Preparatory Survey For The Assam Health System Strengthening Project in India

Government of Assam,
Health and Family Welfare Department

India
Preparatory Survey for

the Assam Health System Strengthening
Project in India
Final Report
(Advanced Version)
March 2022
Japan International Cooperation Agency (JICA)
Koei Research & Consulting Inc.

Yamashita Sekkei Inc. 4R
JR (P)
Nippon Koei India Private Ltd.
22-021
Preparatory Survey for the Assam Health System Strengthening Project in India
Final Report (Advanced Version)
Exchange Rate
USD 1＝JPY 115.262
INR 1 = JPY 1.53857
(JICA Rate in February 2022)
Location Map
i
Abbreviations and Acronyms

3D Three Dimensions
5S Sort, Set, Shine, Standardize, Sustain (Workplace Organization Method)
ACCF Assam Cancer Care Foundation
ACH Air Changes per Hour
AHMC&RI Assam Hills Medical College and Research Institute
AIIMS All India Institute of Medical Science
AMC Annual Maintenance Contract
AMCH Assam Medical College and Hospital
ANM Auxiliary Nursing and Midwife(ry)
APWD Assam Public Works Department
A-RAP Abbreviated Resettlement Action Plan
ASHA Accredited Social Health Activist
AYUSH Ayurveda, Yoga, Naturopathy, Unani, Siddha, Sowa-Rigpa and Homoeopathy
B Basement Floor
BPL Below Poverty Line
BSNL Bharat Sanchar Nigam Limited (telephone landline company)
CBR Cost Benefit Ratio
CDH Civil and District Hospital
CH Civil Hospital
CHC Community Health Centres
CHE Current Health Expenditure
CMC Comprehensive Maintenance Contract
CME Continuing Medical Education
CNE Continuing Nursing Education
COPD Chronic Obstructive Pulmonary Disease
COVID-19 Coronavirus Disease 2019
CPAP Continuous Positive Airway Pressure
CPWD Central Government PWD
CSR Corporate Social Responsibility
CSSD Central Sterile Supply Department
CT Computer Tomography
DAC Development Assistance Committee of the Organisation for Economic Co-
operation and Development
DALYs Disability-adjusted Life Year
DDO Drawing and Disbursing Officer
DFW Directorate of Family Welfare
DGCT Digital Content Technologies
DH District Hospital
DHS Directorate of Health Services
DMCH Diphu Medical College and Hospital
DME Directorate of Medical Education
DMU Dimapur Airport
EC Environmental Certificate/ Executive Committee
ECG Electrocardiogram
ECMO Extracorporeal Membrane Oxygenation
EIA Environmental Impact Assessment
EIRR Economic Internal Rate of Return
EMoP Environmental Monitoring Plan
EMP Environmental Management Plan
ENPV Economic Net Present Value
ENT Ear, Nose and Throat
ER Emergency Room
ESC Environmental and Social Considerations
ETP Effluent Treatment Plant
FAAMCH Fakhruddin Ali Ahmed Medical College and Hospital
FIRR Financial Internal Rate of Return
FRU First Referral Unit
ii
FY Fiscal Year
G Ground Floor
GEM Government e-Marketplace
GGE General Government Expenditure
GHE Government Health Expenditure
GMCH Guwahati Medical College and Hospital
GNM General Nurse Midwife(ry)
GOA Government of Assam
GOI Government of India
GP General Physician
GSDP Gross State Domestic Product
HEAJ Healthcare Engineering Association of Japan
HEPA High Efficiency Particulate Air
HFO High frequency oscillation
HFWD Health and Family Welfare Department
HIV Human Immunodeficiency Virus
HMIS Hospital Management Information System
ICB International Competitive Bidding
ICT Information and Communication Technology
ICU Intensive Care Unit
IDS Individual Dialysis System
IMR Infant Mortality Rate
INR Indian
IPD Inpatient Department
IPHS Indian Public Health Standards
IPL Intense Pulsed Light
IT Information Technology
IVR Interventional Radiology
JICA Guidelines JICA Guidelines for Environmental and Social Considerations
JMCH Jorhat Medical College and Hospital
JPY Japanese Yen
KPI Key Performance Indicator
LCB Local Competitive Bidding
LMICs Lower Middle-income Countries
MBBS Bachelor of Medicine and Bachelor of Surgery
MC Medical College
MCH Medical College Hospital
MCI Medical Council of India
MEP Mechanical, Electrical and Plumbing
MH Model Hospital
MHFW Ministry of Health and Family Welfare
MHRB Medical & Health Recruitment Board
MIS Management Information System
MM Man-Months
MMR Maternal Mortality Ratio
MRD Medical Records Department
MRI Magnetic Resonance Imaging
NABH National Accreditation Board for Hospitals and Health Care Providers
NBC National Building Code
NCB National Competitive Bidding
NCDs Non-communicable Diseases
NER North Eastern Region
NGO Non-governmental Organization
NHM National Health Mission
NHP National Health Policy
NIC National Informatics Centre
NICU Neonatal Intensive Care Unit
NMC National Medical Commission
NSO National Statistics Office
iii
O&M Operation and Maintenance

ODA Official Development Assistance
OJT On-the-Job Training
OOPE Out-of-pocket Expenditure
OPD Outpatient Department
OT Operation Theatre
P/Q Pre-Qualification
PACS Picture Archiving and Communication System
PET Positron Emission Tomography
PCI Percutaneous Coronary Intervention
PG Postgraduate
PHC Primary Health Care/ Primary Health Centre
PICU Paediatric Intensive Care Unit
PIU Project Implementation Unit
PMC Project Management Consultant
PM-JAY Health Insurance
PMU Project Management Unit
PPP Public and Private Partnership
PWD Public Works Department
QC Quality Control
QCBS Quality- and Cost-based Selection
QMS Quality Management System
RFP Request for Proposal
RO Reverse Osmosis
SBD Standard Bidding Documents
SC Sub Centre
SD State Dispensary
SDCH Sub-district/ Civil Hospital
SDGs Sustainable Development Goals
SEIAA State Level Environment Impact Assessment Authority
SMCH Silchar Medical College and Hospital
SNCU Special New-born Care Unit
SOR Schedule of Rates
SPBC State Pollution Control Board
SPD Sterile Processing Department
sqm Square meter
STP Septic Tank / Sewage Treatment Plant
TABS Thermo Active Building System
TB Tuberculosis
TBC To be considered
THE Total Health Expenditure
TMCH Tezpur Medical College and Hospital
TOR/ ToR Terms of Reference
TQM Total Quality Management
U5MR Under-five Mortality Rate
UHC Universal Health Coverage
UPS Uninterruptible Power Supply
USD United States Dollar
USG Ultrasound / Sonography
UV Ultraviolet
VSATS Very Small Aperture Terminal
VSM Value Stream Mapping
WHO World Health Organization
iv
Preparatory Survey for

the Assam Health System Strengthening Project in India
Final Report
(Advanced Version)
Table of Contents
Location Map
Abbreviations and Acronyms
Background of the Survey......................................................................................................... 1-1

1.1 Background of the Project and Purpose of the Survey ..................................................................... 1-1
1.2 Outline of the Project ........................................................................................................................ 1-3
Appropriateness of the Project .................................................................................................. 2-1
2.1 Healthcare Sector .............................................................................................................................. 2-1
2.2 Health Finance ................................................................................................................................ 2-24
2.3 Health Information and Communication Technology (ICT)........................................................... 2-33
2.4 Medical Institutes............................................................................................................................ 2-37
Overview of the Project Site ..................................................................................................... 3-1
3.1 Socio-Economic Overview ............................................................................................................... 3-1
3.2 General Environmental Condition .................................................................................................... 3-3
3.3 Project Site ...................................................................................................................................... 3-10
3.4 Construction Regulation and Restrictions....................................................................................... 3-17
Major Issues in the Health Sector in Assam State ..................................................................... 4-1
Development Plan for Strengthening of Health System in Assam ............................................ 5-1
5.1 Vision / Mission ................................................................................................................................ 5-1
5.2 Development Concept....................................................................................................................... 5-1
5.3 Stage-wise Development Plan .......................................................................................................... 5-2
Facility Plan .............................................................................................................................. 6-1
6.1 Minimum Standard Requirements for the Medical College ............................................................. 6-1
6.2 Request from the Government of Assam .......................................................................................... 6-2
6.3 Facility Plan ...................................................................................................................................... 6-4
6.4 Considerations for Design in the Implementation Stage................................................................. 6-18
Equipment Plan ......................................................................................................................... 7-1
7.1 Tertiary Medical Institute (Medical College Hospital) ..................................................................... 7-1
7.2 Secondary Medical Institutes ............................................................................................................ 7-3
7.3 Primary Healthcare Facilities ............................................................................................................ 7-5
7.4 Others................................................................................................................................................ 7-5
7.5 Advantage of Japanese Medical Equipment ..................................................................................... 7-6
v
7.6 Operation and Maintenance of Medical Equipment ......................................................................... 7-6

7.7 After Sales Service of Local Agents in New Delhi ........................................................................... 7-7
7.8 Procurement Plan .............................................................................................................................. 7-8
Human Resource Development Plan of Medical Institutes....................................................... 8-1
8.1 Human Resources to be Allocated in the New Facilities .................................................................. 8-1
Recommendations on Health ICT Improvement....................................................................... 9-1
9.1 Phasing of the Project: ...................................................................................................................... 9-1
Environmental and Social Considerations .............................................................................. 10-1
10.1 Legal Framework for Environmental and Social Considerations ................................................... 10-1
10.2 Proposed Project Components Subject to Environmental and Social Impacts ............................... 10-8
10.3 Alternative Study ............................................................................................................................ 10-9
10.4 Scoping and TOR for Environmental and Social Consideration Study ........................................ 10-10
10.5 The result of Environmental and Social Impact Assessment ........................................................ 10-15
10.6 Impact Assessment........................................................................................................................ 10-19
10.7 Mitigation Measures ..................................................................................................................... 10-22
10.8 Environmental Monitoring Plan ................................................................................................... 10-23
10.9 Implementation Structure of Environmental Management Plan ................................................... 10-25
10.10 Stakeholder Meeting ..................................................................................................................... 10-26
Proposed Operation Plan ..........................................................................................................11-1
11.1 Organisation and Personnel .............................................................................................................11-1
11.2 Finance and Budget .........................................................................................................................11-2
11.3 Operation Management....................................................................................................................11-6
11.4 Maintenance Operation ....................................................................................................................11-8
Project Implementation ........................................................................................................... 12-1
12.1 Project Implementation Structure ................................................................................................... 12-1
12.2 Project Implementation Schedule ................................................................................................... 12-2
12.3 Project Implementation Plan ........................................................................................................... 12-7
Project Cost ............................................................................................................................. 13-1
13.1 (This Part Intentionally Left Blank) ................................................................................................ 13-1
13.2 (This Part Intentionally Left Blank) ................................................................................................ 13-2
13.3 Operation and Maintenance Cost .................................................................................................... 13-3
Monitoring and Evaluation Framework .................................................................................. 14-1
14.1 Monitoring and Evaluation Indicators ............................................................................................ 14-1
14.2 Economic Analysis ......................................................................................................................... 14-4
Cooperation between India and Japan (Utilising Japanese Knowledge and
Technology) ............................................................................................................................ 15-1
vi
Annexes
Annex I Methodology of the Subcontracted Survey
Annex II Important Modules in the National Health Mission
Annex III NHM - MIS PLAN 2021-22
Annex IV Hospital Management Information System (HMIS) Vendors Sample List
Annex V National Health Digital Mission
Annex VI Visit to Tripura National Information Centre (NIC) and Study of e-Hospital
Annex VII List of Interviewees for ICT Survey Visit
Annex VIII Record of Public Consultation
vii
List of Figuress
Figure 1-1 Background and Significance of the Project ............................................................................. 1-2
Figure 2-1 Organisation of Health and Family Welfare Department.......................................................... 2-4
Figure 2-2 Change in Top 15 Causes of DALYs in Assam State, 1990-2016 ............................................ 2-5
Figure 2-3 Contribution of Top 10 Risks to DALYs in Assam State, 1990-2016....................................... 2-6
Figure 2-4 COVID-19 Infected Cases in Assam State from 19 June to 12 September 2021 ..................... 2-8
Figure 2-5 Referral System in Assam State ................................................................................................ 2-9
Figure 2-6 Number of Private Hospitals per 100,000 Population .............................................................. 2-9
Figure 2-7 Level of Household Income of the Respondents .................................................................... 2-12
Figure 2-8 Proportion of Respondents who Came to the Nearest Facility ............................................... 2-13
Figure 2-9 Satisfaction with Hospital Facility .......................................................................................... 2-13
Figure 2-10 Comfortableness with the Hospital Staff ................................................................................ 2-13
Figure 2-11 Satisfaction with Doctor’s Behaviour ..................................................................................... 2-14
Figure 2-12 “Do you recommend this hospital to your friends/ family members?”................................... 2-14
Figure 2-13 “Will you go to private facility if it is affordable?” ................................................................ 2-14
Figure 2-14 Medical Education System in India ........................................................................................ 2-17
Figure 2-15 Number of Doctors per 100,000 Population by States............................................................ 2-18
Figure 2-16 Density of Registered Medical Doctors .................................................................................. 2-18
Figure 2-17 Density of Nursing and Midwifery Personnel ........................................................................ 2-18
Figure 2-18 Satisfaction with Working Environment (MCH) .................................................................... 2-21
Figure 2-19 Determinants of Satisfaction of Working Environment (Multiple Answers) (MCH) ............. 2-21
Figure 2-20 Factors to Choose the Workplace (Multiple Answers) (MCH) ............................................... 2-22
Figure 2-21 Satisfaction with Learning Environment (MCH).................................................................... 2-22
Figure 2-22 Determinants of Satisfaction of Learning Environment (Multiple Answers) (MCH)............. 2-23
Figure 2-23 Preference of Working in Rural Areas (MCH) ....................................................................... 2-23
Figure 2-24 Trends of Out-of-pocket Expenditure and Domestic General Expenditure, India .................. 2-24
Figure 2-25 Out-of-pocket Expenditure by Healthcare Functions, FY 2016-2017 .................................... 2-25
Figure 2-26 Out-of-pocket Expenditure by Healthcare Providers, India, FY 2016-2017 .......................... 2-25
Figure 2-27 Total Health Expenditure as a Share of GSDP for Selected States, FY 2016-17 .................... 2-26
Figure 2-28 Government Health Expenditure as a Share of GSDP for Selected States, FY 2016-17 ........ 2-26
Figure 2-29 Government Health Expenditure as a Share of General Government Expenditure for
Selected States, FY 2016-17 ................................................................................................... 2-26
Figure 2-30 Out-of-pocket Expenditure as a Share of Total Health Expenditure for Selected States,
FY 2016-17 ............................................................................................................................. 2-27
Figure 2-31 Out-of-pocket Expenditure per Capita for Selected States, FY 2016-17 ................................ 2-27
Figure 2-32 Growth Rate of GSDP and State’s Contribution toward GDP ................................................ 2-28
Figure 2-33 Trend of Revenue and Expenditure of the Government of Assam.......................................... 2-29
Figure 2-34 Composition of Government Revenue in Assam .................................................................... 2-30
Figure 2-35 Composition of the State’s Own Tax Revenue in Assam ........................................................ 2-30
Figure 2-36 Major Fiscal Indicators of the Government of Assam ............................................................ 2-31
viii
Figure 2-37 Composition of Outstanding Debt of the Government of Assam ........................................... 2-31
Figure 2-38 Composition of Government Expenditure in Assam .............................................................. 2-32
Figure 3-1 Population Pyramid in Assam ................................................................................................... 3-1
Figure 3-2 Projected Urban Population to Total Population ....................................................................... 3-2
Figure 3-3 Per Capita Net State Domestic Product .................................................................................... 3-2
Figure 3-4 Net State Value Added by Economic Activity .......................................................................... 3-3
Figure 3-5 Monthly Precipitation, Mean Maximum and Minimum Daily Temperature (Dispur) .............. 3-3
Figure 3-6 Trend in District Level Rainfall (left) Rainy Season and June-September (right) .................... 3-4
Figure 3-7 Average Frequency of Rainy Days (left) and June-September (right) ...................................... 3-4
Figure 3-8 Agro-Climate Division of Assam State..................................................................................... 3-5
Figure 3-9 Geological Base Map of Assam with Different Geological Formations ................................... 3-6
Figure 3-10 Major River System .................................................................................................................. 3-7
Figure 3-11 Wildlife Protected Areas in Assam ........................................................................................... 3-8
Figure 3-12 Tectonic Map of North Eastern Region .................................................................................... 3-9
Figure 3-13 Flood Hazard Map of Assam .................................................................................................. 3-10
Figure 5-1 Collaboration between Target Hospitals ................................................................................... 5-3
Figure 6-1 Site Map (SMCH) ..................................................................................................................... 6-7
Figure 6-2 Site Map (TMCH)..................................................................................................................... 6-8
Figure 6-3 Site Map (JMCH) ................................................................................................................... 6-10
Figure 6-4 Site Map (FAAMCH) ..............................................................................................................6-11
Figure 6-5 Site Map (DMCH) .................................................................................................................. 6-12
Figure 6-6 Site Map (LMCH)................................................................................................................... 6-13
Figure 6-7 Location of the Site ................................................................................................................. 6-16
Figure 6-8 Site Plan .................................................................................................................................. 6-17
Figure 8-1 Recommended Norms for Hospital Nursing Service ................................................................ 8-2
Figure 10-1 Flow of Environmental Clearance Procedures........................................................................ 10-8
Figure 10-2 Institutional Arrangement for Environmental Management during Construction ................ 10-25
Figure 10-3 Institutional Arrangement for Environmental Management during Construction ................ 10-26
Figure 11-1 Budgetary Flow in Health in Assam ........................................................................................11-2
Figure 11-2 Budget Allocation Process .......................................................................................................11-4
Figure 11-3 Composition of Budget on Health by Budget Entity in Assam ...............................................11-5
Figure 12-1 Draft of Organisation Chart of the Project .............................................................................. 12-1
Figure 12-2 Project Implementation Schedule (Construction) ................................................................... 12-4
Figure 12-3 Project Implementation Schedule (Medical Equipment, Furniture, and ICT) ........................ 12-5
Figure 12-4 Project Implementation Schedule (Soft Component) ............................................................. 12-6
ix
List of Tables
Table 2-1 Priorities of the National Health Policy 2017 ........................................................................... 2-1
Table 2-2 Targets of the National Health Plan 2017 and Key Performance Indicators of Assam
2019-20 ..................................................................................................................................... 2-2
Table 2-3 Progress in Health Sector Priority Actions in Assam................................................................ 2-2
Table 2-4 Priorities of Health and Family Welfare Department of Assam under 2021/22 Budget ........ 2-3
Table 2-5 Roles of Federal, State, and District Health Authorities ........................................................... 2-3
Table 2-6 Major Demographic and Health Indicators of Assam and India ............................................... 2-5
Table 2-7 Infant and Maternal Deaths in Districts in Assam (2016) ......................................................... 2-7
Table 2-8 Health Facilities in Districts in Assam (2019) ........................................................................ 2-10
Table 2-9 Chief Minister’s Free Diagnostic Services Programme ...........................................................2-11
Table 2-10 Assam Cancer Centre...............................................................................................................2-11
Table 2-11 General Characteristics of Respondent for the Patient Satisfactory Survey ........................... 2-12
Table 2-12 Major Professional Categories and 53 Professions by the Allied and Healthcare
Professions Bill, 2018 ............................................................................................................. 2-16
Table 2-13 Levels of Nursing Education in India ..................................................................................... 2-17
Table 2-14 Estimated Vacancy Rate in Secondary and Primary Health Institute in Assam (2020) .......... 2-19
Table 2-15 Vacancy Rate of Health Personnel in Medical College Hospitals in Assam (2021) ............... 2-20
Table 2-16 General Characteristics of Respondent for the Staff Satisfactory Survey............................... 2-20
Table 2-17 Health Financing Indicators of India, 2018 ............................................................................ 2-24
Table 2-18 Summary of HIS Implementation Status of the Target Medical College Hospitals................ 2-34
Table 2-19 Brief Comparative State of e-Hospital and other Software .................................................... 2-35
Table 2-20 Summary of HMIS and HIS in Assam.................................................................................... 2-36
Table 2-21 Summary of the Candidate Medical College Hospitals (1) .................................................... 2-37
Table 2-22 Summary of the Candidate Medical College Hospitals (2) .................................................... 2-38
Table 3-1 Groundwater Quality Problems ................................................................................................ 3-7
Table 3-2 Current Specifications and Conditions of Seven MCH .......................................................... 3-10
Table 3-3 Gauhati Medical College and Hospital (GMCH) ....................................................................3-11
Table 3-4 Assam Medical College and Hospital (AMCH) ..................................................................... 3-12
Table 3-5 Silchar Medical College and Hospital (SMCH) ..................................................................... 3-12
Table 3-6 Jorhat Medical College and Hospital (JMCH)........................................................................ 3-13
Table 3-7 Tezpur Medical College and Hospital (TMCH) ..................................................................... 3-14
Table 3-8 Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH)....................................... 3-14
Table 3-9 Diphu Medical College and Hospital (DMCH) ...................................................................... 3-15
Table 3-10 Sampled District Hospitals ..................................................................................................... 3-15
Table 3-11 Swahid Mukunda Kakati (SMK) Civil Hospital, Nalbari ....................................................... 3-16
Table 3-12 Udalguri Civil Hospital, Udalguri........................................................................................... 3-16
Table 3-13 S.K Roy Civil Hospital, Hailakandi........................................................................................ 3-16
Table 3-14 Sivasagar Civil Hospital, Sivasagar ........................................................................................ 3-16
Table 3-15 Goalpara Civil Hospital, Goalpara.......................................................................................... 3-17
x
Table 3-16 Excerpts from Building Construction By-laws ....................................................................... 3-18

Table 3-17 Excerpts from the Guidelines for Indian Public Health Standards (IPHS) ............................. 3-18
Table 3-18 Major Issues on Relative Barrier Free Rules .......................................................................... 3-19
Table 3-19 Topics of NABH Design Guidelines....................................................................................... 3-20
Table 4-1 Major Facts and Issues in the Health Sector in Assam ............................................................. 4-2
Table 5-1 List of the Components for Development Plan......................................................................... 5-1
Table 5-2 List of Candidate Facilities for Component 4 ........................................................................... 5-2
Table 5-3 Outline of Soft Component (Plan) ............................................................................................ 5-4
Table 6-1 Major Requirements Set in the Regulations ............................................................................. 6-1
Table 6-2 Minimum Required Departments ............................................................................................. 6-2
Table 6-3 Requested Facility Components by GOA ................................................................................. 6-2
Table 6-4 District Hospitals to be Upgraded ............................................................................................. 6-3
Table 6-5 Proposed Two Hospital Types................................................................................................... 6-4
Table 6-6 Facility Improvement Plan........................................................................................................ 6-5
Table 6-7 Proposed Facility for SMCH .................................................................................................... 6-6
Table 6-8 Proposed Facility for TMCH .................................................................................................... 6-8
Table 6-9 Proposed Facility for JMCH ..................................................................................................... 6-9
Table 6-10 Proposed Facility for FAAMCH ............................................................................................. 6-10
Table 6-11 Proposed Facility for DMCH ...................................................................................................6-11
Table 6-12 Proposed Facility for DMCH .................................................................................................. 6-12
Table 6-13 Hospital Type 1: 150-bed Hospital ......................................................................................... 6-13
Table 6-14 Hospital Type 2: Emergency Centre ....................................................................................... 6-14
Table 6-15 District Hospitals Proposed by GOA ...................................................................................... 6-15
Table 6-16 Distribution of Building Type ................................................................................................. 6-15
Table 6-17 Swasthya Bhawan ................................................................................................................... 6-15
Table 6-18 Area Statement........................................................................................................................ 6-16
Table 6-19 Floor Plan and 3D Image of the Proposed Building ............................................................... 6-17
Table 6-20 Considerations for Design in the Implementation Stage ........................................................ 6-19
Table 7-1 List of Medical College & Hospital .......................................................................................... 7-1
Table 7-2 Contents of the Major Medical Equipment by Departments / Sections .................................... 7-2
Table 7-3 Contents of the Major Medical Equipment by Departments / Sections .................................... 7-3
Table 7-4 Contents of the Equipment for Diagnostic Imaging Department of Assam Medical
College & Hospital and Guwahati Medical College & Hospital .............................................. 7-3
Table 7-5 Candidate Secondary Hospitals ................................................................................................ 7-4
Table 7-6 Contents of Major Equipment of Type 1 .................................................................................. 7-4
Table 7-7 Contents of Major Equipment of Type 2 .................................................................................. 7-5
Table 7-8 Pilot Primary Health Centres .................................................................................................... 7-5
Table 7-9 Equipment for Dedicated Training, Monitoring, Administrative Centre, “Swasthya
Bhawan” - Component 5........................................................................................................... 7-5
Table 7-10 Equipment Concerned to Improvement of Medical College Infrastructure Classroom,
xi
Libraries, Hostel, Smart Classrooms - Component 8................................................................ 7-6

Table 7-11 Equipment Concerned to ICT on Comprehensive Hospital Management System and
Smart Hospital in AMCH & GMCH ........................................................................................ 7-6
Table 7-12 Advantage of Japanese Medical Equipment ............................................................................. 7-6
Table 7-13 Roles of Stakeholders on Maintenance of Medical Equipment ................................................ 7-7
Table 7-14 Reference Survey Results for Manufacturers in New Delhi ..................................................... 7-8
Table 8-1 Required Numbers of Doctors at Proposed Super Specialty Hospitals .................................... 8-2
Table 8-2 Required Numbers of Doctors/Nurses/Paramedics................................................................... 8-3
Table 9-1 Existing NHM MIS Cells ......................................................................................................... 9-1
Table 9-2 Example in One Medical College of 500 Beds Type ................................................................ 9-2
Table 9-3 Important Modules in NHM ..................................................................................................... 9-4
Table 10-1 Gap Analysis between Indian Laws and JICA Guidelines ...................................................... 10-3
Table 10-2 Summary of the Project Components that May Affect Environment by Institute .................. 10-9
Table 10-3 Comparison of Alternatives .................................................................................................. 10-10
Table 10-4 Result of Scoping .................................................................................................................. 10-10
Table 10-5 Draft ToR for the Environmental and Social Consideration Study ....................................... 10-13
Table 10-6 Result of Environmental and Social Impact Assessment of the Project ............................... 10-15
Table 10-7 Result of Impact Assessment ................................................................................................ 10-19
Table 10-8 Proposed Mitigation Measures ............................................................................................. 10-22
Table 10-9 Proposed Environmental Monitoring Plan (Construction Phase) ......................................... 10-24
Table 10-10 Proposed Environmental Monitoring Plan (Operation Phase) .............................................. 10-24
Table 11-1 Categories of Biomedical Waste ..............................................................................................11-7
Table 11-2 Method of Biomedical Waste Treatment..................................................................................11-8
Table 11-3 Major Regular Inspections Related to Facility ........................................................................11-9
Table 12-1 Prerequisites of the Project Schedule...................................................................................... 12-3
Table 12-2 Estimated Construction Period ............................................................................................... 12-3
Table 12-3 (This Part Intentionally Left Blank)........................................................................................ 12-8
Table 12-5 (This Part Intentionally Left Blank)...................................................................................... 12-10
Table 12-6 Work Allocation of Assam Side .............................................................................................12-11
Table 13-6 Annual Expenditure per Bed................................................................................................... 13-4
Table 13-7 Annual Estimated O&M Cost of the Proposed Hospitals ....................................................... 13-4
Table 14-1 Operation and Effect Indicators .............................................................................................. 14-3
Table 14-2 General Assumptions of Economic Analysis .......................................................................... 14-5
xii
Table 14-4 Long-term Projection of Income per Capita in Assam ........................................................... 14-6
Table 14-5 Comparison of Hospital Service Rates ................................................................................... 14-7
Table 14-6 Transportation and Accommodation Costs for Inpatients’ Families ....................................... 14-7
xiii
Background of the Survey
1.1 Background of the Project and Purpose of the Survey
Background of the Project

The target area of the survey is Assam State, which is the largest state in the North Eastern Region (NER)
in India accounting nearly 70% of the population of all eight states of NER. It is the third lowest in all
Indian states in achieving the “Sustainable Development Goal (SDG) 3” (Ensure healthy lives and promote
wellbeing for all at all ages) [NITI Aayog, 2019]. As of 12th November 2021, a total of 580,657 infected
persons have been confirmed for coronavirus disease 2019 (COVID-19), and the death toll has reached
1,119 [Government of Assam, 2021].
The Government of Assam (GOA) has made efforts to strengthen the primary healthcare system with the
aim of achieving Universal Health Coverage (UHC) through the implementation of the National Health
Mission (NHM). However, strengthening the entire medical system in terms of fostering medical personnel
by medical college hospitals, preventing the outflow of human resources, strengthening the systems and
operations of secondary and tertiary medical institutions, renewing aging facilities and equipment, and
strengthening cooperation between medical institutions are remaining to be major issues. In addition, the
spread of COVID-19 has caused further burden on the medical institutions in the state. The project aims to
improve access and quality of service for rural residents in Assam State by improving and strengthening
the medical and educational institutions, focusing on core medical centres of secondary and tertiary medical
institutions.
Also, GOA formulates a policy on reducing the out-of-pocket expenditure (OOPE) for the use of healthcare
services. These include free medicines, free cardiac surgery for children, compensation for the poor, and a
reduction in the number of visits to private institutions by improving the quality of public medical facilities.
The utilisation rate of public medical institutions is 50.6%, which is higher than the national average of
32.5%, especially in the rural areas [NSO, 2020]. There is a large disparity in service provision and health
situations in Assam, and in the tea plantation area, where 20% of the population lives, as doctors are not
stationed in half of the healthcare facilities [The Enterprise of Healthcare, 2019]. In addition, the three
districts along the Brahmaputra River, where 10% of the population lives, are in the bottom 20 health
rankings of the Aspiration District Program [NITI Aayog, 2018].
The population has increased by 14% from 2011 to 2019, but expansion of the system of healthcare service
provision has not caught up, and the number of doctors per 100,000 population is 40.3, which is far below
the national average (79.7) [WHO, 2016]. To keep the high-quality human resources in the public medical
institutions, it is important to improve the working conditions and environment that enables a continuous
study of knowledge and skills, but existing facilities and equipment of public hospitals are aging and not
attractive environments for healthcare professionals.
In addition, the spread of COVID-19 infection has caused further burden on medical institutions, and there
is a strong demand for system strengthening from the perspective of infectious disease control. For these
1-1
reasons, this project is important in the health sector of India and Assam and will greatly contribute to the
realisation of UHC.
In this circumstance, "the Assam Health System Strengthening Project" has been formulated, which aims
to improve the abovementioned situations, strengthen the functions of medical institutions focused on
tertiary hospitals which are core medical centres, remedy the medical burdens, and create an environment
where residents in Assam State can access equally to necessary medical services.
The background and significance of this project are shown in Figure 1-1.
Background
 Inadequate and/or aging facilities / equipment / management system, paper-based medical

information system, inadequate patient flow, and hygiene management system.
 Issues on excessive patient concentration in the tertiary medical institutions, limited capacity in
secondary and tertiary medical institutions, need for use of the public medical institutions by
low-income group, long patient waiting times, and inadequate advanced medical service
provision and hospital management.
 Issues on strengthening the cooperation among hospitals in the area and improvement of the
referral system.
 There is a program by GOA to strengthen the primary care system. However, strengthening the
entire medical system and rending the medical burden by strengthening the operation and
management capacity of secondary and tertiary medical institutions, and strengthening
cooperation among medical institutions, are remaining issues.
 With the spread of COVID-19, it is necessary to strengthen the system from the viewpoint of
infectious disease control.
Significance
It is an important project in the health sector of India and Assam as the project aims to improve
access to public medical services and quality medical services for rural residents, through the
improvement of secondary and tertiary medical institutions, which are core medical centres.
Source: JICA Survey Team

Figure 1-1 Background and Significance of the Project
The healthcare issues facing Assam State are essential but improving only the hardware cannot solve those
issues in a short period. It is also difficult to start interventions in all areas of the state at once to solve those
issues. Therefore, this project focuses on the "establishment of model project that enables the Indian side
to develop horizontally through self-efforts (see following box).
 Developing an environment that can ensure qualified medical personnel (Regarding the
quantitative expansion, the construction of medical colleges is in progress; therefore, the project
will develop an environment where high-quality clinical education can be provided in medical
college hospitals).
 Strengthening cooperation between secondary and tertiary level medical institutions
(establishment of referral systems, system of dispatch the doctors, provision of technical guidance
and training, etc.)
1-2
Purpose of the Survey

The purpose of the survey is to collect and analyse necessary information for evaluation in the
implementation of the project under the Japanese yen loan scheme. Such information includes but not
limited to the background, objectives, outline, cost, implementation agency, management and maintenance
structure of the project, and the consideration of social and environmental aspect.
1.2 Outline of the Project
Objectives of the Project

This project aims to strengthen the healthcare system in Assam State by strengthening the functions of
medical institutions and educational/ human resource development institutions, which are core medical
centres of secondary and tertiary medical institutions (medical college hospitals).
Outline of the Project
(1) Strengthening medical institutions (facilities, equipment)
1) Improvement of existing tertiary medical institutions (medical college hospitals) and provision of
related equipment.
2) Improvement of existing secondary medical institutions and provision of related equipment.
(2) Strengthening the capabilities of medical professionals.
(3) Strengthening the organisational and management capabilities for provision of the medical services.
(4) Consulting service including design development, tender assistance, supervision for construction
and equipment work, and capacity development.
Survey Area
The target survey area is Assam State, India.
Responsible Ministry / Implementing Agency
Government of Assam, Health and Family Welfare Department (HFWD)
1-3
Appropriateness of the Project

The survey has been conducted by desktop research, direct observations to health facilities, direct and
virtual interviews with Assam stakeholders, as well as a sub-contracted survey on seven medical college
hospitals, selected civil/district hospitals, and primary health facilities. The sub-contracted survey included
outline of medical facility and equipment, management status, as well as satisfaction of health personnel
and patients. The survey targeted seven medical college hospitals (MCHs), which were included in the
terms of reference (TOR) of the survey, and six civil/district hospitals (CDHs) identified based on the
discussion between the Government of Assam (GOA) and the Japan International Cooperation Agency
(JICA) Survey Team. The detailed methodology of the subcontracted survey is described in Annex A.
2.1 Healthcare Sector
Major Policies on Healthcare Sector in India and Assam

Soon after its independence, India started formulating a health policy based on the recommendations of the
Bhore Committee Report in 1946: public healthcare system, healthcare workers on the government payroll,
and emphasis on limiting the need for private practitioners. The first National Health Policy (NHP) was
developed in 1983 to provide primary health care (PHC) access to all citizens by 2000. Under NHP 1983,
PHC networks were established by using health volunteers. However, since the mid-1990s, the private
sector has rapidly expanded, and the public sector took the private model such as user charge and
outsourcing of services. In 2002, the second NHP was formulated with the goals of delivering health
services to the general population through decentralisation, utilisation of private sector, and increase in
public healthcare spending. Also, utilization of alternative medicines such as Ayurveda was emphasised.
In this era, disease structure had been changed; while maternal and child health was improved, non-
communicable diseases (NCDs) increased health and financial burden [Gauttam, P, et al., 2021].
NHP 2017 is based on the principles of universality, affordability, equity, patient-centred, and quality care,
inclusive partnership, pluralism, decentralisation, as well as dynamism based on the World Health
Organization (WHO) “Heath in All Policies”. The priorities of NHP 2017 are summarised in Table 2-1.
Table 2-1 Priorities of the National Health Policy 2017

 Universal health coverage
- Availability: health insurance (PM-JAY) and comprehensive primary healthcare (Ayushman Bharat)
- Affordability: secondary and tertiary care through partnership between public and other sectors
- Reduction of out-of-pocket expenses
 Reinforcing trust in public healthcare system
- Primary – comprehensive and continuum through the life
- Secondary – strengthening of district and sub-district hospitals
 Information management
 Growth of private sector
 Prevention and health promotion
Source: [MHFW, GOI, 2017]
Table 2-2 presents the targets of NHP 2017 and key performance indicators (KPIs) of Assam for 2019-20.
2-1
Table 2-2 Targets of the National Health Plan 2017 and

Key Performance Indicators of Assam 2019-20
Indicators NHP2017 Year Assam KPIs (2019-20)
Under 5 mortality rate (per 1,000 livebirths) 23 2025 43
Maternal mortality ratio (per 100,000 livebirths) 100 2020 192
Infant mortality rate (per 1,000 livebirths) 28 2019 34
Premature mortality from NCDs* Reduce by 25% 2025 Reduce by 28.1%
Utilisation of public health facilities Increase by 50% 2025 Increase by 3.9% for OPD
Antenatal care coverage >90% 2025 97.6%
OOP in CHE 53.7%
Life expectancy 70 years 2025 (66.2 years in 2017-18)
Public health expenditure 2.5% of GDP 2025 (3.5% in 2018)
*Cardiovascular diseases, cancer, diabetes, and chronic respiratory disease
Source: [Gauttam, P, et al., 2021] [MHFW, GOI, 2017] [National Health Mission, Assam, 13 March 2019]
Progress of the flagship and priority actions from 2017 to 2021 are summarised in Table 2-3. The
Government of Assam has been making great effort to increase production of medical doctors by
establishing medical colleges and hospitals.
Table 2-3 Progress in Health Sector Priority Actions in Assam

Major Progress 2017-21
Medical  Aiming at annual production of 1,200
Education  GMCH, AMCH, SMCH, JMCH, TMCH, FAAMCHG civil construction and renovation
almost completed
 New – Dhubri, Nagaon, North Lakhimpur, and Diphu
(Assam Hills Medical College and Research Institute Diphu, Nagaon MC, Dhubri MC,
and North Lakhimpur MC)
 New – Nalbari, Tinsukia, Kokrajhar
 New general nurse and midwife (GNM) and paramedical training institute at Gohpur
AIIMS Guwahati  Foundation works, DPR prepared and under evaluation
Nursing  Aiming at annual production of 5,000, upgrading training colleges and schools both
Education government and private
 ANM and GNM in rural areas incentives INR 1,500
Tea Gardens  Wage compensation for pregnancy period
 80 mobile medical units in PPP to cover 440 tea gardens
 Health camps
 Hospitals in PPP in 150 tea gardens
Upgrading  Expansion of village health outreach programme
Primary Level  Upgrading of 5 SDH to DH, 1 new DH, and 116 model hospitals approved.
Facilities  NHM upgrading model hospital: 94 functioning
 Upgraded 3 SDCH to DH, 1 DH to 100 bedded DH, 1 DH to 200 bedded DH
 Improvement some SDCH/FRU, PHCs
Volunteers  Financial benefits for staff working in societies INR 5 x 93 families
 Wages for ASHA additional INR 1,000 x 31,955
Cancer Hospitals  GMCH-PET-CT functional, PET-MRI proposed for state cancer institute
 Assam Cancer Care Foundation
 State Caner Centre Guwhati (200 beds)
 19 cancer hospitals construction works were started
Drugs  Increase essential drug list from 200 to 407, make medicines available and affordable
costs
 AMRIT pharmacies (private sector) in MCHs and DHs are functioning.
Atal Amrit  Cashless scheme launched on 18 April 2018, AAA cards, hospital help desk with
Abhiyan Arogyamitras at all DHs and MCHs, 24x7 service facilities in government and private
hospitals ARM, 24x7 call centre, health camps
 Expanded target illness
 52 hospitals empanelled
Samarth Assam  Aiming to decrease mortality of Children 0 to 6, provide infant care, birth defect registry
to proper treatment and follow up children’s hospital will be set up in Guwahati.
Source: [Gov of Assam, 2021]
2-2
Table 2-4 Priorities of Health and Family Welfare Department of Assam

under 2021/22 Budget
 Sonali Xaishab Bikkashit Axom
- Develop 1,000 model Anganwadi Centre with proper water supply and electricity
 1,000 health sub-centres will be converted to hospitals (Buniyadi Swasthya Kendra: BSK)
- Free medical consultation, diagnostics test/ medical treatment of primary diseases including diabetes,
hypertension, asthma, and communicable diseases
 Priority capital projects
- Super-specialty hospital at GMCH
- Ongoing construction of medical colleges: Kokrajhar, Charaideo, Tinsukia, Lakhimpur, Nalbari, Nagaon,
Dhubri, and Biswanath
 Proposed projects: new MCHs in Golaghat, Dhemaji, Morigaon, Bongaigaon, and Tamulpur
 Other projects
- Blood banks: upgrade at Guwahati MCH, new with component separation units (CSU) at Lakhimpur and
Nagaon MCHs
- Increase of medical colleges to 20 to increase production of doctors and postgraduate students
- Upgrade SDHs at Biswanath, Charaideo, Majuli, West Karbi Anglong, and South Salmara to District
Hospitals
- 100 bedded MCH wing at S.K. Roy Civil Hospital, Hailakandi District
Source: [Gov of Assam, 2021]
Table 2-5 Roles of Federal, State, and District Health Authorities

Level Roles
Federal:  Regulatory power: health policy decisions but is not directly involved in
Ministry of Health and Family healthcare delivery. The ministry comprises two departments:
Welfare  The Department of Health and Family Welfare: organising and delivering all
national health programs
 The Department of Health Research: responsible for promotion of health and
clinical research, development of health research and ethics guidelines,
outbreak investigations, and trainings
State:  Conduct healthcare activities
Directorates of Health  Management and monitoring of the healthcare workforce
Services,  Implementation of federally-funded national health programs
Health and Family Welfare  Collection of health information and statistics
Department  Control of food and drug quality
 Supervision of local healthcare entities and organisations
 Promotion of alternative medicine practices.
District:  Grassroots governance and administration in rural villages
Panchayati Raj/ Zilla Parishad  Establishment of primary health centres
(District Council)
Source: [The Commonwealth Fund, 2020]
The implementation structure, the position within GOA (delegation of authority to the project), the
relationship with each department, the personnel composition, and understanding the demarcation /
responsibility, budget scale / execution status, etc., of the implementation agency of the GOA, Health and
Family Welfare Department (HFWD) (Figure 2-1) will be clarified. Also, the consensus with the HFWD
regarding the implementation system of this project will be built.
It is assumed that the Directorate of Health Services (in charge of medical institutions), the Directorate of
Medical Education (in charge of medical colleges), and the National Health Mission (maternal and child
health, infectious diseases, NCDs countermeasures) will be involved in the implementation of the project.
2-3
On the other hand, rationalisation of the decision-making process is important when implementing the
project. Therefore, in this survey, the process of decision-making, authority, demarcation, and responsibility
within the HFWD and GOA related to design, design change, procurement, construction, etc., will be
scrutinised. In addition, information from other projects underway will be collected and the actual situation
and issues will be confirmed.
A Project Management Unit (PMU) will be set up within the HFWD as an executing agency in
implementing the project. In addition, a governing body & executive committee should be established from
the perspective of state-wide management. Based on these, consensus building will be achieved for
improving the efficiency of decision-making process during project implementation.
Minister
Principal Secretary
Directorate of
Directorate of Health Directorate of Food and Assam State
National Assam State
Drug Directorate of Blood
Health Services Medical Health AIDS Control
Administ- AYUSH Transfusion
Services [Family Education Mission Society
Welfare] ration Counsel
Branches Composition of the State Health Mission

• Establishment branch: appointment, transfer, promotion, and • Impart quality medical education; • Chair: Chief minister/ Co-chair: Minister for health and family welfare
pension of staff • Promote expertise in medical science, dental, • Convener: Principal secretary
• Health establishment branch: private service providers nursing, pharma and paramedical science; • Members: ministers and officials from relevant ministries, representatives
• Nursing brunch: nursing establishment (appointment and • To develop and sustain medical education and from CBO/NGO/development partners
transfer), education, training, council capacity building of human resources; Programmes
• H&D branch: health infrastructure maintenance, renovation • To promote research in medical science and • Reproductive, maternal, newborn and child health and adolescent
and upgrade it’s allied disciplines; (RMNCH+A)
• Accounts branch: receipt and expenditure of funding • Administrative control of undergraduate, • Disease control (communicable and NCDs)
• Budget branch: annual budget preparation postgraduate in medical science, dental, • Health system strengthening (ASHA, PPP, community health and sanitation,
• Planning branch, General branch, Statistic branch nursing, pharma and paramedical science hospital management)
• Purchase board: drugs, and pharmaceutical, medical items Composition of the District Health Mission
• Direct administrative control over the tertiary
• State health education bureau: education and awareness for • Chair: Zilla Parishad (District Council)/ Co-chair: District Collector/
health care hospitals attached to the medical
general population Vice Chair: CEO Zilla Parishad
colleges.
• Disease-based programmes (TB, blindness, Leprosy, Tobacco • Convener: Chief medical officer
control, Fluorosis, Iodine deficiency, Deafness, Mental health • Members: district authorities, hospital management societies, health
programme managers, representatives from CBO/NGO
Source: [Health and Welfare Department, Assam, 2021] [Gov of India, 2021]
Figure 2-1 Organisation of Health and Family Welfare Department
Relevant Development Plans and Donors’ Activities

In 2017, the Assam Cancer Care Foundation was established as a partnership between GOA and Tata Trusts.
The foundation is planning to establish a three-level cancer grid in the state by establishing facilities that
specialise in cancer treatment, strengthening chemotherapy, radiation therapy, and surgical treatment at the
Department of Oncology of the medical university; as well as starting day care services at the district
hospital. It will also implement programs for human resource development and raising awareness among
residents.
Health Conditions and Disease Burden in Assam

In terms of population, Assam State is the biggest in the North Eastern Region1, whose population accounts
for nearly 70% of the region [UIDAI, 2020]. Most of the population, i.e., 86%, lives in the rural area. Table
2-6 presents the major health and relevant indicators of Assam State and India. According to the Census
Organization of India, the population in 2021 is projected at 36.5 million. Population growth has shown
significant gap among the states in India. Generally, it is lower in the southern part, at less than 10%, and
higher in the northern part, especially the North Eastern Region. According to the recent interview [MINT,
1
Arunachal Pradesh, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim, Tripura
2-4
2020], institutional delivery in 2019-2020 was 91% and it could contribute to improve maternal and
neonatal mortality.
Table 2-6 Major Demographic and Health Indicators of Assam and India
Indicators Assam India Year
Population 31,205,576 1,210,193,422 2011
Under 14 32.8% 28.6% 2011
65 and over 4.2% 5.3% 2011
Population growth from 2001 17.07% 1.64% 2011
Sex ratio (female to 1,000 male) 958 940 2011
Life expectancy (years at birth) 66.2 69.0 2017-18
Literacy Male 77.85% 82.14% 2011
Female 66.27% 65.46% 2011
Per capita GSDP at constant prices (INR) 65,138 100,268 2011-12
Population living below national poverty line 32.0% 21.9% 2019
Maternal mortality ratio (per 100,000 livebirths) 215 113 2017-18
Neonatal mortality (per 1,000 livebirths) 32.8 29.5 2015-16
Infant mortality (per 1,000 livebirths) 47.6 40.7 2015-16
Under-five mortality (per 1,000 livebirths) 56.5 49.7 2015-16
Institutional delivery 70.6% 78.9% 2015-16
ANC by a skilled provider* 82.5% 79.3% 2015-16
Four or more ANC visits 46.4% 51.2% 2015-16
Note: *doctor, auxiliary nurse midwife, nurse, midwife, and lady health visitor
Source: [Census Organization of India, 2011], [NSO, 2019], [IIPS, 2017], [NITI Aayog, 2019]
As shown in Figure 2-2, the burden of non-communicable diseases has increased from 1990 to 2016.
However, diarrhoea and infectious diseases, as well as nutrition condition such as anaemia, still account for
certain proportions among major causes of Disability-adjusted Life Year (DALYs). Regarding coronavirus
disease 2019 (COVID-19), accumulated cases were at 219,272 and deaths were at 1,112, as of April 13,
2021. All seven medical college hospitals, a military hospital, and 15 government hospitals are designated
as “COVID-19 hospitals” [Gov of Assam, 2021].
100%
COPD
90% NCDs
Stroke
80% NCDs
Ischaemic heart disease
70% Hepatitis
Diabetes
60%
Diarrhoeal diseases
50% Lower respiratory infections
Tuberculosis
40%
Preterm birth complications
30%
Other neonatal disorders
20% Neonatal encephalopathy
Iron-deficiency anaemia
10%
Self-harm
0% Road injuries
1990 2016
Sense organ diseases
year
Source: [Health Data, 2017]

