Terms of Reference for Appointment of a Project Management Consultant for Establishing and management of Medical College and Hospitalat Nagaland Consultancy support under Nagaland Health Project funded by the World Bank Background The state of Nagaland is preparing a Health Project with the support of the World Bank under International Development Association (IDA) funding. The Nagaland Health Project will be implemented for 7 years to strengthen health systems and investment in other areas such as community participation for health, investment at health facilities to make them functional, improve hospitals and other interventions in the Department of Medical Health and Family Welfare, Government of Nagaland. Under the Project, the Government is planning to strengthen access to health service, service delivery and also improve information on medicines/drugs and their delivery through Information communication and technology. As part of the project, the state has also requested to provide the necessary technical support in developing the detail project report for medical college. The proposed Medical College at Kohima will have at least 50 seats and shall be built and managed by Government of Nagaland with nearly 300 beds. There is need for detailed project report for establishment of medical college and hospital along with technical assistance to manage the medical college & hospital for three years. The Department of Health and Family Welfare, Nagaland is steadfastly moving towards improving the health delivery system in the State and is planning to develop medical college in Kohima with 100 academic seats linked with State s capital Hospital known as Naga Hospital Authority Kohima (NHAK) the only 300 bedded hospitals in the state. The desired impact of this intervention is to address priority bottlenecks for improving the supply, utilization and quality of health services. The NHAK, State Referral Hospital, District Hospital, Kohima aims to provide quality health care in the form of preventive, promotive and curative services to the people with sustained efforts to ensure equitable, affordable, and accessible health care. The present challenge is to universalize primary health care on one side and strengthen the secondary and tertiary level health care on the other.the Government of Nagaland has difficulty in finding doctors to work at all levels especially at the primary health centre and Community Health Centres. This is due to the fact that there is shortage of doctors as the state is dependent on the seats allocated to it by GOI and regional institutes in the North East. After the NRHM program was introduced the facilities in most centres have improved including housing and equipment. However, though monetary support for placement of doctors in rural areas is provided under NRHM, due to the shortage of doctors in the State many health centres remain without a doctor.
Most of the neighbouring states in the northeast region have made rapid strides in providing quality health care to the people through medical colleges and tertiary hospitals. Unfortunately, due to political turmoil, lack of peace and stability, the state has lagged behind in this respect. As a result, patients requiring treatment for difficult illnesses are required to travel great distances to other places outside the state at a huge cost. This adversely affects the state economy. On the other side, the technical manpower development is slow as the state has to depend mainly on central pool of MBBS/PG quota which leaves the state far behind other neighbouring states like Assam, Manipur, Meghalaya, Tripura, Sikkim etc. Objective The objective of the consultancy services is to provide handholding support in documentation and management of medical college for three to five years. Assess the progress made by state with respect to proposed medical college and hospital with specific focus on physical infrastructure, human resource requirement, medical equipments revenue models and financial viability with respect to the Medical Council of India s ( MCI) requirements. The detail scope of work and specific deliverables are mentioned in the sections below. Scope of work Architectural Design Site survey and evaluation of site, analysis and impact of existing structures / proposed development of its immediate environments etc. and ascertaining local bye-laws, ground/design controls applicable to the site of work, details of various approvals required from local/ statutory authorities Preparation of detailed working drawing and layout plans indicating features like internal and external, water supply, sanitary installations, storm water drainage, rain water harvesting system, landscaping, internal roads, paved areas, culverts, compound walls, internal and external electrical installations compound lighting, etc. complete, which shall be in accordance with local Bye laws and obtaining required approvals Preparation and submission of detailed designs, working drawings and documents for all internal utility services like plumbing, fire fighting, electrification, fire detection, lifts, telephones, PABX, public address system, acoustics and other specialized services etc. as per the requirements of the Project suitable for construction and release to site. Preparation and submission of detailed designs, working drawings and documents for all external utility services like water supply, sewerage, storm water drainage, fire hydrants schemes, treatment plants for water and sewage, water supply intakes arrangements, roads, street lighting, telephone system, electrical sub-station and other related schemes, boundary walls and any other specialized services as per project requirement suitable for construction and release to site
