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LIST OF ANNEXES
1. Results Framework
2. Status of DLIs
3. Financial Management
4. Procurement Management
5. Notes from field visit
List of supporting documents filed in WB docs and available at www.uphssp.org
1. Component wise progress report
2. World Bank Review Mission ppt Final
Annexure 1 Results framework
Project Development Objective (PDO) results indicators and Intermediate Result (IR) Indicators
Project Development Objective (PDO) results indicators
Sl.
No. Indicators 5 Years
Target 2015-16
Yr-4
Progress 2015-16
Yr-4 Current Progress
1 Indicator-1: Number of hospitals under the
accreditation program producing data to
monitor: service productivity, efficiency,
quality, patient satisfaction, and grievance
registration and redressal at 40 Hospitals
covered under NABH
90% i.e.
36 Hosp.
90% i.e.
36 Hosp
0
Target difficult to be achieve for FY 2015-16
Total 20 hospitals are already assessed by the NABH for entry
level accreditation. Similarly 3 are in the pipeline of entry level
assessment by NABH. 17 remaining hospitals are also lined up
for the comparative gap analysis with hospitals managers
appointed for the assignment.
Facility Health Report Card of District Hospitals has these
indicators and is available in public view under ‘Health Report
Card’ at www.uphssp.org.
Hospitals have initiated producing data to monitor: service
productivity, efficiency, quality, patient satisfaction, and
grievance registration and redressal.
Indicators related to equity are not generated now and will be
collected and analyzed from January 2016.
2 Indicator-2: Number of districts using the
personnel information system for paying
salaries of health workers- program in total 75
Districts 75% i.e.
58 Dist.
60% i.e. 45
Dist.
60% i.e. 45
Districts
Under progress for FY 2015-16
Due to GO from Directorate of Treasuries, districts have to
prepare salary bill using web based system operational in
Treasuries of districts.
It is being planned to prepare an interface from PIS to act as an
interface for Treasuries or vice versa. NIC as well as Dept. of
Finance are being contacted to prepare the interface and
approve.
3 Indicator-3: Number of districts with
completed and published facility-based report
cards detailing national health programs
indicators and facility-level performance data -
program in total 75 Districts
90% i.e.
68 Dist.
75% i.e.
56 Dist.
75% i.e.
56 Dist.
Under progress for 2015-16:
Facility Health Report Card of CMOs and District Hospitals is
available in public view under ‘Health Report Card’ at
www.uphssp.org; For 2015-16, all facilities of 56 districts have published Health
3
Sl.
No. Indicators 5 Years
Target 2015-16
Yr-4
Progress 2015-16
Yr-4 Current Progress
Report Cards. In total, 45 CMOs and 148 District Hospitals
have published Health Report Card for 2015-16;
4 Indicator-4: Number of Blocks of Primary
Health Centers participating in the social
accountability pilots for which a service
delivery assessment has been completed and at
least one corrective action by government is
verified by the community-50 Blocks in 5
Districts. 80% i.e.
40 Dist.
50% i.e.
25 blocks
0
Under Progress
The preparatory phase process has been started by the CDA
SIRD
Tools for Monitoring & Evaluations has been finalized and
shared
Community score care, citizen charter and HR manuals (SOPs)
has been ready to finalization stage.
Selection of State/Districts/Blocks level facilitators has been
completed. HR agency for GPCs has been finalized and
awarded.
GPCs will be on board in the month of February, 2016.
5 Indicator-5: Number of facilities using
performance based outsourcing of service
contracts- In hospitals covered under NABH
Accreditation-50 Nos.
50Hosp. 50 Hosp. 39 Hospitals Unlikely to achieve target for 2015-16
Cleaning & Gardening contracts implemented in 39 hospitals;
11 more hospitals are being included
High End Laboratory tests started in 40 hospitals; 10 more
hospitals are being included.
6 Indicator-6:Number of hospitals (Hospitals
covered under NABH-40 Nos) under the
accreditation program that have been certified
for
90% i.e.
36Hosp.
90% i.e.
36
Hosp.
