The Health Department is providing curative services through Civil Hospital, THQ Hospitals, Rural Health Centres, Basic Health Units, Rural Dispensaries, City Medical Centres and MCH Centres. The staff of these health facilities are well trained and they have full skill in their responsibilities. These health facilities are providing primary & secondary level care facilities. The tertiary level care, undergraduate & post graduate medical education is being provided by Nishtar Medical College & Hospital, which is an autonomous medical institution. The Multan Institute of Cardiology and Children Hospital Complex are also autonomous Hospitals and providing specialized care to the needy people.
1. EXPANDED PROGRAMME ON IMMUNIZATION (EPI)
For the programme, multi purpose health workers in the rural as well as urban areas are serving in the District. The immunization services are provided through both static and outreach teams throughout the district. The main function of these teams is to immunize the children against 9 fetal diseases i.e. Diphtheria, Whooping Cough, Tetanus, Polio, Measles, Tuberculosis and Hepatitis-B and Child Bearing Age Women against Tetnus Oxide. The vaccination coverage report is given as follow:
Immunization Schedule for Children
Immunization Schedule for
Child Bearing Age Women
BCG & OPV Zero
At first contact or as early as possible during pregnancy
(during the 1st Trimester)
At 6 Weeks
OPV 1, Penta 1
At least 4 weeks after TT-1
At 10 Weeks
OPV 2, Penta 2
At least 6 months after TT-2
(in 2nd Pregnancy)
AT 14 Weeks
OPV 3, Penta 3
At least one year after TT-3
(in 3rd Pregnancy)
At 9 Months
At 15 Months
Measles - 1st
Measles - 2nd
At least one year after TT-4
(in 4th Pregnancy)
2. COMMUNICABLE DISEASE CONTROL PROGRAMME
Presently communicable disease control cell is focusing on malaria control programme in the district.
MALARIA CONTROL PROGRAMME
- Malaria kills a child every 40 seconds, globally.
- Malaria kills over one million people globally each year and the majority of the victims are children.
- Almost 300 million people suffer globally from acute malaria each year.
- With acute disease a child may die within 24 hours without prompt and effective treatment.
- In endemic areas women are more likely to have malaria during pregnancy, which can leads to severe anaemia and a high risk of death.
- Infants born to mothers with malaria are more likely to have low birth weight, which is the single greatest risk of death during the month of life.
- Health systems’ failure, during resistance, people movement, deteriorating sanitation, climatic changes and unplanned development activates are contributing to the spread of malaria.
- Prompt and effective treatment of suspected malaria fever cases can significantly reduce malaria death.
TYPES OF MALARIA
Malaria is a common and serious disease. It is a protozoal infection transmitted to human beings by infected female mosquito bite mainly between sunset and sunrise.
The classic clinical course of malaria consists of bouts of fever accompanied by other symptoms and alternating with period of freedom from any feeling of illness. At the beginning of the disease, headache, malaise, fatigue, nausea, muscular pains, slight diarrhea and slight increase of body temperature are symptoms, often mistaken for influenza or a gastro-intestinal infection.
Complicated (severe) Malaria
Falciparum malaria, if not treated promptly, can progress into the sever form of the disease. This occurs mostly in young children and pregnant women. This result in organ failure, delirium, impaired consciousness and generalized convulsions, followed by persistent coma and death.
SINGS & SYMPTOMS OF SEVERE MALARIA
History of fever plus at least one of the following:
- Prostration (inability to sit) .
- Altered consciousness.
- Lethargy or coma.
- Breathing difficulties.
- Sever anaemia.
- Convulsions followed.
- By unconsciousness,
- Inability to drink.
For adults, the same sings and symptoms are valid, with the addition of:
- Dark and /or limited production of urine.
In Multan district Communicable Disease Control Supervisors are working at union council level for the control of malaria. A blood slide of every patient with fever or fever history is prepared and sent to nearby Government CDC laboratory for examination to diagnose the malaria cases. If any slide is found positive for malaria then immediate radical treatment is given to the patient through concerned CDC Supervisor. Furthermore, epidemiological contact survey is also conducted for screening of malaria cases. If more cases are found from same area then mass blood survey is conducted to give 100% coverage to the whole population of that area.
