Annex-C

MINIMUM HEALTH SERVICES DELIVERY PACKAGE

FOR SECONDARY CARE HOSPITALS (MHSDP)

GOVERNMENT OF KHYBER PAKHTUNKHW A

H E A L TH DE P A R T M E N T

March, 2019
Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

Contents
Background......................................................................................................................... 23
1 Current status of health and Health Services Delivery in Khyber Pakhtunkhwa ........ 23
2 Categorisation of Secondary Care Hospitals in Khyber Pakhtunkhwa ...................... 25
3 Rationale for revision of Categorization and Development of MHSDP for Secondary
Health Care ..................................................................................................................... 27
SECONDARY HEALTHCARE DELIVERY PACKAGE ........................................................ 27
Clinical and Specialized Services: ....................................................................................... 27
Category A: ......................................................................................................................... 27
Category “B” ....................................................................................................................... 33
Category “C” ....................................................................................................................... 38
Category “D” ....................................................................................................................... 42
Preventive and primary health care services for all categories of secondary care hospitals 45
Physical Infrastructure guidelines for all secondary care hospitals ...................................... 46
4 Factors to be considered in locating a district hospital .............................................. 46
5 Size of the Site ......................................................................................................... 47
6 Topography .............................................................................................................. 47
7 Departmental Planning and Design .......................................................................... 47
8 Bed Strength and Specialities across Category A, B, C and D secondary care
hospitals .......................................................................................................................... 52
Financial Resources Required ............................................................................................ 53
Appendices; ........................................................................................................................ 54
1 Human Resource Requirements for Category A, B, C and D Hospitals .................... 54
2 Equipment requirements for Category A, B, C and D Secondary Care Hospitals ...... 57
3 List of Medicines prepared by (MCC), 2015-16, Govt. of Khyber Pakhtunkhwa ........ 67

List of Tables
Table 1: Health Facilities by types in Khyber Pakhtunkhwa ................................................. 25
Table 2: Speciality wise status across categories of SC- Hospitals in Khyber Pakhtunkhwa
(2002) ................................................................................................................................. 25
Table 3: District Wise Approved Categorization of Hospitals ............................................... 26
Table 4: MHSDP-SC FOR CATEGORY A HOSPITALS ...................................................... 28
Table 4: MHSDP-SC FOR CATEGORY A HOSPITALS ...................................................... 33
Table 5: Preventive Health Care Services at Secondary Level Hospitals ............................ 45
Table 6: Summary of the Criterion for Categorisation of Secondary Care Hospitals ............ 53
Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

Acronyms

BHUs Basic Health Units

BPHS Basic Package of Health Services
CMWs Community Midwifes
DHIS District Health Information System
DHQH District Headquarter Hospital
EPHS Essential Package of Health Services
HSD Health Service Delivery
IDPs Internally Displaced Persons
LHWs Lady Health Workers
MCHCs Maternal and Child Health Centres
MHSDP-SC Minimum Health Service Delivery Secondary Care
PSPU Policy and Strategic Planning Unit
RHCs Rural Health Centres
THQH Tehsil Headquarter Hospital
Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

Background
1 Current status of health and Health Services Delivery in Khyber
Pakhtunkhwa
Pakistan is the sixth most populous country in the world, with a population of around
207 million1. The population of Khyber Pakhtunkhwa has increased from 17.7million
in 1998 to 40.53 million (Settled districts and Merged districts) in 2017of which a vast
majority (81.2%) lives in rural areas2. Khyber Pakhtunkhwa has 35 districts (28 settled
and 7 merged districts), with a total area of 101,741 km2 and constitute 17% of the
total population of Pakistan. In addition, it is estimated that there are more than 1.8
million Afghan refugees living in the province. The average household size in Khyber
Pakhtunkhwa is 7.2 people, second highest in Pakistan after Baluchistan (7.90
people)3. High population growth rate, Afghan refugees, Internally Displaced Persons
(IDPs) and volatile security situation are some of the key challenges that the
government of Khyber Pakhtunkhwa is facing.
Despite the above mentioned challenges faced by the province, health indicators of
the province has shown significant improvement. Khyber Pakhtunkhwa has the lowest
infant and under 5 mortality (53 & 64 per 1000 live births, respectively) compared to
other provinces in Pakistan (Figure 11).

Childhood mortalities by province

(Deaths / 1000 live births)

66 Balochistan
53
Infant Khyber
60
mortality Pakhtunkhwa
National

73
Sindh
National 62
Punjab
Baluchstan

78 National / Pakistan
64
Under-5
77
mortality
85
National 74

Figure 1: Provincial comparison of Infant and Under 5 mortality rates (Source:

PDHS 2017-18)

1National Institute of Population Studies. Accessed from [Link]

2Bureau of Statistics, Khyber Pakhtunkhwa. Retrieved from [Link]
[Link]/prd_images/[Link]
3Household integrated economic survey (HIES), 2013-14. Retrieved from

[Link]
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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

Overall, the Infant Mortality and Under-5 Mortalitiy show a declining trend in the
country when compared across the four surveys (PDHS) conducted since 1990s to
date (Figure 02).

Trend of childhood mortalidites across PDHSs 1990/91 - 2017/18

Infant mortality Under-5 mortality

112
94
89
74

86 78 74
62

PDHS 1990-91 PDHS 2006-07 PDHS 2012-13 PDHS 2017-18

Figure 2: Trend of childhood mortalities across the PDHS in Pakistan (PDHS

1990/91 -2017/18).
With regards to access to health services, 80% of the women in Khyber Pakhtunkhwa
had an antenatal check up from a skilled provider. Other provinces fared well in this
regard, except Baluchistan where 56% of the women had their antenatal check-up
from a skilled health care provider. Somilarly around three fifth of the deliveries (62%)
in Khyber Pakhtunkhwa are being conducted at health facilities and 67% of births were
attended by skilled health care provider in Khyber Pakhtunkhwa.(Figure 3).

National / Pakistan Punjab Sindh Khyber Pakhtunkhwa Balochistan

92
86 86
80
72 75
69 69 71
66 67
National

62
Khyber Pakhtunkhwa

56
Khyber Pakhtukhwa
Khyber Pakhtunkhwa

National
Punjab

National

38
Punjab

35
Sindh

Punjab
Baluchistan

Baluchistan
Sindh

Baluchistan

Sindh

Ante Natal Care (ANC) (%) Birth occurred at health facility Birth attended by a skilled
(%) provider (%)

Figure 3: Percentage of women receiving antenatal care from a skilled

provider, place of birth and skilled birth attendance (Source: PDHS 2017-18)

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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

The public sector health service delivery in Khyber Pakhtunkhwa is through a three-
tiered system involving primary, secondary and tertiary health care. The primary health
care primarily focusses on the provision of preventive and promotive health care while
the secondary and tertiary health care primarily provides curative health services. The
health facilities operating in the province are provided in the Table 1.
Table 1: Health Facilities by types in Khyber Pakhtunkhwa

[Link] Type Number

1. Tertiary Hospitals/Medical 9
Teaching Institutes (MTIs)
2. Category A Hospitals 7
3. Category B Hospitals 13
4. Category C Hospitals 26
5. Category D Hospitals 63
6. Rural Health Centers 111
7. Basic Health Units 769
8. Civil Dispensaries 437
Source; DHIS Health Department Khyber Pakhtunkhwa Dec, 2018

2 Categorisation of Secondary Care Hospitals in Khyber Pakhtunkhwa

The secondary level of care were previously named as District Head Quarter (DHQ) and THQ
hospitals but the level of services to be provided by the hospitals varied from hospital to
hospital. To ensure the access and equity of services the department conducted the exercise
of standardization in year 2002 wherein all the hospitals were categorized into Category A, B
,C, [Link] on the population of the district and the number of beds of each type of hospital
so that a ratio of 1 bed to 2500 population is achieved. The notification defined the specialities
which are to be provided in each category as well as staffing for each category. It was also
agreed that the updradation of infrastructure as well as equipment will be done through ADP.
The process of updradation of infrastructure of hospital is being conducted since 2002 through
the ADP and number of the hospitals has been standardized. However, the services are not
optimally provided because of the nonavailability of sufficient staff. Secondly since the services
in each speciality were not clearly defined so the uniformity of services and needs could not
be ensured.

Table 2: Speciality wise status across categories of SC-Hospitals in Khyber Pakhtunkhwa (2002)

CATE
CATEGORY CATEGORY CATEGORY
GORY
B C D
A

SURGERY
MEDICINE
SPECIALTIES
GYNAE/OBS
PAEDIATRICS
EYE
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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

CATE
CATEGORY CATEGORY CATEGORY
GORY
B C D
A
ENT
ORTHOPAEDICS
ANESTHESIA
RADIOLOGY
PATHOLOGY
CARDIOLOGY
PSYCHIATRY
CHEST/TB
DIALYSIS UNIT
DERMATOLOGY
DENTISTRY UNIT
PAEDS SURGERY
NEUROSURGERY
SPECIALIZED SERVICES
Casualty
Labor Room
Dentistry Unit
Blood Bank
Operation Theator
ICU/CCU
Dialysis Unit
Nursery Paeds/ICU
Phsyiotherapy

The number of Category A, B, C and D hospitals across districts in the province of Khyber
Pakhtunkhwa are provided in the table below

Table 3: District Wise Approved Categorization of Hospitals

Category
[Link] District Category A Category A Category C Category D
B
MTIs Non MTIs
1 Abbottabad 1 0 1 0 3
2 Bannu 1 0 0 0 2
3 Battagram 0 0 0 1 1
4 Buner 0 0 0 0 1
5 Charsadda 0 1 1 2 1
6 Chitral 0 0 1 0 2
7 [Link] 1 0 0 0 4
8 Dir Lower 0 1 0 2 4
9 Dir Upper 0 0 1 0 3
10 Hangu 0 0 0 1 2
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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

11 Haripur 0 0 1 1 3
12 Karak 0 0 1 2 3
13 Kohat 0 1 0 1 2
14 Kohistan 0 0 0 0 0
Lakki
15 0 0 1 2 2
Marwat
16 Malakand 0 0 1 1 3
17 Mansehra 0 1 0 1 4
18 Mardan 1 1 0 1 4
19 Nowshera 1 0 2 0 5
20 Peshawar 4 0 1 5 5
21 Shangla 0 0 1 1 1
22 Swabi 0 1 1 2 2
23 Swat 0 1 0 2 5
24 Tank 0 0 0 1 1
25 Tor Ghar 0 0 0 0 0
9 7 13 26 63
Total

Source; DHIS Health Department Khyber Pakhtunkhwa , December 2018

3 Rationale for revision of Categorization and Development of MHSDP

for Secondary Health Care
The Government of Khyber Pakhtunkhwa developed secondary level MHSDP to promote
standardization and delivery of equitable health services, by defining the minimum package of
health services for secondary health care levels, which includes the categorized services i.e.
A, B, C and D. It can also serve as a management tool to guide resource allocation, which
responds to local priorities and needs.

As regards various other services which are part and parcel of MHSDP will be mainly
dependent on the human and other resources allocations, based on the standards already
defined. Thus, all of them have been combined rather than duplicating it again and again for
each of the services. It should also be noted that the MHSDP will be a living document and
should be improved after undertaking a formal assessment of the progress. In addition, the
optimal functioning of each of the categories of hospitals can be ensured by developing and
implementing a practically applicable referral system.

SECONDARY HEALTHCARE DELIVERY PACKAGE

Clinical and Specialized Services:
Category A:
Category-A hospital has 350 inpatient beds with 21 specialities and is intended to serve a
population of around one million [Link] has both in-patient and outpatient services, in
addition to emergency, diagnostic and other day care facilities. The clinical specialities that
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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

are recommended to be available at a category A hospital include Surgery, Medicine,

Gynae/Obs, Paediatrics, Eye, ENT, Orthopaedics, Cardiology, Psychiatry, Pulmonology,
Gastroentrology, Anethesia, Pathology, Radiology, Paediatric Surgery,Urology, Peads
Surgery, Dentistry, Neurosurgery, Dermatology, Trauma, Foriensic, Intensive Care Unit and a
Paeds Nursery/[Link] Hospital in addition to the above will also be providing additional
specialized serviceswhich includes Dialysis, Dentistry, Physiotherapy, ICU, CCU, blood bank,
delivery and pharmacy services etc. The table below provide the services that are to be
provided by the Category-A hospitals based on the available clinical specialities and support
services.

Table 4: MHSDP-SC FOR CATEGORY A HOSPITALS

S.N
o Services Department Remarks
Clinical Services
General Medical (Outpatients, In-patient,
1.
Emergency)
Infectious Diseases,Allergy and
Immunology,Endocrinology, Diabetes and Metabolism,
Medical Department
Hematology, Oncology, Rheumatology, , Diabetes
mellitus & other endocrine associated conditions,
2. GI disorders:
Amoebiasis, Gastroenteritis, Diarrhea(chronic),
Gastritis, Irritable bowel syndrome, Peptic ulcer Gastroenterology
disease, Helminthic infection, GI tract bleeding,Liver Department
cirrhosis & other liver conditions (abscess, cyst, etc.),
3. Respiratory Problems
Upper and Lower Respiratory Tract infections,
Pneumonia, Chronic Obstructive Pulmonary Disease
Pulmonology
(COPD), Tuberculosis, Asthma, Allergies, Chronic
Department
Bronchitis, Emphysema, Acute Bronchitis, Cystic
Fibrosis
4. Renal disorders
Acute glomerulonephritis, Acute renal failure,
Hypo/hyperkalemia, Nephrotic syndrome, Chronic renal Urology Department
failure,
General Paediatric (Outpatients, In-patient,
5.
Emergency)
Infectious diseases in children,Neonatal care, Neonatal
resuscitation; ENC. Full supportive care for Preterm
baby , management of complication of newborn,
Management of neonatal jaundice and infections, ,
Birth injuries, Incubation, Infants of diabetic mothers, Pediatrics
Asthma (chronic)Diarrhea (chronic), Failure to thrive Department
Growth retardation, Malnutrition, Congenital anomalies.

