constant lievens academy of health sciences and...
TRANSCRIPT
Constant Lievens Academy of Health Sciences and Hospital
Master Plan
2015
SITEVIEW
C O N T E N T S
A. CBCI Education Mission
B. Health Care and Education Regulations
C. Health Care & Medical Education Market Viability
D. Identified Campus Area and its Nuances
E. Academy Campus Modelling
F. Development Strategy and Master Plan
G. Economic Viability
H. Critical Implementation Issues
Annexure
A C B C I E D U C A T I O N M I S S I O N
1 . M I S S I O N
CBCI Society for Medical Education, North India, is interested to establish an
Academy of Medical Education and Healthcare (Constant Livens Academy of Health
Sciences and Hospital) in the heart of tribal region of Mandar Block, Ranchi district,
Jharkhand. This will involve Setting up :
a. An undergraduate (MBBS) College
b. Supporting Teaching Hospital
c. Nursing Education – School and College
d. Other Forms of Health Care in the form of Alternate Healing
e. Supporting Infrastructure
The mission of CBCI Society for Medical Education, North India is very noble and is in
three folds:
Provide access and affordable cost solution in health care and Medical Education
to the society around.
Provide platform to develop doctors, nurses and supporting Staff from within the
society to serve the region.
To create effective Eco System for the society around the academy.
B H E A L T H C A R E &
E D U C A T I O N R E G U L A T I O N S
2 . M E D I C A L C O L L E G E R E G U L A T O R Y
S P E C I F I C A T I O N S
2.1. Medical Council of India Regulations
The medical college specifications are governed by Medical Council of India. They have
clearly specified the area of campus, the covered area of facilities to be provided, the
specifications of teaching hospital, the laboratory facilities, faculty & Staff requirement for
different levels of annual student intake. (i.e. 50 or 100 or 150…). The Medical Council of
India also clearly specifies the process of application, their inspection frequency an d the
certification mechanism.
Holy Family Medical College will be a 100 student’s intake college annually. The MCI
regulation as it applies is as follows:
Campus Area
The campus area required including the hospital and college should be around 25 acres
in a unitary land parcel. However in the case of scheduled tribal area then the 25 acres
land required can be in two land parcels separated not more than 10 Kilometres.
Mandar comes under the purview of Tribal area schedule.
Medical College Covered area
The minimum covered area desired under various facilities as per MCI for 100 student’s
annual intake for MBBS program will in all be 10450 Sq. M. The Details by facilities is
presented in the table:
Table 2.1: Minimum Covered Area Requirement
(Area in Sq. Meters) TOTAL
• Administration 430
• Lecture Theatres 1650
• Examination Room 300
• Student Facilities 400
• Central Library 1650
• Auditorium 800
• Common Laboratories 1120
• Central Laboratory 100
• Departments - for Faculty & Teaching 3050
• Others (10%) 950
TOTAL CARPET AREA - MBBS PROGRAM 10450
Residential facility covered area.
The College has to make provision for hostel for students and residential
accommodation for teaching & non-teaching college personnel. Medical Council of India
expects hostel accommodation for at least 75% of the students and adequate provision
of residential accommodation for teaching & non-teaching personnel.
Table 2.2: Residential Area Requirement
TYPE OF RESIDENTS SQ. MTS.
• HOSTEL FOR 75% OF 500 Students 3375
• INTERNS 100% 2700
• RESIDENTS 100% 3000
• TEACHING 20% 4400
• NON TEACHING 20% 3600
TOTAL >> >> 17075
Medical Council of India has not made any clear regulation on the minimum % provision
to be adhered for interns, residents, teaching and non-teaching personnel.
Faculty & Staff Requirement
The strength of faculty & staff (excluding administration officials & Staff) with additions
year wise as per Medical Council of India is summarised in the table. In the final count
the total faculty & staff (excluding administration officials & Staff) will have to be 184.
Table 2.3 : Minimum Faculty & Staff Required
Faculty Letter of
Permission Year 2 Year 3 Year 4 Recognition TOTAL
• Professor 6 15 16 18 19 22
• Associate Prof 14 17 23 25 25 27
• Asst. Prof 17 35 43 39 39 41
• Sr. Resident 24 32 46 49 49 51
• Jr. resident 24 35 54 57 57 58
• Tutor 17 24 27 27 27 30
• Statistician 1 1 1 1 1
• LMO 2 2 2 2 2
• A.N.M.O 1 1 1 1 1
• M.W.O 1 1 1 1 1
TOTAL 102 163 214 220 221 235
Laboratory & Equipment’s
The Medical Council of India clearly specifies the number of laboratories to be
maintained and equipping each of the laboratories with desirable facilities, & list of
equipment’s. The list is quite elaborate and is contained in the regulation. The covered
space required for each of the laboratories has already been specified under minimum
covered area requirement for the college.
Teaching Hospital Facility Requirement
A Graduate Program – MBBS of 100 Admissions annually would have to have a teaching
hospital with a 300 Bed Teaching Hospital at the start of 1st session (with 60% bed
occupancy) and by 4th year end an additional functional 200 Bed facility would need to
be in place.
Rural Health Training Centre requirement
The College Shall have one rural health training center under Administrative control of
Dean of the college for training of students in community oriented primary health care
and rural based health education for the rural community attached to it. This health
Centre shall be within a distance of 30 km. or within one hour of commuting distance
from the medical college. Separate residential arrangements for boys, girls and interns
with mess facilities shall also be provided. Adequate transport carrying out field work
and teaching and training activities by the department of community medicine.’
2.2. Nursing Council of India Regulations
a. Nursing School:
Should be connected to a 100 bed parent hospital with a bed occupancy of 75%
If undertaken along with Nursing School then the hospital connected should have
the capacity equivalent to 3 Beds per student intake.
Should be teaching facility area of ~ 2200 Sq. Meters and a Hostel to accommodate
the nursing students. (3000 SQ. M)
The teaching staff will comprise of :
Table 2.4: Nursing Teaching Faculty Teaching Faculty
Principal 1 Vice Principal 1
Tutor 10
Others Staff 16
Total 28
If undertaken along with Nursing School then the area required for teaching facility
and the accommodation will have to be enhanced.
b. Nursing College :
The Nursing college regulation for setting up a 40 enrolment BSc. Course in Nursing includes
the following:
Should be connected with a hospital of 120 beds: Ratio of 1student per 3 patients
If undertaken along with Nursing School then the hospital connected should have the
capacity equivalent to 3 Beds per student intake.
Should be teaching facility area of ~ 2200 Sq. Meters and a Hostel to accommodate the
nursing students. (3000 SQ. M)
The teaching staff will comprise of :
Table 2.5: Nursing Teaching Faculty Teaching Faculty
Principal 1 Vice Principal 1
Professor 0 Associate Professor 2
Assistant Professor 3
Tutor 10 Others
Staff 20 Total 37
If undertaken along with Nursing School then the area required for teaching facility and
the accommodation will have to be enhanced.
2.3. Alternative Healing Centres ( AYUSH)
Every state in India has a department under the clinical establishment act 2010 has a
registration process that needs to be completed for operating such centres.
2.4. University Grants Commission Regulations
The medical college has to be affiliated with a University. This is a must. To start with a
Temporary Affiliation needs to be obtained with a university as per University grants
commission. On completing 5 years one can seek Permanent Affiliation. However the
regulation keeps the choice of university open for the college to decide and seek.
2.5. Hospital Establishment Regulations
There are many several laws the new Hospital has to comply with to ensure that the facilities
are created after due process of registration, they are safe for the public using them, have
at least the minimum essential infrastructure for the type and volume of workload
anticipated, and are subject to periodic inspections to ensure compliance. All these laws are
administered by various departments/bodies of the government at various levels. The
detailed list of various certificates and licenses are detailed in Annexure 2.1 along with the
list of various laws governing different facets of hospital administration.
C H E A T H C A R E & H E A L T H
E D U C A T I O N M A R K E T
P R O T E N T I A L
3 . H E A L T H C A R E & H E A L T H
E D U C A T I O N M A R K E T
P O T E N T I A L
Today Jharkhand state has a very poor Health care infrastructure including Hospitals and medical &
Nursing Education. The total beds per 1000 population is the lowest at 0.3 beds whereas Indian
average is around 1.8 Beds per 1000 population. The situation is quite grave. Similar is the situation
for Medical & Health Care education.
Assessment of hospital density in the state shows a very skewed ratio and is in favour of the urban
cities of Ranchi, Jamshedpur, Dhanbad and Bokaro. The rural areas in the state have a very poor
support of hospital beds.
Table 3.1: Hospital Density: Beds/ 1000 Population
Location Beds /
1000 Population
Ranchi City 2.36
Jamshedpur City 2.5
Dhanbad City 1.4
Rural Areas of Jharkhand 0.05
STATE OF JHARKHAND 0.30
3.1. HOSPITAL MARKET POTENTIAL - RANCHI
a. Current Ranchi Hospital market
Ranchi the capital of Jharkhand has several specialty hospitals and serves virtually the entire
east Jharkhand state including Mandar region as they are devoid of any large hospital
barring PHCs and CHCs. Thus Ranchi market virtually spells out the Market emanating from
50 kilometres on the west of Ranchi and more than 100 – 200 kilometres on the east of
Ranchi City. The current Demand in Ranchi city hospitals as collected is detailed in Table 2.
