Karnataka Health Systems Development Project

Item

Title
Karnataka Health Systems Development Project
extracted text
4

Karnataka Health Systems Development Project

Notes for the
World Bank Review Mission
Visiting Bangalore

on March 8 to 11,1997

03/07/97/Let Mar

Contents
Page Nos.

1

Financial performance of KHSDP upto January, 1996,
and anticipated expenditure upto March 31, 1997.

1 to 7

2

Health Sector Development Policy Programme in
Karnataka

8 to 10

3

Procurement of Civil Works

11 to 24

4

A brief note on the installation of Blood Banks

25 to 26

5 ^Training Components of KHSDP

27 to 30

6 - Note on Procurement Activities

31 to 44

7 ^ Activities of Strategic Planning Cell of KHSDP

45 to 48

8

Hospitals Management

49 to53

9

Access to Disadvantaged Sections

54 to 58

10

Improvement of Access to Health Services for Women

59 to 64

11 "Hospitals Based Quality Assurance Programme
12

Proposal for Setting up Equipment Maintenance
Facilities

65 to 72

73 to 79

Financial performance of KHSDP upto January, 1996,
and anticipated expenditure upto March 31,1997

The Project activities should have started from 1st of April 1996. However, the launching
of the project itself was delayed by nearly 3 months. After the launching, finding of office
accommodation took two months hence in the beginning, for nearly 5 months activities could not
start. There are various components under which expenditure should have been booked as
provided in the S.A.R. The Component wise provision during the financial year 1996-97, the
expenditure incurred upto December, 1996 and the probable expenditure by 31st March is
discussed as detailed below:
INVESTMENT COSTS:

1. Civil works renovation: An amount of Rs. 9.06 crores is provided for the year 1996-97 as in
S.A.R. No expenditure is booked under this head as the civil works are yet to commence.
There are 47 hospitals in 1st phase of the project. Each hospital is considered as a work and a
comprehensive estimate is prepared covering renovation, hospital and staff quarters. Works
are yet to start, no expenditure is booked upto January, 1996 and it is also not possible to
make any expenditure under this head as for 15 works tenders are floated only in the last
week of February, 1997.
2. Civil works extension: An amount of Rs. 28.63 crores is provided for the year, 1996-97 Upto

December, 1996, no expenditure is booked under this head as the civil works as explained
above are yet to start. However, as approved by the Project Governing Board, extension work
to the existing food laboratory building behind the Public Health Institute to accommodate the
Staff of the project is started. As the work is already in progress, it is anticipated that an
amount of Rs. 15 lakhs will be spent by March end, 1997.
T

3. Professional Services: An amount of Rs. 3.5 crores is provided for the year, 1996-97 as in
S.A.R. This amount is provided in the project to meet the expenditure towards payment of
professional fee for the work done by persons like private architects, etc. engaged by the
project office. So far 30 architects have been empanalled by the project office to finalise the
drawings of 150 hospital works. An amount of Rs. 8.7 lakhs is paid to these architects so far
and it is expected that another Rs. 9.5 lakhs will be spent by 31st March, 1997. As only an
advanced payment is made in most of the cases, the expenditure incurred under this head is
less compared to the amount available. However, in the first quarter of the financial year,
1997-98, the expenditure under this item will increase as in majority of the works, sufficient
progress will be made in finalising preliminary drawings and final drawings.

4. Furniture: An amount of Rs. 31 lakhs is provided for the year, 1996-97 as in S.A.R. This
amount is provided to meet the expenditure incurred towards providing furniture to the
hospitals included in the first phase of procurement plan and also for providing furniture to the
project office. The furniture to the hospitals forms part of the National Competitive Bidding
Process and the document for NCB is already approved by the World Bank. In the beginning,
as importance was first given to float tenders for purchase of hospital equipment, the tender is
03/06/97, Note-fm-stt

1

as importance was first given to float tenders for purchase of hospital equipment, the tender is
yet to be floated for furniture. This tender will be issued in the first quarter of financial year,
1997 clubbing the requirements of the first phase and the second phase as in the procurement
plan. However, an amount of Rs. 7.4 lakhs is already spent to purchase furniture required to
the project office. An amount of Rs. 7.6 lakhs is likely to be spent before 31st March, 1997 to
provide furniture to the officers of the Additional Directors and the remaining officers posted
to the project. This expenditure is booked following the procedure of local shopping as
provided in the project.

5. Equipment (Medical): No amount is provided under this head for the year, 1996-97.
6. Equipment (Others): An amount of Rs. 3.28 crores is provided for the year, 1996-97 as in
S.A.R. This amount is provided to procure the hospital equipment including the Bio-medical
equipment as in the procurement plan. Out of 149 packages, most of the packages of
procurement are under National Competitive Bidding, except 6 packages which are under
International Competitive Bidding. The procurement of equipment for the first two phases of
the procurement plan is clubbed and the Bank has already cleared the bid documents and the
technical specifications. So far for more than 90 packages both under NCB and ICB the
tenders are floated. The evaluation in respect of 31 packages is completed and 49 packages is
under progress. The subject will be finalised by 15th of March, 1997. Therefore, most of the
expenditure will come in first two quarters of the financial year 1997-98 as the time of
delivery of equipment as per the terms and conditions of the bidding document varies from 60
to 120 days. So far an amount of Rs. 10.2 lakhs is spent under this head to procure the
equipment required for project office following the local shopping norms. It is anticipated that
as an advance payment to the successful bidders of the packages which are already cleared
under NCB by Steering Committee and also for the Blood Bank equipment, it is expected that
an amount of Rs. 1 crore will be spent by March end, 1997.

7. Vehicles: An amount of Rs. 91 lakhs is provided for the year, 1996-97 as in S.A.R. So far an
amount of Rs. 24.6 lakhs is spent under the local shopping norms for procurement of vehicles
required to the project office. Under this component, the vehicles for Taluka Medical Officers,
the District Surgeons, ambulances and the vehicles required to the engineering wing and
surveillance wing are also to be procured. The procurement is under ICB norms and the
tender document is cleared by the World Bank in February 2nd week. Here also the
procurement of the vehicles by the first two phases is clubbed and it is also likely that the
remaining expenditure under this component will be possible only in the second quarter of the
financial year, 1997-98.
8. Medical Lab Supplies: An amount of Rs. 50 lakhs is provided for the year, 1996-97 as in
S.A.R. Under this component the procurement of equipment to the laboratories of the
surveillance wing, pathology lab, etc., are included. For some of the equipment, the bids are
already in the final stages and it is expected that an amount of Rs. 3.5 lakhs will be paid as
advance amount to the successful bidders by March, 1997. Major portion of the expenditure
will be booked in the first quarter of 1997-98.

03/03/97, Note-fm-stt

2

9. Medicines: An amount of Rs. 1 crore and 25 lakhs is provided for the year, 1996-97 as in
S.A.R. So far no expenditure is booked under this head. There are 3 components under this
head for procurement as follows:
(i) The medicines required for the additional beds created under the project;
(ii) Medicines required for Women’s Health Care Programme;
(iii) Medicines required under Yellow Card Scheme;

Medicine required for the first component cannot be procured as the additional beds have
not been created so far. As regards item (2) and (3). Action has been taken to accord sanction
procurement of medicines worth Rs. 81.55 lakhs for Women Health care programme and those
of Rs. 31.99 lakhs for SC/ST population health check up camp (Yellow Card) in five districts
10. Other Supplies: An amount of Rs. 58 lakhs is provided for the year, 1996-97 as in S.A.R.
This includes the items like Workshop equipment incinerators, computers, typewriters,
photocopiers and fax machines to the hospitals. For procurement of incinerators which is
under ICB, the bid document was finalised, but the IFB was not issued as there is an
instruction from the Central Pollution Control Board not to install the incinerators till the
standards are finalised by the Board. Regarding the computers, the agency which was
entrusted with the study of feasibility report have given the draft report which is discussed and
suggestions are given before a final report is given by them. Based on this, the configuration
of computers will have to be finalised. The typewriters, photocopiers and fax machines will be
procured on NCB norms for which the tenders will be floated in the first quarter of 1997-98.

11. MIS and IEC Materials: An amount of Rs. 87 lakhs is provided for the year, 1996-97 as in
S.A.R. So far no expenditure is booked under this item as the feasibility report on the
Management Information System is recently given and after discussions based on the
feasibility report the software component, etc. will be worked out. It may not possible to book
any expenditure by March, 1997 in view of the above reason. However, it might be possible to
start this in the first quarter of 1997-98. Regarding EEC materials, the strategic plan wing has
been entrusted with the responsibility. The Strategic plan wing have finalised a monthly
bulletin to be approved shortly under this activity. Further, the clinical protocols and referal
protocols are also being discussed. It might not be possible to finalise these items before
March end, 1997.
12. Local Training: An amount of Rs. 20 lakhs is provided for the year, 1996-97 as in S.A.R. So
far two batches of doctors have been trained as part of this programme. Further to develop
resource persons, a trainers training programme is also done with the support of JIPMER
from Pondicherry. In respect of various disciplines, the training programme will be finalised
shortly and it will be possible to speed up this program in the coming months. It is anticipated
that an amount of 10 lakhs will be spent before March end, 1997.

13. Consultants: An amount of Rs. 29 lakhs is provided for the year, 1996-97 as in S.A.R. So far
an amount of Rs. 5.9 lakhs is spent under this item. It is anticipated that an amount of Rs. 11.9
lakhs will be spent for the remaining months during the year, 1996-97. Under this component,

03/03/97, Note-fm-stt

3

Page 3

that an amount of Rs. 7 lakhs will be spent for the remaining 3 months. Under this item, the
T. A. for the staff, printing and stationery, advertisement charges, etc. are included.

■<

5

03/03/97, Note-fm-stt

Page 5

Financial Performance Upto January 1997
The Total Budget for The Project 55.00 Crores.

SL.
NO.

1

PARTICULARS

___________ 2____________

INVESTMENT COSTS:1. Civil Works (Renovation)
2. Civil Works (Extension)_________
3. Professional Services___________
_____________ __
4. Furniture
5. Equipment (Medical)___________
6. Equipment (Others)____________
7. Vehicles _________________ __
8. Medical Lab Supplies__________
9. Medicines
10. Other Supplies_______________
11. MIS/IEC Materials____________
12. Local Training_____
13. Consultants_____________ _____
14. Studies_____ ___________ __
15. Workshops_________ _________
16. Fellowships _____________ __
______________
17. NGO’s
TOTAL INVESTMENT
COSTS_____________________
RECURRENT COSTS:18. Salaries and Additional Staff____
19. Operational Expenses__________
20. Building Maintenance__________
21. Equipment Maintenance________
TOTAL RECURRENT COSTS
TOTAL BASELINE COSTS
22. Physical Contingencies_________
23. Price Contingencies___________
TOTAL PROJECT COST

Total
Provision
as per the
Project
Proposal
('«
millions)

Provision
for
1996-97

(in millions)

PROBABL
E
EXPENDI­
TURE BY
31st
MARCH,
1997
(in millions)

6

ACTUAL
EXPENDI­
TURE
UPTO
Jan’97

('«
millions)

3

4

5

251.6
954,4
110.6
104.1

90.60
286.30
35.40
3.10

0.011

327.7
151.4
124.8
418.2
116.1
32,3
100.1
19,5
28.0
21.5
8.4
12.7
3107.60

32.80
9.10
5,00
12.50
5,80
8.70
2,00
2.90
3.50
2.10
2.60
4.30
506.70

1.220
2.464

574,6
301.7
57.4
59.5
993.2
372.8
984.5
5458.00

Vrm.doc

Page 6

0.997
0.953

0,15
0,95
0.76
10.5

0.35
12.10

0.195

1,00
1.19
0.15'

0.538
0.759

0.225

7.138

27.375

5.70
3.00

0.680
2.345

0.26
0.70

8.8
515.5
50.60
20.60
586.60

3.025
10.163

0.96
16.235

10.163

28.335

Health Sector Development Policy Programme in Karnataka
The State Government has begun a serious exercise to assess the strengths and
weaknesses of its Health care system. The major issues on which the State
Government is engaging its attention, and the direction of its future Reform package
has been spelt out in the Health Sector Development Policy matrix seen below.
______ Issue
1. Adequacy of the
overall size of the
health budget to
meet public
health goals

___________ Effect____________
Public health expenditure is about
5% of the state budget and 1.48 %
of GDP. These health expenditures
are inadequate to provide essential
primary health care together with a
basic package of clinical/curative
services.

2. Imbalances in
public
expenditure
between different
levels of the
health sector
3. Redressing
Regional
imbalance

With increasing expenditure on
tertiary level health care, there has
been a relative decline in the
and
investment
in
primary
secondary level facilities. This
imbalance needs correction.
The six districts of Gulbarga, Bidar,
Bijapur, Raichur, Dharwad and
Bellary show poor health indicators
on account of uneven development
in the health infrastructure and
delivery of services

4. Quality of and
access to hospital
services

Quality of medical services is
inadequate; in addition, access to
health care services is limited
especially for populations in the
least developed areas of the State,
particularly women, scheduled
castes and scheduled tribes.

Proposed Change or Action
Recognising the link between basic public
health provision and poverty alleviation,
the Government will not only maintain the
share of health sector allocations within the
overall budget as reflected in 1995-96
Budget, but will step up the allocations
progressively.

Budgetary allocations for the health sector
in 93-94 was Rs.7400 lakhs and during 9697 it was Rs.8966.75 lakhs._____________
The State recognises the need for focusing
attention on the primary and secondary
levels of health care and also to step up
allocations for the same levels. A major
portion of the increased allocation will go
the primary and secondary levels.________
Through both project as well as non­
project interventions, a policy of positive
discrimination in favour of the under
developed districts and the less developed
regions within advanced districts (i.e. tribal
areas) will be followed to reduce the
existing imbalance. This differential policy
is
already
under
implementation.
Additional resources are being provided
out of State’s own funds for filling critical
gaps in primary health care through
Hyderabad
Karnataka Development
Board._____________________________
Quality and access will be improved by: i)
upgrading and
expanding physical
capacity;
ii)
upgrading
clinical
effectiveness and quality of services at
Community, Taluka, and District hospitals;
iii) improving the referral system; iv)
adopting staffing and technical norms in
line with the recommendations of the high
level committee. In respect of Scheduled
Caste and Scheduled Tribes access will be
improved through a system of annual
health check-ups.
Patients below poverty line who cannot
aiioru nigh cost ireatiiieni ioi serious
ailments such as oncologic and cardiac
disorders will be assisted through a
specially constituted society for providing

______ Issue
5. Strategic
Planning

___________ Effect___________
Inadequate strategic planning
capacity in the health sector has
resulted in sub-optimal use of
resources. Decisions on public
health spending priorities presently
do not take into full consideration
the size and scope of services
provided by private-commercial
and voluntary sectors; the health
manpower supply situation; and the
predicted future epidemiological
profile in Karnataka.

6. Work force

Improvement of services at
hospitals is significantly restricted
by workhorse problems, both in
terms of quality and quantity. The
number of staff sanctioned at
hospitals does not fit current needs;
there are many vacancies due to
poor and cumbersome recruitment
procedures, and unimaginative
personnel policies.

7. The role of the
private sector
and voluntary
organisations

The distribution of medical
specialists is not commensurate
with the need e.g.: a general
surgeon in place of an Obstetrician
& Gynaecologist.______________
The health services development
strategy of the Government has not
taken sufficient account of the
scope and coverage of nonGovemmental providers and the
role of this sector in delivering
quality health care.

Page 914

_____ Proposed Change or Action_____
The capacity for strategic planning will be
enhanced through establishment of a
Planning Cell directly reporting to the
Secretary Health and Family Welfare.
This will, either independently or through
sponsored specific research projects: study
the role of the private sector; review the
suitability of present regulations; Study
evolving epidemiological profile in
Karnataka; monitor the burden of disease
and recommend cost-effective means for
achieving the best use of limited
resources; and undertake periodic review
of the health manpower supply situation
and training needs in the state. A study of
the scope and prospects of enlisting the
private sector support for promotion of
health care at primary and secondary
levels will be undertaken._____________
No ban on recruitment will be imposed
with regard to recruiting staff. In a short
period the problem of mismatching in
medical staff will be solved; the practice of
deputing staff to non essential
assignments will be put to an end; doctors
recruited on contract where direct
recruitment process is slow and doctors
will be asked to serve a mandatory' period
of six years in rural areas before being
considered for posting at more preferred
places.
Since there is a large number of lady
Doctors’ vacancies, participation by
private lady Doctors in Government
facilities will be encouraged.
Legislation will be introduced to regulate
all medical institutions. The role of the
private sector would be continuously
monitored, the quality of services provided
by private care practitioners would be
assessed and regulations relating to
improvements in service quality would be
evaluated. Nursing home and private
doctors are contemplated.____________
Referrals between private primary care
and the public sector secondary level
diagnosis, treatment and care would be
encouraged through District Health
Committees.