Figure 2-2 Change in Top 15 Causes of DALYs in Assam State, 1990-2016
2-5
As presented in Figure 2-3, nutrition condition and environmental health were major risk factors of DALYs
both in 1990 and 2016; however, unhealthy lifestyles increased in 2016.
100%
90%
Malnutrition (maternal and child)
80%
WASH
% in total DALYs Risk
70%
Air pollution
60%
Tobacco use
50%
Dietary risks
40%
High blood pressure
30%
High fasting plasma glucose
20%
Alcohol & drug use
10%
Occupational risks
0%
1990 2016 High body-mass index
Year
Source: [Health Data, 2017]

Figure 2-3 Contribution of Top 10 Risks to DALYs in Assam State, 1990-2016
Table 2-7 presents the comparison of estimated infant and maternal death per 100,000 population among
the districts. There are six aspirational districts in the health sector selected based on maternal and child
health status. Also, the health status of tea garden areas has been a concern and therefore, GOA has been
making interventions to enhance health services in tea gardens [GOA and NHM Assam, 2016].
In comparison of the numbers of death per 100,000 population, the state centre, Kamrup Metro, showed
the highest both in infant and maternal death. Also, in some districts in Lower Assam including Goalpara,
and Kokrajhar, as well as Barak Valley including Cachar, Hailakandi, and Karimganjm, the number of
infant deaths per population was higher within the state. Regarding maternal death, Chacar and Dibrugarh
were also higher.
2-6
Table 2-7 Infant and Maternal Deaths in Districts in Assam (2016)

Note Population Infant Death/ 100,000 Maternal Death/
Population 100,000 Population
North Dhemaji 686,133 31.2 1.5
Lakhimpur Aps 1,042,137 16.6 0.5
Darrang 928,500 25.3 2.3
Udalguri Tea 831,668 12.9 1.1
Sonitpur Tea 1,924,110 21.4 4.1
Lower Biswanath
Barpeta 1,693,622 25.0 3.5
Bajali Tea
Baksa Tea 950,075 12.1 0.3
Bongaigaon 738,804 29.4 2.8
Chirang Tea 482,162 29.0 2.7
Dhubri 1,949,258 32.9 3.2
South Salmara Tea
Goalpara Tea 1,008,183 49.5 3.3
Kokrajhar Tea 887,142 44.4 4.1
Kamrup Metro 1,253,938 132.1 8.0
Kamrup Rural Tea 1,517,542 12.1 0.9
Nalbari Tea 771,639 10.8 0.7
Central Dima Hasao 214,102 36.9 3.7
Morigaon Tea 957,423 16.7 1.0
Karbi Anglong Tea Aps 956,313 21.2 2.7
West Karbianglong Tea
Nagaon 2,823,768 18.2 2.3
Hojai Aps
Upper Dibrugarh 1,326,335 22.5 6.7
Tinsukia Tea 1,327,929 11.9 1.2
Jorhat Tea 1,092,256 47.8 2.4
Majuli
Golaghat 1,066,888 23.1 1.5
Sivasagar Tea 1,151,050 5.8 0.6
Charaideo Tea
Barak Cachar 1,736,617 43.0 8.0
Valley Hailakandi Tea 659,296 44.6 1.2
Karimganj 1,228,686 64.4 2.8
Note: Districts with blank are newly separated ones.
Tea = tea garden areas, Asp = Aspirational districts
Source: [Census Organization of India, 2011]
Infant death/100,000 and maternal death/100,000 were estimated by JICA Survey Team with referring to
[NHM Assam, 2021] and [Gov of Assam, 2017]
Figure 2-4 presents the number of COVID-19 infected people from 19 June to 12 September 2021. As of
13 September 2021, the cumulative number of confirmed cases were 580,657 and deaths were 5,502. From
March to May 2021, the confirmed cases had increased, but getting better until September 2021.
2-7
Source: [Google, 2021]

Figure 2-4 COVID-19 Infected Cases in Assam State from 19 June to 12 September 2021
Major measures undertaken by GOA were as follows [Gov of Assam, 2021]:

• 80% of hospital beds (16,461) for isolation;
• 2,964 beds with oxygen;
• 1,151 beds for ICU (400 in Guwahati, 100 in temporary COVID hospital);
• Free treatment with food for BPL families; and
• 78 million of above age 18 have been vaccinated.
Medical Services and Referral System in Assam
Overview
Figure 2-5 summarises the referral system in Assam State. Health service provision system could not cover
the increasing population at 14% from 2011 to 2019 [The Enterprise of Healthcare, 2019]. Primary level
health facilities cover more population than the national standards. The coverage population of a primary
level health facility varies among districts. For example, Dima Hasao and Majuli districts seem to have
enough number of primary health facilities, while community health centres in Cachar, Kamrup
Metropolitan, Kokrajhar, South Salmara, and Sivasagar cover more than twice of the standard population
(120,000)2.
Patient referral should be carried out in accordance with the referral guidelines. The patients should access
the nearest primary facilities, and they could be referred based on the decision of a health personnel.
However, it is not strictly regulated. Then, patient could access the health facility at any level without any
penalty or additional payment.
2 Population per health facility was calculated by number of health facilities provided by JICA and population in Census 2011.
2-8
DME, HFWD Assam Cancer Care Foundation

PPP
Cancer Screening
Medical Centre (1) Corner (4)
College Hospitals
Cancer
(MCH) (8)
Hospitals
Tertiary (4)
One per district, DHS, HFWD Secondary (5)
75-500 bed District/ Civil Hospital (DH) (24):
Doctors 29-68, Nurses 76-325 Chief Minister’s Free Diagnostic
depend on coverage population
Services Programme
31 – 100 beds CT (28) X-ray (130)

depend on coverage population Sub Divisional Civil Hospital (SDCH) (14):
Doctors 20-55, Nurses 18-30 Hub Laboratory
(28)
120,000 for general/ Community Health Centre (CHC)/
NHM
Mini Hub Laboratory (42)
80,000 for remote areas First Referral Unit (FRU)/ Model Hospitals (MH)
(199): 4 medical officers, 21 Paramedical staff**
30,000 for general/ Charitable hospitals (5)
20,000 for remote areas Primary Health Centre (PHC)/BPHC*/MPHC*/RPCH*/ Tea garden hospitals (150)
State Dispensary (SD) (1,002):
Rural areas: 1 medical officer, 14 paramedical staff
5,000 for general/ Private
3,000 for Sub Centre (SC) (4,713): Poly Clinics (244)
remote areas Auxiliary nurse midwife (ANM) 1 / Female or Male health worker 1 Diagnostic Centres (355)
*BPHC=Block PHC, MPHC=Mini PHC, RPHC=River-line PHC **Paramedical staff includes nurses.
Source: [Census Organization of India, 2011] [MHFW, 2012] [Gwmsath Mushahary & Manjil Basumatary, June 2020]
[Directorate of Economic and Statistics, 2017] [Assam Cancer Care Foundation, 2021]
Figure 2-5 Referral System in Assam State
As presented in Table 2-8, eight medical college hospitals are serving tertiary medical services and seven
more hospitals are under development. In India, the number of medical colleges for 100,000 population is
0.03 on average and those are similar in the divisions in Assam. And Hojai, Karbi Along, and Dibrugarh
have no secondary level hospitals (Table 2-8).
According to the HFWD of GOA [HFWD, Assam, 2018], because the number of private hospitals is also
limited, many people seek tertiary care in another state. It causes high out-of-pocket expenditure (OOPE),
especially for hospitalisation. As shown in Figure 2-6, the number of private hospitals per 100,000
population in Assam (1.4) is less than half of the national average (3.2).
14.00
12.00
10.00
8.00
6.00
4.00
India
2.00
0.00
Source: [CDDEP, 2020] [Unique Identification of India, 2020]

Figure 2-6 Number of Private Hospitals per 100,000 Population
2-9
Hospital beds per 1,000 population was 0.89 on average in Assam. Districts in Upper Assam tend to have
higher beds to population ratio, while Duburi, Nagaon, and Karimganj have less than half of the state
average.
Table 2-8 Health Facilities in Districts in Assam (2019)

Medical Community Primary
Per 100,000 District Subdistrict Beds per
Districts College
pop. Hospitals Hospitals
Health Health Sub Centres
1,000 pop.
Hospitals Centres Centres
Dhemaji 0.018 1 0 4 24 98 0.67
Lakhimpur 1 1 8 29 157 0.89
North
Darrang 1 0 7 33 176 0.69

Udalguri 1 0 7 24 150 0.68
Sonitpur 1 1 0 7 29 148 0.71
Biswanath 0.018 0 2 3 26 141
Barpeta 1 1 1 11 48 264 0.72
Bajali
Baksa 1 0 8 36 157 0.57
Bongaigaon 1 0 4 29 108 0.72
Chirang 1 0 4 24 87 1.02
Lower
Dhubri 1 1 6 35 187 0.29

South Salmara 0 1 2 8 51
Goalpara 1 0 7 37 155 0.57
Kokrajhar 1 1 2 46 162 0.88
Kamrup Metro 1 1 0 3 45 51 2.53
Kamrup Rural 1 1 13 65 280 0.64
Nalbari 1 0 11 44 122 0.74
Dima Hasao 0.020 1 0 3 12 76 1.75
Morigaon 1 0 6 34 122 0.48
Central
Karbi Anglong 1 0 0 6 24 104 0.64

West Karbianglong 0 1 2 18 50
Nagaon 1 0 13 72 258 0.33
Hojai 0 0 5 7 94
Dibrugarh 1 0.034 0 0 10 31 234 1.96
Tinsukia 1 0 8 22 166 0.65
Jorhat 1 0 1 6 35 110 1.14
Upper
Majuli 0 1 2 7 34
Golaghat 1 1 9 39 143 1.07
Sivasagar 1 1 2 27 150 0.51
Charaideo 0 1 2 19 70
Cachar 1 0.028 1 0 7 31 270 1.04
Valley
Barak
Hailakandi 1 0 4 13 107 0.57

Karimganj 1 0 7 29 231 0.43
Assam 8 0.026 24 14 199 1,002 4,713 0.85
Source: HFWD Assam, [Census Organization of India, 2011]
PPP in Health Sector

In the Assam health sector, public and private partnership (PPP) is effectively applied in diagnostic services
for the poor (Table 2-9) and primary health services, such as tea garden hospitals and charitable hospitals,
are summarised in the box below.
2-10
Table 2-9 Chief Minister’s Free Diagnostic Services Programme

Beneficiaries as
Services Start Locations Service Providers
of Sep. 2020
CT May 2017 28 district/civil hospitals Spandan Diagnostics
461,235
Pvt. Ltd.
X-ray May 2017 130 facilities including Krsnaa Diagnostics
district/civil hospitals, CHC, and Pvt. Ltd. 1,372,424
PHC
Laboratory Sep 2018 Hublabs in 28 district hospitals HLL Life Care Ltd.
Services Mini hub labs in 13 subdistrict 3,239,793
hospitals and 29 FRU/CHC
Source: [HFWD Assam, 2021]
 Charitable hospitals
- Providing maternal and child health services, including immunisation, antenatal care, basic testing, delivery,
outpatient services for below poverty line (BPL) families
- Five hospitals in 2016/17; Assam State Government subsidies INR 1,500,000 per year
 Tea garden hospitals (since 2007)
- 2007: 50 → 2020: 150 hospitals
- MoU between NHM and hospital operator: subsidisation - INR 750,000 per year
- Subsidisation (INR 750,000/year) for MCH services, emergency care, referral to public facilities,
communicable diseases and NCDs care, facility improvement, etc., as well as salary of doctors and
paramedical staff
- Essential drugs and an ambulance are provided.
Source: [HFWD Assam, 2021]
In partnership with Tata Trusts, GOA established Assam Cancer Foundation to provide cancer prevention
and care services from primary to tertiary levels, as well as strengthen research capacity (Table 2-10).
Table 2-10 Assam Cancer Centre

Business Assam Cancer Care Foundation INR 1400 Core (JPY 20.6
Entities Investment
(GOA and Tata Trusts) bil.)
Partners State Cancer Centre, National Caner Grid, Cachar Cancer Hospital and Research Centre (NPO),
Alamelu Charitable Foundation, Dr. B. Borooah Cancer Institute, Atal Armit Abhiyan, Pfaizer,
Tata group companies, Chinese medical equipment company, etc.
Service Public Private
Network State Cancer Institute, Guwahati Hospital
Guwahati Screening and
Assam Medical College ACCF Cancer Centre Awareness
Hospital (MCH) (advanced medical services and research) Kiosk at OPD
Other MCHs Cancer Diagnosis and treatment
Civil/District Hospitals hospitals Diagnosis, onco-care/day care
Other  Fellowship, specialist training
Activities  Research – South Asia Cancer Research Centre (SACRC)
 Cancer Hospitals at Dibrugarh, Barpeta, Tezpur, Lakhimpur, Mangaldoi, Kokrajhar, and Jorhat
will become functional in 2021.
Note: Hospitals at Guwahati, Silchar and Diphu are targeted to be completed during 2022.
Source: [Assam Cancer Care Foundation, 2021] [Bikash Singh, 2017] [Gov of Assam, 2021]
Patient Satisfaction and Care Seeking Behaviour

The general characteristics of the respondents are summarised in Table 2-11.
2-11
Table 2-11 General Characteristics of Respondent for the Patient Satisfactory Survey
U5 6-9 10's 20's 30's 40's 50's 60's 70's 80's+ No answer Total
Medical College Hospitals (MCH)
IPD Female 2 1 9 30 22 28 16 11 3 1 123
Male 3 7 12 30 42 38 36 23 9 2 202
No answer 12 12
OPD Female 2 4 6 28 22 22 23 15 3 125
Male 5 10 12 60 31 26 25 10 5 7 191
No answer 10 10
Civil/District Hospitals (CDH)
IPD Female 3 5 9 36 10 5 1 3 1 73
Male 3 1 3 10 7 5 6 4 1 1 41
No answer 1 1
OPD Female 1 2 3 12 8 8 3 1 38
Male 1 7 19 16 9 4 1 1 1 59
Note: IPD= inpatient department, OPD= outpatient department
As shown in Figure 2-7, the household income of the respondents in civil/district hospitals (CDH) was
lower than that in the medical college hospitals. In CDH, 75% were free of charge and 38% in MCH. Most
of the payments were made for testing. Although 33% applied Atal Amrit Yojana (health insurance for the
poor) and 40% used other financial support scheme, most of the respondents did not have a health card3 to
obtain financial assistance from the government with simpler process because they did not know.
IPD
MCH
OPD
IPD
CDH
OPD
86% 88% 90% 92% 94% 96% 98% 100%
Rs.0 - Rs.250,000 Rs.250,001 - Rs. 500,000 Rs.500,001 - Rs. 750,000

Rs.750,001 - Rs. 1,000,000 Rs. 1,500,000+

Figure 2-7 Level of Household Income of the Respondents
As shown in Figure 2-8, most of the respondents in CDH accessed the nearest hospitals and 93% came
directly without referral from the primary level facilities. In MCH, 25% were referred from the secondary
level hospitals. According to local experts, even if patients go to the nearest CDH, as necessary equipment
or specialised doctors are not available, they are referred to MCH. Therefore, people prefer to go directly
to MCH.
3 Although they do not have a health card, they can obtain financial assistance by applying at the counter in every hospital visit.
2-12
IPD
MCH OPD
IPD
CDH
OPD
0% 20% 40% 60% 80% 100%
No Yes

Figure 2-8 Proportion of Respondents who Came to the Nearest Facility
Satisfaction with hospital facilities was lower in CDH. Among the three rooms, satisfaction in a waiting
room was lower than in the other rooms (Figure 2-9).
Examination room
MCH
Consultation room
Waiting room
Examination room
CDH
Consultation room
Waiting room
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Excellent Good Fair Poor Very Poor

Figure 2-9 Satisfaction with Hospital Facility
In MCH, the proportion of respondents who did not feel comfortable with the receptionist and nurses was
higher, while in CDH, nearly half felt comfortable with the nurses (Figure 2-10).
Nurses
MCH
Doctors
Receptionist
Nurses
CDH
Doctors
Receptionist
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Excellent Good Fair Poor Very Poor

Figure 2-10 Comfortableness with the Hospital Staff
2-13
Regarding doctor’s behaviour in MCH, although some rated excellent, the proportion of good was lower
than in CDH (Figure 2-11). In CHD, a few did not receive any explanation or answer to the question.
Answering to your question

MCH
Diagnosis
Doctor's explanation
Answering to your question

CDH
Diagnosis
Doctor's explanation
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Excellent Good Fair Poor Very Poor Not Explained

Figure 2-11 Satisfaction with Doctor’s Behaviour
Although most of the respondents will recommend the hospital to friends or family members (Figure 2-12),
more than half of them would go to private facilities if they were affordable (Figure 2-13). According to
the interviews with some experts in community health in Assam, people tend to think that free and cheap
services are not good in quality.
IPD IPD
MCH
MCH
OPD OPD
IPD IPD
CDH
CDH
OPD OPD
0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100%
Don't know Never No Yes Yes very much No Yes
Source: JICA Survey Team Source: JICA Survey Team

Figure 2-12 “Do you recommend this Figure 2-13 “Will you go to private facility
hospital to your friends/ if it is affordable?”
family members?”
Many respondents complained about the cleanliness of the hospitals especially toilets. Those in the inpatient
department required fan and drinking water facility. Also, insufficient stock of medicine in the pharmacy
was pointed out. At the same time, they would like health personnel to improve the attitude to the patients
both for doctors and paramedical staff. Some of them have observed that the number of doctors was not
sufficient especially in CDH. Time for consulting was less than 15 minutes in almost all of the CHDs and
80% of MCH.
According to the local experts, rural people tend to hesitate to meet with health personnel because doctors
and nurses are not kind enough to tell their concerns or symptoms. In addition, women and their family
would like to see female doctors because of cultural context, but the number is limited. Therefore,
2-14
community health volunteers, ASHA, encourage such women and girls to have access to health services
and convince male family members to let women seek healthcare in public health facilities.
Health Personnel
Overview
In addition to insufficient number of public hospitals, human resource for health in the public sector is one
of the critical challenges in the referral system in India. As for the urban-rural distribution, 66% of
physicians worked in the urban areas, and 80% of physicians and surgeons were in the private sector
although more than 50% of doctors are produced by government medical colleges [Karan A, Negandhi H,
Nair R, et al., 2019].
Although India achieved the World Health Organization (WHO) recommended doctor-population ratio in
2018 [Raman Kumar and Ranabir Pal, 2018], it still varies among the states. According to WHO, the
number of allopathic doctors per 100,000 population is one of the worst in the five states in India (Figure
2-15). According to an estimate using the National Sample Survey (NSS) 2016 and Registry Data [Karan
A, Negandhi H, Nair R, et al., 2019], the number of qualified doctors (allopathic, AYUSH, and dental
practitioners) per 10,000 population in Assam State (1.8) was the lowest in India4.
WHO’s report in 2016 points out several challenges in the human resources for health in India [WHO,
2016].
 Lack of doctors in rural areas

 Lack of medical qualification
The report recommended to step up the capacity to produce and deploy medically trained personnel rapidly.
There are 15 major professional categories including 53 professions in allied and healthcare streams as
shown in Table 2-12.
4 It ranged from 1.8 to 19.7 in Maharashtra and 11.3 in India.
2-15
Table 2-12 Major Professional Categories and 53 Professions by

the Allied and Healthcare Professions Bill, 2018
1 Life Science Professional (i) Biotechnologist (ii) Biochemist (nonclinical) (iii) Cell Geneticist (iv)
Microbiologist (non-clinical) (v) Molecular Biologist (non-clinical) (vi)
Molecular Geneticist (vii) Environment Protection Officer (viii)
Ecologist (ix) Biomedical Engineer (x) Medical Equipment Technologist
(xi) Occupational Health and Safety Officer (Inspector)
2 Trauma and Burn Care (i) Burn Care Technologist (ii) Emergency Medical Technologist
Professional (Paramedic) (iii) Advance Care Paramedic
3 Physiotherapy Professional Physiotherapist
4 Nutrition Science Professional (i) Dietician (including Clinical Dietician, Food Service Dietician) (ii)
Nutritionist (including Public Health Nutritionist, Sports Nutritionist)
5 Ophthalmic Sciences Professional (i) Optometrist (ii) Ophthalmic Assistant
6 Occupational Therapy (i) Occupational Therapist (ii) Movement Therapist (including Art, Dance
Professional and Movement Therapist or Recreational Therapist) (iii) Podiatrist
7 Behavioural Health Sciences (i) Psychologist (Except Clinical Psychologist covered under RCI for
Professional PWD) (ii) Behavioural Analyst (iii) Integrated Behaviour Health Counsel
(iv) Health Educator including Disease Counsellors, Diabetes Educators,
Lactation Consultants (v) Human Immunodeficiency Virus (HIV)
Counsellors or Family Planning Counsellors (vi) Mental Health Support
Workers
8 Primary, Community and other Community Health Promoters
Miscellaneous Care Professional
9 Medical Radiology, Imaging and (i) Medical Physicist (ii) Nuclear Medicine Technologist (iii) Radiology
Therapeutic Technology and Imaging Technologist (Diagnostic Medical Radiographer, Magnetic
Professional Resonance Imaging (MRI), Computed Tomography (CT),
Mammographer, Diagnostic Medical Sonographers) (iv) Radiotherapy
Technologist (v) Dosimetrist (vi) Electrocardiogram (ECG) Technologist
or Echocardiogram (ECHO) Technologist
10 Medical Laboratory Sciences (i) Cytotechnologist (ii) Forensic Science Technologist (iii)
Professional Histotechnologist (iv) Hematotechnologist (v) Medical Lab Technologist
11 Health and Information (i) Health Information Management Professional (including Medical
Management Professional Records Analyst) (ii) Health Information Management Technologist (iii)
Clinical Coder (iv) Medical Secretary and Medical Transcriptionist
12 Physician Associate or Physician Physician Associates and Assistants
Assistant
13 Cardiovascular, Neuroscience and (i) Cardiovascular Technologists (ii) Perfusionist (iii) Respiratory
Pulmonary Technology Technologist (iv)Electroencephalogram (EEG) or Electroneurodiagnostic
Professional (END) or Electromyography (EMG) Technologists or Neuro Lab
Technologists or Sleep Lab Technologists
14 Renal Technology Professional Dialysis Therapy Technologists or Urology Technologists
15 Surgical and Anaesthesia-related (i) Anaesthesia Assistants and Technologists (ii) Operation Theatre (OT)
Technology Professional Technologists (iii) Endoscopy and Laparoscopy Technologists
Source: The Allied and Healthcare Professions Bill, 2018
The National Health Policy 2017 by MoHFW recommends that medical and para-medical education be
integrated with the service delivery system, so that the students learn in the real environment and not just
in the confines of the medical school.
The National Medical Council (NMC) was established to maintain minimum standards of medical
education in India. NMC has made it mandatory for doctors to complete 30 hours of Continuing Medical
Education (CME) once in every five years to renew their license by attending workshops and seminars,
which are organised by various healthcare institutions in India. For nurses, Continuing Nursing Education
(CNE) is applied after the registration at each state nursing council.
2-16
Medical education in India comprises about 554 medical colleges [National Medical Commission, 2021]
including both public and private across the country. These medical colleges have a capacity of producing
83,125 Bachelor of Medicine and Bachelor of Surgery (MBBS) graduates at present. Figure 2-14 shows
the system of medical education in India. Undergraduate medical education (MBBS course) in India takes
about five-and-a-half years, including one year of compulsory internship. The period of four-and-a-half
years (nine semesters, six months each) is divided into three phases. Each semester consists of
approximately 120 teaching days of eight hours each college working time, including one hour of lunch.
The MBBS course is divided into three phases, viz., Pre-clinical, Para-clinical, and Clinical Phase.
MBBS MD/MS/DNB DM/M.Ch./FNB(Senior

(Pre-clinical, Para-Clinical and Clinical)
5.5years including one year of compulsory internship
(Junior Residency) Residency)
Super Specialty
Under Graduate Education Postgraduate Education
1,000 seats in Assam 607 seats in Assam 29 seats in Assam

4,105 seats in Kerala 1,333 seats in Kerala 229 seats in Kerala
Source: National Health Profile 2020, Central Bureau of Health Intelligence, Ministry of Health and Family Welfare
Figure 2-14 Medical Education System in India
There are two main routes into nurse training in India. One is a three-year diploma training in the School
of Nursing to become a General Nurse Midwife (GNM). Another one is a four-year training in a College
of Nursing to obtain a B.Sc. degree. Some nursing colleges also offer post-registration B.Sc. courses and
M.Sc. courses. There are six levels of nursing education in India as summarised in Table 2-13.
Table 2-13 Levels of Nursing Education in India

No. Level Description
Auxiliary Nursing and Midwifery Medical nursing course that focuses on the care of individual,
1
(ANM) families, and communities
General Nursing and Midwifery Medical nursing course that focuses on caring for the sick in hospitals
2
(GNM)
Graduate Nursing Programme Four-year course prepared nurses to work at the bedside and take up
(B.Sc. Nursing) leadership roles in public health nursing
3
Post Basic B.Sc. Nursing Two-year nursing programmes for those who have already finished
GNM
4 Postgraduate Degree in Nursing Trains nurses to be clinical and community health nursing specialists
5 MPhil in Nursing One-year programme for research in undertaking doctoral work
6 Ph.D. Programme in Nursing Ph.D. course for three years
Assam
Assam HFWD pointed out that due to the limited intake capacity of medical colleges, many students seek
medical education opportunity in other states. Also, around 30% of doctors in government hospitals move
to the private sector or other states for better working condition annually [HFWD, Assam, 2018].
2-17
300.0
250.0
200.0
All India
150.0
100.0
50.0
0.0
Karnataka
Kerala
Chandigarh
Manipur
Mizoram
Orissa
Gujarat
Tamil Nadu
Tripura
Daman & Diu
Maharashtra
Jammu & Kashmir
Goa
Himachal Pradesh
Haryana
Delhi
Sikkim
Chhattisgarh
Madhya Pradesh
Nagaland
Meghalaya
Assam
Andhra Pradesh
Lakshadweep
Uttarakhand
Pondicherry
Rajasthan
Uttar Pradesh
Bihar
Jharkhand
Punjab
West Bengal
Dadra & Nagar Haveli
Andaman & Nicobar Is.

Arunachal Pradesh
Source: [WHO, 2016]

Figure 2-15 Number of Doctors per 100,000 Population by States
According to the National Health Profile 2020, Assam’s density of medical doctors was 0.77 per 1,000
population, and that of nurses and midwives was 0.72 per 1,000 population, while WHO recommends one
doctor for every 1,000 population. Compared with Kerala, which has a similar population size as Assam,
and Tamil Nadu, which has better health indicators, the number of doctors and number of nurses and
midwives are inadequate in Assam (Figure 2-16 and Figure 2-17).
*Total Population is based on 2011 Census and number of registered *Total Population is based on 2011 Census and number of registered
Medical Doctors is based on the data in 2019. nurses and midwives are based on the data in 2018.
Source: National Health Profile 2020, Central Bureau of Health Source: National Health Profile 2020, Central Bureau of Health
Intelligence, Ministry of Health and Family Welfare Intelligence, Ministry of Health and Family Welfare
Figure 2-16 Density of Registered Medical Figure 2-17 Density of Nursing and
Doctors Midwifery Personnel
There are seven medical colleges in Assam, and they have the capacity of producing 1,000 MBBS graduates
while Kerala State has four times as large. The number of seats for postgraduate education is also less
compared with the other states which have better heath profile.
Regarding nursing education, there are three government nursing college for B.Sc. Nursing and 22 GNM
School of Nursing in Assam. Medical and Health Recruitment Board is responsible for recruitment of
professionals of government health facilities except directors who are appointed by Chief Secretary of
Health.
2-18
While the healthcare delivery system has remained focused on the strengthening of doctors, nurses, and
frontline workers, numerous other healthcare workers have been identified. In order “to provide for
regulation and maintenance of standards of education and services by the allied and healthcare professionals
and the maintenance of a Central Register of Allied and Healthcare Professionals and for matters connected
therewith or incidental thereto5, the Allied and Healthcare Professions Bill, 2018, was introduced.
The estimated vacancy rate of doctors is much higher than nurses as estimated in Table 2-14. Fulfilment of
the health workforce varied among the districts. Vacancy rates in Barak Valley were generally higher than
in the other divisions.
Table 2-14 Estimated Vacancy Rate in Secondary and Primary Health Institute in Assam
(2020)
Doctors Nurses
Secondary Primary Health Secondary Primary Health
Hospitals Facilities Hospitals Facilities
Dhemaji 25.0% 34.0% 19.0% 0.0%
Lakhimpur 41.3% 33.3% 0.0% 0.0%
North
Darrang 37.1% 34.2% 0.0% 0.0%

Udalguri
Sonitpur
Biswanath
Barpeta 33.5% 0.0% 29.4%
Bajali
Baksa 16.7% 2.6% 0.0% 2.4%
Bongaigaon 50.0% 31.1% 0.0% 0.0%
Chirang 22.7% 54.8% 4.3% 4.0%
Lower
Dhubri 39.0% 39.5% 1.0% 1.0%

South Salmara 38.9% 2.1% 14.1%
Goalpara 28.1% 11.9% 4.2% 5.8%
Kokrajhar 50.0% 54.6% 0.0% 4.1%
Kamrup Metro 35.7% 28.8% 14.8% 0.0%
Kamrup Rural
Nalbari 28.6% 25.7% 0.0% 0.0%
Dima Hasao 40.0% 67.4% 0.0% 0.0%
Morigaon 26.3% 0.0% 15.0%
Central
Karbi Anglong 34.5% 32.2% 3.8% 6.7%

West Karbianglong 42.9% 36.4% 0.0% 7.7%
Nagaon 18.8% 0.0% 1.0%
Hojai 33.3% 0.0% 21.6%
Dibrugarh 18.8% 1.6%
Tinsukia 61.1% 50.0% 44.4% 30.5%
Jorhat 20.8% 0.0% 1.3%
Upper
Majuli 33.3% 0.0% 2.4%

Golaghat 43.2% 50.4% 1.6% 2.7%
Sivasagar 30.0% 52.3% 1.5% 0.8%
Charaideo 0.0% 4.8% 0.0% 0.0%
Cachar 27.8% 49.0% 40.8% 38.6%
Valley
Barak
Hailakandi 37.8% 57.4% 62.7% 44.0%

Karimganj 34.3% 51.9% 54.5% 52.5%
Assam 34.6% 35.4% 9.1% 9.9%
Note: Blanks are no data.
Source: Estimated by the JICA Survey Team based on the staff list provided by GOA.
5 Ministry of Health and Family Welfare, India. (2018) The Allied and Healthcare Professions Bill.
2-19
In the medical college hospitals, the vacancy rate of medical doctors was the highest in Jorhat MCH.
Fakhrudding Ali Ahmed MCH and Sichar MCH had more than 50% vacancy of co-medical staff (Table
2-15).
Table 2-15 Vacancy Rate of Health Personnel in Medical College Hospitals in Assam (2021)
Medical Doctors Co-medical staff
Assam MCH 19.2% 25.6%
Fakhruddin Ali Ahmed MCH 17.2% 58.0%
Dipih MCH 13.5%
Jorhat MCH 36.0% 9.5%
Silchar MCH 27.5% 54.6%
Note: Guwahati and Tezpur MCHs did not submit the data.
Level of Satisfaction
The general characteristics of the respondents are summarised in Table 2-16. The average age of medical
interns was 24.1 years and that of nursing students was 23.2 years.
Table 2-16 General Characteristics of Respondent for the Staff Satisfactory Survey
No
20's 30's 40's 50's 60's+ Total
Answer
MCH Senior Medical Doctors Female 12 7 8 8 104
Male 12 16 28 13
No answer 63
Medical Teachers Female 11 17 19 27 3 164
Male 1 24 42 17 3
No answer 81
Medical Doctors Female 15 7 5 80
(≦5 years working) Male 12 31 9 1
No answer 56
Nurses Female 26 47 32 33 140
Male 1 1
No answer 43
Paramedical Staff Female 16 5 8 1 135
Male 27 25 28 25
No answer 6
Medical Interns Female 47 165
Male 50
No answer 68
Nursing Students Female 90 90
CDH Senior Medical Doctors n.a. 50
Nurses n.a. 100
As shown in Figure 2-18, most of the respondents in MCH were satisfied with the working environment.
However, around 30% of medical interns were not satisfied. They would like to improve the facilities and
services during the night shift, such as a 24-hour canteen, doctors’ room, and safety and security especially
during night-time. Medical doctors and interns also wanted to reduce the workload, especially among the
young doctors. In CDH, 90% of senior doctors were satisfied and 96% of nurses were happy to work there.
2-20
Paramedicals
Nurses
Medical Interns
Medical Doctors
Medical teachers
Senior Doctors
0% 20% 40% 60% 80% 100%
Never No Yes Yes, very much

Figure 2-18 Satisfaction with Working Environment (MCH)
Both senior and young doctors wanted to strengthen the specialised services in terms of human resources,
equipment, and facilities. They also would like to establish 24/7 laboratory services and increase efficiency
of patient management and procedure by introducing information and communications technology (ICT).
Senior doctors seemed to have wide range of concerns about the working environment such as involvement
in decision-making process, gender consideration, relationship with patient and administrative staff, quality
of patient services, multidisciplinary cooperation, improvement of management policy, etc.
Figure 2-19 illustrates the major factors for satisfaction with workplace. Human relationship seems to be
the biggest factor followed by working hours/days. Medical interns and young doctors also prioritise
professional development such as opportunity of domestic and international training or workshops on
advanced technology. Teachers also prioritise laboratory and library.
Paramedicals
Nurses
Medical Interns
Medical Doctors
Medical teachers
Senior Doctors
0% 20% 40% 60% 80% 100%
Working hours / days Professional Development

Human relationship with hospital staff Human relationship with patients/ patients' family
Salary and allowances Facility/ Smart Facility
Medical equipment Laboratory Facility
Library Facility Others
Figure 2-19 Determinants of Satisfaction of Working Environment (Multiple Answers) (MCH)
2-21
Figure 2-20 shows the factors considered when they choose the workplace. They value facility and
equipment as much as employment condition. Also, medical doctors, interns, and nursing students may
want to work with respectful senior doctors.
Paramedicals
Nursing Students
Nurses
Medical Interns
Medical Doctors
0% 20% 40% 60% 80% 100%

Reputation of the hospital Facility and/medical equipment of the hospital
Employment condition (salary, allowance, etc.) Senior doctors in the hospital
Family's advice Others
Figure 2-20 Factors to Choose the Workplace (Multiple Answers) (MCH)
As for the learning environment, almost half of the senior doctors were not satisfied (Figure 2-21).
Nurses
Medical Interns
Medical Doctors
Senior Doctors
0% 20% 40% 60% 80% 100%
Never No Yes Yes, very much

Figure 2-21 Satisfaction with Learning Environment (MCH)
As shown in Figure 2-22, satisfaction with the learning environment depends on the curriculum and the
quality of on-the-job training (OJT) and mentoring. However, medical teachers pointed out that the number
of mentors/ teachers was not sufficient. Young doctors mentioned that post-graduate research, both
domestic and international, as well as pre-service education curriculum should be improved.
2-22
Paramedicals
Nursing Students
Nurses
Medical Interns
Medical Doctors
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Curriculum of Continuous Medical Education (CME) Quality of OJT (On Job Training)
SMART Education facilities Availing education/training with international medical institution
Quality of mentoring Other
Figure 2-22 Determinants of Satisfaction of Learning Environment (Multiple Answers)
(MCH)
Relevant to human resource shortage, interns and nursing students were more willing to work in the rural
areas than nurses and young doctors (Figure 2-23). Most of the positive reasons were that they were from
rural areas, and they wanted to serve the poor who really needs medical services. In addition, medical
interns expect to gain knowledges and experiences by working in the rural areas. On the other hand, the
respondents are concerned with their security and that of their families in the rural areas. Also, basic
infrastructure such as electricity and safe water, as well as education opportunity for their children hindered
them to work in the rural areas. Doctors also pointed out that in rural areas, they could not utilise and
improve their specialty.
Paramedicals
Nursing Students
Nurses
Medical Interns
Medical Doctors
0% 20% 40% 60% 80% 100%
Don't know No Yes

Figure 2-23 Preference of Working in Rural Areas (MCH)
When they have to work in the rural areas, they wish to be provided with appropriate medical equipment,
facility, and supporting staff, proper living environment, as well as sufficient allowance.
2-23
2.2 Health Finance
National Level
India’s current health expenditure (CHE) is comparable to countries of similar income levels, both in per
capita terms and as a share of gross domestic product (GDP). In per capita terms, India’s CHE was USD
73 in 2018. As a share of GDP, India’s CHE was 3.5% in 2018 (Table 2-1710). All the indicators related
to government health expenditure (GHE) were also lower than the average of lower-middle income
countries (LMICs). OOPE as a share of CHE was 62.7%, which was much higher than average of LMICs
(Table 2-17). GHE as a share of general government expenditure (GGE) has been slightly increased over
the past two decades, while OOPE as a share of CHE has been slightly decreased at the same period (Figure
2-24).
Table 2-17 Health Financing Indicators of India, 2018

Indicators India
GDP per capita (current USD) 2,006
Current health expenditure per capita (current USD) 73
Current health expenditure (% of GDP) 3.5
Domestic general government health expenditure (% of current health expenditure) 27.0
Domestic general government health expenditure (% of GDP) 1.0
Domestic general government health expenditure (% of general government expenditure) 3.4
Out-of-pocket expenditure (% of current health expenditure) 62.7
Source: [World Bank, 2021]
Out-of-pocket expenditure (% of current health expenditure)

80%
60% 72% 73%

62% 65% India
40%
20%
0%
Domestic general gov. health exp. (% of general gov. exp.)
4%
3%
3.3% 3.4% India
3.0% 3.1%
2%
The Modi
1% The Singh administration administration
0%
2000 2005 2010 2015
Source: [World Bank, 2021]
Figure 2-24 Trends of Out-of-pocket Expenditure and Domestic General Expenditure, India
Both breakdowns of OOPE by healthcare functions and by healthcare providers are shown in the following
figures (Figure 2-25 and Figure 2-26). Prescribed medicines were the highest burden of OOPE (42.4%),
followed by general and specialised inpatient curative care (18.3% and 12.8%). Other than pharmacies,
OOPE in private general hospitals was the highest (28.1%), whose amount was about four times higher
than in the government general hospitals (7.4%).
2-24
Prescribed medicines 42.4%
General inpatient curative care 18.3%
Specialized inpatient curative care 12.8%
Laboratory and imaging services 6.8%
Patient transportation 6.2%
Specialized outpatient curative care 5.8%
General outpatient curative care 4.8%
Immunazation programs 1.3%
Healthy condition monitoring 0.8%
Over-the-counter medicines 0.5%
All therapeutic appliances and other medical goods 0.2%
Dental outpatient curative care 0.1%
0% 10% 20% 30% 40% 50%

Source: [National Health Systems Resource Center, 2019]
Out of pocket expenditure by healthcare functions (%)
Figure 2-25 Out-of-pocket Expenditure by Healthcare Functions, FY 2016-2017
Pharmacies 44.2%
General hospitals - Private 28.1%
General hospitals - Government 7.4%
Medical and diagnostic laboratories 6.8%
Providers of patient transportation and emergency rescue 6.2%
Offices of general medical practitioners 5.2%
Providers of preventive care 0.8%
All other ambulatory centers 0.6%
Other healthcare providers not elsewhere classified 0.4%

Retail sellers and other suppliers of durable medical goods
0.2%
and medical appliances
Other healthcare practitioners 0.1%
0% 10% 20% 30% 40% 50%

Source:
Out of pocket [National by
expenditure Health Systems providers
healthcare Resource Center,
(%) 2019]
Figure 2-26 Out-of-pocket Expenditure by Healthcare Providers, India, FY 2016-2017
Overview of Health Finance in Assam

Assam’s total health expenditure (THE) as a share of gross state domestic product (GSDP) was 3.3% for
the fiscal year (FY) 2016-17, which stood at the middle among the states (Figure 2-27). The government
health expenditure (GHE) as a share of GSDP was 1.29%, which was relatively higher compared with the
other states (Figure 2-28). Similarly, GHE as a share of general government expenditure (GGE) was 6.0%,
which was also relatively high (Figure 2-29). It suggests that the Government of Assam has placed higher
priority to the health sector; nonetheless, these numbers are still far below the well-known targets: 5% for
GHE/GDP [Rottingen, J.-A., Ottersen, T., Ablo, A., et al., 2014] and 15% for GHE/GGE [UNAIDS, 2013],
respectively.
2-25
Bihar 6.4%
Uttar Pradesh 6.1%
West Bengal 4.7%
Odisha 4.6%
Kerela 4.5%
Andhra Pradesh 4.2%
Jammu and Kashmir 4.1%
Punjab 4.0%
Chhattisgarsh 4.0%
Jharkhand 3.5%
Madhya Pradesh 3.4%
Rajasthan 3.4%
Assam 3.3%
Himachal Pradesh 3.1%
Maharashtra 2.9%
Karnataka 2.8%
Tamil Nadu 2.8%
Uttarakhand 2.3%
Haryana 2.2%
Gujarat 2.1%
0% 1% 2% 3% 4% 5% 6% 7%
Total Health Expenditure (% of Gross State Domestic Product)

Figure 2-27 Total Health Expenditure as a Share of GSDP for Selected States, FY 2016-17

Chhattisgarsh 1.36%
Bihar 1.36%
Uttar Pradesh 1.35%
Assam 1.29%
Odisha 1.27%
Kerela 1.18%
Rajasthan 1.11%
Jharkhand 1.09%
Andhra Pradesh 1.02%
West Bengal 1.00%
Madhya Pradesh 0.97%
Uttarakhand 0.82%
Punjab 0.80%
Gujarat 0.79%
Tamil Nadu 0.76%
Karnataka 0.76%
Maharashtra 0.67%
Haryana 0.65%
0% 1% 2%
Government Health Expenditure (% of Gross State Domestic Product)

Figure 2-28 Government Health Expenditure as a Share of GSDP for Selected States,
FY 2016-17
Kerela 7.4%
Gujarat 7.2%
Maharashtra 6.2%
Chhattisgarsh 6.0%
Assam 6.0%
West Bengal 6.0%
Rajasthan 5.9%
Punjab 5.7%
Karnataka 5.7%
Tamil Nadu 5.7%
Uttar Pradesh 5.5%
Andhra Pradesh 5.4%
Uttarakhand 5.3%
Odisha 5.0%
Haryana 4.8%
Bihar 4.7%
Jharkhand 4.6%
Madhya Pradesh 4.3%
0% 2% 4% 6% 8%
Government Health Expenditure (% of General Government Expenditure)

Figure 2-29 Government Health Expenditure as a Share of General Government
Expenditure for Selected States, FY 2016-17
2-26
Out-of-pocket expenditure (OOPE) in Assam was relatively low, both as a share of THE and in per capita
terms, compared with other states in FY 2016-17 (Figure 2-30 and Figure 2-31). However, 53.8% for
OOPE/THE is far beyond the target of less than 15-20%, which is suggested by WHO [WHO, 2010].
Bihar 77.6%
Punjab 77.3%
Uttar Pradesh 74.8%
West Bengal 74.1%
Andhra Pradesh 72.2%
Madhya Pradesh 68.9%
Odisha 68.9%
Kerela 67.0%
Jharkhand 66.0%
Uttarakhand 62.2%
Tamil Nadu 62.1%
Maharashtra 56.7%
Rajasthan 56.7%
Haryana 56.6%
Chhattisgarsh 55.9%
Assam 53.8%
Karnataka 49.2%
Gujarat 48.1%
0% 20% 40% 60% 80%
Out of Pocket Expenditure (% of Total Health Expenditure)

Figure 2-30 Out-of-pocket Expenditure as a Share of Total Health Expenditure for Selected
States, FY 2016-17
Kerela 5,419
Punjab 4,608
Andhra Pradesh 3,322
West Bengal 3,169
Maharashtra 2,956
Tamil Nadu 2,938
Odisha 2,796
Uttar Pradesh 2,597
Haryana 2,564
Himachal Pradesh 2,550
Karnataka 2,548
Uttarakhand 2,498
Jammu and Kashmir 2,311
Chhattisgarsh 2,040
Madhya Pradesh 1,944
Rajasthan 1,934
Bihar 1,830
Gujarat 1,781
Jharkhand 1,527
Assam 1,378
0 1,000 2,000 3,000 4,000 5,000 6,000
Out of Pocket Expenditure per Capita (INR)

Figure 2-31 Out-of-pocket Expenditure per Capita for Selected States, FY 2016-17
Fiscal Space for Health

As mentioned above, although the Government of Assam may have a stronger policy intention to maintain
a sufficient level of GHE compared with other states, the health financing indicators have not reached the
targets yet. To achieve the targets, the Government of Assam needs to secure the budgetary room to increase
GHE without jeopardising its financial conditions. The rest of this subsection will give a broad overview
of the fiscal space for health in Assam.
Mathematically, GHE can be described as follows [Teo, Hui Sin; Bales, Sarah; Bredenkamp, Caryn; Cain,
Jewelwayne Salcedo, 2019]:
2-27
𝐺𝐺𝐸 𝐺𝐻𝐸
𝐺𝐻𝐸 = 𝐺𝐷𝑆𝑃 × ×
𝐺𝑆𝐷𝑃 𝐺𝐺𝐸
Each of these elements implies that GHE will increase when: 1) GSDP increases, which would be a result
of growth in the state’s economy, 2) GGE share of GSDP increases, which would come from increase in
aggregate government fiscal resources such as revenues and debt financing, and 3) GHE share of GGE,
which would be attributed to prioritisation of health within the government policy.
Economic Growth
A first key element of overall fiscal space as well as of fiscal space for health is economic growth.
According to the statements laid before the Assam Legislative Assembly as required under the Assam Fiscal
Responsibility and Budget Management Act, 2005 (2021-2022), GSDP over the last seven years for Assam
has seen an upward trend moving from INR 1,777 billion in 2013-14 to INR 3,513 billion in 2019-20. It
has grown at a compound annual growth rate (CAGR) of 12.0% between FY 2013-14 to FY 2019-20, while
CAGR for India (i.e., GDP) has been 10.4% for the same period. Consequently, the states’ contribution
towards the GDP has slightly increased.
Growth Rate (%)
20%
16.5%
GSDP (Assam)
15% 11.4%
10%
10.7%
5% 7.8%
GDP (India)
0%
State's Contribution toward GDP (%)
2.0%
1.5% 1.73%
1.58%
1.0%
0.5%
0.0%
2013-14 2014-15 2015-16 2016-17 2017-18 2018-19 2019-20
Source: [Finance Minister, Assam, 2021]
Figure 2-32 Growth Rate of GSDP and State’s Contribution toward GDP
Although growth prospects in India have been downgraded following the unprecedented COVID-19
outbreak, IMF sees India’s GDP growing by 8.5%, which is 160 basis points higher than its earlier
projection, in FY 2022-23. If that happens, India will become the most rapidly expanding large economy
in the world. The economic outlook of Assam, in a similar way, might be expected to be positive with
steady recovery from the setback.
Financial Situation of the Government of Assam

A second source of fiscal space is from additional fiscal resources, which would allow the government to
increase its aggregate expenditures. Those additional fiscal resources come from higher aggregate
government revenues, debt financing, and so on. From FY 2015-16 to FY 2019-20, the government revenue
and expenditure shares of GSDP have gradually climbed from 21.3% to 22.4% and from 18.4% to 23.5%,
respectively (Figure 2-33).
2-28
25%
23.1% 23.9% 23.5%
20% 21.3% 22.6% 22.1% 22.8% 22.4%
20.9%
18.4%
15%
10%
5%
0%
Expendiures
Expendiures
Expendiures
Expendiures
Expendiures
Receipts
Receipts
Receipts
Receipts
Receipts
2015-16 2016-17 2017-18 2018-19 2019-20
Receipts and Expenditure in Cosolidated Fund (% of GSDP)

