This document summarizes a new initiative in India that provides free laboratory services through public-private partnerships. Under the initiative, over 1,100 public health centers, 190 community health centers, 30 area hospitals and 8 district hospitals will offer free diagnostic testing. Tests will either be performed on-site by existing lab technicians or outsourced to 80 new labs established by a private provider. The private provider is responsible for establishing and operating the labs, sample transportation, and reporting results back to the public facilities. The initiative aims to reduce out-of-pocket healthcare expenses and improve access to diagnostics for poor populations.

1. January 28, 2016 [NOTES ON 5 NEW INITIATIVES_NHM]
Notesfor the sensitization workshop on 5 new initiatives (29.01.2016) 1
Notes for Sensitization workshop on New Initiatives
NTR Vaidyapariksha-Free Laboratory Services
Objective
 It has been established that 40% of out of pocket expenditure in OPDs and
up to 15% in IPDs is due to lack of diagnostics, leading to high levels of
dissatisfaction among health seekers.
 It has also been realized that providing these diagnostic services would
drastically reduce the out of pocket expenditure of the poor.
 Hence under NHM support, free diagnostics program has been initiated in
PPP mode.
Coverage
 The free Diagnostics programme would be implemented in all 1186 PHCs,
192 CHCs, 31 Area Hospitals, and 8 District Hospitals.
 However teaching hospitals would not come under this programme since
NHM does not support tertiary care hospitals.
Strategy
 Under this programme the tests that are not currently done in the facilities
such as PHCs, CHCs, AHsand DHs would alone be outsourced.
 The tests that are being done currently, would continue to be carried out
by the available Lab Technicians in those facilities.
 Tests that are in high volumes and low cost will be performed within the
public facility by existing Lab Technicians.
 High cost and low volume tests for which no equipment is available are
outsourced.
 Only tests that are not currently provided in PHCs/CHCs &DHs, are
outsourced.
 Hence this arrangement will not weaken the existing capacity available at
the public health facilities.
 The tests so outsourced are not meant for general screening and those
tests would be prescribed to the patients who visit public health facilities.
 The payment shall be made per sample, basis only regardless of the no of
tests performed with the same sample.
Test for diagnosing Haemoglobinopathies in tribal areas is included from
AH and above in the present package for the first time in the Country.
M/s. Medall Healthcare Pvt Ltd, is service provider for Laboratory Services

2. January 28, 2016 [NOTES ON 5 NEW INITIATIVES_NHM]
Notesfor the sensitization workshop on 5 new initiatives (29.01.2016) 2
Details of the programme
 The service provider (M/s. Medall Healthcare Pvt Ltd) would establish 80
labs across the state and out of which 39 labs will be high end labs
catering to the requirements of Area hospitals and District hospitals and 41
labs are low end labs to cater to the requirements of CHCs and PHCs.
 The labs so established would be reachable within half an hour from the
public facility.
 The service provider will provide all Clinical equipment, Application
software, Billing, Sample collection, Sample management, Laboratory
Equipment Management, Laboratory quality controletc along with a trained
manpower and supervisor for quality check.
 31 Labs serving AH and DH were Inspectedby appropriate authorities to
ensure quality of services. The remaining Labs will also be inspected as
soon as they were established.
 The reports generated from the facilities of the service provider would also
be cross checked for ensuring quality, in order to achieve this about 1% of
the sample collected every day would be sent for a third party check.
 The service provider will provide trained phlebotomists during the working
hours for blood collections in all hospitals including PHCs(1186),
CHCs(192), AHs(31) and DHs(8).
 A phlebotomist arranged by the Service Provider would be stationed in all
the public facilities and who collects the samples and sends the same to
the nearest laboratory.
 The results reported shall be reported back to the public facility by using
both online with digital signature/email and also a hard copy to be handed
over personally by the service provider.
 The service provider will be responsible for the safe transportation of the
samples to the processing centers.
 The service provider would provide access to full MIS with analytics of top
10 diseases, complete pattern of diseases on a real time basis with drill
down reports upto Panchayat Level.
 The service provider is also required to provide institution wise analytics
for PHCs, CHC, Area Hospital and District Hospitals.
Key performance Indicators
District level:
1. No of laboratory cases reported in three categories –PHCs; CHCs; AH
and DH

