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EXECUTIVE SUMMARY The report consists of 7 chapters which have been subdivided into appropriate topics. The First Chapter of the report is for introduction of the District Government Rahimyarkhan. This Chapter of the report explains the Organizational structure of the District Government, Rahim Yar Khan. In this chapter, the structure of the District Government and functions of District Government are discussed. The second chapter of the report is about my department of placement (District Monitoring Office, Rahim Yar Khan). It explains in detail the structure of the Department, Functions of the department, Duties assigned, and communication at the District Monitoring Office. The third Chapter constitutes the introduction, mission, vision, objectives, thrust areas under ESR, key features, achievements and working of the Punjab Education Sector Reforms Program, especially it contains the information about pillars of Punjab Education Sector Reforms Program on which basis this program based. In the fourth chapter, the Monitoring & Evaluation of PESRP is explained in detail. It contain the methods / process, how to do on going monitoring by the PMIU, Field Monitoring, how to do computerization of monitoring data on specific software, transmission of inspection data to PMIU/CMMF and detail about District Review Committee. The fifth chapter constitutes the introduction, vision, objectives, Broad ingredients of reform, and outcomes of the Punjab Health Sector Reforms Program.

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PROGRAMME MONITORING & IMPLEMENTATION UNIT This chapter also has complete information about the BHUs (Basic Health Units), its working, strength of staff, role and functioning of the BHUs, its community support (school and community session), information about RD (Rural Dispensaries), curative services at BHUs and RDs and Evaluation by World Bank. Sixth chapter covers the Monitoring & Evaluation of Punjab Health Sector Reform Program and contain detail about field monitoring at District level, how to do follow up of monitoring reports. In the seventh chapter, my achievements during this six months internship in the District Monitoring Office such as new knowledge, problems encountered, and impacts of experience on career are summarized. At last complete SWOT Analysis of the District Monitoring Office, Rahimyarkhan is conducted, also give the suggestions & recommendations, conclusion and write about terms and abbreviations used in report. Bibliography and Appendix form an integral part of the report.

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Chapter: 1 The District Government Rahim Yar Khan

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THE DISTRICT GOVERNMENT RAHIM YAR KHAN The District Government Rahim Yar Khan, like all other District Governments of the Country, came into being under the devolution system in 2001 and Punjab Program Monitoring and Implementation Unit is an autonomous body of the Provincial Government of Punjab work under the supervision of District Coordination Officer, Rahimyarkhan. The District Government Rahim Yar Khan is constituted by the 140 Union Councils of the district. Each U.C consists of One Nazim and One Naib Nazim and 14 other members called Councilors. All these are directly elected by the public in the Local Government Elections held after 4 years. The U.C Nazim is also a member of the Zila Assembly. Zila Nazim who is elected by the majority votes of the members of the District Assembly is the head of the District Government. He is responsible to look after all the matters of the District with the help of District Coordination Officer and The District Police Officer like development programs, law and order etc. The Naib Zila Nazim is the speaker and head of the Zila Assembly secretariat. He is responsible to conduct the Ijlas of the assembly and assist the Zila Nazim in his functions.

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STRUCTURE OF DISTRICT GOVERNMENT DEPARTMENTS: The District Government consists of 10 Departments. These Departments are listed below:  District coordination Office  Finance & Planning  Revenue  Education  Agriculture  Health  Community Development  Information Technology  Literacy  Law Each of these departments has its sub departments. The District Coordination Officer is the head of District Coordination Office and all the District Government Departments. The District Coordination Officer Coordinates between the Provincial Government and the District Government and deal the correspondence of these Governments. The head of remaining all departments is called the Executive District Office rand the heads their sub-departments is called District Officer/ Deputy District Officer.

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PROGRAMME MONITORING & IMPLEMENTATION UNIT The organization hierarchy chart shown on next page explains the hierarchy of the District Government functionaries.

ORGANIZATIONAL HIERARCHY:

ZILA NAZIM

District Coordination Officer

Naib Zila Nazim

DO (Coordination)

Council Officer

District Monitoring Officer

Zila Council Secretariat

DDO (Coord) DO (Civil Defense) DO (HRM)

DDO (HRM)

EDO

EDO

EDO

Revenue

Agriculture

Health

Respective DOs & DDOs

Respective DOs & DDOs

Respective DOs & DDOs

EDO

EDO

(F & P)

(W & S)

Respective DOs & DDOs

Respective DOs & DDOs

EDO

EDO

Education

(C.D)

Respective DOs & DDOs

EDO

EDO

(I.T)

Literacy

Respective DOs & DDOs

EDO Law

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DO Literacy

CHAPTER NO. 2

DISTRICT MONITORING OFFICE

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MY PLACEMENT: During the period of six months Internship, my placement remained in the office of the District Monitoring Officer, District Rahim Yar Khan.