3. DISTRICT QUALITY CONTROL BOARD (DQCB)
After devolution the Provincial Health Department established the DQCBs in May 2002. DQCB Multan started its working in August 2002. The main functions of the DQCB are to scrutinize the cases of violation of Drugs Act. Issue necessary advice to Drug Inspectors including warning, prosecution and launching of F.I.Rs except the cases of Ministry of Health licensed manufacturers and cases of spurious drugs including Drug Testing Laboratory Reports.
4. DRUG BRANCH
The main function of the drug branch is to ensure the availability and sale of quality drugs in the District.
Activities of the Drug Inspectors
- To inspect all establishments of drugs licensed for sale and all establishments licensed of manufactures of drugs within the area assigned to him and to keep record of such inspections.
- To satisfy himself that the conditions of the licenses are being observed.
- To take and send for test or analysis, samples of any drug from Drug Testing Laboratory.
- To investigate any complaint in writing which may be made to him from the licensing authority?
- To institute prosecution in respect of contraventions of the act and these rules in Drug Court.
- To make such inquires and inspections as may be necessary to stop manufacture and sale of drug in contravention of the act and rules framed there under.
- To inspect all premises licensed under the act and these rules before renewal of such licenses.
Type of licenses to sell drugs
- License to sell drugs by way of retail sale
- License to sell drugs by way of wholesale
- License to sell narcotics and other controlled drugs
- License for pharmacy
FORMS OF LICENSES TO SELL DRUGS
- A license to sell store, exhibit for the distribute drugs by way of retail sale shall be issued in Form9.
- A license to sell store, exhibit for the distribute drugs by way of wholesale sale shall be issued in Form10.
- A license to sell store, exhibit for the distribute narcotics, and other controlled drugs shall be in Form11.
- A license to sell drugs in pharmacy shall be in Form12.
PROCEDURE FOR GRANT OF NEW DRUG SALE LICENSE
Application for the grant or renewal of license referred to in clauses (i) to (iv) of rule 15 shall be made in Form-8 to the licensing authority.
- An application under sub rule (1) shall be accompanied by a fee in Head of account “125200 –Health, 125880 other receipts” on challan Form No. 32 in National Bank of Pakistan duly signed by the licensing authority before depositing to the National Bank of Pakistan.
- Rs.600/- for each New Drug Sale license, Rs.300/- for renewal of each drug sale license, Rs.50/- for change of qualified person for each drug sale license and Rs.600/- for change of premises for each drug sale license.
- A fee of Rs.50/- shall be paid for duplicate copy of license referred to in clauses (i) to (iv) of rule 15 if the original is defaced, damaged or lost and such copy of the license shall bear the words “ duplicate copy”.
SALE AT MORE THAN ONE PLACE
If drugs are sold, stored, exhibited for sale or distributed at more than one place, a separate license shall be required in respect of each place. (Provided that a Drug Sale License shall not be required for a godown used only for storage of drugs, and which meets the storage conditions and is enlisted alongwith its complete address on the Drug Sale License).
DURATION OF LICENSES:
(1) A license issued under these rules shall unless suspended or cancelled earlier, remain in force for two years from the date of issue and if an application for renewal of such license is not made within one month of its expiry the license shall stand cancelled.
Provided that if an application for renewal of a license is made before the expiry of the period of its validity or where it is not done so for, reasons beyond the control of the license and the application is made within one month of the expiry of the license, the license shall continue to be in force, until orders are passed on the application.
PRE-CONDITION FOR THE ISSUE OF LICENSE:
(1). The Licensing Authority shall not issue:
- Licenses in Forms 9 and 12 unless:-
- the premises have proper and adequate facilities for storage of drugs and for their protection from direct sunlight dust or dirt including refrigeration facilities :
- the premises are clean and in hygienic and tidy condition; and
- in the case of a pharmacy, the requirements laid down in schedule ‘F’.
