
Total
S OURCE : DHO OFFICE
MNCH staff in District Gaw adar

Table 2.6 summarises the status of MNCH staffing in health facilities including DHQH, RHC
and BHU in the district. The information was collected from DHO office during survey.
This information may not match with subsequent tables containing similar information on
human resource (HR) collected from respective surveyed health facilities (No. 3.9, 3.14,3.18,
3.19,3.20).
TABLE 2. 6: AVAILABILITY OF MNCH SERVICES STAFFING IN GAWADAR
Sanctioned
Filled posts
R= Regular,
C= On Contract
Filled
Gynaecologist
100
Paediatrician
100
Anaesthetist
100
Radiologist
Pathologist
11
63
18
13
72
10
O.T. Technician
40
Anaesthesia
Technician
67
LHV
12
11
90
Nurses
40
157*
165
105
67
67
Posts
Women Medical
Officers (WMO)
Medical Officers
(MOs)
Blood transfusion
officers
Blood bank
technician
Lady Health
Workers (LHW)
Laboratory
Technician
X-ray Technician
% Filled
DHQH=1
THQH=0
RHC=3
BHU=20
42
Sanctioned
Filled posts
R= Regular,
C= On Contract
Filled
Dispenser
20
16
80
11
Vaccinators
20
14
70
Ambulance
Drivers
62
TOTAL
270
243
90
52
0
15
S OURCE : DHIS C ELL , DHO OFFICE
11
Posts
% Filled
* LHW ARE COMMUNITY BASED
DHQH=1
THQH=0
RHC=3
BHU=20
Financial Allocations
Budgetary allocations and expenditures over the last three years for the district (in PKR
Million) are presented in table 2.7; allocations mentioned below are lump sum as provided by
DHO office.
TABLE 2.7: FINANCIAL ALLOCATION IN DISTRICT GAWADAR
District
Health
Budget
2007-08
2008-09
2009-10
Allocation
Expenditure
Allocation
Expenditure
Allocation
Expenditure
NonDevelopment
53
52.1
64.1
54.3
65
63
Development
Total
53
52.1
64.1
54.3
65
63
S OURCE : DHO OFFICE
Donor Contribution
Information about donor contribution for MNCH services was asked from DHO office in terms
of financial input. It was reported that donor contribution was provided to this district, but
district health department was unable to provide monetary value of the support provided.
During survey, information about donor inputs on surveyed health facilities was also
collected; however, selected health facilities were found having received such inputs in
terms of infrastructure, equipment, ambulances.
NMNCH Programme Indicators

Information on NMNCHP indicators is being compiled at office of DHO and this information
has been gathered on the sets of indicators, which is reproduced as such in following
43

tables. It is important to note that services utilisation data reported by district office take into
account utilisation of all public sector facilities in the district.
This information may not match with subsequent tables containing information on drugs and
supplies (Table No. 3.6, 3.11, 3.16, 3.21) and C-sections (No. 3.31) collected from
respective health facilities included in survey.
TABLE 2.8: NMNCHP MONITORING INDICATORS (YEAR 2010)
Services Management
Number of district monthly performance review meetings held during last year
Number of facilities with stock-out of FP commodities
Number of facilities stock outs of essential EmONC drugs
Support Services
Number of facilities with laboratory services available
Number of facilities with blood transfusion services available
Service Utilisation
Antenatal care coverage
1055
Percentage of children <12 months fully vaccinated
63%
TT-2 coverage
2853
Number of deliveries at health facilities
Number of live births at health facilities
1394
Postnatal coverage
Number of family planning visits (by type of modern method)at health facilities
Number of Caesarean Sections at Comprehensive EmONC facilities
960
0
Morbidity and Mortality (at public health facilities)

Number of maternal deaths
20
Number of neonatal deaths
Number of diarrhoea / dysentery in <5 years age group
7595
Number of pneumonia in <5 years age group
2269
Lady Health Workers (NP FP&PHC)

Number of new pregnant mothers registered
1582
Number of SBA deliveries reported
618
Number of maternal deaths reported
01
Number of modern FP methods users

Number of infant deaths reported
1695
08
Community Mid-Wives (NMNCHP)

Number of first antenatal care visits (ANC 1)
Number of ANC revisits
Number of TT 2 given
CMW were
not
Deployed
44

Number of deliveries
Number of post natal visits
Number of family planning visits (both new and follow-up)
Number of FP commodities provided
Number of maternal complications referred
Number of neonates referred
Number of clean/safe delivery kits used
Stock out of clean/safe delivery kits
Stock out of FP commodities
Number of pregnant women referred by LHW
Number of maternal deaths
Number of neonatal deaths
S OURCE : DHIS C ELL , MNCH C ELL , EPI C ELL , MIS NP FOR FP&PHC-DHO O FFICE
Provision of Staff by the NMNCHP

The NMNCHP is supposed to provide support in human resource at target health facilities,
including specialists, doctors and paramedics. The programme is currently under
implementation and number of facilities having staff provided by the NMNCHP is given in the
table 2.9.
TABLE 2.9: NUMBER OF FACILITIES WITH STAFF PROVIDED BY THE NMNCHP
Staff Cadre
Number of Health facilities

DHQH
THQH
RHC
BHU
Gynaecologist
-*
Anaesthetist
Paediatrician/Neonatologist
WMO
OT technician
BB technician
Lab technician
Nurses
LHV
Ambulance drivers
S OURCE : MNCH C ELL DHO O FFICE -* DATA NOT AVAILABLE
MNCH Staff Trainings

Part of the mandate of the Programme is to build capacity of MNCH related staff through
conducting skill development trainings of the staff in standards of service provision,
counselling techniques and client centeredness. Information about trainings of MNCH staff is
45

presented in the table 2.10. It is important to note here that this information collected from
district office may not match with similar information contained in Table No. 3.23 collected
from the surveyed facilities.
TABLE 2. 10: NUMBER OF STAFF TRAINED ON DELIVERING MNCH SERVICES
Category of
staff
Number of staff trained (during last three years)

EmONC
ENC
IMNCI
IMPAC
FP
Surgical
FP
Counselling
Client
centeredness
Gynaecologist
Paediatrician
Anaesthetics
WMO
MO
11
11
OT Technician
Nurse
10
0
4
LHV
S OURCE : MNCH C ELL DHO O FFICE
CMW Training and Deployment

Part of the mandate of the Programme is to train and deploy CMW for improving community
based MNCH services. Information collected from district NMNCH cell related to the CMW
training and deployment is presented in the table 2.11
TABLE 2.11: STATUS OF CMW TRAINING AND DEPLOYMENT
Training and Deployment of Community Mid-Wives (NMNCHP)

Number of selected CMW verified for their residential status
34
Number of CMW with completed training
19
Number of CMW deployed by NMNCHP
Number of CMW Schools where renovation/ construction completed
CMW Manual/Books available (Number of sets)
19
CMW training equipment/models available (Number)
40
Number of CMW sponsored/supported by partners

