Development of Healthcare facility at Smith village

Development of Healthcare facility at Smith village

AgendaAgenda

Conclusion

Funding Structure

Cost Budgeting

Project Scheduling

Proposed Model

Deliverables

Present Healthcare Observations

Vision

Vision and missionVision and mission

To set up a unique and trendsetting modular healthcare structure in the Smith Village

To set up a unique and trendsetting modular healthcare structure in the Smith Village

Project ScopeProject Scope

• Infant Care• Maternal Reproductive Health• Emergency Service• Accessible & Good Quality Care• Immunization & Vaccination

• Infant Care• Maternal Reproductive Health• Emergency Service• Accessible & Good Quality Care• Immunization & Vaccination

Background Observations Background Observations

• Most people who can afford still go outside this region for specialty healthcare

• Borrow / sell off their assets to go out of the state for specialty healthcare

• People who cannot afford have no option• Quality & effective healthcare facilities

are yet to penetrate into many areas• Medical treatment is still very expensive

in this region

• Most people who can afford still go outside this region for specialty healthcare

• Borrow / sell off their assets to go out of the state for specialty healthcare

• People who cannot afford have no option• Quality & effective healthcare facilities

are yet to penetrate into many areas• Medical treatment is still very expensive

in this region

Contd…Contd…

Quality specialty healthcare is still not affordable & accessible to all

Inability to attract / retain quality manpowerA huge scope for development in many specialty &

super-specialty areas like◦Medicine Subspecialties : Chest Medicine,

Rheumatology, etc◦Infectious diseases in children◦Neonatal & Pediatric intensive care◦Neurology & Neurosurgery◦Transfusion medicine◦Geriatric care

Quality specialty healthcare is still not affordable & accessible to all

Inability to attract / retain quality manpowerA huge scope for development in many specialty &

super-specialty areas like◦Medicine Subspecialties : Chest Medicine,

Rheumatology, etc◦Infectious diseases in children◦Neonatal & Pediatric intensive care◦Neurology & Neurosurgery◦Transfusion medicine◦Geriatric care

Patient-reported assessmentPatient-reported assessment

Aspects of Practice

Fee-splitting practicesOver-prescription of drugsOver-prescription of diagnosticsInadequate sterilization of medical equipmentInadequate measures of disposal of wasteInadequate fulfilment of standardsInappropriate use of medical technologyBreakdown of trust in doctor-patient

relationshipInadequate information given to patientsLack of accessibility during emergencies

Aspects of Practice

Fee-splitting practicesOver-prescription of drugsOver-prescription of diagnosticsInadequate sterilization of medical equipmentInadequate measures of disposal of wasteInadequate fulfilment of standardsInappropriate use of medical technologyBreakdown of trust in doctor-patient

relationshipInadequate information given to patientsLack of accessibility during emergencies

Prevalance – High(on the scale of

10)8864912356

Prevalance – High(on the scale of

10)8864912356

Status of Public Health Services (1972-2007)

Status of Public Health Services (1972-2007)

Source: Meghalaya state development report

Health Infrastructure Of MeghalayaHealth Infrastructure Of Meghalaya

Item Required In Position Shortfall

Sub-centre 597 401 196

Primary Health Centre 90 103 -

Community Health Centre 22 26 -

Multipurpose Worker (Female)/ANM 504 608 -

Health Worker (Male)/MPW(M) 401 273 128

Health Assistants(Female)/LHV 103 75 28

Health Assistants(Male) 103 87 16

Doctor at PHCs 103 106 -

Surgeons 26 1 25

Obstetricians & Gynaecologists 26 0 26

Physicians 26 1 25

Paediatricians 26 0 26

Total specialists at CHCs 104 2 102

Radiographers 26 25 1

Pharmacist 129 113 16

Laboratory Technicians 129 130 -

Nurse Midwife 285 174 111

Healthcare facility in SmithHealthcare facility in Smith• Smith is a village situated in Khasi hills

district of Meghalaya, about 20km from Shillong

• Near National Highway • 1 Primary Health Center• Anti-Malaria, Anti-Leprosy programmes have

been implemented by NHRM • Manned by a Medical Officer supported by

14 paramedical and other staff • It has 5 beds for patients

• Smith is a village situated in Khasi hills district of Meghalaya, about 20km from Shillong

• Near National Highway • 1 Primary Health Center• Anti-Malaria, Anti-Leprosy programmes have

been implemented by NHRM • Manned by a Medical Officer supported by

14 paramedical and other staff • It has 5 beds for patients

Healthcare Facility requirements in Smith

Healthcare Facility requirements in Smith

 • Maternal and Child healthcare facility not present• Lack of specialist Doctors• More vehicle required for emergency purposes• No of doctors is not sufficient to look after the

population of Smith and adjoining villages• Standardised healthcare is not being provided to most

of the patients• Patients suffering from critical illness and injuries

cannot be treated in the PHC and are being referred to the city hospitals in Shillong

• Still 24 hours referral service not available

 • Maternal and Child healthcare facility not present• Lack of specialist Doctors• More vehicle required for emergency purposes• No of doctors is not sufficient to look after the

population of Smith and adjoining villages• Standardised healthcare is not being provided to most

of the patients• Patients suffering from critical illness and injuries

cannot be treated in the PHC and are being referred to the city hospitals in Shillong

• Still 24 hours referral service not available

Smith hospitalSmith hospital• The focus of the hospital will be on maternal and

child healthcare which are lacking in this area• Specialist doctors and nurses will be available

round the clock to cater to emergencies and child delivery cases

• Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR)

• Tie-up with the NRHM • Hospital will ensure accessible, affordable,

accountable and good quality hospital care reaches the rural people.