Well-baby clinic to be established in the Paediatric

OPD.
General Cardiology (Outpatients, In-patient,
6.
Emergency)
Congenital heart disease, Deep-vein thrombosis, Heart
failure, Hypertension, Pulmonary oedema, Rheumatic
heart disease, Myocardial infarction, Ischemic heart Cardiology
disease Department

7. General Dermatology(Outpatients, In-patient)

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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

Table 4: MHSDP-SC FOR CATEGORY A HOSPITALS

S.N
o Services Department Remarks
Common dermatological problems such as eczema,
rosacea, seborrheic dermatitis, contact dermatitis,
keratosis pilaris, psoriasis, vitiligo, impetigo, warts,
pemphigoid, pruritic urticarial papules and plaques, Dermatology
dermatitis. Department
Stablize
Skin Cancer
and Refer
General Psychiatry (Outpatients, In-patient,
8. Emergency)

Acute confusion (Acute psychosis), Depression;

Anxiety and stress-related disorders; Sleep disorders;
Mania, Schizophrenia, Suicidal ideation, Substance Psychiatry
abuse and dependency, Post-traumatic stress Department
problems; IQ/Personality assessment,
Psycho-social services
9. Neurology:
Management of CVA, Multiple sclerosis, convulsive Neurology
disorders, epilepsy, parkinosinism, peripheral Department
neuropathy etc
General surgery (Outpatients, In-patient,
10.
Emergency)
Elective Surgery
Repair of perforated peptic ulcer, typhoid ileal
perforation,Appendicectomy, bowel obstruction ,
colostomy, gall bladder disease, hernia,
hydrocelectomy, relief of urinary obstruction,
Surgical
catheterization of suprapubic cystostomy,
Department
Thyroidectomy, Mastectomy, Biliary tract operations,
Haemorrhoidectomy, Mesh repair of inguinal /Ventral
Hernias/ Incisional Hernia, Open
Cholecystectomy,Ureterolithotomy, Vesicolithotomy,
11. A&E Services
All medical emergencies including animal/snake bite,
Pneumothorax and hemothorax
Abdominal trauma (minor), Acute appendicitis,
Perforated peptic ulcer, Intestinal obstruction,
Diverticulitis, Inflammatory bowel disease, Mesenteric
adenitis, Cholecystitis, Cholangitis, Cystitis, Urinary Accident and
Tract Infection, Ureteric colic, Acute urinary retention, Emergency
Peritonitis, Cricothyroidotomy, Soft Tissue Injuries, Department
Tendon injuries, Abdominal trauma (major), Splenic
rupture, Retroperitoneal haemorrhage,
Shock/Septicaemia, Management of Burns,
Advanced acute abdominal conditions like Vascular,
Stabilize
Pancreatic, Urological and requiring sub-specialised
and refer.
supervision
Major disaster plan TRIAGE and assessment of
Accident and
trauma patients along with stabilization of the patient
Emergency
with referral to the sub-specialty concerned (if
Department
required),
General Ophthalmology (Outpatients, In-patient,
12.
Emergency)
Emergencies: Trauma (except intraocular foreign body
and orbital fracture); Eye Department

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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

Table 4: MHSDP-SC FOR CATEGORY A HOSPITALS

S.N
o Services Department Remarks
Common eye conditions; Cataract, Glaucoma,
Refraction, Diabetic eye complications
13. General ENT (Outpatients, In-patient, Emergency)
Epistaxis,Upper respiratory tract infections,
Granulomatous conditions of nose & PNS, Nasal
polyp,Septal surgeries, Nasal & facial trauma, Smell
disorders, Obstructive sleep apnoea, Deep neck
abscesses, Thyroid masses, Acute management of
laryngo-tracheal & neck trauma, Tracheostomy, ENT Department
Dysphagia, Otitis Externa, Wax in ear, Balance
disorders, Otosclerosis, Otological trauma, Mastoiditis,
Deaf and Dumb childDiagnostic nasendoscopy, Stridor
& airway obstruction with facility for rigid bronchoscopy
Head & Neck benign & malignant tumours– primary & Screen
metastatic and Refer
General Orthopaedic (Outpatients, In-patient,
14.
Emergency)
Closed fracture with or without dislocation of all joints
and bones, Volkmann's ischemia and compartment
syndrome, Soft tissue injuries and crush injuries, Skin
graft and tendon injuries, Acute
osteomyelitis,Debridement of osteomyelitis, drainage Orthopaedic
of septic osteoarthritis, Pyogenic septic arthritis,Bone Department
Cyst, Carpal tunnel lesion, Hand flexors and extensors
injuries, Amputation (open amputation), Menopausal
osteoporosis, Open Reduction Internal Fixation (ORIF)
small bones of hand & foot,
General Gynae/Obs (Outpatients, In-patient,
15.
Emergency)
Antenatal care
Management of Anemia , Antepartum Haemorrhage,
Abortion, Malnutrition, Malaria, UTI &STI, Rhesus (Rh)
incompatibility, Management of pre-eclampsia,
Management of, Ectopic pregnancy
Natal Care
Normal delivery, assisted delivery, Management of
Obstetrics and
complicated labour, management of Shock ,
Gynaecology
Management of prolapsed cord,Management of
Department
shoulder dystocia, Manage prolonged and obstructed
labour, Caesarean section,Retained placenta,
Management of delvery in high risk [Link] of
labour, Eclampsia.
Postnatal care
Management of PPH/shock, Management of puerperal
sepsis

Gynaecological care:
Manual vacuum aspiration, D & C , Hystrectomy for
uterine rupture or intractable postpartum haemorrhage,
Obstetrics and
Uterus fibromyoma, Infertility, Ovarian cyst and
Gynaecology
adnexal masses (simple), Menstrual
Department
disturbances,Pelvic inflammatory disease (PID),
Abscesses, Prolapse,Complications of puerperium,
Deep vein thrombosis (DVT),management of abortion,

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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

Table 4: MHSDP-SC FOR CATEGORY A HOSPITALS

S.N
o Services Department Remarks
Detection and treatment of reproductive and sexual
tract infections, management of precancerous lesions.

Family Planning:
Provision of oral pills , condoms, injections , Implants,
Tubal ligation, Complications of contraceptives
16. Paediatric Surgery:
Diseases, Trauma and Malformation of Children (cleft Paediatric
lip and palate, repair of anorectal malformations ) , Surgery
Neonatal Surgeries, Surgeries related to paediatric Department
urology, oncology etc.
Neuro surgery
Shunt of hydrocephalus,Head injury, spinal injury,
peripheral neuropathy, pain management. Pediatric
neurosurgery.
General Dental services (Outpatients, In-patient,
17.
Emergency)
Crowning/ Dentures/Pulpitis, Periodontitis,
Pericoronitis, Gingivitis, Cellulitis (oral), Alveolitis (dry Dentistry
socket), Acute necrotizing ulcerative gingivitis, Abscess Department
(periapical), RCT
18. Laboratory (Outpatients, In-patient, Emergency)
FBC, ESR, LFTs, Blood urea and electrolytes;
CSF/pleural fluid/ascitic fluid/ pericardial aspirate
microscopy; Biochemistry, gram's and ZN stain;
HBsAg, Anti-HCV; HIV; Toxoplasm/brucella Pathology
andtibodies; Serum amylase, CPK, Blood glucose; Unit/Department
ABGs; Culture and sensitivity testing; Screening of
donor, blood grouping and cross match; Storage
(Blood bank services)
Radiology (Outpatients, In-patient, Emergency)
19.
Intervention Radiology, MRI ,Ultrasound(3D)
Chest/orbit/Abdomen/ Pelvis; Dopplers , CT Radiology
brain/Chest/Abdomen/ Pelvis/Spine; Barium swallow; Unit/Department
Intravenous Urography (IVU)
20. Anaesthesia services:
General, epidural, spinal Anaesthesia . Intensive care Anesthesia
and perfusion services Department
21. Medicolegal services and Toxicology
Routine medico-legal, Specialized medico-legal Forensic
including re-examination, Department
22. Pharmacy (Outpatients, In-patient, Emergency)
Support prescription of drugs; Manage main drug store
(Inventory/stock, forecasting etc); Drug utilization
Pharmacy Unit
evaluation; Pharmacovigilance; Drug therapeutic
goods information and poison control center
23. Physiotherapy services
Frozen shoulder; Backache therapy; Post-fracture
PhysiotherapyUnit
therapy; Therapy of joints; Short wave diathermy;
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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

Table 4: MHSDP-SC FOR CATEGORY A HOSPITALS

S.N
o Services Department Remarks
Physiotherapy for chest; Mobilization (postoperative
and post stroke)
24. IT and Hospital Management Information System
Central Patient registration, Human Resource, Payroll,
General Ledger, Medical Records, Radiology,
Pathology, Procurement and inventory Management,
Pharmacy, Admission and Discharge, Nursing Administration
Management, Operation Theatre, Corporate Billing, Department
Maintenance Mangement etc, Maintenance of
computers; Closed Circuit TV; Central speaker
announcement; Health educational corner at OPDs
Infection prevention & control, safe environment,
25.
hygiene and safe waste disposal:
Ensure aseptic sterilized diagnostic & therapeutic
procedures; Notify ORs and house staff of
MRSA/VRSA and other nosocomial infection when it Administration
occurs; Segregation of sharp and non-sharp medical Department
waste and local or contractual arrangement for its safe
disposal as per guidelines.
Emergency Preparedness and Disaster
Management Services: Plan available to respond to Administration
26.
the emergency/ disaster, Buffer supplies to address Department
emergencies
06
ambulance
Administration
27. Ambulance Service: s with 24/7
Department
service
availability

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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

Category “B”
Table 5: MHSDP-SC FOR CATEGORY-B HOSPITALS
S.N
o Services Department Remarks
Clinical Services
General Medical (Outpatients, In-patient,
1.
Emergency)
Infectious Diseases,Allergy and
Immunology,Endocrinology, Diabetes and Metabolism,
Hematology, Oncology, Rheumatology, , Diabetes
mellitus & other endocrine associated conditions,coma, Medical Department
management of CVA, Multiple sclerosis, convulsive
disorder, epilepsy, parkinsonism, peripheral
neuropathies etc.
2. GI disorders:
Amoebiasis, Gastroenteritis, Diarrhea(chronic),
Gastritis, Irritable bowel syndrome, Peptic ulcer Gastroenterology
disease, Helminthic infection, GI tract bleeding,Liver Department
cirrhosis & other liver conditions (abscess, cyst, etc.),
3. Respiratory Problems
Upper and Lower Respiratory Tract infections,
Pneumonia, Chronic Obstructive Pulmonary Disease
Pulmonology
(COPD), Tuberculosis, Asthma, Allergies, Chronic
Department
Bronchitis, Emphysema, Acute Bronchitis, Cystic
Fibrosis
4. Renal disorders
Acute glomerulonephritis, Acute renal failure,
Hypo/hyperkalemia, Nephrotic syndrome, Chronic renal Urology Department
failure,
General Paediatric (Outpatients, In-patient,
5.
Emergency)
Infectious diseases in children, Neonatal care,
Neonatal resuscitation; ENC. Full supportive care for
Preterm baby , management of complication of
newborn, Management of neonatal jaundice and
infections, , Birth injuries, Incubation, Asthma Pediatrics
(chronic)Diarrhea (chronic), Failure to thrive Department
Growth retardation, Malnutrition, Congenital anomalies.

Well-baby clinic to be established in the Paediatric

OPD.
General Cardiology (Outpatients, In-patient,
6.
Emergency)
Congenital heart disease, Deep-vein thrombosis, Heart
failure, Hypertension, Pulmonary oedema, Rheumatic
heart disease, Myocardial infarction, Ischemic heart Cardiology
disease Department

7. General Dermatology(Outpatients, In-patient)

Common dermatological problems such as eczema,
rosacea, seborrheic dermatitis, contact dermatitis,
keratosis pilaris, psoriasis, vitiligo, impetigo, warts,
pemphigoid, pruritic urticarial papules and plaques, Dermatology
dermatitis. Department
Stablize
Skin Cancer
and Refer
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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

Table 5: MHSDP-SC FOR CATEGORY-B HOSPITALS

S.N
o Services Department Remarks
General Psychiatry (Outpatients, In-patient,
8. Emergency)

Acute confusion (Acute psychosis), Depression;

Anxiety and stress-related disorders; Sleep disorders;
Mania, Schizophrenia, Suicidal ideation, Substance Psychiatry
abuse and dependency, Post-traumatic stress Department
problems; IQ/Personality assessment,
Psycho-social services
General surgery (Outpatients, In-patient,
9.
Emergency)
Elective Surgery
Repair of perforated peptic ulcer, typhoid ileal
perforation,Appendicectomy, bowel obstruction ,
colostomy, gall bladder disease, hernia,
hydrocelectomy, relief of urinary obstruction,
Surgical
catheterization of suprapubic cystostomy,
Department
Thyroidectomy, Mastectomy, Biliary tract operations,
Haemorrhoidectomy, Mesh repair of inguinal /Ventral
Hernias/ Incisional Hernia, Open
Cholecystectomy,Ureterolithotomy, Vesicolithotomy,
10. A&E Services
All medical emergencies including animal/snake bite,
Pneumothorax and hemothorax
Abdominal trauma (minor), Acute appendicitis,
Perforated peptic ulcer, Intestinal obstruction,
Diverticulitis, Inflammatory bowel disease, Mesenteric
adenitis, Cholecystitis, Cholangitis, Cystitis, Urinary Accident and
Tract Infection, Ureteric colic, Acute urinary retention, Emergency
Peritonitis, Cricothyroidotomy, Soft Tissue Injuries, Department
Tendon injuries, Abdominal trauma (major), Splenic
rupture, Retroperitoneal haemorrhage,
Shock/Septicaemia, Management of Burns,
Advanced acute abdominal conditions like Vascular,
Stabilize
Pancreatic, Urological and requiring sub-specialised
and refer.
supervision
Major disaster plan TRIAGE and assessment of
Accident and
trauma patients along with stabilization of the patient
Emergency
with referral to the sub-specialty concerned (if
Department
required),
General Ophthalmology (Outpatients, In-patient,
11.
Emergency)
Emergencies: Trauma (except intraocular foreign body
and orbital fracture);
Common eye conditions; Cataract, Glaucoma, Eye Department
Refraction, Diabetic eye complications
12. General ENT (Outpatients, In-patient, Emergency)
Epistaxis,Upper respiratory tract infections,
Granulomatous conditions of nose & PNS, Nasal
polyp,Septal surgeries, Nasal & facial trauma, Smell
disorders, Obstructive sleep apnoea, Deep neck
ENT Department
abscesses, Thyroid masses, Acute management of
laryngo-tracheal & neck trauma, Tracheostomy,
Dysphagia, Otitis Externa, Wax in ear, Balance
disorders, Otosclerosis, Otological trauma, Mastoiditis,
Deaf and Dumb child Diagnostic nasendoscopy,
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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

