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Upchaar

Upchaar is a financing assistance program for providing low cost funds for treatment especially in case of elective surgeries and hospitalizationso as to ensure that disease burden should not result in the financial burden for the individual and family.Under this program various surgical centerswill be developed in tier-1 or metro cities where surgical treatment shall be provided to majorly economically weaker section of society free of cost with the help of funds accumulated via donations and CSR.


AIM:

To assistall the patients requiring surgical or hospitalization intervention receive it irrespective irrespective of their social status, financial status or their geographical distribution


OBJECTIVE:

To ensure all the patients requiring elective surgeries and hospitalizationand have affordability issues should have access to such facilities and they receive respective treatmentsthrough financial assistance provided under Upchaar program by Community Health Mission.


FUNCTIONING:

Community Health Mission will dofollowing to achieve their objective

Develop network of hospitals in various cities where surgeries can be performed and ensure that surgeries are performed for the needy patients at least possible cost. Also provide financial assistance to the patients for the surgeries.



Develop its own owned surgical centres which are managed by competent healthcare management companies or group of doctors, where elective surgeries are performed for needy patients at least cost or free of cost by taking support from the corporates, HNI’s and other agencies in the form ofdonations and CSR.

Promote the Upchaar program among socioeconomically weaker section of society so that they are able to avail such services as and when they require based on the laid criteria selection.




Projects

Standalone 35 beds Surgical centre at Delhi

Achievements

Building for the surgical centre identifiedat Shri Ram Hospital and Diagnostic centre, Raghu Nagar, Pankha road, West Delhi and agreement with the ownerhas been done

The management team for operating the centre identified

Surgeons for the centre identified

Basic laboratory services, OPD services,pharmacy and Physiotherapy services started

Marketing drive of promotion of the UPCHAAR Program started

Reequipments

Renovation of the building as per requirement of Surgical centre

Procurement of Equipment

Operational funds

Projects

Stand-alone 50 beds Surgical centre in Guwahati, Assam

Achievements

Building for the surgical centre identifiedat GS Road, Guwahati

The management team for operating the centre identified

Surgeons for the centre identified

Reequipments

Agreement for the building is to be done.

Renovation of the building as per requirement of Surgical centre

Procurement of Equipment

Operational funds

Projects

Stand-alone 50 beds Surgical centre inLucknow, Uttar Pradesh

Achievements

Land for the surgical centre has been identified and to be procured

Reequipments

Agreement with the landowner

Development of the building as per requirement

Procurement of Equipment

Operational funds

PROJECT PROPOSAL FOR 35 BEDS STAND-ALONE SURGICAL CENTER

In India with more than 1 billion population there is high requirement of healthcare infrastructure and healthcare services across the country. Despite central and state government’s continuously efforts on increasing healthcare footprints in the urban and rural areas there is still a huge gap between the requirement and availability.


The present government healthcare infrastructure is under continuous stress of providing treatment to critically ill patients and patients suffering from acute diseases. The same is true in case of surgeries as well where immediate attention is given to acute and critically ill patients requiring immediate surgery. Hence, there is long waiting period for performing elective surgeries.


Secondly there is affordability issue with weaker section of society to get the surgical treatment. The government of India has taken various steps to provide financial assistance for healthcare services to the weaker section of society by

(a) putting cap on various prostheses like knee replacement and hip replacement prostheses, Cardiac stents, etc.

(b) by enlisting various drugs in essential category and putting a cap on the MRP of these drugs,

c) buy starting Ayushman Bharat Scheme a financial assurance scheme which ensures provision of up to 4 lack INR for the healthcare treatment to 40 crore population categorised under low SEC section. ,

Due to this the patients requiring elective surgeries keep on suffering from their disease for longer period of time and results in very poor quality of life and low expectance. Hence Community Health Mission under its UPCHAAR Program proposes to establish a 35 beds Surgical centre at West Delhi, in line with AYUSHMAN BHARAT SCHEME of Govt. Of India and provide necessary elective surgical treatment to low SEC Category patients and there by enhance their life expectance and quality.