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DISTRICT MONITORING OFFICE: The Chief Minister Punjab approved Poverty Focused Investment Strategy (PFIS) as a guiding frame work for the future development planning and strategic programming of investments in the Education Sector. PFIS articulates Punjab Government’s commitment and strategy to achieve the development targets to set forth by Chief Minister’s vision 2020, Punjab Poverty Reduction Strategy Paper and Millennium Development Goals (MDGs). It identifies the issues and gaps that need to be addressed to fully exploit the potential of education and health sector for pro-poor impact. District Monitoring Office, Rahim Yar Khan works under the control of Programme Monitoring and Implementation Unit (PMIU), Govt. of the Punjab. The District Monitoring Office monitors and reports on the following Programmes at District level:  Punjab Education Sector Reforms Programme (PESRP).  Punjab Health Sector Reforms Programme (PHSRP).  Other assignments from time to time for monitoring. The District Monitoring Officer, Rahimyarkhan is the Head of District Monitoring Office and he is responsible for daily correspondence and monitoring, complaints and submission of reports to the Higher Authorities within the stipulated time. He also coordinate with the District Coordination Officer Rahimyarkhan in case of disposal of cases, complaints, reports and arrangement of committees at District level in Committee Room of DCO, Rahimyarkhan. Strength of the department comprises of the office staff and field / front line Monitoring & Evaluation Assistants (MEAs) of Chief Minister’s Monitoring Force. The Islamia University of Bahawalpur, Rahimyarkhan Campus

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ORAGANIZATIONAL HIERARCHY:

District Monitoring Officer

Monitoring & Evaluation Assistants

Senior Data Processor

Data Process

Assistant

Computer Operator

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COMMUNICATION IN DISTRICT MONITORING OFFICE RAHIM YAR KHAN The District Monitoring Office works under the control of Programme Monitoring & Implementation Unit (PMIU) of the Govt. of Punjab. The communication in the department is of three levels: Top-Down: From the higher authorities/ Department to the Subordinates/ Departments i.e. letters/Circulars received from the PMIU/CMMF/DCO/Secretary (Education/Health) etc. Bottom-Up: From the lower level to the higher level i.e. DMO communicating to the Deputy Director (M&E)/DCO/ Secretary/Higher Authorities etc. Parallel: Between the two Officers/Departments of parallel ranks i.e. District Monitoring Officer communicating with the District Officer (Education)/ DO (Planning & Development). TECHNOLOGIES USED FOR COMMUNICATION:  Telephone  Fax  Internet (E-mail)

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CHAPTER:

3

PUNJAB EDUCATION SECTOR REFORM PROGRAMME (PESRP)

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PUNJAB EDUCATION SECTOR REFORM PROGRAMME

Mission Statement Developing human resources in Pakistan as a pre-requisite for global peace, progress and prosperity.

Vision 

Quality Education enabling all citizens to reach their maximum potential



Produce responsible, enlightened and skilled citizens



Integrate Pakistan into the global framework of human –centered economic development

Thrust Areas Under ESR  National Literacy Campaign –Integrated Approach to Poverty Reduction  Mainstreaming Madrassahs  Universal Primary/Elementary Education  Improving the Quality of Education: Curriculum Reform, Text Books, Teacher Education & Training, Exam Reforms and Assessment  Technical Stream at Secondary Level & Polytechnics / Mono-technics at district level  Higher Education Sector  Public Private Partnership The Islamia University of Bahawalpur, Rahimyarkhan Campus

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Objectives  Universalization of primary education and adult literacy.  Mainstreaming Madaris for diversifying employment opportunities for their graduates.  Improvement in the quality of education at all levels through better teachers, upgraded training options, curriculum & textbook reforms, and competency based examination system for promoting Pakistan as a knowledged-based society.  Introducing a third stream of gender and area specific technical and vocational education at secondary level with innovative approaches for students’ counseling.  Empowerment to district education authorities  Promote Public Private-Partnerships.  Diversification of General Education.

Government of Pakistan Ministry of Education

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INTRODUCTION: Punjab Education Sector Reform Programme (PESRP) was started under the frame work of Poverty focused investment strategy (PFIS) by the approval of Chief Minister Punjab. Govt. of Punjab initiative PESRP in 2004 for future development planning and strategic programming of investment in education sector in Punjab. It identifies the issues and gaps that need to be addressed to fully exploit the potential of education sector for propoor impact. The education department has formulated the mid-term development frame work and its annual development program based on the vision and strategies given by Punjab Education Sector Reform Programme for education. Following are the three pillars of the Punjab Education Sector Reform Program: (A)

Improve fiscal sustainability and improve the fiduciary environment to:

(i)

Ensure that public expenditure continues to be increased and effectively used for education at both provincial and district levels.