0
Under progress; however, unlikely to achieve target for 2015-
16:
NABH handholding of 23 hospitals is in process. GoUP has
decided that 17 hospitals of phase-1 will be supported in-house.
Equipment & HR gaps identified-procurement under process
Entry level assessments of 20+1 facilities have been done by
the QCI and CAPA report submitted to the facilities for
necessary action.
Forms and formats drafting have been completed. Procurement
s under process.
Agency for Training for ACLS is hired, training to be started in
January.
Licenses under process.
1. Entry level pre-accreditation
2. Progressive level pre-accreditation 50% i.e.
20Hosp.
40% i.e.
16Hosp. 0
3. Final accreditation (quality)
25% i.e.
10Hosp.
10% i.e.
4Hosp. 0
4
Intermediate Result (IR) Indicators
Sl.
No. Indicators 5 Years
Target 2015-16
Yr-4
Progress 2015-16
Yr-4 Current Progress
1 IR1: Number of agreed research studies
completed and results disseminated to key
Stakeholders
4 studies 3 1 (completed, not
disseminated)
Under progress
A research matrix developed- further updating of the
matrix is an ongoing exercise.
Development of Health Atlas for the State of Uttar
Pradesh (to understand the disease burden and to aid in
planning process is being finalized.
Draft Request for proposal on improve health services
delivery in Uttar Pradesh submitted
2 IR2: Annual validation of the DRC report for
health programs completed
Yes Yes Yes
Achieved
It is an ongoing process, data being used at various levels
however the same will be institutionalized with the
deployment of full time M&E Consultant;
The team at DRC generates monthly reports for review
and ensure validation of data;
Review meeting initiated by DG, M&H;
Comparison with reporting done on other portals;
Field visits by DRC team.
3 IR3: Percentage of districts that completed
training of Financial Management staff 90% 90% 0 To be initiated
The training shall be held along with the supply chain
management training.
4 IR4:Percentage of districts that completed
procurement and SCM training of staff
90% 90% 0
Under progress
Practical training of handholding for bid and RFP document
preparation of CMSD staff has been done by E & Y.
Procurement manual and mode bid documents have been
submitted and once it is approved by the govt. training of
field staff will start.
5 IR5: Pilots for social accountability and
performance based incentives designed,
implemented, and evaluated
(DLI target interpretation and indicators to be
modified as per the design change)
Independent
assessment of
SA done and
results shared
with
Surveys for end
line evaluation
with agreed
methodology
completed
Target for Yr-1
being completed
in Yr-4
Under progress but delayed
MoU signed and preparatory phase process has been
started by the CDA SIRD
Tools for monitoring and evaluations has been finalized
5
Sl.
No. Indicators 5 Years
Target 2015-16
Yr-4
Progress 2015-16
Yr-4 Current Progress
stakeholders and shared.
Community score card, citizen charter and HR manuals
(SOPs) has been ready to finalization stage.
Draft IT base monitoring tools developed and shared with
IA teams of World Bank and SIRD.
Selection of state/Districts/Blocks level facilitators has
been completed.
HR agency for GPCs has been finalized and awarded.
GPCs will be on board in the month of February, 2016.
6 IR6: Environment Management
(i) Percentage of hospitals that are connected
with CTF services; and
(ii) Percentage of hospitals in the accreditation
program having HCWM monitoring
mechanisms and staff trained in HCWM
(Denominator: 923 Hospitals 150 DH Hosp. +
773 FRU / CHCs)
85%;
85%
Independent
evaluation
completed
(i) 65%;
(ii) 65%
(i) 85%
58%
Under progress for 2015-16
Mapping of CBWTF facilities in the state has been
completed. Mapping of HCFs for tie-ups with CBWTFs is
underway and has been partially completed.
Training of health care staff in all 23 hospitals in
accreditation process has been undertaken in Octavo (QA)
consultants-58 % covered.
Draft technical guidelines for a standard contract for
collection, transportation, treatment & disposal of BMW
by common biomedical waste treatment facilities have
been developed and shared with NHM and DGMH. Draft
RFP is under circulation for comments.
Draft concept notes on waste water management plan and
draft concept note on Mercury phase out plan have been
developed.
