Upgrading Secondary Level Health Care Facilities in the Gulbarga Division State of Karnataka
Item
- Title
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Upgrading Secondary Level Health
Care Facilities in the Gulbarga
Division
State of Karnataka - extracted text
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j REPUBLIC OF INDIA
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Department of Health and Family Welfare
Bangalore, Karnataka
I KREDITANSTALT FUR WIEDERAUFBAU (KFW)
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Project:
Financial Cooperation with India
Upgrading Secondary Level Health
Care Facilities in the Gulbarga
Division
State of Karnataka
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Progress Report N° 9
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December 1999 - January 2000
Consortium
SAIMIPLAIM
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MEDICONSULT
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Upgrading Secondary Level Health Care Facilities
intheGulbarga Division, State of Karnataka____
Progress Report N° 9
CONTENT
1.
EXECUTIVE SUMMARY
2
2.
ACTIVITIES
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2.2
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Activities of the KHSDP Administration.............................................................................
4
Equipment Maintenance in Gulbarga Division
Co-ordination of the FC Project with the Technical Measures in Gulbarga Division
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7
2.2.1
2.2.2
2.2.3
Personnel at Gulbarga Project Office
Urgent Repairs of District Hospitals.................................................................................
Urgent Repairs of other Hospitals....................................................................................
Planning Progress
Equipment Maintenance Workshops
Procurement of Medical Equipment.':..;:..
Quality Auditing Services for the Hospital Buildings works under the KfWproject..
2.3.1
2.3.2
2.3.3
2.3.4
2.3.5
2.3.6
2.3.7
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Financial Auditing Services..............................................................................................
Activities of the Consultant
2.4
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Project co-ordination and Preparation of Implementation
Visit of SANIPLAN Consultants.......................................................................................
Review of Monitoring Plan
Revision of Project Planning Matrix
2.4.1
2.4.2
2.4.3
2.4.4
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RESOURCES
3.
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Personnel.....
3.1
Consulting Inputs
Local Support Personnel
3.1.1
3.1.2
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Equipment / Materials
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4.1
Project ......
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4.2
Consulting Services
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FINANCIAL SITUATION
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Project
5.1.1
6.
7
TIME SCHEDULE
5.1
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Activities of the Engineering Wing KHSDP
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Project Governing Board
Project Steering Committee
2.1.1
2.1.2
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Activities of the Government of Karnataka.......................................................................
2.1
Disposition Account.
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15
5.2
Cost Estimates
15
5.3
Consulting Services
15
CONSTRAINTS, OPPORTUNITIES AND RECOMMENDATIONS
4.
♦
6.1
Constraints and Opportunities
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SANIPLAN / MEDICONSULT
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Upgrading Secondary Level Health Care Facilities
in the Gulbarga Division, State of Karnataka
6.1.1
6.1.2
6.1.3
6.1.4
6.1.5
6.1.6
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6.2
Progress Report N* 9
Planning Phase.......................................
Medical Equipment..................................
Water Conservation................................
Solid Waste Disposal..............................
Land Tenure Problems............................
Revision of Designs during Implementation
Recommendations
.16
...16
...16
...16
...16
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Annexures:
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Annex 1:
Proceedings of the 15th Meeting of the Project Governing Board
Annex 2:
Number of trained Medical Doctors under the KHSDP (1999-2000)
Annex 3:
Number of trained Staff Nurses and Paramedics under the KHSDP (19992000)
annex 4:
Staff Status of Divisional Project Office Gulbarga January 2000
Annex 5:
STAFf Position and Progress Report of District Equipment Maintenance Unit
Gulbarga Division January 2000
Annex 6:
Consultant Mission Report with Photo Documentation
Annex?:
Itinerary of Consultant Mission
Annex 8:
Hospital Performance Indicators
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Examples of Hospitals in the Gulbarga Division reporting to
KHSDP on Performance Indicators
A
nalysis of Performance Indicators of Bidar Hospital (under
Annex 8.2:
THE FC-COMPONENT)
Annex 8.3: Analysis of two Hospitals rehabilitated 1997 under the WB
supported KHSDP Component
Annex 8.1:
$
Annex 9:
Time Schedule
Annex 10: Statement Showing Expenditure of Project Office Gulbarga Division uo to
End of 1999
Annex 11: Expenditures Civil Works (Urgent Repair Works)
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Annex 12: Estimated Costs for Civil Works (up-dated)
Annex 13: Annual Health Check up in the five Districts of Gulbarga Division 1999
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SANIPLAN / MEDICONSULT
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Upgrading Secondary Level Health Care Facilities
in the Gulbarga Division, State of Karnataka
Progress Report N” 9
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Abbreviations
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DoHFW
GOK
KfW
KHSDP
MIS
NGO
WB
Department of Health and Family Welfare
Government of Karnataka
Kreditanstalt fur Wiederaufbau, Germany
Karnataka Health System Development Project (supported by WB and KfW)
Management Information System
Non-govemment Organisation
World Bank
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Exchange Rate
1 USS = 42.60 Rupees (16. January 2000)
1 DM = 22.10 Rupees (16. January 2000)
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1 Crore = 10 million
1 Lakh = 100,000
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SANIPLAN / MEDICONSULT
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Upgrading Secondary Level Health Care Facilities
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1.
Progress Report
9
EXECUTIVE SUMMARY
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Description of the Project Progress
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The present Progress Report No. ^covers the German supported section of the KHSDP for
the months December 1999 to January 2000. )
The project activities to date include:
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The development and approval of the functional layouts and preliminary designs for
renovation and upgrading of 23 hospitals (March 98 — June 99)
Development and approval of civil works basic tender document (1998)
Development medical equipment contract documentation including quantities and
equipment layouts (1998, May 99)
Assessment and refinement of urgent repairs required at the district hospitals at Bellary?
and Gulbarga (mid 1999)
Regular (half yearly) monitoring of Government contribution and progress of the WB
supported technical assistance component in Gulbarga Division
Assessment and estimates of urgent repairs to 8 of the project hospitals (mid-end of
1999) .
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Urgent repairs completed at Gulbarga District Hospital and other hospitals
Completion of l^final designs and the respective tender documents (until January)
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2000) .
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Tendering of seyeft hospitals works £December_1999). I
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Completion of bid evaluation for five'hospital worksJJanuary 2000))and clearance by
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KfW.
Three final designs including tender documentation completed and submitted_to4he
International Hospital>Planner for clearance.
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Contract award for five)civil works and start of implementation pn 25th JanuaryJ>000
Ongoing development of final designs of the remaining Ijlyhospitals -^"7
Preliminary designs for three district hospitals developed and discussed with the
International Hospital Planner
Though the programme is still behind the estimated schedule drawn up at the time of the
project award, the present programme progress has been speeded up substantially. The local
Consulting Project Co-ordinator, located within the premises of the KHSDP, has been
constantly working with the local architects on the development of the final designs and the
tender documents in close collaboration with the KHSDP personnel. Two SANIPLAN experts
(Public Health/Project Manager and the International Hospital Planner) visited the project in
January 2000 to assist in the on-going activities (clearance of bid evaluation reports, urgent
repair work and preliminary design of district hospitals as well as monitoring of project progress
of FC measures and the WB supported technical component in Gulbarga Division).
The preparations for the procurement of medical equipment have been completed. It is
planned to initiate the procurement as soon as the civil work component is near to completion
(about 4 months before commissioning of the hospitals). Prior to the procurement, the KHSDP
plans a short review of the requirements due to changes in the equipment status in
comparison to the latest assessment.
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Upgrading Secondary Level Health Care Facilities
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Progress Report N° 9
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Overview: Project Status Major Activities - End of January 2000
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Civil Works Component:
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Activity
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___________
Review of emergency measures (to be
executed by PEA)
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Development of preliminary designs approval
Development of final design and tender
documentation
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Elaboration of civil works model bid document
and approval by GOK and KfW
__________
i*5: Clearance of final designs and tender
documentation
___________________
Call for bids_________________ __________
& Evaluation of bids ______________________
Of Non-objection to award proposal by KfW
Contract award
* re^submissioji.
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Equipment Component:
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Planned
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23 hospitals
10, hospitals
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5
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Review of emergency supplies by PEA_____
Review of medical equipment lists & analysis
of requirements__________________________
Preparation of final procurement lists_______
Elaboration of cost estimates and budget
schedule
________ __
Preparation of specification equipment and
vehicles
________________ _
Determination of procurement procedures
Elaboration of logistical framework for
supplies
_____________________________
Elaboration of model bid document and
approval by GOK and KfW
Review of requirements______________ ____
;@Q/ Call for tenders for the delivery of equipment
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Cinaliearl
x
x
w
X
X
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Finalised $
8 hospitals
hospitals
X
X
X
X
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On-going
2 district
hospitals
X
X
X
X
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Upgrading Secondary Level Health Care Facilities
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Progress Report N° 9
2.
ACTIVITIES
2.1
Activities of the Government of Karnataka
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The Government of Karnataka represented by the KHSDP continued to co-ordinate, manage,
implement, and monitor project activities. Relevant steps of project implementation and project
finances are controlled and approved by the Project Governing Board and the Project Steering
Committee.
2.1.1
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Project Governing Board
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During the reporting period, the progress on the KfW Project was reviewed by the Chief
- Secretary, Government of Karnataka, in the 13* meeting of Project Governing Board held on
l'0tf’N^vembeM9997The proceedings of the meeting are enclosed as Annex 1
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2.1.2 Project Steering Committeg^jbf )
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A Steering Committee Meeting/was held on January 4lh, 20GGrln the meeting, the
contract awards of the Jirst-five hospital works were approved:
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Aurad
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Mannekahalli
Sandoor
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Kushtagi
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Humnabad
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At the same meetmg. administrative approval of the final designs and bid
documentation was obtained for three more hospitals: I
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^hahbad
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Huvina Hadagali
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Madapa Hjpperga
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Activities of the KHSDP Administration
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Equipment Maintenance in Gulbarga Division
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Same status as described in Progress Report 8.
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2.2.2
Co-ordination of the FC Project with the Technical Measures in Gulbarga Division
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The KHSDP administration is responsible for the co-ordination of the technical measures
implemented under the World Bank supported project component in Gulbarga Division and the
KfW financed civil works and equipment project component. The following up-dated table
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Progress Report N" 9
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(status: January 2060) summarises the progress of the WB supported KHSDP components in
the Stafe_Of Karnataka in comparison with the KHSDP activities in Gulbarga Division.
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Summary of Major KHSDP Activities - Comparison State and Gulbarga Division
KHSDP Components
Progress in WB supported project
area
Management
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Strategic Planning Cell
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Civil Works
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Co-ordination activities are being continued successfully between
KHSDP, KfW component, RCH, SHS II, IPP VII, IPP IX
The mal-distribution and mismatch of specialists in the hospitals exists to
a great extent. KHSDP continued to work on the re-distribution and filling
up of posts in most of hospitals under the KHSDP (Gulbarga Division
included)
The report on study of waste management practices in hospitals has been
presented in October 1999.
Up-date action on Health Policy Matrix on-going
Microbial Contamination study issued
Manual for commissioning of hospitals where work is completed prepared
Study on manpower planning in the Dep. Of H&FW initiated
Discussion on certain basic changes in policy on public/private mix on
going
Study on user charges completed
Planning for almost 90% of the
hospitals completed
Civil works will be completed for
93 hospitals until April 2000
Recruitment process in progress
for:
573 assistant surgeons
115 dental surgeons
and
867
staff
nurses
paramedics
Recruitment process completed
for entomologists and graduate
pharmacists
Staff recruitment
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Training of personnel
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Referral System
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Progress in KfW supported
Gulbarga Division
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24 hospitals: final design and
tender stage
4£out of ,24-hospital works
grounded (award given January
SSr-iOOQ)--1
45-50% of the posts under the
KHSDP filled (doctors and
nurses)
recruitment of 23 assistant dental
surgeons in progress
75 pasts of assistant surgeons
will be filled under the KHSDP scrutiny of applications in
progress
13 X-ray technicians posted
15 driver posts filled
253 staff nurses posted (some of
them have not reported
Training of all district laboratory medical officers, entomologists
completed
196 out of 380 specialist doctors trained during 1999-2000 (Annex 2)
867 out of 1784 staff nurses/paramedics trained during 1999-2000
(Annex 3)
fresh and refresher training at 60 hospitals carried out
pilot training on behavioural change on-going
Referral activities have been
initiated in three districts where
Referral system will be
implemented shortly
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Upgrading Secondary Level Health Care Facilities
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hospitals have been up-graded.
Performance of the system is
being monitored.
Initial reports indicate that it
would take at least one more year
to install a properly functioning
referral system
It is planned to initiate the
implementation of the referral
system in all districts independent
from completion of the
infrastructure works
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Maintenance and repair
of equipment
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- Waste disposal system
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Drug supply system
Yellow Card Scheme
one time repair at all hospitals under the KHSDP completed state-wide
workshops in all districts established, equipped and functioning
maintenance teams in place and working
Discussion on policy formulation
for waste reduction and re
cycling strategies on-going
Question of installation of
incinerators at district hospitals
will depend on political decisions
of the Indian Government
Meanwhile in Karnataka, a waste
disposal system (segregation of
waste, deep burner) has been
introduced at all hospitals
commissioned under the KHSDP
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Progress Report N° 9
No new waste management
system has been introduced so
far since rehabilitation work at
the hospitals have not yet been
started
Improved state-wide, no drug shortage reported
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Implemented in all districts of Karnataka, rounds of yellow card check ups
for Scheduled Casts and Tribes conducted regularly twice a year. Annual
health check up in the five districts of Gulbarga Division see Annex 13
Access to Women’s
Health
Implemented through one NGO
in one pilot district (Mysore)
No extension yet, since the GOI
has come up with a separate
scheme for women’s health which
is being implemented through 6
NGOs
Not implemented here
Epidemiological
Surveillance of
Communicable Diseases
Surveillance units in all 27
districts (including new districts)
designated
11 district surveillance
laboratories completed
in 7 places construction in
progress
procurement of equipment in
progress
State level working committees
functioning, district level co
ordinating committees constituted
Software developed and
computer procurement in
progress
Surveillance units for all districts
in Gulbarga Division designated
Unit at Gulbarga initiated
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Upgrading Secondary Level Health Care Facilities
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Progress Report N° 9
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Contracting out of nonclinical services
Contracting out of non-clinical
services at all (90) completed
hospitals finalised by April 2000
Not yet initiated
IEC
IEC needs and comprehensive
strategy identified by the KHSDP
IEC activities for referral system
initiated in some districts
IEC measures for Yellow Card
System carried out
Facility linked IEC activities (e.g.
for waste management) initiated
in 60 up-graded hospitals
IEC measures for Yellow Card
Scheme carried out
Quality clinical audit at 30
commissioned hospitals
completed
Regular reporting and analysis of
hospital performance indicators
on-going
Feedback provided to reporting
hospitals
Increase of attendance after
completion of infrastructure works
due to improved services
measured
About 80 % of hospitals under
the KHSDP report regularly
Increase of attendance
recognised due to better
monitoring
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Quality assurance
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• Supposed September 2001/ '—
Supposed March 2002
Completion of the
KHSDP and giving over
to Ministry of Health____________________ ______________ __ _________________________
(Source: KHSDP Mid Term Review 1999; Information by Dr/Rachama'c/KHSDP in January 2000)
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2.2.3
Personnel at Gulbarga Project Office
In Gulbarga Division, the project office established by the Government covers both the WB
supported KHSDP measures and the KfW supported programme component. The Engineering
Division has been established but not yet completely staffed since civil works apart from urgent
repairs have not yet been initiated. The staff status at the Gulbarga office is shown in Annex 4.
