GOVERNMENT OF THE PUNJAB

PLANNING & DEVELOPMENT BOARD

SECTION HEALTH-II

MINUTES OF THE 12TH PDWP MEETING HELD ON 04-11-2020

Agenda Item No. 1-A Prevention and Control of Hepatitis in Punjab
Date & Time: 04-11-2020 at 10:00 AM
Venue: Auditorium of P&D Board
Participants: List Attached (Annex-A)
The Chief (Health-II), P&D Board briefed that the scheme was originally approved by
the PDWP on 19-8-2016 at a total cost of Rs.1.997 Billion (GoPb Share Rs. 0.619 Billion
&PSDP share Rs.1.378 Billion) from 2016 to 2018. Later on, scheme was 1 st revised by
PDWP on 27-10-2017 at a total cost of Rs. 5.69 Billion (GoPb Share Rs.4.449 Billion &
PSDP share Rs.1.244 Billion) from 2016 to 2019. Subsequently, gestation period of the
scheme was extended by Secretary P&SHD up to June, 2020 at already approved scope &
cost. Now P&SHD has submitted PC-1 for 2 nd revision at total cost of Rs. 5.393 Billion
(GoPb Share Rs. 5.146 Billion & PSDP share Rs. 0.247 Billion) for gestation period from 01-
07-2016 to 30.06.2022. Allocation for the scheme in ADP 2020-21 is Rs. 934.000 Million
whereas expenditure till June 2020 is Rs. 2.916 Billion (ADP: Rs. 2.678 Billion PSDP: Rs.
0.238 Billion).

She apprised that in instant PC-1, 23 Filter clinics established by PKLI will be
integrated under the umbrella of Hepatitis Control Program whereas overall Macro
Elimination Services will be expanded to 165 (145 of P&SHD and 20 Specialized & Special
initiative clinics) Clinics of SHC&MED, NGOs and Trust hospitals. Furthermore, curative and
preventive services will also be expanded from 140,000 patients to 335,880 patients and
from 7.435 million patients to 8.435 million patients respectively. Expansion of Services to
Jail Inmates, Madrassas, Universities and High Risk groups (Transgender) and data
Integration of Basic Hepatitis Clinics services already established by 20 Teaching Hospitals
of SHC& MED through EMR system is also proposed. She informed that two Pre-PDWPs
were held under the chairmanship of Member (HNP) wherein scheme was discussed in
detail. While discussing observations of the Pre-PDWPs, she stated that in response to
observations of Health section of P&D Board, P&SH department submitted that a meeting of
Steering Committee was held on 23-09-2020 in which it was decided that Hepatitis services
in Punjab were integrated and brought under one umbrella. P&SH Department was asked to
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provide status of PSDP saving amounting Rs. 1.002 billion, whether program has any
commitment from Federal Government or not. P&SH Department informed that after 2017
there is neither funding from Federal Government nor any commitment to provide PSDP
funds therefore same need to be met out of Provincial allocation / ADP. She informed that
cost of human resource of DHQs & THQs amounting Rs.187.392 million was deleted as
same would be met through non-development budget whereas PMU cost was also reduced
with bare minimum staff of 40 employees which includes 13 Lab Technologist for Hepatitis
Control Program Lab. Overall cost of project was reduced from Rs. 5.69 billion to Rs. 5.39
billion and placed before the forum for consideration.

Member SI asked that is there any overlapping of cost of PKLI established filter
clinics in DHQs and Hepatitis Control Program established hepatitis clinics in THQs. Chief
(Health-II) informed that PKLI human resource cost is already deleted from PC-1 as it is
already met through current side whereas instant PC-1 is just to the extent of medicines only
for PKLI established clinics. DG (Monitoring & Evaluation) asked that 30%-40% of
population avail public sector health services whereas rest relies on private sector. Is there
any intervention proposed to include rest of the 60%-70% of population. Chief (Health-II)
informed that there is provision in PC-1 for micro elimination plan to be established in
trust/private sector clinics.

Director PERI stated that prevalence rate of hepatitis has increased however
coverage has also enhanced. what is the department strategy to reduce prevalence rate. He
asked that this project is functional since 2016 but there is no third-party validation carried
out to know the impact of interventions. There should be clear exit strategy of the project.
Member PSD stated that as there is no commitment of PSDP funds from Federal
Government therefore it will be additional burden on ADP. He further stated that there
should be more focus on preventive side instead of curative side by department in order to
reduce increasing prevalence of disease. Deputy Secretary (Finance) stated that in annual
recurring cost there is Rs. 400 million allocated for PMU and clinical cost, furthermore, Rs.
20 million for contingent staff is allocated which need to be rationalized.

Program Manager (Hepatitis Control Program) informed that prevalence rate of HBV
was deceased as its vaccine is available and new born are vaccinated under vaccination
program which has also enhanced immunity against HBV whereas for HCV there is no
vaccine available and its major spreading factor is reuse of Syringe/needle and faulty blood
transfusion etc. as it is a blood born disease. Under instant PC-1 against the target of

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140,000 patient, program has treated more than 200,000 patients whereas WHO standards
demand treatment of 850,000 patient yearly in Punjab which required huge funds. P&SH
Department has its own Educate, Prevent, Test and Treat model thorough which prevention
is achieved by curative intervention to stop transmission of disease with the network of
established hepatitis clinics. Additional Secretary (Dev) added that a pilot study was
conducted in District Nankana under micro elimination plan and it costs around Rs. 7,000
per individual and if it is replicated to population of Punjab, it costs huge amount. That’s why
P&SH Department restricted to the revision of PC-1 with change in scope. He added that
this project has three components i.e. Curative, Preventive and PMU with rationalized cost.
Furthermore, this PC-1 is brought with reduced cost of Rs. 300 million for approval before
the forum.

