Detailed Project Report (DPR) on NURSING COLLEGE AND HOSPITAL (INR 50 CRORE WORTH PROJECT TO CATER 60 INTAKE STUDENTS AND 50 BEDDED HOSPITAL)

NURSING COLLEGE AND HOSPITAL (INR 50 CRORE WORTH PROJECT TO CATER 60 INTAKE STUDENTS AND 50 BEDDED HOSPITAL) 

EIRI/EDPR/4820  J.C. 3041

INTRODUCTION

Health care is gaining increasing importance in recent years. The concept of health care is emerging from providing treatment to the disease to the improvement of overall health status and also maintenance of good health.

India, a signatory to the "Alma Alta" declaration of 1978, is committed to the goal of "HEALTH FOR ALL" by the year 2000 A.D. In order to achieve the targets and thereby improving the health status of people in the country, tremendous efforts are required to be made not only by government but also by people. It is in this perspective development of health care assumes significant importance. New Challenges and new opportunities for investing in health care i.e. in hospitals and nursing homes etc. have arisen.

The expectation was that with adequate investments in health infrastructure and appropriate mix of Public health strategies, the country would be well-placed to meet this laudable goal. However, even in the target year, we can at best claim partial success in meeting the goal of a healthy population.

• Life expectancy in the country is still at 62 years as against the target of 64 years.

• Infant mortality rate is still hovers at 71 per 1000 live births against the target of below 60 per 1000

• People dyeing as a result of communicable diseases are 470 per 100000.

• Doctors per 1000 population : 0.41

• Hospital Beds per 1000 population in the country : 0.7

In the very beginning, there were government owned hospitals where one had to pay no money for treatment. Then, a private ward facility was started in the hospitals. The patient had to pay rent for a private room while medicines and doctors were available free of cost. The private ward helped the patient to avoid the untidiness of a general ward and noise etc. The patients, who were in a position to afford the room rent, were admitted to private rooms. The poor's, however, got admission in rushed general wards.

Increasing negligence by the doctors of these hospitals and the overcrowding in them gave private hospitals to have a good business. No. of private hospitals began to come in light with all facilities for E.C.G.S, X-Rays, Laboratories, 24-hours emergency and admission facilities for ill persons, seriously injured in pregnant ladies. The medium class and high class families started preferring these private hospitals and nursing homes as one's life is considered to be much costly and  expenses for treatment can be neglected.

A medical college in meant to impart education of medical field to students to qualify them as doctors in different specialized disciplines so as to treat patients suffering from various ailments doctors with their dedicated spirit serve the nation at large by providing medication and treatment for eradication of diseases which exchanger health and add  suffering to humanity. Normally a medical college is associated with a hospital.

Hospitals provide the facilities of O.P.D. and admission for seriously ill seriously injured, seriously burnt and pregnant ladies, causalities etc.

Presently, every city or town in india has no. of private hospitals furnished with latest medical facilities available and with more qualified surgeons, physicians and specialist  doctors. Even sometimes, they are furnished with more modern machines than those  available in the nearby Government Hospital. These hospitals can be seen well crowded as they provide very good service at a smile. As they are run by privates very good medical care is provided by them.

A private hospital is a place where one may get treatment from ordinary fever to a major surgery operation. As a matter of fact, no limitation has been made for the facilities available in a hospital. However, generally all  private hospitals are provided with latest facilities and ultra modern machines. In a hospital, surgeons, physicians, E.N.T., specialists, children specialist, Eye-surgeon, psychologists and sex-specialist are essential.

COST ESTIMATION

Plant Capacity            60 Student and/Day

50 Bedded 

Land & Building (4 Acre.)  Rs. 22.22  Cr    

Plant & Machinery                    Rs. 25.73 Cr 

Working Capital for 3 Month    Rs. 1.62 Cr 

Total Capital Investment          Rs. 50.18 Cr 

Rate of Return                          26%

Break Even Point                      53%

CONTENTS

B.I.S SPECIFICATION

GLOBAL ECONOMIC OVERVIEW

A WAXING AND WANING OUTLOOK

GLOBAL INFLATION WILL CONTINUE TO DECLINE.