The Regional Directobhas taken charge-as* Additional Director of the KfW supported project
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Activities of the Engineering Wing KHSDP
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The following major activities were carried out by the Engineering Wing KHSDP during the
reporting period:
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Urgent repairs to 8 hospitals including ope district hospital
Development of final designs and the respective tender documents
Evaluation of seven bids
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Upgrading Secondary Level Health Care Facilities
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Progress Report N° 9
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2.3.1
Urgent Repairs of District Hospitals
Bellary District Hospital: Rewiring and Repairs & Construction of New Shed; work
completed
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Gulbarqa District Hospital: Urgent repairs of the hospital have been completed.
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2.3.2
Urgent Repairs of other Hospitals
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The urgent repairs have been taken up in the following 8 hospitals:
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Chikkajoqihalli Hospital: Rewiring and improvements to water supply - Work Completed.
)
Kudlaqi Hospital: Improvements to.water supply - Not yet taken up.
Sandur Hospital: Improvements to.water supply & Electrical repairs - Work completed.
)
Madana Hipperqa Hospital: Repairs to Electrical & Sanitary works. - Work on-going.
Kalqi Hospital: Repairs to Electrical & Sanitary works - Work on-going.
Aland Hospital: Repairs to Electrical & Sanitary works - Work on-going.
Linqasuqur Hospital: Providing drains and OPD entrance to the portion where
encroachment has been removed - Work completed.
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2.3.3
Planning Progress
The development of the designs for hospital rehabilitation and up grading up to date (end of
reporting period January 2000) is as follows:
General Hospitals:
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Preliminary design of hospital Sindanur in Raichur District requested 4o4>e re-submitted
to KfW, has now been completed by the local architects_and forvyarded for clearance to
the International Hospital Planner.—
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During the reporting period, a total of 4mihal designs have been cleared
Additionat^tWdfinal-designs—and-tender—documentation^Tvere-forwarded—to—the—
International Hospital PlanTier=Final designs and tender documents of the remaining ^hospitals are in progress
Bid opening and evaluation has been completed for five-hospital works: Aurad,
Mannekahalli, Humnabad, Sandoor, Kusthagi; evaluation of two bids are in progress’Chincholi aiEd Basavakalyana
KfW gave non-objection to the evaluation results and the works at five hospitals were
grounded on 25 January 2000
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Upgrading Secondary Level Health Care Facilities
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Progress Report IJ'- 9
The final designs of hospitals at Shahbad;-Madana-Hipperga-anct_Huvfna^Ha^agati---have been cleared by the consultant on
For Hipperga Hospital, drily
conditional clearance was given; comments of the consultant have been incorporated
and bids have been invited for all three hospitals on 5. 01.00.
The three bids will be opened on 8th of February 2000
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Bellary District Hospital:
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Preliminary design for reconstruction of the hospital has been developed by the local
architects and discussed with the International Hospital Planner during his visit to
Karnataka in January 2000. - .
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Gulbarga District Hospital:
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Preliminary design of rehabilitation of the hospital has been prepared by the local
architects and discussed by the Internationa! Hospital Planner. -•—- ''
Bidar District Hospital:
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Preliminary design of rehabilitation of the hospital has been prepared by the local
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architects and discussed by the.International Hospital Planner.
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Comment to the rehabilitation of district hospitals in phase one of the KfW supported project:
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Only two district hospitals, Bellary and Bidar, were originally been included in the first phase of
the KfW supported project in Gulbarga Division. However, assessment of requirements
showed that Bellary District Hospital requires re-construction of the entire hospital rather than
rehabilitation due to the dilapidating condition of most of its buildings. The KHSDP plans now
to include the rehabilitation of Gulbarga District Hospital together with Bidar District Hospital in
phase one of the project. Depending on the availability of funds in phase one due to possible
savings, the KHSDP discusses to take up the reconstruction of Bellary District Hospital in
addition.
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BED Chikkajogihalli
1
BEO Huvina Hadagali
2___
BEO Hospet
3___
BEO Kudlagi
4
BEO
5l_
BEO Si rag up pa
6__
BIO Aurad
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1
BIO Basavakalyan
2___
BIO Humnabag < >
3
5555
cleared
aS
Bellary
x
x
x
x
X
X
Bidar
X
x
x
X
Bidar
X
x
X
y
Bidar
x
x
X
___________
Bellary
Bids
Bellary
Bellary
______
Bellary
Bellary
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BIO Mannekahalli
4
BIOS Bhalki
j Bidar
GUO Chincholi
1 _____ _______
GUO Javargi
2_________
GUO Kalgi
3 __
GUO Madana
4 ___ Hipperga
GUO Shahabad
5 ____________
GUO Shapur
6^___________
GUO Yadgir
7____________
GUO Afzalpur
8
Gulbarga
GUO Aland
9
Gulbarga .
RAO Devadurga
1 __
RAO Gangavati
2__
RAO Koppal
3 __
RAO Kushtagi^fW
4
RAO Lingasugur
5__
RAO Sindhnoor
6
Raichur
Progress Report N° 9
x
X
X
x
Land tenure
problems solved,
designs will be
prepared
Bidar
X
x
Gulbarga
x
x
Gulbarga
x
x
x
Gulbarga
Gulbarga
^7
^7,
Gulbarga
Gulbarga
Postponed due to
land tenure
problems_______
Postponed due to
land tenure
problems______
Gulbarga
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Raichur
Raichur
X
Raichur
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2.3.3.1 Hospitals on Hold:
SI No.
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Raichur
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Raichur
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Hospital
Afzalpur
Gulbarga
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Aland
Gulbarga
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Bhalki
Bidar
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SANIPLAN / MEDICONSULT
Part of existing hospital grounds are claimed by a
3rd party. Works postponed_____________________
No space for any expansion. Works postponed
Land was-made available by the Education
Department solhat the civil works witTbe taken up
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Upgrading Secondary Level Health Care Facilities
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Progress Report N° 9
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In respect of the Hospital at Bhalki, the pre-design of the hospital is finalised. The pre-designs
will be reviewed by the International Hospital Plannerand submitted to KfW for approval.
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2.3.4
Equipment Maintenance Workshops
Three of the four district hospitals have existing buildings that are suitable for equipment
maintenance workshops. The rehabilitation of the workshop in Gulbarga is completed. At
Bellary, estimates have been sanctioned by the Steering Committee for building a new
workshop building in the context of the re-construction of the hospital. For the rehabilitation of ,
the workshop at Bidar District Hospital, cost estimates were not yet prepared.
All workshops are/adequately staffed and the maintenance teams had been trained at
Bangalore. The statements of staff position and progress on activities of the district equipment
maintenance units are shown in Annex 5.
Procurement of Medical Equipment
)
2.3.5
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At present, there are no activities required since the procurement will be postponed until civil
works will be near to completion. However, due to several changes in the equipment status of
the hospitals through equipment provision from different sources and/or repair of equipment,
the equipment status will have to be reviewed and revised prior to the procurement according
to the actual inventory lists.
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Quality Auditing Services for the Hospital Buildings works under the KfW project
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2.3.6
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The Engineering Wing has invited for quotations for Quality Auditing Services at hospitals in
Gulbarga Division where civil works will soon be taken up under the KfW supported project.
The estimates for the costs of the Quality Audit and the TOR are based on the experiences
made under the WB supported project component.
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2.3.7
Financial Auditing Services
2.4
Activities of the Consultant
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2.4.1
Project co-ordination and Preparation of Implementation
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All the activities of the KHSDP engineering wing and the medical equipment department
relating to the KfW supported section of the Karnataka Health Systems Development Project
were carried out with the assistance of the consultant team.
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The activities during the reporting period were largely related to project co-ordination and
management, the clearance of final designs and tender documents, and the co-ordination for
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approvals. The local Consulting Project Co-ordinator assisted in the development of final
designs and bid documents through close collaboration with the local architects.
Visit of SANIPLAN Consultants
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2.4.2
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A mission of Dr. M. Mantel, public/health and managing consultant from the SANIPLAN home
office, Mr. U. Fitz to Bangalore was carried out from January 16 to 24, 2000 on written request
of the Project Executive Agency (PEA) with the following agenda.
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Assessment of progress of the World Bank supported KHSDP activities in Gulbarga
Division
Initial monitoring visit to hospitals for which final designs have been completed and
contract award proposals have been finalised
Random inspection on appropriateness of urgent repair works completed recently at
selected hospitals
Clearance of the evaluation reports for the first five hospital works
Discussion of planning issues concerning the district hospitals
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The mission report of the Consultant and the itinerary are attached in Annex 6 and 7.
2.4.3
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Review of Monitoring Plan
A draft monitoring plan was developed by the Consultant according to KfW requirements. The
plan was discussed with the KHSDP Administrator during the consulting mission. The PEA will
review and comment the draft until February 2000.
2.4.4
Revision of Project Planning Matrix
Under the KHSDP, a quality performance system was developed. The system includes the
reporting of the hospitals under the KHSDP on specific indicators such as'utilisation and
number of services provided (Examples in Annex 8.1-8.3). In addition, after rehabilitation of the
hospitals, a medical audit (hospital inspection) is being carried regularly evaluating the hospital
performance on the basis of e.g. case sheets introduced at the hospitals and inspection of the
department. The Hospital Inspection Booklet developed under the KHSDP is available to the
Consultant.
To be in accordance with the indicators defined under the quality assurance programme, the
original Project Planning Matrix of the FC Component needs to be reviewed and revised. A
draft of the revised project-planning matrix was presented by the Consultant to the KHSDP
Administrator during the consultant mission in January 2000. The PEA will review the proposed
indicators in view of full compliance with the quality control system developed under the
KHSDP.
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3.
RESOURCES
3.1
Personnel
3.1.1
Consulting Inputs
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Consultant personnel was involved in activities during the reporting period as follows:
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Consulting
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Name of
Function
Activities
| ^Consultant
Consultant
International Experts
SANIPLAN
Dr. M. Mantel
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A. Doring /
R. M. Bauer
Public Health
Specialist,
Health Planner
and Overall
Project Coordinator
Saniplan
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U.R. Fitz
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Hospital
Architect
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Monitoring of WB KHSDP
component;.
Visit to Bangalore and Bellary
District from 16.-25.01.2000
Project Back-stopping engineering
component, financial management
and home office support_________
Clearance of Preliminary Design &
Final Design and co-ordination of
the same with KfW; review of
evaluation results of five works;
Initial monitoring visit to Bangalore
and Bellary District from 16.-
25,01,2000_____________________
MEDICONSULT*
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No particular activity during the reporting period
National Experts
SANIPLAN
Local Project
Co-ordinator
Full time Local Project Management
and Co-ordination; assistance in
completion of final designs and
tender documentation, assistance in
tendering and bid evaluation_______
* Note: As per revised terms of reference as approved by KfW no further consulting services are
required with respect to the Medical Equipment during the planning stage.
M.C
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Local Support Personnel
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During the reporting period, the following supporting staff was working at the Consultant Office
at the KHSDP in Bangalore:
a)
b)
c)
One Secretary (Engineering Graduate) One Attender
One Driver
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Equipment / Materials
No further changes with reference to progress report 87.
4.
TIME SCHEDULE
4.1
Project
Despite of the joint efforts of the KHSDP and the Consultant and the substantial speeding up
of the planning and tender activities, the time schedule as estimated and proposed in the
- Amendment No. 1 cannot exactly be met. This is mainly due to the actual time requirements
for the finalising of the tender documentation and the procedures of approval although the
latter was already cut down to a minimum. However, a realistic time schedule can be made as
follows:
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the first five works have been started in end of JanuaryJZOOO —
it is planned that by March 2000, a total of 10 contracts will have been awarded
by June 2000, the detailed designs and tender documentation of all 2?Thospital works
will be completed
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by December 2000, all civil works will be grounded
the implementation period is estimated between 12 and 18 months depending on the
scope of civil works
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The up-dated time schedule is attached in Annex 9.
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Consulting Services
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Carrie
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Dr. M. Mantel_________
U. R, Fitz____________
M. C. Thirumalachar
A. Poring / R. M. Bauer
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2,18________ ________ 0,57________
2,90________ ________ 1,82________
6,73________
15,27
1,07
0,93
4.2.1
Local Project Manager and local consultants:
Project Co-ordinator since 15th July 1999.
4.2 2
Public Health Consultant: Dr. Michaela Mantel continued the monitoring of the
technical project component in Gulbarga Division supported by WB. She visited the
project in January 2000.
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4,72
22,00
2,00
A
Sri. M.C Thirumalachar is working as
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Progress Report N° 9
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4,2 2
Hospital Planner & Architect: (Mr. Fitz) has reviewed the Preliminary Designs, Final
Designs, Tender Documents and reports received from the KHSDP. He visited the
Project in January 2000 to initiate the project implementation at five hospitals.
4.2.3
Management Team. Overall project management, backstopping and financial
management was provided by the home office team consisting of Mr. A. Dbring and
Mr. R. M. Bauer.
5.
FINANCIAL SITUATION
5.1
Project
5.1.1
Disposition Account
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Project Office Gulbarqa Division
In 1999, the utilisation of the disposition fund by the Gulbarga Project Office included the
purchase of vehicles, furniture, the payment of local architects and the expenses for urgent
repairs. The Statement of expenditures of the office is attached in Annex 10.
Expenses Urgent Repair
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Please see Annex 11
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5.2
Cost Estimates
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The rough cost estimates for the construction and medical equipment based on the recently
completed detailed designs and the component wise brake up of anticipated expenditure
showing deficit/surplus were presented in progress report 8.
After evaluation of the first five bids, the table (Annex 12) has been up-datec^by-replacing the
cost estimates withjthe actual contract amounts^foctheJjrs£fivejiosp1tal civil works. In
comparison with the latest estimates it is shown that the first five civil works will have a excess
+ of about 17%. With having evaluated^ only five tenders, it is to early to analyse the trend
weather the actual costs will succeed the cost estimates or if saving can be made.
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Statement on expenses for consultant work, travel costs and other cost up to the end of
January 2000 will be submitted under separate cover to KfW.
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6.
CONSTRAINTS, OPPORTUNITIES AND RECOMMENDATIONS
6.1
Constraints and Opportunities
6.1.1
Planning Phase
The project is still behind schedule compared to the original time schedule laid down in the
Consulting Contract dated September 1997. However, with the re-organisation of the
consulting services and an effective local project management, the project progress has been
reported by the KHSDP and the Steering Committee as being satisfying. The joint efforts of
the KHSDP personnel and the Consultant will further aim at catching up with the original time
schedule as fast as possible.
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Medical Equipment
Due to recent changes in the equipment status of the hospitals in the State in general and in
Gulbarga Division in particular, there will be a need to re-assess the actual requirements based
on the up-dated inventory lists. The changes in the equipment status occur mainly due to
recent provision of equipment items from other sources and the “one time repair work done
under the KHSDP.
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6.1.3
Water Conservation
The KHSDP plans to take up the items required for water purification at the hospitals under the
equipment component of the project.
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6.1,4
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Solid Waste Disposal
The waste disposal systems at the hospitals under the FC project component in Gulbarga
Division will be established after completion of the civil works and the commissioning of the
hospitals. The staff will be trained on segregation of waste.JDeep^umej!-facilities-are4nclcnle^
_in_the_detailed design of-the-civil-works. The use of incinerators is stiff subject to the policy of
the All India Government. Up to date, no final decision has been made' in this regard.
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6.1.5
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No further progress on this issue can be reported.
Land Tenure Problems
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6.1.6
Revision of Designs during Implementation
Scrutinising detailed estimates of some of the works for which final designs have been
developed, it appears that there is scope for reduction of construction cost through reducing
unnecessary expansion plans. In addition, on visit to the hospitals, it appeared that in a few
cases, the preliminary designs had been based on wrongly drawn ground maps. Detailed
discussions were held with the International Hospital Planner on this issue and flexibility during
the implementation phase is regarded as essential in order to meet the realistic requirements
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(see also MEMO of Mr. Fitz in Annex 6). These experiences were also made in the WB
supported civil works component in other parts of the State. Changes during the
implementation of civil works had been non-objected by WB as long as the budget limits were
pot exceeded
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Recommendations
Based on the status of the project and the constraints identified, the recommendations are as
follows:
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Gulbarga District Hospital and Bidar District Hospital: detailed designs and tender v
documentation are in progress and should be completed as soon as possible.
