PROJECT INFORMATION MEMORANDUM

Transcription

1 PROJECT INFORMATION MEMORANDUM

2 Contents 1. Project at a glance Hospital Location Market survey findings - Demography... 9 Demographic profile... 9 Projected population growth... 9 Demographic transition... 9 Urbanization Literacy Per capita income Market survey findings Disease pattern Mortality due to diseases Jammu and Kashmir Healthcare infrastructure Jammu and Kashmir Market survey findings -Service utilization Utilization at government facilities Utilization at Medical College Hospitals Catchment areas Primary catchment area Secondary catchment area Tertiary catchment area Service mix Facility matrix Existing facilities Proposed facility matrix Outpatient consultation rooms Diagnostic facilities Bed distribution Operating rooms Other clinical procedure / support areas cost of the project Assumptions Pricing of services Utilisation

3 12. Annexure Equipment Plan Medical equipment Hospital support equipment Administrative equipment Automobile plan Furniture plan Manpower plan

4 1. Project at a glance Phase 1 Multi specialty Hospital of Shri Mata Vaishno Devi Institute of Medical Excellence (SMVDIME) Location Promoters Bed capacity 230 Key specialties Other specialties Major clinical facilities Major diagnostic facilities Hospital support facilities Staff welfare facilities Other facilities Kakryal, Jammu & Kashmir, India Shri Mata Vaishno Devi Shrine Board (SMVDSB) Medical Oncology, Surgical Oncology, Radiation Oncology, Orthopaedics, Neurology, Neurosurgery, Cardiology, Cardiothoracic surgery, Emergency Medicine and Trauma care Medicine, GI Surgery, Gynaecology & Obstetrics, Paediatrics, Neonatology, Nephrology, Urology, General Medicine, General Surgery, Ophthalmology, ENT, Dentistry, Dermatology Operating Rooms, Cardiac Catheterization Lab, LINAC, Bone Marrow Transplant, Endoscopy & Colonoscopy, Blood Bank, Physiotherapy, Telemedicine Radiology - X-Ray, USG, CT Simulator, MRI, Nuclear Med Cardiology - ECG, ECHO, TMT, Holter Neurology - EEG, EMG, Sleep Lab Others - BMD, Mammography, PFT, Uro Flowmetry Eye - A Scan, B Scan Laboratory Medicine - Haematology, Biochemistry, Serology, Histopathology, Immunology CSSD, Laundry, Kitchen & cafeteria (outsourced), Ambulance services, Biomedical waste management (outsourced), Mortuary, Telemedicine Nurse s hostel, Doctor s hostel Patients inn, guest house (to be constructed later) Built to bring world class healthcare to Jammu & Kashmir Sprawling 45 acre campus, 15 acre demarcated for Phase 1 multi-specialty hospital Located in the foot hills of Himalayas, with a direct view to the Trikuta Hills Opposite Shri Mata Vaishno Devi University; 15 Kms from Katra Bus Station, 60 minutes drive from Jammu Railway Station/Airport Facility No. Consultation Rooms 24 Operating Rooms 06 Labor Room 01 Cardiac Cath Lab 01 Nuclear Medicine 01 Endo & Colonoscopy 01 LINAC 01 Facility No. Emergency Triage 02 Emergency Observation 06 Emergency Resuscitation 01 IP Deluxe Beds 02 IP Private Beds 21 IP Semi Private Beds 42 IP General Ward Beds 66 Day care beds 18 CCU/ICU/NICU Beds 54 BMT Beds 02 Pre-Op Beds 06 Post-Op Beds 04 Dialysis % of the total beds as ICU beds Facility No. X Ray 02 USG 02 CT Simulator 01 MRI 01 ECG 02 ECHO 01 TMT 01 Holter 01 EEG 01 EMG 01 Sleep Lab 01 Mammography 01 PFT 01 BMD 01 UDF 01 A Scan 01 B Scan 01 4

5 (i) (ii) 5

6 (iii) (iv) (v) (i) Architect s artist impression of the hospital building (ii) Actual unfinished building Front and lateral elevation (iii) Front View of building (iv) Work in progress (Doctor s and Nurse s Hostel) (v) Work in progress - Interiors 6

7 2. Hospital Location SMVDIME is located at Kakryal in Jammu and Kashmir (J&K), the northern most state of India. Kakryal is located at around 15 kms from Katra (the base camp for Shri Mata Vaishno Devi Shrine pilgrimage) and 40 kms from Jammu Tawi city. Jammu Tawi city is situated at around 576 kms from New Delhi, the capital city of India. Kakryal houses the Shri Mata Vaishno Devi University. SMVDIME is located adjacent to the Shri Mata Vaishno Devi University campus. The satellite image of the hospital site and the building is portrayed below in relation to Shri Mata Vaishno Devi University. The state of J&K is administratively divided into 22 districts. A satellite image of the districts of J&K is provided below. 7

8 The approximate distance of the district capitals from SMVDIME site is provided below along with the population of each district (Source: For distance- Google Maps; For Population Census of India 2011). District Kms Population District Kms Population District Kms Population Udhampur ,357 Kishtwar ,037 Ganderbal ,003 Jammu 40 1,526,406 Anantnag 215 1,096,749 Bandipora ,099 Reasi ,714 Kulgam ,181 Baramulla 320 1,015,503 Samba ,611 Poonch ,820 Kupwara ,564 Ramban ,000 Shopian ,960 Kargil ,388 Kathua ,711 Pulwama ,060 Leh ,104 Doda ,576 Srinagar 264 1,250,173 Rajauri ,266 Badgam ,331 8