The current demand in Ranchi is more for Government Hospital, which enjoys near 250%
occupancy followed by private and other charitable hospitals, which have very poor
occupancy ranging from 55% to 75%.
TABLE 3.2: CURRENT RANCHI HOSPITAL BED DEMAND
Hospital Type Ownership Beds Occupancy Demand
Full Facility
Government 1125 250% 2800
Private (Including charitable Hospitals)
1305 55% 717
Specialty Private 220 75% 165
TOTAL CURRENT DEMAND >>> 3862
TOTAL DEMAND AT 75% OCCUPANCY 5000
A visit to the Government hospital showed another 25% ailing patients were around hospital
corridors waiting for their turn to be treated. If we consider this then the actual demand is
higher by another 20 %. The government market share is around 80%. The demand for
hospital beds considering also the spill-over to the corridors the demand will be 4562 and
considering the peak at 75% occupancy the demand for hospital capacity will be 6000 beds
b. Current Ranchi Hospital market by Affordability levels
The per capita income of Jharkhand population is around 60% of Indian Average per capita
income and the rural population in Jharkhand have a per capita income of 25- 30% of Indian
average Per capita income. The affordable levels of the population in comparison to Indian
are quite low. The rural population in Jharkhand look forward to low cost health is solution
and as such prefers Government Hospitals and Charitable Institutions. However due to
extreme pressure in Government hospitals they also get treated in private hospitals, which
are expensive. The share of Government Hospital is around 80%. The present expenditure
rural population of Jharkhand as per various studies shows the following numbers.
Table 3.3: Present expenditure on Health Care by Rural Jharkhand
Health care Cost in Rs.
Annual per capita expenditure towards outpatient Health care
500
Expenditure towards inpatient care (Hospitalization)
15000
The populations look towards affordable cost which necessary need to be much lower than the
expenditure they are incurring at present as detailed in Table 3.
The Ranchi demand if it is seen from the light of affordable Health care then the situation is
quite different. Most of the ailing patients prefer affordable Hospitalization and health care. The
table below gives a very clear view of present hospital bed demand by level of affordability.
TABLE 3.4: RANCHI: CURRENT AFFORDABLE HOSPITAL BED DEMAND
Hospital Type Hospitalisation
Affordability Beds Occupancy Demand
Full Facility
Affordable 1535 210% 3207
High Cost 895 55% 490
Specialty High Cost 220 75% 165
TOTAL CURRENT DEMAND >>> 3862
Total demand for affordable Hospital beds 3207
TOTAL DEMAND AT 75% OCCUPANCY FOR
AFFORDABLE HOSPITALS >>>
4275
Similarly considering the spill over to the corridors by ailing population in the government hospital
the actual demand for affordable hospital beds will be 3907 and the capacity of affordable hospital
at 75% occupancy (keeping peak lOccupancy ) will need to be 5200.
c. Current Ranchi Hospital market by affordability & reach
The affordable hospitalization market as per the primary survey showed considerable
hospitalization demand coming from hinterland residents extending as far as 200 kilometres east
of Ranchi besides demand from Ranchi Residents. The demand from hinterland is generated by
referrals from PHC and CHC and other doctors in the region. The primary survey showed
especially of affordable Hospitalization a share of 50% of the total demand. The demand for
affordable market by Ranchi and Hinterland residents is provide in Table 3:
TABLE 3.5: AFFORDABLE HOSPITALISATION REGIONAL DEMAND SHARE
Region Actual Beds
Added Spill Over
At 75% Occupancy
Ranchi Residents 1800 2000 2667
Hinterland Residents 1400 1900 2533
TOTAL 3200 3900 5200
The demand for affordable Hospitalization from the hinterland is quite erroneous as it
documents only those who look forward to hospitalization away from their home and those who
can afford to travel to the city with accompanying attendant’s and relatives. The actual demand
for Affordable hospitalization and health care emanating from hinterland will be far greater than
it actually seems.
3.2. HOSPITAL MARKET POTENTIAL – RANCHI HINTERLAND CATCHMENT
a. Health & Hospital Care Demand Norms
A recent study presents the demand for hospital care both in-patient and outpatient care.
The norms of demand are as provided from the survey:
Table 3.6: Demand Norms in Ranchi Hinterland
NORMS Persons
per ‘000 population
1. Annual Number of Ailing patients 1680
2. Annual Number of ailing patients seeking outpatient treatment
880
3. Annual Number of ailing persons seeking inpatient hospitalization
35
4. Number of days stay in hospital under 5.5
ANNUAL NUMBER OF OUTPATIENT TREATMENT DEMAND
1478
ANNUAL NUMBER OF HOSPITAL BEDS NIGHTS DEMAND
323
OVERALL HOSPITAL BED CAPACITY 0.90
Superimposing the norms of demand a clear picture of demand in the hinterland catchment
of Ranchi can be established.
b. Hinterland catchment
The hinterland of Ranchi covers virtually a large population of 80 Lakhs. The map shows the
catchment.
The market for outpatients will be 37000 per day and demand for hospital beds per year will be
7200 Beds. However the Availability for the hinterland population is very low in Ranchi at only
1900 beds. The shortfall is virtually 75%. This shortfall is either met by PHC or local charitable
organizations in the region or they are taken care of at home.
3.3. HOSPITAL MARKET POTENTIAL – MANDAR CATCHMENT
a. Mandar Catchment Definition
Ailing patients come from far-flung places for hospitalization to Ranchi from distances of
over 150 to 200 kilometres. However propensity to come to Ranchi for hospitalization
decreases with distance. A safe bet could be a catchment of 50 kilometres radius for
hospitalization and around 10 Kilometres for outpatient health care.
b. Mandar Hospital care market
On the basis of the norms discussed earlier the demand in the catchment will be as
summarized in table:
Table3.7: Hospital care (out Patient & in Patient) Market Potential
RADIUS Around Mandar
Population (Lakhs)
2017
Out patient Traffic Per day
In Patient Hospitalization
Market (Bed Nights
Per year)
Hospital Bed Demand
100% Occupancy
75% Occupancy
50 KMS 37.5 15184 1211250 3375 4500
25 KMS 18.75 7592 605625 1688 2250
10 KMS 7.5 3036 242250 675 900
The demand potential quite encouraging to set up a Hospital both to take are of outpatient
and inpatient demand even at a small share in the beginning to later with the
establishment of full-fledged hospital the share can see a rise. A 500-bed hospital is more
than feasible.
c. Mandar Hospital care market for Pre & Post Natal care
In addition to hospitalization for diseases and other ailments hospital is required for
Childbirth. Survey shows that 20 births take place per 1000 annually and nearly 60% birth is
in the hospital (40% at home) with an average stay of 1.5 days. Considering the norms the
total additional capacity of beds required in the Mandar catchment will be as summarized.
Table 3.8: Hospital market for Pre & Post Natal care.
RADIUS
Population
(Lakhs)
2017
Child
Birth
Per Year
Child birth
Hospital
Bed
occupation
(1.5 Days
for 60% of
child birth in
the
hospital))
No of
additional
Hospital Beds
Capacity
Demand
(100%
Occupancy)
No of
Additional
Hospital Beds
Capacity
Demand
(75%
Occupancy)
50 KMS 37.5 75000 67500 185 247
25 KMS 18.75 37500 33750 92 123
10 KMS 7.5 15000 13500 37 49
The 50 kilometre catchment will generate a hospital capacity demand by 247 and nearby
catchment will generate demand by 49 Beds.
d. Overall Mandar Hospital care market
The total Hospital market potential for Mandar is summarised in the table 3.9:
Table 3.9: Overall Mandar Hospital market Potential.
RADIUS
Hospital capacity demand
potential for Health care
for ailing population
Hospital capacity
demand potential for
Pre & Post Natal Care
Overall Hospital
capacity demand
potential for Health
care
100%
Occupancy
75%
Occupancy
100%
Occupancy
75%
Occupancy
100%
Occupancy
75%
Occupancy
50 KMS 3375 4500 185 247 3560 4747
25 KMS 1688 2250 92 123 1780 2373
10 KMS 675 900 37 49 712 949
4 . M E D I C A L E D U C A T I O N &
A L T E R N A T E H E A L I N G
M A R K E T
4.1. Medical College market
At present in Jharkhand there are three colleges (one each in Ranchi, Jamshedpur and
Dhanbad) with a total intake of 250 undergraduate students and 161 postgraduate students
only. However when one compares with the norms of medical education in India then
Jharkhand as a state is lagging behind considerably.
Table 4.1 : Density Of Medical Colleges
REGION DENSITY OF MEDICAL COLLEGE
(Enrolment per one lakh Population)
INDIA 4.20
JHARKHAND 0.70
In Jharkhand there is an acute shortage of doctors, which is clearly reflected in the health
care infrastructure statistics discussed earlier. Most of the doctors coming from Jharkhand
medical colleges normally venture outside the state and also move overseas. Thus definitely
there is a big need to bolster this issue by increasing the capacity of enrolment in the state.
If one considers an all India density then every year Jharkhand should have an
undergraduate enrolment of 1500.
In effect an additional 1250 enrolment market exists for undergraduate (MBBS) Courses.
4.2. Nursing School & College
The situation in Jharkhand for nursing education is similar to Medical education. There are
21 GNM nursing schools with an intake of 745 annually and 6 BSc. Nursing Colleges with 240
intake annually. On the other hand India has an enrolment of 109224 for GNM course and
80245 for BSC courses. The density of Nursing Schools and colleges in comparison to
Jharkhand is abysmal.
