Health Facility Assessment. Provincial MNCH Services Report - Punjab February, 2013

Transcription

1 Health Facility Assessment Provincial MNCH Services Report - Punjab February, 2013

2 Acknowledgement The Technical Resource Facility acknowledges the cooperation and support the National Maternal and Child Health Programme Pakistan in supporting the health facility assessment and in completing this assignment. TRF warmly thank the development partners DFID and AusAID for their critical role in supporting this assessment to improve maternal and child health in Pakistan. Dr. Ishaq Khan Mohmand, Development Consultant worked on the assignment and authored the health facility data analysis. 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 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. Date: 10 th February, 2013 Islamabad i

3 Contents ACRONYMS...1 EXECUTIVE SUMMARY... 2 RECOMMENDATIONS:...4 SECTION 1: INTRODUCTION... 6 OBJECTIVES...6 SCOPE OF HFA...6 REPORT ORGANIZATION...7 SECTION 2: SURVEY FINDINGS... 8 ANALYTICAL FRAMEWORK...8 MNCH SERVICES...8 BASIC HEALTH UNITS...10 RURAL HEALTH CENTERS (RHCS)...13 TEHSIL HEADQUARTER (THQ) HOSPITAL...16 DISTRICT HEADQUARTER (DHQ) HOSPITAL...19 DISTRICT SPECIFIC ANALYSIS: HEALTH FACILITIES OF PUNJAB PROVINCE...22 DISTRICT ATTOCK...23 BASIC HEALTH UNITS(BHUS)...23 RURAL HEALTH CENTERS (RHCS)...24 TEHSIL HEADQUARTER (THQ) HOSPITAL...25 DISTRICT HEADQUARTER (DHQ) HOSPITAL...26 DISTRICT BAHAWALNAGAR...26 BASIC HEALTH UNITS...26 RURAL HEALTH CENTERS (RHCS)...28 TEHSIL HEADQUARTER (THQ) HOSPITAL...29 DISTRICT HEADQUARTER (DHQ) HOSPITAL...30 DISTRICT BAHAWALPUR BASIC HEALTH UNITS...30 RURAL HEALTH CENTERS (RHCS)...32 TEHSIL HEADQUARTER (THQ) HOSPITAL...33 DISTRICT BHAKHAR BASIC HEALTH UNITS (BHUS)...34 RURAL HEALTH CENTERS (RHCS)...34 TEHSIL HEADQUARTER (THQ) HOSPITAL...35 DISTRICT HEADQUARTER (DHQ) HOSPITAL...36 DISTRICT CHAKWAL BASIC HEALTH UNITS(BHUS)...37 RURAL HEALTH CENTERS (RHCS)...38 TEHSIL HEADQUARTER (THQ) HOSPITAL...39 DISTRICT HEADQUARTER (DHQ) HOSPITAL...40 DISTRICT CHINIOT BASIC HEALTH UNITS(BHUS)...41 RURAL HEALTH CENTERS (RHCS)...41 ii

4 TEHSIL HEADQUARTER (THQ) HOSPITAL...42 DISTRICT HEADQUARTER (DHQ) HOSPITAL...43 DISTRICT DG KHAN BASIC HEALTH UNITS(BHUS)...44 RURAL HEALTH CENTERS (RHCS)...45 TEHSIL HEADQUARTER (THQ) HOSPITAL...46 DISTRICT HEADQUARTER (DHQ) HOSPITAL...47 DISTRICT FAISALABAD BASIC HEALTH UNITS(BHUS)...48 RURAL HEALTH CENTERS (RHCS)...50 TEHSIL HEADQUARTER (THQ) HOSPITAL...51 DISTRICT GUJARANWALA BASIC HEALTH UNITS(BHUS)...52 RURAL HEALTH CENTERS (RHCS)...53 TEHSIL HEADQUARTER (THQ) HOSPITAL...54 DISTRICT HEADQUARTER (DHQ) HOSPITAL...54 DISTRICT GUJARAT BASIC HEALTH UNITS (BHUS)...55 RURAL HEALTH CENTERS (RHCS)...57 TEHSIL HEADQUARTER (THQ) HOSPITAL...58 DISTRICT HEADQUARTER (DHQ) HOSPITAL...58 DISTRICT HAFIZABAD BASIC HEALTH UNITS (BHUS)...59 RURAL HEALTH CENTERS (RHCS)...60 TEHSIL HEADQUARTER (THQ) HOSPITAL...61 DISTRICT HEADQUARTER (DHQ) HOSPITAL...62 DISTRICT JHANG BASIC HEALTH UNITS(BHUS)...63 RURAL HEALTH CENTERS (RHCS)...64 TEHSIL HEADQUARTER (THQ) HOSPITAL...65 DISTRICT HEADQUARTER (DHQ) HOSPITAL...66 DISTRICT JHELUM BASIC HEALTH UNITS(BHUS)...66 RURAL HEALTH CENTERS (RHCS)...67 TEHSIL HEADQUARTER (THQ) HOSPITAL...68 DISTRICT HEADQUARTER (DHQ) HOSPITAL...69 DISTRICT KASUR BASIC HEALTH UNITS(BHUS)...70 RURAL HEALTH CENTERS (RHCS)...72 TEHSIL HEADQUARTER (THQ) HOSPITAL...73 DISTRICT HEADQUARTER (DHQ) HOSPITAL...74 DISTRICT KHANEWAL BASIC HEALTH UNITS(BHUS)...75 RURAL HEALTH CENTERS (RHCS)...76 TEHSIL HEADQUARTER (THQ) HOSPITAL...77 iii

5 DISTRICT HEADQUARTER (DHQ) HOSPITAL...78 DISTRICT KHUSHAB BASIC HEALTH UNITS(BHUS)...78 RURAL HEALTH CENTERS (RHCS)...79 TEHSIL HEADQUARTER (THQ) HOSPITAL...80 DISTRICT HEADQUARTER (DHQ) HOSPITAL...81 DISTRICT LAHORE BASIC HEALTH UNITS(BHUS)...82 RURAL HEALTH CENTERS (RHCS)...83 TEHSIL HEADQUARTER (THQ) HOSPITAL...84 DISTRICT HEADQUARTER (DHQ) HOSPITAL...85 DISTRICT LAYYAH BASIC HEALTH UNITS(BHUS)...86 RURAL HEALTH CENTERS (RHCS)...87 TEHSIL HEADQUARTER (THQ) HOSPITAL...88 DISTRICT HEADQUARTER (DHQ) HOSPITAL...89 DISTRICT LODRAN BASIC HEALTH UNITS(BHUS)...89 RURAL HEALTH CENTERS (RHCS)...90 TEHSIL HEADQUARTER (THQ) HOSPITAL...91 DISTRICT HEADQUARTER (DHQ) HOSPITAL...92 DISTRICT MANDI BAHA UDDIN BASIC HEALTH UNITS(BHUS)...93 RURAL HEALTH CENTERS (RHCS)...94 TEHSIL HEADQUARTER (THQ) HOSPITAL...95 DISTRICT HEADQUARTER (DHQ) HOSPITAL...97 DISTRICT MIANWALI BASIC HEALTH UNITS(BHUS)...98 RURAL HEALTH CENTERS (RHCS)...99 TEHSIL HEADQUARTER (THQ) HOSPITAL DISTRICT HEADQUARTER (DHQ) HOSPITAL DISTRICT MULTAN BASIC HEALTH UNITS(BHUS) RURAL HEALTH CENTERS (RHCS) TEHSIL HEADQUARTER (THQ) HOSPITAL DISTRICT MUZAFARGARH BASIC HEALTH UNITS(BHUS) RURAL HEALTH CENTERS (RHCS) TEHSIL HEADQUARTER (THQ) HOSPITAL DISTRICT HEADQUARTER (DHQ) HOSPITAL DISTRICT NANKANA SAHIB BASIC HEALTH UNITS(BHUS) RURAL HEALTH CENTERS (RHCS) DISTRICT HEADQUARTER (DHQ) HOSPITAL DISTRICT NAROWAL iv

6 BASIC HEALTH UNITS RURAL HEALTH CENTERS (RHCS) TEHSIL HEADQUARTER (THQ) HOSPITAL DISTRICT HEADQUARTER (DHQ) HOSPITAL DISTRICT OKARA BASIC HEALTH UNITS(BHUS) RURAL HEALTH CENTERS (RHCS) TEHSIL HEADQUARTER (THQ) HOSPITAL DISTRICT HEADQUARTER (DHQ) HOSPITAL DISTRICT PAKPATTAN BASIC HEALTH UNITS RURAL HEALTH CENTERS (RHCS) TEHSIL HEADQUARTER (THQ) HOSPITAL DISTRICT HEADQUARTER (DHQ) HOSPITAL DISTRICT RAHIM YAR KHAN BASIC HEALTH UNITS(BHUS) RURAL HEALTH CENTERS (RHCS) TEHSIL HEADQUARTER (THQ) HOSPITAL DISTRICT RAJAN PUR BASIC HEALTH UNITS(BHUS) RURAL HEALTH CENTERS (RHCS) TEHSIL HEADQUARTER (THQ) HOSPITAL DISTRICT HEADQUARTER (DHQ) HOSPITAL DISTRICT RAWALPINDI BASIC HEALTH UNITS(BHUS) RURAL HEALTH CENTERS (RHCS) TEHSIL HEADQUARTER (THQ) HOSPITAL DISTRICT SAHIWAL BASIC HEALTH UNITS(BHUS) RURAL HEALTH CENTERS (RHCS) TEHSIL HEADQUARTER (THQ) HOSPITAL DISTRICT HEADQUARTER (DHQ) HOSPITAL DISTRICT SARGODHA BASIC HEALTH UNITS(BHUS) RURAL HEALTH CENTERS (RHCS) TEHSIL HEADQUARTER (THQ) HOSPITAL DISTRICT HEADQUARTER (DHQ) HOSPITAL DISTRICT SHEIKHUPURA BASIC HEALTH UNITS(BHUS) RURAL HEALTH CENTERS (RHCS) TEHSIL HEADQUARTER (THQ) HOSPITAL DISTRICT HEADQUARTER (DHQ) HOSPITAL DISTRICT SIALKOT BASIC HEALTH UNITS(BHUS) RURAL HEALTH CENTERS (RHCS) v

7 TEHSIL HEADQUARTER (THQ) HOSPITAL DISTRICT HEADQUARTER (DHQ) HOSPITAL DISTRICT TOBA TEK SINGH BASIC HEALTH UNITS(BHUS) RURAL HEALTH CENTERS (RHCS) TEHSIL HEADQUARTER (THQ) HOSPITAL DISTRICT HEADQUARTER (DHQ) HOSPITAL DISTRICT VEHARI BASIC HEALTH UNITS(BHUS) RURAL HEALTH CENTERS (RHCS) TEHSIL HEADQUARTER (THQ) HOSPITAL DISTRICT HEADQUARTER (DHQ) HOSPITAL SECTION 3: KEY FINDINGS BASIC HEALTH UNITS RURAL HEALTH CENTRES DISTRICT HEADQUARTER HOSPITALS vi

8 Provincial Report Punjab Acronyms ANC AVD BB technician BHU CH DHO DHQH EmONC ENC EPI HF HFA HR IMNCI Inj. LHS LHV LHW Mag-Sulph. MDGs MNCH MO NMNCHP NVD OT PNC RHC SHC hospitals THQ TRF TT WMO Antenatal Care Vaginal Deliveries Blood Bank Technician Basic Health Unit Civil Hospital District Health Officer District Headquarter Hospital Emergency Obstetric and Newborn Care Emergency Newborn Care Expanded Programme Immunization Health Facilities Health Facility Assessments Human Resource Integrated Management Neonatal and Childhood Illnesses Injection / Injectable drug Lady Health Supervisor Lady Health Visitor Lady Health Worker Inj. Magnesium Sulphate Millennium Development Goals Maternal, Neonatal and Child Health Medical Officer National Maternal Newborn and Child Health Programme Normal Vaginal Deliveries Operation Theatre Post natal care Rural Health Centre Secondary health care Tehsil Headquarter hospital Technical Resource Facility Tetanus Toxoid Women Medical Officer 1

9 EXECUTIVE SUMMARY Reduction in maternal mortality is one the main health and development agendas around the globe. To achieve the Millennium Development Goal (MDG) 75% reduction in the Maternal Mortality Ratio (MMR) between 1990 and 2015, countries throughout the world are investing more resources into providing equitable, adequate maternal health. One way reducing maternal and newborn child mortality is by improving the availability, accessibility, quality and use for the treatment complications that arise during pregnancy, childbirth and immediately after. These are collectively known as Emergency Obstetric & Neonatal Care (EmONC). In Pakistan, the Islamabad Declaration on MNCH strategic framework ( ) was unanimously adopted by all stakeholders, including the provinces, and the federal MNCH cell developed a consensus PC-I document on National MNCH Program. The first national Health Facility Assessment (HFA) was conducted in 2011 covering all provinces and regions Pakistan as part the implementation the Monitoring and Evaluation (M&E) Framework the National Maternal Newborn and Child Health Programme (NMNCHP). The MNCH Services Report 2013 aims to augment the HFA Pakistan; 2011 and describes the availability both preventative as well as emergency obstetric and neonatal care in the public health sector facilities the province. The information provided will be used to support health management teams at provincial and district levels to improve for their respective communities. The Punjab MNCH Services Report synthesises the findings 36 district level assessments covering 902 health facilities. Thirty four (34) District Headquarter (DHQ) hospitals and 84 Tehsil Headquarter (THQ) hospitals were assessed for the provision 24/7 Comprehensive Emergency Obstetric and Newborn Care (EmONC) ser vices; 291 Rural Health Centres (RHCs) were assessed for 24/7 Basic EmONC and 493 (approximately 20% sample) Basic Health Units (BHUs) were assessed for availability 8/6 preventive MNCH. Additionally, complimentary provided at RHCs, THQ and DHQ hospitals such as family planning and normal were also assessed along with data on availability the for performing these. The objectives the assessment were: 1. To assess the functional capacity the primary and secondary level health facilities (BHUs, RHCs, DHQs & THQs) all provinces with an emphasis on the status service availability, utilization, supplies and needed to perform the signal functions preventive MNCH and EmONC as well as some complimentary. 2. To identify the gaps in the provision, supplies and ing, between existing and intended status in assessed hospitals. 3. To establish a baseline data on public health care facilities for future planning. Methodology and Framework The framework for the HFA 2011 was based on the PC-1 the National MNCH Programme. For the purpose standardisation in the present report, the criteria followed for assessing health facilities against the availability the required service components, is the same as that selected for the HFA 2011 and all analysis presented in the MNCH report 2013 is based upon the survey data collected during the period July to December

10 The health facilities were assessed according to the MNCH service package and the service components EmONC. These were based on the international standards for emergency obstetric care. The complimentany were not included while assessing a facility for the provision the EmONC and this is reflected in the data tables as well. The availability the required categories, both specialist and general cadre, was also assessed according to the level the health facility and the for which it was mandated. Comparisons were also made between existing availability against the required categories and numbers as stipulated by the NMNCH program Services Basic Health Units (BHU) Analysis the survey data shows that, out all the assessed BHUs (493), around 91% (447) were providing components preventive MNCH package while 30% BHUs in 11 districts were providing the complete set. Similarly, 93% the assessed facilities had either a WMO or an LHV available at the time the survey and this was one the major factors leading to the availability in these BHUs. While 58% BHU s in district Narrowal followed by district RajanPur and Sheikhupura were providing all preventive MNCH. TT vaccination for pregnant women was available at almost all BHUs. However, Laboratory and EPI / Immunization were available at 93.5% and 93.9%BHUs, respectively. Rural Health Centers Only 10% (29) RHCs were providing the complete range basic EmONC. Inj. Magnesium Sulphate was only available at 17.5% (51) RHCs due to which none the RHCs in 18 districts were able to fer the complete package required. District Chiniot was the best performing district in Punjab; where 50% the assessed RHCs were providing all basic EmONC while District Hafizabad was the lowest performing district because none the facilities were able to provide the for removal s and assisted. Likewise, shortage Inj.Magnesium Sulphate and Ampicillin was also reported in all the 5 facilities., for family planning and normal deliveries and care for newborn were provided by almost all the RHCs. However, all the was available in 34%, i.e. 100 RHCs. THQ Hospitals A review all the service components the comprehensive EmONC service package shows that only 2.4%, i.e. 2 THQ hospitals (one each in districts Lahore and Muzaffararh) in Punjab were providing the complete set. Injection Magnesium Sulphate was available in 24%, i.e. 20 THQs while its shortage was reported in 76%, i.e. 64 facilities. Its deficiency was observed to be the main reason, due to which, the THQs were unable to provide comprehensive EmONC. Facility for conducting cesarean section was available at only 29 (34%) THQ hospitals; although blood transfusion were present at around 88% facilities. 3

11 At all the THQs, some the were always available and for family planning and normal deliveries were available at all facilities. However, availability all the to fer the complete set comprehensive EmONC was reported at only 6 (7%) THQ hospitals. Amongst the 2 THQ hospitals assessed in districts Muzaffargarh and Lahore, one (i.e:50%) THQ hospital at each the districts was completely functional. Whereas, the THQs in district Pakpattan was the least functional and was the only facility in the entire Punjab province that lacked the comprehensive family planning. DHQ Hospitals Only 17% i.e. 06 out a total 34, the assessed hospitals were providing the complete set comprehensive EmONC. The performance District Mianwali was particularly unsatisfactory as the DHQ hospital could not provide four i.e: Injections Ampicillin, Oxytocin, Magnesium Sulphate and newborn care the required service components. While for comprehensive family planning, normal and assisted deliveries, the manual removal and removal s were being provided at all the district-level hospitals, it was observed that most the required to perform specialized care was not available in almost half (46%) these facilities. As expected, shortage Injection Magnesium Sulphate was the most common deficient factor reported in around 80% the DHQ hospitals while 30% the facilities were also lacking in injection Oxytocin. Similarly, blood transfusion were available at almost all (97%) the hospitals, whereas, the for cesarean section was available in 35%, i.e. 29 THQ hospitals. Major Issues Regarding availability inputs, the major issues faced by the facilities were mainly due to lack MNCH-related at the facilities; such as WMOs at RHCs and specialists including Gynaecologist, Anaesthetist and Paediatrician at secondary level health care hospitals. supplies i.e. equipment for performing skilled procedures and specialized care (e.g., newborn resuscitation and incubation) as well as drugs (especially Injection Magnesium Sulphate) was also a major issue needing immediate attention. It must be borne in mind that at the time assessment, none the health facilities in Punjab were provided with the complete range items required to perform the signal functions. In spite these challenges and constraints, a large number facilities were still able to provide all the required to the communities while struggling with meagre resources. Recommendations: The access and provision quality EmONC is critical in saving women s lives. Therefore, the actions and interventions proposed on the basis survey findings aim to address the constraints regarding functional and organised service systems at the district level. The key recommendations are as follows: 4

12 1. To equip the health facilities (BHUs, RHCs, THQs, and DHQs) with supply drugs (Inj. Magnesium Sulphate, Oxytocin and Ampicillin) and (either WMO or an LHV) so that they are able to fer complete package EmONC. 2. BHU Mithranpur, district Nankana Sahib must be provided with the immunization (EPI) so that it can become fully functional. 3. Provision TT vaccination and immunization in BHUs districts Mandi Bahauddin and DG Khan. 4. Provision laboratory in 94% (463 out 493) BHUs. 5. Provision for removal s and normal in RHCs district Hafizabad. 6. Provision injection Magnesium Sulphate at RHCs Chowk Azam and Fateh Pur, district Layyah will enable the facilities to become completely functional. 7. Ensure regular supply Inj. Magnesium Sulphate in (240) RHCs where the shortage was reported. 8. Provide for cesearean-section and newborn care in THQ hospitals district Chakwal. 9. Ensure the supply Inj.Magnesium Sulphate in THQ Shorkot so that the facility is able to fer the complete set 24/7 comprehensive EmONC. 10. THQ Kabir Wala in district Khanewal must be provided with all the three injectables and equipped to fer the for ceseareansection and newborn care. 11. Ensure supply Injection. Magnesium Sulphate in 60 THQs, while, the for cesarean section must be provided in 55 THQs. 12. Injection Magnesium Sulphate must be ensured in 27 DHQs where the shortage was reported. 13. Ensure blood transfusion and cesearean section in DHQ hospitals to enable them to qualify for comprehensive package EmONC. 14. Ensure availability all the in 19 DHQs, in which, the was absent / non-available. 5