______ Issue______ ____________ Effect____________
8. Cost sharing and Cost sharing has not been properly
implemented resulting in low levels
service
of funding for supplies, operations
improvement
and maintenance.

9. Prevention and
control of major
communicable
diseases.

The existing surveillance system is
very weak especially at Secondary
level and in urban areas.

10. Contracting
services

Contracting services are under­
utilised.

11. Safeguarding the
operations and
maintenance of
the
health
budget.________
12. ConsolidationVs-Expansion of
Institutions

The existing secondary hospitals
face operational deficiencies and
function poorly due to lack of non­
salary recurrent funds.

13. Poverty
alleviation

The State has been rapidly
expanding the number sub-centres,
PHCs, CHCs, Taluka level, and
sub-district
hospitals without
focusing on improving the physical
facilities
in
the
existing
institutions.__________________
About 40 % of households are
below the poverty line in
Karnataka. In this group, health
indicators such as mortality and
morbidity rates, are especially
adverse.

Page 145

_____ Proposed Change or Action_____
The Government will set up a working
group to examine the issue of cost sharing,
last revised in 1988, while protecting the
poorest sections of society. The guiding
principle of cost sharing would be to
partly cover non salaiy recurrent costs.
In addition, adequate administrative and
organisational
mechanisms
for
implementing schemes for cost sharing
would be put in place. A mechanism to
give back a major portion of revenues
raised by the institution will be
introduced._______________________
The project aims to establish an effective
surveillance system which will contribute
to reducing morbidity and mortality rates
due to major communicable diseases. The
post of Addl. Director (Communicable
Diseases) has been filled up. His job
responsibility has been defined.________
The Department will monitor cost­
effectiveness and quality of existing
contracted services. Furthermore the
Government will review as appropriate
new proposals for contracting-out health
services especially support services, such
as
laundry,
cleaning
services,
manufacturing I V fluids etc. On a
confirmation basis. In district hospital of
Karwar and Tumkur cleaning service has
been contracted at._____ ____________
The State will make adequate provision in
the health budget for drugs and other
medical supplies, and for maintenance of
equipment and buildings.

Further expansion of beds, and hospital
institutions will be strictly need-based, and
will be undertaken only after ensuring the
existing facilities are properly maintained
and utilised.
The investment made in this project
specially through special programmes for
the disadvantaged section viz., SC/ST and
women, will aim at augmenting the
productivity/eaming potential through
better health status.

Growth in Share of Expenditure on Health by Sctors

Etjevenne Expemiinire
O’ban Health Services - Allopathy
Lhrten Health Services - Outer Systems
Rumi Health Sendees - Allopathy
Rural Health Services - Other Systems
Family Welfare
Public Health
A_ssistaDce to Local Bodies
Total Prunary & Secondary Heakh
Adlecical Education
Total Revenue Expendnurc

1994-95
Accounts
Plan Non-Plan
1728.46 12239.55
206.55
2.17
384.79
128.08
55.57
24.30
464.17
7654.88
1689.80
1388.81
11445.09
4059.41
14986.11 26485.52
1397.55 2905.82
16383.66 29391.34

Pdcem increase over p’es’ious year
Slure ofPnmaiy & Seccruday Sectors

91.47

90.11

CZapital Expenditure
T^otal Primary Secondary Health
XZledical Educadon
TTotal Capital Expen±nire

394.30
696.94
1091.24

0.00
0.00
0.00

F*er^ent increase over previous year
Share of Primary & Secondly Sectors

36.13

1995-96
Revised
Plan Non-Pla
Total
13991.0
1741.74
13968.01
227. S
6.00
208.72
359.9
524.53
512.87
64^
42.15
79.87
509.3
8119.05 9681.73
2023.3
2384.60
3078.61
15504.50 3883.60 12647.6
41471.63 18264.35 29824.B
4303.37 1052.75 4O75.£
45775.00 19317.10 338994

Rupees Lakhs
1996-97
Budget
Total
Plan Non-Plan
Total
2451332
15733.14 8848.00 15665.32
292.01
10.50
281.51
233.83
1335.48
287.58
1047.90
883.92
103.82
64.82
39.00
106.74
596.90 11244.84
10191.31 10647.94
2389.50
5681.72
4408.13 3292.22
16531.56 4435.50 14022.44 18457.94
48088 63 28321.06 33308.07 61629.13
1455.42 4635.29 6090.71
5128.31
53216.94• 29776.48 37943.36 67719.84

90.60

17.90
94.55

15.4
87.‘8

16.26
90.36

54.15
95.11

11.93
87.78

27.25
91.01

394.30
696.94
1091.24

708.69
193.00
901.69

0.0
0.0
0.0

708.69
193.00
901.69

1525 00
473.00
1998.00

0.00
0.00
0.00

1525 00
473.00
1998.00

36.13

-17.37
78.60

-17.37
78.60

121.58
76.33

Page 1

121.58
76.33

Procurement of Civil Works
1. Preamble:

Phase

The procurement of civil works under KHSDP to be taken up in 4 phases is as follows:_____
Category of Hospital________________ Total Number
Total cost
SDH
TLH
MCH
CHC
of Hospitals
in Millions
DH
05
07
04
07

30
27
29
24

02
07

III
IV

03
02
07
05

07
11
18

03

Total

17

23

110

12

I
II

03

47
54
58
42

267.02
295.78
300.49
331.71

39

201

1195.00

2. Present Stage:

Out of the 201 hospitals, work on preparation of plans etc., has been assigned in respect of 154
hospitals covered under Phase I & II. Of them, the World Bank Architect has cleared the plans in respect
of 28 hospital. However, written communication regarding the clearance for 6 hospitals (H.D. Kote,
Mudhol, Khanapur, Byadgi, Hangal and Korategere) is yet to be received from World Bank. Final
drawings are prepared by the architects for 19 hospitals and 3 have backed out. Alternative arrangements
have been made to appoint other architects. In respect of 17 hospitals tender formalities are completed
and bids have been invited. For 2 more hospitals detailed drawings are ready and no sooner the sample
bid document for less than Rs.30 lakhs cost is approved by the World Bank tenders are to be floated.
With this Rs. work is tendered to be tendered. Work on these hospitals may begin by ls^ week of May.
Detailed drawings and estimates are already ready for 6 more hospitals. They will be tendered when
once the World Bank gives its clearance.

Apart from the above 28 hospitals, preliminary drawings have been cleared by the Building
Scrutiny Committee in respect of 25 hospitals. Further steps can be taken on these drawings after they
are cleared by the World Bank architect.

Clearance from World Bank office, New Delhi is awaited to the simple bidding document for
works costing less than Rs. 30.00 lakhs. In respect of 7 hospitals mentioned below IFB has been
published in the News Papers (copy enclosed). A bar chart showing the present stage is enclosed.
As per the SAR target all 101 hospitals coming under Phase I & II of the programme should have
been tendered by now. However, this has not happened so far. All attempts are being made to expedite
the civil work procurement activities with these corrections it should be possible for the project
authorities to tender all the civil works in Phase I & II by May 1997. With this the work at site would be
initiated by August 1997 in all the Phase I & II sets. In addition hospitals covered under the Phase III of
the programme will have to be tendered by July 1997 and the work will have to start by September 1997
If this is achieved work amounting to Rs.55 crores would have been initiated by June 1997.

%

Request to the World Bank Review Mission :
1) The pending 25 preliminary drawings may please be cleared at the earliest so that we can go
ahead with the final drawings.
2) Communication may please be sent regarding the clearance of World Bank for the
preliminary drawings in respect of 6 hospitals.
3) Programme of the visit of World Bank architect in the month of April and May, may please
be finalised in March itself so that the architects can be suitably informed.
1

03/03/97, KHSDP-PROC

Page 11

Annexure I
Progress of Construction Programme, as on 28.2.97
District

Centre

Beds

Million Rupees

=T9 Targeted stage of work as on 20.2 97
O)

s
s8-

8

Is

Q)

3•5

<5

______Of

UJ

re
•5

________ UJ

a?

E
00

Quarters Hospital Quarters Hospital
Phase I
1 Kolar

Bagepalli

50

50

024

211

052

6 55

9.42

2 Kolar

Gudibanda

40

50

024

1 39

0.26

1.51

3.40

3 Bangalore Rural Devanahalli

30

30

0.00

0.56

1.66

0.70

2.92

4 Kolar

Chikballapur

60

100

0.09

2.76

2.46

449

9.80

5 Kolar

Chintamani

74

100

0.07

2.26

1.04

600

9.38

6 Kolar

Sidlaghatta

50

50

0.25

1.99

0.40

589

8.54

7 Kolar

Bangarapet

35

30

0.17

1.35

040

1.38

3.30

8 Kolar

Robertsonpet, ED

24

24

0.12

0.00

000

0.90

I

re
o



w
a>

£
E §

n

= Present stage of work
re
£
V)
■o

O)

O)

s
ilo si?
c

m CD

1 <0

Ih
.1 & *

E ?
S. 5
2

&
E

S’*
0? *re
I I- oo co ors os a,el
o an
g $° u_ re flZ a if

CD O

o

■O

01

I
.1

■o

I?

I

bJ

1.62



■ ■■

ata

9 Bangalore Rural Magadi

30

30

0.28

0.25

080

425

5.58

10 Bangalore Rural Nelamangala

12

50

0.00

0 14

054

541

6.09

11 Tumkur

Kunigal

32

50

000

012

028

392

4.32

12 Hassan

Harisave

20

30

0.05

0.54

028

0 17

1.03

13 Mandya

Nagamangala

30

30

0.00

017

1 66

007

1.90

14 Chlkmagalur

Tarikere

50

50

0.21

098

0 14

766

8.99

]

15 Shimoga

Bhadravathi

30

50

0.00

1.07

1.90

1.35

4.32

J

16 Chikmagalur

Birur

50

50

0.00

1.12

080

243

4.34

J

17 Chitradurga

Holalkere

30

50

0.00

1.02

000

550

6521

1

Page 1 of 13

Atonexure 1
Progress of Construction Programme, as on 28.2.97
District

Centre

Beds

Million Rupees

-T9 Targeted stage of work as on 20 2.97

- Present stage of work
c’

s

f

UJ

o
CL

s
8

I

i

SQ.

4)

I I
76
o

_____ g
_______ UJ
Quarters Hospital Quarters Hospital

so

a?
£

o

H,

•i

o
C <2
c
ro

w
o>

o

sE

ll

O- Q

Cd

Io

s

115 I- fE Wc I I f ! v
i
I
o
I
h S. 5
c
I or oo 2? 5 W ? I i. ro& o 2
oll
V)
0)

o
o>

■U

O, 75 CO

g_

>

q

18 Shimoga

Channagiri

50

50

0.70

078

0.52

1.62

3 621

J

19 Shimoga

Shimoga

600

600

4.50

1350

000

000

18.001

20 Shimoga

Honnali

6

30

052

043

028

000

1.23

1
1

21 Hassan

Belur

10

50

000

1.70

0.50

11.90

14.10

22 Hassan

Holenarsipura

100

100

0.00

0.85

026

689

8.00;

23 Kodagu

Madikeri (W & C)

210

210

0.00

1.88

6.82

605

14.75

Gonikoppal

50

50

0.00

366

026

5.37

9.29

25 Mysore

Heggadadevankote

50

50

000

0.11

2 18

1 03

3.32

26 Mysore

Hunsur

50

100

000

096

246

677

10.19;

27 Mysore

Periyarpatna

30

30

0.00

0 47

028

0.30

1.05

shi 24 Kodagu

]

k.

]



28 Mysore

T Narasipura

40

100

000

/ 0 62

384

600

1046

29 D. Kannada

Mangalore Lady Goshen

260

260

085

r o oo

626

1 22

8 33i

30 D. Kannada

Mangalore Wenlock

70S

705

0.08

2.26

000

000

234

31 D. Kannada

MulW

44

50

0 05

2 85

2 18

1 36

644

32 D. Kannada

Bantwal

30

30

0.19

1 96

079

402

688

J

33 D. Kannada

Belthangadi

30

30

2.57

245

028

0 00

5.30!

1

34 D. Kannada

Puttur

64

100

072

221

384

3 22

9.99

Page 2 of 13

1

Annexure I
Progress of Construction Programme, as on 28.2.97
District

Centre

Million Rupees

Beds

a>

5o

§

s

0)

Khanapur

28

36 Blegaum

Kfttur

6

37 U. Kannada

DhandeH

38 U. Kannada

Haliyal

39 U. Kannada
40 U. Kannada

•5 □
hi co

000

030

000

3.16

3.46;

30

0.00

038

0 14

030

0.821

50

1.98

000

0.00

30

30

0.00

0 57

1 66

000

2.23

Uoida

10

30

0.00

0 24

000

000

0.24

Yellapur

30

30

0.00

0.85

1 66

000

251

Saundattl / Yellamma

50

50

0.00

058

000

291

3.49

42 Belgaum

Yaragattl

6

30

0.00

030

000

030

0.60

Belgaum

Ramdurg

50

5tr

(TOOl

030

052

Dharwad

Nargund

24

30

0.00

0.76

0.71

295

4.42

Dharwad

Dharwad

170

250

1.00

4 10

12 00

1831

Bi)apur

Basavana Bagewadi

10

50!

0.00

0.30

1.89

Muddebihal

30

50

0.00

1.38

052

1.90

14.88

66.00

136.44

267.02

Belgaum

47 Bijapur

TOTAL of Phase I

0.00

Phase li

48 Bangalore

Bangalore, Vanivilas

49 Bangalore

Bangalore, HSIS W & C

605
120

120

000

-=2

re
o

O’



u
a>
CO

<

2.
£

Quarters Hospital Quarters Hospital
35 Blegaum

= Present stage of work

=T9 Targeted stage of work as on 20.2.97

1600

000

000

000

000

000

Page 3 of 13

f

i/)

I-s i

c
E

O)

a>

a a?
o
3
CO

a>

u.
E

«

23 C

o
or2 o

o
0

ei

ra
u. n;

(A

cn
■O

■O

o
O)

s
■a

a>

■i
o

I

S

I
w

Annexure I
Progress of Construction Programme, as on 28.2.97
District

Centre

Beds

= Present stage of work

=T9 Targeted stage of work as on 20.2.97

Million Rupees

O)

s
f

O)

I

g- £

S

o

2

*0

ro
o

v
9______ U1
_____ a:
Quarters Hospital Quarters Hospital

•s

a?
d
co

o
o
(Z

<

a
o

H <O

•5)

c
a> c
E ro

.-=

2 c

a>
Hco

o
tr o

f



co

•C

1

I f <0
I
E 3
f 8“ el E2. ?
§
w

'o
O)

o

o>

ii

O

t5 CO
£ 3 £ u-.11
re

o

o

sE

P

I

-O

H

Ih
8%

35 Blegaum

Khanapur

28

30

000

030

000

3 16

3.46

36 Blegaum

Krttur

6

30

000

0 38

0 14

030

082

]

37 U. Kannada

Dhandeli

46

50

1.98

1.14

000

0.00

3.12j

1

38 U. Kannada

Haliyal

30

30

0.00

057

1 66

000

2.23

39 U. Kannada

Joida

10

30

0.00

0 24

000

000

024

40 U. Kannada

Yellapur

30

30

0.00

0.85

1 66

000

251

41 Belgaum

Saundattl / Yellamma

50

50

0.00

058

000

291

3.49

42 Belgaum

Yaragattl

6

30

0.00

030

000

030

0.601

iwn

43 Belgaum

Ramdurg

501

50

ot
T

osa

052

(136

TTS'

]

44 Dharwad

Nargund

24

30

0.00

076

071

2 95

442!

45 Dharwad

Dharwad

170

250

1.00

)4.10

1 21

12 00

1831

46 Bijapur

Basavana Bagewadi

10

50

0.00

0.12

1.47

030

1.89

47 Btjapur

Muddebihal

30

50

0.00

1.38

000

052

1.90

14.88

66.00

49.71

136.44

267.02

]

I

J -

TOTAL of Phase I

7

.

