FY2022/23 BASIC KIT REVIEW PLANNING FORM

SELECT DIST HOIMA HCIIs Spend Tracking HCIIIs Spend Tracking

HCII CYCLE UGX 1,073,081 V E N V E N
HCIII CYCLE UGX 4,817,373 Spend in UGX UGX 0 UGX 0 UGX 0 Spend in UGX UGX 0 UGX 0 UGX 0
REGION HOIMA As a % of Budget 0.0% 0.0% 0.0% As a % of Budget 0.0% 0.0% 0.0%
ZONE ZONE 3 Budget Remaining UGX 1,073,081 Budget Remaining UGX 4,817,373
% Remaining 100.0% % Remaining 100.0%
HCIIs HCIIIs
CODE DESCRIPTION UNIT VEN PRICE LOC FY21/22 QTY FY22/23 QTY DISTRICT COST FY21/22 QTY FY22/23 QTY DISTRICT COST
ORAL MEDICINES
220928 ACETYLSALICYLIC ACID 75MG SR TABLET(CARDIOASPIRIN) 100 E 5,700 BLOCKED AT HCII - 0 -
220018 ALBENDAZOLE 400MG TABLET 500 V 57,300 YES AT HCII 0 - 1 -
220030 AMITRIPTYLINE 25MG TABLET 1000 V 19,600 BLOCKED AT HCII - 1 -
220034 AMOXICILLIN 250MG CAPSULE 1000 V 63,950 YES AT HCII 6 - 15 -
220070 AMOXICILLIN DISPERSABLE TABLETS 250MG 100 V 7,350 YES AT HCII 6 - 15 -
220060 BENDROFLUAZIDE 5MG TABLET 1000 E 34,750 BLOCKED AT HCII - 1 -
220065 BENZHEXOL 2MG TABLET 500 V 67,200 BLOCKED AT HCII - 0 -
220571 BISACODYL 5MG TABLETS 100 E 1,900 BLOCKED AT HCII - 1 -
151142 CALCIUM LACTATE 300MG TABLETS 1000 N 44,250 BLOCKED AT HCII - 1 -
220012 CHARCOAL ACTIVATED 250MG TABLET 100 E 7,900 YES AT HCII 0 - 1 -
220100 CARBAMAZEPINE 200MG TABLET 1000 V 80,700 BLOCKED AT HCII - 2 -
220145 CHLORPHENAMINE MALEATE 4MG TABLET 1000 E 6,850 YES AT HCII 4 - 5 -
220155 CHLORPROMAZINE 100MG TABLET 1000 N 52,200 BLOCKED AT HCII - 0 -
220162 CIPROFLOXACIN 500MG TABLET 100 V 12,100 YES AT HCII 5 - 8 -
220187 CLOXACILLIN 250MG CAPSULES 100 E 7,750 BLOCKED AT HCII - 1 -
205068 CO-PACKAGED ORS AND ZINC TABLETS 1 V 1,600 YES AT HCII 10 - 30 -
220435 DIAZEPAM 5 MG TABLET 1000 V 17,350 BLOCKED AT HCII - 0 -
351053 DISPENSING ENVELOPES PLASTIC 75X110MM 500 V 5,400 YES AT HCII 5 - 8 -
220222 DOXYCYCLINE 100MG CAPS 100 V 7,300 YES AT HCII 7 - 8 -
220235 ERYTHROMYCIN STEARATE 250MG TABLET 1000 V 110,450 BLOCKED AT HCII - 1 -
220255 FERROUS SULPHATE/FUMARATE 150-200 MG+FOLIC ACID 0.25 -0.4MG TAB 1000 V 12,900 YES AT HCII 2 - 5 -
220266 FOLIC ACID 5MG TABLET 1000 E 11,350 YES AT HCII 2 - 2 -
220289 GRISEOFULVIN 500MG TABLET 100 E 24,200 BLOCKED AT HCII - 3 -
220320 IBUPROFEN 200MG TABLET 1000 E 28,700 BLOCKED AT HCII - 2 -
220396 KETOCONAZOLE 200MG TABLET 100 N 10,200 BLOCKED AT HCII - 2 -
220385 MAGNESIUM TRISILICATE COMP 250+120MG TABLET 1000 E 12,600 YES AT HCII 1 - 1 -
220390 MEBENDAZOLE 100MG TAB 1000 E 20,000 YES AT HCII 1 - 2 -
220403 METFORMIN HCL 500MG TABLET 100 V 2,800 BLOCKED AT HCII - 2 -
220526 METHYLDOPA 250MG TABLETS 100 E 18,700 BLOCKED AT HCII - 0 -
220415 METRONIDAZOLE 200MG TABLET 1000 V 20,550 YES AT HCII 3 - 9 -
220417 MULTIVITAMIN TABLET 1000 N 12,450 YES AT HCII 0 - 1 -
220434 NIFEDIPINE RETARD 20MG TABLET 100 E 3,150 BLOCKED AT HCII - 10 -
220445 NITROFURANTOIN 100MG TABLET 1000 E 35,350 YES AT HCII 0 - 1 -
205101 NYSTATIN 100,000IU/ML ORAL SUSPENSION,30ML 1 N 2,300 YES AT HCII 4 - 5 -