Directives for constitution of district monitoring committee
and three year authorized of HCFs and CBWTFs (by UP
PCB) have been issued.
7 IR7: Percentage of hospitals that prepared
Action Plan based on facility survey under
NABH
100%
40Hosp.
100% by 2014-15
(no target for 2015-
16)
58% i.e.
23 Hosp
Under progress
Draft action plan has been prepared
Recruitment for QA cell (TAP and DGM&H) is almost
complete. Recruitment of one post of DGMH and 2 posts
at TAP are under process.
Recruitment of HR through T & M is underway
Equipment procurement is under process.
Training of staff for ACLS/BCLS to begin in January.
6
Sl.
No. Indicators 5 Years
Target 2015-16
Yr-4
Progress 2015-16
Yr-4 Current Progress
Committees constituted; follow up regular meetings is
on:
Number of position filled-
Post Sanctioned Indented Joined
Doctors 409 309 38
Hospital Man 41 41 24
Nursing staff 1473 743 476
Para medical 793 661 409
7
Annexure 2 Status of Disbursement Link Indicators (DLI’s)
Two DLIS – DLI-2 and DLI-6 of FY 2015 are considered achieved, the annual targets and status update for DLIs under the project for FY 2014 and FY 2015:
DLI No. Indicator
Annual DLI Target
FY2014 FY2015
Target Status/
Remarks
Target Status
DLI-1 Percentage of districts using the personnel
information system for paying salaries of
health workers
10% Achieved 30%
Not achieved
Project achieved DLI due for FY 2014 i.e. 10% of
districts; however, recent report of DLI verification
suggests that DLIs for FY 15 (30% (or 23) districts) and
FY 16 (60% (or 45) districts) are not considered
achieved due to following reasons
Treasury department is using its own computer based
system in most cases and PIS not utilized
Database of staff prepared once is not updated
regularly and there are gaps
PIS may serve as useful database; however, it is
redundant now as salary disbursement tool
DLI-2 Percentage of districts with completed
and published facility- based report cards
detailing national health programs
indicators and facility-level performance
data
20% Achieved
50%
Achieved
Project achieved DLIs due for FY 14 (20% (or 15)
districts) as well as for FY 15 (50% (or 38) districts)
74 out of 75 districts have HRCs to some degree
UPHSSP has put in the system in place and data is
being provided to public, we may consider this DLI
achieved; however, there are many discrepancies
among the registers maintained by respective
hospitals and data quality which needs to be looked in
to.
Also, project need to move towards publishing HRCs
for facilities below district hospitals.
DLI-3 Percentage reduction in procurement
cycle time
Assessment
completed and
accepted by the
Achieved
10%
reduction
from baseline
Not achieved
The training of CMSD staff is yet to start.
It is unlikely that the CMSD will be able to
8
DLI No. Indicator
Annual DLI Target
FY2014 FY2015
Target Status/
Remarks
Target Status
government, and
Action Plan
prepared
demonstrate the learning into practice and show
reduction in procurement time.
DLI-4 Percentage of Primary Health Centers
participating in the social accountability
pilots for which a service delivery
assessment has been completed and at
least one corrective action by government
is verified by the community
NGO hired and
implementation
started in treatment
districts
Not
Achieved
20% (8
districts)
Not achieved
SA intervention proposal design has been finalized &
MoU Signed with CIDA-/SIRDUP on 5th June 2015
Collection of training modules, designing of
community score cards, development of customized
training modules, preparation of manuals and
checklists for routine monitoring are in right direction
However, no data to support that any PHC,
participating in the pilot, has at least one corrective
action by government and is verified by the
community.
DLI for FY 14 has lapsed
Considering the changes in the modalities of
implementation of this activity, we may need to
consider changing the indicator to “percentage of
blocks”; otherwise difficult to achieve this DLI.
DLI-5 Percentage of hospitals under the
accreditation program that annually
produce data and monitor: service
productivity, efficiency, quality, patient
satisfaction, and grievance registration
and redressal 30%
Not
Achieved 60%
Not achieved
The project has established reporting system, and in
some cases registers have been developed to capture
data on indicators.