(ii)

Strengthen the districts’ financing capacity and ensure that adequate resources are transferred to districts to meet education needs.

(iii)

Increase transparency of financial management and procurement processes and practices.

(iv)

Strengthen provincial and district capacities to monitor financial flows.

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(B)

Increase equitable access to education and improve quality and relevance of

education. This forms the core reform agenda. Access agenda will focus on programs to: (i)

Reduce the high drop outs at pre-primary and primary level, especially for girls.

(ii)

Strengthen the elementary and secondary sector levels.

(iii)

Encourage the participation of private sector.

The quality agenda will seek to: (i)

Improve school performance and student learning outcomes

(ii)

Improve quality of learning through better teaching practices, better textbooks and examination system.

(C) Improve public education sector governance and management to: (i)

Strengthen the sector planning and policy development capacity of the provincial education department.

(ii)

Strengthen capacity of district education departments to improve service delivery.

(iii)

Strengthen monitoring and evaluation

(iv)

Enhance school based management and monitoring of school performance by communities.

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KEY FEATURES OF PESRP:  Monitoring & Evaluation.  Increase in enrollment of students.  Provision of Missing Facilities in schools.  Provision of Free Text Books to students.  Stipend to Girl Students.  Awareness Campaigns to create and enhance the importance of education among the people of Punjab.  Teacher Recruitment.  Teacher Professional Development.  Formation of School Councils.  Expanding Public Private Partnership.  Upgradation of Schools.  Uniform Academic Session  Free Education up to Matriculation  Composite examination at Matric level  Composite examination will be introduced in 2009 for HSSC  English language has been made compulsory from Class-1 onwards  Registration of private sector educational institutions be done on the pattern of madaris.  Revise curriculum to ensure that: o Technical stream of education is introduced from class 8th. o Information Technology/ Computer education is introduced from lower classes. o All duplication of subjects is eliminated. o Contents do no reflect thinking of any particular sect/school of thought. The Islamia University of Bahawalpur, Rahimyarkhan Campus

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PROGRAMME MONITORING & IMPLEMENTATION UNIT o Ethics, moral education and Haqooq-ul-ibad be included and stressed.

o Curriculum be upgraded to ensure latest developments/ideas in science and technology are included and it is progressive with vertical and horizontal linkages.  Format of the question papers for the Board examinations will be revised. The papers will have three parts: o (i) 20% will be objective questions. The questions will have multiple choices. o (ii) 50% questions will be for short answers. o (iii) 30% questions will be for descriptive answers. o During the year 2006 teachers will be trained to prepare the children to answer the questions on this patter. o Question papers will be prepared in this format from the year 2007.  College level education be run by provincial education departments  Availability and accessibility of schools particularly in rural areas

ACHIEVEMENTS OF THE PROGRAMME:  Establishment of minimum standards for school infrastructure, facilities and staff to reflect quality considerations and institute an effective monitoring system.  Improving the access of girls to schools through the introduction of incentive system.  Improving the retention rates of students by provision of conducive learning environment, teaching tools and aids, effective monitoring and revitalizing the public sector resources.

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PROGRAMME MONITORING & IMPLEMENTATION UNIT  Discouraging drop outs in schools by provision of a child-friendly environment through banning corporal punishment.

 Improving the skills of teachers away from rote learning to student centered learning and adopting a system of continuous professional developing teachers reinvigorating Punjab Education Foundation to encourage greater participation of private sector in provision of education to populace, and to explore and encourage public private partnerships.  Instituting advance HRM system for effective utilization of public sector human resource across the different tires of education managements throughout the province.

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CHAPTER: 4 MONITORING & EVALUATION OF PESRP

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MONITORING & EVALUATION OF PESRP PESRP has an inbuilt component of Monitoring & Evaluation. All the data is fully computerized and the datasets are professionally analyzed and then used for decision making. This monitoring system is based on the programme’s ongoing monitoring, supplemented by a strong field monitoring component also in the shape of the District Monitoring Team, and a robust third party validation system. ONGOING MONITORING BY THE PMIU: At the onset of the programme, the Govt. of Punjab established Programme Monitoring & Implementation Unit (PMIU) to oversee the monitoring & evaluation systems for the education sector in Punjab. In a remarkably short time the PMIU developed a robust monitoring system that is independently scrutinized by periodic third party validations, and continuous to monitor, analyze and report progress on the various inputs of the reform programme. The PMIU continues to undertake robust analysis to identify needs and help inform policy decisions (such as prioritizing missing facilities and teacher vacancies on an actual need basis). In addition to monitoring of programme inputs, PMIU conducts school census twice during the academic year (in May and October). FIELD MONITORING: To complement the process monitoring setup for various activities of the reform initiative of the Govt. of the Punjab, an elaborate field monitoring mechanism has been established in the province. The purpose is to bring about real improvement in policy implementation through results based management and outcome monitoring.