Phase II

48 Bangalore

Bangalore, Vanivilas

605

605

2 15

1600

000

000

49 Bangalore

Bangalore, HSIS W & C

120

120

000

000

000

000

Page 3 of 13

1





Annexure I

Progress of Construction Programme, as on 28.2.97
District

Centre

X

<5

&

Beds

UJ

Million Rupees

=T9 Targeted stage of work as on 20.2.97

S

S

§
o

s

ga?□
o

o
(X

______ (E

Quarters Hospital Quarters Hospital
0.65
072
0.71
065

Q.

0)

cn

______ LU

I

o

m
u

£
g

go 2a?

F co

15
o>

SB

L

Ho
£ s
E |

Present stage of work

i

f

(T O

0

•O

w

"c

I I. I
§
I
1
1
f
□ I

I
2.5
5
.2 &
CT

tg c

*o

o
o>

o

£0 O>

E V)

I
m0
a_ q co

I

O)

■O

0) £

a. q >

U- CQ

a. o

CD O

to

O CO

UJ

50 Bangalore

Anekal

18

50

51 Bangalore

K.R. Puram

10

100

0.00

0.00

384

15.75

1959

52 Bangalore Rural Hoskote

23

30

000

000

1 23

5.05

6.28

53 Bangalore

9

100

000

000

332

15.75

19.07

54 Bangalore Rural Doddaballapur

50

50

0.00

1 44

2 18

062

424

1

55 Kolar

Bathlahalli

30

30

0.00

0.90

000

000

0.90

J

*> - 56 Kolar

Gauribidanur

110

110

0.34

2 42

2 18

6 69

11.62

]

r: 57 Tumkur

Tumkur

330

400

0.00

248

608

0.00

8 56

58 Tumkur

Korategere

30

50

000

0 44

000

801

8.45

59 Tumkur

Gubbi

16

30

000

0.79

0.28

059

1.66

60 Hassan

Arsikere

100

100

0.02

2 42

1 21

5 17

8.82

61 Tumkur

Tiptur

56

100

000

1 09

0 26

699

8 34

62 Tumkur

Chikkanayakanhalli

30

50

0.00

0 14

071

675

7.601

1

63 Tumkur

Turuvekere

16

30

0.00

Oil

0 28

475

5.13^

!

64 Chitradurga

Chitradurga

389

450

000

0 69

507

1388

1964

j

65 Chitradurga

Nayakanahatti

0

30

0.00

024

028

6 15

667

66 Chitradurga

Parashurampura

30

30

0.00

059

044

0.18

0.91

Yellahanka

Page 4 of 13

2.73

1

j

J

Annexure I
Progress of Construction Programme, as on 28.2.97
District

Centre

Beds

= Present stage of work

=T9 Targeted stage of work as on 20.2.97

Million Rupees

O)

I II
re
o

i

1

o

§
go

re
•5

__ 5

re
_____ g
Quarters Hospital Quarters
0.00
033
069

a?
£
CO

£I
I
o □
co

c
<D c
E re

ts

2
c
re o

or o

L- f

o>

^■9

E 3
E s O

ui
a_ c
q cd

r

re

o

t§ 1

L

If 2l 1liI
o

f&
u» re

Q. Q

<A
C

■O

re
E

s
f i I
O)

p
CD

■U

*0

Q

■O

V

5

o 5

O CO

UJ

Hospital
1.62

264

000

490

5.10

0.22

0.71

3 69

4.62!

0.00

0.69

028

3 12

409

30

0.00

019

1.66

7 14

8.99

100

100

0.31

4.76

1.42

210

859

Nrtte

6

30

1 69

081

1 66

000

4.161

74 Shlmoga

Hosanagara

30

50

000

1.39

0.00

000

0.80

75

Tirthahalli

100

100

000

244

1 38

3 83

6.59

76 Mandya

K.M. Dodcfl

6

30

0 15

226

0 28

0^0

2 87

77 Mandya

Malavalli

50

100

0.03

0.05

220

2.47

6.95

78 Mysofe

Mysore, SMT

52

50

0.00

005

097

030

1.321

j

79 Mysore

NPCW&C

22

30

0.00

0.00

000

000

0.00

I

80 Mysore

V.V.Puram W & C

22

30

0.00

002

000

223

O.OOl

J

81 Mysore

Bannur

6

30

000

0.30

097

0.30

1.57

82 Mysore

Talkad

6

30

0.00

0.32

000

050

0.82i

]

83 D. Kannada

Kundapur

82

100

0.00

1.85

237

000

422

1

67 Chftradurga

Chellkare

30

50

68 Chftradurga

Molkalmuru

• 50

50

0.00

0.20

69 Chikmagalur

Koppa

50

50

0.00

701 Chikmagalur

Narasimharajpuram

18

30

71 Chikmagalur

Shringeri

18

72 D. Kannada

Karkal

21 73 D. Kannada

3________
*

£

S
55
S
Q.

*0

I

Page 5 of 13

]

6

District

Centre

Annexure I
Progress of Construction Programme, as on 28.2.97
Beds

Million Rupees

=T9 Targeted stage of work as on 20 2.97

= Present stage of work

O)

4
<5

s
sa.

fo

I
UJ

O-

2

<D

a?
o

_____ UJ
Hospital Quarters
2.12
1 66

Hospital
052

4.30


co

I

ro
o

1
o t

CL C
O

*0

c jG
E "
3 3
c in
o c
0) o
(T O

h

II
1E°
2 « w.

To


O)

IS! f

in

IE

o

in
O>
c

0

o
o>

■u

s

o

x;

§

h £S. -I i-g I 5 I?

u

c
a>



o «
o <n

84 D. Kannada

Shirva

21

30

______ <g
Quarters
0 00

85 U. Kannada

Bhatkal

40

50

0.00

1.50

0.00

000

1.50

]

86 D. Kannada

Udupi

124

124

078

3 16

341

1.49

8.84

I

87 D. Kannada

Udupi, W & C

76

76

0.12

050

207

1280

15.49

88 Dharwad

Byadgi

30

30

0.05

1.18

0.00

222

3.45

89 Dharwad

Haven

58

100

0 41

1 53

000

2.13

4.07

y90 Dhaiwad

Ranibennur MCH

30

30

0.00

080

1.66

1.21

3.67

Dharwad

Ranibennur TLH

30

50

0.00

031

2.18

368

6.17

92 Dharwad

Hangal

30

30

0.40

1.59

052

0.18

2.68

93 U. Kannada

Sirs!

56

100

0.00

2.32

043

288

5.63

94 Belgaum

Athni

28

50

000

025

2 18

269

5.12

95 Bijapur

Biligi

6

30

0.00

0.59

0 57

008

1.24

96 Bijapur

Jhamkhandl

50

100

000

037

1.38

037

2.12i

97 Bijapur

Mudhol

30

30

000

023

043

580

6.46

98 Belgaum

Bailhongal

50

50

0.00

0 17

0.28

0 30

075

99 Bijapur

Rabkavi Banhatti

30

30

0.00

0 16

0.28

030

0.741

100 Bijapur

Mahallngapur

6

30

000

0 12

0.57

0 30

0.99

Page 6 of 13

H co

O- Q co

O. Q

CO o

LU

0

J

Annexure I
Progress of Construction Programme, as on 28.2.97
District

Centre

Beds

Million Rupees

1

§
55

|

101 Bijapur

Talikota

30

o
oZ

30

TOTAL of Phase II

= Present stage of work

=T9 Targeted stage of work as on 20 2.97

a
S

fo

aT

Q.

a>

_____ til
Quarters Hospital Quarters Hospital
0 00
0 70
000
0 16

o

£□

GO

I

w
o

-

i

*0

c £2

2 EI
C

Q. C
O 3
H GO

o>

V)

f

Si



o

O)

f

h&
H
.2
£
ill
o

CZ)

tr o

flu o m

U-

tp

2 ?
S/5
2» 2

g_ q

tn

sI

w
■O

o

I

-a
CO Q

s s
o

o

5

o 5
O <0

LU

087'

7.09

64.68

59.98

164.03

295.78

Phase ill
102 Tumkur

Madhuglri

50

50

000

004

1 32

0 31

1 67

103 Tumkur

Sira

30

56

000

0 19

028

0.44

091

104 Tumkur

Pavgada

30

50

000

049

000

3 28

3.77

105 Chitradurga

Hosadurga

36

50

0.00

0.29

0

4.55

4.84;

yc 5 06 Chitradurga

Hiriyur

74

100

0.00

0.48

071

000

1.191

707 Dharwad

Hirekerur

26

50

0.26

096

1.06

1.34

361

108 Shimoga

Sagar

100

100

0 12

1 23

028

0 00

1.63

109 Shimoga

Shikaripur

28

50

0 54

096

0 28

000

1.78

110 Shimoga

Siralkoppa

6

30

0.00

1 13

0 14

000

1.27

111 Shimoga

Sorab

18

50

000

0 46

2 18

4 59

7.23

112, Shimoga

Kannagl

24

30

033

037

071

000

1.40|

113 Uttar Kannada

Slddapur

30

30

000

0 59

086

000

1.45^

114 Hassan

Arkalgud

30

50

0.03

1 55

1.49

1.44

4.51

115 Hassan

Haiti Mysore

14

30

001

050

075

000

1.25

116 Hassan

Konanur

15

30

0.03

048

0 22

0.00

0.72

1
1

g_______

Page 7 of 13

1

1

]

'
*Annexure 1
Progress of Construction Programme, as on 28.2.97
District

Centre

Beds

Million Rupees

I

5
<5

ro
o

s

O)

o

5

Q-

= Present stage of work
76
£
V)
•8

=T9 Targeted stage of work as on 20 2.97

ac

Is

I SF i
£

§

I
_____ ul

_____ or
Quarters Hospital Quarters Hospital

o

ST
2:2
(/)

O 2
H CO

*o
C £
Q)

O)

I

-

E

2 c

o
o: o

k I- I “ i
CD

E 3 o

Q CO

o

$

sE

hHp

D il £1
w

o

Q- Q

co Q

o
c
■O

"U

s

*6

11

is2
5
LU

o s
o co

117 Hassan

Hassan

344

500

1 80

5.78

357

0.90

12.05

118 Hassan

Channarayapatna

46

50

000

431

1 32

3.59

922

119 Hassan

Dudda

6

30

016

0.46

1 02

000

1.64

120 Mandya

Krishnanajpet

30

30

0.16

289

080

0.00

3 851

]

121 Mysore

Krishnarajanagara

80

100

000

038

1 64

0.62

2.64

J

122 Mysore
ha
-------%23 D. Kannada

Saligrama

10

30

0.03

022

0.14

027

0.75]

Sulya

30

50

093

240

2 18

000

552

1

{*24 Kodagu

Madikeri

200

200

0.00

647

7 68

39 04

53.19

J

125 Kodagu

Kushalnagar

50

50

0.00

0 59

1 23

688

8.70

J

126 Kodagu

Sanivarasanthe

30

30

000

082

028

000

1.10

127 Kodagu

Somvarpet

120

120

0.03

Oil

1 60

274

448

128 Kodagu

Kutta

28

30

000

1.19

071

3 17

507

129 Kodagu

Polibetta

40

50

002

093

1 23

045

2.621

130 Kodagu

Sldapura

40

50

Oil

1 14

1 64

1 39

428

131 Kodagu

Virajpet

240

240

000

8 61

268

1095

22 24

J
1

132 Mysore

Mysore, ED

50

50

000

0.15

2 18

030

133 Mysore

Gundlupet

50

50

1.80

5.18

022

058

zZOBBBZZ

J
J

Page 8 of 13

J

1

Aiinexiii e I
Progress of Construction Programme, as on 28.2.97
District

Centre

=T9 Targeted stage of work as on 20.2.97
o>

Million Rupees

Beds

I*
fl

8

O)

X
LU

55

o
ol

I

«

_____ g
Quarters

f

75

w
(A

■U

s

I *o "o§ 5o
I
1.
M
s
E
"
cr
w
.9
co
2 £ 11 f is
o
a?
E S O

I
o c
£ a>
?
° la a.S.«? Q52
o s
5 h
o
e
»

o
H in O CO
(/) |- co 1 g o £L CO £ £ § U- re
I .8

S

I

= Present stage of work
O)

c

0)

SQ.

0)

______ UJ
Hospital Quarters

Hospital

Kabbahalli

7

30

0.10

1.67

1.23

1 55

4.55

135 Mysore

Yelandur

6

30

0 13

093

0 97

3 13

5.16:

136 Bangalore

Banalore, ED

128

128

0.00

384

000

0.00

3 84

137 Bangalore Rural

Channapatna

100

100

0.00

1.24

284

596

11.04

138 Bangalore Rural

Kanakapura

50

50

000

064

026

870

9.60

139 Bangalore Rural

Ramanagaram

50

50

0.14

Oil

3 48

000

2.43

Dharwad

Akki Alur

30

30

0.17

1.02

0 14

1 91

3.23

141 Dharwad

Savanur

30

50

0.26

1.22

0 14

1.94

142 Dharwad

Shlggaon

30

50

0.43;

111

0 14

1 04

2.72

143 Dharwad

Hubll

144 Dharwad

Kundgol

30

30

0.36

1 60

0 14

1.46

3 56;

145 Dharwad

Kalghatgi

6

30

000

0.92

000

4.45

146 Dharwad

Lakshemeshwar

25

30

0.10

069

000

1 56

2.351

147 U. Kannada

(Tibetan) Mundgod

50

50

0.00

000

000

000

000

148 U. Kannada

Mundgod TLH

6

30

0.00

0.18

1 66

360

5.44

149 Belgaum

Belgaum

740

740

0.00

0 55

0.00

13 84

14 39

150 Belgaum

Chikodi

13

50

0.00

026

1 21

000

1.47

c

O)

■O

o

CO Q

CO

1341 Mysore

O)

0J

bJ

Page 9 of 13

3.57!

_-

5.37

;

;

<

* Anntxure I
Progress of Construction Programme, as on 28.2.97
District

Centre

Million Rupees

Beds

= Present stage of work

=T9 Targeted stage of work as on 20.2.97
o>

s
Io

I

3

<4

al

S0

>.

c

8.
___ £

____

■5

Quarters Hospital Quarters Hospital
151 Belgaum

Nipanl

10

30

0 00

1.04

028

3.50

4.82

152 Belgaum

Raybag

6

30

0.00

030

000

039

069

153 Belgaum

Gokak

40

50

000

081

0.78

683

8.42

154 Belgaum

Hukeri

30

30

0.00

0.15

000

030

0.45

155 Bijapur

Bijapur ✓

396

400

000

1 26

643

698

14 67

156 Bijapur

Indi

50

50

000

021

028

007

056:

Tadavalga x

6

30

000

025

097

351

4.73|

Kalgl

6

30

000

047

0 57

041

1.451

30

50

000

0 14

080

000

094

8.04

71.93

62.48

158.04

300.49

-ffl------------(jg57 Bijapur
nJ
^8 Bijapur
159 Bijapur

Singi

x

Total of Phase III

2
CO

I I

I

76
o

'o

€.

a> c
to
8 f

o
r co

«

f
c

L

£
O)

■O x>

F

2 0

o
or o

o

w

5

E

•o

•U

o
o>

o

f g || i

Fi I

Oo
£ ro 0

.G I
i!
Q. Q m

a- y m

■O

(U

Is h
O «

Q <0

LU

1

J

Phase IV

160 Kolar

Kolar

317

400

000

8.13

427

993

22 34

161 Kolar

Robertsonpet, KGF

140

150

0.00

392

602

080

10 79

162 Kolar

Robertsonpet, W & C

85

100

0.00

246

242

363

8.50

163 Kolar

Malur

32

50

020

219

000

1.16

355

J

164 Kolar

Mulbagal

30

50

027

1 81

000

234

442

J

165 Kolar

Srinlvaspur

74

50

0.15

1 56

0 95

1 20

3 86

Page 10 of 13

?

?A

Annexlire I
Progress of Construction Programme, as on 28.2.97
District

Centre

Beds

f
i

5

UJ

s

O

- Present stage of work
re

V)
•o

=T9 Targeted stage of work as on 20 2 97

Million Rupees

8

I

55
c

8.

