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PROJECT REPORT
NEW ERA PATIENT-FRIENDLY HOSPITAL PRIVATE LIMITED SHUKUL BAZAR, SULTANPUR, UTTAR PRADESH, INDIA
Bejon Misra, Managing Director
[email protected] & Dr. Bidhan Das, Consultant MBBS, MHA (AIIMS)
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CONTENTS Page
Executive Summary
3
About the Organization
5
Preamble
7
Introduction
8
Technical Analysis & Justification
12
Health Care Plan
22
Functional Plan and Programs
24
Departmentation
29
Facilities Management
32
Licenses permits and statutory obligations
34
Organisation Structure
36
Staffing Pattern and Qualification
37
Annexures 1.
Layout Map of the Facility (Annexure-1)
38
2.
List of Equipment and Furniture (Annexure-2)
42
3.
List of Drugs (Annexure-3)
50
4.
Universal Precautions (Annexure-4)
62
5.
Charter of Patient’s Rights as a Consumer (Annexure-5)
64
6.
Financial Details (Annexure-6)
66
7.
Geographical Map of the Location (Annexure-7)
86
8.
Micro Health Insurance
88
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EXECUTIVE SUMMARY It is rightly said that India lives in its villages. About 78% of the population of the country lives in rural India.
The country has the dubious distinction of being the 2nd largest populous country in the world. The flip side is that in spite of being a vast country having a huge population of 108 crores the health status of the country is very poor.
As evidenced by the World Health Report, the health indicators are far inferior to its neighboring developing countries. Health being a state subject the government has a very well structured public health system.
The three tier level of health-care organization with the root at the level of primary health centers going through CHCs, DHs and tertiary centers like medical colleges and centers of excellence like AIIMS, PGI etc.
In spite of all this, the reach and acceptance of the facilities particularly in the PHCs and CHCs is very poor.
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Several studies have revealed that the community prefers to go to a private provider and pay out of pocket rather than going to a public facility even though it is free. This is evidenced by the fact that the GDP on account of health is 5.2%. out of which the share of the Government is only 1.8% and the rest is from the private providers.
Health care in India is a sunrise sector and the country is witnessing a mushrooming of corporate hospitals being ironically concentrated at the Metropolitan cities with a focus on the international health business. At the end the rural sector is left untouched even if the population is ready to pay.
Govt. has taken a revolutionary step in the form of National Rural Health Mission (NRHM) and furthered it by laying standards for the same in the form of IPHS 2006. The results of this program are to be seen in the years to come.
The basic issue is to regain the trust of the community on the public health facilities. The areas of concern in order to achieve the trust is -
Accessibility
-
Availability
-
Affordability
-
Affability
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IMPLEMENTING AGENCY: NEW ERA PATIENT-FRIENDLY HOSPITAL PRIVATE LIMITED OBJECTIVES: To develop and implement state-of-art health delivery system for providing quality healthcare facilities at an affordable price for all. To conduct research and development studies for bringing policy changes in the healthcare delivery system globally especially in developing countries for the poor and disadvantaged consumers.
To educate consumers and make them aware on their rights and provide informed choice in an effective and efficient manner.
New Era Patient-Friendly Hospital Private Limited has ventured into this area so as to create a model incorporating all the features stated in the NRHM, National Population – Policy and IPHS 2006. Located in rural surrounding the place is 70 km off Lucknow in the State of Utter Pradesh (INDIA) and close to Jagdishpur Industrial Area on the Lucknow to Sultanpur Highway in a village called Pureshuklan in Shukul Ka Bazar Block, district Sultanpur.
This initiative will function as a private ‘for profit’ model. The aim is to emulate and replicate this model to other parts of the country particularly in the
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economically back ward states and in turn help the Government to implement the NRHM in the real sense of the term.
The facility has been planned and designed as per BIS standards for 30 bedded hospital as well as IPHS 2006.
It has 30 beds with basic broad specialties, supplemented with diagnostic services including an ultrasound, ICU and an operating room.
The structural standards have been met with, the process and outcome standards are being worked upon so as to enable the hospital to be accredited by the National Accreditation Board for Hospital and health care providers in the days to come.
The concept of Public Private Partnership can very well be applied to this model. The facility is geared up to handle and support all national health programs, Counseling services, NGO participation, PRI involvement, preventive health, IEC services, Sanitation, Hygiene and safe water supply to the community apart from patient/consumer education and awareness on rights and responsibilities.
The rights of patients and staff are to be respected and the approach will be market/consumer driven. Governance of the facility will be professionally managed.
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PREAMBLE This report has been prepared to formulate the project “commissioning of the New Era Patient-Friendly Hospital Private Limited at “Pureshuklan” (Post Office Shukul Bazaar), District Sultanpur in the State of Uttar Pradesh in INDIA. The report is based on the discussion and data generated, from various meeting held with the promoters of the project, who are members of the Governing Board and visits to the sights. Data is also collected for the disease pattern, incidence of various diseases and other relevant social, cultural and health status indicators. All the data has been qualified to accommodate the functional requirements of various departments in this hospital. The Departmentation plan as listed has been discussed and approved. The hospital activity has been adopted to be of primary to secondary level of health care, so as to be in the linen of NRHM and Millennium Development goals (MDG). The provision in this report has been made for specific purpose of conceptual proposal and designing of the hospital. In this report, due consideration has been given to under stand the market needs of the locality, research has been conducted for various national health programs, national health policy, NRHM, world health report, IPHS 2006, and BIS standards for 30 bedded hospital. New Delhi Dated : 30 August 2006
Bejon Misra & Dr. Bidhan Das
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INTRODUCTION
Pursuant to the executive summary in the report it has very adequately been emphasized that the need for a model rural hospital meeting all possible standards to a reasonable extent be created in order to provide quality health care at the most affordable cost. However, needless to say that the infrastructure so created shall be easily replicated all over the country and other developing countries so as to bring good quality health care to the door step of the community and in turn progress towards HEALTH FOR ALL and achieving the MDGs.
In order to meet this demand for comprehensive health care services this model hospital has been named as “New Era Patient-Friendly Hospital Private Limited” hospital. The hospital shall not only provide and supplement the much needed beds in this segment but also augment the emergency health care services and prove to the world that quality health care services can be provided at a very low capital cost. It will further demonstrate how this model can be financially viable and sustainable. The hospital addresses the unmet needs of the community as consumers and therefore empowers them with their right to health and availability of services for the money paid, so as to appreciate the value for money. The proposed hospital shall provide a comprehensive medical, surgical, obstetrics, pediatrics, orthopedics, eye & ENT, Ayurveda, Homeopathy as well as
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all the needed support services. Most importantly it will be functional 24/7 all through out the year so as to make available emergency medical care round the clock at a very reasonable cost which the community can afford.
The Mission of the Hospital “To provide quality health care accessible and affordable to all round the clock”.
Proposal To commission this multi specialty hospital so as to provide comprehensive medical, surgical, obstetrics, pediatrics, orthopedic, eye & ENT, Ayurveda, Homeopathy care as a not for profit venture but a self sustaining model. The hospital shall be linked with telemedicine to designated centers of excellence in the country and coupled with a micro insurance model for the community to pay for their health care needs.
The services provided will be at a very nominal and affordable price. However, for the underprivileged group a self-financing scheme based on a co-operative model will be created.
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Objectives 1.
To ensure availability of comprehensive quality health care accessible to all without any discrimination or bias.
2.
To provide the services round the clock 24/7.
3.
To enable access of the services to the community at an affordable price.
4.
To run the facility in a transparent manner so as to create an environment of empowerment and ownership of the community.
5.
To provide value for money to the consumers of health care.
6.
To act as a role model for others to emulate.
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NAME OF THE HOSPITAL
NEW ERA PATIENT-FRIENDLY HOSPITAL PRIVATE LIMITED “Demand Quality Health Care”
Location:
Pureshuklan, District Sultanpur, U.P. India
Size of the Hospital 30 bedded in patient unit with suitable component of out patient unit, Emergency Department, ICU, OT, and needed support services. Organisation Owning the Hospital
New Era Patient-Friendly Hospital Private Limited The Registered office: National Capital Territory of Delhi. Date of Commencement of Business of the Hospital
January 2007
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Governing Board of the Hospital
1.
Dr. Mahendra Pratap Narain Pande, D.O. (Lon) Chairman
2.
Mr. Bejon Misra S/o Late Satyendra Nath Misra W018, Regency Park II, DLF Phase IV, Gurgaon (Professional)
3.
Mr. Rajeev Misra S/o Late Mahesh Misra C-20, Defence Colony, New Delhi – 110024 (Professional)
4.
Dr. Mahendra Jeet Sharma S/o Late Sh. Gopi Nath Sharma 572/1B, Civil Lines, MGS Gate, Sultanpur – 22804 Uttar Pradesh
5.