Table 4.2 : Density of Nursing Schools & Colleges
Region Intake per one Lakh Population
GNM BSc.
INDIA 9.1 6.7
JHARKHAND 2.1 0.7
The skewed nature of density presents a shortage of nursing staff like in the case of Doctors
in Jharkhand. Nursing gives a good opportunity for Jharkhand especially tribal to take up
this profession. The trend in Jharkhand women is in this direction but due to shortage of
schools and colleges there has been a shortage of opportunity.
Thus to reach even 50% of density of India, Jharkhand would require an additional nursing
schools and colleges.
Nursing schools = 24 [of Avg. 35 intake]
Nursing Colleges = 24 [of 40 intake]
4.3. Wellness (Alternative Healing) Market
Wellness is a new area that is gaining recognition and importance. This area talks of
prevention rather than cure. The wellness centres normally cater to providing solutions to
lifestyle disease and alternative mode of healing. They are normally attached to hospitals in
the form of traditional systems (Yoga, Ayurveda, Unani, Siddha, Homeopathy, Naturopathy,
acupuncture, Acupressure, Kairali…).
As per government of India the total wellness (Alternative Healing) market is around Rs.
49000 Crores and services Constitute around 40% i.e. Rs. 19600 Crores.
The Best and successful model is of Jindal Nature care in Bangalore, Ayurvedic Healing
Village (Kairali style of Treatment) and Ramdev’s Patanjali. Besides them there are several
healing centres across India fast becoming a norm.
There is no real facility in East India. A small wellness (Alternative Healing) centre in
Mandar will have a clear market
D I D E N T I F I E D C A M P U S A R E A
A N D I T S N U A N C E S
5 . T H E C A M P U S N U A N C E S
The Society has identified a campus in Mandar, near (35 kilometres) the capital city of Jharkhand
Ranchi constituting 25 Acres of land in two parcels on both sides of the national Highway 75 to meet
the norm of Medical Council of India. The Illustration presents the two parcels of land made
available for the Project.
Land Parcel A:
The erstwhile Holy Family Hospital houses own one parcel of land houses today a 150 bed hospital
which has been in developed over the years beginning of 1947 run by American Missionaries and
presently run by Medical mission Sisters. The holy family hospital land has besides the hospital has a
nursing school with 20 enrolments annually along with residences of doctors earlier developed and
other old structures catering to the hospital. Presently the hospital is more or less dysfunctional. In
its premises the sisters are running a “de addiction Centre”. The pictures clearly present the layout
and the structures presently existing.
The Medical Mission sisters from their
existing Holy family hospital land (35
Acres) have transferred a land parcel
of 17 acres (Land A) comprising of the
existing old 150-bed hospital
structure, Nursing school and other
supporting structures. The de-
addiction presently being run in the
hospital premises will be relocated in
the remaining land available in
balance land available with Holy
Family Hospital, Mandar.
The present hospital structure available is capable of being made functional and the Nursing College
is fully functional.
Land Parcel B:
On the other side of the NH75 across the Holy
family Hospital an 8-acre land of parish land has
been made available for the purpose of Medical
College. This land is totally is devoid of any
structures and is a clean land available for
development. The Entire land provided has to
be developed to meet the requirement and has
to be effectively integrated with the part
campus across NH75. The pictures below clearly
show its present state.
6 . A R E A N U A N C E S
The location of the identified campus has its nuances relating to availability of Water, Power, Road
infrastructure, Sewage infrastructure, Bio Hazard material disposal facility, natural calamity risk level
and Maoist unrest.
6.1. Water Supply
The water availability will be an issue. At present the water is made available from ground
resource including a pond. However once a full-fledged medial college cum teaching hospital,
residential complex and Hostels and other supporting institutions the water requirement will be
quite high.
At present Water table in the area is around 30 Feet, which is good enough to create it as a
source. In addition there is a plan by the government to lay a pipeline to draw water from
Bearkho river (around 3 Kms. off Mandar) treat them and supply to the region. The project is
expected to be complete in the next in next 2-3 years
6.2. Power Supply
Presently the electricity situation is not good. One witnesses atleast a power cut for around 3 to
4 or more hours daily. This situation as we understand is expected to remain in the coming years
too. Supply presently for the Hospital is from Substations nearby Lohardaga. New Substation is
being proposed in Itki to come up in a few years. In the meantime any project in the area would
have to have own power backup.
6.3. NH 75 ROAD DEVELOPMENT
The main arterial road coming from Ranchi City to Mandar National Highway (NH75) expected to
be widened into a 4-lane carriageway. The Plans are afoot to commence the widening process
from August 2015. Any project being conceived will have to take this into consideration of
factoring reducing the land on either side by 5 meters.
Since the land earmarked for the project is on “NH75” the planning to consider this aspect.
6.4. Sewage Disposal
There is no sewage system is in place. Nor are there any plans by the local authority to put up
sewage handling system. The project authority in planning has to consider developing own
sewage disposal system.
6.5. Bio Hazard Material Disposal
Currently no biohazards handling facility is being provided by the Block office/Ranchi
Municipality. There are also no plans to start such facility in near future. The project has to make
own arrangement.
6.6. NATURAL DISASTER RISK
Indications based on years of data collated by the government there is real threat of natural
disaster calamity of flooding in the region. However there is some level of concern in respect to
Earthquake as the region is the seismic prone zone. The planning of the project has to factor
such a risk in its design of structures.
6.7. MAOIST RISK
The area is a Maoist affected area and is close to some of the training camps. The project design
in the area has to provide considerable safety measures.
E A C A D E M Y C A M P U S M O D E L I N G
7 . A C A D E M Y C A M P U S
M O D E L I N G
The Constant Livens Academy of Health Sciences & Hospital will be modelled to provide High quality
affordable Health Care and produce superior health care professionals from within the region,
Which essentially means Quality, Scaling, cross subsidization, Optimizing investment, effecting High
utilization / productivity and controlling Costs.
In addition the academy modelling has to consider the constraints of quality teaching staff and
specialists for health care. Building an organization takes its time which in the initial periods will
have effect on bed occupancy in the Hospital and reduced interest of good students.
Thus to achieve the goal the academy will be modelled as follows:
a. A Medical & Health Care Education Hub to include
A Medical college initially with a 100-seat enrolment for MBBS course to later expand to
150-seat enrolment.
Introduce Nursing College (BSc.) Courses with 40 intakes and expand to 60 intakes.
Expand the Nursing School Intake capacity to 40 (from present 20) and later expand to 60.
b. A teaching hospital including a specialty wings
A Teaching hospital - Initially as per the norms of MCI creates a 300-bed hospital and
increases it to 500-bed hospital. Thereafter with the success to add another 200 to 300 -bed
capacity.
In the hospital create specialty wings in disciplines new to Ranchi & the region around.
c. An alternative Healing centre
To handle all lifestyle based problems (Naturopathy & Yoga)
Preventive cures
Alternative medicine. (“Unani”, Ayurveda, Homeopathy & Siddha)
d. Installing differential pricing model in health care
Special low cost health care for the needy
A normal cost health care for the affording population
Niche Specialty wings with effective market related pricing
e. Pushing for high utilization of resources
Ensuring high bed occupancy levels in the hospitals
Ensuring quick turnovers rate – reducing the stay in the hospital.
Creating a home care solution.
f. Developing innovative designs in Infra facilities to reduce initial investments.
g. Encouraging developers in building non-medical infrastructures - Residences & Hostels to reduce
initial investment and its operations.
h. Inviting concessionaires to invest and operate in Pharmacy, Radiology, Laundry and Food
Services Operations.
i. Entering innovative leasing & funding arrangement for facility and equipment.
j. Build health insurance system for local patients in the lines as established in Bengaluru for
affordable health care for the disadvantaged society.
k. Enter into partnerships with sister institutions (eg. St. Johns Hospital, Bangalore) for “Technology
Transfer” of systems & Process including Digital processes.
l. Enter into arrangements with sister institutions for VIRTUAL TEACHING arrangements in critical
subjects and issues…
m. Enrol outside specialists for teaching and Healthcare :
for visits to perform intricate surgery or difficult ailment…
specialists from Ranchi City for specific Health issues in Hospital / subjects in the college…
n. Installing State of Art Teaching Environment including the following.
A well-developed Syllabus to meet the course content as mandated (by the affiliated
university) and includes new content on a continual basis to meet the growing needs of
medical science.
Employ Teaching methods to include case study centric and group/ teamwork, in addition to
normal pedagogical style of lecture.
Support them with State of Art Teaching Class Rooms (more than mandated) with Smart
boards, audio video hook ups, Complete broad band connection with desks with laptop
connectivity, all notes and books in digital form with library back up
State of art laboratories (mandated) + augmented with more specialized equipment and
facilities with time to make it amenable for Research.
Use of Special virtual systems and Models as being followed internationally besides as
mandated with cadavers…
Any other advanced mode of teaching systems to position as a world class Medical college
F D E V E L O P M E N T S T R A T E G Y &
M A S T E R P L A N
8 . D E V E L O P M E N T S T R A T E G Y
& T I M E L I N E
The project will be developed in phases keeping the mind the defined academy modelling (Section
D), present infrastructures & Buildings in the land parcel and the regulations for colleges and
hospital. The development will be as follows.
a. The existing old hospital structure will be refurbished to a capacity of 150 – 180 beds. (To Open
in January 2017)
b. Along with the old structure a new structure for 150 additional beds will be taken up and only a
critical wing will be developed to include Operation Theatres, ICU and HDU. (To Open in January
2017)
c. The alternative healing facility will also be developed to coincide with the Hospital opening.
