LIST OF CHAPTERS

S.N.
1.

Sub
Head
1.1
1.2
1.3
1.3.1
1.3.2
1.3.3
1.3.4
1.3.5
1.3.6
1.3.7
1.3.8

1.3.9
1.3.10
1.3.11
1.3.12
2.1
2.1.1
2.1.2
2.1.3
2.1.4
2.1.5
2.1.6
2.1.7
2.1.8
2.1.9

Subject
Executive Summary
Project at a Glance
Introduction & Project
Profile
About the Hospital
Degree of Specialization
Existing Assets of the
Hospital
Existing manpower details
of the Hospital
Major
activities/achievements of
the Hospital
Target Groups
Catchments Area
Constitution, Licensing &
Empanelment of the
Hospital
Unit Location
Pollution control Measures
Growth Strategy
The mission of the Hospital
Project Details
The Preamble
Introduction
Objectives
The Proposal
The proposed machine &
its leverage for the
Hospital
Functional &
Implementation Plan
Training Component
Automation
Project Rationale

Chapter No.

Page No.

I
4-5

6
7-10
11-13
14
15
16
17
18

II

18
19
19
19
20
20
21-22
23-24
25
26-30
31-33
34
35-37
38-39

3.1
3.1.1
3.1.2
3.1.3
3.1.4
3.1.5
3.1.6
3.1.7
3.1.8
3.1.9
3.1.10

4
5
6
7

4.1
5.1
6.1
7.1

8.1

9.1

Demographic Details
Locational Details
Project Location
Health Indicators of
Arunachal Pradesh
Health Index of Arunachal
Pradesh
Industrial Prospect
Healthcare Sector
Overview & Trends
Investment Plan in
Healthcare
Competitive Scenario
Market Outlook
Service Factor &
Employment Generation
Promoters Profile
Swot Analysis
Major Assumptions
Project Cost & Proposed
Means of Finance
Cost of Production &
Profitability
Some financial Indicators &
Schedules of
Implementation

III
40-41
42
43-44
45-46
47-48
49-50
51
52
53-54
55-56
IV
V
VI
VII

57-58
59-60
61
62-63

VIII

64

IX

65-67

LIST OF ANNEXURES
S.N.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.

Annexure
Project Cost
Pre-Operative Expenses
Proposed means of finance
Details of Plant & Machinery
Details of Office Equipments
Indicator Ratio
Income Estimation
Direct Expenses Estimation
Projected Balance Sheet
Projected Profit & Loss A/c
Depreciation
Cost of Production & Profitability
Summary
Cash Flow Statement
Fund Flow Statement
Salary & Direct Labor
Calculation of Break Even
Pay Back Period
Calculation of Repayment
EMI Calculation Schedule
Debt service Coverage Ratio
Working Capital Requirement
Computation of Interest Liability
Fund Position
Interest Earning

Annexure
No.
I
I(a)
II
III
IV
V
VI
VII
VIII
IX
X
XI
XII
XIII
XIV
XV
XVI
XVII
XVIII
XIX
XX
XXI
XXII
XXIII

Page No.
68
69
70
71
72
73-76
77
78
79
80
81-85
86
87
88
89-90
91
92
93
94-95
96
97
98
99
100

CHAPTER I
Executive Summary
PROJECT AT A GLANCE
1. Name of the Project

Heema Hospital

2. Project Location

O Point Tinali, Itanagar

Dist: Papum-pare, Arunachal Pradesh
791111

3. Project Objective

To add facilities to existing Multi Specialty

Hospital

4. Proprietors name

Mrs Byabang Yaji

5. Firms Constitution

Proprietorship

6. Contact Address (Office)

Heema Hospital
O Point Tinali, Itanagar
Papumpare Distt. Arunachal Pradesh
791111

7. Contact Nos.

0360-2291094/0360-2217800
0360-2290551(Fax)
9436050006/9402690187

8. Project Cost

(Rs. In lakhs)

(d) Units proposed financial projection Summary:

st

1 Year

Total revenue
PBIDT
PBIT
PBIT Ratio
Net cash Accruals

:
:
:
:
:

nd

rd

Year

3 Year

4th Year

Figs in Lakhs
5th Year

68.90

83.77

87.63

99.60

121.49

44.01

48.28

46.80

48.92

62.13

25.39

32.91

35.10

41.39

59.31

37%

39%

40%

42%

49%

25.39

36.91

39.10

45.39

63.28

(e) Debt Service Coverage Ratio

Maximum
Minimum
Average
(e) Break Even Point ( Sales)

1.52

1.02

1.23

38.57

:
:

30.33

3 years 3 months

Safety Margin available

in first year of operation

(f) Pay Back Period

(g) Cash Surplus at the
end of last year of projection
(h) Repayment period
(i) Employment Generation

:
:

64.00Lakhs

5 years with moratorium of 6 months

6(in the first year of operation)

11.

Introduction&ProjectProfile:
a. About the Hospital:
Heema Hospital is the first private multi-specialty Hospital of the State.

The hospital started as Heema Clinic in 1991 with 5 bedded indoor capacity
and with its continuous successful service and gradual development of its
brand image it developed itself as fully functional Multi-specialty Hospital in
2007 with a total intake capacity of 50 beds.
The Hospital is located at O Point Tinali, Itanagar at the main road and
its location is in the heart of the capital city with easy access for 24x7 as to
Road transport, Public transport System, Electric Supply, Water Supply and
Sewer treatment facility. With nearby Auto, Taxi & Bus Stands, make it easily
accessible to any mode of transportation for the needy patients in any hour of
emergency to reach the hospital within shortest possible time. Police and Fire
Station are at stones throw away distance from its existing location thus
ensuring round the clock security.
Equipped with an ambulance it can provide safe transportation of both
stable and unstable patients to the designated referral hospitals in case of
emergency or as per the need of the hour.
The hospital has an outsourced laundry service to provide clean linen.
The sterilization of requisite linen is being carried out in-house. The hospital
also has an organized catering service to provide regular and therapeutic diets.

b. Degree of Specialization
The hospital provides primary as well as secondary level care including
the preventive, promotive, curative and rehabilitative services within the ambit
of its capacity. The hospital has made provisions for future expansion for
size and adding on departments if need be.
It is providing comprehensive intensive care for all types of medical and
surgical cases. The hospital is equipped to provide expert first aid and all
services for resuscitation and preservation of life.
It has a basic casualty unit, a comprehensive critical and intensive
care unit providing ventilator support, shock therapy, and backup support
for all three services. The various activities as listed above are being supported
by the following clinical support services.

Operating room / Labor

room

Imaging department with:

o X-ray machine
o Ultrasound machine
o Color Doppler Machine

Theatre sterile supply unit

Laboratory services
Right since its inception

of the unit as multi-specialty Hospital, it had been conceptualized to be a

leading medical treatment centre to cater the varied health-care needs of the
various target groups including the patients from within and outside the State.

For the purpose, the hospital is being managed by a group of managing

committee members expert in their respective fields and they assist the
proprietor in taking major policy decisions. Regular focus is kept to provide the
affordable and comprehensive health care services to the patients. Emphasis is
always on the best health care aids as well as best talents working for the
hospital. Quality aspect is always the prime focus of the management.
Therefore, even for the procurement of the CT-Scan Machine, the promoter has
obtained quotations from the leading Healthcare products suppliers whose
machineries are capable of providing state of the art healthcare solutions.
Proposed unit, equipped with better and latest healthcare technologies would
have monopolistic edge over the other few units presently operating within the
State.
Heema Hospitals patient-focused philosophy has always been to
continually integrate cutting edge healthcare applications into the daily clinical
routine, providing high quality patient care while simultaneously reducing
costs. While patients continue to expect higher diagnostic accuracy, healthcare
institutions and facility centers are being forced to reduce time to diagnosis and
unnecessary hospitalization. To meet these and tomorrows demands for higher
quality and cost effective healthcare, Heema Hospital is committed to improve
its technological assistance and blending the modern developments for reduced
healthcare cost and expand its accessibility to the wider range of needy
patients.
c. Existing Service Facilities:
Hospital has developed as fully functional multi-specialty centre and it
has OPD services available for:
* Minor General/Laparoscopic Surgery
* Gynecology and Obstetrician

* Oncology
* Medicine
* Pediatrician & Neonatal Care Services
* ENT Services
* Eye
* Orthopedic
* Skin
* Pathology
* Physiotherapy
* Diet Counseling Centre
*

Acupuncture

10

Its indoor facilities includes:

* State of art Operation Theatre with latest equipments
* NICU (Neo-Natal Intensive Care Unit)
* Delivery Room
* Ultrasound
* Air-conditioned Labour room
* Minor OT facility
* Dressing room
* Well equipped and sufficiently stocked Pharmacy
* Conference Hall
* Ambulance Facility
* 20-seater capacity canteen for the inmates and their relatives.
* Lodging arrangement for the doctors and nurses.
* Mess facility for the resident doctors & Nurses.
In-patient department has following sub-categorization:
* Medicine Ward
* Surgery Ward
* ENT/EYE Ward
* Children Ward
* General Ward
With the procurement of latest investigative tools to aid in the diagnosis
and treatment of its patient, the hospital has proliferated its diagnostic services
in following divisions:
* Video Endoscopy Division
* X-Ray Division
* ECG Division
* Audiometry Division

11

* Ultrasonography/Colour Doppler Division

* Optometry Division
* General Pathology Division

d. Existing Assets of the Hospital:

Sl.
No
1.