9 3. Market survey findings - Demography A secondary market survey was conducted to assess the demographic, morbidity and mortality patterns in India and J&K. The survey also included assessment of the healthcare infrastructure requirements in India and J&K along with the facilities available in the major hospitals in J&K. The findings of the market survey are provided in the subsequent sections. Demographic profile Parameter India J&K Population 121,01,93,422 1,25,48,926 Growth Percent 17.64% 23.71% Population Density 382/Sq Km 146 / Sq Km Life Expectancy 67.1 Years 65.8 Years Crude Birth Rate Crude Death Rate Urban Population Percent 27.8% 27.2% Sex ratio Literacy rate 74.04% 68.74% The population of India as per 2011 census was 1.21 Billion ( ). The present population of India (the second most populous nation in the world) is almost equal to the combined population of United States of America, Indonesia, Bangladesh, Pakistan and Japan. India added more than 181 million to its population in the last decade with a growth rate of 17.64%. This absolute addition is slightly lower than the population of Brazil, the fifth most populous country in the world. With only 2.4% of the surface area India accounts for 17.5% of the world population. The major demographic parameters of India as per 2011 census are listed in the table. At present a little more than one person out of every sixth person in the world is from India. This huge population of India has increased the demand for services and products and has poised India to be one of the largest markets across the globe. The demand for healthcare services as well has increased manifold along with the population. J&K houses 1.04% of the population of India and is growing faster (at the rate of 23.71%) than the country. The population density of J&K is lower than that of the country and thus increasing the catchment areas (in terms of distance) for healthcare facilities. While the whole of Indian healthcare is attracting private investments, J&K is one of the few states with minimal private investments and as a result the state lacks high-quality secondary and tertiary healthcare facilities. The people of J&K are majorly dependent on the government facilities/system for their healthcare needs. Thus the population of J&K poises a huge need for better healthcare facilities. The proposed hospital is expected to bridge the existing demand supply gap and be one of the apex healthcare facilities in the state. Projected population growth As discussed earlier the population of India grew at the rate of 17.64% in the last decade. The decadal decrease has registered the sharpest decline in the last decade since independence. It declined from 23.87% for to 21.54% for the period This decadal growth percent has further decreased by 3.90 points for the period The population projections by Population Research Bureau, United Nations suggest that India will cross 1.59 billion mark between the years to overtake China to be the world s most populous country. It is estimated that by 2060 India s population would cross 1.7 billion. Similar to the country, there has been a decline in the population growth of J&K. The growth rate in the earlier decade was 29.04%. With the population of J&K growing faster than the country, the population is expected to double earlier. The decline in growth rate has decreased the net addition of population; however the increase in terms of absolute numbers (for both India and J&K) will be substantially high owing to high base population. This increasing population has raised the need for better healthcare facilities in India and the already lacking state of J&K. Demographic transition India is poised to face a huge demographic transition due to the not much controlled birth rate and decreasing death rate. A study indicates that by 2025 India will house over 189 million people aged above 60 years. Increase in the average age of population and increase in the population aged above 40 years is expected to increase the health burden on the country, thus directly increasing the need for more tertiary care facilities. The life expectancy of J&K is marginally (1.3 years) lower than that of the country. This marginal decrease may not affect the increase in healthcare facility needs. It is also imperative to note that in terms of the highest increase of life expectancy between 2002 and 2008, J&K was one of the states with highest increase. (The top five states were Assam and MP (3.1 years), J&K (2.8 9

10 years), Odisha (2.6 years), Maharashtra and Rajasthan (2.4 years) (Source: Registrar General, Census of India). Thus with rapidly increasing life expectancy, the healthcare burden of J&K is expected to increase in the future years. Urbanization The urban population across the world is around 51% while the same is 27% in India. However in terms of absolute numbers, the urban population in India is more than the population of the United States of America and Brazil. Presently India has the second largest number of urban residents across the globe. It is expected by the year 2020 that one third of Indian population will reside in urban India. The percent of urbanization in J&K is nearly at par with that of the country average. Urbanization leads to increase in literacy, healthcare awareness and consumerism; thus increasing the need for more and better managed healthcare facilities. Literacy Literacy rate in India has been increasing over years. It has increased from 12% in 1947 to 74% in The last decadal literacy rate is 9.2% higher than the previous decade. The increase in literacy rate for J&K between 2001 and 2011 is 13% which is higher than the national average. Literacy leads to better economy and awareness and thus increasing consumerism. Thus increasing literacy rate will increase the health seeking behaviour and demand for better healthcare services. Per capita income Indian economy has been growing steadily over the years. It is expected that India s GDP in current prices will overtake France and Italy by 2020, UK and Russia by 2025 and Japan by By 2035, it is expected that India will be the third largest economy after US and China. The present per capita income of India is around 1600 USD. It is expected to be between USD by 2025, if the economy grows at the rate of 9% annually. The per capita income of J&K (Rs in ) is lower than the national average (Rs 60772), but has increased at the rate of 11.6% from the earlier year. This increase in per capita income is an indicator of improving economy and spending capacity of the population. Thus the private spending on healthcare is expected to increase further in the future. 10