S OURCE : MNCH C ELL DHO O FFICE
31
46
Annex 2: Input Criteria for MNCH Services

A. Civil w orks criteria
CIVIL WORKS SCOPE FOR BHU
OPTIMAL ITEMS
2. Examination area
3. Hand washing facilities
2. Scrub area
3. Functional attached wash room for patient
Ob/Gin OPD or LHV room

Labour room
1. Delivery room
WMO or LHV residence
1. Available
2. Good condition
MINIMAL ITEMS
Available
LHV Room
CIVIL WORKS SCOPE FOR RHC

OPTIMAL ITEMS
2. Examination area
Ob/Gyn OPD
Ob/Gyn Ward
1. Patient area
Labour room
1. Delivery room
Clinical laboratory
1. Laboratory room
LHV Room
2. Functional attached wash room

2. Scrub area
3. Functional attached wash room for patient
2. Working area
3. Functional attached washroom
2. Examination area
1. Available
2. Good condition
1. Available
2. Good condition
MINIMAL ITEMS
Available
Available
Available
Available
1. Available
2. Good condition
1. Available
2. Good condition
WMO residence
LHV residence
Ob/Gyn OPD
Ob/Gyn Ward
Labour room
LHV Room
WMO residence
LHV residence
CIVIL WORKS SCOPE FOR DHQH & THQH
Ob/Gyn OPD
Ob/Gyn ward
1. Patient area
2. Nursing station
Labour room
1. Delivery room
2. Preparation/ stage room
3. Scrub area
OPTIMAL ITEMS
2. Examination area
3. Store for General items/drugs, or
5.
6.
7.
8.
Store for General items/drugs,

Store for Equipment
Functional attached wash room for patient
Functional attached wash room for staff
47

4. Staff duty room
5.
6.
7.
8.
9.
10.
Operation theatre
1. Patient preparation room
2. Operating room
3. Recovery room
4. Scrub area
Paediatric ward
1. Patient area
2. Nursing station
Paediatric nursery
1. Patient area
2. Nursing station
Clinical laboratory
1. Laboratory room
2. Working area
Blood bank
1. Blood collection room
2. Working area
LHV Room
2. Examination area
Ultrasound room
Gynaecologist residence
Anaesthetist residence
Paediatrician residence
WMO residence
LHV residence
Nurse residence
Lab technician residence
BB technician residence
Anaesthesia technician residence
3. Store for General items/drugs, or equip

3. Store for General items/drugs, or equip
4. Change room
3.
4.
5.
3.
4.
5.
Anaesthetist residence
Paediatrician residence
WMO residence
Lab technician residence
Doctors duty room

Store for chemical / reagents, or equip
Functional attached washroom
Staff duty room
Store for equipment / reagents

Examination area
Available
Good condition
Available
Good condition
Available
Good condition
Available
Good condition
Available
Good condition
Available
Good condition
Available
Good condition
Available
Good condition
Available
Good condition
MINIMAL ITEMS
Ob/Gyn OPD
Ob/Gyn Ward
Labour room
Operation theatre
Paediatric ward
Clinical laboratory
Gynaecologist residence
Sterilisation area
Doctors room
Support staff duty room
Store for General items/drugs, or equip.
Store of equipment
Functional attached washroom for staff
Available
Available
Available
Available
Available
Available
Available
Good condition
Available
Good condition
Available
Good condition
Available
Good condition
Available
Good condition
48
B. Human Resource criteria

HUMAN RESOURCE FOR PREVENTIVE
EmONC
OPTIMAL HR FOR BHU
Category
Number
MO, or
1
LHV
1
MINIMAL HR FOR BHU
MO, or
1
LHV
1
-
HUMAN RESOURCE FOR 24/7 Basic EmONC

OPTIMAL HR FOR RHC
Category
Number
WMO
2
OT technician
1
Lab technician
1
LHV
2
Ambulance driver
1
MINIMAL HR FOR RHC
WMO
1
Lab technician
1
LHV
1
-
HUMAN RESOURCE FOR 24/7 Comprehensive EmONC

OPTIMAL HR FOR DHQH
OPTIMAL HR FOR THQH
Category
Number
Gynaecologist
2
Anaesthetist
2
Paediatrician
2
WMO
6
OT technician
4
BB technician
4
Lab technician
3
4
Nurses
20
LHV
4
Ambulance drivers
4
MINIMAL HR FOR DHQH
Gynaecologist
1
Anaesthetist
1
Paediatrician
1
WMO
4
OT technician
1
Lab technician
1
Nurses
6
LHV
1
Category
Number
Gynaecologist
1
Anaesthetist
1
Paediatrician
1
WMO
4
OT technician
4
BB technician
4
Lab technician
2
4
Nurses
12
LHV
4
Ambulance drivers
4
MINIMAL HR FOR THQH
Gynaecologist
1
Anaesthetist
1
Paediatrician
1
WMO
2
OT technician
1
Lab technician
1
Nurses
4
LHV
1
49
C. Equipment criteria
General hospital equipment

1. Electric water cooler
OPD / WMO office
1. Office / plain chairs
2. Examination couch
3. Office tables with drawer
4. Steel almirah large
5. Patient stool
6. Weight machine adult
EQUIPMENT FOR BHU

OPTIMAL ITEMS
2. Water filter
3. Incinerator
7. Weight machine infant
8. Height measuring board
9. Height measuring device
10. B.P Apparatus mercury-desk type
11. Foetal stethoscope
12. Steam inhaler
13. Nebuliser
14. Examination lamp
Lady health visitor's room

1. Weight scale Adult
2. Weight scale Infant
5. Disposable syringe cutter
6. D & C instruments set
1.
2.
3.
4.
5.
7.
8.
9.
10.
11.
12.
P.V. Examination light

Examination couch
Office chairs
Office tables with drawer
Patient stool
Steel almirah large
MINIMAL ITEMS
Office chairs
6. Weight scale Infant
Office tulizerables with drawer
B.P Apparatus mercury-desk type
Foetal stethoscope
Weight scale Adult
EQUIPMENT FOR RHC

OPTIMAL ITEMS
General hospital
1. Ambulance
Female ward items
1. Fowler bed (Iron)
2. Attendant's bench
3. Bed side locker
4. Overhead food trolley
OPD / WMO Office
1. Office chairs
2. Plain chairs
6. Patient stool
Labour room
1. UPS power supply system (2000W)
2. Suction machine electric
3. Infant weight machine
5. Electric instrument steriliser 12"x6"
6. Jar for forceps
7. Spring type dressing forceps (ss)
8. Sim's speculum right angle, small
9. Sim's speculum right angle, medium
3. Water filter
4. Incinerator
5.
6.
7.
8.
9.
8.
9.
10.
11.
12.
13.
14.
15.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
6.
Dust bin stainless steel

Screen folding complete
Baby cot
Stethoscope
Weight machine infant
Height measuring board
Height measuring device
Foetal stethoscope
Steam inhaler
Nebuliser
Examination lamp
Sim's speculum right angle, large
Sponge forceps
Long straight artery forceps
Uterine sound
Vulsellum forceps
Scissors dissecting blunt pointed
Artery forceps
Blunt-ended scissors
D & C instruments set
Infant ambo bag
Examination couch
50
1.
2.
3.
4.
5.
Weight scale Adult