Mr. Trtirunillai Krishanan Govindan S/o Late Sh. T.D. Krishan (Retired) 90C, Pocket L, Mayur Vihar Phase I, Delhi – 110091
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TECHNICAL ANALYSIS Located in village for Pureshuklan, surrounded by many mango groves and farmland. The building is well ventilated and certain portions are air-conditioned. There is adequate access from the main road on two sides. Approach road is wide enough for cars, jeeps, vans, Lorries and other means of transport.
The building plan has been considered keeping the location and socio cultural habits of the community. It is a two storied building having ramps so as to transport immobile patients to the first floor. The hospital will have an advanced pathology lab based on semi automation, a good imaging department; emergency services round the clock, an operating room and an ICU to provide critical care and life stabilization care for all cases.
Equipped with an ambulance it can provide safe transportation of both stable and unstable patients to the designated referral hospitals. The nearest tertiary care hospital is SGPI, Lucknow and KGMC, Lucknow which are approximately 70 kms away with a driving time of 1 ½ hours. It has been envisaged to contain the cost of health care to bring it within the reach of the population who at present are not able to afford the cost of health care.
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In addition, we bring out the following points for consideration. General 1.
For selected specialties as stated above the hospital shall provide all needed services.
2.
For all other specialties it shall provide only essential services to preserve life and stabilize the patient’s condition and evacuate the patient to an alternative health care facility.
3.
The hospital shall maintain its accounts in a very transparent manner, and make it public.
4.
It will accept grants/donations from all concerned and submit the income/expense statement to the funding organization.
5.
Being governed by a collaborative approach it will take the mandates of the stakeholders in the business in to consideration.
Degree of Specialization 1.
The hospital shall provide primary as well as secondary level care including the preventive, promotive, curative and rehabilitative services within the ambit of its capacity.
2.
The hospital has made provisions for future expansion for size and adding on departments if need be.
3.
It will provide comprehensive intensive care for all types of medical and surgical cases.
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4.
The hospital shall be equipped to provide expert first aid and all services for resuscitation and preservation of life.
5.
It will provide a basic casualty unit, a comprehensive critical and intensive care unit providing ventilator support, shock therapy, and backup support for all there services.
6.
The various activities as listed above shall be supported by the following clinical support services. a.
1 operating room / labor room
b.
1 four bedded ICU
c.
Imaging department with 1 portable X-ray machine 1 fixed X-ray machine 1 ultrasound machine 1 theatre sterile supply unit
d. 7.
Laboratory services
The hospital will have an out sourced laundry service to provide clean linen. The sterilization of requisite linen shall be carried out in-house.
8.
The hospital will also have an organized catering service to provide regular and therapeutic diets.
9.
The hospital shall have relationship with more than 1 hospital at Sultanpur, Barabanki and Lucknow for casualty evacuation, specialized investigation and other services not available in-house.
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CATCHMENT AREA a.
Shukla Bazar
b.
Jagdishpur
c.
Odoria
d.
Dadera
e.
Munimpur
f.
Nindura
g.
Banikader
h.
Fatehpur
i.
Haidergarh
j.
Mawai
k.
Puredalai
l.
Ram Nagar
m.
Rudauli
n.
Siddhaur
o.
Sirauli Gauspur
p.
Suratganj
q.
Trivediganj
r.
Sultanpur
s.
Baba Ka Bazar
t.
Suleha
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u.
Inhauna
v.
Rae Bareli
w.
Rani Ganj
x.
Rudauli
y.
Faizabad
z.
Barabanki
The hospital will be geared up to cater to the requirement of the population within a radius of 10 kms from the site. Work Load The proposed hospital shall attract adequate number of patients from the neighboring blocks. Once stabilised it shall also attract patients from neighboring district.
Population of attachment area
-
500,000
Sex ratio
-
933 females/1000 males
Growth Rate
-
1.46% per year
Broad Age Distribution of Population Below 15
-
39.77%
15 – 59
-
53.56%
Above 59
-
6.67%
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Health Indicators
Birth Rate
-
25.8% / 1000/year
Death Rate
-
8.5% /1000/year
General fertility rate
-
103.2% /1000/year
Infant Mortality Rate
-
710% /1000/year
Expectancy of life at birth
-
66.04% year (64.8 for all India)
Proportion of workers to total population
-
34.18% (51.00% for males only)
General morbidity rate
-
81.0% once a year
Accident/emergency rate
-
7.5% year
Hospital occupancy rate
-
18.0% year of population day
Facilities Available There are primary health centers, community health centers, sub-centers, FRUs along with district hospital in the catchment area. However, the consumers are not happy with the services provided by them and avail their health care services from private providers as evidenced by several studies.
There are certain private providers along with Ayurveda and Homeopathy practitioners but none of them provide the comprehensive range of services. Hence this effort of providing all services under one roof is envisaged.
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Disease Profile
1.
Infectious & Parasitic Diseases
Uttar Pradesh Male Female 16.6 14.3
2.
Neoplasms
3.0
3.5
3.
Endocrine, Nutritional, Metabolic Diseases & Immunity Disorders
3.0
3.3
4.
Diseases of Blood & Blood Forming Organs
2.0
2.8
5.
Mental Disorders
0.1
0.1
6.
Diseases of the Nervous System & Sense Organs
3.1
3.2
7.
Diseases of the Circulatory System
23.0
20.8
8.
Diseases of the Respiratory System
7.2
7.0
9.
Diseases of the Digestive System
5.6
3.5
10.
Diseases of the Genito-urinary System
1.6
1.4
11.
Complications of Pregnancy
0.0
2.1
12.
Diseases of the Skin & Subcutaneous Tissues
0.2
0.2
13.
Diseases of the Musculoskeletal System & Connective Tissues
0.1
0.1
14.
Congenital Anomalies
0.5
0.7
15.
Certain Conditions Originating in Perinatal Period
8.6
9.1
16.
Symptoms, Signs and ill Defined Conditions
13.9
14.8
17.
Injury and Poisoning
11.5
13.1
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The data used has been taken from Health Information of India 2001. Published in June 2003 by Central Bureau of Health Intelligence, Min. of Health and Family Welfare, Govt. of India or the previous edition. JUSTIFICATION According to the World Health Report 2000 — “while private health expenses in industrial countries now average only some 25 percent because of universal health coverage (except in the United States, where it is 56%), in India, families typically pay 80 percent of their health care costs as "out-of- pocket" expenses when they receive health care”.
The above table gives an idea about the household spending or out of pocket expenses in India as per source mentioned in the table.
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The above table reveals that in spite of the huge Government infrastructure in terms of health care in rural areas it has failed to meet the requirements of rural masses.
This table clearly reveals that the private providers in health care capture a larger market share of the health care business in our country.
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This table elaborates clearly that the private practition ers and smaller nursing homes capture a larger share of the rural health care market.
The figure explains the reasons for preferring private providers vis-à-vis government providers
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It has been made very clear by several studies including the above that majority of the health care providers in rural India have less than 30 beds.
Studies further reveal that the private for profit hospitals capture most of the private health care market.
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The above table elaborates that hospitals in rural areas should have met minimum standards laid down by NABH.
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Projected Work Load of the Hospital For the population base growing at rate of 1.5% approximately per annum and hospital beds growing at the rate of 10% per annum.
OPD From the catchment area
-
23,250 per year
Referral Cases
-
9,200 per year
Emergency
-
1% of total OPD – 325 patients per year Say 1 patient per day
-
5 days
In Patients Average length of stay
15% of OPD Patients visits x 5 days (average length of stay = 17,520 patients bed days per year) Hence total number of bed required will be 47. All the processes will be very structured so as to bring down the average length of stay to 3-4 days. Therefore a bed strength of 30 will be sufficient.
Details of Site Location
:
Pureshuklan
Size of the Plot
:
12,000 sq. ft.
Specific use of Land
:
Hospital
Permissible floor space index
:
30%
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Building Height
:
8 meters
Road Access
:
Available
Public Transport Service
:
Available
Electric Supply
:
Available
Water Supply
:
Available
Sewage Treatment
:
Will be met with
Refuse Disposal
:
Will be out sourced & Treated by Deep Burial
Telephone Lines
:
3 lines
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PHYSICAL FACILITY (All Data are derived from BIS Standards for 30 bedded Hospital, IPHS 2006) Area a.
Total built up area 8,000 sq. ft.
b.
Area of ground floor 4,000 sq. ft.
c.
Area of First Floor 4,000 sq. ft.
Building Height
-
8 meters
Hospital Engineering Services a.
Load of Electricity - 25 KVA
b.
Generator - 10 KVA
c.
UPS – 3 KVA
d.
Electrical Distribution box and panels
Fire Fighting System
-
Yes
Solar Heating System
-
Planned
Telecommunicating System -
EPBAX having 3 incoming and 10 out going
Nurse call system
-
Yes
Computers
-
HIS
Water
-
2 Sources (Municipality and Bore well)
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HEALTH CARE PLAN Objective It is proposed that the hospital positions it self as a center of excellence, providing health care services to the targeted community and the following services to capture the market in the society. a.
Pre-marital counseling
b.
Registration of young couples
c.
Marriage counseling
d.
Sex education
e.
Ante-natal checking of expecting mothers
f.