Particulars

Year

of

No.s

Historic Cost

Remarks

Purchase/Const.

(Excl. Dep.)*

Land

2000

2.00 Lakhs

Building

2007
2008
2007
2008
2007
2007
2007
2009
2007 & 2011

1
1
1
1
1
1
1
2

225.00 Lakhs
14.00 Lakhs
7.00 Lakhs
19.00 Lakhs
7.00 Lakhs
7.00 Lakhs
2.00 Lakhs
1.50 Lakhs
1.00 Lakhs

2008
2008

3
6

15.00 Lakhs

Combined cost unit.

2007
2007 &2011
2007 & 2011
2007 & 2011
2007, 08 &10
2007 & 2008
2007 & 2008
2007
2007 & 2008

1
2
2
2
3
2
2
1
4

set
Nos
Nos.
Nos.
Nos.
Nos.
Nos.
Set
Nos.

62.00 Lakhs

Combined cost unit.

2007
2007
2009
2007
2007
2007
2007
2007

1
1
1
1
2
1
1
1

Nos
Nos.
Nos.
Nos.
Nos.
Nos.
Nos.
Nos.

20.00 Lakhs

Land

allotment

procured in 2011.

2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
(a)
(b)
12.
(a)
(b)

(d)
(e)
(f)
(g)
(h)
(i)
12.
(a)
(b)

(d)
(e)
(f)
(g)
(h)

Video-Endoscopy
Endoscopy
Ultra sound(Colour Doppler)
Ultra sound(Plain)
X-Ray 100 M.A.
X-Ray 60 M.A.
Audiometry Testing Machine
ECG
Neo-Natal Intensive Care Unit with:
Phototherapy
Baby Warmer
Operation Theatre equipped with:
Laparoscopy Instruments
Anesthesia Machine
OT Light
OT Table
Pulse Oxeometer
Auto Clab
Sterliser Machine
Operation Instruments
Suction Machine
Laboratory Equipped with:
Auto Analyser
Microscope
CBC Machine
QBC Machine
Centrifuge
Colorimeter
Mixer Machine
Incubator

12

13.
14.
15.

10.00 Lakhs
DG sets
10.00 Lakhs
Water Pumps & Tube well
10.00 Lakhs
Total
412.50 Lakhs
*Figs have been rounded off to nearest lakhs for easy explanation.
Ambulance

2007
2007 & 2011
2007

2 Nos.
2 Nos
4 Nos.

Existing physical facilities:

Particulars

No.

Basement-I

rooms
12

of

Description
Major Operation Theatre-1

(Surgical Ward)

Doctors Dressing-1
Recovery Room-1
Labor Room-1
Observation Room-1
ICU-1
Single Room-3
Double Room-2

Basement-II

Metron Room-1
Cabin-Male-1

11

(Medicine Ward)

Double Room-2
Cabin-Female-1
Single Room-5
Deluxe Room-1

Basement-III

Suite Room-1
General Ward-Male-1

10

(General Ward)

General Ward-Female-1
Isolation Ward-1
Infectious Ward-1
Living Room-Med. Supdt-1
RMO Lodge-2
Nurse Hostel
Staff Room-2

13

Remarks

Ground Floor

11

Pharmacy-1

(OPD Ward)

Reception/Cash Counter-1
Laboratory-1
Surgery OPD-1
X-Ray Room-1
Minor OT Room-1
Medical Supdt. Room-1
Gynae Room-1
RMO Room-1
Medicine/Skin-1

1st Floor

Ortho/Ent-1
CMD Office-1

(CMD Office)

Office-1
Endoscopy-1
Ultrasound Room-1
Kitchen-1

nd

Canteen-1
Conference Hall-1

Floor

(Hall Area)

Drying Space-1

Copy of Land passbook for the

existing land on which the hospital has
been constructed have been attached
as Suppl-III with the Project Report.
Copy of existing hospitals design
and its floor plan have been attached
as Suppl-II with the Project Report.

14

e. Existing Man Power* details of the Hospital:

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

Posts
Doctors
Nurses (GNM & ANM)
OT Staff
X-Ray Technician
Ultrasound Technician
Endoscopy Technician
Lab Technician & Staff
Pharmacy Staff
Office Staff
Attendants
Electrician
Painter
Carpenter
Cook
Plumber
Washerman
Security Staff
Sweepers

No.s
10
35
6
2
2
2
3
4
5
12
1
1
1
4
2
5
2
8
105

Total
*Includes contractual and part-time employees also.

15

Remarks

f. Major Activities/achievements of the Hospital

During its palpable existence for last 20 years it has voluntarily
undertaken

several

social

welfare

measures

as

part

of

its

Social

Responsibility which has left a long lasting impression on the local populace
and thus connecting effectively even with the deprived and underprivileged
sections of the Society at far flung areas of remote districts of Arunachal
Pradesh. Some of such efforts/achievements have been underlined below:
*

Free Medical Camp at Koloriang, Kurung Kumey District in association

with ANSU during 4-5 Dec.2008

*

Free Medical Camp at Bene & Logum Jini Village, Aalo, West Siang

District in association with APDA & Ex-R.K. Mission Student on 31 st

January 2009
*

Conducted first open Neuro-surgery by Dr. N. Boruah, MCH, HoD

Nurosurgery Deptt., GNRCH on 15-2-2009

*

Free Two-day Respiratory Disease & Chronic Obstructive Pulmonary

Disease(COPD) Checkup camp at Itanagar in July2009 in association with

Lupin, a MNC drug company
*

One day seminar on infant feeding at Heema Hospital Complex, Itanagar

with Nestle Company.

*

Safe

motherhood

& Save

Girl Child Programme at

Itanagar

in

collaboration with Federation of Obstetric and Gynecological Societies of

India(FOGSI) in Sept 2009 at Itanagar
*

CME on Malaria with Zydus Cadilla, a MNC drug company at Itanagar.

CME on rabies with Ranbaxy Pharma

Free Screening Camp on hypertension & Cholesterol Level in association

with Emcure Pharmaceuticals Ltd.

16

Set up first and the only neo-natal intensive care unit in the State of

Arunachal Pradesh in March 2009

*

Imparting regular healthcare training to 50-60 girls for six-months

training duration.
g. Target groups:
The hospital, with its 20 years of successful existence, present
investment of Rs. 412.50 Cr in fixed assets, manpower of 105 persons
including several experts in their field, has established its lasting brand image
among the local populace of the State. As recognition of its illustrious existence
and untiring continuous service, Govt of Arunachal Pradesh has brought it
under the aegis of its empanelled organizations where its Govt. employees and
their dependent are allowed to avail healthcare facilities as per the CGHS Rule.
This recognition would have major upward thrust to the financials of the
hospital. It would bring within its ambit a big chunk of Govt. employees and
their dependent for the healthcare services for which they used to go outside
the State erstwhile. In order to cater the increased volume of patients and their
varied healthcare requirement, hospital has planned to go for major expansion
plan to its existing facilities and the inclusion of technology like CT-Scan would
definitely a big boost to its existing comprehensive service paraphernalia.
Besides, due to its affordable and price-effective cost range, it is a preferred
choice for almost all income group for their healthcare needs.
Management is hopeful to cater its effective healthcare services within a
radius of 50 kms from the existing location. Though, with its growing
popularity and public acceptance, it is already getting patients from the remote
districts of the State which are situated very far from the capital complex viz,
Kurung Kumey, Lower Subansiri & Upper Subansiri districts. The management
endeavor is to cater to the local populace of the catchment area as well.

17

h. Catchment Area
(i)

Ganga

(ii)

Chandannagar

(iii)

Gohpur

(iv)

Naharlagun

(v)

Nirjuli

(vi)

Doimukh

(vii) Banderdewa

18

i. Constitution, Licensing & Empanelment of the Hospital

It has been registered with the Govt. of Arunachal Pradesh as a
proprietorship healthcare facility centre. Keeping in view, its continuous growth
and popularity it has been empanelled with several organizations for providing
healthcare services on contractual basis. Most prominent of them is
recognition by Govt. of Arunachal Pradesh, Deptt. of Health & Family Welfare
Itanagar for treatment of its employees & their dependents vide Gazette
Notification No. MPH-8/91-92/Pt-II/08-09 dtd 5th Sept 2010 under the rule
2(d) of CGHS,CS(MA)Rule,1944. Besides it has been empanelled with following
other prominent organizations as well:
* SBI Life w.e.f 10th May 2002
* BSNL
* ICICI w.e.f 1st Feb 2009
* NEDFi
* Bajaj Alliannz Insurance Company
* Birla Insurance Company
* Medicare TPA Service w.e.f 31st Aug 2009
* Seetha Sri Tax Service
* Jeevan Samridhi Medicare Marketing Pvt. Ltd. w.e.f 5th Oct 2007
* Mdindia Healthcare Service w.e.f 31st Aug 2009

j. Unit Location
It is located at O Point Tinali, Itanagar and proposed expansion would
take place at the adjacent plot of land available with the Proprietor at the same
location.