Source: [Government of Assam, 2021] and [Finance Department, Government of Assam, 2021]
Figure 2-33 Trend of Revenue and Expenditure of the Government of Assam
The overall composition of Receipts in Consolidated Fund has not been changed significantly in the recent
past; on the other hand, there has been structural change to India’s tax system (i.e., introduction of Goods
and Services Taxes (GST)) and shifts in the composition of tax revenue (Figure 2-34 and Figure 2-35).
Introduction of GST has brought about a paradigm shift in the taxing power of both the central and the state,
and the state’s tax revenue has now been pooled into GST leaving little scope with the state government to
augment its revenue from GST by way of tweaking of GST rate since such power is vested in the GST
Council. However, according to the Analytical Statement 2021-22, the implementation of GST is expected
to have a positive impact on the state government’s finances in the medium to long term. After introducing
the GST in FY 2018-19, the state’s own tax revenue increased at least at the same speed of the GSDP
growth (11.4%). Moreover, the other factors behind the increase of the state’s own tax are explained as
follows, which implies that the tax collection capacity of the state government has improved.
 The introduction of the online system of revenue collection, vis-a-vis amendment in the rules, has
made excise acts and rules more stringent and this has led to stepping up of innovative enforcement
activities resulting to increase in the collection of excise duty in the state.
 Increase in the collection of stamp and registration fee is due to the enhancement of the registration
fee and stamp duty in some documents via marriage, trust, will, release of adoption deed, revocation
deed, security bond, etc.
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(percentage in the bar chart indicate % of GSDP)

100%
2% Loans and Advances
2% 3% 4% 4%
80% 5% Public Debt
6% 5% 4%
6%
2% Grants-In-Aid
60% 1% 1% 2%
2%
Non-Tax Revenue
40% 8% 8% 8%
7%
6%
State Share of Union
Taxes
20%
5% 5% State's Own Tax
4% 5% 5%
Revenue
0%
2015-16 2016-17 2017-18 2018-19 2019-20
Composition of Receipts in Consolidated Fund
Source: [Finance Minister, Assam, 2021] and [Finance Department, Government of Assam, 2021]
Figure 2-34 Composition of Government Revenue in Assam
100% Other Taxes

0.4% 0.4%
0.4% Assam Passenger
80% 0.4% 0.4% Goods Tax
1.5% 1.3% Moter Vehicle Tax
60%
2.3% State Excise
40%
3.3% 3.4% Stamps & Registration
2.7% 2.5%
20% Sales Tax
1.4%
State GST (SGST)
0%
2015-16 2016-17 2017-18 2018-19 2019-20
Composition of State's Own Tax Revenue
Source: [Finance Minister, Assam, 2021] and [Finance Department, Government of Assam, 2021]
Figure 2-35 Composition of the State’s Own Tax Revenue in Assam
In addition to aggregate government revenue, other fiscal indicators such as Gross Fiscal Deficit as a
percentage of GSDP, Debt-to-GSDP ratio, and Interest Payment to Total Revenue ratio have also shown
favourable financial conditions in Assam. Those fiscal indicators have mostly met the targets set by the
Assam Fiscal Responsibility and Budget Management Act (AFRBM) during the past seven years. Although
the Debt-to-GSDP ratio has been increasing recently, which is mainly due to the increase in Open Market
Borrowings (OMBs) and institutional loan, the ratio itself is still below the targeted ceiling and the burden
on interest payment has not shown a sharp growth (Figure 2-36 and Figure 2-37).
2-30
30% AFRBM Target for Debt-GSDP Ratio: Below 28.3%
19.5%
20%
15.5% 16.2%
AFRBM Target for Interest Payment: Below 15.0%

10% 6.8% 5.9% 6.3%
0% 3.3%
2.1% 2.3%
AFRBM Target for Gross Fiscal Deficit: Below 3.5%
-10%
2013-14 2014-15 2015-16 2016-17 2017-18 2018-19 2019-20 2020-21
Debt-GSDP Ratio (%)

Interest Payment to Total Revenue Ratio (%)
Gross Fiscal Deficit (% of GSDP)

Figure 2-36 Major Fiscal Indicators of the Government of Assam

100%
State Provident
4% Fund
4% 4% 4% 4%
4% 4%
80% Central Loan
2%
3% NSSF Loan
3%
60%
4% 4%
4%
4% Institutional
Loan
40%
Market Loan
12%
10%
8%
20% 6% 6% 6%
5%
0%
2013-14 2014-15 2015-16 2016-17 2017-18 2018-19 2019-20 2020-21
Composition of Outstanding Debt

Figure 2-37 Composition of Outstanding Debt of the Government of Assam
Prioritisation of Health
The third key source of fiscal space for health is an increase in the share of government expenditure that
goes to health. As a share of total government expenditure, government expenditure on health in Assam
has been stably maintained at around 6% in recent years (Figure 2-38), which is relatively higher than in
the other states in comparison as mentioned above. This desirable trend is expected to continue, since the
Budget Speech 2021-22 clearly articulated that adequate provision of affordable and quality healthcare to
the population has been a priority.
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100%
Others
80%
Grant No. 25: Miscellaneous
General Services & others
Grant No. PD: Public Debt And

60% Servicing Of Debt
3%
5% Grant No. 64: Roads & Bridges
11% 7%
7% 2%
40% 3% 8% 8%
9% Grant No. 23: Pension
14% 10% 9%
11%
9% Grant No. 71: Education
7%
20% (Elementary,Scy.Etc.)
18% 16% 13% 13% Grant No. 29: Medical & Public
Health
7% 6% 6% 6%
0%
2017-18 2018-19 2019-20 2020-21
Actual Actual Revised Budget
Estimate Estimate
Source: [Government of Assam, 2021]

Figure 2-38 Composition of Government Expenditure in Assam
To summarise, given the moderate prospects of economic growth and the upward trend of the government
revenue and expenditure with the context of relatively favourable fiscal conditions of GOA, as well as the
sustainable prioritisation of health in government expenditure, fiscal space for health in Assam is expected
to be secured in the short to medium term.
Social Health Insurance Scheme

There are some social health insurance schemes in Assam.
Atal Amrit Abhiyan

Atal Amrit Abhiyan is a cashless health insurance scheme for families with an annual income below INR
500,000. This scheme provides free treatment for critical diseases as well as intensive care unit (ICU)
packages, trauma care, critical care, paediatrics and paediatric surgery and bone marrow transplantation in
super-specialty public and private sector hospitals within and outside the state. As of FY 2019-20,
treatments for the following specialties are also covered by the newly launched scheme called Vistarita Atal
Amrit Abhiyan:
 ICU Packages
 Trauma
 Critical Care Paediatrics
 Paediatric Surgery
 Japanese Encephalitis and Acute Encephalitis Syndrome
 Supplementary Packages
So far, a total of 145,220 people have received benefits under this scheme, of which 4,860 have been
covered under the Vistarita Atal Amrit Abhiyan scheme.
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Pradhan Mantri Jan Arogya Yojana (PM-JAY)

PM-JAY was launched in September 2018. This scheme provides comprehensive coverage of up to INR
500,000 per family per year for secondary and tertiary care treatment. Under this scheme, a total of 150,973
beneficiaries have received cashless treatment until now.
2.3 Health Information and Communication Technology (ICT)

In the survey, Hospital Information Management System (HMIS)/ Hospital Information System (HIS) was
examined by studying the following:
1. The prevailing structure of HIS at Directorates and the National Health Mission;
2. The implementation of Hospital Information Systems in the medical college hospitals (work in
progress now) and the suitability of NIC’s e-Hospital software for large-scale state-wide
implementation;
3. The GOI’s National Digital Health Mission and how best to hasten digitisation of hospital operations
and its integration into the Mission; and
4. General recommendations for strengthening of the information system in Assam.
The ICT plan will strengthen the hospital operations and medical records management of medical
college/DHS and other sub-district hospitals by implementing the Government of India’s e-Hospital system
developed by NIC or other appropriate software vendors. The aim is to generate online data for appropriate
decision-making at hospital level, directorate, and government level. Additionally, the ICT plan proposes
to recommend database driven management systems in HR, equipment management, drug procurement and
distribution. The ICT plan also aims to integrate the Assam medical system into the National Digital Health
Mission of GOI over a period of five years, thereby improving the quality and ease of care. The ICT plan
will bring in more transparency and reduce the cost of care.
Conservative timelines of three years for medical colleges and four years for district/CHC hospitals are
proposed with a budget outlay of INR 45.54 crores; and five to seven years’ timeline for PHC and other
hospitals with a budget of INR 56.6 crore. Hardware, software, implementation, HR, and operational
expenses are provided over five years.
Present Situation
Medical College Hospitals

Medical college hospitals in Assam have been using two types of software systems for data capturing,
GMCH and Dibrugarh, with an old legacy computer system and minimal data, as developed by AMTRON,
the Assam government hardware and software corporation (Table 2-18).
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Table 2-18 Summary of HIS Implementation Status of the Target Medical College Hospitals
Name of the hospital System Remarks
Assam Medical College & Amtron, Guwahati developed Non – compatible for NDHM – local server
Hospital, Dibrugarh system. Functional for OPD and based. It needed to be moved to cloud based e-
billing and several other modules Hospital software to include medical records
Guwahati Medical College Amtron, Guwahati developed Non – compatible for NDHM – local server
& Hospital system. Functional for OPD and based. It needed to be moved to cloud based e-
billing and several other modules Hospital software to include medical records
Silchar Medical College & e-Hospital (GOI’s NIC Basic modules of e-Hospital system are well
Hospital developed) implemented. Full modules to be implemented
FAA Medical College & Amtron Guwahati Basic modules OPD and billing implemented
Hospital Barpeta
Tezpur Medical College & Amtron Guwahati Basic modules OPD and billing implemented
Hospital
Jorhat Medical College & Amtron Guwahati Basic modules OPD and billing implemented
Hospital
Diphu Medical College & Amtron Guwahati Basic modules OPD and billing implemented
Hospital
Note: The following assessments are made through site visits, facilities survey data, interviews, observations by technical experts
in NIC, luminous, CDAK, NIC, Pune, luminous info way along with present and past teams of NHM.
Management information System of the National Health Mission

The National Health Mission (NHM) covers all other hospitals other than the tertiary medical colleges.
NHM is having a strong management information system (MIS) cell in line with the national health
information system guidelines, budget process, data elements, hardware (from sub-district and district
hospital levels). It has in-house developed software modules like human resource management (HRM),
EEE (Annex II). NHM created and maintain the standardised websites for all the stakeholder departments.
NHM since 2007 has been connecting the rural hospitals, getting the data entry, validation, and report
preparation. It continued to upgrade its tools, processes, and hardware (deployed even Very Small Aperture
Terminal (VSATS) and gained experience of connectivity even 13 years ago).
NHM is strong in terms of systems (established over the last 15 years) data collection and validation
practices, hardware, training mechanisms, quality of teams in house, and even good budget support.
At present NHM operates mainly through the Swasthya Sewa Dapoon – Integrated MIS GIS System
(Annex III).
Information Management System in Health Administration

The Directorate of Health Services (DHS), Directorate of Medical Education (DME), and Directorate of
Family Welfare (DFW) of the Health and Family Welfare Department of Assam (HFWD) have no in-house
system or support for data for decision-making. However, they can always seek, access, and use the portals
of NHM reporting modules or the Assam specific modules of HRM, PHARMA, etc.; but in practice, they
seek/access the data on less occasions, do not regularly update the HR postings, etc., and almost not aware
of modules like drugs vaccines, distribution logistics management system (DVDMS), biomedical
equipment maintenance and management system.
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e-Hospital Software as Developed by National Informatics Center, Delhi

Several private vendors/HIS systems are available in the market (mostly cloud based). They are reasonably
priced. But the chief orientation of these software is billing and revenue collection apart from referral
linkages and payment mechanisms. Large hospital chains like Apollo have homegrown software and suit
their business/revenue orientation (Annex IV).
The fairly proven and increasingly accepted HIS has been developed by the National Informatics Center,
Delhi as a standardised HIS application in hospitals across India (www.ehospital.gov.in). It consists of all
useful modules starting from outpatient department (OPD) to inpatient department (IPD) to e-prescriptions,
medical records, and blood bank.
e-Hospital has been implemented in 678 hospitals (most of them are the basic modules) but is robust as it
has handled the AIIMS, Delhi, and other top hospitals’ patient’s load and requirement with complete
modules. e-Hospital is in the process of upgrading their modules to the next level by incorporating the GOI
digital health mission standards. Detailed modules of e-Hospital and site visit to TRIPURA are presented
in Annex V.
Brief comparative states of e-Hospital and other software are summarised in Table 2-19.
Table 2-19 Brief Comparative State of e-Hospital and other Software

Other Government
Item e-Hospital of NIC Supported like Private
eSushrut of CDAC
Large user base Around 700 hospitals Up to 200 hospitals Large number
GOI support Yes (developed NIC, GOI) Yes Case specific – they will
have to comply with
NHDM
Continuous Yes Not sure Yes
upgrading
Cost Low – but latest demand for INR 12 Medium Competitive
cloud charges a year for hospital is too
high (implementation cost is
additional)
Flexibility Medium – in consultation with the Medium High
Tripura NIC, we can leverage sufficient (possible to customise and
customisation. develop easier interfaces –
but may take time)
Compatibility High Yes Unspecified at present –
with digital health but possible
mission
Cloud based Yes Yes Company and product
specific
Speed of Medium (needed to hire large teams to Medium High
implementation speedup implementation)
In use in Assam Yes, in SMCH, Silchar, LGBRIMH, Not yet Many public and private
Tezpur and all district hospitals in the hospitals across India by
Government of Assam. Thirty district multiple vendors
hospitals will be covered within this
financial year.
HER Compliance Yes Yes Unspecified at present
Table 2-20 summarises outline of health information system in Assam.
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Table 2-20 Summary of HMIS and HIS in Assam.

NHM DHS/DFW DME Medical Colleges
Section/Cell/Department Fully Not present – Not present Not present
established
Teams Dedicated up to Not present - Not present Not present
7 numbers
HR Manpower in Manpower in - No dedicated IT person
position at position at or IT coordinator from
state/dt/block state/dt/block level doctors’ cadre
level
Modules/Software All most for all Not present Not present e-Hospital basic
/Tools purposes – modules in
rather too many implementation,
AMTRON modules in
AMC, GHM&C
Periodicity/ Regularity Daily/weekly eVIN and CoWIN Seek from Generate on demand by
/monthly system. Others Seek Colleges and DME or govt.
reports for GOI from NHM NHM
Data for Decision- Fairly Established for eVIN Need to grow Need to grow
making established and CoWIN system.
Need to grow for
other subjects
Website Strong and Good website Good website – Good website – active
continuous active in in admission times
updated admission times
Hardware Support Best and Use for normal Use for normal Good but scattered for
highest communication communication various purposes
Note: Atal Amrit Abhiyan society and other autonomous organisations have own software and formats for collecting – insurance
related – beneficiary details at the OPD level in hospitals. (Needed to study)
Attempt has been made in 2017/2018 by NHM to develop most of the procurement/maintenance modules for
drugs/equipment systems. Due to the host of logistical issues of engaging national vendors, NHM ended up developing its
in-house system for drugs procurement and distribution, which is acceptable.
GOA may evaluate the implementation of e-Hospital in medical college and district hospitals as it is already
underway whether to implement the full modules under this project or to seek a private top software vendor
to integrate fully with the national digital health mission.
GOI’s Massive Plan and Digital Health Records of Indians through National Digital Health
Mission
The National Digital Health Mission is a digital health ecosystem being implemented by GOI in the Union
Territories (to be extended to all states soon) now under which every Indian citizen will have unique health
IDs, digitised health records as well as a registry of doctors and health facilities (Annex V).
A unique health ID will be provided to every citizen, which will contain details of their diseases, diagnoses,
report, medication, etc., in a common database through a single ID. This will essentially be a digitised
version of all their health records. This digital database will be linked to the registry of doctors and health
facilities across the country [Gov of India, 2021].
Digital data/records will help medical college professors’ conduct/publish quality research articles, secure
funding from national bodies, and improve their professional knowledge through submission of research
papers in national and international conferences.
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2.4 Medical Institutes
Outlines of the Medical College Hospitals

Table 2-21 and Table 2-22 summarise the outline of the seven medical hospitals. Generally, the facilities
seemed to be deteriorated and layouts may not be appropriate to have efficient movement of patients and
staff.
Table 2-21 Summary of the Candidate Medical College Hospitals (1)

Name AMCH GMCH SMCH JMCH
Assam Medical Gauhati Medical Silchar Medical Jorhat Medical
College Hospital College Hospital College Hospital College Hospital
Location Dibrugarh Guwahati Cachar Jorhat
Establishment
1947 1960 1968 2009
Year
1,365 2,185 1,151 500
Number of Inpatients
Inpatients 36,311/year
Beds 54,978/year
(2019.9～2020.8)
(2018.4～2019.3)
Medicine Medicine General Medicine Medicine
Existing
General Surgery General Surgery General Surgery Surgery
Clinical
Orthopaedics Orthopaedics Orthopaedics Orthopaedics
Department
Plastic Surgery Plastic Surgery Pulmonary Medicine Cardiology
Cardiology Cardiology Neurology Neurosurgery
Neurology Cardiovascular Neurosurgery Obstetrics
Obstetrics Neurology Obstetrics Gynaecology
Gynaecology Neurosurgery Gynaecology Paediatrics
Paediatrics Gastroenterology Paediatrics ENT
ENT Nephrology ENT Ophthalmology
Ophthalmology Endocrinology Ophthalmology Dermatology
Dermatology Urology Dermatology Psychiatry
Psychiatry Obstetrics Psychiatry Dentistry
Dentistry Gynaecology Dentistry TB and Chest
Paediatrics Community Medicine Community Medicine
ENT Emergency and
Ophthalmology Trauma
Dermatology
Psychiatry
Oncology
TB and Chest
Community Medicine
Emergency
No. of Doctors 341 (no data) 219 216
No. of Nurses 378 (no data) 313 346
657,390/year 240,237/year
More than 1,000 More than 4,000 (2018.4～2019.3) (2019.9～2020.8)
OPD Patients
patients/day patients/day More than 2,000 More than 800
patients/day patients/day
Major: 4,835/year Major: 7,473/year
Operation
No Data No Data Minor: 4,166/year Minor: 9,468/year
Theatre
(2018.4～2019.3) (2019.9～2020.8)
MRI: 2,058/year MRI: 1,614/year
CT: 16,461/year CT: 9,135/year
Diagnostic
No Data No Data USG: 35,795/year USG: 16,923/year
Imaging
X-ray: 69,796/year X-ray: 27,420/year
(2018.4～2019.3) (2019.9～2020.8)
2-37
Name AMCH GMCH SMCH JMCH

Assam Medical Gauhati Medical Silchar Medical Jorhat Medical
College Hospital College Hospital College Hospital College Hospital
All department Although the buildings
buildings are are constructed only
deteriorated. ten years ago, all
Some inpatients are department buildings
All department
bedded in the floor due are deteriorated.
Existing buildings are
to the scarcity of beds. Some inpatients are
Facility No Data deteriorated.
OPD waiting area is bedded in the floor due
Condition There is no waiting
not sufficient to to the scarcity of beds.
space for outpatients.
accommodate all No lifts.
patients. ICU is not functional
No lifts or most of lifts because of the out of
are not functioned. dated environment.
Cancer Hospital
Cancer Radiation Cancer Hospital
Under Super Specialty
Block Doctors’ Quarters OPD building
Construction Hospital
(Tomo therapy) refurbishment
(What department ?)
Super Specialty Wings Super Specialty Wings
Smart Hospital, (Cardiology, (Cardiology,
Nephrology, Nephrology,
Training, Monitoring,
Smart Hospital, Neurology, Neurology,
Requirements Administrative Centre
Dormitory for staffs Cardiovascular Cardiovascular
from GoA on (approx. 9,300 ㎡),
and Surgery, Neurosurgery, Surgery, Neurosurgery,
24 September Dormitory for staffs
Night Shelter (200 Urology), Urology),
2021 and
beds) Dormitory for staffs Dormitory for staffs
Night Shelter (200 and and
beds)
Night Shelter (200 Night Shelter (200
beds) beds)
Table 2-22 Summary of the Candidate Medical College Hospitals (2)

Name FAAMCH TMCH DMCH
Fakhruddin Ali Ahmed Tezpur Medical College Diphu Medical College
Medical College Hospital Hospital Hospital
Location Barpeta Tezpur Diphu, Karbi Anglong
Establishment
2011 2013 2019
Year
Number of
500 500 300
Beds
Medicine General Medicine General Medicine
Existing
Surgery General Surgery General Surgery
Clinical
Orthopaedics Orthopaedics Orthopaedics
Department
Obstetrics Pulmonary Medicine Pulmonary Medicine
Gynaecology Obstetrics Obstetrics
Paediatrics Gynaecology Gynaecology
ENT Paediatrics Paediatrics
Ophthalmology ENT ENT
Dermatology Ophthalmology Ophthalmology
Psychiatry Dermatology Dermatology
T.B. and Chest Psychiatry Psychiatry
Rehabilitation Dentistry Dentistry
Community Medicine Community Medicine Community Medicine
Emergency and Trauma Emergency and Trauma
No. of Doctors 159 167 135
No. of Nurses 345 361 452
2-38
Name FAAMCH TMCH DMCH

Fakhruddin Ali Ahmed Tezpur Medical College Diphu Medical College
Medical College Hospital Hospital Hospital
69631/year
Nearly 800 ～1,000
OPD Patients More than 1,000 patients/day (2019.11～2020.10)
patients/day
More than 250 patients/day
Major: 857/year
Operation
No Data No Data Minor: 146/year
Theatre
(2019.11～2020.10)
Diagnostic
No Data No Data No Data
Imaging
Although the buildings are
Although the buildings are constructed only ten years
constructed only ten years ago, all department buildings
ago, all department buildings are deteriorated.
are deteriorated. Some inpatients are bedded in Buildings are new.
Existing
Some inpatients are bedded in the floor due to the scarcity of Some medical equipment are
Facility
the floor due to the scarcity of beds. already procured but not yet
Condition
beds. ICU is not functional because installed. (ex. MRI etc.)
ICU is not functional because of the out of dated
of the out of dated environment.
environment. No lift or Most of lifts are not
functioned.
Doctors Quarter Staff Quarter
Under Cancer Hospital
Hostels for Doctors and Hostels for Doctors and
Construction Mother and Child Hospital
Nurses Nurses
Super Specialty Wings Super Specialty Wings Super Specialty Wings
Requirements (Cardiology, Nephrology, (Cardiology, Nephrology, (Cardiology, Nephrology,
from GoA on Neurology, Cardiovascular Neurology, Cardiovascular Neurology, Cardiovascular
24 September Surgery, Neurosurgery, Surgery, Neurosurgery, Surgery, Neurosurgery,
2021 Urology), Dormitory for staffs Urology), Dormitory for staffs Urology), Dormitory for staffs
and Night Shelter (200 beds) and Night Shelter (200 beds) and Night Shelter (200 beds)
Hospital Management
According to HFWD, every medical college hospital as a hospital management society. It is autonomous
in functions and decision making to provide support to operation of the medical college hospital. A principal
takes chair and superintendents are the members. Also, Director of Medical Education of HFWD, and
representatives from other government agencies and public are involved. The governing board is headed
by a public representative, such as local member of legislative assembly. Financial sources of the society
are donations and government grants, which is usually Rs. 30 to 50 million per year per society. Also, user
funds are generated from patient registration fee and other medical services to be deposited in the society’s
bank account. The user funds are utilized to hire contractual staff, operation and maintenance of hospital
functions, purchase of consumables.
Also, in district/civil hospitals have hospital management society chaired by directors. Since introduction
of the free diagnostic initiative, deposit from user fund has been decreased. The society also receives funds
from the National Health Mission.
Under the subcontracted survey, the JICA Survey Team inquired about the management vision and
commitment of the target hospitals, as well as concrete tools for management review. Six out of seven
MCHs and four from six CDHs responded to the questionnaire. All the hospitals stated their management
2-39
vision and mission, but the commitment of the hospital to realise the management vision seemed not clear.
According to the questionnaire survey to the hospital staff, there were some comments that decision-making
procedure had not been opened to the staff but it was just limited to some personnel.
Mid-term and long-term development plans seemed to focus on infrastructure development such as
installation of new facilities, and renovation and/or upgrade of the existing facilities.
The Plan-Do-Check-Action (PDCA) cycle seemed not to be familiar in most of the hospitals, except two
in each of the MCHs and CDHs which stated that they use PDCA cycle in management. Regarding risk
management, three MCHs and one CDH opened about incident report or risk management information, and
one MCH out of those provided periodic training on risk management. Another MCH seemed to prepare
an incident report, but it is closed to hospital staff.
2-40
Overview of the Project Site
3.1 Socio-Economic Overview
Geography and Demography

Assam is in the northeast of India and is the largest NER state in terms of population while second in terms
of area. Assam covers an area of 78,438 km2, which accounts for nearly 2.4% of India’s total geographical
area. The state is bordered by Bhutan and the State of Arunachal Pradesh to the north; Nagaland, Arunachal
Pradesh and Manipur to the east; Meghalaya, Tripura, Mizoram, and Bangladesh to the south; and West
Bengal to the west. A significant geographical aspect of Assam is that it contains three of the six
physiographic divisions of India – The Northern Himalayas (Eastern Hills), The Northern Plains
(Brahmaputra plain), and Deccan Plateau (Karbi Anglong). There is a distinct monsoon season in which a
large part of the annual rainfall is concentrated. The landscape includes tea gardens, the river Brahmaputra,
many historical monuments and temples. Another aspect that separates Assam from the rest of Indian states
is the rich composite culture of the state. Assamese constitute most of the state's population, but the state
has over two dozen other big and small tribal groups with many of them having their own language, writing
system, and traditions.
According to the Population Projection Report, the total population of Assam in 2011 was 31.2 million and
projected to be 39.4 million in 2036. Figure 3-1 shows Assam’s population pyramid in 2011 and 2036. In
2011, the proportion of teenagers and twenties is high. However, in 2036, the shape of the pyramid is
projected to be changed to a hanging bell shape, which indicates that the number of children will be
declining while the overall population, including working age population and the people aged 65 or older,
will be growing.
2011 2036
80+ 80+
70-74 70-74
60-64 60-64
50-54 50-54
40-44 40-44
30-34 30-34
20-24 20-24
10-14
10-14
0-4
0-4
12% 8% 4% 0% 4% 8% 12%
12% 8% 4% 0% 4% 8% 12%
Male Female
Male Female
Source: [National Commission on Population, Ministry of Health & Family Welfare, Mirman Bhawan, 2020]
Figure 3-1 Population Pyramid in Assam
3-1
40%
India 39%
30%
31%
20%
Assam
17%
10% 14%
0%
2011 2016 2021 2026 2031 2036
Projected Urban Population to Total Population (%)
Source: [National Commission on Population, Ministry of Health & Family Welfare, Mirman Bhawan, 2020]
Figure 3-2 Projected Urban Population to Total Population
Economy
In FY 2019-20, Assam’s Net State Domestic Product (NSDP) per capita was INR 86,801, or approximately
USD 1,200 (Figure 3-3), which was the fifth lowest among the states. According to the statistics, other than
the service sector, the percentage contribution of agriculture and industry sector is more or less static (Figure
3-4). The tea industry occupies an important place in Assam and plays a very special role in the state
economy. Assam tea has maintained its international reputation and keeps significant share in the world tea
market. The total area under tea cultivation in Assam is accounting for more than half of the country’s total
area under tea. In addition, the tea industry in Assam also provides average daily employment to more than
68,600 persons in the state, which is around 50 percent of the total average daily number of labourers
employed in the country, according to the Economic Survey.
Goa 435,959
Sikkim 403,376
Delhi 376,221
Chandigarh 330,015
Haryana 247,628
Telangana 233,325
Karnataka 223,175
Kerala 221,904
Puducherry 221,493
Andaman & Nicobar Islands 218,649
Gujarat 213,936
Tamil Nadu 213,396
Uttarakhand 202,895
Maharashtra 202,130
Himachal Pradesh 190,407
Mizoram 187,327
Arunachal Pradesh 169,742
Andhra Pradesh 168,480
Punjab 155,491
All-India 134,186
Tripura 125,675
Nagaland 120,518
Rajasthan 115,492
West Bengal 113,163
Orissa 110,434
Chhattisgarh 105,089
Madhya Pradesh 103,288
Jammu & Kashmir 102,789
Meghalaya 87,170
Assam 86,801
Manipur 84,746
Jharkhand 77,739
Uttar Pradesh 65,704
Bihar 45,071
0 100,000 200,000 300,000 400,000 500,000
Per Capita Net State Domestic Product (At Current Prices, INR)
Source: [Reserve Bank of India, 2021]

Figure 3-3 Per Capita Net State Domestic Product
3-2
100%
80%
47% 46% Services
50%
60% Industry (excl.

Manufacturing)
21% 22% Manufacturing

40% 20%
10% 11% Agriculture, forestry

11%
20% and fishing
22% 21% 18%

0%
2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18 2018-19 2019-20
Net State Value Added By Economic Activity (At Current Prices)

Source: [Reserve Bank of India, 2021]
Figure 3-4 Net State Value Added by Economic Activity
3.2 General Environmental Condition
Climate
Assam State has a tropical monsoon climate, with an annual precipitation of around 2,100 mm and
maximum temperature in summer (May-August) of around 35-38 °C and a minimum of 6–8 °C in winter
(November-February). Figure 3-5 presents the annual distribution of precipitation, and the maximum and
minimum temperatures at Dispur. The state gets the highest rainfall (28.7%) due to the southwest monsoon
in July followed by June (28.6%). August and September receive 23.8% and 18.9% of southwest monsoon
rainfall, respectively. Also, more than 66% of the annual rainfall is received during the southwest monsoon
season only. The variability of monsoon or annual rainfall is also very low (12%).
Source: [meteoblue, 2021]

Figure 3-5 Monthly Precipitation, Mean Maximum and Minimum Daily Temperature
3-3
(Dispur)
Source: [Ministry of Earth Sciences, 2021]

Figure 3-6 Trend in District Level Rainfall (left) Rainy Season and June-September (right)
Source: [Ministry of Earth Sciences, 2021]

Figure 3-7 Average Frequency of Rainy Days (left) and June-September (right)
Agro-Climatic Division
Considering climate, topography, soil characteristics, and the cropping pattern, the state is divided into six
agro-climatic zones, namely: Barak Valley Zone, Hill Zone, Upper Brahmaputra Valley Zone, Central
Brahmaputra Valley Zone, Lower Brahmaputra Valley Zone, and North Bank Plain Zone. The
characteristics of each zone are described as follows:
Upper Brahmaputra Valley Zone: The zone includes Tinsukia, Dibrugarh, Sibsagar, Jorhat, and Golaghat
districts, where season-wise average rainfall ranges between 74.4 mm in winter and 1,060 mm in summer.
Rice is the principal crop and sugarcane and mustard are the other important crops that are grown in the
region.
3-4
Central Brahmaputra Valley Zone: The zone encompasses Kamrup, Nagaon, and Morigaon districts.
Season-wise average rainfall of the Central Brahmaputra Valley varies between 31 mm in winter and 1,271
mm in summer. Rice, mustard, jute, and pulse are the main crops of the zone.
Lower Brahmaputra Valley Zone: The zone stretches over Goalpara, Dhubri, Kokrajhar, and Bongaigaon
districts. In this zone, rainfall mainly occurs due to the summer monsoon that originates from the Bay of
Bengal and ranges from 89 mm during winter to 1,203 mm during monsoon in summer. The climate is
suitable for rice, mustard, potato, wheat, and jute cultivation, because of fertile soils.
Hill Zone: It includes Karbi Anglong and N C Hills. The average seasonal rainfall during the monsoon
season is about 719 mm, and shifting cultivation is practised in this region. Crops such as rice and sugarcane
are cultivated in the zone mainly for sustenance.
Barak Valley Zone: Cachar, Hailakandi, and Karimganj districts are included in Barak Valley Agro-
Climatic Zone. The average seasonal rainfall during the monsoon season is about 1,957 mm. This region is
also known for the cultivation of rice and sugarcane.
North Bank Plain Zone: This agro-climatic zone stretches over the districts of Dhemaji, Lakhimpur,
Sonitpur, Darrang, Nalbari, and Barpeta (newly formed districts like Udalguri, Baska, and Chirang are
included here). While rice is the main crop of the region, mustard and sugarcane are also grown. The
temperature varies from 22 oC to 35 oC, and annual rainfall varies from 1,500 mm in the western part to
3,400 mm in the northeastern part of the zone.
Source: [HK Nath, 2018]

Figure 3-8 Agro-Climate Division of Assam State
Geology
A major part of the state is covered by the recent alluvium of the east-west trending Brahmaputra floodplain
(BFT), which is said to be tectonic in origin, in which the valley portion was formed by the compression
between the European and the Indian plates and also led to the formation of the Himalayan Mountains [N
Das, et al., 2017]. Sediment characteristics vary based on the origins and features of the northern and
southern tributaries. The larger northern tributaries, of Himalayan origin, have greater sediment discharge,
3-5
consisting mainly of silt fractions. The beds and the banks of the southern tributaries were formed by non-
alluvial sediments. The Karbi Anglong Hills and North Cachar Hills located at the central portion consist
of gneisses, schists, and granite, while transported soils were formed through the weathering of rocks of the
Himalayas and the Assam Plateau [Mahanta C, 1995]. Cachar Plain in the south comprises recent alluvium.
Source: JICA Survey Team based on Geological Survey of India

Figure 3-9 Geological Base Map of Assam with Different Geological Formations
Hydrology
Assam is endowed with enormous water resources. The large perennial rivers and other water bodies with
rich aquifer speak about the vastness of its water resources. Surface water is available in the form of river,
stream, lake, swamp, pond, etc. Groundwater is available at low to moderate depths in almost the entire
state. Although there is seasonal and regional variation in the availability of water resources, the annual
availability of water resource remains almost the same.
Surface Water
Apart from the annual rainwater received, thanks to the good monsoon and low pressure in the Bay of
Bengal, the state is endowed with several perennial rivers and lakes. The state is drained by the river systems
of Brahmaputra and the Barak rivers. There are about 73 important tributaries of the Brahmaputra River
and 11 tributaries of Barak River. The vast potential surface water resource of the state is not yet properly
utilised in the state. In the last few decades, the rate of consumption of water in the agricultural sector,
industrial sector, and in the urban centres has increased significantly. The discharges of untreated domestic
3-6
wastewater, industrial wastewater, runoff from the agricultural fields, and urban sewage water are posing
threat to the water bodies of the state.
Source: WWF
Figure 3-10 Major River System
Groundwater
Assam is one of the rich states of the country in terms of the groundwater development potentiality. The
entire Brahmaputra Valley, covering more than 70 percent of the total geographical area of the state,
contains prolific aquifer system with water table lying within 5 m of land surface. The Barak Valley also
has a good potentiality for the development of groundwater. In some parts of the state, there is a problem
of groundwater contamination such as Fluoride, Iron, and Arsenic as shown in Table 3-1
Table 3-1 Groundwater Quality Problems

Contaminants Levels Districts Affected (in part)
Fluoride >1.5 mg/L Goalpapra, Kamrup, Karbi Anglong, Nagaon,
Iron >1.0 mg/L Cachar, Darrang, Dhemaji, Dhubri, Goalpapra, Golaghat, Hailakandi,
Jorhat, Kamrup, Karbi Anglong, Karimganj, Kokrajhar, Lakhimpur,
Morigaon, Nagaon, Nalbari, Sibsagar, Sonitpur
Arsenic >0.05 mg/L Dhemaji
Source: Central Ground Water Board (CGWB)
Protected Areas
Out of the five national parks in Assam, two are designated as World Natural Heritage Sites by the United
Nations Educational, Scientific and Cultural Organization (UNESCO). Assam has rich biodiversity and is
endowed with rich topography covering lush hills and valleys dissected by the majestic Brahmaputra and
its many tributaries. It is home to over 180 species of mammals, including rare and endangered species like
the great Indian one-horned rhinoceros, the royal Bengal tiger, the golden langur and hoolock gibbon, and
3-7
a spectacular range of avifauna. Assam's most famous parks are Kaziranga and Manas. Both were conferred
World Heritage Status in 1985. There are 18 notified wildlife sanctuaries spread across the state. It is
expected that none of the candidate project site is located within 10 km from protected area.
Source: Wildlife Institute of India

Figure 3-11 Wildlife Protected Areas in Assam
Natural Disasters
Seismology
The NER of India including Assam State is an earthquake prone area. The region has experienced many
earthquakes of tectonic origin. The risk probabilities of earthquake are less over the entire Brahmaputra
Valley. Two major earthquakes in history, one with magnitude 8.7 that occurred in 1897 and another with
magnitude 8.6 in 1950, both caused large-scale damage in lives and properties in the region. Sir Edward
Gait (1933) has mentioned that the occurrence of destructive earthquakes in this region since 1500
happened once or twice every century. In the last century, destructive earthquakes occurred in
1918, ’23, ’30, ’32, ’38, ’43, ’47, ’50, and in ’88.
As indicated in the previous section, much of Assam lies in the Brahmaputra River Valley, except for a few
southern districts. The northern and eastern parts of this valley are bounded by the Himalayan Frontal
Thrust (HFF). In the eastern parts along with the HFF, there is the Lohit and Naga thrusts. Among the large
earthquakes in this region were the events in 1869 and 1897. The 1897 earthquake is well known for the
dramatic accounts of violent upthrow during the shock. The northeast Himalayan region of India is one of
the most seismically hazardous zones in South Asia. GSI has determined the 3-D seismic velocity (Vp)
structure of the crust of that region using selected arrival time data from two groups of shallows to
intermediate-depth local earthquakes recorded by two different seismic networks by applying the 3-D
tomography method of Zhao et al. (1992).
3-8
Source: Earthscrust.org.au (based on Gupta et. Al. 2005)

Figure 3-12 Tectonic Map of North Eastern Region
Annual Floods
The State of Assam has a total surface area of about 78,438 km 2, which forms part of the Brahmaputra
basin. The basin lies within the monsoon rainfall regime receiving an annual rainfall of about 2,300 mm,
60-70% of which is observed during the monsoon season from June to September. The Brahmaputra River,
along with its host tributaries, causes devastating floods almost every year with colossal loss and damage
to infrastructure and environment in the state. The unique environmental setting, i.e., the eastern Himalayas,
highly potential monsoon regime, and accelerated rates of erosion, rapid channel aggradation, deforestation,
intense land use pressure, and high population growth especially in the floodplain belt, are some of the
dominant factors that cause recurrent floods in the State of Assam with the extent of risk hazard as indicated
in Figure 3-13 (Goswami, 1998, Kotoky et.al., 2003).
The flood prone area of the state as assessed by the Rastriya Barh Ayog (RBA) is 31.05 lakh hectares
against the total area of the state of 7,852,300 ha, i.e., about. 40% of the total land area of Assam, and 9.4%
of the total flood prone area of the country. Average annual loss due to flood in Assam is estimated to be
around two billion Indian rupees.
3-9
Source: Department of Space, GoI

Figure 3-13 Flood Hazard Map of Assam
3.3 Project Site
Tertiary Medical Institute (Medical College Hospital)

There are seven medical college hospitals in Assam and the one in Lakhimpur is about to begin admission.
The current specifications of the seven MCH are shown in Table 3-2 below.
Table 3-2 Current Specifications and Conditions of Seven MCH

Additional
Name of the Establishment No. of MBBS No. of
Location Departments to the
Institute (Year) Student Beds
Standard
Radiation Oncology/
1. GMCH Kamrup (M) 1960 156 2,284 Cardiology/ Neurology/
Neurosurgery
Radiation Oncology/
2. AMCH Dibrugarh 1960 170 1,954
Cardiology/ Neurology
3. SMCH Cachar 1968 100 1,256 Cardiology
Cardiology/
4. JMCH Jorhat 2009 100 500
Neurosurgery
5. TMCH Sonitpur 2013 100 500 -
6. FAAMCH Barpeta 2011 100 500 -
Karbi- Radiation Oncology
7. DMCH 2011 100 300
Anglong (ACCF)
8. LMCH Lakhimpur 2021 - - -
3-10
Gauhati Medical College and Hospital, Kamrup (M)

Gauhati Medical College and Hospital (GMCH) is one of the premier health care institutions established in
Assam in 1960 in the NER of India, which provides tertiary level medical care with a bed strength of 2,500
beds. It provides medical education at undergraduate, postgraduate and super specialty levels. Basic
information is shown in Table 3-3 below.
The hospital has all the basic specialties and super specialties like Cardiology, Cardiovascular, Neurology,
Nephrology, and Neurosurgery. A new block of super specialty hospital across the road is under
construction.
The distance from the nearest airport, Lokapriya Gopinath Bordoloi Airport, Guwahati to GMCH is 24.3
km (Driving time is approx. 49 min).
Table 3-3 Gauhati Medical College and Hospital (GMCH)

Address: Bhangagarh, PO Indrapur 781032 Assam
Site Area: No Data (No site plan shared)
Establishment: Year 1960
MBBS Course: 156 students / year
Bed Strength: 2,284
OPD Patients: More than 4,000 patients/day
Operation Cases: No Data.
Diagnostic Imaging: No Data.
Clinical Departments: Medicine, General Surgery, Orthopaedics, Plastic Surgery, Cardiology,
Cardiovascular, Neurology, Neurosurgery, Gastroenterology,
Nephrology, Endocrinology, Urology, Obstetrics, Gynaecology,
Paediatrics, ENT, Ophthalmology, Dermatology, Psychiatry, Oncology,
T.B. and Chest, Community Medicine, Emergency
Facilities under Construction: Cancer Radiation Block (Tomo-therapy)
Assam Medical College and Hospital, Dibrugarh

Assam Medical College and Hospital (AMCH) was the first medical college set up in Assam and the whole
NER in India. It is the tertiary medical referral centre for upper Assam and areas in neighbouring states.
Basic information is shown in Table 3-4 below.
The distance from Guwahati to Assam MCH is 448.0 km (Driving time is 9 hours and 56 minutes). The
distance from the nearest airport, Mohanbari Airport, to Assam MCH is 10.4 km (Driving time is approx.
25 min) via NH-15.
3-11
Table 3-4 Assam Medical College and Hospital (AMCH)

Address: AMC Road, Barbari, Assam 786002 in Dibrugarh Town of Assam
Site Area: Approx. 666,855 sqm
Bed Strength: 1,954
Operation Cases: No Data
Diagnostic Imaging: No Data
Clinical Departments: Medicine, General Surgery, Orthopaedics, Plastic Surgery, Cardiology,
Neurology, Obstetrics, Gynaecology, Paediatrics, ENT, Ophthalmology,
Dermatology, Psychiatry, Dentistry
Facilities under Construction: Cancer Hospital and Super Specialty Hospital
Observations on Existing All department buildings are deteriorated. Some inpatients are bedded on
Facilities: the floor due to the scarcity of beds. OPD waiting area is not sufficient to
accommodate all patients. No lifts or most of lifts are not functioned.
Silchar Medical College and Hospital, Silchar

Silchar Medical College and Hospital (SMCH) is a medical college based in Cachar District, Assam. This
college is the third medical college of the state government for promoting medical education in the state. It
is the only referral hospital in the southern part of Assam, also referred to as the Barak Valley, and serves
neighbouring states including Mizoram, North Tripura, West Manipur, and Southeast Meghalaya. Basic
The nearest airport from the college is Silchar Airport, which is about 31.2 km away from the college and
well connected to Guwahati, Kolkata, and New Delhi.
Table 3-5 Silchar Medical College and Hospital (SMCH)

Address: Ghungoor Road, Masimpur, Silchar, Assam 788014
Bed Strength: 1,256
OPD Patients: 657,390/year (2018.4～2019.3)
More than 2,000 patients/day
Operation Cases: Major: 4,835/year (2018.4～2019.3)
Minor: 4,166/year (2018.4～2019.3)
Diagnostic Imaging: MRI: 2,058/year (2018.4～2019.3)
CT: 16,461/year (2018.4～2019.3)
USG: 35,795/year (2018.4～2019.3)
X-ray: 69,796/year (2018.4～2019.3)
Clinical Departments: General Medicine, General Surgery, Orthopaedics, Pulmonary Medicine,
Neurology, Neurosurgery, Obstetrics, Gynaecology, Paediatrics, ENT,
Ophthalmology, Dermatology, Psychiatry, Dentistry, Community
Medicine, Emergency and Trauma
Facilities under Construction: Faculty/ Doctors Quarters
Observations on Existing All department buildings are deteriorated. There is no waiting space for
Facilities: outpatients.
3-12
Jorhat Medical College, Jorhat

Jorhat Medical College and Hospital (JMCH) is a medical college based in Jorhat, Assam. This college is
the fourth medical college of the state government for the improvement of medical education in the state
and started functioning in 2009 in the premises of the former Jorhat District Hospital. Basic information is
shown in Table 3-6 below.
The JMCH is located at Swahid Kushal Kownar Path, KB Road, Barbheta, Jorhat Assam, India. The
distance from Guwahati to Jorhat MCH is 304.0 km (Driving time is 6 hours and 51 minutes). The distance
from the nearest airport, Raraiyah Airport, to Jorhat MCH is 3.6 km (Driving time is approx. 10 min), the
land is adjacent to the MCH compound. Again, the distance from Jorhat Town to Jorhat MCH is 3.0 km
(Driving time is approx. 8-10 min).
Table 3-6 Jorhat Medical College and Hospital (JMCH)

Address: Swahid Kushal Kownar Path, KB Road, Barbheta, Jorhat Assam
Bed Strength: 500
OPD Patients: 240,237/year (2019.9～2020.8)
More than 800 patients/day
Operation Cases: Major: 7,473/year (2019.9～2020.8)
Minor: 9,468/year (2019.9～2020.8)
Diagnostic Imaging: MRI: 1,614/year (2019.9～2020.8)
CT: 9,135/year (2019.9～2020.8)
USG: 16,923/year (2019.9～2020.8)
X-ray: 27,420/year (2019.9～2020.8)
Clinical Departments: Medicine, Surgery, Orthopaedics, Cardiology, Neurosurgery, Obstetrics,
Gynaecology, Paediatrics, ENT, Ophthalmology, Dermatology, Psychiatry,
Dentistry, TB and Chest, Community Medicine
Facilities under Construction: Renovation of OPD Building, Cancer Hospital
Observations on Existing Although the buildings were constructed only ten years ago, all the
Facilities: department buildings are deteriorated. Some inpatients are bedded on the
floor due to the scarcity of beds. No lifts. ICU is not functional because of
the outdated environment.
Tezpur Medical College, Tezpur

Tezpur Medical College and Hospital (TMCH) is a medical college based in Tezpur. This college is the
sixth medical college of the state government for promoting medical education in the state. Basic
The distance from Guwahati to Tezpur MCH is 159.6 km (Driving time is 3 hours and 37 minutes). The
distance from the nearest airport, Salonibari Airport, to Tezpur MCH is 16.9 km (Driving time is approx.
29 min) via NH-15. Distance from Tezpur Town to Tezpur MCH is 15.3 km (Driving time is approx. 26-
30 min).
3-13
Table 3-7 Tezpur Medical College and Hospital (TMCH)

Address: Tumuki, Bihaguri, NH-52 (now NH-15) Tezpur Assam
Bed Strength: 500
OPD Patients: Nearly 800 ～1,000 patients/day
Clinical Departments: General Medicine, General Surgery, Orthopaedics, Pulmonary Medicine,
Obstetrics, Gynaecology, Paediatrics, ENT, Ophthalmology, Dermatology,
Psychiatry, Dentistry, Community Medicine, Emergency and Trauma
Facilities under Construction: Doctors Quarter, Hostels for Doctors and Nurses
Observations on Existing Although the buildings were constructed only ten years ago, all department
Facilities: buildings are deteriorated. Some inpatients are bedded on the floor due to
the scarcity of beds. ICU is not functional because of the outdated
environment. No lift or Most of lifts are not functioned.
Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta

Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH) is a medical college based in Barpeta.
This college is the fifth medical college of the state government for promoting medical education in the
state. Basic information is shown in Table 3-8 below.
The shortest distance from Guwahati to FAA MCH is 98.8 km (Driving time 2 hours and 29 minutes) via
Hao-Doulashal. The distance from the nearest airport, Lokapriya Gopinath Bordoloi Airport, Guwahati to
FAA MCH is 110.0 km (Driving time is approx. 2 hour 45 min).
Table 3-8 Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH)
Address: Jania Road, Joti Gaon, Barpeta Assam 781301
Bed Strength: 500
Clinical Departments: Medicine, Surgery, Orthopaedics, Obstetrics, Gynaecology, Paediatrics,
ENT, Ophthalmology, Dermatology, Psychiatry, T.B. and Chest,
Rehabilitation, Community Medicine
Facilities under Construction: Cancer Hospital, Mother and Child Hospital
Observations on Existing Although the buildings are constructed only ten years ago, all department
Facilities: buildings are deteriorated. Some inpatients are bedded in the floor due to
environment.
Diphu Medical College and Hospital, Karbi-Anglong

Diphu Medical College and Hospital (DMCH) is a medical college based in Diphu, Karbi Anglong Assam,
and was established in 2011 and started in 2019. The name of Diphu Medical College during that time was
Assam Hills Medical College and Research Institute (AHMC&RI). This college is the seventh medical
college of the state government for the promotion of medical education in the state. Basic information is
shown in Table 3-9 below.
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Diphu is a small well-known town in the hilly natural beautiful district of Assam. The natural ambience of
the college campus attracts all people. The distance from Guwahati to Diphu MCH is 247.3 km (Driving
time is approx. 4 hours and 54 minutes) via NH-27. It is the only referral hospital in Karbi Anglong District,
Assam, and also for the other neighbouring districts of Lumding and Hojai. There is no airport in Karbi
Anglong District. The nearest airport from the college is Dimapur Airport (DMU), Nagaland which is about
62.9 km away from the college.
Table 3-9 Diphu Medical College and Hospital (DMCH)

Address: Baghmari, Diphu, Karbi Anglong Assam 782462
Bed strength: 300
OPD Patients: More than 250 patients/day
Operation Cases: Major: 857/year (2019.11～2020.10)
Minor: 146/year (2019.11～2020.10)
Clinical Departments: Medicine, Surgery, Orthopaedics, Pulmonary Medicine, Obstetrics,
Gynaecology, Paediatrics, ENT, Ophthalmology, Dermatology, Psychiatry,
Dentistry, Community Medicine
Facilities under Construction: Cancer Hospital, Mother and Child Hospital
Observations on Existing Although the buildings were constructed only ten years ago, all department
Facilities: buildings are deteriorated. Some inpatients are bedded on the floor due to
environment.
Secondary Medical Institutes

There are 25 district hospitals in Assam and the selected hospitals as sample hospitals have been surveyed
as shown in Table 3-10 below.
Table 3-10 Sampled District Hospitals

Name of District No. of Tea Aspirational
Location Name of MCH in the District
Hospital Beds Garden Districts
Swahid Mukunda Nalbari, Kamrup GMCH (Guwahati Medical 235
Kakati (SMK) Civil Metropolitan College & Hospital)
Hospital
Udalguri Civil Udalguri, GMCH (Guwahati Medical 147 v v
Hospital Kamrup College & Hospital) or TMCH
Metropolitan (Tezpur Medical College &
Hospital)
S.K Roy Civil Hailakandi, SMCH (Silchar Medical College 129 v v
Hospital Cachar and Hospital)
Sivasagar Civil Sivasagar, Jorhat JMCH (Jorhat Medical College 269 v
Hospital and Hospital)
Goalpara Civil Goalpara, Fakuriddin Ali Ahmed Medical 216 v
Hospital Barpeta College & Hospital (FAAMCH)
SMK Civil Hospital, Nalbari, Kamrup Metropolitan

SMK Civil Hospital is a district hospital based in Nalbari, Kamrup Metropolitan. The nearest MCH is
GMCH and a new medical college is currently under construction at Nalbari. Basic information is shown
in Table 3-11 below.
3-15
There are several buildings in the compound including administrative building and staff quarter. Sewage
treatment plant, oxygen generation plant, RO purifier room, incinerator and power backup generator are
functional, whilst electricity Sub-station needs to be maintained as water logging is a major issue.
Table 3-11 Swahid Mukunda Kakati (SMK) Civil Hospital, Nalbari

Address: Nalbari Rd, Nalbari, Assam - 781335
Bed Strength: 235
Name of MCH in the District: GMCH (Guwahati Medical College & Hospital). A new medical college is
currently under construction at Nalbari.
Udalguri Civil Hospital, Udalguri, Kamrup Metropolitan

Udalguri Civil Hospital is a district hospital based in Udalguri, Kamrup Metropolitan. The nearest MCH is
GMCH and Tamulpur Medical College & Hospital which is under construction. Basic information is shown
in Table 3-12 below.
The hospital building is old, and power backup generator is non-functional.
Table 3-12 Udalguri Civil Hospital, Udalguri

Address: Sankar Nagar Road, Udalguri, Assam - 784509
Bed Strength: 147
Name of MCH in the District: GMCH (Guwahati Medical College & Hospital)
S.K Roy Civil Hospital, Hailakandi, Cachar

S.K Roy Civil Hospital is a district hospital based in Hailakandi, Cachar. The nearest MCH is SMCH. Basic
The hospital is equipped with oxygen generation plant. There are several power backup generators, some
are functional.
Table 3-13 S.K Roy Civil Hospital, Hailakandi

Address: NH 154, Bashdahar, Hailakandi, Assam 788151
Bed Strength: 129
Name of MCH in the District: SMCH (Silchar Medical College & Hospital)
Sivasagar Civil Hospital, Sivasagar, Jorhat

Sivasagar Civil Hospital is a district hospital based in Sivasagar, Jorhat. The nearest MCH is JMCH. Basic
The hospital is equipped with an oxygen generation plant. The access road is quite busy. The hospital
building is old, and ruined roof and structure are partly observed. The access road is wide enough to
accommodate two-way traffic.
Table 3-14 Sivasagar Civil Hospital, Sivasagar

Address: NH 154, Bashdahar, Hailakandi, Assam 788151
Bed Strength: 269
Name of MCH in the District: JMCH (Jorhat Medical College and Hospital)
3-16
Goalpara Civil Hospital, Goalpara, Barpeta

Goalpara Civil Hospital is a district hospital based in Goalpara, Barpeta. Goalpara Civil Hospital has
received multiple awards as the best civil hospital in Assam. The nearest MCH is FAAMCH. Basic
Water leakage is commonly observed in the roof of the hospital buildings. Maintenance of the oxygen
generation plant and cleanliness of the surrounding area are needed. Electricity sub-station needs to be
maintained as water logging is a major issue. Power backup generators are fully functional.
Table 3-15 Goalpara Civil Hospital, Goalpara

Address: National Hwy 37, Bhalukdubi, Assam 783121
Bed Strength: 216
Name of MCH in the District: Fakuriddin Ali Ahmed Medical College & Hospital (FAAMCH)
3.4 Construction Regulation and Restrictions
Facility Planning Guidelines / Building Regulations

In India, each state has its building codes and regulations. The Assam State Government's Building Code
is strict, in the backdrop of flood and earthquake threats. When selecting a hospital site, the available site
area and the necessary areas should be considered according to the plan of the building size and number of
floors. In addition, the Indian Public Health Standards (IPHS), promulgated in 2012, provides design
guidelines for 500-bed regional flagship hospitals.
The criteria for designing buildings will basically conform to the following. Other building codes and
standards referred shall be from the National Building Code (NBC).
 Guidelines for District Hospitals / Community Health Centres (CHC), Indian Public Health Standards
(IPHS)
 Design Guidelines, National Accreditation Board for Hospitals and Health Care Providers (NABH)
 Standard Requirements for Medical Colleges, National Medical Council (NMC)
 Design Guidelines of the Healthcare Engineering Association of Japan (HEAJ): To ensure the quality
required as international standard, OT rooms and ICUs will conform to this.
 Assam Notified Urban Areas Other than Guwahati Building Rules 2014
 Guwahati Building Construction By-laws 2014 March (Amendment 05.05.2020)
Major Issues on Relative Building Rules

Table 3-16 and Table 3-17 show the Major Issues on Relative Building Rules excerpted from the “Assam
Building Construction By-laws” and “the Guidelines for Indian Public Health Standards (IPHS)”.
3-17
Table 3-16 Excerpts from Building Construction By-laws

Issues Contents
 Front road: Road width 9 m or more, drainage channel 1 m or more on both sides *There
must be considerable space for front road
 Parking: One car per 60 sqm for staff, one car per 200 sqm for outpatients, one car per
five beds in wards. (Also, one Car for every ten beds + one two-wheeler for every five
beds + one car for every five cabins of Single Accommodation.)
 Lot size: minimum area of 1,000 sqm, ground coverage of 45% (Horizontal projection
area), floor-area ratio of 150%.
 Building wall setback distance: 7.5 m (front road), 4.5 m (adjacent land boundary. Subject
to height of building and Local Fire Approval, generally we keep at least 6 m as per
Criteria for
National Building Code.) *This will be large restrictions on the number of floors and area
Planned Hospital
Sites of the building.
 A pedestrian ramp of 2,000 mm width in 1:12 or less slope is required for all patient
occupied floors of the hospital.
 No restrictions regarding height but required to be approved by the Airport Authority of
India / Indian Air Force in case the site is near an airport / air force station, respectively.
 Green Area Cover: Minimum 20% of the total site area is to be kept under plantation or
green cover; or 50% of open area (generally 50% of open area is more than or near about
20% of the total site area). Of these, at least 25% of the total open space should be in
organised / consolidated green area (and not incidental areas like verges on parking or
strips of green along footpaths).
 For hospitals with more than 40 beds; installation of wastewater reuse facilities.
Criteria for
 For hospitals with more than 5,000 sqm; installation of solar heat utilisation facilities;
Hospital Facility
Planning evacuation stairs should be located within 18 meters from each part of the hospital.
Maximum travel distance to be within 22.5 m for buildings with fire sprinkler system.
Table 3-17 Excerpts from the Guidelines for Indian Public Health Standards (IPHS)
Issues Contents
 Hospitals with more than 500 beds should have a site area of at least 65,000 sqm (45,000
Standards sqm for hospitals, 20,000 sqm for residential areas).
related to  Teaching hospitals should be sized at 100-110 sqm/bed.
Facility Size  A minimum of 2,500 sqm of facilities for short-term stays should be planned adjacent to
the hospital.
 The opening area (area of windows) for ventilation should be at least 20% of the floor
area.
 Corridors should be at least 3 m wide to allow stretchers with IVs to pass each other.
 The slope of the ramp should be 1/15 to 1/18 to allow beds and stretchers to change
direction.
 The roof height should not be less than approximately 3.6 m measured at any point from
Standards for
floor to roof.
the Entire
Facility  It should have a high boundary wall, at least two exit gates.
 There shall be dedicated parking space separately for ambulances, hospital staff, and
visitors.
 For easy access to non-ambulant (wheelchair, stretcher), semi-ambulant, visually disabled,
and elderly persons infrastructure.
 Rainwater harvesting, solar energy use and use of energy-efficient bulbs/ equipment
should be encouraged.
 The area of the outpatient waiting area should be at a minimum of 38 sqm, calculated at
0.093 sqm/outpatient per day. (1 sq ft/per average daily patient with minimum 400 sq ft of
area.)
Standards for  A waiting area for 4-5 doctors (about 12 sqm) should be provided.
Outpatient  A consultation room for infectious diseases should be located away from the general
Departments outpatient department independently.
(OPD)  All examination rooms must be equipped with examination tables, Schaukasten (X Ray
view box), curtains, and hand wash basins.
 There should be one male toilet (urinal) for every 100 people and two female toilets for
every 100 people; there should be one urinal for every 50 people.
3-18
Issues Contents
 Potable drinking water, Functional and clean toilets with running water and flush,
Fans/Coolers shall be installed.
 The area of general wards shall be 15-18 sqm/bed, with a minimum of 7 sqm per bed.
 It is recommended that 10% of the total number of beds should be private rooms and 20%
should be day care beds.
 One nursing unit should have 40-45 beds, half of which should be for acute care and half
of which should be for chronic care.
Standards for  One toilet and shower should be provided for every six beds.
Inpatient  One urinal should be provided for every 20 beds.
Departments  Two hand wash basins should be provided for every 24 beds.
(Ward)  There should be one additional hand-washing facility for every 24 beds.
 All wards shall have positive pressure, except for infected beds.
 Minimum area for apertures (windows/ Ventilators opening): 20% of the floor area (if on
same wall), 15% of the floor area (if on opposite walls)
 Minimum distance between centres of beds: 2.5 m (minimum)
 Clearance at foot end of each bed: 1.2 m (minimum)
 Number of operation theatres to be the ratio of one OT per 50 general hospital beds and
Standards for one OT per 25 surgical beds shall be established.
Operation  ICU beds: 5 to 10 % of total beds
Theatres (OT)  Floor space for each ICU bed: 25 to 30 sqm (this includes support services)
 Floor space for Paediatric ICU beds: 10 to 12 sqm per bed
Intermediate
Care Area
 10% of the total bed strength is recommended as private wards beds.
Imaging  The room shall have a sub-waiting area with toilet facility and a change room facility.
 Room size: The laboratory shall have adequate space from the point of view of workload
Clinical
Laboratory
 Storage space: It shall be adequate (10% of total floor space) with separate storage space
for inflammable items.
 Location: Conveniently accessible from all clinics.
 Size: Adequate to contain 5 percent of the total clinical visits to the OPD in one session.
Pharmacy For every 200 OPD patients daily/ one dispensing counter.
 Components: Pharmacy should have component of medical store facility for indoor
patients and separate pharmacy with accessibility for OPD patients.
Summary of Other Regulations and Rules
Barrier Free Related Rules

The National Building Code of India, Assam Notified Urban Areas (Other than Guwahati) Building Rules
2014, Guwahati Building Construction (Regulation) By-laws 2014 and IPHS 2012 stipulate the barrier free
related regulations below (Table 3-18).
Table 3-18 Major Issues on Relative Barrier Free Rules

Major Rules Relative to Barrier Free
 Install handrails for the physically challenged at stairs and ramps.
 Slopes for use of evacuation and barrier free shall be at least 2.4 m wide and have a maximum slope of 1:12.
 At least one of the approaches to a facility shall be equipped with ramp.
 Ensure that there are at least two parking spaces for the physically challenged within 30 m from the entrance
and exit. The width of the cell should be at least 3.6 m.
 At least one of the elevators should be large enough to accommodate a wheelchair (80 cm by 150 cm).
 Install toilets for use by the physically challenged.
 Door width to be at least 90 cm.
3-19
Summary of NABH Design Guidelines

The National Accreditation Board for Hospitals and Healthcare Providers (NABH) is a constituent board
of the Quality Council of India set up to establish and operate the accreditation programme for healthcare
organisations. Table 3-19 shows the major topics mentioned in the guidelines.
Table 3-19 Topics of NABH Design Guidelines

General
 Patient safety alarms.
 Child friendly paediatric service.
 Warnings outside Radiology service rooms.
 Storage area for medicines and consumables and safe storage areas for high-risk medicines.
Universal Design
 Fall prevention system for elders.
 Grab bars, ramps with railing for disabled.
 Bilingual signage display of patients’ rights and responsibilities in strategic locations like entrance / lobby of
the hospital, registration, billing, OPD, and IPD area.
Ambulance
 It should have a demarcated space / parking area.
 It should also have updated stock of medicines and piece of equipment like ECG.
Infection Prevention
 Better to have positive and negative isolation rooms.
 Hand washing facilities.
 Elbow taps instead of screw taps.
MEP and Infrastructure
 The engineering plant should have sufficient spaces for alternate sources like compressor or vacuum plants.
 A central waste collection area for keeping biomedical waste.
Fire
 Fire water tanks, fire exit routes etc. should be planned as per NBC norms.
Source: Architectural Planning February 2019, How to Design a Hospital which is NABH compliant
3-20
Major Issues in the Health Sector in Assam State

Based on the situation analysis made in Chapters 2 and 3, the major facts and issues in the health sector in
Assam are summarised as shown in Table 4-1.
To achieve universal health coverage (UHC), the nearest health facility should be reliable for the people.
For that, interventions in both health service providers and users should be taken. Regarding health service
providers, referral system should function appropriately, i.e., primary and secondary health facilities could
provide proper diagnosis and treatment, then decide regarding referral with sufficient communication with
patients and other health facilities. In addition, when the patients have careful and clear explanation on
treatment or referral, they may seek care at the same health facility, the nearest from their community, from
next time.
However, according to the results of the survey, medical doctors are too busy to give time for the patients.
Because the number of doctors in the public sector is not enough to cover the increasing population, they
are overloaded. Also, as there is limited number of specialised doctors, specialised or advanced services
could be provided in limited hospitals. Therefore, patients who want quality and reliable services would
access directly to the tertiary hospitals, MCH. As a result, MCH would always be congested by patients
with minor illness and make the doctors busy. Then, the doctors get tired and leave for better opportunity.
And patients must wait for long time. In addition, hospital staff could not consider the mental aspects of
the patient.
The Government of Assam (GOA) has been increasing medical student seats aiming at 1,200 per year.
Then, a strategy to attract them to public health facilities and improve retention rate could be required.
According to the results of the questionnaire survey to the doctors, they value facility and equipment when
they choose a workplace, and human relationship and professional development opportunity may affect
their satisfaction. Therefore, upgrade of facility and equipment, as well as providing attractive training or
workshop opportunities, could be effective to improve the retention rate of medical doctors. Then, the
people might be attracted to such health facilities and doctors.
At the same time, effective intervention to improve health literacy of the people should be made. When the
people have a certain level of health literacy, people could choose appropriate care-seeking behaviour. In
addition, they could prevent diseases as they obtain healthy lifestyle and hygiene practice.
4-1
Table 4-1 Major Facts and Issues in the Health Sector in Assam
* = To be expected to take measures in the project
Facts Existing Efforts by GOA Issues *
 Sufficient number of health  Increasing annual  Strategy to retain health
personnel are not hired/ retained in production of heath personnel in public sector
public health facilities, especially personnel by should be developed.
in specialised medicine, rural areas, establishing new MCHs  Behaviour of hospital staff ✓
and female doctors. and a paramedical to patients should be more
 Student intake of medical training institution kind.
education institutions are not  Strengthening training  Workload of doctors should
enough to provide necessary capacity by integration be declined.
number to cover the population. of training and education  Mental health and
Human Resource for Health
 Doctors may be overload of the function of the communication skill of

work. government hospital staff should be
 Behaviour of health personnel may considered.
not be appropriate to patients.  Opportunities of learning ✓
 Satisfaction with workplace seems and exchanging knowledge
to depend on human relationship with domestic and
with co-workers, patients, and international experts should
patient families. be provided.
 Facility and equipment are valued
when they choose the workplace.
 Satisfaction with learning
environment seems to depend on
contents and quality of curriculum,
quality of OJT, as well as
opportunity to learn advanced
knowledge and technology both
domestic and international.
 Generally, facilities seemed to be  Installing super specialty  Capacity of proper ✓
deteriorated and not properly functions to MCHs operation, daily and
maintained.  Upgrading secondary preventive maintenance of
 Medical equipment seemed not to and primary health medical equipment should
Facility and Equipment
be well maintained and facilities be developed.

appropriately operated.  5S-KAIZEN-TQM could be ✓
 Hygiene facilities such as drinking introduced to improve
water supply and toilets seem not clearness and condition of
to be sufficiently served. facilities and equipment.
 Necessary diagnostic and treatment
could not be sufficiently provided
in CDH.
 Toilets are not clean.
 Advanced equipment is not
available to provide specialised
services.
 Patient procedure seems not to be  Introducing ICT to  QMS concept could be ✓
efficient due to insufficient digital hospital information introduced to enhance
solution. management and patient management capacity.
 Decision-making process may not services to MCHs and  Security measurements
Management
be transparent for frontline staff. CDHs should be enhanced in terms

 Laboratory testing are not available  Introducing PPP to of facility, knowledge of
for 24/7 to obtain prompt results. laboratory services, staff, awareness of patients
 Security of the hospital staff may teagarden hospitals, and and families, legal support,
not be well ensured. cancer care etc.
 Services during night shift such as
canteen may not be sufficient.
4-2
Facts Existing Efforts by GOA Issues *

 Most of patients could receive the  Various financial  Sustainability of financial
services free of charge or low cost. assistance schemes are resources should be
Finance
Health
 Out-of-pocket expenditure is rather provided to vulnerable ensured.

lower in India. groups
Medical Supply Administration
 Necessary drugs may not be  Expanding essential

Drugs and
sufficiently stocked in pharmacies. drug list

 Introducing PPP to
pharmacy operation
 The people may be not aware of  Information is uploaded  Various public relation
Governance/
schemes for financial assistance on the official website. measurements should be

from the government. considered for people who
do not have ICT access.
 People do not trust cheap or free  Mobilising ASHA to  Quality of diagnostic and
service. facilitate community treatment, and patient
 People tend to seek care directly to people to seek care to services should be improved
tertiary hospitals. public health facilities. to gain trust of the people to
Cultural and Social Context
 People prefer to access private public health facilities.

health facility if affordable.  Health literacy of the people
 Women and girls would like to be should be increased to
seen by female doctors. choose appropriate health
 Living condition in rural area such care, and healthy lifestyle.
as education opportunity for
children and infrastructure hinder
health personnel to work there.
 Frequent flood and mountainous
areas hinder access to health
services, as well as hospital
operation.
4-3
Development Plan for Strengthening of Health System in Assam
5.1 Vision / Mission

The mission of the development plan is to achieve universal health coverage (UHC) through the
improvement of access to public medical services and quality medical services but improving only the
hardware cannot achieve it and it is also difficult to cover all the areas of the state at once. Therefore, the
project focuses on the "establishment of model health system that enables the Indian side to develop
horizontally through self-efforts”. Particularly, the development plan aims to achieve the following:
 Developing an environment that can ensure qualified medical personnel (Regarding the quantitative
expansion, the project will develop an environment where high-quality clinical education can be
provided in medical college hospitals);
 Strengthening cooperation among each level of medical institutions (establishment of referral systems,
system of dispatch of doctors, provision of technical guidance and training, etc.).
As shown in Chapter 1 and Chapter 2, the population of Assam is 312,000, wherein 50.6% of the population
uses public medical institutions, which is higher than the national average of 32.5%. In the rural areas,
especially in the respirational area and around the Brahmaputra River, the percentage of the population is
as high as 30%, and the percentage of the poor is 32.0%. Therefore, the provision of quality medical services
by public medical institutions is indispensable.
5.2 Development Concept

In response to the above-mentioned challenges, the following development components should be in place
to establish a UHC model (Table 5-1).
Table 5-1 List of the Components for Development Plan

Component Contents
1. Strengthening Medical Institutions (Facilities, Equipment)
1 Super Specialty Wing in Medical Colleges
2 Critical Equipment in All Medical Colleges
3 Smart Hospital at GMCH, AMCH with Modern Technology and Information Technology
System
4 Infrastructure Improvement in District Hospital
5 Dedicated Training, Monitoring, Administrative Centre, Swasthya Bhawan.
2. Strengthening the Capabilities of Medical Professionals
6 Capacity Building of Medical Staffs
3. Strengthening the Organisational and Management Capabilities for the Provision of Medical Services
7 Hospital Management
8 Improve Hospital Management Information System
9 Establish Regional UHC System in Selected Area
The development of medical personnel is essential for the provision of quality medical services. However,
in countries with global standards, medical education is usually provided through clinical training in
hospitals, rather than in classrooms (theoretical lessons). Therefore, the basic concept of the project is to
5-1
establish clinical training in tertiary medical institutions, and at the same time, by developing district
hospitals, to strengthen the medical services base in the catchment area, to receive patients from primary
medical institutions and to establish a technical support system for primary medical institutions. For this
reason, the project concept goes beyond the mere provision of hardware, such as facilities and equipment,
to include technical interventions with soft components.
5.3 Stage-wise Development Plan

In the development plan, a stage-wise approach is considered in terms of establishing the UHC system in
Assam. Because as stated in the concept, both hardware and software interventions are required to establish
the system and there will be both time and physical constraints to proceed to the whole of Assam. These
periods are defined as short term (three years), medium term (five years) and long term (ten years). The
concept of each term is as follows:
Short-term Development Plan

The short-term period is three years, from the commencement of the project until the construction of
facilities and provision of equipment are completed. In addition, it is essential to strengthen the software
component to establish the model. Therefore, technical support (soft component) for the construction of the
model might be considered. The specific components of the project are as follows:
 Component 1 Candidate facilities: Silchar Medical College, Cachar Hospital (SMCH), Tezpur
Medical College Hospital (TMCH), Jorhat Medical College
Hospital (JMCH), Fakhruddin Ali Ahmed Medical College
Hospital, Barpeta (FAAMCH), Diphu Medical College
Hospital (DMCH) and Lakhimpur Medical College Hospital
(LMCH)
 Component 2 Candidate facilities: Same as above
 Component 3 Candidate facilities: Gauhati Medical College Hospital (GMCH), Assam Medical
College Hospital (AMCH)
 Component 4 Candidate facilities: See table below (Considerable collaboration between tertiary
and secondary medical institutions) (Table 5-2)
Table 5-2 List of Candidate Facilities for Component 4

No. Name of District Hospital Name of Collaborating Medical College Hospital
1 Silchar Civil Hospital (CH) SMCH
2 Mangaldoi CH GMCH, TMCH
3 Udalguri CH GMCH, Tamulpur MCH (Under Construction)
4 Hojai CH GMCH, Nagaon MCH (Under Construction)
5 Haflong CH SMCH, DMCH
6 Hailakandi CH SMCH
 Component 5 Candidate facilities: Integrated training and administrative centre, “Swasthya

Bhawan”
 Component 6 Same as Component 1, 3, and 4
 Component 7 Same as component 1, 3, 4, and CHCs around 6 civil hospitals
5-2
 Component 8 Same as Component 1, 3, 4, and integrated training and administrative centre,

“Swasthya Bhawan”
 Component 9 Same as Component 6
In the short-term period, it will focus on inter-institutional collaboration, the establishment of referral
systems, the acquisition of knowledge, and the competence of patient referrals and health professionals in
the Project Management Unit (PMU) organised by the state government and the Project Implementation
Units (PIUs) organised by the candidate medical institutions (see Figure 5-1).
On the other hand, the existing facilities will be used to increase the knowledge of establishing a system
for the improvement of medical skills, from tertiary to secondary and secondary to primary level medical
institutions, as well as for awareness-raising and health promotion activities in the community.
The following is an image of the collaboration between tertiary medical institutions and secondary medical
institutions in the short-term period (Figure 5-1), and the establishment of the UHC system through
collaboration among primary, secondary, and tertiary institutions, aiming to establish a model around the
area enclosed by the circle (the area covered by tertiary medical institution).
Project Targets

Figure 5-1 Collaboration between Target Hospitals
Based on the survey and the requests from the Government of Assam (GOA), soft components (component
6-9) are planned. The outline of each component is shown in Table 5-3.
5-3
Table 5-3 Outline of Soft Component (Plan)

Compon Current Issues and
No. Contents
ent Challenges
➢ Lack of experienced 6-1. Conduct training on patient care and attitude to patient (conduct
doctors trainings on warm reception, interacting comfortably, informed
Capacity ➢ Lack of learning consent, care for terminal patients, etc.)
Building chances in/from other 6-2. Improve internship program (introduce online training programs
6 of states and countries in cooperation with Japanese hospitals and hospitals in other states
Medical ➢ Low quality of such as AIIMS and Fortis.)
Staffs patient service 6-3. Conduct refresher training for staffs (introduce the latest
technology and research which can be useful for their daily
operation.)
➢ Staff involvement in 7-1. Improve existing basic training courses
decision making （Basic trainings for hospital management such as Infection Control,
process Medical Waste Management, Fire safety, Disaster preparedness,
➢ Necessity for etc.）
introducing 7-2. Conduct trainings and activities of 5S-KAIZEN and Total
management review Quality Management. Below training programs will be planed. The
tools trainings will be divided based on the target group (management,
Hospital ➢ Lack of administration officers, doctors, and nurses who oversee the
7 Manage multidisciplinary department)
ment cooperation ➢ Strategic planning
➢ Necessity for ➢ Problem solving
improving ➢ Quality Control (QC)
management policy ➢ Value Stream Mapping (VSM)
➢ Necessity for ➢ Quality and Safety
improving patient ➢ Concept of TQM approaches
procedure ➢ Implementation of TQM approaches
➢ Monitoring and Evaluation
➢ Necessity for 8-1. Conduct trainings on e-Hospital and MIS management at
installing e-Hospital targeted facilities including Swasthya Bhawan
system by GOI to all ➢ Training on Administrative Modules of Hospital Information
Improve
the hospitals Management Systems
Hospital
➢ Lack of trainings to ➢ Training/ Refresher Training on Basic Computer knowledge
Manage
utilise the MIS ➢ Training on Registration Module
8 ment
system ➢ Training on Clinic Module
Informati
➢ Necessity for ➢ Training on Indoor Module
on
promoting data-based ➢ Training on Laboratory Management Module and Radiology
System
decision making by Module
the directorate ➢ Training on Stock Management and Dispensing Module
systems ➢ Training of Doctors on Use of Data for Research Purpose
➢ Patients directly go to 9-1．Strengthen cooperation among primary, secondary, and tertiary.
secondary hospitals ➢ MCHs provides trainings for CDHs and CHCs including
without referral from lectures and practical training
Establish the primary level ➢ MCHs dispatch lecturers and supervisors to CDHs and CHCs
Regional facilities ➢ MCHs provide refresher training for CDHs and CHCs
UHC ➢ Patients prefer to go 9-2. Conduct pilot activities to refer patients from primary to
9 System to MCH as necessary secondary, secondary to tertiary, and vice versa.
in doctors and 9-3. Conduct awareness activities to improve health literacy of the
Selected equipment are not people
Area available at CDHs 9-4. Conduct public health campaign to prevent diseases
(immunisation, health lifestyle, hygiene practice, etc.)
9-5. Introduce patient management system to support smooth referral
and counter-referral system at primary and secondary levels
5-4
Medium-term Development Plan

This will be for two years after the completion of the facility and delivery of the equipment. In the medium
term, the aim is to establish a model in which the facilities and equipment are fully operated and properly
managed by the parties concerned. It is a period to ensure the provision of quality medical services and
clinical training for the fostering of medical personnel through the reliable operation and maintenance of
facilities and equipment. On the other hand, the UHC model will be established regarding the knowledge
of referrals and the system for improving the capacity of medical personnel through inter-facility
collaboration among each tier of medical institution and activities for the community people, which were
established during the short term. The Project Management Unit (PMU) and the Project Implementation
Unit (PIU) organised in the PMU and at the candidate facilities as described in Chapter 10-1 will be
responsible for the implementation of the project. The PMU and PIU will prepare the implementation plans
and carry out the project in accordance with their plans. On the other hand, to improve UHC, it is important
to strengthen the capabilities of medical professionals and strengthen the organisational and management
capabilities. Therefore, under the Japanese yen loan scheme, the soft components will be carried out to
strengthen these capabilities.
Long-term Development Plan

This will be for five years after the end of the medium-term period. In the long-term period, the aim is to
roll out the established model throughout the whole of Assam State. The PMU and PIU will assess the
progress of the medium-term plan, and then develop plans for the implementation of the long-term plan
and implement the project according to these plans. At the end of each year, the PMU and PIU will review
the progress of the plans, and, if necessary, revise the plans to achieve the goals in the long term
(establishment of the UHC model).
5-5
Facility Plan
6.1 Minimum Standard Requirements for the Medical College
Background of Medical College Facility

The National Medical Commission (NMC), formerly known as the Medical Council of India (MCI) until
May 2020, is an authority under the Ministry of Health and Family Welfare which made public notice to
inform that the following regulations: (i) “Minimum Requirements for Annual MBBS Admissions
Regulations，2020” and (ii) “Amendment to Establishment of Medical College Regulations” were placed
in public domain for comments in October 2020.
These are the new norms which stipulate the minimum requirements for medical colleges (MC) and medical
college hospitals (MCH) of their facility, equipment, and staffing requirements in India. These guidelines
have to be strictly followed for their establishment.
The Japan International Cooperation Agency (JICA) Survey Team analysed this aiming to propose a facility
development policy.
Facility Requirements for MBBS Course

The requirements for a medical college and hospital are categorised by the number of MBBS students
annually. The minimum requirements include accommodation in the college and its associated teaching
hospitals, staff (teaching and technical both), and equipment in the college departments and hospitals.
Table 6-1 shows the major requirements set for an MCH catering to 100 MBBS, 150 MBBS, and 200
MBBS.
Table 6-1 Major Requirements Set in the Regulations

Location 100 MBBS 150 MBBS 200 MBBS
Referred Regulation *Public-notice-Reg-Regulations- Minimum-Standard-
Standard-for-
for-Minimum-requirement-and- Requirements-for-150-
200
Name of Institute establishment-medical-colleges Admissions
No. of MBBS 100 150 200
No. of Bed 430 700 900
Major OT 7 9 10
Minor OT 2 2 2
ICU (Incl. NICU) 25 25 25
Rural Health Training Centre 1 1 1
Urban Health Training Centre 1 1 1
The minimum required departments for MC and MCH are shown in Table 6-2.
6-1
Table 6-2 Minimum Required Departments

No. Departments: No. Departments:
1 Anatomy 13 Respiratory Medicine (Pulmonary, TB, Chest)
2 Physiology 14 General Surgery
3 Biochemistry 15 Orthopaedics
4 Pathology 16 Radio-Diagnosis (Radiology)
5 Microbiology 17 Oto-Rhinolaryngology (ENT)
6 Pharmacology 18 Ophthalmology
7 Forensic Medicine & Toxicology 19 Obstetrics & Gynaecology
8 Community Medicine 20 Anaesthesiology
9 General Medicine 21 Dentistry
10 Paediatrics 22 Physical Medicine & Rehabilitation
11 Psychiatry 23 Emergency Medicine
12 Dermatology 24 Radiation Oncology (optional) (Radiotherapy)
Analysis of Existing Facilities

Comparing the current specification of the seven MCH and the above requirements, most of them fulfil the
standards, but some have lower number of beds, which can be proposed for upgradation. Furthermore, the
departments for non-communicable diseases (NCDs) such as Cardiology, Nephrology, Neurology,
Cardiovascular Surgery, Neurosurgery, Urology are fully set in only a few of the MCH, and the rest of the
hospitals either do not have or do not have enough capacity for these departments. Radiation Oncology
Department is also one idea, but it is excluded from this project, since Assam Cancer Care Foundation
(ACCF) is starting to develop related facilities.
6.2 Request from the Government of Assam

From the above considerations, a component request was submitted by the Government of Assam (GOA)
from September to October 2021, which included the facility components requested by GOA as shown in
Table 6-3.
Table 6-3 Requested Facility Components by GOA

Requested Facility
Justification
Components
Super specialty wing in six medical colleges other than GMCH and AMCH.
Super Specialty Wing in
Required departments are: Cardiology, Nephrology, Neurology, Cardio-thoracic
Medical Colleges
Surgery, Neurosurgery, and Urology.
As suggested by the JICA Survey Team:
Infrastructure Improvement
(2 types of hospitals have been suggested. Type 1: General 150 bedded hospital
in District Hospital
and Type 2: Emergency department hospital without beds.)
Facility which acts as a command, control and integrated training and
administrative centre for all health-related activities will bring together all
Dedicated Training,
verticals for much better co-ordination.
Monitoring, Administrative
Consolidation of administrative and training functions, which are currently
Centre, Swasthya Bhawan
dispersed and inefficient in various locations, is appropriate from the perspective
of human resource development.
6-2
Improvement of Super Specialty Wings in Medical Colleges

Since super specialty wing has already been initiated in GMCH and AMCH, it was requested in other six
medical colleges, i.e., Silchar Medical College (Cachar), Tezpur Medical College, Jorhat Medical College,
Fakhruddin Ali Ahmed Medical College (Barpeta), Diphu Medical College, and Lakhimpur Medical
College.
For optimal utilisation, the following super medicine and surgical super specialty departments were
requested:
1. Cardiology; 2. Nephrology; 3. Neurology; 4. Cardio-thoracic Surgery; 5. Neurosurgery; and 6. Urology.
In general, it is reasonable to set up such super specialty departments in tertiary level hospitals which require
urgent and immediate treatment. In the case of Assam, considering the geographical and demographical
situation, it is reasonable to set up such super specialty hospital in each medical college hospital.
Facility Upgrade in District Hospital

One of the project concepts is to build up a referral model from secondary level hospitals to tertiary level
hospitals. In order to achieve this, it is ideal to select secondary level hospitals that are within close distance
to tertiary level hospitals.
As for the hospital volume and type, the JICA Survey Team proposed two types of hospitals. One is a
general 150-bedded hospital and the other is an emergency department hospital without beds, and these
were accepted by GOA.
Location
The following Table 6-4 shows the six district hospitals initially proposed by GOA for facility improvement
under the JICA project. After internal discussion within GOA, Goalpara Civil Hospital and Sivsagar Civil
Hospital were excluded from the request list due to their plan of new MCH establishment. Geographical
location and vertical integration with existing and upcoming medical college hospitals have been taken into
consideration.
Table 6-4 District Hospitals to be Upgraded

Distance
Name of the District Hospital Name of the Medical College
(km)
S.M Dev Civil Hospital, Silchar Silchar Medical College & Hospital 4
Fakhruddin Ali Ahmed Medical College & Hospital 71
Goalpara Civil Hospital
Dhubri Medical College & Hospital (Under Construction) 132
Gauhati Medical College & Hospital 75
Mangaldoi Civil Hospital, Darrang
Tezpur Medical College & Hospital 87
Jorhat Medical College & Hospital 55
Sivsagar Civil Hospital Assam Medical College & Hospital, Dibrugarh 90
Charaideo Medical College & Hospital (Under Construction) 40
Udalguri Civil Hospital, Udalguri
Tamulpur Medical College & Hospital (Under Construction) 68
Hojai Civil Hospital, Hojai
Nagaon Medical College & Hospital (Under Construction) 53
Haflong Civil Hospital, Dima Silchar Medical College & Hospital 111
Hasao Diphu Medical College & Hospital 162
S.K Roy Civil Hospital, Hailakandi Silchar Medical College & Hospital 41
6-3
Study of Hospital Type

Regarding the proposed building, two types of building were proposed by the JICA Survey Team, and this
was accepted by GOA. The proposal was made in consideration of the following:
 Analyse the gap between the number of beds needed and the actual number of beds based on the
hospital coverage area.
 For those bed numbers that are below the requirement, a hospital with inpatient ward is proposed. The
proposed bed strength shall be limited to 150 beds, taking into consideration the available management
resources (Type 1).
 For those already meeting the bed requirement, plan an emergency centre (Type 2).
Table 6-5 shows the considerations made for the proposal of the two types of district hospitals.
Table 6-5 Proposed Two Hospital Types

Type Features of Type
 Apply to the area where the number of beds is insufficient to the population.
 This type is focusing on the provision of basic, general medical service.
Type 1
 (As for NCD case, district hospitals will conduct only diagnosis. Patients will be referred to cancer
centre or tertiary hospital for further detailed examination and treatment.)
 Focusing on the provision of emergency service.
 After the first aid, if required, patients will be referred to tertiary hospital.
Type 2
 This type is applied to the area where number of beds is sufficient to the population, but the
clinical service is insufficient.
Training Facility for Capacity Building

GOA wants to introduce an integrated administrative and training hub in Guwahati. The idea is to create a
“Swasthya Bhawan”. This facility will connect all the three Directorates of the Health and Family Welfare
Department (HFDW) (as presently, all are scattered in different locations) in the same place having a
centrally administrative unit for operation, central management information system (MIS), and monitoring
unit for the whole health system. Moreover, this building shall be equipped with a modern integrated
training hall for all kinds of staff training.
The facility is focused on training, capacity development, management personnel and digitalisation, and
creating a central administrative hub. It will act as command, control, and integrated training and
administrative centre for all health-related activities and bring together all verticals for much better co-
ordination.
Consolidating administrative and training functions, which are currently dispersed and inefficient in various
locations, is appropriate from the perspective of human resource development.
6.3 Facility Plan

Considering the above analysis and requirements, Table 6-6 shows the facility improvement plan which
has been considered. Since the existing facilities are in operation, it is assumed that the basic infrastructure
such as power inlet line and water supply are in place enough for the existing buildings, but further site
survey is required to determine if they meet the demand for the newly developed facilities.
6-4
Basically, the access roads shall be no problem; as for electricity, power back-up is preferred to be arranged.
For water supply, own source is suggested to be arranged by GOA since there is no proper water supply
system in any of the locations. (General facility infrastructure equipment such as transformer, generator,
STP and ETP which fulfil the capacity of the planned facilities shall be considered as facility development.)
Table 6-6 Facility Improvement Plan

Floor Area
Proposal for Various Institutions Stories Remarks
(sqm)
1. Super Specialty Wing in Medical Colleges
Total 170 beds
1 Silchar Medical College Hospital, Cachar 29,500 G+5
(Include ICU 50 beds)
Total 200 beds
2 Tezpur Medical College Hospital, Tezpur 32,500 G+6
Total 260 beds
3 Jorhat Medical College Hospital, Jorhat 37,500 G+3 (+B2)
Fakhruddin Ali Ahmed Medical College
4 19,000 G+5 (+B1) ICU 50 beds
Hospital, Barpeta
5 Diphu Medical College Hospital, Diphu 19,000 G+5 (+B1) ICU 50 beds
Lakhimpur Medical College Hospital,
6 19,000 G+5 (+B1) ICU 50 beds
Lakhimpur
2. Infrastructure Improvement in District Hospital
Type 1 (At four locations)
Total 150 beds
S.M Dev Civil Hospital, Silchar 18,000 G+2
Total 150 beds
Udalguri Civil Hospital, Udalguri 18,000 G+2
Total 150 beds
Hojai Civil Hospital, Hojai 18,000 G+2
Total 150 beds
S.K Roy Civil Hospital, Hailakandi 18,000 G+2
Type 2 (At two locations)
Mangaldoi Civil Hospital, Darrang 6,000 G+1 Emergency Centre
Haflong Civil Hospital, Dima Hasao 6,000 G+1 Emergency Centre
3. Dedicated Training, Monitoring, Administrative Centre, Swasthya Bhawan
Training Health
8,047 G+6
Centre
Improvement of Super Specialty Wings in Medical Colleges

Since super specialty wing has already been initiated in GMCH and AMCH, it was requested to establish
in the other six medical colleges, i.e., Silchar Medical College (Cachar), Tezpur Medical College, Jorhat
Medical College, Fakhruddin Ali Ahmed Medical College (Barpeta), Diphu Medical College, and
Lakhimpur Medical College.
For optimal utilisation, the following super medicine and super specialty departments were requested:
1. Cardiology; 2. Nephrology; 3. Neurology; 4. Cardio-thoracic Surgery; 5. Neurosurgery; and 6. Urology.
It is rational for a tertiary level hospital to have such super specialty departments, and considering the
geographical and demographical cases in Assam, it is a logical plan.
6-5
Silchar Medical College Hospital (SMCH), Cachar

As the third medical college of the State Government, and the only referral hospital in the southern part of
Assam, Silchar Medical College and Hospital (SMCH) is expected to be fully functional just as GMCH
and AMCH. Proposed facilities are shown in Table 6-7, and the site map is shown in Figure 6-1.
The proposed site shall be altered as per GOA decision and it is required to make site available by
demolishing existing old structures. Site acquisition shall be a prerequisite for this project.
Table 6-7 Proposed Facility for SMCH

Hospital Type: Super Specialty Hospital
Floor Area and Story: Approx. 29,500 sqm
1) Integrated Block: 28,000 sqm, G+5 story
2) Engineering Service Block: 1,500 sqm, G+2 story
Footprint Area: Approx. 7,000 sqm
1) Integrated Block: 6,500 sqm
2) Engineering Service Block: 500 sqm
Height of the Facility: Approx. 30 m (34 m including other structures, i.e., Lift Machine Room)
Targeted Clinical Cardiology, Cardiac Surgery, Neurology, Neurosurgery, Nephrology, and Urology
Department:
Bed Strength: 170 beds (ICU 50 beds, ward 30 beds × 4 units)
Facility: Outpatient Department, Emergency Unit (Triage 2 beds, Recovery 6 beds), Diagnostic
Imaging (CT × 1, MRI × 1, X-ray × 2, Fluoroscopy × 1, etc.), Angiography Unit
(Single-plane × 1, By-plane × 1), Endoscopy Unit (Upper × 1, Colonoscopy × 1) ,
Physiological Laboratory (ECOE, ECG, Stress ECG, EMG, EEG, etc.), Operation
Theatre including Hybrid Operation Theatre (OT × 3, Hybrid OT × 1), Laboratory
(Chemistry, Microbiology, Pathology, Blood Bank), Dialysis (10 beds), Rehabilitation
(Physiotherapy, Operation Therapy, Speech Therapy), Pharmacy, Medical Engineering,
CSSD, Kitchen, Laundry, SPD, Morgue, Lecture Room, Administration, Medical
Record, Engineering Service Block
6-6

Figure 6-1 Site Map (SMCH)
Tezpur Medical College Hospital (TMCH), Tezpur

Tezpur Medical College and Hospital (TMCH) is the sixth medical college of the State Government for
promoting medical education in the state. Proposed facilities are shown in Table 6-8, and the site map is
shown in Figure 6-2.
The proposed site by GOA is lying in the northeast corner of the compound and is adjacent to the existing
main hospital building. Site acquisition shall be a prerequisite for this project.
6-7
Table 6-8 Proposed Facility for TMCH

Hospital Type: Super Specialty Hospital
Required Site Area: Approx.10,000 sqm
1) Integrated Block: 31,000 sqm, G+6 story
1) Integrated Block: 6,500 sqm
Targeted Clinical Cardiology, Cardiac Surgery, Neurology, Neurosurgery, Nephrology, and Urology,
Department: Gastroenterology
Bed Strength: 200 beds (ICU 50 beds, ward 30 beds × 5 units)
Facility: Outpatient Department, Emergency Unit (Triage 2 beds, Recovery 6 beds),
Diagnostic Imaging (CT × 1, MRI × 1, X-ray × 2, Fluoroscopy × 1, etc.),
Angiography Unit (Single-plane × 1, By-plane × 1), Endoscopy Unit (Upper × 1,
Colonoscopy × 1) , Physiological Laboratory (ECOE, ECG, Stress ECG, EMG, EEG
etc.), Operation Theatre including Hybrid Operation Theatre (OT × 3, Hybrid OT ×
1), Laboratory (Chemistry, Microbiology, Pathology, Blood Bank), Dialysis (10
beds), Rehabilitation (Physiotherapy, Operation Therapy, Speech Therapy),
Pharmacy, Medical Engineering, CSSD, Kitchen, Laundry, SPD, Morgue, Lecture
Room, Administration, Medical Record, Engineering Service Block

Figure 6-2 Site Map (TMCH)
6-8
Jorhat Medical College Hospital (JMCH), Jorhat

Jorhat Medical College and Hospital 6 (JMCH) is the fourth medical college of the State Government.
Proposed facilities are shown in Table 6-9, and the site map is shown in Figure 6-3.
A lot of land on the east side of the compound is proposed by GOA. Currently, the proposed land is occupied
by some facilities formerly used as Jorhat District Hospital, which is currently used as a facility for the
medical college. Site acquisition shall be a prerequisite for this project.
The airport at Jorhat shares boundary wall with the medical college; the maximum permissible height may
not be more than 21 m, depending on the location of the site with respect to the airport runway.
Therefore, the proposed building shall be planned lower than 21 m. This height limit includes lift machine
room, lightning arrestor, DG chimney, and any other structure that may stick out over the building.
Table 6-9 Proposed Facility for JMCH