4)

o

____ jS

ol

____

Quarters Hospital Quarters Hospital
1.14
1 89
1.01
0.00

404

a?
£
a
co

I

5

o

1
8
O

3

r <n

1

O)

I

L

O>

?E

L

’o

n § Ic I
8 -y I
I
s

o
h Q 2 1 35 oo tnJ2
0 > 11 u.2 &ro o.Fl
II
£1.
■O

r.f
11
1
8
§i
0) o
O

’o

w

h

3

■U

0)

CD

O-

Q >

CD

Q

ID

166 Chitradurga

Bharamasagara

8

30

167 Chitradurga

Sirigeri

30

30

0.00

0.75

000

0 97

1.72

168 Chitradurga

Davanagere MCH

100

100

001

229

1 42

1038

14.10

J

169 Chitradurga

Davanagere SDH

900

850 “

--------- 0.00

820

4 32 ’

592

18 44

1

170 Chitradurga

Harihara

50

50

0.00

1.36

218

4.86

8.40

]

171 Chitradurga

Jagalur

50

50

0.00

0.46

000

400

4.46

1$ Chikmagalur

Chickmagalur W&C

88

100

0.53

1 98

1 42

328

1

1|$ Chikmagalur

Chickmagalur

177

300

0.30

0.58

269

22.27

]

174 Chikmagalur

Kadur

50

100

0.06

1.05

235

6 12

9.58

175 Chikmagalur

Mudigere

64

100

000

1.28

246

1 10

484

176 Hassan

Alur

30

30

001

1.50

1.66

1.47

464

177 Hassan

Sakleshpur

133

150

0.05

251

265

375

896

178 Mandya

Mandya

310

400

0.20

706

615

28 35

41.76

179 Mandya

Maddur

40

50

0.00

1 81

1 66

357

7.04

180 Mandya

Pandavapur

50

50

0.05

1 70

000

000

1.75

181 Mandya

Srirangapatna

30

30

0.01

085

1 66

600

8.52

182 Mysore

Mysore, Cheluvamba

390

400

000

022

928

2 88

12.38

_____

Page 11 of 13

$

1

1

Annexure I
Progress of Construction Programme, as on 28.2.97
District

Centre

Beds

- Present stage of work

=T9 Targeted stage of work as on 20.2.97

Million Rupees

O)

D)

§

55

I
Uj

o
oZ

§

t5 •

M

SQ.

•5

________ UJ
_____ ae _
Quarters Hospital Quarters Hospital
0.14 "
576
4 12
1.35

11.37

£
CO

I

“o

c
<2
0) E
.t:
E c

i

L
rs s f 1.


■o -o

o>

o

•e

<0

•E
O)
E

o

If
2 ?
a
E5
O? “I 2. § I ? f
tr I or8 oo o
>11 f &

o
h- (O

O

CO

co

O-

Q >

u. w

a> JO
Q- D

■O

0)

CD

Q

S

o

1

I 'g
C

o 5
O

183 Mysore

Chamarajanagar

112

150

184 Mysore

Kollegal

100

150

0.02

205

5 16

200

9.23

185 Mysore

Nanjangud

30

100

0.00

000

000

000

0.00

186 U. Kannada

Karwar

300

400

000

3.39

738

000

1077

187 U. Kannada

Ankola

12

50

000

0.53

092

000

1.45

J

188 U. Kannada

Honnavar

30

50

0.98

0.42

043

000

1.83

1

U. Kannada

Kumta

30

50

000

086

2.18

000

3.04

Dharwad

Gadag

114

114

009

1 53

1.11

2.48

521

191 Dharwad

Gadag, W & C

45

50

007

0 85

2 18

3 19

6.29

192 Dharwad

Mundargi

30

30

004

089

040

1 86

3.19

193 Dharwad

Shirhatti

17

30

046

1.21

0 14

1 35

3.16

194 Dharwad

Gajendragarh

30

30

000

0 75

1 66

1 25

366

195 Dharwad

Ron

30

50

0.47

097

080

1.47

371

196 Bijapur

Badami

30

30

000

0.94

000

0 16

1 10

197 Dharwad

Navalgund

18

30

000

0 62

040

6 62

7.64

1

198 Bijapur

Guledagudda

30

30

0.08

058

097

1 01

264

1

199 Bijapur

Bagafkot

150

150

000

000

086

1626

17 12

Page 12 of 13

J

Annexure I
Progress of Construction Programme, as on 28.2.97

District

Centre

Beds

=T9 Targeted stage of work as on 20.2.97
o>

Million Rupees

I
s
fo

I

£

«>

•R

2W Bijapur
201

Bijapur

45

50

Hospital Quarters
UTT ”noTS
O75U

likal

36

50

0 00

033

4.33
34.34

TOTAL of Phase t, II, III
5 IV

8"
aT <
£
CO

________ UJ

Hungcmd

TOTAL of Phase IV

2

8-

_____ o:
Quarters

UJ

52

§
5>
a

Hospital

032

T22

1.49

014

1.96

72.75

84.90

169.74

331.71

275.36

257.07

628.25

1195.00

$
KJ
4^

Page 13 of 13

co

"o
c J2
a* c

£

o
H co

I

L

■O

= Present stage of work
U)



1 8 q ■s

g o

a. •g m

2 S q

*0

co

sE

■O

I- h I 3 s .s1 L
Hl h
FI
s

■o -o „

I8

8 5

o>

ol Q >

0- Q

P
to v

*0

o

-U

5

UJ

o fl
O u>

A brief note on the installation of Blood Banks

Out of 33 Blood Banks to be located PWD has taken up Construction/Renovation of Blood
Banks in 10 places as detailed below. In one place i.e. District Hospital, Mangalore is
informed that District Surgeon has taken up the work. KHSDP(Engineering Wing) has taken
up Renovation work at District Hospital, Raichur & District Hospital, Belgaum. For the
remaining 20 places Drawings & Estimates are to be prepared.

Taken up by P. W.D. Taken up by
District Surgeon
D.H. Mangalore
D.H., Bijapur
D.H. Dharwad
- Karwar
a
- Udupi
u
- Chitradurga
- Tumkur
u
- Mandya
u
- Kolar
u - Madikeri
“ - Shimoga
ll

li

Drawings & Estimate to be prepared

<

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.

D.H. Mysore
D.H. Hassan
D.H. Bellary
D.H. Chickmagalur
D.H. Gulbarga
H.S.I.S. Hospital, Bangalore
SDH, Hospet
D.H. Bidar
SDH. Davanagere
SDH Hiriyur
SDHGadag
SDH Haveri
SDH Yadgir
SDH Virajpet
SDH Kollegal
SDH Lingasugur
SDH Sagar
SDHSirsi
SDH Puttur
SDH Bagalkot

Page 25

Taken up KHSDP
(Engineering Wing)
D.H. Raichur
D.H. Belgaum

Position of Installation of Blood Banks as on 21-2-97.
Position of Blood Bank building for installation

Position of Equipment procurement

of equipments

DTB = Draft Tender Bid approval; TDF = Tender Document

Staff in position
+ = posted

Fund; TE = Tender Evaluation; WO = Work order issued; S =
Supplied; C = Commissioned

Blank = Not Intended as it is available

w
o
a>

a>
CD
re
C

>.
£

§

§
_________ 1___

Z2

5
>D)

I

I

i
3

■3
CT

■3
re
CL

3 3§
re
Q.

4

s
6

3
CL

7

c
a;

2 1
8

E

o

9

a.
E
o

3
£

o

■£

■x

3

o

>. §
■3

■c

I

Id
o

J2
o
ro

ai

cp
a>

O
O

V)

10 TT 12 13 14 "l?

PWD

16
WO

17

WO

3. DH Mysore
4. DH Shimoga

o

w
= S

ai


1. DH Hassan

2. DH Mandya

aj
N

I o 1 te I c
£
o s £ c 3
I
,E
J
t)
o
o
o
□ s
JL m
E

2 3- cL w
£X
£
5

a>

0

re

o

Q.
O

re
ai
CD

8

s
a:
u
aj

E

o

Te
WO

O

o

u



E

8

c
CQ

19

TE

s>>

0

2

w


*

E

CD



o

S

re
0

oi

>re

o

E

22

23 24 25

I I
£
<
20

TE

CD

o

A

o

c
<v

w
§
ra

s
<v

E

10

o

ra
QJ
O)

O)

a>

ai
o

s
1
5 E I $ £ I 6

■s

Q.
Q.

0)
w

a>

Z

$ s

a>
a>

< V)

z

26 21 28 29 30 31 32 33 34

Nl Nl

TE

TE

TE

TE

TE

TE

+

Nl

Not needed as it is available

PWD

WO

5. DH Bidar

WO

WO

TE

TE

TE

TE

TE

TE

TE

TE

6. DH Bijapur

PWD

WO

7. DH Dhan/vad

PWD

Not needed as equipments are already available

8. DH Kolar

PWD

WO

9. DH Tumkur

PWD

WO TE

10. Udupi

PWD

WO TE"

11. DH Belgaum

KHSDP

WO TE

12. DH Raichur

KHSDP

WO

13. DH Karwar

PWD

WO

14. DH Bellary

WO

15. HSIS Hospital,
Bangalore

NA

+

TE

TE WO

WO

TE

TE

TE

TE

TE

TE

TE

TE

TE TE

TE TE

+

TE

TE TE TE

TE TE TE

TE
TE

TE

TE

+

TE TE
TE

+

TE

TE TE

+

TE TE

16. DH Chikmagalur

TE

17. DH Chitradurga

PWD

WO

18. DH Mangalore
(Wenlock)

DS

wo7]te/ WO/ TE/ TE/ TE/|TE/ te7|te/|te/|te/

19. DH Gulbarga

20. DH Madikeri

PWD

21. SDH Hospet
22. SDH Davangere
23. SDH Hiriyur
24. SDH Gadag
25. SDH Haveri
26. SDH Yadgir
27. SDH Virajpet
28. SDH Kollegal
29. SDH Lingsugur
30. SDH Sagar
31. SDH Sirs!
32. SDH Puttur
33. SDH Bagalkote

1

WO

TE

TE

TE TE

TE

TE

TE

wo TE WO

TE

TE

TE TE

TE TE TE TE

WO

WO

TE

TE

TE TE

TE TE

TE

WO

WO

TE- TE

TE

TE

TE

TE

+

+

+

TRAINING COMPONENT OF KHSDP
One of the main components of the KHSDP is to upgrade the technical skills of the
Medical and Para-Medical Staff working in various categories of the Health Institutions of
Government of Karnataka through in service training. This is in order to improve the quality
& effectiveness of hospital services in a Government Sector. All categories of Staff will be
trained to update their Clinical, Managerial and Maintenance skills. The strengthening of
services at these hospitals will improve referral system provide better quality of service and
reduce the burden on tertiary hospitals. The State has prepared a comprehensive training
programme for all categories of staff to be implemented during the project period. The
comprehensive training programme has identified the target group to receive training, the
subjects that need to be addressed, number of staff in each category to be trained, training of
trainers, development of training material and modules and number of trainees each year.

The clinical training deals primarily with the obtaining knowledge, attitude and skill to
carryout a specific procedure or activity. This training is based on competency based training
or learning by doing. There are two distinct groups who are to be provided appropriate
training for upgrading clinical skills.
1. Doctors who have post graduate qualification but working in CHC/Taluk Level
Hospitals. Their skills acquired during post graduate studies are not fully utilised.
2. Doctors who are M.B.B.S. without any post graduate training. They are mainly
posted at the CHC/Taluk Hospitals.
The first priority list of clinical skills for physicians have been identified in the areas of
Internal Medicine, OBG, Neonatalogy, Surgery and Anaesthesia. The training of these
Physicians will be conducted at the District Hospitals where a class room has been identified
and Audio Visual Aids are being procured.
Status of the Training Components of the Project (1996-97):
A. Training of Physicians of Community Level/Taluka Level Hospitals at the District Hospital.






St. John’s Medical College was identified to train the Master Trainers as TOTs for
each district.
Two Specialists from five specialities namely Medicine, Surgery, OBG, Paediatrics
and Anesthesia were selected from each district to undergo training at St. John’s as
Master Trainers. These trainers would in turn train the CHC - Taluk level doctors
at the district hospital.
The detailed Objectives, Methodology and the Training Programme conducted
during January 1997 in each speciality at St. John’s is as follows :
1. To familarise the working group and provide guidance in curriculum
development
2. To train working groups in training technology related to clinical in
communication skills.
3. To enable working groups prepare action plan for training of CHC/Taluk
level doctors.

Mydoc/Kish-Trg

Page 27

B. Training of Specialists from District hospitals at Specialised Institutions:






Nurses:






Letters have been sent to the list of institutions which had been identified for
training specialist doctors and their consent is being obtained to train our doctors.
15 out of 37 institutions identified have responded favourably. Reminder letters
have again gone to institutions who are yet to respond.
A detailed list of specialist doctors was obtained from the Directorate of Health
Services and database created at the KHSDP office. Using this a training matrix
has been developed for the Project period. Keeping the training objectives in mind
the syllabus and course content has been prepared.
The specialist training will be operational at various institutions from April 1997.

A detailed list of Nurses has been obtained from the Directorate of Health Services
and the database is being finalised to prepare the training course content.
The course content and syllabus has been defined and the various institutions for
training also been identified and their consent is being obtained.
The first batch of nurses is expected to be trained from April 1997.

Clinical Protocols (1996-97):

The clinical protocols are primarily intended to provide guidelines and standards for
management of common conditions for physicians especially for those who do not have post
graduate qualification. Clinical Protocols in 67 topics have been obtained from Andhra
Pradesh Health Department. A list of specialists affiliated to various teaching institutions in
Bangalore have been identified. They have been given the A.P. Clinical Protocols and asked to
update them within a time frame of two weeks.
The Clinical Protocol for OBG topics is ready for printing and will be circulated
shortly. The remaining topics of other subjects will be ready for printing within a weeks time
i.e., by end of March first week, 1997.
Status of Referral System (1996-97):
Quality of Medical care will be maintained only when a proper and effective referral
system is formulated and implemented. Presently, there is no formulated referral system.
Under the referral system, the patient will be encouraged to avail the facilities available at the
primary level of hospitals before proceeding to secondary or tertiary care hospitals. The
referral card will be used whenever a patient is referred.

The referral system is planned to be implemented in Chitradurga District on a Pilot
basis. In this connection, a sensitisation meeting was held at the District Surgeons Office at
Chitradurga 2 months ago. This was attended by all the doctors of the Taluk and CHC
Hospitals. They were brief about the objectives and implementation of the referral system. A
draft referral manual has been prepared based on the A.P. Model. A referral card has also been
prepared and these cards will be printed for Chitradurga District by April, 1997 for
implementation. A zoning system has also been devised for the district. The District Referral
Committee is yet to be set up and this is proposed to be functional by April, 1997.

03/03/97/Kish-Trg

Page 28

Specialists drawn from various teaching institutions/KHSDP were trained as Master Trainers.
Two District Surgeons were also included. Seven participants were from Medical Colleges.
The details of their specialisation are as follows :

Medicine
Surgery
OBG
Paeditrics
Opthalmology
Anesthesia
Radiology
Administration-4

-3
-3
-4
-2
-1
-2
-1

Methodology of the Programme
1. In an initial meeting of the participating specialists the course co-ordinator

explained the objectives of the programme and mechanics.
2. The course is residential, participants have been provided accommodation
in the campus.
3. The Doctors spend one month in their respective speciality departments. In
each department formal session/discussions are held in the topics provided.
In addition participants are posted in various areas of the department of
practical experience. Schedule of training for each department is enclosed.
4. Pre test and post test are conducted. Sample papers are enclosed.
5. Sessions in Education technology are held with Pre and post test
evaluation.
• A two hours session on genetic counseling are also held for each batch. Item 5 & 6
are common for all doctors.
• A five day workshop was conducted at Bangalore by the NTTC - JIPMER team of
Pondicherry on Training Methodologies for various specialists especially from the
Teaching Faculty of the Medical Colleges in Bangalore. The objectives and the list
of Specialists is enclosed as Annexure.
• So far three batches of twenty each (TOTs) have completed the training at St.
John’s. These specialists are from the various districts of the State and the
categorisation is enclosed as an Annexure.
• It is proposed to have two more batches of NTTC-JIPMER training programmes
at Bangalore in the month of March & June, 1997.
• The training of the CHC-Taluk level doctors training programme is being initiated
at Chitradurga and Belgaum District Hospital from 10th of March. The training
curriculum and subject contents have already been defined and necessary audio
visulal aids have been procured. All the teaching sessions will be at the District
Hospital only.

Mydoc/Kish-Trg

Page 29

Status of Trainers Training:

At St. John’s Medical College, Bangalore four batches of Training for Trainers are
arranged during Nov - Dec 96, Jan 97, Feb 97 and March 97 and 78 Specialist Doctors are
trained in the following Specialities.

Type of Speciality

Nov - Dec 96

Jan 97

Feb 97

4
4
4
3
4_
19

4
3
4
5
4
20

3
3
5
5
3
19

Medicine
Surgery
O.BG.
Paediatrics
Anaesthesia
Total

Mar 97
(Tentative)
4
4
4
3
5
20

Total
15
14
17
16
16
78

Statement showing the numbers of Specialists trained - District Wise
at St. John’s Medical College, Bangalore
SI. No.

