project information memorandum - bmc.gov.inbmc.gov.in/download/keyprojects_05072016062039pm.pdf ·...

Project Information Memorandum Bhubaneswar Municipal Corporation Healthcare Network Project

July 2016

Table of Contents

Table of contents

Project Snapshot 3

Introduction 4

Overview of state of Odisha 5

Demographic and socio-economic profile 5

Healthcare scenario 6

Disease Profile of Odisha: 6

Healthcare Infrastructure 7

Public healthcare facilities in Khorda 8

Profile of existing BMC hospital and dispensaries 9

Location of hospital 9

Existing BMC Dispensaries 9

Proposed Project Structure 10

Project objectives 10

Project Structure 10

Project Scope 10

Obligations of the private player 10

Financing the Project:- 10

Construction & Commissioning of Project: 11

Operations & Management: 11

Treatment of Select Patients and applicable tariff 11

Obligations of BMC 12

. Project Information Memorandum - Bhubaneswar Municipal Corporation Healthcare Network Project

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Project Snapshot

Project Name Establishment and Augmentation of Healthcare Network In Bhubaneswar

Under PPP Framework

Project Type Concession model under PPP Framework

Concession Type Design, Build, Finance, Operate & Transfer

Project Authority Bhubaneswar Municipality Corporation (BMC)

Project Term 34 years, extended by 34 years in case of no material default from operator

Scope of Project BMC to offer site for Greenfield hospital and existing dispensaries for development

and refurbishment.

Private player needs to develop a Greenfield multi - specialty care hospital and

upgrade 5 existing dispensaries into accredited health centers with fully functioning

staff and equipment

Viability Gap Funding (VGF) payable by Authority

20% of the project cost with an upper cap of Rs 51.0 Cr. The VGF shall be disbursed by Authority as per the provisions of the Concession Agreement.

Project Location Bhubaneswar, Odisha: Green field multi specialty hospital at Mauza Gadakana and

Dispensaries at Kapilaprasad, Brahmeswar Patna, Rasulgarh, Gadakana &

Bharatpur.

Minimum Beds The minimum number of beds to be installed by the private player are:

Multispecialty Hospital (Mauza Gadakana): 300 beds

Kapilaprasad: 100 beds

Brahmeswar Patna: 30 beds

Rasulgarh: 30 beds

Gadakana: 30 beds

Bharatpur: 6 beds

Tariff Structure Private player free to determine tariff for General Patients;

Discounted rates for Select Patients.

Treatment of Select Patients to be funded through Government health schemes like

Rashtriya Swasthya Bima Yojna, Biju Krushak Kalyan Yojna, or Odisha State

Treatment Fund

Existing employees BMC to redeploy existing staff

Accreditation

requirement

Private partner to obtain accreditation from NABH for hospital network within 36

months from the COD.

Remuneration of Independent Engineer and Independent Panel

The Concessionaire shall reimburse the remuneration, cost and expense of the Independent Engineer and Independent Panel to the Authority up to the maximum limit of 2% of the project cost. Any remuneration, cost and expenses of the Independent Engineer and Independent Panel over and above the aforementioned limit will be borne by the Authority.


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Introduction

Bhubaneswar, located in Khorda district, is the capital of the state of Odisha. In 2011, Khorda had population of

2,246,341 of which 881,988 resided in Bhubaneswar city. Bhubaneswar bears a large portion of disease

burden with over 1.5 million reported out-patents in public hospitals within Bhubaneswar municipal limits. There

is marked shortage of health infrastructure and services in Khorda district and Bhubaneswar city

Bhubaneswar Municipal Corporation (BMC) is responsible for operating medical facilities in Bhubaneswar

including a 106 bed hospital and four satellite dispensaries catering to the city's poor and underserved

population.

BMC is keen to build a Greenfield multi-specialty hospital, and upgrade the existing dispensaries into primary

and secondary care health centres. The objective is to bridge the gap in the demand and supply of beds in

Bhubaneswar, provide access to good quality medical care to people of Bhubaneswar at affordable rates with

special focus on BPL population. BMC intends to build the green field hospital, to be located at Mauza

Gadakana, with at least 300 bed capacity at a plot admeasuring 5.6 acres The site has access to road on three

sides of the land and ensures excellent connectivity due to presence of 100 meters divided road.

