Prime Minister’s Health Initiative

In line with the Sustainable Development Goals (2&3)

The Prime Minister has initiated a program in 8 Districts of

Punjab in order to provide equitable access to quality
healthcare services to all, especially poorest of the poor
living in remotest areas. Thus ensuring healthy life for them by
focusing on preventive and curative service delivery
 REGIONAL COMPARISON

Child Mortalities
Afghanistan Pakistan India Bangladesh Nepal Sri Lanka

68 69
60
52

42
39 39
32 34 32
27 28 28
24
21

9 8 6

Under 5 Mortality Rate Infant Mortality Rate Neonatal Mortality Rate

2
 REGIONAL COMPARISON
Impact Indicators

Fertility Rates Maternal Mortality Ratio

Afghanistan Pakistan India Bangladesh Nepal Afghanistan Pakistan India
Sri Lanka Bangladesh Nepal Sri Lanka

396
4.6

3.6
258

2.3 178 174 176

2.1 2.1 2

30

Fertility Rate Maternal Mortality Ratio

Source: World Development Indicators, World Bank
Source: Pakistan Demographic & Health Survey 2018
 MAJOR GAPS

• Inadequate health sector allocations

• Poor health governance

• Lack of quality of services

• Ineffective use of available infrastructure

• under utilization of Primary Health Facilities

4
 DISTRICTS
Critical health indicators from MICS 2018

Critical Health Indicators Average

Attock 67.2% Skilled birth attendance rate

Mianwali 46.6 Neonatal mortality rate (Per 1000)

65.0 Infant mortality rate (Per 1000)

Chiniot
71.9% Full immunization rate
Jhang
Kasur
33.1% Contraceptive prevalence rate
D.G. Khan
8.2% Wasting rate
Lodhran
Selected Districts
36.4% Stunting rate
Rajanpur
Districts
Attock, Mianwali, Chiniot, Kasur,
Lodhran, Jhang, Rajanpur, DG Khan
Source: Multiple Indicators Survey Punjab, 2018, Bureau of Statistics
 LIST OF INTERVENTIONS

1 Improving Governance 5 Increase in LHWs

All viable BHUs to be

2 upgraded to 24/7 6 Strengthening of Management
Information Systems

Enhancing Scope of BHUs

3 (BHU 24/7 Plus Model)
7 Urban Health Centers

4 Revamping of RHCs 8 Strengthening of family

planning services
 PROPOSED INTERVENTIONS

296 Health Facilities will be targeted

Upgradation of 195 Revamping of 35

BHUs to 24/7 BHUs RHCs – Emergency Block

Upgradation of 42 Establishment 35
of
24/7 BHUs to PLUS Model neonatal nurseries at RHCs

Upgradation of 16 Construction of 8
Urban Health Centers warehouses
Attock (2), DGK (1), Jhang (3),
Mianwali (1), Rawalpindi (6), Installation of EMR at
Gujranwala (3)
300 Health Facilities
7
 PROPOSED INTERVENTIONS
Additional Human Resource to be recruited

2000 Staff

i. Child Specialist
ii. MO
iii. WMO
iv. Nurses
v. Dispenser
vi. LHV
vii. Ayas
viii. Security Guards
 PROPOSED INTERVENTIONS
Additional Equipment

Equipment
Including:
i. 227 Infant warmers
ii. 140 new beds
iii. 211 delivery tables
iv. 16 new X Ray machines
v. 600 new Android Tablets
vi. 35 new ECG Machines
vii. 35 new Nebulizers
viii. 35 Suction machines
 PROPOSED INTERVENTIONS
Estimated Costing for 20 Districts in 2 Phases

Costs are in PKR Billion

Number of One Time Cost Recurring Cost

Phase Duration Total Cost
Districts (Capital + Revenue) (HR + Supplies)

Dec 2018 –
8 1 1.5 2.5
June 2020
1st
July 2020 –
8 0 1.7 1.7
June 2021
 Updates

Activity Expected Completion

Hiring of human resources 30th April

Civil Works 30th June

Procurement of equipment 15th June

 Targets
Current

Target 2030

Neonatal Mortality Rate

(deaths per 1000 live births)
41 to be reduced to
12 Stunting Prevalence %
(children under 5 with
31 to be reduced to
0
low height for age)