(2) Licenses in Form 10 unless the applicant is an indentor, importer, manufacturer, distributor or wholesaler of drugs and fulfils the conditions laid down in sub-clause (a) and
(3) License in Form 11 unless:-
(i) the applicant possesses a license in Form 9 or Form 10 or Form 12; and
(ii) the applicant has never been convicted and sentenced to pay Rs.5000 or more as fine under Section 27(1)of the Drugs Act,1976 for selling any spurious or unregistered drugs or for selling drugs without a Drugs Sale License:
Provided that for the purposes of clause 20(a) (i) in remote areas where electricity facilities are not available an Ice Box may be kept instead of a refrigerator.
- The sale of drugs shall be supervised under license in Forms 9,10 and 11 by a person who is registered under section 24(1)(a) & (b) of the Pharmacy Act (XI of 1967) but the sale of drugs under license in Forms 12 shall be supervised by a person who is registered under Section 24(1)(a)of the said Act.
Provided that provisions of this rule for licenses already issued for category “C” holders or wholesale licenses shall come into force after 5 years from the notification of these rules).
CONDITIONS OF LICENCEDS
(1) Licenses in Forms 9, 10, 11 and 12 shall be issued subject to the conditions stated therein and to the following general conditions namely:-
(a) the supply by way of retail sale of any drug shall be recorded suitably and such records, bills or counterfoils shall be preserved for a period of at least five years from the date of such sale; and
(b) drugs specified in Schedules B & D and preparations containing such drug shall not be sold by retail Sale, except on and in accordance with the prescription of a practitioner registered with Pakistan Medical & Dental Council. A prescription shall be dispensed only once, unless or otherwise specifically directed by the prescriber to repeat it:
Provided that no such prescription shall be required for sale of these drugs to a registered medical practitioner, hospital, dispensary or any other institution approved by an order of the licensing authority for such sale.
( c) The sale of any drug specified in schedules B & D by way of retail sale shall be recorded at the time of supply in a register specially maintained for purpose and the serial number of entry in the register shall be entered in the prescription, and the following particulars shall be entered in the register namely:-
- Sr. No.
- Date of sale.
- Name of the prescriber.
- Name of the patient/purchaser.
- Name of the drug.
- Name of the manufacturer.
- Batch No.
- Signature of the qualified person.
Provided that if the drug specified in schedule D is sold on a prescription on which the drug has been sold on a previous occasion, it shall be sufficient if the entry in the register includes S. No. the date of sale, the quantity sold, and a sufficient reference to an entry in the register recording the dispensing of the drug on a previous occasion.
- For the purpose of this rule, a prescription shall:-
- be in writing and be signed by the person giving it with his usual signature and be dated by him;
- specify the name and address of the person for whose treatment it is given; and
- indicate the total quantities of drugs to be supplied and doses to be taken.
- All invoices and bills of purchase of drugs shall be preserved for period of at least five years.
- (a) (i) In case of sale of drugs by way of wholesale by manufacturers or their authorized agents, they must invariably ensure that the purchaser holds a valid Drug Sale License or is a Registered Medical Practitioner and shall issue an invoice and warranty at the time of sale of drugs.
Provided that in case of sale to a Registered Medical Practitioner they must invariably supply a copy of invoice warranty to the Drug Inspector of the area concerned.
- The Registered Medical Practitioners and Doctors of veterinary medicine shall be exempted from the requirement of Drug Sale License for the storage of drugs:
- the drugs are dispensed to their own patients;
- the drugs are not sold across the counter; and
- the record of the drugs specified in scheduled “B” is maintained as prescribed under Rule 21 (1) (C) (Viii) of these Rules.
(b) similarly the wholesaler while selling drug to a retailer must also invariably ensure that the retailer holds a valid Drug Sale License as required under the Act and these rules and shall issue an invoice and warranty at the time of sale of drugs.
(C) the invoice and warranty must bear the full name and address of the purchaser and shall be signed by the warrantor clearly indicating his name and must be dated.
- Records shall be maintained of all purchases and sales of drugs by way of wholesale, and such records shall be preserved for five years and shall include the following particulars namely:-
- the date of purchase and sale.
- the name and address of the concern from which purchased and the concerns to whom sold;
- the names of the drugs, their batch number, their dates of expiry where applicable and the quantities; and
- The name of the manufacturer.
1. Except as otherwise provided in these rules, all registers records maintained under these rules shall be preserved for a period of less than five years from the date of last entry
2. The licenses shall produce for inspection by an Inspector on demand all registers and records maintained under these rules and shall supply to the Inspector such information as he may require.