BMC is also operating 5 dispensaries located at Kapilaprasad, Brahmeshwar Patna, Gadakana, Rasulgarh and

Bharatpur. Dispensaries operate between 8:00 AM to 12:00 noon during which they provide basic services

such as OPD consultation, dressings, sutures and free medicines. No major equipments are present in the

dispensaries and no investigations/ surgical procedures are conducted in the facilities.

The selected private sector partner will collaborate with the BMC and will be responsible for designing,

constructing, equipping, financing, and maintaining the Greenfield Multispecialty Hospital and the medical

facilities/hospitals at 5 dispensaries’ location for the concession period of 34 years as per the terms of the

concession agreement.


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23,644 21,087 13,890

40,570 34,294

20,817

Khorda(Bhubaneswar)

Cuttack Puri

2005 2009

Per Capita Income at current prices (INR), 2005 & 2009

Overview of state of Odisha

Demographic and socio-economic profile

Odisha is a major state in eastern India with a population of 41 million (Census 2011) and contributes 3.47% of

the national population. However the state contributes only 2.17% of the domestic product of India. The per

capita domestic product is 24,098 in Odisha which is below national average. However, there is high potential

for growth in the State and the NDP growth rate for Odisha is 8.48% compared to the national GDP growth rate

of 8%. The developmental & educational interventions and economic improvement has resulted in a gradual

improvement in the health status of the population. The key statistics of demographic and socio-economic

profile of Odisha is provided in table below:

Demographic Indicaors (2011) Odisha India

Total Population (In millions) 42 1210

% contribution to national population 3.47 100

Sex Ratio (females per 1000 males) 978 940

Under 6 sex ratio (females per 1000 males) 934 914

Economic Indicators (2009-10)

Net domestic product (at factor cost) (Rs Crore) (For state) 97,359 44,93,743

Contribution of Agriculture to NSDP/ GDP (%) 21.05 14.62

Contribution of Industry to NSDP/ GDP (%) 17.28 20.16

Contribution of Services to NSDP/ GDP (%) 61.66 65.22

Per capita Net State Domestic Product (factor cost) (Rs) (for State) 24,098 33,731

NDP growth rate (%) (for State) 8.48 8.00

Khorda district has seen a robust economic growth in the recent past with per capita growing at the rate of

~14.5%and has the highest per capita income across districts in Odisha. The district serves as the hub of trade

and commerce, tourism and industrial activities for Odisha. This has attracted people from across Odisha which

has resulted in high population growth of 19.65%. In 2011, Khorda had population of 22,46,341 compared to a

population of 18,77,395 in 2001. Around 5.36 percent of total population of Odisha resides in Khorda district

alone. In 2001 census, this figure for Khorda District was at 5.10 percent of Odisha population. Bhubaneswar

has been functioning as an administrative capital with sustained growth in tertiary economic activities. People

across Odisha have started visiting Khorda for better healthcare treatment resulting in increase in demand for

better healthcare facilities.

Demographic indicators of Khorda district

Bhubaneswar, now being dubbed 'the rising star of the East', has attracted Rs 6,00,000 crore investment from

varied industries such as IT, technology, steel, aluminium, tourism, health and education sectors. Huge capex

by the large industrial houses in core infrastructure sector has witnessed a rise of 11.5 per cent in the last two

Demographic indicators 2011

Population(in million) 22,46,341

Population growth 19.65%

Sex ratio (per 1000) 925

Population density (persons per sq km)

799

Average Literacy 87.51

Total Child Population (0-6 Age) 2,22,275

Child Proportion (0-6 Age) 9.89% Source : Census, 2011


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years. The recent industrial, infrastructural and educational development in Bhubaneswar has made the city

considered to be one of the cleanest and planned cities of modern India and one of the 6 fastest growing

middle tier cities of India.