Bellary District Hospital: possibilities for taking up the reconstruction of the hospital
under phase I of the KfW supported project shall be evaluated. The decision will
certainly depend on the availability of funds out of possible savings for civil works. KfW
should be contacted in this matter.
The joint efforts of the KHSDP and the Consultant shall continue to focus on speeding
up of the planning process in order to reach the aim of completion of detailed designs
and tender documentation in June 2000 with_the_next-batGh-oHenders to be'floated by
The KHSDP will further try to solve the land tenure problems at the two hospitals
Afzalpur and Aland.
The construction and conversion of the remaining maintenance workshops should be
implemented as soon as possible.
Review and up-date of medical equipment inventory lists are required. Consequently,
the requirement lists for the provision of equipment need to be revised according to the
up-dated inventory.
Discussjon with J<fy^on^2dbility. dunng Thejmplementation pbiase-for changesTof
de sign s-due to loca[ con d ition s^
Staffing of hospitalsunderthe KfW component: close monitoring of the availability of
sufficient personnel for hospitals under the KfW supported component. At latest at the
time of commissioning of the hospitals, staff should be made available by the State.
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Annex 1
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Proceedings of the 1 5th Meeting of the Project Governing Board
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Proceedings of the 15th Meeting of the Project Governing Hoard of the
Karnataka Health Systems Development Project held on 1(fh November 1999 under
the Chairmanship of Chief Secretary to Government of Karnataka
Members Present:
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1. The Chief Secretary to Government of Karnataka
2. The Principal Secretary to Government, Finance Department represented by
Under Secretary
3. The Principal Secretary to Government, Health & F W Department
4. The Secretary to Government, Planning Department
5. The Secretary to Government, Public Works Department
"6. ^The Commissioner, Health & Family Welfare Department (Special Invitee)
7. - The Project Administrator & E/o Special Secretary to Government, KHSDP
8. The Chief Engineer, KHSDP
9. The Director, H & FW Services
10. The Additional Director (Project), KHSDP
11. The Additional Director (KfW Project), Gulbarga
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Members who could not attend the Meeting:
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1. The Principal Secretary to Hon’ble Chief Minister, Government of Karnataka
2. The Representative of the Government of India, Ministry of Health & Family Welfare
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Subject No. ]
Confirmation of the Proceedings of the lfh Meeting of the Project Governing Board held
on 13th July, 1999
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The proceedings of the 14th meeting of the Project Governing Board held on
13 ‘ July, 1999 was read and confirmed.
Subject No. 2
Action taken report of the Proceedings of the l^fh Meeting of the Project Governing Board
held on 13th July, 1999
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The Committee reviewed the action taken on the proceedings of the 14Ul meeting of
the Project Governing Board held on 13th July, 1999.
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While reviewing the action taken on the proceedings of the previous meeting, the
Commissioner, Health & Family Welfare observed that in the proceedings of the 14,h meeting
of the Project Governing Board, in respect of Subject No. 8, it is mentioned that the Project
Administrator will inform the cabinet about the funds provided by the project for completion
of ground + two floors in the new building of Me. Gann Hospital and reducing the bed
strength from 1200 to 600. The Project Administrator informed the Committee that soon after
the visit of the World Bank, Draft Cabinet Note will be submitted in this regard.
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While reviewing the action taken report in respect of Subject No. 11, the Project
Administrator informed that the Planning Department will have to place the subject before the
State Level Co-ordination Committee for the additional proposal of including Phase II
hospitals of KfW in KHSDP. The Chairman requested the Secretary, Planning to get the early
clearance for the proposal.
The Project Administrator informed the Committee that there will be savings in the
project to an extent of Rs. 192 Crores. The Director, Health & Family Welfare has been
requested to give the proposal of including additional Community Health Centres in the
project for upgradation. The Chairman requested the Principal Secretary, Health & Family
Welfare to give information about the number of Community Health Centres which could be
taken up for upgradation under the project. The Principal Secretary, Health & Family Welfare
- suggested that as sufficient savings are there in the project, all the Community Health Centres
which are not already included in the project could be taken up for upgradation under
KHSDP. This was agreed to by the Committee and the Chairman requested the Director,
Health & Family Welfare to send these proposal immediately to the Government giving
justification for inclusion of the Community Health Centres for upgradation.
The Chairman also requested the Principal Secretary, Health & Family Welfare to take
up the matter with the World Bank for providing funds to improve Victoria Hospital, K.R.
Hospital, Bowring & Lady Curzen Hospital, K.C. General Hospital and Jayanagar Hospital
out of the savings amount. The Project Administrator informed that this was already discussed
with the Supervision Team of the World Bank during mid-term review held in June 1999. The
World Bank was not readily agreeing to the proposal as these hospitals are teaching hospitals
and do not come under the definition of secondary hospitals. The Chairman suggested that it is
necessary to upgrade these hospitals as there are no other referral hospitals for the people of
Bangalore and the surrounding places. He further requested the Principal Secretary, I lealth &
Family Welfare to take up the matter with World Bank officers for including Mental Hospital
at Dharwad for improvements out of the savings amount of the project.
The Principal Secretary, Health & Family Welfare requested the Chairman regarding
the additional proposals to be placed before the Supervision Team of the World Bank as they
are yet to be cleared by the SLCC. The Chairman suggested that these proposals could be
discussed with the World Bank Supervision Team during their visit to the State on 15th
November, 1999 and also place these proposals at the earliest before the SLCC for clearance.
Subject No. 3
Status Note on Karnataka Health Systems Development Project and KfW assisted Project
The Project Governing Board reviewed the progress achieved in the implementation of
the various components of Karnataka Health Systems Development Project and the financial
progress in the implementation of the Karnataka Health Systems Development Project.
Similarly the Committee also noted the progress made in the implementation of KfW assisted
project.
While reviewing the progress achieved in various components of the Karnataka Health
Systems Development Project, the Principal Secretary, Health & Family Welfare brought to
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the notice of the Committee, the proposal of Private Public Mix which was discussed with the
World Bank Supervision Team in June 1999. The Project Administrator briefly explained the
concept of Private Public Mix that has been thought of as a pilot project to be implemented in
Devanahalli Taluk. The Chairman welcomed the proposal and requested the Project
Administrator to implement this in some more Taluks of South Canara, Dharwad District, etc.
to understand the implications of the scheme much more effectively.
Subject No. 4
Approval of the Project Governing Board to the Evaluation Report and the Proceedings of
the Tender Sub-Committee for procurement of Dental X-ray Machines, Blood Gas
Analysers, Ultrasound Scanners and Ultrasound Scanners (Portable)
The Project Administrator briefly explained to the Committee the procedure followed
in.tlie evaluation of bids. Regarding the procurement of Portable Ultrasound Scanners to all
the hospitals with 50 beds and more, there was detailed discussion. The Project Administrator
informed that this facility will be useful in the hospitals for detection of any complications
associated with pregnancy at an early stage and remedial action could be taken at the
appropriate time. The Director, State Institute of Health & Family Welfare stated that with the
supply of Ultrasound Scanners, there will be possibility of female foeticide increasing in the
hospitals as the Doctors may use the Ultrasound Scanner for sex determination. The
Commissioner, Health & Family Welfare and the Principal Secretary, Health & Family Welfare
also expressed fear for the same reasons. Further the Commissioner, Health & Family Welfare
also brought the Proceedings of the Tender Evaluation Committee to the notice of the
Committee. In the Proceedings of the Tender Evaluation Committee, it is mentioned that all
the posts of Gynaecologists will have to be filled up in the hospitals where the Portable
Ultrasound Scanners are supplied. The Principal Secretary, Health & Family Welfare
expressed apprehension about filling up of the posts of Gynaecologists in all the hospitals and
also training them early. If this was not done, the equipment would go unused. The Project
Administrator informed that it will not be possible to postpone the supply of equipment once
the Notification of Award is made in favour of the successful bidder. After detailed discussion,
the Committee decided to reject all bids received for the procurement of Ultrasound Scanner
(Portable) with No Objection from the World Bank and go for re-biddiflg at the appropriate
time taking into consideration the availability of Gynaecologists in the project hospitals.
Thereafter the Project Governing Board considered the evaluation note and
recommendations of the Tender Evaluation Committee for the procurement of Blood Gas
Analysers and Ultrasound Scanners. The Project Governing Board approved the evaluation
note and the proceeding of the tender evaluation committee and gave approval for forwarding
the same to the World Bank for prior review and no objection.
Further the Project Governing Board approved the Proceedings of the Tender Sub
Committee for procurement of Dental X-ray Machines and issue of Notification of Award in
favour of successful bidder as it does not require Pre-award Review by the World Bank.
The Project Governing Board approved the recommendation of the Tender Evaluation
Committee for issue of Notification of Award for the supply of (a) Blood Gas Analysers
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in favour of M/s. Trivitron Medical Systems Ltd., Chennai at an unit of cost of
Rs. 6,04,617.80 and a total price of Rs. 1,39,06,209/- for 23 units of model Rapid M348 after
getting no objection from the World Bank.
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(b) Ultrasound Scanner
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in favour of M/s. Wipro GE Medical Systems, Bangalore at an unit of cost of
Rs. 4,78,807.52 and a total price of Rs. 1,24,48,995.53 for 26 units of model Logic a 200
after getting no objection from the World Bank.
(c) Denial X-ray Machines
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- . in favour of M/s. Villa India, New Delhi at an unit of cost of Rs. 66,300/- and a total
price of Rs. 17,90,100/- for 27 units of model KONO-65 which is at L2.
Subject No. 5
Renovation and Expansion of Taluk Level Hospital at Virajpet in Kodagu District
and
Subject No. 6
Renovation and Expansion of District Hospital (Me Gann) at Shimoga in Shimoga District
The Chairman observed that during discussion with the former Commissioner of the
Karnataka Housing Board on the construction of Housing Complex for National Games, the
Commissioner had informed about the inferior quality of work done by M/s. Engineering
Projects India Ltd. who has given a certificate that M/s. Lanco Constructions Ltd., Bangalore
were their associate contractors. The Secretary, Public Works Department mentioned that if
there is any unauthorised subcontracting then that experience cannot be reckoned for
shortlisting a firm. It was felt desirable to properly examine whether M/s. Lanco Constructions
Ltd., Bangalore can be held to be technically qualified based upon certificate of being associate
contractor given by M/s. Engineering Projects India Ltd. There is also need for verifying
quality of their work in the National Games Housing Project. The Chairman requested the
Principal Secretary, Health & Family Welfare to examine these issues in depth in consultation
with the former and the present Commissioners of the Karnataka Housing Board and the
Secretary, Public Works Department. With this, the subjects were deferred to be placed before
the next Project Governing Board Meeting.
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Subject No. 7
Construction of Taluk Level Hospital at Yelahanka in Bangalore District
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The Chief Engineer briefed the Project Governing Board, the reasons for increase in
the estimated cost compared to the provision made in the project report. After noting the
reasons for increase in the estimated cost, the Project Governing Board gave administrative
approval for renovation and expansion of Taluk Level Hospital at Yelahanka in Bangalore
District at an estimated cost of Rs. 275.00 lakhs.
Subject No. 8
Renovation and Expansion of District Hospital (Sri Jayachamarajendra Hospital) at
Hassan in Hassan District
*
The Chief Engineer briefed the Project Governing Board, the reasons for increase in
the estimated cost compared to the provision made in the project report. After noting the
reasons for increase in the estimated cost, the Project Governing Board gave administrative
approval for renovation and expansion of District Hospital (Sri Jayachamarajendra Hospital) at
Hassan in Hassan District at an estimated cost of Rs. 390.00 lakhs.
Subject No. 9
Renovation and Expansion of District Hospital at Kanvar in Uttara Kannada District
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The Chief Engineer briefed the Project Governing Board, the reasons for increase in
the estimated cost compared to the provision made in the project report. After noting the
reasons for increase in the estimated cost, the Project Governing Board gave administrative
approval for renovation and expansion of District Hospital at Karwar in Uttara Kannada
District at an estimated cost of Rs. 295.00 lakhs.
Subject No. 10
Compliance to the Audit observations raised by the Accountant General in the Audit
Report of Karnataka Health Systems Development Projectfor the Year 1997-98
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The Project Administrator briefly explained to the Committee the observation of the
Audit and action taken to comply with the audit observations. He informed the Committee
that all the observations are now dropped except the observation relating to payment of per
diem charges to the trainee doctors. He informed that action has been taken to get the
clearance of the Finance Department for the proposal before the issue of Government Order as
suggested by the Accountant General's Office. The Project Governing Board noted the action
taken in attending to the audit observations for the year 1997-98.
Subject No. 11
Contracting out Non-dinical Services in Government Hospitals
fhe Project Administrator briefly explained the steps taken in getting the clearance of
the Labour Department to the revised Bid Document for contracting out Non-clinical Services
in project hospitals. The Chairman requested the Secretary, Public Works Department to take
up the maintenance of circuit houses and inspection bungalows atlcast in 2-3 districts on a
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pilot basis following the procedure that is followed in Karnataka Health Systems Development
Project for contracting out non-clinical services.
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Subject No. 12
Approval of the Project Governing Board for including Commissioner, Health & Family
Welfare as a Member of the Project Governing Board and the Project Steering Committee
for KHSDP and KfW Projects
The proposal was approved by the Project Governing Board. The Chairman requested
the Principal Secretary, Health & Family Welfare to get the approval of the Hon’ble Chief
Minister before the Government Order is issued as the Project Governing Board is constituted
as per the decision of the State Cabinet. After issuing the necessary orders, the proposal may
be submitted to the State Cabinet for its ratification.
With the permission of the Chairman, the following additional subject was taken up for
discussion and resolved
Additional Agenda No. 1
Renovation and Expansion of Vanivilas Hospital (M.C.H.) at Bangalore
)
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The Project Governing Board approved the proceedings of the tender evaluation
committee for civil works and the evaluation note for award of work of renovation and
expansion of Vanivilas Hospital (M.C.H.) at Bangalore. The Project Governing Board
approved the recommendations of the tender evaluation committee for issue of notification of
award in favour ofM/s. J.N. Constructions, Bangalore at a contract value of Rs. 2,98,07,773/which is 10.22% less than the estimated contract value with reference to 1996-97 SR after
getting no objection from the World Bank subject to the condition that the Project Authorities
will take additional performance security for an amount of Rs. 36,75,000/- towards
unbalanced items.
The meeting concluded with vote of thanks to the Chairman by all members present
)
Sd/Chairman
Project Governing Board, KHSDP
and the Chief Secretary to
Government of Karnataka
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No. HFW (PR) 89 WBA 96
Copy of above proceedings is forwarded to the following officers for information and
further needful action.
(D.M. AGA)
Under Secretary to Government,
KHSDP, H&FW Department
)
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1. The Principal Secretary to Government, Finance Department, Vidhana Soudha, Bangalore
2. The Joint Secretary to Government of India, Ministry of Health & Family Welfare, New
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3.
4.
5.
6.
7.
8.
9.
Delhi, Fax No.011-3014252
The Principal Secretary to Hon’ble Chief Minister, Vidhana Soudha, Bangalore.
The Secretary to Government, Planning Department, M.S. Building, Bangalore.
The Secretary to Government, Public Works Department, M.S. building, Bangalore.
The Director, H & F W Services, Anand Rao Circle, Bangalore.
The Additional Director (Projects), KHSDP, Bangalore.
The Additional Director, KfW Project, Gulbarga
The Chief Engineer, KHSDP, Bangalore.
Copy submittedfor information :
- 1 The Chief Secretary to Government of Karnataka, Vidhana Soudha, Bangalore.
2,’The Principal Secretary to Government, Health & Family Welfare Department, M.S.