DHO Name and Signature: Facility In-charge( Name Signature):

Date: page 1 of 4
Date: PRICES ARE SUBJECT TO CHANGE AS PER THE PREVAILING MARKET RATES
 HCIIs HCIIIs
220556 OMEPRAZOLE 20MG CAPSULES 100 V 3,850 BLOCKED AT HCII - 5 -
205097 PARACETAMOL 120MG/5ML SUSPENSION 1 N 1,050 YES AT HCII 0 - 0 -
220460 PARACETAMOL 500MG TABLETS 1000 E 20,550 YES AT HCII 8 - 16 -
220470 PHENOBARBITAL 30MG TABLET 1000 V 38,200 YES AT HCII 0 - 1 -
220480 PHENYTOIN SODIUM 100MG TABLET 1000 V 90,400 YES AT HCII 1 - 1 -
220494 PREDINISOLONE 5MG TABLET 1000 E 19,650 BLOCKED AT HCII - 1 -
220520 PROMETHAZINE HCL 25MG TABLET 1000 E 14,750 YES AT HCII 0 - 1 -
220541 PYRIMETHAMINE 25MG+SULFADOXINE 500MG TABLET 100 V 24,250 YES AT HCII 0 - 10 -
220551 QUININE SULPHATE 300MG TABLET 1000 E 163,050 BLOCKED AT HCII - 0 -
220570 SALBUTAMOL 4MG TABLET 1000 N 4,800 BLOCKED AT HCII - 1 -
221001 VITAMIN A (RETINOL) 200.000 I U CAPSULE 100 V 20,800 YES AT HCII 0 - 0 -
PARENTERALS
215025 AMPICILLIN 500MG POWDER FOR RECONSTITUTION IV/IM/INFUSION 100 V 37,800 BLOCKED AT HCII - 1 -
215015 AMINOPHYLLINE 250MG/10ML INJ. SLOW IV INF 10ML 1 N 850 BLOCKED AT HCII - 1 -
215437 CALCIUM GLUCONATE INJECTION, 10%, 10ML VIAL 1 V 6,950 BLOCKED AT HCII - 1 -
215051 CEFTRIAXONE SODIUM 1G POWDER FOR INJ.VIAL 1 V 1,600 BLOCKED AT HCII - 40 -
215080 CHLORPROMAZINE HCL 50MG/2ML INJ DEEP IM 100 E 54,000 BLOCKED AT HCII - 0 -
215055 CHLORAMPHENICOL SODIUM SUCCINATE 1G INJ 50 E 80,200 BLOCKED AT HCII - 0 -
215085 CLOXACILLIN 500MG INJ (PFR) IV/IM 50 E 33,000 BLOCKED AT HCII - 0 -
216081 DARROWS SOLUTION (HALF STRENGTH),500ML INFUSION VIAL 24 V 58,850 BLOCKED AT HCII - 0 -