13 Section 1: Introduction According to the maternal mortality estimates for Punjab more than 227 maternal deaths 1 occur during pregnancy, childbirth or during the post-partum period. Skilled and responsive care, at and after birth, can avert nearly all fatal outcomes and ease much the suffering. The Government Pakistan is committed to achieve the Millennium Development Goals (MDGs) and the Ministry Health has established the National Maternal Newborn and Child Health Programme (NMNCHP) for achieving the 2015 targets for the health related MDGs 4 and 5. The overreaching goal the programme is to improve the health status mothers, newborns, and children with a focus on poor and marginalized populations. Objectives The Health Facility Assessment (HFA) Pakistan is part an overall Monitoring and Evaluation Framework for the NMNCH, and the present report aims to describe the availability, level function and quality MNCH service at public sector health facilities at District level. The objectives the MNCH assessment were: 1. To assess the functional capacity the primary and secondary level health facilities ( BHUs, RHCs, DHQs & THQs) all provinces with an emphasis on the current status service availability, utilization and supplies, and needed to perform the signal functions preventive MNCH and EmONC as well as some complimentary. 2. To identify the gaps in the provision, supplies and, between existing and intended status in assessed hospitals. 3. To establish a baseline data on public health care facilities for future planning. While the report intends to help district and provincial health managers in assessing performance benchmarks and realigning their activities for bridging the gaps in MNCH for achieving the MDGs, it does not portrays the overall situation health sector in the districts. Scope HFA The survey included District Headquarter Hospital (DHQH), Tehsil/Taluka Headquarter Hospitals (THQHs), Rural Health Centres (RHCs) and 20% Basic Health Units (BHUs) randomly selected within the district. Selection the BHUs was done through geographical stratification on the basis proportionate distribution. Client exit interviews were conducted at the surveyed facilities (10 at DHQH, 5 at each THQH and RHC), excluding BHUs. 1 PDHS

14 Table 1.1 shows the numbers health facilities in the district and health facilities surveyed TABLE: 1. 1: SCOPE OF HFA Punjab Province Number Total facilities Number facilities surveyed Number Health Facilities by type DHQH THQHs RHCs BHUs Total ,454 2, Report Organization The HFA Provincial Report is structured in three sections: Section 1: Introduction to the survey, its objectives, scope and duration Section 2:This section describes the major findings based on the analysis HFA data compiled from the field Section 3: Key actions and recommendations based on the findings 7

15 Section 2: Survey Findings This section describes the status MNCH, at each level health facility, against a MNCH package (listed in Figure 2.1 below) which has been adopted from HFA Analytical Framework For the purpose standardisation, the criteria followed for assessing these health facilities against the availability the required service components is the same as that selected for the HFA 2011 and all analysis presented in this report is based upon the survey data collected during the period July to December Health facilities were assessed for the respective MNCH service packages that each institution is mandated to perform; as assessed in the HFA, for the provision level-specific packages MNCH. Service components EmONC, incorporated in the NMNCHP PC-1, are the same as internationally accepted signal functions for emergency obstetric care. First Level Care Facility (FLCF)/BHUs were assessed for preventive MNCH, available for 8 hours a day, 6 days a week (8/6), the package is composed a set 09 including availability human resource (either an LHV or a WMO) RHCs were assessed for provision basic EmONC package available for 24 hours a day, 7 days a week (24/7). The package is comprised 07 signal functions or service components. Family planning (counselling & for at least 3 family planning methods) and for performing normal deliveries were also assessed as complimentary. THQ and DHQ hospitals operating within the districts were also assessed for provision comprehensive EmONC package, available for 24 hours a day, 7 days a week (24/7). The comprehensive EmONC package is comprised 08 subcomponents including the two main components; provision cesarean section and blood transfusion and 6 Basic EmONC as well as newborn care (resuscitation and incubator) are also included in the package. Additionally, comprehensive family planning (including male and female sterilisation) and for performing normal deliveries were also assessed as complimentary. The complimentany were not included while assessing a facility for the provision the EmONC and this is reflected in the data tables as well. The availability the required categories, both specialist and general cadre, was also assessed according to the level the health facility and the for which it was mandated. Comparisons were also made between existing availability against the required categories and numbers as stipulated by the NMNCH program. MNCH Services The packages MNCH assessed include preventive MNCH at BHUs, Basic EmONC at RHCs and comprehensive EmONC at THQ and DHQ hospitals. Additional, such as family planning and normal deliveries were also 8

16 assessed in RHCs, THQ and DHQ hospitals. The range MNCH are given in figure 2.1 below. FIGURE 2.1. RANGE OF SERVICES THAT SIGNAL OPTIMAL MNCH SERVICES BHUs: Facilities available for RHCs: Facilities available for DHQ/THQ Hospitals: Facilities available for 8/6 Preventive MNCH Services 1. Antenatal checkup 2. Lab (Anemia, Malaria, pregnancy test, urine test for sugar & Protein) 3. Normal 4. Family planning (at least 3 methods) 5. TT immunization 6. EPI vaccination 7. Growth monitoring 8. Nutrition counselling 9. HR (at least one LHV or Doctor) 24/7 Basic EmONC Services 1. Parenteral antibiotics 2. Parenteral oxytocic drugs 3. Parenteral anticonvulsants for pregnancy induced convulsions (due to hypertension) 4. removal 5. s 6. (vacuum / forceps extraction,) 7. Newborn resuscitation Additional Services 8. Normal Delivery 9. FP Services (at least 3 FP methods) 10. HR (skilled female providers-wmo and LHVs) 24/7 Comprehensive EmONC 1. Surgery (C-section) 2. Blood transfusion 3. Basic EmONC 4. Newborn care (resuscitation & incubator) Additional Services 1. HR (skilled for conducting, C-section, blood transfusion and anaesthesia), 2. Comprehensive family planning including sterilisation 3. Services for Normal Delivery The Punjab MNCH Services Report synthesises the findings 36 district level assessments covering 902 health facilities assessed. Thirty four (34) DHQ hospitals and 84 THQ hospitals were assessed for provision 24/7 comprehensive EmONC. Two hundred and ninety-one ( 291) RHCs were assessed for 24/7 basic EmONC and 493 BHUs (approximately 20% sample) were assessed for availability 8/6 preventive MNCH. The following section describes the status MNCH service availability at each level health facilities operating within the public sector health system the province. District-wise consolidated data has been analysed in accordance with the HFA framework described 9

17 above with ranking showing the proportion facilities that were able to provide the specified service components explained in Figure 2.1 (see above). Basic Health Units 8/ 6 Preventive MNCH Services A total 493 BHUs were assessed for provision 8/6 preventive MNCH service package. The data analysis revealed that amongst the assessed BHUs 91% (447 out 493) were completely functional and were providing all the components preventive MNCH service package. TT vaccination and immunization were available at 97% and 96% the assessed facilities, respectively. It was reported that 9.3% (46 out 493) facilities failed to provide the complete package MNCH service due to lack one or more the components. In district Narowal, almost 58.3% (7 out 12) were able to provide MNCH. Likewise, in districts RajanPur and Sheikupura, the MNCH were available in 66.7% (4 out 6) and 77% (10 out 13) BHUs. The overall data the assessed BHUs is presented in the table below: 10

18 TABLE 2.1: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES PROVINCIAL OVERVIEW BHUs Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total Assessed Attock Rawalpindi Gujranwala Sialkot Mianwali Bhakar Lahore Kasur TT Singh Chiniot Lodhran Faisalabad Khanewal Sahiwal Multan Vehari Muzafargarh Bahawalpur Jhang

19 RY Khan MandiBahauddin Pakpattan Okara Jhelum Gujrat Khushab Layyah Chakwal Hafizabad Nankana Sahib DG Kahn Bahawalnagar Sargodha Sheikhupura Rajan Pur Narowal Total

20 Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs A total 291 RHCs were assessed for the provision 24/7 basic EmONC package, in addition to certain complimentary, as elaborated in figure 2.1 above. The data analysis indicates that only 10% (29 out 291) RHCs were able to fer the complete set 24/7 basic EmONC. The shortage Injection Magnesium Sulphate was observed as the most common deficient component in 13 districts. The drug was available at only 17.5% (51 out 291) RHCs, whereas, its non-availability was reported in 82%, i.e. 240 RHCs. Similarly, shortage Injection Ampicillin and Injection Magnesium Sulphate was also reported throughout all the RHCs, as is evident from the table 2.2 below. This shortage injectables may highlight the problem in supply and demand drugs, as per requirement for basic EmONC at the district level. Almost all the RHCs had some the and were provided for family planning, normal deliveries and newborn care. However, all required to perform MNCH were not available in 34.4% (100 out 291) RHCs. District Chiniot was the best performing district in which half ( 50%) the assessed RHCs were providing all the 24/7 basic EmONC. While, district Hafizabad was reported to be the poor performing district, because, the for removal s and normal were not available in any the RHCs. 13

21 TABLE 2.2: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - PROVINCIAL OVERVIEW RHCs removal Newborn resuscitation Inj Ampicillin Inj Magnesium Sulfate Providing all Basic EmONC Normal FP (At least 3- FP methods) some (WMO/LHV) all Total Assessed Chiniot Attock Bhakhar Rajan Pur Muzafargarh Bahawalpur Gujrat Rawalpindi Faisalabad Lahore Narowal Sheikhupura Nankana Sahib Jhang Vehari DG Kahn Sargodha RY Khan

22 Jhelum Chakwal Gujranwala Hafizabad MandiBahauddin Sialkot Khushab Mianwali Kasur TT Singh Sahiwal Pakpattan Okara Multan Khanewal Lodhran Layyah Bahawalnagar Total

23 Tehsil Headquarter (THQ) Hospital 24/ 7Comprehensive EmONC Services A total 84 THQ hospitals were assessed for provision 24/7 comprehensive EmONC package, in addition to certain complimentary as elaborated in figure 2.1 above. The survey data revealed that only 2.4% (2 out 84) the THQ Hospitals (Lahore and Muzaffargarh) were providing 24/7 comprehensive EmONC service package. Moreover, presence all the was observed only in 6 THQs (Lahore, Hafizabad, Sargodha, TT Singh, and Jhang). The for manual removal, removal s, assisted and comprehensive family planning were available in almost 95% (80) THQs. THQ hospital Pakpattan was reported to be the least functional facility because it was unable to provide the for removal s, assisted, cesarean section and family planning. All the was not available and there was shortage injection ampicillin and magnesium sulphate, as well. The common deficiencies observed were the shortage Injection Magnesium Sulphate and for cesarean section; which were available in 24% ( 20) and 35% ( 29) THQ hospitals, respectively. The above-mentioned survey findings may refer to the issue supply and demand the drug at the tehsil level. The presence in only 7% (6) THQs may be one the reasons due to which the facilities could not provide required for conducting cesarean section. The survey data is presented in the table below. 16

24 TABLE 2.3: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY THQ HOSPITALS PROVINCIAL OVERVIEW THQ removal Inj Ampicillin Inj Magnesium Sulfate C-Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensive EmONC Normal Comprehensive FP (including surgical sterilization) some all Total Assessed Lahore Muzafargarh Attock Rawalpindi Jhelum Chakwal Gujranwala Hafizabad Gujrat MandiBahauddin Sialkot Narowal Sargodha Khushab Mianwali Bhakhar Sheikhupura

25 Kasur Faisalabad TT Singh Jhang Chiniot Sahiwal Pakpattan Okara Multan Khanewal Lodhran Vehari DG Kahn Rajan Pur Layyah Bahawalpur Bahawalnagar RY Khan Total

26 District Headquarter (DHQ) Hospital 24/ 7Comprehensive EmONC Services Thirty-four (34) DHQ hospitals were assessed for 24/7 comprehensive EmONC, in addition to some the complimentary as elaborated in figure 2.1 above. The survey data indicates that only 17.6% (6) DHQs (Chakwal, Sargodha, Lahore, Rajanpur, Muzaffargarh) were providing the complete set 24/7 comprehensive EmONC. Some the and for comprehensive family planning, normal, and assisted, manual removal and removal s were uniformly available throughout the province. However, availability all the was reported in only 44.1% (15)DHQs. Similarly, blood transfusion were available in 97% the DHQ hospitals, and cesarean section was fered in 70% (24) DHQs. DHQ district Mianwali was reported to be the least functional due to the non-availability all the, deficiency all the three injectables and lack for the newborn care. The non-availability Injection Magnesium Sulphate was the most common factor observed in around 80% the DHQ hospitals, whereas, Inj. Oxytocin was deficient in 30% the facilities. The survey data is presented in the table below: 19

27 TABLE 2.4: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY DHQ HOSPITALS PROVINCIAL OVERVIEW THQ removal Inj Ampicillin Inj Magnesium Sulfate C-Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all CEmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed Chakwal Sargodha Lahore Rajan Pur Muzafargarh Attock Jhelum Gujranwala Hafizabad Gujrat MandiBahauddin Sialkot Narowal Khushab Mianwali Bhakhar Sheikhupura Nankana Sahib Kasur TT Singh Jhang Chiniot Sahiwal

28 Pakpattan Okara Khanewal Lodhran Vehari DG Kahn Layyah Bahawalnagar Total

29 22 District Specific Analysis: Health Facilities Punjab Province

30 District Attock Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services A total 12 BHUs were assessed for the provision 8/6 preventive MNCH. The data indicates that all assessed BHUs had either a WMO or an LHV to fer the MNCH. Likewise, antenatal care, normal, TT vaccination, family planning, growth monitoring, nutrition counselling, immunization, and laboratory were also fered by all the BHUs. (See Table 2.1) TABLE 2.5: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT ATTOCK BHUs Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Hameed BHU Bolianwal BHU Dakhnair BHU Kohlia BHU Pour Miana BHU Jabbi BHU Lund BHU Aurangabad BHU Jhamat BHU Khunda

31 BHU Khour BHU Nalhad Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Five (5) RHCs were assessed for provision 24/7 basic EmONC service package and for certain additional complimentary, as mentioned in figure 2.1 above. The data indicates that 40% (2 out 5) RHCs - Domail and Rangoo - were providing the complete set basic EmONC and were completely functional. Non-availability Inj. Magnesium Sulphate in RHCs Bahtar, Chabb and Maghian was the common factor due to which these RHCs were unable to fer the complete package. Moreover, non-availability all was also reported at RHC Maghian. (See Table 2.2). TABLE 2.6: DISTRIBUTION OF BASIC EMONC SERVICESPROVIDED BYRHCS - DISTRICT ATTOCK RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3-FP methods) Availabilit y some (WMO/LHV ) Availabilit y all Total Assessed RHC Bahtar RHC Chabb RHC Domail RHC Maghian RHC

32 Rangoo Total Tehsil Headquarter ( THQ) Hospita l 24/ 7Comprehensive EmONC Services Five (5) THQ hospitals were assessed for provision 24/7 comprehensive EmONC package. Analysis the data, (Table 2.3) indicates that some was available at all THQ hospitals and normal deliveries were being routinely performed. However, THQ Hospital Hazro was the only facility that fered cesarean section and was also providing all the major sub-components the comprehensive EmONC package, except Inj. Magnesium Sulphate.The blood transfusion facility was available at 80% the facilities, except THQ Hospital Hassan Abdal. Whereas, comprehensive family planning and newborn care were being provided at 80% and 40% the facilities, respectively. According to the data, due to the non-availability all, lack skilled as well as Inj. Magnesium Sulphate, none the facilities in district Attock were able to provide all the and therefore could not be designated as fully functional comprehensive EmONC facilities. TABLE 2.7: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYTHQHS DISTRICT ATTOCK THQH removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensive EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed THQ Hassan Abdal THQ Fateh Jang THQ Hazro THQ Jand THQ Pindi Gheb Total

33 District Headquarter (DHQ) Hospita l 24/ 7Comprehensive EmONC Services The DHQ Hospital Attock which was assessed for provision 24/7 comprehensive EmONC package.the survey data indicates that blood transfusion, normal deliveries, gynecological and newborn care as well as C.section were being performed at the facility and some was also available. However, non-availability Injections Oxytocin and Magnesium Sulphate were the only limiting factor due to which the DHQ was not completely functional for provision 24/7 comprehensive EmONC package. (See Table 2.4) TABLE 2.8: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYDHQHS DISTRICT ATTOCK DHQH removal Inj Magnesium Sulphate C-Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensive EmONC Normal Comprehensive FP (including surgical sterlization) some all Total assessed DHQ Hospital Attock District Bahawalnagar Basic Health Units 8/ 6 Preventive MNCH Services. A total 21 BHUs were assessed for the provision 8/6 preventive MNCH.The data revealed that 81% (17) these are fully functional and providing all components the preventive MNCH package. (See Table 2.9) Whereas, BHU Kalia Shah was the only facility which completely lacked all the and. Essential, laboratory and growth monitoring were not available in BHUs Jand Wala, Chak 297 HR and Sobeywala. The lack at the BHUs Chak 297 HR and Sobeywala may be a factor due to which the facility was unable to fer the for antenatal care, normal deliveries and family planning. 26

34 TABLE 2.9: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT BAHAWALNAGAR BHUs Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunizatio n (EPI) Laboratory (WMO/LHV) BHU Ghulab Ali BHU Jand Wala BHU Kalia Shah BHU Kot Hemraj BHU Malikpura BHU Chak 10-F BHU Chak 47-F BHU Chak 116-M BHU Chak 140-M BHU Chak 10-1R BHU Chak 38-3R BHU Chak 58-4R BHU Chak 110-6R BHU Chak200-8R BHU Chak 165-7R BHU Chak 297-HR BHU Chak 302-HR BHU Kabutri BHU Said Ali BHU Khola Mirzeka BHU Sobeywala Facilities providing all preventive MNCH Total assessed 27

35 Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Ten (10) RHCs were assessed for provision 24/7 basic EmONC package and additional complimentary. The data indicates that some, supply Injection Oxytocin and for newborn resuscitation, normal deliveries and family planning were available at all the facilities. While all was available in only RHCs Daharan Wala, Faqir Wali, Fort Maroot and Madrisa. Injection Magnesium Sulphate was not available in any the facilities and likewise one or the other MNCH service components were also not available in assessed RHCs.Therefore, none the RHCs in district Bahawalnagar were completely functional for 24/7 basic EmONC service packge. (See Table 2.10) TABLE 2.10: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICTBAHAWALNAGAR RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3-FP methods) some (WMO/LHV) all Total Assessed RHC Chak 6-G RHC Dahran Wala RHC Dunga Bonga RHC Faqir Wali RHC Fort Maroot RHC Khichi Wala RHC Madni Sadiq Gunj RHC Madrisa RHC Mecload Gunj

36 RHC Shaher Farid Total Tehsil Headquarter ( THQ) Hospita l 24/ 7Comprehensive EmONC Services Four (4) THQ hospitals were assessed for provision 24/7 Comprehensive EmONC package. Analysis the data (Table 2.11) shows that all 4 THQ hospitals had some and were providing for manual removal, removal s, assisted, blood transfusion, newborn care, normal and comprehensive family planning. However, due to the lack availability all, Injection Magnesium Sulphate, Injection Ampicillin and for cesarean section, none the THQs could qualify as 24/7 comprehensive EmONC facility. TABLE 2.11: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYTHQHS DISTRICT BAHAWALNAGAR THQH removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscit ation and Incubator) Providing all comprehensive EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed THQ Chishtian THQ Fort Abbas THQ Haroon Abad THQ Minchan Abad Total

