OUT SOURCING OF GOVERNMENT HOSPITALS IN

REMOTE AREAS

BY

RAJBHRA MEDICARE PVT LTD

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PRESENTATION BY

RAJBHRA MEDICARE PRIVATE LIMITED ON OUTSOURCING

OF COMMUNITY HEALTH CENTRES &

DISTRICT HOSPITALS ON

“REVENUE SHARING BASIS”

ABOUT

05/01/2023 3

RAJBHRAAn ISO 9001:2008 company, has been a forerunner in providing preventive, diagnostic and curative healthcare services through Mobile Medical units & Rural hospitals in the underserved inaccessible regions in various states in India.

WE have already worked in various states for State Governments as well as Corporates and NGOs.

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RAJBHRA AS LEAD

MANAGER VISION

“AFFORDABLE AND QUALITY HEALTH CARE”

Changing FocusBeing part of the process of development and rejuvenation of communities by facilitating efforts to improve medical services

and Health awareness especially in vulnerable groups like Women

and Children Improving StandardsCreating a system of primary, secondary & tertiary health care, which

builds on quality care through Mobile OPD units, well developed hospitals and develops support from the various health partners and functionaries.Advancing Quality

Providing appropriate, rational and low-cost health care services

delivered in supplementing the activities of the Government/Other health functionaries and

infrastructure

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CURRENT RURAL HEALTH SCENARIO OF INDIA India has a billion people, but

with very low incomes…

and therefore Affordability for health is minimum…..

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Rural India is still far behind* 700 million people* 637,000 villages

* 86% earn less than $2 (Rs 100) per day* 70 % disabled lives here* Access to safe drinking water –

mostly denied* Most villages on electricity grid

But 80% will have power lessthan 8 hours a day

* sanitation facilities < 85% * 50% children dropout before

fifth grade* Total number of Primary* Health Centers : 23,458

1(PHC):35,000(population size)

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A glimpse at numbers

Total number of PHCs in India : 23,458PHC : Population ratio : 1 per 35,000Doctors at PHCs : 25,086PHCs w/o a single doctor : 2,533Number of Doctors per1000 in India : 0.6

Attrition of Doctors and Nurses due to….•Pay scale• Quality of health infrastructure & facilities* No Opportunity for self enhancement of specialization.

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Rural Healthcare Scenario

19%

15%

10%

86%

%age PHCPrivate clinic/Nursing Charitable Private Pract. & RMP

Public

Under staffed, under funded, lack of infra

Private

Lack of delivery, more focus on revenue, no sustained tertiary level professionals

Public Private P

Tested, penalties, commitment, profit, sharing of revenue

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Rural – Urban Health Divide>Inequity to Access Doctors to population ratio is lower by ~6 times in rural

areas Hospital beds to population ratio is ~15 times lower in

rural areas Per Capita expenditure on public health is ~7 times lower

>Heath Care in Rural India 1.5 times more expensive than in Urban

>20 million Indians are pushed below poverty line every year due to healthcare expenditure alone*

*Health costs are the SINGLE LARGEST contributors to non-productive rural debt

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The state is having 12 districts with a population of 51,70, 877 (1991 census). The density of population is 93 persons per sq.km. The state has an area of 55, 673 sq.km., 10.54% of the Himalayan land. Majority (91.3) of the population is in rural areas. About half the area is covered under tribal belt with just 2.2 lakhs population. The sex ratio is 976 females per 1000 males (as per 1991 census) District

CHC PHCBilaspur 17 11 Chamba 28 11 Hamirpur 17 6 Kangra 50 34 Kinnaur 17 0 Kullu 14 5 L & Speti 9 5 Mandi 44 13 Shimla 47 30Sirmaur 24 14Solan 20 17 Una 12 9

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——————————————————————————————— Staff Position in Himachal Source Department

Category Sanctioned Position Vacant———————————————————————————————1. Medical officers 1498 1369 1292. Staff Nurses 1427 1107 3203. Female Health Workers 2210 1974 2364. Male Health Workers 2011 1594 4175. Sr. Lab Technicians 612 457 1556. Lab Assistants 169 115 547. Pharmacists 857 684 1738. Chief Pharmacists 80 73 79. Radio Grapher 183 143 4010. Ophthalmic Assistance 145 95 5011. OTAs 95 77 1812. Male Health Supervisors 413 385 2813. Female Health Supervisors 350 385 20————————————————————————————

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Operations & Management of

Community Health Centres under PPP

Mode

July 2013 June 2013

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WHAT WE DID IN ………………………..

TRANFORMATION

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Rajbhra Hospitals in Uttrakhand

CHC - RAIPUR CHC - SAHIYA

CHC - NAUGAON CHC - THATYURE

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WE HAVE TRANSFORMED THE CONCEPT OF RURAL HEALTH BY PROVIDING

SPECIALIZED AND EXPERINCED MEDICAL PROFESSIONALS OF ALLTHE MEDICAL BRANCHES 24X7 PROFESSIONAL NURSES AND OT TECHNCIANS UNIFORMS AND STRCIT DISCPLINE STRICT ADHERECNCE TO IPHS STANDARDS STRICT AND EFFICIENT CLEANLINESS COMPLETE HOSPITALS ARE ONLINE AND PAPERLESS HIGHEST STANDRDS OF LABORATORY AND DIAGNOSTICS EFFICIENT PATIENT CARE

WE HAVE TRIED MAKING RURAL HEALTH AFFORDABLE AND DEPENDABLE…….