19

k. Pollution Control measures:

Hospital has outsourcing arrangement for waste disposal. Deptt. of PHE
carries away the Solid waste disposed off by the hospital for deep burial at a
distant safe location. Water disposal is through sewer line passing close to the
hospital complex.
l. Growth Strategy
Proposed unit have been envisaged to obtain horizontal as well as vertical
growth.
m. The Mission of the Hospital
To provide quality health care accessible and affordable to all, round the
clock.

20

CHAPTER II
The Preamble:
The saying Health is wealth is extremely old. This clearly shows that
the importance of health was felt even during the olden times. This has only
intensified and there are many hospitals to treat the increasing numbers of
patients as a result of newer diseases. The health problems never seem to cease
nor remain unaltered by time. Therefore, hospitals must be well equipped to
form an arsenal against diseases. The Proprietor seem to have realize this
concept pretty well as they have grown from relative obscurity to their present
position. The hospitals in Arunachal Pradesh are always in great demand as
with time, the numbers of diseased people only increase.
This report has been prepared to formulate the expansion plan of Heema
Hospital located at O Point Tinali, Itanagar, Arunachal Pradesh to venture into
new services viz, CT Scan facilities.
The report is based on the discussion and data generated, from
various meeting held with the promoters of the project, who are members of
the Governing Board and visits to the sights. Data is collected for the disease
pattern, incidence of various diseases and other relevant social, cultural and
health status indicators. All the data has been quantified to accommodate the
functional requirements of various departments in this hospital.
The provision in this report has been made for specific purpose of
conceptual proposal and designing of the hospital. In this report, due
consideration has been given to under stand the market needs of the locality,
research has been conducted for various national health programs, national

21

health policy, NRHM, world health report, IPHS 2006, and BIS standards for
the hospital sector.

22

Introduction:
Pursuant to the executive summary in the report it has very
adequately been emphasized that the need for a model hospital meeting all
possible standards to a reasonable extent be created in order to provide quality
health care at the most affordable cost so as to bring good quality health care
to

the

door

step

of

the

community

and

in

turn

progress towards

HEALTH FOR ALL and achieving the MDGs.

Recent advancement in medical science and technology have radically
changed the art and practice of contemporary medicine & clinical approaches.
Many new diagnostic and therapeutic modalities have been developed and
perfected during the past two decades. Although most of these techniques are
capital intensive, these are highly efficient, safe and cost effective.
Improvements in National & Regional economy and literacy rates have
changed the pattern and extent of the use of healthcare services in the
country. People are becoming aware of their health needs and are acquiring the
ability to make a deliberate choice of the health service they need.
Consequently, the demand for better quality medi-care is rapidly increasing.
Staff benefits in Govt, Trade & Industries and third party financing of medicare through voluntary social insurance are further increasing the growing
demand
In order to meet the growing demand for comprehensive health care
services offered by the hospital, it has been decided to incorporate additional
equipments and facilities so that one roof services could be provided to the
patients in need of health services. The hospital shall not only provide and
supplement the much needed beds in this segment but also augment the
emergency health care services and prove that quality healthcare services can

23

be provided at affordable cost. It will further demonstrate how this model can
be financially viable and sustainable. The hospital addresses the unmet needs
of the community as consumers and therefore empowers them with their
right to health and availability of services for the money paid, so as to
appreciate the value for money. The proposed expansion plan of the hospital
shall

provide

comprehensive

medical,

surgical, obstetrics, pediatrics,

orthopedics, eye & ENT as well as all the needed support services. Most
importantly it will be functional 24/7 all through out the year so as to
make

available

emergency

medical

care

round

the clock at a very

reasonable cost which the community and local populace can afford.

24

Objectives:
The hospital will have a hierarchy of objectives viz, Service, Training &
Research. The most important objective for which the hospital will make all out
effort will be to provide high quality service at an affordable cost not only for
the affluent sections of the society, but also to those who may not be
economically well off. The outpatient services would be provided on the concept
of polyclinics and referral clinics. The out-patient service will be provided not
only in the morning hour but in the afternoon and in the evening so as to give
maximum flexibility to the visiting patients.
It would be endeavor of the hospital to treat patients through
ambulatory care as far as possible. Those who need admission will first be fully
investigated

through

the

diagnostic

departments

and

as

per

the

recommendation of the attending doctor.

Present proposal is in furtherance of its existing commitment :
* To ensure availability of comprehensive quality health care
accessible to all without any discrimination or bias.
* To provide the services round the clock 24/7.
* To enable access of the services to the community at an
affordable price.
* To provide value for money to the consumers of health care.
* To develop and implement State-of-art health delivery system for
providing quality healthcare facilities at an affordable price for all.
* To conduct research and development studies for bringing
policy changes in the healthcare delivery system in the region
especially within the State of Arunachal Pradesh for the poor and
disadvantaged patients.

25

* To educate consumers and make them aware on their rights and

provide informed choice in an effective and efficient manner.
* To act as a role model for others to emulate.
Heema Hospital has ventured into this area so as to create a model
incorporating all the features stated in the NRHM, National Population
Policy and IPHS 2006.
This initiative will function as a private for profit model. It has presently
50 beds intake capacity with basic broad specialties, supplemented with
diagnostic services including an ultrasound, ICU and an operating room. The
structural standards have been met with, the process and outcome standards
are being worked upon so as to enable the hospital to be accredited by the
National Accreditation Board for Hospital and health care providers in the days
to come.
The concept of Public Private Partnership can very well be applied to this
model. The

facility is geared up to handle and support all national health

programs, Counseling services, NGO participation, PRI involvement, preventive

health, IEC services, Sanitation, Hygiene and Safe water supply to the
community apart from patient/consumer education and awareness on rights
and responsibilities.
The rights of patients and staff are to be respected and the
approach will be market/consumer driven. Governance of the facility will
continue to be professionally managed.

26

The Proposal:
Proposed venture is the outcome of the strategically planned expansion
initiated by the promoter for expanding its spectrum of services of the Heema
Hospital in the light of growing demands for its services and expected
increase in patient visits due to recent Govt. recognition as a referral hospital
for treatment of its employees and their dependents. The proposed expansion
arrangement has added advantage of reduced cost on account of administrative
and maintenance cost and broadening of its service base.
Proposal contains inclusion of CT- Scan machine for expanding its
service range. Expansion plan have been carefully devised to avail best possible
financial leverage for the hospital and gradual expansion have been envisaged
within a reasonable time frame of 5 years.
It is further preferred due to existence of better scope for establishing
common facilities like, sanitation, mail box, telephone services, water and
safety reasons. The proposed expansion of existing unit will not only provide a
cost

effective

and

profitable

fusion

of

commercial

and

administrative

advantages but will have an apparent edge over the scattered small units
around the capital complex.
Considering the overall scenario with a keen approach towards
profitability and cost reduction factor the proposed unit will satisfactorily cater
to the potential needs of the consumers of the State. With all these advantages
the proposed unit will be utilizing its profitable potential and no extra
marketing effort is needed to bring it to the full capacity utilization. Its rates
have been rationally envisaged keeping in view its locational advantages and
prevailing market rates.

27

Gradual diversification with a well balanced approach towards horizontal

growth along with vertical growth have been envisaged and adequately reflected
in the project proposal.

28

The Proposed Machine and its leverage for the

Hospital:
Somatom Scope 16 Slice Edition of CT Scan Machine of Siemens, a
globally recognized healthcare product manufacturer, is their premium product
designed to allow high quality imaging for routine CT-examinations, including
chest/abdomen/pelvis, CT-angiography and virtual colonoscopy. This CT
scanner is designed for use in general radiology departments, diagnostic
imaging centres, and specialty facilities. This flexible high performance scanner
includes features designed to automate clinical examination process, ease
through reconstruction and post processing and aid in accuracy of diagnoses.
It is a powerful set of CT applications that improves productivity by working the
way user does. Users can do all their planning, scanning, visualization and
archiving in a simple, easy to use graphical user interface(GUI) that is
harmonized across Siemens Healthcare. Built with brilliance CT technologies
inside including detectors, x-ray tube and workflow, the Somatom Scope edition
brings a simplified workflow in a reliable clinical tool.
Highlights:
Includes Ultra Fast Ceramic (UFC)Tm Detector.
Iterative Reconstruction in Image Space(IRIS)* in the SOMATOM
Scope enables it to reduce noise and deliver increased image quality
as well as

significant dose savings for a wider range of clinical

applications.
CARE Dose4DTm a fully automated real-time dose management
enables dose reduction by almost 68%.