Healthcare scenario

Since the year 1947, there has been a gradual improvement in the health status of the population due to

several factors including developmental and educational interventions, economic improvement and better

health care services. While the Infant Mortality Rate (IMR) has declined from 135 in 1981 to 51 in 2013, it is still

above the national average of 40. Selected key health indicators of Odisha are:

Indicators %

% of pregnant women registered for ANC in 1st trimester 74.0%

% of pregnant women who had at least 3 ANC Check ups 85.5 %

% of Institutional deliveries out of total reported deliveries 89.5 %

% of home deliveries by non- skilled birth attendance

84%

DPT3 Vaccine 89.9 %

Measles Vaccine 88.1 %

% of fully immunized children 51.8 %

DPT Booster Dose

(Children aged 18-23 months who received DPT booster dose) 43.5 %

Vitamin A 1st Dose 92.4 %

Early Initiation of Breast Feeding (<1hr) 94.0 %

ORT or Increased Fluids for Diarrhea

(Among children <2 year of age who had diarrhea in preceding 2 weeks) 49.0 %

Care Seeking for ARI in any health Facility

(Among children <2 year of age who had ARI in preceding 2 weeks) 66.9 %

HMIS Report, Odisha, Immunization Technical Support Unit Dashboard, District Level Household Facility Survey 3 of Reproductive and Child Health Project

Disease Profile of Odisha:

In Odisha majority of the deaths is a result of Intestinal, infectious and parasitic diseases. Disease of the

circulatory system and conditions originating from prenatal period also major cause groups of deaths in Odisha.

The distribution percentage of all deaths in Odisha by major cause groups are provided in the pie chart below:.


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1,659

7,099

91

8,715

Rural Hospitals Rural Beds Urban Hospitals Urban Beds

Number of Hospitals & Beds in Public Sector

23,970

2,653

Average Population Served PerGovernment Hospital

Average Population Served PerGovernment Bed

Density of Public Hospitals & Beds

6,688

1331

420

65

Sub-Centers

Primary Healthy Centers

Community Health Centers

Sub-Divisional and DistrictHospitals

Public Health Infrastructure in Odisha

Source: Report on Medical Certification of Causes of Deaths 2013 by Vital Statistical Division of Office of Registrar General of India

Healthcare Infrastructure

Healthcare delivery in the state is catered by mix of

public & private institutions. Private healthcare

facilities in the state are largely concentrated in

Bhubaneswar & Cuttack. As of March 2011, there

were 4,020 Allopathic Medical Institutions in the

state, including 1,944 medical institutions in public

sector and 2,076 medical institutions in private

sector. Public facilities in Odisha are highest in

number amongst Indian states but suffer from poor

utilization.

Khorda District has both public and private facilities to provide healthcare service to the population. Khorda

consists of 202 sub-centers, 46 Primary health centers, 14 Community health centers, and 2 District hospitals

in terms of government healthcare infrastructure.

19.70%

14.90%

6.20%

16.90%

8.60%

2.40%

5.70%

8.60%

17%

Disease of Circulatory system

Infectious & parasitic diseases

Disease of respiratory system

Certain conditions in Perinatal period

Injury poisioning etc.

Neoplasms

Disease of digestive system

Symptoms, Signs, abnormal clinicalfindings

Others


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Public healthcare facilities in Khorda

Public hospitals and nursing homes mainly comprised of the

healthcare system in the district till 90s. There was a serious dearth

of super-specialty treatment even in the early 2000. Kalinga was

the first fully fledged corporate hospital of the entire district/

state. Despite having a sizable population of cancer patients of the

country, the state did not have a comprehensive oncology care

facility. However, since 2005, several multi-specialty and super

specialty hospitals have come up in the city. Also, 3 private medical

colleges have been established in the city to take care of the

growing need for the medical professionals in the district/ state.

Industrial and infrastructural development has boosted the healthcare market in Bhubaneswar, attracting

corporate entities to expand their base further in the city. Besides existing players such as Care and Apollo

expanding their bed capacity in the city, several new players are also establishing their facilities. AIIMS is also

planning to establish a hospital in the city.