However, recent assessment by verification agency
says that there is no well-defined protocol in place for
data collection
Also the 17 facilities for NABH phase-I hospitals
need to be included if 60% (24 facilities) needs to be
achieved.
9
DLI No. Indicator
Annual DLI Target
FY2014 FY2015
Target Status/
Remarks
Target Status
DLI-6 Number of facilities using performance
based contracts for 40 non clinical
services (outsourcing to the private sector
for housekeeping and laboratory services)
15
Not
Achieved
30
Achieved
Contracts for gardening and cleaning as well as high-
end lab tests completed and implementation
underway
DLI for FY 14 has lapsed
DLI-7 Percentage of hospitals under the
accreditation program that have been
certified for Pre Accreditation Entry level
certification
25% Not
Achieved 60%
Not achieved
The project has made progress on applying for entry
level accreditation in all the 23 hospitals.
Pre assessment 21 hospitals has been completed and
corrective and preventive action report making is in
progress
Looking at current progress, difficult to achieve this
DLI
Decision on 17 hospitals from phase-I has been
taken; however, it would take time to show any
progress in recent future. These hospitals would be
critical to achieve DLIs for FY 15 & 16.
10
Annexure 3 Financial Management
Disbursements/ expenditure: Disbursements as on January 7, 2016 were SDR 17.07 million (17.80%) out
of the credit of SDR 95.90 million. In USD terms disbursement is USD 23.55 million (including an advance
of USD 10 million) out of the credit of USD 132.31 million. There has been little change in the
disbursement since the last mission (June 2015). As per PAD targets the project is required to disburse USD
93 million by December, 2015; thus there is a disbursement lag of approx. USD 70 million.
The project has also been disbursed USD 12 million against DLIs-1 (USD 2 million), DLI-2 (USD 4
million), DLI-3 (USD 2 million), DLI-6 (USD 2 million) and DLI-7 (USD 2 million).
Expenditure for current FY: Till December 31, 2015, the project has made an expenditure of Rs. 12.20
Crores out of which IFRs of Rs. 6.63 Crores has already been submitted by the project and claims released
by the Bank. The project will be submitting an interim IFR for the quarter ended December 31 for claim of
expenses of Rs. 5.57 Crores. For the last quarter of the current financial year, the project expects to incur
Rs. 37.31 Crores.
As per Table 1, Cumulative Project Expenditure till December 31, 2016 is Rs. 35.64 Crores.
Year till
date
Project till
date
Expenditures by Component
1.0 Strengthening management & accountability systems 390.22 816.78
1.1 Project Implementation/Operational Expenses for PSU, TAP & PA 214.65 214.65 1766.64
1.2 Introducing strategic planning function 4.73 4.73 6.28
1.3 Improve use of data for program management 156.43 156.43 369.63
1.4 Strengthening accountability in FM, Proc., SCM systems 21.83 21.83 143.52
1.5 Introducing & strengthening social accountability & provider incentives 10.40 10.40 10.75
Sub-Total 408.04 408.04 2296.82
2.0 Improving quality assurance and private sector engagement 167.17 2914.00
2.1 Service quality improvement & supporting regulatory environment 12.51 12.51 275.96
2.2 Improving quality of service delivery to enable accreditation 1.25 1.25 40.79
2.3 Contracting with private sector to improve delivery service quality 241.25 241.25 393.28
2.4 Availability of Human Resources 0.00 0.00 0.00
Sub-Total 255.01 255.01 710.03
Total Expenditures 663.05 663.05 3006.85 557.39 3730.78
For the
Semester-1
Cumulative Forecast for
next 3
months
Particulars
(Amt Rs. in Lacs)
Actual Exp.
Till Dec 31,
2015
Disbursement Linked Expenditure: In addition to the forecast for 37.31 Crores for quarter 4, the project
may also submit DLI 1, 2, 4, 5 and 6. Third party evaluation of the DLI number 2, 4, 5 and 6 has been
completed (by IIM Kashipur).
Internal Audit: Internal audit for financial year 2014-2015 is complete and reports received by the project.