3. January 28, 2016 [NOTES ON 5 NEW INITIATIVES_NHM]
Notesfor the sensitization workshop on 5 new initiatives (29.01.2016) 3
2. Turnaround time of reported laboratory cases in four categories –
PHCs;CHCs; AH and DH
3. Number of laboratory cases reported beyond turnaround time
4. Facility with the highest number of laboratory cases
5. Facility with lowest number of laboratory cases
6. Total Count of laboratory cases repeated within 7 days – FACILITY wise
7. Total count of ‘badly taken laboratory cases on which report could not be
given- FACILITY wise
8. Total count of ‘Critical Result’ reported in the laboratory cases facility wise
9. Normal and Abnormal results ratio (percentage value) for all three
categories –PHCs, CHCs, AH and DH- Facility wise
 The service provider is responsible for the 7 tests in PHCs, 21 tests in
CHC’s and 41 tests in AH& DHs. Wherever Lab Technicians are not
available the service provider would conduct all the prescribed tests.
Type of
Facility
No. Of
Facilities
No of
In house tests
Number of Tests
out-sourced
DH 8 19 41
AH 31 19 41
CHC 192 16 21
PHC 1156 12 7
 39 labs have been already established on priority basis to cater to the
Area hospitals and District hospitals where these services are ready for
launch.
Details of the in-house and Outsourced Tests:
A. List of laboratory tests at PHC (19)
S.No In house Tests at PHC
in the PHC
Tests Outsourced in PHC
1 Hb Estimation
2 MP slide method
3 ESR
4 Clotting time & Bleeding time
5 Blood group
6 Blood sugar
7 HIV Test
8 Sputum for AFB

4. January 28, 2016 [NOTES ON 5 NEW INITIATIVES_NHM]
Notesfor the sensitization workshop on 5 new initiatives (29.01.2016) 4
9 Malaria Rapid Test
10 Urine Sugar & Albumin
11 Urine Pregnancy test
12 HBsAg
13 TLC
14 DLC
15 Platelet count
16 S. Bilirubin
17 Rapid Plasma Reagin (RPR)
18 Dengue Rapid test
19 Stool for ova and cyst
B. List of laboratory tests at CHC (40)
In house Tests in the CHC Tests outsourced in CHCs
Hematology
1 Hb
2 TLC
3 DLC
4 MP (Slide Method)
5 ESR
6 ABO – Rh
7 CBC
8 TRBC
9 Packed cell volume
10 Platelet Count by Cell Counter
11 Prothrombin time test and INR
Serology
1 HIV rapid test
2 Malaria rapid test
Urine
1. Urine Sugar and Albumin
2. Urine Microscopy
3 Urine complete by strip method

5. January 28, 2016 [NOTES ON 5 NEW INITIATIVES_NHM]
Notesfor the sensitization workshop on 5 new initiatives (29.01.2016) 5
Clinical Pathology
1. Urine Pregnancy test
2 Stool for ova & cyst
Biochemistry
1. Blood Sugar
2 Blood Urea
3 S. Creatinine
4 S. Bilirubin (T)
5 S. Bilirubin (D)
6 SGOT
7 SGPT
8 S. Alkaline Phosphatise
9 S.T. Protein
10 S. Albumin
11 S.T. Cholesterol
12 S. Triglycerides
13 S.VLDL
14 S.HDL
15 S. Amylase
16 RPR Rapid test
17 Dengue rapid test
Microbiology
1. Sputum for AFB
Cardiology
1. ECG
C. List of laboratory tests at District / Area Hospitals(63)
In house Tests in AH/DH Tests outsourced in AH/DHs
Hematology
1. Hb Estimation
2. TLC
3. DLC
4 MP – Slide method
5. ESR
6. PFB
7. Blood group
8 CBC
9 Peripheral blood smear
10 Total Eosinophil count
11 Total red Blood cell count

