Development of Healthcare facility

at Smith village
Agenda
 Vision and mission



To set up a unique and trendsetting
modular healthcare structure in the Smith
Village
 Project Scope
• Infant Care
• Maternal Reproductive Health
• Emergency Service
• Accessible & Good Quality Care
• Immunization & Vaccination

 Background Observations
• Most people who can afford still go outside
this region for specialty healthcare
• Borrow / sell off their assets to go out of
the state for specialty healthcare
• People who cannot afford have no option
• Quality & effective healthcare facilities
are yet to penetrate into many areas
• Medical treatment is still very expensive in
this region

 Contd…
 Quality specialty healthcare is still not affordable &
accessible to all
 Inability to attract / retain quality manpower
 A huge scope for development in many specialty &
super-specialty areas like
◦ Medicine Subspecialties : Chest Medicine,
Rheumatology, etc
◦ Infectious diseases in children
◦ Neonatal & Pediatric intensive care
◦ Neurology & Neurosurgery
◦ Transfusion medicine
◦ Geriatric care

 Patient-reported assessment

 Aspects of Practice
 Prevalance – High
 (on the scale of 10)


 Fee-splitting practices
 8

Over-prescription of drugs
 8
Over-prescription of diagnostics
 6
Inadequate sterilization of medical equipment
 4
Inadequate measures of disposal of waste
 9
Inadequate fulfilment of standards
 1
Inappropriate use of medical technology

2
Breakdown of trust in doctor-patient
 3
relationship  5
Inadequate information given to patients
 6
Lack of accessibility during emergencies
Status of Public Health Services
(1972-2007)

Source: Meghalaya state development report

 Health Infrastructure Of Meghalaya
Item Required In Position Shortfall
Sub-centre 597 401 196
Primary Health Centre 90 103 -
Community Health Centre 22 26 -
Multipurpose Worker (Female)/ANM 504 608 -

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

Health Assistants(Female)/LHV 103 75 28

Health Assistants(Male) 103 87 16

Doctor at PHCs 103 106 -
Surgeons 26 1 25
Obstetricians & Gynaecologists 26 0 26

Physicians 26 1 25
Paediatricians 26 0 26
Total specialists at CHCs 104 2 102
Radiographers 26 25 1
Pharmacist 129 113 16
Laboratory Technicians 129 130 -
Nurse Midwife 285 174 111
 Healthcare facility in Smith
• Smith is a village situated in Khasi hills district
of Meghalaya, about 20km from Shillong
• Near National Highway
• 1 Primary Health Center
• Anti-Malaria, Anti-Leprosy programmes have
been implemented by NHRM
• Manned by a Medical Officer supported by
14 paramedical and other staff 
• It has 5 beds for patients
•
•
 Healthcare Facility requirements in
Smith
 


• Maternal and Child healthcare facility not present

• Lack of specialist Doctors
• More vehicle required for emergency purposes
• No of doctors is not sufficient to look after the
population of Smith and adjoining villages
• Standardised healthcare is not being provided to most
of the patients
• Patients suffering from critical illness and injuries
cannot be treated in the PHC and are being referred
to the city hospitals in Shillong
• Still 24 hours referral service not available
•
 Smith hospital
• The focus of the hospital will be on maternal and
child healthcare which are lacking in this area
• Specialist doctors and nurses will be available
round the clock to cater to emergencies and
child delivery cases
• Reduction in Infant Mortality Rate (IMR) and
Maternal Mortality Ratio (MMR)
• Tie-up with the NRHM
• Hospital will ensure accessible, affordable,
accountable and good quality hospital care
reaches the rural people.
•
 Deliverables
• Assessment of prevailing conditions of
Healthcare in the East-Khasi Hills( smith village)
• Registration for hospital
• Construction of healthcare facility
• Purchase of equipments
• Pharmaceutical supports
• Recruitment of staff

 Comparative Analysis
PHC
 
Smith hospital
• Medical officer-1 • Medical officer-2
• Nurse-1 • Nurse-4
• Clerk-1 • Clerk-1
• Lab technician-1 • Receptionist-2
• Driver-1 • Lab technician-1
• Pharmacist-1 • Driver-1
• Pharmacist-1
• Other staff-2
 Medical equipments
• Outdoor instruments
– Sphygmomanometer
– Stethoscope
– CNS kit
– ECG machine
• Operation theatre
– Operating microscope
– Basic operating instruments
– Emergency lighting instruments
– Operation table
– AC
– Disinfecting machine
• Laboratory instruments
– Microscopes
– Slides
– Test-tubes
– Other necessary equipments