215165 EPINEPHRINE (ADRENALINE) 1MG/ML INJ IV/IM/SC 100 V 51,600 BLOCKED AT HCII - 0 -
215205 GENTAMYCIN 80MG/2ML INJ IV/IM 100 V 21,750 BLOCKED AT HCII - 1 -
216025 GLUCOSE (DEXTROSE) 5% INFUSION 500ML 24 V 36,050 BLOCKED AT HCII - 0 -
216030 GLUCOSE 50% INJECTION 100ML 1 V 3,100 BLOCKED AT HCII - 1 -
215225 HYDROCORTISONE 100MG INJECTION 50 V 49,400 BLOCKED AT HCII - 1 -
211305 LIDOCAINE HCL 2% INJECTION 20-50ML VIAL 1 V 1,400 BLOCKED AT HCII - 2 -
215333 MAGNESIUM SULPHATE 50% 10ML INJ.10ML 1 V 5,000 BLOCKED AT HCII - 2 -
215380 OXYTOCIN 10IU/1ML INJECTION 100 V 58,350 BLOCKED AT HCII - 1 -
215035 PENICILLIN, BENZATHINE BENZYL 2.4MU/1.44G AMPOULE 10 E 11,300 BLOCKED AT HCII - 1 -
215440 PENICILLIN, PROCAINE 3MU+ BENZYL 1MU INF 10 N 10,850 BLOCKED AT HCII - 1 -
215045 PENICILLIN. BENZYL 1MU/600MG INJ (PFR) IM 10 V 3,500 BLOCKED AT HCII - 1 -
216040 SODIUM (RINGERS) LACTATE COMPOUND INFUSION 24 E 36,050 BLOCKED AT HCII - 1 -
216080 SODIUM CHLORIDE/NORMAL SALINE 0.9% INFUSION 500ML 24 V 36,050 BLOCKED AT HCII - 1 -
216510 WATER FOR INJECTION 10ML 100 V 11,400 BLOCKED AT HCII - 1 -
215890 VITAMIN K1(PHYTOMENADIONE) 10MG/ML INJ IML 1 E 700 BLOCKED AT HCII - 5 -
EYE/EAR/NOSE
202007 BETAMETHASONE 0.1% EYE/EAR/NASAL DROPS 5ML 1 N 1,250 BLOCKED AT HCII - 0 -
202021 CHLORAMPHENICOL 0.5% EYE DROPS 5ML 1 E 650 YES AT HCII 10 - 10 -
203009 CHLORAMPHENICOL 5% EAR DROPS 10ML 1 E 1,350 YES AT HCII 0 - 0 -
202033 GENTAMYCINE 0.30% EYE/EAR DROP 5ML 1 E 650 YES AT HCII 0 - 10 -
202064 TETRACYCLINE 1% EYE OINTMENT 3.5G TUBE 1 V 800 YES AT HCII 30 - 50 -
202020 CHLORAMPHENICOL 1% EYE OINTMENT 3G 1 E 1,800 YES AT HCII 0 - 0 -
PESSARIES
220175 CLOTRIMAZOLE 100MG PESSARY 6 V 1,450 YES AT HCII 10 - 20 -