37 District Headquarter (DHQ) Hospita l 24/ 7Comprehensive EmONC Services The DHQ hospital Bahawalnagar was assessed for provision 24/7 comprehensive EmONC package.the data revealed that some was available and the for manual removal, removal s, assisted, blood transfusion, newborn care, normal and comprehensive family planning were being provided at the DHQ Bahawalnagar. Moreover, adequate quantity Injection Ampicillin was also available. However, the lack availability all and deficiency drugs, Injection Oxytocin and Injection Magnesium Sulphate prevented DHQ Bahawalnagar to provide 24/7 comprehensive EmONC. (See Table 2.12) TABLE 2.12: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYDHQHS DISTRICT BAHAWALNAGAR DHQ DHQ Hospital Bahawalnagar removal Inj Magnesium Sulphate C-Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensive EmONC Normal Comprehensi ve FP (including surgical sterilization) some all Total assessed District Bahawalpur Basic Health Units 8/ 6 Preventive MNCH Services A total 14 BHUs were assessed for the provision 8/6 preventive MNCH. According to the data findings, 90% (13 out 14) BHUs were completely functional and were providing all components 8/6 preventive MNCH package. BHU Chak 194 Murad was the only facility, where the absence and all other was reported. However, the BHUs was fering the for TT vaccination and EPI. (See Table 2.13) 30

38 TABLE 2.13: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT BAHAWALPUR BHUs Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Aali Wahan BHU Ahmad Naich BHU Januwala BHU Lotla Musa Khan BHU Goth Mehroo BHU Khanpur Nouranga BHU Mangwani BHU Chak 90-F BHU Chak 194-Murad 1 1 BHU Shahpur BHU Bheli BHU Chak 47-DNB BHU Chak 91-DB BHU Chak 105-DNB Total

39 Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Ten (10) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. The data indicates that only 30% (3) RHCs Channi Goth, Dera Bukha and Mubarik Pur in district Bahawalpur were completely functional and were providing the complete set basic EmONC.The deficiency Injection Magnesium Sulphate was reported in 50% the facilities and was the only factor due to whch RHCs Choona Wala, Lal Sohanra and Uch Sharif were unable to fer complete basic EmONC service package. Likewise, lack service for removal s was the only deiciency in RHC Head Rajgan that prevented the facility from being fully functional. RHC Khangah Shariff was the only facility in which for manual removal, removal s, assisted and all the were not available, however, the supply Injection Magnesium Sulphate was present at the facility. (See Table 2.14) TABLE 2.14: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICT BAHAWALPUR RHCs removal Newborn resuscitation Inj Amplicillin Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3-FP methods) some (WMO/LHV) all Total Assessed RHC Channi Goth RHC Choona Wala RHC Dera Bukha RHC Head Rajgan RHC Khangah Sharif RHC Khutri Banglow RHC Lal Sohanra RHC Mubarik Pur RHC Qaim Pur RHC Uch Sharif Total

40 Tehsil Headquarter (THQ) Hospital 24/ 7Comprehensive EmONC Services Four (4) THQ hospitals were assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.15) shows that some and the supply Injection Oxytocin and Ampicillin was available at 3 THQs Khairpur Tamewali, Hasil Pur and Yazman. The 3 facilities were also providing for manual removal, removal s, assisted, blood transfusion, normal and comprehensive family planning. However, the non-availability all the, deficiency Injection Magnesium Sulphate and lack for newborn care were the factors due to which none the BHUs were considered to be fully functional. THQ Ahmed Pur East was the only facility in which cesarean section was being performed, in addition to the other.therefore, none the THQs could provide all the and could not be designated as 24/7 comprehensive EmONC facilities. TABLE 2.15: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY THQHS DISTRICT BAHAWALPUR THQ removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensi ve EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed THQ Ahmed Pur East THQ Khairpur Tamewali THQ Hasil Pur THQ Yazman Total District Bhakhar 33

41 Basic Health Units (BHUs) 8/ 6 Preventive MNCH Services. A total 8 BHUs were assessed for the provision 8/6 preventive MNCH. The data indicates that all assessed BHUs were providing all components the 8/6 preventive MNCH package and either a WMO or an LHV was available at the time survey to provide these. Therefore, all BHUs were considered as fully functional for 8/6 preventive MNCH package. (See Table 2.16) TABLE 2.16: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT BHAKHAR BHUs Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunizatio n (EPI) Laboratory (WMO/LHV) BHU Mahnewala BHU Muslimkot BHU Sial BHU Barranga BHU Basti Mai Roshan BHU Noora BHU Chak 67-ML BHU Chak 9-TDA Facilities providing all preventive MNCH Total Total assessed Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Three (3) RHCs were assessed for provision basic 24/7 EmONC package and for additional complimentary. The data indicates that only RHC Behal was completely functional in district Bhakar and was providing the complete set 24/7 basic EmONC. RHC Jandaan 34

42 Wala was unable to provide for assisted and all the was also not available. Likewise, non-availability Injection Magnesium Sulphate was reported in 2 RHCs - Dulley Wala and Jandaan Wala. Absence and supply and demand issue the drug prevented the facilities from being fully functional. (See Table 2.17) TABLE 2.17: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICTBHAKHAR RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3- FP methods) some (WMO/LHV) all Total Assessed RHC Behal RHC Dulley Wala RHC Jandaan Wala Total Tehsil Headquarter ( THQ) Hospita l 24/ 7Comprehensive EmONC Services Three (3) THQs were assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.18) revealed that some was available at all the THQ hospitals and normal deliveries were being performed at all these facilities. However, cesarean section and the for newborn care were only available at THQ Hospital Mankera and Kallarkot, respectively. Non-availability all the and Injection Magnesium Sulphate was observed in all the 3 THQ hospitals.thqs Mankera and Darya Khan were unable to fer for newborn care while blood transfusion was not available only at THQ Kallurkot.Therefore, none the THQs were completely funtional to provide 24/7 comprehensive EmONC package. TABLE 2.18: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYTHQHS DISTRICT BHAKHAR 35

43 THQH removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensive EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed THQ Kallur Kot THQ Mankera THQ Darya Khan -upgrd Total District Headquarter (DHQ) Hospita l 24/ 7Comprehensive EmONC Services The DHQ hospital Bhakhar was assessed for provision 24/7 comprehensive EmONC package. The survey data revealed that some was available and the for manual removal, removal s, assisted, blood transfusion, newborn care, normal and comprehensive family planning were provided at the DHQ Bhakkar. Moreover, supplies for Injection Ampicillin and Oxytocin were also available. However, due to the deficiency Injection Magnesium Sulphate and the inablity to provide for cesarean section, DHQ Bhakar could not be declared as a 24/7 comprehensive EmONC facility in the district. The lack availability all the requisite seems to be a contributing factor in this failure. (See Table 2.19) TABLE 2.19: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYDHQHS DISTRICT BHAKHAR 36

44 DHQHs removal Inj Magnesium Sulphate C-Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensive EmONC Normal Comprehensi ve FP (including surgical sterilization) some all DHQ Hospital Bhakhar District Chakwal Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services A total 13 BHUs were assessed for the provision 8/6 preventive MNCH.The data shows that 80% (11) BHUs were fully functional and had all the available to provide complete set for 8/6 preventive MNCH. The non-availability EPI immunization was reported in BHUs Bhilomar and Goohi due to which these facilities were not fully functional. (See Table 2.20) TABLE 2.20: DISTRIBUTION OF PREVENTIVE MNCH SERVICES COMPONENTS PROVIDED BY BHUS DISTRICT CHAKWAL Total assessed BHUs Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Badshshpur BHU Bhirpur BHU Jamalwal BHU Karsal BHU Karyala

45 BHU Maingon BHU Saigalabad BHU Sarkalan BHU Khajoola BHU Bhilomar BHU Chinji BHU Goohl BHU Multan Khurd Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Nine (9) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. The data indicates that all the 13 RHCs had and were able to provide the for manual removal, removal s, newborn resuscitation, assisted, normal and comprehensive family planning. However, deficiency Injection Magnesium Sulphate was reported in all 13 RHCs due to which none the facilities were able to provide 24/7 basic EmONC in district Chakwal. Non-availability Injection Ampicillin was observed in RHC Balkassar and Dhudhial whereas, RHC Pir Phulai was deficient in all the three injectables. (See Table 2.21). Lack availability injectables highlight the supply and demand issue at the district level. 38

46 TABLE 2.21: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS DISTRICT CHAKWAL RHCs removal Newborn resuscitation Inj Amplicillin Inj Oxytocin Inj Magnesium Sulfate Providing all Basic EmONC Normal FP (At least 3-FP methods) some (WMO/LHV) all Total Assessed RHC Balkassar RHC Bochal Kalan RHC Dhudhial RHC Dhuman RHC Jhatala RHC Lawa RHC Munday RHC Pir Phulahi RHC Tamman Total Tehsil Headquarter ( THQ) Hospita l 24/ 7Comprehensive EmONC Services Two (2) THQ hospitals were assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.22) indicates that some the was available and the for manual removal, removal s, assisted, blood transfusion and normal were being provided at both the THQs Choa Syedan Shah and Tala Ganj in district Chakwal. Likewise, Injection Ampicillin and Injection Oxytocin were also available at both the THQs. However, due to the shortage Injection Magnesium Sulphate and lack for cesarean section and newborn care, none the THQ hospitals in district Chakwal were able to provide the complete set 24/7 comprehensive EmONC service components. 39

47 TABLE 2.22: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY THQ HOSPITALS DISTRICT CHAKWAL THQ removal Remova l Inj Amplicillin Inj Magnesium Sulfate C- Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensiv e EmONC Normal Comprehensiv e FP (including surgical sterlization) some all Total assessed THQ Choa Syedan Shah THQ Tala Ganj Total District Headquarter ( DHQ) Hospita l 24/ 7Comprehensive EmONC Services The DHQ Hospital Chakwal was assessed for provision 24/7 comprehensive EmONC package. The data gathered from the facility reveals that DHQ Hospital Chakwal is fully functional for 24/7 comprehensive EmONC, as it is providing for all the comprehensive EmONC components and has all the. (See Table 2.23) TABLE 2.23: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY DHQ HOSPITAL DISTRICTCHAKWAL DHQ removal Inj Magnesium Sulfate C- Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensive EmONC Normal Comprehensi ve FP (including surgical sterlization) some all Total assessed DHQ Hospital Chakwal

48 District Chiniot Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services A total 7 BHUs were assessed for the provision 8/6 preventive MNCH. The data indicates that all assessed BHUs were fully functional as they were providing all components the preventive MNCH package and all the was also present. (See Table 2.24) TABLE 2.24: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT CHINIOT BHUs Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Chak 191-JB BHU Chak 205-JB BHU Chak BHU Chak 148-JB BHU Harsa Sheikh BHU Bhaiwal BHU Jabbana Total Rural Health Centers (RHCs) 41

49 24/7 Basic EmONC Services at RHCs Four (4) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. The data indicates that 2 the RHCs Chak 14-JB and Bhowana were completely functional as they were providing the complete set 24/7 basic EmONC and all the was also available. At RHCs Ahmad Nagar and Barana only some the were available. However, they were able to provide all the but lacked Injection Magnesium Sulphate, due to which they could not qualifyas fully functional facilities. (See Table 2.25) TABLE 2.25: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICTCHINIOT RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3- FP methods) some (WMO/LHV) all Total Assessed RHC Ahmed Nagar RHC Barana RHC Chak 14-JB RHC Bhowana Total Tehsil Headquarter ( THQ) Hospita l 24/ 7Comprehensive EmONC Services 42

50 There is 1 THQ hospital Lalian in the district Chiniot which was assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.26) shows that some was available at the THQ Hospital Lalian and the for manual removal, removal s, assisted, blood transfusion and normal and comprehensive family planning were available. However, non-availability for cesarean section, newborn care and deficiency Injection Magnesium Sulphate prevented thethq hospital from fering a comprehensive package 24/7 comprehensive EmONC facilities. TABLE 2.26: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYTHQHS DISTRICT CHINIOT THQH removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscit ation and Incubator ) Providing all comprehensiv e EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed THQ Lalian (upgrd) Total District Headquarter (DHQ) Hospita l 24/ 7Comprehensive EmONC Services The DHQ hospital Chiniot was assessed for provision 24/7 comprehensive EmONC package. The survey data indicates that, only some the were available at the facility.the hospital was able to provide all the except the newborn care while injection Magnesium Sulphate was also not available. Due to these, the hospital could not be considered as completely functional for 24/7 comprehensive EmONC. (See Table 2.27) TABLE 2.27: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYDHQHS DISTRICT CHINIOT 43

51 DHQHs removal Inj Magnesium Sulphate C-Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensive EmONC Normal Comprehensi ve FP (including surgical sterilization) some all Total assessed DHQ Hospital Chiniot District DG Khan Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services A total 11 BHUs were assessed for the provision comprehensive 8/6 preventive MNCH. The data indicates that 80% (9) the facilities were completely functional as the was present and all preventive MNCH service components were being provided. The BHU Main Pheroo was deficient in only immunization and TT vaccination due to which it was not fering the comprehensive set preventive MNCH. Whereas, BHU Betwala was completely non-functional in terms ing and service. (See Table 2.28) TABLE 2.28: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT DG KHAN BHUs Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunizati on (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Bait Betwala BHU Haji Ghazi Gharbi BHU Ghousabad

52 BHU Khanpur Nouranga BHU Main Pheroo BHU Rakhimunh BHU Talpur BHU Kot Qasarani BHU Makwal Kalan BHU More Jhangi BHU Nari Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Ten (10) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. The data indicates that only one RHC Sarwar Wali was fully functional and was fering the comprehensive set 24/7 basic EmONC. Non-availability all and lack Injection Magnesium Sulphate were the common factors missing in RHCs Bhaarti and Sakhi Sarwar. While both the Injectables Oxytocin and Magnesium Sulphate were not available at RHCs Choti Zareen, Kot Chutta, Shahdan Lund and Tibi Qaiserani. (See Table 2.29). TABLE 2.29: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICTDG KHAN RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3- FP methods) some (WMO/LHV) all Total Assessed RHC Bhaarti RHC Choti Zareen RHC Kot Chutta

53 RHC Qadirabad RHC Sakhi Sarwar RHC Sarwarwali RHC Shadan Lund RHC Shah Sardar din RHC Tibbi Qaiserani RHC Vohva Total Tehsil Headquarter ( THQ) Hospita l 24/ 7Comprehensive EmONC Services Two (2) THQ hospitals were assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.30) indicates that, some was available, normal deliveries and blood transfusion were being performed at both the THQ Hospitals;Taunsa Sharif and Civil Hospital Fort Manro. Lack availability all was the common deficiency observed at both the THQs. THQ Tounsa Sharif had some available and was able to provideall the such as manual removal, removal s, assisted, cesarean section, blood transfusion, newborn care, normal and comprehensive family planning. However, a lack Injection Ampicillin was the only factor due to which the facility could not be classified as fully functional for 24/7 comprehensive EmONC.Civil Hospital Fort Manro could not provide most the except blood transfusion and also lacked in injection, Magnesium Sulphate and therefore also failed to be designated as a fully functional facility. 46

54 TABLE 2.30: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYTHQHS DISTRICT DG KHAN THQH removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscit ation and Incubator ) Providing all comprehensiv e EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed THQ Tounsa Sharif THQ Civil Hospital Fort Manro Total District Headquarter (DHQ) Hospita l 24/ 7Comprehensive EmONC Services DHQ Hospital DG Khan was assessed for provision comprehensive EmONC package. The data revealed that all alongwith all the service components comprehensive EmONC were available at the DHQ. However, the deficiency Injection Magnesium Sulphate was the only factor due to which the facility was unable to provide 24/7 comprehensive EmONC. (See Table 2.31) TABLE 2.31: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYDHQHS DISTRICT DG KHAN DHQHs removal Inj Magnesium Sulphate C-Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensive EmONC Normal Comprehensi ve FP (including surgical sterilization) some all Total assessed DHQ Hospital DG Khan city

55 District Faisalabad Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services A total 34 BHUs were assessed for the provision 8/6 preventive MNCH.The detail indicates that 98% (32) BHUs were providing the complete set 8/6 preventive MNCH. However, the absence and non-availability laboratory service was reported in BHUs, Chak 237-GB and Chak 506-GB. The BHU Chak 506-GB was the least functional facility as it was only providing TT vaccination and Immunization. (See 2.32) Table 2.32: Distribution Preventive MNCH Services Provided by Districts Facilities District Faisalabad BHU Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunizatio n (EPI) Laboratory (WMO/LHV) BHU Chak 156-RB BHU Chak 293-RB BHU Chak 157-RB BHU Chak 49-JB BHU Chak 275-RB BHU Chak 6-JB BHU Chak 27-JB BHU Chak 38-JB BHU Chak 78-JB BHU Chak 85-JB Facilities providing all preventive MNCH BHU Chak 111-JB Total assessed 48

56 BHU Chak 189-RB BHU Chak 249-RB BHU Chak 32-GB BHU Chak 55-GB BHU Chak 100-RB BHU Chak 104-GB BHU Chak 105-RB Gibb Wala BHU Chak 106-GB BHU Chak 216-RB BHU Chak 234-GB BHU Chak 237-GB BHU Chak 648-GB BHU Chak 143-GB BHU Chak 170-GB BHU Chak 200-Gb BHU Chak 219-Gb BHU Chak 448-GB BHU Chak 474-Gb BHU Chak 545-Gb BHU Chak 554-GB BHU Chak 506-Gb 1 1 BHU Chak 507-Gb BHU Chak 418-Gb Total

57 Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Eleven (11) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. The data indicates that only 2 RHCs Dijkot and Satiana were completely functional according to the standards 24/7 basic EmONC. The shortage Injection Magnesium Sulphate was the most common deficiency observed in 7 RHCs, while, absence all was reported in 5 facilities.likewise, the for assisted and removal s was reported in 54% (5) RHCs, i.e: Lundian Wala, Mamun Kanian, Pindi Sheikh Musa and Chak 193-GB Murid. (See Table 2.33) TABLE 2.33: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICTFAISALABAD RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3- FP methods) some (WMO/LHV) all Total Assessed RHC Chak 30-JB RHC Chak 229-RB RHC Chak 65-GB RHC Dijkot RHC Kanjwani RHC Khurrarianwala RHC Lundian Wala RHC Mamun Kanjan RHC Pindi Sheikh Musa

58 RHC Chak 193-GB Murid Wala RHC Satiana Total Tehsil Headquarter ( THQ) Hospita l 24/ 7Comprehensive EmONC Services Five (5) THQ hospitals were assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.34) indicates that some was available at all the THQ hospitals and for manual removal, removal s, assisted, comprehensive family planning and normal deliveries were being routinely performed. However, due to the shortage Injection Magnesium Sulphate, lack for cesarean section and newborn care, none the facilities in district Faisalabad were able to fer the complete set 24/7 comprehensive EmONC serices. All the required was not found at any the 5 THQs. TABLE 2.34: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYTHQHS DISTRICT FAISALABAD THQH removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscit ation and Incubator ) Providing all comprehensiv e EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed THQ Jaranwala THQ Faisal Abad THQ Tandalianwala THQ Sumandri THQ Chak Jhumra Total

59 District Gujaranwala Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services A total 18 BHUs were assessed for provision 8/6 preventive MNCH.The data indicates that all assessed BHUs were completely functional and were able to fer all the components 8/6 preventive MNCH. (See Table 2.35) TABLE 2.35: DISTRIBUTION OF PREVENTIVE MNCH SERVICES COMPONENTS PROVIDED BY FACILITIES DISTRICT GUJRANWALA BHU Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Attawa BHU Botala Sharam Singh BHU Ferozewala BHU Gondlanwala BHU Tawlwandi Musa Khan BHU Dandian BHU Gulloke BHU Kotli Nawab BHU Artali Virkan BHU Budda Goraya BHU Jallan BHU Kot Ladha