Natal services for mother and child
g.
Post natal monitoring of mother and child upto 3 years including immunization, child’s growth monitoring and support for birth of the sibling
h.
Care of child in pre-school and school
i.
Child counseling
j.
Tobacco cessation campaign
k.
School health
l.
First AID and emergency services
m.
Continuing health education to the community
n.
Evacuation of patients to tertiary facilities
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o.
Specialty clinics
p.
Telemedicine facility
q.
To co-ordinate with the district health and family welfare department in implementing all national health programmes in the region.
r.
Comprehensive medical records keeping
s.
Co-operative based micro health insurance scheme
t.
Health Check package
u.
Preventive health
v.
Health education
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FUNCTIONAL PLAN AND PROGRAMS 1.
The hospital shall provide its services on a fee for service basis to all. However, due consideration will be given to the socio economic status of the community.
2.
Capital cost of plan and building is Rs. 42 lakhs.
3.
Projected cost of medical equipments and building utility equipments will be around Rs. 72 lakhs.
4.
The hospital will be self-sustaining financially.
5.
The calculations of occupancy rate and break even are enclosed.
6.
Depreciations as applicable are adapted.
7.
Technology up gradations will be supported by donations
8.
Hospital tariff will be so structured that it provides sustainability along with maintenance of the building, and equipments.
9.
Hospital accounts shall be computerized and all taxes shall be accounted for.
10.
The medical superintendent will be the designated authority for authorizing any incidental expenditure and shall maintained an account for the same.
11.
All patients will be given and information booklets.
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12.
Patients shall sign the respective general and informed consent form.
13.
Operations of the hospital will be carried out according to the laws of the land.
14.
The hospital shall provide services as per the following timetable.
IPD Ward Rounds
Morning Evening
Urgent Consultations Cross Consultations
Routine Urgent
Diagnostic Services
Routine Urgent
All Nursing Procedures, as required, shall be provided as per the ward schedule. Therapeutic Services Routine (Other than Nursing Procedures) Urgent Discharge
Routine
Urgent
9 1.m. – 12 noon, 7 days a week 7 p.m. – 9 p.m. 7 days a week On call from the ward sister, 24 hours, Round the year Morning: 9 a.m. – 12 p.m., 7 days a week On call from the ward sister, 24 hours, Round the year Morning: 8 a.m. – 11 a.m., 7 days a week On call from the ward sister, 24 hours, Round the year
Afternoon: 2 p.m. – 5 p.m., 7 days a week On call from the ward sister, 24 hours, Round the year To be initiated during the ward rounds and all formalities to be completed and patient discharged by Noon of same day or next day. On call from the ward sister, 24 hours, Round the year.
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OPD Routine 12 hours per day, 6 days a week Consultations Special 3 – 4 hours in the afternoon hours, Clinics after notified lunch interval, 4 days a week, in Hospital OPD. Emergency Services To be provided 24 hours, Round the year, and will include all other hospital services that are needed including emergency surgery. Surgical Suit Services Elective Surgery, Surgical Suit, Maintenance Special Dressings
As per schedule of the surgical suit, 6 days a week after finishing the OT list on 6th, once a week. After Notified lunch interval, 6 days a week
Registration of cases Examination – IPD cases - OPD Cases
4-6 hours in the morning hours, upto notified lunch interval, 6 days a week 8-11 a.m. 6 days a week
Imaging Services
Delivery Reports
9 a.m. upto notified lunch interval, 6 days a week. After notified Lunch Interval, 5 days a week of Within 2-4 hours of Examination
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Laboratory Services Registration of cases Collection of Samples
Delivery Reports
4-6 hours in the morning hours, upto notified Lunch Interval, 6 days a week 4-6 hours in the morning hours, upto notified lunch interval, 6 days a week. For special clinics: 4 days a week in the clinics. of All Stat tests, as soon as possible. For all other tests, results shall be posted to requesting location . Hard copies shall be delivered in the notified schedule, 6 days a week.
Ancillary Therapies Routine Special procedures
As per schedule of the respective department, 6 days a week On call from the ward sister, 24 hours, Round the year.
15.
There shall be a proper admission and discharge procedure.
16.
Patient has to pay for all the medication and surgical supplies.
17.
Money to be collected at a central billing and reception area.
18.
A discharge summary will be given to all the discharge patients.
19.
Fire and emergency drills to be carried out regularly.
20.
Casualty Medical Officer shall control the ambulance services
21.
Staff in the hospital to be provided health care facilities according to the policies.
22.
Laundry services to be out sourced.
23.
Flow diagrams to be displayed at all areas.
24.
Care should be taken so as to prevent criss- crossing of traffic.
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25.
Medical Superintendent shall conduct periodic staff meetings.
26.
All major hospital routines to be documented.
27.
The governing board shall designate by a written resolution authorizing the medical superintendent to give concessions to patients as an when required.
28.
Medical consultants will be on free for service basis.
29.
A token amount of 10% from their fees will be deducted as hospitals share.
30.
Free treatment could be given to the underprivileged sections of the society.
OPD a.
OPD consulting room shall be utilized on a three hours slot basis in four shifts in two chambers from 8 a.m. to 8 p.m.
b.
Female ayahs to be deployed in the OPD.
c.
Citizens’ charters to be displayed.
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DEPARTMENTATION 1.
Functional Department a.
General Surgery
b.
Internal Medicine
c.
Gynecology and Obstetrics
d.
Pediatrics
e.
Orthopedics
f.
EYE
g.
ENT
h.
Ayurveda
i.
Homeopathy
j.
Physical Medicine and Rehabilitation
k.
Anesthesia
l.
Radio Diagnosis
m.
Laboratory Medicine
n.
Emergency Medicine
2.
Support Departments a.
Reception and Public relationship
b.
Hospital administration
c.
Human Resource Development
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d.
Finance and Accounts
e.
Medical Records
f.
Purchase and Store
g.
Cafeteria
h.
Laundry
i.
Maintenance
j.
Pharmacy
k.
Security
3.
Hospital Shall Provide Residential Accommodation for Nurses
4.
Functional Areas a.
ICU - 4 beds
b.
Observation ward – 2 beds
c.
Male ward – 12 beds
d.
Female ward – 12 beds
OPD a.
OPD - 2 rooms
b.
Casualty – 1 room
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Support Areas a. Imaging Departments b.
Laboratory
c.
Physiotherapy
d.
Generator Room
e.
Electricity Distribution panel
f.
Water Storage
g.
Medical Gas Storage Area
h.
Cafeteria
i.
Pharmacy
FACILITY MANAGEMENT -
Temple
-
Public Education Centre
-
MSW’s Desk
-
Cafeteria
-
Pharmacy
-
Emergency
-
O.P.D.
-
Reception
-
Distribution Panel/Switch Box
-
Generator Room
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-
Laboratory
-
X-Ray
-
Ultrasound Room
-
Admin. Area and IT + Accounts
-
Accounts / HR
-
Observation Room
-
Wards (Male + Female)
-
Doctors duty room
-
Nurses Changing room
-
Store and Medical Record Room
-
I.C.U.
-
O.T. Complex
-
Conference room
-
Corridors
-
Guest Room
-
Solar Heating System
LICENSES PERMITS AND STATUTORY OBLIGATIONS a.
Building Permit (Completion Certificate)
b.
Registration under MTP Act
c.
Registration of the Ultrasound machine under PNDT Act.
d.
The Wholesale and Retail Drug-License
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e.
The Excise Permit to store Spirit.
f.
The permit to store opium and its derivatives under the Narcotic and Psychotropic Substances Act.
g.
No Objection Certificate from the Chief Fire Officer, from the Region.
h.
No Objection Certificate under Pollution Control Act.
i.
No Objection Certificate under Bio-medical Waste Rules, 1998.
j.
The Vehicle Registration Certificates in respect of all vehicles the hospital owns.
k.
Radiation Protection Certificate in respect of All X-ray Equipment from BARC.
l.
PAN Number
m.
ESI Registration
n.
Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002: “All hospitals are obliged to provide medical care to preserve life to all injured citizens brought to hospital”.
o.
Pharmacy License
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ORGINASTION STRUCTURE Governing Body
Medical Superintendent
Consultants
• • • • • • • • •
Surgery Medicine Gynaecology Paediatrics Orthopaedics EYE ENT Lab Radiology
Nurses
o o o o o
Nursing Supdt Nurses Ward Boys Ayahas Sweepers
Administration
ICU/OT/Casualty
o o o o
IT Receptionist Billing & Accounts MRD Security Drivers Maintanance Store & Purchase
Anesthesist Technicians TSSU CMO
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STAFFING PATTERN WITH QUALIFICATION 1.
Medical Superintendent
-
MBBS, DHA, 10 years of experience
2.
Nursing Superintendent
-
Diploma Nursing, 15 years of experience
3.
GDMOs
-
MBBS, BUMS, with 1 year experience
4.
Nurses
-
Diploma Nursing – 1 year experience
5.
Receptionist
-
Graduates
6.