DHO Name and Signature: Facility In-charge( Name Signature):

Date: page 2 of 4
Date: PRICES ARE SUBJECT TO CHANGE AS PER THE PREVAILING MARKET RATES
 HCIIs HCIIIs
220177 DIAZEPAM 2.5MG SUPPOSITORIES 5 V 18,850 YES AT HCII 0 - 1 -
220178 PARACETAMOL 125MG SUPPOSITORIES 5 E 4,900 YES AT HCII 1 - 2 -
220171 NYSTATIN VAGINAL PESSARIES 100,000UNITS 15 N 1,150 YES AT HCII - 0 -
TOPICAL PREPARATIONS
201117 SILVER SULFADIAZINE 1% CREAM 15GM 1 N 1,350 YES AT HCII 5 - 10 -
201034 CLOTRIMAZOLE 1% TOPICAL CREAM 20G 1 E 1,050 BLOCKED AT HCII - 30 -
201028 CALAMINE LOTION 15%,100ML BOTTLE 1 E 1,950 YES AT HCII 1 - 2 -
201018 BENZYL BENZOATE 25% APPLICATION 1 N 1,050 YES AT HCII 3 - 5 -
MEDICAL SUNDRIES
ADMINISTRATION SETS
308310 AD SYRINGES 10ML+ NEEDLE DISP. DETACHED 100 V 19,600 BLOCKED AT HCII - 1 -
308302 AD SYRINGES 2ML+ NEEDLE DISP. DETACHED 100 V 13,850 BLOCKED AT HCII - 2 -
308305 AD SYRINGES 5ML+ NEEDLE DISP. DETACHED 100 V 15,300 BLOCKED AT HCII - 2 -
302620 CANNULA I.V, WITH INJ. PORT & STOPPER 20G, 0.9MM 100 E 37,200 BLOCKED AT HCII - 0 -
302623 CANNULA I.V, WITH INJ. PORT & STOPPER 24G, 1.9MM 100 V 40,900 BLOCKED AT HCII - 1 -
302622 CANNULA I.V, WITH INJ. PORT & STOPPER 22G, 0.7MM 100 N 38,300 BLOCKED AT HCII - 0 -
302618 CANNULA IV , WITH INJ. PORT & STOPPER 18G, 1.2MM 100 V 36,700 BLOCKED AT HCII - 0 -
302146 SET INFUSION ADULT, 15-20 DROPS/ML, + NEEDLE 21G 1 V 450 BLOCKED AT HCII - 10 -
302151 SET INFUSION PAEDIATRIC, BURETTE 100ML-150ML 1 V 2,200 BLOCKED AT HCII - 0 -
155360 MALARIA RAPID TEST KITS 25 TESTS 25 V 0 YES AT HCII 40 - 50 -
BANDAGES
301090 BANDAGE COTTON W.O.W. HYDROPHILIC, 75MM X 4M 1 N 500 YES AT HCII 0 - 0 -
301175 PLASTER ADHESIVE ZINC OXIDE, 75MM X 5M 1 N 3,650 YES AT HCII 2 - 3 -
301195 COTTON WOOL B.P. 500G 1 V 8,050 YES AT HCII 1 - 5 -
301105 GAUZE W.O.W HYDROPHILIC 90CM X 50M 1 E 36,600 YES AT HCII 1 - 3 -
BLADES
303025 BLADES SCALPEL SIZE 22 100 V 16,950 YES AT HCII 0 - 1 -
GLOVES
302070 GLOVES EXAMINATION LATEX, MEDIUM NON-STERILE 100 V 32,600 YES AT HCII 6 - 15 -
302118 GLOVES HEAVY DUTY, HOUSEHOLD 8 MEDIUM 1 E 5,000 YES AT HCII 1 - 1 -
302095 GLOVES SURGEON 7 1/2 STERILE PAIRS 50 V 38,300 YES AT HCII 0 - 4 -
302069 GYNAECOLOGICAL GLOVES S-7 1/2,LATEX 1 PAIR 1 E 3,300 YES AT HCII 0 - 1 -
DISINFECTANTS
351497 ALCOHOL HANDSCRUB DISINFECTANT 1L 1 N 24,600 YES AT HCII 1 - 1 -
207008 CHLORHEXIDINE GLUCONATE 4%W/V 500ML WITH DISPENSER 1 V 8,950 YES AT HCII 0 - 1 -
207145 HYDROGEN PEROXIDE 6% SOLUTION 200ML BOTTLE 1 E 1,050 YES AT HCII 1 - 1 -
207011 LIQUID SOAP DETERGENT FOR HOSPITAL USE, 20LTR 1 V 40,400 YES AT HCII 1 - 2 -
207012 POVIDONE IODINE SCRUB 7.5% 500ML BOTTLE 1 N 25,150 BLOCKED AT HCII - 0 -
207017 SODIUM HYPOCHLORITE 6% SOLUTION 5 LTR 1 V 39,300 YES AT HCII 0 - 1 -
220959 CHLORHEXIDINE 7% GEL 1 V 3,000 YES AT HCII 0 - 20 -
PROTECTIVES
320011 APRON PLASTIFIED LINEN HEAVY DUTY 90 X 100 CM 1 E 3,950 YES AT HCII 0 - 0 -
320009 APRON PROTECTIVE DISPOSABLE 90 X 100CM (50 PIECES) 1 E 41,000 BLOCKED AT HCII - 0 -
370732 BIN LINERS (12L BLACK) 100 V 29,550 YES AT HCII 1 - 1 -

DHO Name and Signature: Facility In-charge( Name Signature):