60 BHU Nokhar BHU Bucha Chatah BHU Hardo Saharan BHU Jaura Sian BHU Mohalanke BHU Noianwala Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Nine (9) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. The data shows that all the facilities had some available and were providing the for newborn resuscitation, normal and comprehensive family planning but Injection Magnesium Sulphate was completely deficient at all the facilities due to which, none the RHCs were able to fer the complete set 24/7 basic EmONC. RHC Wahndo were not able to provide the for manual removal and s and assisted while RHC Ahmad Nagar was the only facility in which shortage Injection Ampicillin was reported. (See 2.36) TABLE 2.36: DISTRIBUTION OF BASIC EMONC SERVICE PROVIDED BY RHCS, DISTRICTGUJRANWALA RHCs removal Newborn resuscitation Inj Magnesium Sulfate Providing all Basic EmONC Normal FP (At least 3-FP methods) some (WMO/LHV) all Total Assessed RHC Ahmed Nagar RHC Ali Pur Chatta RHC Dounkal

61 RHC Emin Abad RHC Gakhar RHC Qila Didar Sing RHC Rasool Nagar RHC Sohdra RHC Wahndo Total Tehsil Headquarter ( THQ) Hospita l 24/ 7Comprehensive EmONC Services Three (3) THQ hospitals were assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.37) indicates that all the THQs were providing manual removal, removal s, assisted, blood transfusion, normal and comprehensive family planning. However, shortage Injection Magnesium Sulphate was the key factor due to which none the RHCs were able to provide complete set 24/7 comprehensive EmONC. Similarly, all the was also not available at any the THQs. TABLE 2.37: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYTHQHS DISTRICT GUJRANWALA THQH removal Inj Amplicillin Inj Oxytocin Inj Magnesiu m Sulfate C- Section Blood Transfusio n Newborn care (Resuscitation and Incubator) Providing all comprehensive EmONC Normal Comprehensive FP (including surgical sterlization) THQ Kamonki THQ Wazir Abad THQ Noshera Virkan some all Total Total assessed District Headquarter ( DHQ) Hospita l 54

62 24/ 7Comprehensive EmONC Services DHQ hospital Gujranwala was assessed for provision comprehensive EmONC package. The survey data indicated that only some the was available and for manual removal, removal s, assisted, cesarean section, blood transfusion, newborn care, normal and comprehensive family planning were provided at the DHQ Gunjranwala. However, shortage injection Magnesium Sulphate was the main factor due to which the facility was unable to provide the complete set comprehensive EmONC and was not fully functional for provision 24/7 comprehensive EmONC package. (See Table 2.38) TABLE 2.38: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY DHQ HOSPITAL DISTRICT GUJRANWALA DHQH DHQ Gujranwala City removal InjAmplicillin Inj Magnesium Sulfate C-Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all compreh ensive EmONC Normal Comprehen sive FP (including surgical sterlization) some all Total assessed District Gujarat Basic Health Units (BHUs) 8/ 6 Preventive MNCH Services Eighteen (18) BHUs were assesed for the provision 8/6 preventive MNCH.The data revealed that 16 out 18 BHUs had and were able to provide all the components the preventive MNCH. Therefore, 88% the assessed BHUs were completely functional. BHU Pir Khana was the least functional facility and was able to provide only TT vaccination. Likewise, shortage TT vaccination and immunization were reported at BHU Mirza Tahir, as well. (See Table 2.39)This may highlight the poor immunization coverage in the catchment areas the respective BHUs, due to the non-availability vaccination.the data the individual BHUs is presented in table TABLE 2.39: DISTRIBUTION OF PREVENTIVE MNCH SERVICES COMPONENTS PROVIDED BY FACILITIES DISTRICT GUJRAT 55

63 BHU Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Alam Garh BHU Goleki BHU Hajiwala BHU Hariawala BHU Hunjra BHU Kot Ranjha BHU Mahmoodabad BHU Rangpur BHU Sheikh Chughani BHU Amra Kalan BHU Burnali BHU Channan BHU Jaura BHU Mirza Tahir BHU Murala BHU Panjan Kassana BHU Bhag Nagar BHU Pir Khana 1 56

64 Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Nine (9) RHCs, were assessed for provision basic EmONC package and for additional complimentary. The data revealed that only 2 out these 9 facilities (RHCs Dinga and Kunja) had all the and were providing all the components BEmONC. Thus, only 22% the assessed RHCs were completely functional. A uniform supply Injection Oxytocin was reported throughout the RHCs whereas, shortage Injection Magnesium Sulphate and Ampicillin was found in 6 and 2 RHCs, respectively. This refer to the problem supply or logistics the two drugs at the district level. RHC Tanda was the least functional facility as only Injection Oxytocin was available and for manual removal, newborn resuscitation, normal and family planning were being fered while rest the injectables and were deficient. (See Table 2.40) TABLE 2.40: DISTRIBUTION OF RHC PROVIDED BASIC EMONC SERVICE COMPONENTS BY RHCS, DISTRICT RHCs removal Newborn resuscitation Inj Magnesium Sulfate Providing all Basic EmONC Normal FP (At least 3-FP methods) some (WMO/LHV) all Total Assessed RHC Dinga RHC Doulat Nagar RHC Kunjah RHC Lala Musa RHC Malka RHC Pindi Sultan Pur RHC Sarai Alamgir RHC Shadiwal RHC Tanda

65 Total Tehsil Headquarter ( THQ) Hospita l 24/7Comprehensive EmONC Services THQ hospital Kharian was assessed for provision the comprehensive EmONC package. Analysis the data (Table 2.41) shows that at the THQ hospital only some the were available along with an ample supply Injection Ampicillin and Oxytocin. The facility was also providing for manual removal, removal s, assisted, cesarean section, blood transfusion, normal and comprehensive family planning. However, due to the shortage Injection Magnesium Sulphate and lack for newborn care, the THQ Kharian was not considered as fully functional. TABLE 2.41: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYTHQHS DISTRICT GUJRAT THQ removal Inj Magnesium Sulfate C- Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensive EmONC Normal Comprehensive FP (including surgical sterlization) some all Total assessed THQ Kharian Total District Headquarter ( DHQ) Hospita l 24/ 7Comprehensive EmONC Services 58

66 The DHQ hospital Gujrat was assessed for provision comprehensive EmONC package. The survey data indicates that all the was available and the facility was fering all the manual removal, removal s, assisted, cesarean section, blood transfusion, newborn care, normal and comprehensive family planning. However, the shortage Injection Magnesium Sulphate was the only factor due to which the DHQ Gujrat was not fully funtional to fer 24/7 comprehensive EmONC service. (See Table 2.42) TABLE 2.42: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED DHQ HOSPITAL DISTRICT GUJRAT DHQHs removal InjAmplicillin Inj Magnesium Sulfate C-Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensive EmONC Normal Comprehensive FP (including surgical sterlization) some all Total assessed DHQ Gujrat City District Hafizabad Basic Health Units (BHUs) 8/ 6 Preventive MNCH Services A total 6 BHUs were assessed for provision 8/6 preventive MNCH.The data revealed that 83% (5 out 6)BHUs were fully functional and were providing all the components 8/6 preventive MNCH. BHU Jandka was the only facility which was not able to provide the immunization and could not be considered fully functional. However, the facility was fering all the other components i.e. antenatal care, normal, TT vaccination, family planning, growth monitoring, nutrition counselling and laboratory. This highlight the fact that if EPI are made available at BHU Jandka, it will be able to fer the complete set preventive MNCH. (See Table 2.43) TABLE 2.43: DISTRIBUTION OF PREVENTIVE MNCH SERVICES COMPONENTS PROVIDED BY FACILITIES DISTRICT HAFIZABAD 59

67 BHU Antenata l care Normal deliver y TT vaccinatio n FP service s (at least 3 FP method ) Growth monitorin g Nutrition counselin g Immunizatio n (EPI) Laborator y (WMO/LHV ) BHU Bhobrah BHU Jandaka BHU Kolo Tarrar BHU Nawan Ghagoke BHU Pindi Dudhal BHU Rasoolpur Tarrar Facilities providing all preventiv e MNCH Total Total assessed Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Five (5) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. The data indicates that only some the was available at all the 5 RHCs which were able to fer newborn resuscitation, normal and family planning. However, none the facilities were able to provide the for removal s and assisted. Likewise, shortage Injection Magnesium Sulphate and Ampicillin was also reported in all the 5 facilities.injection Oxytocin was available in RHCs Sukheki Mandi, Vanike Tarar and Kassoke only. This may refer to supply and demand issue the drug in the district. Hence, none the RHCs were fully functional to provide 24/7 Basic EmONC. (See Table 2.44) 60

68 TABLE 2.44: DISTRIBUTION OF RHC PROVIDED BASIC EMONC SERVICE COMPONENTS BY RHCS, DISTRICT HAFIZABAD. RHCs removal Newborn resuscitation Inj Magnesium Sulfate Providing all Basic EmONC Normal FP (At least 3-FP methods) some (WMO/LHV) all Total Assessed RHC Jalal Pur Bhattian RHC Kaleki Mandi RHC Sukheki Mandi RHC Vanike Tarar RHC kassoke Total Tehsil Headquarter ( THQ) Hospita l 24/ 7Comprehensive EmONC Services THQ hospital Pindi Bhattian was assessed for provision comprehensive EmONC package. Analysis the data, (Table 2.45) indicates that most the were provided at the THQ hospital Pindi Bhattian. However, due to the lack for newborn care and deficiency Injection Magnesium Sulphate and Ampicillin,the facility was not able to provide 24/7 comprehensive EmONC. 61

69 TABLE 2.45: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYTHQHS DISTRICT HAFIZABAD THQ removal Inj Magnesium Sulfate C- Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensiv e EmONC Normal Comprehensive FP (including surgical sterlization) some all Total assessed THQ Pindi Bhattian Total District Headquarter ( DHQ) Hospita l 24/ 7Comprehensive EmONC Services The DHQ hospital Hafizabad was assessed for provision comprehensive EmONC package. The survey data shows that some the and all the components manual removal, removal s, assisted, blood transfusion, newborn care, normal and comprehensive family planning were available. However, due to the the shortage Injection Magnesium Sulphate, Oxytocin and lack for cesarean section the DHQ Hafizabad failed to fer the complete package 24/7 comprehensive EmONC. (See Table 2.46) TABLE 2.46: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY DHQ HOSPITAL DISTRICTHAFIZABAD DHQH removal InjAmplicillin Inj Magnesium Sulfate C-Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensiv e EmONC Normal Comprehensive FP (including surgical sterlization) some all Total assessed 62

70 DHQ Hafiz Abad District Jhang Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services Twelve (12) BHUs were assessed for the provision 8/6 preventive MNCH. The data revealed that 92% (11) the assessed facilities were fully functional as they were providing all components the preventive MNCH package. BHU Essay Wala was the only facility in which neither a WMO nor LHV was present and laboratory were also not available. Therefore, it failed to qualify for provision 8/6 preventive MNCH. (See Table 2.47) TABLE 2.47: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT JHANG BHU Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunizatio n (EPI) Laboratory (WMO/LHV) BHU Ashaba BHU Chak 165-JB BHU Jabbu Ana BHU Kot Lakhana BHU Ratta Matta BHU Uch Gul Imam Facilities providing all preventive MNCH Total assessed 63

71 BHU Vijhlana BHU Jalalpur BHU Pir Bahadur Shah BHU Dab Kalan BHU Samandoana BHU Essaywala Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Nine (9) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. The data indicates that only RHC Garh Maharaja was completely functional and all the was available, and the facility was fering all the components 24/7 basic EmONC service.the common deficiency observed was the shortage Injection Magnesium Sulphate as the drug was only available in RHC Garh Maharaja.The absence injectables was generally reported in almost all the BHUs. All the three injectables were not available in RHC Kot Shakir and Rodu Sultan. (See Table 2.48) TABLE 2.48: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICTJHANG RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3- FP methods) some (WMO/LHV) all Total Assessed RHC Bagh RHC Garh Maharaja RHC Haveli Bahadar Shah

72 RHC Haveli Sheikh Raju RHC Kot Shakir RHC Mochiwala RHC Mukhiana RHC Rodu Sultan RHC Shah Jewna Total Tehsil Headquarter ( THQ) Hospita l 24/ 7Comprehensive EmONC Services Two (2) THQ hospitals were assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.49) shows that both the THQs had some, supply injections Ampicillin and Oxytocin was present and the for manual removal, removal s, assisted, blood transfusion, normal and comprehensive family planning were being fered. However, deficiency Injection Magnesium Sulphate was reported in both the THQs. Therefore, none the THQs were completely functional to fer 24/7 comprehensive EmONC. If the supply Injection Magnesium Sulphate is provided at THQ Shorkot, the facility will be able to fer the complete set 24/7 comprehensive EmONC. TABLE 2.49: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYTHQHS DISTRICT JHANG THQH removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscit ation and Incubator ) Providing all comprehensiv e EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed THQ Shorkot THQ Ahmed Pur

73 Sial-upgrd Total District Headquarter (DHQ) Hospita l 24/ 7Comprehensive EmONC Services The DHQ Hospital Jhang shows that the facility was fully equipped with all the, supply injectables was also present and was fering the for manual removal, removal s, assisted, cesarean section, blood transfusion, normal and comprehensive family planning. However, due to the lack only one MNCH component newborn care, the DHQ Jhang was unable to fer 24/7 comprehensive EmONC package. (See Table 2.50).The deficiency also highlights the lack specialized paediatric care in the district. TABLE 2.50: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYDHQHS DISTRICT JHANG DHQH removal Inj Magnesium Sulphate C-Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensive EmONC Normal Comprehensi ve FP (including surgical sterilization) some all Total assessed DHQ Hospital Jhang City District Jhelum Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services 66

74 Nine (9) BHUs were assessed for the provision 8/6 preventive MNCH.The data indicates that 88% (8 out 9) BHUs were fully functional. The was available and all the components antenatal care, normal, TT vaccination, family planning, growth monitoring, nutrition counselling, immunization, and laboratory were being fered. However, BHU Dhoke Loona was the only facility which could not fer even one the required. (See Table 2.51) TABLE 2.51: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY BHUS DISTRICT JHELUM BHU Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Chak Khasa BHU Chotala BHU Dhoke Loona BHU Pandorian BHU Chak Shadi BHU Dharyala Jalap BHU Toba BHU Kohali BHU Phulray Sayyedan Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Five (5) RHCs were assessed for provision basic EmONC package and for additional complimentary. The data indicates that the manual removal, newborn resuscitation, normal and family planning and injections Oxytocin and Ampicillin were 67

75 available in all 5 facilities, while, shortage Injection Magnesium Sulphate was reported in the 5 RHCs. Therefore, none the RHCs were able to provide complete set basic EmONC package. However, the absence all was observed at 2 RHCs Jalal Pur Sharif and Khalas Pur, alongwith, lack for removal s and assisted. (See Table 2.52) TABLE 2.52: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICTJHELUM RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3- FP methods) some (WMO/LHV) all Total Assessed RHC Dina RHC Domaili RHC Jalal Pur Sharif RHC Khalas Pur RHC Lilla Total Tehsil Headquarter ( THQ) Hospita l 24/ 7Comprehensive EmONC Services Two (2) THQ hospitals were assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.53) revealed that in both the THQs the complete set comprehensive EmONC service components were not available. Therefore, none the facilities were fully functional to provide 24/7 comprehensive EmONC service package. Shortage injections Ampicillin and Oxytocin was observed in THQ Pind Dadan Khan, while Injection Magnesium Sulphate and newborn care was not available in THQ Sohawa. TABLE 2.53: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY THQ HOSPITALS DISTRICT JHELUM 68

76 THQ removal Inj Magnesium Sulfate C- Section Blood Transfusion Newborn care (Resuscitati on and Incubator) Providin g all compreh ensive EmONC Normal Comprehensiv e FP (including surgical sterlization) Availabilit y some all Total assessed THQ Pind Dadan Khan THQ Sohawa Total District Headquarter ( DHQ) Hospita l 24/ 7Comprehensive EmONC Services The DHQ hospital Jhelum was assessed for provision 24/7 comprehensive EmONC package. The survey data indicates that all the was present and the manual removal, removal s, assisted, cesarean section, blood transfusion, newborn care, normal and comprehensive family planning were available. However, due to the shortage injection Oxytocin and Magnesium Sulphate, the facility failed to provide the full components comprehensive EmONC. (See Table 2.54) 69

77 TABLE 2.54: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED DHQ HOSPITAL DISTRICT JHELUM DHQHs removal InjAmplicillin Inj Magnesium Sulfate C-Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensive EmONC Normal Comprehensive FP (including surgical sterlization) some all Total assessed DHQ Hospital Jhelum District Kasur Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services. A total 16 BHUs were assessed for the provision 8/6 preventive MNCH. The data indicates that all the and for antenatal care, normal, TT vaccination, family planning, growth monitoring, nutrition counselling, immunization and laboratory were available at all the BHUs. Therefore, all the assessed BHUs were functional and providing complete set 8/6 preventive MNCH. (See Table 2.55) 70

78 TABLE 2.55: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT KASUR BHU Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed 1 BHU Alpan Kalan BHU Atari Virk BHU Baghiana Kalan BHU Bhopeywal BHU Doblian BHU Gagga Sarai BHU Hussain Khan Wala BHU Jumber Khurd BHU Baghiar More BHU Baroon Raja Jang BHU Burj Kalan BHU Greenkot BHU Kharapar Hithar BHU Olikh Ottar BHU Orara BHU Taragarh Total

79 Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Twelve (12) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. The data indicates that none the RHCs were completely functional to provide the complete set 24/7 basic EmONC package.the most common deficient factor observed in all the RHCs was shortage injection Magnesium Sulphate, while, injection Ampicillin was not available in 2 RHCs Ellah Abad and Habib Abad (Wan Radha Ram). The availability only some the, provision manual removal, newborn resuscitation, normal and family planning and supply injection oxytocin was observed at all the 12 RHCs. Lack for removal s was reported in 67% (8) RHCs in district Jehlum whereas 50% (6) RHCs were providing the assisted. (See Table 2.56) TABLE 2.56: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICTKASUR RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3- FP methods) some (WMO/LHV) all Total Assessed RHC Ganda Sing Wala, Kasur RHC Habib Abad (Wan Radha Ram), Kasur RHC Halla, Kasur RHC Jaura, Kasur RHC Khudian Khas, Kasur

80 RHC Kot Radha Kishan, Kasur RHC Mustafa Abad, Kasur RHC Phool Nagar, Kasur RHC Raja Jang, Kasur RHC Changa Manga, Kasur RHC Ellah Abad, Kasur RHC Kangan Pur Total Tehsil Headquarter ( THQ) Hospita l 24/ 7Comprehensive EmONC Services Two THQ hospitals were assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.57) indicates that only some the and injections ampicillin as well as oxytocin were available at both the THQ hospitals and were provided for manual removal, removal s, assisted, newborn care, normal and comprehensive family planning. Blood transfusion facilities were available at THQ Chunian, only.the shortage injection Magnesium Sulphate and lack for cesarean section were reported at both the THQs. Therefore, none the THQs; Chunian and Pattoki, were able to provide the complete package comprehensive EmONC. 73

81 TABLE 2.57: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYTHQHS DISTRICT KASUR THQH removal C- Section Inj Magnesium Sulphate Blood Transfusion Newborn care (Resusci tation and Incubato r) Providing all comprehensi ve EmONC Normal Comprehensiv e FP (including surgical sterilization) THQ Chunian, Kasur THQ Pattoki, Kasur Availabilit y some all Total Total assessed District Headquarter (DHQ) Hospita l 24/ 7Comprehensive EmONC Services The DHQ hospital Kasur was assessed for provision 24/7 comprehensive EmONC package. The survey data indicates that newborn care and comprehensive family planning were being provided at the facility. The three injectables (ampicillin, oxytocin and magnesium sulphate) and all were not available. Likewise, absence for manual removal, removal s, assisted, cesarean section and blood transfusion were also reported. This indicates a shortage service providers, supplies and at the hospital, due to which the DHQ Kasur failed to fer the comprehensive package EmONC. (See Table 2.58) TABLE 2.58: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYDHQHS DISTRICT KASUR DHQHs removal Inj Magnesium Sulphate C-Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensive EmONC Normal Comprehensi ve FP (including surgical sterilization) some all DHQ Hospital Kasur Total assessed 74