District

1.
2.
3.
4.
5.
6.
7.
8.
9.

Bangalore
Bangalore (R)
Belgaum
Bellary
Bidar
Bijapur
Chickmagalur
Chitradurga
Dakshina
Kannada
Dharwad
Gulbarga
Hassan
Kodagu
Kolar
Mandya
Mysore
Raichur
Shimoga
Tumkur
Uttara Kannada

10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.

Total

Mydoc/Kish-Trg

Medicine

Surgery

OBG

Paediatrics

1

1
1

1

1
1
1
1

1
1
1
1
1

1
1
1
1
1
1

1

1
1
1
1
1
1
1

5
3
5
5
4
5
4

1
1
2
1
1
1

1
1
1
1
1

5
4
6
4
5
5

1
1
1

1
1
1

1
1
1
1

5
5
5
2

17

16

16

78

1
1
1
1
1
1
1

1
1
1
1

1
1
1
1

1
1
1
1
1
1

1
1
1
1

1
1
1

15

14

Page 30

Total

Anaesthesia

1
1

Activities

1996

o In |d J F
Curriculum
Development
Modules
Development
Training of
Trainers
Training of
Specialists

Training of
General Doctors

Nurses

Training of other
Technicians

1997

mJj JTa S O

w

Clinical Training - Implementation Plan
2000
1999
1998
M A Mjj J A S O N D J F M A W J A s 0 N D J F M A
J F M A mJj J A S O N D

2001
J A S 0 N D

Activities

Preparatory_____________ _
1 .Curriculum Development
2. Development of Syllabus
3. Development of Course
contents_________________
4. Identification of trainers
training resource personnel

Year_l_1996-97
J jJaT£ O | N

J
I —

Year I11997-98
A| M|J

E [a}s|0|n|d;j|f|m

Year V 2000-2001
Year IV 1999-2000
Year III 1998-99
A | M 1 J } J [ A | S | O | N 1 D | J | F j M | A | M { J [ J | A 1 S | O { N I D | J I F | M | A] M| J| Jj A| S|O| N| D| J!~FrM~

[lit

E3!
—— t

I I

J

5. Identification of institutions
6. Identification of trainees
7. Formulation of training
methodologies___________ _
8. Approval of Steering
Committee.
________

Training of Trainer*
1. Identification of Trainers
2. Idenitification of trainees
for trainers training______
3. Detailing of trainers
training course_________

w

=

ill!

I i I

Ti
zzz

nm

4. Formulalion of trainers
team at each district hosprtaj

Training of Special!tts
1. Internal medicine
2. Cardiology_________
3 General Surgery
4. ENT
5. Ophthalmology_____
6. Orthopaedics_______
7. Endoscopy______ _
8. Neurosurgery______
9. Psychiatry_________
10. Anaesthesia______
11.OBG____________
12. Paediatrics_______
13. Dental

14. Anaesthesia (For MBBS)
15. Skin
_

□. o c n

Note on Procurement Activities
First IFB Procurement
1. The first IFB for procurement of equipment for 13 packages was issued on 1-101-996. 2. The
Bids were opened on 13-11-1996. As per the bid documents the validity of these bid documents
is 12-2-1997. As approved by the Steering Committee, the notices have been sent to all
responsive bidders for an extension of time by 60 days along with the extension for Bid Security.
As per this extension the last date for deciding the LI with all verification is 12-4-1997. Out of 13
packages, the bids in respect of 3 packages in full have been rejected. On one package out of 3
equipment, the bids in respect of 2 equipment have been rejected. 3. The letters have been sent on
24-2-1997 to all the responsive bidders to give Performance Statement to decide on eligibility
criteria. A period of 15 days is given to furnish these details.

Second IFB Procurement
The second IFB for procurement for 50 packages was issued on 15-10-1996. The Bids were
opened on 16-11-1996. As per the Bid documents, the validity of these bid is Rs. 16-2-1997. As
approved by Steering Committee notices have been issued to all the Bidders for an extension of
time by 60 days along with the extension of Bid Security. As per the extension, the last date for
deciding LI with all verification is 15-4-1997. Out of 50 packages, the bids received in respect of
12 packages are already rejected by the Steering Committee. For 1 Bid there was no response. In
respect of 9 bids, Steering Committee has given its approval. In respect of 3 packages the
Steering Committee have asked for certain details. In respect of remaining 25 packages, the
preliminary work for scrutiny of bid is over. The Tender Sub-Committee has to hold meetings and
decide on the ranking to be given before it is placed for Steering Committee’s decision. The
notices are sent to the responsive bidders on 24-2-1997 asking them to furnish the performance
statement.
Third IFB Procurement

1) The third IFB was issued on 25-11-1996. 2) The Bids were opened on 27-12-1996. The
preliminary scrutiny of all the bids with reference to commercial aspects and technical aspects
(excluding evaluation on technical specifications) has been done. As all these packages are for
procurement of surgical equipment, it might be better to go for a demonstration of equipment
directly by the Tender Sub-Committee. The last date of Bid validity for theses packages is 27-31996. However, the bid validity may have to be extended by another 60 days in respect of these
packages also to ensure that there is no vitiation of any proceedings.
Fourth IFB Procurement
The fourth IFB was issued on 11-12-1996. The bids were opened on 11-1-1997:
validity date is 11-4-1997. The preliminary scrutiny is yet to start.

The Bid

1

03/06/97, Note-proc-act

Page 31

Fifth IFB Procurement

The fifth IFB on ICB norms was issued on 11-12-1996. The Bids were opened on 28-1-1997:
The Bid validity date is 28-4-1997. The preliminary scrutiny is yet to start.

Sixth IFB Procurement

The sixth IFB on ICB norms is ready for publication. The ICB document is cleared by World
Bank. This IFB is for procurement of Vehicles and Autoclaves.

Further as and when cleared by the Steering Committee, after verifying eligibility criteria
(Now the letters have been sent to the responsive bidders), final notices have to be sent to the
Bidders. Before it is initiated the STEM Consultants (R.P. Rao, Manjunath Road and Sudhesh)
may be asked to verify the details of LI again. Further Sri Sudish may be requested to prepare
evaluation report, in respect of the rejected ones, before it is taken for rebidding as the World
Bank clearance is required for re-bidding.

Note on Procurement of Blood Bank Equipment on Local Shopping Norms


Considering the urgency of the matter as approved by the Project Administrator,
Quotation were obtained from the surgical firms for supply of Blood Bank equipment. The
Steering Committee in its meeting held on 24-12-1996 approved for procurement of two
equipment. However in respect of the remaining equipment as decided by the Steering
Committee, the demonstration of equipment and verification of rates will have to be done by the
Tender Sub-Committee. So far, the Tender Sub-Committee after demonstration of the equipment
has cleared 3 more equipment. In respect of the remaining 6 equipment for which quotation were
taken, the Committee has asked for certain clarifications. This has to be sorted out early.
However, there is no time limit for this process as this equipment procurement for Blood Bank is
under Local Shopping Norms.

03/06/97, Note-proc-act

2

Page 32

Note on the position of procurement of equipments as on 28-2-97
First Set of 13 Packages issued as on 1.10.96

S

SI.

Name of the Equipment

NO.

No. of units required to be purchased during

the years

I


§

5
f
£

£c

2 £

h

?3

c

1996-97 1997-98 1998-99 99-2000 2000-2001

rea.

Pl S •£
2 1“ * 3
il lil

1 ECG

88

33

36

157

86

17000

2669000

88

2 Cardie Monitors

4

28

23

55

4

25000

1375000

4

Defibrilators

16

12

9

37

16

65000

2405000

16

3 Audiometer

9

6

5

20

9

50000

1000000

9

4 Baby Incubators

13

8

8

29

13

20000

580000

13

Phototherpy Unit

29

15

17

61

29

6000

366000

29

5 Operating Microscope

A

5

5

14

4

65000

910000

A

6 Foetal Moniter

9

6

5

20

9

6000

120000

9

7 Shortwave Diathermy

7

24

14

45

7.

20000

900000

7

8 Ventilators

16

12

9

37

16

75000

2775000

16

9 Boyles Apparatus with fiou tech

6

3

2

11

6

125000

1375000

6

19

9

13

41

19

60000

2460000

19

10 Qpthalmo Scope

5

24

12

41

5

5000

205000

5

11 Slit lamp

A

4

4

14

6

21000

294000

6

Retino Scope

5

2

5

12

5

3000

36000

5

Perimeter

8

4

4

16

8

6000

96000

8

90

59

42

191

90

20000

3820000

90

62

39

33

134

62

0

62

18

11

12

41

18

41000

18

U)
UJ

Boyles Apparatus without flou tech

12 Emergency Resuscitation Kit
Baby Emergency Resuscitation Kit

13 Head light

Decision of the

Stage of procurement

Steering Committee

o 4>

*0
Si
CTC

3



§ .

1000

Draft bld

Draft bid

Bid

Bids

Bids

document

document

floated

opened

evaluated

To Rebid Accepted

i

5
B
o
E
o

1 o

v>
£

e
c

s
Q.
V)

£
iu

Q-

§

s
s

W

Q

£
5Q.

5

o
c
Q.
X

I I I I
re

re

Note on the position of procurement of equipments as on 28-2-97
Second Set of 50 packages issued as on 16-10-96
c

•6

d
st

§ at
si.

No.

Name of the Equipment

No. of units required to be purchased during
the years


I

i

=s

p o

*2-

£
E
at

c

* §
5
2
Z ft-

Hi

«5

h

o o

Pi

Decision of the

Stage of procurement

Steering Committee

tn

H _ W QRs 000s

s

2

O O

Draft bld

1996-97 1997-98 1998-99 99-2000 2000-2001

?
i Bs 82

Rs 000s

1 Endoscope Fibre Optic

4

10

5

19

4

200

3800

4

2 Cyrosurgery (Deluxe)

4

6

4

14

4.

8

112

4

3 Pulse Air Tonometer

7

9

5

21

7

5

105

7

4 AMC Equipment

8

7

5

20

8

25

500

8

5 Dental Unit

70

45

30

145

70

28

4060

70

Dental Chair

66

42

27

135

66

14

1890

66

6 Airotor

31

9

14

54

31

21

1134

31

7 Operation Table (ordinary)

59

21

30

110

59

8

880

59

Operation Table (Hydraulic)

26

18

12

56

26

35

I960,

26

8 Shadowless Lamp (Mobile)

87

54

42

183

87

8

1464

87

O.T. Lights (Shadowiess)

116

68

48

232

116

45

10440

116

Focusing Lights (Mobile)

80

44

35

159

80

1

159

80

9, Suction Apparatus (High Vacuum)

96

56

44

196

96

8

1568

96

Suction Apparatus (Electrical)

121

64

56

241

121

5

1205

121

Foot Suction Apparatus

114

70

51

235

114

1

235

114

10 Vacuum Extractors

112

54

50

216

112

2

432.

112

11 Instrument Sterlizer

434

278

220

932

434

3

2796

434

12 Diathermy Machine

35

11

19

65

35

12

780

35

Page 1

<A

n

Draft bid

document

document

finalised

cleared by W,B-

Bid

Bids

floated opened

Bids
evaluated

To Rebid

Accepted

o

fo
o

a.
c


a.

a

£
f

Q.

U

OJ
in

1 5 I
fl­

at

X

|
I I2* %
Q

ra

Note on the position of procurement of equipments as on 28-2-97
Second Set of 50 packages issued as on 16-10*96
c
■Q

e
SI.
No.

Name of the Equipment

No. of units required to be purchased during
the years

I

0

st
^2

o

II
HI =o 23
8 g.
iA. 11 h
Hl 11
tr

i

«0

L

Stage of procurement

Decision of the
Steering Committee

c r»

3 0

U o
■= Jr 0

1996-97 1997-98 1998-99 99-2000 2000-2001

Gynaec Electric Cautery

MS

w

(A

Rs 000s

Rs 000s

151

55

58

264

151

1

264

151

13 Automist

123

67

59

249

123

5

1245

123

14 Dental Lab (Bath, Motor, Lathe)

13

1

5

19

13

20

380

13

15 Microscopes (Binocular)

70

41

35

146

70

9

1314

70

16 Chemical Baiances

16

6

9

31

16

6

186

16

Simple Balances

80

36

31

147

80

1

147

80

17 Photo Electric Calorimeter

27

8

12

47

27

8

376

27

18 Flame Cell Photometer

34

6

13

53

34

18

954

34

19 Spectro Photometer

7

7

4

18

7

22

396

7

20 Auto Analyser

7

6

5

18

7

40

720

7

21 Micro Pipettes

4

4

4

12

4

5

60

4

22 Water Bath

85

45

39

169

85

3

507

85

23 Hot Air Oven

114

57

51

222

114

8

1776

114

24 Incubators

31

1

11

43

31

8.

344

31

25 Distilled Water Stills

31

3

12

46

31

3

138

31

26 Centrifuges

97

45

42

184

97

4

736

97

27 Hot Plates

27

6

12

45

27

2.

90

27

28 Rotor/Shaker

6

5

5

16

6.

2

32

6

Page 2

f
§

Draft bid
document

Draft bid
document

■MM

Blds
Bids
Bid
To Rebld Accepted
floated opened evaluated

a
a

Eo
X

o

i 1
o>

2

Q.
E

a*
a.

o
v>

Q.

f

§

O

0

•o

S

I I

UJ

0
Q.

Q

I

1

Note on the position of procurement of equipments as on 28-2-97
Second Set of 50 packages issued as on 16-10-96


®

SI.
No.

Name of the Equipment

-I
i!

*5

£

~
c
p o



the years

li
?!
£1

2


® Q.

It n * ° 3

5

Steering Committee

2
S

= 2

“ o o

■= J;

Rs 000s

30

134

64

1

134

64

PH Meter

5

6

4

15

5

15

225

5

30 Glucometer

94

49

40

183

94

6

1098

94

90

58

49

197

90

1

197

90

31 Microtom

13

2

5

20

13

12

240

13

32 Oven (Wax embedding)

10

5

4

19

10

8

152

10

33 Tissue Processor

6

7

5

18

6

70

1260

6

34 Quick Test Kit for Aslo, Trtre, ESR

210

134

116

460

210

.0

210

35 Timer Stop Watch

87

42

35

164

87

0.7

114.8

87

Alaram Clock

34

2

13

49

34

0.4

19.6

34

36 Refrigerators 300 ltrs.

115

84

54

253

115

20

5060

115

37 A/C Machines with Stabilizer

82

77

61

220

82

28,

6160

82

38 Water Coolers

95

53

46

194

95

15

2910

95

391 Two Body Mortuary (Cold Storage)

26

2

10

38

26

100

3800

26

40 Generator 5 KVA

23

19

10

52

23

100

5200

23

Generator 15 KVA

30

12

13

55

30

150

8250

30

Generator 50 KVA

28

8

36

28

200

7200

28

Generator 62.5 KVA

10

15

34

10

250

8500

10

(TO

Page 3

5
a

2
m

Draft bid

Draft bid

document

document

Bid

Bids

floated opened

Bids

evaluated

To Rebid

Accepted

w

■o

o>

Q.

2

c
o

®

HI 11

40

9

Decision of the

C T3

64

Himoglobin Meter

Stage of procurement

2 -2

Rs 000s

1996-97 1997-98 1998-99 99-2000 2000-2001

9

®

No. of units required to be purchased during

€I29 Counting Chamber

e

o

>.
a.

(/>

®

o

S
£

UJ

3

s

i

2

Q.

c

®

Q.

l I

I £ i

o

Note on the position of procurement of equipments as on 28-2-97
Second Set of 50 packages issued as on 16-10-96

SI.
No.

d
il
5

Name of the Equipment

No. of units required to be purchased during
the years

fa>

o-

2

c

>0

2

®

§ o

p o

«I
ii h ron

n it HI 11

1996-97 1997-98 1998-99 99-2000 2000-2001

*0

Rs 000s

Rs 000s

80

49

223

94

20

4460

94

42 X-ray Viewing Box

186

107

96

389

186

1.5

583,5

186

43 Developing Tanks (X-ray)

68

44

42

154

68

0.75

115,5

68

44 Safe Light X-ray Dark Room

52

36

27

115

52

0.25

28.75

52

45 Casettes X-ray

68

36

34

138

68

0.4

55.2

68

46 Intensifying Screen (various)

82

56

43

181

82

2

362

82

47 Lead Aprons

73

48

39

160

73

2.6

416

73

56

39

25

120

56

7.5

900

56

48 Chest Stands X-Ray

60

42

30

132

60

0.91

118.8

60

49 Stethoscope

205

134

92

431

205

0

205

50 B.P. Apparatus infant,

425

313

202

940

425

470

425

93

48

48

189

93

oj

93

B.P. Apparatus43 size cups,

Stage of procurement

Steering Committee

’o §=

94

0.5

Decision of the

C "O

41 Hot Water Systems (Solar Unit)

Lead Protection Screen

v>



11 ii

Page 4

Is 4 1 I
5

mo.