Hospital Type: Super Specialty Hospital and Energy Centre
1) Central Clinical Block: 36,000 sqm, G+3 story, with 2 basement floors.
1) Central Clinical Block: 7,500 sqm
Height of the Facility: Approx. 22.7 m (22.7 m including other structures, i.e., Lift Machine Room)
Department:
Bed Strength: 260 beds (ICU 20 beds)
Facility: Outpatient Department
Emergency Unit (Triage 2 beds, Recovery 6 beds), Diagnostic Imaging (CT × 1, MRI
× 1, X-ray × 2, Fluoroscopy × 1, etc.), Angiography Unit (Single-plane × 1, By-plane
× 1), Endoscopy Unit (Upper × 1, Colonoscopy × 1), Physiological Laboratory
(ECOE, ECG, Stress ECG, EMG, EEG, etc.), Operation Theatre including Hybrid
Operation Theatre (OT × 3, Hybrid OT × 1), Laboratory (Chemistry, Microbiology,
Pathology, Blood Bank), Dialysis (10 beds), Rehabilitation (Physiotherapy, Operation
Therapy, Speech Therapy), Pharmacy, Medical Engineering, CSSD, Morgue, Lecture
Room, Administration, Medical Record, Engineering Service Block
6 During the public consultation, there was an opinion that the name would like to be “Jananayak Deveshwar Sharma Civil
Hospital”.
6-9

Figure 6-3 Site Map (JMCH)
Fakhruddin Ali Ahmed Medical College Hospital (FAAMCH), Barpeta

Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH) is the fifth medical college of the State
Government. Proposed facilities are shown in Table 6-10, and the site map is shown in Figure 6-4.
The lot of land proposed by GOA in the compound is currently occupied by the Nursing School and
Superintendent Quarter. Site acquisition shall be a prerequisite for this project.
Table 6-10 Proposed Facility for FAAMCH

Required Site Area: Approx. 6,000 sqm
1) Central Clinical Block: 17,500 sqm, G+5 story, with basement floor.
Department:
Colonoscopy × 1), Physiological Laboratory (ECOE, ECG, Stress ECG, EMG, EEG,
etc.), Operation Theatre including Hybrid Operation Theatre (OT × 3, Hybrid OT ×
1), Laboratory (Chemistry, Microbiology, Pathology, Blood Bank), Dialysis (10
beds), Rehabilitation (Physiotherapy, Operation Therapy, Speech Therapy),
Pharmacy, Medical Engineering, CSSD, Morgue, Lecture Room, Medical Record,
Engineering Service Block
6-10

Figure 6-4 Site Map (FAAMCH)
Diphu Medical College Hospital (DMCH), Diphu

Diphu Medical College and Hospital (DMCH) is the seventh medical college of the State Government
established in 2011 and started in 2019. Proposed facilities are shown in Table 6-11, and the site map is
shown in Figure 6-5.
GOA proposed a lot of government site outside of the hospital compound, adjacent to the medical college.
Site acquisition shall be a prerequisite for this project.
Table 6-11 Proposed Facility for DMCH

Department:
Facility: Outpatient Department, Emergency Unit (Triage 2 beds, Recovery 6 beds), Diagnostic
Imaging (CT × 1, MRI × 1, X-ray × 2, Fluoroscopy × 1, etc.), Angiography Unit
(Single-plane × 1, By-plane × 1), Endoscopy Unit (Upper × 1, Colonoscopy × 1),
Physiological Laboratory (ECOE, ECG, Stress ECG, EMG, EEG, etc.), Operation
Theatre including Hybrid Operation Theatre (OT × 3, Hybrid OT × 1), Laboratory
(Chemistry, Microbiology, Pathology, Blood Bank), Dialysis (10 beds), Rehabilitation
(Physiotherapy, Operation Therapy, Speech Therapy), Pharmacy, Medical Engineering,
CSSD, Morgue, Lecture Room, Medical Record, Engineering Service Block
6-11

Figure 6-5 Site Map (DMCH)
Lakhimpur Medical College Hospital (LMCH), Lakhimpur

Lakhimpur Medical College Hospital (LMCH) is the newest MCH in Assam, preparing its operation.
Proposed facilities are shown in Table 6-12, and the site map is shown in Figure 6-6.
Currently, the proposed land by GOA is occupied by some facilities. Site acquisition shall be a prerequisite
for this project.
Table 6-12 Proposed Facility for DMCH

Department:
Colonoscopy × 1), Physiological Laboratory (ECOE, ECG, Stress ECG, EMG,
EEG, etc.), Operation Theatre including Hybrid Operation Theatre (OT × 3, Hybrid
OT × 1), Laboratory (Chemistry, Microbiology, Pathology, Blood Bank)
Dialysis (10 beds), Rehabilitation (Physiotherapy, Operation Therapy, Speech
Therapy), Pharmacy, Medical Engineering, CSSD, Morgue, Lecture Room,
Medical Record, Engineering Service Block
6-12

Figure 6-6 Site Map (LMCH)
Facility Upgrade in District Hospital

The details of the proposed 150-bed inpatient ward (Type 1) and emergency centre (Type 2) are as follows:
Hospital Type 1: 150-bed Hospital

By analysing bed gap between the actual bed strength and the bed demand calculated from demarcation of
the region, the number of lacking beds was figured out and it varies from below 100 to 500.
In general, the number of beds in hospital is an important factor in setting the scale of the hospital
management; a rapid increase in the number of beds may burden the hospital. Therefore, the JICA Survey
Team has set the recommended size of bed increase by 150 beds, and GOA has accepted this idea.
The basic specification of the Building Type 1: 150-bed hospital shall be shown in Table 6-13.
Table 6-13 Hospital Type 1: 150-bed Hospital

Floor Area: Approx. 18,000 sqm
Story: G+2
Targeted Clinical Department: General Medicine, General Surgery, Obstetrics & Gynaecology,
Paediatrics, Ophthalmology, ENT, Orthopaedics, Psychiatry, Dental,
Emergency
Bed Strength: 150 (ICU 10 beds, Emergency ward 20 beds, ward 30 beds × 4 units)
Facility: Outpatient Department, Emergency Unit, Diagnostic Imaging (CT, MRI,
X-ray, Fluoroscopy, etc.), Endoscopy Unit, Operation Theatre (4 rooms),
Delivery Unit, Laboratory, Pharmacy, CSSD, Kitchen, Laundry, SPD,
Morgue, Administration, Lecture Room
6-13
Hospital Type 2: Emergency Centre

This building type is focusing on the provision of emergency service. After the first aid, if required, patients
will be referred to the tertiary hospital. This type is applied to the area where the number of beds is sufficient
to the population, but the clinical service is insufficient. Basic information of proposed hospital Type 2
shall be shown in Table 6-14.
Table 6-14 Hospital Type 2: Emergency Centre

Floor Area: Approx. 6,000 sqm
Story: G+1
Targeted Clinical Department: General Medicine, General Surgery, Obstetrics & Gynaecology,
Paediatrics, Ophthalmology, ENT, Orthopaedics, Psychiatry, Dental,
Emergency
Bed Strength: No bed
Facility: Outpatient Department, Emergency Unit, Diagnostic Imaging (CT, MRI,
X-ray, Fluoroscopy, etc.), Endoscopy Unit, Delivery Unit, Operation
Theatre (2 rooms), Laboratory, Pharmacy, CSSD, Morgue,
Administration, Lecture Room
Distribution of the Building Types

One of the project concepts was to build up a referral model from tertiary level to secondary level hospitals.
To consolidate with this, district hospitals that are close to a tertiary level hospital was ideal to be selected.
The district hospitals shown in Table 6-15 are proposed by GOA for infrastructure improvement under the
JICA project. The geographical location and vertical integration with existing and upcoming medical
colleges have been taken into consideration. As for Goalpara CH and Sivasagar CH, medical college is
upcoming and therefore these are excluded from the list by GOA.
For S.M Dev Civil Hospital, Silchar and S.K Roy Civil Hospital, Hailakandi, the process of demolition is to be
initiated in phase-wise manner by GOA prior to the construction so that the functioning of the hospital services
is not affected during the construction.
As for Haflong Civil Hospital, Dima Hasao, the existing building to be demolished is an abandoned training
school. Hence, it is confirmed by GOA that it will not affect the functioning of the hospital services.
6-14
Table 6-15 District Hospitals Proposed by GOA

Number of Beds Required Proposed
Sl. Name of the District Name of the Gap
Currently Number of Building
No. Hospital Medical College (a) - (b)
Available (a) Beds (b) Type
S.M Dev Civil
1 SMCH 134 500 -366 Type 1
Hospital, Silchar
Mangaldoi Civil
2 GMCH, TMCH 313 300 13 Type 2
Hospital, Darrang
GMCH, Tamulpur
Udalguri Civil
3 MCH (Under 147 300 -153 Type 1
Hospital, Udalguri
Construction)
GMCH, Nagaon
Hojai Civil Hospital,
4 MCH (Under 50 - - Type 1
Hojai
Construction)
Haflong Civil Hospital,
5 SMCH, DMCH 232 100 132 Type 2
Dima Hasao
S.K Roy Civil
6 SMCH 129 200 -71 Type 1
Hospital, Hailakandi
From the analysis of the above requested locations, four blocks of Type 1 building and two blocks of Type
2 building shall be planned as shown in Table 6-16.
Table 6-16 Distribution of Building Type

Hospital Type Location Quantity
Type 1 S.M Dev CH, Udalguri CH, Hojai CH, S.K Roy CH 4
Type 2 Mangaldoi CH, Haflong CH 2
Training Facility for Capacity Building

It is a command, control, and integrated training and administrative centre, “Swasthya Bhawan”, which
focuses on training, capacity development, management personnel and digitalisation, and creating a central
administrative hub that will bring together all verticals for much better co-ordination and aims to build up
human resource capacity. Basic information is shown in Table 6-17, followed by the location of the site as
shown in Figure 6-7, area statement as shown in Table 6-18, site plan as shown in Figure 6-8, and floor
plan and 3D image of the proposed building as shown in Table 6-19.
Table 6-17 Swasthya Bhawan

Plinth Floor Area: 8,047.6 sqm
Proposed Site Area: 6,870 sqm
Story: G+6
Source: “PROPOSED NEW SWASTHYA BHAWAN AT SIXMILE, GUWAHATI” by GOA
6-15

Figure 6-7 Location of the Site
Table 6-18 Area Statement

Floor Area (sqm) Facilities Provided
Ground Floor 1,113.6 Entrance Lobby, Parking, Lifts, Staircases, Toilets
NHM Office Area (2 halls), Officer's Cabin-6 nos., Lifts, Staircases,
First Floor 1,020.5
Toilets, Public Waiting Space
NHM Office Area (2 halls), Officer’s Cabin-4 nos., Senior Officer's
Second Floor 1,283.2 Cabin-2 nos., 40-seater Office, Conference Hall, Lifts, Staircases,
Toilets, Public Waiting Space
NHM Office Area with Officer’s Cabin-2 nos., Senior Officer's Cabin-2
Third Floor 1,283.2 nos., Office Area with Managers of Different Departments, Lifts,
Staircases, Toilets, Public Waiting Space
NHM Office- Managing Director's Cabin with PA and Waiting Space,
Senior Officer's Cabin-2 nos., Conference Hall of 60 Seats, Board Room
Fourth Floor 1,283.2
(14-seater), Lifts, Staircases, Toilets, Public Waiting Space, AMC &
ANC Office Area with Officer's Cabin
AYUSH-Office Area with Senior Officer's Cabin, Lifts, Staircases,
Fifth Floor 1,283.2 Toilets, Public Waiting Space, 250-seater Auditorium/Seminar Hall with
Pre-function Area
Sixth Floor 780.7 Kitchen and Cafeteria
8,047.6
6-16

Figure 6-8 Site Plan
Table 6-19 Floor Plan and 3D Image of the Proposed Building
Ground Floor Plan First Floor Plan
6-17
Second Floor Plan Third Floor Plan
Fourth Floor Plan Fifth Floor Plan
Sixth Floor Plan 3D Image View of the Proposed Building

6.4 Considerations for Design in the Implementation Stage

The issues shown in Table 6-20 will be considered and shall be reflected in the design during the
implementation stage.
6-18
Table 6-20 Considerations for Design in the Implementation Stage

Issues Considerations
Consider security around women's restrooms,
changing rooms, and in the Obstetrics and
Gynaecology Department. The entrance should
not be easily visible from the crowds.
Gender Considerations Consider independent outpatient treatment rooms
or separated with curtains.
Waiting area usually gathered with crowds,
regardless of gender. Considerations can include
setting up a women-only waiting area.
Considering multilingual and multicultural
situation, facilities should be designed with idea
of barrier-free and universal design. Also, install
Barrier-free
ramps and lifts, handrails, and toilets for disabled
Considerations
in accordance with the regulations and rules.
From a medium- to long-term perspective, hospitals are often required to update their
facilities in response to updates in the medical technology. In order to realise this,
Skeleton Infill Facility
installation of dry-structure partition walls and lowering the structural slab floor in
Structure that Enables to
advance to accommodate future changes in water supply and cable pit for diagnostic
Accommodate Future
imaging and plan facilities that are easily adaptable to future changes.
Changes
Planning the hospital facility under these principles from the design stage enables the
facility to flexibly respond to future changes.
Cardiovascular operation theatres require a much larger column-free space than
normal operation theatres due to the large number of medical devices used. It is same
Long-span Structure that
for the hybrid operation theatres where CT and angiography are used during surgery.
can Accommodate
In such rooms that require large flat plan, pre-stressed concrete can be adopted to
Future Changes
reduce the number of columns. It is very significant to adopt such long-span structure
to accommodate a plane large floor plan for providing advanced medical care.
Assam has one of the world's highest rainfall and is known for its high agricultural
productivity such as tea, but it is also prone to frequent natural disasters such as
cyclones, major floods, and cliff collapses. The facility must be able to continuously
Knowledge of Back Up provide medical care and treatment to the injured and sick in the event of such
Functions as Disaster disaster. Considerations may be taken for receiving infrastructure from two supply
Base Hospital sources is a minimum requirement, installing a private power generation system that
can supply power for at least 72 hours (or a week when limiting the function area),
planning a rainwater reservoir when the city water supply is cut off, and reusing of
water.
Regarding flood, the major problem shall be the artificial flood during rainy seasons
due to lack of proper stormwater drainage system. In general, it is advisable to have
the finished ground level of the proposed locations to be kept at about 1.0 m above
Flood Water the Highest Flood Level.
Generally, a good construction period in Assam is from end-September to mid-May.
Major constructions like foundation and structural work should be completed during
this period.
In India, large hospitals in high-risk areas for earthquakes have begun to use seismic
Seismically Isolated isolation, and in Assam, there is a hospital currently being planned. Introducing
Structure seismic isolation structures in Assam enabled to ensure that medical activities
continue even in the event of a major earthquake.
Green Hospital regarding To reduce the energy consumption in the event of a disaster, as for the building
Sustainable facade, appropriate insulation materials shall be placed, air-tight window frames and
Development Goals pair glass shall be introduced, exterior louvers to reduce heat load, rooftop and wall
(SDGs) greening, and solar panels shall be considered.
6-19
Equipment Plan
7.1 Tertiary Medical Institute (Medical College Hospital)

The following eight medical college & hospital (Table 7-1) are targeted for the project:
Table 7-1 List of Medical College & Hospital

Medical College & Hospital Location Establishment
1 Gauhati Medical College & Hospital Guwahati 1968
2 Assam Medical College & Hospital Dibrugarh 1947
3 Silchar Medical College & Hospital Cachar 1968
4 Jorhat Medical College & Hospital Jorhat 2009
5 Fakhruddin Ali Ahmed Medical College & Hospital Barpeta 2005
6 Tezpur Medical College & Hospital Tezpur 2005
7 Diphu Medical College & Hospital Diphu 2011
8 Lakhimpur Medical College & Hospital Lakhimpur 2021
For example, Gauhati Medical College & Hospital provides undergraduate and post-graduate education in:
Medicine, Nursing, Midwifery, Pharmacy, Orthopaedics, Cardiology, Otorhinolaryngology, General
Surgery, Anatomy, Pathology, Biochemistry, Ophthalmology, Paediatrics, Microbiology, Obstetrics and
Gynaecology, Psychiatry, Dentistry, Neurology, Pharmacology, Forensics, Anaesthesiology, Dermatology,
Plastic Surgery, Radiology, Physiology
As for patient care, it runs outpatient departments in General Medicine, General Surgery, Orthopaedics,
Ophthalmology, Dermatology, Pulmonary Medicine, Geriatric Medicine, Obstetrics and Gynaecology,
Dentistry, Paediatrics, Physiotherapy, and Psychiatry. Special outpatient departments for Rheumatology,
Diabetes, Neurology, Nephrology, Cardiothoracic and Vascular Surgery, Plastic Surgery, Paediatric
Surgery, Urology, Cardiology, and Neurosurgery run on specified days of the week. Emergency services
run in Casualty, Paediatric Medicine, Obstetrics, and Psychiatry.
Keywords for the Equipment Plan for Each Facility

The plan of the medical equipment has been implemented taking into consideration the following:
 The availability of human resources who can operate the equipment, such as specialist doctors and
medical radiologists, etc.
 For equipment that needs to be installed to the facilities, space for installation and ancillary facilities
such as power supply, air conditioning, X-ray shielding, load-bearing capacity, etc., must be available.
 Maintenance services are available both in and outside of the target medical college & hospital.
 Procurement of consumables necessary for the operation of the equipment is secured (budget and
procurement routes).
 The equipment must be suitable for clinical, educational, and research purposes.
Equipment Plan
【Expected cooperation components for medical equipment, request-wise】
The following table indicates the major planned equipment to be procured under the yen loan project.
7-1
Component 1: Super Specialty Wing in Medical College & Hospital for Tezpur, Cilchar, Jorhat,
Diphu, Fakhruddin Ali Ahmed, and Lakhimpur (Total six Medical College & Hospital) ＊No.
of beds depends on the hospitals
The medical equipment is considered and planned based on the facility architectural design (refer to Chapter
6 Facility Plan). Table 7-2 presents the major medical equipment by each service department / section.
Table 7-2 Contents of the Major Medical Equipment by Departments / Sections

Department Major Medical Equipment
Target departments as the super specialty: CATH Lab including all accessories and EP, Multiparameter
Cardiology, CVD, Neurology, monitor, Dialysis machine, CRRT machine, 8-channel
Neurosurgery, Nephrology, and Urology EMG/NCV/EP machine, Heart lung machine, etc.
ICU and general ward ＊No. of beds depends on the hospitals
Outpatient department Consultation desk and chair, Examination bed, etc.
Emergency unit (Triage, recovery) Stretcher, Patient monitor, Portable ultrasound scanner, etc.
Angiography unit Single plane x 1 unit, Biplane x 1 unit
Endoscopy unit Upper video endoscope, colonoscope, etc.
Physiological laboratory ECOE, ECG, Stress ECG, CMG, EEG, etc.
Operation theatre OT table, Diathermy unit, Suction unit, Surgical C-arm unit, etc.
Biochemistry analyser, Haematology analyser, Coagulation
Clinical laboratory
analyser, etc.
Rehabilitation Physiotherapy equipment, Occupational therapy equipment, etc.
CSSD High pressure steam steriliser, Water distiller, etc.
Morgue Mortuary refrigerator, Anatomy table, Instrument set, etc.
Lecture room Projector, Screen, Desk and chair, etc.
Medical record File cabinet, Desk and chair, etc.
Note: Personal computer to be used inside the hospital is prepared by the Indian side, and not covered by yen loan.
Source: Prepared by the Consultant (Based on questionnaire and interview survey)
Component 2: To Improve Diagnostic / Curative Facilities for 8 Medical College & Hospitals
The medical equipment is necessary for the existing medical college & hospitals and was planned in view
of the requests from the respective medical college & hospitals and the availabilities of the existing
resources and infrastructure status. The items to be procured for the existing service departments / sections
are designed in order to start standard essential diagnosis and treatment. Details are shown in Table 7-3.
7-2
Table 7-3 Contents of the Major Medical Equipment by Departments / Sections

Hydraulic OT table, Laparoscope set, Open surgery instrument, Ultrasonic cutting &
General Surgery
coagulation, etc.
Medicine Multiparameter monitor, Syringe infusion pump, BIPAP/ CPAP, etc.
Neonatal open care system, Ventilator (Neonatal) with HFO, Phototherapy machine
Paediatrics
(single surface), Transcutaneous bilirubin analyser, etc.
Orthopaedic table with attachments, Cautery machine with vessel sealing, General
Orthopaedics
orthopaedic instruments, etc.
Slit lamp, Non-contact tonometer with pachymetry, ND YAG Laser - 1064 nm, Hand-
Ophthalmology
held kerotometer, etc.
Psychiatry Electro convulsive therapy (ECT) machine, EEG machine, etc.
IPL (Intense pulse light system), Motor (Electric) dermabrader, Hand foot UV
Dermatology
phototherapy device, etc.
ENT ENT operating microscope, OAE (screening), BERA with ASSR, etc.
Obstetrics & Laparoscopic surgery set with hysterestoscope and resectoscope with high-definition
Gynaecology camera & monitor, Delivery bed, etc.
Physical Medicine & DVT prophylaxis pumps (calf and ankle) one set (pair), Tilt table (Manual), Motorised
Rehabilitation (PMR) wheelchair, Shoulder CPM, Short wave diathermy, Interferential therapy, etc.
Respiratory & Advanced PFT machine, Lung volume and diffusion apparatus, Cardiopulmonary
Pulmonary Medicine exercise system, Polysomnography system, Rigid bronchoscope, etc.
Radiology CT 256 Slice, MRI 3T, Digital X-ray 1000 mA, Colour doppler (2D & 3D), etc.
Anaesthesia workstation with monitor and ventilator, Defibrillator with CPR capability,
Anaesthesiology
ICU ventilator, ICU monitor with CNS, etc.
Haemoglobin meter, Blood collection monitor, -80 deep freezer, Cell counter (3-part
Blood Bank
diff.), etc.
Emergency and ICU ventilators, ICU beds, Operating table electro-hydraulic, Assorted surgical
Traumatology instrument, etc.
No new facilities are planned to be constructed at Assam Medical College & Hospital and Guwahati
Medical College & Hospital due to the presence of existing super specialty wings. Therefore, it was
necessary to investigate the equipment plan for all the existing departments / sections and the following
diagnostic imaging equipment (Table 7-4) has been planned.
Table 7-4 Contents of the Equipment for Diagnostic Imaging Department of Assam
Medical College & Hospital and Guwahati Medical College & Hospital
Diagnostic Imaging CT 256 slices, MRI 3T, Digital X-ray unit, Mobile X-ray unit, Ultrasound scanner colour
doppler, Portable colour doppler unit, CR system, Mammography unit
7.2 Secondary Medical Institutes
Keywords for the Equipment Plan for Facilities

 The availability of human resources who can operate the equipment, such as specialist doctors and
medical radiologists, etc.
 For equipment that needs to be installed to the facilities, space for installation and ancillary facilities
such as power supply, air conditioning, X-ray shielding, load-bearing capacity, etc. must be available.
 Maintenance services are available both in and outside of the target medical college & hospital.
7-3
 The equipment is clinically relevant.
 The equipment that contributes to improve IMR, U5MR, and MMR (e.g., paediatrics, obstetrics and
gynaecology) is prioritised.
Equipment Plan
The facilities to be covered by the project are listed in Table 7-5.
Table 7-5 Candidate Secondary Hospitals

Hospital Type Remarks
1 Silchar Civil Hospital 1 150 beds
2 Mangaldoi Civil Hospital 2 Emergency centre, no bed
3 Udalguri Civil Hospital 1 150 beds
4 Hojai Civil Hospital 1 150 beds
5 Haflong Civil Hospital 2 Emergency centre, no bed
6 Hailakandi Civil Hospital 1 150 beds
Two types of secondary hospitals were designed: facilities with 150 beds (Type 1) and facilities with
emergency and no beds (Type 2). Medical equipment was planned into the facility design.
Equipment Plan of Type 1

Table 7-6 lists the equipment planned for Type 1 hospitals.
Table 7-6 Contents of Major Equipment of Type 1

ECG machine-12 channel, Defibrillator, Mobile X-ray-100 mA, Portable ventilator,
Emergency Unit
etc.
ICU Multiparameter monitor, ICU ventilators, ICU bed, etc.
Surgical Unit Operating table (electro-hydraulic), Plaster saw with suction, etc.
Outpatient Department Examination couch, Consultation desk and chair, etc.
Random access medium throughput fully automated chemistry analyser, Cell counter
Laboratory
and sizer, Blood gas analyser, etc.
LEEP system with smoke evacuator & integrated cart, Cryo-surgical system, Caesarean
Delivery Unit
set, etc.
Diagnostic Imaging CT 128 slices, MRI 1.5T, X-ray general, etc.
CSSD High pressure steam steriliser 400 L and 80 L
Endoscopy Unit Upper and lower video endoscope system, etc.
Pharmacy Refrigerator (300-380L), Medicine cabinet, Iron rack, etc.
General Ward Hospital bed with IV stand, Suction pump, etc.
Laundry Washing machine, Drying machine, etc.
Morgue Mortuary refrigerator, etc.
There is a possibility to provide 300 beds based on the huge medical demand of inhabitants.
Equipment Plan of Type 2

Table 7-7 lists the equipment planned for Type 2 hospitals.
7-4
Table 7-7 Contents of Major Equipment of Type 2

Outpatient Department Examination couch, Consultation desk and chair, etc.
Labour Unit Delivery bed, LEEP system with smoke evacuator & integrated cart, Hysterectomy
set, etc.
Laboratory Random access medium throughput fully automated chemistry analyser, Cell
counter and sizer, Blood gas analyser, etc.
Diagnostic Imaging CT 128 slices, MRI 1.5 T, X-ray general, etc.
CSSD High pressure steam steriliser 400 L and 80 L
Endoscopy Unit Upper and lower video endoscope system, etc.
ICU Multiparameter monitor, ICU ventilators. ICU bed, etc.
Surgical Unit Operating Table (electro-hydraulic), Plaster waw with suction, etc.
7.3 Primary Healthcare Facilities
Keywords for the Equipment Plan for Facilities

 The availability of human resources who can operate the equipment, such as general physicians (GPs),
midwifery staffs and nurses, etc.
 For equipment that needs to be installed, utilities such as electricity, water supply, etc. must be available.
 Maintenance services are available by equipment suppliers of the pilot primary health centres.
Equipment Plan
The facilities to be covered by the project are listed in Table 7-8.
Table 7-8 Pilot Primary Health Centres

1 ANC Height & weighing scale, Diagnostic set, Bilirubin analyser (percutaneous), etc.
2 Labour & Delivery Labour bed, Delivery bed, Fetal doppler, Transport incubator, etc.
3 PNA / Vaccine Vaccine refrigerator, Neonatal weighing scale, etc.
4 Inpatient (Observation) Beds, Baby cots, etc.
5 Sterilisation Tabletop autoclave
7.4 Others
Table 7-9 to Table 7-11shows other equipment to be planned for the project.
Table 7-9 Equipment for Dedicated Training, Monitoring, Administrative Centre,

“Swasthya Bhawan” - Component 5
Department Major Equipment
Lecture room Projector, Screen, Desk, Chair, and Shelf
7-5
Table 7-10 Equipment Concerned to Improvement of Medical College Infrastructure

Classroom, Libraries, Hostel, Smart Classrooms - Component 8
Classroom, smart
Desk and chair for 2-student, Projector, Screen, Computer for teachers, Tablet, etc.
classroom
Libraries Issue desk, Book trolley, DVD/Video display unit, etc.
Hostel Desk, Chair, Shelf, etc.
Table 7-11 Equipment Concerned to ICT on Comprehensive Hospital Management System

and Smart Hospital in AMCH & GMCH
Administration block, major clinical departments Persona computers, database servers, etc.
The above equipment is expected to be procured under the yen loan project as of Preparatory Survey time. In
addition, due to budget ceiling, some component which is not high priority for the Assam side might not be
covered by the yen loan.
7.5 Advantage of Japanese Medical Equipment

Medical equipment made in Japan has advantages mainly for image diagnostic equipment and endoscopic
equipment. Details are shown in the following Table 7-12.
Table 7-12 Advantage of Japanese Medical Equipment

Image Diagnostic  CT scanner 320 slices developed in Japan can scan cardiac movement only within a
Equipment second so that paediatrics and elder patients who have difficulty stopping their breathing
can easily obtain high resolution image. In addition, this CT can minimise radiation
exposure, suitable for infant/paediatrics. This high-quality image can be used without
any data processing before PCI (Percutaneous Coronary Intervention) treatment at
cardiology, and also suitable for oncology treatment. Considering NCD patients such as
circulatory disease or oncology, this CT provides high quality image for accurate
diagnosis.
 Resolution of ultrasound scanner is very much advanced. Thus, it is suitable for cardiac
follow up patients to check their heart movement after operation or intervention.
(Included in the project)
 Angiography system is pre-installed with stent enhancement software and 3D road
mapping system so that the doctor can easily confirm where to insert stent, and it is
suitable for intervention radiology treatment. (Included in the project)
Video Endoscopic  Diameter is very small compared with that of European made, and suitable for paediatric
Equipment patients and relatively small body adult Indian whose body shape is similar to Japanese.
(Included in the project)
Haemodialysis  Haemodialysis including Dialyser is more economical and safer than the western method
Healthcare using Individual Dialysis System (IDS) because it enables the centralised preparation
Equipment and supply of dialysis fluid to each patient. (Included in the project)
7.6 Operation and Maintenance of Medical Equipment

The maintenance of medical devices consists of common maintenance (routine and periodic inspections)
and repairs.
7-6
Routine inspections include visual inspections that can be carried out without the use of tools or measuring
instruments, checking of alarm operation, imaging accuracy checks using phantoms, etc., to ensure the safe
and proper use of the medical equipment.
Periodic inspections include cleaning, calibration, replacement of consumable parts, etc. These inspections
are carried out by the equipment supplier or distributor, who dismantles and inspects the equipment
regardless of whether it is faulty or not, then, replaces deteriorated parts if necessary. In Assam, the
authorised technicians of the distributors in Kolkata and Guwahati are ready to take immediate action.
In the Indian government tender, the Comprehensive Maintenance Contract (CMC) costs for three years
will be included in the purchase price of the equipment. In addition, the bidder will be required to submit
an estimate of the lifetime maintenance cost for ten years from the date of delivery, and the amount of
maintenance is committed and paid in the fourth year and every year thereafter.
The roles of the DME, end-users (respective healthcare facilities) and equipment distributors in common
maintenance (routine and periodic) and repair are generally divided as shown in Table 7-13.
Table 7-13 Roles of Stakeholders on Maintenance of Medical Equipment

Level GOA (DME) End-users (Healthcare Facilities) Equipment Distributors
Tertiary The DME guides / The end users should carry out a routine Dispatch of certified
promote the renewal inspection and, if any abnormality is found, technicians / engineers to
of maintenance request the distributor to carry out inspection ensure periodic / regular
contracts to public and repair according to the following inspections and repairs to
healthcare facilities. procedure: ensure proper operation of
Head of each department ⇒ Hospital the equipment.
Procurement department ⇒ Distributors
Secondary Same as above Same as above Same as above
Primary Same as above Same as above Same as above
Source: JICA Survey Team, based on questionnaire and interview survey
The following measures have been taken in terms of maintaining and developing the skills and knowledge
of the equipment users.
Generally, Guwahati Medical College & Hospital and Assam Medical College & Hospital, where many
advanced medical equipment (such as CT, MRI, PET scanners, radiotherapy machines, etc.) are introduced
in the facilities, have established a multifaceted personnel exchange and network with other medical college
& hospitals in the state.
As a part of this, training of doctors and para-medical staff such as radiologists and laboratory technicians,
etc. are also conducted at Guwahati Medical College & Hospital and Assam Medical College & Hospital
to acquire skills through hands-on and attachment training, for example, when new medical equipment is
introduced in the facilities.
7.7 After Sales Service of Local Agents in New Delhi

Local agents of planned equipment under the yen loan project located in Gurugram, New Delhi are looking after
medical equipment markets in the State of Assam including execution of after sales services. Some manufacturer
has its workshop in Kolkata, and conducts corrective maintenances. The detailed survey result of each agent is
7-7
mentioned in Table 7-14.
Table 7-14 Reference Survey Results for Manufacturers in New Delhi

Agency Name Olympus Medical Systems India Fujifilm India
 X-ray (Mobile, stationary,
 Rigid and flexible endoscopes
mammography)
Product  Laparoscopic instruments
 PACS
 Ultra clinics
 Flexible endoscopes
Certified engineers*/ 3 technician/engineers in Assam and workshop in
New Delhi (Gurugram)
branch Kolkata are responsible for maintenance
*Certified Service Engineer for the Installation, Diagnostics, Troubleshooting, Preventive Maintenance and Support
7.8 Procurement Plan

Procurement of medical equipment from foreign countries requires international competitive bidding (ICB)
procedures. High-precision medical equipment needs periodic maintenance and regular supply of spare
parts and consumable items. In order to maintain such equipment, it is desirable that the manufacturers
have local agents in Guwahati, Kolkata or New Delhi (Gurugram), so that maintenance services can be
performed in a timely manner.
It is also recommended to limit procurement range with Development Assistance Committee (DAC)
member countries in order to guarantee the accuracy and quality of such precision equipment.
Procurement of general medical equipment, educational equipment or furniture, and ICT system from local
manufacturers may apply local competitive bidding (LCB) procedures.
The image diagnostic equipment procurement cost consists of turnkey works, warranty, and Comprehensive
Maintenance Contract (CMC), and also includes the cost of installation, initial operational fees, and UPS.
It is necessary to consider adequate packaging in terms of feasible maintenance and management system,
as well as cost saving.
7-8
Human Resource Development Plan of Medical Institutes
8.1 Human Resources to be Allocated in the New Facilities
Medical College Hospitals

The required number of faculty posts including entry level posts is created by the Health and Family
Welfare Department, Government of Assam (HFWD) as per the minimum standard requirements set by the
National Medical Commission (NMC) and service-related requirements of the medical college & hospitals.
Once the posts are created, the Government of Assam advises the Medical & Health Recruitment Board
(MHRB), Assam for selection of suitable candidates in the entry level posts (Demonstrator / Registrar).
The list of selected candidates is then submitted by MHRB with a recommendation to the Government of
Assam for appointment and the Health Department appoints the candidates in various medical colleges
accordingly. The senior faculty posts (Assistant Professor, Associate Professor, and Professor) are
promotional cadre posts. HFWD constitutes a high-level Departmental Promotion Committee (DPC) for
promotion of faculty members of medical colleges from time to time on the basis of gradation list
maintaining reservation roster.
The postgraduate (PG) students who have completed their PG courses have to serve under the State
Government for a mandatory period of one year as Senior Resident / Post PG Resident with a provision of
further extension of ten years, as and when required by the government. The number of doctors and students
will be determined based on the “Postgraduate Medical Education Regulations, 2000, Medical Council of
India” to establish the super specialty hospital. According to the regulations, one Professor, one Associate
Professor, one Assistant Professor, one Senior Resident, and two Junior Residents will be required in the
first unit. The required numbers of doctors for the proposed super specialty hospitals are presented in Table
8-1.
8-1
Table 8-1 Required Numbers of Doctors at Proposed Super Specialty Hospitals

Number of Beds Clinical Departments Required Numbers of Doctors
Targeted Hospitals
(Planned) (Planned)
Silchar Medical 170 beds (ICU 50 Cardiology, Cardiac Surgery,  In one department, at least three
College Hospital, beds, ward 30 Neurology, Neurosurgery, faculty members (one
Cachar beds × 4 units) Nephrology and Urology Professor, one Associate
200 beds (ICU 50 Cardiology, Cardiac Surgery, Professor/Reader & one Asst.
Tezpur Medical
beds, ward 30 Neurology, Neurosurgery, Professor/Lecturer) per 20 beds
College Hospital,
beds × 5 units) Nephrology and Urology,  The ratio of postgraduate
Tezpur
Gastroenterology teacher to the number of
Jorhat Medical 260 beds (ICU 20 Cardiology, Cardiac Surgery, students to be admitted for
College Hospital, beds) Neurology, Neurosurgery, super specialty course shall be
Jorhat Nephrology and Urology 1:2 for Professor/Assoc.
Fakhruddin Ali 50 beds (ICU 50 Cardiology, Cardiac Surgery, Professor and 1:1 for remaining
Ahmed Medical beds) Neurology, Neurosurgery, cadre in each unit per year
College Hospital, Nephrology and Urology subject to a maximum of 4 PG
Barpeta seats for the course per unit per
Diphu Medical 50 beds (ICU 50 Cardiology, Cardiac Surgery, academic year provided the
College Hospital, beds) Neurology, Neurosurgery, complement of 10 teaching
Diphu Nephrology and Urology beds per seat is added to the
Lakhimpur Medical 50 beds (ICU 50 Cardiology, Cardiac Surgery, prescribed bed strength of 20
College Hospital, beds) Neurology, Neurosurgery, for the unit.
Lakhimpur Nephrology and Urology
Source: JICA Survey Team, based on Postgraduate Medical Education Regulations, 2000
The number of nurses and other medical workers will be calculated based on the “Minimum Standard
Requirements for the Medical College for 100 Admissions Annually Regulations, 1999” by the Medical
Council of India. Figure 8-1 presents the recommended norms for hospital nursing service.
Source: Minimum Standard Requirements for the Medical College for 100 Admissions Annually Regulations, 1999, NMC
Figure 8-1 Recommended Norms for Hospital Nursing Service
8-2
Civil Hospitals
Based on the proposed departments of civil hospitals (Type 1), the numbers of doctors, nurses, and
paramedics as listed in Table 8-2 will be required as per the Indian Public Health Standards (IPHS),
promulgated in 2012.
Table 8-2 Required Numbers of Doctors/Nurses/Paramedics

Position 100 beds 200 beds 300 beds
Medicine 2 2 3
Surgery 2 2 3
Obstetrics & Gynaecology 2 3 4
Paediatrics 2 3 4
Anaesthesia 2 2 3
Ophthalmology 1 1 2
Orthopaedics 1 1 2
Psychiatry 1 1 1
Dental 1 1 2
Staff Nurses* 45 90 135
Paramedics* 31 42 66
Note: *Numbers of staff nurses and paramedics might be changed as proposed Type 1 building does not include all the essential
departments for civil hospital.
Source: JICA Survey Team, based on Indian Public Health Standards (IPHS), promulgated in 2012
The details of the staffing plan will be discussed as soon as the clinical departments and the number of beds
of each proposed hospital are determined. According to Assam HFWD, 3,148 vacant posts are already
advertised for filling up. Necessary steps are being taken to fill up another 5,707 vacant posts under different
directorates. Further, about 1,100 doctors pass every year from the existing medical colleges and with the
establishment of new medical colleges.
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Recommendations on Health ICT Improvement
9.1 Phasing of the Project:

The Assam government may like to implement all e-Hospital modules in all the medical college hospitals
under the proposed project. Most of the hospitals began with the basic Outpatient Department (OPD),
Billing modules and by April 2022 would have been sufficiently ready for the total system (all modules).
Strengthening the HMIS/HIS System in the State of Assam
Strengthening the National Health Mission

At present, the Management Information System cell of the National Health Mission (NHM MIS cell) at
the national and state level is organised in Table 9-1.
Table 9-1 Existing NHM MIS Cells

Level Under Regular Services Under NHM
State Level  Demographer – Vacant  State MIS Manager (1)
 Statistician  Data Analyst (4)
 Statistical Investigator  Programmer (3)
 GIS Expert (1)
 System Administrator (1)
 Data Manager
 System Assistant (1)
District Level  Statistical Investigator  District Data Manager (33)
 Statistical Investigator (UIP)  Assistant District Manager (in 27 districts)
 Computer Assistant (under UIP)
Health Block  Computer  Block Data Manager
Level  LHV
Below Block  LHV  PHC Accountant cum Assistant Block Programme
Level Manager (Also used for reporting)
Suggestions for Improvement

1. Providing contemporary designations to the existing longstanding staff like Director of
Information Technology (IT), or Head of Management Information System (MIS), Database
Architect, Quality Assurance (QA) Lead, Team Leader, Development Specialist – need to be
explored.
2. Incentive system may be suggested in the form of field visit allowance or some other form as
overtime or holidays work is not counted to the staff.
3. Periodic good practices and achievements at the field/HO to be updated directly to the
stakeholders.
4. In view of the national digital health mission, short-term training in digital medical records/visit
to developers like the National Informatics Centre (NIC), Delhi/Tripura, World Health
Organization (WHO) may be encouraged.
5. Hardware/servers upgrading to be considered.
6. It may be explored to strengthen the Assam Medical Services Corporation which is a separate
company formed five years ago for various procurement roles if it gives flexibility from the
government/government e-marketplace (GEM) portal-related complexities.
9-1
 DME system – Executive Assistant IT to Directorate of Medical Education (DME) (could be a

qualified doctor with IT skill set) to be created and he will be responsible for data, updating, retrieving
from various portals of NHM, support to the DME.
 DHS system – Executive Assistant IT to Directorate of Health Services (DHS) (could be a qualified
doctor with IT skill set) to be created and he will be responsible for data, updating, retrieving from
various portals of NHM, support to the DHS.
 Medical college hospitals - Coordinator IT (could be a qualified doctor with IT skill set suitably from
community health department) to be created and she/he will be responsible for implementation,
overseeing, data, updating, retrieving from the software system. She/he will be supported by full-time
IT hardware professional and in case of large hospital, support team consisting of hardware and
software skills is required. Sample provision of computers/terminals department-wise is shown in
Table 9-2
Table 9-2 Example in One Medical College of 500 Beds Type

Sr. No Department No. of Computers
1 Help Desk 2
2 OPD 6
3 Clinics (Doctor Chamber) 30
4 Radiology and Pathology labs 15
5 Emergency 2
6 Nurse stations / IPD 20
7 Central Store 3
8 Pharmacy 5
9 OT 10
10 ICU 5
11 PICU 2
12 SNCU 2
13 Billing 5
14 Laundry 1
15 Diet 1
16 MRD Department 2
Total 111
Organisation Committee
Digital health records under the national digital health mission will give tremendous opportunity and also
sufficient challenges in implementation. A suitable committee may be formed with medical/IT/legal to
oversee, coordinate, and propagate the system. This committee may also decide the continuation of e-
Hospital or seek other vendor services.
Concerns and Possible Solutions/Alternatives
e-Hospital Implementation Issues

e-Hospital has been implemented in hundreds of hospitals across India. Some of the lessons learnt and
suggestions are (if e-Hospital is chosen):
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1. Doctors/clinicians need to be supported with forms filling (e-prescription data); the process has to
start gradually and increase over one year. May need a medical assistant in the initial days.
2. Having a tablet type of interface which allows the doctors to scribble will be much more
acceptable to the doctors.
3. Nurses at workstations need motivation and training in using/inputting the data.
4. Less paid/undertrained outsourcing staff can be a big bottleneck.
5. Latest hardware always helps the quicker inputting of the data.
High Cost and Complexity of Local Area Network and Possible Solution
Medical colleges/hospitals are spread over several buildings and floors and in vast campuses. Guwahati
Medical College & Hospital (GMCH), which is six times larger and more complex than the rest of the
newly built colleges which have better building design and work flow, has been assessed and attempted
to provide a local area network with cabling, nodes, routers, and switches. Average cost of this networking
for a typical medical college is coming to INR 60 lakhs (by NIC estimates) to INR 3.8 crores to GMHC.
This cost is prohibitive and even entails a continuous maintenance of the system with several stages of
Uninterruptible Power Supply (UPS). Due to the proliferation of internet providers, the government may
ask them to provide wireless routers in hospital buildings at their own cost so that wireless internet is
available to each desktop/laptop thus reducing network investments and complexity of the system. This
is now possible as the system proposed is totally cloud based and each desk/computer needs basic internet.
GEM Portable and Procurement Problems

NHM continuously faces the issue of hardware procurement (on time) either for the thermo active building
system (TABS), printers, UPS, desktops due to the Government of India (GOI) guidelines on the GEM
portal (a national portal for procurement of government agencies).
Until 2016, the procurement was with the rate contract mechanisms as notified by Digital Content
Technologies (DGCT) and fairly smooth. The present system of GEM portal and overload of vendors are
delaying, if not blocking, the procurement of hardware.
Command and Control System has been Created for COVID-19 Management
It should be with state of the art hardware, software, and processes including the HR efforts may be made
to continue using the system by expanding data items in the normal times also. This way, the sophisticated,
well refined system may continue to be in use for normal and emergency management.
Encourage the Use of Existing Investments in Portals/Modules Development

Huge investments are made and being made into the health system but the track of the buildings,
equipment, and human resources is not in an organised way by the concerned department/college/hospital.
The important modules (Table 9-3) are developed under GOI/NHM guidelines and in use. (There are
several other modules for use in NHM-related activities.)
9-3
Table 9-3 Important Modules in NHM

Important Modules in NHM Access to DHS/DFW/DME
1 HR – MIS Yes
2 Inventory management Yes
3 Drug stock Yes
4 RCH portal Yes
5 Civil works Yes
6 Health services monitoring Yes
7 Bio medical equipment maintenance program Yes
Note Detailed modules are given in ANNEX I
Encouraging Data-based Decision Making by the Directorate Systems

It should be for the promotions, posting, training, and incentivising by the DME, DHS, DFW and is highly
recommended to avoid delays and ensure transparency and efficiency in decision making.
Management of Data Entry Without Additional Staff

Generally, during operations (checking the patient, reading his reports or recording the assessment), the
nurse or doctor has to enter the data into the forms in the computer. There are apprehensions whether this
will be treated as additional workload or non-acceptable due to computer aversion illiteracy in some parts
of Assam.
Limited Support of Vendors In e-Hospital Implementation

NIC’s e-Hospital has limited empanelled vendors for the State of Assam (one vendor). Efforts may be
made to empanel at least two more vendors to the system as the load of installing the software in large
number of hospitals cannot be taken by one vendor. Additionally, local NHM team can also hire, train,
and implement at least in few hospitals so as to internalise the knowledge.
Project Monitoring Unit

Progress monitoring system to be formed to monitor each and every activity approved under the Japan
International Cooperation Agency (JICA) project – line activity – linking to departments – persons –
institution – master - photograph – (oxygen system monitoring by GOI – recent example) (this chapter to
be expanded under the organisational structure/systems chapter)
Incentivising the Software Implementers

NIC has provided modest budget for the implementation services by the empanelled vendor. This budget
may need to be revised or if the revision is a national level decision by NIC, the project may provide some
daily allowances to the implementation staff/agency to offset their HR cost in the challenging locations.
Otherwise, there may be delays and project overruns and incomplete work in progress at hospitals
resulting in frustration with the front level staff of the hospitals.
Online/Mobile OPD Registration

In Assam, overall, the doctors’ care/examination and subsequent treatment is at an acceptable level, but
the wait time/queue in the OPD is stressful to sick patients or their attendant. Online OPD registration
shall be encouraged through mobile phone with simple interface. They may be encouraged to do it even
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in the hospital waiting area through a dedicated councillor (to begin with). Gradually, they may be able
to do it even before they go to the hospital.
Assam Health Dashboard

It is proposed to expand the (starting with the available data online/offline) Assam health dashboard that
is already accessible to the decision makers. NIC – e-Hospital has provision to provide for a dashboard
by clubbing selected hospitals. There may be a need to customise the display items, categorisation of
hospitals, and add some offline data to make the data usable. e-Hospital can show live statistics of patient
load, doctors/nurses, tests, admissions, discharges, billing information and many others as the data is in
the cloud.
Other Suggestions that are Part of the HIS
Tele-consulting for Follow-up Visits

For simple follow-up visits, the patients may be encouraged to tele-consult with the doctors – or tele-
consult through the nearest primary health centre (PHC)/community health centre (CHC) thereby
avoiding the long travel, waiting and other related hassles. e-Hospital module may be tweaked for this
provision.
Satellite Internet for Remote Hospitals

District hospitals/medical colleges sometimes are located near the main town in a village plus type
demography where fibre connection is generally not available (Bharat Sanchar Nigam Limited (BSNL)7
possible), the situation in subdivisional hospitals and in PHCs may be problematic in 20 to 30% of the
places. Thanks to the newest satellite technologies like Starlink (by Tesla’s Elon Musk-promoted) One
Web by Airtel, by April/May next year, it may be possible to get satellite internet at any place in India (is
already available in many countries) with most reliable bandwidths of up to 200 megabits per second
(mbps) with very low latency and at a reasonable price. [India Today, 2021] [Times of India, 2021]
7 Landine
9-5
Environmental and Social Considerations