29

 Dedicated biopsy and intervention modes for quick and easy

movement to the site of last scan or a saved table position without
the need for constant support from the CT Control room.
syngo CT Workspace provides a broad spectrum of dedicated
applications such as syngo CT oncology, syngo Colonography Ct and
syngo Neuro DSA that offers superb post-processing capabilities as
well as new marketing opportunities for CT service.
Remote access and control facility through syngo CT Workspace.
Service

solutions

based

on

Siemens

Remote

Service

(SRS)

technology
16-slices per revolution for large volumes and thin slices
Rapid view reconstruction system for high quality imaging at upto
6 images per second
Dosewise

design

offers

optimal

dose

efficiency

without

compromising image quality

Brilliance workspace user environment improves productivity by
working the way the user does
Includes features like dynamic Focal spot(DFS) which doubles the
data sampling density thus doubling the effective detectors and
providing high spatial resolution in axial and spiral scanning.
Logical guided flow prompts the user through the scanning and
visualization processes.
Scan tools to optimize productivity, workflow and diagnostic
confidence.
Access to new applications and lower cost upgrades to the system
Lower requirement for preventive maintenance

30

Technical specifications:
Scan control Panel

Controls & displays for gantry tilt, patient couch elevation

and strokes are located on both sides of the gantry.

Scan control Box

Gantry aperture

:700cm Bore Size

Gantry tilt

:-300 to +300 ; 0.50 increments

Slimmest Gantry :69cm(27in)

Smallest Footprint: 18m2 (194 sqft) including control room

Gantry and patient couch controls and displays are located

conveniently at the operators console.

Additional features include emergency stop, intercom, and

scan enable/pause buttons

Auto Voice

A standard set of commands for patient communication;

before, during and after scanning.

Commands

for

patient

communication

in

multiple

languages. Also provides the ability to record customized

messages.
Table

Longitudinal motion:

Manual Stroke

Scannable range :1500mm

Speed

Position accuracy :0.25 mm

: 1580mm

:0.1 to 100mm/sec

Vertical Motion:

31

Range

Table

:430 to 970 mm above floor; 1.0 increment

load capacity:200Kg(440lbs)

with 0.25mm z-axis

accuracy

Floating table top :Carbon fibre table top with foot pedal and
push button table brake release

Table Accessories

Table accessories include patient restraint straps, a standard

headholder, a table pad, cushions and pads for optimal
patient positioning and comfort.

Scan Planning:

The brilliance workspace provides intuitive registration and

easy entry of patient information and clinical procedure
selection, using anatomic graphical display and sample
images.

Expert protocol planning:

Tailor protocols to meet specific needs via selection of

parameters optimized for certain studies.

Sureview Plan

Planning

viainteractive

mouse

control

of

multiple,

independent acquisition series of any type of surviwe image.

Scan Length:

upto 1500mm

Scan Width :

500mm

Provides flexibility as to Manual scan as well as automatic

scan

32

 System:

System works on Rotate-rotate architecture with optimized

geometry for low dose imaging.

The generator uses modern, low voltage slip ring technology

to provide a constant high voltage to the CT x-ray tube
assembly.

Output Capacity

: 50 Kw

kV selections

:90,120, 140 kVp

mA selections

:30 to 420 mA

X-Ray tube

Anode Storage capacity :5.0 MHU

Maximum cooling rate

Smallest Focal spot (IEC):0.8 x 0.5/0.8 x0.7

: 815kHU/min

Detector

Direct to digital signal conversion with TACH technology

reduces dose and improves image quality.

Material

:Solid State-Gadolinium Oxisulfide(GOS)

Slip Ring

: Capacititive-1.1Gbps transfer rate

Data sampling rate: upto 4640 views/revolution/element

Slice Collimations :
16x0.75mm,12x1.5mm,16x1.5mm,12x0.75mm,10x0.75mm,
10x1.5mm4x0.75mm,2x0.75mm

Image Quality

Spatial Resolution(High)

:15.0lp/cm@cutoff

Spatial Resolution(Std)

:12.0lp/cm@cutoff

33

Noise

:0.35%[120kVp,250mAs, 9mm

250mm FOV, SA filter, 20cm water equivalent phantom]

Low Contrast Resolution:4mm@0.3%[120kVp,250mAs, 9mm

250mm FOV,USA filter, 40mGy surface, 20cm CATPHAN
phantom]

Absorption Range

:-1024 to +3072 Hounsfield

unit
List of installations of Siemens SOMATOM Emotion 6/16 slice CT
Scanners at some renowned healthcare Centres:

Sl.No.

Customer/Centres name

State

Year of

Model

1.
2.

Reddy HealthCare Pvt. Ltd.

Ramakrishna Mission

West Bengal
West Bengal

installation
2011
2011

Emotion 16
Emotion 16

3.
4.
5.
6.

Hospital
Bokaro General Hospital
Green Valley
Ayush Hospital
Directorate of Health

Jharkhand
Assam
Orissa
Andman &

2006
2005
2007
2011

Emotion
Emotion
Emotion
Emotion

7.
8.

Services
Mizoram Health Care
Narayan Medical college &

Nicobar Island
Mizoram
Bihar

2011
2011

Emotion 16
Emotion 16

6
6
6
16

Hospital

Copy of the quotation by Siemens for the proposed Machine has been attached
as Suppl-V with the Project Report.

34

Functional & Implementation Plan:

The proposed unit has been envisaged to cater as a one roof healthcare
solution to the consumers. Its objective is to gradually diversify its service base
to the maximum alternatives encompassing its product range viz, Surgery,
Intensive Care Treatment and Life Support, Medicines, Pathology and Imaging
etc. It plans to hire best talents of the industry in the nearby vicinity so as to
have a cutting edge in competition for its service ranges. With continuous
monitoring over the product development as well as analytical assessment of
consumer satisfaction it would put its best endeavor to scale up the targets
within achievable ranges thus offering a varied range of choices for the
consumers and different economy level for the services offered. It is proposed
that the hospital positions itself as a center of excellence, providing health care
services to the targeted community so as to make its bigger presence in the
society and add to its brand image.
The hospital shall provide its services on a fee for service basis to all.
However, due consideration will be given to the socio-economic status of the
community.
The existing design of the building have been prepared so as to fully
satisfy the professional requirements of the medical staff, nursing staff, Paramedical staff etc and that the modern principle of planning i;e Design must
follow function is completely followed. The design of the building has taken in
to consideration the requirements of the patients, relations and other
community members so that they are satisfied and also their socio-cultural
background has been provided for. The building design has taken in to
consideration, maintenance and housekeeping so that after commissioning it is
easy and economical to maintain.

35

Same principles have been borne in to mind while working out the
human resource requirements, equipment requirements etc.
Projected cost of medical equipments and building utility equipments will
be around Rs.182.03 lakhs. Quotations from leading and renowned suppliers
have been called to choose the best among them so as to aid its value to the
services and brand image of the hospital. Major equipment needed is CT-Scan
Machine for which SOMATOM Scope16 Slice edition of Siemens CT-Scan & 125
KVA Kirloskar Green 3-phase water cooled silent DG set have been the
preferred choice of the managing committee members. It is planned to be
procured in the first year of the project cycle and major part of bank finance
would be utilized for the purpose.
The hospital will be self-sustaining financially. The calculations of
occupancy rate and break even are enclosed. Depreciations as applicable are
adapted.
Technology up gradations will be supported by internal revenue of the
Hospital. Tariff will be so structured that it provides sustainability along with
maintenance of the building, and equipments. Hospital

accounts shall be

computerized and all taxes shall be accounted for.

The medical superintendent will be the designated authority for
authorizing any incidental expenditure and shall maintained an account
for the same.
Existing procedures would be supplemented with additional norms as
per the advice of the managing committee and consumer feed backs received
time to time. However, in general following operational procedures would be
followed by the hospital:
IPD
All patients will be given information booklets.

36

 Patients shall sign the respective general and informed consent form.
Operations of the hospital will be carried out according to the laws
of the land.
The hospital shall provide services as per the prescribed timetable.
There shall be a proper admission and discharge procedure.
Patient has to pay for all the medication and surgical supplies.
Money to be collected at a central billing and reception area.
A discharge summary will be given to all the discharge patients.
Fire and emergency drills to be carried out regularly.
Casualty Medical Officer shall control the ambulance services.
Staff in the hospital to be provided health care facilities according
to the policies.
Laundry services to be out sourced.
Flow diagrams to be displayed at all areas.
Care should be taken so as to prevent criss- crossing of traffic.

OPD
Medical Superintendent shall conduct periodic staff meetings.
All major hospital routines to be documented.
The governing board shall designate by a written resolution
authorizing the medical superintendent to give concessions to
patients as an when required.
Medical consultants will be on fee for service basis.
Free treatment could be given to the underprivileged sections of the
society.
OPD consulting room shall be utilized on a three hours slot basis in four
shifts from 8 a.m. to 8 p.m.
Female ayahs to be deployed in the OPD.