6. January 28, 2016 [NOTES ON 5 NEW INITIATIVES_NHM]
Notesfor the sensitization workshop on 5 new initiatives (29.01.2016) 6
12 Platelet count by cell counter
13 PCV
14 Coomb’s test – direct
15 Coomb’s test – indirect
16 Prothrombin time test and INR
Serology
1. RPR Rapid test
2. HIV Rapid test
3 Malaria Rapid Test
4. HBsAg(Rapid) Test
5 Dengue Rapid Test
6 Rheumatoid Factor
7 Anti streptolysin
8 S.CRP
Tests Mandated in the hospital
Haemoglobinopathy
Biochemistry and Immunoassay
1. Blood sugar
2. Serum creatinine
3. S. Bilirubin (T)
4 S. Bilirubin (D)
5. Blood Urea
6. SGOT
7. SGPT
8 S. Alkaline Phosphatase
9 S.Total Protein
10 S. Albumin
11 S. Calcium /Potassium / Sodium
12 Troponin - I / Troponin – T
13 S.LDH
14 S. Amylase
15 S. Uric Acid
16 S. Total Cholesterol
17 S. Triglycerides
18 S.VLDL
19 S.HDL
20 TSH
21 HbA1C

7. January 28, 2016 [NOTES ON 5 NEW INITIATIVES_NHM]
Notesfor the sensitization workshop on 5 new initiatives (29.01.2016) 7
Clinical Pathology
1 Urine Pregnancy test
2 Stool for ova & cyst
3 Fluid (CSF, ascitic, pleural) cell
count & Biochemistry4 Semen Analysis sperm count
Urine Analysis
1 Urine sugar and albumin
2 Urine microscopy
3 Urine complete by strip
Microbiology
1 Sputum for AFB
2 Blood Culture
3 Urine Culture
Pathology
1 Histopathology
2 Cytology
3 Bone marrow aspiration
Cardiology
1 ECG
Responsibility of Medical Officers of PHC / Superintendents or RMOs of
CHC,AH,DH:
 To allow the M/s. Medall Healthcare Pvt Ltd, to start collecting samples by
the phlebotomist arranged by the Service Provider
 Phlebotomist would be stationed in all the public facilities and who collects
the samples and sends the same to the nearest laboratory.
 Test results will be sent back to the facility by mail and a signed hard copy
by the service provider.
 To verify weather all results are coming within the TAT .
 District management(DM&Hos/DCHS) shall monitor the services provided
by service provider at facilities and ensure quality services are delivered in
time.
Free Laboratory Services were launched by Hon’ble CM on 1st
january 2016 in
all DH and AHs.
Free Laboratory Services will be extended to all CHCs and PHCs from 21st
to
31st
January in phased manner .

8. January 28, 2016 [NOTES ON 5 NEW INITIATIVES_NHM]
Notesfor the sensitization workshop on 5 new initiatives (29.01.2016) 8
NTR Vaidyapariksha - Tele Radiology & CT scan Services
Objective:
 It has been observed in most of the hospitals though X-Ray Machines are
available they are not put to use either due to the absence of qualified
radiologists or dysfunctional equipment resulting in hardships to the patients.
 In view of this, to obviate this chronic problem, it has been decided to extend
quality radiology services in 113 locations by providing access to the radiology
services within the facility thereby enabling the patients to minimise their Out
of Pocket expenditure.
Strategy:
 The X-Ray Machines which are lying idle either because of non-availability of
Radiographer or qualified Radiologist or non-functioning of the existing
equipment due to various reasons, would be made operational through PPP
mode.
 In addition to the existing X-ray machine either Computerised Radiography
unit or Image Digitiser would be arranged in the facility by the service provider
and the same will be established online connectivity with a remote hub where
expert radiologist is available for obtaining expert opinion there by all the
existing radiology equipment will be brought under use and also enables the
patients to get radiology services wetted by a qualified radiologist free of cost.
M/s. Krsna Diagnostics Pvt Ltd is the service provider for Tele radiology
Services.
Coverage:
 This facility will be made available in CHCs, Area and District Hospitals across
the State of Andhra Pradesh totalling 113 locations.
Details of Programme:
 Under this intervention, the service provider will provide Tele radiology
services through digitization of X-ray film, transmission of the data through
Licensed Software.
 In the remote hub a qualified radiologist will do the study using FDA & CE
approved Tele-radiology platforms and detailed report with digital signature
will be sent back online to the institution.

