P re se n ta tio n G ro u p

DR MUHABBAT ALI
DR REHAN
DR ALI RAJA
DR NIDA
DR ZUBAIDA
 PLANNING THE
PLANNING
 Establishment of DHMT
Composition of DHMT
1 EDO Health Chairman
2 District officer (Health) Member
3 DDHO (HQ) Secretary
4 EDO( community development) Member
5 EDO ( education) Member
6 District coordination officer Member
7 2 nominees of district nazim Member
8 Representative of NGO Member
9 2 co opted members Member
Terms of reference of
plan
 This plan will be the adaptation of
the National Plan for TB Control at
the district level.
 It will be in line with the government
policy and guidelines.
 Purpose of the plan will be to adopt
the government policies at district
level.
 Period of the plan will be one year.
Roles and
responsibilities
 Chairman to request the planning team
to have a systemic review specific to
their sphere of representation.
 Secretary to ensure the availability of
all members and preliminary
documentation available.
 Community representatives to identify
ethnographic profile of different
communities in DG Khan and
identifying target groups.
 Representatives of other sectors to
provide intersectoral collaboration
and inform about the policies of their
own departments.
REVIEW OF NATIONAL
POLICY AND GUIDELINES
FOR TB
 Integration of DOTS into existing
services.
 Case detection through sputum
smear microscopic examination.
 Standardized short course
chemotherapy for at least all
smear positive TB cases.
 A regular and un interrupted supply
of all anti TB drugs.
 Establishment of monitoring and
Policy and guidelines
Contd…
 Training program based on DOTS
expanded down to district level.
 Using standardized registers for
efficient recording and reporting.


SITUATION ANALYSIS
 BACKGROUND:
 Founded by Haji Khan.
 Situated in south western part of
Pakistan.
 Includes 2 major tehsils i.e DG Khan
and Taunsa and one tribal area.
 Divided into an eastern (plain) and
western region( hilly).
 Total area is 11922 square km.
 Total population is 20,18000.
 86% population lives in rural areas.
Situational analysis
contd..
 52% population is male and 48% is
female.
 Average household size is 6.9
 Population growth rate is 3.42%
 Literacy rate is 36%.
 Primary school enrollment rate is
34%
 60% of population lives below
poverty line.

 DEMOGRAPHIC
INFORMATION
DEMOGRAPHI DG KHAN PUNJAB PAKISTAN
CS
POPULATION( 806 31304 70150
THOUSANDS)
POPULATION 287 10481 20922
UNDER 15
(THOUSANDS)
POPULATION 3.42 1.9 1.9
YEARS
CDR OF
UNDER
GROWTH AGEAGE 09 12.5 8
OF
CBR05 YEARS 42.5
RATE 33.8 31
LIFE 61 64 63
EXPECTANCY 06
TFR 4.7 4
% URBAN 14 32 34
POPULATION
 INDICATORS ON WOMEN
AND FERTILITY BEHAVIORS
WOMEN AND FERTILITY DG KHAN PUNJAB PAKISTAN
BEHAVIOR

TRF 6 4.7 4
CPR 27 36 36
ANC COVERAGE BY 47 44 35
SKILLED ATTENDANT

BIRTH CARE BY SKILLED 26 33 20

ATTENDANT

Social indicators
SOCIAL INDICATOR DG KHAN PUNJAB PAKISTAN

ADULT LITERACY RATE 36 52 49

PER CAPITA INCOME Rs 878 / month Rs 1385/ month Rs 3660/ month

 HEALTH AND NUTRITIONAL
INDICATORS OF DG KHAN
HEALTH AND NUTRITIONDG KHAN PUNJAB PAKISTAN

U5MR 128 112 101

IMR 87 77 77
%AGE OF POPULATION 77 92 90
USING SAFE DRINKING
WATER

%AGE OF POPULATION 33 58 54
USING ADEQUATE
SANITATION FACILITIES

%AGE OF PREGNANT 36 63 45
WOMEN IMMUNIZED
FOR TETANUS

%AGE OF UNDER5 WHO 45 34 38

ARE UNDERWEIGHT
PREVALENCE OF TB 10% 10%
MORTALITY DUE TO TB 40 DEATHS/100,000 40 DEATHS/100,000
POPULATION PER YEAR POPULATION PER YEAR
 HEALTH FACILITIES
DHQ 01
THQ 01
CIVIL HOSPITALS 01
RHC  09
BHU
 53
MCH CENTERS 05
DISPENSARIES 29

Organizational structure of DHS DG Khan

EDO HEALTH

gram directorMSDHDC
–THQ Hospitals
MS-DHQ Hospital
District Officer Health AIHS Nursing superintendent

District sanitary inspector DSV DDHO,District

s coordinator
District
NPFP coordinator
and PHC women health
 Health problems among
vulnerable population
segments of DG Khan
Age group Health problem Best estimate
Pre school High IMR 87
children(approx 17.5%
of population) High U5 MR 128
High prevalence of 45%
under weight children
Women CBA(approx Low CPR 27%
22% of population)
General population High Tuberculosis 329 cases per 100,000
prevalence population
High mortality due to 40 deaths per 100,000
TB population per year
 PROBLEM
PRIORITIZATION
HEALTH
PROBLEM
MAGNITUDE
SEVERIT VULNERABILI
TY TO
COST POLITICAL
EFFECTIVENE EXPEDIENCY
TOTAL SCORE