Secretary P&D Board stated that although it seems downward cost revision but in
actual 700 million will be additional burden on ADP due to discontinuation of PSDP share.
He inquired that it has been 4 months till the expiry of the gestation period of the project,
who approved the gestation period if not then why it is submitted late. He also inquired that it
has been four years till the initiation of the project. Is there any midterm evaluation
conducted by department to determine the efficiency of interventions made under this
program. Additional Secretary (Dev) informed that PC-1 was submitted in August 2020
whereas it should have been submitted earlier. Program Manager (Hepatitis Control
Program) informed there is no midterm evaluation carried out yet as P&SH Department was
working on integration of Hepatitis program so that after integration a compact model would
be come out and then evaluation would be conducted.

Senior Chief (Coordination) inquired that PSDP share was part of the project cost
whereas Rs. 246 million is proposed in revised cost estimate whether it is approved from
CDWP or not as jointly funded PC-1 needs approval form CDWP forum. Chief (Health-II)
informed that initially it was a Federal PC-1. After devolution it was shifted to provinces and
PSDP share was discontinued after July 2017. PSDP fund of amount Rs. 246 million was
consumed therefore it is reflected as part of PC-1 cost. Additional Secretary (Dev) also
endorsed the point of view of Chief (Health-II) that at the time of transfer of instant PC-1,
Federal Government made commitment to provide its share which was discontinued later
on. P&SH Department raised this issue in CCI meetings regarding provision of outstanding
amount from Federal Government. Only that amount is reflected in revised PC-1 which has
been utilized. If this PC-1 was made by Punjab Government then it must be sent to CDWP

MINUTES OF THE 12TH PDWP MEETING HELD ON 04-11-2020 Page 3

for approval whereas in instant PC-1, department is demanding same fund from provincial
share. Therefore, it doesn’t require approval from CDWP. He also stated that Federal
Government is planning to bring a PC-1 for hepatitis control, department has requested to
provide funding in this program for additional scope. Chief Coord of the view that this PC-1
need approval from CDWP if PSDP funds to be reflected in project cost. Senior Chief
(Health-I) informed that this project was approved in June 2016 with Federal share which
was discontinued after June 2017. He added that it is available in writing that discontinuation
of Federal funding has been materialized since July 2017. He stated that in CCI meeting
2011 it was decided that funding will continue till 2015. Later in 2015, it was further decided
to continue funding till June 2017. Afterward it was discontinued by Federal Government.
Additional Secretary (Dev) also quoted a letter of Jan 2018 in which it was mentioned that
Provincial Government is informed that with effect of July 2017, Federal Government will not
provide funding to any vertical program.

Chair directed P&SH Department to conduct a midterm evaluation of the program.

After discussion, the competent authority approved the scheme.

Decisions: -
After detailed discussion following decisions were made:-

1. The 2nd revision of the scheme “Prevention and Control of Hepatitis in Punjab” is
approved at the cost of Rs. 5,392.838 million (Revenue) with gestation period from
01.07.2016 to 30-06-2022.
2. P&SH Department will conduct a Midterm evaluation of the program in order to
substantiate the achievements of the interventions made under this PC-1.

MINUTES OF THE 12TH PDWP MEETING HELD ON 04-11-2020 Page 4

 Annexure-A
LIST OF PARTICIPANTS 12th PDWP DATED 04-11-2020
(Health-II Sector, P&D Board)
PLANNING&DEVELOPMENT BOARD
NAME OF THE OFFICERS DESIGNATION
1. Mr. Hamed Yaqoob Shiekh Chairman P&D Board (In Chair)
2. Mr.Imran Sikandar Baloch Secretary, P&D Board
3. Dr. Muhammad Abid Bodla Member (ID/Water/Environment)
4. Mr. Mahmood Hasan Member (SI)
5. Mr. Nabeel Javed Chief Economist
6. Mr. M. Akhter Member (PSD)
7. Mr.M Khan Ranjha Member IT & Governance
8. Mr. Omer Masud Urban Unit
9. Dr. Javid Latif Sr. Chief (Coordination)
10. Dr. Azhar Ali Khan Rana DG M&E
11. Dr. Aman ullah Joint Chief Economist
12. Mr. Ikram ul Haq Chief (Consultancy Section)
13. Mr. Tariq Javed Chief (Technical)
14. Ms. Uzma Hafeez Chief (Health-II)
15. Mr. Muhammad Sohail Arshad Planning Officer, (Health-II)
16. Mr. Shahid Idress Assistant Chief (Coordination-II)
17. Mr. Hassan Ranjha Planning Officer, (Coordination-II)
Punjab Economic Research Institute
18 Dr. Shahid Mehmood Adil Director PERI
P&S Healthcare Department
19. Mr. Omer Farooq Alvi Additional Secretary (D&F),
20. Dr. Khalid Mahmood Project Manager Hepatitis Control
Program
21. Dr. Yadullah Deputy Project Manager Hepatitis Control
Program
22. Mr. Asif Rashed Planning Officer

MINUTES OF THE 12TH PDWP MEETING HELD ON 04-11-2020 Page 5