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The field monitoring system comprises of District Monitoring Officers posted in every district of the province. The DMOs are assisted by the Monitoring & Evaluation Assistants. The monitoring establishment has been well-equipped in terms of transport and modern IT tools such as computers, cameras among other items to perform the assign tasks and to provide real time monitoring reports. Under this monitoring arrangement each school in Punjab is being visited, at least once in a month by the MEAs. Data collected by the MEAs is properly digitized in the office of DMO and analyzed by the PMIU to see districts’ performance vis-à-vis key indicators. The field monitors keep a close watch on various development initiatives of the provincial government in the districts, keep and facilitate the information flow lines with the administrative departments and PMIUs intact and also to keep a constant liaison been provided with the database of those sectors in which they have been engaged, they constantly analyzed the latest developments, and apprise the District Government of the emerging trends. The database created by the PMIU is placed with the DMO to make information and analysis available to district officials. This field monitoring system is already beginning to show results, as useful information from the field especially relating to quality of civil works (development initiatives) and on teacher attendance is being provided to the Education Department. MONITORING PROCESS OF FIELD MONITORING: The monitoring process at district level is commenced by the District Monitoring Office. The MEAs assist and report to the District Monitoring Officer regarding field monitoring of schools and ongoing development schemes there at under different phases of Education Sector Reforms (ESR).

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Each school of the district has been assigned a unique EMIS Code. Each of the MEAs is assigned to visit the schools situated in one union council. The MEAs have been provided state of the art proforma for school inspection (copy attached as appendix) which contains the following information:  Illegal Fee/Funds.  Staff (Teaching & Non-Teaching). •

No. of sanctioned and filled posts.

•

Physically present

•

On sanctioned leave

•

On official duty

•

Un-authorized absent

•

Late Comer

 Details of Absent Teaching & Non-Teaching Staff.  Enrollment of Students. •

No. of students enrolled of each class.

•

No. of students presents of each class.

 School Council Funds.  Farogh-e-Taleem Fund.  Inspection By Education Department Officers (in last six months).  Details of Stipend to girl students from class VI to X.  Details of Provision of Free Text Books to each class.  Facilities •

Provision of Furniture to teachers and students.

•

Classroom facility.

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 Teachers training activities.  School cleanliness. •

Students

•

Building

•

Lawns/Play Grounds

 Availability/Non-availability and Functionality of Utilities •

Electricity

•

Drinking water facility.

•

Toilet facility.

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COMPUTERIZATION OF MONITORING DATA The observations and data collected through the above mentioned inspection form is submitted by the MEAs to the District Monitoring Office. Each inspection form, then, is computerized on Inspection database software. This inspection database software contains the same inspection form as detailed above and other processing tools for analysis and converting the data into information. TRANSMISSION OF INSPECTION DATA TO PMIU/CMMF: The function of District Monitoring Office is only to assist the Education Department and not to take any action against any irregularity. Soft copy of the monitoring data is created through database software and then forwarded to Dy. Director (M & E) of PMIU and Dy. Director (Monitoring) of CMMF for onward processing and necessary action. A hard copy of the same is sent to the District Coordination Officer and Executive District Officer (Edu). At the PMIU, this inspection data is further processed and then the reports are forwarded to the education department for further necessary action accordingly. The Dy. Director (Monitoring) forwards his report to the Secretary (Education), District Coordination Officer, Executive District Officer (Edu) for further necessary action. DISTRICT REVIEW COMMITTEE: A committee to review the performance and evaluation of the education department at district level has been formulated. The committee is farmed as under:

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1. The District Coordination Officer.

(Chairman)

2. The District Monitoring Officer.

(Secretary)

3. The Executive District Officer (Edu). 4. The Executive District Officer (F&P). 5. All DEO’s of Education Department. 6. The District Officer (Building). 7. The District Project Manager (NLC). 8. The Senior Post Master. The meeting of District Review Committee is held at end of each month under the Chairmanship of District Coordination Officer to review all the matters regarding Punjab Education Sector Reforms Programme (PESRP). The implementation of decisions taken in the meeting are further reviewed in the next DRC meeting.