Table 5: MHSDP-SC FOR CATEGORY-B HOSPITALS

S.N
o Services Department Remarks
Stridor & airway obstruction with facility for rigid
bronchoscopy
Head & Neck benign & malignant tumours– primary & Screen
metastatic and Refer
General Orthopaedic (Outpatients, In-patient,
13.
Emergency)
Closed fracture with or without dislocation of all joints
and bones, Volkmann's ischemia and compartment
syndrome, Soft tissue injuries and crush injuries, Skin
graft and tendon injuries, Acute
osteomyelitis,Debridement of osteomyelitis, drainage Orthopaedic
of septic osteoarthritis, Pyogenic septic arthritis, Bone Department
Cyst, Carpal tunnel lesion, Hand flexors and extensors
injuries, Amputation (open amputation), Menopausal
osteoporosis, Open Reduction Internal Fixation (ORIF)
small bones of hand & foot,
General Gynae/Obs (Outpatients, In-patient,
14.
Emergency)
Antenatal care
Management of Anemia , Antepartum Haemorrhage,
Abortion, Malnutrition, Malaria, UTI &STI, Rhesus (Rh)
incompatibility, Management of pre-eclampsia,
Management of Ectopic pregnancy
Natal Care
Normal delivery, assisted delivery, Management of
Obstetrics and
complicated labour, management of Shock ,
Gynaecology
Management of prolapsed cord,Management of
Department
shoulder dystocia, Manage prolonged and obstructed
labour, Caesarean section,Retained placenta,
Management of delvery in high risk [Link] of
labour, Eclampsia.
Postnatal care
Management of PPH/shock, Management of puerperal
sepsis

Gynaecological care:
Manual vacuum aspiration, D & C , Hystrectomy for
uterine rupture or intractable postpartum haemorrhage,
Uterus fibromyoma, Infertility, Ovarian cyst and
adnexal masses (simple), Menstrual
disturbances,Pelvic inflammatory disease (PID), Obstetrics and
Abscesses, Prolapse,Complications of puerperium, Gynaecology
Deep vein thrombosis (DVT),management of abortion, Department
Detection and treatment of reproductive and sexual
tract infections, management of precancerous lesions.
Family Planning:
Provision of oral pills , condoms, injections , Implants,
Tubal ligation, Complications of contraceptives
General Dental services (Outpatients, In-patient,
15.
Emergency)
Crowning/ Dentures/Pulpitis, Periodontitis,
Pericoronitis, Gingivitis, Cellulitis (oral), Alveolitis (dry Dentistry
socket), Acute necrotizing ulcerative gingivitis, Abscess Department
(periapical), RCT

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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

Table 5: MHSDP-SC FOR CATEGORY-B HOSPITALS

S.N
o Services Department Remarks
16. Laboratory (Outpatients, In-patient, Emergency)
FBC, ESR, LFTs, Blood urea and electrolytes;
CSF/pleural fluid/ascitic fluid/ pericardial aspirate
microscopy; Biochemistry, gram's and ZN stain;
HBsAg, Anti-HCV; HIV; Toxoplasm/brucella Pathology
andtibodies; Serum amylase, CPK, Blood glucose; Unit/Department
ABGs; Culture and sensitivity testing; Screening of
donor, blood grouping and cross match; Storage
(Blood bank services)
Radiology (Outpatients, In-patient, Emergency)
17.
Intervention Radiology, MRI ,Ultrasound(3D)
Chest/orbit/Abdomen/ Pelvis; Dopplers , CT Radiology
brain/Chest/Abdomen/ Pelvis/Spine; Barium swallow; Unit/Department
Intravenous Urography (IVU)
18. Anaesthesia services:
General, epidural, spinal Anaesthesia . Intensive care Anesthesia
and perfusion services Department
19. Medicolegal services and Toxicology
Forensic
Routine medico-legal,
Department
20. Pharmacy (Outpatients, In-patient, Emergency)
Support prescription of drugs; Manage main drug store
(Inventory/stock, forecasting etc); Drug utilization
Pharmacy Unit
evaluation; Pharmacovigilance; Drug therapeutic
goods information and poison control center
21. Physiotherapy services
Frozen shoulder; Backache therapy; Post-fracture
therapy; Therapy of joints; Short wave diathermy;
Physiotherapy Unit
Physiotherapy for chest; Mobilization (postoperative
and post stroke)
22. IT and Hospital Management Information System
Human
Central patient registration,
Resource, Payroll, General Ledger, Medical
Records,Radiology,
Pathology, Procurement and inventory
Management, Pharmacy, Admission and Administration
Discharge, Nursing Management, Operation Department
Theatre, Corporate Billing, Maintenance
Management etc.
,Maintenance of computers; Closed Circuit TV; Central
speaker announcement; Health educational corner at
OPDs
Infection prevention & control, safe environment,
23.
hygiene and safe waste disposal:
Ensure aseptic sterilized diagnostic & therapeutic
procedures; Notify ORs and house staff of
MRSA/VRSA and other nosocomial infection when it Administration
occurs; Segregation of sharp and non-sharp medical Department
waste and local or contractual arrangement for its safe
disposal as per guidelines.

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Table 5: MHSDP-SC FOR CATEGORY-B HOSPITALS

S.N
o Services Department Remarks
Emergency Preparedness and Disaster
Management Services: Plan available to respond to Administration
24.
the emergency/ disaster, Buffer supplies to address Department
emergencies
04
ambulance
Administration
25. Ambulance Service: s with 24/7
Department
service
availability

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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

Category “C”
Table 6: MHSDP-SC FOR CATEGORY-C HOSPITALS
S.N
o Services Department Remarks
Clinical Services
1. General Medical (Outpatients, In-patient, Emergency)
Infectious Diseases , Ac and Chronic diarrhea, IBS, Peptic
Ulcer, Liver disorders, COPDs, Pneumonia, , UTIs , STIs,
renal failure, Tuberculosis, Allergy and Immunology, Medical
Endocrinology, Diabetes and Metabolism, Hematology, Department
Oncology, Rheumatology, Thyroid dysfunctions, Diabetes
mellitus & other endocrine associated conditions,
Myocardial infarction, Ischemic heart disease, skin cancer
Stabilize
or any other patient needing specialized care , stroke ,
and refer
coma, convulsive disorders
2. General Pediatric (Outpatients, In-patient, Emergency)
Infectious diseases , Neonatal care, Neonatal resuscitation;
ENC. Management of neonatal jaundice and infections,
Phototherapy, Birth injuries, Asthma (chronic) Diarrhea Pediatrics
(chronic), Failure to thrive, Growth retardation, Malnutrition. Department

Well-baby clinic to be established in the pediatric OPD.

General Psychiatry (Outpatients, In-patient,
3.
Emergency)
Acute confusion (Acute psychosis), Depression; Anxiety
and stress-related disorders; Sleep disorders; Mania,
Schizophrenia, Suicidal ideation, Substance abuse and
Psychiatry
dependency, Post-traumatic stress problems;
Department
IQ/Personality assessment.

Psycho-social services
4. General surgery (Outpatients, In-patient, Emergency)
Biliary tract operations, Proctological operations (perianal
abscess), Hernioraphy, prolapse, Superficial abscesses,
Cysts, Cavity abscesses, Circumcision, Vasectomy, DJ
Stent Removal, Lord’s Dilatation, T. Stich, Polypectomy,
Surgical
Excision of Fibro adenoma Breast, Appendicectomy,
Department
Haemorrhoidectomy, Hydrocele surgery, Undescended
Testes (UDT), Perianal Abscess/ Fistula (Low), Peri Anal
Fistula High/complex, Mesh repair of inguinal /Ventral
Hernias/ Incisional Hernia, Excision of pilonidal Sinus.
5. A&E Services
All medical emergencies including animal/snake bite
Abdominal trauma (minor), Acute appendicitis,
Diverticulitis, Inflammatory bowel disease, Cholecystitis,
Cholangitis, Cystitis, Urinary Tract Infection, Ureteric colic,
Acute urinary retention, Acute abdomen, Accident and
Cricothyroidotomy, Soft Tissue Injuries, Tendon injuries, Emergency
burns,Closed Fracture with Dislocation, initial management Department
of open fracture.
Advanced acute abdominal conditions like Vascular,
Stabilize
Pancreatic, Urological and requiring sub-specialised
and refer.
supervision, Abdominal trauma (major), Splenic rupture,
Retroperitoneal haemorrhage, Shock/Septicaemia,
intestinal obstruction, Head injury and spinal injury

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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

Major disaster plan TRIAGE and assessment of trauma Accident and

patients along with stabilization of the patient with referral Emergency
to the sub-specialty concerned (if required), Department
General Ophthalmology (Outpatients, In-patient,
6.
Emergency)
Referral in
Emergencies: Trauma (except intraocular foreign body and case of
orbital fracture); complicated
Eye trauma
Department
Common eye conditions; Cataract, Glaucoma, Refraction,
Diabetic eye complications
7. General ENT (Outpatients, In-patient, Emergency)
Epistaxis,Upper respiratory tract infections, Rhinitis, Acute
&Chronic sinusitis, Granulomatous conditions of nose &
PNS, Nasal polyp,Septal surgeries, Nasal & facial trauma,
Smell disorders, Obstructive sleep apnoea, Pharyngeal
infections, Adenoids & Tonsils & its surgeries, Laryngeal,
infections-paediatrics & adults, Voice disorders, Deep neck
abscesses, Thyroid masses, Acute management of
laryngo-tracheal & neck trauma, Tracheostomy, Dysphagia, ENT
Otitis Externa, Wax in ear, Acute otitis media; Chronic otitis Department
media, Balance disorders, Common complications of otitis
media, Otitis media with effusion, Diagnostic
nasendoscopy, Stridor & airway obstruction with facility for
rigid bronchoscopy
Head & Neck benign & malignant tumours– primary &
metastatic Screen and
Mastoiditis, Deaf and Dumb child, Otosclerosis, Otological Refer
trauma,
General Orthopaedic (Outpatients, In-patient,
8.
Emergency)
Closed fracture with or without dislocation of all joints and
bones, Soft tissue injuries and crush injuries, Gout arthritis,
Orthopaedic
Rheumatoid arthritis, Bone Cyst, Carpal tunnel lesion,
Department
Hand flexors and extensors injuries,Manipulation Under
Anesthesia (MUA).
General Gynae/Obs (Outpatients, In-patient,
9.
Emergency)
Antenatal care
Management of Anemia , Antepartum Haemorrhage,
Abortion, Malnutrition, Malaria, UTI &STI, Rhesus (Rh)
incompatibility, Management of pre-eclampsia,
Management of, Ectopic pregnancy
Natal Care Obstetrics and
Normal delivery, assisted delivery, Management of Gynaecology
complicated labour, Manage prolonged and obstructed Department
labour, Caesarean section, Retained placenta.
Postnatal care
Management of PPH/shock, Management of puerperal
sepsis (simple).

Gynaecological care:

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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

Uterus fibromyoma, Hystrectomy, Infertility, Ovarian cyst

and adnexal masses (simple), Menstrual
disturbances,Pelvic inflammatory disease (PID),
Abscesses, Prolapse and trans-vaginal operations, Obstetrics and
Complications of puerperium, Deep vein thrombosis Gynaecology
(DVT),management of abortion, Department
Family Planning:
Provision of oral pills , condoms, injections , Implants,
Tubal ligation, Complications of contraceptives
General Dental services (Outpatients, In-patient,
10.
Emergency)
Crowning/ Dentures/ Pulpitis, Periodontitis, Pericoronitis,
Dentistry
Gingivitis, Cellulitis (oral), Alveolitis (dry socket), Acute
Department
necrotizing ulcerative gingivitis, Abscess (periapical), RCT
Specialized Services
11. Laboratory (Outpatients, In-patient, Emergency)
FBC, ESR, LFTs, Blood urea and electrolytes; CSF/pleural
fluid/ascitic fluid/ pericardial aspirate microscopy;
Biochemistry, gram's and ZN stain; HBsAg, Anti-HCV; HIV; Pathology
Toxoplasm/brucella andtibodies; Serum amylase, CPK, Unit/Departme
Blood glucose; ABGs; Culture and sensitivity testing; nt
Screening of donor, blood grouping and cross match;
Storage (Blood bank services)
Radiology (Outpatients, In-patient, Emergency)
12.
X-ray Chest/abdomen (erect & Radiology
Supine)/spine/hands/pelvis/joints/ Sinuses; X-ray for Unit/Departme
fracture; X-ray for age estimation; Ultrasound nt
13. Anaesthesia services:
General anaesthesia, Local anaesthesia, Spinal
anaesthesia, Epidural anaesthesia Anesthesia Stabilize
Department and Refer

14. Mortuary (Medicolegal

Forensic
Routine medico-legal,
Department
15. Pharmacy (Outpatients, In-patient, Emergency)
Support prescription of drugs; Manage main drug store
Pharmacy
(Inventory/stock, forecasting etc); Drug utilization
Unit/Departme
evaluation; Pharmacovigilance; Drug therapeutic goods
nt
information and poison control center
16. Physiotherapy services
Post-fracture therapy; Therapy of joints; Short wave Physiotherapy
diathermy; Physiotherapy for chest; Mobilization Unit/Departme
(postoperative and post stroke) nt
17. IT and Hospital Management Information System
Maintenance of computers; Closed Circuit TV; Central
Administration
speaker announcement; Health educational corner at
Department
OPDs
Infection prevention & control, safe environment,
18.
hygiene and safe waste disposal:
Ensure aseptic sterilized diagnostic & therapeutic
Administration
procedures; Notify ORs and house staff of MRSA/VRSA
Department
and other nosocomial infection when it occurs; Segregation

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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

of sharp and non-sharp medical waste and local or

contractual arrangement for its safe disposal
Emergency Preparedness and Disaster Management
Administration
19. Services: Plan available to respond to the emergency/
Department
disaster, Buffer supplies to address emergencies
Minimum
03
Administration ambulances
20. Ambulance Service:
Department with 24/7
service
availability

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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

Category “D”
Table 7: MHSDP-SC FOR CATEGORY D HOSPITALS
S.N
o Services Department Remarks
Clinical Services
1. General Medical (Outpatients, In-patient, Emergency)
Infectious Diseases,Gastroenteritis, Diarrhea(chronic),
Gastritis, Irritable bowel syndrome, Peptic ulcer disease,
Helminthic infection,liver disorders, Allergy and Immunology,
Endocrinology, Diabetes and Metabolism, Hematology,
Oncology, Rheumatology, Thyroid dysfunctions, Diabetes
mellitus & other endocrine associated conditions, Herpes
Zoster, Hepatosplenomegaly, Stroke, Coma, pneumonia, Medical
respiratory infections , COPD, UTI, STIs, Nephrotic and Department
nephritic disorders , hypertension, CCF, RHD. Basic
dermotological therapeutic services, basic management of
Psychiatric disorders.