Weight scale Infant
EQUIPMENT FOR RHC

OPTIMAL ITEMS
7. Office chairs
9. Patient stool
MINIMAL ITEMS
2.
3.
4.
5.
6.
Female Ward items

1. Fowler bed (Iron)
OPD / WMO Office
1. Office chairs
Labour room
2. Sim's Speculum right angle, medium
3. Sponge forceps
4. Uterine sound
1. Office chairs
3. Weight scale Adult

Stethoscope
Foetal stethoscope
5.
6.
7.
8.
Vulsellum forceps
Artery forceps
4.
5.
6.
7.
Weight scale Infant

Examination couch
EQUIPMENT FOR DHQ HOSPITAL

OPTIMAL ITEMS
General hospital
3. Desktop computer with monitor and
1. Ambulance
accessories
2. Defibrillator
Gynae/Obs. Ward items
10. Scissors curved 5 inch
1. Cabinet Instrument large
11. Scissors sharp 5 inch straight
2. Fowler bed (Iron )
12. Chital forceps
13. Kidney tray s.s 10 inch
4. Bed side locker
14. Jar for forceps
5. Screen folding complete
15. Infusion / drip stands
16. Foetal monitor (foetal Doppler desk type)
7. Artery forceps 7 inch
17. Infant B.P apparatus
8. B P Apparatus mercury Desk type
9. Dissecting forceps plain 7 inch
19. Baby cot
6. Stethoscope adult size
OPD / Gynaecologists Office
7. B.P apparatus desktop type
8. Office chair
9. Office table with drawers
10. Patient stool
4. Ultrasound machine
11. Patient waiting bench
5. Examination lamp
6. Phototherapy unit
Paediatric nursery
7. Baby warmer
1. Air ways 2 size
8. Infant B.P apparatus (Cuff 2.5 cm)
2. Infant ambo bag
9. Room thermometer
3. Infant laryngoscope set
10. Baby cot
4. Suction apparatus: electrically
11. Steam inhaler
operated
12. Oxygen cylinder complete with trolley
5. Infant Incubators
Paediatric ward
6. Emergency medicine trolley
1. Suction machine
7. Patient's attendant bench
3. Stethoscope Paediatric Littman type
9. Bed side locker s.s top
4. Nebuliser
51

EQUIPMENT FOR DHQ HOSPITAL
OPTIMAL ITEMS
Labour room
13. Artery forceps
14. Blunt-ended scissors
15. Episiotomy instruments set complete
3. Jar for forceps
16. D&C instruments set complete
17. Delivery forceps set
18. Infant ambo bag
19. Portable light rechargeable batteries
7. Sim's speculum right angle, large
20. Sterilising drum
8. Sponge forceps
21. Vacuum extractor
9. Long straight artery forceps
22. Delivery table
10. Uterine sound
11. Vulsellum forceps
12. Scissors dissecting blunt pointed
Operation theatre
17. Surgical knife handle # 3
1. Needle holder
2. Stitch scissors
19. Abdominal retractors, double-ended
3. Dissecting forceps, toothed
(Richardson)
4. Sim's speculum large
20. Curved operating scissors, blunt pointed
5. Sim's speculum medium
(Mayo), 17 cm
6. Vacuum extractor
21. Straight operating scissors, blunt pointed
7. Obstetric forceps
(Mayo), 17 cm
8. Rectangular instrument tray lids
22. Aesthetic face masks (3 sizes)
9. Towel clips
23. Anaesthesia machine
10. Sponge forceps, 22.5 cm
24. Laryngoscopes
11. Straight artery forceps, 16 cm
25. X-Ray illuminator
12. Uterine homeostasis forceps, 20 cm
26. Gynae Instrument set
13. Hysterectomy forceps, straight, 22.5
27. General Instrument set
cm
28. Adult ambo bag and mask
14. Mosquito forceps, 12.5 cm
15. Tissue forceps, 19 cm
30. Myomectomy screw
16. Needle holder, straight, 17.5 cm
31. Air conditioners
Laboratory
3. Counter (hand tally differential)
1. Spin machine
4. Steel Elmira large
2. Chemistry analyser
5. Lab cabinet
MINIMAL ITEMS
Gynae/Obs. Ward Items
4. B.P apparatus desktop type
5. Office chair
2. Examination lamp
6. Office table with drawers
3. Stethoscope adult size
Paediatric nursery
4. Suction apparatus: electrically operated
1. Air ways 2 size
2. Infant ambo bag
Paediatric ward
2. Nebuliser
Labour room
6. Uterine sound
9. D&C instruments set complete
10. Delivery forceps set
5. Sponge forceps
11. Delivery Table
Operation theatre
1. Anaesthesia Machine
2. Laryngoscopes
52
EQUIPMENT FOR THQ HOSPITAL

OPTIMAL ITEMS
General hospital
3. Desktop computer with monitor and
1. Ambulance
accessories
2. Defibrillator
10. Scissors curved 5 inch
1. Cabinet Instrument large
11. Scissors sharp 5 inch straight
12. Chital forceps
13. Kidney tray s.s 10 inch
4. Bed side locker
14. Jar for forceps
16. Foetal monitor (foetal Doppler desk type)
7. Artery forceps 7 inch
17. Infant B.P apparatus
9. Dissecting forceps plain 7 inch
19. Baby cot
4. Ultrasound machine
5. Examination lamp
Paediatric nursery
7. Baby warmer
1. Air ways 2 size
2. Infant ambo bag
9. Room thermometer
10. Baby cot
4. Suction apparatus: electrically
11. Steam inhaler
operated
Paediatric ward
6. Emergency medicine trolley
1. Suction machine
7. Patient's attendant bench
9. Bed side locker s.s top
4. Nebuliser
Labour room
10. Uterine sound
3. Jar for forceps
13. Artery forceps
16. Infant ambo bag
17. Portable light rechargeable batteries
8. Sponge forceps
18. Sterilising drum
19. Vacuum extractor
Operation theatre
1. Needle holder
2. Stitch scissors
19. Abdominal retractors, double-ended
3. Dissecting forceps, toothed
(Richardson)
4. Sim's speculum large
20. Curved operating scissors, blunt pointed
5. Sim's speculum medium
(Mayo), 17 cm
6. Vacuum extractor
21. Straight operating scissors, blunt pointed
7. Obstetric forceps
(Mayo), 17 cm
8. Rectangular instrument tray lids
22. Aesthetic face masks (3 sizes)
9. Towel clips
10. Sponge forceps, 22.5 cm
24. Laryngoscopes
11. Straight artery forceps, 16 cm
25. X-Ray illuminator
12. Uterine homeostasis forceps, 20 cm
13. Hysterectomy forceps, straight, 22.5
27. General Instrument set
cm
28. Adult ambo bag and mask
53