Under 5 Mortality Rate

(deaths per 1000 live births)
69 to be reduced to
25 Wasting Prevalence %
(children under 5 with
8 to be reduced to 0
low weight for height)

Skilled Birth Attendance %

(delivery assisted by any skilled 76 to be increased to
>90 Full Immunization Rate
(children who received
76 to be
increased to 100
attendant) all vaccinations)

Contraceptive
Prevalence Rate %
30 to be increased to
>75
(any modern method of contraception used)

Source: Multiple Indicators Survey Punjab, 2018, Bureau of Statistics

Thank You!!
 HR HIRING STATUS
Advertisement Status
• Advertisement for Security Services for 195 24/7 BHUs – Financial Bid has been opened

• Advertisement for Aya Hiring – On Hold due to Hiring Ban

LHV Hiring Status

District
Total BHUs with Hiring Total BHUs with 1 LHV Total BHUs with 0
Number of BHUs
Complete (2 LHVs) Hired (Out of 2) LHVs Hired

Attock 40 16 7 17
D. G. Khan 23 16 2 5
Jhang 24 17 6 1
Kasur 43 43 - -
Mianwali 21 18 3 -
Rajanpur 4 4 - -
Lodhran 18 16 2 -
Chiniot 22 6 6 11
Total 195 136 26 33
 PROPOSED INTERVENTIONS
Major procurements are a part of the DFID supported expenditure

Total Expenditure Quantification &

Expenditure Name Tender Status Bidding Status
(in PKR Million) Specifications
40 Million AAT
issued,
Equipment for 195 24/7 BHUs 78.0 Completed Submitted remaining will be
issued by 18th
March

Equipment for 35 RHC Emergency Submitted and

Blocks
59.8 Completed will open by -
11th March 2019
Equipment for 35 Pediatric Under Process
Nurseries
138.0 Completed
At PMU
Submitted and
Equipment for Warehouses 40.0 Completed will open by -
11th March 2019
Additional Medicines for 195
BHUs
100.00 Completed Submitted AAT Issued

Under Process
Staff Buses for Districts 44.00 At Development Wing

EMR Equipment 10.00 Under Process

Total 469.8
 PROPOSED INTERVENTIONS
195 BHUs Infrastructure Revamping Update
Maintenance & Repair Work at BHUs
District Number of BHUs Administrative
Tender Date of Opening of Tender Initiation of Civil Work
Approval

• Work order for 24 to be

• 12th February (Accepted
for 24 out of 40 BHUs)
Attock 40 Complete Published • Retendering published
for 16 on 22nd Feb and •
will open on 8th March
issued by 7th March and
work will start by 10tH
March
16 BHUs are expected to
start by end March

Work order will be issued by

D. G. Khan 23 Complete Published 20th February 6th March and work will start
by 10th March
Work order will be issued by
Jhang 24 Complete Published 21st February 4th March and work will start
by 9th March
Work Order will be issued by
Kasur 43 Complete Published 13th February 4th March & will initiate by 7th
March
Work Order will be issued by
Mianwali 21 Complete Published 20th February 4th March and initiate by 7th
March
Work order will be issued by
Rajanpur 4 Complete Published 21st February 6th March and work will start
by 10th March
Work will initiate by 11 th
Lodhran 18 Complete Published 23rd February
March
Work will initiate by 21st
Chiniot 22 Complete Published 13th March
March
 PROPOSED INTERVENTIONS
28 RHCs Infrastructure Update

Construction of 28 Emergency Block at RHCs

District
Number of Administrative Tender Date of Opening Initiation of
RHCs Approval Submission of Tender Civil Work

Attock 3 Complete Complete 12th February Started

To start by 8th
D. G. Khan 4 Complete Complete 20th February March
Jhang 4 Complete Complete 26th January Started

Kasur 5 Complete Complete 13th February Started

Mianwali 5 Complete Complete 20th February Started

Rajanpur 3 Complete Complete 21st February Started

Lodhran 2 Complete Complete 12th February Started

Chiniot 2 Complete Complete 22nd February Started

 PROPOSED INTERVENTIONS
7 Additional RHCs Infrastructure Update – (RHCs were added in late February)