11 4. Market survey findings Disease pattern The course of development in countries leads to epidemiological transition wherein the initial high burden of disease and mortality due to infectious diseases and maternal and child mortality declines and gives way to non communicable diseases, injuries and geriatric problems as the main burden of disease. However the Indian epidemiological transition is marked by dual challenge of controlling/eradicating infectious diseases and the need to contend with non communicable diseases such as cancer, cardiovascular diseases, diabetes, COPD and others. Adding on to the dual challenge is the social determinants of health such as malnutrition and the array of re-emerging diseases like influenza and SARS. Annual Report to the People published by the Ministry of Health and Family Welfare (Govt. of India) indicates that communicable diseases, maternal, peri natal and nutritional disorders constitute 38 per cent of deaths in the country. Non-communicable diseases account for 42 per cent of all deaths. Injuries and ill-defined causes constitute 10 per cent of deaths each. However, majority of ill-defined causes are at older ages (70 or higher years) and likely to be from noncommunicable diseases. Rural areas report more deaths (41 percent) due to communicable, maternal, peri natal and nutritional conditions. The proportion of deaths due to non-communicable diseases is less in rural areas (40 percent). Injuries constitute about the same proportion (about 10 percent) in both rural and urban areas. Mortality due to diseases Jammu and Kashmir The major reasons for mortality (of patients/population above 6 years of age) in J&K during the period of April 2010 to September 2011 as reported by National Health Systems Resource Centre (NHSRC) were analysed. The top five reasons for mortality (ranked as per percentage of deaths) are as follows. Idiopathic (47.45%) Cardiac disease (10.68%) Known chronic disease (9.22%) Trauma / Accident / Burn (7.89%) Respiratory disease Not TB (6.73%) Diseases of public health importance such as Diarrhoea, Tuberculosis, Malaria, AIDS and other fevers are reasons for 6.87% of the deaths. Absolute emergency conditions such as Trauma, Accident, Burn and Animal stings/bites have lead to 9.66% of the total deaths. It can be assumed that idiopathic deaths constitute brought dead cases. Per the observed patterns across the country most of these deaths are due to cardiac disease, stroke or due to any other existing chronic diseases such as Diabetes (organ failure, acute glycaemia, etc), cancer or chronic diseases that was left undiagnosed. Cause of Mortality % Diarrhoeal disease 2.79% Tuberculosis 0.89% Other Respiratory disease 6.73% Malaria 0.58% Other fever related 2.48% HIV / AIDS 0.13% Cardiac diseases 10.68% Neurological diseases 2.75% Trauma/Accident/Burn 7.89% Suicide 1.20% Animal bites / Stings 1.77% Known acute disease 5.45% Known chronic disease 9.22% Idiopathic 47.45% % The mortality reasons in J&K are mixed with prevalence of both communicable and non communicable diseases. However the percentage of deaths due to non communicable diseases is high, depicting the need for better secondary and tertiary care hospitals in the state of J&K. 11

12 Healthcare infrastructure Jammu and Kashmir A report from Directorate of health services from various states in the year shows that the number of people served per government hospital bed in the state of J&K is 2813 (less than 0.5 beds per 1000 population). The Department of Health and Family Welfare (D0HFW), J&K has enlisted 4 Medical college associated hospitals, 19 district hospitals, 77 sub-district/community hospitals, 427 Primary health centres and other hospitals/dispensaries in the state with a total bed capacity of around 12,932 beds. The details of some of the major government owned hospitals in J&K is provided below-- Government Medical College Hospital, Jammu (GMCHJ): Government Medical College Hospital, Jammu is the largest government hospital in the Jammu province with a bed capacity of 862 (850 inpatient and 12 ICU) beds. The hospital houses around 22 (10 major and 12 minor) operating rooms with associated diagnostic and treatment facilities. The hospital does not have radiation oncology services (LINAC) and LASIK services. GMCHJ is the major hospital located in the primary catchment area of SMVDIME. The summary of the infrastructure details of GMCHJ is provided in the table below. Facility Number Inpatient Beds 850 ICU Beds 12 Beds 862 Major OT 12 Minor OT 10 Cardiac Cath Lab 1 X - Ray 100 ma 5 X - Ray 300 ma and above 6 CT Scan 4 MRI 1 Dialysis 10 TMT 1 EEG 2 C Arm 4 Laparoscopy 6 Other than the medical college hospital, Jammu medical college also have other hospitals associated with it. The details of the associate hospitals are as follows. Shri Maharaja Gulab Singh Hospital -- The hospital houses 550 beds and serves majorly in the specialties of Gynaecology, Obstetrics, ENT and Dermatology. Major diagnostic services available in the hospital are USG, X-ray, ECG and laboratory. Government Chest Diseases Hospital -- The hospital houses 200 beds and serves only for ailments related to chest and thoracic diseases. Major diagnostic services available in the hospital are X-ray, Bronchoscopy, Lung Function Tests, Blood Gas Analysis, ECG, Ultrasound, Polysomnography and laboratory. Government Psychiatric Diseases Hospital -- The hospital houses 75 beds and serves only psychiatric and geriatric patients. Major diagnostic services available in the hospital are X-ray, EEG and laboratory. Acharya Shri Chander Medical College Hospital, Jammu (ASCMCH): ASCMCH is located in Jammu and has been designed and commissioned to meet the needs of medical college. The 532 bed hospital provides secondary level of care in most clinical specialties. Government Medical College, Srinagar (GMCS): Government Medical College, Srinagar was one of the earliest medical college setup in the country. The college has many hospitals associated with it. The hospitals majorly serve the patients from Kashmir province. The details of the associated hospitals are as follows-- Shri Maharaja Hari Singh Hospital - The hospital houses 750 beds and serves the specialties of Medicine, Surgery, Ophthalmology, ENT, Dermatology, Radiotherapy, Cardiology, Gastroenterology, Neurology, Urology, Cardiothoracic surgery and Paediatric surgery. Major diagnostic services available in the hospital are MRI, CT scan, USG, X-ray, ECG, Colour Doppler, Nerve Conduction tests, Endoscopy and Laboratory. Lal Ded Hospital for Obstetrics and Gynaecology - The hospital is under construction and is proposed to house 500 beds exclusively for gynaecology and obstetrics. Government Chest Diseases Hospital - The hospital houses 350 beds and serves only for ailments related to chest and thoracic ailments. Major diagnostic services available in the hospital are X-ray, USG and laboratory. Bone and Joint Hospital - The hospital houses 150 beds (244 proposed) and serves only for orthopaedic ailments. Major diagnostic services available in the hospital are X-ray and laboratory. 12