9. January 28, 2016 [NOTES ON 5 NEW INITIATIVES_NHM]
Notesfor the sensitization workshop on 5 new initiatives (29.01.2016) 9
 X-Ray Image taken will be converted into a digital image either through
Computerized Radiography unit or a digitizer. The digitized image will then be
transmitted to a remote hub where qualified radiologist downloads the image
and reads the image. Detailed study with opinion of Radiologist will then be
sent back to the facility of origin online immediately.
 This process enables the doctors to diagnose the actual ailment for better
treatment.
 Report will be made available online and hard copy will be made available in
the institution where the sample is collected for the benefit of the patient.
 This initiative will not only reduce out of pocket expenditure of the patient but
also saves time.
 District management shall monitor the services provided by service provider
at facilities.
Tele radiology services in all 113 locations will be ready by 1st
January2016.
Key Performance Indicators to Tele Radiology
1. Number of X-rays reported per District
2. No of X-rays reported in three categories – CHCs; AH and DH
3. Turnaround time of reported X-rays in three categories – CHCs; AH and
DH
4. Number of X-ray reported beyond turnaround time
5. District with the highest number of X-ray cases
6. District with lowest number of X-rays cases
7. Facility with highest number of X-rays
8. Facility with lowest number of X-rays
9. Total Count of X-rays repeated within 7 days – FACILITY wise and district
wise
10. Total count of ‘badly taken X-rays/inadequate exposure etc’ on which
report could not be given- district wise and FACILITY wise
11. Total count of ‘Critical Result’ reported in the X-ray- district wise
12. Total ratio (percentage) of Normal vs abnormal results district wise
13. Facilities with dysfunctional X-rays district wise
District level:
14. No of X-rays reported in three categories – CHCs; AH and DH
15. Turnaround time of reported X-rays in three categories – CHCs; AH and
DH
16. Number of X-ray reported beyond turnaround time
17. Facility with the highest number of X-ray cases
18. Facility with lowest number of X-rays
19. Total Count of X-rays repeated within 7 days – FACILITY wise

10. January 28, 2016 [NOTES ON 5 NEW INITIATIVES_NHM]
Notesfor the sensitization workshop on 5 new initiatives (29.01.2016) 10
20. Total count of ‘badly taken X-rays/inadequate exposure etc’ on which
report could not be given- FACILITY wise
21. Total count of ‘Critical Result’ reported in the X-ray- facility wise
22. Total ratio (percentage) of Normal vs abnormal results facility wise
23. Facilities with dysfunctional X-rays district wise
Responsibility of Superintendents or RMOs of CHC,AH,DH:
 To allow M/s. Krsna Diagnostics Pvt Ltd to start the services in all 113
locations
 District management(DM&HOs/DCHS) shall monitor the services provided by
service provider at facilities and ensure quality services are delivered in time.
Free Tele Radiology Services were launched by Hon’ble CM on 1st
january 2016
CT SCAN SERVICES
Objectives:
 Advanced Radiology services such as CT scan is required to be made
available to the patients at every District Hospital for accurate diagnosis of
certain health conditions.
Coverage
 Currently out of eight District Hospitals CT is available only in four locations,
hence it is decided to extend CT facility in the remaining DHs: Tekkali in
SrikakulamDt, Cheerala in PrakasamDt, Proddutur in KadapaDt and Gudur in
Nellore Dt.
Strategy:
 Providing the CT Scan Services under PPP mode at 4 District Hospitals
where CT Scans are currently not available.
M/s. Krsna Diagnostic Pvt Ltd is the service provider for CT scan Services
Programme Details:
 Service provider will provide CT Scan Machines at all four locations along with
the interiors and other amenities including HT Power Connection and power
back up.