This report is prepared with an objective to provide basic information about surgical centre.

1. Project at a Glance

2. Cost of development of the Surgical Centre

3. Space plan and Location of the Centre

4. Services offered in the hospitals

5. List of hospital equipment requirement with estimate cost

6. Number of medical/ paramedical/non-medical staff required

7. Estimated Number of patients under each category who will be treated

8. Operational cost of the Surgical centre

9. Estimation of cost of project

10. Patient selection criteria in brief

11. Scope of roles and responsibility of CHM and Operations Management company The report establishes the economic viability of the project. Ensuing sections of this report discuss aspects of this project.


Name of the Organization COMMUNITY HEALTH MISSION
Registered Office 510, 5th Floor, Jaina Towers-2, District Centre, Janak Puri, New Delhi 110058
Type of Organization Section 8 not for profit company registered as per companies act of 2013
Certificates 12 A, 80G
Name of the Centre Nirog Bharat Surgical Centre (Shriram Hospital & Diagnostic Centre)
Location RZ-2, Raghu Nagar, Pankha Road, Near Dabri Mord, West Delhi, Delhi - 110048
No. Of Floors Ground + 3 floors
Space Available Total Plot area – 250 Sq. Yd. Ground Floor – 2250 Sq.ft.; First Floor – 1800 Sq.ft.; Second Floor - 1800 Sq.ft.; Third Floor – 1800 Sq.ft.
Facilities 35 beds with 6 ICU/HDU beds and 2 Operation Theatre, OPD, Pharmacy, Radiology, Pathology & Physiotherapy
Cost of Renovation ₹ 78,30,000/- (Seventy-eight lakh thirty thousand only)
Cost of Equipment ₹ 4,50,73,000/- (Four crore fifty lakh seventy-three thousand only)
Total Cost of Development ₹ 5,47,03,000/- (Five crore forty-seven lakh three thousand only)
Number of Patients provided OPD service in a year More Than 25000 patients

SCOPE OF SERVICE

01

Type Of Services

OPD Service, Dentistry, Physiotherapy, X-Ray & Ultrasound, Advance Pathology, Pharmacy, IN – Patient service, Surgical
Operation Theatre

02

Departments

General Surgery, Gastroenterology, Orthopaedics, Urology, Gynaecology, ENT, Ophthalmology, Medicine, Anaesthesia, Dental Surgery


SPACE ALLOCATION

Floors Description Qty
Ground Floor    
Reception + Waiting Area 1
OPD Rooms 5
Ultra sound room 1
X-Ray Room 1
Phlebotomy/Procedure Room 1
Physiotherapy room 1
Pharmacy 1
Public Toilets 3
     
First Floor   Beds
Dental Room 1
Pathology Laboratory 1
Pvt Rooms 5
General Ward 5
Nurse Area 1
Floors Description Qty
Second Floor   Beds
Pvt Rooms 0
General Ward Beds 20
     
Third Floor OT 2
CSSD Room 1
Pre-Post OP Beds 4
Pvt Rooms 2
ICU/HDU 2
     
Roof Water Tank  
Solar heaters  
DG Set  
Online UPS  
Water Tanks  
Fire Tanks  


LIST OF MEDICAL EQUIPMENT REQUIRED

Medical Equipment Quantity
X-Ray + CR System 1
USG 1
Dental Set Up 1
Full Lab Setup 1
Patient Bed & Accessories 54
Bed Alarm System 1
Modular OT 3
OT Tables & Lights 3
Anaesthesia Machines (Type 1) with Ventilator 2
Anaesthesia Machines (Type 2) 1
Operating Instruments 1
CSSD Set Up 1
Laparoscope 1
Medical Equipment Quantity
Cautery 4
Microscope Operating 1
Endoscopy Set 1
C-Arm Machine 1
Suction Machines 54
MGPS system 1
Mobile USG 1
Monitors 12
ABG Machines 1
Defibrillators 4
Other Misc. Equipment 1
ECG Machine 2
Ambulance ALS 1