13 Government Hospital for Children - The hospital houses 175 beds and serves only for paediatric ailments. Major diagnostic services available in the hospital are X-ray, USG and laboratory. Government Psychiatric Diseases Hospital - The hospital houses 175 beds and serves only psychiatric and geriatric patients. Major diagnostic services available in the hospital are X-ray, EEG and laboratory. Sher I Kashmir Institute of Medical Sciences, Srinagar (SKIMS): SKIMS is one of the premier hospitals in the state of J&K. The hospital has most of the primary, secondary and tertiary specialties which includes General medicine, General Surgery, Gynae & Obs, Gastro eneterology, GI surgery, Cardiology, cardio thoracic surgery, Endocrinology, Nephrology, urology, Paediatrics, neonatology, Plastic surgery, Neurology, Neuro surgery, Medical oncology, surgical oncology, radiation oncology and Immunology. The hospital houses 850 beds with well equipped diagnostic and support departments. Other than the above hospitals, J&K also houses the following government hospitals - G B Pant Hospital, Srinagar (200 beds) Gandhi Memorial Hospital, Jammu (160 beds) Government Children Hospital, Jammu (200 beds) Majority of the private healthcare facilities in J&K are small nursing homes / hospitals with a bed capacity of beds, owned and managed by physicians. All the hospitals except Government Medical College, Jammu and Sher I Kashmir Institute of Medical sciences, of the state lack facilities to provide tertiary care services. The patients have to travel to Punjab or National Capital Region for their tertiary care. Due to lack of private investments in the state, there is a huge demand for tertiary care hospital that can provide quality healthcare services. However considering the huge demand supply gap, larger hospital chains are establishing their outpatient / inpatient facilities in J&K. The demand supply gap, state of the art infrastructure, quality of care and the trust of population on the Shrine Board combined can be expected to attract patient volumes to SMVDIME from all parts of the state and the country. 13

14 5. Market survey findings -Service utilization The healthcare service utilization at the government facilities in J&K were analysed from the data obtained from NHSRC. Also utilization details of Government Medical College Hospital and Acharya Shri Chander Medical College Hospital in Jammu were collected from the medical records department of respective hospitals. Utilization at government facilities The utilization of government healthcare services for the period from April 2011 to September 2011 was analyzed using the data published by NHSRC. The analysis depicts a high outpatient visit rate. The number of dental visits is high as the data includes the utilization of dental colleges. It could be observed that 7.2% of outpatients (excluding AYUSH and Dental OP) were admitted. 29.7% of the inpatients underwent surgeries. 17% (8607 in number) of the total surgeries were major surgeries performed under general/spinal anaesthesia. The utilization in SMVDIME could be expected to be higher than the government hospitals owing to the service mix of SMVDIME. The details of the analysed data are provided in the table below. Particulars Details Outpatient visits Dental Outpatients % of Dental Outpatients 4.3% AYUSH Outpatients % of AYSUH Outpatients 6.0% Inpatients % of admissions on OP (Exclude 7.2% Dental and AYUSH) Surgeries % of surgical admissions 29.7% OP-IP conversion rate 7.2% IP Surgery Conversion rate % 17% of the total surgeries were major surgeries performed under general/spinal anaesthesia The NHSRC data includes primary level government facilities and hence the SMVDIME can expect further increased utilization rates In J&K, a total of 2,62,528 pregnancies were estimated for the period from April 2011 to September 2011, of which 30% (72,991) were estimated for the districts of Jammu, Kathua, Udhampur, Reasi and Poonch. The hospital could expect to perform high number of deliveries if proper EmOC services are provided in these districts. Utilization at Medical College Hospitals Government Medical College Hospital, Jammu Above 1000 Outpatient visits per day emergency patients per day admissions per day OP IP conversion rate % Over 30% of admissions are direct surgical admissions surgeries per day (include minor and major) One Angiography procedure per day Angioplasty is performed once in three days Aurtogram is performed once in 9 days Pace maker is performed once in three days Acharya Shri Chander Medical College Hospital, Jammu Around 400 outpatient visits per day Around 33 emergency patient visits per day OP-IP conversion of 12% with around 44 admissions daily General surgeries, Eye surgeries and deliveries are the major revenue streams Around 3 dialysis per day On analysis of the secondary data obtained from Sher I Kashmir Institute of Medical sciences, it could be observed that the hospital serves over 5 lakh outpatients, 80 thousand emergency patients and 55 thousand inpatients at an OP- IP conversion rate of above 10%. SMVDIME could expect similar or even better service utilization at maximum capacity utilization. 14

15 6. Catchment areas The catchment areas for SMVDIME is expected to be wide due to the following reasons Lack of tertiary care facilities in J&K The hospital being promoted as a state of the art tertiary care facility which shall provide world class quality healthcare services Low density of population and healthcare facilities in the state Popularity of Shri Mata Vaishno Devi Shrine Board SMVDIME is the first hospital of its size and magnitude in the state of J&K. Hence it is expected that the whole state of J&K will be the catchment area for the hospital. The hospital is expected to attract patients with chronic and severe illness from all parts of J&K and from the bordering areas in the adjoining states of Punjab and Himachal Pradesh. The hospital is also expected to attract patients from other parts of the country owing to the faith of pilgrims on Shri Mata Vaishno Devi Shrine. Also it is imperative to consider the travel time to the hospital from various parts of the state and hence the existing government hospitals in Kashmir province will continue to attract patients for emergency, primary and secondary care treatment. Primary catchment area The primary catchment area for the hospital is assumed to be the adjoining areas of the hospital up to 150 kms of travel distance. The districts of Udhampur, Jammu, Reasi, Samba, Ramban, Kathua and Doda will form the primary catchment area. These districts constitute around 32% of the total population of J&K. The hospital is expected to receive patients pertaining to all levels of care (primary, secondary and tertiary) from the primary catchment area. The primary catchment area will also include the pilgrims visiting the shrine (in most cases emergency patients). Thus the hospital might expect around 100% of its primary & emergency care, 70% of secondary care patient load from the primary catchment area. The other Kms from the hospital site Udhampur, Jammu, Reasi, Samba, Ramban, Kathua and Doda districts Catchment Population 3,955,375 (32% of the total population of J&K major hospitals in the primary catchment area are Jammu Medical college and Shri Aacharya Chander Medical College Hospital. Both the hospitals are medical college hospitals with focus on primary and secondary care specialties. Since SMVDIME is planned to be state of the art with best of medical facilities the hospital will attract majority of patients to be the leading healthcare provider in the region. Secondary catchment area The secondary catchment area for the hospital is assumed to be the areas from 151 to 300 kms of travel distance. The districts of Rajauri, Kishtwar, Anantanag, Kulgam, Poonch, Shopian, Pulwama, Srinagar, Badgam, and Ganderbal will form the secondary catchment area. These districts constitute around 48% of the total population of J&K. The hospital is expected to receive patients pertaining to mostly secondary and tertiary level of care from the secondary catchment area. Thus the hospital might expect around 25% of secondary care patient load from the secondary catchment area. The other major hospitals in the secondary catchment area are associate hospitals of Government Medical College- Srinagar and Sher-I-Kashmir hospital. Tertiary catchment area The Tertiary catchment area for the hospital is assumed to be the other districts of J&K and the rest of India. The districts of Bandipora, Baramulla, Kupwara, Kargil and Leh will form the tertiary catchment area. These districts constitute around 20% of the total population of J&K. The hospital is expected to receive patients pertaining only to secondary and tertiary levels of care from the tertiary catchment area. The hospital is also expected to receive terminally ill patients from the bordering areas of Punjab, Himachal Pradesh and rest of India, owing to the faith of the people on Shri Mata Vaishno Devi Shrine Kms from the hospital site Rajauri, Kishtwar, Anantanag, Kulgam, Poonch, Shopian, Pulwama, Srinagar, Badgam, and Ganderbal districts Catchment Population 5,985,580 (48% of the total population of J& K) Above 300 Kms from the hospital site Bandipora, Baramulla, Kupwara, Kargil and Leh districts and other states Catchment Population 2,566,658 (20% of the total population of J& K) 15