11. January 28, 2016 [NOTES ON 5 NEW INITIATIVES_NHM]
Notesfor the sensitization workshop on 5 new initiatives (29.01.2016) 11
 Qualified Radiologists and supporting staff will be positioned by the service
provider. All reports will be generated in the facility itself by availing the in-
house expertise provided by the Service provider.
CT scan services in Tekkali in SrikakulamDt,Prodduturin kadapaDt will be ready by
1st February 2016.
102 CALL CENTRE:
Objectives:
1. Ensuring the delivery of Comprehensive Services related to pregnant,
postnatal women and Infants by creating awareness on various services they
are entitled to receive freely from Government.
2. Handholding all the high risk pregnant women in availing every service from
public health facility.
3. Reduction of Maternal and Infant deaths through continuous monitoring of
Maternal & Child Health Services.
4. Improvement in quality of RCH services provided by the public health facilities
5. Demand generation on services and entitlements.
Strategy:
A centralised 24X7 Health Help Line dedicated for pregnant and postnatal women
would be established for monitoring the Services provided to the Pregnant Women
with special focus on High Risk Pregnant Women.
M/s. GVK EMRI is the service provider for 102 Services
Programme Details:
The Service provider will establish call centre with 30 seater capacity housed with
Para medial & Medical staff at a centralised location. He shall providing Medical
Advice, Directory Services and ensuring the referral transport services are
responsibilities of the service provider.
Every Day 12600 Minutes of outbound calls will be made from the call centre by the
Service provider for evaluating the services provided to pregnant and postnatal
women.
Four Pre-recorded Messages to pregnant women and 3 to the postnatal women for
ensuring the ANC, PNC and Immunisation services, would be made.
Maintenance of database and software for real time display of all the services
provided by the Call Centre would be done. In addition the Service provider shall
also Gauge the public perception on services provided by health department.
102 call center will be ready by 1st January, 2016.

12. January 28, 2016 [NOTES ON 5 NEW INITIATIVES_NHM]
Notesfor the sensitization workshop on 5 new initiatives (29.01.2016) 12
Key Performance Indicators:
1. Number of Incoming Calls Received:
a. Number of Incoming Calls answered with Medical Advice :
b. Number of Incoming Calls answered with Advisory Services:
c. Number of Incoming Calls answered with providing Transport Services:
d. Number of Incoming calls answered for registering Grievance services:
2. Number of Pre recorded Messages sent Pregnant Women:
a. For ANC Checkups(3 times)
b. For Birth Plan
c. For Admission to Hospitals
3. Number of Pre recorded Messages sent post natal Women:
a. CMs Message for Congratulating
b. For Immunisation
4. Number of Out Bound Calls Made to Pregnant Women:
a. For ANC Checkups
b. For Birth Plan
c. For Admission to Hospitals
5. Number of Outbound calls made to Postnatal women:
a. For Post Delivery Status
b. FP Method Utilisation
c. Immunisation Schedule
Drop Back Services (ThalliBidda Express)
Objectives:
Providing safe transport of postnatal women with infant by dedicated fleet of vehicles
under 102 Services is the core objective. It is decided to ensure that every women
delivered in Public Health Facility is dropped back home safely. Providing referral
transport to the pregnant women is one of the vital interventions for keeping the IMR
and MMR at minimum
Strategy:
Out of the total 8.4 Lakh women estimated to deliver app.4.2 lakh women deliver in
public health facilities during the current year. All the post-natal women delivered in
Public health facilities will be dropped back home safely under this intervention
through dedicated fleet of 278 vehicles
M/s. GVK EMRI is the service provider for 102 Services

13. January 28, 2016 [NOTES ON 5 NEW INITIATIVES_NHM]
Notesfor the sensitization workshop on 5 new initiatives (29.01.2016) 13
Programme Details:
a. All the Postnatal Women who deliver in Government Hospital shall be
provided with the Drop Back Services through dedicated vehicle.
b. Service Provider transports the Post Natal Women, Child and one attendant
from Government Health Facility to Home. The Drop Back timing is between 8
AM to 6 PM.
c. Service Provider shall arrange the vehicle ready for pick up within 30 minutes
from the receipt of call from the institution. Penalties will be imposed in case of
non-attending the cases or non-attending within the time.
d. All the vehicles are fitted with GPS system for real time monitoring of
movement of vehicles online.
e. Service Provider shall maintain database and software application for
uploading all the details on real time basis and also movement of vehicles on
real time basis.
Drop Back services will be ready by 1st January, 2016.
Key Performance Indicators for Drop Back Services:
1. Number of Post Natal women transported per day, per district:
2. Average number of post-natal women per vehicle ride per district and per
block
3. Number of postnatal women arranged with drop back services within 30
minutes from call:
4. Average time from Call to Pick up at the facility
5. Average time from pick up to drop
6. Average Distance travelled for drop back of postnatal women at home:
7. Total vehicle failures per vehicle per month
Bio Medical Equipment Maintenance
Objective:
Regular maintenance and upkeep is required for optimum functionality of the Medical
Equipment in the Public Health Facilities.
Currently Rs 480 crore worth of equipment is available in all the Public Health
Facilities and approximately 28% of equipment is dysfunctional either due to lack of
maintenance or for want of repairs. Optimum functionality can be achieved through