Key observations of the auditors include:
Non / incorrect booking of expenses – Rs. 36.43 Lacs
Difference in expenses reported by Treasury and PSU – Rs. 1.02 Lacs
Cleaning and Gardening Contractors – non-submission of weekly reports by the contractors; Delay in
payment of bills to contractors.
Payment of fee to professional for services not relating to project – Rs. 0.39 Lacs
Incorrect deduction and deposit of TDS
12
Placing of computer operators in hospital before the relevant hardware and software were installed
resulting in payment of salaries which were non-productive – Rs. 26.40 Lacs
Incomplete registration records of PF / ESI submitted by HR agencies
Excess claim of service tax by Tax Operator – Rs. 0.41 Lacs
Non-verification of fixed assets
The Project is following up on the observations of internal audit. Further, internal audit for the financial
year 2015-2016 is yet to commence since though the contract period of the internal auditors is still valid,
the term of internal auditors as per the ToR has expired. The contract includes a provision for extension of
one year based on satisfactory performance. The project will review the work of auditors and, if found
satisfactory, extend the contract for financial year 2015-2016.
Statutory Audit: Audit by AG for the financial year 2014-2015 is complete and report submitted to Bank.
In their report, the AG has disallowed a sum of INR 13.397 million on account of payments made for non-
project related expenses, non-production of vouchers etc. Also, there are certain other observations which
include: non-physical verification of fixed assets and dead stock register, report of internal auditors not
made available and poor financial management for non-utilization of budget. The project will follow-up on
these observations and submit a copy of the compliance report to the Bank.
Projected Expenditure for FY 2016-2017: For the financial year 2015-2016, the project has requested
GoUP for a budget provision of Rs. 150 Crores, comprising of Rs. 120 Crores for revenue and Rs. 30
Crores for capital expenses. This significant rise in the projected expenses (from an expected Rs. 49.51
Crores in FY 2015-2016) is primarily attributable to the contracts which the project has entered / will enter
into with the service providers including: a) cleaning and gardening (Rs. 10.80 Crores); b) pathology tests
Rs. (40 Crores); c) contractual payments to doctors (Rs. 18.50 Crores); d) contractual payment to
paramedics (Rs. 50 Crores); f) procurement of hospital equipments (Rs. 18 Crores) etc.
Staffing: The project has 8 sanctioned posts for Finance and Accounts at the PSU level. Out of these only 5
posts are filled. A table containing the details of sanctioned and vacant posts is as under:
Sr. Post Sanctioned Filled Vacant
1 Finance Controller 1 1 --
2 Financial Management Advisor 1 1 --
3 Assistant Accounts Officer 2 1 1
4 Accountants 3 1 2
5 Cashier 1 -- 1
Total 8 4 4
With the projected increase in activities, the project will need the sanctioned strength. The project will take
steps to hire staff for the vacant posts.
Field Visit: Field visit was made to Women’s Hospital Unnao. Expenditure incurred by the hospital during
FY 2014-2015 was Rs. 4.66 Lacs against an allotment of Rs. 6.56 Lacs. For FY 2015-2016, the expenditure
incurred up to September 30, 2015 is Rs. 7.82 Lacs. The expenditure includes only the payment made to
cleaning and gardening contractor, the contracted rate for which is @ Rs. 1.57 Lacs per month. Further, this
year the projected expenditure is expected to rise significantly as the service provider for pathology tests
has also commenced its work in the hospital.
Cash book is maintained by the hospital in Form No. 2 prescribed in para 68 in Chapter 3 of Financial
Rules. As on the date of visit the cash book was filled up to October 31 and verified by the Drawing
Disbursing Officer (Chief Medical Superintendent - CMS) till August 28.
13
Discussion with the accounts section of the hospital revealed that the daily / weekly reports are submitted
by the contractor along with the bills (and not at the end of day / week). The hospital management should
ensure that all the reports required to be submitted by the contractor are submitted in time.
Agreed Action Points
Sr. Action By Whom Timeline
1 Renewal of Contract for internal auditor PSU January 31
2 Filing up the vacant posts in accounts and finance wing PSU April 30
14
Annexure 4 Procurement Management
The mission had detailed discussions with the project team and Procurement Agent on January 5-6, 2016.