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CHAPTER: 5 HELTH SECTOR REFORMS PROGRAMME

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HEALTH SECTOR REFORMS PROGRAMME Govt. attaches highest priority to improvements in Health Sector Reform Programme in Punjab. The linkages of the health sector with the poverty of well documented. The primary and secondary health sectors are essentially pro-poor. Health Sector Reform Programme is a step in the directions of developing comprehensive health sector reform agenda. The Health Sector Reform Program (HSRP) has been launched with a comprehensive set of interventions to overcome the inadequacies in Primary and Secondary Health Care Services, widespread prevalence of communicable diseases, urban-rural imbalances, professional and managerial deficiencies in District Health System, basic nutrition gaps in target population, deficient health education system, addiction and mental health as well as unregulated Private Sector. The HSRP envisions a healthy population with a sound health care system practicing healthy life style, in partnership with private sector including civil society, which is effective, efficient and responsive to the health needs of low socio-economic groups especially women in the eproductive age. INTRODUCTION: The Punjab Health Sector Reform Programme (PHSRP) was launched in with block allocations of Rs. 700 million and Rs. 500 million during ADP 2004-05 and ADP 200506, respectively. The scope of the PHSRP broadly includes provision of missing human and physical facilities at the Basic Health Units (BHUs) and Rural Health Centers (RHCs), improvement in health service delivery, human resource development, timely supply of essential medicines and health awareness / health education. Civil works constituted about 70% of the programme, while the remaining 30% of it is concerned with provision of equipments. The Islamia University of Bahawalpur, Rahimyarkhan Campus

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The programme envisaged the signing of terms of partnership between the District Governments and the Provincial Government, whereby the Provincial Government has been committed to provide the District Government with the missing infrastructure to strengthen the existing medical facilities at the BHU and RHC level. The HSRP provides for a comprehensive needs analysis of the missing facilities (physical & manpower) at the BHU and RHC level with the assistance of District Governments. VISION Healthy population with a sound health care system practicing healthy life style, in partnership with private sector including civil society, which is effective, efficient and responsive to the health needs of low socio-economic groups especially women in the reproductive age. Concretizing the Vision: Ten Specific Areas of Reforms In order to concretize the above vision, 10 specific areas have been identified. These are: 1.

Reducing widespread prevalence of communicable diseases.

2.

Addressing inadequacies in primary/secondary health care services.

3.

Removing professional/managerial deficiencies in the District Health System.

4.

Promoting greater gender equity.

5.

Bridging basic nutrition gaps in the target-population.

6.

Correcting urban bias in health sector.

7.

Introducing required regulation in private medical sector.

8.

Creating Mass Awareness in Public Health matters.

9.

Effecting Improvements in the Drug Sector.

10.

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OBJECTIVES  Measurable impact on MDGs through improvement in the health delivery services with significant reduction in incidence of diseases Implementation of a standardized service delivery package in the devolved set-up.  Better Health Management System.  A well thought-out trategy to be implemented for patient care.  Reduction in poverty as well as social protection for vulnerable population groups.  Greater focus on preventive health care particularly in the rural areas.  Improved Primary, Secondary and Tertiary Health.  Care through effective and quality referral system and optimal utilization of facilities.  Enhanced capacity for planning, costing and budgeting.  Improved capacity for data analysis research as well as evidence and outcome based planning.  To make Community Participation meaningful and to give Public Private Partnership a purposeful dimension.  To implement the guidelines for medium-term strategic planning developed by the Punjab Devolved.  Social Services Programme .

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BROAD INGRIDIENTS OF REFORM: The PHSRP covers many areas. However, there are some basic common areas and convergences of actions, some of which are listed below:  Improvement/Performance of health management system.  Access and quality of trained manpower, drugs and technology in health service system.  Improve health care delivery infrastructure.  Review existing policy framework for health service delivery.  Health mask awareness.  Broaden health financial mechanisms.  Introduce public private partnerships. OUTCOMES: The HSR has been developed after careful mapping of reforms initiative being implemented in the Punjab under various programmes and projects. The program has far reaching outcomes for Punjab and Pakistan. Some of these are briefly listed below:  Integration of all Primary Health Care Services including preventive health care, school health andnutrition services at the BHU level.  Provision of missing facilities in RHCs / BHUs, adequate medicines and ensuring availability of staff.  Upgradation of facilities in DHQ/THQ Hospitals.  Upgradation of training facilities for nurse / paramedics.  Introduction of a new cadre of health professionals with specialization in community medicine for working in PHC facilities. The Islamia University of Bahawalpur, Rahimyarkhan Campus

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 Revision of curriculum of MBBS in collaboration with the PMDC with a view to laying a greater emphasis on community medicine.  Introduction of state of the art management systems for human resource, inventory control, information control, planning and monitoring of operations in secondary / tertiary care health facilities.  Promote and provide mechanism for research and evidence based planning.  Generate purposeful community participation and Public Private Partnership.  Reform the Medico-Legal System.  Design and implement School Health and Child Nutrition Program.  Develop a close and mutually-supportive interaction with the PDSSP  Design and implement Social Protection / Health  Insurance for vulnerable groups e.g., aged population, govt. employees etc