37

Training
The component of training will be built in from the beginning itself so
that only the staff having proper training will be permitted at the time of
appointment and periodic training both in-service and on job while in hospital.
The hospital will also have formal teaching for the nurses and the paramedical
staff. The hospital would put its efforts to obtain DNB course recognition
whereby not only a big level of teaching will be ensured but will also ensure
super specialty training and education for the doctors. The hospital would
endeavor to make arrangement for periodic exchange programme and training
for its staff so as to ensure high standards of patient care.

38

Automation:
Software would be used for the automation of Hospital Management. It
would be maintained at two levels of users:

Administrator Level

User Level

The Software would be designed to include:

Maintaining Patient details.

Providing Prescription, Precautions and Diet advice.

Providing and maintaining all kinds of tests for a patient.

Billing and Report generation.

Main facilities available in this proposed software would be:

Maintaining records of indoor/outdoor patients.

Maintaining patients diagnosis details, advised tests to be done.

Providing different test facilities to a doctor for diagnosis of

patients.
o X-Ray
o Urine Test
o Stool Test
o Sonography Test
o Gastroscopy Test
o Colonoscopy Test
o Blood Test
o Biochemistry Test

Maintaining patients injection entry records.

Maintaining patients prescription, medicine and diet advice

details.

39

Providing billing details for indoor/outdoor patients.

Maintaining backup of data as per user requirements (between

mentioned dates).

Results of tests, prescription, precautions and diet advice will be

automatically updated in the database.

Related test reports, patient details report, prescription and billing

reports can be generated as per user requirements.

User or Administrator can search a patients record by his/her

name or their registration date.

40

41

Project Rationale:
The justification for the existence of the entire medical industry is, of
course, better healthcare for all patients. But the realities of clinical practice
often make this simple-to understand goal quite difficult to realize; stay within
budgets, reduce hospital stays, speedup time to diagnosis and deal with
personnel

issues

while

maintaining

high

clinical

standards

and

volume/throughput. At the same time patients demand better and faster

results. In order to meet their share of responsibilities in addressing these
challenges, Heema Hospital, from its early stage had kept its focus on the
needs and demands of their patients.
Over the year this focus has been sharpened to following key areas;
To lead technological and medical advancement
To maximize workflow efficiency
To make available best healthcare facilities at affordable price
range
To set the standards in patient care
It had been continuous effort by the Hospital management to use
innovative and modern technologies at the pace with current development so
as to lift the clinical practice to a next level of excellence and enable widest
access to better patient care. It is a strong belief of the management that even
the farthest technical horizons are temporary and can be surpassed with
consistent dedication to improved healthcare.

This visionary approach,

backed up by the, by far, largest investment in improved technologies and best

suitable talents of the industry has made Heema Hospital the innovative
leader in healthcare over the years and their ambitious management team

42

continuously endeavors to set the trend in always changing environment,

providing Answers for life.
The project is functional at a time when commercial and developmental
activities in North East in general and Arunachal Pradesh in particular are in
full swing. Prime-ministers package for establishment of Trans-highway across
Arunachal Pradesh as well as several power projects pouring in the State has
catalytic effect on the commercial activities. Sustained governmental effort to
show-case State of Arunachal Pradesh as a tourist-hub has started showing its
results and the region is witnessing continuous growth in terms of outside
visitors. All these efforts and changes taking places on developmental as well
as commercial front, has created a huge business potential for the aspiring
entrepreneurs within the State. At this stage of growth, with no outside big
competitors, it would be easier for any commercially prudent business concern
to stabilize and grow and to make an indelible mark on its long term business
prospects.

43

CHAPTER III
Locational Details
Arunachal Pradesh erstwhile known as North Eastern Frontier Agency
(NEFA) is known as The land of rising sun. The state is situated as a sentinel
in the northeastern part of India, bounded by international boundaries with
China in the north, Myanmar in the southeast and Bhutan in the west.
Arunachal Pradesh (Land of the Dawn-Lit Mountains) is situated in the NorthEastern part of India with 83743 sq. kms area and has a long international
border with Bhutan to the west (160 km), China to the north and north-east
(1,080 km) and Myanmar to the east (440 km). It stretches from snow-capped
mountains in the north to the plains of Brahmaputra valley in the south. It is a
developing state having largest area (nearly 84000 sq km in area) among all the
north-eastern States including Assam. It is situated between latitude 26 0 30' N
and 290 30 ' N and longitude 910 30' E and 970 30' E. Itanagar is the capital of
Arunachal Pradesh and located at an altitude of 530 meters above MSL.
Arunachal Pradesh attained its statehood on 20th February 1987. It has
16 districts namely Tawang, West Kameng, East Kameng, Papumpare, Lower
Subansiri, Upper Subansiri, East Siang, West Siang, Upper Siang, Dibang
Valley, Lower Dibang Valley, Lohit, Changlang, Tirap, Kurung Kumey and
Anjaw. It also possess 36 sub divisions, 69 blocks and 149 circles.
The population of Arunachal Pradesh is 1.1 million according to 2001
census and is scattered over 16 towns and 4065 villages. The State has the
lowest density of 13 persons per sq. km. As against decadal growth rate of
21.54% at the national level, the population of the State has grown by 27%
over the period 1991-2001. The sex ratio of Arunachal Pradesh at 893 females
to 1000 males is lower than the national average of 933. Total literacy of the

44

State rose to 44.24% from 41.59% in 1991. There are 20 major tribes and a
number of sub-tribes inhabiting the area.
The decadal growth rate of the state is 27.0% (against 21.54% for the
country) and the population of the state continues to grow at a much faster
rate than the national rate.

45

Project Location:
Present Project proposal is for major expansion of the existing multispecialty Heema Hospital which is situated at O Point Tinali, Itanagar,
Arunachal Pradesh on the adjacent plot of land in the name of the Proprietor
Itanagar being the capital city of the State of Arunachal Pradesh has
total population of approx 1.1 Lakhs with major bulk of concentrated income
group residing. All the major Govt. departments including Civil Secretariat is
being located within 1 km range of the existing hospital complex.

46

HEALTH INDICATORS OF ARUNACHAL PRADESH

The Total Fertility Rate of the State is NA. The Infant Mortality Rate is 32
and Maternal Mortality Ratio is NA (SRS 2004 - 06). The Sex Ratio in the State
is 893 (as compared to 933 for the country). Comparative figures of major
health and demographic indicators are as follows:
Table I: Demographic, Socio-economic and Health profile of Arunachal Pradesh
State as compared to India figures
S.No.

1
2
3
4
5
6
7
8
9
10
11
12

Item
Total population (Census 2001) (in million)

Decadal Growth (Census 2001) (%)

Crude Birth Rate (SRS 2008)
Crude Death Rate (SRS 2008)
Total Fertility Rate (SRS 2008)
Infant Mortality Rate (SRS 2008)
Maternal Mortality Ratio (SRS 2004 - 06)
Sex Ratio (Census 2001)
Population below Poverty line (%)
Schedule Caste population (in million)
Schedule Tribe population (in million)
Female Literacy Rate (Census 2001) (%)

47

Arunachal Pradesh

India

1.1
27.0
21.8
5.2
NA
32

1028.61
21.54
22.8
7.4
2.6
53
254
933
26.10
166.64
84.33
53.7

893
33.47
0.006
0.71
43.5

Table II: Health Infrastructure of Arunachal Pradesh

Item
Sub-centre
Primary Health Centre
Community Health Centre
Multipurpose
Worker(Female)/ANM
Health Worker
(Male)/MPW(M)
Health
Assistants(Female)/LHV
Health Assistants(Male)
Doctor at PHCs
Surgeons
Obstetricians &
Gynaecologists
Physicians
Paediatricians
Total specialists at CHCs
Radiographers
Pharmacist
Laboratory Technicians
Nurse Midwife

Required In Position
254
592
39
116
9
44
708
256

Shortfall
-

452

592

156

436

116

116

116
116
44
44

0
87
5
1

116
29
39
43

44
44
176
44
160
160
424

3
0
9
7
66
52
312

41
44
167
37
94
108
112

(Source: RHS Bulletin, March 2008, M/O Health & F.W., GOI)
The other Health Institution in the State are detailed as under:

Health Institution
Medical College
District Hospitals
Referral Hospitals
City Family Welfare Centre
Rural Dispensaries
Ayurvedic Hospitals
Ayurvedic Dispensaries
Unani Hospitals
Unani Dispensaries
Homeopathic Hospitals
Homeopathic Dispensary

