Community Health Center

1. Operations & Management of
Community Health Centres
under PPP Mode
Community health Centers & District Hospitals
outsourced in public private partnership

2. Project Structure
S No Particulars Description
1 Project Owner Department of Medical Health & Family Welfare
2 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 cases
c) Surgeries /Orthopedic
d) Minor Injuries
e) In Patient Services
7
Monitoring
Arrangement
a) Expert Committee like PwC or E&Y etc.

3. Clinical Staff
Sr.
No.
Clinical Staff Number
1 General surgeon 1
2 Physician 1
3 Obstetrician & Gynaecologist 1
4 Paediatrician 1
5 Radiologist 1
6 Orthopaedic 1
7 ENT surgeon 1
8 Anaesthetist 1
9 Eye surgeon (1 for every CHC) 1
10 Dental surgeon 1
11 General duty medical officer 2
12 Staff Nurse 10
13 Maternity assistant (ANM) 2
14 Total 24

4. 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 time
Recruit, retain and manage qualified and experienced medical human
resource
IT-based Management Information Systems to manage the hospitals and
inventory.
Maintenance of all movable and immovable assets of the hospital
Abide by the existing Government laws/ rules and policies
Undertake all statutory responsibilities
Timings - OPD (8.00 AM to 4.00 PM) and Diagnostic (8.00 AM to 8.00 PM).
Emergency 24 X 7

5. Identified Services for PPP Partner
Clinical 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 & Laundry
Hospital Waste Management, Pest Control and Sterilisation Services
Clinical Record Keeping, Security, Patient discharge process
Minor Repairs
Out of Scope for Private Partner
Medico legal cases
Promotion and management of Government health schemes
Ambulance services
Collection of user charges
Major Repairs due to ageing and natural disaster

6. 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

7. Selection Process of PPP Partner
OPTION 1: One stage-two bid process :
 Technical
 Financial
Basis to evaluate Technical Experience
Number of years of experience in managing similar facilities
Size 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

8. 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

9. 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&FW
This would not include any non medical appliances, equipments,
consumables, instruments – measuring or otherwise, furniture,
software/hardware
The requirement, specification and cost of equipment would be
reviewed and verified by the Government
All such Procurements would be guided by Uttarakhand Procurement
Rules 2008

10. 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

11. Key Performance Indicators
Payment 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
consumabl
es/reagent
s
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
equipment
s
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

12. Key Performance Indicators
Scoring 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)

13. Termination Payments on DOMH&FW Event of
Default
 The Concessionaire shall be entitled to revoke the
Performance Security, if subsisting

14. Project Monitoring
Expert Committee
i. Representative of DOMH&FW not below the rank of Additional
Secretary
ii. Two super specialist doctors from hospital
iii. 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