Substances specified in Schedule ‘E’ and falling under the list of poisons and those specified in Schedule ‘B’ shall be stored in the retail shop:-
- in a part of the promises to which customers do not have access; or
- in an almarah or cupboard or drawer locked, and reserved solely for the storage of such drugs.
- Substances falling under the list of poisons in Schedule ‘E’ shall be stored in containers, impervious to the poison, and sufficient stout to prevent leakage arising the ordinary risks of handing and transport.
- A substance falling in the list of poison under Schedule ‘E’ when compounded and dispensed, shall be labeled with Poison.
CANCELLATION AND SUSPENSION OF LICENSES
- The licensing authority, may, on the report of a Provincial Inspector or the Board, after giving the license an opportunity to show cause (by an order in writing stating the reasons therefore cancel a license issued under these rules or suspend it for such period as it thinks fit), if in its opinion the licensee has failed to comply with any of the conditions of the license or with any of their conditions of the license or with any of the provisions of the Act or these rules.
- A licensee whose license has been cancelled or suspended may appeal to the Appellate Board within sixty days of the date of such order.
5. ANTI-ADULTERATION CAMPAIGN AND SANITATION BRANCH
Main objective of the anti-adulteration campaign is to check the sale of pure food in District. For this purpose field teams collect the samples of Milk & Milk Products, Oil & Oil Products, Beverage, Sweets, Cereals & Cereals Products, Spices & Condiments, Bakery & confectionery, Sugar, Tea, Fruits & Vegetable Products and other items from the shops, factories, restaurants, etc and these samples are sent to Government Public Analyst Laboratory for its fitness for human consumption.
6. BLOOD BANK
It is the policy of the Government to ensure safe blood to the needy patients. To achieve this end a Blood Transfusion unit is working at Nishtar Hospital. Other Blood units are at Civil Hospital Multan and THQ Hospital Shujabad. At these units the blood of the donors is screened for HbsAg and HIV. These units also have equipment for preservation of donated blood.
7. NATIONAL MATERNAL, NEONATAL AND CHILD HEALTH (MNCH) PROGRAMME
Pakistan’s Maternal and Child Health indicators remain extremely poor every year as 25,000 to 30,000 women die from complications of pregnancy and child birth. Millions more suffer ill health and disability. One million children die before the age of 5 while 16,000 die in the first month after birth. Pakistan is fully committed to the ICPD Goals and Targets, 1994 as well as Millennium Development Declaration 2000. The Government of Pakistan’s Poverty Reduction Strategy Paper (PRSP) identifies revival of economic growth and reduction of poverty as the twin challenges for Pakistan, and reaffirms its commitment to improve public service delivery through structural and programmatic reforms as a key strategy for achieving the MDGs.
Prior to 2005, Ministry of Health did not have a separate strategy on MNCH, as a result of which the maternal newborn and child health services were weak, insufficient and fragmented. The Ministry of Health established a cell in the Ministry in February 2005. After elaborate consultations with experts, professionals, development partners and provincial governments. The cell prepared MNCH policy and strategic framework which was presented in the Public Health Forum on 1 April 2005. The Prime Minister of Pakistan while endorsing MNCH Policy and strategy committed full support to the government of Pakistan for launching a comprehensive national MNCH Program based on the National strategy. As an out come of the forum the Islamabad Declaration on MNCH strategic framework was unanimously adopted on 2 April 2005 by all stake holders including the provinces and the development partners. All the partners pledged to align their activities in the field of MNCH for integration. DFID as an active member of the Technical Advisory Group and otherwise was one of the leading supporters of the program. After an exhaustive consultative process with the provinces and districts spanning over a period of more than one year the MCH Cell was able to bring out a consensus document PC-I on National MNCH Program.