Status of Procurement Carried out with the Aid of Procurement Agent Hired under the Project
The status of procurement of Goods/Works/Non Consultancy Services conducted with the help of the
Procurement Agent, Accenture Services Private Limited, New Delhi, as advised by the Project is as below:
Table 1 : Procurement to be initiated
Procurement valued at USD 10.8 M approximately is to be initiated, as below.
S. No. Procurements to be Initiated Estimated Value [$]* 1. Outsourcing of Cleaning and Gardening in 11
Hospitals 423,077
2. Outsourcing of Pathology Services in 11
Hospitals 1,538,462
3. Hiring of Laundry Agency 1,538,462 4. Hiring of EQAS Agency 67,692 5. Hiring of Agency for Lead shielding works in
all respects 69,231
6. Procurement of Equipment for 40 hospitals 6,153,846 7. Hiring of Agency for HVAC works 1,076,923
Table 2 : Procurement under Process
Procurement valued at USD 2.03 Million has been initiated and is under process, as below.
S. No. Procurements Under Process Estimated Value [$]* 1. Hiring of Calibration Agency 30,769 2. Minor Civil Works in 21 Hospitals 2,000,000
Table 3 : Contracts Awarded and Signed
Contracts worth USD 7.83 Million have been awarded and signed, as below.
S. No. Contract Signed Estimated Value [$]* 1. Outsourcing of Cleaning and Gardening in 12
hospitals 676,923
2. Outsourcing of Cleaning and Gardening in 27
hospitals 740,000
3. Outsourcing of Pathology Services in 40
hospitals 6,153,846
4. Hiring of Signage Agency 80,000 5. Hiring of Printing Agency for Cleaning Forms
and Formats 8,246
6. Hiring of HR Recruitment Agency 88,385 7. Hiring of HR Recruitment and Management
Agency 81,969
8. Hiring of ACLS/BCLS Agency 6,708 *1 INR=65 USD
15
Prior Review Thresholds and Procurement Method Thresholds
The mission clarified arrangements for prior review by the Bank, and thresholds for procurement methods,
as below:
- Goods up to $3 million equivalent can be procured using NCB
- Works up to $40 million equivalent can be procured using NCB
- Goods and Works up to $ 100,000 can be procured using Shopping
- Framework agreement using DGS&D rate contracts can be used to procure goods up to NCB threshold
contracts will need to comply with the following :
Use of DGS&D rate contracts as Framework Agreement must be reflected in the procurement plan
agreed by the Bank for particular goods
Before issuing the purchasing order, the Task Team will have to advise the government on carrying
out a price analysis on the specific good that is intended to be purchased. If after this due diligence
the borrower concludes [and Bank agrees] that the DGS&D rate contract is not suitable, then the
borrower will have to proceed using NCB or shopping depending on the value
To meet the Bank's requirements for right to audit and F&C, these clauses may be included in the
Purchase Orders [in case the purchasers are directly placing the purchase orders to DGS&D rate
contract holders]. On the other hand, if indent is placed through DGS&D, the Purchaser has the
option to sign a separate undertaking with DGS&D rate contract holder, where Bank’s right to audit
and F&C clauses could be mentioned.
Procurement Plan Update
The mission requested complete update of procurement plan on on-line web-based procurement planning
and tracking tool, SEPA. The project has already received training on the system last year and has received
on line approvals of the procurement plan through SEPA in the past. The mission further clarified that
procurements to be initiated need to be included in the modified and updated procurement plan to be sent to
the Bank for review, for on-line clearance.
Procurement Post Review
Procurement post review of contracts awarded during the period July 1, 2014-June 30, 2015 was conducted.
The final report is under preparation and shall be shared by the Bank for PSU’s review and comments, if
any. Once the comments are received the needful action, as required shall be taken.