(Opening January 2017)
d. The new block of 150 beds Hospital will come into operation in January 2018.
e. In the same time the intake capacity of nursing school will be doubled to 40 annually.
f. A new Nursing college offering BSc. Courses with a capacity of 40 enrolments annually.
(Opening Date January 2019)
g. In the June 2021 a new Hospital Block with a capacity of 200 beds will be inaugurated.
h. Thereafter the Nursing school capacity, Nursing college capacity, the hospital capacity and
Medical college capacity depending on the situation will be enhanced.
The time line is illustrated and presented in the following page:
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June2015
June2016
June2017
June2018
June2019
June2020
June2025
June2024
June2023
June2022
June2021
DoublingNursingSchoolIntaketo
40(Jan’2018)
Augmen ngBedCapacity(if
required?)by200(Jly’2025)
OpeningaWellnessCentre
Jan’2017
Renewalof150bedOld1947
HospitalJan’2017
ANew150bedHospital
(Jan’2018)
OpeningNursingCollegeBSc.
40Intake(Jan’2019)
AMedicalCollegefor
MBBS(Jly’2018)
Augmen ngBedcapacityby
200(Jly’2021)
Pe
rsp
ecve
Pla
n
TI
ME
LI
NE
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9 . D E V E L O P M E N T M A S T E R
P L A N
9.1. Medical College
The medical council of India has specified minimum covered area of 10450 Sq. Meters of all
the facilities for an MBBS course. Added to that a 50% area for circulation in the college for
corridors, utilities, stairs, and large foyers / vestibules / hallways etc.… The overall covered
area (FAR) to be developed will be 14000 Sq. Meters
Table 9.1: Medical College Covered Area
DETAILS TOTAL
Total Carpet Area - MBBS Program 10450
Circulation Area 3550
Total For Graduate Program 14000
The college will be developed in two phases. In the first phase 67% of the college area will
be constructed and thereafter the balance will be constructed. The college will be in 4 floors
with ground coverage of 3500 Sq. Meters.
The college will be built as a complete shell and ready to move. However depending on the
requirement the shell will be fitted with furniture & Fixtures, Office equipment, Laboratory
equipment and safety equipment’s. The quality of construction of the academic
infrastructure will be in line with the best international construction practices. Only
necessary areas including laboratory will be air-conditioned.
9.2. Teaching Hospital
The teaching hospital as per the MCI guideline has to have a capacity of 500 beds in 4 years
from the start of the MBBS program. As a first phase of Hospital capacity augmentation the
existing old Hospital structure (10000 Sq. Mts. Of Covered area) in the premi ses will be
completely overhauled to accommodate 150 beds with OPD facility. This refurbished old
hospital will be augmented with the construction of a new modern wing (part of a new
block) to have Operation theatres, ICU / HDU facility along with modern diagnostics. In the
second phase of augmentation the new modern block will be complete to accommodate
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150 beds and be ready with the opening of first session of the medical college. By the 4 th
year of college commencement as per MCI regulation another new block will be constructed
to accommodate 200-bed capacity (The hospital capacity will be 500 Beds meting MCI
regulation for a 100 seat enrolment undergraduate medical college). The hospital capacity
will be constructed in three phases.
Table 9.2 : Hospital Construction
Phase Structure + No. of Beds Area
(Sq. Mts.)
I
Old Hospital Refurbishment ( 150 Bed capacity + OPD facility)
10000
Part of New Hospital Block A 2400
II Completion of the new Block A (150 Bed capacity) 9600
III Completion New Hospital Block B ( 200 Bed Capacity) 16000
Total 500 38000
The quality of construction of hospital will be in line with the best international construction
practices with complete fitment including all provisions of HVAC, gas pipelines, bio hazard
waste management, and effluent management. Necessary areas of the hospital will be fully
air-conditioned and will be supported by backup power with built in redundancy. The new
hospital blocks will have 5 floors with a ground coverage of 2400 Sq. Meters and 3200 Sq.
Meters respectively.
The Hospital will be built as a complete shell and ready to move. However depending on the
academy strategy the hospital will then have to only fit in the space with hospital furniture &
fixtures, Laboratory and medical equipment’s and accessories as per their needs.
9.3. Alternative Healing Centre
The alternative healing centre will comprise of 50 individual cottages with an overall covered
area of 1800 Sq. Meters. Each of the cottages will be single storied. The construction will be
in two phases with equal number of cottages.
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9.4. Nursing school & College
a. Nursing School:
The present nursing school is in a good position to accommodate 40-student annual
enrolment (from present 20) with the present Hostel facility is also converted into
classrooms. A new hostel will be constructed separately.
b. Nursing College:
The nursing school will be augmented by new building block to accommodate 40-seat
annual enrolment BSc. Nursing courses. The new structure will be integrated with the
present structure of Nursing School. The augmentation will be for another 2500 Sq.
Meters of covered area for the college. The college structure will be in four floors.
9.5. Building residential facilities for students, teaching staff and personnel
The development of hostels and residential accommodation will be carried out in phases as
the number of students and staff increases with the years. The plan is to have the following:
Medical College Hostels: The hostel will have all amenities including mess, common
room, Laundromat and other amenities. The hostels will be fitted provision for box air
conditioners with Wi-Fi and other needed facilities. The facilities provided will be priced
on usage basis. The rooms will be provisioned for 100% students (even though MCI asks
for 75% provision) and will be both in single and double occupancy format. The hostels
will be in two blocks one each of Male & female students positioned in two separate
land parcels. The hostel blocks will be constructed in four floors.
Table 9.3: Medical Students Hostel
Unit Type Area
(Sq. Mts.) No. Of Units
Total Area (Sq. Mts.)
SINGLE ROOMS 25 300 7500
DOUBLE ROOMS 35 100 3500
11000
Nursing school / college students Hostels / Hospital nurses: The hostel will be in
the form of dormitories both for students as well for Hospital nurses. Provision will
be made for 100% students and Hospital nurses requirements. The hostel will be in
four floors.
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Table 9.4: Nursing Students & Hospital Nurses Hostel
Unit Type Area
(Sq. Mts.) No. Of Units
Total Area (Sq. Mts.)
NURSING COLLEGE
DORMATORY (4) 50 60 3000
HOSPITAL NURSES
DORMATORY (4) 60 100 6000
TOTAL AREA 160 9000
Residences: The residences will be provided for hospital doctors, Hospital staff,
teaching faculty, administration staff and others. The plan is to provide considerable
number of apartments (more than the stipulation of MCI) in 1BHK, 2 BHK and 3 BHK
format. If necessary in future depending on the demand the residential facilities can
be expanded. The residences will be in blocks of 4 floors. They will the land parcel
across the road away from the hospital.
The plan will include 275 residential units constituting construction of 19500 Sq. M
of covered area and the same is detailed as follows:
Table 9.5: Resident Types
Unit Type Area ( Sq. M) No. of Units Total Area
(Sq. M)
1 BHK 50 200 10000
2 BHK 110 50 5500
3 BHK 160 25 4000
Total >>>> 275 19500
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9.6. Car Park facility
The Hospital is located in the rural area. The number of vehicles anticipated will be very low.
Any parking required will be in open spaces. Provisions will be made I the open spaces for
parking.
9.7. Structuring existing facilities
Some of the old structures will be gradually demolished once new structures come into
place. During the time of construction they will be used as interim residences, and storage
and other for other requirements. The old structures include Doctor residences, Ancient
hospital & storage sheds and other structures.
The existing trees in the area will be more or less untouched and designing of structures will
be around them. However efforts will be made in the designing to ensure minimal removal
of existing trees. As far as possible the trees will be replanted in other areas of the campus.
In addition new trees will be planted.
9.8. FAR utilization
The master plan will utilize only around 77% of allowable ground coverage and around 66%
of allowable FAR. This level of utilization leaves considerable opportunity to add more
assets in the future in the campus.
Table 9.6: FAR & Ground Coverage Utilization
( In Sq. M) FAR Land Coverage
Hospital Block (old) 10000 7500
Hospital Block (New) 28000 5600
Alternate Healing Center 1800 1800
Existing Nursing College 3500 1750
Academic Block (Medical College + New Nursing College)
16500 4125
Residential Block 39500 9875
SUB TOTAL 99300 30650
Allowed (25Acres @ 40% Ground coverage and 150 FAR)
150000 40000
% Utilisation 66.20% 76.60%
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9.9. Construction Phasing
The construction will be in phases dictated the need of the each of the facilities. Most of the
structures / facilities will be in taken up in two phases except for residential and hostel
facilities which will be completed in five phases. The phasing of each of the facilities /
structures is detailed in Table 9.7:
Table 9.7: Phasing of Construction
Project Particulars
Number
of
Phases
2015 2016 2017 2018 2019 2020 2021
150 Bed Hospital Renewal 1 I
150 Bed New Block 2 I II
200 Bed Hospital 2 I II
College 2 I II
Nursing College 2 I II
Wellness Centre 2 I II
Medical College Student Hostels
5
I II III IV V
Hostel (Nurses B Sc.) 160 Students
3
I II III
Hospital Nurses (320) 5 I II III IV V
Residences 5 I II III IV V
The broad construction-phasing layout along with perspective plan is shown Illustration 9.1
to 9.11.
