Operations & Management of

Community Health Centres under PPP

ModeCommunity health Centers & District

Hospitals outsourced in public private partnership

Project StructureS No Particulars Description

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

3 Number of CHCs

a) Minimum Number of CHC’s outsourced should be 4

4 Concession Period 10 years

5

Financial Grant by The Government

a) Capital Grant for equipments above Rs 5.00 Lakhs on one time basis

b) For any subsequent purchase of more than Rs. 2.00 lakh, 100% Grant subject to approval by DOMH&FW

c) Operating Grant : Fixed Plus Variable

6

Identified Services

a) Diagnostics : X-ray, ultrasound, ECG & Pathology

b) Maternity casesc) Surgeries /Orthopedic d) Minor Injuriese) In Patient Services

7 Monitoring Arrangement

a) Expert Committee like PwC or E&Y etc.

Clinical StaffSr. No.

Clinical Staff Number

1 General surgeon 12 Physician 13 Obstetrician & Gynaecologist 14 Paediatrician 15 Radiologist 16 Orthopaedic 17 ENT surgeon 18 Anaesthetist 19 Eye surgeon (1 for every CHC) 110 Dental surgeon 111 General duty medical officer 212 Staff Nurse 1013 Maternity assistant (ANM) 214 Total 24

Scope of Private Partner

Clinical Services (defined in next page)Upgrade the facility and manage the same as per the prescribed standards of Indian Public Health System (IPHS)Add specialized services / beds for procedures over and above existing scope as prescribed by the DoMH&FW from time to timeRecruit, retain and manage qualified and experienced medical

human resourceIT-based Management Information Systems to manage the

hospitals and inventory.Maintenance of all movable and immovable assets of the hospitalAbide by the existing Government laws/ rules and policies

Undertake all statutory responsibilitiesTimings - OPD (8.00 AM to 4.00 PM) and Diagnostic (8.00 AM to 8.00 PM). Emergency 24 X 7

Identified Services for PPP PartnerClinical Services : OPD , IPD, emergency, drug dispensing, diagnostic (identified radiology and pathology, CT scan etc) maternity cases, surgeries, Orthopaedic surgeries, replacements, etc. Catering & Dietary and Linen & LaundryHospital Waste Management, Pest Control and Sterilisation Services

Clinical Record Keeping, Security, Patient discharge processMinor Repairs

Out of Scope for Private PartnerMedico legal casesPromotion and management of Government health schemesAmbulance servicesCollection of user chargesMajor Repairs due to ageing and natural disaster

GRANT STRUCTURE EITHER THROUGH FINANCIAL BID PARAMETER OR ON

UTTRAKHAND GOVT RATES User Charges to be collected by Chikitsa Prabandhan Samiti at Government Rates

The O&M expenses categorized into

Fixed (Hospital Management, Housekeeping, In patients Human Resources, financing charges etc) and

Variable based on Diagnostic Procedures, Maternity Cases, Surgeries, Orthopedic surgeries etc

Government Grant towards Fixed (monthly based on area) and Variable (based on actual services rendered)

Demand risk is transferred to PPP Partner and Operating Risk is shared

Selection Process of PPP Partner

OPTION 1: One stage-two bid process : Technical Financial

Basis to evaluate Technical ExperienceNumber of years of experience in managing similar facilitiesSize of facilities managed (based on cumulative number of

beds) Number of Maternity Cases handled (since there are

significant number of maternity cases in CHC’s : 4-6 per day)Experience of managing multi locations (based on number of

centres managing)

OPTION 2: Nomination basis based on Uttrakhand price bid : TIRAL OPERATIONS FOR 5 YEARS, IF SUCESSFUL THEN

TENDER

Financial Bid

Revenue Grant

2 VARIABLE GRANT (actual services rendered)a) Diagnostic Per procedure as per existing Govt rates or RSBY rates

b) Maternity Cases/Surgeries

Per procedure as per existing Govt rates or RSBY rates

c) Accidental Cases Per procedure as per existing Govt rates or RSBY rates

2) FIXED MONTHLY GRANT (towards housekeeping, hospital management, human resources, finance charges etc)

a) Fixed Grant Rs per sq mtr of built up area per month

Present Value of Total Grant = Variable (per procedure bid amount converted into annual grant based on projected number of procedures) + Fixed Grant