82 District Khanewal Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services A total 12 BHUs were assessed for the provision 8/6 preventive MNCH. The data shows that 92% (11 out 12) the assessed BHUs were completely functional and all the was present and the facilities were able to fer antenatal care, normal, TT vaccination, family planning, growth monitoring, nutrition counselling, immunisation and laboratory. BHU Chak 27-Gagh was the only facility which was deficient in all the and was therefore completely non-functional. (See Table 2.59) TABLE 2.59: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT KHANEWAL BHU Antenata l care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Ali Sher Wahin BHU Chak R BHU Chak 9-Gagh BHU Chak 27-Gagh BHU Dandi Sargana BHU Haq Nawazwala BHU Jasso Kanwan BHU Sardarpur

83 BHU Shamkot BHU Chak 11A-8R BHU Chak 30-10R BHU Chak R BHU Chak 7-8AR BHU Chak 50-15L BHU Chak 67-15L BHU Chak 70-15L Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Four (4) RHCs were assessed for provision basic EmONC package and for additional complimentary. The data indicates that, due to the shortage injections ampicillin and magnesium sulphate in all the RHCs, none the facilities were able to provide 24/7 basic EmONC. Similarly, non-availability all was reported in RHC Talamba along with lack provision for manual removal, assisted, normal and family planning. (See Table 2.60) TABLE 2.60: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICTKHANEWAL RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3- FP methods) some (WMO/LHV) all Total Assessed RHC Abdul Hakeem RHC Kacha Khu

84 RHC Sarai Sidhu RHC Talamba Total Tehsil Headquarter ( THQ) Hospita l 24/ 7Comprehensive EmONC Services Three (3) THQ hospitals which were assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.61) shows that only some was present at the time the survey while for manual removal, removal s, assisted, blood transfusion, normal and comprehensive family planning were available at all the 3 THQs. However, the absence injection magnesium sulphate was reported at all the THQs due to which none the THQs were able to fer 24/7 comprehensive EmONC. THQ Kabir Wala was the least efficient and lacked the availability all the three injectables and the for cesarean section and newborn care. TABLE 2.61: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYTHQHS DISTRICT KHANEWAL THQH removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscit ation and Incubator ) Providing all comprehensive EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed THQ Jahanian THQ Kabir Wala THQ Mian Channu Total

85 District Headquarter (DHQ) Hospita l 24/ 7Comprehensive EmONC Services The DHQ Hospital Khanewal was assessed for provision 24/7 comprehensive EmONC package. The survey data revealed that only some the was available, the supply injection ampicillin was available and the manual removal, removal s, assisted, blood transfusion, normal and comprehensive family planning were being fered. However, due to the shortage injections oxytocin, magnesium sulphate and deficiency cesarean section as well as newborn care, the DHQ Khanewal was not able to provide complete package 24/7 comprehensive EmONC service. (See Table 2.62) TABLE 2.62: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYDHQHS DISTRICT KHANEWAL DHQHs removal Inj Magnesium Sulphate C-Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensive EmONC Normal Comprehensi ve FP (including surgical sterilization) some all Total assessed DHQ Hospital Khanewal District Khushab Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services. A total 8 BHUs were assessed for provision 8/6 preventive MNCH. The data revealed that 88% (7 ) the assessed BHUs were completely functional. The and the antenatal care, normal, TT vaccination, family planning, growth monitoring, nutrition counselling, immunisation and laboratory were also fered by all the BHUs. BHU Khatwan was the only facility which was 78

86 reported to be deficient in ing and all the preventive MNCH. However, it was able to provide the, immunisation and TT vaccination. (See Table 2.63). TABLE 2.63: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT KHUSHAB BHU Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Bijjar BHU Chak 56-MB BHU Daiwal BHU Shummar (Gujnial) BHU Sandral BHU Anga BHU Jharkal BHU Khatwan Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Five (5) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. The data indicates that RHCs Hadali, Khabeki and Roda were providing almost all the basic EmONC and the was also available. However, the only deficiency injection magnesium sulphate prevented the 3 RHCs to be completely functional. RHCs Mitha Tiwana and Padhrar were lacking the removal s along with the non-availability all the. Moreover, facilities manual removal and assisted were also not available at RHCs Mitha Tiwana and Padhrar, respectively. Therefore, none the RHCs were fully functional to provide 24/7 BEmONC. (See Table 2.64) 79

87 TABLE 2.64: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICTKHUSHAB RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3- FP methods) some (WMO/LHV) all Total Assessed RHC Hadali RHC Khabeki RHC Mitha Tiwana RHC Padhrar RHC Roda Total Tehsil Headquarter ( THQ) Hospita l 24/ 7Comprehensive EmONC Services Three (3) THQ hospitals were assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.65) shows that some and supply injections ampicillin and oxytocin was available at all the THQ hospitals. The manual removal, removal s, assisted, normal and comprehensive family planning were also available. However, lack injection magnesium sulphate, non-availability all and non-existance for C-section were the main factors due to 80

88 which none the THQs were fully functional to provide 24/7 comprehensive EmONC.The for newborn care were lacking at THQs Naushera and Noor Pur while blood transfusion were deficient in only THQ Noor Pur. TABLE 2.65: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYTHQHS DISTRICT KHUSHAB THQH removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscit ation and Incubator ) Providing all comprehensive EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed THQ Khushab THQ Naushera THQ Noor Pur Total District Headquarter (DHQ) Hospita l 24/ 7Comprehensive EmONC Services The DHQ hospital Khushab was assessed for provision 24/7 comprehensive EmONC package. The facility was providing manual removal, removal s, assisted, cesarean section, blood transfusion, newborn care, normal and comprehensive family planning. Some the and injections ampicillin and oxytocin were also available. However, the absence injection magnesium sulphate prevented the DHQ hospital Khushab to be completely functional and qualify for provision 24/7 comprehensive EmONC. (See Table 2.66) 81

89 TABLE 2.66: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYDHQHS DISTRICT KHUSHAB DHQHs removal Inj Magnesium Sulphate C-Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensive EmONC Normal Comprehensi ve FP (including surgical sterilization) some all Total assessed DHQ Jauharaba d Khushab District Lahore Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services. Seven (7) BHUs were assessed for provision 8/6 preventive MNCH. The data revealed that all assessed BHUs were fully functional in district Lahore. The facilities were providing all components the preventive MNCH package. Similarly, all the assessed facilities had either a WMO or an LHV available to provide the MNCH. (See Table 2.67) TABLE 2.67: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT LAHORE BHU Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Chappa BHU Hadiara

90 BHU Koharrian BHU Minhala BHU Narwar BHU Rangeelpur BHU Tayyara Jallo Pind Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Six (6) RHCs were assessed for provision basic EmONC package and for additional complimentary. The data indicates that only 1 RHC Awan Dhaiwala, was completely functional as it was providing all the components basic EmONC package and it had all the ing. RHC Khana Nau could be upgraded to a completely functional facility, if the supply injection magnesium sulphate is provided to the facility. All the 6 RHCs were equipped with a supply injection Oxytocin and were providing manual removal, removal s, newborn resuscitation, assisted, normal and family planning. The most common deficiency observed was injections magnesium sulphate and ampicillin as the drugs were available in only 33% (2 out 6) RHCs. (See Table 2.68) TABLE 2.68: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICTLAHORE RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3- FP methods) some (WMO/LHV) all Total Assessed RHC Awan Dhaiwala, Lahore RHC Burki, Lahore

91 RHC Chung, Lahore RHC Kahna Nau, Lahore RHC Manga Mandi, Lahore RHC Raiwind, Lahore Total Tehsil Headquarter ( THQ) Hospita l 24/ 7Comprehensive EmONC Services Two (2) THQ hospitals which were assessed for provision 24/7 comprehensive EmONC package. Analysis the survey data (Table 2.69) shows that THQ Mauzang was able to fer all the service components and was declared as fully functional facility to provide 24/7 comprehensive EmONC. Non-availability newborn care was the main factor due to which THQ hospital Said Mittha was not able to provide all the components comprehensive EmONC despite the availability some the, most the and all the three injectables.the above-mentioned deficiencies highlight the dearth specialised paediatric care at THQ hospital Said Mittha. TABLE 2.69: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYTHQHS DISTRICT LAHORE THQH removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscit ation and Incubator ) Providing all comprehensiv e EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed THQ Said Mittha

92 Lahore THQ Mozang Lahore Total District Headquarter (DHQ) Hospita l 24/ 7Comprehensive EmONC Services Two (2) DHQ hospitals Mian Munshi Lahore and Kot Khawaja Saeed Lahore were assessed for provision 24/7 comprehensive EmONC package. The survey data revealed that both the DHQ hospitals were fully equipped with all the injectables and all the was available for service provision. Similarly, the for manual removal, removal s, assisted, cesarean section, blood transfusion, newborn care, normal and comprehensive family planning were also fered. Therefore, both DHQ hospitals in Lahore were fully functional for provision 24/7 comprehensive EmONC package. (See Table 2.70) TABLE 2.70: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYDHQHS DISTRICT LAHORE DHQHs removal Inj Magnesium Sulphate C-Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensive EmONC Normal Comprehensi ve FP (including surgical sterilization) some all DHQ Mian Munshi Lahore DHQ Kot Khawja Saeed Lahore Total Total assessed 85

93 District Layyah Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services. Twelve (12) BHUs were assessed for provision 8/6 preventive MNCH. The data shows that 92% (11) the assessed BHUs were fully functional and the facilities were providing all components the preventive MNCH package. Similarly, all the assessed facilities had either a WMO or an LHV available to provide the MNCH. BHU Chak 90-A-TDA was the only facility in which no WMO or LHV was present and there was a lack growth monitoring and laboratory, as well. (See Table 2.71) TABLE 2.71: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT LAYYAH BHU Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Khaireywala BHU Sher Garh BHU Chak 120-TDA BHU Chak 90-A-TDA BHU Jhoke Jaskani BHU Shahpur BHU Bakharay Ahmad Khan BHU Ladhana Total

94 Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Four (4) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. The data indicates that all the facilities had some the and supply injection ampicillin. They were also able to fer newborn resuscitation, normal and family planning, yet, none the RHCs were fully functional because they were deficient in one or more components the basic EmONC service package.shortage injection magnesium sulphate was commonly observed in 3 out 4 RHCs. It was the only deficiency reported in RHCs Chowk Azam and Fateh Pur. The two facilities could be completely functional if the drug was made available at these RHCs in district Layyah. Nonavailability all, lack for manual removal, removal s and assisted were also reported at RHCs Mirhan (Dhori Adda) and Jamman Shah. (See Table 2.72) TABLE 2.72: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICTLAYYAH RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3- FP methods) some (WMO/LHV) all Total Assessed RHC Chowk Azam RHC Fateh Pur RHC Mirhan (Dhori Adda) upgrd RHC Jamman Shah Total

95 Tehsil Headquarter ( THQ) Hospita l 24/ 7Comprehensive EmONC Services Three (3) THQ hospitals were assessed for provision 24/7 comprehensive EmONC package. Analysis the survey data (Table 2.73) shows that some, along with injections ampicillin and oxytocin, were available at all the THQ hospitals. The for manual removal, blood transfusion and normal deliveries were also performed by all these facilities. However, lack newborn care was the common factor observed in all the THQs, due to which, none the facilities were fully functional to provide comprehensive EmONC package.the facility cesarean section was only fered at THQ Kot Sulan in district Layyah. THQ Chubara was the least functional facility as it was deficient in injection magnesium sulphate. The for removal s, assisted, cesarean section, newborn care and comprehensive family planning were also missing at the THQ. TABLE 2.73: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYTHQHS DISTRICT LAYYAH THQH removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscitati on and Incubator) Providing all comprehen sive EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed THQ Chubara THQ Karorr THQ Kot Sultan-upgrd Total

96 District Headquarter (DHQ) Hospita l 24/ 7Comprehensive EmONC Services The DHQ hospital Layyah was assessed for provision 24/7 comprehensive EmONC package. The facility was providing manual removal, removal s, assisted, cesarean section, blood transfusion, newborn care, normal and comprehensive family planning. Some the and injections ampicillin and oxytocin were also available. However, due to the absence injection magnesium sulphate, the DHQ failed to to provide the 24/7 comprehensive EmONC. (See Table 2.74) TABLE 2.74: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYDHQHS DISTRICT LAYYAH DHQHs removal Inj Magnesium Sulphate C-Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensive EmONC Normal Comprehensi ve FP (including surgical sterilization) some all Total assessed DHQ Hospital Layyah District Lodran Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services. 89

97 A total 10 BHUs were assessed for the provision 8/6 preventive MNCH. The data revealed that 100% the assessed BHUs were fully functional and the facilities were providing all components the preventive MNCH package. Similarly, all the assessed facilities had either a WMO or an LHV available to provide the MNCH. (See Table 2.75) TABLE 2.75: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT LODRAN BHU Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Chak 35-M BHU Chak 360-WB BHU Chak 386-WB BHU Bahawalgarh BHU Chhaly Wahin BHU Noor Shah Gillani BHU Adam Wahan BHU Chak Himta BHU Chak 12-MPR BHU Chamb Kalyar Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs 90

98 Four (4) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. The data indicates that all the facilities had some the and supply injection ampicillin and oxytocin. The RHCs were also able to fer manual removal, removal s, newborn resuscitation, assisted, normal and family planning. However, shortage injection magnesium sulphate was the only deficiency which prevented the RHCs from being completely functional. This refers to the supply and demand issue the drug at the district level, and if the drug was made available, all the 4 RHCs in district Lodran will be able to provide all the components basic EmONC. (See Table 2.76) TABLE 2.76: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICTLODRAN RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3- FP methods) some (WMO/LHV) all Total Assessed RHC Chak 231-WB RHC Chak 53-M RHC Gogran RHC Makhdom Aali Total Tehsil Headquarter ( THQ) Hospita l 24/ 7Comprehensive EmONC Services Two THQ hospitals were assessed for provision comprehensive EmONC package and for additional complimentary. The data indicates that most the were provided at the THQ hospitals Dunia Pur and Karor Pakka in district Lodran although only some the were available. Likewise, THQ Karor Pakka was the only facility which was able to provide for cesarean section. However, due 91

99 to a lack for newborn care and deficiency injection magnesium sulphate, none the THQs were able to provide 24/7 comprehensive EmONC. (See Table 2.77) TABLE 2.77: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYTHQHS DISTRICT LODRAN THQH removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscit ation and Incubator ) Providing all comprehensiv e EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed THQ Dunia Pur THQ Karor Pakka Total District Headquarter (DHQ) Hospita l 24/ 7Comprehensive EmONC Services The DHQ hospital Lodran was assessed for provision 24/7 comprehensive EmONC package. The facility was providing manual removal, removal s, assisted, cesarean section, blood transfusion, newborn care, normal and comprehensive family planning. Either a WMO or an LHV was present and the three injectables were also available. However, an absence injection magnesium sulphate prevented the DHQ to be completely functional and qualify for provision 24/7 comprehensive EmONC. (See Table 2.78) TABLE 2.78: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYDHQHS DISTRICT LODRAN 92

100 DHQHs removal Inj Magnesium Sulphate C-Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensive EmONC Normal Comprehensi ve FP (including surgical sterilization) some all Total assessed DHQ Hospital Lodran District Mandi Baha Uddin Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services. A total 18 BHUs were assessed for provision 8/6 preventive MNCH.The data indicates that 94% (17) BHUs were fully functional and had all the available to provide complete set for 8/6 preventive MNCH. The non-availability EPI and TT immunization was reported in BHU Nain Ranjha due to which the BHU failed to deliver the complete package preventive MNCH. (See Table 2.79) TABLE 2.79: DISTRIBUTION OF PREVENTIVE MNCH SERVICES COMPONENTS PROVIDED BY FACILITIES DISTRICT MANDI BAHA UDDIN BHU Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Bhiki Sharif BHU Cahk BHU Morala

101 BHU Sevia BHU Ghanian BHU Khosa BHU Pindi Kalu BHU Mona Depot BHU Nain Ranjha BHU Rukken Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Eight (8) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. The data indicates that none the RHCs were completely functional according to the standards 24/7 basic EmONC. The shortage Injection Magnesium Sulphate was the common deficiency observed in all the 8 RHCs. While, absence injection oxytocin was reported in 75% (6 ou t 8) facilities. Moreover, 3 the facilities (RHCs Jokalian, Kuthiala Sheikhan and Malakwal) were not able to fer for assisted, manual removal the or the removal s. Presence some the and for newborn resuscitation, normal and family planning were reported throughout all the RHCs. (See Table 2.80) 94

102 TABLE 2.80: DISTRIBUTION OF BASIC EMONC SERVICE COMPONENTS PROVIDEDBY RHCS, DISTRICT MANDI BAHA UDDIN RHCs removal Newborn resuscitation Inj Magnesium Sulfate Providing all Basic EmONC Normal FP (At least 3-FP methods) some (WMO/LHV) all Total Assessed RHC Bheikho More RHC Chailianwala RHC Jokalian RHC Kuthiala Sheikhan RHC Malakwal RHC Miana Gondal RHC Mong RHC Phirianwali Total Tehsil Headquarter ( THQ) Hospita l 24/ 7Comprehensive EmONC Services One THQ hospital Phalia was assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.81) revealed that only some the was available at the THQ and for manual removal, removal s, newborn resuscitation, assisted, normal and family planning were being routinely performed. However, due to the shortage Injection Magnesium Sulphate and lack for cesarean section the facility failed to fer the complete set 24/7 comprehensive EmONC. 95

103 96

104 TABLE 2.81: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYTHQ HOSPITALS DISTRICT MANDI BAHA UDDIN THQ removal Inj Magnesium Sulfate C- Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensive EmONC Normal Comprehensive FP (including surgical sterlization) some all Total assessed THQ Phalia Total District Headquarter ( DHQ) Hospita l 24/ 7Comprehensive EmONC Services DHQ hospital district Mandi Baha-ud-din was assessed for provision comprehensive EmONC package. The survey data indicates that only some the was available and the facility was providing the for manual removal, removal s, assisted, cesarean section, blood transfusion, newborn care, normal and comprehensive family planning. However, due to a shortage injection magnesium sulphate as well as a lack for cesarean section and blood transfusion, the DHQ was unable to provide the complete set comprehensive EmONC and was not fully functional. See Table 2.82) TABLE 2.82: Distribution Comprehensive EmONC Services provided by DHQ hospital District MANDI BAHA UDDIN DHQHs removal placent a Remova l Assiste d InjAmplicillin Inj Magnesium Sulfate C-Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensiv e EmONC Normal Comprehensiv e FP (including surgical sterlization) Availabilit y some Availabilit y all Total assessed 97

105 DHQ MandiBhahauddin District Mianwali Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services. A total 8 BHUs were assessed for provision 8/6 preventive MNCH. The data revealed that 100% the assessed BHUs were fully functional and the facilities were providing all components the preventive MNCH package. Similarly, all the assessed facilities had either a WMO or an LHV available to provide the MNCH. (See Table 2.83) TABLE 2.83: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT MIANWALI BHU Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Chappri BHU Mitha Khatak BHU Bani Afghan BHU Chiddru BHU Dher Umeed Ali Shah (Thathi) BHU Pai Khel BHU Shadia BHU Chak 4-DB