BHUs (BASIC HEALTH UNITS): District Rahimyarkhan having 104 BHUs. BHUs were established as the “First Level Healthcare Facilities” (FLHFs) in the rural areas under the Health Policy of the 1970s and early 1980s. A BHU was designated to be the FLHF for the area of a Union Council which, in the Punjab, means an average of 11 “revenue estates”, commonly referred to as “villages”. Each BHU is established upon approximately 2 to 3 acres of land and comprises the Healthcare block, an MO’s residence and, ordinarily, 5 other residences for the staff. The total constructed area of a BHU exceeds 9,000 sft with its own water supply and rainage facilities.

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A proposal was made to the Chief Minister, Punjab, in January 2003. In it, he was apprised of: (i)

The proposition developed by the Zila Nazim of RYK for the PRSP to take over the management of all the 104 BHUs in that District.

(ii)

The broad features of how these health facilities (HFs) were proposed to be managed by the PRSP.

The newly established District Governments (DG) had, since August 2001, inherited authority from the Provincial Government in many sectors of which the Primary Healthcare sector was one. In March 2003, two months after the approval of the Chief Minister, an Agreement was signed between the District Government of RYK (DGRYK) and the PRSP. The essential framework of the Agreement was crafted with much care in the absence of precedents that could serve as models. It was thoroughly vetted by the Health, Finance, Local Government and the Law Departments of the Provincial Government for the comfort of the nascent District Government. And finally, it was the un-flinching support of the then Zila Nazim, RYK * that over-rode the reservations persisting within the DGRYK. The plans for the management of the Initiative had to suffer a fundamental review soon after the Agreement was concluded. Contrary to expectations, PRSP could not be provided the services of key management personnel by the Government. As a result, the “Project Management Unit” (PMU) had to be created within the DOH of the GoPb and not in the PRSP. As an administrative arrangement, this was seriously flawed, to say the least. But this is how the work had to commence. PRSP’s association with the operation, though intimate from the start, remained indirect in some ways until the end of June 2004.

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Given the number of medical professionals in RYK in March 2003, assigning one MO to a cluster of 3 BHUs. Accordingly, the 104 BHUs in the District, were clustered and assigned by the first week of July 2003. Had the number of medical professionals been different in RYK, clustering may also have been otherwise. The next two changes that the PMU was able to initiate were (i) the staff presence and (ii) the availability of medicines at the BHUs. Credit for these achievements must go to the small PMU, led by the first Project Director, all of them driven by an exemplary crusading spirit.

COMMUNITY SUPPORT:

PRSP envisions that the most effective way to ensure that a service delivers the desired volume and quality is to assign an appropriate role to the beneficiaries. There can be no greater assurance of the desired volume and quality, on a continuing basis, than this linkage. The CMIPHC has, therefore, organized a “Support Group” attached to every BHU. Each Group comprises carefully selected individuals who represent important interests like elected Councillors, teachers, women, students, professions, minorities, etc, etc. The Group meets at least once a month and integrates the BHU with the community that has a stake in the services delivered through the BHU. It is a responsibility of the Group to see that the BHU is enabled, at all times and on a sustained basis, to provide larger and better range of services. A member of the DSU staff arranges, attends and minutes all meetings.

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COMMUNITY HEALTH SESSIONS: This is a new activity of PRSP at the BHUs. Every MO (and Paramedic) is now going out into the villages and getting the community together for interactive sessions on Healthcare issues. These sessions are expected to create and enhance public awareness on hygiene, sanitation, nutrition, family health, disease prevention, family planning, immunization, inoculations, child health, etc, etc. SCHOOL HEALTH SESSIONS: This too is a new activity. Every MO (and Paramedic) is now going into the schools in the area of the BHU and holding interactive sessions with the students/teachers in the relevant fields. School children are also brought to the BHUs for such sessions if the BHU in not far. Children are screened for some of the common medical problems that they could be suffering from. Health Cards, which record important data on the child, are now being provided to students who have been screened. District RYK

Students Screened Treated

2006 9285 7705

2007 22695 11256

2008 33299 14977

Total 65279 33938

FEMALE MEDICAL OFFICERS (FMOS): This is a brand new service at the BHUs and a most significant development in the rural Punjab. The number of female medical professionals willing to serve in remote rural areas, in the public and private sectors, has always been small. The rural women are, therefore, exceptionally disadvantaged in their access to essential medical assistance.

