60% 300,000 50% 250,000 40% 30% 20% 10% 200,000 150,000 100,000 50,000 0% 0 Pre-Qualification Specialist Technical Officer Time Contribution 10% Average Salary 250,000 25% 150,000 Tender Coordination Officer 55% Coordination Support Officer 10% 100,000 60,000 Note: *Salary based on 25 working days/month Source: Created by authors based on data from Primary and Secondary Healthcare Department (P&SHD) PKR /Month Units 70,000,000 60,000,000 50,000,000 40,000,000 30,000,000 * 20,000,000 10,000,000 0 * * * * Jun- Aug Sep Oct Nov Dec Jan Jul-16 16 16 16 16 16 16 17 Feb Mar Apr May-Jun- 17 17 17 17 17 Jul-17 Aug Sep Oct Nov Dec Jan- 17 17 17 17 17 18 Stocks (Units) 27,5 30,6 26,2 25,5 21,1 19,7 18,7 11,3 15,5 22,1 24,1 34,3 48,2 57,9 44,7 35,8 30,0 27,3 23,0 16,5 Consumption (Units) 2,59 2,77 3,53 4,36 3,64 4,40 4,21 3,64 3,23 3,01 3,44 3,17 4,33 4,32 6,22 6,72 6,02 6,62 5,14 4,01 *Stocks (Units) Consumption (Units) Source: Created by authors based on data from Primary and Secondary Healthcare Department (P&SHD) Provincial Secretary P&SH Special Secretary P&SH Additional Secretaries -AS P&SH Primary & Secondary Healthcare Secretariat Directorate General of Health Services -DGHS and Wings Other Projects (IRMNCH, HCP, ACP, etc) Supports Units (Procurement cell, Finance Department) District Chief Executive Officer-CEO District Health Officer DHO Director Provincial Health Development Center PHDC District Drug Inspector Additional DHO Rural Areas Tehsil /Union Council Reporting Line Senior Medical Officer SMO/Medical Officer MO (RHC) 315 Finance and Planning F&P Officer District Health Authority (DHA) office 36 (BHU) Senior Medical Officer SMO/Medical Officer MO 2520 Secondary Health Service Delivery Units Medical Superintendent -MS (DHQ) 26 Senior Medical Officer SMO/Medical Officer MO Medical Superintendent- MS (THQ) (MHU) 119 54 Primary Health Service Delivery Units Secondary Health Service Delivery Units Catchment Area and Bed Strength: DHQ: 1-3 Million; 60-150+ Beds per facility THQ: 0.5-1 Million; 40-60 Beds per facility Services Provided: Promotive, preventive, curative, advance diagnostics, inpatient services, advance specialist, and referral services. Basic and comprehensive Emergency Obstetric and New Born Care (EmONC). Referral point for patients coming from THQH, RHC, BHU, LHW and other primary care facilities. THQS can refer patients to DHQs as well as Tertiary care hospitals. DHQs Refers patients to the tertiary care hospitals and/or specialized institutions. *Provision of 100 essential medicines Primary Health Service Delivery Units Catchment Area and Bed Strength: RHC: 0.1 Million; 10-20 Beds per facility BHU: 0.025 Million; 2-6 Beds per facility Services Provided: Promotive, preventive, curative and referral services. . Outreach/community based services through LHWs, Vaccinators etc. Basic medical and surgical care, Mother and Child Healthcare (MCH) services, family planning services. Basic Diagnostic assistance: Ultrasound, X-Ray, basic Lab tests at RHC and MHUS First level referral point to patients referred by LHWs. Refer patients to secondary level facilities as and when necessary Provision of 18 essential medicines Source: Created by authors based on interview and other data from Primary and Secondary Healthcare Department (P&SHD) ('000s of Units) Fefol Spansule- Monthly Demand 30,000 25,000 20,000 15,000 10,000 5,000 0 Feb. 17 Mar. 17 Apr. 17 May. 17 