Implementation of eProcurement Under the Project
No eProcurement has been done by the project so far. The project had plans to conduct it’s first NCB
eProcurement for minor civil works. However, currently, the project proposes to go in for it’s first
eProcurement for procuring equipment under the project, using NIC platform. Digital signatures of the
Financial Controller [Mr. R. P. Singh] and Additional Project Director [Dr. Harsh Sharma] have been
received and that for the Assistant Director [Dr. Shipra Pandey] is awaited. Training on eProcurement is to
be organized by the Project, in consultation with the UP Electronics Corporation Limited of the
Government of Uttar Pradesh. The targeted date for the training, as advised by the Project, is January 18,
2016.
Procurement Complaints Register
The project has established a Protocol for Handling Complaints [derived from the UP Health Sector Project
1] and has established a manual complaints register. Four complaints have been recorded in the register on
date. It is recommended that the project moves from manual to a computerized, web-based, password
protected, online procurement complaints management system so that the complainant can track the status
of his/her complaint, in real time.
16
Contract Management
Renewal of Contracts
The project was advised to renew contracts on a timely basis and keep a list of contracts coming up for
renewal in the next 6 months so as to take action on contract renewal on a timely basis.
Contract Management Software
The project requested use of contract management software that it has developed in-house to track contract
renewals, timeliness of payments and spend visibility. The Bank seconds the suggestion of the project,
given the decentralized nature of contract management.
Procurement Capacity Building
Procurement capacity of the project has improved, which is evidenced from Table 3 on contracts awarded
and signed. As a follow up to the last mission’s request from the APD for a two day training program for
the benefit of the offices of the project, the project officials have been requested to send topic-specific
training requirement to the Bank, so that a customized procurement training tailoring to the requirements of
the project can be delivered.
Record Keeping
Record keeping is in physical form as well as in electronic form. However, retrieval of physical records is
not easy or timely, as evidenced during the procurement post review, because list of records and their
location is not available. The record keeping system needs improvement.
Procurement Rating
Given that project has gained momentum and has awarded contracts worth USD 7.8 Million in the last
calendar year, and is taking steps to speed up procurement in this calendar year, including training in
eProcurement, the procurement performance is presently being retained as moderately satisfactory and shall
be reviewed, as required.
17
Annexure 5 Notes from field visit
The team visited 3 hospitals with a view of reviewing overall functioning of hospital, implementation of
cleaning & gardening outsourcing, HRC, PIS, drugs logistics system and NABH, team also made some
other observations.
District Hospital (Male), Faizabad:
Hospital Profile:
215 bedded hospital
2000 plus OPD visits every day from the beneficiaries not only from the district but neighboring
districts also as this is a divisional hospital
Visiting Mission Team’s observation about implementation of activities:
Team observed that the hospital was overcrowded with the attendants of the patients, some security
mechanism should be adopted for crowd management and restrict the attendants and patients
visitors only in visiting hours.
There should be proper space management for doctors to diagnose the OPD patients to help in
managing the crowd.
Manpower is an issue as the hospital has just 19 staff nurses and 9 sisters for average 2000 IPD.
The CMS informed the team that the project has been apprised about the situation.
Cleaning is still an issue with the hospital though Dr. Tripathi quoted that they see a very good
improvement in the cleaning services prior to this contract with outsourced cleaning agency.
Agency (Prime services cleaning) is in place for quite some time with sufficient machinery and
manpower however, they are missing on maintaining the checklists for facility cleaning. However,
one good thing is that this agency is maintain the End user feedback on the cleaning services and
they seemed quite satisfactory.
Team witnessed a very successful implementation of outsourced pathology services by SRL. They
have started their services just one month back but doing a good job with average 20 cases attended
per day. Efforts towards good IEC of these initiatives of free high end lab services should be made
to make the beneficiaries aware of these services available to them.
Sri Ram Hospital Ayodhya:
Hospital Profile:
151 bedded (only 85 beds functional)
700-800 average OPD per month and 800-900 average IPD
Visiting Mission Team’s observation about implementation of activities:
More than 100 year old hospital however, functioning well, has been assessed for the entry level
accreditation. The signage were properly put in every place, wherever required for the guidance of
the beneficiaries.
Cleaning is managed in house by the hospital, however, the premises were clean with sufficient
medical and paramedical staff posted in sanctioned posts.