106 Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Nine (9) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. The data revealed that availability some and the newborn resuscitation, normal and family planning were fered throughout all the RHCs. However, none the RHCs were able to provide the complete set basic EmONC service package due to the deficiency in one or more the service compnents.the most common deficiency reported was injection magnesium sulphate as it was only available at 1 RHC Trag. Provision injection magnesium sulphate at RHCs Kundian and Kammar Mushani will enable the 2 RHCs to fer the complete package the basic EmONC. (See Table 2.84) TABLE 2.84: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS DISTRICTMIANWALI RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3- FP methods) some (WMO/LHV) all Total Assessed RHC Chakrala RHC Daud Khel RHC Hafiz Wala RHC Kammar Mushani RHC Kundian

107 RHC Mouch RHC Tabbisar RHC Trag RHC Wan Bachran Total Tehsil Headquarter ( THQ) Hospita l 24/ 7Comprehensive EmONC Services Three (3) THQ hospitals were assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.85) shows that all the THQs were fering manual removal, removal s, assisted, normal and comprehensive family planning. Only some was present and supplies for injections ampicillin and oxytocin were also available. But there was a shortage injection magnesium sulphate and lack cesarean section throughout all the facilities. Therefore, none the THQs were able to provide the complete set comprehensive EmONC. Services for blood transfusion and newborn care were only ferred by THQs Piplan and Isa Khel, respectively.the above-mentioned deficiencies highlight a dearth specialized paediatric care at THQs Kala Bagh and Piplan. TABLE 2.85: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYTHQHS DISTRICT MIANWALI THQH removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resusci tation and Incubato r) Providing all comprehensi ve EmONC Normal Comprehensiv e FP (including surgical sterilization) Availabilit y some all Total assessed THQ Isa Khel THQ Kala Bagh THQ Piplan

108 Total District Headquarter (DHQ) Hospita l 24/ 7Comprehensive EmONC Services The DHQ hospital Mianwali was assessed for provision 24/7 comprehensive EmONC package. The facility was providing manual removal, removal s, assisted, cesarean section, blood transfusion, normal and comprehensive family planning. Some the was also present.however due to the absence all the three injectables and for newborn care, the DHQ was not completely functional and was unable to qualify for provision 24/7 comprehensive EmONC. (See Table 2.86) TABLE 2.86: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYDHQHS DISTRICT MIANWALI DHQHs removal Inj Magnesium Sulphate C-Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensive EmONC Normal Comprehensi ve FP (including surgical sterilization) some all Total assessed DHQ Hospital Mianwali District Multan Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services. 101

109 Fifteen (15) BHUs were assessed for provision 8/6 preventive MNCH. The data revealed that 93% (14 ) the assessed BHUs were completely functional. All required and the antenatal care, normal, TT vaccination, family planning, growth monitoring, nutrition counselling, immunization and laboratory were available at all the BHUs. However, BHU Durabpur was the only facility which was reported to be deficient in ing and all the preventive MNCH, except, routine EPI (immunization). (See Table 2.87) TABLE 2.87: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT MULTAN BHUs Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Bangalwala BHU Basti Alamgir BHU Budhla Sant BHU Chak 10-T BHU Durana Lugana BHU Khadal BHU Khairabad BHU Khokharan BHU Tatepur BHU Bait Kaitch BHU Durabpur 1 BHU Kannu BHU Gardaizpur BHU Jajalpur Khakhi

110 BHU Rsoolpur Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Five (5) RHCs were assessed for provision basic EmONC package and for additional complimentary. The data indicates that none the RHCs were completely functional due to lack one or more the service components the basic EmONC package. Presence some and provision for manual removal, newborn resuscitation, normal and family planning were reported in all 5 RHCs.The common deficiency injection magnesium sulphate was observed in 80% the RHCs, except, RHC Ayazabad Marhal. RHC Makhdoon Rashid was the least functional facility, due to the shortage injection magnesium sulphate and lack for removal s and assisted. It was noticed that if the supply injection magnesium sulphate is provided to RHCs Shershah, Kotli Nijabat and Matotili, all the 3 RHCs will be upgraded to completely functional facilities for basic EmONC. (See Table 2.88) TABLE 2.88: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICTMULTAN RHCs removal Newborn resuscitatio n Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3- FP methods) some (WMO/LHV) all Total Assessed RHC Mardanpur RHC Qadirpur rawan RHC Makhdoon Rashid RHC Shershah RHC Ayazabad marhal 103

111 RHC Kotli Nijabat RHC Matotili Total Tehsil Headquarter ( THQ) Hospita l 24/ 7Comprehensive EmONC Services Two (2) THQ hospitals were assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.89) revealed that only some the and injections ampicillin and oxytocin were available at both the THQ hospitals. The for manual removal, removal s, assisted, blood transfusion, normal and family planning were also, being routinely performed. However, due to the shortage injection magnesium sulphate and lack for cesarean section in both the THQs, the facilities failed to fer the complete set 24/7 comprehensive EmONC. TABLE 2.89: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY DHQHS DISTRICT MULTAN THQH removal Inj Magnesium Sulphate C- Section Blood In district Multan, Transfusion Newborn care (Resuscit ation and Incubator ) Providing all comprehensiv e EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed THQ Jalal Pur Pir Wala THQ Shuja Abad Total No DHQ Hospital was present in District Multan. 104

112 District Muzafargarh Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services. Twelve (12) BHUs were assessed for provision 8/6 preventive MNCH. The data revealed that 92% (11) the assessed BHUswere fully functional as they were providing all components the preventive MNCH package and all the was also present. BHU Gagari was the only facility which lacked the full compliment and could not fer any the preventive MNCH and thus was completely nonfunctional. (See Table 2.90) 105

113 TABLE 2.90: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT MUZAFARGARH BHU Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Bait Dayai BHU Gagari BHU Khizerabad BHU Jhuggiwala BHU Bait Mir Hazar BHU Ghazi Ghat BHU Mahmoodkot BHU Patal Kot Adu BHU Chak 632-TDA BHU Makwal Kalan BHU Darin BHU Garay Wain BHU Osman Koria BHU Thatta Qureshi Total

114 Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Thirteen (13) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary The data shows that 31% (4) RHCs had all, adequate supply injectables and were fering all the service components for 24/7 basic EmONC package. Therefore, only 4 RHCs Rohillan Wali, Jatoi, Qasba Gujrat and Seet Purwere declared as fully functional. Only some and an adeduate supply injection ampicillin was available in all 13 RHCs. Likewise, for manual removal, newborn resuscitation, assisted, normal and family planning were also provided throughout all the RHCs. Injection Magnesium Sulphate was deficient in 69% (9 out 13) facilities and the supply drug was reported in 4 RHCs Jatoi, Qasba Gujrat, Rohillan Wali and Seet Pur. Deficiency injections oxytocin and magnesium sulphate was generally reported and if the drugs are supplied, 5 RHCs Basira, Khairpur Sadat, Shah Jamal, Shaher Sultan and Sinawan will be able to provide 100% the basic EmONC package. (See Table 2.91) TABLE 2.91: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICTMUZAFARGARH RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3- FP methods) some (WMO/LHV) all Total Assessed RHC Basira RHC Chowk Sarwar Shaheed RHC D D Pannah RHC Jatoi RHC Khair Pur Sadat RHC Khan Garh

115 RHC Qasba Gujrat RHC Rang Pur RHC Rohillan Wali RHC Seet Pur RHC Shah Jamal RHC Shaher Sultan RHC Sinawan Total Tehsil Headquarter ( THQ) Hospita l 24/ 7Comprehensive EmONC Services Two (2) THQ hospitals were assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.92) indicated that THQ Ali Pur was the only facility which was fully functional and it was able to provide all the components 24/7 comprehensive EmONC service package even though only some the was present to provide these. At THQ hospital Kot Addu shortage injection oxytocin and lack for cesarean section and newborn care prevented the facility from providing 24/7 comprehensive EmONC. Therefore, none the THQs could be designated as fully functional comprehensive EmONC facilities. TABLE 2.92: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYTHQHS DISTRICT MUZAFARGARH THQH removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscit ation and Incubator ) Providing all comprehensiv e EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed THQ Ali Pur

116 THQ Kot Addu Total District Headquarter (DHQ) Hospita l 24/ 7Comprehensive EmONC Services The DHQ Hospital Muzaffargarh was assessed for provision 24/7 comprehensive EmONC package. The survey data indicates that the facility was fully equipped with all the ing and injectables. The for manual removal, removal s, assisted, cesarean section, blood transfusion, newborn care, normal and comprehensive family planning were also fered. Therefore, the DHQ was fully functional for provision 24/7 comprehensive EmONC package. (See Table 2.93) TABLE 2.93: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYDHQHS DISTRICT MUZAFARGARH DHQHs removal Inj Magnesium Sulphate C-Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensive EmONC Normal Comprehensi ve FP (including surgical sterilization) some all Total assessed DHQ Hospital Muzafargarh District Nankana Sahib Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services. Telve (12) BHUs were assessed for provision 8/6 preventive MNCH. The data indicates that 83% (10) BHUs are fully functional and are providing all components the preventive MNCH package. Non-availability and lack growth monitoring were 109

117 reported at BHU Budha.BHU Mithranpur was unable to provide the immunization (EPI) only. Therefore, if the facility is equipped with routine EPI, it will become fully functional and will fer complete package preventive MNCH. (See Table 2.94) TABLE 2.94: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT NANKANA SAHIB BHU Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Budha BHU Chandar Nagar BHU Dodhay BHU Malka Haji BHU Mehrpur BHU Mithranpur BHU Youngsonabad BHU Adil Garh BHU Amerkot BHU Bhorroo Chak BHU Mandiala Chak BHU Qila Meer Zaman Total

118 Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Nine (9) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. The data indicates that 11% (1) RHC, Sangilla Hill was completely functional facility as it was providing the complete set basic EmONC. It was reported that all the facilities had some the and were also able to fer newborn resuscitation, normal and family planning. However, due to the deficiency in one or more components the basic EmONC service package, 89% (8 out 9) the RHCs were not fully functional.shortage injection magnesium sulphate was commonly observed in 8 RHCs. It was the only deficiency due to which RHCs Rehan Wala, Shah Kot and Warbriton were unable to fer the complete set. Therefore, if the drug was made available at these 3 RHCs, they will be fully functional for basic EmONC package.non-availability the full compliment the, shortage injection magnesium sulphate and lack for assisted were reported at RHCs Bucheki, Khangah Dogran, More Khunda and Safdar Abad. (See Table 2.95) TABLE 2.95: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS DISTRICTNANKANA SAHIB RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3- FP methods) some (WMO/LHV) all Total Assessed RHC Bucheki RHC Khangah Dogran RHC More Khunda RHC Rehan Wala RHC Safdar

119 Abad RHC Sangila Hill RHC Shah Kot RHC Syed Wala RHC Warbriton Total District Headquarter (DHQ) Hospita l 24/ 7Comprehensive EmONC Services The DHQ hospital Nankana Sahib was assessed for provision 24/7 comprehensive EmONC package. The facility was providing manual removal, removal s, assisted, blood transfusion, normal and comprehensive family planning. Either a WMO or an LHV was present and injections ampicillin and oxytocin were also available. However, the shortage injection magnesium sulphate and absence for cesarean section and newborn care prevented the DHQ to be completely functional and qualify for provision 24/7 comprehensive EmONC. (See Table 2.96) 112

120 TABLE 2.96: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYDHQHS DISTRICT NANKANA SAHIB DHQHs removal Inj Amplicillin Inj Magnesium Sulphate C-Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensive EmONC Normal Comprehensi ve FP (including surgical sterilization) some all DHQ Hospital Nankana Sahib District Narowal Basic Health Units 8/ 6 Preventive MNCH Services. A total 12 BHUs were assesed for the provision 8/6 preventive MNCH. The data revealed that 7 out 12 BHUs had and were able to provide all the components the preventive MNCH. Therefore, 58.3% the assessed BHUs were completely functional. It was observed that the antenatal care, normal, TT vaccination, growth monitoring, nutrition counselling and immunization were uniformly present throughout all the BHUs. Non-availability and deficiency laboratory were commonly reported in 42% (5) BHUs. The 2 facilities Ali Pur Syeddan and Babral were also lacking family planning, in addition to the above-mentioned facilities. (See Table 2.97) TABLE 2.97: DISTRIBUTION OF PREVENTIVE MNCH SERVICES COMPONENTS PROVIDED BY FACILITIES DISTRICT NAROWAL Total assessed BHU Antenata l care Normal deliver y TT vaccinatio n FP service s (at least 3 FP method) Growth monitorin g Nutrition counselin g Immunizatio n (EPI) Laborator y (WMO/LHV ) Facilities providing all preventiv e MNCH Total assessed 113

121 BHU Alipur Sayyedan BHU Bathanwala BHU Khan Khasa BHU Manak BHU Pejowali BHU Babral BHU Gumtala BHU Ikhlaspur BHU Rajba Kalan BHU Toola BHU Mandiali BHU Romal Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Seven (7) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. The data indicates that only 1 RHC Bado Malhi was completely functional according to the standards 24/7 basic EmONC. The shortage Injection Magnesium Sulphate was the commonest deficiency observed in 86% (6) RHCs. While, absence a full compliment was reported in RHCs Kot Nainan and Laiser Kalan. Likewise, the non-availability for manual removal, assisted and removal s was reported in RHC Laiser Kalan, only. (See Table 2.98) 114

122 TABLE 2.98: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDEDBY RHCS -DISTRICTNAROWAL RHCs removal Newborn resuscitation Inj Magnesium Sulfate Providing all Basic EmONC Normal FP (At least 3-FP methods) some (WMO/LHV) all Total Assessed RHC Bado Malhi RHC Kot Nainan RHC Laiser Kalan RHC Qila Ahmed Abad RHC Sankhatra RHC Shah Gareeb RHC Zafar Wal Total Tehsil Headquarter ( THQ) Hospita l 24/ 7Comprehensive EmONC Services One (1) THQ hospitalshakar Garh was assessed for provision 24/7 comprehensive EmONC package. The data (Table 2.99) revealed that only some was available at the THQ and for manual removal, removal s, assisted, cesarean section, blood transfusion, normal and family planning were being routinely performed. Likewise, supply injection oxytocin was also reported. However, due to the shortage injections ampicillin and magnesium sulphate and lack for newborn care, the facility failed to fer the complete set 24/7 comprehensive EmONC. 115

123 TABLE 2.99: DISTRIBUTION OF THQ PROVIDING COMPREHENSIVE EMONC SERVICES COMPONENTS DISTRICT NAROWAL THQ removal Inj Magnesium Sulfate C- Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensive EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed THQ Shakar Garh Total District Headquarter ( DHQ) Hospita l 24/ 7Comprehensive EmONC Services The DHQ hospital Narwhal was assessed for provision 24/7 comprehensive EmONC package. The survey data indicates that the shortage injection magnesium sulphate and lack for cesarean section and newborn care were reported in DHQ due to which the facility failed to provide the full components comprehensive EmONC. However, some the, supply injections ampicillin and oxytocin were present. The manual removal, removal s, assisted, blood transfusion, normal and comprehensive family planning were also available at the DHQ. (See Table 2.100) TABLE 2.100: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY DHQ HOSPITALS DISTRICT NAROWAL DHQHs removal Assiste d InjAmplicillin Inj Magnesium Sulfate C-Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensiv e EmONC Normal Comprehensiv e FP (including surgical sterlization) Availabilit y some Availabilit y all Total assessed DHQ Narowal City

124 District Okara Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services. A total 19 BHUs were assessed for provision 8/6 preventive MNCH. The data indicates that 89% (17) BHUs were completely functional and were providing all components 8/6 preventive MNCH package. BHUs Qadirabad and Kud Bohar were the two facilities where non-availability was reported. Likewise, antenatal care, normal, family planning, nutrition counselling and laboratory were also not fered by both the facilities. In addition to above, BHU Kud Bohar was also not able to provide immunization (EPI). (See Table 2.101) TABLE 2.101: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT OKARA BHU Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Bahawal Das BHU Bahlolpur BHU Bhoman Shah BHU Bhutta Mohabbat BHU Hokmatgarh BHU Mazharabad BHU Mehlu Sheikhuka BHU Phullan Toli BHU Qadirabad

125 BHU Shah Muhammad BHU Chak 4-4L BHU Chak 7-1L BHU Chak 12-GD BHU Chak 13-1R BHU Chak 23-4L BHU Chak 26-2L BHU Chak 34-1AL BHU Kud Bohar 1 1 BHU Lasharian Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Ten (10) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. The data revealed that availability some and the for manual removal, newborn resuscitation, normal and family planning were fered throughout all the RHCs. Similarly, supply injection oxytocin was available in 9 RHCs, except, RHC Mandi Ahmad Abad. However, none the RHCs were able to provide the complete set basic EmONC service package due to the deficiency in one or more the service compnents.the most common deficiency reported was injection magnesium sulphate and it was only available at 1 RHC Baseer Pur. It was observed that provision injection magnesium sulphate at RHCs Renala Khurd and Shehbor will enable the two RHCs to fer the complete package the basic EmONC. (See Table 2.102) 118

126 TABLE 2.102: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS DISTRICTOKARA RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3- FP methods) some (WMO/LHV) all Total Assessed RHC Akhtar Abad RHC Banbala RHC Baseer Pur RHC Battak RHC Gogera RHC Hujra Shah Muqeem RHC Mandi Ahmed Abad RHC Renala Khurd RHC Shehbor RHC Wasaway Wala Total Tehsil Headquarter ( THQ) Hospita l 24/ 7Comprehensive EmONC Services 119

127 Two (2) THQ hospitals were assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.103) indicates that both the THQs had availability some and were fering the for manual removal, removal s, assisted, blood transfusion, normal and comprehensive family planning. However, non-availability a full compliment the was observed in both the THQs. Furthermore, a lack newborn resuscitation and shortage injections ampicillin and oxytocin were reported at THQ Depalpur whereas, THQ Haveli Lakha was deficient in injection magnesium sulphate and failed to fer cesarean section. Therefore, none the THQS were able to provide all the and therefore could not be designated as fully functional comprehensive EmONC facilities. TABLE 2.103: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYTHQHS DISTRICT OKARA THQH removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscit ation and Incubator ) Providing all comprehensiv e EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed THQ Depalpur THQ Haveli Lakha Total District Headquarter (DHQ) Hospita l 24/ 7Comprehensive EmONC Services The DHQ hospital Okara was assessed for provision 24/7 comprehensive EmONC package. The facility was providing manual removal, removal s, assisted, cesarean section, blood transfusion, normal and comprehensive family planning. all the and injection ampicillin was also reported at the DHQ. However, due to the shortage injections oxytocin and magnesium sulphate and lack newborn care, the DHQ was unable to provide complete set 24/7 comprehensive EmONC. (See Table 2.104) TABLE 2.104: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYDHQHS DISTRICT OKARA 120

128 DHQHs DHQ Hospital Okara removal Inj Magnesium Sulphate C-Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensive EmONC Normal Comprehensi ve FP (including surgical sterilization) some all Total assessed District Pakpattan Basic Health Units 8/ 6 Preventive MNCH Services. A total 10 BHUs were assessed for the provision 8/6 preventive MNCH. The data revealed that 90% (9) the assessed BHUs were fully functional and were providing all components the preventive MNCH package. Similarly, all the assessed facilities had either a WMO or an LHV available to provide the MNCH. BHU Chak 72 was the only facility which was deficient in immunization, due to which it was not able to provide all components preventive MNCH service. Hence, provision routine EPI service will enable the BHU Chak 72 to qualify to be completely functional. (See Table 2.105) 121

129 TABLE 2.105: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT PAKPATTAN BHU Antenatal care Normal TT vaccination FP (at least 3 FP methods) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Chak 11-SP BHU Chak 72-D BHU Chak 84-D BHU Pacca Sidhar BHU Shah Khagga BHU Chak 67-EB BHU Chak 83-EB BHU Chak 129-EB BHU Chak 351-EB BHU Kot Hera Singh Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Four (4) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. RHCs Chak 163-EB Muhammad Nagar and Qaboola were providing almost all the basic EmONC and complete availability was also reported during the survey. However, the only deficiency injection magnesium sulphate prevented the 2 RHCs to be completely functional. Therefore, none the RHCs were fully functional and were unable to provide 24/7 basic EmONC. Absence injection magnesium sulphate was observed throughout all 122