Y INTERVENTIO SS
N
High prevalence
and mortality ++++ +++ ++++ ++ +++ 16
due to TB

High U5MR
+++ +++ ++ +++ ++++ 15

High IMR
+++ ++++ ++ +++ +++ 15

Malnutrition
+++ +++ ++ +++ +++ 14

Low CPR ++ ++ + ++++ +++ 12

 Increased diaease burden

oor quality of life Economic loss

High Prevalence of TB in DG Khan

uate preventive services Inadequate curative services

or BCG coverage Lack of community involvement

Poor referral
Poor compliance
Late diagnosis

Poor Accessibility Non availability

Long duration of treatment / side effec

to Lack
hard of
to Vaccine
reach areas
trained Non
not
staff poor cold ofchain
availability
available maintenance
staff
Non
Lackavailability
of awarenessof ATT in Inadequate
facilities lab fac
PHCcounseling
Poor
 Low disease burden

oved quality of life Economic benefits

Low Prevalence of TB in DG Khan

ate preventive services Adequate curative services

oved BCG coverage Increased communityNoinvolvement

need for Improved
referral compliance
Timely diagno

Improved Accessibility
Increased availability
Completing full duration of treatme

hard
Adequate
to reach
Availability
trained
areas Availability
staff
of vaccine
of staff
MaintenanceIncreased
cold chainawareness
ofAvailability Adequate lab faci
of ATT in PHCCounseling
facilities
 Listing of possible
interventions
ENTRY POINTS IDEAS FOR INTERVENTION

TRAINING OF HEALTH TRAINING FOR CASE MANAGEMENT AND COUNSELING SKILLS

CARE PROVIDERS TRAINING FOR VACCINATION SKILLS
TRAINING FOR MAINTENANCE OF COLD CHAIN

BCC ELECTRONIC MEDIA (TV, RADIO, CABLE)/PRINT MEDIA/ DISTRIBUTION

OF IEC MATERIAL
COUNSELING IN HEALTH FACILITIES
AWARENESS CAMPS
OUTREACH SERVICES TRAINING OF BY
COUNSELING LHV,S AND
IMAM LHW,S AND
MASJID FOR NAZIM
BCG VACCINATION AT HOMES
COUNSELING AT HOMES

AVAILABILITY OF ATT SENDING DEMAND FOR AVAILABILITY OF ATT IN BHU

IMPROVEMENT OF TIMELY REFERRAL TO FIRST REFERRAL HEALTH FACILITY

REFERRAL SYSTEM

IMPROVEMENT OF LAB PROCUREMENT OF LAB EQUIPMENT e.g ZN stain.

FACILITIES
 Coverage of health needs through
existing health care programs
Facility based Trained staff Awareness ATT/Vaccine Inadequate lab Timely referral Accessibility
services availability facilities

OPD
EPI/DOTS
Nutritional
services
Lab tests
Health
education
Out reach
services
EPI
Home visits

CDC
Health
education
Referral
 AVAILABLE HUMAN
RESOURCE
HR POSITION AT BHU
POST SANCTIONED FILLED VACANT
MO 53 50 03
LHV 50 31 19
FHT 10 05 05
HT 47 36 11
VACCINATOR 53 53 00

HR POSITION AT RHC
POST SANCTIONED FILLED VACANT
SMO 09 06 03
MO 12 09 03
LHV 09 08 01
FHT 02 02 00
HT 04 04 00
DISPENSER 30 25 05
FINANCIAL RESOURCES

 Districtbudgetary allocation shows a

declining trend for health sector
allocation reducing its share from
17% to 12.5% in recent year.
 Allocation for DHQ and THQ were
increased whereas for BHU and
RHC were decreased by 09%.
 Comparison of total with
health budget

Category wise health sector budget

breakup
 SWOT ANALYSIS
STRENGTHS WEAKNESS

Availability of 80% human resource37% EPI coverage

Infrastructure: one DHQ, 09 RHC,s, Only 50% trained staff for TB

one THQ, 53 BHU, one civil DOTS

hospital, 29 dispensaries. 81 vacant posts for doctors.


Non availability of ATT at BHU

No monitoring and evaluation

THREATS system.
OPPORTUNITIES
Poor referral system

Lack of transport.
Quackery Integration with NGO,s
Poor lab facilities.
36% literacy rate Integration with private sector
Lack of inter sectoral collaboration
Feudalism Global funding

86% population living in rural

areas.
60% people live below poverty line.

Average household size is 6.9

 Intervention matrix
HEALTH NEED LIMITATIONS/DEFECIENCIES SUGGESTED CHANGES/
IN EXISTING SYSTEM INTERVENTIONS

Well trained health care providers Lack of training program Training of doctors who will train
their staff regarding case management
and counseling.