EQUIPMENT FOR THQ HOSPITAL
OPTIMAL ITEMS
14. Mosquito forceps, 12.5 cm
15. Tissue forceps, 19 cm
30. Myomectomy screw
16. Needle holder, straight, 17.5 cm
31. Air conditioners
Laboratory
3. Counter (hand tally differential)
1. Spin machine
4. Steel Elmira large
2. Chemistry analyser
5. Lab cabinet
MINIMAL ITEMS
2. Examination lamp
Paediatric nursery
4. Suction apparatus: electrically operated
1. Air ways 2 size
2. Infant ambo bag
Paediatric ward
2. Nebuliser
Labour room
4. Sponge forceps
5. Uterine sound
Operation theatre
2. Laryngoscopes
D. Drugs and supplies criteria

DRUG & SUPPLIES FOR BHU
OPTIMAL ITEMS
Supplies
1. Gloves
2. Clean / Safe delivery kit
3. Disposable/ Auto disable Syringes
Tracer Drugs
1. Cap Amoxicillin
2. Syrup Amoxicillin
3. Tablet Metronidazole
4. Syrup Metronidazole
5. Tablet iron
6. Tablet folic acid
Vaccines
1. BCG
2. OPV
FP Commodities
1. Condoms
2. COC
3. POP
Supplies
Tracer Drugs
Vaccines
1. BCG
2. OPV
4. Reagents/ strips for routine lab tests

5. Surgical Spirit
6. Oral Rehydration Salt ORS
7.
8.
9.
10.
11.
12.
Tetracycline Ointment
Injection Oxytocin
IV Solutions
Syp. Salbutamol
Syp. Chloroquine
Syp. Zinc Sulphate
3. Penta-valent
4. Measles
5. TT
4. IUCDs
5. Injection DMPA
6. Injection Net-En
MINIMAL ITEMS
1. Tablet iron
3. Penta-valent
4. Measles
5. TT
54
FP Commodities (any three)

1. Condoms
2. IUCDs
DRUG & SUPPLIES FOR BHU

OPTIMAL ITEMS
3. COC or POP
4. Injection DMPA or Net-En
DRUG / SUPPLIES FOR RHC

OPTIMAL ITEMS
Supplies
1. Gloves
5. Surgical Spirit
Tracer Drugs
1. Injection Dexamethasone
11. Tetracycline Ointment
2. Injection Adrenaline
12. Injection Oxytocin
3. Injection Atropine
13. Injection Magnesium sulphate
4. Injection Ampicillin
14. IV Solutions
5. Cap Amoxicillin
15. Syp. Salbutamol
16. Syp. Chloroquine
17. Syp. Zinc Sulphate
18. Injection Diclofenac Sodium
9. Tablet iron
Vaccines
3. Penta-valent
1. BCG
4. Measles
2. OPV
5. TT
FP Commodities
4. IUCDs
1. Condoms
5. Injection DMPA
2. COC
6. Injection Net-En
3. POP
MINIMAL ITEMS
Supplies
Tracer Drugs
Vaccines
3. Penta-valent
1. BCG
4. Measles
2. OPV
5. TT
3. COC or POP
1. Condoms
2. IUCDs
55

DRUG / SUPPLIES FOR DHQH & THQH
OPTIMAL ITEMS
Supplies
5. Screening Kits for Hep B,C & HIV
1. Gloves
6. Blood grouping reagents
7. Blood bags with transfusion sets
8. Surgical Spirit
Tracer Drugs
14. IV Solutions
15. Syp. Salbutamol
5. Cap Amoxicillin
19. Injection Thiopentone Sodium
9. Tablet iron
20. Injection Neostigmine
21. Injection Propofol
Vaccines
3. Penta-valent
1. BCG
4. Measles
2. OPV
5. TT
FP Commodities
4. IUCDs
1. Condoms
5. Injection DMPA
2. COC
6. Injection Net-En
3. POP
7. Implants
MINIMAL ITEMS
Supplies
1. Gloves
Tracer Drugs
7. Injection Thiopentone Sodium
8. Injection Neostigmine
9. Injection Propofol
Vaccines
3. Penta-valent
1. BCG
4. Measles
2. OPV
5. TT
3. COC or POP
1. Condoms
2. IUCDs
5. Implants
E. Support Service Criteria

SUPPORT SERVICES FOR BHU
SUPPORT SERVICES FOR RHC
OPTIMAL CRITERIA
Basic lab tests
1. Doctor or LHV
2. Reagents and strips
OPTIMAL CRITERIA
Basic lab tests
1. Space
2. Doctor or LHV or Lab technician
Ambulance services
1. Functional ambulance
2. Ambulance driver
MINIMAL CRITERIA FOR BHU

Basic lab tests
1. Doctor or LHV
MINIMAL CRITERIA FOR RHC

Basic lab tests
1. Space
56

2. Doctor or LHV or Lab Technician

SUPPORT SERVICE CRITERIA FOR SHC HOSPITALS

OPTIMAL CRITERIA
Basic lab tests
3.
1. Space
4.
2. Laboratory technician
Blood transfusion services
2.
1. BB Technician or Lab technician
Radiology services
2.
1. Space
Operation theatre services
4.
1. Space
5.
2. Anaesthetist
6.
3. OT Technician
Ambulance services
2.
Reagents and strips

Laboratory Equipment
Screening strips for Hep B, C & HIV
Ultrasound equipment
Anaesthesia Technician
OT equipment
Drugs and supplies
Ambulance driver
MINIMAL CRITERIA
2. Lab Technician
Basic lab tests

1. Space
Blood transfusion services
1. Laboratory or BB Technician
Radiology services
1. Space
Operation theatre services
1. Space
2. Anaesthetist or Anaesthesia Technician
2. Screening strips for Hep B, C & HIV

2. Ultrasound equipment
3. OT equipment
4. Drugs and supplies
F. Infection Control & Waste Management Criteria

ASSESSMENT CRITERIA
Infection Control Hand washing
1. Hand washing basin with running water
3. Towel
2. Soap
4. Gloves
Personal Protection Materials
1. Face masks
2. Safety goggles
3. Heavy duty leather gloves
1. Safety boxes
4. Gowns
5. Industrials boots
Waste collection materials
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
57
G. Input Criteria for Basic EmONC services at THQ Hospital

G.1 Civil works
OPD
Female ward
1. Patient area
Labour room
1. Delivery room
Clinical laboratory
1. Laboratory room
LHV Room
CIVIL WORKS SCOPE

2. Examination area
2.
3.
2.
3.
2.
3.
WMO residence
LHV residence
Scrub area
Functional attached wash room for patient
Working area
Examination area
Hand washing facilities
Available
Good condition
Available
Good condition
G.2 Human Resource

HUMAN RESOURCE
Category
Number
WMO
OT technician
2
1
Lab technician
LHV
Ambulance drivers
1
2
1
G. 3 Equipment
EQUIPMENT
General hospital
1. Ambulance
Female ward
6. Baby cot
3. Bed side locker
OPD
3. Examination lamp
Labour room
8. Sponge forceps
10. Uterine sound
3. Jar for forceps
13. Artery forceps
58
G.4 Drugs and Supplies