• The focus of the hospital will be on maternal and child healthcare which are lacking in this area

• Specialist doctors and nurses will be available round the clock to cater to emergencies and child delivery cases

• Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR)

• Tie-up with the NRHM • Hospital will ensure accessible, affordable,

accountable and good quality hospital care reaches the rural people.

DeliverablesDeliverables• Assessment of prevailing conditions of

Healthcare in the East-Khasi Hills( smith village)

• Registration for hospital• Construction of healthcare facility• Purchase of equipments• Pharmaceutical supports • Recruitment of staff

• Assessment of prevailing conditions of Healthcare in the East-Khasi Hills( smith village)

• Registration for hospital• Construction of healthcare facility• Purchase of equipments• Pharmaceutical supports • Recruitment of staff

Comparative AnalysisComparative Analysis

PHC• Medical officer-1• Nurse-1• Clerk-1• Lab technician-1• Driver-1• Pharmacist-1

• Medical officer-1• Nurse-1• Clerk-1• Lab technician-1• Driver-1• Pharmacist-1

Smith hospital• Medical officer-2• Nurse-4• Clerk-1• Receptionist-2• Lab technician-1• Driver-1• Pharmacist-1• Other staff-2

• Medical officer-2• Nurse-4• Clerk-1• Receptionist-2• Lab technician-1• Driver-1• Pharmacist-1• Other staff-2

Medical equipmentsMedical equipments

• Outdoor instruments– Sphygmomanometer– Stethoscope– CNS kit– ECG machine

• Operation theatre– Operating microscope– Basic operating instruments– Emergency lighting instruments– Operation table– AC– Disinfecting machine

• Laboratory instruments– Microscopes– Slides – Test-tubes– Other necessary equipments

• Outdoor instruments– Sphygmomanometer– Stethoscope– CNS kit– ECG machine

• Operation theatre– Operating microscope– Basic operating instruments– Emergency lighting instruments– Operation table– AC– Disinfecting machine

• Laboratory instruments– Microscopes– Slides – Test-tubes– Other necessary equipments

Work breakdown structureWork breakdown structure

Civil & Structural • Design • Foundation • Framing • Walls • Roofing • Finish work

Architectural • Site

preparation

Mechanical• HVAC • Plumbing • Central plant

Electrical • Distribution• Lighting • Emergency

Medical equipment

Smith hospit

al

Activity ListActivity ListTask Number Task Name Duration Predecessors

1 Project Requirements Planning 10 days 2 Budget Preparation 10 days 5,14,17,223 Budget Financing & Approval 30 days 24 Facility Construction 297 days 5 Building Plan preparation 14 days 16 Selection of Land for Building Construction 7 days 5,37 Purchase of Land 14 days 68 Tendering process for building 35 days 79 Finalising Building Contarct 7 days 8

10 Construction of Buiding 180 days 911 Staff Allocation 114 days 12 Staff Requirement Planning 7 days 113 Staff Qualification requirement Planning 3 days 1214 Staff Salary Requirement Planning 3 days 1315 Staff Selection 60 days 14,316 Equipment Procurement 167 days 17 Equipment Requirement planning 10 days 118 Equipment procurement tendering 21 days 17,319 Equipment Purchase Order Issue 2 days 1820 Equipment Delivery 90 days 1921 Medicine Procurement 85 days 22 Medicine & related consumable requirement Planning 7 days 123 Medicine Replenishment Cycle Planning 5 days 2224 Medicine Ordering 21 days 23,325 Medicine Delivery 10 days 24

Project SchedulingProject Scheduling

Critical PathCritical Path

• Critical path activities – 1,2,3,5,6,7,8,9,10

• Critical path – 351 days• Facility Construction is the Critical

activity involved• Construction of Building is the most

important subtask

• Critical path activities – 1,2,3,5,6,7,8,9,10

• Critical path – 351 days• Facility Construction is the Critical

activity involved• Construction of Building is the most

important subtask

Building Layout PlanBuilding Layout Plan

Contd…Contd…

Contd..Contd..

Facility Construction SchedulingFacility Construction Scheduling

Proposed ModelProposed Model

A “Not for Profit” healthcare model with a 3-tier approach ◦Paid facilities (30% beds) :: For those who can afford◦Subsidized facilities (50% beds) :: For economically

weaker sections of the society◦ Free facilities (20% beds) :: For people below

poverty line◦ Same pattern to be followed in all diagnostic

services also◦ A healthcare model based on a pattern very successfully

adopted by institutes like LV Prasad Eye Institute, Hyderabad; Aravind Eye Institute, Madurai ; Sri Chitra Tirunal Institute of Medical Sciences & Technology, Trivandrum etc.)

