Setting up of Super-specialty /

Multi-specialty Hospitals

Healthcare
Government of Gujarat
Contents

Project Concept 3
Market Potential 5
Growth Drivers 6
Gujarat Competitive Advantage 7
Project Information 8
- Location

- Connectivity

- Manpower

- Key Private Players

Project Financials 10
Approvals & Clearances 11
Key Department Contacts 12

Page 2
Project Concept
Healthcare Industry- An overview

The Indian healthcare industry size was USD 100 b in 2015

While the healthcare sector is expected to expand from USD 160 b in 2017 to USD 280 b by
2020, India lags behind on healthcare outcomes when compared to similar nations (peers)

Gujarat is rapidly developing into a healthcare hub with the favourable Government-led
healthcare initiatives with leading private healthcare groups entering this market

Gujarats health care facilities attend patients from all over the state including neighboring states
of Rajasthan, Maharashtra and the Union territory Daman & Diu

The state has a mix of Private and Public facilities rendering healthcare services across various
specialties and the private sectors market is expected to grow with state adding to the
purchasing power through assurance model of healthcare delivery

There is also a potential for the state to be a pioneer in healthcare tourism

Background

Government of Gujarat (GoG) is contemplating of setting up a multi-specialty hospital on PPP

basis

The private player would be required to design, finance, construct, equip the hospital with
necessary medical and non-medical infrastructures, run and maintain the hospital for the
concession period

Project Facets

Hospital is expected to be developed as per Indian Public Health Standards and minimum
Standards laid down by the National Accreditation Board for Hospitals & Healthcare Providers
(NABH)

It is envisioned to provide health care facilities in selected disciplines

The broad scope of work is to develop a two hundred and fifty (250) bedded Hospital. The
hospital may be developed in a phased manner as agreed in the Concession Agreement

The private partner would design, build, finance, and operate and maintain the hospital during
the concession period, after which the project, all its assets would be transferred to the
concessioning authority free from all liabilities and encumbrances

The scope includes deployment of adequate number and mix of qualified clinical and non-clinical
staff for operation and management of the hospital and providing the health care services

Page 3
Project Concept
Role of Private Party

The private party is expected to construct, equip, staff and

Construction of operate the core and support facilities at the Hospital and get
facility all the relevant approvals

The private partner is expected to construct a two hundred

250 bedded
and fifty (250) bedded hospital as per the IPHS and the
hospital minimum standard laid down by the NABH

Out of the two hundred and fifty (250) beds, at least one
hundred and twenty five (125) beds may be reserved for
Super speciality in relation to cardiology and cardiac surgery
Super specialty and at least such number of beds as may be required to start
operations of the other Super Speciality department (as
identified by the Medical Council of India)

All associated clinical and non-clinical services including

Medical pathology laboratories, emergency units, diagnostics centre,
infrastructure radiology, pharmacy, kitchen, etc. to support the proposed
hospital

Accommodation should be provided for the clinical and non-

Accommodation clinical staff as well as for the attendants of the patients

Pharmacy, ATMs, car parking, telephone booths, e-suvidha

counter / jan suvidha Kendra etc may be permitted with
Support services prior approval in accordance with the provisions of the
Concession. In addition, restaurants, and canteens may be
allowed

Page 4
Market Potential

Per capita healthcare expenditure in India

2015 68.6 Over the 2009-2015 period per

2014 61.9 capita healthcare expenditure
has increased at a CAGR of 5%
2013 61 This is on account of increasing
Year

income, easier access to

2012 58
healthcare facilities and greater
2011 61 awareness

2010 54

0 10 20 30 40 50 60 70 80
Per capita expenditure n USD

Source: India Brand Equity Foundation, Healthcare Sector Report, January 2016

Healthcare sector growth trend in

India During 2008-20, the market is expected
to grow at a CAGR of 16.5 %
Healthcare industry

300 280
size n USD b

250 The total industry size is expected to

200
touch USD 160 billion by 2017 and USD
160
280 billion by 2020
150
81.3
100 As per the Ministry of Health,
100 59.5 68.4 72.8 development of 50 technologies has
45 51.7
50
been targeted in the FY16, for the
0 treatment of disease like Cancer and TB
2008 2009 2010 2011 2012 2014 2015 2017 2020
E F
Year
E: Estimate, F: Forecast, CAGR: Compound annual growth rate
Source: India Brand Equity Foundation, Healthcare Sector Report, January 2016