16 7. Service mix Service mix defines the specialties of care that will be provided in a hospital. It forms the epicentre of the healthcare delivery model and the business of hospitals, including the capital investment and operational expenses. The proposed tertiary care hospital of SMVDIME has been planned as a multi-specialty hospital with super-specialty disciplines in Oncology, Emergency & Trauma care, Neurology, Neurosurgery, Cardiology, Cardio-thoracic surgery and orthopaedics including joint replacements. The multi-specialty disciplines will include all the other major clinical specialties providing primary or secondary levels of care. The below table depicts the proposed service mix with the clinical specialties and levels of care that is proposed for SMVDIME. Super-specialties Secondary Specialties Primary level of care Diagnostic & Clinical Support Departments Medical Oncology Gynaecology & Obstetrics General / Internal Medicine Physiotherapy Surgical Oncology Paediatrics & Neonatal General Surgery Radiology diagnostics - X Ray, USG, care CT, MRI Radiation Oncology Gastroenterology Dentistry Laboratory diagnostics Bone Marrow Transplant Gastro enteric surgery Ophthalmology Cardiac Diagnostics - ECG, ECHO, TMT, HOLTER Emergency & Trauma Minimal Access Surgeries Otorhinolaryngology Neuro diagnostics EEG, EMG, ENG (Gastro) Neurology Nephrology & Dialysis Dermatology Blood Bank with cell separators Neurosurgery Urology Diabetology Nuclear Medicine Cardiology Cardiac Surgery Thoracic Surgery Orthopaedics & Joint Replacement Cardiac Cath Lab Orthopaedics BMD Uro Dynamic Lab Sleep Lab Mammography Telemedicine Thus the above service mix is expected to serve the unmet healthcare needs for quality healthcare services in the state of J&K for both communicable and non communicable diseases. The hospital will house the best oncology department catering services for medical, surgical and radiation oncology patients. The hospital is also expected to provide world class treatment in specialties such as Neurology, Neurosurgery, Cardiology, Cardiac surgery, orthopaedics. With the above range of super-specialty services combined with the state of the art infrastructure and operational expertise of the private partner, SMVDIME is expected to bring world class healthcare to J&K and serve as one of the best hospitals in the state. 16

17 8. Facility matrix Facility matrix defines the major clinical and non clinical facilities that are proposed to be commissioned at SMVDIME. The restructuring activities to accommodate the proposed facilities will be carried out by the private partner in consultation with SMVDSB. The list of existing facilities and the major facilities that are considered are provided in the below sections. Existing facilities The existing hospital infrastructure has been planned for 183 beds along with the following diagnostic and therapeutic facilities. Facility Number Facility Number Outpatient consultation rooms 24 Day care beds 24 Radiology diagnostics Clinical procedure areas X ray 2 Labor room 0 USG 2 Cardiac Cath Lab 0 CT Simulator 1 LINAC 2 MRI 1 Blood Bank 1 Cardiology diagnostics Physiotherapy 1 ECG 0 Emergency ECHO 0 Triage beds 2 TMT 0 Observation beds 4 Holter monitor 0 Resuscitation room / bed 0 Neurology diagnostics Inpatient Beds EEG 0 Deluxe rooms 2 EMG 0 Private rooms 21 Sleep Lab 0 Semi-private beds 38 Other diagnostics General ward 54 Laboratory Yes Intensive care beds Mammography 1 ICU 16 Nuclear medicine 1 CCU 0 Bone Marrow Densitometer 0 NICU 0 Urodynamic flow 0 Other beds Endoscopy 0 Preoperative beds 6 Operating Rooms Postoperative beds 14 Major OR (include one endoscopy 4 Dialysis 0 room) Infectious OR 1 Bone marrow transplant 2 The hospital has been designed to accommodate the following support and engineering facilities. Telemedicine Sample collection area Pharmacy Nutrition and dietary Patient reception and billing areas Medical Records Laundry Kitchen and cafeteria Purchase and Stores Administrative areas Engineering area Biomedical engineering workshop Biomedical waste management Medical Gas Pipeline System Water Treatment Plant Sewage Treatment Plant Generator and UPS backup Heating Ventilation Air Conditioning 17