I

o

E
g

£ o
Draft bid

Draft bid

Bid

Bids

Bids

document

document

floated

opened

evaluated

To Rebid

Accepted



e

c

£
Q.

0

a

3

iu f

§

v>

&

I S

Q.

TJ

I I A.P

JAL

o

W

Note on the position of procurement of equipments as on 28-2-97
Third Set of 13 Packages issued as on 25.11.96

£

si.
No.

Name of the Equipment

No of units required to be purchased
during the year

E

3

2o

i!
£
c E

* 3

11

£ o
> a.

«oo O-Ia>

u

Stage of procurement

*3

S “■ O

£1

Rs 000s

1 D.D.&C.

218

110

94

422

218

1.2

506.4

M.T.P

218

110

94

422

218

1.2

506.4

Cervical Biopsy

146

74

67

287

146

0.7

200.9

Evacuation

109

52

47

211

109

0.55

116.05

Normal Delivery

260

120

114

494

260

1

494

P.N. Sterilisation

180

78

88

346

180

Episiotomy

260

120

114

494

260

0.7

345.8

Venisection

260

120

114

494

260

0.8

395.2

Caesarean Section

106

53

54

213

106

2

426

Incisition & Drainage

260

120

114

494

260

1

494

Vaginal Hysterectomy

74

38

40

152

74

3,

456

Abdominal Hysterectomy

74

38

40

152

74

5

760

37

19

20

76

37

2.5

190

Appendectomy

37

19

20

76

37

2.5

190

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37

19

20

76

37

1.2

91.2

C.J.

37

19

20

76

37

2.5

190

3 Suture Removal

146

74

67

287

146

0.4

114.8

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146

74

67

287

146

0.9

258.3

2 Vagotomy

§

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16

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252

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500

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37

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76

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37

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16

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37

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76

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798

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37

19

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76

37

0.25

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106

53

54

213

106

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74

38

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152

74

6

912

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74

38

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152

74

1

152

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74

38

40

152

74

2

304

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74

38

40

152

74

2.25

342

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74

38

40

152

74

0.67

101.84

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74

38

40

152

74

0.85

129.2

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106

53

54

213

106

1

213

Page 2

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106

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74

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152

74

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74

38

40

152

74

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74

38

40

152

74

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501.6

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74

38

40

152

74

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74

38

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152

74

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74

38

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152

74

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106

53

54

213

106

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74

38

40

152

74

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74

38

40

152

74

1.7

258.4

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74

38

40

152

74

10

1520

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74

38

40

152

74

23,

3496

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74

38

40

152

74

9.8

1489.6

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74

38

40

152

74

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1064

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74

38

40

152

74

6.8

1033.6

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74

38

40

152

74

7.5

1140

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146

74

67

287

146

0.4

114.8

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16

14

10

40

16

16.5

660

Page 3

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106

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213

106

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106

53

54

213

106

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138

67

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176

94

93

363

176

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103

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43

204

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144

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126

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1967

825

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193

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123

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319

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558

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Activities of Strategic Planning Cell of KHSDP
Karnataka Health Systems Development Project is being implemented in the
entire state with financial assistance from the World Bank. As per the suggestions and
discussions with the World Bank authorities in the pre-project period, it was suggested
to create a Strategic Planning Cell in the Department of Health & Family Welfare
directly under the control of Secretary, Health and Family Welfare and has been
entrusted with some issues of the health sector development policy and monitoring and
evaluation of health programmes. The cell has been created in the Government Order
No. HFW 61 WBA 96 dated 31-5-96.

Composition of the Strategic Planning Cell:
Additional Director
Joint Director
Senior Assistants
First Division Assistants
Typists
Drivers
Group ‘D’

1 Post
3 Posts
4 Posts
4 Posts
2 Posts
4 Posts
2 Posts

Total

20 Posts

Out of the above posts, Additional Director, one Joint Director (Officer on
special duty), one typist and one Group ‘D’ official are presently working in the cell.
The cell is temporarily functioning on the premises of the Population Centre, K.C.
General Hospital Complex, 2nd Cross, Malleswaram, Bangalore - 560 003.
____________ Action Plan of the Strategic Planning Cell, 1996-97,
____________ Action Plan______________
Action Taken
1) Data Bank
To set up a data bank with a view to • A data bank has been set up.
collecting data related to various aspects
Information is being collected from all
of health and population policies and
the district on all important socio­
programmes. The data bank should be of
economic, demographic and health
use in formulating policies and
indicators along with taluka and
programmes by the Department of Health
district maps and infrastructural
and Family Welfare
facilities available.
2) Quarterly Newsletter
It is proposed to publish a quarterly • The first issue of the quarterly
Newsletter.
The objectives is to
Newsletter is being brought out.
disseminate information on the progress
of various programmes,
including
externally assisted projects, under
implementation by the Department.

Page 45

The Newsletter will be published both
in Kannada and English
3) Commissioning of studies

a) A study on User Charges :
The World Bank has been urging •
the Government of Karnataka to ask
the people to pay for government
health services and retain the proceeds
in the same hospital so that facilities
and services can be improved. Before
taking a policy decision in this regard,
it is necessary to find out the opinions,
willingness and ability of people to
pay for government health services.
b) Burden of Disease Study :
It is also proposed to commission
a study on burden of disease in
Karnataka.
All these years, •
researchers have concentrated either
on mortality or on life expectancy to
gauge the health status of the people.
But it is also necessary to find out the
incidence of handicaps and disability
to gauge the health status of the
people.

c) Knowledge,
Attitudes
and
Awareness of AIDS :
With the assistance from the •
Government of India, an AIDS Cell
has been set up in the Directorate of
Health & Family Welfare Services and
information is being disseminated on
the symptoms and causes of AIDS and
various mode of transmission of HIV.
However, there is no baseline data on
the
knowledge,
attitudes
and
awareness of AIDS. It is, therefore,
proposed to commission a baseline
survey on the knowledge, attitudes
and awareness of AIDS with a view to
facilitating the evaluation of the
impact of AIDS control programme in
Karnataka.

03/05/97/SPC Status

Page 46

Proposals are invited from various
research institutes. One proposal on
this study is already received from the
Centre for Studies in Community
Development.

Letters have been addressed to
various institutions inviting research
proposals for conducting the study.

One proposal was received from the
Centre for Environmental and Social
concerns and discussed with the
Project Administrator. It was decided
to suggest the proposal to the Addl.
Director (AIDS) for funding.

1

d) Evaluation of Health Checkup
Scheme (Yellow Card Scheme)
A health check-up scheme •
(Yellow Card Scheme) for Scheduled
Castes and Scheduled Tribes is being
impelemented in five districts of
Karnataka. According to this scheme,
each member of SC/ST families will
be given a Yellow Card which entitles
him/her to a free health check-up
every year either in their own village
or nearby health centre. A study to
evaluate the scheme is being
commissioned.

A research proposal has been received
from STEM which would like to
conduct the study in collaboration
with
the
Population
Centre,
Bangalore. The proposal has been
reviewed and interview schedule have
been discussed. The proposal will be
discussed
with
the
Project
Administrator.

4) Seminars / Workshops :

a) District Level Workshops :
It is proposed to conduct 20 one- •
day district level Workshop on
KHSDP. The aim is to inform the
people concerned about the objectives
of the KHSDP and inputs that would
be going into each district and enlist
their support in the implementation of
KHSDP. The participants in these
workshops would include ZP officials,
CEOs, DSs, DHOs, and Mos of Subdivisional and taluk hospitals and
representatives of NGOs.
b) State Level Seminar :
The World Bank has been insisting
to integrate externally assisted •
projects with on-going programmes
with a view to having synergistic
effect. However, the methods of
integration are not very clear. It is,
therefore, proposed to conduct a twoday state level seminar on the methods
of integration of externally assisted
projects and Government of India
assisted projects like AIDS control
programme
with
on-going
programme.

03/05/97/SPC Status

Page 47

The proposal approved by the
Steering Committee. The Strategic
Planning Cell is scheduling these
workshops for the year 1997-98.

The proposal to conduct a two-day
State level seminar on integration of
externally assisted projects with on­
going programmes in the department
has been approved in principle by the
Project Administrator. Papers would
be invited from experts and seminar
held in May/June 1997.
The
participants would include some
experts in planning and programming,
DHOs, DSs and officers of the
Directorate of Health & Family
Welfare services and KHSDP.

2

5) Setting up of library



A library has been set up and
important and relevant books are
being purchased and journals are
being subscribed.

Convening of the District Level Health Systems Committee :

District Level Health Systems Committees have been set up vide Government
order No.HFW 30 EAP (V) Bangalore, dated 26-12-1995 with the Chief Executive
Officer of the District as Chairman, District Health and Family Welfare Officer as
Member and District Surgeon as Member-Secretary, Additional Director and Officer
on Special Duty visited Hassan, Chikmagalur, Kadur and reviewed the collection of
user charges and utilisation of money thus collected. A report has been prepared and
submitted to the Secretary, Health & Family Welfare, and Project Administrator.
A Study of the Existing System of Management of Hospital Waste (Clinical Waste)

District Hospital, Hassan, Chikmagalur, General Hospital, Kadur and HSIS
Hospital for Women and Children, Bangalore have been visited to know about the
existing system of management of hospital waste. At present, the placentas are being
collected by dai as per the decision of the government and an amount of Rs.2/- is being
collected for each of the health placenta and this amount has been credited to the
Government treasury. The infectious waste is being dumped in one of the corner
places in the vacant hospital premises and sometimes disposed off by burying in the pit
or by burning. A study will be commissioned to examine the existing system and
suggest proper method as per the guidelines of the world Bank.

03/05/97/SPC Status

Page 48

3

Hospitals Management
1.

Introduction

Hospital Administration covers not only delivery of patient care
services but also management of existing facilities and ensuring that gaps in facilities as
compared to norms are filled. While patient care gets maximum attention the other
important activities that are often neglected in government hospitals especially in the
smaller hospitals are:

1. housekeeping, i.e., maintaining the premises in clean/ aseptic condition
depending on the area,
2. proper storage of clean linen, dirty linen waiting to be collected by the
laundry,
3. ensuring availability of drugs and hospital supphes etc.,
4. maintenance of equipment,
5. maintenance of building, sanitary and electrical fittings,
6. disposal by sale of condemned equipment, furniture and non-hazardous and
recyclable waste, and
7. handling of hazardous hospital waste.
The first two functions are the responsibility of the Nursing Superintendent/
Matron. The third item is generally handled by the pharmacist/storekeeper. The
remaining items are not assigned to any individual and the Chief Medical Officer/
Hospital Superintendent is supposed to look after. The other doctors in the hospital
also give greater attention to patient care than to other hospital administration
components.
Apart from the preoccupation with patient care, the hospital superintendent has
no administrative and financial powers to condemn and order disposal of

• time barred drugs,
• linen, glass ware and mattresses which have become unserviceable by their ware and
tear, and
• damaged and unusable books, instruments, equipment, furniture and glassware etc..

2.

Provisions in the Project & Action to be Taken
Disposal of condemned furniture, equipment, date expired drugs etc.

The KHSD Project approved by the Government of Karnataka envisages
delegation of administrative and financial powers to officers at various levels. If the
Government Orders are issued in this connection and the hospital superintendents are
informed of the delegation of powers, accumulation, of unusable items will not take
place due to lack of administrative and financial powers. Once the condemned items

Page 4f

and waste materials are disposed of in the prescribed manner precious space will be
released for more useful activities.
Contracting out of Housekeeping Services

The GO No. HFW 274 HSH 80, Bangalore dated 16.10.1980 provides one
Group D staff for every three beds in hospitals with less than 250 beds and one for two
beds in hospitals with bed strength equal to or exceeding 250. The working group on
staffing has recommended that services like cleaning, laundry and wherever possible
kitchen services should be contracted out and recommended one Group D for every 6
beds instead of 3 beds as provided in the said G.O. The Staffing norms have been
accepted by the government and the additional staff sanctioned for the project are
based on the recommendations of the working group. As per the revised norms, in all
5,830 Group D staff are required for the hospitals covered by the project, while there
are 3,626 persons in position. Of the shortfall of 2,204 posts, 1,113 posts are due to
expansion of selected hospitals.

Steps should be taken to contract out cleaning, laundry and wherever possible
kitchen. Upper limits for contract value for each type of service in relation to bed
strength have to be prescribed by the Government and communicated to the CEO,
DHO, DS of each district and hospital superintendents for implementation.
Maintenance of Building, furniture and Equipment
The project provides setting up of Engineering wing for new civil works as well
as annual maintenance of existing buildings. The annual budget for maintenance will
be under the control of the Engineering Wing instead of the PWD. The State
Government has to provide two percent of the replacement cost of the buildings
instead of original cost as being currently provided maintenance by the Engineering
Wing after renovations have been carried out under the Project. The project provides
for meeting maintenance expenses during the project period for the maintenance
expansions carried out during the project period. One fourth of the provision (1/2% of
the replacement value of building) will be made available for the Hospital
Superintendent for urgent repairs. The balance amount will be available to the
Engineering Wing for annual maintenance.

Maintenance of Furniture and Equipment
An Equipment Maintenance Team is proposed to be set up in each district to
undertake preventive and breakdown maintenance of equipment. The Team will be
under the Administrative control of the District Surgeon and maintain equipment in all
Community Health Centres, Sub-district, District and Teaching Hospitals and will
also attend to minor repairs of sanitary and electrical fittings. The Teams will be
technically supported by a Central Equipment Maintenance Wing.

Page 5^

Handling of Hospital Waste
The Central Pollution Control Board (CPCB) has issued guidelines for
Management of Hospital Waste. The Board has also finahsed specifications for
incinerators and discharge of effluents. The Karnataka and Maharashtra Pollution
Control Boards have given clearance to some of the hospitals in the private and public

sectors to install incinerators.

The Project provides for purchase and installation of equipment for hospital
waste management. The guide lines issued by the Pollution Control Board have to be
reviewed and procedures defined for wastes not covered by the guidelines CPCB. The
specifications for containers for storage of different types of waste, their movement
and disposal required to be finalised for each hospital type.
Detailed guidelines for cohection, segregation, storage, movement and final
disposal have to be written and equipment and containers procured.

3.

Action Plan

Preparatory Activities
The Project Administration has studied the Environmental Standards And
Guidelines For Management of Hospital Wastes issued by the Central Pollution
Control Board and has arrived at a waste management plan for different sizes of
hospitals. The typical layout plans of 30,50,100 and 250+ bed hospitals were studied
and waste generating points by category of waste identified. The number of bins
required for storing segregated waste and wheel barrows for moving them by hospital
size is presented below.

Hospital
Size
No. of Beds
30
50
100
150
250
400

500
740

Number
of
Hospitals

Total number

Wheel barrows
Closed Bins
88 _ ______ 16 ___________ 4
18 ___________ 5_
92
30 _________ 8_
39
4 _______ 35 ___________ 9
58 ___________15
7
21
9 _______ 93
3 ______ 116 __________ 29
44
174
6

Approximately a quarter of the containers are required for storing hazardous
wastes. Disposable polythene bags are required to use as a liner for these containers as
the contents including the bag have to be incinerated.

Page 513

The waste sharps, glass syringes and bottles will be autoclaved and shredded.
The autoclaves available in most of the hospital have adequate capacity. Additional
autoclave will be provided in case additional capacity is required. Shredders will be
procured and provided to each hospital.

Oil fired incinerators meeting specifications of CPCB and approved by state
Pollution control Boards will be provided to hospitals. The waste handling capacity of
the incinerator will depend on the size of the hospital as given below:

Waste Handling
Capacity Kg/hr.
10
25
50
100
200

Hospital
Bed Strength
30/50
100
250
500
750

Provision is made in the World Bank Project for meeting the Investment cost of
Rs. 675 lakhs and operating expenses of 682 lakhs. In addition, A provision of Rs. 176
lakhs for waste handling equipment has been made in the agreement between the
Government of Karnataka and KfW.