14. January 28, 2016 [NOTES ON 5 NEW INITIATIVES_NHM]
Notesfor the sensitization workshop on 5 new initiatives (29.01.2016) 14
PPP Mode thereby delivering the quality health services to the needy.Hence it has
been decided to maintain all the Bio-Medical equipment through PPP mode.
Coverage
All the Bio-Medical equipment in all 1186 PHC, 192 CHCs, 31 Area Hospitals, 8
District Hospitals, 20 Teaching & allied hospitals and 11 Medical colleges would be
covered under this programme.
Strategy
All equipment registered would be geo-tagged, repaired, maintained and calibrated
on continuous basis by the PPP partner by positioning qualified bio medical service
engineers. And the process would be monitored through a dedicated round the clock
call centre. It is also mandated to ensure the AMCs already entered by other
agencies.
M/s. TBS India is the service provider for biomedical equipment maintenance
Details of the Programme:
It is the endeavour of the Government to provide health care services to all the
patients visiting Public Health Facilities. Government Health Institutions are equipped
sufficiently to serve the needs of the patients.Due to high dysfunctional rate of
existing equipment expected service delivery is affected adversely. Hence it is
decided to maintain all the equipment on real time basis through PPP.
Bio medical equipment maintenance includes:
 Tagging of individual equipment with a Bar coded sticker is done and full
details of equipment captured in a software resulting in detailed equipment
inventory would be available online.
 Repairs and replacement of spare parts.
 Preventive maintenance of equipment
 Calibration of equipment
 Training for Medical & Paramedical staff on existing equipment and on
new equipment for better utilization.
 Chasing AMCs and Warranties whereever available
 Agency will provide biomedical engineering HR and ensure an upkeep
time of 95% for THs, DHs, 90% for CHCs and 80% for PHCs at any given
point of time
 Agency will provide a toll free number for equipment fault registration of
equipment.
 Agency will establish a Round the clock functional call center.
 As and when new equipment is procured same would also come under
maintenance.
 Agency will place dedicated engineer at every Teaching hospital, Medical
College & District hospitals and mobile teams for CHCs and PHCs.

15. January 28, 2016 [NOTES ON 5 NEW INITIATIVES_NHM]
Notesfor the sensitization workshop on 5 new initiatives (29.01.2016) 15
Bio medical equipment maintenance services in all TH, DH and AH, will be ready by
1st January, 2016.
Key Performance Indicators
State Level:
1. Total number of equipment functional - per day; per week, per month:
2. Total Number of equipment Dysfunctional/ Open call - per day; per week,
per month:
3. Average turnaround time for closed calls - per day; per week, per month:
4. Total number of Preventive maintenances done per Quarter:
5. Calibrations of equipment done categories wise per quarter:
6. Count of Pending calls - per day, per week:
7. Total No of equipment in which spare parts were replaced- per week
8. District with the Highest Call received, dysfunctional rate, Dysfunctional
rate:
9. Average turnaround time per district for all facilities:
10. Total number of standby critical care equipment supplied per week:
11. No. of Dedicated and Shared Human Resource per district
12. No of training sessions of doctors/nurses per district per quarter
District level:
1. Total number of equipment functional - per day; per week, per month:
2. Total Number of equipment Dysfunctional/ Open call - per day; per week,
per month:
3. Average turnaround time for closed calls - per day; per week, per month:
4. Total number of Preventive maintenances done per Quarter:
5. Calibrations of equipment done categories wise per quarter:
6. Count of Pending calls - per day, per week:
7. Total No of equipment in which spare parts were replaced- per week
8. Total number of standby critical care equipment supplied per week:
9. No of training sessions of doctors/nurses per quarter