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Illustra on9.6PROPOSEDLAYOUT
1
2
3
4
LEGEND1. HOSPITAL2. HOSPITALEXTENSION3. COLLEGE4. CONVENT5. BOYS’HOSTEL6. STAFFRESIDENCE7. NURSES’COLLEGE8. GIRLS’HOSTEL9. WELLNESSCENTRE
5
6
7
8
9
1
2
3
4
5
6
7
8
9
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G E C O N O M I C V I A B I L I T Y
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1 0 . I N V E S T M E N T C O S T
The estimates of investment cost to be incurred for the College Project as well for augmented
Hospital capacity and related other education facilities of a Nursing college, alternate healing center
and residential facilities are elaborated in this section of the master plan report.
10.1. Investment Cost Assumptions
The cost assumptions made for constructing structures (namely medical college block, Alternate
Healing Center, Nursing College, residential blocks, hostels, and additional hospital capacity);
carrying out External development; providing laboratory equipment’s & facilities, equipping with
Office equipment’s, furniture & fitments for hostels & residential facilities, Special hostel
amenities, IT & Wi-Fi connectivity etc.: and Preliminary & preoperative costs is presented:
a. Construction Cost
The structures as defined in the master plan will conform to highest standards in line with
the requirement of a prestigious Medical college, Nursing College, Residential facilities,
Hostel, and super specialty hospital facility. The construction cost incl udes every element
required in a structure for ready occupation excluding furniture & fixtures, Wi -Fi connection
of service provider, laboratory equipment’s, hospital instruments & equipment’s, office
equipment’s and other fitments. The total construction cost will be as follows:
Table 10.1: Construction Cost
New Structures
Area to be constructed (In Sq. M)
Construction Cost per Sq. M
Total Construction Cost
(Rs. Crores)
Refurbishment of Old Hospital
10000 13000 13.00
Hospital 28000 32000 89.60
Academic Medical & Nursing College
16500 22000 36.30
Residential 39500 22000 86.90
TOTAL 225.80
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b. Refurbishment of existing Hospital structure:
The old hospital structure has to be refurbished and modified to suit the present
requirement as a Hospital. The Refurbishment will involve:
Remodelling and modification of total existing Hospital as per requirements.
Change Electrical wiring, Change of fittings, change of electrical panels as per
requirement.
Water / Plumbing points to be checked and modified as per requirement.
Installation of UPS / Electrical Panels / Transformers.
Medical Gases
Fire Alarm System
Nurse Call System
Provision for DATA Points.
Re-development of Entrance & Patient waiting area.
Re-development of Radiology & Labs.
Construction of Water Tanks.
c. Architect / Project management Cost
The construction cost including professional fee for designing, project management and all
taxes as applicable. A 9.94% of the construction cost has been considered towards
professional fee (5%) and related tax (4.94%)
d. External Development Cost
The external development cost includes gamut of development elements. The table
summarized the elements and the cost:
Table 10.2: Development Cost
PARTICULARS Rs. Crores
Sewage Treatment Plant (2) 2
Water Tanks + Pump House + Water Distribution Network
2.25
Fencing (Both Parts of the Campus) 1
Roads, Street Lighting, Storm Water, Sewage 6.25
Rain water Harvesting 1
Landscaping 2.5
Sub Station / Power Distribution and Power Backup 3
Solar Power (1MW) 7
TOTAL 25
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e. Office Equipment’s; Furniture, furnishings & fixtures; Wi -Fi & IT facilities
The cost has been estimated on a ballpark figure considering the manpower and students
numbers. A block estimate of Rs. 5 Crores has been assumed.
f. Laboratory Equipment’s
The laboratory equipment required as per MCI regulation varies as per rough estimates
between Rs. 4 Crores.
g. Hospital Medical Equipment’s
The Element wise hospital equipment requirement presents a Rs. 25 Crores investment. The
Table 10.3 details out the equipment and the approximate cost.
Table 10.3: List of Medical equipment
FACILITIES COSTS
(In Rs. Crores) DENTAL X -RAY 749
LABORATORY (INCL BLOOD BANK) 99
THEATRE 248
ICU 270
HDU 11
CSSD 84
OUT PATIENT DEPARTMENT 34
PHARMACY 8
EYE UNIT 67
ENT 44 DENTAL UNIT 52
DENTAL LABORATORY 17
MINOR THEATER 2
CASUALTY 38
X - RAY 213
LABORATORY 5
WARD 10
MATERNITY 56
PHSYSIOTHERAPY 29
MATERNITY THEATER 56
OCCUPATIONAL THERAPY 4
ORTHOPAEDIC TECHNOLOGY 13
MAINTENANCE WORKSHOP 8
KITCHEN 28
LAUNDRY 77
MORTUARY 47
HOSPITAL / MEDICAL FURNITURE 230
TOTAL 2500
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h. Preliminary & preoperative Costs.
These costs include cost of for obtaining clearances for the building, setting up the college,
affiliation to a university, clearances for a hospital, manpower induction & training (much
before the opening of the college) and other expenses.
8.1. Overall Project Investment
The total investment for the project will be around Rs. 320.50 Crores spread over 7 years. The
table in the succeeding page presents the investment distribution over the years.
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Table : Investment cost over the Development Period
Project Particulars
TOTAL COST ( Rs.
Crores)
2015 2016 2017 2018 2019 2020 2021
150 Bed Hospital Renewal 13 13
150 Bed New Block 38.4 11.6 26.8
200 Bed Hospital 51.2 30.7 20.5
College 30.8 20.6 10.2
Nursing College 5.5 1.1 4.4
Wellness Centre 5.7 3 2.7
Hostels ( Medical Students) 24.2 4.8 4.8 4.8 4.9 4.9
Hostel (Nurses B Sc) 6.6 2.6 2.6 1.4
Hospital Nurses (320) 13.2 2.6 2.6 2.6 2.6 2.8
Residences 42.9 8.6 8.6 8.6 8.6 8.5
Land Development & Services 25 9 3 3 4 4 2
Furniture (College + Hostel) 5 1 2 1 1
College Equipment /Lab 4 2 2
Medical equipment (Hospital) 25 10 5 10
Preliminary & Preoperative Costs 4.5 0.5 2.5 1.5
Work Contract Tax 12.7 0 2.3 3.5 1.8 1.2 2.6 1.3
Project Management & Consulting 12.8 0 2.3 3.5 1.8 1.2 2.6 1.4
TOTAL PROJECT COST 320.5 0.5 52.4 90.7 50.3 28 57.5 41.1
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1 1 . O P E R A T I O N A L C O S T S &
R E V E N U E S A S S U M P T I O N S
REVENUE ASSUMPTIONS >>>>
The Academy revenues accrue from Hospital, Medical College, Nursing School, Nursing College
and Alternate healing center.
1. Medical College
a. Student Fee
The student fee in a medical college in the country varies quite considerably depending
on the ownership (Private / Government) and the years since it has been established.
The Fees is Government medical Colleges are illogically very low due to high level of
government subsidy and initial establishment investment. On the other hand keeping
with escalating costs and cost of building medical college and the possible cross subsidy
of attached medical hospital the fees are around Rs. 6.5 per annum.
Table 11.1 Annual Student Fee Range
in Rupees Mean Range Median
Govt. Colleges 6320 240-27000 1350
Private Colleges 6.5 lakhs 6-9.81 lakhs 6.4 lakhs
As the mission of the academy is to provide affordable medical education and keeping
with the fee structure of other charitable missionary medical colleges the student
annual fee considered will at best be around Rs. 4 lakhs.
b. Student Hostel Fee
Hostel Room Rentals
The student hostel rentals too are in the same lines as that of annual college fee.
The rentals in Government medical Colleges are very low due to high level of
government subsidy and initial establishment investment. On the other hand
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keeping with escalating costs and cost of new construction the annual rental will be
around Rs.50000.
Table 11.2 Annual Student Fee Range
in Rupees Mean Range Median
Govt. Colleges 18000 2900-49000 3600
Private Colleges 40500 21000-60000 40500
The hostels are basic and are not fully air-conditioned but will have fitted with all
necessary amenities. Some of the amenities will be made available at cost - Air-
condition, Laundromat etc…
Hostel Mess cost
The mess in medical colleges (Government / Private run colleges) is on sub contract and
their costs are more or less similar. The present costs vary between Rs. 130 to Rs. 200
per day for four meals. The variance is due to the type of mess one choses (Vege tarian /
non-vegetarian etc…). This cost is directly connected with food inflation and salary
inflation of contractors.
The Holy family hospital would have an annual hostel fee including messing at around
Rs. 50000.
2. Nursing School & College
The nursing education will be very nominal including teaching fee, Hostel rental and mess
charges.
ANNUAL TUITION FEE = Rs. 0.75 Lakhs
ANNUAL HOSTEL RENT = Rs. 0.30 Lakhs
ANNUAL MESS FEE = Rs. 0.50 Lakhs
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3. Medical Hospital
The mission of the academy is to provide affordable health care. The charges will be in line
with the per-capita expenditure of rural population in Jharkhand as per the Government of
India survey. Thus the charges adjusting for inflation effective from January 2017 will be as
follows:
OPD CONSULTATATION= Rs. 100 / VISIT (Does not include medicine)
HOSPITALISATION CHARGES = Rs. 20000 (4.5 DAYS AVERAGE STAY)
Including all expenses relating to Food, medicine, surgical consumables,
consultation, stay, surgery, free stay for attendant etc.)