Construction of 7 Additional Emergency Block at RHC

District Number of
Administrative Tender Date of Opening of Initiation of
Additional
Approval Submission Tender Civil Work
RHCS

Attock 1 Complete Complete 19th March -

D. G. Khan 1 Complete Complete 20th March -

Jhang 1 Complete Complete 16th March -

Kasur 2 Complete Complete 15th March -

Mianwali 1 Submitted 31st March -

Rajanpur - Not Required

Lodhran 1 Submitted 31st March -

Chiniot - Not Required

 PROPOSED INTERVENTIONS
Bathrooms Construction Revamping Update
Construction of Bathrooms
Number of
District Date of Opening of
Bathrooms Admin Approval Tender Initiation of Civil Work
Tender
Attock 24 Complete Published 19th March Start of April
Work order will be
issued by 6th March,
D. G. Khan 13 Complete Published 20th February
work will start by 10th
March

Jhang 0 Bathrooms are being constructed by UNICEF

Work Order will be

Kasur 29 Complete Published 13th February issued by 4th March, will
initiate by 7th March

Work Order will be

Mianwali 13 Complete Published 20th February issued by 4th March, will
initiate by 7th March

Work order will be

issued by 6th March,
Rajanpur 4 Complete Published 21st February
work will start by 10th
March
Work will initiate by 11th
Lodhran 12 Complete Published 23rd February
March
Work will initiate by 21st
Chiniot 10 Complete Published 13th March
March

Total 105
PROPOSED INTERVENTIONS
Warehouse Construction Update

Construction of Warehouse

District
Administrative Approval Tender Status Tender Opening Initiation of Work

Attock Submitted Submitted 19th March 28th March

D. G. Khan Submitted Submitted 20th March 28th March

Jhang Submitted Pending - 1st Week April

Kasur Submitted Submitted 12th March 18th March

Mianwali Submitted Submitted 20th March 28th March

Rajanpur Submitted Submitted 28th March 5th April

Lodhran Submitted Submitted 20th March 28th March

Chiniot Submitted Submitted 20th March 28th March

 Service Packages at Primary Level
Normal BHU 24/7 BHU BHU Plus RHC RHC Plus

In addition to
• Basic OPD Normal BHU In addition to In addition to
24/7 BHU • General OPD,
regular RHC
minor
• Obstetric and • Nutrition services operations and
• Medical officer
family planning in morning dentist services
for evening in morning shift
services OPD
• Obstetric • Additional
• All services are services round • Indoor care and scope includes
• Evening family neonatal
offered 6 Hours the clock obstetric
planning services round nursery and
a day, 6 days a services the clock emergency
week • LHVs for evening
block
and night

6/6 for OPD

12/6 for OPD 6/6 for OPD
6/6 for OPD 24/7 indoor,
6/6 All services 24/7 for 24/7 indoor and
24/7 for Obstetrics obstetrics and
obstetrics obstetrics
paediatrics
 Estimated Annual Unit Cost
Costs are in Millions of PKR

Recurring Cost One Time Cost Cost for Y2

Category (Equipment + Total Cost for Y1
(HR + Supplies) (recurring)
Infrastructure)
BHU 24/7 2.8 1.2 4 3.1

BHU Plus 4.2   4.2 4.6

RHC Plus 17.5 15 32.5 19.2

UHC 4.4 1.6 6 4.7

Warehouse 3.9 25.5 29.3 4.2

 UPGRADATION PLAN
BHUs to be BHUs to be
Existing 24/7 Number of RHCs
District Total BHUs upgraded to upgraded to 24/7 Total RHCs
BHUs to be revamped
24/7* Plus

Attock 63 20 40 6 5 4
DG Khan 55 27 23 6 9 5
Jhang 58 32 24 6 10 5
Kasur 81 32 43 8 11 7
Mianwali 42 16 21 4 10 6

Rajanpur 33 22 4 3 7 3

Lodhran 48 28 18 5 4 3
Chiniot 36 11 22 4 3 2
Total 416 188 195 42 59 35
 
*33 BHUs with poor building condition, location or weak performance have been excluded from upgradation
 PROPOSED INTERVENTIONS
IMPROVING GOVERNANCE