Number
14

1
2
2
44

48

Health Index of Arunachal Pradesh

Our country has the dubious distinction of being the 2nd largest
populous country in the world. The flip side is that in spite of being a
vast country having a huge population of 121 crores the health status of the
country is very poor. As evidenced by the World Health Report, the health
indicators are far inferior to its neighboring developing countries. Health being
a state subject the government has a very well structured public health system.
The three tier level of health-care organization with the root at the level of
primary health centers going through CHCs, DHs and tertiary centers like
medical colleges and centers of excellence like AIIMS, PGI etc. In spite of all
this, the reach and acceptance of the facilities particularly in the PHCs
and CHCs is very poor.
The condition of the health of Arunachal Pradesh is best understood
through the national health index published on the basis of the studies
conducted in the state. Although the total fertility rate of the state could not be
conclusively ascertained, certain other indicators are provided below:
Item

Arunachal Pradesh

National Average of India

Infant Mortality Rate

37

58

Maternal Mortality Ratio

NA

301

Total Fertility Rate

NA

2.9

Crude Death Rate

5.0

7.6

Crude Birth Rate

23.3

23.8

Sex Ratio

893

933

Last Updated on 03 January 2011

Due to its peculiar topography and difficult terrain, there is widely

dispersed settlement pattern of the population that applies to both rural and

49

urban areas. This particular factor is posing a big challenge for the Healthcare
delivery mechanism within the state. The rural population constitutes 79.59%
and the urban only 20.41 %. The percentage of population below poverty line in
1999-2000 is 33.47 (SRS Bulletin, April 2001) with a percentage decadal
growth of 26.21 and Average Annual Exponential Growth Rate of 2.33. The
decadal growth rate of urban population is a staggering 101.29 %. The total
literacy rate of the state is 54.74% with a male literacy rate of 64.07% and
female literacy rate of 44.24%. The per capita income (97-98) of the state is Rs.
13424. [Source: Provisional Census of India 2001].

50

Industry Prospect:
Healthcare in India is a sunrise sector and the country is witnessing
rapid growth of multi-specialty health service hospitals with a focus to provide
comprehensive health services in the line of international health Service
Standards. In India, the emergence of private Medicare services, especially
through commercialization and corporatization, has contributed to the
transformation. The rapid commercialization of the medical practices with the
establishment of multi-million rupee hospitals, nursing homes and diagnostic
centers, specialized and general, the demand has registered a very high growth
rate in the recent years.
The healthcare sector is one of the most challenging and fastest growing
sectors in India. Revenues from the healthcare sector account for 5.2 per cent
of the GDP, making it the third largest growth segment in India. The healthcare
industry in the country, which comprises hospital and allied sectors, is
projected to grow 23 per cent per annum. According to McKinsey & Co. a
leading industrial and management consulting organization, the Indian
healthcare sector, including pharmaceutical, diagnostics and hospital services,
is expected to more than double its revenues to Rs 2000 billion by 2010.
Expenditure on healthcare services, including diagnostics, hospital occupancy
and outpatient consulting, the largest component of this spend is expected to
grow more than 125% to Rs 1560 billion by 2012 from Rs 690 billion now.
The sector has registered a growth of 9.3 per cent between 2000-2009,
comparable to the sectoral growth rate of other emerging economies such as
China, Brazil and Mexico. According to the report, the growth in the sector
would be driven by healthcare facilities, private and public sector, medical
diagnostic and pathology labs and the medical insurance sector.

51

Healthcare facilities, inclusive of public and private hospitals, the core

sector, around which the healthcare sector is centered, would continue to
contribute over 70 per cent of the total sector and touch a figure of US$ 54.7
billion by 2012. Adds a FICCI-Ernst and Young report, India needs an
investment of US$ 14.4 billion in the healthcare sector by 2025, to increase its
bed density to at least two per thousand populations.
The growth in the healthcare services in the country is driven by the
350-million strong middle class aspiring for quality health care services and
increased international confidence on India as a potential, high quality & low
cost medical tourism destination. According to the WHO report, India needs to
add 80,000 hospital beds each year for the next five years to meet the demands
of its growing population.
The

Indian

healthcare

industry,

unlike

other

industries,

stands

untouched by recession. There had been a steady growth in this sector,

revenues from the healthcare sector accounts for 5.2% of the GDP, making it
the third largest growing sector in India, and further the healthcare sector is
projected to grow to nearly 1,80,000 crores by year 2012 and a compounded
annual growth rate (CAGR) of 15-17 percent for at least the next 7-10 years.
High quality talent pool, proven track record, favourable government
policies,

ability to deliver healthcare services at low cost and high quality

infrastructure has put India into global map for outsourcing various healthcare
related services. This has been further intensified by Government of Indias
recent budget declarations, where enough emphasis has been given on setting
up of healthcare delivery infrastructure mainly in Tier I & Tire II cities. In
view of the above, Indian healthcare delivery Industry is upbeat about the
future of hospitals in the country.

52

53

Healthcare Sector Over View And Trends

Indian Healthcare Sector structure / Market size
The sector comprises hospital and allied sectors that include:
(a.)

Medical care providers that includes physicians, specialist clinics,

nursing homes and hospitals

(b.)

Diagnostic service centers and pathology laboratories

(c.)Medical equipment manufacturers

(d.)

Contract

research

organizations

and

pharmaceutical

manufacturers
(e.)Third party support service providers
In India, 80% of all the healthcare expenditure is borne by the patients.
Expenditure borne by the state is 12%. The expenditure covered by insurance
claims is 3%. As a result the price sensitivity is quite high. The high level
healthcare facilities are out of reach for the patients.
Among the top five therapeutic segments, gastro-intestinal and cardiac
are

experiencing

both

high

volume

and

value

growth.

Opthologicals,

cardiovascular, anti-diabetic and neurological drugs continue to top the growth

list. The anti-infective, neurology, cardiovascular and anti-diabetic segments
have witnessed a high number of new product launches in recent years.
Current Healthcare Landscape
Amount spent on healthcare - 103,000 crores / annum
86,000 crores is the Healthcare delivery market
17,000 crores is the Retail pharma market
Private spending on healthcare delivery 69,000 crores,61 % of this is
spent on OPD services, 44,000 crores Indicates low levels of affordability and a
disease pattern dominated by infections

54

39 % on IPD services = 25,000 crores

85 % of IPD spend is in 5 areas : cardio, cancer, accidents, infections and
maternity

Road Ahead 2020

Private spending on healthcare delivery 156,000 crores because of an
increase in population will lead to increase treatments. Change in socioeconomic mix will lead to 8 % increase in treatment rate and 30 % increase in
avg. price paid. Change in prices 26 % increase in price per treatment.
Change in mix of diseases 50 % increase in prevalence of lifestyle diseases
will lead to 12% increase in treatment rate & 7 % in price and this would lead
to a change in GDP from 5.2%to 6.2%
Private spending would increase by another 39,000 crores if the
insurance is likely to impact on middle-income households approx. 350 million
in 2020, leading to achieving GDP spending to 7.5% and private spending on
healthcare delivery to 195,000 cr.
Healthcare Fact File

Parameters

Current

By 2020

No. Of Beds

1.2 beds per 1000

9,14,543 In addition

No. Of Doctors

50,00,000 doctors

6,25,130 In addition

No. Of Nurses

0.8 per 1000

8,36,000 In addition

Infant Mortality Rate

34:1000

10:1000

Maternal Mortality Rate

4:1000

1 :1000

% of population Insured

12.00%

50.00%

Total Private Spending

69,000 Crores

156,000 Crores

OPD Spending

44,000 Crores

82,000 Crores

55

Hospitals

30,000 hospitals approx

17300 In addition

Primary Health Centres /

Community Health Centres

1,50,000 approx

1,64,000 In addition

Retails chemist outlets

3,50,000

24,000 In addition

Medical Colleges

229

179 New

Estd Current mrkt size

103,000 Crores

1,80,000 Crores

Average life Expectancy

63.3 years

74 years

Investments plan in Healthcare:

The sector has been attracting huge investments from domestic players
as well as financial investors and private equity (PE) firms. Funds such as ICICI
Ventures, IFC, Ashmore and Apax Partners invested about US$ 450 million in
the first six months of 2008-09 compared with US$ 125 million in the same
period a year ago, according to an analysis carried out by Feedback Ventures.
Feedback Ventures expects PE funds to invest at least US$ 1 billion in the
healthcare sector in the next five years.
According to a Venture Intelligence study, 12 per cent of the US$ 77
million venture capital investments in the July-September 2009 quarter were in
the healthcare sector. As part of its Healthy imagination initiative, GE will
spend US$ 3 billion over the next six years on research and development,
provide US $2 billion of financing over the next six years to drive healthcare
information technology and health in rural and under served areas, and invest
US$ 1 billion in partnerships, content and services.
The government, along with participation from the private sector, is
planning to invest US$ 1 billion to US $2 billion in an effort to make India one
of the top five global pharmaceutical innovation hubs by 2020.

56

The Ajay Piramal Group-owned private equity (PE) firm, India Venture
Advisers, will launch its second US$ 150 million healthcare fund next year.
Leading international clinic chain Asklepios International is gearing up for a
foray into the Indian healthcare market. As part of the 2.3 billion euro groups
strategy to enter the sub-continent, Asklepios is mulling the launch of a US$
100 to US$ 200 million fund. Gulf-based healthcare group Dr. Moopen is
investing over US$ 200 million for setting up hospitals and eye-care centers
across India. Healthcare major, Fortis Hospitals plans to invest US$ 55 million,
to expand its facilities pan-India.