FUTURE-PROOFING THE ECONOMY

RECENT DEVELOPMENTS

GOVERNMENT INITIATIVES

ROAD AHEAD

GLOBAL HEALTH SCENARIO

INDIAN HEALTH SCENARIO

INDIAN SCENARIO

ONE HEALTH

GLOBAL SCENARIO

INDIAN SCENARIO

INDIAN HEALTHCARE INDUSTRY OVERVIEW

MARKET SIZE

INVESTMENTS/ DEVELOPMENTS

GOVERNMENT INITIATIVES

ROAD AHEAD

EXECUTIVE SUMMARY

ADVANTAGE INDIA

MARKET OVERVIEW AND TRENDS

PER CAPITA HEALTHCARE EXPENDITURE HAS RISEN AT A FAST PACE

HEALTHCARE INFRASTRUCTURE HAS RISEN AT A FAST PACE

COVID-19 FIGHTBACK FROM THE INDIAN HEALTHCARE SECTOR

INDIAN HEALTHCARE SECTOR IS POISED TO GROW

RISING INCOME, AGEING POPULATION TO BE KEY HEALTHCARE DEMAND DRIVER

RE-EMERGENCE OF TRADITIONAL MEDICAL CARE

FDI INFLOW

MEDICAL TOURISM: A NEW GROWTH FACTOR FOR INDIA’S HEALTHCARE SECTOR

OPPORTUNITIES IN HEALTHCARE

OPPORTUNITIES IN HEALTH INSURANCE

ROBOTIC SURGERY – RESHAPING THE HEALTHCARE SECTOR

THE INDIAN ROBOTIC SURGERY MARKET

THE WAY AHEAD

ROBOT-ASSISTED SURGERY IN INDIA: A SWOT ANALYSIS

STRENGTHS

WEAKNESS

OPPORTUNITIES

THREATS

MODERN MEDICAL INSTRUMENTS

BUILDING CONSTRUCTION & FURNISHING OF THE NURSING HOSPITAL

MODERN MEDICAL EQUIPMENT

HOSPITAL/MEDICAL EQUIPMENTS AND SUPPLIERS

PROPOSED MINIMUM STANDARDS FOR PRIVATE HOSPITALS/NURSING HOSPITAL

FUNCTIONAL PROGRAMME FOR A NURSING HOSPITAL

HUMAN RESOURCE REQUIREMENTS

QUALIFICATIONS

AVAILABILITY OF PERSONNEL:

MINIMUM REQUIREMENT OF PERSONNEL :

NURSING STAFF :

NURSING AIDS:

PARAMEDICAL STAFF :

ENGINEERING STAFF

ADMINISTRATIVE AND ANCILLARY STAFF

INSTRUMENTS AND EQUIPMENT

ENTRANCE ZONE

WAITING AREA

B. TREATMENT/DRESSING ROOM AND INJECTION ROOM

C. EXAMINATION AND CONSULTATION ROOMS (OPDS) AND CASUALTY

PATHOLOGY

INTERMEDIATE ZONE

B. NURSING STATION

D.. TROLLEY BAY

OPERATION THEATRE

INSTRUMENTS FOR GENERAL SURGERY & (MATERNITY) OBSTETRICS/GYNAECOLOGY

OPERATION THEATRE

EQUIPMENT FOR SURGERY AND OBSTETRICS/GYN

DELIVERY SUITE: EQUIPMENT & INSTRUMENTS (FOR MATERNITY HOSPITALS ONLY)

B. LABOUR ROOM

EPISIOTOMY SET 4-5 SETS

EQUIPMENT FOR SERVICE ZONE

ENTRANCE ZONE

AMBULATORY ZONE

7. NURSING STATION FOR OPD BLOCK WITH CLEAN AND DIRTY UTILITY 17.5 SQ.M

2. RADIOLOGY -

CRITICAL ZONE

OPERATING SUITE

MINIMUM SPACE REQUIREMENTS

B. CLEAN ZONE

C. ASEPTIC ZONE

4. THEATRE PACK PREPARATION AREA WITH STERILE STORAGE 10.5 SQ.M

A. EXAMINATION AND PREPARATION ROOM WITH CHANGING AND TOILET FACILITIES 14 SQ.M

J. DOCTORS' AND NURSES' CHANGE ROOM WITH TOILET 10.5 SQ.M

INTERMEDIATE ZONE

NOTE:

SERVICE ZONE

8. ADMINISTRATOR AND NURSING-IN-CHARGE OFFICE 10.5 SQ.M

BUILDING ENGINEERING ENVIRONMENTAL STANDARDS

2. CEILINGS

3. FLOOR HEIGHT

4. FLOORS AND WALLS

5. DOORS:

6. WINDOWS

7. CORRIDOR

8. WATER SUPPLY, PLUMBING AND OTHER PIPING SYSTEMS

FOR MORE THAN 20 BEDS

FOR LESS THAN 40 BEDS

OXYGEN CYLINDERS

9. ELECTRICAL STANDARDS

10. ACCESS ROUTES TO VARIOUS FACILITIES OF THE NURSING HOME:

11. COMMUNICATION SYSTEM

12. FIRE-FIGHTING SYSTEM

13. VENTILATION REQUIREMENTS FOR AREAS AFFECTING PATIENT CARE IN NURSING HOMES

14. REQUIREMENTS FOR SANITARY FITMENTS IN NURSING HOMES FOR PATIENTS

OUTPATIENT BLOCK

THE RADIOLOGY DEPARTMENT MUST HAVE FOLLOWING SPECIAL TOILET FACILITIES IN CASE IT CARRIES OUT PROCEDURES LIKE IVP.

15 WASTE DISPOSAL:

PRINCIPLES OF PLANT LAYOUT

PLANT LOCATION FACTORS

EXPLANATION OF TERMS USED

IN THE PROJECT REPORT

PROJECT IMPLEMENTATION SCHEDULES

LOCATION

COMPLETE PLANT AND MACHINERY SUPPLIERS

STATUTORY APPROVALS FROM GOVERNMENT

WHAT LICENSE REQUIRED TO OPEN A HOSPITAL AND THEIR PROCEDURE

HOSPITAL INDUSTRY RELATED LAW

INDIAN MEDICAL COUNCIL ACT, 1956 (“IMC ACT”)

INDIAN MEDICAL COUNCIL (PROFESSIONAL CONDUCT, ETIQUETTE AND ETHICS) REGULATIONS, 2002 ("ETHICS REGULATIONS")

THE INDIAN MEDICAL ASSOCIATION (IMA)

INDIAN NURSING COUNCIL ACT, 1947 (“NURSING ACT”)

THE NATIONAL MEDICAL COMMISSION BILL, 2019

NATIONAL MEDICAL COMMISSION ACT, 2019 (“NMC ACT”)

CLINICAL ESTABLISHMENTS (REGISTRATION & REGULATION) ACT, 2010 (“CLINICAL ESTABLISHMENTS ACT”)

THE MEDICAL TERMINATION OF PREGNANCY ACT, 1971 176

LAWS GOVERNING TO SALE, STORAGE OF DRUGS AND MEDICATION

THE DRUGS CONTROL ACT 1950

DRUGS AND COSMETICS ACT, 1940 (“DRUGS ACT”), THE DRUGS AND COSMETICS RULES, 1945 (“DRUGS RULES”) AND THE NEW DRUGS AND CLINICAL TRIALS RULES, 2019 (“CLINICAL TRIALS RULES”) 177

DRUGS (PRICES CONTROL) ORDER, 2013 (“DPCO”)

NARCOTIC DRUGS AND PSYCHOTROPIC SUBSTANCES ACT, 1985 ("NDPS ACT") AND THE NARCOTIC DRUGS AND PSYCHOTROPIC

GUIDELINES FOR EXCHANGE OF HUMAN BIOLOGICAL MATERIAL FOR BIOMEDICAL RESEARCH PURPOSES, 1997 (“HBM GUIDELINES”)

PHARMACY ACT, 1948 AND PHARMACY PRACTICE REGULATIONS, 2015

OTHER ACTS:

SALE OF GOODS ACT 1930

LAWS GOVERNING MANAGEMENT OF PATIENTS

MEDICAL TERMINATION OF PREGNANCY ACT, 1971 (“MTP ACT”) AND THE RULES THEREUNDER

TRANSPLANTATION OF HUMAN ORGANS ACT, 1994 (“TRANSPLANTATION ACT”)