LIST OF NON-MEDICAL EQUIPMENT REQUIRED

Non-medical Equipment Quantity
Generator 1
Online UPS 1
Solar System for Hot Water 1
Fire System 1
STP 1
Patient Lift 1


STAFF REQUIREMENT

Unit Head 1
Operations In-charge 1
Medical Officer 1
Pathologist 1
Customer Care  
Executives 4
IPD Billing Executive 2
OT Nurse + Technician  
Senior 1
Staff 1
Junior 2
OT Technician 1
ICU Nurse  
Senior 1
Staff 4
Junior 7
Ward + OPD Nurse
Senior 1
Staff 8
Junior 11
Path Technicians  
Senior 1
Staff 2
Junior 2
Imaging Technician 1
USG Executive 2
Security Personnel 3
House Keeping Staff 6
Maintenance 1
Sales Team 4
   
Total Manpower Required 69

Doctors Number
Orthopaedics 1
Asst Ortho 1
ENT 1
Asst ENT* 1
Ophthalmology 1
General Surgery 1
Asst General Surgery* 1
Gastroenterologist 1
Urology 1
Gynaecology 1
Medicine 1
Registered Medical Practitioner 4
Anaesthetist 3
Dental Surgeon 1
Physiotherapist 2
Radiologist 1
Doctor's Required 22


EXPECTED PATIENTS TO BE TREATED IN OPD AREA QUATERLY FOR A YEAR

No of Patients treated on OPD Basis
Per Month Patients in OPD QTY 1 QTY 2 QTY 3 QTY 4 Total Patient Treated Per Year
OPD 3240 5904 7992 8640 25776
X-Ray 972 1771 2396 2592 7731
USG 810 1476 1998 2160 6444
Physio 80 126 171 197 574
Dental 150 295 465 567 1477
Pathology 1400 2644 3641 4062 11747
Pharmacy 3150 6652 9373 10878 30053
Minor Treatment 205 554 1042 1296 3097

No of Patients treated on OPD Basis
Per Month Patients Operated and
Admitted in IPD
QTY 1 QTY 2 QTY 3 QTY 4 Total Patient Operated Per Year
Orthopaedics         206
Arthroscopy 5 9 12 12  
TKR/ THR/ Shoulder 9 15 18 18  
Other Surgical Procedures 14 23 27 27  
Spine 2 3 6 6  
ENT         144
Head & Neck Surgery 4 8 9 9 144
Other Surgeries 18 29 33 34  
Ophthalmology 23 39 43 45 150
General Surgery         438
GI Surgery 24 40 45 48  
General Surgery 35 59 67 70  
GI Endoscopy 8 12 15 15  
GI Medical Treatment 0 0 0 0  
Urology 44 75 85 88 292
Gynaecology 35 56 64 67 222
Medical Line Of Rx 0 0 0 0 0
Total IN Patients 221 368 424 439 1452


FINANCIALS

Annual Operational Expenditure
  QTY 1 QTY 2 QTY 3 QTY 4 Total Annually
Staff Cost 44,25,000 44,25,000 44,25,000 44,25,000 1,77,00,000
Doctors Cost 51,30,000 51,30,000 51,30,000 51,30,000 2,05,20,000
Cost of Drugs & consumables for Surgeries 34,42,700 57,50,900 66,55,400 68,67,500 2,27,16,500
Administrative Cost 62,28,031 72,85,386 79,03,296 81,27,891 2,95,44,604
Total Expenditure 1,92,25,731 2,25,91,286 2,41,13,696 2,45,50,391 9,04,81,104

Staff cost includes salaries for all the medical and Para-medical staff excluding the doctor’s Charges.

Doctors Cost includes the doctor’s charges for providing OPD service, performing Surgeries and management of IPD patients pre & post surgeries

Administrative cost includes all the cost pertaining to running the facility, management company fees and performing the promotional work.



FUND REQUIREMENT

Project Cost
One Time Development Cost     5,47,03,000
  New Construction    
  Renovation 78,30,000  
  Equipment (Capital assets) 4,68,73,000  
Operational Expenses for 1 year     9,04,81,104
  Staff Cost 1,77,00,000  
  Doctors Cost 2,05,20,000  
  Cost of Surgery 2,27,16,500  
  Administrative Cost 2,95,44,604  
Total Project Costt     14,51,84,104

These funds are required for establishing the surgical centre and operating the same for 1 year period.