–
 Work breakdown structure
Architectural
Site preparation

Civil & Structural

Design
Foundation
Framing
Walls
Smith hospital Roofing
Finish work

Mechanical
HVAC
Plumbing
Central plant

Electrical
Distribution
Lighting
Emergency

Medical equipment
 Activity List
Task Number Task Name Duration Predecessors

1 Project Requirements Planning 10 days  

2 Budget Preparation 10 days 5,14,17,22
3 Budget Financing & Approval 30 days 2
4 Facility Construction 297 days  
5 Building Plan preparation 14 days 1
6 Selection of Land for Building Construction 7 days 5,3
7 Purchase of Land 14 days 6
8 Tendering process for building 35 days 7
9 Finalising Building Contarct 7 days 8
10 Construction of Buiding 180 days 9
11 Staff Allocation 114 days  
12 Staff Requirement Planning 7 days 1
13 Staff Qualification requirement Planning 3 days 12
14 Staff Salary Requirement Planning 3 days 13
15 Staff Selection 60 days 14,3
16 Equipment Procurement 167 days  
17 Equipment Requirement planning 10 days 1
18 Equipment procurement tendering 21 days 17,3
19 Equipment Purchase Order Issue 2 days 18
20 Equipment Delivery 90 days 19
21 Medicine Procurement 85 days  
22 Medicine & related consumable requirement Planning 7 days 1
23 Medicine Replenishment Cycle Planning 5 days 22
24 Medicine Ordering 21 days 23,3
25 Medicine Delivery 10 days 24
Project Scheduling
 Critical Path
•
• Critical path activities – 1,2,3,5,6,7,8,9,10
• Critical path – 351 days
• Facility Construction is the Critical activity
involved
• Construction of Building is the most
important subtask
Building Layout Plan
Contd…
Contd..
Facility Construction Scheduling
 Proposed Model
A “Not for Profit” healthcare model with a 3-tier
approach
◦ Paid facilities (30% beds) :: For those who can afford
◦ Subsidized facilities (50% beds) :: For economically
weaker sections of the society
◦ Free facilities (20% beds) :: For people below
poverty line
◦ Same pattern to be followed in all diagnostic
services also
◦ A healthcare model based on a pattern very successfully
adopted by institutes like LV Prasad Eye Institute,
Hyderabad; Aravind Eye Institute, Madurai ; Sri Chitra
Tirunal Institute of Medical Sciences & Technology,
Trivandrum etc.)

 Concept: Rogi Kalyan Samiti/ Hospital
management society

• A registered society, acts as a group of trustees for the

hospitals to manage the affairs of the hospital

•
• Consists of members from local Panchayati Raj
Institutions (PRIs), NGOs, local elected representatives
and officials from Government sector
 Nature & Purpose
• The concept is simple, appealing and easy to replicate
across the State.
•
• To provide sustainable quality care with accountability
& people’s participation with total transparency.
•
• Needed for ensuring a degree of permanency and
sustainability
•
• Concept has to be taken across sections of the
community, local representatives and political
regime
•
 Tying-up with NGO/other voluntary
healthcare dept.
• Red Cross Society
•
• Rottary club
•
• World Health Organisation initiatives
•
• NHRM representatives and Ministry of
Health both at state level and centre
level

 Initial Capital Expenditure
Initial Investment (In Rs.)
Building
Structural Work 1,000,000.00
Civil Work 600,000.00
Electricals 200,000.00
Water connection & Sanitation 200,000.00
2,000,000.00
Medical/Laboratary Equipment 150,000.00
Furnitures 100,000.00
Refrigerator 10,000.00
Computers (3*22,500) 67,500.00
Beds (15*1,500) 22,500.00
Total 2,350,000.00
 Sources of Fund
Sources (In Rs.)

Donations 783,333.33

Loans from financial institutions 783,333.33

Grants from government / other donor agencies 783,333.33

Total 2,350,000.00
Estimated Monthly Expenditure
Est. Monthly Expenditure (In Rs.)
Salary
Doctor (2*26,000) 54,000.00
Nurses (4*5000) 20,000.00
Receptionist (2*5000) 10,000.00
Pharmacist (1*5000) 5,000.00
Lab technician (1*5000) 5,000.00
Clerk cum Accountant (1*7000) 7,000.00
Other Staff (2*2,500) 5,000.00
106,000.00
Basic medicine & Medi-care Supplies 20,000.00
Laborotory Requirements 10,000.00
Electricity/Maintainance 3,000.00
Mobile Van Rent 5,000.00
Repayment of Debt. 6,528.00
Total 150,528.00
 Potential Source of Income
• The main source of income of
hospital is receipts from patients
• Grants from different parties:
Donations, Govt., NGOs, Public
• Outpatient
• Daycare
• Inpatient hospital services
• Retail sales in the pharmacy
• Investment Income
 Additional Sources of Income
• Utilize all Government assets and services to impose
user charges
•
• Shall be free to determine the quantum of charges on
the basis of local circumstances.
•
• Private organizations offering high tech services like
pathology, MRI, CAT SCAN, Sonography etc
•
• Could be permitted to set up their units within the
hospital premises in return for providing their
services at a rate fixed by the RKS/ HMS
•
Thank you