DRUG / SUPPLIES
Supplies
1. Gloves
9. Tablet iron
Tracer Drugs
14. IV Solutions
5. Cap Amoxicillin
15. Syp. Salbutamol
Vaccines
3. Penta-valent
1. BCG
4. Measles
2. OPV
5. TT
FP Commodities
4. IUCDs
1. Condoms
5. Injection DMPA
2. COC
6. Injection Net-En
3. POP
G.5 Support Services

SUPPORT SERVICE
Laboratory services
1. Basic Laboratory tests
Ambulance Services
2. Ambulance driver
59
Annex 3 - A: Status of Surveyed HF against Minimal

Level of Inputs
A. Status of BHU
i.
STATUS OF ASSESSED INFRASTRUCTURE IN BHU

Status of building components at Surveyed BHU
BHU Pishkan
BHU Nagor
Sharif
BHU
Ganz
BHU
Basool
BHU
Kolanch
Kocho
LHV Room Available
LHV Room Functional
Infrastructure
ii.
STATUS OF MNCH RELATED STAFF IN BHU

Status of MNCH related staff in BHU
Staff categories
Required
Number
BHU Pishkan
BHU Nagor
Sharif
BHU
Ganz
BHU
Basool
BHU
Kolanch
Kocho
WMO or LHV
iii.
STATUS OF FUNCTIONAL EQUIPMENT IN BHU

Availability of functional equipment items at surveyed
BHU
Equipment
Total Items
Assessed items
10
iv.
BHU Pishkan
BHU Nagor
Sharif
BHU
Ganz
BHU
Basool
BHU
Kolanch
Kocho
STATUS OF DRUGS AND SUPPLIES IN BHU

Item groups
Total Items
required at
each BHU
BHU Pishkan
BHU Nagor
Sharif
BHU
Ganz
BHU
Basool
BHU
Kolanch
Kocho
Supplies*
Drugs*
Vaccines
FP Commodities
60

* Tracer items were selected for assessment from list provided in the PC-1 NMNCHP
v.
STATUS OF SUPPORT SERVICES IN BHU

Support services
Total Items
required at
each BHU
BHU
Pishkan
BHU Nagor
Sharif
BHU
Ganz
BHU
Basool
BHU
Kolanch
Kocho
Basic lab tests*
*Include facility for tests of pregnancy, haemoglobin, urine for protein and sugar, and
malaria.
B. 24/7 Basic EmONC Services at RHC

i.
STATUS OF ASSESSED INFRASTRUCTURE IN RHC
Infrastructure
Status
RHC Jiwani
RHC Ormara
RHC Pasni
OPD
Female ward
Labour Room
LHV Room
Residence
Doctor
Residence
LHV
Status of building components at each

RHC
61

ii.
STATUS OF MNCH RELATED STAFF IN RHC
Staff categories
Required
number at each
RHC
WMO
Number of MNCH related staff available at

each RHC
RHC Jiwani
RHC Ormara
RHC Pasni
LHV
Lab technician
iii.
STATUS OF FUNCTIONAL EQUIPMENT IN RHC
Equipment
Total Items
required at each
RHC
Female ward

available at each RHC
RHC Jiwani
RHC Ormara
RHC Pasni
WMO OPD
Labour room
LHV Room
iv.
STATUS OF DRUGS AND SUPPLIES IN RHC

Item groups
Total Items
required at each
RHC
RHC Jiwani
RHC Ormara
RHC Pasni
Supplies*
Drugs*
Vaccines
FP Commodities
62

v.
STATUS OF SUPPORT SERVICES IN RHC

Support services
Total Items
required at
each RHC
RHC Jiwani
RHC Ormara
RHC Pasni
Basic lab tests*
Ambulance service
*Include facility for tests of pregnancy, haemoglobin, urine for protein and sugar, and malaria.
C. 24/7Comprehensive EmONC Services at DHQ Hospital

STATUS OF ASSESSED INFRASTRUCTURE IN DHQ HOSPITAL
i.
Availability of building components

Infrastructure
Status
DHQH Gawadar
A
Residence:
Gynaecologist
Residence:
Anaesthetist
Residence:
Paediatrician
Residence:
OPD
Female ward
Labour room
Operation theatre
Paediatrics ward
Clinical lab
63

WMO
Residence
Lab Technician
ii.
STATUS OF MNCH RELATED STAFF IN SHC HOSPITALS

Availability at DHQH
Staff categories
iii.
Required number
DHQH Gawadar
Gynaecologist
Anaesthetist
Paediatrician
WMO
OT technician
Lab technician
Nurses
LHV
STATUS OF FUNCTIONAL EQUIPMENT IN DHQ HOSPITAL

Availability of functional equipment items
Total Items
DHQH Gawadar
Equipment
iv.
Female ward
OPD
Paediatric nursery
Paediatric ward
Labour room
11
Operation theatre
STATUS OF DRUGS AND SUPPLIES IN SHC HOSPITALS
Item groups
Total Items
Number of items available at DHQ

Hospitals
DHQH Gawadar
Supplies*
Drugs*
Vaccines
FP Commodities
6
9
5
5
5
0
4
4
64

v.
STATUS OF SUPPORT SERVICES IN SHC HOSPITALS
Item groups
Total Items
Number of items
available at
DHQH Gawadar
Basic laboratory tests*
Blood transfusion
Ambulance services
Radiology services
Operation theatre
16
10
*Include facility for tests of pregnancy, haemoglobin, urine for protein and sugar, and
malaria.
65
A nnex 3 B: List of Items Required

Each item is assessed against the standard quantity in different assessed components of the
service provision areas. Standard quantity of same item may vary in each component.
Annexed tables include aggregate quantity of each item in all the surveyed components.
Therefore, table may show requirement of an item despite having same aggregate quantity
in respect of standard, available and functional, as explained in the following table. Annexed
tables shows the aggregate quantities of each assessed item, therefore, requirement may
arise even the overall standard quantity is available and functional in the facility.
Component
Quantity of an item
FUNC*
STD*
AVL*
RQRD*
OPD
Ward
Aggregate
* STD: Standard, AVL: Available, FUNC: Functional, RQRD: Required
A. List of items required for DHQ Hospital in District Gawadar
DHQ Hospital Gawadar

Items 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
Bed side locker s.s top
C.T.G. machine
Cabinet Instrument large
Chemistry analyser
Chital forceps
Counter (hand tally differential)
Curved operating scissors, blunt pointed (Mayo),
17 cm
Item Quantities
Standard
12
2
Available
8
2
Functional
4
2
Required
8
-
10
1
1
2
2
8
30
1
4
21
2
60
6
1
2
1
2
2
10
7
3
5
7
2
3
3
3
6
1
1
1
2
1
10
3
1
5
7
2
3
3
3
6
1
1
1
2
1
10
1
3
28
1
1
18
54
5
1
1
1
6
6
7
2
7
2
66