Psychosocial services.

Stabilize
Myocardial infarction, Ischemic heart disease
and refer

2. General Pediatric (Outpatients, In-patient, Emergency)

All uncomplicated bacterial, viral, fungal and protozoal
infections; Neonatal care, Neonatal resuscitation; ENC.
Management of neonatal jaundice and infections,
Phototherapy, Birth injuries, Incubation, Infants of diabetic
mothers, Asthma (chronic)Diarrhea (chronic), Failure to
Pediatrics
thrive, Growth retardation, Malnutrition—severe or moderate,
Department
acute/chronic,micronutrient deficiency (Vitamin A/C/D
deficiencies, anemia, iodine deficiency), Manage Neonatal
complications, Congenital anomalies, Bilirubin
encephalopathy (kernicterus), Thalassemia etc.
Well-baby clinic to be established in the pediatric OPD.
3. General surgery (Outpatients, In-patient, Emergency)
Biliary tract operations, Proctological operations (perianal
abscess), Hernioraphy, Superficial abscesses, Cysts, Cavity
abscesses, Circumcision, Vasectomy, Venous cut down,
Excision of sebaceous cyst, Wedge resection of IGTN,
Excision of Lipoma, Lymph node Biopsy, Skin lesion Biopsy,
Cauterization of viral warts, Examination Under Anesthesia
(EUA), Excision of Fibro adenoma Breast, I/D of Breast
Abscess, I/D & D/D under G/A, Feeding Open Surgical
Appendicectomy, Haemorrhoidectomy, Lateral Internal Department
Sphincterotomy, Herniotomy, Hydrocele surgery, Varicocele
surgery, Undescended Testes (UDT), Simple Mastectomy,
Wide Local Excision, Varicose Veins Surgery, Perianal
Abscess/ Fistula (Low), Peri Anal Fistula High/complex,
Mesh repair of inguinal /Ventral Hernias/ Incisional Hernia,
Open Cholecystectomy,Excision of pilonidal Sinus, closed
fracture without dislocation.
4. A&E Services
All medical emergencies including animal/snake bite
Abdominal trauma (minor), Acute appendicitis, Intestinal
obstruction, Diverticulitis, Inflammatory bowel disease,

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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

Mesenteric adenitis, Cholecystitis, Cholangitis, Cystitis,

Urinary Tract Infection, Ureteric colic, Acute urinary retention,
Peritonitis.
Advanced acute abdominal conditions like Vascular,
Pancreatic, Urological and requiring sub-specialised
supervision Abdominal trauma (major), Splenic rupture, Accident and
Retroperitoneal haemorrhage, Shock/Septicaemia, Closed Emergency
Fracture with Dislocation, open fracture, burns, head injury, Department
spinal injury. Stabilize
Pneumothorax and hemothorax – chest intubation with and refer.
observation

Major disaster plan TRIAGE and assessment of trauma Accident and

patients along with stabilization of the patient with referral to Emergency
the sub-specialty concerned (if required), Department
5. General Gynae/Obs (Outpatients, In-patient, Emergency)
Antenatal care
Anemia, Antepartum Haemorrhage, Abortion, Rhesus (Rh)
incompatibility, Management of pre-eclampsia, Management
of, Ectopic pregnancy
Natal Care
Normal delivery, assisted delivery, Management of Obstetrics and
complicated labour, Management of prolapsed Gynaecology
cord,Management of shoulder dystocia, Manage prolonged Department
and obstructed labour, Caesarean section,Retained
placenta.
Postnatal care
Management of PPH/shock, Management of puerperal
sepsis (simple)

Gynaecological care:
Uterus fibromyoma,Hysterectomy, Infertility, Ovarian cyst
and adnexal masses (simple), Menstrual disturbances,Pelvic
inflammatory disease (PID), Abscesses, Prolapse and trans- Obstetrics and
vaginal operations, Complications of puerperium, Deep vein Gynaecology
thrombosis (DVT),management of abortion, Department
Family Planning:
Provision of oral pills , condoms, injections , Implants, Tubal
ligation, Complications of contraceptives
General Dental services (Outpatients, In-patient,
6.
Emergency)
Crowning/ Dentures/Pulpitis, Periodontitis, Pericoronitis,
Dentistry
Gingivitis, Cellulitis (oral), Alveolitis (dry socket), Acute
Department
necrotizing ulcerative gingivitis, Abscess (periapical), RCT
Specialized Services
7. Laboratory (Outpatients, In-patient, Emergency)
FBC, ESR, LFTs, Blood urea and electrolytes; CSF/pleural
fluid/ascitic fluid/ pericardial aspirate microscopy;
Biochemistry, gram's and ZN stain; HBsAg, Anti-HCV; HIV; Pathology
Toxoplasm/brucella andtibodies; Serum amylase, CPK, Unit/Departme
Blood glucose; ABGs; Culture and sensitivity testing; nt
Screening of donor, blood grouping and cross match;
Storage (Blood bank services)
8. Radiology (Outpatients, In-patient, Emergency)

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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

X-ray Chest/abdomen (erect &

Radiology
Supine)/spine/hands/pelvis/joints/ Sinuses; X-ray for fracture;
Unit/Departme
X-ray for age estimation; Ultrasound Chest/orbit/Abdomen/
nt
Pelvis,
9. Anaesthesia services:
General anaesthesia, Local anaesthesia, Spinal
anaesthesia, Epidural anaesthesia Anesthesia Stabilize
Department and Refer

10. Mortuary (Medicolegal

Forensic
Routine medico-legal.
Department
11. Pharmacy (Outpatients, In-patient, Emergency)
Support prescription of drugs; Manage main drug store
Pharmacy
(Inventory/stock, forecasting etc); Drug utilization evaluation;
Unit/Departme
Pharmacovigilance; Drug therapeutic goods information and
nt
poison control center
12. Physiotherapy services
Frozen shoulder; Backache therapy; Post-fracture therapy; Physiotherapy
Therapy of joints; Short wave diathermy; Physiotherapy for Unit/Departme
chest; Mobilization (postoperative and post stroke) nt
13. IT and Hospital Management Information System
Maintenance of computers; Closed Circuit TV; Central Administration
speaker announcement; Health educational corner at OPDs Department
Incinerator
should be
Infection prevention & control, safe environment,
14. available
hygiene and safe waste disposal:
at the
Facility
Ensure aseptic sterilized diagnostic & therapeutic
procedures; Notify ORs and house staff of MRSA/VRSA and
Administration
other nosocomial infection when it occurs; Segregation of
Department
sharp and non-sharp medical waste and local or contractual
arrangement for its safe disposal
Emergency Preparedness and Disaster Management
Administration
15. Services: Plan available to respond to the emergency/
Department
disaster, Buffer supplies to address emergencies
Minimum
02
Administration ambulance
16. Ambulance Service:
Department s with 24/7
service
availability

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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

Preventive and primary health care services for all

categories of secondary care hospitals
The role of preventive and promotive care at the secondary level care facilities cannot be
underscored. The secondary health care facilities are being utilized for not only basic primary
and preventive care but also to provide outreach care and link with various primary care
programmes. Based on the recommendations of the preventive care sub-committee, following
are proposed for all categories of secondary care hospitals

- There should be a Preventive Care Unit within the hospital which should provide
training/capacity building of the hospital staff on preventive care.
- The OPDs should have a prevention room that caters for the preventive health care services.
- The OPDs should have standardized preventive care videos displayed in local language.
- The secondary care hospitals should be linked/connected through web portals to have
access to standard preventive care messages within and across districts.
Thekey preventive health care services for the prevailing healthproblems, their prevention and
controlthat should be available across all categories of secondary care hospitals are provided
[Link] proposed Preventive Care Unit in the hospital should serve as the focal point for
promotion of the preventive health care services at the hospital and provide training/capacity
building of the hospital staff on preventive care.

Table 6: Preventive Health Care Services at Secondary Level Hospitals

Activities / measures
to be taken
1. Health Education to seek regular antenatal care and delivery by SBA and postnatal care.
2. Counselling on family planning methods
3. Awareness about breast examination for early detection of breast cancers.
4. Immunization of pregnant ladies.

1. Promote exclusive breastfeeding and appropriate weaning practice.

2. Management of parasitic infections .
3. VIt A supplementation.
4. Routine immunization
5.

Health education on prevention and control of communicable disieases such as TB, Malaria,
hepatitis and HIV / AIDs.
Timely reporting of notifiable diseases.
Hazards of tobacco
1. Importance of physical activity
2. Control of Diabetes etc.
3. Weight control.
4. Importance of balanced diet.
5. Importance of Hygine

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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

Activities / measures
to be taken

1. All the relevant clinical specialties should provide health education and screening services
for population over the age of 60 with a focus on following geriatric problems
a. Cataract &Visual impairment
b. Arthritis &locomotion disorder
c. Cerebrovascular disease&Hypertension
d. Neurological problems
e. Respiratory problems including Chronic bronchitis
f. GIT problems
g. Psychiatric problems
h. Loss of Hearing

Physical Infrastructure guidelines for all secondary care

hospitals
The importance of an adequate infrastructure for effective and quality health service delivery
cannot be underscored. Adequate infrastructure not only promotes the quality of the services
provided but also helps in better and facilitated access of the patients to the health facilities.
The following guidelines are provided with regards to infrastructure requirements for the
secondary care hospitals based on the recommendations/standards of the World Health
Organisation (WHO) for secondary care hospitals4. It is well understood that it might not be
possible to implement all the proposed standards/guidelines by the secondary care hospitals
which are already established for practical reasons. However, all the secondary care hospitals
should try to implement the proposed standards to the best possible extent. It is proposed that
the secondary care hospitals that will be established in future or are in pipeline should consider
these standards. In addition to that, quality of care managment standards as already produced
for the services and infrastructure by the Department of Health, Khyber Pakhtunkhwa should
also be followed.

4 Factors to be considered in locating a district hospital

Following factors should be considered while identifying a location for a district hospital4
(1) It should be within 15-30 min travelling timefor the catchment area population and must
have metal access road. In a district with good roads and adequate means of transport, this
would mean a service zone with a radius of about 25 km.
(2) It should be grouped with other institutional facilities, such as educational (school), tribal
(cultural) and commercial (market) centres.
(3) It should be free from dangers of flooding; it must not, therefore, be sited at the lowest point
of the district.
(4) It should be in an area free of pollution of any kind, including air, noise, water and land
pollution.

4District
Health Facilities, Guidelines for Development and Operations, WHO Regional Publications,
Western Pacific Series No.22
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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

(5) It must be serviced by public utilities: water, sewage and storm-water disposal, electricity,
gas and telephone. In areas where such utilities are not available, substitutes must be found,
such as a deep well for water, generators for electricity and radio communication for
telephone.

5 Size of the Site

The site must be large enough for all the planned functional requirements to be met and for
anyexpansion envisioned within the coming ten years. Recommended standards vary
from1.25 to 4 ha (25 to 79 Kanals) per 100 beds; the following minimum requirements have
been proposed4:
a) 25-bed-capacity - 2 ha/40 Kanals (800 m2/1.6 Kanals per bed)
b) 100-bed capacity - 4 ha/79 Kanals (400 m2/0.79 Kanal per bed)
c) 200-bed capacity - 7 ha/138 Kanals (350 m2/0.69 Kanals per bed)
d) 300-bed capacity - 10 ha/198 Kanals (333 m2/0.65 per bed)
These areas are for the hospital buildings only, excluding the area needed for staff housing.
For smaller hospitals, single-storey construction generally results in effective use of the
building, less reliance on expensive mechanical services and lower running and maintenance
costs. Thus, hospitals up to 150 beds should be single-storey constructions (with a foundation
to support six stories for future needs)unless other parameters dictate that they be multi-
storeyed4.

6 Topography
Topography is a determinant of the distribution of form and space. A flat terrain is the easiest
and least expensive to build on. A rolling or sloping terrain is more difficult and more expensive
to build on, but the solutions can be interesting and innovative; by using the natural slope of
the ground, the drainage and sewage disposal systems can be designed so as to result in
lower construction and maintenance costs4.

7 Departmental Planning and Design

The different departments of the hospital should be grouped according to zone, as follows4
(Figure 4)

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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

Figure 4: Zoning of the district hospital departments4Error! Bookmark not defined.