Conduct of Workshop
It is proposed that a two day workshop on Hospital Management covering the
subjects described above be conducted to orient the Superintendents . As the
workshop could effectively be managed with 20 to 25 participants, a workshop for two
small districts and one for large districts are planned. The workshops would be
conducted by specialists from Project Management and Consultants. The participants
would be DHO, DS and Hospital Superintendents of the districts. The cost of
conducting one workshop is estimated as Rs. 35,000, Rs. 20,000 for organising the
workshop and Rs. 15,000 towards TA/DA of participants. In all 14 workshops will be
conducted at a total cost of Rs. 4.90 lakhs. The workshops are scheduled from April 3,
to May 30, 1997.

Delegation of Powers

G.O. No. HFW/447/IFW 96 dated 8.3.96 defining the administrative and
financial powers delegated to the officers at various levels in the Directorate, the DHO
and DHS in the districts and the superintendents of hospitals. The hospital
Superintendents have to be made aware of the financial admimstrative powers
delegated to them. A copy of the GO is presented in Annexe I
Contracting out of Services
With the implementation of new staffing norms, cleaning and laundry services
may be contracted out. The upper limit for of payment for cleaning of the premises and
laundry services is fixed at Rs. 400 per bed per month on the basis of anticipated
savings in salary of permanent staff. The hospital Superintendent will contract out on
Page 524

the basis of quotations invited from local parties. Contracting out of kitchen services
will be explored.

Maintenance of Buildings
The budget for maintenance of buildings be determined on the basis of two
percent of the replacement value of the building and not original value. The budget
provision be made as part of the Budget of Health Department instead of the present
practice of including in the budget. The annual maintenance of the buildings will be the
responsibility of the Engineering Wing created in the Health Department. For this
purpose the 75 percent of the Budget provision be given to the Engineering wing and
the balance to the Hospital Superintendent to meet the expenses for urgent repairs of
plumbing and electrical fittings, clearing clogged drains etc. The equipment
maintenance teams under the control of the district surgeons would undertake
preventive maintenance of plumbing and electrical work and breakdown maintenance
at District Hospital. At other hospitals the hospital superintendent be authorised to
engage local latx)ur to undertake breakdown maintenance.

The electrician, plumber and carpenter at district hospital should be placed
under the control on the equipment maintenance engineer posted at the hospital.

Maintenance of Equipment
The preventive and breakdown maintenance of hospital plant and equipment
will be the responsibility of the equipment maintenance unit under the control of the
District Surgeon and will be located at the district Hospital. Preventive maintenance
schedule will be drawn up for each equipment in each hospital by the Engineer Inchar^e of the maintenance unit and implemented. Requests for breakdown service will
be made to the District Surgeon who will send the mobile unit foe executing
emergency repairs.
Participation of NGOs in Management of Hospital Waste

An NGO has been asked to study Talujca Hospital at DevenahaDi and Submit
propps^s by March 13, 1997 for review and examining the feasibility of involving
NGQs in Management of Hospital Waste.

Page 5$

Access to Disadvantaged Sections
The Health Check-up Scheme for SC/ST population (Yellow Card Scheme)
It is proposed to introduce a system of health check-up on an annual basis in respect of
SC/ST families residing in the rural areas. Each member of every SC/ST household would undergo a
thorough medical examination which would include:
(1) Complete physical examination and identifying individuals requiring diagnosis tests and /
or treatment and referral where ever required.
(2) Simple laboratory investigations like examination of urine, blood etc., for early detection
of diseases, if any.

The Camp will be organised at the sub-centre or in the villages covered by it provided
suitable premises are available.
On an average the SC/ST population per sub-centre is estimated at 981 persons. A sub-centre
covers about 3.5 villages, hence approximately 280 persons belonging to SC/ST have to be examined
in a village.

A team led by the Medical Officer of the PHC will carry conduct health check-up of the
SC/ST population and provide free treatment to those who are ill. The team will consist of:








Medial officer of the PHC.
Lady Medical Officer (Private doctor to be engaged if Govt, doctor is not available)
Lab Technician
Senior Health Assistant (Female) (LHV),
Senior Health Assistant (Male),
Junior Health Assistant (Female) (ANM) of Sub-centre, and
Junior Health Assistant (Male) of Sub-centre if available.

Operationalisation of the Scheme

Planning by MO of PHC
The MO of the PHC will draw up an annual calendar (giving date and venue) for conducting
health check-up camps in the villages covered by his PHC and forward to the Taluka Medical Officer
along with estimated fund requirement for the year with break down by month.

The MO will also indent for the drugs required from the list of approved drugs given in
Annex 5.
The fund requirement will include the following :
1. Honorarium to lady doctor from the private sector if proposed to be engaged.
2. Charges for hiring vehicle for conveying the medical team to the camp site and back and
3. Expenses for coffee/tea and snacks to the members of the team.

Action by Taluka Medical Officer

The Taluka Medical Officer will scrutinise the annual plan for forward his recommendations
to the DHO for release of funds and supply of drugs.

03/07/97/Access YC

Page 54

Action by PHO

The DHO will consolidate the requests from Taluka Medical officers and request the Project
Administrator for Release of Funds for the Year.

The DHO will also collect each month the statement of accounts for the health Check-up
scheme from the MO of the PHC, consolidate the statements and submit at the end of each quarter to
the Project Administrator.
Activities to be undertaken prior to the camp

The Jr. Health Worker (Female) and where available Jr. Health Worker (Male) will prior to
the scheduled date of the camp visit each SC/ST house hold in the selected village and inform them
of the date and the objectives of the health Check-up camp to create awareness and the need to attend
the health check-up camp. She/he will also fill out the first two pages of the “Yellow Card” for each
permanent member of the household and hand over to the head of the household and ask him/her to
bring the family members along with their “Yellow Card”
Activities to be undertaken at the camp

The Senior Health Workers male and female will carry out the initial examination of the
patient and record results on pulse, B.P anaemia, height and weight, general appearance. They will
adopt syndrome approach to ascertain whether detailed futher examination by the medical officer is
necessary.
The MO/LMO will carry out detailed examination of those identified by Sr. Health Worker
and order blood and / or urine tests if required. The will also treat the sick persons and dispense
drugs. If the patient requires detailed diagnosis and specialist treatment, he she will be referred to the
nearest hospital where such facilities exist.

Where ever cases are referred to the next higher hospital, the patient will be given a Referral
slip (in duplicate). The patient should be asked to produce the referral slip and the Yellow Card at
the referral hospital to receive prompt attention. The referral hospital doctor should give a feedback
about the treatment suggested by filling in the copy of the Referral Slip and returning to the patient
for follow up by the PHC doctor/staff.

The scheme will be implemented during 1996-97 in the districts of Bijapur, Kolar, Hassan,
Mysore and Raichur. The scheme will be extended to Belgaum, Bellary, Chitradurga, Dakshina
Kannada and Gulbarga districts during 1997-98 and to the remaining districts in 1998-99.
Health Check-up for Women
In the first phase of the Project, the focus will be on the following new interventions, which
are relatively easy to introduce :

1. Promotion of positive health practices, such as personal hygiene especially during
menstruation, adequate nutrition etc.,;
2. Screening for and treatment of reproductive tract interventions and sexually transmitted
diseases ;
3. Screening and management of gynaecological problems ;
4. Cervical cancer screening and treatment ;and

03/07/97/Access_YC

Page 55

5. Increased policy dialogue and strategic efforts to reduce gender discrimination and
violence.

In the second phase a beginning will be made in introducing the following additional
interventions :

6. Management of problems associated with onset of menarche and menopause;
7. Screening and treatment for Breast Cancer; and
8. Prevention and treatment of infertility.

It needs to be emphasised that while the above range of services have important health
components, they also require interventions which are much beyond the scope of the Department.
The Programme will cover all other women not covered by the Health Check-up scheme for
SC/ST. The ANM will adopt the syndrome approach to identify cases among women aged 10-60
needing further screening and referral. She will identify suspected cases for each type of
disorder/disease among the following target groups by syndrome approach and refer to LHV/MO of
PHC for detailed check-up and treatment if found necessary.
Role of District Officials

The health check-up schemes will be successful if only participation by, Panchayat members
at the Zilla, Taluka and Village level. Further the involvement of anganwadi workers to promote
positive health practices, such as personal hygiene especially during menstruation, adequate nutrition.
The CEO should arrange for involvement of Panchayat Members, Social Welfare
Department. The DHO is responsible for implementing the Health Check-up scheme in his/her
district. He/she should brief the Taluka Medical Officers and they in turn brief the MOs of the PHCs.
The PHC doctors should train paramedical staff to carry out the preliminary investigations.
Implementation of the yellow card scheme during the 96-97

During the year 96-97 the scheme was implemented in 5 districts. The details of the
number of persons treated under the Yellow Card scheme. I shown in the statement
appended. A brief review of the implementation of the Yellow Card scheme was taken up
with the help of the STEM consultants. They have suggested some modifications which will
be considered during the implementation of the programme during the year 97-98.
An amount of Rs.80.93 lakhs is estimated towards the cost of drugs to be supplied
under Yellow Card scheme. In addition an amount of Rs. 100.00 lakhs is estimated towards
the POL, hiring of vehicles and the honorarium to the private doctors is also mentioned.
Programme for the year 1997-98.

During the year 1997-98 the yellow card scheme is proposed to cover the whole state
of Karnataka. Data on approximate number of cards to be issued and the cost of drugs is
shown in table 2.

03/07/97/Access_YC

Page 56

Statement showing the performance during April 1996 to March 1997 under
Yellow Card Scheme
Table 1
SI. No.

2

2
45

Name of
the
District

Total
SC/ST
Populatio
n

No. of
villages
screened

No. of
Taluks
screened

No. of
persons
examined
/screened

No. of
patients
treated

Kolar
Mysore
Bijapur
Hassan
Raichur
TOTAL

2.21 lakhs
3.16 lakhs
2.92 lakhs
1.56 lakhs
2.30 lakhs

359
78
84_

7
2
_2_
2
2
15

4898
7105
18158
12258
9569
51980

3152
~5519
7356
6735
6645
29407

_5.L
78
656

No.
referred
for
special
treatment
12
105
68
35
12
232

Statement showing the population of SC/ST District wise and amount to be spent for printing
of yellow cards and supply of Drugs during the year 1997-98.
Table 2

SI.
No.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.

District

Bangalore (U)
Bangalore (R)
Belgaum
Bellary_____
Bijapur_____
Bidar_______
Chikmagalur
Chitradurga
D. Kannada
Dharwad
Gulbarga
Hassan______
Kodagu_____
Kolar_______
Mysore_____
Mandya_____
Shimoga
Raichur
Tumkur_____
U. Kannada

03/07/97/Access_YC

SC/ST population
(in lakhs)
7.66 ___
3.76
4,90 ___
5.30
2,92
2.65
2.23
4.51
2.82
5.16_____
7.18
1.56
1.00
2.21 ___
3.16
2.39
4.13
2.30
5,77
1.03

Cost of Yellow
Cards (in lakhs)
7.66
3.76
4.90
5.30

2,65
2.23
4.5 f
2.82
5.16
7.18’

1.00

2.39
4.13

5.77
1.03
60.44

Page 57

Cost of Drugs
(in lakhs)
1.40
2.86
____5.98
2.60
4.51
2,29
3.33 __
4.54
7.06
5.91
5.07
4.61
1.63
3.73
6.85
3.75
3.77
3.74
4.16
3.14
80.93

Total

9.06
6.62
10.88
7.90
4.51
4.94
5.56
9.05
9.88
11.07
12.20
4.61
2.63
3.73
6.85
6.14
7.90
3.74
9.93
4.17
141.37

improvement oi
Access to Health Services for Women

1.

Introduction

The Family Planning programmes was launched to control population growth,
through promotion of contraceptive methods with emphasis on terminal methods.
During the course of implementation of the programme it was realised that real
headway in acceptance of contraception can be made if child survival could be
ensured. The Family Planning Programme was converted into a Family Welfare
Programme which beside promoting contraception, initiated programmes for child
survival through ante-natal, intra-natal and postnatal care of pregnant women and
immunisation of children against vaccine preventable diseases.
The Child Survival and Safe Motherhood (CSSM) Programme launched in
1992, aimed at providing access to some essential services to improve women’s
health. The services, which are being emphasised include:







Immunisation against vaccine preventable diseases and ORT for
diarrhoea.
Offering wider choice of short and long term contraceptive methods;
Enhanced maternity care;
Safe pregnancy and delivery services;
Nutrition assistance to pregnant, nursing and lactating mothers; and,
Prevention and management of unwanted pregnancies.

Subsequently it was felt that instead of setting targets as has been practised
hitherto, a target free approach which caters to client’s perceptions and needs would
yield better results.
Management of reproductive health infections and sexually transmitted
infections has recently been added to the existing components and a project
“Reproductive and Child Health” with the assistance of World Bank is being
finalised by the MoHFW, Government of India.

2.

Interventions Planned under KHSDP

The interventions made so far or being contemplated under RCH project,
mainly relate to maternal health. Recent literature has pointed to the urgent need to
address other aspects of women’s health which go beyond her role as a mother.
Women’s low social status and reproductive role expose them to high health
risks. The health of women is an important concern as it affects the next generation,
and her productivity in economic activities. There is overwhelming evidence to show

that many of the interventions that address women’s health problems are highly costeffective. Special attention is required to reach females during adolescence, when
reproductive and other lifestyle behaviours set the stage for later life.
While formulating the project proposals for Karnataka Health Systems
Development project in 1995, it was felt that programmes should be evolved to
improve access for women to health services. One should view women’s health
through the life cycle approach that takes into account both the specific and the
cumulative effects of poor health and nutrition. Many of the problems that affect
women of reproductive age, their new bom, and older women begin in childhood and
adolescence. The strategy to improve women’s health must revolve round promoting
gender sensitive policies, on the one hand, and strengthening women’s health services
on the other. Towards this end, during the Project period, a range of expanded
services are proposed to be introduced, both with and without specific project
interventions. In the first phase of the Project, the focus will be on the following new
interventions, which are relatively easy to introduce:
1. Promotion of positive health practices, such as personal hygiene especially
during menstruation, adequate nutrition etc.;
2. Screening for and treatment of reproductive tract interventions and sexually
transmitted diseases;
3. Screening and management of gynaecological problems;
4. Screening and treatment of cervical cancer; and
5. Increased Policy dialogue and strategic efforts to reduce gender
discrimination and violence.

In the second phase a beginning will be made in introducing the following
additional interventions:
6. Management of problems associated with onset of menarche and

menopause;
7. Screening and treatment for Breast Cancer; and
8. Prevention and treatment of infertility.
It needs to be emphasised that while the above range of services have
important health components, they also require interventions which are much beyond
the scope of the Department.

The Project envisages support to the primary health care sector by providing
technical services, referral facilities and financial assistance.

The Programme will cover all other women in the age group 10-60 years. The
ANM will identify suspected cases for each type of disorder/disease among the
following target groups by syndrome approach and refer to LHV/MO of PHC for
detailed check-up and treatment if found necessary.

Table 1. Proposed Strategy for Detecting and Treating for RTI and STD
Disorder/Disease
Menstrual disorders
Sexually transmitted
diseases &
Reproductive tract
infection
Gynaecological
Disorders

Age Group/
(Women/Cases)
10-19 unmarried
(140/28)
15-49
(770/154)

Screening
by______
LMO

Diagnostic
Test

Treatment
by______
LMO

LMO

STD/ RTI
Sensitivity

LMO

15-60
(880/132)

LHV/
LMO

Malignancy
(Cervical cancer)

35-60
(630/25)

LMO

PAP Smear

Infertility

20-30
(77)___
15-44
(120/30)
15-44
(120/15)

LMO

Semen
Exam.

High Risk Pregnancy
(detected during ANC)
High Risk Pregnancy
(detected during labour)

LMO

Shift immediately to

50 bed
Hospital/
District
Hospital
Cancer
treatment
centres
District
Hospital
50 bed
Hospital
50 bed
Hospital

An ANM has to screen approximately 1020 females in the age group 10-60 or
approximately four cases per day. The number of cases referred to LMO of PHC will
be less than 300 in a year. An LMO from PHC or a lady doctor from private sector
visits the sub-centre one day in a month to examine the cases referred to by the ANM
and provide treatment or refer to appropriate hospital indicated in the last column of
the Table 1 .

In order to cope with the expected increase in diagnostic tests, it is proposed to
add one laboratory technician to each 100 bed hospital.

Training of Medical and Paramedical Staff
These cadres will be imparted essential skills for screening and identifying
individuals who need detailed examination by Medical Officers.

ANMs will be given training in identifying suspected cases by syndrome
approach and LHV in screening for gynaecological disorders. The duration of training
will be three days and will be imparted at 100 bed or district hospitals.