To ensure effective affordability for ailing patients the footfall / demand for the hospital has
to be ensured to meet at least 50% of the ailing patients for outpatient treatment in the
nearby catchment (7.5 Kilometer radius) and a 85% of bed occupancy at an average 4.5 days
stay.
4. Alternative Healing Centre
This facility will be one of its kinds in the state. The pricing of its services will be at market
price applicable across India. Keeping with the affordable market of Ranchi, Jamshedpur and
other cities in Jharkhand the charges will be as follows:
COST PER DAY OF STAY PER PERSON RS. 7500 - RS. 10000
Will include all necessary Assorted Packs & Baths primarily for detox & relaxation,
Food, Exercise, yoga, Alternative medicine … however additional charges will be
payable for special treatments & any Medical interventions…
OPERATIONAL COSTS >>>>
The major costs will be of Manpower followed by Utilities and supplies.
a. Manpower
A remuneration survey of faculty, Consulting Doctors, Resident Doctors, and other related
staff presented a broad range. Keeping with the idea to attract best talent and also
considering the cost of living in Ranchi the following remuneration has been considered.
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Table 11.3: Manpower Profile
DESIGNATION ANNUAL CTC
(INR Lacs)
Director 60
Consultants 60
Professor 40
Associate Professor 30
Assistant Professor 22.5
Sr. Resident 10
Jr. Resident 6
Assistant Nursing Superintendent 4.5
Nurses 2
Nurse Support 2
Medical Technicians 2.5
Tutors 6
Statistician 4.5
LMO 4.5
ANMO 4.5
MWO 4.5
LDC 2.35
Assistant Administrative Officer 4.5
Cashier 2.5
Attendants In Wellness Huts 1.5
Instructors In Wellness Huts 4.5
Security Staff 1.5
Utility Operator/ Maintenance Staff
1.5
Administration Staff 2
Accounts Staff 2
Billing Staff 2
b. Utilities, supplies and other expenses
The other predominant costs are in utilities (water & power) and supplies (for laboratories,
hostel mess etc.). The costs are on actuals.
Power
The connected power in the campus is 1-1.5 MW. The cost per electricity considered will
be Rs. 7 per unit. The consumption of electricity is maximum in the hospital. The
electricity cost incurred for a patient and the student is as follows:
- Inpatient day = Rs. 1000
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- Student = Rs. 100 per day ( Hostel + college)
Repairs & Maintenance:
The assets of the college and the hospital will be plant & equipment, medical and
laboratory equipment, furniture and fixtures, estate besides the building. A 0.25% of the
asset cost has been considered as the maintenance cost.
Insurance Charges
A pint .1% of the asset value has been considered as the insurance charges.
Supplies:
They include laboratory supplies, Hospital consumables, Office supplies, Hostel mess
supplies etc.. The cost considered are as follows:
o Medical students & Nursing Students supplies: 25% of their fees
o Hospital Supplies : 25% of In-patient revenue
Administration expenses
A 1% of the total income of the college and the hospital including hostel has been
assumed or the administration cost.
Contingency
A 2.5% of the total expenses have been assumed as contingency cost towards
miscellaneous, unforeseen expenses and assumption inaccuracies.
No income tax has been considered as the project will registered under charitable institution
and avail exemption.
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1 2 . F I N A N C I A L V I A B I L I T Y
The viability hinges on the main component of Hospital followed by the medical and nursing
education. A detailed profitability analysis with the assumptions laid down (section) shows following
viability indices:
Table 12.1: Viability Indices
Institutions INTERNAL RATE OF RETURN (%)
PAYBACK PERIOD (YEARS)
Teaching Hospital 1% 18
Medical College 9% 12
Nursing College NEGLIGIBLE 18
Alternate Healing Centre
114% 2
Overall Project 8% 11
The hospital has a long payback period and the return on investment is very low. Similar is the case
with affordable nursing and medical college education. The only savior for medical college as can be
seen from the financial viability indices is due to cross subsidization by Hospital with respect to
absorbing the cost of teaching staff. The only light in the indices is the strong viability of alternate
healing center and its uniqueness to garner good revenues. The detailed working results of each of
the components of the academy is detailed in Annexure 12.1 – 12.5
SENSITIVITY
The financial viability is very sensitive for Hospital. A 10% revenue reduction can bring a negative
return and affects the payback period considerably (24 years). The main backbone of the academy
can affect the overall viability. It is necessary that the utilization levels of the hospital have to be at
its peak and the productivity levels including management of expenses across have to be at its best.
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1 3 . F I N A N C I N G S T R A T E G Y
On the basis of working results the following will be requirement of finance over the seven -year
period.
Table 13.1: Financing Mode
Investment (Rs. Crore)
Financing Mode (Rs. Crore)
o Total Project Investment 320 o Equity 260
o Add Working Capital 10 o Internal Accruals 70
330
330
The total equity or own funds required will be quite large. The internal accruals has a risk if the
situation envisaged does not go as expected.
It is understood that CBCI Society does not encourage loans from banks and prefers to have their
own finances as donations, grants, sponsorship, and internal accruals of the Hospital. However a
large investment project cannot be achieved through financing from other sources. The
dependence on other means slows down the financing inflows and overall affects the pro ject
implementation timeline besides incurring price escalation and lower viability.
It is true that the project is spread over 7 years and there is sufficient time to obtain donations,
grants. However such means need considerable effort to meet the requirement. It is advisable
to find innovative ways to obtain funds:
Strategy 1: Reduce impact of Investment
There are several elements, which can be outsourced in the form of developers setting up
residences and Hostels and also taking up its management. This can reduce the investment by
Rs. 95 Crores (30% of overall investment)
Strategy 2: Donations (Other Fixed assets)
There are several fixed assets (Other than buildings) including Laboratory equipment, Medical
equipment, office equipment, Furniture & Fixtures, which can be obtained through donations.
These fixed assets constitute another Rs. 34 Crores in investment. However amassing them will
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be time consuming and may hinder speed of implementation. Nonetheless this may ease the
investment pressure.
Strategy 3: Donations & Sponsorships (Fixed Assets)
One of the trends in Hospital & college donations has been to fund specific facilities in their
name – College auditorium, College Laboratory, Lecture theatre and Special Hospital Wing etc.
These facilities constitute in investment around Rs. 121 Crores (38% of project investment)
Strategy 4: Availing Soft Loans
There are several international agencies that provide soft loans for such projects with very
nominal interest and an extended payment schedule. This route is very effective and provides
clear latitude for quick implementation and reduces the risk of any operational eventuality.
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G C R I T I C A L I M P L E M E N T A T I O N
I S S U E S
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1 4 . I M P L E M E N T A T I O N I S S U E S
The implementation issues in the order of criticality is discussed:
A. Medical College >>>
6.1. MCD & other authority Clearances (CRITICAL)
The municipal and other authorities take their time to issue clearances. The clearance in such
projects takes at least a minimum of 6 -9 months but may even take for complete clearance up
to 12 months. Only upon clearance can the construction commence.
It is recommended that detailed design (10 year time line) be prepared to include the academic
structures, the old hospital structure, hospital capacity augmentation, the residential facilities
and overall campus planning and the environment impact etc… The preparation of plan will in
itself take 2 months and thereafter the time required for obtaining clearance. To meet the
timeline this should be taken up immediately.
6.2. Program Management (Must)
CBCI Society should immediately form a steering Team. The steering committee will have the
responsibility
To pitch and route finance for the project,
To identify and facilitate appointment of consultants, Architects & Construction project
managers
To apply, coordinate (with consultants) and follow-up for MCI Clearance.
To apply, coordinate (with consultants) and follow-up for University affiliation
To act as a bridge with the consultants, architects & constitution project managers.
To be responsible for purchases relating to the project
To identify and initiate collaboration with external universities & colleges for technical
knowhow for the medical college.
To facilitate in search and selection of faculty and staff for the college.
To promote the start of the medical college.
To carry out PR with all government and non-government agencies to ensure effective
implementation of the medical college.
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To look into all other issues to ensure speedy and seamless commencement of the
college.
6.3. Architect Consultant (Must)
Holy family should go for professional Architect who will ensure complete physical infrastructure
of the college as well the augmentation of teaching hospital and will report to the Steering Team
of Holy Family.
The responsibilities of the construction manager will be:
1. Designing the project (College, Hospital)
2. Obtaining clearances from all authorities (Municipal corporation, urban arts Commission,
Airport authorities of India, Pollution board, water board, electricity board all other
necessary authorizes central & state government)
3. Preparing tenders and appointing contractors
4. Monitoring construction and quality of construction
5. Preparing inventory and cash management for the project
6. Co-ordinate with Holy family steering Team.
7. Recommending purchases
8. Installation and commissioning of all utilities, HVAC etc…
6.4. MCI Clearance (CRITICAL)
The steering Team formed will prepare application in coordination with the project managers
and consultants and follow the time line as specified. In the beginning of 2016 the application
need to be filed.
6.5. University Affiliation (CRITICAL)
The medical college will have to be affiliated to a university as per the regulations of University
Grants commission. The university Grants commission (Affiliation of colleges by Universities)
Regulations 2009 does not mention any restriction on the university with whom one can affiliate
nor does it talk about regional boundaries / restrictions. In Jharkhand alone each of three
colleges have different affiliations.