18 Proposed facility matrix The hospital was originally designed to house 183 beds, 5 operating rooms with diagnostic and support areas (detailed in the above section). It was decided by SMVDSB to the increase number and range of facilities to augment the financial viability of the hospital. The facility matrix for the feasibility study has accounted the additional facilities that shall be built after restructuring. It has been considered that the hospital will house 230 beds with 6 operating rooms. Additional diagnostic facilities for cardiology, cardiac surgery, neurology, neurosurgery and urology are proposed to be included. Also clinical procedure areas such as labor room, dialysis and cardiac catheterization lab are proposed to be commissioned. Outpatient consultation rooms The present infrastructure is developed to house 24 outpatient consultation rooms. It could also be observed that each consultation room has an examination room attached. It is proposed to commission all the 24 consultation rooms in the first year. The examination rooms may be converted to consultation rooms in future depending on the volume of patients and the number of physicians visiting in the hospital. Diagnostic facilities As discussed earlier in this report additional diagnostic facilities are proposed to commission the planned multispecialty hospital. All the diagnostics are proposed to be commissioned in the first year apart from specialty specific diagnostics as per the schedule of the roll out of the clinical specialties. The diagnostic facilities proposed are as follows. Radiology diagnostics X ray (2 in number and includes mobile x-rays), CT Simulator, MRI, USG Nuclear medicine Gamma camera Cardiac diagnostics ECG (2 in number), ECHO, Holter, Tread Mill Test Neurology diagnostics EEG, EMG, Sleep Lab Eye A Scan, B Scan Other diagnostics Mammography, Nuclear medicine, Pulmonary Function Test, Bone Marrow Densitometry, Urodynamic flow, Endoscopy and colonoscopy Laboratory diagnostics Haematology, Biochemistry, Microbiology, Histopathology, Immunology, serology and Virology Bed distribution It is proposed to commission 47 additional beds to the presently designed 183 beds. Also the ICU bed distribution is segregated as CCU, Surgical ICU, Medical ICU and Step down ICU to match with the clinical needs. At present 23.5% of the total beds are ICU beds. The post operative beds may be converted into ICU beds if required, depending on the volume of patients requiring intensive clinical care. The details of the planned 230 beds is as follows. Facility IP - Deluxe / Suite 2 IP - Private Rooms 21 IP - Semi-private 42 IP - General Ward 66 Day care (General) 12 Day care (Chemo) 6 Bone marrow transplant 2 Dialysis 6 Post-operative beds 4 Pre-operative beds 6 CCU 10 ICU Specialty Surgical 8 ICU General Surgical 6 ICU Isolation 2 18

19 ICU Medical 10 ICU Step Down 14 NICU 4 Emergency Triage 2 Emergency Observation 6 Trauma Resuscitation 1 Operating rooms The existing surgical complex would require re-designing. It is proposed to commission at least one additional operating room to the presently designed five operating rooms. The operating rooms are categorized to the specialty of surgeries that will be performed. All the operating rooms are assumed to be commissioned in Year 1. The type and number of operating rooms considered are as follows- Facility Major OT Cardiothoracic 1 Major OT - Orthopaedic and Neurosurgery 1 Major OT Oncosurgery 1 General OT - Gastro, Gynae & Others 2 Infectious OT 1 6 Other clinical procedure / support areas It is proposed to customise / add procedure/support areas to match with that of the service mix. Labour Room, Cardiac Catheterization lab and Emergency procedure room are added to the existing facilities. The below table depicts the proposed clinical procedure rooms. Facility Labour Room 1 Cardiac Cath Lab 1 Emergency Minor Procedure Room 1 Blood Bank 1 Physiotherapy 1 LINAC 1 19

20 9. cost of the project The total cost of the project is estimated at Rs lakhs. Assumptions Infrastructure The hospital was initially designed to house 183 beds and 5 operating rooms. After analysis and assessment of the site it was decided that certain areas of the hospital will be redesigned and structured to meet the facilities detailed in the facility matrix section of this report. This restructuring and refurbishment shall be carried out by the private partner. The total expense for the above restructuring is estimated to be Rs 500 Lakhs. SMVDSB will invest the cost. This amount has been added to the total project cost. The hospital will house 230 beds with 6 operating rooms and additional diagnostic facilities. Land 15 acres of land is demarcated for the hospital from the Project Site of 45 acres. The cost of the land is assumed at Rs. 100 lakhs. Medical equipment Department wise major equipment is assumed based on the existing industry trends preferred by major hospital chains / large hospitals A mix of indigenous and imported equipment is considered. High end equipment is considered for diagnostic and critical patient care areas such as OTs and Intensive care units. The operating expenses and lead time for operational maintenance has been considered in the selection of equipment and the technology. The cost of equipment is as per the prevailing rates in Northern India. The final rates may vary depending on the negotiating capacity of the private partner. VAT, Delivery and Installation Charges (a total of 15.5%) is considered. Hospital support equipment The hospital support equipment consists of the equipment that shall be commissioned in the support departments such as Pharmacy, Central Sterile Supplies Department, Laundry, Morgue and Telemedicine. Telemedicine setup for the hospital is only considered. The equipment for nodal telemedicine centers has not been considered. The Kitchen & cafeteria and Biomedical waste management equipment is not considered as the department is considered to be outsourced. Administrative equipment The administrative equipment consists of Hospital Management Information System, computers, printers, scanners, photocopiers, projectors, software, television, music systems and other patient recreation devices that shall be commissioned in the hospital. Automobile One fully equipped and two semi- equipped ambulances have been assumed to be procured. The other automobiles include one for CEO, one for other hospital utilities and one for camps. Medical furniture Medical furniture consists of all the furniture that shall be used for direct patient care such as beds, bed side tables/lockers, trolleys, stretchers, wheel chairs and others. Non medical furniture Non medical furniture consists of all office furniture, chairs, work stations, racks, counters and other fixed and movable fixtures. The estimate of the total cost of the project is provided in the table below. 20