(1) Outermost zone, which is the most community oriented

Primary health care support areas including family planning clinic

Out-patient department; consists of reception and waiting areas, consultation rooms,
examination rooms, treatment rooms, and staff and supply areas.
Emergency department; This fast-paced department requires a large area that is flexible and
can be converted into private areas when necessary, usually by the use of curtains on tracks
around delineated [Link] is vital that the provisions for movement within the emergency
department allow for fluidity, with rapid access to the operating, X-ray and other departments.
Because of the nature of emergencies, it is recommended that if resources are available,
beds be clustered and dedicated to specific types of emergency cases. Accident and trauma,
fracture and orthopaedic, obstetrics and gynaecology, and paediatrics cases require different
ministrations and emergency procedures.
Administration; the administrative department is orientated to the public but is at the same
time private. Areas for business, accounting, auditing, cashiers and records, which have a
functional relationship with the public, must be located near the entrance of the hospital.
Offices for hospital management, however, can be located in more private areas.
Admitting office, reception
(2) Second zone, which receives workload from (1)

Radiology and imaging department; with X-ray, Ultrasound and CT scan facilities (in a
Category A hospital). The diagnostic imaging area should be on the ground floor of the
hospital, with easy, covered access for wheel-chairs, patient trolleys and beds. Its location
close to the emergency section of the out-patient department is helpful, but easy access for
all patients should be the first consideration. A separate building is not necessary. The X-ray
department should consist of three room; (i) the X-ray room (ii) the dark-room; and (iii) office
and storage space. The ultrasound room should contain a patient couch, firm but comfortable,
a chair and at least 1 m2 for the equipment. The lighting must be dim-bright, light makes it
difficult to examine a patient properly-but the room must not be very dark. Handwashing
facilities should be located either in the room or close by. There must be a toilet close to the
ultrasound room.
Laboratories; The laboratory must be located and designed so as to:
 provide suitable, direct access for patients
 allow reception of deliveries of chemicals
 allow for disposal of laboratory materials and specimens.
The basic utilities that are to be provided in the laboratory are water supply, sanitary drains
and drain vents, electricity, compressed air, distilled water, carbon dioxide, steam and gas.
Others may be necessary depending on the types of tests to be performed. A method must
be designed for identifying the different pipes in the laboratory; the following colour code may
be used:

 hot water orange

 cold water blue
 drain brown

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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

 steam gray
 compressed air white
Blood bank;To have blood donation and transfusion services it is important to have screening
carried out for anaemia and infectious agents. There should also be facility for adequate
storage of the donated blood after screening.
Pharmacy;The pharmacy must be located so that it is:
 accessible to the out-patient department,
 accessible to the central delivery yard.
(3) Middle zone between outer and inner zones

Operating department; the number of operating theatres required is obviously related to the
number of hospital beds. As a general rule, one operating theatre is required for every 50
general inpatient beds and for every 25 surgical [Link] preferred location is on the same
floor as the surgical wards, which may be the ground floor. It should be connected to the
surgical ward by the simplest possible route, It should also:
 be easily accessible from the accident and emergency department;
 be easily accessible for the delivery suite;
 adjoin the intensive care unit;
 adjoin the central sterile supply department;
 be located in a cul-de-sac, so that entry and exit can be controlled; there should
be no through-traffic
The overriding principle is that the centre of the theatre suite should be the cleanest area,
the requirement for cleanliness decreasing towards the perimeter of the department i.e.
the concept of progressive asepticism.

The OT department should provide following rooms/areas (Figure 5)

Transfer area
This area should be large enough to allow for the transfer of a patient from a bed to a
trolley. A line should be clearly marked in red on the floor, beyond which no person from
outside the operating department should be permitted to set foot without obtaining
authority and putting on protective clothing.

Holding bay

This space is required when the corridor system is used and should be located to allow
supervision of patients waiting to go into the theatre. One bed per two theatres should be
foreseen.

Staff changing rooms

Access to staff changing rooms should be made from the entry side of the transfer area.
At both the transfer area and the theatre side of the changing rooms, space must be
provided for the storage, putting on and removal of theatre shoes.
Operating theatres

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Each theatre should be no less than 6 x 6 m (36 m2) in area and should have access from
the 1 anaesthetic room, scrub-up room and supply room. Separate exit doors should be
provided.
Scrub-up room
Scrub-up facilities may be shared by two theatres. A minimum of three scrub up places
is required for one theatre, but five places are adequate for two theatres. A clear area
within the scrub-up room, at least 2.1 x 2.1 m, must be provided for gowning and for trolley
or shelf space for gowns and masks.
Sub-clean-up
In suites of four or more operating theatres, a small utility area is required for each pair of
operating theatres, for the disposal of liquid wastes, for rinsing dropped instruments and
to hold rubbish, linen and tissue temporarily until they are removed to the main clean-up
room.
Sub-sterilizing
An area for sterilizing dropped instruments should be provided to serve two theatres.
Recovery room
The recovery room should be located on the hospital corridor near the entrance to the
operating department. The number of patients to be held, until they come out of
anaesthesia, depends on the theatre throughput; two beds per theatre is usually
satisfactory. In hospitals where there is an intensive care unit, additional room and
facilities will be needed.

Figure
5: Traffic flow in operating department

Intensive Care Unit; The intensive care unit is for critically ill patients who need constant
medical attention and highly specialized equipment, to control bleeding, to support breathing,
to control toxaemia and to prevent shock. They come either from the recovery room of the
operating theatre, from wards or from the admitting section of the hospital. This unit requires
many engineering services, in the form of controlled environment, medical gases,
compressed air and power sources. As these requirements are very similar to those in the
operating department, it is advisable to locate the intensive care unit adjacent to the recovery
room of the operating [Link] number of beds in this unit should correspond to
approximately 1-2% of the total beds in the hospital.
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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

Obstetrics and Gynaecology department;Proximity to the operating department is desirable,

as transfer of delivery patients may be necessary. The Obstetrics and Gynaecology
department is a useful one for primary health care activities. Education and training materials
on maternal and child health and on family planning can be effectively transmitted to receptive
fathers in the waiting room. An area should be provided for this purpose.
Paediatrics Unit/Nursery; the nursery should be located adjacent to the delivery department
to ensure protected transport of newborns. Areas must be provided for cribs for both well and
ill babies and for support services that include formula and preparation rooms.
(4) Inner zone, in the interior but with direct access for the public

Inpatient wards; the wards in a hospital are usually classified according to specialties:
medicine, paediatrics, obstetrics-gynaecology and surgery, which are the basic services
offered by a district hospital. There are no radical differences between the requirements of
medical and surgical wards and only minor differences between those of the other specialties.
(5) Service zone, disposed around a service yard

Laundry and housekeeping; (a) The housekeeper's office should be on the lowest floor,
adjacent to the central linen room.
(b) The central linen room supplies linen for the whole hospital. It must have shelves
and spaces for sewing, mending and marking new linen. If laundry is to be handled in
the hospital, the central linen room must be adjacent to the "clean" end of the laundry
room.
(c) The soiled linen area is for sorting and checking all soiled laundry from the hospital.
It must be next to the "dirty" end of the laundry area and provided with sorting bins.
(d) Laundry can either be done in-house or contracted to an outside enterprise. If it is
to be done in-house, proper washing and drying equipment must be installed. If it is to
be contracted out, areas must be provided for receiving clean and dispatching dirty
linen and for sorting.
The facilities must thus include:

 a soiled linen room;

 a clean linen and mending room;
 a laundry-cart storage room;
 a laundry processing room, with equipment sufficient to take care of 7 days' linen;
 janitor's closet, with storage space for housekeeping supplies and equipment and
a service sink;
 storage space for laundry supplies.
The last three are not needed if laundry is to be contracted out.

Storage;The standard for central storage space is 2 m2 per bed; in smaller hospitals, this
value is usually increased.
The following compartments must be provided in the hospital storage area:

 pharmacy storeroom,
 furniture room,
 anaesthesia storeroom,
 records storage and
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 central storeroom.
The risks of fire and explosion in a medical supplies storeroom and storage of dangerous
substances such as nitric and picric acids and inflammable materials such 'as alcohol,
oxygen and other gas cylinders merit special attention.

For smooth, rapid flow of materials both to and from the central store, sufficient space and
ramps should be provided for handling, unpacking, loading, unloading and inspection. In
a hospital planned with a functional central supply and delivery system, many of the
traditional ancillary rooms could be eliminated from some departments and be replaced by
systems of lifts, with sufficient parking space in the wards for trolleys.

Maintenance and engineering;(a) Boiler room: The boiler plant must be designed by a
qualified engineer to ensure the safety of patients and staff.
(b) Fuel storage: The space will vary according to the fuel used.
(c) Groundkeeper's tool room: Space must be provided for working and for the storage of
equipment and tools for the staff in charge of landscaping and general upkeep of the
garden and grounds.
(d) Garage: The garage is best located in a shed or building separated from the hospital
itself. If the hospital is to maintain 24-hour ambulance service, additional facilities must be
provided for drivers' sleeping quarters.
(e) Maintenance workshop: A carefully planned and organized maintenance programme
for general repair of medical and nonmedical equipment is necessary for ensuring reliable
hospital service. A mechanical workshop with an electric shop, well equipped with tools,
equipment and supplies, is conducive to preventive maintenance and is most important in
emergencies. Failure of lights or essential equipment in an operating theatre, such as
respirators, can have serious consequences. Adequate space for equipment like lathes,
welding materials and wood- and metal-working machines should be provided, and there
should be storage space for damaged material, such as stretchers, beds, wheelchairs,
portable machines and food trolleys. As most repair work is done outside of normal working
hours, space should be provided for workers, maintenance staff, supervisory personnel
and biomedical engineers.

Mortuary; the mortuary should be in a special service yard, with a discreet entrance; it should
be away from the out-patient department, ward block and nursery.
Staff facilities/Residential block; The residential block for the doctors, paramedics and support
staff should be located on the periphery near roads and public transport: staff dormitories,
quarters or housing.

8 Bed Strength and Specialities across Category A, B, C and D

secondary care hospitals
The secondary levels of care as provided in Khyber Pakhtunkhwa has been categorized in to
Category A, B, C, and D hospitals according to the bed size, the catchment population. All the
four categories of hospitals have both in-patient and outpatient services, in addition to
emergency, diagnostic and other day care facilities. Category “A” secondary care hospital has
the highest number of specialties and the number of inpatient beds. The number of specialties
and the inpatient beds decreases across category “A” to category “D” hospitals5. The bed

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strength and the available specialities by the four hospital categories are provided in theTable
7.

Table 7: Summary of the Criterion for Categorisation of Secondary Care Hospitals

CATEGORY CATEGORY CATEGORY CATEGORY

A B C D
SURGERY 40 beds 30 beds 20 beds 8 beds
MEDICINE 40 beds 30 beds 20 beds 8 beds
GYNAE/OBS 40 beds 20 beds 15 beds ;10 beds
PAEDIATRICS 40 beds 20 beds 10 beds 10 beds
EYE 30 beds 20 beds 10 beds 0
ENT 30 beds 20 beds 10 beds 0
ORTHOPAEDICS 20 beds 10 beds 10 beds 0
CARDIOLOGY 15 beds 10 beds 0 0
PSYCHIATRY 15 beds 10 beds 0 0
CHEST/TB 10 beds 10 beds 0 0
INPATIENT
BEDS DIALYSIS UNIT 6U 4U 0 0
DENTISTRY UNIT 6U 4U 2U 1U
PAEDS SURGERY 10 beds 0 0 0
NEUROSURGERY 10 beds 0 0 0
DERMATOLOGY 10 beds 0 0 0
ACCIDENT AND
10 beds 10 beds 5 beds 4 beds
EMERGENCY (Casualty)
LABOR ROOM 10 beds 5 beds 5 beds 2
ICU/CCU 10 beds 10 beds 5 beds 0
NURSERY PEADS/ICU 10 beds 5 beds 0 0
350 Beds 210 Beds 110 Beds 42 Beds
+ + + +
6 Dialysis 6 Dialysis 2 1 Dentistry
TOTAL BEDS Units Units Dentistry Unit
+ + Units
6 Dentistry 6 Dentistry
Units Units

Financial Resources Required

In order to estimate the overall cost implications of implementing the MHSDP-SC at Category
A, B, C, and D Secondary Care Hospitals, a financial assessment has been done based on
the standards agreed in the MHSDP-SC, see ‘’Costing of Secondary Health Care Package in
Khyber Pakhtunkhwa.

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Appendices;

1 HumanResource Requirements for Category A, B, C and D Hospitals

REVISED STAFFING STANDARDS FOR HOSPITALS

Category B Category D
S.N
Staff Category Category A Recomende Category C Recomende
o.
Recomended d Recomended d

MANAGEMET STAFF
1 Medical Superintendent 1 1 1 1
Deputy Medical
2 Superintendent 3 3 2 2
Total 4 4 3 3
SPECALIST
1 Physician 2 2 1 1
2 Surgeon 2 2 1 1
3 Gynaecologist 2 2 1 1
4 Paediatrician 2 2 1 1
5 Anesthetist 8 6 4 1
6 Ophthalmologist 2 2 1 0
7 ENT Specialist 2 2 1 0
8 Pathologist 1 1 1 0
9 Radiologist 2 2 2 1
10 Orthopedic Surgeon 2 2 1 0
11 Trauma Surgeon 1 0 0 0
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12 Forensic Expert 1 0 0 0
13 Neurosurgeon 1 0 0 0
14 Psychiatrist 2 1 1 0
15 Pulmonologist 1 1 0 0
16 Dermatologist 2 1 0 0
17 Gastroenterologist 1 1 0 0
18 Urologist 1 1 0 0
19 Pediatrics Surgeon 1 0 0 0
20 Dental Specialist 1 0 0 0
21 Cardiologist 2 1 0 0
22 Neurologist 1 0
Total 40 29 15 6
MEDICAL STAFF
79 with at
128 with at least 4
least 4 WMOs. WMOs. (2 44 with atleast
(4 Chief Chief Medical 4 WMOs. (2 16 with
Medical officers , 15 Chief Medical atleast 3
officers , 25 principal officers , 8 WMOs. ( 3
General Cadre Medical
1 principal medical principal principal
Officers medical officer,29 medical medical
officer,46 senior officer,16 officer,6
senior medical medical senior medical senior medical
officers,53 officers, 33 officers,18 officers, 7
medical medical medical medical
officers officers officers officers
2 Dental surgeons 6 6 2 1
Total 134 85 46 17
NURSING STAFF
4 nurses/10
beds for
general beds ,
1 nurse per 2
beds /shift
for special
beds, 2
Charge Nurse
nurses per 1 General
bed for beds 175, General beds
critical beds special beds 95, special
Beds (275 + 30, critical beds 5,
55 + 26) beds 19. critical beds
110+82+156= 52+45+114= 5.
1 348 211 38+30+8=76 16
2 Head Nurse 35 21 8 2
3 Nursing Superintendent 2 1 1 0
Deputy Chief Nursing
4 Superintendent 1 1 0 0
Chief Nursing
0
5 Superintendent 1 0 0
Total 387 234 85 18
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NON- MEDICAL STAFF