Overall healthcare infrastructure in Bhubaneswar

District Hospital

2

Community Health Centres

13

Primary Healthy Centres

46

Sub-Centres

202


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Profile of existing BMC hospital and dispensaries

Location of hospital

The site of the Greenfield Hospital is located at Mauza

Gadakana and is spread across an area of 5 acres. The

area ensures excellent connectivity and all the major private

and government medical facilities are located in the radius

of 10-12 km from the “BMC new hospital” site. The 5

dispensaries are located at Kapilaprasad, Brahmeshwar

Patna, Gadakana, Rasulgarh and Bharatpur.

Existing BMC Dispensaries

The five dispensaries provide basic services such as

outpatient services, dressings, sutures and free medicines.

Their catchment area is around 3-4 kms and all OPD services are provided free of cost to the patients.

Location Plot size No. of patients in

FY 2013 Catchment Area

Rasulgarh ~1,687 sq. mt.

OPD: 14,806 Catchment consists of low income to low middle income population.

Brahmeshwar Patna

~2,913 sq. mt.

OPD: 22,902 One of the upcoming areas of Bhubaneswar – reality projects are booming in the area. New BMC hospital site is located in the nearby area of the dispensary

Gadakana ~4,249 sq. mt.

OPD: 8,544 Dispensary is just on the back side of Care hospital. Area is the fastest growing epicenter of the city

Bharatpur ~4,925 sq. mt.

OPD: 11,404 Large slum dweller population on the back side of the dispensary.

Kapilaprasad ~4,168 sq. mt

OPD: 13,654 Dispensary is in the vicinity of old BMC hospital. Excellent connectivity through 100 mtrs road.


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Proposed Project Structure

Project objectives

The objectives of BMC from the project are:

Access – Provide a new BMC hospital and add infrastructure at existing facilities to help bridge the

demand supply gap for health facilities in Bhubaneswar

Quality – Provide high quality medical care with focus on Below Poverty Line (Select) population

Equity – Provide equitable access to care with no discrimination to poor patients

Affordability – Provide subsidized care to the poor and underprivileged

Project Structure

Project Scope

The scope for the PPP project is as follows:

Set up a Greenfield hospital and upgrade the 5 (five) existing dispensaries run by Bhubaneswar Municipal

Corporation at Bharatpur, Rasulgarh, Gadakana, Brahmeswar Patna and Kapilaprasad

Under PPP mode on design, build, finance, operate and transfer (“DBFOT”) basis.

For a minimum period of 34 years which can be extended by 34 years in case of no material default from

the operator.

Obligations of the private player

Financing the Project:-

The Private Player shall obtain sufficient funding for the Project from the Lenders and/or from own

resources for construction, refurbishment and equipping the Greenfield hospital and other medical facilities.


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Government may consider reasonable modifications to the concession agreement as may be required by

the Lenders and execution of such further appropriate documentation or additional writings, in order to

facilitate the financial closure which does not materially and adversely affect the rights and interests of the

parties.

Construction & Commissioning of Project:

The Private Player shall undertake the construction, refurbishment, procurement, installation of

equipments, completion, testing and commissioning of the Greenfield Hospital and other medical facilities

in accordance with the provisions of the Concession Agreement and the Applicable Laws.

The Private Player will ensure that before starting construction, he will put Porta cabins and make a

temporary OPD so that all the existing operations remain unaffected during the course of construction.

BMC will continue operations at the temporary OPD till the time operations begin by the private operator.

The private player shall also construct about 1,000 sq ft space for Urban Primary Health Centers (U-

PHCs) under Department of Health and Family Welfare, Government of Odisha and provide such

space which will be utilized to

o Provide preventive & outreach services at each of these locations and

o Staff and operate separate administrative unit at the sites for the services to be provided by them

The Authority has specified the minimum and maximum number of beds that can be constructed at the

respective sites as below

Location Mancheswar Kapilaprasad Bharatpur Brahmeswar

Patna

Rasulgarh Gadakana

Facility Hospital Hospital Clinic Hospital Hospital Hospital

Minimum beds 300 100 10 30 30 30

Level of care Secondary &

Tertiary

Primary &

Secondary Primary

Primary &

Secondary

Primary &

Secondary

Primary &

Secondary

Operations & Management:

The Private Player shall be solely and exclusively responsible for the entire operations, maintenance &

management of the project during the concession period.