57

Competitive Scenario:
There are few hospitals viz, R.K. Mission Hospital, Ganga, Niba Clinic,
Papunallah in the surrounding area along with primary health centers,
community health centers, sub-centers, FRUs along with General hospital at
Naharlagun. However, Heema Hospital being the multi-specialty hospital has a
cutting edge over others due to its latest equipments, best available talents,
strategic location, easy approach and state of art of facilities for the patients.
There are certain private providers along with Ayurveda and Homeopathy
practitioners but none of them provide the comprehensive range of services.
Hence this effort of providing all services under one roof is envisaged.

58

Market Outlook
With Pharmaceuticals and hospital services accounting for 75% of the
total healthcare market against a backdrop of rising population, increasing
middle class, low production costs, social and economic progress, and need for
better infrastructure and services, many FDI opportunities exists for:
Hospitals, Medical Tourism, Pharmaceuticals, Biotechnologies, Medical Devices
and Health Insurance.
Driving the development of the market will be mostly the private sector,
not the public sector. Currently, private sector contributes 75% to the total
market and will likely continue to in the long term.
Indias public health management too premature compared to most
countries standards,

often characterized

by resource crunch, political

interference, inflexibility and other bureaucratic roadblocks.

With some 70% of the population residing in the rural areas, much of the
development will be invested heavily in rural medical infrastructure, including
the quality of medical education institutions.
The private sector players who will survive in this market are those who
provide affordable and quality healthcare. Although the middle class is
growing, the majority of the population still cannot afford health insurance to
help cover medical expenses. Consequently, price sensitivity is still quite high
and the high-level healthcare facilities are not in the reach of many.
Proposed venture is the outcome of the foresighted efforts initiated by the
proprietor for initiating to expand capacitative and functional units of the
existing

multi-specialty

hospital.

Envisaged

project

is

under

the

able

patronization of Mrs Byabang Yaji.

Arunachal Pradesh as a whole is witnessing fast growth on the economic
front due to several multi-crores projects being undertaken at various level and

59

locations. These business developments have far reaching impact on the lifestyle, psyche, and aesthetic sense of the people of the State. Their aspirations,
expectations and demands have changed significantly due to increased and
continuous interaction with the mainstream people thronging within the State
in connection with their businesses or otherwise for tourism purposes. It has
created several investment avenues for the aspiring entrepreneurs of the State.
Its strategic location offers easy access to the consumers as it is situated
in the heart of capital complex, whereby all types of business activities,
shopping complexes and office complexes are coming up. Place witnesses
tremendous population growth due to continuously increasing growth of
commercial activities within the near vicinity of the administrative office of the
unit.
Considering the overall scenario with a keen approach towards
profitability and cost reduction factor the unit is satisfactorily catering to the
potential needs of the consumers of the State and would continue to do so in
the near future as well.
Gradual diversification with a well balanced approach towards horizontal
growth along with vertical growth have been envisaged and adequately reflected
in the project proposal.

60

Service Factor & Employment Generation:India faces a huge need gap in terms of availability of number of hospital
beds per 1000 population. With a world average of 3.96 hospital beds per 1000
population India stands just a little over 1.2 hospital beds per 1000 population.
Moreover, India faces a shortage of doctors, nurses and paramedics that are
needed to propel the growing healthcare industry. India is now looking at
establishing academic medical centers (AMCs) for the delivery of higher quality
care with leading examples of The Manipal Group & All India Institute of
Medical Sciences (AIIMS) already in place.
A recent survey conducted by HarNeedi.com, gives an out look on the
roles that are in great demand, Specialist doctors such as, Cardiologists,
Cardiothoracic surgeons, Interventional Cardiologists, Orthopedics, Emergency
Medicine Specialists, Oncologists, Radiologists, Ophthalmologists, Neurologists,
Neurosurgeons, Gynecologists, Urologists, Duty doctors etc are in great
demand. Some of the other profiles that are in great demand are that of
experienced nurses and technicians who can handle various specialties such
as ICUs, Cath labs, Operation Theaters, Emergency Departments etc.
Technicians, like Radiographers, CT Technician, Radiotherapy technicians,
emergency medical technicians etc. are also in great demand. Considering all
the above facts and the massive growth in the healthcare industry, huge
investments would offer several opportunities for Indian entrepreneurs to
create 'win-win' situations and there would be emerging opportunities for
professionals as well in the near future.
Lack of educational awareness and resulting constricted employment
opportunity has confined the opportunity among the youth as Government
service and supply contractor to various Government departments. This

61

vicious circle is creating a heavy burden on the Government to cater to the

employment needs of the state.
Since austerity measures proclaimed by Ministry of Finance has banned
further post creation in Government departments, it is further aggravating the
employment scenario in the state.
In the present situation worst sufferers are the poor and marginally educated
populace of the region who are neither qualified enough nor have enough
capital to set up their own business.
The unit is effectively catering to their needs as it provides balanced
opportunities to professionals as well as lesser qualified persons a job
opportunity within the State and to cater to their financial needs.
During its first year of operation it would be providing direct employment
opportunity to 6 persons which will further rise with increased business
activities.

62

CHAPTER IV
PROPRIETOR
GENERAL BACKGROUND:The proposed expansion project has been envisaged to be operated by a
dynamic and overtly recognized person Mrs Byabang Yaji W/o Late Byabang
Heri. She is 1948 born and is having ample business experience in different
sectors including medical sector as well. Her son Dr. Byabang Rana is a
medical practioner himself and is providing her active logical as well as
administrative support in successfully running the present business venture of
Heema Hospital. Her father Late Takam Lotak was a famous priest of the entire
Nyishi community of that time from very young age.
She is an enterprising lady. She has started her first business venture in
fishery farming. Later she has started the first hotel in the Palin Area in early
70s.

She

also

started

horticulture

&

Agriculture

farming

&

earned

considerable money out of it. In the early 80s she started another venture in
video cinema hall and chain of eateries in and around palin area.
With her hard earned income she educated her sons & daughters, all of
whom are well placed in different walks of life. Eldest son Dr. Byabang Rana is
a leading & prominent medical practioner of the State of Arunachal Pradesh.
He is a doctor with successful service experience and is associated in honorary
capacity with one of the leading multi-specialty Hospital of the State Heema
Hospital which has witnessed phenomenal rise under his able guidance. It
can well be witnessed from the fact that though it came in to existence in early
1990s but today it can boast of having largest professional team in the local

63

healthcare industry, with highest number of doctors & trained professionals

working in one single Hospital.
With vision set on the 5-10 years, Mrs Byabang Yaji and her team of
professionals have entered into professional and contractual agreement with
several companies and Govt. undertakings for rendering the health services to
their employees and dependents.
She had been associated with more than 12 NGOs in various capacities
and had taken lead role regularly towards the welfare activities in Health,
Education & Social Awareness Camps in and outside Arunachal Pradesh.
His initiatives in theses sectors are as follows:
Conducted several Eye/Tubectomy/First Aid/Blood donation
camps in remotest places of various districts of Arunachal
Pradesh.
Donated and participated in several Blood donation Camps
organized by APYC(I) & RKM Hospital.
For commercial prudence, the project has been envisaged as a
proprietary concern under direct command of Mrs Byabang Yaji who has
adequate experience in this sector.
The project envisages having sufficient cushion for accommodating
professionals and able candidates on its pay roll for further expansion and
effective running of the concern.

64

CHAPTER V
SWOT ANALYSIS
A.Strengths:
a. Promoter has rich experience of healthcare sector working experience to
lead the unit successfully utilizing her commercial prudence.

b. Promoter is already associates with the healthcare sector for more than
20 years, thus have knowledge of ground realities of the business.

c. Her diversified business connections would be instrumental in successful

operation and widening of its consumer base.

d.Her

sons professional qualification as a doctor would be an added

leverage for the concern for hiring best suited talents for the firm.

e. Being a closely

held concern, its close monitoring and compliances can

easily be secured.

f. With the recent recognition by Govt. of Arunachal Pradesh as a referral

Hospital under CGHS Rule for their employees and dependents, the
hospital would have definite increase in its consumer base for their
healthcare solution requirements.

g. Being

resident of Arunachal Pradesh, promoter is exempted from the

Income Tax liabilities and it would have significant impact on the

ultimate cash flow of the unit.

B.Weaknesses
a. The project

requires heavy capital expenditure to create necessary

infrastructural facilities.

b. Medicines and supplies requirements have to be fulfilled from outside the

State, thus posing transportation bottlenecks and added cost to the
concern.

c. It

is difficult to find well trained staff members required for successful

running of the concern.