PRE-CONCEPTION AND PRE-NATAL DIAGNOSTIC TECHNIQUES (PROHIBITION OF SEX SELECTION) ACT, 1994 (“PCNDT ACT”) AND

REGISTRATION OF BIRTHS AND DEATHS ACT, 1969 (“RBD ACT”) 182

NATIONAL ETHICAL GUIDELINES FOR BIOMEDICAL AND HEALTH RESEARCH INVOLVING HUMAN PARTICIPANTS, 2017 (“ICMR CODE”)

LAWS GOVERNING THE SAFETY OF PATIENTS, PUBLIC AND STAFFS WITHIN HOSPITAL PREMISES:

THE ATOMIC ENERGY ACT, 1962

ATOMIC ENERGY (RADIATION PROTECTION) RULES, 2004 (“RADIATION RULES”)

ATOMIC ENERGY (SAFE DISPOSAL OF RADIOACTIVE WASTES) RULES, 1987 (“RADIOACTIVE WASTE RULES”)

RADIATION SURVEILLANCE PROCEDURES FOR MEDICAL APPLICATION OF RADIATION, 1989 (“SURVEILLANCE PROCEDURES”)

SAFETY CODE FOR MEDICAL DIAGNOSTIC X-RAY EQUIPMENT AND INSTALLATIONS, 2001 (THE “X-RAY SAFETY CODE”)

SAFETY CODE FOR NUCLEAR MEDICINE FACILITIES, 2011 (“NUCLEAR MEDICINE FACILITIES CODE”)

DRAFT DIGITAL INFORMATION SECURITY IN HEALTHCARE ACT (“DISHA”)

CENTRAL GOVERNMENT HEALTH SCHEME ("CGHS")

LAWS GOVERNING TO MEDICOLEGAL ASPECTS

CONSUMER PROTECTION ACT, 1986 (“CONSUMER PROTECTION ACT”)

LAWS GOVERNING PROFESSIONAL TRAINING AND RESEARCH:

ETHICAL GUIDELINES FOR BIOMEDICAL RESEARCH ON HUMAN PARTICIPANTS, 2006 (“ICMR CODE”)

FOOD SAFETY REGULATIONS

FOOD SAFETY AND STANDARDS ACT, 2006 (“FSS ACT”)

LAWS GOVERNING ENVIRONMENT SAFETY:

ENVIRONMENTAL LEGISLATION

BIO-MEDICAL WASTE MANAGEMENT RULES, 2016 (“BMW RULES”)

AIR (PREVENTION AND CONTROL OF POLLUTION) ACT, 1981 (THE “AIR ACT”) AND WATER (PREVENTION AND CONTROL OF POLLUTION) ACT, 1974 (THE “WATER ACT”)

HAZARDOUS AND OTHER WASTES (MANAGEMENT AND TRANSBOUNDARY MOVEMENT) RULES, 2016 (THE “HAZARDOUS WASTE RULES”)

PUBLIC LIABILITY INSURANCE ACT, 1991 (“PUBLIC LIABILITY ACT”)

FIRE PREVENTION AND LIFE SAFETY MEASURES

OTHER LAWS:

LAWS RELATING TO EMPLOYMENT EMPLOYMENT AND LABOUR LAWS

THE CODE ON WAGES, 2019 (THE “CODE”)

• THE PAYMENT OF WAGES ACT, 1936

• THE MINIMUM WAGES ACT, 1948

• THE PAYMENT OF BONUS ACT, 1965 (THE “POB ACT”)

• THE EQUAL REMUNERATION ACT, 1976

CODE ON SOCIAL SECURITY, 2020

• EMPLOYEE’S COMPENSATION ACT, 1923

• EMPLOYEE’S STATE INSURANCE ACT, 1948

• EMPLOYEE’S PROVIDENT FUND AND MISCELLANEOUS PROVISIONS ACT, 1952

• MATERNITY BENEFIT ACT, 1961

• PAYMENT OF GRATUITY ACT, 1972

THE EMPLOYEES’ PENSION SCHEME, 1995

EMPLOYEES’ DEPOSIT LINKED INSURANCE SCHEME, 1976

THE SEXUAL HARASSMENT OF WOMEN AT WORKPLACE (PREVENTION, PROHIBITION AND REDRESSED) ACT, 2013 (THE “ACT”)

CHILD LABOUR (PROHIBITION AND REGULATION) ACT, 1986 (THE “CLPR ACT”)