1 Clinical Psychologist 1 1 1 0
2 Pharmacist 7 4 2 1
3 Speech Therapist 1 0 0 0
4 Physiotherapist 6 4 2 2
6 Nutritionist 2 1 0 0
7 Health education officer 1 1 0 0
8 Epidemiologist 1 0 0 0
Total 19 11 5 3
PARAMEDICAL STAFF
Clinical Technician
1 (radiology) 13 9 6 4
Clinical Technician
2 (Dentistry) 8 6 2 1
Clinical Technician
3 (pathology ) 20 13 7 4
Clinical Technician
(pathology ) for Blood
4 Transfusion Services 7 4 3 2
Clinical Technician
5 (ophthalmology) 5 3 2 1
Clinical Technician
6 (optometrist) 2 1
12 with at 8 with at 7 with at 4 with at
Clinical Technician
7 least 20 % least 20 % least 20 % least 20 %
(Cardiology)
female staff. female staff. female staff. female staff.
Clinical Technician
8 (Surgical ) 44 34 16 8
Clinical Technician
9 (Anaesthesia) 22 17 8 4
Clinical Technician
10 (Pharmacy) 7 5 2 1
11 Multipurpose Technician 7 6 4 3
12 Clinical Technician (MCH) 13 11 8 5
13 Physiotherapy Technician 7 5 2 2
Clinical technician
14 (Dialysis ) 13 13
15 Technologist 3 1
Clinical technician
16 Pulmonology 4 4
Clinical technician
Gestroentrolgoy 4 4
SeniorTechnologist 1 1
clinical techinician
(Neurology) 6
Total 195 103 68 39

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ADMINISTRATIVE AND SUPPORT STAFF

1 Biomedical Engineer 1
2 Biomedical Technician 1 1
4 Account Officer 1 1
5 Head Clerk 1 1
6 IT Manager 1 1 1 1
7 Accountant 1 1 1 1
8 Statistical Officer 1 1 1
9 Social Welfare Officer 1 1 1
10 Store Keeper 3 3 3 1
11 Computer Operator 47 32 17 10
12 Naib Qasid 8 6 4 3
13 Senior Clerk 1 1 1 1
3 per
3 per ambulance 3 per 3 per
14 Driver ambulance and 1 per ambulance ambulance
and 1 per office and 1 per and 1 per
office vehicle vehicle office vehicle office vehicle
15 Junior Clerk 1 1 1 1
16 Personal Assistant 1 1 1
17 Security Guard 40 20 16 12
18 Telephone Operator 6 4 3 2
19 Gardner 10 6 4 2
20 Cleaners/Sweeper 55 31 29 9
21 Dhobi 8 6 4 2
22 Tube Well Operator 3 3 3 3
150 (30% 110 (30% 50 (30 % 30 (30%
23 Ward Orderly Female) female) female) Female)
24 Plumber 3 2 1 1
25 Electrician 3 2 1 1
26 Carpenter 1 1 1
27 Tailor Master 1 1 1 1
Total 352 137 139 81
Grand Total 1131 603 361 167

(* Exclusive of Drivers, which are subject to the number of ambulances and

official vehicles)

2 Equipment requirements for Category A, B, C and D Secondary Care

Hospitals
[Link] Infrastructure and equipment CAT-A CAT-B CAT-C CAT-D Remarks
Out-Patient facilities
1. General provisions (for all OPDs)
Consultation room, Waiting area
Token system, Health education corners in all Yes Yes Yes Yes
OPDs with posters.

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[Link] Infrastructure and equipment CAT-A CAT-B CAT-C CAT-D Remarks

TV and DVD player in OPDs for showing
health education related programmes in local
languages; Stretcher/wheel chair ramp
Furniture:
Items to be
Examination couch, Screen, Chair for the
available in
consultant, 3 Chairs for the patient and Yes Yes Yes Yes
each OPD
attendant
room
Equipment:
Stethoscope, BP apparatus stand type,
Tendon hammer, Measuring tape, Torch, items to be
Cotton wool, Spatula, Tuning fork 128 available in
Yes Yes Yes Yes
cycles/second,weighing each OPD
machine,ophthalmoscope, X-ray illuminator room
double table type
One in
Defibrillator with ECG monitor Yes Yes Yes Yes
OPD block
3 for CAT
A, 2 for
CAT B, 1
each for
Resuscitation Unit Yes Yes Yes Yes
CAT C and
CAT D
Outpatient
Department
Oxygen cylinder with trolley stand, Oxygen
flow meter without humidifier, Oxygen masks Yes Yes Yes Yes
all sizes
Electric water cooler with filter Yes Yes Yes Yes
One for
Portable emergency light with battery backup Yes Yes Yes Yes each OPD
room
20 for CAT
A,15 for
CAT B, 10
for CAT C
Wheel chair Yes Yes Yes Yes
and 6 for
CAT D
hospital
OPD
10 for CAT
A, 6 for
CAT B, 4
for CAT C
Stretcher Yes Yes Yes Yes
and 2 for
CAT D
hospital
OPD
Quantities
Box for proper disposal of sharps, Yes Yes Yes Yes
as per need
One for
every
speciality
Desktop computer with printer and UPS Yes Yes Yes Yes and atleast
for OPD
registration
point .

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[Link] Infrastructure and equipment CAT-A CAT-B CAT-C CAT-D Remarks

Specialty dependent additional equipment
2. Cardiology:
One in the
whole
ECG machine Yes Yes Yes Yes
Outpatient
Department
One in the
whole
Echocardiography +/- ETT Yes Yes No No
Outpatient
Department
One in the
General Medical: whole
3. Yes Yes Yes No
Pulmonary function unit, Outpatient
Department
4. Paediatric:
One of
each items
Paediatric stethoscope, Paediatric weighing to be
machine, BP Apparatus with small Yes Yes Yes Yes available in
cuff,Nebulizer each
Paediatric
OPD room
5. Dermatology:
One for
each
Dermatolog
Magnifying glass, Woods lamp,Glass slides Yes Yes No No
y OPD
room

6. Psychiatry:
One of
each item
EEG machine, personality disorder
Yes Yes No No for each
examination - full version with interpretation,
Psychiatry
OPD room
7. General Surgery
One of
Proctoscope,Foley’s Catheter with bag, kidney each item
tray along with a set of dissecting forceps Yes Yes Yes Yes for each
artery clips and needle holders Psychiatry
OPD room
8. Ophthalmology
Refraction System
One of
Autorefractometer with K-reading, each item
Retinoscope, Ophthalmoscope, Refraction Yes Yes Yes No for each
box, Vision drum, UPS Eye OPD
room
Consultant OPD
One of
each item
Slit lamp, Applanation, Tonometer,
Yes Yes Yes No for each
A-B scan, YAG-Laser, Argon laser,Torches
Consultant
Ophthalmol

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[Link] Infrastructure and equipment CAT-A CAT-B CAT-C CAT-D Remarks

ogist OPD
room
9. ENT
One of
ENT examination unit/ENT mirror and light each item
source, Rechargeable autoscope, Tuning forks Yes Yes Yes No for each
512 cycles/second, Audiometer ENT OPD
room
10. Gynae/Obs;
Antenatal clinic Yes Yes Yes Yes
One of
each items
Gynae examination kit, Fetoscope/sonic aid,Kit
Yes Yes Yes Yes in each
for insertion/removal of IUCD, Ultrasound
Gynae
OPD room
11. Orthopaedic:
Items to be
available in
each
POP cutter, Cotton roll, Crepe bandage, Local Orthopaedi
anesthetic, Yes Yes Yes No c OPD
Injectable analgesic room as
per
requiremen
t
12. Dental
Complete dental unit with X-Ray with
accessories, Instruments Sets, Root Canal Yes Yes Yes Yes
Instruments, Instrument tray/kidney tray Bowls
In-patient facilities
13. General provision (for all wards)
Infrastructure
Ward,Consultant office with bath room, To be
Doctors duty room with bath room, Doctors available in
changing room, Nurses changing room with Yes Yes Yes Yes each
bath room, Bath Rooms for patients (one bath inpatient
room/6 patients), Neonatal Cots ward
4 High
Dependenc
y Beds
/ward
High Dependency Beds 1
Yes Yes No No
Beds for thalassemia patients thalassemi
a bed per
twenty
inpatient
beds
Equipment
Each item
Stethoscope, BP apparatus stand type,
should be
Tendon hammer, Measuring tap, Torch, Cotton
available in
wool,Spatula
Yes Yes Yes Yes each
Tuning fork 128 cycles/second,weighing
inpatient
machine, examination gloves,ophthalmoscope,
ward in
Portable Defibrillator with ECG
quantities

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[Link] Infrastructure and equipment CAT-A CAT-B CAT-C CAT-D Remarks

monitor,Resuscitation unit, Ambu bag, ascertained
Endotracheal tubes various sizes, by ward
Nursing station, ECG monitored beds, Pulse size/need
oxymeter,Glucometer,Nasogastric tubes,
Foleys/Celestic urinary catheter, I.V cannula
various sizes,Central line, Drip stands,
Instrument tray/Kidney tray/Bowls,
Laryngoscope adult straight & curved, Oxygen
cylinder with trolley stand, Oxygen flow meter
with humidifier,Oxygen flow meter without
humidifier,Oxygen masks all sizes,SS
urinal/bed pans,Electric water cooler with
filter,Heavy duty suction machine,Light duty
nebulizer,Light duty suction units,Refrigerator
12 cf.,Spirometer,
X-ray illuminator double wall type,
Sterilizing drums, Meigle forceps,
Portable emergency light with battery backup,
General Surgery Dressing Instruments Sets,
Desktop computer with printer, UPS
Specialty dependent additional equipment
14. Medicine and Allied ward
All items to
be
available in
Chest drain with under water seal, Three way
Medicine
pleural tape needle, Ascitic tap needle,
Yes Yes Yes Yes and Allied
Pleural/liver biopsy needle, Bone marrow
ward in
aspiration needle,
quantities
ascertained
by need
One in
each
ECG machine (for all in-patients in the facility) Yes Yes Yes Yes Medicine
and Allied
ward
Surgery and Allied ward
15.
All items to
be
available in
Dressing kit, Drains Different Types,
Surgery
Foley’s Catheter,Drainage Bags,
Yes Yes Yes Yes and Allied
Airways,Chest Drains, Blood Transfusion sets,
ward in
Gloves, proctoscopes, Naso-Gastric Tubes,
quantities
ascertained
by need
16. Orthpaedic ward
Fracture bed with frame beam and pulley, Yes Yes Yes No
Though
there is no
Orthopaedi
c ward in
POP cutter, Yes Yes Yes Yes CAT D
hospital,
POP cutter
should be
available in

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[Link] Infrastructure and equipment CAT-A CAT-B CAT-C CAT-D Remarks

Surgical
ward
17. ENT ward
All items to
Rechargeable Autoscope self- illuminating,
be
ENT dressing,
available in
Nasal polypus complete set, Head light
ENT ward
electric, Diagnostic Set ENT, Yes Yes Yes No
in
Tracheotomy set, Minor procedure room: Light
quantities
source, items for nasal packing/ ear packing
ascertained
and foreign body ear/nose.
by need
18. EYE ward
All items to
be
Direct Ophthalmoscope & retinoscope with
available in
charger, Refraction box,Boiler, Eye dressing
ENT ward
instruments,Torches, Vision drum, Yes Yes Yes No
in
Perkin tonometer, Desktop computer with UPS
quantities
for data entry, Laptop & overhead projector
ascertained
by need
19. Mother and Child ward
Ultrasound, Butter fly various sizes
Paediatric urinary catheters, Intensive baby
incubator, Oxygen tent paediatric, , BP
Apparatus with small cuff, Phototherapy
machine, Stethoscope paediatrics, Infant
Warmer, Gynae Table, Stethoscopes foetal
(aluminium), Gynae examination kit, Female
metal catheter F201, F 203, F204, F28,
Ultrasound machine, Nebulizers, Suction
Machines- Neonatal, Pediatric;
Ophthalmoscope;
Neonatal/Pediatric Laryngoscopes with straight
and Curved blades;
Different sizes endotracheal tubes (premature,
term, neonatal, Child), Auroscopes
Paediatric resuscitation unit Yes Yes No No
Incubators Yes Yes No No
Oxygen Concentrators Yes Yes No No
Cardiac Monitors/DC Cardioversion, Yes Yes No No
Infusion pumps Yes Yes No No
20. Psychiatry ward
Wechsler intelligence test with key
adult/Children, Progressive matrices with key,
Wilconsin cord sorting test with key, Yes Yes No No
International personality disorder examination -
full version with interpretation
21. CCU/ICU Yes Yes Yes No
10% of total bed strength of the facility with
Yes Yes Yes No
monitors
3 for CAT
A, 2 for
Ventilator Yes Yes No No
CAT B
hospital

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[Link] Infrastructure and equipment CAT-A CAT-B CAT-C CAT-D Remarks

4 for CAT A
and 2 for
Temporary Pace Maker Yes Yes No No
CAT B
hospital
22. Operation Rooms (ORs)
Infrastructure
Anaesthetist office with bath room,
Anaesthesia technicians changing room with
bath room, Nursing staff changing room with
bath room, Pre-med room, central Sterilization Yes Yes Yes Yes
room (for the whole hospital), Scrub room,
Recovery room, Patient pre-operative, waiting
room
4 for CAT
A, 3 for
CAT B, 2
Operation Rooms with H-VEC facility Yes Yes Yes Yes for CAT C
and 1 for
CAT D
hospital
Operation Rooms (ORs) Equipment
General Provision
Stethoscope, Stethoscope Paediatric,
BP Apparatus mercury stand type,
Instrument tray/Kidney tray/Bowls,
Laryngoscope adult straight & curved,
Laryngoscope paediatric straight & curved,
Meigle forceps, Diathermy with appliances,
Catheter, Miscellaneous instruments sets,
Nitrous oxide cylinder, Oxygen cylinder with
trolley stand, Oxygen flow meter with
humidifier, Oxygen flow meter without Each item
humidifier, Oxygen masks all sizes, SS Basin should be
with stand, available in
SS Urinals/Bed pans,Sterilizing drums, each OR in
Yes Yes Yes Yes
Tracheotomy set, Wt. machine adult, Wt. quantities
machine children, X-ray illuminator double wall ascertained
type, Anaesthesia machine, Automatic by OR
operation table, Defibrillator on trolley, size/need
Electric water cooler, Heavy duty suction
machine, Infusion pumps,
Light duty nebulizer, Mobile OT light with
battery,Operation table hydraulic
semiautomatic, OT ceiling light LED type with
satellite and backup power supply, Pulse
oximeter, Refrigerator 12 cb. Ft., Resuscitation
unit, FineDiathermy, NIBP (Non Invasive
Monitors Devices)
Mobile x-ray 30 Yes Yes Yes No
Craniotomy set with pneumatic drill with air Yes Yes No No
Sterilization room:
Autoclave vertical automatic, Autoclave
Yes Yes Yes Yes
horizontal Hot air oven
Specialty dependent ORs equipment
23. General Surgery