Preparation of working drawings using Auto CAD for various floors, toilets, staircases, lift, etc. explaining the general planning with schedule of internal and external materials and finishes and dimensions. Plumbing/Electrical layout indicating internal and external, pumps, engine alternator, substation, fire fighting system, elevators, UPS and location of channels for electric cables, telephone, LAN, AC ducts and other conduits for services, complete in accordance with the relevant National Building Code/local Bye laws including 2D drawings and 3D views Structural Design Consultant shall carry out an independent detailed Soil Investigation based on the requirements of approved architectural drawings. The Soil Investigation shall be carried out in accordance with provisions of relevant BIS Codes and also arrange for testing the underground water for fitness for construction and portability. The structural analysis and design shall be done by using latest version of software packages such as STAADPRO or equivalent. Consultant shall supply all design calculations/computer input and output giving specific reference to BIS/NBC, along with soft copies. The structural drawing showing the reinforcement details / bar bending schedule shall be prepared as per latest edition of software Survey Design for the various services as per the provisions of the design brief for respective services - IBMS, Fire Detection and Fire fighting system, Access control system, elevators, power management system, sub-station, DG sets, Solar panels, water treatment plants, waste management system, medical college waste management system, and other services Engineering Documents Preparation of Detailed estimate on Nagaland PWD norms with complete working details, schedules such as internal and external finishes, hardware sanitary fitting and tap ware, and electro mechanical services, building specifications including specification for all trades and services, and bill of quantities including those of various services all based on schedule of rates conforming to specifications and procedures approved and prescribed by GoN to describe the whole project adequately. Supplying details of calculations of such Schedule of quantities to enable GoN to check them before preparation of draft tender documents. Where prescribed specifications and/or schedule of rates do not provide for certain items/services, specification and rates based on proper market rate analysis supported by Quotations from reputed/specialized agencies shall be adopted along with Engineering Market Rate
Obtaining of all approvals from all Local/ Statutory authorities Pursuing and obtaining of all approvals from all Local/ Statutory authorities according to prevailing bye-laws, Laws, and Regulations etc. The GoN shall pay all statutory fees required for obtaining the approvals from various local bodies/statutory bodies by producing relevant documents Preparation and Submission of plans/drawings to local civic bodies for obtaining approval of the Local/Statutory authorities according to the applicable acts, laws, regulations etc. and make any changes desired by such authorities Medical technology and information technology planning Consultant shall form Advisory Group of medical health experts including surgeons, doctors, and public health experts having over 25 years experience to assist in medical technology planning Consultant shall form Advisory group of Hospital and Medical College Management experts having experience of over 25 years in development of clinical standards, patient level costing, performance improvement etc. to advise on effective performance management and continuous quality improvement initiative across clinical and administrative areas Develop overall medical equipment plan in alignment with the phasing plan Overall business and HIS architecture along with functionalities across different areas (clinical and administrative) Develop strategy for equipment procurement including vendor approach (combination of a-la-carte, functional packages, single vendor) and commercial strategy (outright purchase, lease, etc) Assist in developing technical specifications Float inquiry to reputed vendors by giving technical specifications Prepare comparative statements and arrange demonstrations Assist in evaluation of technical bids and short-listing of suitable vendors Assist in placing order on finalization of equipment and further inspection and installation as per the schedule Bid Process Management for construction partner Defining minimum standards/qualifying criteria for potential construction partner Prepare Request for Qualification (RFQ)/Expression of Interest (EOI) document and assist in pre-qualification of bidders Assist in Evaluation of Request for Qualification and short-listing of qualified bidders for the next stage
Preparation of request for proposal / Bid documents with suitable evaluation criteria, construction methodology, and special conditions as felt necessary by the consultant in consultation with the GoN and The World Bank Issue request for proposal / Bid documents to the short-listed bidders. Assist in responding to the queries that may be raised during the pre-bid meetings and prepare minutes along with addendum / corrigendum to the bid documents as required. Upon receipt and opening of bids, facilitate to prepare technical and financial bid evaluation reports with recommendations. Prepare legally vetted concession contract agreement for the project. Step Post completion approvals Consultant shall assist GoN in obtaining final completion certificates from different authorities in respect of various building and services and securing permission of local/ statutory authorities and such other authorities for occupation of the building Preparing and submitting AS BUILT DRAWINGS for the building and all services for reference and records of the GON and The World