FIRE PREVENTION LAWS AND THE NATIONAL BUILDING CODE OF INDIA, 2016

THE OTHER IMPORTANT REGULATIONS:

LAWS RELATING TO TAXATION

GOODS AND SERVICE TAX ACT, 2017 (“GST ACT”)

LAWS RELATING TO INTELLECTUAL PROPERTY RIGHTS

INTELLECTUAL PROPERTY LEGISLATION THE TRADE MARKS ACT, 1999 (THE “TRADE MARKS ACT”)

OTHER APPLICABLE LAWS

THE MICRO, SMALL AND MEDIUM ENTERPRISES DEVELOPMENT ACT, 2006 (“MSME ACT”)

THE COMPANIES ACT 1956 AND THE COMPANIES ACT, 2013:

SEXUAL HARASSMENT AT WORKPLACE (PREVENTION, PROHIBITION AND REDRESSAL) ACT, 2013 (“POSH ACT”)

SHOPS AND COMMERCIAL ESTABLISHMENTS LEGISLATIONS

MUNICIPALITY LAWS

POLICE LAWS

THE INDIAN CONTRACT ACT, 1872

TRANSFER OF PROPERTY ACT, 1882

REGISTRATION ACT, 1908 202

LIST OF CONSULTANT FOR SETTING UP HOSPTAL & COLLAGE

LIST OF NABET ACCREDITED HOSPITAL & HEALTHCARE CONSULTANT (NABH STANDARD)

ENVIRONMENTAL MANAGEMENT PLAN

SOLID WASTE MANAGEMENT

OPERATION PHASE

SCHEME OF SEWAGE TREATMENT PLANT:

TREATMENT PROCESS:

THE PROCESS FOR SEWAGE TREATMENT PLANT BASED ON MBBR TECHNOLOGY

BENEFITS OF USING MBBR TECHNOLOGY

PROCESS FLOW DIAGRAM FOR ETP

ETP DESIGN

WATER CONSERVATION & AUGMENTATION

DUAL FLUSH WC (2 – 6 LITERS INSTEAD OF 10 LITERS) SHALL BE USED TO OPTIMIZE THE WATER DEMAND.

BLOCK DIAGRAM FOR PROPOSED RAIN WATER HARVESTING / AQUIFER RECHARGING SYSTEM

SOLID WASTE MANAGEMENT

TABLE: TOTAL SW GENERATION FROM THE PROPOSED PROJECT

COMPOST FORMATION POTENTIAL OF THE PROJECT

COMPOST GENERATION POTENTIAL OF THE PROJECT (CHEN, 2016)

STANDARD OPERATING PROCEDURE OF ORGANIC WASTE CONVERTER:

TABLE: HOSPITAL AND BIOMEDICAL WASTE GENERATION FROM BEDDED AREA (MINISTRY OF HEALTH 

AND FAMILY WELFARE; PANDIT ET AL 2006)

SEGREGATION OF BIOMEDICAL WASTE AND ITS STORAGE:-

BIOMEDICAL WASTE CATEGORIZATION

AIR POLLUTION CONTROL:

STACK HEIGHT CALCULATIONS

LANDSCAPING & HORTICULTURE

SHRUBS/ HERBS TO BE PLANTED

PROPOSED IMPLEMENTATION SCHEDULE 12 MONTHS

PLANT LATOUT

ORGANIZATION CHART

LIST PLANT & MACHINERY

65 EEG (ELECTROENCEPHALOGRAPHY)

67 C-ARM SCAN

APPENDIX – A:

01. PLANT ECONOMICS

02. LAND & BUILDING

03. PLANT AND MACHINERY

04. OTHER FIXED ASSESTS

05. FIXED CAPITAL

06. RAW MATERIAL

07. SALARY AND WAGES

08. UTILITIES AND OVERHEADS

09. TOTAL WORKING CAPITAL

10. TOTAL CAPITAL INVESTMENT

11. COST OF PRODUCTION

12. TURN OVER/ANNUM

13. BREAK EVEN POINT

14. RESOURCES FOR FINANCE

15. INSTALMENT PAYABLE IN 5 YEARS

16. DEPRECIATION CHART FOR 5 YEARS

17. PROFIT ANALYSIS FOR 5 YEARS

18. PROJECTED BALANCE SHEET FOR (5 YEARS)