Building, Bangalore.
3. The Project Administrator, KHSDP & Ex-Officio Special Secretary to Government,
Health & Family Welfare Department, Bangalore.
4. The Special Secretary to Government (PMU), Finance Department, II Floor, Vidhana
Soudha, Bangalore.
5. The Commissioner, Health & Family Welfare Department, Ananda Rao Circle, Bangalore
.1
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Annex 2
Number of trained Medical Doctors under the KHSDP
MV*
STATEMENT SHOWING TRAINING OF SPECIALIST
Institution
SI.
No.
Speciality
DOCTORS UNDER KHSDP DURING 1999-2000
Trai
ned,
Apr-99
Propo' Train- Propo Train PropPropo Train- Profio Train- Propo TrainDuration of
osed
Propa Train- Propo Train- Propo Train- Propo Trained
sed
ed
Propo
Train’ll. ed
sed
<
ed
sed
Propo
TrainPropo
Tratned
sed
Course
ed
sed
ed
aed
ed
ied
ed
aed
ed
aed
ed
sed
ed
sed
Poly Trauma
Management
Orthopaedltlans
(MS/D. Ortho)
Poly Trauma
Management
Orthopaedltlans
(MS ID. Ortho)
3
90 days
2
90 days
2
1
HOSMAT Hospital,
Bangalore
2
Mai'ya Hospital,
Bangalore.
3
Sri. Jayadeva Institute
of Cardiology.
Bangalore
I.C.C.U
Physicians
MD (Gen Medicine)
4
Indira Gandhi institute
of Child Health,
Bangalore.
Neo-Natal Care
Paedlatritlans
(MD/DCH)
45 days
5
M S Ramadan Medical
Col'ege Hospital,
Bangalore.
laparoscopic & Foetal
Monitor for OBG
Specialist* j
(MD (OBG) / DGO)
30 days
4
6
Govt Dental College.
Bangalore
Dental Surgeons
(BDS/MDS)
30 days
7
Arcane Diagnostic
Centre, Bangalore
Ultrasonography
(Radiologist/
OBG Spl. / Surgeons)
e
Sreenivas Scanning
Centre, Bangalore
Ultrasonography
(Radiologist/
OBG Spl. / Surgeons)
9
Victoria Hospital.
Bangalore
30 days
4
4
2
1
4
2
4
2
4
4
1
4
4
3
4
1
4
4
4
4
2
4
5
4
2
4
2
2
1
2
2
1
2
3
3
2
3
4
3
2
3
2
2
1
2
1
2
2
2
3
3
1
3
2
3
2
1
4
4
4
2
2
4
3
3
4
2
2
1
2
3
4
3
30 days
2
2
2
Ultrasonography
(Radiologist /
Physician/Surgeon)
30 days
3
1
3
1
3
2
3
2
3
ENT(MS/DIO)
30 days
2
2
2
1
2
2
2
1
2
10
Basavanagudi ENT
Care Centre,
Bangalore
2
4
2
3
2
4
2
2
1
2
30 days
3
General Surgeon (MS)
2
11
SOS Tuberculosis &
Rajiv Gandhi Chest
Diseases Hospital,
Bangalore
5
8
8
5
15 days
6
5
Medico Legal MBBS
5
5
12
Victoria Hospital.
Bangalore
13
St Johns Medical
College, Bangalore
Dermatology
30 days
Total
Total
Mgr'2000
Feb '2000
Jan '2000
Dec-99 j
Nov-99
Oct-99
Sep-99
Aug-99
Jul-99
Jun-99
May-99
MM**
30 days
27
4
5
5
5
21
31
3
15
31
6
17
31
23
31
25
35
31
1
4
4
4
4
3
4
1
4
2
4
2
4
2
2
2
4
4
5
2
2
8
7
2
8
1
4
48
21
4
28
14
4
4
4
48
21
2
2
2
24
3
3
3
3
36
28
3
5
3
2
2
2
2
2
24
8
2
3
8
3
3
3
3
36
20
2
1
2
1
2
2
2
24
11
2
1
2
2
2
2
2
24
22
5
3
5
3
5
5
5
60
34
2
2
12
8
380
198
2
2
2
3
2
3
2
33
15
33
31
33
18
33
0
29
0
37
0
dr-trg-jheetl.xJj
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Annex 3
. Number of trained Staff Nurses and Paramedics under the KHSDP
t
STATEMENT SHOWING TRAINING OF STAFF NURSES I PARAMEDICS UNDER KIISDP DURING 1999-2000
SI.
No.
Institution ,
Total
Mar '2000
Feb '2000
Jap '2000
Dec-99
Nov-99
Oct-99
Sep-99
Aug-99
Jul-99
Jun-99
May-99
Apr-99
Train
Propo Train
Propo
Train
Propo
Train
Propo
Train
Train Propo Train Propo Train Propo Train Propo
ed
sed
ed
sed
ed
Propo Train Propo Train Propo Train Propo Train Propo
sed
ed
ed ‘ sed
sed
ed
sed
ed
sed
ed
sed
ed
sed
ed
sed
ed
sed
ed
sed
sed
ed
69
180
20
20
20
10
20
6
20
12
20
19
20
14
20
8
20
1
J.N. Medical College,
Belgaum.
8
2
13
2
97
20
20
20
14
20
20
20
17
7
16
20
20
20
7
13
20
20
20
240
Baptyi College of Nursing.
Davanagere.
8
20
240
106
8
14
20
16
20
20
16
20
20
20
5
27
20
8
20
4
20
20
K.M.C.Hospital, Hubli
20
3
20
20
20
20
13
240
20
17
20
20
20
20
20
20
14
5
II
20
20
20
20
133
J.S.S.Medical College.
Mysore.
13
4
M.S Rantaiah Medical
College, Bangalore
5
20
20
12
99
20
20
240
4
12
20
16
20
20
20
20
20
9
10
19
20
20
12
5
MR Medical College,
Gulbarga
20
5
20
20
15
20
104
9
9
240
15
20
20
20
20
20
20
7
20
16
8
20
20
6
Sri Jayadeva Inst, of
Cardiology, Bangalore
11
6
6
6
9
7
6
5
83
6
8
72
6
6
6
II
12
6
14
6
6
6
6
7
Indira Gandhi Inst, of Child
Health, Bangalore
8
6
6
6
81
6
6
72
5
7
6
10
6
6
9
6
6
6
10
10
12
6
10
8
Physiotherapist, HOSMAT
Hospital, Bangalore.
12
0
9
10
11
Ophthalmic Nursing
_____ Training_____
Pharmacists Training,
KSPC, Bangalore
Total
2
2
4
136
5
104
4
118
5
98
4
118
4
110
4
138
4
97
4
138
2
2
2
2
1
94
4
138
9
87
4
138
4
84
4
136
3
83
4
8
4
4
4
48
43
50
52
50
50
50
200
52
166
110
186
1784
867
0
186
0
186
0
nurs-trg-sht8
Annex 4
Staff status of Divisional Project Office Gulbarga
C
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5
/<?
PRESENT STAFF POSITION OF /ADDITIONAL DIRECTOR ICARNATAKA SECONDARY LEVEL HOSPITAL
DEVELOPMENT PROJECT/ (KB‘.T)./ GULB/XRGA.
SI
NO.
1
Name of the Post,
Sanctioned
forking
Vacant.
3
4
5
2
1•
Additional Director
ACCOUNTS SECTION
1
1
Nil.
2.
Accounts Officer.
1
1
Nil.
3.
1
1
Nil.
4,
Accounts Supdt.
First Division Accounts.Assit.
2
2
Nil.
5,
Group ’D* Snipioyee
1
Nil
1
i
ADADJISTRATIVE SECTION
6.
Administrative Officer.
1
Nil
1
7.
Office Superintendent.
First Division Assistant.
1
2
nil
1
2
Group 'D' Employee.
8.
9.
TOTAL:-
1
Nil
1
Nil
11
6
5
i
Q
___
Additional Direc^dr_____^
Karnataka Secondary Level llospTCal
’.^development Project/ (Itr..')/Guloarga.
I
C. )
V
S’-1
A M II E X U R E - 1
<
0„TCE o. T--S 3KCVTIVZ
<, „ L » * E G A
D^SM (!□>•.» saKiBK* SZWZBKY LEVEL XCSLLELL
VKGAEL KSOTOZI
OL 21-12-1999 (SAZCEOZZED STSEiKHS AS SEE 2.C .ZLzS.E. A. <EE) K.sre 97
DATED 20-12-1997
SI.
Sanctioned Post \/ith
ilo.
Details.
Iio.of Sanctioned Post
Ho.of Post Already
Filled up.
01. E;:ccutive Engineer.
01
01
02. Assistant Engineer.
01
01
03. Account Superintendent
01
01
0d-. First Division Assistant
01
05. Second Division Assistant
01
06. T/rist
01
07. Driver
01
00. Croup ’D’
01
09. Security Gaurd
01
TOTAL
09
Het Vaccancy
<
01
01
01
01
01
01
OS
1
Oi-
Ex<cnt}l»ve
Engineering Division (KFW)
Karnataka Secondary Level
Hospital Development Project
Gu’barga
I
0 fp © ®
■1
® ©
A H jj E X U R E - 2
OFFICE OF T-ZE EXECUTIVE ElIGlifLER,
-..GxI'J£Rt:;g SIB-DIVZSI0IT (ZZFu) IQ^HATAICA SEOCirDARY LEVEL
> ::gsp2?t?jj
DEVELOPMENT PROJECT G U L 3 A R G A
ViCCAi.’CY FOSITTOU
0” 31-12-1999 (SA. 2TI0HED STREHG
Ti AS PER
g.o. ir-:?:.F.;z. (pr) I4:i^z 97
DATED 20-12-1997
si .
no.
Sanctioned Post vzitli
Details
Ho .of Sanctioned Post
llo.of Post Already4
Filled up.
01. Assistant Executive Engineer
01
01
02. Assistant Engineer.
02
01
03. junior Engineer
02
04. First Division Assistant
i
02
01
05. Second division Assistant
01
01
00. Group ’D1
01
I
01
09. Security Gaurd
01
01
TOT
L
11
02 Junior Engineer is
u-orliing against tie Post
— of Assistant Engineer.
01
01
07. Driver
?.er.iar.:s
01
QI
(JG- Tv;-ist
Met Vaecar.cv
01
04
07
jvc~frp >7^7
^inecrine DjvHen
I
arna,al<a Secondary Level
Pi’al Development Project
Gulbar^a
>
1
© ®
Q O fj
A II II E X U R E
•
® •® y
2
O5TICE OF TIE EXECUTIVE E1’GII2£ER/ El'GIVEERIITG SU3-DIWSZO11 (ILF./) JELLARY IIARi ATAl LA SECC-IIDAR’- LEVEL Ilf SPITAL
DEVELOPMENT PROJECT, D S L L A RY VACCAZICY POSZTIGl' AS Oil 21-12-1999 (SAICTIOEED STREEGTI AS PER C.C .UC.II.F. J.
(PR)
14: XFW 97 DATED 20-12-1997
SI .
No.
Sanctioned Post \/itii
Details
Molof Sanctioned Post
I !c . o f Post Al re ady.
Filled up.
ilct Vocccincy
01
01. Assistant Executive Engineer
01
02o /Assistant Engineer
02
03. Junior Engineer
02
04. First Division Assistant
01.
01
05. Second Division .Assistant
01
ul
01
•ul
01
V>1
03. Group ’D1
01
Jl
09 . Securi ty Gaurd
01
01
Tv .ist
11
TOTAL
Roraarks.
02
01
01
l
00
02
z
Cxctriutive Fngln^r V
Karnataka Secondary Level
I
Gulbarga
r-.
Annex 5
Staff position and Progress Report of District Equipment
Maintenance Unit Gulbarga Division
I
v
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.5
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<H
f3
STAT324iNT SHOEING
THE STAFF POSITION OF DISRICT EQUIPMENT
MAINTENANCE UNIT OF
GUL3ARGA DIVISION AS ON 31-12-1999.
ame of the institution.
Name of the posts
Engineer
'
Technician
Gr. in
S
S
: W
V
Engineer
or. ii
S ; <;
: V
2
3
strict Hospital
He11ary.
4
1
rv*
5
1
6
a
7
1
1
9
7
io
3
ii
4
Office Supdt.
S
12
:W
v
13
14
S.D.
Driver
s : W : V S:/. ,'; v
15
16 17
1
Group * D'
; V:
S:
13 19 20 21 22 23 24
1
2
1
1
1
1
1
1
1
1
1
1
7
3
4
1
V
25 26
27
28
29
2
2
16
4
12
1
2
2
13
6
7
1
2
2
13
5
8
2
2
strict Hospital
<7aichur.
1
^otal
S; W;
strict Hospital
Bidar.
1
1
2
5
1
1
strict Hospital
'julbargu.
I
O
C
3
Z/'
w.
%
I
V & %
G> 4-*
si
(?l
NO. Name of the
Unit.
G'-1
C ®
W
□1st.
d”t tS-T? "
°s;;i
1999-2000
1)
2)
district Hospital
^aichur*
i
8666-00
Rs.
® ® 9. 9
© K?
of Equipments repaired/installed
1997“581998—99
1999-2300
»
33516-00
65042-00
107224-30
32
244
441 .
78.
83.-
Total
<
717
^istrict Hospital
Bellary.
3)
district Hospital
^ulbarga.
4)
district Hospital
Bidar.
I
<
• G •
,. ij
I
161
c-
•
• -
■
•
Annex 6
Consultant Mission Report with Photo Documentation
<■
r
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1
KHSDP - HEALTH CARE FACILITIES GULBARGA
Site Inspection #1
©
UPGRADING OF SECONDARY LEVEL HEALTH CARE
FACILITIES IN THE GULBARGA DIVISION, STATE OF
KARNATAKA, INDIA - PHASE I
SITE INSPECTION VISIT # 1
Pre-Contract Evaluation of Construction Sites
& '
•A./
o
□
□
□
□
Kudligi
Sandur
Kushtagi
Gangavathi
Hospet
Consultant's Report
January 2000
©
7-
v-
i
B
KHSDP - HEALTH CARE FACILITIES GULBARGA
Site Inspection #1
INTRODUCTION
General Remarks
This'Report is summarising the Consultant’s activities and find
ings during a first site inspection visit carried out in January 2000.
Although the main works have not started yet (5 hospitals are in
the process of contract award), it was considered essential to
review the works carried'out so far under the ‘urgent repairs’
budget and to discuss technical issues pertaining to the gen
eral construction standards and methodologies, feasibility of
proposed construction schedules, etc.. The KHSDP had there
fore requested for a first site visit by the Consultant. This first field
visit by the newly appointed international Health Facility Archi
tect was also an opportunity to discuss at site the planned con
struction / rehabilitation measures.
Consultant's Tasks
As per the current agreement the Consultant’s main tasks dur
ing this project phase (construction), pertaining to the present
activities, are as follows:
&
rv<
□
□
&
□
□
IV.
■
CT' .
u./
Works Schedule
■7
INSPECTION VISIT .
Contract Management
>.V'
Review monthly reports submitted by the auditor
Through his local project co-ordinator and upon request
of the PEA, assist the PEA in day-to-day checking and ap
proval of drawings, specifications and work schedules
prepared by the contractors
Monitoring of execution of contracts
Cany out field visits at appropriate intervals and monitor
on-going construction works
The input of the International Health Facility Planner is scheduled for a total of 50 man days, during approx. 6 visits; the next
visit will be planned for as soon as at least 5 hospital construc
tion works are advanced to approx. 20 % completion..
Besides inspecting some of the ‘urgent repairs’ already carried
out during previous months at several hospitals under the KfW
project component, it was considered equally essential by the
KHSDP and the Consultant to discuss general technical aspects
of contract management prior to starting the actual construc
tion works. This also has to be seen in light of previous misap
prehension during implementation of the KfW component and
to avoid similar situations arising in future. It is of utmost impor
tance that the contract management is carried out in a way,
which allows for the earliest possible completion of all hospitals
within the budget.