The hospital is constructing another building (funded with NRHM monies) to house the new
operation theatre with wards along with ICU and kitchen. The team foresee the need of additional
manpower to serve with expanded operations.
Hospital is providing basic pathology services and for high end pathology services referring the
patients to District hospital, Faizabad.
District Female Hospital, Unnao:
Hospital Profile:
The hospital has around 80 functional beds and provides maternal and child health services with
obstetrics, gynecology and pediatrics specialists.
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There are 8 doctors (including 6 specialists) and only 8 nurses. The number of nurses is low
considering the number of beds as well as patient load at the facility.
The hospital caters to around 300 outpatients per day and around 500-600 delivering per month
including 50 caesarian sections per month.
Visiting Mission Team’s observation about implementation of activities:
Cleaning and gardening services is outsourced in the hospital. Although the CMS expressed overall
satisfaction with the performance of the vendor, further probing indicated inadequate monitoring of
the quality of cleaning services. However, the facility manager he generic rating (3 or 4) is given on
regular basis. The physical space inside the hospital building, especially in out-patient clinic, is
narrow and is extremely crowded. Due to large foot-fall, keeping the corridors clean may not be
easy. The wards were relatively clean, as acknowledged by the staff nurse present; but with
bathrooms were not clean. But areas such as Operation Theater and labor room need more cleaning
and closer supervision. It was observed that even in areas where patient footfall is not high; the
premise is not adequately clean. It was observed that 2 young men were on duty to clean the female
ward, which may become sensitive. It was indicated that in the absence of a valid (current) contract,
the vendor is providing only minimal services. Suggestions were made to the CMS and other staff
to have a robust monitoring of services and provide ratings according to performance. The hospital
is on the expansion mode- soon an NICU, an SICU and additional wards are likely to come up.
Some part of the hospital premise is maintained (cleaned) by hospital staff, which is not cleaned at
all. The landscaping and gardening aspect of the contract is apparently not followed. These
concerns must be kept in purview during the renewal of the contract.
Laboratory services (for high-end tests), had recently started in the hospital, through a private
vendor. According to the vendor, the volume of tests performed are very low (5-6 per day), which
is not easy to sustain. But the vendor was hopeful that the volume would increase after a formal
inauguration, and through publicity campaign. The space allotted to the vendor is inadequate, and
lack of round the clock electricity supply is apparently hindering the quality of sample and
performance of the collection center. The vendor indicated that there are around 25 private sector
diagnostic facilities and laboratories within one kilometer radius of the hospital. A large number of
hospital patients are still being referred for tests to these private labs, leading to inconvenience and
more expenditure to the patients. This practice (of referring patients to the private labs) needs to be
discouraged.
The hospital carries out only caesarian and minor surgical procedures; no major surgeries such as
Hysterectomies are performed in the hospital. Hospital does routine and basic investigations. Since
the past one month, a private vendor has been hired through UPHSSP project, for providing high-
end tests. The OT complex is located at the ground floor in make-shift room. The hospital is
undergoing major renovation with extensive civil work. Due to this the hospital premise is strewn
with construction rubble and dust.
Expenditure incurred by the hospital during FY 2014-2015 was Rs. 4.66 Lacs against an allotment
of Rs. 6.56 Lacs. For FY 2015-2016, the expenditure incurred up to September 30, 2015 is Rs. 7.82
Lacs. The expenditure includes only the payment made to cleaning and gardening contractor, the
contracted rate for which is @ Rs. 1.57 Lacs per month. Further, this year the projected expenditure
is expected to rise significantly as the service provider for pathology tests has also commenced its
work in the hospital.
Cash book is maintained by the hospital in Form No. 2 prescribed in para 68 in Chapter 3 of
Financial Rules. As on the date of visit the cash book was filled up to October 31 and verified by
the Drawing Disbursing Officer (Chief Medical Superintendent - CMS) till August 28. Discussion with the accounts section of the hospital revealed that the daily / weekly reports are
submitted by the contractor along with the bills (and not at the end of day / week). The hospital
management should ensure that all the reports required to be submitted by the contractor are
submitted in time.
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