Defibrillator
Delivery forceps set
Delivery table
Desktop computer with monitor and accessories
Dissecting forceps plain 7"
Dissecting forceps, toothed
ECG machine
Electric instrument steriliser 12"x6"
Electric water cooler
Emergency medicine trolley
Episiotomy instruments set complete
Examination couch
Foetal monitor (foetal Doppler desk type)
Foetal stethoscope
Fowler bed (Iron)
General Instrument set
Glucometer
Gynae Instrument set
Haematology analyser
Hysterectomy forceps, straight, 22.5 cm
Incinerator 50kg
Infant ambo bag
Infant B.P apparatus (Cuff 2.5 cm)
Infant laryngoscope set
Infant weight machine
Infusion / drip stands
Infusion pump
Jar for forceps
Kidney tray s.s 10"
Lab Cabinet
Lab Incubator
Laryngoscopes set (Adult)
LaserJet printer
Long straight artery forceps 10"
Mosquito forceps, 12.5 cm
Myomectomy screw
Nebuliser
Needle holder, straight, 17.5 cm
Needle holder, straight, 8"
Obstetric forceps
Office chair
Ophthalmoscope
Overhead food trolley
Oxygen cylinder complete with trolley & regulator
Patient stool
Patient waiting bench
Patient's attendant bench
Phototherapy unit
Portable Light e rechargeable batteries (OT)
Power Generator 50 Kva (Diesel)
Pulse oximeter
Rectangular instrument tray e lids
Refrigerator 10 cuft
Room thermometer
Scissors curved 5"
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
4
2
2
2
1
30
9
3
2
2
30
1
1
1
3
3
3
1
2
1
1
4
12
3
1
1
1
3
7
1
1
1
7
5
4
1
3
6
4
3
1
4
1
1
2
12
2
6
27
6
1
1
3
3
5
5
3
4
3
1
1
1
4
12
2
1
1
1
3
7
1
1
1
4
5
4
1
3
6
4
3
1
4
1
1
2
12
2
6
15
6
1
1
3
3
5
5
3
4
3
1
1
1
4
30
1
2
3
1
1
1
53
2
1
14
1
1
2
12
2
1
1
3
3
1
24
2
6
1
1
1
30
6
3
25
1
1
3
1
1
1
67

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 (ss)
Steam inhaler
Steel Almirah large
Sterilising drum
Stethoscope adult size
Stethoscope Paediatric Littman type
Stitch scissors
Straight artery forceps, 16 cm
Straight operating scissors, blunt pointed (Mayo),
17 cm
Suction apparatus: electrically operated
Surgical knife handle # 3
Surgical knife handle # 4
Tissue forceps, 19 cm
Towel clips
Ultrasound machine
UPS for computer
UPS power supply system (2000W)
Uterine homeostasis forceps, 20 cm
Uterine sound
Vacuum extractor
Vulsellum forceps
Water distillation unit
Water filter
Weight machine adult
X-Ray illuminator
Total quantities
3
2
10
1
4
4
3
3
3
1
7
2
4
2
4
2
4
4
36
1
5
1
2
4
2
2
1
2
15
1
5
1
4
2
2
1
2
15
3
1
5
1
4
4
2
3
3
1
3
2
4
4
3
2
21
6
4
3
3
36
36
1
4
4
18
2
2
3
1
2
2
1
766
4
1
4
6
7
18
1
2
1
1
1
1
317
4
1
4
6
7
18
1
2
1
1
1
288
2
3
29
18
4
4
16
2
1
2
1
2
2
537
68
B. List of required items at RHC District Gaw adar
AVL
FUNC
RQRD
AVL
FUNC
RQRD
Item Quantities
RQRD
Item Quantities
FUNC
RHC Pasni Gawadar
AVL
Ambulance
Artery forceps 7"
Attendant's bench
Baby Cot
Bed side locker s.s top
Clean delivery kits
Disposable syringe cutter
Electric instrument steriliser 12"x6"
Examination couch
Foetal stethoscope
Fowler bed (Iron)
General Instrument set
Incinerator 50kg
Infant ambo bag
Jar for forceps
Long straight artery forceps 10"
Nebuliser
Office chair
Overhead food trolley
Patient stool
Plain chairs
Sim's speculum right angle, medium
Sim's speculum right angle, small
Sponge forceps, 22.5 cm
Spring type dressing forceps (ss)
Steam inhaler
Steel Almirah large
Stethoscope adult size
Suction apparatus: electrically
operated
UPS power supply system (2000W)
RHC Ormara Gawadar
Standard Quantity
Items name
RHC Jeanie Gawadar

Item
Quantities
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
1
2
1
1
1
1
2
1
1
1
2
2
3
1
1
2
2
2
4
1
2
-
1
2
2
-
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
1
2
2
2
2
2
2
2
1
1
2
7
25
2
2
8
5
1
1
1
2
3
13
1
1
4
1
1
2
2
4
2
20
1
4
2
3
2
3
1
2
-
2
7
25
2
2
8
5
1
1
1
2
3
1
1
2
1
1
1
1
10
1
2
3
2
3
1
2
-
2
12
99
1
20
1
1
20
1
2
1
1
1
1
1
1
5
1
20
2
1
1
2
2
1
1
4
2
1
6
3
50
2
1
1
1
2
3
1
1
2
5
1
3
3
3
9
1
2
2
2
3
1
1
2
-
1
4
2
1
6
3
50
2
1
1
1
2
3
1
1
2
5
1
3
3
3
9
1
2
2
2
3
1
1
2
-
20
3
14
50
1
19
20
1
1
1
1
2
1
3
20
2
2
1
1
1
69

Uterine sound
Vulsellum forceps
Water filter
Total
2
2
1
2
277
2
32
1
6
2
2
1
1
271
5
133
5
96
2
2
1
207
2
2
124
2
2
124
2
1
168
C. List of items required for surve yed BHU in District Gawadar
Item Quantities
RQRD
AVL
FUNC
RQRD
AVL
FUNC
RQRD
1
50
1
1
1
2
1
2
2
1
2
1
4
2
2
2
4
1
2
1
2
85
Item
Quantities
BHU Kolanch
Kocho
Gawadar
Item
Quantities
FUNC
Standard Quantity

Clean Delivery Kits
Examination couch
Foetal stethoscope
Incinerator 50kg
Nebuliser
Office chair
Patient stool
Plain chairs
Steam inhaler
Steel Almirah large
Water filter
Total
BHU Ganz - Gawadar
AVL
Items name
BHU Basool Gawadar
1
1
1
1
1
2
1
8
1
1
1
1
1
1
6
50
1
1
1
1
1
2
2
1
2
1
3
1
2
1
3
1
2
1
2
79
2
1
4
2
1
6
3
4
4
3
1
31
2
1
4
2
1
6
3
4
4
2
1
30
50
1
1
1
2
2
1
2
2
1
1
1
65
1
1
1
1
1
1
4
2
12
1
2
3
1
50
1
1
1
2
1
2
2
1
2
1
4
2
2
2
3
1
1
1
2
83
70
Items name
B P Apparatus mercury Desk
type
Clean Delivery Kits
Electric Water Cooler
Examination Couch
Foetal stethoscope
Incinerator 50kg
Nebuliser
Office Chair
Office Tables with drawer
Patient Stool
Plain Chairs
Steam inhaler
Steel Almirah large
Water filter
Total
Standard
Quantity
1
50
1
1
1
2
1
2
2
1
2
1
4
2
2
2
4
1
2
1
2
85
BHU Nagor Sharif Gawadar