21 Particulars Amount (Rs. Lakhs) (Rs. Lakhs) (A) - Land Sub total - (A) (B) - Main Hospital Civil works, interiors, engineering, MEP and services 10, Modification of existing infrastructure Medical, support & admin equipment Medical Equipment 5, Medical Furniture Hospital Support Equipment Administrative Equipment Automobile Non Medical Furniture Contingency Sub total - (B) 17, ( C)- Residential and other buildings Residential buildings 4, Other buildings i.e. Guest House, Patient-Inn, Dharamshalla, Shops & 1, Bank accommodation Development of site and Road works Services works i.e. Power Stations, STP, Water & Electric supply Sub total - ( C) 7, Project Cost 25, The private entity is expected to bring in investments towards medical equipment and medical furniture to the extent committed as a part of the bid, while the remaining investments, if any, shall be provided by SMVDSB. SMVDSB will also invest in redesigning the existing infrastructure to accommodate more facilities. However the redesigning and refurbishment of infrastructure to accommodate additional facilities shall be carried out by the private partner. 21

22 10. Pricing of services 1. The Applicable Tariffs for various services provided by Concessionaire shall be fixed on the basis of the CGHS rates for super specialty hospitals for Delhi. The rates for services shall be maximum upto the rates as a percentage of the CGHS rates for super specialty hospitals for Delhi as per the Bid of the Selected Bidder. 2. The prices will undergo annual revision as per the revision under CGHS in the normal course. However, in case of delay of revision of rates by CGHS, the rates shall be revised on an annual basis which could result in a price revision of maximum upto 5%. Such revision shall be subsumed/ set off against the new applicable CGHS tariffs as and when released. 3. In case CGHS rates for super specialty hospitals for Delhi for a particular procedure is not available, then the rate applicable shall be the CGHS rates for NABH accredited hospitals for Delhi. In case of investigations, where rates for super specialty hospitals or NABH hospitals for Delhi are not available, then CGHS rates for NABL accredited empanelled diagnostic laboratories and imaging centres for Delhi shall be considered. 4. In case for specific services, where the CGHS rates for super specialty hospitals or rates for NABH accredited hospitals or investigation rates for NABL empanelled laboratories and diagnostic centres for Delhi are not prescribed and such rates are not published, then rates for such services provided by Concessionaire shall be mutually decided and agreed upon by the parties to the Agreement. 22

23 11. Utilisation The capacity utilization of the hospital is assumed to gradually increase from 25% in year 1 to a maximum of 85% in year 6. The OP-IP conversion rate is assumed to be 9%. The IP-Surgery rate is assumed to be 47%. The inpatient, major diagnostic and emergency departments will be operational 365 days a year The outpatient unit will be operational 301 days a year while the operational days for surgical units is considered to be 310 days a year to include emergency surgeries The year wise number of major procedures assumed up-to year 6 is as follows. Year Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Procedures /Day OP Visits Emergency Patients IP Admissions X ray CT Scan MRI USG ECG TMT ECHO EEG EMG Endoscopy Colonoscopy Dialysis Angiogram Angioplasty LINAC New Chemotherapy Normal Deliveries C-Section Deliveries Day care minor procedures Minor Surgeries Moderate Surgeries Major Surgeries

24 12. Annexure Equipment Plan Medical equipment OUTPATIENT ROOMS 0 Cost Digital Weight Machine 2, ,200 Height Machine 1, ,000 Body Mass Index 5,00, ,00,000 Stethoscope ,400 BP Apparatus 1, ,200 Thermometer Torch ,600 OP Patient Call System 2,00, ,00,000 X-ray view box 3, ,000 Dental Consultation Room 7,00, ,00,000 Eye Consultation Room 2,00, ,00,000 Sub total 17,47,240 RADIOLOGY DIAGNOSTICS Cost True DR with IITV - 80 KW (1000 ma) 80,00, ,00,000 HF 500 ma 16,00, ,00,000 HF ( ma) 6,00, ,30,000 Computerised Radiography 14,00, ,00,000 Dry Laser Imager 4,00, ,00,000 PACS 75,00, ,00,000 X-ray viewer ( 4 Film panel) 75, ,00,000 X-ray room Accessories (Lead Panel, Barriers) 2,00, ,00,000 USG 24,00, ,00,000 CT Simulator 4,50,00, ,50,00,000 MRI 3.5 Tesla 4,50,00, ,50,00,000 BMD (with pencil Beam and Dual Chamber) 30,00, ,00,000 Digital Mammography 24,00, ,00,000 Sub total 12,16,30,000 CARDIOLOGY DIAGNOSTICS Cost ECG 75, ,50,000 TMT (with Blue tooth) 12,00, ,00,000 24

25 Crash Cart with Defib 2,00, ,00,000 ECHO (both Cardiac & Neuro) 43,00, ,00,000 Holter (Recorder (4) with Analyser) 14,00, ,00,000 Sub total 72,50,000 NEUROLOGY DIAGNOSTICS Cost EEG 10,00, ,00,000 EMG 16,00, ,00,000 Sleep Lab 12,00, ,00,000 Sub total 38,00,000 EYE & OTHER DIAGNOSTICS Cost A Scan 4,00, ,00,000 B Scan 13,20, ,20,000 Indirect Ophthalmoscope 25, ,000 PFT 16,00, ,00,000 Uro Flowmetry & Uro dynamics 16,00, ,00,000 Sub total 49,45,000 NUCLEAR MEDICINE Cost Gamma Camera 30,00, ,00,000 Hot Lab & Others (Schields etc) 6,00,00, ,00,00,000 Sub total 6,30,00,000 ENDOSCOPY & COLONOSCOPY Cost Endoscopy with ERCP (Upper & Lower GI) 25,00, ,00,000 Sub total 25,00,000 LABORATORY & BLOOD BANK Cost Binocular Microscope 32, ,000 Centrifuge 13, ,000 Swing out head with glass tubes 3, ,200 Mini Rotary Shaker 6, ,000 D10HBA1C Analyser 11,00, ,00,000 Autoclave 15, ,000 Incubator 10, ,000 25