IT Manager
-
5 years experience in Software & Hardware
7.
Admin./HR
-
Graduate with MBA
8.
Accounts
-
B.Com.
9.
Lab Technician
-
MLT.
10.
X-Ray Technician
-
Radiography Course
11.
OT Technician
-
ORA Course
12.
Electrician
-
ITI Diploma
13.
Plumber
14.
Driver
-
Heavy vehicle License with 5 years exp.
15.
M.S.W.
-
Counselling Course
16.
Ward Boys
-
17.
Sweepers
-
18.
Ayahas
Page 42
ANNEXURE - 1 LAYOUT MAP OF THE FACILITY
Page 43
LAYOUT MAP OF THE FACILITY
Page 44
LAYOUT MAP OF THE FACILITY
Page 45
LAYOUT MAP OF THE FACILITY
Page 46
ANNEXURE -2
LIST OF SUGGESTED EQUIPMENTS AND FURNITURES 1.
Normal Delivery Kit
2.
Equipment for assisted vacuum delivery
3.
Equipment for assisted forceps delivery
4.
Standard Surgical Set (for minor procedures like episiotomies stitching)
5.
Equipment for Manual Vacuum Aspiration
6.
Equipment for New Born Care and Neonatal Resuscitation
7.
IUD insertion kit
8.
Equipment / reagents for essential laboratory investigations
9.
Refrigerator.
10.
ILR/Deep Freezer
11.
Ice box
12.
Computer with accessories including internet facility
13.
Baby warmer/incubator.
14.
Binocular microscope
15.
Equipments for Eye care and vision testing: Tonometers (Schiotz), direct opthalmoscope, illuminated vision testing drum, trial lens sets with trial frames, snellen and near vision charts, Battery operated torch
16.
Equipments under various National Programmes
17.
Radiant warmer for new born baby
Page 47
18.
Baby scale
19.
Table lamp with 200 watt bulb for new borne baby
20.
Phototherapy unit
21.
Self inflating bag and mask-neonatal size
22.
Laryngoscope and Endotracheal intubation tubes (neonatal)
23.
Mucus extractor with suction tube and a foot operated suction machine
24.
Feeding tubes for baby
25.
Sponge holding forceps – 2
26.
Valsellum uterine forceps – 2
27.
Tenaculum uterine forceps – 2
28.
MVA syringe and cannulae of sizes 4-8 (2 sets; one for back up in case of technical problems)
29.
Kidney tray for emptying contents of MVA syringe
30.
Containers for tissues
31.
Torch without batteries – 2
32.
Battery dry cells 1.5 volt (large size) – 4
33.
Bowl for antiseptic solution for soaking cotton swabs
34.
Tray containing chlorine solution for keeping soiled instruments
35.
Residual chlorine in drinking water testing kits
36.
H2S Strip test bottles
Page 48
Requirements for the Labour Room 1.
A labour table
2.
Suction machine
3.
Facility for Oxygen administration
4.
Sterilisation equipment
5.
24-hour running water
6.
Electricity supply with back-up facility (generator with POL)
7.
Attached toilet facilities
8.
An area earmarked for new-born care
9.
Emergency drug tray: This must have the following drugs
10.
a.
Inj. Oxytocin
b.
Inj. Diazepam
c.
Tab. Nifedepine
d.
Magnesium sulphate
e.
Inj. Lignocaine hydrochloride
f.
Inj. Methyl ergometrine maleate
g.
Sterilised cotton and gauze
Delivery kits, including those for normal delivery and assisted deliveries.
Page 49
PRIVACY of a woman in labour should be ensured as a quality assurance issue. List of Equipments for Pap Smear 1.
Cusco’s vaginal speculum (each of small, medium and large size)
2.
Sim’s vaginal speculum – single & double ended - (each of small, medium and large size)
3.
Anterior Vaginal wall retractor
4.
Sterile Gloves
5.
Sterilised cotton swabs and swab sticks in a jar with lid
6.
Kidney tray for keeping used instruments
7.
Bowl for antiseptic solution
8.
Antiseptic solution: Chlorhexidine 1% or Cetrimide 2% (if povidone iodine solution is available, it is preferable to use that)
9.
Chittle forceps
10.
Proper light source / torch
11.
For vaginal and Pap Smears: a.
Clean slides with cover slips
b.
Cotton swab sticks
c.
KOH solution in bottle with dropper
d.
Saline in bottle with dropper
e.
Ayre’s spatula
f.
Fixing solution / hair spray
Page 50
Requirements of the Laboratory Reagents 1.
For Cyan meth - haemoglobin method for Hb estimation
2.
Uristix for urine albumin and sugar analysis
3.
ABO & Rh antibodies
4.
KOH solution for Whiff test
5.
Gram’s iodine
6.
Crystal Violet stain
7.
Acetone-Ethanol decolourising solution.
8.
Safranine stain
9.
PH test strips
10.
RPR test kits for syphilis
Glassware and other Equipment 1.
Colorimeter for Hb estimation
2.
Test tubes
3.
Pipettes
4.
Glass rods
5.
Glass slides
6.
Cover slips
7.
Light Microscope
Page 51
List of Furniture (including surgical) Examination table
5
Writing tables with table sheets
8
Plastic chairs (for in-patients’ attendants)
10
Armless chairs
12
Full size steel almirah
8
Labour table
1
OT table
1
Arm board for adult and child
4
Wheel chair
1
Stretcher on trolley
1
Instrument trolley
2
Wooden screen
1
Foot step
5
Coat rack
2
Bed side table
30
Bed stead iron (for in-patients)
30
Baby cot
2
Stool
30
Medicine chest
4
Lamp
5
Shadowless lamp light (for OT and Labour room)
2
Page 52
Side Wooden racks
10
Fans
10
Tube light
18
Sundry Articles including Linen: Buckets
10
Mugs
10
LPG stove
1
LPG cylinder
2
Sauce pan with lid
2
Water receptacle
2
Rubber/plastic shutting
10 meters
Drum with tap for storing water
5
I V stand
16
Mattress for beds
30
Foam Mattress for OT table
1
Foam Mattress for labour table
1
Macintosh for labour and OT table
4 metres
Kelly’s pad for labour and OT table
2 sets
Bed sheets
50
Pillows with covers
40
Blankets
30
Baby blankets
2
Page 53
Towels
30
Curtains with rods
50 metres
ANNEXURES -3
DRUGS (To be vetted by the Hospital Drug Committee) Oxygen
Inhalation
Local Anaesthetics Lignocaine Hydrochloride
Topical Forms 2-5%
Preoperative Medication and Sedation for Short Term Procedures Diazepam
Tablets 5 mg Injection 5 mg / ml
Analgesics, antipyretics and Non-Steroidal Anti-inflammatory Medicines, Non-Opioid Analgesics, Antipyretics and Nonsteroidal Anti-inflammatory
Medicines Acetyl Salicylic Acid
Tablets 300mg & 50 mg
Ibuprofen
Tablets 400 mg
Paracetamol
Injection 150 mg / ml
Page 54
Syrup 125 mg / 5ml Antiallergics and Medicines used in Anaphylaxis Adrenaline
Injection
Chlorpheniramine Maleate
Tablets 4 mg
Dexchlorpheniramine Maleate
Syrup 0.5 mg / 5 ml
Dexamethasone
Tablets 0.5 mg
Pheniramine Maleate
Injection 22.75 mg / ml
Promethazine
Tablets 10 mg, 25 mg Syrup 5 mg / 5 ml Capsules 250 mg, 500 mg
Ampicillin
Capsules 250 mg., 500 mg Powder for suspension 125 mg / 5 ml Injection 500 mg
Benzathine Benzylpenicillin
Injection 6 lacs, 12 lacs, 24 lacs units
Benzylpenicillin
Injection 5 lacs, 10 lacs units
Cloxacillin
Capsules 250 mg, 500 mg Liquid 125 mg / 5 ml
Procaine Benzylpenicillin
Injection Crystalline penicillin (1 lac units) + Procaine penicillin (3 lacs units)
Cephalexin
Syrup 125 mg/5 ml Capsules 250 mg., 500 mg*
Page 55
Ciprofloxacin
Injection 200 mg / 100 ml
Hydrochloride
Tablets 250 mg., 500 mg
Co-Trimoxazole
Tablets 40 + 200 mg, 80 + 400 mg
(Trimethoprim + Sulphamethoxazole)
Suspension 40 + 200 mg / 5 ml
Doxycycline
Capsules 100 mg
Erythromycin Estolate
Syrup 125 mg / 5 ml Tablets 250 mg, 500 mg
Gentamicin
Injection 10 mg / ml, 40 mg / ml
Metronidaozle
Tablets 200 mg, 400 mg Injection 500 mg / 100 ml
Antidotes and Other Substances used in Poisonings Nonspecific Activated Charcoal Powder Atropine Sulphate
Injection 0.6 mg / ml
Specific Antisnake Venom
Injection Polyvalent Solution/ Lyophilyzed Polyvalent Serum
Anticonvulsants/Antiepileptics Carbamazepine
Tablets 100 mg, 200 mg Syrup 20 mg / ml
Phenytoin Sodium
Capsules or Tablets 50 mg, 100 mg Syrup 25 mg / ml
Page 56
Antiinfective Medicines Anthelminthics Intestinal Anthelminthics Mebendazole
Tablets 100 mg Suspension 100 mg/ 5 ml
Albendazole
Tablets 400mg
Antifilarials Diethylcarbamazine Citrate
Tablets 150 mg
Antibacterials Amoxicillin
Powder for suspension 125 mg / 5 ml Capsules 250 mg, 500 mg
Cardiovascular Medicines Antianginal Medicines Acetyl Salicylic Acid
Tablets 75 mg,100mg,350mg.