The Japan International Cooperation Agency (JICA) is accountable for the environmental and social
considerations (ESC) of the project and it is necessary to confirm the implementation of ESC by the project
proponents. In addition, JICA provides technical support for ESC-related studies including conducting the
Environmental and Social Consideration Survey during the preparatory survey. The objective of the survey
is to avoid significant impact from this project based on the JICA Guidelines for Environmental and Social
Considerations April 2010 (hereinafter referred to as “JICA guidelines”). The result of the assessment
together with mitigation measures and environmental monitoring plans need to be reflected in the project
implementation planning.
10.1 Legal Framework for Environmental and Social Considerations
Institutional Setting
The ministry in charge of ESC in India is the Ministry of Environment, Forest and Climate Change (MoEF),
which has institutions at both central and state levels. Under MoEF, the Central Pollution Control Board
(CPCB) is established to formulate the policy, regulations, and guidelines for environmental conservation.
It also operationalises international agreements such as the Montreal Protocol, Ramsar Convention, and
Washington Convention.
At the state level, there are departments responsible for environmental protection and the State Pollution
Control Board (SPCB), which plays the principal role in pollution control in practice.
Laws and Regulations Related to Environmental Considerations
Environmental (Protection) Act (1986) and Its Amendment (1991)

The act provides foundation for environmental protection and improvement of environment in India and
stipulates the role and power of the government, as well as penalties to non-compliance with the act and
related rules.
Environment (Protection) Rules (1986)

The rules provide standards for emissions or discharge of environmental pollutants, restrictions on the
location of specific industries, and procedures of sample analysis of such pollutants.
Environmental Clearance Notification (2006) and Its Amendment (2009)

The notification had been initially established in 1994 followed by the Environmental Protection Act and
Rules in 1986. It provides the categorisation of projects based on the scale and type of activities that may
cause environmental degradation and specifies the procedures to follow. It also specifies the type of project
which should obtain environmental clearance and require the conduct of environmental impact assessment
(EIA). Demarcation between national and state level environmental authorities is covered by the
notification. The amendment in 2009 enhanced the obligation of project proponents to disclose information
related to project implementation and the results of environmental monitoring.
10-1
The government issued the draft of EIA Notification in March 2020, which includes more exemptions and
dilutes the environmental standards. As a result, the draft received around 1.7 million comments by the end
of the public consultation period.
Gap Analysis
This section provides the gap between the JICA Guidelines for Environmental and Social Considerations
(2010) and the relevant laws in India. Overall, there is no fundamental gap between them; nonetheless,
some minor gaps arose, such as: 1) timing of conducting EIA study, 2) target of information disclosure, and
3) criteria for public consultation. The result of the gap analysis is presented in Table 10-1.
10-2
Table 10-1 Gap Analysis between Indian Laws and JICA Guidelines
JICA Guidelines on Environmental and Social Gap between JICA Guidelines and Government
Relevant Law in India
Considerations 2010 Law / Actions to be Taken
Underlying Principles
Environmental impacts that may be caused by projects EIA Notification (2006) There is no major gap between the underlying
must be assessed and examined in the earliest possible The objectives are to impose certain restrictions and principles, but with minor gaps as follows:
planning stage. Alternatives or mitigation measures to prohibitions on new projects or activities, or on the expansion Timing of EIA study assumed in the JICA guidelines
avoid or minimize adverse impacts must be examined or modernization of existing projects or activities based on is during the basic design stage or before concluding
and incorporated into the project plan. their potential environmental impacts as indicated in the agreement documents between project proponents
schedule to the notification. and JICA in case EIA is required; whereas, EIA study
for projects categorized under area development
should be conducted after the detailed design phase
in India.
<Actions to be/have been taken>

EIA survey should be conducted during the
preparatory survey and the results should be reflected
and incorporated into the following phases of project
implementation especially EIA study to be
undertaken after detailed design.
Information Disclosure
EIA reports (which may be referred to differently in EIA Notification (2006) Expected target of disclosed information is slightly
different systems) must be written in the official - The Applicant shall make a request through a simple letter different, where the JICA guidelines requires far
language or in a language widely used in the country in to the Member Secretary of the SPCB or Union Territory reach of information, while under Indian law, the
which the project is to be implemented. When Pollution Control Committee (UTPCC), in whose approved EIA report written in English shall be
explaining projects to residents, written materials must jurisdiction the project is located, to arrange the public publicized via the State Government’s website.
be provided in a language and form understandable to hearing within the prescribed statutory period.
them; - Whereas, the project that falls under Schedule 8(b) <Actions to be taken>
EIA reports are required to be made available to the “Townships and Area Development Projects” of the - To request State Government to publicize the
residents of the country in which the project is to be Notifications is excluded from public hearing specified in project information through local media in a
implemented. The EIA reports are always required to be the EIA Notification. timely manner, and to make available the
available for perusal by project stakeholders such as - EIA report shall be publicized via State Government’s summary of the EIA report in the local
local residents and copying must be permitted. website after approval. language as well as in English language to the
concerned project authorities and residents. It
must also be available in selected offices or
10-3
public libraries or panchayats.
Social Acceptability
For projects with a potentially large environmental The Member-Secretary of the concerned SPCB or UTPCC The projects categorized into “Building/Construction
impact, enough consultations with local stakeholders, shall finalize the date, time, and exact venue for the conduct of projects” are exempted from public consultation
such as local residents, must be conducted via disclosure public hearing within seven (7) days of the date of receipt of process as per EIA Notification, 2006.
of information at an early stage, at which time the draft Environmental Impact Assessment report from the Still in compliance with the JICA guidelines, it is
alternatives for project plans may be examined. The project proponent and advertise the same in one major national recommended to conduct public consultation during
outcome of such consultations must be incorporated into daily and one regional vernacular daily. A minimum notice preparatory survey and the comments should be
the contents of the project plans. period of thirty (30) days shall be provided to the public for incorporated into planning and implementation of the
- In preparing EIA reports, consultations with furnishing their responses; project. *Considering the situation related to
stakeholders, such as residents, must take place after ➢ The advertisement shall also inform the public about the COVID-19 at the time of the preparatory survey
sufficient information has been disclosed. Records places or offices where the public could access the draft where mass gatherings are not allowed, interviews to
of such consultations must be prepared; Environmental Impact Assessment report and the community representatives were conducted instead
- Consultations with relevant stakeholders, such as Summary Environmental Impact Assessment report before of a meeting. Result of the interview is described in
residents, should take place if necessary throughout the public hearing. section 10.10, and record of interviews is attached to
the preparation and implementation stages of a ➢ No postponement of the date, time, venue of the public the report.
project. Holding consultations is highly desirable, hearing shall be undertaken, unless some untoward
especially when the items to be considered in the emergency occurs and only on the recommendation of the
EIA are being selected, and when the draft report is concerned District Magistrate; the postponement shall be
being prepared; notified to the public through the same national and
regional vernacular dailies and prominently displayed at
all the identified offices by the concerned SPCB or
UTPCC
Scope of Impacts to be Assessed

The impacts to be assessed about environmental and The environmental clearance process for new projects will No major gap is observed.
social considerations include impacts on human health comprise a maximum of four stages, all of which may not
and safety, as well as on the natural environment, that apply to cases as set forth below in this notification. These
are transmitted through air, water, soil, waste, accidents, four stages in sequential order are: (1) Screening (Only for
water usage, climate change, ecosystems, fauna and Category ‘B’ projects and activities), (2) Scoping, (3) Public
flora, including trans-boundary or global scale impacts. Consultation, and (4) Appraisal
These also include social impacts, including migration For Social Consultation>
of population and involuntary resettlement, local
economy such as employment and livelihood, utilization
10-4
of land and local resources, social institutions such as Land Acquisition Act 1894 (Amended in 1984) and The Right
social capital and local decision-making institutions, to Fair Compensation and Transparency in Land Acquisition,
existing social infrastructures and services, vulnerable Rehabilitation and Resettlement Act, 2013.
social groups such as poor and indigenous peoples, The Provision of the Panchayats (Extension to the Scheduled
equality of benefits and losses and equality in the Areas) Act, 1996.
development process, gender, children’s rights, cultural The Madhya Pradesh Panchayat Raj Act, 1993.
heritage, local conflicts of interest, infectious diseases For Environment Survey> Environmental Impact Assessment
such as HIV/AIDS, and working conditions including Guidance Manual for Building, Construction, Townships
occupational safety. and Area development projects provides the following items
In addition to the direct and immediate impacts of to be assessed:
projects, their derivative, secondary, and cumulative ➢ Land environment
impacts as well as the impacts of projects that are ➢ Water environment
indivisible from the project are also to be examined and ➢ Air environment
assessed to a reasonable extent. It is also desirable that ➢ Noise environment
the impacts that can occur at any time throughout the ➢ Biological environment
project cycle should be considered throughout the life ➢ Socioeconomic Environment
cycle of the project. ➢ Solid waste
Monitoring
Project proponents should make efforts to make the As per EIA Notification, 2006, There are some gaps regarding availability of
results of the monitoring process available to local (i) It shall be mandatory for the project management to submit monitoring results to local project stakeholders.
project stakeholders. half-yearly compliance reports in respect of the stipulated prior
When third parties point out, in concrete terms, that environmental clearance terms and conditions in hard and soft <Actions to be/have been taken>
environmental and social considerations are not being copies to the regulatory authority concerned, on 1st of June and Project proponent should consider the method of
fully undertaken, forums for discussion and examination 1st of December of each calendar year. unveiling the result of monitoring stipulated under
of countermeasures are established based on sufficient (ii) All such compliance reports submitted by the project the environmental clearance to the general public,
information disclosure, including stakeholders’ management shall be public documents. Copies of the same such as uploading to the website and to show the
participation in relevant projects. Project proponents, shall be given to any person on application to the concerned solution for issues pointed out under the
etc. should make efforts to reach an agreement on regulatory authority. The latest such compliance report shall environmental management plan.
procedures to be adopted with a view to resolving also be displayed on the website of the concerned regulatory
problems. authority.
10-5
Ecosystem and Biota
Projects must not involve significant conversion or Forests (Conservation) Act, 1980 and Rules 1981 as amended No major gap observed.
degradation of critical natural habitats and critical 2004.
forests. The Act restricts the powers of the State in respect of de-
reservation of forests and the use of forestlands for non-forest
purposes. An advisory committee has been created to oversee
the implementation of the statute.
Wildlife (Protection) Act 1972

➢ The Act provides for the protection of wild animals, birds
and plants; and for matters connected therewith or
ancillary or incidental thereto.
➢ The application of the Order of the Supreme Court in WP
460 of 2004 dated 04.12.2006 has directed that all
projects which require environmental clearance and are
located within the distance of 10 km of National Park and
Sanctuaries must be placed before the Standing
Committee of the National Board for Wildlife constituted
under the Wildlife (Protection) Act, 1972.
Source: JICA Survey Team, based on related regulations in India and the JICA Environmental and Social Consideration Guidelines (2010)
10-6
Environmental Clearance and EIA Procedures in India

The project target facilities and institutions can be categorised into three types in relation to the necessity
of an Environmental Certificate (EC) and procedures to obtain the certificate based on the categorisation
provided by the EIA Notification. They are, in the order of extent of impacts, described as follows:
1) The projects require to conduct EIA study to obtain EC by State Level Environment Impact Assessment
Authority (SEIAA), which falls under category 8(b): Townships and Area development projects covering
an area larger than 50 ha and/or build up area larger than 150,000 m2;
2) The project falls under category 8(a): Building and Construction projects, build up area between 20,000
and 150,000 m2, which requires Environmental Clearance by SEIAA;
3) The project of smaller scale compared with category 8(b) and 8(a), which do not require EC.
Figure 10-1 presents the flow of EC application related to 1) and 2) types of projects. The procedure needs
to be initiated by the project proponent after the detailed design is approved by the project management
unit (PMU), and hand-in-hand with the approval of the building design by the municipality and the
guideline values of emission approved by the pollution control board. It is estimated that the entire process
from application to acquisition of EC may take around six months. This needs to be incorporated into the
implementation schedule of the project and the terms of reference (ToR) for the consultant.
10-7
The procedure for 8(b) projects The procedure for 8(a) projects
Note) SEAC: State level Expert Appraisal Committee

SPCB: State Pollution Control Board
UTPCC: Union Territory Pollution Control Committee
Source: EIA Guidance Manual, Ministry of Environment and Forests (2010)
Figure 10-1 Flow of Environmental Clearance Procedures
10.2 Proposed Project Components Subject to Environmental and Social Impacts

The summary of the project components that may affect social and natural environment of surrounding area
are shown in Table 10-2. (the table is provisional and will be updated based on decision made by Assam
state government and JICA team)
10-8
Table 10-2 Summary of the Project Components that May Affect Environment by Institute
Applicable
Total area Floor area Facilities that may cause environmental
Proposal for Various institutions EIA
(sqm) (sqm) impacts, Remarks
category
Super Specialty wing in Medical colleges.
Total 170 beds (including ICU 50 beds),
*applicable EIA procedure should be checked with
SEIAA after detailed design phase as facilities to be
Silchar Medical College assisted under the project is completely within
1 844,116 29,500 8(b)*
Hospital, Cachar existing compound.
Demolition is required for existing structure
(510.78 m2), which does NOT contain Asbestos
NOR biosafety level 3 facility.
Tezpur Medical College Total 200 beds (including ICU 50 beds)
2 147,158 32,500 8(a)
Hospital, Tezpur Demolition is not required.
Total 260 beds (including ICU 20 beds)
Jorhat Medical College Demolition is required for existing structure (app.
3 194,985 37,500 8(a)
Hospital, Jorhat 12,000 m2), which does NOT contain Asbestos
NOR biosafety level 3 facility.
Fakhruddin Ali Ahmed ICU 50 beds
Demolition is required for existing structure (3,924
4 Medical College Hospital, 167,225 19,000 - m2), which does NOT contain Asbestos NOR
Barpeta biosafety level 3 facility.
Diphu Medical College ICU 50 beds
5 308,698 19,000 -
Hospital, Diphu Demolition is not required.
ICU 50 beds
Lakhimpur Medical College Demolition is required for existing structure (3,000
6 7,700 19,000 -
Hospital, Lakhimpur m2), which includes facilities built with Asbestos
(2,600 m2),
Infrastructure improvement in District Hospital
Type 1 (At six locations) 25,000 18,000 - Total 150 beds (Include ICU 10 beds)
Type 2 (At two locations) 10,000 6,000 - Emergency Centre
Dedicated Training, monitoring, administrative centre, Swasthya Bhawan
6,870 8,047.6 - Training Health Centre
10.3 Alternative Study

The alternative study was conducted by comparing 3 options namely 1) Not conducting project, 2)
Alternative1: Expansion and improvement of medical facilities that includes land acquisition in addition to
existing land area, and 3) Alternative 2: Improvement of medical facilities within existing land area (thus
may require demolition of existing structures). As show in Table 10-3, the Alternative2 has been evaluated
as the best option as the option can contribute improvement of medical services while minimizing negative
environmental and social impacts by appropriate mitigation measures.
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Table 10-3 Comparison of Alternatives

Alternative 1: Alternative 2:
Expansion and improvement of Improvement of selected
Option No Project
selected Tertiary and Secondary Tertiary and Secondary medical
medical institutes institutes within premises
Outline The option of not implementing Expansion of selected medical Improvement of selected medical
any improvements of medical college hospitals and district college hospitals and district
system and maintain current hospitals into surrounding area of hospitals within the land owned by
facilities. existing facilities. medical facilities
Impact on No impact on surrounding - The negative impact on air - Same impacts are expected as
Natural environment is expected as there pollution, noise and vibration to Alternative 1 during
Environment will be no construction activities. surrounding area is expected construction and operation.
during construction phase. - Vegetation of surrounding
- Operation of expanded facilities areas will be maintained.
may cause air pollution by - (for several facilities)
power generator and additional demolition of existing
load to water resources of the facilities may be required, that
area. may cause additional air
- Expected land acquisition may pollution, noise & vibration,
cause cutting vegetation. and solid wastes. The impact
can be mitigated by following
related regulations.
Impacts on It is expected that the medical - Increased medical capacity and - Positive impact same as
Social facilities will not be able to quality of medical services will alternative 1 is expected.
Environment accommodate patients at contribute improvement of - Land acquisition may not be
required level, which may result public health status of the area. required.
in poor public health status. - Land acquisition and clearance
will be required that may cause
involuntary resettlement of
surrounding residents.
Overall Although no environmental This option is second best, as it is This option is evaluated as the
evaluation impact is expected, quality and expected to cause negative social limited the Best Option as the
coverage of medical service impact due to expansion of facility negative impact by demolishing
would be deteriorated in the long area and may cause involuntary existing facilities is expected to be
term. resettlements. minimized, and involuntary
resettlements will be avoided.
10.4 Scoping and TOR for Environmental and Social Consideration Study
The purpose of scoping and drafting of ToR of the EIA study is to properly select the environmental and
social impact items, on which the project potentially impacts through its implementation activities, and to
decide the parameters and methodology of the survey. The result of the scoping is shown in Table 10-4 and
the ToR is shown in Table 10-5.
Table 10-4 Result of Scoping

Rating
Impact Item Construction Operation Reason
Phase (CP)/ Phase (OP)
Pollution
Air Pollution ✓ ✓ CP: Some negative impacts on air quality are anticipated due to increased
transportation and operation of heavy equipment/ vehicles temporarily during
construction activities.
OP: Some negative impacts on air quality are anticipated due to the increase
of traffic volume of patients and staff, and transportation of goods necessary
for operating the hospital. Impact on air quality is also expected due to the
10-10
Rating
operation of power generator in case of emergency power supply.
Water Pollution ✓ ✓ CP: There is a risk of temporary water pollution due to discharge of turbid
water and leakage of oils from the construction activities.
OP: Impact on water quality caused by the operation of the hospital and
increased residents (staff and students) is expected.
Solid Waste ✓ ✓ CP: Increase of solid waste amount due to construction waste and general
waste from workers is expected.
OP: Increase of various solid wastes is expected due to medical and
research activities (biomedical and radioactive waste, hazardous waste), and
increased number of residents such as staff and inpatients (general waste).
Soil ✓ ✓ CP: There is potential risk of soil contamination due to oil leakage from the
Contamination construction activities.
OP: There is potential risk of soil contamination by improper management of
fuel and leakage of waste liquid.
Noise and ✓ ✓ CP: Temporary increase of noise and vibration levels due to the operation of
Vibration construction machineries and traveling of construction vehicles is expected.
OP: Increase of noise and vibration levels due to traveling of vehicles
associated with the operation of the hospital, and operation of back-up power
generator and air system is expected. Operation of medical equipment may not
generate noise and vibration.
Ground ✓ ✓ CP: Ground subsidence is expected due to the usage of groundwater for
Subsidence construction activities.
OP: There is risk of ground subsidence due to over abstraction of
groundwater; however, it can be avoided if water will be provided from the
public water system.
Offensive ✓ ✓ CP: No construction activities are expected that would cause offensive odour,
Odour but improper management of construction waste may generate it.
OP: Improper management of waste (general/bio-medical) generated at the
project site would cause offensive odour.
Bottom CP/OP: No impact is predicted as there will be no direct discharge of
Sediment wastewater to water body.
Natural Environment
Protected Area CP/OP: There are not any protected areas in and around the project sites.
Flora/ Fauna CP/OP: It is assumed that impact on flora/ fauna/ ecosystem by the
and Ecosystem development of the project is minimal, as most of the project areas are already
developed.
Hydrology ✓ ✓ CP: Earthwork by filling excavated soil would cause modification of
hydrology in and around the site especially during flash flood.
OP: Alternation of land surface may cause modification of hydrology in and
around the site.
Topography ✓ CP: Topography of the site needs to be adjusted for levelling.
and
Geographical
Features
Social Environment
Involuntary CP/OP: Involuntary resettlement is not required for the project, as the land for
Resettlement the project development is already secured by the local government.
The Poor CP/OP: Any activities that might impact on the poor are not planned in the
project.
Indigenous, or CP/OP: No impact on indigenous or ethnic people is expected, because there
Ethnic People are no indigenous or ethnic people residing in and around the project site.
Local Economy ✓ ✓ CP: Job creation for construction workers is expected during the construction
(e.g., period because it includes construction work.
Employment OP: Positive impact on local economy is expected by the operation of the
and Livelihood) hospital.
10-11
Rating
Land Use and ✓ ✓ CP/OP: Impact of the project is expected as the land use is modified for the
Utilisation of project, although the intensity of impact is expected to be small considering
Local Resources the relatively small scale of the project component in comparison to the
existing facilities.
Water Usage ✓ ✓ CP/OP: Some impact is expected as the project plans to utilise groundwater
and public water. Intensity of the impact needs to be assessed by studying the
current condition of groundwater and water supply.
Existing Social ✓ ✓ CP/OP: Impact on traffic condition is expected due to increase of traffic for
Infrastructures construction activities and operation of hospital. The extent of impact needs to
and Services be assessed comprehensively considering ongoing road expansion and housing
(including area development around the site.
Traffic
Condition)
Misdistribution CP/OP: The project may not cause misdistribution of benefits and damages in
of Benefits and the surrounding area considering the characteristics of the project.
Damages
Local Conflicts CP/OP: In consideration of the project characteristics, the project will not
of Interest cause conflicts of interest in the surrounding area.
Cultural CP/OP: No impact on cultural heritage is expected since there is no cultural
Heritage heritage in and around the project site.
Landscape ✓ ✓ CP/OP: Some modification on landscape is expected as the building height
will be up to 5 floors in some project sites.
Gender CP/OP: No impact on gender is anticipated by the project.
Children’s CP/OP: No impact on children’s rights is anticipated by the project.
Rights
Health and Safety
Occupational ✓ ✓ CP: Some impacts are anticipated due to large-scale construction works.
Health and OP: Some impacts are anticipated due to handling of infectious diseases and
Safety hazardous materials for medical activities.
Community ✓ ✓ CP: Some negative impacts on public health are anticipated due to the influx
Health and of construction workers and discharge of pollutants caused by the construction
Safety activities.
OP: Positive impact is expected due to the improvement of medical service by
the project.
Other
Transboundary ✓ ✓ CP: Greenhouse gases (GHGs) would be emitted from the construction
impacts machines and vehicle.
including OP: Emission of GHGs is expected due to the operation of the air
Climate Change conditioning system and traveling of vehicles associated with the operation of
the hospital.
✓: positive/negative impact is expected to some extent.
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Table 10-5 Draft ToR for the Environmental and Social Consideration Study
Environmental
Survey Items Survey Methods
Factors
Air Pollution  Current condition of air quality around the  To review existing reports/data
project site and nearby monitoring station  To confirm relevant regulations in India
as available  To survey situations and measures taken by other
 Environmental standards of air quality in similar institutions
India and other related international
standards if necessary
 Estimation of impact, proposed mitigation
measures and monitoring plan
Water Pollution  Current condition of water quality in and  To review existing reports/data
around the project site  To confirm relevant regulations
 Environmental standards of water quality,  To conduct the field survey, to review existing
effluent and licensing system in India and reports/materials
other related international standards if  To survey situations and measures taken by other
necessary similar projects
 Current condition of wastewater collection
 Estimation of impact, mitigation measures
and monitoring plan
Solid Waste  Regulations related to medical/ hazardous  To confirm relevant regulations in India
waste management in Assam state  To review existing reports/materials
 Current situation of waste management in  To survey situations and measures taken by other
Assam state similar projects
 Estimation of impact, propose mitigation
Soil  Environmental standards of soil quality in  To confirm relevant regulations in India
Contamination India and other related international  To review existing reports/materials and similar
standards if necessary projects
 Potential risk of soil contamination caused  To survey situations and measures taken by other
by the project activities similar projects
Noise and  Environmental standards of noise and  To confirm relevant regulations in India
Vibration vibration in India and other related  To conduct the field survey around the project site
international standards if necessary  To survey situations and measures taken by other
 Current situation of the surroundings of similar projects
the project site (Distance to the residential
areas, school, etc.)
Ground  Current ground condition around the  To review existing reports/materials
Subsidence project site  To survey situations and measures taken by other
 Current situation of groundwater usage similar projects
around the project site
Offensive Odour  To identify possible source of the  To review construction plan and operation plan
offensive odour during the project  To survey situations and measures taken by other
implementation similar projects
Hydrology  Current condition of hydrology in the  To conduct the field survey around the project site
surrounding area  To review construction plan and operation plan
 Drainage plan during project  To survey situations and measures taken by other
implementation similar projects
measures, and monitoring plan
10-13
Environmental
Survey Items Survey Methods
Factors
Local Economy  Employment plan during the construction  To examine the construction plan
(e.g., Employment phase  To review similar projects
and Livelihood)  Prediction of impact on local economy
caused by the operation of the hospital
Water Usage  Current situation related to water usage  To conduct the field survey, to examine the results of
 Water usage plan during the project the field survey, to review similar projects
implementation period  To examine the usage of water necessary for project
implementation
Existing Social  Existing social infrastructures around the  To conduct the field survey around the project site
Infrastructures and project site  To examine the construction plan, to review similar
Service  Operation plan of the construction projects
machinery and vehicles during the
construction phase
Occupational  Potential risks related to occupational  To review the project activities
Health and Safety health and safety  To review existing documents, reports, and materials
 Guidelines related to occupational health
and safety in India and other related
international guidelines
Community  Impact on the public health in  To review construction plan and activities
Health and Safety consideration of types of activities during
construction phase
Global Warming  Relevant policies for global warming in  To confirm relevant policies in India and to review
India and current situation of emission of existing reports/materials
greenhouse gases (GHGs)  To examine the construction plan and operation plan,
 Project activities that might emit GHGs to review similar projects
10-14
10.5 The result of Environmental and Social Impact Assessment

The results of environmental and social impact assessment are presented as in Table 10-6.
Table 10-6 Result of Environmental and Social Impact Assessment of the Project
Parameters Result of Survey CP: Construction Phase, OP: Operation Phase
Pollution
Air Pollution • In current condition, the annual average values of SO2 and NO2 in all the stations were well below the
permissible annual average standard values. The values of SO2 ranges from 5-8 μg/m3. The highest
values of NO2 ranges from 10-18 μg/m3, based on the results of National Air Quality Monitoring
Programme by CPCB(2019).
• All medical facilities are connected to public line, therefore power generator will be necessary only
when there is no power supply from the source.
<Impacts and proposed mitigation measures>
CP: Impact on air quality due to operation of construction machineries and traveling of the construction
vehicles is expected. During construction phase, particulate matter will be main pollutant followed by
SOx, NOx and CO from construction machineries and vehicles. These may be reduced by spraying
water, periodical maintenance of machineries and vehicles, and reducing idling time for machinery
operation. Considering the duration of construction activities and present air pollution status which is
within standard values, air pollution quality during construction phase is estimated to be within national
standards.
OP: Impact on air quality due to diesel generator (DG) sets and increased project related transportation are
expected. The overall air quality considering emission of air pollutants from DG while operated, and
baseline air quality is confirmed to be within national standard values.
- In addition, to prevent dispersion of contaminated air, HEPA(High Efficiency Particulate Air) filter
will be installed to the air conditioning system and the system will be maintained by engineering
department of each medical facility.
Water Pollution  Based on the interview to managers in charge of maintenance and operation of each MCH, no
significant water pollution issues are reported.
 There is no law or regulation regarding management of medical effluent that would be generated from
the project activities during operation phase. Instead, medical institutions and hospitals are obliged to
install its own Effluent treatment facilities onsite under instruction of SPCB, and typical design of such
facilities are provided. Effluent management plan will be developed and submitted to SPCB after
detailed design stage for those facilities to go through EC procedure. The effluent management plan
should include estimated amount of effluent and its characteristics, capacity of effluent treatment plant
(ETP), and expected quality of treated effluent. In general, ETP should consist of primary, secondary
and tertiary treatment. The tertiary treatment should include ultra-filtration system, ultraviolet
disinfection system. The electromagnetic flow meter at the inlet and outlet of ETP as instructed by
SPCB. During operation phase, the quality of treated effluent will be tested, and necessary measures will
be taken if required to meet the standard specified by SPCB.
CP: Impact on water quality due to leakage of oil from machineries and construction chemical is expected.
The impact can be minimized by limiting oil handling area and applying impermeable material on the
ground of the area.
OP: Treated wastewater to be discharged through rainwater drainage will be main source of pollution from
project operation. However, as the quantity of wastewater to be treated by water treatment unit and
discharged into surrounding environment via rainwater drainage is estimated to be small. In addition,
the quality of wastewater will strictly comply with SPCB standards, therefore the negative impacts are
expected to be minimum. Another potential impact would be medical effluent, which may contain
hazardous elements. The effluent should be treated by ETP designed to fit expected medical activities
so as to avoid contamination of water environment of surrounding area.
Solid Waste  Major regulations that stipulate waste management are Municipal Solid Wastes (Management and
Handling) Rules (2000), Hazardous and other wastes (Management and Transboundary Movement)
Rules (2015) under responsibility of the Ministry of Environment, Forest and Climate Change.
 In addition, for demolishing existing facilities the waste shall be handled in compliance with
Construction and Demolition Waste Management Rules, 2016.
 General and medical wastes are segregated at source, collected by category, treated on site disposed or
handed over to authorized third party depending on the type of waste.
CP: The excavated solid waste as well as construction related waste will be main component of solid waste
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during the construction phase of the project, including demolishing existing facilities. These should be
maintained inside the proposed project site under responsibility of contractor and be disposed in
accordance with the norms and rules mentioned above.
- For demolishing existing structures especially those which made with Asbestos and other hazardous
materials, waste management rules and regulations, related international regulations and good
practices should be strictly followed by the contractor.
- These responsibilities of contractor shall be clearly defined in the contract agreement to minimize the
risk of making negative impacts to surrounding area.
OP: Various medical, non-medical, hazardous, and non-hazardous wastes will be generated. These should
be segregated at source, collected and stored to be either handed over to authorized third party or recycled
inside project property in case of biodegradable compost in compliance with relevant rules and
regulations.
Soil  Although there is possibility that leakage of hazardous liquid waste, which may contain heavy metals
Contamination and similar compounds results in contaminating soil, there is no written laws or regulations about
handling of them. In practice, SPCB instructs installation of ETP on site and monitors performance of
the plant regularly to prevent soil contamination as described in water pollution.
CP: It is possible that oil leakage may cause soil contamination during construction phase. To avoid
contamination by leakages, fuel to be used shall be stored impermeable storage space, machineries that
have risk of oil leakage shall be well maintained, and the construction site shall be equipped with tools
to treat accidental leakages and workers shall be trained to deal with such accident.
OP: During operation phase, potential contaminates vary from oil and grease, inorganic and organic
chemical compounds and so on. Installation and operation of ETP proposed as a measure to prevent
water pollution is effective as means to prevent soil contamination. In addition safety operation manual
as well as emergency reaction plan in case of accidental leakage shall be prepared and informed to all
related workers to minimize the impact of leakage to surrounding environment.
Noise and  Noise level should be controlled to comply with Noise Pollution (Regulation and Control) Rules (2000)
Vibration and its amendments.
 For the sites, which are located in operating hospital, extra considerations to be made to avoid affecting
hospitalized patients.
CP: During construction phase, various machineries such as concrete mixer, crane, and track generate
noise nearly 90 (dB) as well as project related traffics may generate noise in and around project site. In
addition, there would be a communication problem among work persons due to ambient noise of the
equipment, this can be localized and temporary in nature. To mitigate level of noise generated from
activities to disturb patients in the medical facilities and residents of surrounding area, temporal fence
would be installed during construction period. Also, training to drivers and operator of machineries in
less noise generation would be introduced if available and suitable.
OP: During operation phase, generation of noise because of increased traffic volume with ambulance, cars
of visitors and project personnel, operation of boiler system and emergency generator are expected. To
minimize the impact, equipment that generate less noise were selected.
Ground  Based on the geological classifications and richness of groundwater in the region, the risk of ground
Subsidence subsidence is estimated at minimal.
CP/OP: It is planned to utilize ground water for construction activities or as main water source for several
facilities; therefore, the contractor/management units for each facility should monitor the groundwater
level and ground subsidence (ground level). In case there is sign of rapid depletion of groundwater level
or/and ground level, contractor should seek for other source to avoid worsening the situation.
Offensive  Basically, no activity is planned that may generate offensive odour; however, there are some activities
Odour that potentially may cause generation of odour.
CP: No construction activities are planned that might cause offensive odour. However, inadequate
management of waste and wastewater can be the source of odour.
OP: No activities during the operation phase are planned that might cause offensive odour. However,
inadequate management of waste and wastewater can be source of offensive odour. Therefore,
monitoring plans of related activities should be developed. In addition, management plan should be
developed in case the sign of adverse impact is observed.
Natural Environment
Hydrology  Installation of rainwater drainage may modify current hydrology of inside and surrounding area of the
project sites. At Diphu MCH, cloggage of drainage and temporary floods during monsoon season are
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observed in current condition.
 Several MCH uses groundwater as primary water source. Increased amount of groundwater due to
project activities could cause modification of hydrological status in and around project site area.
CP: It is estimated that Construction and maintenance of drainage inside and around the site will modify
the hydrology of site. In detailed design, layout, elevation, and size of channel should be confirmed to
manage both rainwater and surplus of treated wastewater to be discharged into drainage.
OP: In operation phase, drains should be maintained in good condition to avoid man-caused floods. In
addition, for those facilities that use groundwater as primary water source, periodical monitoring of
groundwater levels and proper extraction planning are recommended. All together, negative impact can
be minimized and positive impact will be expected by modifying and improving seasonal flood flows.
Topography  No large scale excavation or construction activities are planned to modify topography or geographical
and features of project sites.
Geographical CP: No activities would cause adverse impact to topography and geographical features of site.
Features
Social Environment
Local Economy  Increase of job opportunities related to project implementation is expected, since the project includes
(e.g., construction work in some sites and influx of construction workers are expected.
employment <Impacts and proposed mitigation measures>
and livelihood) CP: Temporal increased job opportunities for non-skilled worker and increased customers at restaurants
and other recreational facilities may positively impact local economy. On the other hand, livelihood of
residents may be adversely impacted because of inflow of workers, increased project related traffics and
some pollutions generated from project activities. The contractor should conduct mitigation measures to
minimize pollutions, sensitize workers not to disturb local community, plan timing and route for
construction related traffic to minimize adverse impact, and inform the progress of project and foreseen
activities as much as possible.
OP: During operation phase, positive impact on local economy is expected because of increased job
opportunity as office staff, inflow of people from the neighbouring communities to revitalize local
business, and creation of new business targeting/supporting for the increased number of patients and its
families. Also, improved access to health system may improve public health of community and
individual health status.
Land use and  Proposed project sites have been a part of medical facilities or auxiliary area since foundation of each
utilization of medical facility.
local resources  Land use may be converted into structure from vegetation/bare ground or vice versa due to project
implementation in some facilities.
CP/OP: Land use may be converted into structure from vegetation/bare ground or vice versa due to project
implementation in some facilities. The impact of land use modification and usage of local resource are
estimated to be negligible as the surface area to be modified is relatively small compare to entire land
area for each medical facility.
Water usage  Same as hydrology.
CP: In case usage of ground water will be planned during construction phase, the contractor should
monitor ground water level as stated in ground subsidence to avoid or minimize adverse impact to local
water usage.
OP: For the medical facilities that utilise groundwater as primary water source, increase of groundwater
extraction will be expected due to increased medical activities during operation phase. Though it is
assumed that it would not impact water usage of surrounding community of each project site
considering water rich nature of the region, it is recommended that engineering section of the medical
facility periodically monitor ground water level.
- For the medical facilities that will utilize public water as primary source, no significant impact is
expected during operation phase.
Existing social  All target facilities are connected to road network, which have enough capacity to accommodate project
infrastructures related traffic during construction and operation phases.
and service  Historical and cultural heritages were not confirmed nearby project site so activities would not directly
impact the access to these heritages.
CP: Conceivable major impact on existing social infrastructures and services during the construction phase
is traffic congestion because of construction related vehicles and visitor’s transportation respectively.
The impact is expected to be limited because the number of construction vehicles are small in
10-17

comparison with current traffic volume. In addition, the contractor shall plan timing and route for
construction related traffic to minimize adverse impact, deploy traffic controller, and inform foreseen
activities to the public as needed to avoid traffic congestion or traffic accident around the project site.
OP: It is expected that existing traffic networks around project sites are capable of accommodate increase
of traffic due to expansion and increased number visitors to the medical facilities.
Landscape  Current landscape at project sites are composed of the buildings with similar heights with buildings to be
constructed under the proposed project.
CP: It is expected that the project implementation would impact landscape of the project site. Though the
impact is expected to be minimal for construction phase as the duration is relatively short, and
surrounding buildings at similar heights are already existing on each site.
OP: During operation phase, vegetation would function as buffer zone, so the buildings to be constructed
would not be distinct obstacle while seen from boundary of project sites. Greening and vegetation of
project sites are also requested at public consultation.
Occupational  Various occupational risks are foreseen as in general construction works during construction phase, as
Health and the construction work involves various machineries, and buildings with multi stories are designed.
Safety  Especially demolishing of existing structures which is made with Asbestos material requires further
consideration and tangible personal protective gears (this applies to Lakhimpur MCH).
 During operation phase, potential risks associated with medical treatment utilizing equipment, such as
physical injuries with blades and needles, infectious accident, exposure to radiation and so on are
expected.
CP: During construction phase, the following occupational health and safety measures shall be adopted by
contractor. The measures include to provide safety and health education and training, to provide
appropriate personal protective equipment (helmet, protective shoes, glove, etc.), to establish internal
system for safety and health management, to introduce danger warning signs and to undertake safety
patrol periodically.
- In addition to above mentioned measures, demolition site of buildings with Asbestos should be
covered with polyethylene sheets to prevent dispersion of hazardous materials including Asbestos,
marked in visible mark to avoid entry of workers who are not equipped with proper PPE.
- Workers in charge of demolishing such buildings should wear goggles, HEPA filtered masks and
completely cover body surface to avoid contamination by Asbestos.
OP: As tangible measures, hospital blocks, medical institution and all equipment to be installed are designed
to minimize the risk of occupational health and safety. In addition, several measures, such as training,
providing health check, monitoring risk exposure and so on can be adopted by project proponent as
intangible measures.
Community  Insufficient public health care services are provided in Assam state due to lack of medical personnel and
Health and facilities.
Safety  Physical access to health services is hindered due to mountainous nature of the state and frequent
occurrence of floods.
CP: Some negative impacts on public health, such as spread of infectious diseases due to influx of
construction workers are anticipated, since the project includes construction works. These can be
mitigated by providing training and sensitization program for workers.
OP: During operation phase, improvement of local medical service by the project implementation would
improve access to medical services, increase medical personnel and medical facilities that contribute
positive impacts on public health of Assam state.
Transboundary  Indian government adopted the National Action Plan on Climate Change (NAPCC) on June 30, 2008
impacts and Intended Nationally Determined Commitments (INDC) submitted to the UN Framework
including Convention on Climate Change (UNFCCC) in October 2, 2015.
Climate Change  For applicable medical facilities, in the process of Environmental Clearance application, energy
efficiency of project design and adoption of renewable energy will be examined.
CP: During construction phase, GHGs would be emitted from the operation of the construction machines
and traveling of the vehicles, but the impact is expected to be limited and temporary.
OP: Conceivable major activities that emit GHGs during the operation phase are 1) Operation of
wastewater treatment system, 2) increase of traffic caused by the project operation, and 3) usage of
diesel generator.
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10.6 Impact Assessment

The results of environmental and social impact assessment and comparison of rating during scoping and
evaluation are presented in Table 10-7. Significance of impacts were evaluated based on following concepts.
✓: positive/negative impact is expected to some extent.
A+/-: Significant positive/negative impact is expected.
B+/-: Positive/negative impact is expected to some extent.
D: No impact is expected.
Table 10-7 Result of Impact Assessment

Scoping Evaluation
Item Reason
CP OP CP OP
Pollution
Air Pollution ✓ ✓ B- B- CP: Negative impacts on air quality are anticipated due to increased
transportation and operation of heavy equipment/ vehicles temporary during
construction activities. Proper mitigation measures such as to be taken
OP: Negative impacts on air quality is anticipated due to increase of traffic
volume by patients, staff and transportation of goods necessary for operating
hospital. Impact on air quality is also expected caused by operation of power
generator in case of emergency power supply. Even after applying stack
height design in view of prevent air pollution, some negative impacts may
persist.
Water Pollution ✓ ✓ B- B- CP: There is a risk of temporary water pollution due to leakage of oils and
chemicals from the construction activities. These impacts can be mitigated
with some measures, but the risk of polluting water may persist.
OP: Impacts on water quality due to discharge of wastewater from hospital
staff, patients, residents (staff and students), and mistreatment/leakage of
liquid waste are expected.
Although the wastewater treatment facilities will be installed and treated
wastewater will be reused inside the institution, surplus of treated water will
be discharged through rainwater drainage that may cause pollution. To
minimize the risk, quality of effluent from wastewater treatment plant shall
be checked regularly. For liquid waste management, effluent treatment
system shall be installed under instruction of state pollution prevention
board, and its performance should be checked so to avoid depletion of water
quality in surrounding environment.
Solid Waste ✓ ✓ B-* B- CP: B-) For majority of facilities, increase of solid waste amount due to
construction activities and general waste from workers is expected. The
impact will be limited inside the project site and several mitigation measures
will be available.
*) Additional negative impact is expected for the medical intuitions that
require demolition of existing structures made by Asbestos and other
hazardous materials. In demolition of such structures, waste management
rules and regulations, related international regulations and good practices
should be strictly followed by the contractor.
OP: Increase of various solid wastes is expected due to medical and
research activities (biomedical and radioactive waste, hazardous waste), and
increased number of residents such as staff and in patients (general waste).
The impact can be minimized by segregating wastes at source, collecting
and storing them and handing over to authorized third party or recycling
then inside project property in case of biodegradable compost.
Soil ✓ ✓ B- B- CP: There is possibility of soil contamination due to leakage of oil and
Contamination chemical substances used for construction activities. Impact can be avoided
and mitigated by applying impermeable sheets around oil/chemical handling
area and properly managing them.
OP: Impact on soil contamination is expected due to leakage or
mismanagement of oil and liquid waste containing heavy metals and non-
volatile compounds. The impact can be avoided and mitigated by applying
10-19
Scoping Evaluation
Item Reason
CP OP CP OP
adequate measures, such as installation of confined oil handling area and
effluent treatment facilities.
Noise and ✓ ✓ B- B- CP: Temporary impact on noise and vibration levels due to operation of the
Vibration construction machineries and traveling of the construction vehicle are
expected, and these can be mitigated by applying temporally fence. Also,
considering limited time period for construction, overall impact is estimated
to be within acceptable level.
OP: Impact on noise and vibration levels due to traveling of vehicles
associated with the operation of the hospital, operation of back-up power
generator and air system are expected. These can be mitigated by
periodically maintaining project related machineries and equipment. Also,
operation of medical equipment may not generate noise and vibration as the
project apply high specification for these to minimize noise generation.
Ground ✓ ✓ B- D/ CP: Impact on ground subsidence is expected to be limited because amount
Subsidence B- of groundwater used for construction work will be limited, and the impact
can be limited by monitoring ground level and ground water.
OP: D) For the facilities which utilise public water supply as main source,
impact on ground subsidence is estimated to be minimal or almost negligible
as the project will not use ground water as water source and rainwater will
be recharged to aquifer.
B-) For the facilities that will utilize ground water as main source, the
management units for each facility should monitor the groundwater level
and ground subsidence (ground level). In case there is sign of rapid
depletion of groundwater level or/and ground level, contractor should seek
for other source to avoid worsening the situation.
Offensive ✓ ✓ B- B- CP: No construction activities are expected that would cause offensive
Odour odour, but improper management of construction waste may generate cause
odour generation.
OP: There is possibility to generate offensive odour if waste and sludge
generated from wastewater treatment facility are improperly managed.
Natural Environment
Hydrology ✓ ✓ B- B+/ CP: Earth works for construction and modification of land use of the sites
- would cause modification of hydrology in and around the project sites.
OP: Modified hydrology may cause worsening of flood occurrence, while
in some facilities that has clogging issues in current status, installation of
additional drainage may improve the seasonal flood flows in and around
project site.
Topography ✓ D N/A CP: No adverse impact is expected as the required earth work would be
and minimal.
Geographical
Features
Social Environment
Involuntary N/A N/A CP/OP: There is no impact in terms of involuntary resettlement as the
Resettlement project does not require land acquisition nor involuntary resettlement.
Indigenous, or N/A N/A CP/OP: No impact on indigenous or ethnic people are expected, because
Ethnic People there are no indigenous or ethnic people residing in and around the project
site.
The Poor ✓ N/A B+ CP: Any activity that might impact on the poor are not planned in the
project.
OP: Improvement of universal health coverage in the project area will
contribute improvement of livelihood of the poor.
Local Economy ✓ ✓ B+ B+ CP: Job creation for non-skilled construction related workers is expected.
(e.g., This is expected to be temporal for construction period.
employment OP: Increased job opportunity for office staff, surrounding retails and small
and livelihood) businesses are expected, and they would revitalize local economy.
Land use and ✓ ✓ D D CP/OP: Land use may be converted into structure from vegetation/bare
utilization of ground or vice versa due to project implementation in some facilities. The
local resources impact of land use modification and usage of local resource are estimated to
10-20
Scoping Evaluation
Item Reason
CP OP CP OP
be negligible as the surface area to be modified is relatively small compare
to entire land area for each medical facility.
Water Usage ✓ ✓ B- D/ CP: It is planned that water necessary for construction will be abstracted
B- from groundwater. This may adversary impact water use of surrounding
area; therefore, the contractor shall monitor ground water level to avoid over
abstraction.
OP: D) For the medical facilities that will utilize public water as primary
source, no significant impact is expected during operation phase.
B-) For the medical facilities that utilise groundwater as primary water
source, increase of groundwater extraction will be expected due to increased
medical activities during operation phase. It is assumed that it would not
impact water usage of surrounding community of each project site
considering water rich nature of the region.
Existing social ✓ ✓ B- D CP: It is estimated that the project activity during construction would
infrastructures impact traffic condition of surrounding area due to increased traffic volume
and services for activities. The contractor shall employ traffic guide and plan the
(including operation not to cause concentration of activities as possible.
Traffic OP: No significant impact is expected.
Condition)
Landscape ✓ ✓ B- D CP: Some modification on landscape is expected during construction phase;
however, no impact is expected as those are minimal considering duration of
construction.
OP: No impact on landscape during operation phase is expected.
Health and Safety
Occupational ✓ ✓ B- B- CP: Some impacts are anticipated due to construction works. These can be
Health and avoided or minimized by applying best practices for construction works such
Safety as safety and health training to workers, usage of protection gears and so on.
These should be applied especially for demolition of existing building with
Asbestos and other hazardous materials.
OP: Some impacts to health workers are anticipated due to handling of
infectious diseases, radioactive and hazardous materials for medical
activities. These risks will be minimized by facility design that separates
flow of patients and medical staff to minimize the chance of contact,
formulating safety manual, and accident preparedness plan.
Community ✓ ✓ B- A+ CP: Some negative impacts on public health are anticipated due to influx of
Health and construction workers and possibility of discharging pollutants caused by
Safety construction activities. These would be mitigated by providing training and
education to workers for safe operation and behaviour to the community.
OP: Positive impact is expected due to improvement of medical service to
surrounding communities by the project implementation.
Other
Transboundary ✓ ✓ D D CP: Greenhouse gases (GHGs) would be emitted from operation of
impacts construction machines and vehicle. The impact is estimated to be limited
including considering the duration of construction.
Climate Change OP: Emission of GHGs is expected predominantly due to operation of
generator, wastewater treatment system, air conditioning system and
traveling of vehicles associated with operation of the hospital. The extent of
impacts would be minimized by applying mitigation measures proposed to
other items. In addition, adopting fuel effective/high performance equipment
further contribute reduction of emission of GHG. Overall, considering the
nature and scale of project, impact on global warming is expected to be
minor.
10-21
10.7 Mitigation Measures