Date: page 3 of 4
Date: PRICES ARE SUBJECT TO CHANGE AS PER THE PREVAILING MARKET RATES
 HCIIs HCIIIs
370733 BIN LINERS (12L BROWN) 100 V 27,500 YES AT HCII 0 - 0 -
370734 BIN LINERS (12L RED) 100 V 28,350 YES AT HCII 0 - 1 -
370735 BIN LINERS (12L YELLOW) 100 V 28,200 YES AT HCII 0 - 1 -
304098 SAFETY BOX FOR SYRINGES & NEEDLE DISPOSAL 25 V 0 YES AT HCII 0 - 1 -
320060 FACE MASKS, DISPOSABLE, 3-PLY OPERATION THEATRE 50 E 55,000 YES AT HCII 0 - 1 -
SUTURES
301009 NYLON MONOFILAMENT G2, SL 100CM,1/2 CIRCLE,RC,40MM 12 E 36,200 BLOCKED AT HCII - 0 -
301002 NYLON MONOFILAMENT G1, SL 100CM,1/2 CIRCLE,RC,40MM 12 E 36,550 BLOCKED AT HCII - 0 -
301003 NYLON MONOFILAMENT G2/0, SL 45CM,3/8 CIRCLE,RC, 26MM 12 V 37,000 BLOCKED AT HCII - 0 -
301007 PGA G2/0 SL 75CM,1/2 CIRCLE, TF, 30MM 12 V 74,550 BLOCKED AT HCII - 0 -
301005 PGA G1 SL 90 CM,1/2 CIRCLE, TH, 40MM 12 E 60,100 BLOCKED AT HCII - 1 -
301006 PGA G2 SL 90 CM,1/2 CIRCLE, TH, 40MM 12 N 61,900 BLOCKED AT HCII - 0 -
RECORDS
360018 OUTPATIENT REGISTER BOOK - 200PGS 1 V 16,350 YES AT HCII 0 - 0 -
360043 PRESCRIPTION AND DISPENSING LOG BOOK - 200PGS 1 V 10,400 YES AT HCII 0 - 0 -
370120 REQUISITION AND ISSUE VOUCHER HMIS FORM 017 1 V 16,900 YES AT HCII 1 - 1 -
370129 STOCK CARD HMIS PHAR 001 50 V 14,200 YES AT HCII 0 - 1 -
INSTRUMENTS
390391 AUTOCLAVE MARKING TAPES, ROLL, 50M, 18-19MM WIDE 1 V 14,000 BLOCKED AT HCII - 0 -
404002 DIGITAL BLOOD PRESSURE UNIT ADULT MACHINE 1 V 60,050 YES AT HCII - 0 -
ANTI-MALARIAL MEDICINES
220047 ARTEMETHER 20MG+LUMEFANTRINE 120MG (STRIP OF 6 TAB) 30 V 0 YES AT HCII 6 - 6 -
220042 ARTEMETHER 20MG+LUMEFANTRINE 120MG (STRIP OF 24 TAB) 30 V 0 YES AT HCII 12 - 30 -
220103 ARTESUNATE INJECTION 60MG VIAL 1 V 0 BLOCKED AT HCII - 50 -
220173 ARTESUNATE SUPPOSITORIES 100MG 2 V 0 YES AT HCII 1 - 1 -
REPRODUCTIVE HEALTH SUPPLIES
225046 ETHINYLESTRADIOL0.03+LEVONORGESTREL0 .15MG 3CYCLES 1 E 0 YES AT HCII 30 - 50 -
225121 ETONOGESTREL 68MG IMPLANT (IMPLANON) 1 V 0 BLOCKED AT HCII - 40 -
225052 IUD-COPPER CONTAINING DEVICE TCU380A 1 V 0 BLOCKED AT HCII - 0 -
225104 LEVONORGESTREL 1.5MG TABS 1 E 0 YES AT HCII 2 - 50 -
225054 LEVONORGESTREL 2X75 MG,IMPLANT(JADELLE) 10 V 0 YES AT HCII 0 - 2 -
225005 MALE CONDOMS 52-53MM, NO LOGO 144 V 0 YES AT HCII 40 - 80 -
225100 MANUAL VACUUM ASPIRATION(MVA)DOUBLE VALVE KIT 1 V 0 YES AT HCII 0.5 - 1 -
225059 MEDROXYPROGESTERONE ACETATE 150MG/ML W/SYRINGE 200 V 0 YES AT HCII 1 - 2 -
225048 MISOPROSTOL 200MCG TABS 100 V 0 YES AT HCII 0 - 1 -
250002 SAFE DELIVERY (MATERNITY) KIT 1 V 0 BLOCKED AT HCII - 200 -
225063 SAYANA PRESS 104MG/ML 200X0.65 200 V 0 YES AT HCII 1 - 1 -
NUTRITION MEDICINES
F-75 THERAPEUTIC MILK 400GM CAN
600004 1 E 0 YES AT HCII 0 - 0 -
600002 F-100 THERAPEUTIC MILK 400G CAN 1 E 0 YES AT HCII 0 - 0 -

DHO Name and Signature: Facility In-charge( Name Signature):

Date: page 4 of 4
Date: PRICES ARE SUBJECT TO CHANGE AS PER THE PREVAILING MARKET RATES