During his assignment the Consultant discussed potential risks
(and opportunities) as well as the possible impact of certain
URF - INSPEO1.DOC/ 01/03/00
page 2
!
$
KHSDP - HEALTH CARE FACILITIES GULBARGA
3
Site Inspection #1
modification proposed by the Client from pre-design to design,
as well as after contract award - the Client considers it vital to
retain a certain degree of flexibility during execution of the
works for the following main reasons:
a
□
□
&
©
t.i4’
the largest portion of the works to be carried out will be
renovation / refurbishment of existing structures; this inevi
tably can not be planned in the same way as new con
struction, since numerous unforeseen problems might
arise during execution of the works which require a swift
decision of the supervising Engineer to avoid delays.
Most designs prepared so far are incomplete or lack de
tailing to the extent required at any construction site;
again, it is important for the site engineer to instruct the
contractor.
A number of designs are not to the highest professional
standard - this may be seen in context of most architects
having little or no prior hospital planning experience. The
KHSDP might require to correct minor planning mistakes
during the works execution.
The KHSDP has gained tremendous experience during implementation of approx. 180 hospitals under the World Bank proj
ect; with the above flexibility, backed by a sound monitoring
system (independent technical auditors) it was possible to
achieve sometimes remarkable savings on individual projects
and generally to avoid delays.
The Consultant supports this flexible contract management
approach (as per the procedures adopted under the World
Bank project component) under the assumptions that:
©
□
Type of works, quantities, etc, are changed from the origi
nal contract only to a limited extent, allowing execution
of the works within the framework of the original corrtract
(no major contract amendment should be concluded
with any contractor)
□
Cost will be contained within the allocated budget (dur
ing discussions it was mentioned that the KHSDP has a re
cord of rather undercutting the contracts by applying the
above mentioned flexibility).
©
Ci
C
The flexible contract management approach will be monitored closely by the Consultant during works execution.
c
Urgent Repairs
According to the financing and project agreement urgent re
pairs (advance construction measures) were carried out by the
PEA; these measures should be executed in accordance with
the prescribed procedures of the State Government. The Con
sultant should approve the expenditures prior to refunding. The
URF - INSPEO1 DOC/ 01/03/00
page 3
I
©
KHSDP - HEALTH CARE FACILITIES GULBARGA
Site Inspection #1
expenditures incurred so far will be summarised by the Con
sultant in his next progress report.
In two of the facilities, covered during the described field visit in
January 2000, urgent repairs have been carried out or are
presently on-going.
<
At Kudligi a trial bore has been sunk to secure the hospital's
totally insufficient water supply; unfortunately the bore did not
yield the expected output and had to be given up; the site of.
the trial bore could be clearly established during the Consult
ant's visit. Different options for further proceedings were dis
cussed, including establishment of a bore-well on a nearby
Government owned property and running a separate water
line to the hospital. The Divisional Engineer will further investi
gate.
£
-
&
At Sandoor electrical works have been completed at a total
cost of 6.9 lakhs rupees (= 30.000,- DM at 23 RS/DM), replacing
the hospital's former completely worn out systems. Upgrading
of water supply system is on going at present.
©
Facilities
During this first field inspection trip of the Consultant, emphasis
was put on visiting different, but typical hospital facilities and to
assess and discuss potential problems during works execution.
The following is briefly summarising the observations and some
recommendations made at site.
f J) Kudligi
This hospital is among the recently completed facilities (1994)
and requires comparatively less intervention. As mentioned
above, the water supply of the hospital needs to be secured
on priority basis. Should this involve additional amounts to be
spent it was discussed that some of the present extensions (e.g.
at OT area) might be skipped.
- -
(2) Sandoor
This facility is included in the first batch of contracts to be
awarded shortly. The site visit revealed that some of the
planned extensions are not feasible, as they would extend be
yond the present boundary wall; obviously the architect has
worked on superseded or false survey drawings. On first floor
several rooms are existing which have never been occupied
and could be used as inpatient wards. This might require a
ramp to be built - the local Consultant will initiate respective
planning changes. We are of the opinion that these modifica
tions will not have a serious impact on the cost of the scheme.
(3) Kushtagi
This facility is included in the first batch of contracts to be
awarded shortly. Although present hospital operations are seri
ously hampered by inadequate buildings and lack of equip
ment, this hospital was found to well organised and running.
The impression prevails that this is due to exceptional dedica-
&
Q'
^5
URF - INSPECT DOC/ 01/03/00
page 4
i
0
KHSDP - HEALTH CARE FACILITIES GULBARGA
Site Inspection #1
tion of the medical staff. This hospital is included in the first
batch of contracts to be awarded.
The planning was found to be generally adequate; some minor
adjustments will be required at locations where new construc
tion adjoins existing buildings (floor heights!). It is also recom
mended to review the possibility of retaining the appearance
of some historic buildings better than presently planned (a
small gap - neck connection - between new and old buildings
should be considered).
6)
O'
©
(4) Hospef
The hospital is severely under-utilised at present. It is recom
mended to review the extent of proposed new construction
and concentrate on making better use of the available space.
This recommendation is based on the Consultant’s impression
that the pre-design cost might be severely underestimated for
the planned measures.
(5) Gangavathi
Similar to the above mentioned site problem, the Labour de
partment cannot be constructed at the planned location due
to site constraints. After returning from the field visit a separate
meeting was held with the architect, who will immediately re
view the design. Although it will not be possible to incorporate
these design changes before award of contract, it is not be
lieved to be of any serious impact to the cost of the hospital
construction works.
&
e
©
The present doctor’s quarters were found in a relatively good
condition and are believed to be suitable for repairs, rather
than demolition and new construction (as planned); the local
Consultant will confirm this possible change with the KHSDP.
&
Prepared by Uwe R. Fitz
Health Facility Architect
e
V,.'
Bangalore, dated 23rd January, 2000
C
URF - INSPEC-1 .DOC/ 01/03/00
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Annex 7
.
Itinerary of Consultant Mission
s.
!ir^:
i
ITINERARY
Project:
&
Here:
Financial Cooperation with India
Upgrading Secondary Level Health Care Facilities in the
Gulbarga Division, State of Karnataka
Visit of the Consultants Dr. M. Mantel and Mr. U. Fitz /SANIPLAN to
Karnataka, January 16 to 25, 2000 -
Dr. M. Mantel, SANIPLAN, January 25, 2000
Jf.
15.01.2000
Departure Mr. Fitz from Pune, arrival Bangalore
16.01.00
Departure of Dr. Mantel from Berlin to Mumbai via Paris Air France
17.01.00
Ml*/
, Arrival of Dr. Mantel at Bangalore via Mumbai by Jet Airways
Initial meeting with Mr. Thirumalachar, Consultant Project Coordinator, Dr.
Mantel and Mr.' Fitz at the Consultant Office KHSDP.
Briefing of Dr. Subramanya at the KHSDP and discussion of agenda for the
consultant mission.
18.01.
Work session with Mr. Thirumalachar, Dr. Mantel and Mr. Fitz at the
Consultant office
Clearance of results of the first five bid evaluations by Mr. Fitz.
19.01.
Meetings with Dr. Rachamar and other KHSDP staff on progress of WB
supported Programme activities in Gulbarga Division.
Discussion of preliminary designs for three district hospitals with local
architects.
20.01.
Departure of Mr. Thirumalachsr, Dr. Mantel, Mr. Fitz from Bangalore to
Hospet/Bellary District by office car. Meeting with the Additional Director KfW
Project Gulbarga Division. Meeting with the Executive Engineer and other
personnel of the Engineering Division Gulbarga.
Site visit to three hospitals (Kudligi, Kushtagi, Gangavathi) in Bellary District.
24.01.
Site visit to additional two hospitals (Hospet, Sandoor) in Bellary District.
Travelling back to Bangalore by car.
22.01.
3^
23.01.
. Discussion of progress report with Mr. i nirumalachar.
Meeting with Mr. Srinivas, Chief Engineer Equipment Maintenance.
Wrap up meeting with Dr. Subramanya.
Departure of Dr. Mantel to New Delhi.
Departure Mr. Fitz from Bangalore to Pune.
New Delhi: Meeting of Dr. Mantel with Mr. Vijay Rewal, WB Consultant for
Civil Works at his office in New Delhi.
cT<V
24.01.
Kft/V Office New Delhi: Meeting with Mr. Haller, Director KfW Office
25.01.
Departure Dr. Mantel from Delhi to Paris by Air France and arrival Berlin.
<>■
.j.’a
i
Annex 8
.
Hospital Performance Indicators
i
'?•
rj
J V,
-&■
V.y
Name of the Hospital
(Existing Bed Capacity :
50)
a
w
w
co
Jco
£
______ Yadgiri
3
_____ C
Jan-99
Bed Capacity
___ 50 ___ 50
S
_____ C
Feb-99
In
IPD Remaining Pts.
415 ____ 468
Patients
New Admissions
200
200
Pts Disharged
Pts Died_________
a
____ c
I
Mar-99
Apr-99
JO
■=
Hospital
Deliveries
Emergency
OPP New________
OPP Old_________
Surgery Major
Surgery Minor
Normal__________
High Risk________
Caesarean________
OPP____________
«Zb
3
_____ C
May-99
3
I
Jul-99
Aug-99
Jun-99
206
395
322 ____ 308
444 ____ 452
215 ____ 189 ____ 329
270
220 ____ 192
339
274
1 ______ 2 ______ 1_
3229
747
4028
778
______ !_
3182
572
____ £
3051 >
901 ’
3879
1620
33
15
43
■
9
36
14
28
14
60
88
24
1523
1244
1487
2
3;
___ o ___ O
£
zb
co
□
_____ O
Sep-99
®
C'9
3
3i
£
f
____ c
□
Oct-99
_ s_
Nov-99
Dec-99
Total
50 ___ 50 ___ 50 ___ 50 __ 50 ___ 50 ___ 50 ___ 50 ___ 50 ___ 50
Pts Referred-out
Out
Patients
Surgery
. f.,?
ft-
6' :
___ 2
4275
1765
___ 555
300 ,
283
____ !_
____ 3
4855
2242
39
16
40
17
34
95
85
1338
1861
487
498
244
264
539
247
246
248
256
526
222
222
3900
1877
* 4294
2003
___ 5
4623
2278
___ 3
4405
2315
3993
1892
53
26
61
24
71
19
77
30
64
29
69
17
63
75
53
12
39
69
1591
1777
41
___ 5
39
1651
___ 5
31
1843
___ 7
51
1651
___ 6
16
1536
___ 8
6
1183
13
16
13
40
44
37
30
32
25
305
254
254
241
4
4
I
2
3
4
308
312
2
664
__ 1£
JP___________
Major Surgery-
Investigations
Lab tests
done
Minor Surgery
X-Ray___________
ECG____________
Ultrasound_______
Haematalogy_____
Serology_________
Blood Grouping
Bio-chemistry_____
HIV_____________
Sputum (gram)
Cult. & Sensitivity
Stool____________
Urine____________
CSF
Post Mortems
Hospital
Deaths
Post operative
Casualities
Amount
Received_____
IP________
Emergency
Infants_____
Maternal
Emergency
Planned
9
43
229
273
246
232
337
258
350
297
3
3
3
8
6
3
8
2
3
3
2
1
1
5678
2994
3187
___ 9
2
1
Bed Charges
Tests
47714
18990
___ 0
614
230
__ , 0
___ 0
___ 0
___ 0
___ 0
___ 0
697
___ 0
___ 0
18685
__ 44
252
___ 0
___ 0
221
__ _0
___ 0
3276
___ 0
__ 45
__ 0
___ 2
___ 1_
___ 0
___ 0
___ 0
___ 0
0
Linen________
Calls Attended by Ambulance
1
20
'-5
<5
• z*z
'V'. •
>
n
f.-'.
Name of the Hospital
(Existing Bed Capacity:
40)
In
Patients
Out
Patients
Surgery
Hospital
Deliveries
Emergency
________ Jewargi
Bed Capacity
1PD Remaining Pts.
New Admissions
Pts Disharged
Pts Died________
Pts Referred-out
OPP New_______
OPP Old
Surgery Major
Surgery Minor
Normal_________
High Risk_______
Caesarean
OPP___________
r)
.©
3)
3
£
□
X
S)
a
x
CO
&
3
jC
3
___ o ___ e3 ___ o ____ O5 ____ O
ZJ
Jan-99
Lab tests
done
Post Mortems
Hospital
Deaths
Sep-99
40
262
____ 77
3,
2
3
288
128
356
509
157
28
547
254
15
372
154
38
26
42
35
18
99
10
149
172
■ 174
I
J
3
____ O
Oct-99 Nov-99 Dec-99
____ 40
40
40
240
213
____ 58 ____ 62
240
213
_____ 4
3
262
_____ 2
_____ 2 _____ 6
9950
3275
6045
6705
1171
28
27
31
1141
Total
2460
407
2460
__ 25
__ 27
8471 1
30331
__ 39
8
263
___0
___0
___0
_ [0
50
10
705
228
17
744
164
27
750
173
14
812
172
649
19
922
362
14
87
40
33
60
41
38
45
44
7
204
269
466
385
284
289
253
225
1
Post operative
Casualties
Amount
Received____
Linen_______
Calls Attended by Ambulance
I i
3
10
Major Surgery
Minor Surgery
X-Ray__________
ECG___________
Ultrasound______
Haematalogy_____
Serology________
Blood Grouping
Bio-chemistry
HIV___________
Sputum (gram)
Cult. & Sensitivity
Stool___________
Urine___________
CSF
IP________
Emergency
Infants_____
Maternal
Emergency
Planned
Bed Charges
Tests
3
____ C
Feb-99 Arar-99 Apr-99 May-99 Jun-99 Jul-99 Aug-99
40
40
40
40
40
40
40
40
136
196
207
222 ____ 181
265
233 ___ 305
____ 39 ____ 50 ____ 62 ____ 59
136
196
207
222
181
265
233
305
6
5
2
_____ 3
____ [9
6680
6485
7470
8800
9795
8350
9945
10p20
2075
2190
2455
2160
3030
3035
2175
2090
39
8
17
12
27
19
25
17
19
41
JP___________
Investigations
I
C3
CD
®
v*)
1
104
27
0
___ 60
____0
____0
____0
6654
2070
199
____0
____ 0
491
____0
___ 35
2795
___ 0
___ 2
___ 0
___ 0
___ 0
___ 0
___ 0
___ 0
___ 0
0
0
;a.
r-:
£—T-
g?
Name of the Hospital
(Existing Bed Capacity : 6)
In
Patients
I
CHC Mudhol
[Bed Capacity
IIPD Remaining Pts,
[New Admissions
I Pts Disharged_______
&
Cf:
f
ca
ca
8)
ao
>5.
€
•V)
ra
W)
co
f
J
-C
f
C3
f
J
w
M)
Out
Patients
Surgery
Hospital
Deliveries
Emergency
[Pts Referred-out
I OPP New
|OPD Old
Surgery Major______
Surgery Minor_______
[Normal
____
[High Risk
[Caesarean
OPP
Lab tests
done
789
64
7
754
69
2
741
68
6
6
777
3772
93
700
696
143
1601
4
803
121
774
90
4
9
11
4
3
Post operative
Casualities
Amount
Received
Linen_______
Calls Attended by Ambulance
8671
0
0
561
~~ 0
~ 0
~ 0
0
~ 0
~ 0
0
0
0
~ 0
~~ 0
~~ 0
0
0
Sputum (gram)_______
IP______ _
Emergency
| Infants
| Maternal
[Emergency
[Planned
Bed Char; ;es
Tests
— 0
T0544
0
0
~ 0
Cult. & Sensitivity
Post Mortems
Hospital
Deaths
253
____ 0
____ 0
~
[Major Surgery
[Minor Surgery
[X-Ray
[ECG
Ultrasound__________
[Haematalogy
[Serology_____
Blood Grouping______
[Bio-chemistry
[HIV
[stool
[Urine
CSF
Total
~ ol
738
59
Tip
Investigations
M
ci
3
3
3
■3
-C
3
3
J3
____ O
_Jc ____ O ____
3
____ C ____ O ____
___ o ____ O3 ____ O
Jan-99 Feb-99 Mar-99 Apr-99 May-99
C
____
Jun-99 Jul-99 I Aug-99 Sep-99 Oct-99 Nov-99 |
Dec-99
6
6 ______6 _____ 6 _____ 6
6
6|
6
6
6
6
6
28
11
32
31
~ 25
10
19
34 ~
301
33 ~
pts Died
•T*
16
6
16
6
13
11
1
25
2
26
19
TTil
~"o|
3|
ol
-~0|
—01
~~~o|
""ol
~~o[
~~ol
~0|
0
a
'T.