65

C.Opportunities
a. Presently there

are no major hospital units posing any serious

competitive threat to the Hospital, thus facilitating an easy entry to

broaden its consumer base and expansion opportunity.

b. Being

located within the State would be an added leverage for infusing

consumer confidence.

c. Promoter

being the Office-bearer of several Association and public

organisations, enjoys wide ranging business connections and it would be

instrumental in broadening the consumer base for the hospital.

d.With 360 degree healthcare interests, promoter has a bouquet of range of

services to offer to its clients.

D.Threats
a. Social and civil unrest may hamper the growth of the industry as a whole
and thereby affecting the unit.

b. Changes in Govt. policies might have an adverse impact. But this seems
to be a remote possibility as requirement for this particular industry is
omnipresent in all walks of life.

c. Timely availability of medicines & supplies could pose a serious threat to

the unit as all major inputs are to be procured from outside the State.

d. Erratic power supplies within the capital complex could have impact on
the functioning of the unit, though the firm has kept proposal for a heavy
duty Gen-set for such aberrations but it would add to the costing of the
product and ultimate profitability of the unit.

e. Reported

interests shown by major corporate units to enter the

Arunachal healthcare market, due to high-growth rate vis--vis other

parts of NE India might pose a challenge for the late entrants in the
business.

66

67

CHAPTER VI
MAJOR ASSUMPTIONS
(i) Interest has been calculated @12.5% on the term loan component of the
project financing.
(ii) Depreciation has been calculated on the basis of estimated useful life of
the asset concerned.
(iii)
No provision has been made for income tax as the Promoter, being
resident of Arunachal Pradesh is exempted from the income Tax liabilities
u/s 10(26) of the Income Tax Act, 1961.
(iv)Cost of Plant & Machinery has been calculated as per the quotation of
the supplier of the same. Misc. items included in the Plant & machinery,
forming a negligible proportion to the total cost under the head has been
worked on the basis of prevailing market price which may vary slightly at
the time of actual purchases.
(v) Cost of furniture & fixtures have been worked out as per the prevailing
market rates.
(vi)Cost of office equipments have been taken as per their prevailing market
rates.
(vii)
Other assets which forms a small fraction of total capital cost have
been taken as per the prevailing market rates.
(viii)
Capacity utilization for different years have been taken using
conservative approach of moderate figure of 45% for the first year with
annual projected growth of 5% in the subsequent years.
(ix)Similarly, capacity utilization of CT-Scan facility have been taken as 25%
in the first year with 5% annual growth in subsequent years.
(x) 10% increment have been envisaged for rates in the initial years while 5%
have been projected from 5th year onwards.
(xi)Consumption rates and ratios have been worked out as per the prevailing
industry standards for the unit of similar size and capacity.
(xii)
For CT-Scan, direct expenses have been worked out @10% of the
total revenue earned which is comparable with the prevailing industry
standards.
(xiii)
Consumables have been worked out @ 5% of total direct expenses
incurred.
(xiv)
Power consumption have been worked out as per prevailing
industry rates for the similar units.

68

CHAPTER VII
PROJECT COST AND PROPOSED MEANS OF FINANCE.
The total cost of the project has been estimated at Rs 577.30 Lakhs, the details of
which has been given below:Cost in Rs lakhs
Land
Building and Others
Plant and Machinery
Furniture & Fixture
Office Equipments
Other Assets
Preliminary and
Pre-operative Expenses
Margin Money for Working Capital

:
:
:
:
:
:

NIL
0.00
174.00
0.00
8.03
0.00

:
:

15.97
2.00

Total

200.00

The proprietor is having its administrative office located in the existing

hospital building at O Point Tinali, Itanagar and it is sufficiently spaced to
accommodate administrative office of the proposed unit as well.
The location is within the walking distance from the various academic
and Government offices situated nearby, viz, Arunachal Pradesh State
Assembly and Govt. Higher Secondary etc. Thus, it is located at an ideal
strategic location from Commercial opportunity point of view.
Provision for plant and machinery amounting Rs. 182.03 lakhs have
already been kept by the proprietor for facilitating the inclusion of CT-Scan
Machine & allied equipments for smooth functioning of the unit. Its details as
to number and individual cost per unit have been attached as Annexure-III.

69

The total cost on furniture & fixtures required under the project have
been kept basically to serve the commercial needs of the project as well as
administrative need of the promoter.
The main items of Pre-operative expenses are the interest payable during
the construction period along with administrative and other misc. expenses
estimated to be incurred during the construction period. It includes Recurring
expenses during construction period viz, Traveling & other Expenses incurred
for procurements & other Works, Project Preparation cost and miscellaneous
expenses amounting Rs. 15.97 Lakhs, the details of which are given in
Annexure I(a).
Provision of Rs 2.00 lakhs have been kept for working Capital which will
be the core working capital and will remain floating in the business
permanently as investment in stock, debtors etc.
The proposed means of finance of the project is as below:_
Promoters contribution Rs 40.00 lakhs.
Long Term Loan

Rs 160.00 lakhs

The debt equity ratio will be 4:1 and percentage of promoters

contribution with the project cost is 20% appears to be reasonable considering
the background of the project and the entrepreneur being first generation
businessperson with wide range of experience and expertise in running the
hospital successfully and profitably since 1991. Considering the financial
details it can reasonably be expected that the promoter will be able to recover
debt component of the project amounting Rs. 160.00 lakhs in 3 years 3 months
of the operation for the unit operating as standalone.

70

CHAPTER VIII
COST OF PRODUCTION AND PROFITABILITY
The detailed estimate of cost of production and proftability from its
activities are given in Annexure XIII. The statement of total revenue is given is
in Annexure XI.

Income estimations from Professional Fee, incidental

common services and miscellaneous income have been given in Annexure

VIII, While detailed computation of direct expenses components have been
given in Annexure-IX.

Capacity utilizations for the proposed unit of the

hospital has been worked out with reasonable vertical growth of 50% in the
first year with average annual increment of 5%. Similary, for CT-Scan it has
been worked out as 25% of installed capacity utilization in the first year and
5% annual increment have been envisaged onwards. Rates have been estimated
keeping in view competitive aspect as well as prevailing market condition.
The total manpower requirement is 6 persons in the first year of its
operation and the detail calculation of salary and wages is given is Annexure
XVI. Adequate increment for wages of employees has been envisaged for every
year based on the expected business volume. The total power requirement and
the administrative & miscellaneous expenses have been considered adequately.
The interest of long term loan has been considered @ 12.50% per annum.
The repayment of the term loan will be in Five years with a moratorium of 6
months. The detailed calculation is given in Annexure XIX(a).
The rate of interest for long term investment and deposits has been
considered @ 6.5% per annum. The detailed calculation is given in Annexure
XXIV.

71

The depreciation has been calculated in written down method and the
detailed calculation is given in Annexure XII.

72

CHAPTER IX
SOME FINANCIAL INDICATORS AND SCHEDULE OF
IMPLEMENTATION
From the calculation of cost of production and profitability, debt service
coverage ratio, break even point analysis, cash flow statement and pay back
period it appears that the project is economically viable and the unit will be in
a position to generate projected revenue and expected profits without any
trouble.
A)

Debt Equity ratio

4:1

Thus envisaging that while calculating the financial requirement

sufficient cushion have been left for utilizing the business leverage in future.
B)

Percentage of promoters contribution

With project cost

20%

Some of the important financial indicators of the proposed firm are given
below:(d) Debt Service Coverage Ratio

Maximum
Minimum
Average
(e) Break Even Point ( Sales)

1.52

1.02

1.23

38.57

:
:

30.33

3 years 3 months

Safety Margin available

in first year of operation

(f) Pay Back Period

(g) Cash Surplus at the
end of last year of projection

:
64.00Lakhs

:
:
:

73

Break even analyses have been calculated on the basis of its operation
during the projected 3rd financial year thus choosing the middle year of its
operation. It is further calculated that the total safety margin available during
its first year of operation is Rs. 30.33 lakhs, thus leaving a sufficient margin for
the unforeseen eventualities.
Promoter is leveraging major project cost component through Bank
finances so as to infuse financial discipline in the expansion of the project and
make it a viable proposition. Break Even Analysis envisages sufficient sales
cushion even in the first year of operation for the project to endure fluctuations
in the market. While calculating the financial requirement sufficient cushion
have been left for utilizing the business leverage in future.

74

It is expected that the unit will be commissioned within 4 months if the

firm can arrange the required fund in time. The implementation schedule has
been worked out for the project as below:-

Sl.No.
1.

Activities
Completion

Commencement

Submission of loan application to the

Financial institution after preparation
of project of project report.
1st Week, Aug 2014

2nd Week, Aug 2014

2.

Sanction of financial assistance

2nd Week Aug, 2014

3rd Week Aug, 2014

3.

Disbursement of loan

1st Week Sept, 2014

2nd Week Sept, 2014

4.

Arrangement of land

5.

Construction/Deco. of building

6.

Acquisition of Plant & Machinery and

miscellaneous fixed assets
2nd Week Sept, 2014

7.

Already arranged
Already existing

Commissioning/Inauguration

1st week Nov, 2014

75

2nd Week Oct, 2014