The proposed mitigation measures during Construction Phase and Operation Phase are presented in Table
10-8. During Construction Phase, the contractor for construction is responsible of conducting these
measures under supervision of PMU/PIU. Also, the cost for adopting mitigation measures is included in
construction cost. During Operation phase, engineering section under administration department of each
medical facility will be responsible of maintaining infrastructure of each institution, and each section under
academy and hospital should be responsible of waste management relevant to their specialty.
Table 10-8 Proposed Mitigation Measures

Item Mitigation measures
Construction Phase
Environmental Pollution
Air pollution 1） To seek to use fuel-economy/ low-emission construction vehicle and machineries.
2） To sprinkle water around the project site dust is generated especially during dry season.
3） To maintain construction vehicles and construction machineries adequately.
4） To install temporal enclosure around the construction site.
5） To give guidance for drivers about idling stop and avoiding excessive load operation such as quick
acceleration and overloading.
Water pollution 1） To install appropriate drainage system in the construction site before construction activities
commence.
2） To check leakage of oil and chemical products periodically.
3） To install impermeable material around the oil and chemical storage and oil handling area.
4） To train operators of construction machineries in daily maintenance to prevent oil leakage
5） To collect waste oil into the designated container separately and hand over to authorized third party
for treatment and disposal.
Solid Waste 1） To handle wastes within the project site and store them with cover until handed over to authorized
third party.
2） To segregate waste and recycle or sell to third party as applicable.
3） (for the MCHs require demolition)
To isolate the area bult with hazardous material with polyethene sheet, seal solid wastes
To handle and dispose those wastes under instruction of SPCB
Soil Same as water pollution
Contamination
Noise and 1） To install temporal fence.
Vibration 2） To strive to introduce low-nose and low-vibration machineries.
3） To avoid construction at night-time and public holiday
4） To avoid intensive operation of construction machineries that generate noise and vibration.
Ground 1） To monitor groundwater level and ground subsidence status periodically and adopt other source in
Subsidence case significant declines are observed.
Offensive Odour Same as “solid waste”
Natural Environment
Hydrology 1） To install proper drainage system in the project site.
Social Environment
Water Usage Same as ground subsidence
Existing social 1) To plan timing and route for construction related traffic.
infrastructures 2) To deploy traffic controller
and service 3) To inform foreseen activities to the public as needed.
Landscape 1) To install temporary enclosure wall during construction works.
2) To conduct greening and planting trees around the boundary of project site at the earliest possible
timing.
Health and Safety
Occupational 1） To provide safety and health training to workers when employed and enforce norm of safety
Health and Safety construction.
2） To promote use of appropriate personal protective equipment (helmet, protective shoes, glove, etc.).
3） To establish the system for safety and health management at the construction site, and to clarify the
responsible person and reporting system.
4） To apply good practices for similar construction.
Community 1） To provide training about public health and infectious diseases for construction workers.
Health and Safety
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Item Mitigation measures

Transboundary 1） To adopt fuel-economy/ low-emission construction vehicle and machineries as applicable and
impacts including economically feasible.
Climate Change 2） To control idling operation of machineries.
Operation Phase
Environmental Pollution
Air Pollution 1） To utilize low-pollutant fuel as applicable and financially feasible.
2） To maintain generator periodically to sustain high performance for long term.
Apply same measures as in construction phase.
Water Pollution 1） To monitor quality of treated wastewater and check compliance with standards prescribed by SPCB.
2） To install ETP designed for medical institute, and properly operating them following instruction by
SPCB.
3） To inspect the rainwater drainage system and maintain it periodically.
Solid Waste 1） To segregate waste by type and hazard level of them in proper container, collect and store them in
sealed storage until hand over to authorized third party.
2） To develop manual for waste handling to all medical staff and enforce it to practice.
Soil 1） To develop management rules for chemical products, and to practices the rules with relevant medical
Contamination workers and educational staff.
2） To prepare action plans in case of leakage of chemical substance.
3） To collect solid and liquid wastes with infectious or chemical substances separately, store them in
sealed container or storage until handed over to authorized third parties for disposal or treatment.
4） To inspect the containers and storages regularly and to maintain them in good condition to prevent
accidental leakage.
5） To conduct mitigation measures listed for water pollution and solid waste
Noise and 1） To install low-noise type system, to inspect them regularly to maintain them in good condition.
Vibration 2） To prepare concrete enclosure around the facilities that may generate noise and vibration as needed.
Ground Apply same measures as in construction phase.
Subsidence
Offensive Odour Same as “solid waste”
Natural Environment
Hydrology 1） To inspect rainwater drainages and maintain them properly
Social Environment
Water usage Same as “Ground Subsidence”
Existing Social 1） To separate the traffic route for visitor and non-visitor (staff and third parties) for smooth traffic
Infrastructures management in and around the project site.
and Services 2） Take same measures as construction phase if appropriate.
Landscape 1） To maintain green zone in order to buffer the appearance of buildings that can be seen from
boundaries of project site
Health and Safety
Occupational 1） To formulate the safety manual for hospital operation, update it regularly and to enforce it to all
Health and Safety relevant staff.
2） To provide the safety training for all employees, to formulate the health and safety education plan
and to implement it.
3） To provide annual health check for all employees.
4） To monitor occupational risk associated with medical activities such as radiation exposure level,
solvent handling and worker’s injuries and provide additional health check to prevent irreversible
health damage of staff.
Transboundary 1） To introduce vehicles and machineries that would generate less GHGs, and to maintain them
impacts including adequately.
Climate Change
10.8 Environmental Monitoring Plan

Proposed monitoring plans for construction phase and operation phase are presented in Table 10-9 and
Table 10-10 respectively. These lists are provisional as per preparatory survey, items and frequency shall
be added and modified if required by SPCB during application process of Environmental Certification for
the medical facilities which should go through EIA procedures.
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Table 10-9 Proposed Environmental Monitoring Plan (Construction Phase)

Category Monitoring item Monitoring site Frequency
Air Pollution PM10, PM2.5, SO2, NOx and CO Near the project site Monthly
(Ambient air)
Maintenance situation of temporary Construction Site Monthly
Water
drainage, temporary storm water
Pollution
reservoir, and septic tank
Solid waste <during Demolition only > Construction Site Monthly*
Amount of Generated and Treated To be consulted with SPCB
hazardous wastes and follow the instruction
Generation and treatment amount of Construction Site Monthly
construction and general waste
Status of waste management (if covered Construction Site Monthly
or stored properly etc.)
Soil Oil leakage (daily maintenance record Construction Site Monthly
Contamination of relevant machineries, record of oil
leakage accidents etc.)
Noise and Noise level, Vibration level Several points on boundary of More than monthly, when
Vibration the project site noise generating activities are
conducted
Offensive Record of unusual smell In and around construction site When sensed
Odour
Ground Groundwater level, ground level Well and several point close to Monthly
subsidence/ well
Hydrology/
Water Usage
Existing Social Number of traffic accident that Project Site and its Monthly
Infrastructures involved construction related vehicles surrounding area
and Services Placement of traffic guard in the exit of Construction Site Monthly
the construction site
Occupational Implementation of safety training/ Project Site Monthly
Health and safety driving trainings for the
Safety construction workers
Workers’ accidents Project Site Monthly
Safety situation in the construction site Project Site Everyday

Common Complaints from neighbours Project site and its surrounding Monthly
Table 10-10 Proposed Environmental Monitoring Plan (Operation Phase)

Item Monitoring item Monitoring site Frequency
Common Implementation of environmental Project Site and its Monthly
mitigation plan surroundings
Complaints from neighbors Project Site and its Monthly
surroundings
Air Pollution PM10, PM2.5, SO2, NOx and CO Near the project site Monthly
(Stack PM, SOx, NOx, HC and CO Outlet of stack Once in a month (half year after
Emissions from construction, while generator is
DG set) operated)
Water Pollution pH, BOD, TSS, COD, TN, TP, and total Outlet of STP Monthly
Coliform Outlet of ETP Monthly
Solid Waste Amount of generated waste by each Project Site (waste Monthly
category storage)
Status of waste storage (if there is no Project Site (waste Monthly
leakage, contamination with other storage)
categories, etc.)
Soil Oil leakage (daily maintenance record of Project Site Monthly
Contamination relevant facilities, record of oil leakage
accidents etc.)
Leakage of chemical/hazardous liquids Project Site Monthly
Noise and Implementation status of periodic check of Project Site Monthly (while facilities are
Vibration noise generating facilities and the operated)
emergency power supply
10-24
Item Monitoring item Monitoring site Frequency

Offensive Record of unusual smell In and around When sensed
Odour construction site
Existing Social Traffic accident, status of traffic In and around Project Monthly
Infrastructures congestions Site
and Services
Occupational Implementation of safety training for the Project Site Annual
Health and employees
Safety Occupational accidents Project Site Monthly (Safety and Health
Committee)
Implementation status of employees’ Project Site Annual/Monthly (Safety and
health check Health Committee)
Employees’ radiation dose Project Site Annual/Monthly (Safety and
Health Committee)
10.9 Implementation Structure of Environmental Management Plan

Environmental Management during Construction Phase
During construction phase, the construction contractor will implement the Environmental Management
Plan (EMP) and the Environmental Monitoring Plan (EMoP) under the supervision of the project proponent,
PMU/PIU for the project. The construction contractor will undertake obligations for implementation of
EMP and EMoP, as well as report of the results to PMU/PIU, then PMU submit the results of Environmental
Monitoring to JICA. Also, for the 8(a) and 8(b) categorized project under Indian EIA procedures, PMU/PIU
should submit the same report to SEIAA of Assam state biannually on 1st June and 1st December as
stipulated under Environmental Clearance. It is recommended that the copy of report shall be made
available in selected offices or public libraries or panchayats etc. for interested parties in accordance with
JICA’s guideline (Source: JICA Survey Team
Figure 10-2).
10-25
Figure 10-2 Institutional Arrangement for Environmental Management during Construction
Environmental Management during Operation Phase

Institutional arrangement during operation phase follow similar procedures as construction phase. The
administration departments of each target facilities shall be responsible of instructing Engineering
department for operation and maintenance of infrastructure such as generator sets, wastewater treatment
plant and so on. In addition, for waste management and occupational health protection, each unit that dealt
with waste and operational risk should be responsible of managing them and report to administration. The
proposed institutional structure is presented in Figure 10-3.

Figure 10-3 Institutional Arrangement for Environmental Management during Construction
10.10 Stakeholder Meeting

Outline of Stakeholder Meeting
Initially, stakeholder meeting was planned to be held after approval of the draft final report. However, due
to the prevalence of the COVID-19 situation in the state, holding community level gatherings was not
recommended nor appropriate. Therefore, it was decided to conduct telephonic interview with nominated
community representatives from different sections of the society living in the area. Moreover, Jorhat
Medical College Hospital (JMCH) was selected as a sample representative MCH under the project for the
stakeholder meeting, considering the largest floor area to be developed by the project. Based on the
discussion and recommendation from JMCH, the interviews with 5 community chiefs/representatives
nominated by the JMCH were conducted between 4th to 8th January 2022 via telephone call based on the
presentation of the project outline and summarized result of environmental and social impact assessment
of the project. Each interview lasted between a half to one hour.
10-26
The selected five interviewee represents the local community as follows.

1. Citizens who are well respected in the local community and represents the point of views of the last
generation.
2. An educationist who generally represents point of views of the current generation and aspirations of the
future generation as well and understand what is good for the society.
3. Environmental activists as representative of the farming community and understands the need of the
poor section of the society and also understands the value of the environment.
4. Representatives from the Government, who are responsible to provide good healthy environment to the
public and aims to provide well-being and happiness to the society.
Results of Interview to Community Representatives

General reaction from the community representatives were very positive toward implementation of the
project as requirement of good medical facilities has further got impetus during the COVID-19 pandemic
(for details refer Annex VIII). Among others, some of the key issues were highlighted during the
stakeholders meeting includes; improvement of public access to health care services is mostly regarded as
the positive impact of the project, while some concerns were raised regarding the sentiments attached to
the name of the existing hospital that is proposed to be demolished for the new hospital, operation of
existing facilities within the campus including noise pollution/issues and counter measures to be adopted
for in-patients during demolition and construction phase. In addition, plantation of trees as landscaping and
installation of solar power system as alternative non-polluting energy were recommended for considerations.
As mentioned above, the Project is accepted by surrounding community of Jorhat MCH, and it is expected
to be positively accepted in sites other than Jorhat MCH. However, considering the varying environmental
and social conditions of project sites, the additional measures to invite some public opinions in other project
locations shall be conducted by the HFWD to ensure the social acceptability of the Project in the local
community.
10-27
Proposed Operation Plan
11.1 Organisation and Personnel

The implementing body of the project is Health and Family Welfare Department (HFWD) (Section 2.1).
The following organisations will be established to manage the project:
 Governing Body & Executive Committee: Composed of representatives from the Government of India
(GOI) and HFWD, Government of Assam, with a state-wide management perspective as required, to
supervise the PMU. The committee is the highest authority in the project and is responsible for final
decisions and approvals on the most important matters relating to the project. Meetings are held once
a year, although extraordinary meetings may be held if necessary.
 Project Management Unit (PMU): the PMU is expected to consist of a representative from the HFWD
in the Government of Assam, the Director General of Health Services, the Director General of Medical
Education, the National Health Mission, and the Director General of each hospital; in addition, it
comprises experts in finance, healthcare management, information technology (IT), facilities and
equipment, and personnel training. The PMU is the actual management body of the project. The main
responsibilities of the PMU are implementation of the project, which are the development of the
project’s implementation plan and annual plan, progress management, coordination of relevant
institutions, procurement management, risk management, and quality control. It will also provide
management and supervision to the PIUs at the candidate facilities and communicate with the
management of the candidate facilities to keep their development strategies and policies when required.
At the end of each year, an evaluation report is prepared and presented to the S/C. It will also report
regularly to the HFWD Principal Secretary through meetings and written correspondence.
 Project Implementation Unit (PIU): PIU is organised in each of the medical institution covered by the
project and is responsible for the implementation of the project in the hospital. The PIU is led by the
director of each hospital and consists of the deputy directors in charge of medical service and
administration, as well as head of accounting, facilities and equipment, and human resources
developments. The main responsibilities of the PIU are the development of implementation and annual
plans for the project in each hospital, the management and monitoring of progress, the annual
evaluation of achievement based on the plan, and the reporting to the PIU on quarterly basis. Each PIU
will also be responsible for the collaboration across tertiary, secondary, and primary level's medical
institutions in order to establish the Universal Health Coverage (UHC) model, which is the goal of this
project. The PIU is responsible for coordinating the improvement of the referral system with higher
and lower-level institutions, and coordinating human resource development (providing guidance to
lower-level institutions, dispatching medical personnel, etc.).
11-1
11.2 Finance and Budget
Government Budget
Budgetary Flow
The budgetary flow in the health sector in Assam is shown in Figure 11-1.
NATIONAL LEVEL
Government of India
thru Ministry of Health &
Family Welfare
Annual Budgetary
allocations for health
Funds
sector including NHM
STATE LEVEL
Government of Assam
REGIONAL LEVEL
Medical College
Secretariate/ Medical Directorate Hospital
DISTRICT LEVEL
Princpal
Secretary
DISTRICT Hospital
Joint Director Commissioner &

Head of Secondary Secretary (Health)
Hospital
Principal
Head of College
Funds - annaul budgetary allocations Mission Hospital
Director NHM
Approvals for Expenditures

Approvals for Expenditures
Request for making expenditures
Director Director Request for making expenditures
Funds - annaul budgetary allocations Medical Medical
Health Education
Funds - annual budgetary allocations
Collected and deposited with
Collected and deposited with
Hospital Management
Hospital Management Society
Society (HMS)
CAG and Statutory (HMS)
Audit of HMS
CAG and Statutory
Audit of HMS
CSR Funds/ donations
CSR Funds/ donations
User Fund - Registration fee,

User Fund - Registration fee, treatment charges etc.
treatment charges etc. Grant-in-Aid Grant-in-Aid
Private Sector/ Private Sector/

Individual/ Individual/
Organizations Organizations

Figure 11-1 Budgetary Flow in Health in Assam
11-2
Based on the understanding developed through the discussions with the Government of Assam (GoA) as
well as studying the available material, the budgetary fund flow from the Government of India (GoI) to the
State Government (Assam), and further to the implementation level in the health sector has been prepared
as illustrated in Figure 11-1.
At the national level, the annual budgets are approved and allocated by the Ministry of Health and Family
Welfare to the State Government. The budgets are released mainly through the National Health Mission
(NHM) and other central government schemes.
State Government makes allocations in the annual budgets for various schemes/programs implemented
under the health sector. The Principal Secretary (Health) puts forward proposals to the State Government
for budget allocations for various heath sector schemes/programs at the time of annual budget preparation.
The budget needs to be approved by the Legislative Assembly. Later approvals are granted by the State
Government for the budget releases as per the allocations. The Secretary & Commissioner (Health) assists
the Principal Secretary in this process.
The budgets are released to the respective department heads/ heads of program, namely, Director (Health
Service), Director (Medical Education), and Mission Director (NHM). The budgets are further released by
the authorities viz., Directors or the College Principal or the Joint Director, who are responsible for the
operations/implementation of the scheme and programs. The expenditures are made at the college hospital
(tertiary level) or at the secondary/ primary hospitals as per the prior approvals from the State Government,
and later, utilisation certificates are submitted to report the expenditures made against the allocated budgets.
Every Medical College Hospital has established a ‘Hospital Management Society’ that is autonomous in
functions and decision making. Principal of MCH is Chairperson of the Executive Committee (EC) of the
society whereas Superintendent of MCH is member-secretary to the EC of the society. The executive
committee is constituted by the state government that includes DME, government and public
representatives etc. The society also has a Governing Board that is headed by some public representative
e.g. minister, MLA. The society can receive funds from various sources including the donations and grants
from the government and other institutions as well as CSR funds. Regularly, the society receives around 3-
5 Cr. from the state government as Grant-in-Aid annually. The ‘User funds’ that is generated by way of
patient registration and other treatment/ diagnostic services performed for patients in deposited in society’s
bank account. The fund is being utilized for engaging contractual staff, operation and maintenance of
hospital functions, purchase of consumables like x-ray films, medicines etc. The funds utilization by the
society is subject to the CAG audit as well. Statutory audits are also conducted hiring the auditors from
open market.
Budget Allocation Process

Budget preparation is a complex and extensive exercise that is carried out every financial year. Some of the
key steps are summarised as follows:
 The budget cycle normally starts from the first week of August of the current year and lasts until April
of the next financial year.
11-3
 The commencement of the budget process takes place with the issue of the Budget Circular, which is
normally issued in the month of August each year.
 The Drawing and Disbursing Officers (DDOs) are responsible for estimating the receipts and
expenditure for all the Detailed Heads of Accounts under the Minor Heads operated by them.
 The Estimating Officer will fill in the forms and send two copies to the Controlling Officer through
the prescribed channel or otherwise to the Finance Department, retaining one copy for record in his
office. The estimates of revenue and receipts should be prepared based on the existing rates of taxes,
duties, fees, etc.
 The estimate of expenditure should be for charges which will be paid during the year, including arrears
from previous years and not for liabilities falling due during the coming years.
 Subject to any orders that may be passed by the Finance Minister, the Annual Financial Statement of
receipts and expenditure which are to be credited to, or made out of the Consolidated Fund, may be
laid before the Assembly in three parts.
The Finance Minister presents the budget to the Assembly on a day fixed for the purpose with a written
speech explaining the salient features of the budget, the fiscal health of the government, changes in tax
revenues, if any, relief provided in the existing rates of taxes, and important projects and schemes to be
undertaken during the ensuing financial year.
The budget allocation process is shown in Figure 11-2.

FINANCIAL YEAR APRIL-MARCH FINANCIAL YEAR APRIL-MARCH
A M J J AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH APRIL M
Budget
Calling
Letter Budget Intimation of
(1st week) Estimates savings by
from the DDOs to
Controlling the
Offices Controlling
(latest by Officers (by
15th) Detailed Jan 15th)
estimates of
Compilations
the Sixth
sent of the State
Schedule
to estimates
(Part A) sent Despatch of Grants to be
GOI (Nov last Synopsis of
to Press all Budgets Surrender of communicate
week) discussions
(Dec 3rd and Budget savings and d to
of the Sixth
week) literature (a submission Controlling
Revised Schedule
Estimates Autonomous day prior of of statement Officers (by
from Districts (by presentation (by Feb 15th) Apr 2nd
Controlling Jan 25th) of budget) week)
Offices
(latest by
15th)
Budget,
explanatory
memorandu
m for
printing (by
Jan 31st)

Figure 11-2 Budget Allocation Process
Composition of Budget on Health

The composition of the government expenditure on health by budget entity is shown in Figure 11-3. HFWD
(NHM) accounts for nearly half of the total expenditures in Grant No. 29 Medical & Public Health steadily,
while capital expenditures of DME have been expanding in the recent years.
11-4
100%
HFWD Revenue Exp.

(NHM)
80% 42.2%
46.5% 44.3% 47.1% DME Capital Exp.
47.5%
51.9%
DME Revenue Exp.
60% DHS Capital Exp.
16.6% 9.3% 11.4% PHED Revenue Exp.

8.2%
5.0% 13.6%
40% DHS Revenue Exp.
14.0% 14.2% 16.1% 16.9%
15.3% DHS (FW) Revenue Exp.
30.6%
20% DoAYUSH Capital Exp.
21.3% 21.8% 20.4% 19.4%
17.5%
DoAYUSH Revenue Exp.
8.3% 6.7% 6.7% 6.1% 6.2% 4.7%

0%
Actual Actual Actual Actual Revised Budget
Estimate Estimate
2016-17 2017-18 2018-19 2019-20 2020-21 2021-22
Source: [Government of Assam, 2021]

Figure 11-3 Composition of Budget on Health by Budget Entity in Assam
Financing Plan for the Project
Construction
The construction cost of the project will be financed through the Japan International Cooperation Agency
(JICA) official development assistance (ODA) loan and Assam government’s own fund. The JICA ODA
loan’s ratio is determined as 85% of the total project cost. The JICA ODA loan will be borrowed by the
central government and allocated to the Government of Assam for disbursement of the construction and
consulting services for the project.
The other borrower portion such as land acquisition and administration cost will be covered by Assam
government’s own fund through its budgetary appropriation. (Please refer to Chapter 13 “Project Cost” for
the construction cost estimation.)
Medical Equipment
The procurement cost of the medical equipment planned in this project (including primary to tertiary
healthcare facilities) is financed by JICA ODA loan and Assam government’s own fund.
Operation and Maintenance

Grant subsidy from the Assam government will be the primary source of revenue to recover the operation
and maintenance expenses of the project. Hospital service charges and education fees collected from
patients and students will be another source of revenue.
As described in Section 2.2.2, given the moderate prospects of economic growth and the upward trend of
the government revenue and expenditure with the context of relatively favourable fiscal conditions of the
Government of Assam, as well as the sustainable prioritisation of health in government expenditure, the
fiscal space for health in Assam including this project is expected to be secured at least in the short to
medium term. The Government of Assam has analysed its own fiscal performance and fiscal space and
11-5
concluded that there will be enough funding source for the counterpart (non-eligible part) fund for the
project. According to the Government of Assam, there has not been any project in the past that has been
delayed or stopped due to shortage of budget.
11.3 Operation Management
Facility
The new facility shall be planned and designed with minimum use of advanced and complicated systems
such that it is easy to maintain by local technicians. Furthermore, to keep the facility in good condition for
long term, daily maintenance and inspections of facilities and machineries are important in accordance with
the operation instruction manuals and by knowledgeable technicians.
Medical Waste Management including Biomedical Waste

Biomedical hazardous wastes are brought into the medical waste incineration plant owned by the State
Corporation for disposal. The principal guideline follows the “National Guidelines on Hospital Waste
Management Based upon the Biomedical Waste Rules” set forth by the Government of India to ensure safe
disposal of biomedical waste as per the rules.
Blood bank shall practice first in first out policy for reduction of waste. Adequate measures shall be taken
to prevent expiry of blood or blood components.
Policy on Hospital Waste Management

The policy statement aims “to provide for a system for management of all potentially infectious and
hazardous waste”.
Definition of Biomedical Waste

Biomedical waste means any waste, which is generated during the diagnosis, treatment or immunisation of
human beings or animal or in research activities pertaining thereto or in the production or testing of
biological, including other categories.
Categories of Biomedical Waste

Hazardous, toxic, and biomedical waste has been separated into the following categories for the purpose of
its safe transportation to a specific site for specific treatment. Certain categories of infectious waste require
specific treatment (disinfection/decontamination) before transportation for treatment and disposal. These
categories of biomedical waste are mentioned in Table 11-1.
11-6
Table 11-1 Categories of Biomedical Waste

Category Explanation
No. 1- Human This includes human tissues, organs, and body parts.
Anatomical Waste
No. 2- Animal Waste This includes animal tissues, organs, body parts, carcasses, bleeding parts, fluid,
blood and experimental animal used in research; waste generated by veterinary
hospitals and colleges: discharge from hospital and animal houses.
No. 3- Microbiology & This includes waste from laboratory cultures, stocks or specimens of microorganism
Biotechnology Waste live or attenuated vaccines, human and animal cell culture used in research and
infectious agents from research and industrial laboratories, wastes from production of
biological, toxins, dishes, and devices used for transfer of cultures.
No. 4- Waste Sharps This comprises needles, syringes, scalpels, blades, glass, etc., that may cause
puncture and cuts. This includes both used and unusable sharps.
No. 5 - Discarded This includes wastes comprising outdated, contaminated, and discarded medicines.
Medicines and Cytotoxic
Drugs
No. 6- Soiled Waste It comprises item contaminated with blood, and body fluids including cotton,
dressings, soiled plaster casts, linens, beddings, and other material contaminated with
blood.
No. 7- Solid Waste This includes wastes generated from disposable items, other than the waste sharps,
such as tunings, catheters, intravenous sets, etc.
No. 8- Liquid Waste This includes waste generated form laboratory and washing, cleaning, housekeeping
and disinfecting activities.
No. 9- Incineration Ash This consists of ash form incineration of any biomedical waste.
No. 10- Chemical Waste This contains chemical used in the production of biological and chemical used in
disinfection, insecticides, etc.
Source: Guidelines for District Hospitals (IPHS)
Segregation of Waste
Segregation of waste should be done at each site of generation of biomedical waste, e.g., all patient care
activity areas, diagnostic services areas, operation theatre labour rooms, treatment rooms, etc. The
responsibility of segregation should be with the generator of biomedical waste, i.e., doctors, nurses,
technicians, etc. The biomedical waste should be segregated as per the applicable categories.
Collection of Biomedical Waste

Collection of biomedical waste should be done as per the Biomedical Waste Rules. The collection bags and
the containers should be labelled, i.e., symbols for bio-hazard and cytotoxic. A separate container shall be
placed at every point of generation for general waste to be disposed of through the Municipal Authority.
The trolleys which are used to collect hospital waste should be designed in such a way that there should be
no leakage or spillage of biomedical waste while transporting to the designated site.
Storage of Waste
Storage refers to the holding of biomedical waste for a certain period of time at the site of generation till its
transit for treatment and final disposal.
Treatment of Hospital Waste
General Waste (Non-hazardous, non-toxic, non-infectious)

The safe disposal of this waste should be ensured by the occupier through the Local Municipal Authority.
11-7
Biomedical Waste
Monitoring of incinerator/autoclave/microwave shall be carried out once a month to check the performance
of the equipment. Table 11-2 shows the method of biomedical waste treatment.
Table 11-2 Method of Biomedical Waste Treatment

Incineration: In case of the installation of incinerator, the incinerator should be installed and made
operational as per specifications and an authorisation shall be taken from the concerned
authority for the management and handling of biomedical waste including installation and
operation of the treatment facility. Specific requirement regarding the incinerator and norms
of combustion efficiency and emission levels, etc. have been defined in the Biomedical
Waste Rules. The plastic bags made of chlorinated plastics should not be incinerated.
Deep Burial: Standards for deep burial are also mentioned in the Biomedical Waste Rules. The cities
having less than 5 lakhs population can opt for deep burial for wastes under Categories 1
and 2.
Autoclave and Standards for autoclaving and microwaving are also mentioned in the Biomedical Waste
Microwave Rules. The waste under Categories 3, 4, 6, and 7 can be treated by these techniques.
Treatment:
Shredding: The plastics (IV bottle, IV sets, syringes, catheters, etc.) and sharps (needles, blades, glass,
etc.) should be shredded but only after chemical treatment/ microwaving/ autoclaving,
ensuring disinfection. Needles destroyers can be used for disposal of needles directly
without chemical treatment.
Secured Landfill: The incinerator ash, discarded medicines, cytotoxic substances, and solid chemical waste
should be treated by this option (Categories 5, 9, and 10).
Radioactive The management of radioactive waste should be undertaken as per the guidelines of BARC.
Waste:
Source: Guidelines for District Hospitals (IPHS)
Hazardous Wastes
These include wastes from medical, dental, and veterinary practices during treatment or research activities,
which may contain either inorganic or organic constitutions. These wastes need to be treated in accordance
with Hazardous and Other Wastes Management Rules (2016) by segregating at source duly collecting in
containers, stored safely, and transported separately, then handed over to the authorised third party for
proper disposition. Also, the project proponent should periodically report the status of waste management
to the State Pollution Control Board.
Radioactive Wastes
These include cotton, paper, metal, glasses, plastic objects, and other materials that are used for radioactive
treatment. These wastes need to be treated in accordance with the guidelines provided by the Atomic Energy
Regulatory Board. Generally, radioactive wastes need to be stored in a storage designed exclusively for
radioactive material for half-life period for inactivation, then buried in the ground.
11.4 Maintenance Operation

It is important not only to secure human resources in the field of medical and teaching department, but also
to procure manpower for facility operation and maintenance. It is also necessary to develop efficient
maintenance plan of the facility and equipment in order to keep their sustainable usage.
Facility
Each hospital has a Hospital Management Society who also looks after the general management. The funds
for the operation and maintenance are being managed through the users’ charges collected and budget-
11-8
allocated funds from GoA. Timely action, proper management, and periodical inspection shall be essential
for the facility maintenance.
It is required to implement regular check and periodic maintenance based upon the annual maintenance
plan and keeping the maintenance records. The daily cleaning will encourage people to use the facilities
carefully as well as ensure early detection of damages and/or malfunctions. Regular major inspections/
actions that may need to be carried out are shown in Table 11-3.
Table 11-3 Major Regular Inspections Related to Facility

Building  Daily cleaning
 Repair of parts from wear and tear, damage, and deterioration
Building machineries  Switchboard / Regular inspection and management
 Generator: Supply of oil
 Lighting / Regular inspection and management
 Pump, pipe, valve / Regular inspection and management
 STP, ETP / Water quality monitoring
 Air conditioner, AHU, exhaust fan / Measurement of air environment and cleaning
 Firefighting equipment / Regular inspection and management
Medical Equipment
All equipment shall have warranty and/or CMC renewed from time to time as per the life of the equipment.
For equipment that requires complicated maintenance checks, it can be managed by local agents located in
Assam or Guwahati located around one (1) hour drive from the centre of New Delhi. All equipment should
have annual maintenance contract for regular servicing and repair to ensure that they are in optimum
working conditions and no equipment/instruments should remain non-functional for unreasonably long
time. Outsourcing of services such as laundry, ambulance, dietary, housekeeping and sanitation, waste
disposal, etc. should be preferably arranged by the hospital itself. Manpower and outsourcing work could
be done through local tender mechanism. (Also refer to Section 7.6 for the details.)
11-9
Project Implementation
12.1 Project Implementation Structure
Project Management Structure and its Functions

The agency related to this project is the Government of Assam, Health and Family Welfare Department
(HFWD). It is assumed that the Directorate of Health Services (in charge of medical institutions for district
hospitals and primary health centres), the Directorate of Medical Education (in charge of medical colleges
and medical college hospitals), and the National Health Mission (maternal and child health, infectious
diseases, non-communicable diseases (NCDs) countermeasures) will be involved in the implementation of
the project.
Table 12-1 shows the project management structure.

Figure 12-1 Draft of Organisation Chart of the Project
Roles and Responsibilities of Related Organisations

Executing Agency: The executing agency will be the Government of Assam, Health and Family Welfare
Department (HFWD). HFWD will handle the necessary tasks for project implementation and stakeholder
coordination with JICA. HFWD will establish a Project Management Unit (PMU) within the organisation
which shall take all necessary measures in a timely and efficient manner and will be fully responsible for
the project implementation.
Governing Body & Executive Committee: Governing Body & Executive Committee shall consist of a
representative from the Government of India (GOI) and HFWD of the Government of Assam, consisting
of the perspective of state-wide management if necessary and supervising the PMU.
12-1
PMU: A Project Management Unit (PMU) will be set up within the HFWD as the executing agency for
project implementation. It will consist of representatives from HFWD of the Government of Assam, such
as from the Directorate of Health Services, the Directorate of Medical Education, the National Health
Mission, and each hospital director. PMU is responsible for the implementation of the project. PMU will
communicate with the management of each hospital to know updates regarding its development strategy
and direction, and reflect them in the project implementation if necessary. It will have responsibility to
report the project to JICA and GOI. For daily administrative and technical project management, the PMU
will be supported by the Project Management Consultant (PMC) accordingly to ensure the conceived
management plan and implementation, and act as a decision makers and supervisor for daily activities of
the project.
PIU: Project Implementation Unit (PIU) is organised in each of the medical institution covered by the
project and is responsible for the implementation of the project in the hospital. The PIU is led by the director
of each hospital and consists of the deputy directors in charge of medical service and administration, as
well as head of accounting, facilities and equipment, and human resources developments. The main
responsibilities of the PIU are the development of implementation and annual plans for the project in each
hospital, the management and monitoring of progress, the annual evaluation of achievement based on the
plan, and the reporting to the PIU on quarterly basis. Each PIU will also be responsible for the collaboration
across tertiary, secondary, and primary level's medical institutions in order to establish the Universal Health
Care (UHC) model, which is the goal of this project. The PIU is responsible for coordinating the
improvement of the referral system with higher and lower-level institutions and coordinating human
resource development (providing guidance to lower-level institutions, dispatching medical personnel, etc.).
PMC: Project Management Consultant (PMC) shall be hired by PMU. It is supposed to assist PMU in
making necessary reports to the authorities such as JICA and GOI, and coordinate submissions, approvals,
and concurrences including communication with all internal and external parties concerned (municipality,
authorities, etc.). PMC will consist of a Project Management Expert, Construction Management Expert,
Financial Management Expert, Monitoring and Evaluation Expert, Procurement Expert and Supporting
Staff, etc. and will support facility design, construction supervision, equipment design, and equipment
procurement and installation supervision.
12.2 Project Implementation Schedule
Prerequisites
The overall project implementation schedule is devised based on the prerequisites in Table 12-1. The
procurement method of the construction will be EPC mode (Design Build).
12-2
Table 12-1 Prerequisites of the Project Schedule

Project Milestone
Loan Pledge: February 2022
Signing of L/A: March 2022
Selection of PMC (By the HFWD)
Preparation of Terms of Reference (ToR), JICA concurrence: 4.0 months
Releasing RFP, preparation of proposal by prospective consultant: 2.0 months
Evaluation of submitted proposals (QCBS), JICA concurrence: 4.0 months
Negotiations, JICA concurrence, and consulting agreement: 2.0 months
Design Stage (By the PWD&in-house Consultant)
Basic design: 6.0 months
Bidding Procedure (By the PWD and PMC)
Preparation of bidding document and JICA concurrence: 4.0 months
Releasing of bidding document and preparation of bid by prospective bidder 3.0 months
Evaluation of submitted bids and JICA concurrence: 5.0 months
Negotiations, JICA concurrence, and awarding of contract: 3.0 months
JICA concurrence and conclusion of contract: 1.0 month
Construction Work Period

In general, the construction schedule of a facility is greatly affected by the geological and climatic
conditions of the proposed site. Therefore, it is advisable to determine a realistic schedule by referring to
the expertise of local contractors.
In this report, the overall construction period is estimated as in the following Table 12-2
Table 12-2 Estimated Construction Period

Construction
Six Super Specialty Wing in Medical College Hospitals 30 months
Eight District Hospital Infrastructure Improvement 18 months
Dedicated Training, Monitoring, Administrative Centre, Swasthya Bhawan 18 months
Project Implementation Schedule

Considering the above necessary period for each process, the project implementation shall be as shown in
Figure 12-2, Figure 12-3, and Figure 12-4.
Regarding the EIA procedures in the following schedule, it is assumed that the schematic design is detailed
enough to be submitted for building permits and EIA procedures.
12-3
Year 2022 2023 2024 2025 2026 2027 2028 2029
Fiscal Year FY2021 FY2022 FY2023 FY2024 FY2025 FY2026 FY2027 FY2028 FY2029
Month 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12
Appraisal Re Re
Basic Design
Pledge by PWD vie vie
L/A w w
Detailed
Design Project Implementation (construction & procurement works) Defect Liability Period / Warranty Period
FRAME SCHEDULE PMC Selection
Bidding Procedure (Construction Work) Bidding Procedure (Other Packages, ie. furniture, medical
Project Completion
EIA study for Env. Clearance
Soft Component
Following works may be necessary according to the site condition

・Infrastructure development to the site
WORK BY THE ASSAM STATE
(Water Line, Electric Power Line, Fiber Optic Cable Development
GOV.
・Site Clearance
Review & Monitor

Bidding Procedure (Construction Work) Bidding Procedure (Other Packages, ie. furniture, medical equipment)
JICA Concurrence
Prep. Doc. Evaluation Negotiation
Building Permit
PROJECT MANAGEMENT
UNIT (PMU)
JICA Concurrence
Prep. Bid Evaluation

RFP
Contract
Negotiation
Construction Supervision,
Consultant Equipment, Furniture and ICT System Procurement Supervision
Agreement
CONSULTING SERVICE BY
PROJECT MANAGEMENT Re
CONSULTANT (PMC)
Re
Proposal vi vi
e e
Procurement Scheme: w w
QCBS (80:20) One-year
Inspection
Bidding Assistance (Construction
Work) Bidding Assistance (Other Packages, ie. furniture, medical equipment)
COMPONENT 1-1 Contract

Building Super Specialty
Detailed
Hospitals in 6 MCHs Design Construction (30 months) Defect Liability Period
Procurement Scheme: ICB
Bidding ・6 Medical College Hospitals
Contract
COMPONENT 1-2 Construction (24 months) Defect Liability Period
Facility Improvement in Bidding
District Hospital ・6 District Hospitals
Procurement Scheme: ICB
COMPONENT 1-3 (NOT covered by

Contract
the loan)
Building Dedicated Training, Construction (18 months) Defect Liability Period
Monitoring, Administrative Bidding
Centre
“Swasthya Bhawan”
Procurement Scheme: LCB
Figure 12-2 Project Implementation Schedule (Construction)
12-4
Year 2022 2023 2024 2025 2026 2027 2028 2029
Month 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12
Appraisal Basic Re Re
Pledge Design by vie vie
L/A PWD w
Detailed
w
PMC Selection
FRAME SCHEDULE
Bidding Procedure (Construction Work) Bidding Procedure (Other Packages, ie. furniture, medical
Project Completion
Soft Component
Year 2022 2023 2024 2025 2026 2027 2028 2029

Month 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12
Contract
ICB P/Q
Equipment: Hospital Warranty Period (period depending on each item)
- Outpatient equipment such as Ventilator, Patient monitor, Examination lamp,
LCB Bidding
Procurement Work
Sphygmomanometer
- Imaging diagnostic equipment such as MRI, CT, Angiography, G-X ray, Mobile X-ray
Contract
- OT equipment /CSSD equipment ICB P/Q
Procurement Scheme: ICB/LCB Warranty Period (period depending on each item)
LCB Bidding
Procurement Work
Contract
Warranty Period
COMPONENT 1-4 Furniture: Hospital
- Medical furniture Bidding Procurement Work
EQUIPMENT & FURNITURE - General/Admini. Furniture Contract
Procurement Scheme: LCB Warranty Period
Bidding Procurement Work
Procurement
Contract Work
Warranty Period
Furniture: Other Facilities
Procurement Scheme: LCB Contract
Warranty Period
Year 2022 2023 2024 2025 2026 2027 2028 2029
Month 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12
ICT (Network Infrastructure): Hospital Contract

- Passive components: wiring such as CAT 6A cables, fibre optic cables, patch cords, Warranty Period
patch panels, server room UPSs, ultrasonic survey etc. Bidding ICT Work (Passive, Opening)
- Active components: core/distribution/access switches, wireless access points,
wireless acess controller, firewall, etc. Warranty Period
ICT Work (Active, Opening)
ICT (Computer hardware): Hospital Contract
- PCs, printers, UPSs, barcode printers/scanners Warranty Period
- Video conferencing system: TVs, projectors Bidding ICT Equipment Work
- Server equipment for HMIS
Contract
ICT (Hospital Management Information System): Hospital
Contract Warranty Period
- Application including training Negotiation
Assumed Procurement Scheme: LCB HMIS Work
ICT (Other software): Hospital Contract

COMPONENT 1-5 (NOT covered by - PACS hardware / software Warranty Period
the loan) - Queue management system: hardware / software
ICT Assumed Procurement Scheme: LCB
Bidding Other Software Work
Contract
ICT (Network Infrastructure): Swastha Bhawan
Warranty Period
- Passive components: wiring such as CAT 6A cables, fibre optic cables, patch cords,
Bidding
patch panels, server room UPSs, ultrasonic survey etc. ICT Work (Passive)
- Active components: core/distribution/access switches, wireless access points,
wireless acess controller, firewall, etc.
ICT Work (Active) Warranty Period
Contract
ICT (Computer hardware): Swastha Bhawan Warranty Period
Bidding ICT Equipment Work
Contract
ICT (School Management Information System): Swastha Bhawan
Warranty Period
Assumed Procurement Scheme: LCB Bidding SMIS Work
Figure 12-3 Project Implementation Schedule (Medical Equipment, Furniture, and ICT)
12-5
Year 2022 2023 2024 2025 2026 2027 2028 2029
Month 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12
Appraisal Re Re
Pledge Basic Design
by PWD vie vie
L/A w w
Detailed
PMC Selection
FRAME SCHEDULE Bidding Procedure (Other Packages, ie. furniture, medical
Bidding Procedure (Construction Work)
Project Completion
Soft Component
Year 2022 2023 2024 2025 2026 2027 2028 2029

Month 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12
I-a.Conduct training on patient care and attitude to patient (Conduct trainings on

Warm Reception, Interacting Comfortably, Informed consent, Care for terminal
patients, etc.)
Component 2
Soft Component I: Capacity Building I-b.Improve internship program (Introduce online training programs in cooperation
of Medical Staffs with Japanese hospitals and hospitals in other states such as AIIMS and Fortis.)
I-c.Conduct refresher training for staffs (Introduce the latest technology and
research which can be useful for their daily operation.)
Year 2022 2023 2024 2025 2026 2027 2028 2029
Month 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12
II-a.Improve existing
basic training courses
（Basic trainings for
hospital management
such as Infection Control,
Medical Waste
Management, Fire safety,
Disaster preparedness,
etc.）
Component 3
Soft Component II: Improvement of II-b.Conduct trainings
the Hospital Management and activities of 5S-
KAIZEN and Total Quality
Management (TQM). The
trainings will be divided
based on the target group
(management,
administration officers,
doctors and nurses who
are in charge of the
department)
Year 2022 2023 2024 2025 2026 2027 2028 2029

Month 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12
Component 3
Soft Component Ⅲ Improve III-a.Conduct trainings on eHospital and Management Information System (MIS)
Hospital Management Information management at targeted facilities including Swastha Bhawan
System
Year 2022 2023 2024 2025 2026 2027 2028 2029
Month 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12
IV-a.Strengthen cooperation
among primary, secondary, and
tertiary.
Component 3
Soft Component IV: Establish IV-b.Strengthen referral system from
Regional UHC System in Selected primary to secondary, secondary to
Areas tertiary, and vice versa.
IV-c.Promote health awareness of

local residents to change their medical
behavior
Figure 12-4 Project Implementation Schedule (Soft Component)
12-6
12.3 Project Implementation Plan
Procurement Plan
Upon construction of a new hospital, the tender for civil construction work shall include civil, structural,
architectural, mechanical, electrical and plumbing (MEP), interiors and site development works, and fixed
furniture items. Medical equipment and bought out furniture items shall be separated from the construction
tender.
Facility Construction
Procurement System
Procurement for hospital facility construction will be EPC mode (Design Build), conducted through
international competitive bidding (ICB). The proposed construction work is relatively large scale, and both
functional and technical requirements are high. This requires that the contractor’s workmanship and
construction management expertise also be high. It is therefore implement reviews of the candidate
contractor’s technical capabilities and financial viability.
Procurement for Swasthya Bhawan facility construction will be conducted through local competitive
bidding (LCB).
Normally, a government agency, a nodal agency, manages the project on behalf of the HWF Ministry in
Assam. The state's Public Works Department (PWD) has a dedicated department that handles most
government healthcare projects in Assam, which acts as the nodal agency. The HFWD will be the client of
the nodal agency. The nodal agency will appoint in-house consultants and issue tenders for the construction.
PWD is responsible for all procurements related to construction, and issues the RFP and makes the award.
PWD shall be the executing agency.
On the other hand, infrastructure requirements for MCH are provided by DME and those for CH are
provided by DHS. Thus, the HFWD accords the administrative approvals.
Procurement Condition
All necessary construction equipment are available in Assam as currently, similar sized or bigger projects
than medical colleges are being executed. Necessary materials including finishing materials are available
locally and can also be easily sourced from all over India.
(This Part Intentionally Left Blank)s
12-7
Table 12-3 (This Part Intentionally Left Blank)
12-8
12-9
Public Works Department Cost Norms and Unit Cost Applied to the Project
In India, the unit cost for public buildings is defined by the “Plinth Area Rates” set by the Public Works
Department (PWD). Each of the central government PWD (CPWD) and Assam PWD (APWD) has its own
12-10
cost. Despite of the above, in June 2021, a notification from the Government of Assam on Schedule of
Rates (SOR) for Construction has been issued that all norms and guidelines of the Central Public Works
Department (CPWD) (All India) SOR will be followed by the Assam Public Works Department (Building
Wing).
The base cost is calculated based on the Plinth Area Rates 2021 published by the Central Public Works
Department, which covers the basic construction cost of non-residential buildings. In this base cost, items
such as medical gas supply systems are not included. These additional functions that are not listed in the
Plinth Area Rates are added considering market price.
Work Allocation of Assam Side

The yen loan project may not cover the overall development of the project. Some infrastructure
development works outside/inside the project site are advantageous to be planned/developed prior to the
commencement of the works under the yen loan project. Table 12-6 shows the work allocation for the
Assam side for the construction component.
Table 12-6 Work Allocation of Assam Side

Land Preparation  Land acquisition
 Site clearance and demolition of existing structure and services if required
Utility System  Providing necessary utilities (electric power, telephone/ internet connection, supply
water, drainage, etc.) to the site to operate the facilities
Safety Issues during Construction

The following issues during construction are to be considered:
 Secure the construction site by surrounding it with temporary wall.