.€■ e?'
Name of the Hospital
(Existing Bed Capacity:
30)
In
Patients
Out
Patients
Surgery
Hospital
Deliveries
Emergency
Investigations
Lab tests
done
Post Mortems
Hospital
Deaths
______ Surapura
Bed Capacity
IPD Remaining Pts.
New Admissions
Pts Disharged
Pts Died________
Pts Referred-out
OPD New_______
OPP Old________
Surgery Major
Surgery Minor
Normal
High Risk_______
Caesarean_______
OPD___________
IP_____________
Major Surgery
Minor Surgery
X-Ray__________
ECG___________
Ultrasound_______
Haematalogy_____
Serology________
Blood Grouping
Bio-chemistry
HIV____________
Sputum (gram)
Cult. & Sensitivity
Stool___________
Urine___________
CSF
IP________
Emergency
Infants_____
Maternal
Emergency
Planned
Bed Charges
Tests
Post operative
Casualities
Amount
Received____
Linen_______
Cails Attended by Ambulance
s>
I
■
w
CD
J
3)
3
3
_____ O _____ O
a
I
'T
ti.i
03
CD
3
_____ O
t
__ g
Jan-99 Feb-99 Mar-99 Apr-99 May-99 Jun-99
30 ____ 30
30
30
30 ____ 30
___ 331
332
200
149
159
___ 167
___ 147 ___ 160
___ 132
_____ 3 _____ 2
_____ 5
_____ 3 ___ • 5
_____ 5
1091
1433
1874
638
816
684
____ 62 ____ 76
43
____ 20 ____ 10
____ 32 ____ 24
44
6
2
4
33
CD
-S
S)
§
3
3
____ C ____ O
s
Cfi
13
_____O
Jul-99 Aug-99
____ 30 ____ 30
___ 228
206
___ 156 ___ 175
166 ___ 158
_____ 5
___ 5 ____ 17
2140
2039
1097
1771
27
28
51
39
6
17
9
23
17
20
8
25
4
21
10
4
S;
§
3
____ C
2)
Si
£
J
3
JZ
3
_____ C
_____ Z
Sep-99 Oct-99 Nov-99 Dec-99
____ 30
30
30
30
336
___ 354
294
___ 169
_____ 5
_____ 4
2213
1463
____ 59
58 ____ 10
____ 34
15
34
7
16
4
i
128
96
38
34
159
100
Total
1633
1160
1057
184
40
8581
7219
1699
89
219
46
15
133
63
__ 4
4
60
_0
__ 0
__ 0
__ 0
__ 0
0
555
__ 0
__ 0
__ 0
__ 0
_ 0
__ 0
__ 0
__ 0
__ 0
0
__ 0
__ 0
__ 0
0
0
4
a c<
( 5
r- T.
Name of the Hospital
(Existing Bed Capacity : 40
)
In
Patients
Out
Patients
Surgery
Hospital
Deliveries
Emergency
Investigations
Lab tests
done
&
or
c
c
ISv■
Post Moderns
Hospital
Deaths
________ Hebbal
Bed Capacity
IPD Remaining Pts.
New Admissions
Pts Disharged
Pts Died________
Pts Referred-out
OPP New_______
OPP Old________
Surgery Major
Surgery Minor
Normal_________
High Risk
Caesarean_______
OPP___________
ff_____________
Major Surgery’
Minor Surgery
X-Ray__________
ECG___________
Ultrasound_______
Haematalogy_____
Serology________
Blood Grouping
Bio-chemistry'
HIV____________
Sputum (gram)
Cult. & Sensitivity
Stool___________
Urine___________
CSF
IP________
Emergency
Infants_____
Maternal
Emergency
Planned
Bed Charges
Tests
Post operative
Casualities
Amount
Received____
v Linen_______
i >‘Calls Attended by Ambulance
f »-4 --------------------- *-----------------
¥•
CO
«3
la
13
OO
3
____ C
Jan-99
____ 40
___ 126
___ 127
102
24
1840
395
62
124
42
s?
c? . ¥
C3
j
C3
U)
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■3
____ O _____ O ___ c _____ O
Feb-99 Mar-99 Apr-99 May-99
____ 40 _____ 40 _____40 _____ 40
___ 152 ____ 132 ____ 60 _____70
___ 135 ____ 128 ____ 60 ____ 70
152
92
43
56
62
1925
410
59
1990
300
26
61
34
40
17
1350
100
23
30
24
20
1425
150
21
30
20
R3
CJj
la
C3
OJj
26
1690
235
16
34
30
>■
«3
BO
13
-Q
=
3
3
____ O __ o ____c
Jun-99 Jul-99 Aug-99
____ 40 ___ 40 _____40
____ 60 ___ 65 ____ 60
____ 60
65 ____ 82
58
58
56
24
1650
225
25
30
30
i--',
15
1626
195
14
30
22
S)
£
jC
____ C
Sep-99
____ 40
____ 42
____ 40
41
•5
.'!
’.3
J
Nov-99
3
____ O
Dec-99
____ 40 _____ 40
40
____
Oct-99
____ O
____ 66 ____ 80
____ 58 ____ 70
50
68
16
980
120
20
1040;
95
20
1180
140
26
9
28
12
30
16
4
62
56
32
33
44
28
22
26
40
28
40
68
34
59
47
35
24
40
30
28
28
10
30
10
24
24
10
30
15
28
28
12
34
40
28
10
35
38
40
38
30
40
35
18
16
20
26
19
10
6
24
11
3
7
11
7
6
12
8
34
15
2
30
30
30
51
30
20
19
24
13
28
26
25
14
30
20
40
35
40
21
32
19
32
22
30
22
25
25
10
*
oo
§
Total
913
895
776
___ 0
303
16696
2365
161
449
279
___ 4
___ 0
448
370
86
298
__ 35
___ 0
___ 0
___ 0
___ 0
__ 6£
___ 0
___ 0
157
___ 0
__ 10
301
___ 0
___ 0
___ 0
374
251
___ 0
___ 0
___ 0
___ 0
0
o
'"
’■>
*?
£§1__ £ 1__
c;
Name of the Hospital
(Existing Bed Capacity
:6)
________ Kalgi
Bed Capacity
In
Patients
Out
Patients
Surgery
Hospital
Deliveries
Emergency
Investigations
Lab tests
done
‘'^
J
Jan-99
6
7
IPD Remaining Pts.
. New Admissions
Pts Disharged
Pts Died________
Pts Referred-out
OPP New_______
OPP Old________
Surgery Major
Surgery Minor
Normal_________
High Risk_______
Caesarean_______
OPP___________
IP_____________
Major Surgery
Minor Surgery____
X-Ray__________
ECG___________
Ultrasound_______
Haematalogy_____
Serology________
Blood Grouping
Bio-chemistry____
HIV___________ _
Sputum (gram)
6
8
a
cB
£
□
a
c8
.c
to
?.?
‘3
J
a
-C
3
Post operative
Casualties
Amount
Received____
Linen_______
Calls Attended by Ambulance
J JJJ
c3
-C
77
Total
135
__ 75
132
2_ 0
___ 0
427
287
432
273
407
259
589
191
686
4
2
4
2
658
179
1172
817
5
3
6
163
442
»
45
Stool
Urine___________
CSF
IP________
Emergency
In hints_____
Maternal
Emergency
Planned
Bed Charges
Tests
-J
(..j
____j ____ c
_____O
__ g
Mar-99 Apr-99 May-99 Jun-99
Jul-99
Aug-99 Sep-99 Oct-99 Nov-99 Dec-99
6 ______ 6
6 ______ 6
6
6
6
6
6
6
6
JO _____ 10
18
24
13
_____ H
47
10
10
18
24
49
13
c
Feb-99
Cult. & Sensitivity
Post Mortems
Hospital
Deaths
■S'5 a. - 5
7
118
X
4371
2169
___ 0
___ 0
26
__ 0
___ 0
___0
0
___0
___0
___0
0
___0
442
__ 0
___0
0
__ 0
45
__ 0
__ 7
118
__ 0
__ 0
__ 0
__ 0
__ 0
__ 0
__ 0
__ 0
__ 0
0
0
•<
Name of the Hospital
(Existing Bed Capacity:
30)
In
Patients
Out
Patients
Surgery
Hospital
Deliveries
Emergency
Investigations
Lab tests
done
Post Mortems
Hospital
Deaths
Chittapura
Bed Capacity
IPD Remaining Pts.
New Admissions
Pts Disharged
Pts Died________
Pts Referred-out
OPP New_______
OPP Old________
Surgery Major
Surgery Minor
Normal_________
High Risk_______
Caesarean_______
OPP___________
IP_____________
Major Surgery
Minor Surgery
X-Ray__________
ECG___________
Ultrasound_______
Haematalogy_____
Serology________
Blood Grouping
Bio-chemistry____
HIV____________
Sputum (gram)
Cult. & Sensitivity
Stool____________
Urine___________
CSF
t
S3
CL
S3
CL
I
S3
13
f3
30 ____ 30 _____ 30
11
24
16
30
30
30
30
14
34
42
66
2251
909
1942
833
2074
1016
5
14
7
X)
3
3
3
3
____ 0 ____ 0 _____ 0 ____ 0 _____0 ____ 0
Jan-99 Feb-99 Mar-99 Apr-99 May-99 Jun-99
30 ____ 30
____ H
11
_____ 1_
1
11
1455
425
1760
656
Maternal
Post operative
Casualities
Amount
Received_____
Emergency
Planned
Bed Charges
Tests
Linen____________ ______
Calls Attended by Ambulance
a
r-^
S3
eo
1893
775
1878
2340
2346
794
701
950
4
7
24
25
S3
CL
i
x>
X
3
3
____ O ____ 0
Jul-99 Aug-99
t
S3
X
3
____ O
Sep-99
4
28
25
10
26
19
5
72
24
1
18
S3
60
-C
<P
t:?
I
3
____ 0 _____ 0
Oct-99 Nov-99
30
30
&
___
Dec-99
Total
30
229
_ __
___ 12
_ __ 0
___ 0
17939
7059
__ 4
___ 0
37
___ 0
1 0
___ 0
___ 0
___ 0
0
__ ^_0
___ 0
0
406
___ 3
36
28
85
64
91
1
2
47
3
13
__ 77
___ 0
___ 0
7
8
19
19
16
34
27
76
64
96
__ 93
_ __ 0
___ 0
437
___ 0
1
3
3
1
IP________
Emergency
Infants_____
£9
O
iv'-
t?
___ 5
___ 0
___ 0
_ __ 0
0
___ 0
___ 0
___ 0
0
0
1
( )
Q
rj
@
®
district hospital, BIDAR
r
hospital activity fNDICATORS FOR 199^
bed capacity
283
f Total NO. of 'TotriNO'^f
OP
Total NO. of Patients
IP
Year
(Including
(Including
Emergency) Emergency) Referred Discharged
out
1996
6596
207870
0
1997
75159
422881
0
14030
1998
82909
401277
398
15423
Year
BOR
1996
OPD
6
1997
2
73
1998
4.1
80
4
TOR
ALS
0.0
0
0.1
5
0.2
5
Total
No. of
Deaths
393
449
1527
448
1636
X-ray
ts>
PD
2250
2196
Investigations
Lab
tests
X-ray ECG
43362
285
77125 2345
[50914 4390
Diet
Calls
0
0
0
590
926
9404
49592 ,
1256
1680 25414145703
Lab
tests
586
1740
43362
0
2345
1527
2250
77125
926
4390
1636
2196
50914
1680[25414 45703
285
DiKtarges+Dea,ta) y To(a| fled capac.iy
No. of outpatem i„ a yCar / (Bed Capacity . 365)
ALS - Retaining Patient, ,
I
l->
Surgeries
Ambulance
Linen
Deliveries
BOR -(RemmtatogPaieW!/(Bed Capac.(y . 365))/ 1W)
TOR - a™.,
Total No.of. Total No.of
Surgeries
Deh'varies
(Including
(Including
Emergency) Emergency)
586
1740 .
■98
ECG Linen
0
Diet
Calls
0
590
9404 4959^ 1256
958
958
O C— C:
@ f)
$.-■)
© ?3
(-3
^3
®
DISTRICT HOSPITAL, BIDAR
HOSPITAL ACTIVITY INDICATOR
Bed Occupancy Rafe
JOO -I
\ ;''<73\'.
80 -
V 80
5.00 n
A..M
. 1-18
3.00 -
40 -
2.006
1.00
j
0
1996
1997
5 4 -
O
I
1998
1996
1997
0.15 -
co
cn
I -
0.05 -
0-
0.00
1996
1997
1998
;.• x
»"
.•
1
1996
i
i
- ('I- .
i
a»a iSi
0.10-1
2 S)
1998
Turn Over Rate
0.20 n
3 -
i
Zi
slwsstW
1FH
O' <>:
0.00
AverageLenght Of Stay
5:
6 -i
55
£
■ 4. 1-
■/
4.00 -
60 -
20 -
Ou( Patient Per Bed Day
(
1997
I
1998
j
■1
f
r<’ ?
'
■
CT**
A
'
@ F
©
®
O
DISTRICT IIOSPITAI, BI BAR
HOSPITAL ACTIVITY INJICATOR
Total IP
Medical
Total IP
Surgical
Year 1998
~82909lTotal OP
33397 Medical
401277
73954
82909 Total OP
150251 Surgical
401277
51864
District lospital, Bdar Graph showing Total In Patients to I n
patients of different departments
c\
ex
ex
o
ex
o
o
g
100000 -j ex
o
o
o
g
ex
■CX
Os
Os
ex
CN
rq
eq
CN
rv
oo
oo
■ .s..
co
• 00
co
■s80000 -
J-
60000 -
Si
O
l otal IP
OBS/Oynae
Total IP
82909 Total OP
10627 OBS/Gyna
401277
49913
82909 Total OP
11897 Paediatric
401277
74978
Ortho
82909 Total OP
6720 Ortho
401277
35203
Total IP
Opthalmic
82909 Total OP
2356 Opthalmic
401277
32459
82909 Total OP
144 ENT
401277
30397
Paediatric
Total IP
Total IP
ENT
£
40000 -
Skin
CT>
CD
I
I
401277
~4I483|
rq
vo
o
/n llA life
20000 -
0
3
.. ...........