The Laboratory technician has to be trained at the district/teaching hospital.

Clinical protocols have to be developed for training the LMOs of PHCs and
specialists at CHCs, taluka and district hospitals.

IEC
There is expected to be vast improvement in the range of services at the out
reach and CHCs and taluka level hospitals through Project interventions. However,
mere availability is not enough. Improved services must translate themselves into
improved utilisation. IEC activity will aim at providing information on the services
available at various levels as well as the health check-up schemes for SC/ST
population and women planned under the project. It will also motivate the target
groups to avail of the services offered in the outreach and at hospitals. The IEC
activity will also focus on increasing awareness of and educating adolescent girls and
women on positive health practices.
The existing multipurpose workers are likely to be over-stretched and will not
have adequate time for IEC activity. It is proposed to involve four types of institutions
in IEC activity:

Sub-Centre Health Advisory Committees: The Sub-centre Health Advisory
committees proposed under IPP-IX should be made aware of the

Grama Panchayats: The State has 5640 elected Grama Panchayats, which at
present have 35,153 elected women Members, constituting 43.6% of the total elected
Members. The Karnataka Panchayat Raj Act, 1993 has specifically included
implementation of programmes relating to family welfare and women as functions to
be performed by the Grama Panchayats. The elected Members, more specifically
women Members are vast reservoir of potential leaders who are available at the
village level to support interventions for improving the health status of their
community.
Non Governmental Organisations: The State has an extensive network of
voluntary organisations working in the area of health. Their support is could be
enlisted in expanding interventions relating to health of the disadvantaged sections.

Mahila Swastha Sanghas: 4000 Mahila Swastha Sanghas have already been
established by the Department. Under IPP IX 1000 Sanghas are proposed to be
strengthened. These sanghas can be effectively utilised in spreading awareness on
issues relating to women’s health.
Anganwadis: The State has 185 ICDS Projects and as many as 30,000
Anganwadis. The Anganwadi workers could be utilised to create awareness of the
proposed health care services for the disadvantaged sections.

3.

Suggested Implementation Plan

Overall responsibility

The responsibility of implementing the RCH project at the State level rests
with the Additional Director (FW & MCH) and with the at the District level with the
District MCH Officer. As the KHSD Project component, improving access to basic
health services for women forms a part of RCH Project, The responsibility for
implementation of women’s health component of KHSDP may be entrusted to the
Additional Director (FW & MCH).

Training of Staff
Training of Medical and Paramedical Staff in screening and treatment for
Gynaecological problems and STD should be the first step. The development of
training modules for different categories of staff will be the responsibility of
Additional Director, (FW & MCH). The actual training will be imparted by SIHFW
and District Training Centres planned under IPP-IX. The faculty for training will be
drafted from existing resources till such a time as the Technical Staff sanctioned under
RCH Project are in place.

The Additional Director (FW & MCH) will draw up a list of diagnostic aids
for screening suspected cases and medicines for treatment. The Project Administrator,
with the approval of the World Bank Mission, will float tenders for supply drugs and
diagnostic aids to draw up a list of eligible suppliers and approved rates.

Operationalisation of the Scheme
The LLMO of each PHC will draw up an annual implementation plan and its
break up by quarters for the settlements covered by his PHC and submit to the District
MCH officer who will submit in turn to the DHO for approval. The DHO will in turn
submit the consolidated district plan to the CEO of the Zilla Panchayat. The CEO
will request the Project Administrator for release of funds. At the end of each quarter,
the CEO will submit a statement of expenditure with supporting documents to the
Project Administrator.
The CEO will in turn release through DHO funds to the LMO of PHC as per
the approved plan. The funds are to be utilised for engaging the services of private
lady doctor if there is no lady doctor posted at the PHC, hire charges for vehicle for
outreach activity, if no vehicle is provided to the PHC or POL for Govt, vehicle
provided to the PHC and purchase of drugs and diagnostic aids.
The budget provision in the project for various components are:

Fees to private lady doctor :
Hire charges for vehicle :
Diagnostic aids:

Medicines for STD/RTI:

300 per visit to Sub-centre
2,400 per year for visits of
Health Check-up team
Rs. 6,800 per sub-centre (or 1000 females
in the age group 10-60)/annum
Rs. 13,000 per sub-centre (or 1000 females

Rs.
Rs.

Medicines for SC/ST:
population

in the age group 10-60)/annum
Rs. 3 per person per year

IEC:
Under IPP-IX a number of IEC activities were planned. These include setting
up of Sub-centre Health Committees to encourage community participation, enlisting
female volunteer workers at the village level, production of films, flip-charts etc.
Provision is also made under KHSDP and RCH project.

Experts in mass communication should be engaged as consultants to plan and
implement IEC activity for IPP-IX, KHSDP and RCH projects. The world Bank
mission for IPP-IX has approved the TOR and the budget for consultancy services.
Action need to be initiated to review IEC present activity, define strategy, design
effective action plan and assist in developing IEC materials.

Proposal for Setting Up Equipment Maintenance Facilities

1. Background
The SAR of KHSDP envisages setting up of work shop facilities at Project
Headquarters and in each of the 20 districts. The capital investment and staffing is to
be undertaken by the Government of Karnataka. The funding for capital equipment
and operating expenses during the project period is included in the Project.

The districts have been classified into four categories on the basis of the
number and size of hospitals. The general hospitals and hospitals for ophthalmic
diseases, tuberculosis, leprosy and mental problems which are not included in the
project for renovation/extension are however, included for maintenance coverage. The
classification of districts, capital investment and staffing are presented below. (All this
is provided in the SAR)

Project
HQ

Districts

*

Number of Workshops
Capital Cost Million Rs.
Staffing Number
Joint Director
Dy. Director
Engineers
Technicians
Administrative
Driver/Group D
Recurring Costs/Year
Million Rs.___________
Staff Salaries
Operation Expenses
Maintenance Spares
Total Recurring Costs

1

Category
C~

A

B

Bangalore
U&R

Chitradurga
Dharwad
Mysore

3

6

All

D

Belgaum
Bellary
Bijapur
D. Kannada
Gulbarga
Hassan
Kolar
Shimoga

Bidar
Chikmagalur
Kodagu
Mandya
Raichur
Tumkur
U. Kannada

8

7

25
73.35

1

1

3
9
10
14
9

3
15
30
’12

18
42
24

9

18

16
56
24
24

7
49
14
21

65
187
88
81

20.70
3.19
21.71
45.60

The equipment maintenance staff of 65 Engineers, 187 technicians and 88
Administrative support staff and 81 Group D staff have to be recruited by the
Government and absorbed in Government on a permanent basis after the Project
completion. Government has given sanction for the creation of all the above posts. As
some of them are not provided in the C&R lists of HFW Department, steps are being
taken to form special recruitment rules.

Page 75

Under IPP—III, equipment maintenance workshops were set up at Belgaum and
Gulbarga and four Engineers, five diploma holders and nine ITI trained technicians
were appointed and trained. The groups were disbanded and posted elsewhere after
the project was completed. The present position where these personnel are working is
in no way related to the with which they were recruited, as evidenced from Annex I
Besides these there are two Engineers and eight diploma holders in the transport
workshop. Further there are four technicians in the equipment maintenance group in
the Directorate. It is proposed to absorb the above personnel in Equipment
Maintenance Wing and the remaining personnel are to be recruited following
procedures of the State Government.
At present, all recruitment of personnel is centralised through the Public
Service Commission and subject to Constitutional and other provisions relating to
reservation, age limit, recruitment rules etc. On a conservative estimate it would take
12 to 18 months before recruitment process can be finalised. In the circumstances it
was felt that the maintenance activity could be started immediately by engaging
consultants to manage the maintenance activity
for an initial period and
simultaneously to assist the state in recruiting and training engineers and technicians
to take over the maintenance activity. The world Bank agreed with this suggestion and
requested the State to submit TOR for consultants. The matter was placed before the
PGB and approval was given for inviting proposals from consultants and selecting
suitable consultants. (Copy of the PGB proceeding is enclosed)

It is in this background, the following proposals are made for initiating
maintenance activity immediately to be prepared for receiving, installing and
commissioning equipment which is currently being procured.
2. Proposal

A consulting firm will be hired to set up;
a) Basic maintenance facilities at each of the four divisional head quarters.
b) Equipment Maintenance workshop at Bangalore, Mysore, Dharwad and
Gulbarga districts by utilising the services of maintenance staff already
employed in the Directorate.
c) maintenance facilities in Bijapur district by hiring the services of outside
consultant as an experimental measure.
The consulting firm engaged for setting up of facilities at divisional head
quarters will provide technical support and guidance to maintenance staff manned by
departmental staff and supervise the work of consultant engaged for providing
maintenance facilities in Bijapur district.

3. Maintenance by Departmental Staff

It is proposed that one engineer and four technicians be posted for each
maintenance unit. There are 6 engineers, 13 diploma holders and 13 technicians

Page 7^

available for re-deployment. With this manpower, a maximum of 6 maintenance
teams can be raised. As per the project document Bangalore requires three
maintenance teams, Mysore and Dharwad districts requires two maintenance each and
Gulbarga requires one maintenance team. It is proposed to deploy one maintenance
unit in Bangalore and Gulbarga districts and two each in Mysore and Dharwad
districts. However, to cover the maintenance activity for the balance 15 districts, the
project envisages to engage a consulting agency to set up equipment maintenance unit
in each of the divisions covering these districts.

These equipment maintenance units in each division will report to the
Divisional Joint Director, stationed in the divisional headquarters, for administrative
purposes . For planning and technical guidance these units will be supervised by the
consulting agency at the headquarters.
The administrative support staff for these units will be provided by re­
deployment from the respective districts. The administrative personnel as envisaged in
the Project are Office Superintendent, FDA, SDA, Driver and Group D.
Maintenance Workshop equipment will be procured after examining
availability of the equipment procured under IPP-III for Belgaum and Gulbarga
divisions.

4. Maintenance by Consultant
The district maintenance unit for Bijapur district is proposed to be handed over
to an outside consultant.

5.

Prime Consultant for Setting up of Maintenance System

The prime consultant is expected to set up maintenance units at each
divisional headquarters to undertake maintenance activities in districts which have
not been handed over to either departmental staff or outside consultants and
hospitals in Bangalore district not assigned to departmental staff. Apart from this,
the prime consultant has to assist the State Government in recruiting and training
maintenance staff to ultimately take over all maintenance activity.

The consultant has to engage one Bio-Medical engineer, one X-ray
engineer and ten technicians at each divisional headquarters to cater to the
maintenance needs of the hospitals in the division.

6.

Obligation of the Government




Providing administrative staff.
Equipment and vehicles for all the workshops.
Spares valued at Rs. 17.57 million (cumulative) will be procured by
the Project Administration and stored at Headquarters and also at

Page 75

district headquarters. The procurement and stocking procedures will be
based on ABC and XYZ analysis of spares consumption.

7. Budget Estimate
The number of staff to be employed by the department / consultants is
given below

Staff Category

Bio-medical Engineer
X-ray Engineer
Engineer
Technicians

Dept.
Staff

Bijapur
Consultant

0
0
6
24

0
0
1
4

Prime
Consultant

Total

4
4
0
40

4
4
7
68

The estimated cost of the proposals in Section 3 to 5 are provided in the
following table along with the provisions made in the project proposal.
Comparative Costs of Proposed Project and Revised Maintenance System
All cost in Rs. Million

Item of Expenditure

Maintenance Cost by

Dept. Staff
Capital Expenditure
Building
Furniture
Equipment
Other Facilities
Vehicle
Sub Total
Recurring Expenditure
Staff Salaries (Technical)
Staff Salaries
(Administrative)
Senior Consultants
Total Staff Salaries
TA&DA
POL
Other
Operating
Expenses
Total Expenditure

Total

Provision in
the project
Proposal

22.57
4.14
25.60
4.65
9.40
66.36

Bijapur
Prime
Consultant Consultant

6.84
1.14
9.00
1.20
2.25
20.43

0.76
0.15
0.95
0.15
0.38
2.39

14.06
2.67
16.40
2.70
'6.37
42.2

21.66
3.96
26.35
4.05
9.00
65.02

1.9
1.39

0.67
0.23

7.13
3.94

9.70
5.56

0.00
3.29
0.45
0.54
0.99

0.00
0.90
0.23
0.09
0.32

1.20
12.27
2.16
1.53
3.69

1.20
16.46
2.84
2.16
5.00

24.71

3.61

58.16 86.48
*

* This excludes cost of spares.

Page 76

20.70

3.19

90.25

Immediately on setting up of various maintenance groups as mentioned above,
there will be 8 workshops in operation. The balance 16 workshops and central
workshop will have to be established within next three years and avail the full
reimbursement cost.
The recruitment of the balance departmental staff to phase out the consultancy
groups has to be initiated and completed fast as the reimbursement of the recurring
cost for this group will be diminishing with time. The reimbursement cost is 90 % in
the first years, 75 % in the next two years and 40% in the last year. With any delay in
the recruitment of the departmental staff for maintenance activity, the burden on the
State will increase.

Page 7 7

Action taken on Communicable Diseases under Surveillance Bureau

Proposals

Action Taken

1. Shifting of Communicable Disease
Intelligence Unit, Mandya, along with
its 38 staffs to Bangalore and attach to
the Additional Director (CMD) State
Communicable Disease Surveillance
Unit, and to function as District
Surveillance Unit for Bangalore Urban
and Rural Districts.
_____

New building is being constructed at
Bangalore for the surveillance unit. The
present unit at Mandya will be shifted to
Bangalore by the December of 1997.

2. Up-gradation of existing 18 District Notification is being issued.
Laboratories and re-naming as District
Surveillance Unit.
Special recruitment
formulated.

3. Recruitment of the following staffs :
18
a. Micro Biologists
18
b. Asst. Entomologists
18
c. Senior Health Assts.
18
d. Drivers
20
e. Witlets Operators

■X'

rules

are

being

4. Re-Deployment the following staffs Orders are being issued.
from the Health Department to 18
District
Communicable
Disease
Surveillance Units.
a. Asst. Statistical Officers 18
18
b. Typists-cum-clerks
18
c. Senior health Assts.
36
d. Group ‘D’ servants
5. Sanction of the creation of
following supportive staffs to
Addl. Director (CMD)
a. Gazetted Assistant
b. Office Superintendent
c. First Div. Asst.
d. Second Div. Asst.
e. Stenographer
f. Typist-cum-clerk
g. Statistical Officer
h. Asst. Statistical Officer
Sr. Health Asst.
i.
Group
‘D?
1

the Posts have been sanctioned. Staff are
the being posted.

01
01
02
03
01
01
01
02
04
04

The office of the State Surveillance Unit
is being set up in the premises of
6. There is a Bureau of health
Epidemic Diseases Hospital, Indiranagar,
Intelligence with 14 following staffs,
Bangalore. A decision has been taken to

OR

Page 7*5

6. There is a Bureau of health
Intelligence with 14 following staffs,
which is now attached to the
Directorate of health & F W Services,
Bangalore under the control of Joint
Director (H & P). This B.H.I. is now
shifted and attached to the Additional
(CMD) State Communicable Diseases
Surveillance Bureau to :

Epidemic Diseases Hospital, Indiranagar,
Bangalore. A decision has been taken to
attach the staff of Bureau of Health
Intelligence to this State Surveillance
Unit.

a. Perform the survey conducting
work, compile morbidity and
mortality data, by disease, for
planning and working out the
priorities and strategies.

b. Evaluate the effectiveness of
interventions instituted to
control epidemics.
c. Carry out research studies and
suggest
innovative
innovative
and
effective
methods
of
intervention.

Staff:

Being posted

Statistical Officer -1
Asst. St. Officer -2

F.D.A

-3

S.D.A

-2

Group ‘D’

-4

Stenographer
Typist cum

1

Clerk

1

7. Purchase
of
equipments
and Procurement procedure are being
laboratory supplies as per annexure
(8) ofthe KHSDP report.
8. Purchase of 19 Jeeps (vehicles)

IFB is cleared. Bids are being invited.

9. Purchase of furnitures to the Procurement
additional staff of 18 district initiated.
Communicable Disease Surveillance
Units

procedure

are

being

10. Formation of Intersectoral Co­ Constituted at State level. Orders are
ordination committees at various letel. being issued to the district level.
11. Training programme of various A detailed training programme is already
prepared._________________________
categories of staff in 18 districts.

12. Repairs and additions to the District All district laboratories have been visited
by Engineer.
Estimates are being
Laboratory Buildings.
prepared.

Page^

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