Item Quantities
BHU Pishkan Gawadar

Item Quantities
AVL
FUNC
RQRD
AVL
FUNC
RQRD
2
1
1
3
2
1
2
6
1
19
1
1
1
3
2
2
2
12
50
1
1
1
1
2
2
1
2
1
2
2
2
1
2
1
2
74
1
3
1
1
1
2
1
1
2
1
2
2
2
4
2
26
1
1
1
50
1
1
1
2
1
2
2
1
2
1
4
1
2
2
4
1
2
1
2
84
D. Estimated cost of required equipment at surve yed facilities

Health facility
Estimated cost (in PKR)
DHQH Gawadar
17,152,319
RHC Jiwani
6,638,429
RHC Ormara
1,810,390
RHC Pasni
1,640,306
BHU Basool
678,466
BHU Ganz
455,678
BHU Kolanch Kocho
696,207
BHU Nagor Sharif
655,525
BHU Pishkan
707,366
71
Annex 4: Scope of Civil Works Required

A. Scope of civil w orks required at SHC Hospital
Rough cost Estimate for improvement/Renovation
DHQH Gawadar
Description
Covered Unit
Qty
Rate
Area
Boundary wall
Repair of boundary wall
Sft
1,188
115
Hospital
Main building
Repair
15856
Restoration of brick work
Cft
2,385
120
Restoration of roof tiles
Sft
1,692
84
Restoration of plaster work
Sft
6,311
20
Restoration of floor
Sft
2,523
60
Restoration of distempering
Sft
26,065
10
Restoration of doors/windows
Sft
471
500
Tile work in bathrooms
2
40,000
Restoration toilets
5,946
60
Restoration of electric components
4,144
60
Compound walls
Repair of compound walls ( 4 1/2 " )
Construction of new compound walls
( 9 " Thick )
External development
Repair
Approach road
Internal roads (Tuff Pavers)
Sewerage system ( 9 " dia ) including
manholes
Water supply system ( 3" Dia)
New construction
New construction
Residence
Repair
RCC roof
Restoration of Almirah
Restoration toilets
New construction
3943
Amount
136,649
286,200
142,132
126,216
151,400
260,652
235,500
80,000
356,760
248,651
Sft
Rft
257
25
115
1,500
29,518
37,500
Sft
Sft
Rft
75
5,850
125
60
60
350
4,500
351,000
43,663
Rft
144
350
50,488
Rft
Sft
5
-
350
2,200
1,750
8,674,600
Sft
Sft
Sft
Sft
Sft
Sft
Sft
147
835
2,236
3,012
5,860
48
670
7
2,213
2,877
84
400
20
60
10
500
500
40,000
60
60
12,338
333,850
44,725
180,705
58,600
24,000
335,000
280,000
132,788
172,624
Sft
2,200
19,245,600
3541
8748
Total
32,037,406
Without new construction
4,117,206
72
B. Scope of civil w orks required at surve yed RHC

RHC Jiwani District Gawadar
Description
Covered Unit
Qty
Rate
Area
Boundary wall
Sft
1,140
115
Hospital
Main building
Repair
Restoration toilets
New construction
131,100
4780
Compound walls
Repair
Approach road
manholes
New construction
New construction
Residence
Repair
Restoration toilets
Amount
1013
Cft
Sft
Sft
Sft
Sft
Sft
Sft
1,595
1,260
2,916
5,232
15,880
96
261
4
3,585
1,195
120
84
20
60
10
500
500
40,000
60
60
191,430
105,809
58,320
313,939
158,800
48,000
130,500
160,000
215,100
71,700
Sft
801
115
92,165
Sft
Rft
180
140
60
350
10,800
49,000
Rft
134
350
46,988
Sft
6,000
60
360,000
Sft
2,200
2,228,600
Sft
Sft
Sft
Sft
Sft
Sft
884
1,118
753
4,473
72
542
6
2,037
2,037
84
20
60
10
500
500
40,000
60
60
74,277
22,365
45,158
44,730
36,000
271,000
240,000
122,213
122,213
Sft
2,200
3259
Total
5,350,205
3,121,605
73

RHC Ormara District Gawadar
Description
Covered Unit
Qty
Rate
Area
Boundary wall
Sft
660
115
Hospital
Main building
Repair
Restoration toilets
Residence
Repair
Restoration toilets
New construction
75,900
6308
Compound walls
( 9 " Thick )
Repair
manholes
New construction
Approach road
Sewerage system ( 9 " dia )
New construction
Amount
2617
Sft
Sft
Sft
Sft
Sft
Sft
20
108
230
7,206
48
159
2
2,103
1,892
84
20
60
10
500
500
40,000
60
60
1,680
2,160
13,800
72,060
24,000
79,500
80,000
126,160
113,544
Sft
Rft
219
180
115
1,500
25,156
270,000
Rft
68
350
23,625
Rft
130
350
45,500
Sft
Sft
Rft
Rft
1,200
360
35
365
60
60
350
350
72,000
21,600
12,250
127,750
Sft
2,200
5,757,400
Sft
Sft
Sft
Sft
Sft
210
348
210
1,392
59
210
420
-
84
20
60
10
500
60
60
2,200
17,640
6,960
12,600
13,920
29,500
12,600
25,200
7,110,400
840
3232
Sft
Total
14,172,905
1,305,105
74

RHC Pasni District Gawadar
Description
Covered Unit
Qty
Rate
Area
Boundary wall
Sft
2,363
115
Construction of new boundary wall
Rft
110
1,500
( 9 " Thick )
Hospital
Main building
Repair
RCC roof
Restoration toilets
Residence
Repair
RCC roof
Restoration of doors/Windows
Restoration toilets
New construction
271,688
165,000
3556
Compound walls
Repair
manholes
New construction
Approach road
New construction
Amount
801
Cft
Sft
Sft
Sft
Sft
Sft
Sft
Sft
10,823
238
3,359
15,767
3,235
23,281
48
452
2
1,956
1,915
120
84
400
20
60
10
500
500
40,000
60
60
1,298,751
19,950
1,343,573
315,345
194,109
232,812
24,000
226,000
80,000
117,348
114,886
Sft
1,031
115
118,544
Sft
Rft
4,050
149
60
350
243,000
52,063
Rft
198
350
69,125
Sft
2,520
60
151,200
Sft
2,200
1,762,200
Cft
Sft
Sft
Sft
Sft
Sft
Sft
1,834
135
2,723
3,532
1,695
5,476
857
3
2,608
2,846
120
84
400
20
60
10
500
40,000
60
60
220,050
11,340
1,089,000
70,640
101,700
54,760
428,500
120,000
156,503
170,730
Sft
2,200
138,600
3794
63
Total
9,361,416
7,460,616
75
C. Scope of civil w orks required at surve yed BHU