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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

[Link] Infrastructure and equipment CAT-A CAT-B CAT-C CAT-D Remarks

General Surgery Set, Vascular Repair Set,
Proctoscope electric (set), Sigmoidoscope
(fibroptic),Paediatric surgery minor, Paediatric Yes Yes Yes Yes
surgery major, General surgery sets major,
General surgery sets minor
24. Eye
Operation Theatre
Binocular loup(2.5 x), Operating
microscope,Phacoemulsifier, Bipolar cautery,
Autoclave, Hot air oven,
Boiler, OT tables-2, Cataract sets-4,
DCR sets-2,Glaucoma sets-2, Squint sets-2, Yes Yes Yes No
Entropion/ectropion sets-2,
Chalasion sets-2, Instrument trolleys- 6,drums-
4, Cheital foreceps with container-2, Desktop
computer with UPS for data entry
25. ENT
Binocular Operating microscope, loops, Head
Yes Yes Yes No
light, ENT surgery instruments major
26. Gynae
Gynaecology Sets,Delivery set normal,
Obstructed labour set,Obstetric surgery set Yes Yes Yes Yes
minor, Obstetric surgery set major, E&C set
27. Orthopaedic
Orthopaedic Sets, Set for plating, Orthopaedic
surgery set, Orthopaedic Operation Table with
Traction,
Yes Yes Yes No
Bone drill, 3.5 mm Ortho Set,
4.5 mm Ortho Set, DHS Set, Vascular Repair
Set, Pneumatic Tourniquets,
28. Labor room
Infrastructure
Doctors duty room with bath room, Doctors
changing room,Nurses changing room with
bath room, rooms for patient with a bath room Yes Yes Yes No
and Delivery tables,Baby warmer, Wheel chair,
Stretcher
Intensive Baby Incubator Yes Yes No No
Equipment
Nitrous oxide Cylinder, Nitrous oxide cylinder
flow meter, Stethoscope, BP apparatus stand
type, Measuring tap,
Torch, Cotton wool, weighing
machine,examination gloves,Portable
Defibrillator with ECG monitor,Resuscitation
unit, Ambu bag, Endotracheal tubes various
sizes, Nursing station, Pulse oxymeter,
Glucometer, Foleys urinary catheter, Yes Yes No No
I.V cannula various sizes, Drip stands
Instrument tray/Kidney tray/Bowls, Oxygen
cylinder with trolley stand, Oxygen flow meter
with humidifier, Oxygen flow meter without
humidifier,
Oxygen masks all sizes, Electric water cooler
with filter, Heavy duty suction machine,Light
duty nebuliser, Light duty suction units,
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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

[Link] Infrastructure and equipment CAT-A CAT-B CAT-C CAT-D Remarks

Refrigerator 12 cf. ft., X-ray illuminator double
wall type,
Sterilizing drums, Meigle forceps, Portable
emergency light with battery backup, Delivery
set normal, Obstructed labour set, Mobile OT
Light, Vacuum Extractor, CTG Machine,
Sonic/Doppler Sonic aid,
DNC Set, Infant Trolley with Warmer,
Infant Sucker Machine,Female metal catheter
F201, F203, F204, F28, Stethoscopes foetal
(aluminium), Hysteroscope
29. A&E
Infrastructure
Doctor duty room with bath room, Nursing
dressing room with a bath room, Patients
waiting area, Patient short term stay area, Day Yes Yes Yes Yes
care facility (monitored care for upto 12 hours
by house staff), Minor procedure room
Equipment
Emergency assessment:
Stethoscope, BP apparatus stand type,
Tendon hammer, Measuring tap,
Torch, Cotton wool, Spatula, Tuning fork 128
cycles/second,weighing machine, examination
gloves, ophthalmoscope, Portable Defibrillator
with ECG monitor, Resuscitation unit, Ambu
bag, Endotracheal tubes various sizes,Nursing
station,Pulse
oxymeter,Glucometer,Nasogastric
tubes,Foleys/Celestic urinary catheter,I.V
cannula various sizes, Central line,
Drip stands,Instrument tray/Kidney
tray/Bowls,Laryngoscope adult straight &
curved,Oxygen cylinder with trolley stand,
Oxygen flowmeter with humidifier, Oxygen flow
Yes Yes Yes Yes
meter without humidifier,Oxygen masks all
sizes, SS urinal/bed pans,Heavy duty suction
machine,Light duty nebuliser,
Light duty suction units,Refrigerator 12 cf.
ft.,Spirometer,ray illuminator double wall
type,X-ray illuminator double table
type,Sterilizing drums,
Meigle forceps, Instrument tray/Kidney
tray/Bowls, Portable emergency light with
battery backup,General Surgery Dressing
Instruments Sets,Electric water cooler with
filter, Glucometer,Oxygen tent, TV 28
Inch,Nitrous oxide cylinder 240 cft., Nitrous
oxide cylinder flow meter, Desktop computer
with UPS and printer
4 for CAT
A, 2 for
CAT B, 1
ECG monitored beds Yes Yes Yes Yes each for
CAT C and
CAT D
hospital
X-Ray Unit 500-MA with accessories (mobile), Yes Yes Yes No

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[Link] Infrastructure and equipment CAT-A CAT-B CAT-C CAT-D Remarks

Emergency OR/Minor procedure room:
Autoclave horizontal, ECG machine,
Diathermy, Mobile OT light, Operation table Yes Yes Yes Yes
hydraulic, OT ceiling light with satellite
Cardiac monitor with defibrillator on trolley Yes Yes Yes No
30. Support Services
Electric Water Cooler, Stretchers, wheel chairs Yes Yes Yes Yes
31. Laboratory
Refrigerator 12 cb. Ft., Spectrophotometer with
U/V,LPG cylinder with burner, Microscope
binocular electric, Urine analyser,
Haematology [Link] (Large),
Fed 20 for ESR, Finn Pipette-(Jouster) 05-----
100mq/L,Finn Pipette-(Jouster) 100-----
1000mq/L, Finn Pipette-(Jouster) 0.05-----
20mq/L, Haemoglobin meter (sahli),Urinometer
with glass cylinder for specific gravity, Sprit
lamp,
Yes Yes Yes Yes
Haemocytometer (complete), Aseptic hood,
Autoclave vertical automatic,
Automatic lab, Pipettes set, Blood analyser,
Blood bank refrigerator,
Blood gas analyser, Centrifuge machine, Blood
Chemistry Analyser,
Lab. Incubator, Lab. Weight Machine/Digital
Scale, Glucometer,
Hot Air Oven, Desktop computer with UPS and
printer
32. Radiology
CT scan Yes No No No
Colour doppler/Ultrasound Machine, Yes Yes No No
Radiation densitometer,X-Ray Cassettes all
sizes, Lead gowns,
Gloves, Goggles,
Shield set,Hangers x-ray, Ultrasound Machine
Yes Yes Yes Yes
with double probe (vaginal and abdominal), X-
Ray Illuminator double wall type, X-Ray
Illuminator double table type, Desktop
computer with UPS and printer
33. Pharmacy
Maintenance of stock and inventory, Drugs
mentioned in formulary, Refrigerator 12 cb. Yes Yes Yes Yes
Ft,Desktop computer with UPS and printer
IT Services
34. Computerization of hospital services, Yes Yes Yes Yes
Computers and networking items
Transportat
ion and
Safe Waste disposal disposal at
35. Yes Yes Yes Yes
Collection and segregation at the facility incinerator
at CAT A
hospital
Mortuary
36. Electric skull cutter, Mortuary table, Name Yes No No No
plates, Mortuary instruments sets

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[Link] Infrastructure and equipment CAT-A CAT-B CAT-C CAT-D Remarks

Laundry
37. Yes Yes Yes Yes
Washer, dryer
Canteen
38. Food available for patients, personnel and Yes Yes Yes Yes
attendants
39. Administration Block
Infrastructure
Office Medical Superintendent, Office for
DMSs , Chief Nursing Nuperidendant, Deputy
Nursing superintendent, Office Superintendent
with Sr and Jr clerk, Yes Yes Yes Yes
IT office,All offices including A&E, consultant
offices and ORs, connected through internal
telephone from internal exchange
Equipment
Computer Desktop with UPS and Printer,
Scanner, Sound system with speakers to cover
all essential areas for internal announcement,
DVD Player connected to TV in OPD, A&E,
wards and ORs for patient education on
common illnesses with emphasis on primary
Yes Yes Yes Yes
and secondary prevention,Close Circuit TV
System,
Laptop, Multimedia with overhead project &
screen, Electric Water Cooler with filter,
Refrigerator 12 cu ft,
TV LCD 46 inches, Photocopier
To be
available in
40. Sets of basic gardening equipment Yes Yes Yes Yes
quantities
as per need
To be
available in
41. Fire extinguishers Yes Yes Yes Yes
quantities
as per need
To be
available in
42. Stretcher trolley Yes Yes Yes Yes
quantities
as per need
To be
available in
43. Wheel chairs Yes Yes Yes Yes
quantities
as per need

3 List of Medicines prepared by (MCC), 2015-16, Govt. of Khyber

Pakhtunkhwa
ANAESTHETICS
S.N
NameofMedicine
o
1. Isofluraneliquidforinhalation
2. Sevofluraneliquidforinhalation
3. [Link] 10mg/ml
4. Inj.BupivacaineSpinal7.5%
5. Inj.Lignocaine2%
6. Sol: Lignocaine4%
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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

7. [Link]+ Adrenaline
8. InjGlycopyrolate
9. Inj.AtracuriurnBesylate30mg
10. [Link] 50mg
ANTI-HISTAMINES
S.
NameofMedicine
No
11. Tab.Cetirizine10mg
12. [Link] 5 mg/5ml
13. TabChlorpheniramine4mg
ANTI-INFECTIVES
S.
NameofMedicine
No
14. CapAmoxicillin250 mg
15. CapAmoxicillin500 mg
16. Susp Amoxicillin 125 mg/5 ml
17. Susp Amoxicillin 250 mg/5 ml
18. TabAmoxicillin+ ClavulanicAcid 375 mg
19. TabAmoxicillin+ ClavulanicAcid 625 mg
20. TabAmoxicillin+ ClavulanicAcid1gm.
21. [Link]+ ClavulanicAcid 125 mg+31.5mg/5 ml
22. InjAmoxicillin+ ClavulanicAcid 1.2 gm
23. Cap:Cephradine500mg
24. Inj:Cephradine1gm
25. Inj:Cefotaxime Sodium500mg
26. Inj:Cefotaxime Sodium1gm
27. Inj:Ceftriaxone500mg
28. Inj:Ceftriaxone1gm
29. Inj:Ceftriaxone2gm
30. InjCeftazidime500mg
31. InjCeftazidime 1 gm
32. CapCefixim400 mg
33. Susp.Cefixim100 mg/5ml
34. Susp. Cefixim200 mg/5ml
35. InjCefoperazone+ Salbactum1gm
36. InjCefoperazone+ Salbactum2gm
37. Cap.Doxycycline100mg
38. [Link] 80mg
39. InjAmikacinSulphate100mg
40. InjAmikacinSulphate500mg
41. Tab:Clarithromycin250mg
42. Tab:Clarithromycin500mg
43. Syp:Clarithromycin
44. CapAzithromycin250mg
45. TabAzithromycin500mg,
46. Syp:Azithromycin200mg,
47. Tab:Co-Trimoxazole80 mg+ 400 mg
48. Tab:Co-Trimoxazole160 mg+ 800 mg
49. Susp Co-Trimoxazole40 mg+ 200 mg/5ml
50. Susp Co-Trimoxazole80 mg+400 mg/5ml
51. Tab:Ciprofloxacin500mg
52. Tab:Ciprofloxacin500mg
53. Inf:Ciprofloxacin100ml
54. Cap:Levofloxacin250mg
55. Cap:Levofloxacin500mg
56. Inf:Levofloxacin100ml
57. Inj:Vancomycin500mg
58. Inj:Vancomycin 1gm
[Link] +Tazobactam
59.
4.5 gm
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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

60. Tab:Rifampicin + INH 150 mg + 75 mg

61. Tab:Rifampicin + INH+ Ethambutol (150 mg + 75 mg + 300mg)
62. Tab:Rifampicin + INH+ Pyrazinamide + Ethambutol(150mg + 75 mg + 400 mg + 275 mg)
ANTI-FUNGALS/ANTI-VIRALS
S.
NameofMedicine
No
63. CapFluconazole50mg
64. CapFluconazole150mg
65. NystatinOralDrops
66. TabClotrimazole 500 mgVaginal+ Applicator
Clotrimazole 1%VaginalCream
67.
+ Applicator
68. TabAcyclovir200mg
69. Inj.Acyclovir250mg
70. AcyclovirCream
71. Tab Entacavir0.5mg
72. Tab:Telbivudine600mg
ANTI-MALARIALS
S.N
NameofMedicine
o
73. Tab:Artemether + LumefantarineTablets(40mg+ 240mg)
74. Sulphadoxine+ Pyrimethamine(500 mg+ 25mg) Susp
75. Tab:AmodiaquineBase150mg
AMOEBICIDES
S.N
NameofMedicine
o
76. Tab.Metronidazole400mg
77. Susp Metronidazole200 mg/5 ml
78. Inf:Metronidazole100ml
ANTHELMINTICS
S.N
NameofMedicine
o
79. Tab:Albendazole 200 mg
80. Susp: Albendazole100mg /5 ml
BLOOD FORMATION / COAGULANTS / ANTICOAGULANTS & ANTI ANAEMIC
S.N
NameofMedicine
o
81. TabFerrousSulphate +Vit. C+[Link] + FolicAcid
82. Syp. FerrousSulphate +Vit. C+[Link] + FolicAcid
83. InjHeparinSodium5000 i.u
84. Inj:Enoxaparin40mg
85. Inj:Enoxaparin60mg
86. Inj:Enoxaparin80mg
87. Tab:warfarinsodium1mg
88. Cap.TranexaminicAcid250mg
89. Cap.TranexaminicAcid500mg
90. InjTranexaminicAcid250mg
ANTIDOTES
S.N
NameofMedicine
o
91. Inj:Neostigmine2.5mg
92. Inj.Desferoxamine500mg
93. TabDeferasirox100mg
94. TabDeferasirox400mg
CARDIOVASCULAR
S.N
NameofMedicine
o
95. TabAtenolol50 mg
96. TabAtenolol100 mg
97. TabBisoprolol 5mg