Health Indicators in Gujarat vis-a-vis India

Total Fertility Rate (SRS 2012) 2.4

2.3
Indicators

Maternal Mortality Rate (SRS 2010-12) 178

122

Infant Mortality Rate (SRS 2013) 40

36

0 50 100 150 200

Infant Mortality Rate Maternal Mortality Rate Total Fertility Rate (SRS
(SRS 2013) (SRS 2010-12) 2012)
India 40 178 2.4
Gujarat 36 122 2.3

India Gujarat

Page 5 Source: Sample Registration System 2013, 2014

Growth Drivers

According to 2011 census, the population of Gujarat was 6.03

1 Favorable crore, at an annual growth rate of 1.9 percent the population by
demographics the end of year 2016 would be 6.63 crore
Rising population and increasing per capital income would lead
to an increase in requirement of healthcare services

As per Public Health Foundation of India (PHFI), traditional

2 Growth in lifestyle
diseases in India are increasingly being replaced by lifestyle
diseases
diseases in the past two decades
High blood pressure, stroke, diabetes, diseases associated with
smoking and drinking are mainly lifestyle diseases

As per Euromonitor, between 2015-2030 period, the Indian

median income per household is expected to increase by 89.8%
3 Rising healthcare
to reach USD 10,073 (in constant 2014 prices) by 2030
consumption by
middle class Rise in income coupled with lifestyle diseases leads to
increasing consumption of healthcare services

The insurance industry intends to increase penetration levels to

5% by the year 2020*
4 Growing With about 360 m policies which are expected to grow at a
penetration of CAGR of 12-15% over the next five years, India has the largest
health insurance life insurance sector*
Gujarat in particular has been focusing on an assurance led
model to increase the purchasing power of the population for
health related services

As per World Health Organisation, the total expenditure on

healthcare in India is about 4.1% of GDP, in which government
5 Private Equity in contribution is less than 1% of GDP
Indian Healthcare
Sector Also the 12th Plan has envisaged rise in healthcare expenditure
to about 2.5% of GDP by the end of 2017 , apparently the private
sector investment is going to play a major role#

Source: *IBEF, Insurance sector of India, 2016

# Kalyani B.G. Private Equity in India: A Special Reference to Healthcare Sector, 2015

Page 6
Gujarat Competitive
Advantage
Highlights from Budget 2016-17
Government of Gujarat has made a provision of INR 8212.05 crore under plan and non plan for
health and family welfare department
A provision of INR 101.37 crore for the construction of 50 Sub-Centres in rural areas,
establishment of 63 Primary Health Centres and 15 community health centres
A provision of INR 12.69 crore to upgrade 32 PHCs to provide higher medical services including
gynaecologist and paediatrician in health centres in Urban areas
A provision of INR 15 crore to provide Haemodialysis centres in 10 hospitals
A provision of INR 100 crore to create Diagnosis Centres, Speciality and Super Speciality hospitals
in remote and needy areas under PPP
A provision of INR 82 crore for expansion of Cancer Hospital, Ahmedabad

Source: Page -14, Government of Gujarat, Details of Budget 2016-17, http://anandibenpatel.com/wp-content/uploads/FM-

Speech-Formatted1.pdf

Actual expenditure in plan & non plan under Family Welfare Linked Health Insurance Plan during
2013-14 was 1.22 crore*
Source: * Annual report 2013-14, department of health and family welfare, Government of India
Health facility summary in Gujarat
2% 2%
Mukhyamantri Amrutam MA & MA
19% Vatsalya Yojana provides tertiary
care treatment to Below Poverty Line
(BPL) population & to the families
having an annual income INR 1.20
lakh or below INR 1.20 lakh per
annum
77% The Sum assured is up to INR
2,00,000/- per family per annum on
a family floater basis
Primary Health Centre Community Health Centre
Sub-District Hospital District Hospital

Source: National health mission, State health society, health & family welfare department, Gujarat

Other Advantages
Flourishing Economy
Gujarat contributes 7.2% of the Nation GDP and shows leadership in many areas of
manufacturing and infrastructure sectors
Gujarats SDP (State Domestic Product) at current price registered a growth of 11% during the
year 2014-15
Source: Statisticstimes

Page 7
Project Information

Location Multiple Locations across Gujarat

Possible locations could be tier II cities e.g.

Rajkot, Vapi, Valsad, Vadodara

Infrastructure Availability & Connectivity

Gujarat is well connected to all major
locations such as Delhi, Mumbai and
other nearby states from where Broad
gauge railway line passes through.
Gujarat is well connected to all major
locations such as Delhi and Mumbai
through Delhi-Mumbai Industrial
Corridor ( DMIC) and neighbouring
states.