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The CMIPHC has responded with engaging female medical professionals and assigning clusters of five BHUs to each. She goes around each BHU in the cluster every week. On the sixth day (a Friday), she holds Health sessions at a Girls college/school in the area of the five UCs. Time is also taken out on this day for the capacity building of the LHVs and Midwives. The FMO Days are widely publicised and the schedule is strictly adhered to so that women know precisely when consultation and medical assistance are possible. A specialised pharmacy is provided to the FMO. This new window was opened in November 2004 in RYK. Now Patient can consult and receive assistance and medicines from for a mere Rs.1 Parchee Fee! FMOs are now regularly assisting with pregnancies and delivering family planning services. It must be noted that we have arrived at the present strength of FMOs progressively and that this number is subject to variation from month to month. FEMALE HEALTH SERVICE: District RYK

2006 66533

2007 104280

2008 102067

Total 272880

ROLE AND FUNCTIONS OF A BASIC HEALTH UNIT 1.

Comprehensive medical care and relief, curative and preventive.

2.

Prevention and control of communicable and endemic diseases.

3.

Maternity and child health services and immunization.

4.

School health services.

5.

Health education program.

6.

Family welfare program.

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7.

Improvement of environmental sanitation and provision of safe water.

8.

Improvement of nutritional status.

9.

Collection of vital statistics records.

10.

To participate in and discharge such functions as are required by the National and/or Provincial curative and preventive programmes in PHC sector.

11.

Training of village health workers, birth attendants, dais, etc.

12.

It provides first level referral capability for patients referred by LHW, FHWs for primary level organized curative care using approved essential drugs. BHU in turn refers the patients to RHC as and when necessary.

13.

14.

Provision of static and out-reach services for the following:(a)

MCH, FP, EPI and advice on food and nutrition.

(b)

Sanitation and health education.

(c)

CDD, CDC, ARI and other special programmes.

It is a focal point, where community and the public sector health functionaries come together to resolve issues concerning health.

15.

BHU provides support; logistics, and management to LHW, TBAs, dispensaries, MCH centers, sub health centers etc. falling in its assigned geographical limits.

RURAL DISPENSARIES: The Rural Dispensaries (RDs) or the Mother and Child Health Centers (MCHCs) are in an even sorrier state than the BHUs. These are often more poorly provisioned than a BHU. The RDs are commonly housed in inadequate and ancient buildings with few essential amenities. But RDs can be more centrally located than many BHUs. Given just a little attention, therefore, many RDs come alive with very large numbers turning up at these for medical assistance.

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CHAPTER: 6

MONITORING & EVALUATION OF PHSRP

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MONITORING & EVALUATION OF PHSRP Punjab health sector reforms program has been launched to offer the health department the financial and technical assistance it needs to undertake the challenging task of introducing comprehensive health sector reforms in the Punjab. The HSRP is an implementation and monitoring of the health department’s effort to institutionalized health sector reforms. Health sector reform framework also proposes to check the problem of absenteeism and under-utilization of primary health care facilities. In addition to considering institution of innovative measures to address absenteeism, and enhance the utilization of primary health services, the Programme Monitoring & Implementation Unit (PMIU) has developed a comprehensive monitoring & evaluation framework to assess the impact of these reforms. FIELD MONITORING AT DISTRICT LEVEL: The District Monitoring Office, at district level has been assigned the responsibility to monitor and collect data for evaluation purpose. The District Monitoring Office executes its functions regarding the monitoring of HSR through District Monitoring Officer and Monitoring & Evaluation Assistants (MEAs) who put surprise and periodic visits at the health care centers to check the compliance of the program. For this purpose different inspection forms have been developed each for BHUs & RHCs (both forms are attached under section of appendix).

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The main contents of these forms are briefed as under:  Cleanliness and general outlook of the facility.  Displays.  Availability of utilities.  Disposal of hospital waste.  Purchi Fees.  Patients treated in last calendar month.  Details of staff (Doctors, Paramedics, Alternative Medication Staff, Preventive/Outreach Staff, Technical Staff, Admin/Support Staff, Vacant posts).  Staff Presence and Absenteeism.  Inspection of the facility by the health department officers.  Stock of medicines.  Public opinion.  Indoor patient department.  Development schemes / Provision of missing facilities.  Equipments.

The inspection data under the above mentioned heads is collected by the Monitoring & Evaluation Assistants and the proformas are re-submitted in the District Monitoring Office for onward transmission to the Deputy Director (Monitoring & Evaluation), PMIU/PESRP, Lahore, for further necessary action.

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FOLLOW UP OF MONITORING REPORTS:

The reports send to the PMIU are further forwarded to the Program Director (PHSRP) where these reports are analyzed and computerized. The Program Director (PHSRP) writes the respective District Coordination Officer / Executive District Officer (Health) to take necessary action regarding the inspection reports of BHUs/RHCs. A copy of the same is forwarded to the District Monitoring Officer and Secretary Health for information.