Bank - both in hard cloth mounted drawings and digital mode Setting up the Project Management Office for 3-5 years to oversee construction of the Medical College & Hospital Set up a co-ordination system for interaction with various vendors, establishing clarity of reporting structure and individual responsibilities to have seamless execution on the ground Devise and implement systems and procedures to plan, monitor, co-ordinate and control the events and activities related to the Master Program (including all its component schedules), Project Execution Plan, Changes to Design & Costs, Mitigation of project delays, Health and Safety, Quality and Documentation Periodic site inspections during project implementation till project commissioning Overseeing vendor management and operations activities and will not be involved in construction related PMO activities. Contract and performance management services Clearly defined roles & responsibilities for various partners in the project, including clearly stating obligations of the Operations & Maintenance (O&M) partner along with timelines, expected service level agreements, outputs and quality standards Ensuring that all aspects of quality assurance and other components of the work to the satisfaction of the GoN and The World Bank Developing provisions for handling contract changes and failure of O&M partner are in place
Developing a transparent and appropriate analytical framework which can measure the success and outcome of the project Set procedures to guarantee close monitoring of the O&M partner s performance and general compliance with the agreed contract Set-up conflict resolution dashboards to provide time bound resolution for any issues/conflicts Risk management: Assist GoNin management of risks such as project risks contractually / not contractually allocated, intrinsic risks borne by client, risks associated with changes to the contract with the O&M partner Drafting contingency plans (especially for BCP, DRP, etc) Building indicators which will identify risks early Designing proper escalation matrix for raising risks levels Creating structure for requesting, assessing and implementing changes in the contract Setting up the Project Management Office for Support in Management and Operations of the Medical College & Hospital for 3-5 years post commissioning Consultant shall form Advisory Group of hospital &medical college management planning and healthcare consultants Support the GoN in managing medical college and hospital operations for 3-5 years after commissioning Design the overall organization and governance mechanism for supporting the GoN to establish and run the medical college & hospital though the planning, implementation and operations phase of the project Identify the skill set and experience required for key management positions (clinical and non-clinical), develop job descriptions for the same and assist GoN with recruitment Establishing KPIs and dashboards for performance review Assist the GoN in deciding the courses to be offered based on historical and current data on local and national disease patterns and the MCI guidelines Assistance in developing academic systems and processes as per the MCI guidelines Support in recruitment of professors and doctors for the medical college and hospital Provide support in work force optimization for running the medical college and hospital Assistance in planning and implementation of support services (canteen, housekeeping, hostel and recreational facilities, supply chain, fire safety designing, etc) Developing suitable systems, processes and management systems for operating all facilities to the desired standards
Developing SOPs for equipment, drug procurement, waste management, at the Hospital and Medical College Overseeing and monitoring support for medical equipment purchase, delivery and installation and operationalization for all clinical areas such as OT, Labs etc. Ensuring purchase and stocking of adequate quantity of medical and surgical consumables Capacity building of the staff members about key SOPs and policies of hospital and medical college Deliverables Preliminary financial appraisal of the project including a rough assessment of the cost and revenue streams and economics of scale. The Report must also bring out in detail the minimum scale of the College and associated facilities that to be developed and technical standards to be followed. Development of drawings, structural design and all relevant engineering documents required for contracting agency to do civil work. Development of tender documents for procurement of works, goods and services for medical college and Hospital. Setting up Management team in Kohima to provide day to support in development and management of Medical College and Hospital. Requirements: The consultant shall deploy such personnel, who have knowledge and experience of medical education and public health issues, financial management, and legal expertise in drawing up of contracts for medical college and hospitals as per MCI requirements. They should have professional knowledge and experience with planning, design, financing and running aspect of a Hospital, Medical College Project Consultancy experience with respect to hospital, Medical College Planning, establishment running and financial management thereof of at least one similar project with minimum project cost of Rs 200 crores during last 5 financial years Reporting: The consult will report to Commissioner and Secretary Health and Family welfare, government of Nagaland. For day to day operations, they will coordinate with the project director or any other officer identified by Government of Nagaland. Time frame February 2015 to March 2018. The contracts will be reviewed yearly for extension. The maximum period of the assignment will be for 5 years.