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Thus one can affiliate with the University of One’s choice. St. Johns Medical College, Bangalore is
a sister institution of Holy Family and they have been in medical education for quite some time.
An affiliation with their university would be quite effective.
6.6. Faculty Development Strategy … (CRUCIAL)
This aspect is the most difficult and crucial as the image of the college depends on it. Thus the
teaching staff will have to have a mix of few very well-known faculties as chairs along with other
faculty to add to the image of the college. In addition visiting faculty from well-known medical
colleges including from the sister institution will need to be encouraged.
The search and selection process for the faculty need to begin in the middle of 2017 and the
well-known faculty members need to be inducted much before the start of the session to given
the responsibility as Dean and Vice Dean and to be part of the syllabus development as well as
process of teaching.
6.7. Course Syllabus Development … (CRUCIAL)
The course syllabus is normally defined by the University with whom one is affiliated. However
the teaching based on the syllabus need to be imparted has still to be designed.
The complete teaching process (within the confines of the syllabus + much more) will need to be
developed. It is recommended that one can obtain collaboration from the sister institution of St.
Johns Medical College, Bangalore as well as obtaining international medical college know how
6.8. Medical college Administration Process.
In addition to teaching the college needs clear process for faculty management, college
administration, examination & evaluation process, Student management, administration
process, Hostel management, IT process, student selection & induction process etc…
It is recommended that one should obtain collaboration from sister institution of St. John’s
Medical College, Bangalore.
6.9. Finalizing with a Rural Health Training Centre
The college should identify small missionary rural health center and associate with them. A
possible residential facility can be developed around it for the students.
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B. Teaching Hospital >>>
6.10. Hospital clearances (CRITICAL)
There are many several laws the new Hospital has to comply with to ensure that the facilities
are created after due process of registration, they are safe for the public using them, have at
least the minimum essential infrastructure for the type and volume of workload anticipated,
and are subject to periodic inspections to ensure compliance. All these laws are administered
by various departments/bodies of the government at various levels. The detailed list of
various certificates and licenses are detailed in Annexure 2.4 along with the list of various laws
governing different facets of hospital administration.
This aspect has to be taken up immediately by first making ground with all the necessary
organisations and preparation of documents.
C. Nursing College >>>
6.11. Nursing Council (CRITICAL)
The steering Team formed like in the case for Medical College will prepare the application in
coordination with the project managers and consultants at least one year before the
commencement of the college.
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A N N E X U R E
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Annexure 2.1: Regulations and Laws Governing New and Existing Hospital
LICENCES/CERTIFICATIONS REQUIRED FOR HOSPITALS
A hospital administrator should be aware about the licenses that are essentially required and
to renew them as and when required.
Sr. no. Licenses/certifications Frequency
1 Registration under societies registration act Initially
2 Inspection for electrical installation/ substation Initially
3 NOC from local municipal office for any bye law Initially
4 License for storage of petrol/diesel on form XV under the
petroleum rules 2002
2 yearly
5 Income tax exemption certificate 3 yearly
6 NOC from Delhi fire services Before implementation
7 Registration for operation of X-ray installation with AERB Every 2 years
8 Drug License for medical store, IPD pharmacy, OPD pharmacy Every 5 years
9 License to operate blood bank under rule 122G of drug and
cosmetic act Every 5 years
10 Registration under PNDT Act 1994 Every 5 years
11 Income tax registration/PAN Once only
12 Registration for VAT/Sales tax Once only
13 Registration for EPF Once only
14 Registration for ESI coverage of employee Once only
15 Registration under rule 34, sub rule (6) of MTP Act 1971 One time registration
16 Registration under Delhi nursing Home Act 1953 Yearly
17 Indemnity insurance policy Yearly
18 Standard fire and special perils policy Yearly
19 Authorization for generation of BMW under BMW handling rule
1996 Yearly renewal
20 License for operating lift under Sect 5 and 6 and Rules 4 and 5
(inspector of lift, state govt) Yearly renewal
PERIODIC REPORTS AND RETURN AS LEGAL COMMITMENT FOR HOSPITALS
Sr. no Periodic reports and return for hospitals Frequency
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1 Biomedical waste generation Annual
2 Income Tax Annual return
3 Units processed in blood bank Monthly
4 MTP reports Monthly
5 PNDT report (prenatal USG done) Monthly
6 Employees provident fund Monthly/annual
7 ESI act Monthly/annual
8 VAT Monthly/quarterly online
9 Registration of births and deaths On every occurrence
10 Post-polio paralysis case On every occurrence
11 Communicable disease report On every occurrence
12 Radiologist registration under PNDT On induction of a new radiologist
13 USG machine registration under PNDT On induction of each machine
14 Needle stick injuries On occurrence
15 TLD Badges for monitoring the dosage received Quarterly
16 TDS Quarterly
LAWS GOVERNING THE COMMISSIONING OF HOSPITAL
a. Atomic Energy Act 1962
b. Delhi Lift Rules 1942, Bombay Lift Act 1939
c. Draft Delhi Lifts and Escalators Bill 2007
d. Companies Act 1956
e. Indian Electricity Rules 1956
f. Delhi Electricity Regulatory Commission (Grant of consent for captive power plants)
Regulations 2002
g. Delhi Fire Prevention and Fire Safety Act 1986, and Fire Safety Rule 1987
h. Delhi Nursing Home Registration Act 1953
i. Electricity Act 1998
j. Electricity Rules 1956
k. Indian Telegraph Act 1885
l. National Building Act 2005
m. Radiation Protection Certificate from BARC
n. Society Registration Act
o. Urban Land Act 1976
p. Indian Boilers Act 1923
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q. The Clinical Establishment (Registration and Regulation) Bill 2007
LAWS GOVERNING QUALIFICATION/PRACTICE & CONDUCT OF PROFESSIONALS
a. The Indian Medical Council Act 1956
b. Indian Medical Council (Professional Conduct, Etiquette, and Ethics Regulations 2002)
c. Indian Medical degree Act 1916
d. Indian Nursing Council Act 1947
e. Delhi Nursing Council Act 1997
f. The Dentist’s Act 1948
g. AICTE Rules for Technicians 1987
h. The Paramedical and Physiotherapy Central Councils Bill 2007
i. The Pharmacy Act 1948
j. The Apprenticeship Act 1961
LAWS GOVERNING TO SALE, STORAGE OF DRUGS AND SAFE MEDICATION
a. Blood Bank Regulation Under Drugs and Cosmetics (2nd Amendment) Rules 1999
b. Drugs and Cosmetics Act 1940 and Amendment Act 1982
c. Excise permit to store the spirit, Central Excise Act 1944
d. IPC Section 274 (Adulteration of drugs), Sec 275 (Sale of Adulterated drug), Sec 276 (Sale
of drug as different drug or preparation), Sec 284 (negligent conduct with regard to
poisonous substances)
e. Narcotics and Psychotropic Substances Act
f. Pharmacy Act 1948
g. Sales of Good Act 1930
h. The Drug and Cosmetics Rule 1945
i. The Drugs Control Act 1950
j. VAT Act/Central Sales Tax Act 1956
LAWS GOVERNING ENVIRONMENT SAFETY
a. Air (prevention and control of pollution) Act 1981
b. Biomedical Waste Management Handling Rules 1998 (Amended on 2000)
c. Environment Protection Act and Rule1986, 1996
d. NOC from Pollution Control Board
e. Noise Pollution Control Rule 2000
f. Public Health Bye Law 1959
g. Water (prevention and control of pollution) Act 1974
h. Delhi Municipal Corporation (malaria and other mosquito borne diseases) Bye Law 1975
i. The Cigarettes and Other Tobacco Products (prohibition of advertisement and regulation
of trade and commerce, production, supply and distribution) Bill 2003
j. Prohibition of Smoking in Public Places Rules 2008
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k. IPC Section 278 (making atmosphere noxious to health), Sec 269 (negligent act likely to
spread infection or disease dangerous to life, unlawfully or negligently
LAWS GOVERNING TO EMPLOYMENT AND MANAGEMENT OF MANPOWER
a. Bombay Labor Welfare Fund Act 1953
b. Citizenship Act 1955
c. Delhi Shops and Establishment Act 1954
d. Employee Provident Fund and Miscellaneous Provision Act 1952
e. Employment Exchange (compulsory notification of vacancies) Act 1959
f. Equal Remuneration Act 1976
g. ESI Act 1948
h. ESI Rules 1950
i. Indian Trades Union Act 1926
j. Industrial Dispute Act 1947
k. Maternity Benefits Act 1961
l. Minimum Wages Act 1948
m. Negotiable Instrument Act 1881
n. Payment of Bonus Act 1956
o. Payment of Gratuity Act 1972
p. Payment of Wedges Act 1936
q. Persons with Disabilities Act 1995
r. PPF Act 1968
s. SC and ST ACT 1989
t. Shops and Factories Act (for national holiday)
u. TDS Act
v. The Essential Service Maintenance Act 1981
w. The Payment of Gratuity Act 1972
x. Workmen’s Compensation Act 1923
LAWS GOVERNING TO MEDICOLEGAL ASPECTS
a. Consumer Protection Act 1986
b. Indian Evidence Act
c. Law of privileged communication
d. Law of torts
e. IPC Section 52 (good faith), Sec 80 (accident in doing lawful act), Sec 89 (for insane &
children), Sec 90 (consent under fear) , Sec 92 (good faith/consent), Sec 93
(communication in good faith)
LAWS GOVERNING SAFETY OF PATIENTS, PUBLIC AND STAFF WITHIN HOSPITAL PREMISES
a. The Radiation Surveillance Procedures for the Medical Application of Radiation 1989,
Radiation Protection Rules 1971
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b. AERB Safety Code no. AERB/SC/Med-2(rev-1) 2001
c. Arms Act 1950
d. Boilers Act 1923
e. Explosive Act 1884 (for diesel storage)
f. Gas Cylinder Rules 2004
g. Insecticide Act 1968
h. IPC Section 336 (act endangering life or personal safety of others), Sec 337 (causing hurt
by act endangering life or personal safety of others), Sec 338 (causing grievous hurt by
act endangering the life and personal safety of others).