Increased awareness Poor BCC strategies Advertising on electronic media,

distribution of IEC material,
community involvement, awareness
gatherings.

Availability of ATT in BHU ATT not provided to BHU,s by higher Sending request to higher authorities
authorities. for providing ATT at BHU,s

Referral system Referral system either doesn’t exist or Timely referral after early detection.
if it exists, it is not functional

Adequate lab facilities Lab equipment is either not available Procurement of lab equipment for TB
or of available, it is not functional. diagnosis.
Provision of technicians.
SETTING THE OBJECTIVES
AND TARGETS
 AIM
To improve the health status of

general population in District DG

Khan.
 Objective

To reduce the prevalence of TB by

50% in 03 years in District DG

Khan.



TARGETS
 No of TB patients diagnosed in
health facility.
 No of TB patients managed in health
facility.
 Number of patients given ATT.
 Number of patients who completed
09 months regimen of ATT.
 Number of smear positive cases.
 Number of doctors trained for
managing and treating TB patients.
 Number of patients counseled about
TB in OPD.
 Calculation of the targets

Population of DG Khan 20,18000


Population suffering from 201800

TB(10%)

Desired reduction in TB 100900

patients(5%)
ATTrequired 100900 ATT courses
Number
 of doctors to be trained 182

 patient ratio
Doctor One doctor for 11087 people
Priceof one complete ATT course Rs 5400 per patient

 Targets and activities
matrix
Priority Objectives Target Activity Indicators Risks /
problem
Improvement of Training of 100% Training of 182
health care delivery health care doctors
Training of doctors Percentage of

by master trainer. doctors trained.

assumption
Trainers will be
available.
system Availability
providers of ATT Distribution of ATT Ensure
 theof health Percentage of
Training
to 100% health care to 100 health care provision of ATT


sBudget may not be
care providers by to health care facilities sufficient.
Making
facilities100% labs Equipping
facilities 47 labs Ensure
all the
health care
doctors. Percentage of AFB Will improve the
provided
providers ATT.
trained.
functional with diagnostic availability
facilities. of ZN positive cases.
Percentage of case detection rate.
facilities stain and registered patients


microscope at all given ATT.

Improvement of facilities. Percentage of TB

referral system in cases referred per

all facilities. facility.
 Determination of resource
requirements
Personnels Resources already Additional resources required
available

Master trainer 00 02

Doctors 182 81

Dispensers 193 18

Health technicians 41 10

Lab assistants/technicians 22 17
Determination of resource
requirements
Equipment Resources already Additional resources
available required

IEC material none Required for 100

facilities

Sphygmomanometers 90 60
Weighing machines 70 30
Clinical examination none 182
kits for doctors

Microscopes 20 27
 Adjustments of M & O
Service programs M&O functions
Provision of ATT Assign responsibility for
Set up record system for
Service delivery Assign responsibilities for
Set up record system for
Develop supervisory schedule for
M&O content
 Determining the amount of ATT
required.
TB patient treatment record.
Ordering the ATT
Record system for delivery of ATT.
Coordination with DOTS program.
Training of doctors.
Registration of newly diagnosed
Training of health care providers.
TB patients.
Patients who were given ATT.
Procurement of ATT.
Performance of HCP and doctors.
Order replacement for ATT.
Supervision of doctors and staff.
Budget
Line item Unit Number Unit cost Total cost Source of
Lab Per 39 5000 (Rs)
195000 funds
Regular
technician
Master technician
Only one 02 10000 20000 budget
Donor
trainer
Doctors monthone
Only 182 1000 182000 Donor
who
Non get month
training
salary
EDO Per month 12 20000 240000 Regular
budget
DO Per month 12 10000 120000 budget
Regular
DDOH Per month 12 8000 96000 budget
Regular
budget
 Budget
Line item Unit Number Unit cost Total cost Source of funds
ATT Per patient 100900 600 60540000
IEC material Per facility 100 2000 200000
Utilities
Electricity Per facility 100 25000 2500000 Regular budget
Water Per facility 03 300 900 Regular budget
(THQ,DHQ)
Telephone Per facility 53 1000 53000 Regular budget
(BHU)
RHC Per facility 09 2000 18000 Regular budget
DHQ,THQ Per facility 03 30000 90000 Regular budget
 Budget
Line item Unit Number Unit cost Total cost Source of funds
Procurement
Weighing Per facility 30 1500 45000
machines
Microscopes Per facility 27 15000 405000
ZN Stain Per month 100 800 80000
Clinical exam Per doctor 182 200 36400
kits for doctors
Sphygmomano Per facility 60 2000 120000
meters
Contingencies Lumpsum 400000
Repair and Per facility 100 10000 1000000
maintenance
Activity Jul Aug Sep Oct Nov Dec Jan Feb Mar April May Responsi
ble
person

Training Master
doctors trainer

Distributi Store
on of keeper
ATT

Monitori EDO/DH
ng O

Maintena Dispenser
nce of
record

Referral Doctor