130 the RHCs. In addition to this, RHCs Bunga Hayat was also deficient in injection ampicillin. RHC Malka Hans was lacking the removal s and assisted and only some the were available to provide. (See Table 2.106) TABLE 2.106: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICT PAKPATTAN RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3-FP methods) some (WMO/LHV) all Total Assessed RHC Chak 163-EB Muhammad Nagar RHC Bunga Hayat RHC Malka Hans RHC Qaboola Total Tehsil Headquarter (THQ) Hospital 24/ 7Comprehensive EmONC Services The THQ hospital Arif Wala was assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.107) revealed that some and injection oxytocin were available at the THQ and the for manual removal, blood transfusion, newborn care and normal were also being routinely performed. However, due to the shortage injections ampicillin and magnesium sulphate along with the lack for removal s, assisted, cesarean section and family planning, the facility failed to fer the complete set 24/7 comprehensive EmONC. 123

131 TABLE 2.107: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY THQHS DISTRICT PAKPATTAN THQH removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensive EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed THQ Arif Wala Total District Headquarter (DHQ) Hospital 24/ 7Comprehensive EmONC Services The DHQ hospital Pakpattan was assessed for provision 24/7 comprehensive EmONC package. The facility was fully equipped with injectables such as ampicillin and oxytocin. All esssential were present to provide for manual removal, removal s, assisted, cesarean section, blood transfusion, newborn care, normal and comprehensive family planning.the only deficiency reported was that injection magnesium sulphate due to which the DHQ was not able to qualify as fully functional for 24/7 comprehensive EmONC. (See Table 2.108) TABLE 2.108: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY DHQHS DISTRICT PAKPATTAN DHQHs removal Inj Magnesium Sulphate C-Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensiv e EmONC Normal Comprehensiv e FP (including surgical sterilization) Availabilit y some Availabilit y all Total assessed DHQ Hospital Pakpattan City

132 District Rahim Yar Khan Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services. A total 21 BHUs were assessed for the provision 8/6 preventive MNCH. The data revealed that 90% (19 out 21) the assesed BHUs are fully functional and are providing all components the preventive MNCH package. BHUs Chak 150-A and Jhoke Gulab Shah lacked one or more components preventive MNCH. In BHU Jhoke Gulab Shah only TT Vaccination and Immunization were available while in BHU Chak 150-A, the only shortage observed was TT vaccination and immunization. Therefore, BHU Chak 150-A could be easily upgraded to completely functional facility if the immunization and TT vaccination are made available at the BHU. (See Table 2.109) TABLE 2.109: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT RAHIM YAR KHAN BHUs Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counselling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Bangla Bhatta Sheikhan BHU Chak 7-P BHU Langhiwar BHU Malikpur (Jajja Abbassian) BHU Chak 150-A BHU Chak 79-A BHU Jhoke Gulab Shah 1 1 BHU Goth Mahi

133 BHU Saidpur BHU Zafarabad BHU Basti Raees Ghulam Rasul BHU Chak 55-NP BHU Chak 92-P BHU Ehsanpur BHU Fatehpur Punjabian BHU Hajipur BHU Basti Muhammad Sadiq BHU Chak 148-P BHU Chak 186-P BHU Chok Sawetra BHU Machka Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Nineteen (19) RHCs were assessed for provision basic EmONC package and for additional complimentary. The data indicated that only RHC Ahmed Pur Lamma was providing all the and had all the available and was able to provide the complete set basic EmONC package. All the facilities had some present and were able to fer the newborn resuscitation, normal and family planning. However, all RHCs were deficient in one or more the service components. The most common deficiency was injections ampicillin and oxytocin as these were not availble in 68% RHCs. (See Table 2.110) 126

134 TABLE 2.110: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICT RAHIM YAR KHAN RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3-FP methods) some (WMO/LHV) all Total Assessed RHC Sanjar Pur RHC Ahmed Pur Lamma RHC Allah Abad RHC Bagho Bahar RHC Chak 173-P RHC Feroza RHC Jamal Din Wali RHC Khan Bela RHC Kot Samaba RHC Manthar RHC Mianwali Qureshian RHC Nawan Kot RHC Nawaz Abad RHC Pacca Larran RHC Rajan Pur Kalan RHC Sehja RHC Taranda Sawaey Khan RHC Taranda M Pannah RHC Zahir Pir

135 Total Tehsil Headquarter (THQ) Hospital 24/ 7Comprehensive EmONC Services Three (3) THQ hospitals which were assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.111) indicates that supply injections ampicillin and magnesium sulphate were available at all three RHCs and only some was available at these facilities to provide such as manual removal, removal s, assisted, normal and comprehensive family planning. However, a lack injection oxytocin was the common factor reported in THQs Khan Pur and Sadiq Abad.It can be presumed that if availability was ensured and cesarean section and blood transfusion were made available at THQ Liaquat Pur, the facility will be able to fer the comprehensive package 24/7 EmONC. TABLE 2.111: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY THQHS DISTRICT RAHIM YAR KHAN THQ removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensive EmONC Normal Comprehensiv FP (including surgical sterilization) some all Total assessed THQ Khan Pur THQ Liaqat Pur THQ Sadiq Abad Total There is no DHQ present in District Rahim Yar Khan. 128

136 District Rajan Pur Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services. Six (6) BHUs were assessed for the provision 8/6 preventive MNCH.The data revealed that 67% (4) the assessed BHUs were fully functional and were providing all components the preventive MNCH package. Similarly, all the assessed facilities had either a WMO or an LHV available to provide the MNCH. BHU Uzman was the least functional as it was only able to fer TT vacccination, immunization (EPI) and laboratory. Non-availability was also observed at the BHU. (See Table 2.112) TABLE 2.112: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT RAJAN PUR BHU Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Drigri BHU Kotla Dewan BHU Daragal BHU Fatehpur BHU Noorpur BHU Uzman Total

137 Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Six (6) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. The data indicates that RHCs Bangla Icha and Muhammad Pur were completely functional as they were providing the complete set 24/7 basic EmONC and all the essetial were also available at these facilities. The service assisted was missing at only RHC Harrand. A deficiency all the three injectables; ampicillin, oxytocin and magnesium sulphate was reported in RHC Mithan Kot. (See Table 2.113) TABLE 2.113: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICT RAJAN PUR RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3-FP methods) some (WMO/LHV) all Total Assessed RHC Bangla Icha RHC Dajal RHC Fazil Pur RHC Harrand RHC Muhammad Pur RHC Mithan Kot Total

138 Tehsil Headquarter (THQ) Hospital 24/ 7Comprehensive EmONC Services Two (2) THQ hospitals were assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.114) indicates that all the was present and manual removal, removal s, assisted, cesarean section, blood transfusion, normal and comprehensive family planning were available. However, a lack newborn care was reported in both the facilities due to which none the THQs were able to qualify for provision comprehensive EmONC service package.shortage injections oxytocin and magnesium sulphate and lack for newborn care were observed at THQ Jampur. While THQ Rojhan was unable to provide newborn care, in addition to the non-availability a full compliment. TABLE 2.114: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY THQHS DISTRICT RAJAN PUR THQH removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensive EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed THQ Jam Pur THQ Rojhan Total

139 District Headquarter (DHQ) Hospital 24/ 7Comprehensive EmONC Services The DHQ hospital Rajan Pur was assessed for provision 24/7 comprehensive EmONC package. The survey data indicates that all components CEmONC service package, as well as comprehensive family planning and normal were being performed at the facility.therefore, DHQ was considered completely functional for comprehensive EmONC. However, only some the was reported to be present at the facility. (See Table 2.115) TABLE 2.115: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY DHQHS DISTRICT RAJAN PUR DHQHs removal Inj Magnesium Sulphate C-Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensi ve EmONC Normal Comprehe nsive FP (including surgical sterilizatio n) Availab ility some essenti al Availabil ity all essentia l Total assessed DHQ Hospital Rajan Pur city District Rawalpindi Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services. A total 20 BHUs were assessed for the provision 8/6 preventive MNCH. The data indicates that all the assessed facilities were completely functional and were providing all components the preventive MNCH package. All all the assessed facilities had either a WMO or an LHV available due to which the were completely provided in these BHUs. (See Table 2.116) 132

140 TABLE 1: DISTRIBUTION OF PREVENTIVE MNCH SERVICES COMPONENTS PROVIDED BY DISTRICTS FACILITIES DISTRICT RAWALPINDI BHU Antenata l care Normal deliver y TT vaccinatio n FP service s (at least 3 FP method) Growth monitorin g Nutrition counselin g Immunizatio n (EPI) Laborator y (WMO/LHV ) Facilities providing all preventiv e MNCH Total assessed BHU Bewal BHU Gulyana BHU Jand Mehlu BHU kauntrila BHU Kisranb BHU Thathi BHU Nala Musalmana BHU Bishondot BHU Narar BHU Sir Suba Shah BHU Kot Siayah BHU Ban BHU Kali Mitti BHU Mengal BHU Chak Beli Khan BHU Chappar BHU Dhoke Parh BHU Harianwala

141 BHU Sagri BHU Usman Khatar Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Ten (10) RHCs were assessed for provision basic EmONC package and for additional complimentary. The data revealed that a complete set were available only at RHCs Chauntra and Kallar Syedan. Therefore, 20% (2) the RHCs were designated as completely functional for provision basic EmONC package. Shortage injection magnesium sulphate was the common deficiency reported in 6 facilities and was the only factor which prevented the RHCs from being completely functional. The only deficiency observed at RHC Mandra was the non-availability injection ampicillin and if the drug is supplied, the RHC will be able to fer the comprehensive set basic EmONC. RHC Qazian was unable to provide the for removal, manual removal and assisted. Non-availability a complete set required was also reported at the RHC. (See Table 2.117) TABLE 2.117: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICTRAWALPINDI RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3- FP methods) some (WMO/LHV) all Total Assessed RHC Bagga Sheikhan RHC Chauntra RHC Daultala RHC Kallar Syedan RHC Khayaban-e-Sir Syed

142 RHC Kotli Sattian RHC Lehtrar RHC Mandra RHC Phagwari RHC Qazian Total Tehsil Headquarter (THQ) Hospital 24/ 7Comprehensive EmONC Services Four (4) THQ hospitals were assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.118) indicates that components manual removal, removal s, assisted were being fered throughout all the THQs. Injections ampicillin and oxytocin were also available alongwith the complimentary normal and comprehensive family planning. However, some the saff were available at all the THQ hospitals.therefore, due to lack cesarean section, and nonavailability all none the THQs could fer the complete package 24/7 comprehensive EmONC. Non-availability newborn care was also observed in 3 THQs except THQ Taxila. Similarly, shortage injection magnesium sulphate was reported in THQ hospitals Muree and Taxila. Provision for cesarean section and supply injection magnesium sulphate in THQ Gujjar Khan and Kahuta will enable the facilities to fer the complete EmONC package. TABLE 2.118: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BYTHQ HOSPITALS DISTRICT RAWALPINDI THQ removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensive EmONC Normal Comprehensive FP (including surgical sterlization) some all Total assessed THQ Murree THQ Gujar Khan

143 THQ Kahuta THQ Texila Total There is no DHQ in district Rawalpindi. District Sahiwal Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services A total 15 BHUs were assessed for the provision 24/7 preventive MNCH. The data indicates that all assessed BHUs were abe to provide the antenatal care, normal, TT vaccination, family planning, growth monitoring, nutrition counselling, immunization and laboratory. Similarly, either a WMO or an LHV was also available at 14 BHUs. Thus 93% facilities were fully functional and were providing all the components preventive MNCH.BHU Chak L was the only facility in which TT vaccination and immunization were not available and therefore BHU did not qualify to be fully functional. It was observed that if the BHU Chak L is equipped with vaccination, the facility will be able to fer the complete package preventive MNCH. (See Table 2.119) TABLE 2.119: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT SAHIWAL BHU Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Chak 28-14L BHU Chak 33-12L

144 BHU Chak 83-12L BHU Chak L BHU Chak 107-7R BHU Chak 166-9L BHU Chak 182-9L BHU Chak 1-10L BHU Chak 65-A-GD BHU Chak 62-4R BHU Chak 61-4R BHU Chak 71-5L BHU Chak 53-5L BHU Mir Dad Mufti BHU Tibbi Jay Singh Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Ten (10) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary service. The data indicates that all RHCs had availability some and the for newborn resuscitation and the complimentary normal and family planning were being fered. The supply injection oxytocin was also available in all the facilities. 09 RHCs also had the supply injection oxytocin and were providing the for manual removal and removal s. The deficiency injection magnesium sulphate was reported throughout all the facilities and prevented the RHCs to be completely functional for comprehensive EmONC service package. all and provision assisted was reported in only 20% (2 out 10) RHCs. The least functional facility was RHC Ghazi Abad, which was unable to provide the four for manual removal, removal s, assisted and shortage injection Magnesium Sulphate. (See Table 2.120) TABLE 2.120: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICT SAHIWAL 137

145 RHCs removal Newborn resuscitatio n Inj Amplicillin Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3-FP methods) some (WMO/LHV) all Total Assessed RHC Chak L RHC Chak L RHC Chak 4-14-L Kassowal RHC Chak 55-5-L RHC Chak 8-11-L RHC Chak L RHC Chak L Kameer RHC Ghazi Abad RHC Harrapa RHC Noor Shah Total Tehsil Headquarter (THQ) Hospital 24/ 7Comprehensive EmONC Services Two (2) THQ hospitals were assessed for provision 24/7 comprehensive EmONC package. Analysis the data (See table 2.121) shows that only some the was available at both the THQ hospitals and manual removal, removal s, assisted, blood transfusion, normal and comprehensive family planning were being fered at these facilities. Similary, adequate supply injections ampicillin and oxytocin were also available.the deficiency injection magnesium sulphate, lack cesarean section and non-availability all was observed at both facilities, and highlighted a lack skilled care as well as supplies.thus both the THQs Chichawatni and Hajji Abdul Qayyum were unable to provide comprehensive EmONC package. TABLE 2.121: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY THQHS DISTRICT SAHIWAL 138

146 THQH removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensive EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed THQ Chichawatni THQ Haji Abdul Qayyum Total District Headquarter (DHQ) Hospital 24/ 7Comprehensive EmONC Services The DHQ hospital Sahiwal was assessed for provision 24 /7 comprehensive EmONC package. The survey data indicates that manual removal, removal s, assisted, cesarean section, blood transfusion, newborn care, normal and comprehensive family planning were available at the hospital. Likewise, some the and supply injection ampicillin was also present. However, the shortage injections oxytocin and magnesium sulphate was the only limiting factor due to which the DHQ failed to provide 24 / 7 comprehensive EmONC package. (See Table 2.122) It was observed that if the two injections oxytocin and magnesium sulphate are supplied, the DHQ hospital Sahiwal could be made fully functional. TABLE 2.122: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY DHQHS DISTRICT SAHIWAL DHQHs removal Inj Magnesium Sulphate C-Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensive EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed DHQ Hospital Sahiwal

147 District Sargodha Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services. A total 24 BHUs were assessed for provision 8/6 preventive MNCH. The data indicates that 79% (19 out 24) the assessed BHUs were completely functional. All and the antenatal care, normal, TT vaccination, family plannning, growth monitoring, nutrition counselling, immunization and laboratory were also available at all the BHUs. BHU Korakot was the only facility which was reported to be deficient in and all the preventive MNCH, except, routine EPI (immunization). only some the and a lack laboratory were commonly observed in 17% (4 out 24) BHUs - Bucha Kalan, Ghullapur, Korakot and Chak 30- SB. Lack immunization was the only deficiency reported at BHU Mubara Khan, and if the service is made available, the BHU will be fully functional. (See Table 2.123) TABLE 2.123: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT SARGODHA BHU Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Alipur Sayyedan BHU Chak 2-NB BHU Chak 10-NB BHU Bucha Kalan BHU Chak 15-SB BHU Ghullapur BHU Korakot 1 BHU Dhara

148 BHU Machar Khadi BHU Asianwala BHU Chak 30-SB BHU Chak 58-Nb BHU Chak 92-NB BHU Chak 109-SB BHU Chak 101-SB BHU Chak 110-SB BHU Chak 88-SB BHU Chak 104-SB BHU Kandan BHU Khawajaabad BHU Chak 50-SB BHU Chak 126-SB BHU Chak 142-NB BHU Mubara Khan Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Fourteen (14) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. The data indicates that only RHC Phularwan was providing the complete set basic EmONC. Therefore, only 7% the assessed RHCs, qualified for provision 24/7 basic EmONC package. only some and the for newborn resuscitation, assisted, normal and family planning were also available in all the RHCs.The only weakness observed at RHC Sillan Wali was the shortage injection magnesium sulphate, and if the drug is supplied at the RHC, it will be able to fer the complete set basic EmONC. Non-supply the drug; injection magnesium sulphate was the common deficiency reported in 93% (13 out 14) RHCs. It was observed that for 141

149 removal s and assisted were absent at RHCs Bhabra, Jhawarian, Lilliani, Miani and Midh Ranjha. Similarly, the availability only some the required was also reported in these RHCs.The least functional facility was that RHC Mid Ranjha because it was able to provide the for newborn resuscitation, assisted, normal and family planning only. (See Table 2.124) TABLE 2.124: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICT SARGODHA RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3-FP methods) some (WMO/LHV) all Total Assessed RHC Bhabra RHC Bhagtanwala RHC Bhera RHC Chak 104-NB RHC Chak 46-SB RHC Farooqa RHC Jhawarian RHC Kot Moman RHC Lilliani RHC Miani RHC Midh Ranjha RHC Moazzam Abad RHC Phularwan RHC Sillan Wali Total

150 Tehsil Headquarter (THQ) Hospital 24/ 7Comprehensive EmONC Services Four (4) THQ hospitals were assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.125) shows that only some was available and for manual removal, removal s, assisted, newborn care, normal and comprehensive family planning were being provided at all the THQ hospitals. However, due to the shortage one or more injectables and a lack service components cesarean section and blood transfusion, the THQs were unable to fer the comprehensive EmONC package. A full compliment the was not available in THQ hospitals Shapur, Chak 90-SB and Sahiwal. Similarly, nonsupply injection magnesium sulphate and oxytocin were reported at THQ Bhalwal. TABLE 2.125: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY THQHS DISTRICT SARGODHA THQH removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensive EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed THQ Bhalwal THQ Chak 90-SB THQ Sahiwal THQ Shahpur Total District Headquarter (DHQ) Hospital 24/ 7Comprehensive EmONC Services The DHQ hospital Sargodha was assessed for provision 24/7 comprehensive EmONC package. The data revealed that the DHQ was fully equipped with all the ing as well as the required injectables. The for manual removal, removal s, 143

151 assisted, cesarean section, blood transfusion, newborn care, normal and comprehensive family planning were also fered. Therefore, the facility was fully functional for provision 24/7 comprehensive EmONC package. (See 2.126) TABLE 2.126: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY DHQHS DISTRICT SARGODHA DHQHs removal Inj Magnesium Sulphate C-Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensiv e EmONC Normal Comprehensiv e FP (including surgical sterilization) Availabilit y some Availabilit y all Total assessed DHQ Hospital Sargodha District Sheikhupura Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services. A total 13 BHUs were assessed for provision 8/6 preventive MNCH. The data indicates that 77% ( 10) facilities were providing all components the preventive MNCH package and were completely functional for preventive MNCH. BHUs Adhian and Kathiala Virkan were completely non-functional because all the service components, and needed to fer preventive MNCH, were lacking in these BHUs. Deficiency the EPI immunization was observedat BHU Kot Mahmood and if the EPI are made available, the BHU will qualify to be fully functional preventative MNCH facility. (See Table 2.127) TABLE 2.127: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT SHEIKHUPURA 144