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PROPOSED PURPOSE OF THIS PRESENTATION

“Propose to take over any Community Health Center offered by Government of Himachal Pradesh on agreed terms and conditions and then TRANSFORM AND DELIVER QUALITY AND AFFORDABLE HEALTH IN SIX MONTHS TIME”

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Project StructureS No Particulars Description

1 Project Owner Department of Medical Health & Family Welfare2 PPP Model Operation & Maintenance & Service

3Number of CHCs a) Total number of CHCs on a trial can be one integrated

with any district hospital

4 Concession Period 10 years

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Financial Grant a) Capital Grant for equipments above Rs 15.00 Lakhs on one time basis

b) For any subsequent purchase of more than Rs. 5.00 lakh, 100% Grant subject to approval by DOMH&FW

c) Operating Grant : Fixed Plus Variable on Revenue Sharing between PPP partner and Govt

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Identified Services a) Diagnostics : X-ray, ultrasound, ECG & Pathologyb) Maternity casesc) Minor Injuriesd) In Patient Servicese) Surgical services f) Orthopedic surgeries

7Monitoring Arrangement

a) Expert Committee

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Clinical Staff

Sr. No.

Clinical Staff Number

1 General surgeon 22 Physician 13 Obstetrician & Gynaecologist 24 Paediatrician 15 Radiologist 16 Orthopaedic 17 ENT surgeon 18 Anaesthetist 29 Eye surgeon 1

10 Dental surgeon 111 General duty medical officer 612 Staff Nurse 1513 Maternity assistant (ANM) 814 Total 41

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Scope of Private Partner All Clinical ServicesUpgrade the facility and manage the same as per the prescribed IPHS standardsAdd specialized services / beds for procedures over and above existing scope as prescribed by the DoMH&FW from time to timeRecruit, retain and manage human resources

IT-based Management Information Systems (paperless hospital)

Maintenance of all movable and immovable assets of the hospital

Abide by the existing Government health laws/ rules and policies

Undertake all statutory responsibilities except medico legal cases

Timings - OPD (8.00 AM to 4.00 PM) and Diagnostic (8.00 AM to 8.00 PM). Emergency 24 X 7 and all as a private hospital operations

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Identified Services for PPP PartnerClinical Services : OPD , IPD, emergency, drug dispensing, diagnostic (identified radiology and pathology) and maternity cases, surgeries, orthopaedic surgeries, transplants etc, cataracts, etcCatering & Dietary and Linen & LaundryHospital Waste Management, Pest Control and Sterilisation Services

Online Clinical Record Keeping, Security, Patient discharge process

Out of Scope for Private PartnerMedico legal casesPromotion and management of Government health schemesAmbulance servicesCollection of user charges

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PROPOSED FUNDING STRUCTURE

Fixed grant (Hospital Management, salaries, consumables Housekeeping, In patients Human Resources, financing charges etc) which the government spends annually at present, can be given to Private Partner with a built in discount factor till revenue generated from the hospital is equal to the fixed grant.

A definite time frame (x years) is fixed with the PPP to achieve this Fixed = Revenue.

The variable collected during this definite time period (x years) from the medical services is shared with the government initially in the ratio 70:30 government and PPP and once the revenue= fixed grant, then the ratio of sharing becomes 30:70 in the favor of PPP.

The government ensures health delivery at prices less than or equal to CHGS rates to rural patients.

The model ensures a win win for government and private partner

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PROPOSED FUNDING STRUCTURE

Private Partner gives a Bank guarantee to the government amounting to the fixed grant that the government gives for each month for x years until the revenue =Fixed grant in x years. As an illustration:‘ If Rs A lakhs is what the government gives to the private partner each month to pay forSalaries, consumables, medicines, house keeping, utilities, etc ( after pre negotiations), the private partner issues a BG equivalent to Rs A Lakhs to the government; in case if the If the private partner defaults in sustaining the agreed terms of agreement, then the BG of the Private Partner gets forfeited.’ (The private partner gets a lead time of six months to Organize its infrastructure and professional manpower. ) The variable revenue from medical services is deposited in a account which is predefinedIn a ratio of 70:30 for x years for government and 30:70 after x years for private partner. (In Uttrakhand the CPS of Raipur Hospital has over Rs 50 lakhs in 1,5 years of operations) The Private partner can withdraw only 50% of its share of 30% each month of variable revenue until in the end of x year period. ( Incase if the private partner is not able to achieveRevenue =Fixed grant in x Years it forfeits its remaining 50% to the government.

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PROPOSED FUNDING STRUCTURE/ MONITORING

An Independent Monitoring committee or agency like E&Y or KPMG monitorsThe laid down KPI each month and defines the progress of the hospital and revenue

The monthly review between the independent agency and Government and Private partner defines time bound road map for improvement and suggested Recommendations.

Non adherence and casual approach by the private partner after three successive Review meetings on a particular issue again makes the private partner liable to Forfeit its BG.

Online HMIS compulsory for evaluation and data center centrally located.

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THANK YOU FOR YOUR VALUABLE TIME

AND

NOW OPEN FOR DISCUSSION