Glyceryl Trinitrate
Sublingual Tablets 0.5 mg. Injection 5 mg/ml
Isosorbide 5 Mononitrate
Tablets 10 mg.
Propranolol
Tablets 10mg,40mg Injection 1mg/ml.
Antihypertensive Medicines Amlodipine
Tablets 2.5 mg, 5 mg, 10 mg
Page 57
Atenolol
Tablets 50 mg,100 mg
Enalapril Maleate
Tablets 2.5 mg, 5 mg, 10 mg Injection 1.25 mg / ml
Methyldopa
Tablets 250 mg
Dermatological Medicines (Topical) Antifungal Medicines Benzoic Acid +Salicylic Acid
Ointment or Cream 6% + 3%
Miconazole
Ointment or Cream 2%
Antiinfective Medicines Framycetin Sulphate
Cream 0.5%
Methylrosanilinium Chloride (Gentian Violet)
Aqueous solution 0.5%
Neomycin +Bacitracin
Ointment 5 mg + 500 IU
Povidone Iodine
Solution and Ointment 5%
Silver Nitrate
Lotion 10%
Nalidixic Acid
Tablets 250 mg, 500 mg
Nitrofurantoin
Tablets 100 mg
Norfloxacin
Tablets 400 mg
Tettracycline
Tablets or Capsules 250 mg
Page 58
Antileprosy Medicines and Anti-tubecullar medicines as per national programmes Antifungal Medicines Clotrimazole
Pessaries 100 mg, 200 mg, Gel 2%
Griseofulvin
Capsules or Tablets 125 mg, 250 mg
Nystatin
Tablets 500,000 IU Pessaries 100,000 IU
Antiprotozoal Medicines Antiamoebic and Antigiardiasis Medicines Diloxanide Furoate
Tablets 500 mg
Metronidazole
Tablets 200 mg, 400 mg Injection 500 mg / 100 ml
Tinidazole
Tablets 500 mg
Blood Products and Plasma Substitutes Plasma Subsitutes Dextran-4
Injection 10%
Dextran
Injection6%
Silver Sulphadiazine
Cream 1%
Antiinflammatory and Antipruritic Medicines Betamethasone Cream / Ointment 0.05% Dipropionate Calamine
Lotion
Page 59
Astringent Medicines Zinc Oxide
Dusting Powder
Medicines Affecting Skin Differentiation and Proliferation Glycerin Solution 13.6 Scabicides and Pediculicides Benzyl Benzoate
Lotion 25%
Disinfectants and Antiseptics Antiseptics Benzoin Compound
Tincture
Cetrimide
Solution 20% (conc.for dilution)
Chlorhexidine
Solution 5% (conc. for dilution)
Ethyl Alcohol 70% Solution Gentian Violet
Paint 0.5%, 1%
Hydrogen Peroxide
Solution 6%
Disinfectants Bleaching Powder
Powder
Formaldehyde IP
Solution
Potassium Permanganate
Crystals for solution
Diuretics Furosemide
Injection, 10 mg/ ml, Tablets 40 mg
Page 60
Gastrointestinal Medicines Antacids and other Antiulcer Medicines Aluminium Hydroxide+ Magnesium
Suspension
Hydroxide
Tablet
Omeprazole
Capsules 10 mg, 20 mg, 40 mg
Ranitidine Hydrocholoride
Tablets 150 mg, 300 mg Injection 25 mg / ml
Antiemetics Domperidone
Tablets 10 mg Syrup 1 mg / ml
Metoclopramide
Tablets 10 mg Syrup 5 mg / ml Injection 5 mg / ml
Antispasmodic Medicines Dicyclomine Hydrochloride
Tablets 10 mg, Injection 10 mg / ml
Hyoscine Butyl Bromide
Tablets or 10 mg Injection 20 mg / ml
Laxatives Bisacodyl
Tablets/ suppository 5 mg
Isphaghula
Granules
Medicines used in Diarrhoea Oral Rehydration Salts
Powder for solution As per IP
Page 61
Hormones, other Endocrine Medicines and Contraceptives Adrenal Hormones and Synthetic Substitutes Prednisolone
Tablets 5 mg, 10 mg
Antidiabetics and Hyperglycaemics Insulins and Other Antidiabetic Agents Glibenclamide
Tablets 2.5 mg, 5 mg
Insulin
Injection (Soluble) Injection 40 IU / ml
Metformin
Tablets 500 mg
For Specific Group of Individuals Rabies Vaccine
Injection
Tetanus Toxoid
Injection
Ophthalmological Preparations Antiinfective Agents Chloramphenicol
Drops/Ointment 0.4%, 1%
Ciprofloxacin Hydrochloride
Drops/Ointment 0.3%
Gentamicin
Drops 0.3%
Miconazole
Drops 1%
Sulphacetamide Sodium
Drops 10%, 20%, 30%
Tetracycline Hydrochloride
Ointment 1%
Antiinflammatory Agents Prednisolone Acetate
Drops 0.1%
Prednisolone Sodium Phosphate
Drops 1%
Page 62
Xylometazoline
Drops 0.05%, 0.1%
Local Anaesthetics Medicines used in Psychotic Disorders Chlorpromazine Hydrochloride
Tablets 25 mg, 50 mg, 100 mg Syrup 25 mg / 5 ml Injection 25 mg / ml
Medicines used for Generalized Anxiety and Sleep Disorders Diazepam Tablets 2 mg, 5 mg, 10 mg Antiasthmatic Medicines Aminophylline
Injection 25 mg / ml
Beclomethasone Dipropionate
Inhalation 50 mg, 250 mg/dose
Salbutamol Sulphate
Tablets 2 mg, 4 mg Syrup 2 mg / 5 ml Inhalation 100 mg / dose
Theophylline Compounds
Antitussives
Codeine Phosphate
Tablets 10 mg Syrup 15 mg / 5 ml
Dextromethorphan
Tablets 30 mg
Solutions correcting Water, Electrolyte and Acid-Base Disturbances Oral Oral Rehydration Salts
Powder for Solution As per IP
Glucose
Injection 5% isotonic 50% hypertonic
Glucose with Sodium Chloride
Injection 5% + 0.9%
Page 63
Normal Saline
Injection 0.9%
Potassium Chloride
Injection 11.2% Sol.
Ringer Lactate
Injection
Sodium Bicarbonate
Injection
Miscellaneous Water for Injection
Injection 2 ml, 5 ml, 10 ml
Vitamins and Minerals Ascorbic Acid
Tablets 100 mg, 500 mg
Calcium salts
Tablets 250 mg, 500 mg
Multivitamins
Tablets
Page 64
ANNEXURE - 4
STANDARD PRECAUTIONS The standard precautions should be understood and applied by all medical and paramedical staff involved In providing health services. The basic elements include: 1.
Hand washing thoroughly with soap and running water. a. Before carrying out the procedure b. Immediately if globes are torn and hand is contaminated with blood or other body fluids. c. Soon after the procedure, with gloves on and again after removing the gloves.
2.
Barrier precautions: using protective gloves, mask, waterproof aprons and gowns.
3.
Strict asepsis during the operative procedure and cleaning the operative site. Practise the “no touch technique” which is: any instrument or part of instrument which is to be inserted in the cervical canal must not touch anynon-sterile object / surface prior to insertion.
4.
Decontamination and cleaning of all instruments immediately after each use.
Page 65
5.
Sterilisation / high level disinfection of instruments with meticulous attention.
6.
Appropriate waste disposal.
Sterilization of Instruments 1.
Instruments and linen must be autoclaved.
2.
In case autoclaving is not possible, the instruments must be fully immersed in water in a covered container and boiled for at least 20 minutes.
Sterilisation of Copper T insertion instruments 1.
Copper T is available in a pre-sterilised pack
2.
Ensure that the instruments and gloves used for insertion are autoclaved, or fully immersed in a covered container and boiled for at least 20 minutes
Sterilisation and maintenance of MVA equipment The four basic steps are: 1.
Decontamination of instruments, gloves, cannulae and syringes in 0.5% chlorine solution
2.
Cleaning in lukewarm water using a detergent.
3.
Sterilisation / High Level Disinfection
4.
Storage and re-assembly of instruments.
5.
The person responsible for cleaning must wear utility gloves.
Page 66
ANNEXURE - 5
CITIZEN’S CHARTER Charter of Patients’ Rights for the Hospital
1.
