list of supporting documents filed in wb ...uphssp.org.in/reviewmissiondoc/annexes_jan2016.pdf ·...

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

http://www.uphssp.org/

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.


Target 2015-16

Yr-4

Progress 2015-16


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.


Target 2015-16

Yr-4

Progress 2015-16


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.


Target 2015-16

Yr-4

Progress 2015-16


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.


Target 2015-16

Yr-4

Progress 2015-16


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.

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


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.

18

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.


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.

list of supporting documents filed in wb ...uphssp.org.in/reviewmissiondoc/annexes_jan2016.pdf ·...

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