ESME PROJECT REPORT On Mobile Hospital with Operation Theatre in Rural Areas (HOSPITALS ON WHEELS) A Project Report Submitted In Partial Fulfilment of the Requirements For The Award of the Degree of POST GRADUATE DIPLOMA IN MANAGEMENT TO M.S.RAMAIAH INSTITUTE OF MANAGEMENTBhasvanth Sirasanagandla (101211) Bibhu Shankar Panda (101212) Romain Biswal (101238) Pradhyumn Singh Rathod (101232) Subhra Prasanna Sarkar (101249) PGDM (AUTONOMOUS) BATCH

BY

Under the guidance Prof. G.R Manjunath M.Sc, MBA (IIM A) M.S.RAMAIAH INSTITUTE MANAGEMENT

of

NEW BEL ROAD, BANGALORE-560054

INTRODUCTION:India has made rapid strides in the health sector since independence. However, various eye opening data from NFHS clearly indicate that access to healthcare still remains a challenge. While the health statistics of rural India continue to be poor, the health status and access to health services of urban slum dwellers on the other has also surfaced to be equally deplorable. Despite accounting for 1/4th of the countrys poor population, urban areas have less than 4% of government primary health care facilities. Urban slum dwellers suffer from adverse health conditions owing to mainly two reasons first the lack of education and thus lack of awareness; and second the unwillingness to lose a days wage in order to reach the nearest medical facility. The neglect in even the simplest preventive medical treatment usually leads to a more serious ailment and eventually into deaths. The need of the hour is thus a two pronged approach first to bring quality health care services to doorsteps of the needy and second to promote healthcare awareness and contemporary health care services seeking behavior among the underprivileged. In such a scenario a mobile medical services delivery system is the most practical mechanism. And in subscription to this view, we will initiate the Hospitals on Wheels programme. This is a unique mobile hospital programme that seeks to address problems of mobility, accessibility and availability of primary health care with a special focus on children and women, in urban slums and remote rural areas. It is essentially a compact mobile all service field trauma unit for routine treatment of common field medical requirements & emergencies. It has a comprehensive range of life support systems to save organs and maintain organ functions. The medical equipments and support systems are part of an integrated design and the modularity of the unit enables quick set up for functioning in the field. The open architecture enables us to customize the unit to our clients requirements for efficient usage.

OUR INITIATIVE: HOSPITALS ON WHEELSMobility is extremely important in healthcare. In villages where a proper hospital is miles away - and the one which might be close by, like the government hospital, is almost always without any staff - health care always takes a back seat. This programme is a step to address that issue. In this programme, the mobile hospital which has all the services required for basic health care, especially for women, goes from village to village and gives the underprivileged the health care which they need but cannot afford. Under this programme, eight vans travel the roads of each of outlined villages, covering more than 25 km and two-three villages on rotation basis, rendering health care free. The vans, painted bright green and yellow with happy faces of children, are laden with all the necessary equipments and services like an X-ray machine, ECG machine, basic pathological services for blood and urine test, ante-natal and post-natal services and an out-patient department for common ailments. The staff also distributes condoms and oral contraceptive pills and lay emphasis on family planning. Iron folic tablets, especially for women, a majority of whom are anemic, are distributed as well.

OBJECTIVE: Help the health care system to reach the remote areas serving primarily the underprivileged and economically backward communities. Generation of research data on health profile will help to understand the long-term preventive action. Direct benefits of the project include the curative and diagnostic treatments for the patients. Serve as a unique model to be replicated in other parts of the country, which severely lack the basic health care services.

PROJECT COMPONENTS: DIAGNOSTIC FACILITIES Quick, on the spot. CURATIVE Prescription and on the spot dispensing of medicines for common ailments and referral to hospitals for other cases DATA COLLECTION & ANALYSIS ON HEALTH PROFILES. EDUCATIONAL AND HEALTH AWARENESS PROGRAMS.

PRODUCT ATTRIBUTE : Some design and views of our proposed work:

ELEMENTS OF THE MOBILE HOSPITAL:What is new in the approach: It is essentially a compact mobile all service field trauma unit for routine treatment of common field medical requirements & emergencies. It has a comprehensive range of life support systems to save organs and maintain organ functions. The medical equipments and support systems are part of an integrated design and the modularity of the unit enables quick set up for functioning in the field. The open architecture enables us to customize the unit to our clients requirements for efficient usage.

