There were substantial gaps in health sector infrastructure and essential health requirements, including qualified staff, equipment, drugs, and consumables were elusive. The lack of quality health services forced people to travel outside Bihar to receive advanced tertiary health care. GoB has the responsibility of ensuring good quality medical care at affordable rates.
The GoB mulled several implementation models, all with their pros and cons. It was felt that to usher in a new era of quality health care facilities, roping in private investment was a must. This involved creating public acceptance for PPPs in a traditionally non PPP diaspora. Further, the financial viability of the project would be in question considering the paying capacity of the masses. The GoB decided to take the project on PPP basis, knowing that the involvement of private players will not only bring in time and cost efficiency in development stages but will also fulfill the need of efficiency in operations. After suitably weighing all the PPP mode options, it was decided to go ahead with the DBFOT model.
In order to take up the project, the GoB moved swiftly and decisively. A 7-acre site in Patna owned by GoB was identified for the project so as to eliminate delays in land acquisition and ensuring encumbrance free land to the concessionaire. The GoB provided the land on 33-year lease basis to the concessionaire, co-terminus with the concession period. All stakeholders were roped in, to expedite approvals. The bid parameter was the annual concession fee for the first year, payable on transfer of land from GoB to the Concessionaire. The bid process ensued and through the single stage two envelope bid process, Global Health Patliputra Private Ltd. (GHPPL), a subsidiary of Global Health Private Limited which runs the famous Medanta Hospital at Gurugram, Haryana emerged as the successful bidder.
Implementing Agency- Health Department, Government of Bihar
Health PPPs are different and more complex than conventional infra-PPPs, with much more operational complexities and higher operating cost structure that needed to be considered during project structuring. The catchment area of the hospital and large unserved population provided assured demand for the health care services, resulting in improved financials of the project. Adequate market consultations was key for the success of this project as in health sector, bidders’ universe is very limited in India, particularly for projects in non-metro cities.The flexibility to charge market rates from patients on beds (other than regulated beds) improved the financial of the project and supported cross subsidization of the regulated beds.
The hospital has been instrumental in ushering quality tertiary health care for the masses. In the project, 25% of the operationalized beds are designated as Regulated Beds with rates capped at CGHS rates, as applicable at Patna. The GoB can refer BPL patients to these beds and reimburse to the concessionaire at the applicable CHGS rates, thus proving free of cost health care service. The concessionaire is required to operationalize at least 100 beds which can be expended to 500 beds in coming years. The project has led to increased access to healthcare services to around 25,000 to 30,000 in-patients and 200,000 out- patients per annum.Over 5000 surgeries / 3.5 Lakh investigations have been undertaken till date and has led to awareness creation for critical health care services in the state.The project is also estimated to generate an annual payment of about US$ 1 million, including annual concession fee and revenue share, to GoB, which will grow every year @6.50%, to be used for paying for regulated beds.
The site, which is owned by the GoB, provided to the developer in a timely manner. Unambiguously defining the Key Performance Indicators (KPIs) and linking them with NABH accreditation assured quality of services along with reasonability of costs. should be specific and measurable. The role of PSA was ring-fenced specific to monitoring of such KPIs as per the terms of the concession agreement and not in day to day operation of the hospital, which is necessary to bring in private sector efficiency.