Preamble Hospital exists to provide health care to every citizen of the locality within
the allocated resources and available facilities. The Charter seeks to provide a framework, which enables citizens to know. a.
What services are available and their charges
b.
The quality of services they are entitled to
c.
The names through which complaints regarding denial or poor qualities of services will be addressed.
2.
Objective a.
To make available health care services and the related facilities for consumers.
b.
To provide appropriate advice, treatment, referral and support that would help to cure the ailment to the extent medically possible.
c. 3.
To redress any grievances in this regard. Commitments of the Charter
a.
To provide access to available facilities without discrimination,
Page 67
b.
To provide emergency care, if needed on reaching the hospital
c.
To provide adequate number of notice boards detailing the location of all the facilities and the schedule of camps and other activities.
d.
To provide written information on diagnosis, treatment being administered.
e. 4.
To record complaints and respond at an appointed time. Grievance Redressal
a.
Grievances that consumers have will be recorded.
b.
Aggrieved user after his/her complaint recorded would be allowed to seek a second opinion at a referral hospital.
5.
Responsibilities of the Users a.
Users of hospital would attempt to understand the commitments made in the charter.
b.
Users would not insist on service above the standard set in the charter because it could negatively affect the provision of the minimum acceptable level of service to another user.
c.
Instructions of the hospital personnel would be followed sincerely, and
d.
In case of grievances, the redressal mechanism machinery would be addressed by users without delay.
Page 68
ANNEXURE - 6
FINANCIAL DETAILS
Total Cost of Project
Cost of Land Cost of Construction (This includes civil Construction, Electrical, Ducting)
Cost / Sq. Amount Rate / Sq. ft (Rs.) ft 500,000 500 8000 4,000,000
Cost of Equipments Contigency & Working Capital
7,200,000 1,100,000 12,800,000
The Total Cost of the Project is Rs. 1.25 Crores
Pre Operative Expenses
Rs. 5,00,000
a. Consultancy b. Travelling and Logistics c. Adminitrative Expenses The pre operative expenses have not been considered in calculating the viability.
Page 69
Cost of Equipment
Hospital Furniture Fire Fighting Equioments Medical Gases Autoclave OT Table Boyle's Separators Coutery Machine Ventilator Infusion Pump Suction Machine Defibrillator, Monitor, Recorder Portable Emergency Light Laprascope Set Cardiac Monitors Pulse Oxy Meter Nebulizer Ultrasound Machine with 2 Probes Portable X - Ray Machine 60 MA X - Ray Machine 100 MA View Box Semi Auto Analyser Electrolyte Analyser Microscope Labarotary Autoclave Refrigerator Wax Bag Short Wave Diathermy Ultrasonic Therapy ECG Machine Opthamology OPD Setup HIS & Computers OT Light Silent Genrator Set UPS Surgical Instruments & Drums Linen Water Pump & Motor Surgical Consumables & Dugs Miscellaneous Total Cost of Equipments
No. Price / Unit (Rs.) All All All 1 75,000 1 200,000 1 150,000 1 150,000 1 150,000 1 50,000 3 15,000 2 150,000 1 50,000 1 1,000,000 4 50,000 1 25,000 2 2,500 1 600,000 1 75,000 1 150,000 5 2,000 1 300,000 1 200,000 1 40,000 1 30,000 3 10,000 1 5,000 1 25,000 1 30,000 2 40,000 1 100,000 All 1 100,000 1 700,000 1 300,000 1 150,000 All All All
Amount (Rs.) 250,000 50,000 100,000 75,000 200,000 150,000 150,000 150,000 50,000 45,000 300,000 50,000 1,000,000 200,000 25,000 5,000 600,000 75,000 150,000 10,000 300,000 200,000 40,000 30,000 30,000 5,000 25,000 30,000 80,000 100,000 1,000,000 100,000 700,000 300,000 150,000 50,000 100,000 300,000 25,000 7,200,000
Page 70
Revenue Streams Month Wise Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Amount(Rs.) Amount(Rs.) Amount(Rs.) Amount(Rs.) Amount(Rs.) OPD Consultation Lab Tests - OPD Lab Tests - IPD X - Ray - OPD X - Ray - IPD Ultra Sound Physiotherapy Counselling MTP Delivery Surgeries Indoor Stay ICU Health Checks Ambulance Drugs & Consumables Total Revenue
7500 15000 12000 6000 3750 18000 4500 1500 11250 30000 45000 9000 60000 15000 15000 63000
7750 15500 12400 6200 3875 18600 4650 1550 11625 31000 46500 9300 62000 15500 15500 65100
7750 15500 12400 6200 3875 18600 4650 1550 11625 31000 46500 9300 62000 15500 15500 65100
10500 19600 16800 5600 7000 16800 4200 1400 10500 28000 42000 12600 56000 14000 16800 84000
11625 21700 18600 6200 7750 18600 4650 1550 11625 31000 46500 13950 62000 15500 18600 93000
316500
327050
327050
345800
382850
Page 71
Revenue Streams Month Wise Apr-07 May-07 Jun-07 Jul-07 Aug-07 Amount(Rs.) Amount(Rs.) Amount(Rs.) Amount(Rs.) Amount(Rs.) OPD Consultation Lab Tests - OPD Lab Tests - IPD X - Ray - OPD X - Ray - IPD Ultra Sound Physiotherapy Counselling MTP Delivery Surgeries Indoor Stay ICU Health Checks Ambulance Drugs & Consumables Total Revenue
11250 21000 18000 6000 7500 18000 4500 1500 11250 30000 45000 13500 60000 15000 18000 90000
11625 21700 18600 6200 7750 18600 4650 1550 11625 31000 46500 13950 62000 15500 18600 93000
15000 30000 36000 9000 7500 27000 6000 2250 11250 30000 45000 27000 90000 30000 18000 117000
15500 31000 37200 9300 7750 27900 6200 2325 11625 31000 46500 27900 93000 31000 18600 120900
15500 31000 37200 9300 7750 27900 6200 2325 11625 31000 46500 27900 93000 31000 18600 120900
370500
382850
501000
517700
517700
Page 72
Revenue Streams Month Wise Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Amount(Rs.) Amount(Rs.) Amount(Rs.) Amount(Rs.) Amount(Rs.) OPD Consultation Lab Tests - OPD Lab Tests - IPD X - Ray - OPD X - Ray - IPD Ultra Sound Physiotherapy Counselling MTP Delivery Surgeries Indoor Stay ICU Health Checks Ambulance Drugs & Consumables
15000 30000 36000 9000 7500 27000 6000 2250 11250 30000 45000 27000 90000 30000 18000 117000
15500 31000 37200 9300 7750 27900 6200 2325 11625 31000 46500 27900 93000 31000 18600 120900
18750 36000 48000 12000 11250 36000 6000 3000 15750 42000 63000 36000 120000 45000 21000 270000
19375 37200 49600 12400 11625 37200 6200 3100 16275 43400 65100 37200 124000 46500 21700 279000
19375 37200 49600 12400 11625 37200 6200 3100 16275 43400 65100 37200 124000 46500 21700 279000
Total Revenue
501000
517700
783750
809875
809875
Page 73
Revenue Streams Month Wise Feb-08 Mar-08 Apr-08 May-08 Jun-08 Amount(Rs.) Amount(Rs.) Amount(Rs.) Amount(Rs.) Amount(Rs.) OPD Consultation Lab Tests - OPD Lab Tests - IPD X - Ray - OPD X - Ray - IPD Ultra Sound Physiotherapy Counselling MTP Delivery Surgeries Indoor Stay ICU Health Checks Ambulance Drugs & Consumables
18125 34800 46400 11600 10875 34800 5800 2900 15225 40600 60900 34800 116000 43500 20300 261000
23250 46500 93000 15500 15500 46500 7750 3875 23250 62000 93000 69750 186000 62000 23250 372000
22500 45000 90000 15000 15000 45000 7500 3750 22500 60000 90000 67500 180000 60000 22500 360000
23250 46500 93000 15500 15500 46500 7750 3875 23250 62000 93000 69750 186000 62000 23250 372000
22500 45000 90000 15000 15000 45000 7500 3750 22500 60000 90000 67500 180000 60000 22500 360000
Total Revenue
757625
1143125
1106250
1143125
1106250
Page 74
Revenue Streams Month Wise Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Amount(Rs.) Amount(Rs.) Amount(Rs.) Amount(Rs.) Amount(Rs.) OPD Consultation Lab Tests - OPD Lab Tests - IPD X - Ray - OPD X - Ray - IPD Ultra Sound Physiotherapy Counselling MTP Delivery Surgeries Indoor Stay ICU Health Checks Ambulance Drugs & Consumables Total Revenue
23250 46500 93000 15500 15500 46500 7750 3875 23250 62000 93000 69750 186000 62000 23250 372000
34875 68200 111600 21700 19375 65100 9300 4650 25575 68200 102300 83700 186000 77500 24800 465000
33750 66000 108000 21000 18750 63000 9000 4500 24750 66000 99000 81000 180000 75000 24000 450000
34875 68200 111600 21700 19375 65100 9300 4650 25575 68200 102300 83700 186000 77500 24800 465000
37500 75000 120000 27000 22500 72000 10500 5250 27000 72000 108000 90000 180000 90000 30000 450000
1143125
1367875
1323750
1367875
1416750
Page 75
Revenue Streams Month Wise Dec-08 Jan-09 Feb-09 Mar-09 Amount(Rs.) Amount(Rs.) Amount(Rs.) Amount(Rs.) OPD Consultation Lab Tests - OPD Lab Tests - IPD X - Ray - OPD X - Ray - IPD Ultra Sound Physiotherapy Counselling MTP Delivery Surgeries Indoor Stay ICU Health Checks Ambulance Drugs & Consumables Total Revenue
38750 77500 124000 27900 23250 74400 10850 5425 27900 74400 111600 93000 186000 93000 31000 465000
38750 77500 124000 27900 23250 74400 10850 5425 27900 74400 111600 93000 186000 93000 31000 465000
35000 70000 112000 25200 21000 67200 9800 4900 25200 67200 100800 84000 168000 84000 28000 420000
38750 77500 124000 27900 23250 74400 10850 5425 27900 74400 111600 93000 186000 93000 31000 465000
1463975
1463975
1322300
1463975
Assumptions OPD - 10 Patients per day at a charge of Rs.25 per patient Lab Tests - 5 Patients of OPD at Rs.100 Lab Tests - 2 Patients of In-house at Rs.200 X-Ray- 2 OPD at Rs.100 X-Ray- 1 OPD at Rs.125 Ultra Sound - 2 at Rs.300 Physiotherapy - 3 at Rs.50 Counselling - 2 at Rs.25 MTP - .5 at Rs.1000 Delivery - .5 at Rs.2000 Surgeries - .5 at Rs. 3000 Indoor Stay - 2 at Rs.150 ICU - 1 at Rs.2000 Health Checks - 1 at Rs.500 Ambulance - 1 at Rs.500 Drugs & Consumables - 4000 No.of Beds – 26 + 4
Page 76
Month Wise Expenses Particulars
Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Amount(Rs.) Amount(Rs.) Amount(Rs.) Amount(Rs.) Amount(Rs.)