Establishment of
Role of District Health
E- Governance district advisory
Authority
bodies
• Incentivized • Electronic Medical • Inclusive of citizens
packages (Fixed Record System at representatives
Salary + Pay for each health facility
Performance) • Role of citizen
• Improvement of feedback – reviews
• New Management existing E- and actions for
Structure Monitoring Systems improvement in
services
• Strengthen capacity
for appropriate data
usage
 PROPOSED INTERVENTIONS
2. Scaling up of all viable BHUs for 24/7 functionality for Basic Emergency
Obstetric & Neonatal Care (BEmONC) Child Pneumonia & Diarrhea

Revamping of
Provision of additional
Infrastructure & Hiring of staff
ambulances
Provision of Equipment

• Revamping of • Hiring of additional • On call 24/7 availability

infrastructure to staff to ensure that of ambulance system
provide amiable services are available
environment 24/7 • Transportation of
pregnant women from
• Provision of essential • Training of staff on house to facility and
equipment for Maternal patient safety from Primary facility to
& Newborn Health referral facility

• Transportation of
severely sick children
from Primary Facility to
Referral facility
 PROPOSED INTERVENTIONS
BHU Plus Model (Enhancing the Scope of Services at selected 24/7 BHUs)

Evening shift for all services Basic Diagnostics

• In addition to services available at • Ultrasonography

24/7 BHU, evening OPD &
emergency services • Rapid Diagnostic Tests

• Additional supplies
 PROPOSED INTERVENTIONS
4. Revamping RHCS

Construction of New Expansion in scope of Expansion in staff

Blocks services strength

• New emergency • Establishing level 1 • 1 Paediatrician

block/trauma center neonatal nursery
• 4 Medical Officers
• Establishing
paediatric wards • 6 Nurses
 PROPOSED INTERVENTIONS
Increase in Number of LHWS

Hiring of LHWs

• To be done through outsourced model

• Priority for urban slums and previously uncovered rural areas

 PROPOSED INTERVENTIONS
Strengthened MIS Systems for Service Delivery & Supply Chain Management

Electronic Medical Records

• EMR system to be developed – gradual replacement of

paper based data

• Linkage of data from BHU and RHC to THQ, DHQ and

teaching hospitals

• Linkages with Logistic Management for tracking of

supplies and to minimize stock-outs

• Linkage with Civil Registration of Vital Statistics (CRVS)

 PROPOSED INTERVENTIONS
Urban Health

New Intervention

• Urban Primary Healthcare System is almost non existent, despite

presence of facilities such as Civil Dispensaries & Filter Clinics

• Existing facilities to be converted into GP model services

• MCH Centers present in Urban areas to be operationalized as 24/7

• Urban Dispensaries to be converted to Filter clinics for District

Hospitals/Teaching Hospitals on the model of 24/7 BHU facilities

• Expansion of facilities in urban areas:

• Presence of doctors for Evening shift (OPD)
• Presence of SBA for ANC, PNC, Nutrition, FP Services
 PROPOSED INTERVENTIONS
Strengthening of Family Planning Services
 PROPOSED INTERVENTIONS
Estimated Costing for 20 Districts in 2 Phases

Costs are in PKR Billion

Number of One Time Cost Recurring Cost

Phase Duration Total Cost
Districts (Capital + Revenue) (HR + Supplies)

Dec 2018 –
1st 8 1 1.5 2.5
June 2020

-8 (Phase 1)
+12 (Phase July 2020 –
2nd 1.8 4.4 6.2
2 June 2021
new)

Total
Cost
2.8 5.9 8.7
 TIMELINE

• 120 BHU facilities will be functional 24/7 on

30th April, 2019

• Civil Work Portion will be completed by 30th

June, 2019
 Districts for Phase 2

The Following 12 Districts have been shortlisted

for Phase 2 of the PMHI

• North Punjab: Bhakkar, Khushab, Sargodha,

Hafizabad

• Central Punjab: T.T.Singh, Okara, Sahiwal,

Pakpattan

• South Punjab: Muzaffergarh, Rahimyar Khan,

Bahawalnagar, Bahawalpur
 RHCs Listed for PMHI
List of RHCs that were selected for infrastructural upgradation