Jun. 17 Monthly Demand 13,487 12,569 14,364 13,237 18,080 Jul. 17 18,039 Aug. 17 Sep. 17 25,972 Oct. 17 Nov. 17 Dec. 17 Jan. 18 28,060 25,137 27,643 21,463 16,744 Source: Created by authors based on data from Primary and Secondary Healthcare Department (P&SHD) 2017 2018 Process Steps Design of formulary Collecting demand against essential medicine list Rationalization of demand and finalization of medicine list Prepare Bid Documents/Finalize Bid Document Pre-Bid Meeting Preparation and Meeting Changes to bid criteria or specifications Bid Submission Period Bid opening meeting Evaluation of bids Grievance period Price Confirmation AAT Performance guarantee Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Timeline Contract Signing PO system setup and start of PO issuance 1st installment and delivery 2nd installment and delivery 3rd installment and delivery Man-days* Manpower (No.) 15th Mar-31 Mar 2017 12.5 10 1st Apr-20th Apr 2017 15 9 20th Apr-30 Apr 2017 10 30th Apr-25th May 2017 10.5 25th May-27th May 2017 2 27th May-5th June 2017 2 4 5th June-7th July 1 2.5 7 July 2017 8th July-8th Aug 2017 22.5 7 8th Aug-20th Aug 2017 1 3 20th Aug-24th Aug 2017 5 4 24th Aug-26th Aug 2017 2.5 3 26th Aug-8th Sept 2017 8th Sept-12th Sept 2017 2.5 3 12th Sept-By Dec 2017 1 3 By Jan 2018 end By Mar 2018 end By May 2018 end Source: Created by authors based on data from Primary and Secondary Healthcare Department (P&SHD) Start of Sep 16-Start of Jan 17 Issue Budget Call Letter Submit and Consolidate: . . Estimates of Receipt and Expenditure, Estimates of Excess and Surrender, Estimates of Supplementary Budget, Schedule of New Expenditure Sep16 Nov 16 Oct 16 Dec 16 Start of May-Start of July 17 Resubmission of budget to . Finance and P&D Final Review and Finalization Presentation to Parliament Printing of Budget Book Jan 17 Mar 17 May 17 Feb 17 Apr 17 Jun 17 Jul 17 Start of Jan- Start of May 17 Presentation of first draft budget to Finance and P&D Review and preparation of second draft Second review by Finance and P&D Review by Secretary P&SHD Submission to and review by CM Secretariat Source: Created by authors based on interviews with Primary and Secondary Healthcare Department Officials Malik Mazhar Mahmood Head of Procurement Cell Procurement Specialist I (Drugs/Medicines & Non- Drugs) Muhammad Shahbaz Yasin Procurement Specialist II (Equipment) Muhammad Tariq Khawaja Procurement Specialist III (Services) Syed Ahmad Nazeer Giani Contract Management Specialist Import Specialist Mudassar Farooq Pre-Qualification Specialist 1 (Drugs/Medicines & Non- Drugs) Pre-Qualification Specialist 2 (Equipment) Technical Officer 1 (Drugs/Medicines & Non- Drugs) Technical Officer 2 (Equipment) Tender Coordination Officer 1 (Drugs/Medicines) Tender Coordination Officer 3 (Bio Medical Equipment) Tender Coordination Officer 2 (Non-Drugs) Tender Coordination Officer 4 (Non Bio Medical Equipment) Procurement Qualification Specialist 3 (Services) Legal Expert/Litigation Officer Banking Expert Technical Officer 3 (Services) Research Associate Clearing Officer Tender Coordination Officer 5 (General Services) Field Coordinator 1 Tender Coordination Officer Field Coordinator 2 6 (Specialized Services) Support Coordinator 1 Bio Medical Engineer Support Coordinator 4 Support Coordinator 2 Support Coordinator 3 Source: Created by authors based on data from Primary and Secondary Healthcare Department (P&SHD)