Capital Grant (not part of Financial Bid)This would be mutually agreed based on “actual equipment gap”To fulfill “gap” in capital equipment vis-a-vis Government standards•Government will provide 100% Grant on all new equipments more than Rs. 5.00 Lakhs on one time basis subject to approval by DOMH&FW

•For any subsequent purchase of more than Rs. 5.00 lakh the Government will provide 100% Grant subject to approval by DOMH&FWThis would not include any non medical appliances, equipments, consumables, instruments – measuring or otherwise, furniture, software/hardwareThe requirement, specification and cost of equipment would be reviewed and verified by the GovernmentAll such Procurements would be guided by Uttarakhand Procurement Rules 2008

ALTERNATE PROCESS FOR OUTSOURCING IN PPP

RETRUN ON INVESTMENT OF THE GOVERNMENT THE PPP PARTNER RETURNS THE ENTIRE EXPENDITURE WITHOUT

INTEREST INCURRED BY THE GOVERNMENT TO CREATE THE HOSPITAL INFRASTRCUTURE

REVENUE SHARING WITH THE GOVERNMENT The Private Partner shares revenue with Government in the

ratio of 70:30 for the period of ROI of the Government. After the ROI of the Government is complete, the revenue

sharing becomes 30:70 with the government for a period of 10 years.

The Private Partner has no ownership claim of the hospital The private Partner can charge only Government rates and

RSBY rates to the patients.

GOVERNMENT GRANT ONLY FOR LIMITED PERIOD THE GOVERNMENT GIVES GRANT FOR A LIMITED PERIOD TILL THE

HOSPITAL BECOMES FINANCIALLY SELF SUSTAINED 1 YEAR AGAINST BG

Key Performance IndicatorsPayment based on Key Performance Indicators

S. No

KPI Explanation Calculation (in percentage)

KPI1 Attendance of clinical staff

Attendance of clinical staff is critical to delivery of services. The Concessionaire is encouraged to have proper staff management plans to ensure that service delivery is not affected due to planned/unplanned leaves, replacements etc.

Total number of days the clinical staff was absent in the quarter / (Total number of days the centre was open in the quarter X Total number of clinical staff (As per Schedule 8))

KPI2 Availability of critical consumables/reagents

This KPI captures whether proper inventory management procedures are followed by the Concessionaire to avoid instances where service delivery is disrupted due to non-availability or shortage of critical consumables/kits/reagents.

Sum of total number of days of stock out for each critical consumables that has affected or disrupted service delivery in a quarter / (Total number of days the centre was open in the quarter X Number of critical consumables)

KPI3 Downtime of critical equipments

This KPI forces the Concessionaire to engage the suppliers/OEMs in Service Level Agreements SLAs and Asset Management Contracts (AMCs) for maintenance and servicing of equipments. Reducing equipment down time increases equipment availability which increases throughput.

Sum (cumulative value) of difference in actual downtimes and benchmark downtimes of the identified critical equipments (highlighted in PIM) in a quarter in cases when the actual downtimes exceed the benchmarks / Benchmark downtime for all equipments in that quarter

Key Performance IndicatorsScoring Sheet and Payment

S. No.

Average KPI Score (AKS)

Percentage of total reimbursement to be paid to Concessionaire for the quarter

1 0 – 5 % 100%2 6 – 10% 95 %3 11 – 15% 85 %4 16 – 20% 75 %5 > 20 % 60 % (with show cause and

explanation)

Termination Payments on DOMH&FW Event ofDefault

The Concessionaire shall be entitled to revoke the Performance Security, if subsisting

Project Monitoring

Expert Committee i. Representative of DOMH&FW not below the rank of Additional

Secretaryii. Two super specialist doctors from hospitaliii. Representative from patient group – any one or two patients who

are undergoing treatment in this centre since last fifteen days or their attendant.

iv. Representative of Concessionaire

• The expert committee shall evaluate project deliverables on a 3 monthly basis