Functioning of the Centre

COMMUNITY HEALTH MISSION (CHM) has already taken the possession of the facility on rental basis.

CHM will develop and commission the entire infrastructure for stand-alone surgical centre

CHM will engage a hospital management organization who will be responsible for managing and operating the entire surgical centre and ensure the treatment is provided to the needy as per the instructions of CHM

Team of CHM will be responsible for promotion of UPCHAAR program among the catchment area focusing on the lower SEC category population who are in need of elective surgeries. The selection of the patient will be done as per the selection policy laid down by CHM.

CHM will get the surgical centre accredited to NABH standards and will ensure that the centre is enlisted under AYUSHMAN BHARAT Program of Government of India.

The focus of the surgical centre will be to provide surgical service to patients of lower section of society who need elective surgeries.

The catchment area for the centre is Delhi NCR, Haryana, parts of western Uttar Pradesh.

Based on the principals of Ayushman Bharat centre will provide surgical treatment to other section of the society also.

Key Selection criterion for the patients to be supported for free of cost surgery treatment is as following:

(a) The patient should be from lower socio-economic background as per the government criteria SEC Classification.

(b) The patient should be from within the catchment area of 100 km radius of Delhi NCR

(c) Patient should have been advised to undergo an elective surgical procedure either by any government institute or by the consultants at the surgical centre.

(d) The patient is been referred by registered medical practitioner or a medical institute.

(e) The treatment should be able to enhance the life expectancy of the patients as well as increase the quality of life.

(f) The procedure to be performed on the patient should be covered under the Ayushman Bharat program.

Community Health Mission Common to both Operation’s Partner
Provide all assets form
• Land
• Commissioned Building
• Equipment
• Furniture/ fixtures
Following service vendors will be selected by mutual consent in order to ensure best quality of quintessential support services-
HMIS/ LMIS- as it needs to have interface which can be integrated with CHM network application which will operate externally around the hospital
Secured Data (Internet) provider services
Cyber Security services/ software/ applications
Facility Management- Engineering, Housekeeping, Security, Ambulance Drivers, Vehicle services workshops
Equipment AMC, CMC, repair vendors/ agencies
Legal services professional/ company
Medicolegal services professional/company
Audit services- legal, financial & medical
Pharmacy/ Chemist
Develop the Policy & Procedure Manual with all byelaws, rule, regulations & process, protocols for achieving accreditation (NABH & NABL at least)
Facilitate & obtain all required licences as per the law of the land for running healthcare services (Surgical Centre) Recruit best talent for delivering services and train them to achieve optimum capability of performing in accordance to the industry standards
Provide required funds on monthly basis or per surgery basis to ensure smooth functioning of the surgical centre Responsible for operative management of the facility as per the agreed DPR & the projections/ forecast done up professionally
CHM team will create awareness on the UPCHAAR Program among masses in the catchment area so that maximum eligible patients can avail the services at the Centre Prepare budget and execute all plans as required to achieve the same
Monitor & audit from perspective of the cause/ purpose of CHM. To make healthcare more accessible, affordable & accountable. Promote financial inclusion principles, insurance, assurance in healthcare practices especially within the network in catchment zone of the Surgical Centre All administrative, clinical, marketing, Branding, facilities management & all other support & allied services as required
Audit services- legal, financial & medical Pricing/ Tariff structure to be kept affordable and be developed on activity-based costing methodology. Package pricing should be done with clarity on inclusion & exclusions. Pharmacy shall essentially keep generic medicines for economically weaker classes so that they can afford the same
Payment of all the taxes as applicable Enrolment of the centre under various government programs like Ayushman Bharat, CGHS, DGHS, etc. Offer free services in OPD & IPD as per scope of service of the Surgical Centre and provide service to under privileged/ socioeconomically weaker class under UPCHAAR Program