The Concessionaire shall operate and maintain the Project to comply with operation & maintenance

requirements as set forth in this concession agreement, good industry practice and applicable laws

It will ensure that NABH accreditation shall be obtained for all facilities within 36 months from COD

and all facilities shall meet the NABH standards during the concession period.

The private player shall also operate at least 20 SNCUs in the network and mandatorily provide family

planning clinic at all existing dispensary sites.

The private player will integrate with the current IT systems of DoHFW, NRHM & OSTF for reporting and

operations.

Treatment of Select Patients and applicable tariff

The private operator shall provide medical care to a minimum proportion of Government identified

patients (Select patients) at discounted rates and to General Patients at market rates determined by it.


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The concessionaire shall treat the Select Patients for bed days equivalent to minimum committed % of total

patients bed days in the individual hospital as per the Selection Bid.

The tariff applicable for different categories of patients are provided below

Particulars Patient

Category Multispecialty hospital Other hospitals in network

OPD facilities

Select Patients

o OPD consultation will be provided at 50% discount to CGHS rates to Select Patients at Greenfield multispecialty hospital

o OPD procedures and diagnostics will be charged at a tariff of 50% of CGHS rates.

o OPD consultations will be free for all patients during first half of the day i.e. between 8:00 AM to 2:00 PM. At other times of the day, market rates will be applicable for OPD consultations.

o OPD procedures and diagnostics will be charged at a tariff of 50% of CGHS rates.

General Patients

o Market rates will be applicable for OPD consultations, procedures and diagnostics for General Patients

o OPD consultations will be free for all patients during first half of the day i.e. between 8:00 AM to 2:00 PM. At other times of the day, market rates will be applicable for OPD consultations.

o Market rates will be applicable for OPD procedures and diagnostics for General Patients.

Inpatient Facilities

Select Patients

o Minimum bed days assigned to Select Patients for treatment to be determined by the bid

o Select Patients will be treated under RSBY scheme for treatments up to Rs 30,000 as per RSBY rates.

o For treatment costing more than Rs. 30,000, CGHS rates for Bhubaneswar will be applicable and payment will be made from various government backed schemes as mentioned in subsequent sections.

o Minimum bed days assigned to Select Patients for treatment to be determined by the bid

o Select Patients will be treated under RSBY scheme for treatments up to Rs 30,000 as per RSBY rates.

o For treatment costing more than Rs. 30,000, CGHS rates for Bhubaneswar will be applicable and payment will be made from various government backed schemes as mentioned in subsequent sections.

General Patients

o Market rates will be applicable for Inpatient services for General Patients.

o Market rates will be applicable for Inpatient services for General Patients.

The hospital network shall be empanelled under existing schemes such as

o Odisha State Treatment Fund (OSTF)

o Rashtriya Swasthya Bima Yojna (RSBY)

o Biju Krushak Kalyan Yojna (BKKY)

It is to be noted that as per the guidelines for obtaining assistance under OSTF patients must be referred

from Govt. Medical College or by the CDMOs / CMOs to get admitted in private hospital. Further, as per the

guidelines, patients cannot be referred to a private hospital if similar facilities are available in government

hospitals in the state.

Obligations of BMC

BMC will be responsible for


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Providing right of way to the sites at the 5 existing dispensaries and the land earmarked for green field multi

specialty hospital to the private player

Provide Viability Gap Funding (VGF) of 20% of the project cost with an upper cap of Rs 51.0 Cr as per the

provisions of the Concession Agreement.

Provide utility infrastructure in terms of water connection, power supply, and sewerage network

Monitor KPIs defined in the concession agreement

Re-deployment of existing staff. The private player shall not be required to retain any existing employees at

the hospital or dispensaries.

Assure payment for Select Patients to the private operator on time

The obligations of the parties have been described in detail in the Concession Agreement

project information memorandum - bmc.gov.inbmc.gov.in/download/keyprojects_05072016062039pm.pdf ·...

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