Salary Electricity Water Telephone Transportation Maintainance Drugs & Consumables Marketing & Promotion WebSite Designing & Maintainance Miscellaneous
258,500 10,000 2,000 5,000 8,000 10,000 53,550 25,000
258,500 10,000 2,000 5,000 8,000 10,000 55,335 20,000
258,500 10,000 2,000 5,000 8,000 10,000 55,335 20,000
258,500 10,000 2,000 5,000 8,000 10,000 67,200 15,000
258,500 10,000 2,000 5,000 8,000 10,000 74,400 15,000
10,000 15,000
15,000 15,000
0 15,000
0 15,000
0 18,000
Total Expenses
397,050
398,835
383,835
390,700
400,900
Month Wise Expenses Particulars
Apr-07 May-07 Jun-07 Jul-07 Aug-07 Amount(Rs.) Amount(Rs.) Amount(Rs.) Amount(Rs.) Amount(Rs.)
Salary Electricity Water Telephone Transportation Maintainance Drugs & Consumables Marketing & Promotion WebSite Designing & Maintainance Miscellaneous
258,500 11,000 2,200 5,500 9,000 11,000 72,000 10,000
258,500 11,000 2,200 5,500 9,000 11,000 74,400 10,000
284,350 11,000 2,200 5,500 9,000 11,000 93,600 10,000
284,350 11,000 2,200 5,500 9,000 11,000 96,720 5,000
284,350 11,000 2,200 5,500 9,000 11,000 96,720 5,000
0 18,000
0 18,000
0 18,000
0 18,000
0 18,000
Total Expenses
397,200
399,600
444,650
442,770
442,770
Page 77
Month Wise Expenses Particulars
Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Amount(Rs.) Amount(Rs.) Amount(Rs.) Amount(Rs.) Amount(Rs.)
Salary Electricity Water Telephone Transportation Maintenance Drugs & Consumables Marketing & Promotion WebSite Designing & Maintainance Miscellaneous
284,350 11,000 2,200 5,500 9,000 11,000 93,600 5,000
284,350 11,000 2,200 5,500 9,000 11,000 96,720 5,000
314,850 11,000 2,200 5,500 9,000 11,000 216,000 5,000
314,850 11,000 2,200 5,500 9,000 11,000 223,200 5,000
314,850 12,000 2,500 6,000 11,000 12,000 223,200 5,000
0 18,000
10,000 15,000
0 20,000
0 20,000
0 20,000
Total Expenses
439,650
449,770
594,550
601,750
606,550
Month Wise Expenses Particulars
Feb-08 Mar-08 Apr-08 May-08 Jun-08 Amount(Rs.) Amount(Rs.) Amount(Rs.) Amount(Rs.) Amount(Rs.)
Salary Electricity Water Telephone Transportation Maintainance Drugs & Consumables Marketing & Promotion WebSite Designing & Maintainance Miscellaneous
314,850 12,000 2,500 6,000 11,000 12,000 208,800 5,000
386,875 12,000 2,500 6,000 11,000 12,000 297,600 5,000
386,875 12,000 2,500 6,000 11,000 12,000 288,000 5,000
386,875 12,000 2,500 6,000 11,000 12,000 297,600 5,000
386,875 12,000 2,500 6,000 11,000 12,000 288,000 5,000
0 20,000
0 20,000
0 20,000
0 20,000
0 22,000
Total Expenses
592,150
752,975
743,375
752,975
745,375
Page 78
Month Wise Expenses Particulars
Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Amount(Rs.) Amount(Rs.) Amount(Rs.) Amount(Rs.) Amount(Rs.)
Salary Electricity Water Telephone Transportation Maintainance Drugs & Consumables Marketing & Promotion WebSite Designing & Maintainance Miscellaneous
386,875 12,000 2,500 6,000 11,000 12,000 297,600 5,000
386,875 12,000 2,500 6,000 11,000 12,000 372,000 5,000
386,875 12,000 2,500 6,000 11,000 12,000 360,000 5,000
386,875 12,000 2,500 6,000 11,000 12,000 372,000 5,000
386,875 12,000 2,500 6,000 11,000 12,000 360,000 5,000
0 22,000
0 22,000
0 22,000
0 22,000
10,000 22,000
Total Expenses
754,975
829,375
817,375
829,375
827,375
Month Wise Expenses Particulars
Dec-08 Jan-09 Feb-09 Mar-09 Amount(Rs.) Amount(Rs.) Amount(Rs.) Amount(Rs.)