VAN HIGHLIGHT Air Conditioner 15 KVA DG set with acoustics and mains panel 20 TV, DVD player & LCD projector with portable projector screen Laptop Think-pad 2659 with printer & web-camera Refrigerator, PA system with cordless microphones with receiving stations, roof

mounted speakers, tape deck with 4 internal speakers, Weighing machines, Water pump, intercom system with 4 handsets & 2 speaker phones, Hot plate, Neubauers chamber, Haemocytometer, Emergency lights

Thermo-insulated walls ensure even temperature distribution. Drainage allows easy cleaning of interiors. Special minimal heat and power saving lighting ensures even and bright illumination. Stainless steel & fiberglass interiors ensure easy sterilization. The units have their own roof top water storage tanks as well as external supply ducts. Hot water production facility. Aircraft type overhead Storage spaces.

SPECIFICATION OF THE MOBILE VANThe vehicle used would be a modified Eisher Canter/ Swaraj Mazda or equivalent with the following dimension, Excluding Driver cabin

LengthWidth Height Engine Power Wheels Medical Structure:

18 feet without drivers cabin 6.5 Ft 6.25 Ft 23 Kgm or greater 6(4 Rear 2 Front) Box type for better space utilization.

DIAGNOSTICS: 2.5 KW HF X ray generator with Vetrix 1 column with chest stand dark room

accessories. Automatic film Processor. Multichannel ECG. Semi automatic chemistry Analyzer. Binocular microscope. Ophthalmoscope, otoscope & streak battery retinoscope. Ultrasound scanner with 1 no. 3.5 MHz convex transducer w 12 monochrome monitor

and thermal printer. Miscellaneous items like Stethoscope, Laryngoscope, and Laboratory centrifuge, BP

apparatus, Hot air Oven, Water bath, pH meter, Manual needle cutter.

SPECIFICATION ON THE BASIS OF OT UNIT : O.T. Table Hydraulic. Shadow less lamp.

Suction Machine. Oxygen Cylinder. Wash basin. Defibrillators.

Generator with A/C connection. X-Ray machine (70mA). Auto Analyzer. Boyles Apparatus.

ECG Machine. Ultrasound Machine. Instruments for Minor O.T.

Specification on the basis of Medical Furniture & Other Equipments Doctors table with chair.

Compounder table with Chair. Registration counter. Wall mounted shelves for surgical instruments. Wall mounted shelves for medications. Wall mounted shelves for consumables. Wall mounts for instruments. Steel/ Antistatic vinyl non-checkered flooring.

Floor drainage. Flush mounted fluorescent roof lights. Wall mounted Intercom. X-ray view box. Dedicated shelves for storage of instruments and miscellaneous items. Needle & sharps destroyer. Dedicated bin for storage of used consumables and linen. Dedicated bin for soiled linen for laundry. Overhead angular lockers. Hand drier jet with infrared arrangement. Tent Storage compartment. Generator Compartment with sound less generator.

Specification on the basis of Investigation & RadiologySupport equipments

X-ray machine. Optimax film processor-1(Optional) Light safe cassette passbook. Multipanel x-ray illuminators. Loading cum storing tables. Auto analyzer.

THIS MOBILE CLINIC HAS THE SPECIAL FEATURES: The mobile clinic will be developed on Tata chasis 1512 with rear air suspension. The

entire mobile clinic runs on 12.5 KVA sound proof and vibrations proof generator, however in case of availability of power alternate arrangements have been also made. Onboard facilities of X-Ray, Ultrasound, Lab and ECG along with dispensing. The X-Ray equipment is capable of doing X-Rays of almost all parts of the body specially X-Ray chest in diagnosing and monitoring cases of pulmonary tuberculosis, rampant in Uttaranchal. The fully developed dried films are available in 3 minutes time avoiding all the hassles of wet films. The provision of state-of-the-art ultrasound helps tremendously in the diagnosis of diseases of large number of female population having no access to modern medical technology. The pathology lab besides doing routine blood, urine tests is being provided with semi automatic analyzer capable of doing almost all the blood biochemistry i.e. sugar, cholesterol, urea, lipid profile etc. Availability of ECG machine helps to evaluate patients suffering from various heart ailments. The mobile clinic is supported by a team of Doctors (Lady M.O., Physician and Radiologist), Paramedics (X-Ray, Lab, ECG technicians, Pharmacist), drivers and multiutility worker. The vehicle has provisions to impart health education through audiovisual facilities. It is also integrated with the national preventive health programs including mass immunization so that large number of population in far-flung remote areas is benefited. One Qualis van supports the mobile hospital for carrying the staff.