i. NOC from chief fire office
j. Periodic fitness certificate for operation of lifts
k. Petroleum Act and Storage Rules 2002
l. Prevention of Food Adulteration Act 1954
m. The Indian Fatal Accidents Act 1955
n. The Tamil Nadu Medicare Service Persons and Medicare Service Institutions (prevention
of violence and damage or loss to property) Act 2008
LAWS GOVERNING PROFESSIONAL TRAINING AND RESEARCH
a. MCI rules for MBBS, PG and internship training
b. National board of examination rules for DNB training
c. ICMR rules governing medical research
d. NCI rules for nursing training
e. Ethical Guidelines for Biomedical Research on Human Subjects, 2000
LAWS GOVERNING THE BUSINESS ASPECTS
a. Cable Television Network Act 1995
b. Charitable and Religious Trusts Act 1920
c. Contracts Act 1982
d. Copyright Act 1982
e. Custom Act 1962
f. FEMA 1999
g. Gift Tax Act 1958
h. Income Tax Act 1961
i. Insurance Act 1938
j. Sales of Good Act 1930
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Annexure 12.1: Teaching Hospital – Working Results
2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
OUTPATIENTS
Total Catchment Population in Lakhs 7.5 7.65 7.80 7.95 8.1 8.32 8.45 8.60 8.80 9.00
Population Seeking OPD Help (in Lakhs) 11.55 11.78 12.00 12.25 12.50 12.75 13.00 13.26 13.53 13.80
Hospital Share 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%
Cost / Visit 100 100 100 100 100 100 100 100 100 100
INPATIENTS
Number Of Beds 150 300 300 300 400 500 500 500 500 500
Occupancy 85% 85% 85% 85% 85% 85% 85% 85% 85% 85%
Total Patients Beds Annual 46537.5 93075 93075 93075 124100 155125 155125 155125 155125 155125
Number Of Annual Inpatients 10342 20683 20683 20683 27578 34472 34472 34472 34472 34472
Total Cost Per Inpatient 20000 20000 20000 20000 20000 20000 20000 20000 20000 20000
INCOME ( Rs. Lakhs)
OUTPATIENT 578 589 601 613 625 638 650 663 677 690
INPATIENTS 2068 4137 4137 4137 5516 6894 6894 6894 6894 6894
Total 2646 4726 4737 4750 6141 7532 7545 7558 7571 7585
EXPENSES (Rs. Lakhs)
Salary & Wages 1612 2311 2784 3016 3425 3819 3848 3848 3848 3848
Supplies 517 1034 1034 1034 1379 1724 1724 1724 1724 1724
Power & Utilities 124 248 248 248 331 414 414 414 414 414
Repairs & Maintenance (.25%) 8 20 22 23 33 42 42 42 42 42
Insurance Charges (.1%) 3 8 9 9 13 17 17 17 17 17
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Adminstration Expenses (1%) 26 47 47 47 61 75 75 76 76 76
Contingency (2.5%) 57 92 104 109 131 152 153 153 153 153
TOTAL 2348 3760 4248 4487 5373 6242 6272 6272 6273 6273
SURPLUS / DEFICIT 297 966 489 262 767 1290 1272 1285 1298 1312
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Annexure 12.2: Medical college – Working Results
2018-19 2019-20 2020-21 2021-22 2022-23 2023-24 2024-25 2025-26 2026-27 2027-28 Students NOS 100 200 300 400 500 500 500 500 500 500 Fees ( Rs. Lakhs) 4 4 4 4 4 4 4 4 4 4 Hostel ( Rs. Lakhs) 1 1 1 1 1 1 1 1 1 1 Other fee + Security ( Rs. Lakhs) 1
INCOME ( Rs. Lakhs) Fees 400 800 1200 1600 2000 2000 2000 2000 2000 2000
Hostel Fee 100 200 300 400 500 500 500 500 500 500 Add ( Intial deposits + Admission Fee) 100 100 100 100 100 0 0 0 0 0 Total 606 1205 1805 2405 3005 3005 3005 3005 3005 3005
EXPENSES ( Rs. Lakhs) Salary & Wages 1037 1113 1026 1055 1218 1218 1218 1218 1218 1218
Power & Utilities 40 80 120 160 200 200 200 200 200 200 Repairs & Maintenance (.25%) 12 14 17 18 19 19 19 19 19 19 Insurance Charges (.1%) 5 4 4 5 5 6 6 6 6 6 Supplies 25 50 75 100 125 125 125 125 125 125 Adminstration Expenses (1%) 6 12 18 24 30 30 30 30 30 30 Contingency (2.5%) 28 32 31 34 40 40 40 40 40 40 TOTAL 1152 1304 1291 1395 1637 1637 1637 1637 1637 1637
SURPLUS / DEFICIT -546 -99 514 1010 1368 1368 1368 1368 1368 1368
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Annexure12.3: Nursing College – Working Results
2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 Students (NOS) 40 80 120 160 160 160 160 160 160 160 FEE (RS. LAKHS) 0.75 0.75 0.75 0.75 0.75 0.75 0.75 0.75 0.75 0.75 HOSTEL FEE (RENT+MESS) 0.8 0.8 0.8 0.8 0.8 0.8 0.8 0.8 0.8 0.8 INCOME ( RS. LAKHS) Fees 30 60 90 120 120 120 120 120 120 120 Hostel Fee 32 64 96 128 128 128 128 128 128 128 Total 62 124 186 248 248 248 248 248 248 248 EXPENSES ( RS. LAKHS) Salary & Wages 114 114 114 114 114 114 114 114 114 114 Power & Utilities 0 0 0 0 0 0 0 0 0 0 Repairs & Maintenance (.25%) 1 3 3 3 3 3 3 3 3 3 Insurance Charges (.1%) 1 1 1 1 1 1 1 1 1 1 Supplies 11 21 32 42 42 42 42 42 42 42 Adminstration Expenses (1%) 1 1 2 2 2 2 2 2 2 2 Contingency (2.5%) 3 4 4 4 4 4 4 4 4 4 TOTAL 130 144 156 167 167 167 167 167 167 167 SURPLUS / DEFICIT -68 -20 30 81 81 81 81 81 81 81
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Annexure 12.4: Alternate Healing center – Working Results
2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 Number Of Cottage 25 37 50 50 50 50 50 50 50 50 Capacity Of Pax 37.5 55.5 75 75 75 75 75 75 75 75 Occupancy 50% 50% 50% 60% 60% 70% 75% 75% 75% 75% PAX Days 6843.75 10128.75 13687.5 16425 16425 19162.5 20531.25 20531.25 20531.25 20531.25 Cost Per PAX Day 7500 7500 10000 10000 10000 10000 10000 10000 10000 10000 INCOME ( Rs. Lakhs) Total 513 760 1369 1643 1643 1916 2053 2053 2053 2053 EXPENSES (in Rs. Lakhs) Salary & Wages 75 75 75 75 75 75 75 75 75 75 Supplies 128 190 342 411 411 479 513 513 513 513 Power & Utilities 10 15 21 25 25 29 31 31 31 31 Repairs & Maintenance (.25%) 1 2 2 2 2 2 2 2 2 2 Insurance Charges (.1%) 0 1 1 1 1 1 1 1 1 1 Adminstration Expenses (1%) 5 8 14 16 16 19 21 21 21 21 Contingency (2.5%) 5 7 11 13 13 15 16 16 16 16 TOTAL 225 297 465 542 542 619 658 658 658 658 SURPLUS / DEFICIT 288 462 904 1100 1100 1297 1395 1395 1395 1395
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Annexure 12.5: Consolidated Academy working results
2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
TOTAL INCOME (In Rs. Lakhs) 3159 5788 7012 7959 10012 12339 12851 12864 12877 12891 EXPENSES (In Rs. Lakhs) Salary & Wages 1687 2904 3934 4274 4654 5144 5255 5255 5255 5255 Supplies 645 1237 1414 1507 1877 2315 2362 2362 2362 2362 Power & Utilities 134 283 329 374 498 626 648 648 648 648
Repairs & Maintenance (.25%) 9 27 37 40 53 64 64 64 64 64 Insurance Charges (.1%) 4 11 14 24 39 54 65 65 65 65
Administration Expenses (1%) 32 58 70 80 100 123 129 129 129 129 Contingency (2.5%) 63 113 145 157 181 208 213 213 213 213 TOTAL 2574 4633 5941 6457 7402 8534 8735 8735 8735 8735
SURPLUS 585 1155 1070 1502 2610 3805 4116 4129 4142 4156