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SWOT ANALYSIS STRENGTHS  Monopoly in Monitoring & Evaluation  Support of Government & Social Organization  Provincial and District Capacities to monitor Financial flows  Planning and Policy Development Capacity  Improved service delivery system in district education / health departments  Effective Monitoring and Evaluation System  Empowerment to district education authorities  Availability and accessibility of schools particularly in rural areas  State of the art management systems for human resource, inventory control, information control, planning and monitoring of operations  Vital statistics records

WEAKNESSES  Image – Government Organization  Image – Outdated people & Technology  Ambiguous Management Style  Policies are determined by the Government  Lacking employee training

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OPPORTUNITIES  New Policies coping with new technologies.  Acquiring better monitoring & evaluation software and provide to MEAs.  Providing the best source of data handing through internet by MEAs could lead the organization towards success and reduce the delay in works.  If in case of some competitor, they could work in corporate environment for effective result.  Acquire the best experts to develop effective monitoring software and trained the employees

THREATS  Involvement of Political Factors  Change in Government can change the policies  Lack of Funds  Missing Facilities  Electricity

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SUGGESTIONS AND RECOMMENDATIONS

 Highly qualified and trained staff should be deputed in field for the effective monitoring and evaluation.  Try to adopt competitive methods and procedures.  Try to enhance and accuracy, performance and delays in work by setting work in teams.  Try to adopt one window operation for complaints.  Try to improve your weak areas and as well missing facilities.  With the help of adopting new technology, improve the Monitoring & Evaluation System Software because now it has been outdated and need to update.  Remove ambiguous management style  Give empower to monitoring employees  Must adopt decenteraliztion  Encourage the privatization

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CHAPTER:

7

LEARNING AS INTERN

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NEW KNOWLWDGE ACQUIRED:

LEARNED:  Work processes in different Government Departments and at different levels Use of new computer Software.  Working in a team based culture.  How to overcome the stress situation during high work pressures.  Other skills Building.

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PROBLEMS ENCOUNTERED:

Encountering the problems during the routine work is a part of the experience. Problems are not only the problems but also provide an opportunity to learn. Man learns when he goes through the solving process of these problems. During my six months internship at District Monitoring Office, I also encountered a number of real work problems and learned a lot through solving these problems. The major problems I encountered are listed below;  Difficulty in understanding the technical terms.  Difficulties in understanding the Inspection Data Entry Software.  Problems from Organizational Behavior perspective.

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HOW EXPERIENCE IMPACTS CAREER: Experience is mandatory for career growth, development and for promotional decisions both from individual and organizational perspectives. The Importance of experience is obvious from the following points:  One can asses his strengths and weaknesses.  Skills assessment  Career Development and promotion  Personal plans of actions can be generated.  In early stage of experience, Interests, skills, and abilities can be recognized.  Problem solving.

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BIBLIOGRAPHY: •

Terms Used

•

Abbreviations

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TERMS USED: DATABASE SYSTEM: A database system is a way of organizing information on a computer, implemented by a set of computer programs. This kind of organization should offer: * simplicity - an easy way to collect, access-connect, and display information; * stability - to prevent unnecessary loss of data; * security - to protect against unauthorized access to private data; * speed - for fast results in a short time, and for easy maintenance in case of changes in the organization that stores the information.

INTERNSHIP: A period of practical, Supervised, on the job training. It is designed to supplement formal study and give the individual the skill and knowledge required for entry into a trade or profession. MONITORING: Monitoring is the regular observation and recording of activities taking place in a project or program. It is a process of routinely gathering information on all aspects of the project

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LOCAL GOVERNMENT: The elected Government of a town, Tehsil. Or District working under the control of Provincial government PROGRAM EVALUATION: A program evaluation involves gathering information about a program in order to make decisions about the program

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ABBREVIATIONS: ADP: Annual Development Program BHU: Basic Health Unit DCO: District Coordination Officer DMO: District Monitoring Officer DFA: Draft For Approval EDO: Executive District Officer ESR: Education Sector Refroms E-Mail: Electronic Mail HSR: Health Sector Reforms CMMF: Chief Minister’s monitoring Force PMIU: Programme Monitoring & Implementation Unit NLC: National Logistics Corporation PESRP: Punjab Education Sector Reform Program PHSRP: Punjab Health Sector Reform Program THQ: Tehsil Head Quarter Hospital RHC: Rural Health Center LAN: Local Area network MEAs: Monitoring & Evaluation Assistants PUC: Paper Under Consideration WWW: World Wide Web

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APPENDIX:  ESR School Inspection Form  BHU inspection Form  RHC Inspection Form

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ESR School Inspection Form

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BHU inspection Form

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RHC Inspection Form

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