The medical data including the patients registration is being fully computerized so as to generate medical profile of hitherto inaccessible terrain thus providing a great input to the planners for future projections. Every month, 15 camps are held on predetermined dates (irrespective of Holiday/Sunday) and the same place is visited once a month on same date.

A patient (including BPL category) is required to register by paying a nominal fee of Rs.10/- (Ten only), which is valid for two visits. The people who have been issued Below Poverty Line (BPL) ration cards by Govt. of

Uttaranchal are being offered all facilities free of cost (Consultation, Ultrasound, X-Ray, Lab, ECG and Medicines), the people above poverty line are being nominally charged. Free medicines are also provided to people BPL. During the transit from one place to another, the arrangements for rest houses for

comfortable stay of the Medical team.

SEGMENTATION:Segmentation refers to making clusters of customers who shares similar interest within a cluster. So we are basically focused on the Rural Areas and Semi Urban Areas where nearness of hospital is a big problem.

TARGET MARKET:Initially we target the rural areas of Karnataka namely

Abachikkanahalli Abbanakuppe,Bangalore Rural Abbur, Bangalore Rural Achalu (Kanakapura) Achalu (Ramanagaram) Acharlahalli Adakamaranahalli, Bangalore Rural Adakavala Akkur, Ramanagaram Budigere Byalalu Dandupalya

Kannamangala Karepura Kodihalli, Kanakapura Kudur Mallur, Karnataka Megalapalya Thyamagondlu

These are the Villages under Rural Karnataka where the convenience of medical facility is very poor, so to provide proper medical facility to the people of all these areas we have 8 well equipped mobile hospitals with operation theatre as we have mentioned in the product attributes. The process is controlled by our Medical unit located in Bangalore City and we have several branches in some of these areas for easy operation.

ROUTES:The routes for the Mobile Hospital were finalized in consultation with the Government of Karnataka. The Mobile Hospital is expected to follow two routes/ circuits in one month with fixed schedule and camps.

DISEASE PROFILE: The data collected is based on gender, age, seasons and variouscampsites/ districts. The data collected is now in process of getting analyzed so as to provide an input to the planners to design an effective mobile plan. Most common Diseases in Rural Area:

Acute Peptic Ulcer. Anemia. Ante Natal Check up. Chronic Obstructive Pulmonary Disease. Hypertension. Pelvic Inflammatory Disease. Pulmonary Kochs. Renal Calculi. Upper Respiratory tract infection. Worm infestation.

INVESTMENT PARTICULARSMobile Vans(8 @ Rs. 20,00,000) Equipments(8 vans @ Rs. 9,00,000) Office Premises(19 villages @ Rs.2,00,000) TOTAL

AMOUNT(Rs.)Rs. 1,60,00,000 Rs. 72,00,000 Rs. 3,800,000 Rs. 2,70,00,000

PRICINGWe are planning to charge the least possible cost for the treatment of the people of the Rural Areas by having an eye on their economic condition and according to their affordability and also we are providing the services to the below poverty line peoples. We want to collect the funds from the public and some SHGs through donations and expecting subsidies and other facilities from Government.

BENEFITSAffordability Proximity to patients Fast service Quality Service Community Development Contributes to the welfare of the rural people.

IMPACT:This system can be run in an economically viable basis even while giving certain concessional rates for the poor. Also it can be a good model of philanthropy-cum-business. A few persons from a geographical area can contribute to the capital cost and some can contribute to the running cost even while bulk of the earning is opted by patient services. Imagine each of the districts is having one such unit by private people alone or through government - private partnerships. Even local governments can adopt it making a few young entrepreneurs and doctors to actually execute and manage. There are several possibilities. There is a great business opportunity for many people