BHU Pishkan District Gawadar
Description
Covered Unit
Qty
Rate
Area
Hospital
Main building
Repair
1035
Compound walls
Repair
manholes
New construction
Approach road
New construction
Residence
Repair
Restoration toilets
New construction
Amount
996
Sft
Sft
Sft
Sft
Sft
Sft
140
813
252
3,252
96
54
259
84
20
60
10
500
500
60
11,760
16,260
15,120
32,520
48,000
27,000
15,525
Sft
139
115
15,999
Rft
16
350
5,688
Rft
25
350
8,750
Sft
Sft
180
1,800
60
60
10,800
108,000
Sft
2,200
2,191,200
Sft
Sft
Sft
Sft
351
209
1,404
79
209
209
20
60
10
500
60
60
7,020
12,563
14,040
39,500
12,555
12,555
Sft
2,200
1,650,000
837
750
Total
4,254,854
413,654
76

BHU Nagor Sharif District Gawadar
Description
Covered Unit
Qty
Rate
Area
Boundary wall
Sft
189
115
Hospital
Main building
Repair
21,735
1498
Sft
Sft
Sft
Sft
Sft
132
132
1,866
12
46
375
84
60
10
500
500
60
11,088
7,920
18,660
6,000
23,000
22,470
Rft
76
1,500
114,000
Rft
30
350
10,500
Rft
350
350
122,500
Sft
Sft
Rft
Rft
1,140
1,440
30
70
60
60
350
350
68,400
86,400
10,500
24,500
466
Sft
2,200
1,025,200
750
Sft
2,200
1,650,000
Compound walls
( 9 " Thick )
Repair
manholes
New construction
Approach road
New construction
Amount
Residence
New construction
Total
3,232,203
557,003
77

BHU Ganz District Gawadar
Description
Covered Unit
Qty
Rate
Area
Boundary wall
Construction of new boundary wall
Rft
173
1,500
( 9 " Thick )
Hospital
Main building
Repair
Restoration toilets
259,500
1498
Sft
1,728
375
375
10
60
60
17,280
22,470
22,470
Rft
46
1,500
69,000
Rft
350
2,625
Rft
20
350
7,000
Sft
Sft
Rft
Rft
180
840
20
40
60
60
350
350
10,800
50,400
7,000
14,000
850
Sft
2,200
1,870,000
1500
Sft
2,200
3,300,000
Compound walls
( 9 " Thick )
Repair
manholes
New construction
Approach road
New construction
Amount
Residence
New construction
Total
5,652,545
482,545
78

BHU Basool District Gawadar
Description
Covered Unit
Qty
Rate
Area
Boundary wall
Sft
210
115
Hospital
Main building
Repair
RCC roof
Residence
Repair
Restoration toilets
New construction
24,150
922
Compound walls
Repair
Approach road
New construction
Approach road
New construction
Amount
1453
Cft
Sft
Sft
Sft
Sft
Sft
209
270
1,114
135
1,114
128
922
120
400
20
60
10
500
60
25,056
108,000
22,272
8,100
11,136
64,000
55,320
Sft
14
115
1,610
Sft
7,500
60
450,000
Sft
Sft
Rft
Rft
3,600
360
55
95
60
60
350
350
216,000
21,600
19,250
33,250
Sft
2,200
3,196,600
Cft
Sft
Sft
Sft
Sft
Sft
Sft
352
792
1,879
396
1,879
48
240
1
825
825
120
84
20
60
10
500
500
40,000
60
60
42,282
66,528
37,584
23,760
18,792
24,000
120,000
40,000
49,500
49,500
Sft
2,200
825
Total
4,728,290
1,531,690
79

BHU Kolanch Kocho District Gawadar
Description
Covered Uni
Qty
Rate
Area
t
Boundary wall
Sft
221
115
Hospital
Main building
Repair
Amount
25,358
748
Cft
Sft
Sft
Sft
Sft
62
47
83
23
331
748
120
84
20
60
10
60
7,441
3,922
1,654
1,401
3,307
44,880
Compound walls
Repair
manholes
New construction
Approach road
Sft
208
115
23,893
Rft
35
350
12,250
Rft
90
350
31,500
Sft
60
4,723,200

Sft
Rft
Rft
78,72
0
600
40
75
60
350
350
36,000
14,000
26,250
Sft
2,200
550,000
Cft
Sft
Sft
Sft
Sft
Sft
185
208
492
208
984
106
1
417
417
120
84
20
60
10
500
40,000
60
60
22,140
17,483
9,840
12,488
9,840
53,000
40,000
25,020
25,020
Sft
2,200
New construction
Residence
Repair
Restoration toilets
New construction
250
417
Total
5,719,885
5,169,885
80
D. Estimated cost for execution of civil w orks at surve yed

facilities
Health facility
Estimated cost (in PKR)
DHQH Gawadar
32,037,406
RHC Jiwani
5,350,205
RHC Ormara
14,172,905
RHC Pasni
9,361,416
BHU Basool
4,254,854
BHU Ganz
3,232,203
BHU Kolanch Kocho
5,652,545
BHU Nagor Sharif
4,728,290
BHU Pishkan
5,719,885
81
TRF is funded by UKaid from the Dep

epartment for International Development and AusAID
ID, and managed by HLSP

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Health Facility Assessment Balochistan

TRF acknowledges the cooperation and support of Contech International Health

District Report - Gawadar

District Report - Gawadar

District Report - Gawadar

District Report - Gawadar

District Report - Gawadar

Figure 1: Map of Gawadar ............................................................................................. 5

Blood Bank Technician

Civil Works Assessment Questionnaire

Child bearing age

District Health Officer

District Level Questionnaire

District Health Information System

District Report - Gawadar

Management Information System

Normal Vaginal Deliveries

Planning Commission Proforma 1

Pakistan Social & Living Standards Measurement Survey

Post natal care

District Report - Gawadar

District Report - Gawadar

Major gaps existed in availability of materials for infection control practices

District Report - Gawadar

To assess clients satisfaction and perception of MNCH services

District Report - Gawadar

Number of Health Facilities by type

Number of facilities listed by HID

Number of facilities surveyed

District Report - Gawadar

Section 2: District Information

District Report - Gawadar

TABLE 2. 1: DEMOGRAPHIC PROFILE

Population of Tehsil Gawadar

Population of Tehsil Jiwani

Population of Tehsil Pasni

Population of Tehsil Ormara

Population density (persons

S OURCE : DHIS C ELL DHO O FFICE

TABLE 2. 2: POPULATION GROUPS

S OURCE : PDHS 2006-07

Socioeconomic and Health Indicators

District Report - Gawadar

District Report - Gawadar

Section 3: Health Facility Assessment Survey

24/7 Basic EmONC

District Report - Gawadar

8/6 Preventive MNCH Services at BHU

District Report - Gawadar

Status of building components at Surveyed BHU

District Report - Gawadar

Number of MNCH related staff available at each

Number of functional equipment items available at

Number of items available at each surveyed BHU

District Report - Gawadar

Basic lab tests

Number of items available at each surveyed BHU

24/7 Basic EmONC Services at RHC

Status of building components at each RHC

2. Patient wash room

District Report - Gawadar

Status of building components at each RHC

3. Patient wash room

3. Pt. wash room