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98. TabCaptopril25mg
99. TabLisinopril5 mg
100. TabLisinopril10mg
101. TabVerapamil80mg
102. Tab:AmlodipineBesylate5mg
103. CapGlycerylTrinitrate 2.6mg
104. Tab.IsosorbideMononitrate20mg
105. InjIsosorbideDiNitrate
106. TabAmiodaroneHCl200mg.
107. Inj:AmiodaroneHCl200mg.
108. Inj.DobutamineHCl250 mg
109. Inj:DopamineHCI200mg
110. Inj.Streptokinase1.5miu
111. Resovuastatin10mgTab
112. TabFurosemide20 mg
113. TabFurosemide40 mg
114. InjFurosemide 10 mg
115. Tab:Spironolactone100mg
116. InjNitoprusside50mg
117. TabValsartan80mg
PSYCHOTHERAPEUTICS
S.N
NameofMedicine
o
118. Tab.Bromazepam3mg
119. TabAlprazolam0.5 mg
120. InjMidazolam5 mg
121. Inj.FluphenazineDecanoate25 mg
122. Tab.Haloperidol5 mg
123. TabAmitriptylineHCl25mg
124. Tab.DothiepinHCl25mg
125. FluoxetineHCl20mgCap
126. TabClozapine25mg,
127. TabClozapine100mg,
128. TabEscitalopram10 mg
129. Tab.Risperidone2mg
130. [Link]
131. Tab.Lamotrigine50 mg
ANALGESICS&ANTIPYRETICS
S.N
NameofMedicine
o
132. Tab AcetylSalicylic Acid75 mg
133. Tab AcetylSalicylic Acid300 mg
134. Tab:Diclofenic50mg
135. Inj:Diclofenic75mg
136. TabIbuprofen400mg
137. Susp Ibuprofen100 mg/5 ml
138. TabMefenamic Acid 250mg
139. TabMefenamic Acid 500mg
140. Inj.NalbuphineHCl20 mg
141. TabParacetamol500 mg
142. Syp:Paracetamol120mg/5ml
143. InjParacetamol2ml
144. InjTramadolHCI
145. InjKatorolac30mg
ANTICONVULSANTS
S.N
NameofMedicine
o
146. TabCarbamazepine 200 mg
147. SypCarbamazepine
148. TabDivalporexSodium250 mg
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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

149. TabDivalporexSodium500 mg
150. Syp:DivalporexSodium
ENT PREPARATIONS
S.N
NameofMedicine
o
152. Betamethasone + NeomycinDrops
153. Betamethasone + NeomycinOintment
154. NasalDropsXylometazolineHCl0.05%
DRUGSACTINGON ENDOCRINESYSTEM
S.N
NameofMedicine
o
155. Tab Glibenclamide5 mg
156. TabMetforminHCl500mg
157. Tab:Glimipride2mg
158. InsulinRegular(Human)100 IUvial
159. Insulin Premixed (Human)30/70 100IUvial
160. InjHydrocortisone100mg
161. InjHydrocortisone250mg
162. Inj.Dexamethasone4mg
I.V FLUIDS AND ELECTROLYTES
S.N
NameofMedicine
o
163. Inj. SodiumBicarbonate0.7%ivSolution20ml
164. Inj.PotassiumChloride7.4%ivsolution20ml
165. NormalSaline0.9%100ml
166. NormalSaline0.9%500ml
167. NormalSaline0.9%1000ml
168. Dextrose5%100ml
169. Dextrose5%500ml
170. Dextrose5%1000ml
171. Dextrose +Saline5% 500ml
172. Dextrose +Saline5% 1000ml
173. RingerLactate500ml
174. RingerLactate1000ml
175. RingerLactate + Dextrose500ml
176. RingerLactate + Dextrose1000ml
177. Dextrose5% + 0.45%NaCl500ml
178. Dextrose4.3%+NaCl0.18%500ml
179. InfusionMannitol20%
180. GelatinPolypeptide500ml
181. AminoAcidsInfusion5%+10%
182. Sterilewaterforinjection5ml
183. Dextrose25%20ml
184. Glycine1.5%InfusionwithTSDset
185. OralRe-hydrationSalt.(ORS)
GASTROINTESTINALDRUGS
S.N
NameofMedicine
o
186. AluminiumHydroxide+MagnesiumHydroxide+SemithiconeSusp:
187. AluminiumHydroxide+MagnesiumHydroxide+SemithiconeSusp:
188. TabDimenhydrinate50mg
189. Inj:Dimenhydrinate
190. SypDimenhydrinate
191. Inj:MetoclopramideHCL10mg
192. [Link] 10 mg
193. InjRanitidineHCl
194. Cap:Omeprazole20mg
195. Inj.Omeprazole40mg
196. TabDrotavarineHcl40mg
197. InjDrotravarineHcl40mg
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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

198. InjOctreotied0.1mg
199. InjTerlipressin1mg
IMMUNOLOGICALS / IMMUNOMODULATORS
S.N
NameofMedicine
o
200 Inj:RabiesImmunoglobulin
[Link]
201 (Supplyorderis subjecttoNOCfromNIHIslamabadregardingnon-availabilityofvaccine)

202 Inj Anti – Venom Sera

203 Inj Hepatitis B Vaccine. 20 mcg with DRAP registered disposable syringe
204 [Link]
Inj.PegylatedInterferon180mcg,40Kda+Cap/TabRibavarin400mg+withDRAPregistereddispos
205 ablesyringe3CC (Package rate).

[Link].-D (Rho)
206
Immunoglobulin
OPHTHALMIC PREPARATIONS
S.N
NameofMedicine
o
207. Eye Drops Chloramphenicol0.5
208. Eye Drops Ciprofloxacin0.3%
209. Eye Drops Dexamethasone1%
210. Eye Drops PilocarpineHCL 2 %
211. [Link]
0.5%
212. Eye DropsTropicamide 1%
213. Eye dropTobramycin
214. Eye dropTobramycin + Dexa
215. Eye OintPolymixin + Zinc
Bacitracin
216. Eye OintAcyclovir
217. Eye Drop Polymixin +Neomycine+Dexamethasone
DRUGSUSED IN RESPIRATORYDISORDERS
S.N
NameofMedicine
o
218. TabSalbutamol4mg
219. SolutionSalbutamol
220. Salbutamol100 mcg/doseaerosol
Spray/[Link]
221.
+ Salbutamol
222. SypAcefyline
TOPICAL PREPARATIONS
S.N
NameofMedicine
o
Polymyxin + ZincBacitracin
223
SkinOintment
224. SilverSulphadiazine1%CreamJar pack
225. Clotrimazole 1% Cream
226. Betamethasone0.1%Ointment15gm
227. Betamethasone0.1%Cream:15gm
228. Betamethasone +GentamicinOintment
229. LignocaineHClGel2%
230. PermethrineCream5% w/w
231. PermethrineLotion 5% w/w
DISINFECTANTS&ANTISEPTICS
S.N
NameofMedicine
o
232. SolutionPovidone-Iodine60ml10%
233. SolutionPovidone-Iodine450ml10%
234. Scrub Povidone-Iodine7.5%60ml
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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

235. Scrub Povidone-Iodine7.5%450ml

236. SolutionChloroxylenol4.8%
VITAMINS /MINERALS
S.N
NameofMedicine
o
237. [Link]-Complex
238. SypVitaminB-Complex
239. TabPyridoxineHCl50 mg
240. TabAscorbicAcid 550 mg
241. TabCalciumCarbonate
MISCELLANEOUSTHERAPEUTICAGENTS
S.N
NameofMedicine
o
242. InjOxytocin 5i.u
243. Tab.Misoprostol200mcg
244. Megulminediatrizoate
245. IopromideInj300/370mg
246. TabAlfacalcidol0.5 mcg /ml
247. [Link]
248. [Link]
249. Inj. Methoxy PolyvthleneGlycol-Epoetinbeta
250. SolutionHemodialysis
251. Tab:MycophenolateSodium180mg
252. Tab:MycophenolateSodium360mg
253. Tab:MycophenolateMofetil500mg
254. Cap:Cyclosporine25mg
255. Cap:Cyclosporine100mg
256. Inj:Basiliximab
257. Tab:Everolimus
SURGICAL DISPOSABLES
S.N
NameofMedicine
o
1. Adhesive Tapes (paper/plastic) Non woven surgical tape
2. AdhesivesurgicaltapePE
3. Zinc Oxide AdhesivePlasterdifferentsizes
4. CottonBandages(Surgical)
5. CottonBandages(Surgical)
6. CottonBandages(Surgical)
7. Absorbent Cotton Wool100 gm
8. Absorbent Cotton Wool200 gm
Absorbent Cotton
9.
Wool200 gm
Absorbent Cotton
10.
Wool400 gm
Absorbent Cotton
11.
Wool400 gm
12. CrepeBandages
13. Gauze Cloth Roll
14. Gauze Cloth Roll
15. Medicated DressingDifferentSizes
16. KnittedparaffinGauzewith5% Chlorohexidine(Differentsizesroll)
17. KnittedparaffinGauzewith5% Chlorohexidine(Differentsizesroll)
18. 1CC Disposable Syringeblisterpack(Regular)
19. Insulin 1CC Disposable Syringe blister pack
20. 3CC Disposable Syringe blister pack
21. 5CC Disposable Syringe blister pack
22. 10CC Disposable Syringe blister pack
23. 20CC Disposable Syringe blister pack
24. 50CC Disposable Syringes blister pack
25. 60CC Disposable Syringes blister pack

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26. Foleys Catheter (Plain & Silicon) Different Sizes.

27. [Link] DifferentSizes
28. [Link](Sterilized)blister pack
29. POPBandagesDifferentSizes
30. UrineBag
Spinal needle 23 & 24 (Disposable)
31.
(with and without introducer)
32. Surgical Blade
33. Surgical GlovesSterilized
34. X-rayfilm
39. Autodeveloper20 litre
40. Autofixer20litre
41. X-rayfilms
42. Manualdeveloper
43. Manualfixer
44. MamographyHDR/ADM
45. MamographyADM
SUTURE MATERIAL
CHROMICCATGUT
46. 20mm½ CRB Needle 4/0
47. 20mm½ CRB Needle 3/0
48. 25mm½ CRB Needle 2/0
49. 30mm½ CRB Needle 2/0
50. 30mm½ CRB Needle 0
51. 30mm½ CRB Needle 1
52. 40mm½ CRB Needle 2
53. 40mm½ CRB Needle 0
54. 40mm½ CRB Needle 1
S.N
BLACKBRAIDED SILK
o
55. 16mm½ CRB Needle 4/0
56. 16mm3/8 cuttingcurved4/0
57. 24mm3/8 CRVCutting4/0
58. 30mm½ CRB Needle 3/0
59. 16mm½ RB Needle(Noncutting)3/0
60. 26mm3/8 rev:Cutting2/0
61. 30mm½ RB Needle(Reversecutting) 2/0
62. 30mmcuttingneedle(RB)0
63. 30mm½ RB Needle 0
64. 25mm½ Curvedcutting0
65. 30mm½ CRB Needle 1
66. 30mm½ Curvedcutting1
67. 30mmcuttingneedle ½ RB1
68. 40mm½ RB Needle 1
69. 40mm½ RB Cutting1
70. 40mm½ CRB Needle 2
S.N
POLYGLYCOLIC
o.
71. PolyglyctinBraidedwithDoubleNeedle 6/0
72. 17mm½ CRB5/0
73. 16mm3/8 cuttingRB 4/0
74. 20mm½ round body4/0
75. 16mmCuttingRB 4/0
76. 17mmnon cutting4/0
77. 16mm3/8 cuttingRB 3/0
78. 20mm½ round bodynoncutting3/0
79. 26mm3/8 rev:C 2/0
80. 30mm½ round bodynoncutting2/0
81. 30mm½ CRB 2/0
82. 35mmtaper cut½C 90cm2/0
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Minimum Health Services Delivery Package for Secondary Care Khyber Pakhtunkhwa

83. 48mm½ RB non cutting2

84. 45mm½ round bodynoncutting2
85. 30mm½ round bodynoncutting1
86. 40mm½ round bodynoncutting1
87. 30mm½ round bodynoncutting0
88. 40mm½ CRBnon cutting0
89. 40mm½ CRB Needle 1
90. 35mmtaper cut½ C 90cm1
S.N
POLYGLYCOLIC
o.
91. 2x8mm½ CRB8/0
92. 8mm3/8 fine double6/0
93. 12mm3/8rev:cutting6/0
94. 13mm½ CRB fine double5/0
95. PolypropylenewithDoubleNeedle,RB db end5/0
96. 15mmCC fine 5/0
97. 16mm½ CRB double
98. 15mmCC fine 4/0
99. 16mm½ CRB doubleended 4/0
100. 19mmcuttingcurved4/0
101. 17mmRBDoubleended3/0
102. 19mmcuttingcurved3/0
103. 24mm3/8 CR Cuttingcurved3/0
104. 24mmcuttingcurved3/0
105. 16mmCC 3/0
106. 25mm½ CRB Db ended3/0
107. 26mmRB double ended3/0
108. 30mm½ RB2/0
109. 25mm½ RB 2/0
110. 75mm3/8 Rev:C2/0
111. 25mmtaper cut2/0
112. 75mmSTCuttingNeedle2/0
113. 75mmSt Ct 2/0
114. 36mm3/8 C RvCutting0
115. 30mm½ RB 0
116. 30mm½ RB 1
117. 40mm½ RB1
118. 30mm½ CRB1
POLYPROPYLENE MESH
S.
Size
No
119. 30cmx 30cm
120. 6cmx 11cm
121. 15 cmx 15cm
STEEL WIRE
S.
Size
No
122. 48mm½ TrocarPointHeavy5
BONE WAX
S.
Size
No
123. Bone wax

Page 75 of 56