1998
DistnctHospita!, Bidar Graph showing Total Out Patients to
Out Patients of different depaartemnts »
500000 i
CM
C4
o
400000 -
•
200000 -
12 -
CM
CM
CM
o
o
XT
0
300000 -
100000 -
(N
o
ex
Total OP
r ’
FF rq
i o
eq
o
CN
Tf
Xt
■i
m ••
g ■■
I QO _■
I
-i 8
ST II
• i <N
Pi
0
1998
’ I
I2
I
&
>3
‘•>
a
Q
o. © ©
®
© ® © © ■$ $
GENERAL HOSPITAL, CHENNARAYAPATNA
Bed Occupancy Rate
20 15 t
T
Turn Over Rate
8.32
8.00 --
S:::
6.00 -■
■
4.00 -
1996
1997
1996
1000 --
B
3000
2000
800 -600 X
1483
1997
1997
■
0.39
0.00 4----- 1
1------
1996
1997
sS
1998
No. of -rays conducted
117
1017
783
411
200 -■
0
1996
0.50 -■
1200 T
1000 -800 -600 -■
400 -■
772
200 --
0 4------ 1
1.50 --
1182
400 --
379
2.28
1.94
1998
No. of Deliveries
1200 T
4000
1000 --
::::::::::
1998
2.00 --
1.00 -
1.42
0.00
No. of Lab Test
4428
5000 T
:W:$
2.00 --
0 ------- -
Out Patient Per Bed Day
2.50 T
12
10 -
5
10.00
17
15
o 4—1
1998
1996
1997
1998
1996
1997
19981
Average length of stay
1.80
2.00 T
1.50 -
1.21
1.00 0.50
£1
0.00
1996
1997
1996
I
Page 16
Graph LlOO-xis
<r.
e-
c ® @ e
r>.
C5
\
® @ o
0 \© © © •
© O
DISTRICT HOSPITAL, BIDAR
HOSPITAL ACTIVITY INDICATOR
No. of Linen
30000 n
No. of Diet
60000
24000
18000
12000
6000
0
IIMlflii
45000 -
30000
;^W.M
1996
15000 '
0. Owfcwllywwli
I
•
1997
■illi!
1998
1996
1500 q
Ambulance Calls Attended
1200 -
900 600
300
1996
I
■
jT
MSli
? fef B
0 4-^
o?1
ROWS
1997
1998
1997
1998
»
@\
O c- 'S
o © a G ® O ©
3
©
®
©
Q, <••-.■)
O
®
-S
DISTRICT HOSPITAL, BIDAR
HOSPITAL EFFICIENCY INDICATOR
CLINICAL SERVICES
No. of Surgeries Conducted
2000 i
Number of Deliveries
1636 <<
1527 -
2250
2750
1500 -
2200 - ■■.141746^^:.
1000 -
1650
586
I
1100 -
500 -
:4-
550 -
0
0
1996
1997
1998
•2190
1996
‘. -;v
I
1997
199
DIAGNOSTIC SERVICES
i
No. of Lab tests Conducted
No. of X-ray
100000 -1
77125
80000 60000 -
5000
4000 50914
43362 i
3000 • M|W»345;^
40000 -
2000
20000 -
1000 -
04
0
1996
1997
1998
ifleL,
1996
1
if
1997
1998
@ ■ ■&
€• ® .€
IT-
0
Q ©
-3 © ©
0
® ®
©
general hospital, bhadravati
Avg. Bed Occupancy Rate
40
36
Avg. Out Patient Per Bed Day
4.00 -r
0.11 --
20 -■
10 --
1
Avg. Turn Over Rate
0.11
0.11 T
30 6
11
0.10 --
3.00 -42.00 -1.00 --
0.10
o.io --
o J—i
1996
0.09 --
1997
1998
3.60
2.71
1.46
r.y.’.’.
I
H
0.00 J---- 1
1996
1997
1998
1996
1997
1998
4
Avg. No. of Lab Tests Conducted
AverageLength Of Stay
3.67
4.00 T
1330
1500
3.00 --
1000 --
2.00 -■
722
1.00
1.00 --
961
40 --
500 --
0.00-------------
1996
1997
1998
1996
1997
46
40
20 --
1996
1997
iwi
1996
1997
1998
J_____
Avg. No of Surgeries
44
200 ~r
M
150 -
165
100 -•
?K
0
■
57
o
o -I—i
1998
Avg. No. oJ^C-rays
60 T
32
20 --
Io
o J— J
Avg. No of Deliveries
56
60 T
63
50 --
0 --
1998
1996
1997
1998
I
Page 13
Graph LlOO-xls
-TX
Annex 9
Time Schedule
*7
r
<L‘
i^:.-
c
c-
c
c
i
c
SANIPLAN-MEDICONSULT
Upgrading Secondary Level Health Care Facilities
in the Gulbarga Division, State of Karnataka, Phase 1
©
c
©
G
SUMMARY OF ACTIVITIES
e
Pr_____
Cale 2000
"6 7
4
2001
8
9
12
1
2
3
5
7
6"
8
9
Project preparation
ffl
■■■■I
Elaboration of yearly work plans & project budgets
*
Monitoring of GoK contributions
Assessment of indicators
©
4
Mobilization
Overall project management
G
10 11
Participation in mid-term review
Assistance in project planning
Construction and Engineering Works
Review of emergency measures
Elaboration of preliminary design by local architects
Review of preliminary design
Elaboration/review of final design & tender documents
G
Supply of equipment and vehicles
Elaboration/review of procurement lists, specifications, tender d
C
Assistance in tendering
1 III III
I! II
Construction and Engineering Works
Tendering & contracting of repairs
c
Tender & contracting of rehabilitation & construction
Supply of equipment and vehicles
Tender period, evaluation, negociation
©
Project implementation
©
Repairs
Construction and Engineering Works
Rehabilitation and Construction
Supply of equipment and vehicles
Urgent supplies
Supply of medical & non-medical equipment, consumables
Backstopping and home office support
iiihiiiiihiMt
■■■■ ■■■■ ■■■■ ■■■■ ■■■■ ■■■■ ■■■■ ■■■■ ■■■■ ■■■■ ■■■■ ■■■■
■■
lull
p
i TT T
llilllllli
O
L'
'• • •
Annex 10
Statement showing Expenditure of Project Office Gulbarga Division
.■'7\\
■
■
■
;
-
.
■
L--
i K -■
•
■
S■
.
I-/
1
0
IS C.^
1 >
•
«
•S O (?
•
)
'Li’’
®
<5
@
i
STATilVLSHT SHOz.'IMG TriE DETAILS .EXPENDITURE OF DISPOSAL FUND UPTO 12/99
Cost-of Grant
Project Released.
1
52.67
2
1/06,57,736-00
Expendi
ture upto
31-J-99
E>cpenditure.
from 4/99 to
12/99
3
4
21,10,757-00
50,79,642-00
Total
Expendit
ure*
5
71, 90, 399/—
Expenditure in Detail
Balanc of
Grant.
6
7
DPurchase of Vehicle
23, 31,903
2) Perchase of fernichre
4,12,460
12,20,320
31,95,274
3) Paid to Architecture.
4) Paid to civil works.
34,97,749
Total Expenditure:- 71,59,957'
SJF.S.D. to be paid.
Cunupulative Sxp.
30,442
Rs.
71,90,399
Addi t iona 1 Dir ecto?^^__
Karnataka Secondary Level Hospital
development Project, (lCf',7) Oulbarga.
I
(j
®
<1
Additional Director
Karnataka Secondary Level
Hospital Development Project (KFW)
Gtlbarga
For the Month of:
Form
12/99
Under the Head of Account
2210-01-110-2-80
GRANTS ALLOCATED
SI. No.
Head of Account
1
1
2
3
4
5
6
7
8
9
10
Upto
begining of
Month
3
2
002
Pay of Officers
003 , Pay of Staff
004
Interm Relief
011
Deamess Allowance
014
Other Allowances
041
Travelling
During
the
Month
4
EXPENDITURE,- Excluding AC Bills
Upto end
of
Month
5
Upto
Degining of month
900000
1000000
6
During
the
Month
7
Upto .
end of
Month
8
900000
113999
97280
211279
1000000
763458
111225
874683
NDC Bills
AC
Bills Drawn
NDC
Submitted
Net
Expenditure
Balance of
Grant
9
10
11-8*10
12-5-48*9)
211279
688721
874683
125317
i
050
Office Expenses
058
Electricity & Water
072
Rent, Rate & Taxes
191
Fuel & Oil Expenses - Vehicles
11
200
Vehicle Repairs & Maintenance
12 ■
314
Laboratory Charges
13
14
222
Drugs & Chemicals
060
Other Charges
TOTAL
760000
760000
318009
70931
388940
388940
371060
150000
150000
59363
9053
68416
68416
81584
.200000
1100000
200000
1100000
97223
617661
7218
186581
104441
804242
104441
804242
95559
295758
100000
100000
18184
20379
38563
38563
61437
100000
4310000
100000
4310000
65000
65000
2555564
35000
2052897
65000
502667
2555564
I
We hereby Certify that
1
2
3.
4
5
6
I 1754436
Grants amounting to Rs----- 4310000
Zf*****^--------- - ------ has been allocated to the agency.
Cummulative Expenditure upto the end of the month is Rs
2555564
AC Bill amounting to Rs._----------------------------------__has been drawn from the treasury.
Expendilure statement (NDC) amounting to Rs------------------- ■----------------------- js being submitted.
Bills and Vouchers have been serially numbered and file(>seperately at this office.
The Project expenditure is recorded in relevant Books of Accounts and are up to date
rr>_o
Additioml Dir-ctor'
Karnatika SeconJ-r? Levt' ”.«pint
DcvcUpmc«t Project
x
Signatute^Pffie^Drawing Officer.
'T (?)
-S'
» Name fll the Agency
Loca con
For the Mcrnn of :
/.r.";.
I__________ __________*
~
• .•
S
--------- 1
----"-----------------------1
2210-01-110-2-83
______ GRANTS allocated
Upto
Head of Account
beginning of
Month
1
I
________________ ■
2
3
002 p3y o( Officers
36700(1
2
003 Pay of Staff
3
004 Intenm Relief
46300(1
1660 0(1
4
qj]
5
□ 14 Other Allowances
190000
6
041 Travelling
lOOOOO
7
OSO Office Expenses
fl
053 E’ectnpty A water
9
072 Root. Rate A Taxes
10
191 Fuel A OH Expenses-Vehicles
11
200 Vehicle Repairs A Maintenance
12
314 Laboratory Charges
13
222 Drugs A Chemicals
14
050 Other Charges*
Dearness Allowance
During the
Upto end of
Month
Month
4
1
I
Upto
beginning
of Month
5
367OQO
6
72622
Upto end of
AC Sifls
NOC
Net
Balance of
Month
Month
Drawn
Submitted
Expenditure
Grant
8
9
10
11=Q-*-lO
| 12=S<8-^9)
7
11150
239907 59905
166000 37676
2230
143700C 33544
26577
• 19000C 30647
4283
120000 66555 32172
20000
75000
725000
463031 171817
83772
299^12
39906
299J12
362321
36232 L
34930
34930
93727
96727
634848
634843
83772
39906
I
total
Grants amounting to Rs.
NOC Bills
During the
463000
14370041
650000
EXPENOITURE-Excluaing AC Bills
3373OQ0| 950C0
j 34GB00Q | 12*61.82 30813 I 155431^
We hereby Certrty that
1
«
HMCH>1999
Under the Head of Account?
SI Mo
PJm^
3468000
I 1S54316<
has been allocated to the agency.
2 Cummulatrve Expenditure upto (he end of the month is Rs.
3 AC bills amounting to Rs.
1354316
has been drawn from the treasury.
4 Expenditure statement (NOC) amounting to Rs.
being submitted.
5 Bills and Vouchers have been serially numbered and filed seperately at this office.
6 The Project expenditure is recorded in relevant Books of Accounts and are up to date
7 B.ils. r.ecessar/ vouchers and Bocks of Accounts
are kept aLthis office and will be mado available for Venficatiph.
I
AC'7 AiMiJonrJ Dirctar
KaV'.’.-Ln
-rv *
ixvciop•■■•tn:
—
Guitar ,;*A
(J
Balm
grant
03 31
4
99
Annex 11
Expenditures Civil Works (Urgent Repairs)
c'
I
&
■SJ
__________ _ [N RESPECT OF WORKS PERTAINING TO
StATEMEbTF SHOWING THE EXPENDITURE INCURRED WORKWISE
K.H.S.D.P (KIW), Sub-Division, GULBARGA
of Work
Si.No
Agency
3
2
1
Expenditure
Estimate
Incurred
upto Dec
Amount in
______ 1999
Lakhs
5
4
Remarks
e
Urgent Repairs to Electrical and Sanitary Systems at General
1
Hospital at ALAND in Gulbarga Distnct.
Work is
completed,
Payment is to be
Jagannath
<3-
(a)
For Electrification
Electrification,
Gulbarga
2.37
made
Work is being
<‘7f
(b)
2
For Sanitary Works
N.B Patil,
Chittapur
M.'S
0.38
Urgent Repairs to Electrical and Sanitary Systems at
Community Health Centre at MADANA HIPPERGA in Gulbarga
_______
District.
For Electrification
N.B Patil.
CNittapur
(b)
For Sanitary Works
N.B Patil,
CNittapur
3
Urgent Repairs to Electrical Works and Sanitary Systems at
Community Health Centre at KALGI in Gulbarga District.
(a)
rescinded as the
contractor has not
yet started the
wo rk.
Work is
completed,
Payment is to ba
0.95
madg__________
Work under
0.45
progress
Work is
(a)
For Electrification
Jagannath
Electrification,
Guiutifya
(b)
For Sanitary Works
N.B Patil,
Chittapur
1.50
1.02
completed,
Payment is^to-be
made^
_______
Work is being
rescinded as ths
contractor has not
yet started
work,
©
Improvements to existing work shop building behind General
4
Hospital at Gulbarga Dist.,to Office of the Additional Director
and Engineering Wing of the KfW Project.
(a)
(b)
fi.*
(c)
W)
Rehabilitation & Security
Arrangement (4s wing)
Providing R.C.C Roofing to
existing A.C Shoot roofing for
E.E Office &A.E.E Office
Providing Rooms in front wing
(Attached to
)
Providing W P C to existing
RCC Roof portion
0.17
Criandrashekar
2.93
2.50
Taranadi Annur
321
0.50
Anii Udgirker
1.35
0.90
Agency is to be
fixed____________
Work completed
Final claims to be
settled_________
Work under
progress________
Work completed.
Final claims to bo
settled
i
A-Tneurrt in
Lahtre
txpendttweIncurred upto Due
1999-
Ramarks
4
5
8
Equate
-Arjfmcy
SI.No
Name of Work
1
2
(e)
Repairs existing sewer line to
Additional Director Building at '
Gulbarga
Work is
$
r.
(0
Providing Compound Wall with
Gates_______________________
Land Scaping and
(g)
Arboriculatjon
(h)
Approach Road to KfW Office
u;
If KV
completed,
Anil Udgfrker
O.'SS
Anil Udgirkor
3.40
3.30
Yousuf, Gulbarga
0.70
0.18
Srinath, Gulbarga
0.46
0.20
Payment is to be
made___________
’Work is
completed______
Work under
progress________
Work Is
completed
Work is
<
- ----------------
w *Ji I.W.V
station (R/S wing)
UU4J JU 859bZ447
|_
I
i
J 9
... _ ___ -J—
Urgent repairs to workshop building at General Hospfiei ar
5
if
Gulbarga for converting into KM D. Office
Bhavahara
(a)
Ganapathi,
Office formating to flooring
1.00
0.75
Gulbarga
f1:
S.'
Sinking of ’
borewell is
comploted.and-
Saktivel Borewell
(b)
Sinking Borewell and
commissioning
Company.
1.40
0.82
Gelbarga
(c)
6
Urg&nt repairs to General Hospital at Gulbenga.
Electrical Works,
G ulbarga_______
*41*
U'€
Urgent repairs to Electrical
(a)
(b)
(c)
Mallikarjun . K
0.60
1.57
0.59
I .2?
System to Ward No. 51 & 52
2.58
Second Floor_________ ‘
Repairs to roof leakage over
Chandrashekar
0.51
2.37
<d)
Fixing of Glases to Windows
Chandrashekar
0.34
(e)
Urgent Repairs to Dist.
Hospital, Bidar________
Md. Amzad All
3.00
2.94
31.95
15.05
Total
"(
' I
Work is
completed
Work is ’
completed,
Peyment-rj-to be ''
Work under
progress—
Work under
progress .