Salary Electricity Water Telephone Transportation Maintenance Drugs & Consumables Marketing & Promotion Website Designing & Maintenance Miscellaneous
386,875 12,000 2,500 6,000 11,000 12,000 372,000 5,000
386,875 12,000 2,500 6,000 11,000 12,000 372,000 5,000
386,875 12,000 2,500 6,000 11,000 12,000 336,000 5,000
386,875 12,000 2,500 6,000 11,000 12,000 372,000 5,000
10,000 22,000
10,000 22,000
10,000 22,000
10,000 22,000
Total Expenses
839,375
839,375
803,375
839,375
Page 79
Salary
Medical Superintendent Nursing Superintendent Nurses Receptionist IT Manager Ward Boys / Ayahs Admin & HR Officer Accounts Officer Billing Clerk Driver MSW / Counsellors Lab Technicians X - Ray Technicians OT Technicians Security Guards Electrician Plumber GDMO's Physiotherapist
15000 10000 5000 4000 6000 2500 8000 5000 2000 3000 4000 4000 4000 4000 2500 2000 2000 10000 4000
Nov-06
Dec-06
Jan-07
Feb-07
1.00 15000 10000 80000 12000 6000 10000 8000 5000 2000 6000 8000 12000 12000 12000 12500 2000 2000 40000 4000
1.00 15000 10000 80000 12000 6000 10000 8000 5000 2000 6000 8000 12000 12000 12000 12500 2000 2000 40000 4000
1.00 15000 10000 80000 12000 6000 10000 8000 5000 2000 6000 8000 12000 12000 12000 12500 2000 2000 40000 4000
1.00 15000 10000 80000 12000 6000 10000 8000 5000 2000 6000 8000 12000 12000 12000 12500 2000 2000 40000 4000
258500
258500
258500
258500
Page 80
Salary
Medical Superintendent Nursing Superintendent Nurses Receptionist IT Manager Ward Boys / Ayahs Admin & HR Officer Accounts Officer Billing Clerk Driver MSW / Counsellors Lab Technicians X - Ray Technicians OT Technicians Security Guards Electrician Plumber GDMO's Physiotherapist
Mar-07
Apr-07
May-07
Jun-07
Jul-07
1.00 15000 10000 80000 12000 6000 10000 8000 5000 2000 6000 8000 12000 12000 12000 12500 2000 2000 40000 4000
1.00 15000 10000 80000 12000 6000 10000 8000 5000 2000 6000 8000 12000 12000 12000 12500 2000 2000 40000 4000
1.00 15000 10000 80000 12000 6000 10000 8000 5000 2000 6000 8000 12000 12000 12000 12500 2000 2000 40000 4000
1.00 16500 11000 88000 13200 6600 11000 8800 5500 2200 6600 8800 13200 13200 13200 13750 2200 2200 44000 4400
1.00 16500 11000 88000 13200 6600 11000 8800 5500 2200 6600 8800 13200 13200 13200 13750 2200 2200 44000 4400
258500
258500
258500
284350
284350
Page 81
Salary
Medical Superintendent Nursing Superintendent Nurses Receptionist IT Manager Ward Boys / Ayahs Admin & HR Officer Accounts Officer Billing Clerk Driver MSW / Counsellors Lab Technicians X - Ray Technicians OT Technicians Security Guards Electrician Plumber GDMO's Physiotherapist
Aug-07
Sep-07
Oct-07
Nov-07
Dec-07
1.00 16500 11000 88000 13200 6600 11000 8800 5500 2200 6600 8800 13200 13200 13200 13750 2200 2200 44000 4400
1.00 16500 11000 88000 13200 6600 11000 8800 5500 2200 6600 8800 13200 13200 13200 13750 2200 2200 44000 4400
1.00 16500 11000 88000 13200 6600 11000 8800 5500 2200 6600 8800 13200 13200 13200 13750 2200 2200 44000 4400
1.00 16500 11000 98000 17200 6600 13500 8800 5500 2200 6600 8800 17200 13200 13200 13750 2200 2200 54000 4400
1.00 16500 11000 98000 17200 6600 13500 8800 5500 2200 6600 8800 17200 13200 13200 13750 2200 2200 54000 4400
284350
284350
284350
314850
314850
Page 82
Salary
Medical Superintendent Nursing Superintendent Nurses Receptionist IT Manager Ward Boys / Ayahs Admin & HR Officer Accounts Officer Billing Clerk Driver MSW / Counsellors Lab Technicians X - Ray Technicians OT Technicians Security Guards Electrician Plumber GDMO's Physiotherapist
Jan-08
Feb-08
Mar-08
Apr-08
May-08
1.00 16500 11000 98000 17200 6600 13500 8800 5500 2200 6600 8800 17200 13200 13200 13750 2200 2200 54000 4400
1.00 16500 11000 98000 17200 6600 13500 8800 5500 2200 6600 8800 17200 13200 13200 13750 2200 2200 54000 4400
1.00 18750 12500 125000 25000 7500 18750 10000 6250 2500 7500 10000 20000 15000 20000 15625 2500 2500 62500 5000
1.00 18750 12500 125000 25000 7500 18750 10000 6250 2500 7500 10000 20000 15000 20000 15625 2500 2500 62500 5000
1.00 18750 12500 125000 25000 7500 18750 10000 6250 2500 7500 10000 20000 15000 20000 15625 2500 2500 62500 5000
314850
314850
386875
386875
386875
Page 83
Salary
Medical Superintendent Nursing Superintendent Nurses Receptionist IT Manager Ward Boys / Ayahs Admin & HR Officer Accounts Officer Billing Clerk Driver MSW / Counsellors Lab Technicians X - Ray Technicians OT Technicians Security Guards Electrician Plumber GDMO's Physiotherapist
Jun-08
Jul-08
Aug-08
Sep-08
Oct-08
1.00 18750 12500 125000 25000 7500 18750 10000 6250 2500 7500 10000 20000 15000 20000 15625 2500 2500 62500 5000
1.00 18750 12500 125000 25000 7500 18750 10000 6250 2500 7500 10000 20000 15000 20000 15625 2500 2500 62500 5000
1.00 18750 12500 125000 25000 7500 18750 10000 6250 2500 7500 10000 20000 15000 20000 15625 2500 2500 62500 5000
1.00 18750 12500 125000 25000 7500 18750 10000 6250 2500 7500 10000 20000 15000 20000 15625 2500 2500 62500 5000
1.00 18750 12500 125000 25000 7500 18750 10000 6250 2500 7500 10000 20000 15000 20000 15625 2500 2500 62500 5000
386875
386875
386875
386875
386875
Page 84
Salary
Medical Superintendent Nursing Superintendent Nurses Receptionist IT Manager Ward Boys / Ayahs Admin & HR Officer Accounts Officer Billing Clerk Driver MSW / Counsellors Lab Technicians X - Ray Technicians OT Technicians Security Guards Electrician Plumber GDMO's Physiotherapist
Nov-08
Dec-08
Jan-09
Feb-09
Mar-09
1.00 18750 12500 125000 25000 7500 18750 10000 6250 2500 7500 10000 20000 15000 20000 15625 2500 2500 62500 5000
1.00 18750 12500 125000 25000 7500 18750 10000 6250 2500 7500 10000 20000 15000 20000 15625 2500 2500 62500 5000
1.00 18750 12500 125000 25000 7500 18750 10000 6250 2500 7500 10000 20000 15000 20000 15625 2500 2500 62500 5000
1.00 18750 12500 125000 25000 7500 18750 10000 6250 2500 7500 10000 20000 15000 20000 15625 2500 2500 62500 5000
1.00 18750 12500 125000 25000 7500 18750 10000 6250 2500 7500 10000 20000 15000 20000 15625 2500 2500 62500 5000
386875
386875
386875
386875
386875
Page 85
PROFIT & LOSS ACCOUNT FINANCIAL YEAR 2006 - 2007 Particulars To To To To To To To To To To To To
Salary Electricity Water Telephone Transportation Maintenance Drugs & Consumables Marketing & Promotion Website Designing & Maintenance Miscellaneous Depreciation on Equipments Depreciation on Buildings
Amount (Rs.) Particulars 1292500 OPD Consultation 50000 Lab Tests - OPD 10000 Lab Tests - IPD 25000 X - Ray - OPD 40000 X - Ray - IPD 50000 Ultra Sound 305820 Physiotherapy 95000 Counselling 25000 MTP 78000 Delivery 720000 Surgeries 200000 Indoor Stay ICU Health Checks Ambulance Drugs & Consumables Loss Carried forward to Balance Sheet
Total
2891320
Amount (Rs.) 45125 87300 72200 30200 26250 90600 22650 7550 56625 151000 226500 54150 302000 75500 81400 370200
1189570
2888820
Page 86
PROJECTED STATEMENT OF ACCOUNT FROM 1/4/2007 31/3/2008 PROFIT & LOSS ACCOUNT FINANCIAL YEAR 2007 - 2008 Particulars To To To To To To To To To To To To
Salary Electricity Water Telephone Transportation Maintenance Drugs & Consumables Marketing & Promotion Website Designing & Maintenance Miscellaneous Depreciation on Equipments Depreciation on Buildings
Amount (Rs.) Particulars 3585025 OPD Consultation 135000 Lab Tests - OPD 27300 Lab Tests - IPD 67500 X - Ray - OPD 114000 X - Ray - IPD 135000 Ultra Sound 1792560 Physiotherapy 75000 Counselling 10000 MTP 223000 Delivery 1440000 Surgeries 400000 Indoor Stay ICU Health Checks Ambulance Drugs & Consumables Loss Carried forward to Balance Sheet
Total
8004385
Amount (Rs.) 198250 387400 506800 122000 114375 366000 71700 30500 167025 445400 668100 380100 1251000 427000 236350 2240700
386685
7999385
Page 87
PROJECTED STATEMENT OF ACCOUNT FROM 1/4/2008 31/3/2009 PROFIT & LOSS ACCOUNT FINANCIAL YEAR 2008 - 2009 Particulars To To To To To To To To To To To To
Salary Electricity Water Telephone Transportation Maintenance Drugs & Consumables Marketing & Promotion Website Designing & Maintenance Miscellaneous Depreciation on Equipments Depreciation on Buildings Profit Carried forward to Balance Sheet
Total
Amount (Rs.)
Particulars
Amount (Rs.)
4642500 OPD Consultation 144000 Lab Tests - OPD 30000 Lab Tests - IPD 72000 X - Ray - OPD 132000 X - Ray - IPD 144000 Ultra Sound 4087200 Physiotherapy 60000 Counselling
383750 762900 1301200 261300 231750 738600 110950 55475
50000 MTP 260000 Delivery 1440000 Surgeries 400000 Indoor Stay ICU
303300 808800 1213200 975900 2190000
Health Checks 4232525 Ambulance Drugs & Consumables
927000 316100 5109000
15694225
15689225
Page 88
ANNEXURE - 7
GEOGRAPHICAL MAP OF THE LOCATION
Page 89
Page 90
MICRO HEALTH INSURANCE
Once the hospital is commissioned a detailed plan of actions will be created for a community based co-operative health insurance. This will unable the beneficiaries to a range of services by the hospital.
However, the following points need consideration: a. Contribution by the population b. Subsidy c. Provider payment mechanism d. Range of services entitled