District Name RHC

Attock RHC Rangoo District Name RHC
Attock RHC Chabb Lodhran RHC Gogran
Attock RHC Maghian Lodhran RHC 231/WB
Attock RHC Domel Lodhran RHC Chak 53/M
Chiniot Barana Mianwali Chakrala(Revamped)
Chiniot RHC Chak No.14 Mianwali Wan Bhacraan(Revamped)
D.G Khan Sarwar Wali Mianwali Kundian(Revamped)
D.G Khan Tibbi Qaisrani Mianwali Daud Khel Plus Model
D.G Khan Shadan Lund Mianwali Kamar Mushani Plus Model
D.G Khan Choti Zareen Mianwali RHC Musa Khel
D.G Khan RHC Vehova Rajanpur RHC Dajal
Jhang RHC Rodu Sultan Rajanpur RHC Muhammad Pur
Jhang RHC Kot Shakir Rajanpur RHC Kot Mithan
Jhang RHC Mochiwala
Jhang RHC Haveli Bahadar Shah
Jhang RHC Shahjewana
Kasur RHC Changa Manga
Kasur RHC Habibabad
Kasur RHC Phool Nagar
Kasur RHC Kangan Pur
Kasur RHC Ganda Singh Wala
Kasur RHC Khuddian
Kasur RHC Elah Bad
 RHCs Listed for PMHI
List of RHCs that were selected for infrastructural upgradation

District Name RHC

Attock RHC Rangoo District Name RHC
Attock RHC Chabb Lodhran RHC Gogran
Attock RHC Maghian Lodhran RHC 231/WB
Attock RHC Domel Lodhran RHC Chak 53/M
Chiniot Barana Mianwali Chakrala(Revamped)
Chiniot RHC Chak No.14 Mianwali Wan Bhacraan(Revamped)
D.G Khan Sarwar Wali Mianwali Kundian(Revamped)
D.G Khan Tibbi Qaisrani Mianwali Daud Khel Plus Model
D.G Khan Shadan Lund Mianwali Kamar Mushani Plus Model
D.G Khan Choti Zareen Mianwali RHC Musa Khel
D.G Khan RHC Vehova Rajanpur RHC Dajal
Jhang RHC Rodu Sultan Rajanpur RHC Muhammad Pur
Jhang RHC Kot Shakir Rajanpur RHC Kot Mithan
Jhang RHC Mochiwala
Jhang RHC Haveli Bahadar Shah
Jhang RHC Shahjewana
Kasur RHC Changa Manga
Kasur RHC Habibabad
Kasur RHC Phool Nagar
Kasur RHC Kangan Pur
Kasur RHC Ganda Singh Wala
Kasur RHC Khuddian
Kasur RHC Elah Bad
Targets to be achieved by July 2021

Skilled Birth Neonatal Mortality Infant Mortality Full Immunization Contraceptive

District Stunting Rate
Attendance Rate Rate Rate Rate Prevalence Rate

  Current Target Current Target Current Target Current Target Current Target Current Target

Rajanpur 40 60 33 25 54 43 61 74 20 24 47 40

DG Khan 44 65 30 22 53 42 55 66 21 25 46 40

Kasur 68 75 51 43 73 58 60 72 41 50 33 28

Lodhran 73 80 63 53 88 70 86 90 31 37 44 39

Jhang 73 81 52 44 82 65 75 82 25 30 35 30

Attock 78 85 29 25 40 32 75 83 26 31 23 20

Chiniot 80 86 65 55 85 68 78 86 26 31 36 31

Mianwali 83 87 49 42 66 53 85 90 24 30 27 24
 PROPOSED INTERVENTIONS
Estimated Costing for 20 and 36 Districts in 3 Phases
Costs are in PKR Billion
Number of One Time Cost Recurring Cost
Phase Duration Total Cost
Districts (Capital + Revenue) (HR + Supplies)
Dec 2018 –
1st 8 1 1.5 2.5
June 2020
-8 (Phase 1)
+12 (Phase July 2020 –
2nd 1.8 4.4 6.2
2 June 2021
new)
20 Phase 1&2 Julye 2021 –
3rd 2.5 9 11.5
+ 16 Phase 3 June 2022

Total
5.3 14.9 20.2
Cost