Work under
special Ward
7
.
mads^-
Urgent Repairs to P.W.D Ward
No t - Ground Floor, First Floor, Chandrashekar
■i
erection-oEpump’
isdonerPipeiine
work-Tsrin
progre^s^'
Basaveshwar
Electrification including
providing ceiling fan etc.
Work is
completed
r~r/'f-’/i
progress
Work Is
completed
h
}
i
i
.................
-.-.iS'.
’
• • •
Annex 12
k-
Estimated Costs for Civil Works (Construction I Rehabilitation)
a
I
Upgrading Secondary Level Health Care Facilities
in the Gulbarga Division, State of Karnataka
Estimated Costs for Civil Works (Rehabilitation and Construction)
Status 10.02.2000
ID
Hospital
Cost estimate
No.
Remarks
Rs.
DM*
30
9.138.000
380.750 as per Pre-Design
BE02 Hadagalli
50
7.400.000
308.333 as per Final Design
BE03 Hospet
100
9.420.000
392.500 as per Pre-Design
BE04 Kudligi
50
9.001.000
375.042 as per Pre-Design
BEOS Sandoor
50
7.974.000
332.250 as per Final Design
BE06 Siruguppa
50
12.000.000
500.000 as per Pre-Design
BI01
Aurad
50
12.600.000
525.000 as per Final Design
BI02
Basavakalyan
50
9.300.000
387.500 as per Final Design
BI03
Humnabad
50
13.500.000
562.500 as per Final Design
BI04
Mannekahalli
30
7.260.000
302.500 as per Final Design
&
BIOS
Bhalki
©
GU01 Chincholi
50
17.000.000
708.333 as per Final Design
GU02 Jewargi
50
10.821.000
450.875 as per Pre-Design
GU03 Kalgi
30
6.395.000
266.458 as per Pre-Design
GU04 Madana Hipperga
30
8.865.000
369.375 as per Final Design
GUOS Shahbad
30
10.500.000
437.500 as per Final Design
GU06 Shapur
50
7.050.000
293.750 as per Final Design
GU07 Yadgir
100
16.500.000
687.500 as per Final Design
of beds
<>■
s-
BE01
Chikkajogihalli
■5’-.
&
GU08 Afzalpur
deferred to Phase II
GU09 Aland
deferred to Phase II
RA01
■i?-;
deferred to Phase II
Devadurga
50
17.200.000
716.667 as per Final Design
RA02 Gangavati
100
23.400.000
975.000 as per Pre-Design
RA03 Koppal
50
15.300.000
637.500 as per Final Design
RA04 Kushtagi
50
12.700.000
529.167 as per Final Design
RAOS Lingasugur
100
22.500.000
937.500 as per Pre-Design
RA06 Sindhanoor
50
11.340.000
472.500 as per Pre-Design
1.250
277.164.000
TOTAL
11.548.500
* 1 DM = 24 Rs.
SAN I PLAN / MEDICONSULT
I
<!■
..
>,j.v
Annex 13
Annual Health Check up in the five Districts of Gulbarga Division
-- • -
'C''
I
r
'X
• '>
t
t'Vnll'V
t*M^.
d clino Garu Si‘clienie
oo
0
O
©
Annual Health Checkup for SC/ST Population
District: Gulbarga
~'PhcM>e Statistics
No. i>f I'ullcnls with Dhvase
Name nf Disease
I ctct Cases
Diarrhoea
Jan
*99
213
181
_ Gaslro-enteritis______
Upper Respiratory fnrcclion______
Piteunwniu___________
rubcrculosis (suspec ted)
_ Worm Infestations________________
187
11
58
193
Feb
*99
218
80
5
67
29
26
52
Mar
f99
Apr
■99
May
*99
70
34
3
34
6
3
24
June
167
July
*99
1712
561
66
672
95
75
479
178
55
44
545
123
65
71
36
345
88
43
193
34
210
’99
468
236
19
274
12
14
Aug
’9'J
l.t cs .
__ a) Vitamin A‘ Dciicicncy (night____
blindness. Bctots spots)
b) l~\c infection
c) Cataracl
56
7
15
JJ
29
__ d) RefraclcirY errors_______________
1 Lars :
a) Dischaigc
b) Lurcign llody / Wax
Dental <C gum diseases
! Skin Diseases____________________
50
25
22
2
58
86
73
20
30
£
35
35
£
9
2
17
16
51
32
16
32
20
a. l eprosy_____________________
b. Scabies_____________________
80
72
c. Pyoderma
26
16
10
J. Others______________________
61
2
Pc hie lnllaininalory Diseases_______
7
53
5
38’
2
a.
b
______________
Ccnicitis
Salpingitis
2
34
2
c
InJoiiietritis_________________
Pic-eclampsia___________________
CXJ .-'
Scxu.iII\ I lariMintlCAi Diseases______
Hiyli Blood Pressure______________
10
o? - Diabetes (Sugar present in mine)
cS 1 Gtiilrc
6
6
52
47
2
69
78
8
84
63
288
28
18
3
I
I
s
4
11
7
Lameness from any cause__________
xL)
(S3 -
I
Any other diseases nol included above
18
309
284
440
82
91
36
28
10
2H6
28
15
2
1 I urosis________________________
I
92
76
90
10
10
579
Oct
'99
Nov Dec
’99 *99
Total
26^1
1092
93
1234
153
176
915
0
852
206
163
0
492
190
93
287
119
265
175
196
46
561
444
821
(24
145
41
45
10
290
39
28
2_
10 .
10
1894
(Clinical A Stool posititT cases)_____
Anaemia () Ib”^ 6 gin & below)_____
Sept
’99
1057
.w
Graiul
Total
7749
3136
238
5037
603
387
2684
2987
421
416
904
559
219
526
411
374
742
1059
108
1334
1846
1531
363
320
62
53
16
4tS
91
73
19
274
59
4326
i
©
• *9
S
Ci
■t
G
:-9
®
i3
Yellow Card Scheme
/Vinual Health ( heck up for SC / ST Population
• District: Rnicliur
Phone Shilhtlca_______________
Nu. uf Pallcnlji mIlli DIu-ikc
Ai»me of DLsrase
Jan
’99
I c\cr Cases
Di.inhpca
Feb
*99
Mai•99
<•
Apr
*99
May
’99
June
*99
July
*99
559
268
973
328
1246
450
710
159
350
48
69
246
642
61
65
300
736
136
23
279
612
28
56
229
85
129
35
363
86
74
398
60
II
213
24
58
IIP
43
6
104
173
46
53
13
19
120
30
5
115
12
16
87
133
178
107
6
2
200
184
174 • 128
1069
258
8
19
25
155
26
10
Gasifo-cntcfiiis
lipper Respiratory Inkctiun
PnctiiHonia
1 iilK iciilasisi (iiispcctcJ)
Worm lufeMalkuis________
((.huical
Stool p<)siii\c cases)
Anaemia filing 6 gm & IkIuw)
lies.
a I Vitamin ‘A* Deficiency (niglil
blindness. Iteiols spots)
1>) 1 \c infeclinn
<) Cataract_______
d) RetTactoQ' errors________
I ars :
a) Disdufge
b) fotcien llody Was
Iknial
• - ..
a mu diseases_______
Skin Diseases__________
a.
g b
Leprosy_________
Scabies
____________
c. Puxlcnna
d Olliers________________________
Pchic tntlammalajy Diseases______
a
Ccnicilis_____________________
b Salpingitis___________________
c
I nduiiietrilis
I'ftfnxlainp.sia_____________________
Sexually Transmillcd Diseases_______
I
High Blood Pressure_______________
Diabetes (Sugar present in mine)
106
3
179
144
10
86
103
29
44
22
2
6
6
64
46
28
32
II
- <21
i
co Goitre
5Z
I lurosix
[.amciie\s from an\ cause
Aux nlhcr disease* not included above
49
48
28
2
64
38
130
113
8
168
128
8«I8
4
20
3
11
70
45
6
28
682
1640
707
1371
Aug
*99
Sept
*99
Oct
’99
Nov
*99
Dec
>*99
Total
Grand
Total
3488
1205
0<
2340
273
213
11154
0
1089
299
178
0
542
168
48
150
290
69
S29
542
26
638
533
2204
75
67
5
17
76
204
114
160
2
28
0
4100
5812
1786
0
2502
505
213
4479
0
1089
299
178
0
542
168
48
150
290
69
529
542
26
1036
533
2204
7S
67
5
17
76
204
180
183
2
28
0
4400
\
I
<1-
o
e
q
e
S r W (P o
® o r
€■
c? .y
®
■■
Mi
Yellow {.’ard Scheme
Annual Hcallh Check up for SC/ST Populadun
District :Bdlary_________
————«
Dheuje Satiitki
Nainc uf Disease
cter Cases
‘urihiK.u
asiro-entcrilis
ppct Rcspiralors In fee lion
ncitnitiiua
u here utmis (suspected)
■'orm 1 nJ cslatiens
N<». of I 'n (km t with Dhea j»v
Jun
*99
Mur
•99
1378
858
77
1020
129
57
619
It
3
1736
311
25
764
122
4’4
July
*99
2014
765
67
1320
130
65
554
492
487
78J
21
30
239
142
230
24
111
249
113
80
265
175
101
6
193
138
24
10
13
204
100
63
235
73
279
325
85
333
397
127
332
20
270
197
225
Apr
‘99
1827
1208
Jhnica! & Stool positive cases)
n-aemij (Hbaa 6 gm A below)
w I June
Feb
‘99
1305
643
25
1577
115
106
408
‘9
87
93
14
8___
t cs :
I ViUniin A'Deficiency (night
blindness. Betots spots)
) live in feel ion
J Cuiuract______
) Refractory errors
l I )im hui ga
> 1 <»tcign Ihidy
Wax
cntai ft gum diseases________
■t
3'6
err km Discuses
zrz
g
Leprosy
63
Scabies
395
Pyodenna________
443
Others_______
ztz ehic Inllanirnatnry Diseases
Ccoicitis___________
Salpingitis
Indi imctriiis _______________
'?'■? c*<\Liupsia
«—. Mialh ! raiiMiuitcd Diseases
cr> igh HIixkJ Pressure
tnhcies (Sugar present in mine)
S t,,lrv_____________ __
ihums
- ————------- -------
imcticss Iroin any cause_______
s o' other diseases nut included above
81
54
28
29
_ 8
51
71
19
40
89
21
3786
62
545
370
90
23
32
19
26
4
23
390
287
194
68
96
67
53
JL
13
6
6 .
435
259
84
353
12
95
760
3084
365
60
35
23
3<
3_
6
1^13
275
*99
II
285
218
188
33
24
5
7
194
92
88
2
259
4
1562
Aug
’99
Sept
*99
~~—
Oct
•99
Nov
‘99
Dee
*99
Tola!
f
<«rniul
Total
7381
9260
4397
5267
209
287
6865« 8388
799
927
338
442
2819
3687
0
0
2061
3047
0
16
936
1847
0
0
938
1318
701
894
515
552
0
91
1437
1697
514
590
1545
1966
0
267
213
337
1921
2426
1541
2025
314
588
360
499
249
416
199
214
IIS
128
27
27
637
688
678
1104
581
641
54
58
1150
2139
183
201
11957 13877
I
e 't-
&
3’dlow Card Scheme
Annual llcalili Check up for SC/ST Pnpulatmn
co
District: Bidar
Dhcase Stadstlcj
SI.
An.
No. of PalienK with Disease
Name of Disease
7
8
780
210
51
May
*99
June
'99
July
*99
Aug
*99
Sept
*99
Oct
’99
Nov
'99
Dec
■99
Total
Grand
930
943
mu
0
0
21
29
b) I'.se in led ion___________________
0
24
c) Caln tael________________________
0
41
J) Rcl'rucUirs' errors________________
0
0
13
0
22
0
0
28
0
10
280
870
28
3
7
7
131
212
21
I u1x.Tctdnsi% (nispce 1 ed)
7 Worm Infestations_________________
77
iClinical <£ Stool positive cases) _____
Anaemia (HI)0a 6 ^in & below)______
I >e< :
13
9
£
Apr
’99
380
Upper RopirAhirs Inltxlion______
£
Mar
*99
710
620
883
76S
212
807
218
(J
508
Dianhoea
2 I'llVUUXHUll
6
Feb
*99
16
14
Total
1263
958
345
986
229
11
632
2 I d er Cases___________
2
Jan
■99
157
al Vilamih 'A' Deliciency (night
f
<
blindness. Iktuls spnls) ___
10 Ears:____________________________
or
cr:
£
a) Discharge____________________
b) I oreign Body Wax_____________
II Dental & gum diseases_____________
12 Skin Diseases_____________________
a I .c proxy_______________________
b. Scabies_______________________
c. Pyoderma_____________________
78
0
0
0
88
10
810
d Others________________________
13 Pci vic In Ila minatory Diseases
a Ccriic ilis_____________________
b
c.
Salpingitis____________________
V.ndome Iritis__________________
50
0
0
0
51
5
S
14 Pic-cdampsia_____________________
15 Sexually 1 fimsinitlcd Discuses_______
I
16 lliah IJUkkI Pressure
17 Diabetes (Sugar present in mine)
i
co
CS2
o>
18 Goitre____________________________
19 Hutosis
20 I ainencss from any cause___________
21 Any cither discuses not included abuse
880
823
T
810
0
0
0
II
0
0
0
1703
8
2
0
(I
63
229
3
0
0
1703
1
®
ft
fc:3
V *
■
■
•
1
®
®
®
-Mf
f/?’:
.
Yellow Card Scheme .GV,'!?
Aanual llealtli Check up for SC / ST Population
•
■
tS
®
District: Koipnl
:
.\amf of Disease
Jan
*99
I Upto I
Mar
Feb
No, of Patients with Disease
Apr
’99
May
June
’99
*99
t99
389
8H
160
19
50
88
14
44
20
10
18
17
123
12
12
’99
net Cases
tart hikj
JstnvcHkT ilis
Pjxrr Kespirulorx Inlvctimi_______
tcunumia
38
70
42.
16
16
6
46
ibcrctilosis (suspected)
uffti Itilcslatiuns
32
41
14
12
38
>acnna(]lbll»6 gtn £ IkIow)_____
69
42
6
4
40
es:
Vitamin 'A' Iklicicncy (night
July
*99
ir
SkkiI posilite cases)
1inic.il
“
Dhcuie StutKIca
_ ________ _ ______
2
Aug
‘99
Sept
’99
Oct
*99
Nov
■99
Dec
.99l
10
17
33
134
146
___0
190
190
0
___0
I >c infection
Rcl factory cr rors
0
(I
0
0
gum diseases
0
0
in Diseases_______________
cz:
Leprosy_____
£
Scabies
18
4
14
6
22
IHodcmta_________
< It hets
*
69
_____________________
hie In Ila m ma torv Diseases
Urn ic ilis
_____________
Salpingitis_____________________
o3
L n don i ci n (is___________________
<r> .•■cclampMtt
sually hansmillcd Diseases_______
ah Blood Pressure________________
2
>belts (Sugar present in mine)
5^ 'it re
^co----- :----------------------------------------------(Jsa irons
2
2
3
1-
3
1
Q i\ t■!11ci discuses mil incttnkd iiImhc
100
276
0
__ 0
0
0
0
0
0
0
0
0
0
0
0__
0
0__
0
0__
0
0__
0
0
0__
16
5__
0___
8
__ 0
0
II
121
__ 0
133
5__
__- mencNi li-otn any cause___________
0
0
16
5115
l .
0
133
0__
T
146
0
Cataract___________
.■ntal
12
135
___0
blindness. Helals spots)______
I urcign Hody ■' Wax
123
.
134
0
0
0
0
Discharge__________
794
__ 0
,
its
‘Iota I
794
135
<
Grand
Total
0__
0__
0__
5115
• .•: •
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