Goals and Targets
National MNCH Program will essentially be implemented in 134 districts through their respective provinces. It will also be implemented in AJK, Northern areas, FANA and FATA. National MNCH Program aims at strengthening, upgrading and integrating ongoing interventions and introducing new strategies. The overarching goal of the program is to improve accessibility of quality MNCH services through development and implementation of an integrated and sustainable MNCH program at all levels of the health care delivery system. The program aims at functional integration of the ongoing maternal programs i.e. National Program for Family Planning, Primary Health Care, EPI, Nutrition, and National AIDS Control Programme. The salient feature of this program is that it adds on to what is already being done to achieve the MDGs and as such act as a catalyst to assist the ongoing initiative to fulfill the health related MDGs. The aim is not to displace or replace the current resources available for MNCH but to fill in the resource gaps where ever possible without duplicating inputs or activities.
Priority Areas of the National MNCH Program
- Comprehensive and integrated MNCH services at the district level.
- Community-based skilled Birth Attendants.
- Comprehensive Family planning Services at the Health Facilities.
- Advocacy and demand creation.
- Management and organizational reform.
- Monitoring and Evaluation Framework.
DENGUE BACK GROUND
Dengue fever represents one of the most recent and emerging public health challenges with an ever-increasing incidence across the globe, way beyond its original impact area in the tropics. As estimated 2.5 billion people are said to be at risk from this viral infection across the world. Centre for Disease Control and Prevention (CDC) estimates suggest that around fifty million people are infected by different varieties of this disease annually throughout the world. Dengue can be caused by any one of the four related viruses transmitted by mosquito bite. Two variants of Dengue including Dengue Fever and Dengue Hemorrhagic fever are more important in terms of human health impact. The former takes form of self limiting fever without fatality while later can lead to complications and even death. Dengue has emerged as a global problem after 1950’s. Incidence of disease can be ascribed to a number of diverse factors related to hygiene, urban decay, environmental problems, changed living styles and physical factors. With a rapidly evolving epidemiology, the disease appears to have become more common in recent years and disturbing numbers of human mortalities have been reported.
Dengue is the most rapidly spreading mosquito-borne viral disease in the world. In the last 50 years, incidence has increased many folds with increasing geographic expansion to new countries and, in the present decade, from urban to rural settings. An estimated 50 million dengue infections occur annually and approximately 2.5 billion people live in dengue endemic countries (WHO 2009). It is amongst the Viral Hemorrhagic Fever (VHF) group of diseases which is an emerging and re‐emerging threat the world over. It is one of the important public health emergencies of international concern as per International Health Regulations (IHR).
In Pakistan the first confirmed outbreak of DHF occurred in Karachi in 1994 with 145 cases and one fatality reported. In October 1995, a second outbreak of Dengue like febrile illness was reported from southern Balochistan, affecting the employees of a construction company working on a power generation plant. Fifty-seven out of 76 persons investigated, were found positive against Dengue virus. In September 2003 an outbreak was detected in Haripur district of KPK with a reported morbidity of 1,000 cases and 7 deaths. Thereafter, sporadic cases of DHF continued to be documented from different parts of the country. During 2005—2006, there was an unprecedented increase in DHF epidemic in the country, with a large number of cases being reported from Karachi. More than 3,640 patients were admitted to several referral hospitals in the country. There were 40 deaths, of which 37 were from the province of Sindh, making it the largest and most severe outbreak of DF in the country in terms of case mortality rate.
Dengue viral cases started coming up in Punjab in recent years but were generally controlled with lesser number of causalities. However, the disease suddenly saw an upsurge towards August 2011 especially in Lahore and adjoining areas of Punjab. By 11-11-2011, a total of 20864 cases of Dengue had been reported in the province, including 17256 in Lahore alone. A large number of these cases (20541 in Punjab and 17232 in Lahore) were cured while a total of 323 deaths in the province including 279 in Lahore were reported till 11-11-2011. After Lahore, maximum number of cases have been reported from Faisalabad (783), followed by Rawalpindi (410), Pakpattan (233) and Sheikhupura (225). A number of factors have been tentatively assigned for this incidence including untimely rains conducive for growth and proliferation of Aedes larvae, prevalence of small water bodies especially in residential areas, less rigorous community preventive measures adopted early this year and lower level of common awareness regarding disease prevention. The disease assumed proportions of a full scale outbreak towards September and resulted in emergence of thousands of cases with several hundred deaths across Punjab but with a primary and predominant concentration in Lahore and its adjoining areas.