26 Hot Air Oven 10, ,000 Water Bath (Small) 8, ,000 Water / Air Baths (Large) 46, ,000 Analytical Balance 11, ,500 Auto scan 4 3,10, ,10,000 CP Immuno Assay System 25,00, ,00,000 Blood Culture System 6,00, ,00,000 Fully Automated Random Access Biochemistry Analyser 23,00, ,00,000 Automated Elisa Plate Reader and Microplate Washer 2,00, ,00,000 Automated Urine Analyser 90, ,000 Automated Coagulation Analyser 2,00, ,00,000 Semi Automated Biochemistry Analyser 1,50, ,50,000 ISR Based Electrolyte Analyser 2,30, ,30,000 Fully Automated Haematology Analyser 10,00, ,00,000 Histopath Knife 18, ,000 Histopath Knife Sharpener 20, ,000 Blood Bank Refrigerator (240 bags) 1,00, ,00,000 Blood Bank Refrigerator (40 to 60 bags) 60, ,000 Freezer ( 250bags -40 Deg. C) 3,00, ,00,000 Freezer ( 250bags -86 Deg. C) 6,00, ,00,000 Cell Washing System 4,10, ,10,000 Platelet Incubator Agitator 4,00, ,00,000 Insulated Blood product transport 15, ,000 Refrigerated Cold Centrifuge 13,00, ,00,000 Haemo sealer 91, ,000 Apheresis Equipment 30,00, ,00,000 Blood Collection Monitor 65, ,000 LAF bench (Class 100) 1,20, ,20,000 Bio safety cabinet 1,10, ,10,000 Automated Donor Couches 1,50, ,00,000 Plasma Thaw Bath (37 Deg C) 70, ,000 Cryobath (4 Deg C) 90, ,000 Plasma Expressor Automated 50, ,000 Plasma Expressor Manual 10, ,200 Automated Hb testing 42, ,000 ID system 1,00, ,00,000 Ultrasonic Washer 6,00, ,00,000 RIA Lab 30,00, ,00,000 Medicine Refrigerator 25, ,000 Bio-chemistry kits, etc 7,50, ,50,000 Distilled Water equipment 2,00, ,00,000 Sub total 2,08,07,900 PHYSIOTHERAPY Cost Single Swing Stand 20, ,000 Single Swing Feet for indoor use 7, ,000 26

27 Springs, in pairs 1, ,500 Swirl Spinner 38, ,000 Bolster Swing 31, ,000 Platform Swing 18, ,000 Disc Swing 35, ,000 Tire Swing 9, ,000 Tire Swing Suspension 2, ,500 Spinner 7, ,000 String Swing 12, ,000 Body Sox 9, ,000 IFT 28, ,000 Ultrasound 12, ,000 CPM (Knee Unit) 20, ,500 Muscle Stimulator 7, ,500 Moist Hit (Hydrocolator) 8 packs 15, ,500 Theraband - 5 Pcs (1 mtr) 1, ,000 Finger Exercise Ladder 1, ,500 Quads Chair (with back rest) 9, ,500 Shoulder Wheel 6, ,300 Parallel Bars 10ft (adult) 15, ,500 Postural Mirror (with stand). 6, ,250 Short Wave Diathermy 500W. 31, ,000 Portable TENS 8, ,000 Tilt Table - Motorised 32, ,000 Traction unit 18, ,000 Traction Bed four fold 15, ,500 Walkers Shoulder Abduction Ladder 1, ,350 Elbow Crutches - 1 pair 1, ,100 Auxiliary Crutches - 1 pair 1, ,100 Exercise Staircase L Type 19, ,000 Wax Bag Big - 20x14x10" 7, ,000 Gym Ball dia 2, ,200 Gym Ball dia 3, ,500 Wedge 8*24*28" 2, ,700 Bolster 15*61 cms 6"*24" Long 2, ,100 MAT (1 Piece) (6x2x.5)' 7, ,900 Goniometer long hand - metal Goniometer finger - metal Putty Imported (100 gm Pack) Wax (5Kg. Pack) 1, ,100 Knee Hammer with metal handle Sports tape - 1 inch & 1/2 inch inch Balance board 2, ,100 Brush (2cm & 3cm each 2 pcs) Trampoline 4, ,600 27

28 Weight cuff - Metal (0.5 to 5 kg) ,600 Phyaction E - Electrotherapy 1,95, ,95,000 Phyaction U - Ultrasound 1,42, ,42,000 B P Instrument Digital 2, ,200 Height Machine 1, ,500 BMI 5,00, ,00,000 Digital Weight Machine 2, ,100 Sub total 13,28,320 CATH LAB Cost Digital Flat Panel 2,70,00, ,70,00,000 Syringe Pump 35, ,40,000 Monitor 2,25, ,50,000 ECG 75, ,000 Anaesthesia Work Station 14,00, ,00,000 IABP 18,00, ,00,000 B P Instrument Digital 2, ,200 Digital Weight Machine 2, ,100 Sub total 3,08,69,300 LINAC, BRACHYTHERAPY & CHEMOTHERAPY Cost LINAC 7,50,00, ,50,00,000 Brachytherapy 45,00, ,00,000 Dosimetry System 15,00, ,75,000 Treatment Planning Accessories 6,00, ,00,000 Gamma Med System 5,75, ,75,000 Breast Board and Survey Meter 2,00, ,00,000 Crash Cart 2,00, ,00,000 Syringe Pump 35, ,43,500 Monitor 2,25, ,22,500 ECG 75, ,000 B P Instrument Digital 2, ,200 Digital Weight Machine 2, ,100 Sub total 8,52,95,300 BONE MARROW TRANSPLANT UNIT Cost Bone Marrow Transplant kit 6,00, ,00,000 Crash Cart with Defib 2,00, ,00,000 Syringe Pump 35, ,40,000 Monitor 2,25, ,50,000 ECG 75, ,000 28