152 BHU Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Adhian BHU Burj Attari BHU Sharqpur Khurd BHU Jandiala Kalsan BHU Kathiala Virkan BHU Kirto BHU Kot Mahmood BHU Ajniawala BHU Chappa BHU Ferozew Wattwan BHU Ghang BHU Gajiana Nau BHU Mirza Virkan Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Seven (7) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. The data indicates that only RHC Kala Shah Kaku was providing all the basic EmONC service components and all the was also present. Likewise, presence some the, supply injection ampicillin and the for manual removal, newborn resuscitation, normal 145

153 and family planning were also reported at all the RHCs. However, the common deficiency observed in 86% (6) RHCs, was the shortage injection magnesium sulphate. RHCs Manan Wala and Narang Mandi were unable to fer the for assisted, in addition to nonavailability a complete set and absence injection magnesium sulphate. (See Table 2.128) TABLE 2.128: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICT SHEIKHUPURA RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3-FP methods) some (WMO/LHV) all Total Assessed RHC Farooq Abad RHC Jandiala Sher Khan RHC Kala Shah Kaku RHC Kharian Wala RHC Manan Wala RHC Narang Mandi RHC Sharaq Pur Total Tehsil Headquarter (THQ) Hospital 24/ 7Comprehensive EmONC Services One THQ hospital Muridke was assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.129) shows that supply injections ampicillin and oxytocin, along with for manual removal, removal s, assisted, blood transfusion, normal and comprehensive family planning were available at the THQ. However, due to lack for 146

154 cesarean section, newborn care and shortage injection magnesium sulphate, the facility failed to provide all the components the comprehensive EmONC service package. TABLE 2.129: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY THQHS DISTRICT SHEIKHUPURA THQH removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensive EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed THQ Muridke City Total

155 District Headquarter (DHQ) Hospital 24/ 7Comprehensive EmONC Services The DHQ hospital Seikhupura was assessed for provision 24 /7 comprehensive EmONC package. The survey data indicates that manual removal, removal s, assisted, cesarean section, blood transfusion, newborn care, normal and comprehensive family planning were available. Likewise, some the and supply injection ampicillin and oxytocin were also present.however, shortage injection magnesium sulphate and non-availability all the were the limiting factors due to which the DHQ failed to provide 24/7 comprehensive EmONC package. It was observed that if injection magnesium sulphate is supplied, the DHQ Shiekupura can be made fully functional. (See Table 2.130) TABLE 2.130: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY DHQHS DISTRICT SHEIKHUPURA DHQHs removal Inj Magnesium Sulphate C-Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensiv e EmONC Normal Comprehensiv e FP (including surgical sterilization) Availabilit y some Availabilit y all Total assessed DHQ Hospital Sheikhupura District Sialkot Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services 148

156 A total 18 BHUs were assessed for provision 8/6 preventive MNCH. The data indicates that 100% the assessed BHUs were fully functional and were providing the complete preventive MNCH package. All the facilities were able to fer all the components antenatal care such as normal, TT vaccination, family planning, growth monitoring, nutrition counselling, immunization and laboratory. Similarly, either a WMO or an LHV was present at all the assessed facilities. (See Table 2.131) TABLE 2.131: DISTRIBUTION OF PREVENTIVE MNCH SERVICES COMPONENTS PROVIDED BY FACILITIES DISTRICT SIALKOT BHUs Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counselling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Dhulleki BHU Gojra BHU Kandan Sian BHU Wandalan Sinduan BHU Kotli Khokhran BHU Siranwali BHU Ban Bajwa BHU Beni Sulehrian BHU Chicherwali BHU Chobara BHU Mehdipur BHU Sorangian BHU Bhadal BHU Chauni Sulehrian BHU Chiti Sheikhan

157 BHU Kotli Amir Ali BHU Marala BHU Pathanwali Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs Eight (8) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. The analysis indicated that some the and supply injection oxytocin were available and all the RHCs were able to fer manual removal, removal s, newborn resuscitation, normal and family planning. However, due to the common shortage injection magnesium sulphate throughout all the facilities, none the RHCs were able to provide 24/7 basic EmONC package.the second common deficiency observed was lack injection ampicillin in 3 RHCs Chawinda, Jamke Cheema and Kotli Loharan. This may refer to supply and logistics issue the drugs at the RHCs. Lack for assisted were also reported at RHCs Phuklian and Kalaswala. (See Table 2.132) TABLE 2.132: DISTRIBUTION OF BASIC EMONC SERVICE COMPONENTS PROVIDED BYRHCS, DISTRICTSIALKOT RHCs removal Newborn resuscitation Inj Magnesium Sulfate Providing all Basic EmONC Normal FP (At least 3- FP methods) some (WMO/LHV) all Total Assessed RHC Begowala RHC Chawinda RHC Jamke Cheema RHC Phuklian RHC Kalaswala

158 RHC Kotli Loharan RHC Sambrial RHC Satrah Total Tehsil Headquarter (THQ) Hospital 24/ 7Comprehensive EmONC Services Two THQ hospitals Daska and Pasroor were assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.133) indicated that some the was available and manual removal, removal s, assisted, blood transfusion, normal and comprehensive family planning were being fered. However, the common shortage injection magnesium sulphate and a lack newborn care were the limiting factors due to which both the THQs failed to provide the comprehensive EmONC. It was observed that there was a deficiency all the three injectables in THQ hospital Daska, while, the for cesarean section were not provided at THQ Pasroor. TABLE 2.133: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY THQ HOSPITALS DISTRICT SIALKOT THQ removal Inj Magnesium Sulfate C- Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensive EmONC Normal Comprehensive FP (including surgical sterlization) some all Total assessed THQ Daska THQ Pasroor Total District Headquarter (DHQ) Hospital 151

159 24/ 7Comprehensive EmONC Services The two secondary level health care hospitals, GAIMH Sialkot and GSB Sialkotwere assessed for provision 24/7 comprehensive EmONC package. The facilities were providing manual removal, removal s, assisted, cesarean section, blood transfusion, newborn care, normal and comprehensive family planning. Some the were also available.however, due to the absence all the three injectables in GAIMH Sialkot and shortage injections oxytocin and magnesium sulphate at GSBH Sialkot, none the hospitals were completely functional and qualified for provision 24/7 comprehensive EmONC. (See Table 2.134) TABLE 2.134: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY DHQ HOSPITALS DISTRICT SIALKOT DHQs removal InjAmplicillin Inj Magnesium Sulfate C-Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensive EmONC Normal Comprehensive FP (including surgical sterlization) some all Total assessed G A I M H Sialkot G S B H Sialkot total District Toba Tek Singh Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services. A total 13 BHUs were assessed for provision 8/6 preventive MNCH. The data indicates that all assessed BHUs had either a WMO or an LHV to fer the MNCH. Likewise, antenatal care, normal, TT vaccination, family planning, growth monitoring, nutrition 152

160 counselling, immunization, and laboratory were uniformly fered by all the BHUs.Therefore, all the assessed BHUs were able to fer the complete set preventive MNCH package and were fully functional. (See Table 2.135) TABLE 2.135: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT T.T SINGH BHU Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Chak 92-JB BHU Chak 154-Gb BHU Chak 158-Gb BHU Chak 359-JB BHU Chak 438-JB BHU Chak 718-GB BHU Chak 759-GB BHU Moza Jusa BHU Chak 255-GB BHU Chak 258-GB BHU Chak 262-GB BHU Chak 264-GB BHU Chak 312-GB Total Rural Health Centers (RHCs) 153

161 24/7 Basic EmONC Services at RHCs Six (6) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. The data indicates that some the was available. Services for manual removal, removal s, newborn resuscitation, assisted, normal and family planning were being fered by all the 6 RHCs. However, none the RHCs in Toba Tek Singh were providing the complete set basic EmONC. The common deficiency observed was the shortage injection magnesium sulphate in 83% (5) RHCs. If the drug is supplied the RHCs Chak 394-JB Jaja and Nia Lahore will be able to fer the complete basic EmONC service package. In addition to injection magnesium sulphate, RHC Pir Mahal was deficient in supply injection oxytocin, while, shortage all the three injectables was reported in RHC Rajana. Non availability all at RHCs Chak 740-GB and Chak 316-GB was also observed. (See Table 2.136) TABLE 2.136: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICT T.T SINGH RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3-FP methods) some (WMO/LHV) all Total Assessed RHC Chak 394-JB Jaja RHC Chak 740-GB RHC Nia Lahore RHC Pir Mahal RHC Rajana RHC Chak 316-GB Total Tehsil Headquarter (THQ) Hospital 24/ 7Comprehensive EmONC Services 154

162 Two (2) THQ hospitals were assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.137) indicates that injection magnesium sulphate was not available at both the THQ hospitals, Govt. Eye Cum GH Gojra and Kamalia. In addition to this, injection ampicillin was deficient in THQ Govt. Eye Cum GH Gojra while THQ Kamalia lacked injection oxytocin, failed to fer cesareansection and also non-availability was oreported. The shortage the required injectables was the main factor due to which none the THQ hospitals in district Toba Tek Singh were able to provide the comprehensive EmONC package.however, for manual removal, removal s, assisted, blood transfusion, newborn care, normal and comprehensive family planning were also available at both the THQs. TABLE 2.137: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY THQHS DISTRICT T.T SINGH THQH removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensiv e EmONC Normal Comprehensiv e FP (including surgical sterilization) Availabilit y some Availabilit y all Total assessed THQ Govt Eye Cum G H Gojra THQ Kamalia Total District Headquarter (DHQ) Hospital 24/ 7Comprehensive EmONC Services The DHQ hospital Toba Tek Singh City was assessed for provision 24/7 comprehensive EmONC package. The facility was fully equipped with all the essetial ing and the injectables ampicillin and oxytocin. The for manual removal, removal s, assisted, cesarean section, blood transfusion, newborn care, normal and comprehensive family planning were being optimally provided.however, the only deficiency reported was injection magnesium sulphate due to which the DHQ was not able to qualify as fully functional 155

163 for 24/7 comprehensive EmONC. It was reported that provision injection magnesium sulphate will enable the DHQ Toba Tek Singh City to be completely functional for comprehensive EmONC package. (See Table 2.138) TABLE 2.138: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY DHQHS DISTRICT T.T SINGH DHQHs removal Inj Magnesium Sulphate C-Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensiv e EmONC Normal Comprehensiv e FP (including surgical sterilization) Availabilit y some Availabilit y all Total assessed DHQ Hospital T.T Singh City District Vehari Basic Health Units(BHUs) 8/ 6 Preventive MNCH Services A total 15 BHUs were assessed for provision 24/7 preventive MNCH.The data indicates that the antenatal care, normal, TT vaccination, family planning, growth monitoring, nutrition counselling, immunization, laboratory were being fered and the either a WMO or an LHV was also available at all the assessed BHUs. Thus, 93% facilities were fully functional in district Vehari and were providing all the components preventive MNCH. BHU Chak 22- WB was the only facility in which immunization were not available and therefore the facility did not qualify to be fully functional. It was observed that if the BHU Chak 22- WB is equipped with vaccination, the facility will be able to fer the complete package preventive MNCH. (See Table 2.139) TABLE 2.139: DISTRIBUTION OF PREVENTIVE MNCH SERVICES PROVIDED BY DISTRICTS FACILITIES DISTRICT VEHARI 156

164 BHU Antenatal care Normal TT vaccination FP (at least 3 FP method) Growth monitoring Nutrition counseling Immunization (EPI) Laboratory (WMO/LHV) Facilities providing all preventive MNCH Total assessed BHU Chak 148-EB BHU Chak 199-EB BHU Chak 231-EB BHU Chak 317-EB BHU Chak 409-EB BHU Kikri Kalan BHU Kikri Khurd BHU Lalipur BHU Mitroo BHU Chak 122-WB BHU Chak 168-EB BHU Chak 22-WB BHU Chak 41-WB BHU Chak 52-WB BHU Chak 569-WB Total Rural Health Centers (RHCs) 24/7 Basic EmONC Services at RHCs 157

165 Ten (10) RHCs were assessed for provision basic EmONC package and for additional complimentary. The data indicates that only one the RHCs; Chak 56-WB was fully functional and was providing the complete set basic EmONC. Only some the was available and for manual removal, newborn resuscitation, normal and family planning were also available at all the RHCs. A shortage injection magnesium sulphate was the common factor that was deficient in 90% (9 out 10) facilities while injection oxytocin was lacking in RHC Chak 87-WB and RHC Ludden only. Similarly, ashortage injection ampicillin was reported in RHC Chak 222-ED and RHC Sahuka while all the three injectables were not available at RHC Jallah Jeem.Only some the was present at RHCs Mouza Sharaf and Sahuka and the facilities were also unable to fer removal s and newborn care. (See Table 2.140) TABLE 2.140: DISTRIBUTION OF BASIC EMONC SERVICES PROVIDED BY RHCS - DISTRICT VEHARI RHCs removal Newborn resuscitation Inj Magnesium Sulphate Providing all Basic EmONC Normal FP (At least 3-FP methods) some (WMO/LHV) all Total Assessed RHC Chak 222-ED RHC Chak 56-WB RHC Chak 87-WB RHC Gaggo RHC Jallah Jeem RHC Ludden RHC Machiwal RHC Mouza Sharaf RHC Sahuka RHC Tibba Sultan Pur Total Tehsil Headquarter (THQ) Hospital 158

166 24/ 7Comprehensive EmONC Services Two (2) THQ hospitals Burewala and Mailsi were assessed for provision 24/7 comprehensive EmONC package. Analysis the data (Table 2.141) indicates that some the was available at the facilities and manual removal, removal s, assisted, blood transfusion, newborn care, normal and comprehensive family planning were being fered. However, the common shortage injection magnesium sulphate, and a lack cesarean section were the limiting factors due to which both the THQs failed to provide comprehensive EmONC service package. TABLE 2.141: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY THQHS DISTRICT VEHARI THQH removal Inj Magnesium Sulphate C- Section Blood Transfusion Newborn care (Resuscitation and Incubator) Providing all comprehensive EmONC Normal Comprehensive FP (including surgical sterilization) some all Total assessed THQ Burewala THQ Mailsi Total District Headquarter (DHQ) Hospital 24/ 7Comprehensive EmONC Services The DHQ hospital Vehari City was assessed for provision 24/7 comprehensive EmONC package. The facility was providing for the manual removal, removal s, assisted, cesarean section, blood transfusion, newborn care, normal and comprehensive family planning. Some the and injections ampicillin and oxytocin were also available.however, shortage injection magnesium sulphate was the only factor which prevented the DHQ to be completely functional and qualify for provision 24/7 comprehensive EmONC. It was observed that provision the drug will enable the DHQ to fer the complete comprehensive EmONC package. (See Table 2.142) TABLE 2.142: DISTRIBUTION OF COMPREHENSIVE EMONC SERVICES PROVIDED BY DHQHS DISTRICT VEHARI 159

167 DHQHs removal Inj Magnesium Sulphate C-Section Blood Transfusion Newborn care (Resuscitatio n and Incubator) Providing all comprehensiv e EmONC Normal Comprehensiv e FP (including surgical sterilization) Availabilit y some Availabilit y all Total assessed DHQ Hospital Vehari City

168 Provincial Report Punjab Section 3: Key Findings Improving the availability is a crucial first step to increase access to maternal and neonatal care. In many cases, only limited inputs are needed to expand existing health facilities and enable them to provide Emmons. These interventions may include: repairing or purchasing obstetric-surgical and sterilization equipment; training doctors and nurses in life-saving skills; and improving health management. Health service management improvements include adequate ing health facilities, a steady supply drugs and other supplies, maintenance the health infrastructure and equipment, renovating existing operating theatres or equipping new ones i.e. a system allowing 24-hour readiness. It also means promoting monitoring and evaluation, and constant improvement in the quality. In Punjab, a total 902 health facilities were assessed under the HFA: 34 DHQHs, 84 THQHs, 291 RHCs and 493 BHUs. Findings the HFA data revealed significant gaps in the required inputs for provision quality MNCH. This warrants an immediate need to bridge the gaps in order to improve the MNCH. Salient findings per facility-type are: Basic Health Units A total 493 BHUs were assessed for provision 8/6 preventive MNCH service package. The data indicates that 91% (447) BHU were completely functional and were providing all the components preventive MNCH service package whereas only 9.3% (46) facilit ies failed to provide the complete package MNCH service due to lack one or more the components. TT vaccination and immunization were provided by 97% and 96% the assessed facilities, respectively. Presence was recorded in 461 BHUs. However, laboratory were deficient in 94% (463 out 493) BHUs. One non-functional BHU was reported in each the districts; Jehlum, Hafizabad, MandiBahauddin, Khushab, Jhang, Sahiwal, Pakpattan, Multan, Khanewal, Vehari, Muzaffargarh, Layyah and Bahawalpur, mainly due to the lack immunization, laboratory, growth monitoring and non-availability. The common deficiency reported in 32 BHUs was the non-availability, while laboratory were not fered by 30 facilities. Rural Health Centres Two hundred and ninety-one (291) RHCs were assessed for provision 24/7 basic EmONC package and for additional complimentary. The data indicated that only 10% (29) RHCs were able to fer the complete set 24/7 basic EmONC and were designated as fully functional basic EmONC facilities.

169 Non-availability Inj. Magnesium Sulphate was reported in 13 districts. It was available at only 17.5% (51) RHCs. This may highlight the problems in supply and demand the drug at the district level. Almost all the RHCs had some the and were provided for family planning, normal deliveries and newborn care. However, all the were not available in 34.4% (100) RHCs and absence some the was reported in 20%, 33%, 40%, 40% and 45% RHCs districts Sahiwal, Kasur, Bahawalnagar, Okara and Faisalabad, respectively. District Chiniot was the best performing district in which 50% the assessed RHCs were able to provide all the 24/7 basic EmONC. District Hafizabad was the poor performing district because the for removal s and normal were not fered in any the RHCs. Likewise, shortage Injection Ampicillin and Injection Magnesium Sulphate was also reported throughout all the RHCs. Tehsil Headquarter Hospitals Eighty-four THQ Hospitals were assessed for provision 24/7 comprehensive EmONC package. The survey data revealed that 2.4% (2) the THQ hospitals (Lahore and Muzaffargarh) were able to provide 24/7 comprehensive EmONC service package. All the 36 districts in Punjab had some the and were able to fer the for normal deliveries, while, presence all the was only observed in 6 THQs (Lahore, Hafizabad, Sargodha, TT Singh, and Jhang). The for manual removal, removal s, assisted and comprehensive family planning were available in all the THQs. The common deficiencies observed in the THQs were the shortage Injection. Magnesium Sulphate and lack for cesarean section, as these were available in only 20 and 29 THQs, respectively. The above-mentioned findings may refer to the issue supply and demand the drug at the tehsil level. The absence all in 6 THQs may be one the reasons due to which the facilities were not able to provide skilled required for conducting cesarean section. District Headquarter Hospitals Thirty-four DHQ hospitals were assessed for 24/7 comprehensive EmONC. The data indicates that only 17.6% (6) DHQs (Chakwal, Sargodha, Lahore, Rajanpur, Muzaffargarh) were able to provide the complete set 24/7 comprehensive EmONC. Some the and for comprehensive family planning, normal, manual removal and removal s were available throughout the province. However, availability all the was reported in only 44.1% i.e. (15) DHQs. Similarly, blood transfusion were available in 97% but the cesarean section was fered by only 70%, (24) DHQ hospitals. DHQ district Mianwali was reported to be the least functional due to the non-availability all the, deficiency all the three injectables and lack for the newborn care. The nonavailability Injection Magnesium Sulphate was the most common factor observed in around 80% the DHQs, while, Injection. Oxytocin was deficient in 30% the facilities. 162

170 Provincial Report Punjab