A “Not for Profit” healthcare model with a 3-tier approach ◦Paid facilities (30% beds) :: For those who can afford◦Subsidized facilities (50% beds) :: For economically

weaker sections of the society◦ Free facilities (20% beds) :: For people below

poverty line◦ Same pattern to be followed in all diagnostic

services also◦ A healthcare model based on a pattern very successfully

adopted by institutes like LV Prasad Eye Institute, Hyderabad; Aravind Eye Institute, Madurai ; Sri Chitra Tirunal Institute of Medical Sciences & Technology, Trivandrum etc.)

Concept: Rogi Kalyan Samiti/ Hospital management societyConcept: Rogi Kalyan Samiti/ Hospital management society

• A registered society, acts as a group of trustees for the hospitals to manage the affairs of the hospital

• Consists of members from local Panchayati Raj Institutions (PRIs), NGOs, local elected representatives and officials from Government sector

• Free to prescribe, generate and use the funds with it as per its best judgement for smooth functioning and maintaining the quality of services

• Responsible for proper functioning and management of the hospital and Will function as an NGO as far as functioning is concerned

• A registered society, acts as a group of trustees for the hospitals to manage the affairs of the hospital

• Consists of members from local Panchayati Raj Institutions (PRIs), NGOs, local elected representatives and officials from Government sector

• Free to prescribe, generate and use the funds with it as per its best judgement for smooth functioning and maintaining the quality of services

• Responsible for proper functioning and management of the hospital and Will function as an NGO as far as functioning is concerned

Nature & Purpose Nature & Purpose • The concept is simple, appealing and easy to replicate

across the State.

• To provide sustainable quality care with accountability & people’s participation with total transparency.

• Needed for ensuring a degree of permanency and sustainability

• Concept has to be taken across sections of the community, local representatives and political regime

• The concept is simple, appealing and easy to replicate across the State.

• To provide sustainable quality care with accountability & people’s participation with total transparency.

• Needed for ensuring a degree of permanency and sustainability

• Concept has to be taken across sections of the community, local representatives and political regime

Tying-up with NGO/other voluntary healthcare dept.Tying-up with NGO/other

voluntary healthcare dept.• Red Cross Society

• Rottary club

• World Health Organisation initiatives

• NHRM representatives and Ministry of Health both at state level and centre level

• Red Cross Society

• Rottary club

• World Health Organisation initiatives

• NHRM representatives and Ministry of Health both at state level and centre level

Initial Capital ExpenditureInitial Capital ExpenditureInitial Investment (In Rs.)

Building

Structural Work 1,000,000.00

Civil Work 600,000.00

Electricals 200,000.00

Water connection & Sanitation 200,000.00

  2,000,000.00

Medical/Laboratary Equipment 150,000.00

Furnitures 100,000.00

Refrigerator 10,000.00

Computers (3*22,500) 67,500.00

Beds (15*1,500) 22,500.00

Total 2,350,000.00

Sources of FundSources of Fund

Sources (In Rs.)

Donations 783,333.33

Loans from financial institutions 783,333.33

Grants from government / other donor agencies

783,333.33

Total 2,350,000.00

Estimated Monthly Expenditure Estimated Monthly Expenditure

Est. Monthly Expenditure (In Rs.)Salary  

Doctor (2*26,000) 54,000.00 Nurses (4*5000) 20,000.00 Receptionist (2*5000) 10,000.00 Pharmacist (1*5000) 5,000.00 Lab technician (1*5000) 5,000.00 Clerk cum Accountant (1*7000) 7,000.00 Other Staff (2*2,500) 5,000.00

  106,000.00 Basic medicine & Medi-care Supplies 20,000.00 Laborotory Requirements 10,000.00 Electricity/Maintainance 3,000.00 Mobile Van Rent 5,000.00 Repayment of Debt. 6,528.00 Total 150,528.00

Potential Source of IncomePotential Source of Income

• The main source of income of hospital is receipts from patients

• Grants from different parties: Donations, Govt., NGOs, Public

• Outpatient• Daycare • Inpatient hospital services • Retail sales in the pharmacy• Investment Income

• The main source of income of hospital is receipts from patients

• Grants from different parties: Donations, Govt., NGOs, Public

• Outpatient• Daycare • Inpatient hospital services • Retail sales in the pharmacy• Investment Income

Additional Sources of IncomeAdditional Sources of Income

• Utilize all Government assets and services to impose user charges

• Shall be free to determine the quantum of charges on the basis of local circumstances.

• Private organizations offering high tech services like pathology, MRI, CAT SCAN, Sonography etc

• Could be permitted to set up their units within the hospital premises in return for providing their services at a rate fixed by the RKS/ HMS

• Utilize all Government assets and services to impose user charges

• Shall be free to determine the quantum of charges on the basis of local circumstances.

• Private organizations offering high tech services like pathology, MRI, CAT SCAN, Sonography etc

• Could be permitted to set up their units within the hospital premises in return for providing their services at a rate fixed by the RKS/ HMS

Thank youThank you