Gujarat has an international airport Gujarat has a major seaport in

in Ahmedabad Kandla and around 40 non major
8 domestic airports in Surat seaports.
Vadodara, Rajkot, Bhavnagar,
Junagadh, Jamnagar, Porbandar &
Kachchh which is well connected
with metro cities in India

Page 8
Project Information

Minimum Manpower Requirement for 250-Bedded Hospital

Indicative Minimum Manpower Requirement
Sl. No. Specialists For 250 bedded
1 Medical Specialist 3
2 Surgeon 3
3 Obstetrician & Gynaecologist 4
4 Paediatrician 4
5 Anaesthetist 3
6 Ophthalmologist 2
7 Orthopaedic Surgeon 2
8 Radiologist 2
9 Pathologist 3
10 ENT Specialist 2
11 Dentist 2
12 Medical Officer 15
13 Dermatologist 1
14 Psychiatrist 1
15 Microbiologist 1
16 AYUSH Doctors 1
17 Visiting Doctors (for major operations) 5
18 Nurses & paramedical 201
19 Administrative Staff 21
TOTAL 276
Source: Indian public health standards, guidelines for district hospitals, revised 2012

Key Private Players in Gujarat

HCG Hospitals Zydus Hospitals Sterling Hospitals

Indus Health plus Bankers Heart Institute Narayana Hrudayalaya

Charusat Hospitals Global Hospitals Apollo Hospitals

Page 9
Project Financials

The estimated cost of setting up of a new super-specialty hospital is approximately INR 135.1
crore

Area in sq.
Description of Work Rate INR crore
meter

Land cost would vary depending on the size and location of the site. Approximate land requirement
for the project would be around 10 acre

Civil Works:
Area requirement for 250 bedded hospital, minimum
required area per bed (1,076 sq ft. per bed for all
hospitals)* Therefore built up area requirement is
25,000 sq meter 25000 25000 62.5
Rate @ INR 25,000/ sq meter,
(Escalated rate for Hospital, RCC framed structure
upto 6 storeys from INR 23,500/ sq meter, Plinth Area
Rates-2012 Central PWD, Government of India)

Plant & Machinery/ Engineering Services 24.0

Medical Equipment 26.0

Medical & Non Medical Furniture, Signage etc 5.0

Ambulance & Automobiles 0.6

Site Development 40460 1200 4.8

Total 122.9

Contingency @ 10% 12.2

Total Project Cost 135.1

Estimated annual Human resource cost 11.06

Source: * http://dda.org.in/planning/docs/13_Social_Infrastructure.pdf

Number of Beds 250

No of OPD Rooms 15

Number of Operation Theatres Minor: 3 Major: 6

Estimated Project Cost ~146.5 crore

Note: Above cost is indicative and may vary subject to the scale and facilities in the Project.

Page 10
Approvals & Clearances

Approvals

Minimum Standards & Accreditation

While undertaking the development of the Project, the private party shall adhere to the latest
amended National Building Code of India, other relevant IS Codes and practices, Development
Control Rules, FAR Limits, statutory requirements, guidelines and approvals of the Nodal
Agency, Applicable Laws of land, the principles of Good Industry Practices, the IPHS and the
minimum standard laid down by the NABH, and any other norms as applicable from time to time
They shall also take into account the guidelines issued by the Government of Gujarat and the
State Health Department and obtain the necessary approvals
Keeping in view that the hospital services should be world class, the Hospital shall apply to the
NABH for accreditation and obtain the same within five (5) years from the Date of Commercial
Operations

Clearances

The private party shall be responsible for all the clearances and all other approvals as may be
required for the construction, development and operations of the Project under the Applicable
Law
.
They may apply to the Nodal Agency for single window clearances for obtaining No Objection
for the establishment of the Hospital

Page 11
 Health & Family Welfare Department, Government of Gujarat
www.gujhealth.gov.in

National Health Mission, Government of Gujarat

https://nrhm.gujarat.gov.in

Medical Council of India

www.mciindia.org

Industries Commissionerate

http://ic.gujarat.gov.in

National Accreditation Board for Testing and Calibration Laboratories

www.nabl-india.org

This project profile is based on preliminary study to facilitate prospective entrepreneurs to assess a prima facie scope.
It is, however, advisable to get a detailed feasibility study prepared before taking a final investment decision.

Commissionerate of Health, Medical Services

& Medical Education (Health)
Office Address :Block No. 5, Dr. Jivraj Mehta Bhawan,
Gandhinagar.
Phone No. : 079-23253271
Email : cohealth@gujarat.gov.in
https://gujhealth.gujarat.gov.in/