 Consider enough working and preparation space for the contractor within construction fence/site.
 Limit the number of vehicles entering the construction site, to enable managing access of construction
vehicles and labours, and avoid traffic issues.
 Be conscious of reduction of noise and vibration emittance.
Especially because the development of each facility block will be implemented during the operation of the
existing facilities, consider safe accessway for the patients, their attendants, visitors, and medical staff
during each construction phase. Separate user access route from that of construction vehicle to be planned.
12-11
Project Cost
13.1 (This Part Intentionally Left Blank)
(This Part Intentionally Left Blank)
(This Part Intentionally Left Blank)e
13-1
13.2 (This Part Intentionally Left Blank)
13-2
13.3 Operation and Maintenance Cost

The operation and maintenance (O&M) costs of the hospitals are generally divided into personnel costs,
administrative costs, operation costs, and building and equipment maintenance and repair costs.
Operation and Maintenance Cost of the Proposed Facilities

In general, the facility’s O&M consist of operation costs (electricity, telephone, and water charges) and
building maintenance costs (cost for building maintenance and purchasing spare parts of mechanical
systems, etc.).
The annual O&M cost including the above is roughly estimated as INR 400,000 per bed on average from the
average expenditure in the past four years (2016-2020) of Assam Medical College & Hospital (AMCH) and
Gauhati Medical College & Hospital (GMCH) including salaries and wages calculated from the four-year
expenditure data of MOHFW (Table 13-6). The reason for adopting the past expenditure of AMCH and
GMCH is that their records for the hospital were clearly separated from those of the medical colleges.
13-3
Table 13-6 Annual Expenditure per Bed

(INR)
Average Expenditure of Annual Expense per Average Annual
No. of Beds
Name of Institution Past 4 Years bed Expenditure per
(B)
(2016-2020) (A) (A) / (B) bed
AMCH 536,544,500 1,315 408,019 417,008
GMCH 972,979,750 2,284 425,998
Table 13-7 shows the estimated O&M cost of the proposed facilities.
Table 13-7 Annual Estimated O&M Cost of the Proposed Hospitals

(INR)
O&M Cost per Bed Annual Estimated
Name of Institution No. of Proposed Bed (A)
(INR) (B) Expense (A) x (B)
SMCH 170 417,008 70,891,360
TMCH 200 417,008 83,401,600
JMCH 260 417,008 108,422,080
FAAMCH 50 417,008 20,850,400
DMCH 50 417,008 20,850,400
LMCH 50 417,008 20,850,400
Type 1 (CH) 150 417,008 62,551,200
Type 1 (CH) 150 417,008 62,551,200
Type 1 (CH) 150 417,008 62,551,200
Type 1 (CH) 150 417,008 62,551,200
Type 2 (CH) 50 417,008 20,850,400
Type 2 (CH) 50 417,008 20,850,400
TOTAL 617,171,840
13-4
Monitoring and Evaluation Framework

This chapter describes operation and effect indicators to monitor and evaluate the operation and its effects
to achieve the project objectives, and the economic analysis to evaluate the economic viability of the project.
14.1 Monitoring and Evaluation Indicators
Operation and Effect Indicators

The project aims to strengthen the health care system in Assam State and consists of several development
components which are outlined as follows (refer to Chapter 5).
(1) Strengthening medical institutions (facilities, equipment)
(2) Strengthening the capabilities of medical professionals
(3) Strengthening the organizational and management capabilities for provision of the medical
services
In this section, operation and effect indicators are established for each component above, in order to monitor
the achievement of the project goals. In establishing the indicators, clearness and simplicity, which support
reliable and sustainable monitoring by the implementing agencies, are taken into account.
14-1
Table 14-1 shows the operation and effect indicators proposed for the project. The baseline values are those
which are achieved in 2021 (or the latest available data) and the target values are expected values in the
two years after project completion (2029).
The operation indicators for the above component (1) includes the “number of newly installed beds”, “bed
occupancy rate”, “number of OPD patients”, “number of angiography”, and “number of delivery (including
normal delivery and LSCS)”. As for the effect indicators, infant mortality rate (IMR) and maternal mortality
rate (MMR) could be proposed because those indicators are closely related to one of the overall goals of
the project. However, such mortality rates would be affected not only by the outputs of the project but also
by a variety of external factors. Thus, those mortality rates are not included for evaluation of the project.
The operation indicator for the above component (2) is the “cumulative total number of medical staff who
have participated in the training(s) related to patient-centered care, improved internship program and
refresher training(s)”.
The operation indicators for the above component (3) are the “cumulative total number of staff who have
participated in the training(s) and activities of 5S-KAIZEN and Total Quality Management (TQM),
training(s) on eHospital and Management Information System (MIS) management” and “cumulative total
number of trainers to be trained regarding strengthening referral system and promotion of health awareness
of local residents to change their medical behavior”.
14-2
Table 14-1 Operation and Effect Indicators

Indicators Unit Baseline Target Estimation basis / Notes
1. Strengthening medical institutions (facilities, equipment)
1-1. No. of newly installed bed Refer to Chapter 6 “Facility Plan”
beds - 780
(in the new super specialty wings at the targeted 6 MCHs)
1-2. Bed occupancy rate Target value is estimated based on occupancy rates among existing
(average of the new super specialty wing’ beds at the targeted 6 % - 80 - 90% hospitals
MCHs)
1-3. No. of newly installed bed Refer to Chapter 6 “Facility Plan”
beds - 600
(in the targeted 4 CDHs of Type 1)
1-4. Bed occupancy rate Target value is estimated based on occupancy rates among existing
% - 70 - 80%
(average of the new beds at the targeted 4 CDHs of Type 1) hospitals
1-5. No. of OPD patients Baseline value of some targeted hospitals are not
Perso
(total of the targeted 8 MCHs and the 6 CDHs) available/unobserved during the Survey period. Those missing data
ns 2,536 K 2,721 K
are tentatively replaced with the average of observed MCHs/CDHs.
/year
Target value is reflected total population growth in Assam.
1-6. No. of angiography times/ Tests and/or catheter interventions
- 13,500
(total of the new super specialty wings at the targeted 6 MCHs) year 9 times/day x 250 days/year x 6 MCHs
1-7. No. of delivery (including normal delivery and LSCS) Times Target value is reflected total population growth in Assam.
15,070 16,171
(total of the targeted 6 CDHs) /year
2. Strengthening the capabilities of medical professionals
2-1. Cumulative total No. of medical staff who have participated in Refer to Chapter 5 Table 5-3 “Outline of Soft Component (Plan)”
the training(s) related to patient-centered care, improved Breakdown of No. of target medical staff are 378, 800 and 1,380 for
persons - 2,558
internship program and refresher training(s) the trainings on patient care, the improved internship program and
refresher trainings, respectively.
3. Strengthening the organizational and management capabilities for provision of medical services
3-1. Cumulative total No. of staff who have participated in the Refer to Chapter 5 Table 5-3 “Outline of Soft Component (Plan)”
training(s) and activities of 5S-KAIZEN and Total Quality Breakdown of No. of target staff are 420 and 1,400 for the trainings
persons - 1,820
Management (TQM), training(s) on e-Hospital and and activities of 5S-KAIZEN and TQM and the trainings on e-
Management Information System (MIS) management Hospital and MIS, respectively.
3-2. Cumulative total No. of trainers to be trained regarding Refer to Chapter 5 Table 5-3 “Outline of Soft Component (Plan)”
strengthening referral system and promotion of health Breakdown of No. of target trainers are 108, 80 and 58 for the
awareness of local residents to change their medical behavior persons - 246 activities on patient management system, the public health
campaign to prevent diseases and the awareness activities to
improve health literacy of the people, respectively.
MCH: Medical College Hospital, CDH: Civil District Hospital, LSCS: Lower segment Caesarean section Source: JICA Survey Team
14-3
Qualitative Effects
The qualitative effects envisaged by the project implementation are as follows:
 Improvement of patients’ satisfaction and comfortableness with healthcare services in terms of hospital
facility, hospital staff, doctor’s behaviour, etc. The public hospitals provide affordable services equally
to any individuals of the general public including women and socially vulnerable people; so at least a
half of those patients are envisaged to be female.
 Improvement of living environment in the target areas such as enhancement of advanced healthcare,
improvement of access to healthcare services among residents. Likewise, the residents in the target
areas include women and vulnerable people.
 Improvement of health personnel’s satisfaction with working environment, learning environment, etc.
 Development of high-quality health personnel and provision of qualified health personnel in the state
through clinical trainings. Likewise, health personnel include women.
14.2 Economic Analysis
General Assumption
Economic analysis is an evaluation method of economic viability of a project by comparing economic
benefit, which is calculated by comparing benefit using the “With and Without” case, and economic cost.
The economic viability of the project will be evaluated through estimation of economic internal rate of
return (EIRR), cost benefit ratio (CBR) and economic net present value (ENPV) in the present analysis.
Since the project consists of several components, which comprehensively cover health sector in Assam and
are mutually dependent on each other (refer to Chapter 5), EIRR, CBR and ENPV of the project as a whole
are calculated and evaluated rather than component-by-component or facility-by facility. In fact, it would
be difficult to estimate EIRR, CBR and ENPV component-by-component or facility-by facility, and it might
be also difficult to interpret those fragmented indicators in order to properly evaluate the project with
complex setting.
Most of the soft components of the project are not the direct target of economic analysis, because the
economic benefit of them is difficult to converted to monetary value. However, it should be noted that the
soft components of the project will play an important role to realize the outcome/benefit of other
components and of the project as a whole by contributing for improvement of quality and quantity of health
personnel and organizational and management capabilities.
The “without” case is set as the case where the public hospitals in the target area are maintained in their
current status.
Healthcare services at public hospitals in Assam are basically free of charge, except for some medical
services (such as initial consultation (registration) fees and some tests and treatments) and medicines, which
are funded by the government tax revenues (in the form of government subsidies). Thus, the hospital service
revenue is minimal compared with the project cost. In addition, the government of Assam is planning to
expand the coverage of the public health insurance system in the future, which will further reduce the
14-4
patient's co-payment (payment at the hospital counter). Moreover, in this survey, it was unable to obtain
financial data such as financial statements of public hospitals, as well as information on the public health
insurance system in Assam, such as coverage, expenditure and the share of government subsidies in the
financial resources. Based on this situation, financial analysis is not implemented because it cannot be said
that public hospitals necessarily collect fees from users (patients), and it is difficult to analyze and forecast
the fee revenue at the same time.
General assumptions made for the economic analysis are described as per Table 14-2.
Table 14-2 General Assumptions of Economic Analysis

Item Assumption
Project period Year 2022 to 2057
- Construction period: 2022 – 2027 (6 years)
- Operation period: 2028 – 2057 (30 years)
Exchange rate USD 1.00 = JPY 114
USD 1.00 = INR 74.5
INR 1.00 = JPY 1.53
Prices Cash flow projection is expressed in constant prices excluding inflation. Local currency
portion of cost and benefit is adjusted with Standard Conversion Factor of 0.9.
Physical contingency Construction: 5.0%
Consulting services: 5.0%
Transfer items Taxes, interest and subsidies are eliminated from the economic analysis
Hurdle rate for EIRR 10%
Economic Cost
Table 14-3 shows the construction cost as well as the O&M cost of the project, which are mentioned in
Chapter 13 and converted to the economic cost.
Economic Benefit
Advanced Medical Care

Quantifiable benefit from the provision of advanced medical care is envisaged from the medical treatments
of non-communicable diseases (NCDs) such as severe heart and brain diseases. An existing study shows
that NCDs are typically present in individuals aged 55 years or older in many developed countries; however,
their onset occurs in India a decade earlier (from not less than 45 years of age). Also, according to WHO,
NCDs are estimated to account for 63% of total deaths in India. The introduction of angiography devices
14-5
in super specialty wings in six medical college hospitals will enable both investigation and treatment
surgery to cope with such diseases. The economic benefit in this regard is estimated based on the following
assumptions:
 Usage capacity of angiography devices is assumed at nine times per day per unit: of which, use for
catheter treatment surgery operation accounts for a third (33%), and medical test usage accounts for
the other two thirds (67%). Treatment surgery is operated at 250 days per year.
 Survival rate after the catheter treatment surgery using angiography is assumed at 60%.
 The patients are 45-65 years of age and their economic activities up to 65 will be prolonged for ten
years on average. The economic effects are quantified through long-term projection of Assam’s income
per capita. Since data on long-term projection of the growth rate of Assam’s income per capita was not
available, the long-term projection of real GDP growth for India, which was published by OECD, was
used instead in order to estimate Assam’s income per capita in future periods8.
Table 14-4 Long-term Projection of Income per Capita in Assam

2025 2030 2035 2040 2045 2050 2055
Income per capita (INR) 114,413 145,701 177,163 207,803 237,968 268,556 301,188
Source: JICA Survey Team based on OECD long-term economic scenarios
This benefit is closely related to the components of “Super Specialty Wings in MCHs” as well as the soft
components.
Reducing Patients’ Expense (OPD and IPD) at Private Hospitals

In the project, equipment for medical care will be installed at the targeted MCHs and DCHs. The service
charge at those public hospitals (OPD and IPD) will be lower than the one at existing private hospitals. It
is assumed that the patients use public hospitals instead of the existing private hospitals to reduce their
payment after the project implemented. Since information on the cost of providing healthcare services in
public hospitals was not available in the survey, the economic benefit in this regard is estimated based on
the following assumptions:
 The costs of providing the same healthcare service are assumed to be the same in public hospitals and
private hospitals. The costs are not included in the calculation of economic benefit of this project
because it is necessary whether the service is provided in a public hospital or a private hospital.
 In private hospitals, patients pay for the fee of healthcare service, which is the sum of the costs and
profits. This is equivalent to the revenue of private hospital. On the other hand, public hospitals are not
for profit, so they do not add profits to their costs. Therefore, it is assumed that this project will reduce
the patients’ expense on health equivalent to the amount of profit for private hospitals.
The benefit of reducing patients’ expense after the project implementation is calculated as follows:
Benefit of reducing patients’ expense = “Profit margin of private hospitals per patient” * “Number of
patients at the targeted MCHs and DCHs”
8 The compound annual growth rates (CAGR) of GDP per capita both for Assam and for India over the past nine years have
been almost the same (9.8%), and the growth rates of GDP per capita and GNI per capita for India over the past ten years
have been staying at the same level.
14-6
Since data on sales and profits of private hospitals for the entire state of Assam or the entire country was
not available, data of an individual hospital is used instead. Table 14-5 shows the healthcare service rates
at a typical private hospital operated in Assam, namely Apollo Hospitals 9 . According to the Apollo
Hospitals Investor Presentation, average EBITDA margin is 22% in the past 12 years. The profit margin of
private hospitals per patient is calculated by multiplying the average service rate by EBITDA margin rate.
Table 14-5 Comparison of Hospital Service Rates

Private Hospitals
OPD revenue per outpatient INR 7,300
IPD revenue per inpatient INR 151,000
EBITDA margin 22%
Source: JICA Survey Team and Apollo Hospitals Investor Presentation June 2021
This benefit is closely related to the components of “Critical Equipment in all MCHs” and “Infrastructure
Improvement in DCHs” as well as the soft components.
Reducing Travel Costs

The benefit of reducing transportation and accommodation costs for inpatients’ families to accompany the
inpatients is calculated as follows:
Reducing transportation and accommodation costs for inpatients’ families to accompany the inpatients
= “Transportation and accommodation costs per family of inpatient to the nearest MCH” * “Number of
patients who would receive medical services at tertiary public hospitals instead of the secondary hospitals
unless the project would be in place”
It is assumed that the patients, who would need to receive proper medical services at secondary public
hospitals, would have to directly go (bypass) to tertiary public hospitals due to insufficient quality or
quantity of services provided by their nearest secondary public hospitals, in the absence of the project. The
economic benefit in this regard is estimated based on the following assumptions:
 At least one family member accompanies the inpatient and stays for four days.
 Average distance from where patients live to the nearest tertiary hospitals is 50 km and they use taxi.
Table 14-6 Transportation and Accommodation Costs for Inpatients’ Families

Unit Price Quantity Total
Transportation cost per family INR 1,032 per one way 2 ways INR 2,065
Accommodation cost per family INR 1,600 per night 4 nights INR 6,400
Source: JICA Survey Team and NUMBEO « Taxi Fares in Guwahati, India »
This benefit is closely related to the components of “Infrastructure Improvement in DCHs” as well as the soft
components. Although the benefit of reducing travel costs for inpatients’ families could be arisen not only from
the above assumed situation but also other cases such as eliminating travels to private hospitals, etc., those
benefits are not included due to the difficulty of collecting reliable data and making logical assumptions.
Estimation of EIRR
Results of the economic analysis of the entire projects is shown in the following table. Each indicator is
calculated based on the following method:
9 https://www.apollohospitals.com/
14-7
EIRR = (Discount rate which makes economic value at 0)
CBR (B/C) = (Net Present Value of Economic Benefits) ÷ (Net Present Value of Economic Costs)
ENPV = (Net Present Value of Economic Benefit) – (Net Present Value of Economic Costs)
Table 14-8 shows the economic cash flow projection of the project. Table 14-9 shows the results of the
sensitivity analysis. It indicates that O&M cost increase is less sensitive to the EIRR results than
construction cost increase. Also, EIRR will be higher than the hurdle rate in case of 20% decrease in hospital
services at MCHs and DCHs (OPD, IPD, and advanced medical care) and benefit from transportation and
accommodation costs reduction.
14-8
14-9
Cooperation between India and Japan

(Utilising Japanese Knowledge and Technology)
As an approach to solve the essential issues related to the medical services in Assam, it is conceivable to
utilise the Japanese experience and knowledge. Specifically, it includes hospital management, 5S (Sort, Set,
Shine, Standardise, Sustain) / Total Quality Management (TQM), human resource development / medical
education, medical technology, operation and maintenance system, and infectious disease control.
JICA's scheme for this purpose may include soft components, the incidental technical cooperation projects
related to this project, and regular technical cooperation projects. On the other hand, it is also possible to
utilize the experience and knowledge of Japanese universities, hospitals, and private companies. Therefore,
the following approaches are required for project implementation in order to collaborate with Japanese
universities, hospitals, and private companies.
Table 15-1 Approaches to promote India-Japan Cooperation with Japanese Universities,

Hospitals and Private Companies
(1) Survey on the possibility of utilising the technology and knowledge of Japanese universities, hospitals, and
private companies for India.
(2) Analysis of what kind of technology / knowledge is effective for solving issues.
(3) Needs in Assam confirmation survey and holding workshop in India related to the contents clarified by the
needs survey, conduct online seminars for Japanese universities and companies.
(4) Sign the Memorandums of Understanding with Japanese companies, universities and hospitals that meet the
Indian needs
15-1
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e
Annex I Methodology of the Subcontracted Survey
1. EXECUTIVE SUMMARY
The Team Leader of JICA Survey Team – Mr. Hiroshi Abo on behalf of Koei Research & Consulting Inc. Japan (KRC)
entered in to a contract with United Engineers Alliance (UEA) Pvt. Ltd. (the Sub-Consultant) on 2nd day of the month of June
2021 for the execution of the Preparatory Survey for Health System Strengthening Project in Assam State, India (the Project)
under the contract dated 24th March 2021 between JICA & KRC Consortium.
The assignment commenced from 16th June 2021 is to provide to carry out the Field Survey of the Public Hospitals that
includes 7 MCHs and 6 DCHs and 6 PHF (Target Hospitals) for the Survey to support KRC Consortium to effectively design
the Project. The services delivered by a team of surveyors with short term inputs in different MCHs and DCHs (Target
Hospitals) on priority. The survey aims to find out bottleneck or the challenge in patient services in government hospitals and
teaching/learning environment of education in the medical college & hospitals under Level of Satisfaction and Care seeking
behaviour. Subsequently, the field survey team will be conducting the survey activities on (i) management & satisfaction and
(ii) Facility & Medical Equipment of Target Hospitals.
The main object of the progress report is to highlight the assessment of the current situation of the project parameters, as
originally envisaged in the Terms of Reference (TOR), after their findings during the progressive phase. The report also
includes the Surveor’s approach and methodology towards successful completion of the project and perception of the work
schedule, personnel deployment and the timelines for the project.
Figure -1
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2. INTRODUCTION
2.1 Purpose of the Progress Report
The main purpose of this Final Report is to bring out the field level existing status for planning the Project and to provide
information of the services to be completed based on existing scenario.
The final phase has been completed close liaison with KRC, GOA, MCHs and other key stakeholders enabling greater clarity
in determining the Survey areas of work and approach to conducting the services.
It is important for the contents of the Final Report to be understood and agreed by the stakeholders in order to be accurate
and to accomplish the work.
2.2 Project Background
For universal health coverage (UHC) of Assam people with no one left behind, the State Government requested JICA for
assistance on strengthening of health service network through improvement of public hospitals. To formulae of Japanese
ODA loan project, JICA will conduct the preparatory study for health system strengthening in Assam State (the study) aiming
to identify the scope and prepare the implementation plan. To ensure effectiveness and sustainability of the project, the study
will cover not only the health facilities but also the health system, provision and utilization of health services in Assam State.
Especially, human resources might be one of the priorities to ensure quantity and quality.
2.3 Overall Objectives
Under the study, the field survey on public hospitals (the survey) will be conducted with the following objectives:
Collect data and information on facility, medical equipment, as well as operation and management of public hospitals in
Assam State
Collect and analyse information on level of satisfaction and possible determinants of patients and hospital staff
Target Hospitals:
7 medical college and hospitals
The final list of target hospitals included 6 numbers of District Civil Hospitals and One Primary Health Facility
nearby each District Civil Hospital. The list is shown below:
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The List of Target Medical College & Hospitals and District Civil Hospitals:
No District Name Education Hospital State Level District Hospital

Hospital
1 Barpeta ✓ Fakuriddin Ali Ahmed Medical Barpeta Civil Hospital
College & Hospital Kalgachia
Bongaigaon Bongaigaon CH
Goalpara ✓ 200 BEDDED CIVIL
HOSPITAL
Baksa Dr. Ravi Boro Civil
Hospital Baksa
Chirang J.S.B CIVIL Hospital
Chirang
Kokrajhar RNB CIVIL HOSPITAL
KOKRAJHAR
Dhubri Dhubri Civil Hospital
2 Cachar ✓ Silchar Medical College and S.M.Deb Civil Hospital
Hospital Silchar
Dima Hasao Haflong Civil Hospital
Hailakandi ✓ S.K.Roy Civil Hospital
Karimganj Karimganj Civil Hospital
3 Dibrugarh ✓ Assam Medical College and
Hospital
Tinsukia ✓ LGB Civil Hospital
Dhemaji Dhemaji Civil Hospital
4 Jorhat ✓ Jorhat Medical College and
Hospital
Golaghat Kushal Konwar Civil
Hospital
Sivasagar ✓ Sivasagar Civil Hospital
Lakhimpur North Lakhimpur Civil
Hospital
5 Kamrup M ✓ Guwahati Medical College & MMCH (Annex Sonapur District Hospital
Hospital (GMCH) Hospital of GMCH)
Ayurbedic College
Kamrup R TRB Civil Hospital
Nalbari ✓ SMK Civil Hospital
Darrang MANGALDAI CIVIL
HOSPITAL
Udalguri ✓ Udalguri Civil Hospital
Morigaon Morigaon Civil Hospital
6 Karbi Anglong ✓ Diphu Medical College and
Hospital
Nagaon B.P.Civil Hospital (MCH
wings Mohkhuhli)
7 Sonitpur ✓ Tezpur Medical College and Kanaklata Civil Hospital
Hospital
Table - 1
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2.4 Stakeholders and Beneficiaries
2.4.1 Stakeholders
The main stakeholders are the Health Department, Government of Assam, all the 7 MCHs and Target Hospitals (DCHs/
PHFs), the Project Development Partners (KRC, Yamashita Sekkei Inc., and Nippon Koei India Pvt. Ltd.). The funded and
promoted partner is JICA.
2.4.2 Beneficiaries
The main beneficiary is the Health Department and its various organizational units involved in planning and developing the
Health System maintenance and improvement project. Benefits also spread to service providers, patients, medical students
and the society impacted by strengthening of Health System.
2.5 Team mobilization
The Field Survey Consultancy Service agreement was executed on 02nd June 2021 and the date of commencement of
services was declared as 16th June 2021.
There are members in the team who were actively involved in the development of Questionnaires for Level of Satisfaction
and Care seeking behavior survey. The team under the leadership of Mr. Dipon Ghosh, Director-UEA, Dr. Nibedita Paul,
Team Leader- Survey and Mr. Santanu Hazarika, Civil Engineer together with Mr. Bhopendra Madar, Coordinator and Mr.
Rituparna Borkakoti, IT; developed questionnaires for different medical cadres and patients in any MCH/ DCH/ PHF.
The present status of mobilized Surveyors has been represented as tabular form as follows.
Table -2
Sl. No. Position Name
1 Team Leader – Field Survey Dr. Nibedita Paul
2 Surveyor (Coordinator) Mr. Bhopendra Madar
3 Surveyor (Coordinator & IT) Mr. Rituparna Borkakati
4 Surveyor Mr. Abhijit Banik
5 Surveyor Md. Aakib Ahmed Rezbi
6 Surveyor Mr Sailodhar Gohain
7 Surveyor Mr. Krishna Gopal Banik
8 Civil Engineer Mr. Partha Pratim Sarma
9 Sr. Civil Engineer Mr. Santanu Hazarika
10 Communicator Ms. Surabhi Agarwal
11 Surveyor Mr. Sujal Bhowal
12 Civil Engineer Md. Wasim Ahmed
13 Surveyor Md. Rafiqul Haque Ahmed
14 Surveyor Mr. Ramakant Goala
15 Surveyor Mr. Pradip Debnath
16 Surveyor Mr. Chandan Hazarika
17 Civil Engineer Mr. Nileem Kalita
18 Surveyor Mr. Suraj Banik
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3. THE APPRAISAL OF THE SERVICES PROVIDED.
3.1 General
The Field Survey Consultancy Services are intended to assist KRC and the consortium (Yamashita Sekkei Inc., and Nippon
Koei India Pvt. Ltd.) in conducting the field survey for all the 7 MCHs and 6 DCHs/ 6 PHFs (Target Hospitals) our appraisal of
the field survey services to be provided, has been formed by:
i. TOR and findings during the progressive phase of Level of Satisfaction;
ii. Status of survey activities;
iii. Needs for ongoing and immediate activities;
iv. Reports and other documents, etc.; and
v. Meeting with the Stakeholders (JICA, HFWD -GoA, DME, DHS, NHM, etc)
3.2 Coordination and Support
Under the overall guidance of KRC & the Consortium, the Field Survey teams are required to work closely with the Health
Department, GoA, all the & MCHs and the Target Hospitals. We also anticipate involvement of the representative from each
MCH and the Target Hospitals for coordination and support during entire survey activities.
At this current (COVID-19) Pandemic situation and under strict SOP from ASDAMA –The coordination and support from the
stakeholders and GoA will finally result in achieving broad goals against defined timeframe.
There are four different departments that are looking after the MCHs, Target Hospitals and Various Government Schemes.
The departments are:
Directorate of Medical Education (DME): Looks after all the operations of Medical College & Hospitals in Assam
Directorate of Health Services (DHS): Looks after all the operations of District Civil Hospitals and Primary Health Facilities in
Assam
Directorate of Health and Family Welfare (DHFW): Generally Directorate of Health and Family Welfare is the Department of
Assam for implementation of programmes like small family norms, universal immunization programmes and also to
implement the PC PNDT# act. All programmes are funded by Govt. of India as under RCH-II programme##.
National Health Mission (NHM), Assam: NHM supports to provide healthcare to rural population throughout the State Assam
with special focus on districts which have weak public health indicators and for weak infrastructure to bring about reduction in
child and maternal mortality. NHM also supports to improve universal access to public services for food and nutrition,
sanitation and hygiene and universal access to public health care services with emphasis on services addressing women’s
and children’s health and universal immunization. Also to support to improve access to integrated comprehensive primary
health care to bring about population stabilization. Generally NHM supports to promote healthy life styles.
Hence, our field survey activities are directly linked to and supported & coordinated by, DME and DHS.
Note: (1) # The PC-PNDT Act [The Preconception and Prenatal Diagnostics Techniques (Prohibition of Sex Determination)] was enacted
on 20 September 1994 with the intent to prohibit prenatal diagnostic techniques for determination of the sex of the fetus leading to female
feticide.
(2) ## Reproductive and Child Health (RCH) programme is a comprehensive sector wide flagship programme, under the umbrella of the
Government of India's (GoI) National Health Mission (NHM), to deliver the RCH targets for reduction of maternal and infant mortality and
total fertility rates.
3.3 Summary of the Services
The Field Survey services are being carried out in two phases under the three Components listed in the Terms of Reference
(TOR) and shown as below,
Component 1: Level of Satisfaction and Care Seeking Behaviour
1. Level of satisfaction of MEDICAL EDUCATION /TRAINING/ CME;
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2. Level of satisfaction of MEDICAL SERVICE PROVIDERS;
3. Level of PATIENT SATISFACTION; and
4. Care seeking behavior of people in Assam.
Component 2A: Management and Satisfaction
1. General Information & Management;

2. Patient statistics; and
3. Human Resources.
Component 2B: Facility and Equipment
1. Existing Facilities and concerns;

2. Availability and size of construction sites for facility expansion;
3. Survey of infrastructure condition (Electrical, Water Supply, Sewage, etc.);
4. Accessibility condition;
5. Access road;
6. Medical Equipment; and
7. Other information.
Accordingly, we feel stage wise Tasks to be performed are as below,
Summary of List of Tasks and its Descriptions

List of Task Description
1. Preparation, design and Focus technical aspects on activities related to the preparation of questionnaire for the
approval of questionnaires survey works to be undertaken under the programmes. Subsequently, approvals from the
concerned authorities.
2: Preparation of Work Plan A detailed work plan and activity schedule for Component 1 and Component (2A & 2B)
and Activity Schedule has been prepared to track the progress within the timeline.
3: Development of Web On finalization of the Questionnaires, the questionnaires shall be converted for online web
application online application App.
Questionnaire
4: Selection of Surveyors for The Team Leader – Survey shall select the Surveyors as per the requirement and gravity
the particular MCHs/ Target of the services for each MCH and DCH/ PHF.
Hospitals
5: COVID -19 Protocol All the members of the Survey team are to maintain the COVID-19 protocol strictly to
avoid infection.
6: Presentation, Approval and Communications from KRC and UEA to GOA and other stakeholders for the necessary
Permissions from GOA and approvals, permissions and accessibility for conducting the Survey activities without any
other stakeholders for hindrance.
conducting the survey activities.
7: Registration of the Survey An online registration process has been initiated to register all the sample stakeholders
stakeholders from MCH/ DCH (Doctors, interns, nurse, nursing student and other paramedical staff, etc.) for online
interview.
8: Direct interviewing of In- In the presence of the Surveyor and the coordinator, there will be an interview session
patient and Out-patient of MCH/ with the in-patient or out-patient, maintaining the COVID- protocol, using the Android
DCH mobile phone or iPad with the Surveyor.
9: Online interviewing of After completion of the registration process, there will be automatic generation of an OTP
Doctors, Interns, nurse and and User Id for each stakeholder for the online interview which will be informed through
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List of Task Description
other staff in MCH/ DCH SMS to the person concerned. The Surveyor shall follow up and guide the stakeholder for
any confusion during the interview session using his/her Android mobile phone or iPad or
Laptop/ Desktop.
10: Communication & All communication to any stakeholder of GOA/ KRC has to be reported from Director-
Reporting UEA.
There has been What’s App group formed within the team of surveyors to report daily
activities to the Team Leader- Survey. The team will also take note of the local situation
and appraise accordingly to all the team members for their movement and during any
adverse situation in relation to the security issue, if any, the concerned team member
shall intimate the Team Leader- Survey immediately for necessary decision.
11: Meetings & representations Director – UEA and Team Leader – Survey shall attend all the necessary meetings that
only after requested/invited by KRC. Again the meetings with GOA/ MCHs/ DCHs may be
attended by Director-UEA/ Team Leader/ Coordinator on behalf of KRC on the approval
of KRC only.
12: Data Filtering and Analysis After collection of sample data from various stakeholders as per ToR, the data shall be
scrutinised, filtered and analysed using Microsoft Excel, SPSS and Python Programming.
13: Preparation of Reports The draft final report shall be prepared based on the requirement of project need and the
sample data. The report shall highlight the various parameters that require for decision
making in the development of the project.
The field survey activity started on 19th July 2021 from Diphu MCH and Silchar MCH.
Due to current COVID-19 situation, preparedness for 3rd Phase of Pandemic, restrictions from travelling at night in curfew
and strict SOP from ASDAMA, GoA, the progress of the survey gets affected. Again there is inter-state border dispute
between Assam & Mizoram that created security issue for the surveyors’ movement. So, to keep the momentum of the
survey activities, the surveyors are to keep moving at the places where the security and safety issues are minimum or nil.
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Preparatory Study For Healthh System Strengthening Project IIn Assam State In The Republic of India
4. PROJECT ORGANIZATION AND PROCEDURE

4.1 Project Organisation
4.1.1 Survey Team Structure
Assam JICA
Government
Headquarters
Health & Family
INDIA Office
Welfare
Subletting survey on;

-Level of satisfaction (patient,
doctors, nurses)
-Basic information of facility
and equipment
- Basic information of hospital
management
4.1.2 Organisation Structure of the Field Survey Services

A dedicated Field Survey team under the leadership of Dr. Nibedita Paul has been established to cover all the 7 MCHs and 6
numbers of DCHs/ PHFs. The entire team is in close coordination with the representatives of the 7 MCHs are on site for the
survey activities. Regular communication with the Principal/ Chief Superintendent/ Superintendent is made for any Support in
conducting the survey activities. On the other hand, the survey team also communicated DHS for collecting the permission
and approval for conducting the survey activities in the selected DCHs/ PHFs.
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5. APPROACH & METHODOLOGY
5.1 General Approach
After initial discussion with KRC on 24th May 2021, UEA initiated and started in-house perceptive and assessment on the
approach for conducting the survey activities. The first meeting on 8th June 2021 with the entire Survey team, JICA and the
Government of Assam showed the light on the concept of the project, the purpose and the objective.
UEA then communicated the initial team members for preparing the work plan, methodology and questionnaires for
conducting the survey activities during COVID-19 situation when the infection rates were very high in Assam as compared to
other Indian States. Moreover, there was strict SOP from ASDMA, GoA.
The first point rose in the group that we have to avoid direct contacts while interviewing the medical cadres and patients.
Accordingly, planning for web application software App was incorporated in the methodology.
After attending series of meetings and discussions with the Survey Team, JICA and HFWD, GoA, we finally able to develop
11 numbers of Questionnaire for Level of Satisfaction and Care seeking behavior and One each set of questionnaire for
Facility & Equipment and Management & Satisfaction for all 7 MCH.
There shall be separate set of questionnaires for DCHs/ PHFs for Level of Satisfaction and Care seeking behavior and one
each set of questionnaire for Facility & Equipment and Management & Satisfaction.
There are groups of surveyors formed in viewing the current security scenario for conducting the survey activities where the
preference of surveyors is from the same district or area to avoid night travelling during curfew for security reasons.
However, there are Surveyors (team leader, coordinators and demonstrators) who have to travel to all the selected hospitals
for initiating, communicating the stakeholders and conducting the survey activities.
i. Preparation of Questionnaires and Work Plan

The preparation of questionnaires for Level of satisfaction started in the month of June and then the questionnaires were
converted in software application for online interviewing.
After discussion with the Principal, GMCH on 12th July 2021, the following sample outlines were drawn & concluded and
accordingly the questionnaires were modified and finalized.
The details of sample size for Level of satisfaction and Care seeking behavior of MCHs are as follows:
I. Level of satisfaction with Medical Education & Training

Stakeholder Name Sample Size/ Survey Item Output
Professor in MCH (Doctor) 10 number (covering all the
departments) Teaching/ Mentoring
Associate Professor in MCH 10 number (covering all the environment (facility, Needs for teaching
(Doctor) departments) equipment, condition, etc.) environment improvement
Assistant Professor in MCH 15 number (covering all the
(Doctor) departments)
Doctor (year of experience < 15 number (covering all the
=5) departments) Learning environment
Incentives to learning,
Interns 15 numbers (covering all (facility, equipment,
Needs for learning
departments) condition, etc.), contents of
environment improvement
Other Staff 20 numbers (covering all education/ training
departments)
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II. Level of satisfaction of medical service providers
Stakeholder Name Sample Size Survey Item Output
Doctor (year of experience > 15 number (covering all the
5) departments)
Doctor (year of experience < 10 number (covering all the
=5) departments)
Nurse 15 number (covering all the
Working environment/ Needs for medical
departments)
condition, facility, equipment, personnel and incentives
Nursing Student 10 number (covering all the
retention strategy, etc. to retention
departments)
Other Paramedical Staff (e.g. 10 number (covering all the
Pharmaceutical, Laboratory, departments)
Medical Equipment operators,
etc.)
III. Level of patient satisfaction

Patients in OPD of medical 50 number (covering all the Facility, equipment, clinical Needs of patients and
college hospitals departments) services/ outcomes, patient their family
services/ hospitality,
Patients in IPD of medical 50 number (covering all the consideration for the
college hospitals departments) vulnerable, reasons to skip the
nearest district hospital, etc.
IV. Care seeking behavior of people in Assam

Academic experts on medical Care seeking behavior and its Perception on
anthropology/ social medicine Maximum 2 numbers background factors in Assam government health
services
Proportionately we collected the information of the sample size of DCH/ PHF as per ToR,
The Questionnaires are:

Level of Satisfaction and care seeking behavior
1. Medical Teachers 5. Nurse 9. IPD
2. Doctors (> 5 Yrs experience) 6. Nursing student 10. OPD
3. Doctors (< =5 Yrs experience) 7. Other paramedical staff 11. Middle Class Patients
4. Interns 8. Academic Experts
However, we came to know that the Nursing Education/training and Education for other paramedical training have not
included with GMCH, JMCH, TMCH and DMCH. However, we have received the response for students for nursing and other
paramedical services in SMCH, AMCH and FAA MCH.
A work plan has been drafted for completing the survey activities within the time limit assigned, however we could able to
start the survey activities on 19th July 2021, initiating from DMCH and SMCH after obtaining the permission for inter-district
mobility on 16th July 2021. Again on the stakeholders meeting on 3rd August 2021, decision for selection of DCHs/ PHFs is
finalized.
On the other hand, we also finalized the questionnaire for Facility & Equipment and Management & Satisfaction and the
survey activities started from 29th July 2021.
ii. Planning for Survey Activities

Initially, the team started with 4 members for preparation of questionnaires, work plan and other planning activities. After
finalization of the questionnaire and obtaining the permission for accessibility in all 7 MCH, the team communicated to all the
7 MCHs for collecting the contact details of Doctors, Nurse, Interns, and other staff as per the sample size for the registration
in the web application.
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There were another 6 Surveyors, mobilized for conducting the survey activities of IPD & OPD in DMCH, GMCH, FAA MCH
and SMCH. At the same time they were involved in following up with the Doctors, Nurses, etc. for assisting in filling up the
online questionnaires. UEA also engaged a communicator who is supporting the Doctors, Nurses, etc. remotely and
clarifying all their queries and curiosities on the project. E.g. (a) what is JICA? (b) Will it affect my career, if not answering
any question? (c) How is the project helping me as I am retiring shortly? etc. Some were even deleting the SMS that
generated after registration of the concerned medical cadre as they are afraid of software hacking of their bank account.
Here the communicator plays a very good role to clarify and in boosting their confidence.
After inclusion of 6 DCHs and 6 PHFs, we engaged 9 more Surveyors for expediting the activities.
There are total 18 Surveyors and Engineers engaged in this Survey for conducting the survey activities within the
time limit.
iii. Communication with GoA, DME, MCHs, DHS

UEA received over whelming response from the Government of Assam and other stakeholder departments. UEA firstly
communicated Dr. Siddharth Singh, IAS Commissioner and Secretary to GoA, HFWD on 24th June 2021 where all the
department heads (DME, DHS, NHM, Jt. Director HFWD, etc.) were present. UEA presented the survey plan of actions and
requested for their support. UEA submitted the sample questionnaires for Level of satisfaction and care seeking behaviour to
GoA.
Again Dr. Singh and Dr. Laxmanan, IAS Mission Director NHM advised UEA to start all the 7 MCH without further delay and
accordingly it was then directed and advised to DME for necessary action.
On 25th June 2021, KRC wrote a letter to the Principal Secretary to GoA, HFWD on the accessibility and permission for
survey activities.
Again on 7th July, UEA representatives met Prof. (Dr.) Anup Kumar Barman, DME and appraise the methodology using a
PPT presentation, subsequently on 8th July 2021 UEA wrote a letter to DME, requesting for informing the Head of all 7 MCHs
regarding UEA’s engagement for conducting the Satisfaction Survey in all MCH. Accordingly, the DME issued a notification
on 9th July 2021 to all MCHs. DME also issued a notification on 16th July 21 for the permission for inter-district vehicle
movement for all the surveyors during Lockdown/ Containment/ Curfew areas as per SOP from ASDMA.
In the mean while, UEA met the Principal, GMCH on 12th July 2021 for initiating the Survey activities, Prof. (Dr.) Achyut
Baishya then explained to the survey team on the positions of the Medical College & Hospitals. He pointed that there is no
such Senior Doctor or Junior Doctor concept in the MCH. The positions are Professor, Associate Professor, Assistant
Professor and all of them are involved in teaching as well as in medical service too. He also mentioned that the Nursing
College and Paramedical Institute are excluded from GMCH. So, he can support only for those items which are available
with GMCH. A separate letter was submitted to him on 13th July 2021 with modified sample size and questionnaires were
then modified accordingly.
On 16th and 22nd July 2021, UEA communicated to all 7 MCHs, informing list of Surveyors to be present at the concerned
MCH for conducting the survey activities.
Again on 31st July 2021, UEA communicated to all 7 MCHs and shared the questionnaires for (i) Management & Satisfaction
and (ii) Facility & Medical Equipment.
Again to acknowledge, UEA received the list of contacts for Doctors, Nurse, Interns, Other Paramedical staffs, etc. from all
the MCHs except JMCH and GMCH. However, UEA wrote a letter on 22nd July 2021 to JMCH for further submission of the
list as requested.
Again, on the confirmation of DCHs on 4th August 2021 by HFWD, GoA and JICA; a letter from UEA was submitted to
Dr. Rathindra Bhuyan, Director of Health Services, Assam for informing the concerned DCHs for survey activities and
selection of nearest PHFs that attached to DCHs.
iv. Mobilization of Surveyors
The Surveyors were mobilized in phase manner as the target hospitals are selected and finalized for sample survey by JICA
and GoA on 4th August 2021. The initial survey preparation activities were started in the month of June (8th June 2021) for
planning & preparation of questionnaires and converting those into web application. The field survey started for Level of
satisfaction and Care seeking behavior on 19th July 2021 from DMCH and SMCH and then subsequently FAA MCH.
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UEA also engaged Surveyors for (i) Management & Satisfaction and (ii) Facility & Medical Equipment with effect from 29th
July 2021 initiated from SMCH.
v. Evaluation, Controlling and Monitoring of Progress
Controlling involves taking management actions, whereas the Evaluation process deals with the comparison of performance
with what was planned and drawing appropriate conclusions. At the same time UEA management is monitoring the entire
survey activities and its progress.
5.2 Web Application Approach

Considering the ongoing COVID situation in Assam, UEA took the initiative to conduct the survey activities using
Web Application App. However, the network and internet connectivity is still a major issue in Assam.
Application Model for Surveying Health System Strengthening, Assam

For conducting the survey under Component -1
i.e. Level of Satisfaction and care seeking behaviour
of the Patient, Nurse, Doctors, Professors and
students related with Medical or Health departments
a web based application based survey model has
planned to design which will be running any Android
based mobile or web browser and operated through
any Android 4G Mobile Handset / Tablet or any
Laptop devices.
The data will be saved on the server through cloud

based environment which will be again retrieved as
and when require for further analysis.
Figure - 2
Importance of HSS Web Based Survey Application
Web based survey will be most appropriate during this pandemic situation
Surveyor will be more safe and secured
It will be helpful to collect data systematically
It will also helpful for organization of data
Collected data will be kept more secured
Real time data will be collected
Data will be authenticated
Use of log-in password will help in identification of user/surveyor.
Main Features of the HSS Web Based Survey Application

Removes all manual paper work related with the survey
Parallel data collection Process
Reduce long time interview process
Surveyor Identified easily from where data is not submitted as per work schedule
Survey data are easily accessible for further analysis
User of the application can easily submitted the data without any fault
System also indicates the user to identify all left out question before submitting
The secret key of the application can hides all the records from the surveyor submitted by the user.
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Web based Survey Model:

In the web based survey model the “System Administrator” can add the Hospital Wise Surveyor in the
System and Generate user login and password for the particular Hospital. The Surveyor can then visit to the
Hospital and collect data after interviewing the patients and other staff of the Hospital and submit in the web
based model along with the photograph of the concern person and GPS location of the survey.
Figure -3
The survey application saved data to the Server through internet which will be retrieved by the system admin as
and when require for further analysis of the data.
To view the survey filled up form
Desktop View
Figure -4
Kindly refer our earlier progress report for details of Web application methodology.
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5.3 Status of Survey Activities
The survey activities are completed despite the COVID situation and shortage of time; however, after
several pursuance’s, we are yet to receive the documents from GMCH. The team faced lots of difficulties
to enter into the GMCH premises for the collection of photos of the various infrastructure facilities due to
COVID situation. We also found the non availability of some of the stakeholders (e.g. nursing student,
academic experts, etc.) in some of the MCHs..
5.4 Summary of Correspondences with KRC and Health Department of Government of Assam
From To Dated Subject

PS, All
8th June 21 Notification: Strengthening Health System and Excellence of Medical Education
GoA Stakeholders
25th June 21
Request for permission for field survey, collecting documents, and movement in
KRC PS, GoA (Mailed on 28th
lockdown/curfew
June 21)
Requesting to notify an officer to coordinate with the field survey team for the
KRC CS, GoA 2nd July 21
survey activities in Guwahati Medical College & Hospital and other 6 MCHs
25th June 21
Request for permission for field survey, collecting documents, and movement in
KRC CS, GoA (Mailed on 8th
lockdown/curfew
July 21)
Requesting for kind support for conducting the field survey activities in Guwahati
UEA DME 8th July 21
Medical College & Hospital and other 6 MCHs in Assam.
DME All MCH 9th July 21 Regarding Preparatory survey for Assam Health System Strengthening Project'
Requesting for kind support for conducting the field survey activities in Guwahati
UEA GMCH 13th July 21
Medical College & Hospital.
Requesting for granting permission for inter districts Vehicle Movement for
UEA DME 14th July 21 conducting the field survey activities in 7 MCHs and Other Target Hospitals in
Assam.
DME UEA 16th July 21 Permission from DME
UEA 6 MCH 22nd July 21 Requesting for kind support for conducting the field survey activities
Questionnaire for Survey on (1) Management & Satisfaction and (2) Facility &
UEA 7 MCH 31st July 21
Equipment.
Requesting for kind support for conducting the field survey activities in the Six
UEA DHS 4th August 21 Target Civil Hospitals and One each Primary Health Facility near to the Civil
Hospital.
Requesting for granting permission for inter districts Vehicle Movement for
UEA DME 6th August 21 conducting the field survey activities in 7 MCHs and Other Target Hospitals in
Assam : for more numbers of surveyors
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5.6 Detailed List of Representatives from Health Department of Government of Assam
HFWD, GoA HFWD, GoA DME DHS MHC

Shri Anurag Dr. Siddartha Prof. (Dr.) Anup Dr. Ratindra Bhuiyan, Guwahati MCH:
Goel, IAS Singh, IAS Kumar Barman, Director, DHS : Dr U K Sarmah:
Principal Commissioner & Director, DME 9435100090, 9435340059,
Secretary Secretary HFWD 9864065349 Dr Kuldeep
HFWD Government of Dr. Lalsing, Additional Goswami :
Government of Assam Director DHS: 9707049789,
Assam 9101877330, Metron:
Ms. Anjali Nath :
7002302270
Prof. (Dr.) Goalpara: Jt. Director FAA MCH Barpeta:
N Sarmah, Deputy Dr Abhijit Basu : Dr Uddip Talukder:
Director DME: 8876482434, 8753956772
9864296343 9435199163
Hailakandi: Jt. Director Diphu MCH:

Dr Ashutosh Barman : Dr Sumitra Hagjer,
9435071031 Principal:
9435144372
Tinsukia: Jt. Director Silchar MCH:
Dr Altaf Ahmed (JD) Dr A K Barua:
:8638851943, 9401952153
9678084343,
Dr Mridul Gogoi
(Superintendent CH):
9435528637
Sivasagar: Jt. Director Dibrugarh MCH:
Dr S M Sarmah: Dr Rupak Gogoi :
9435093640, 9435031260
6001813611
Nalbari: Jt. Director Tezpur MCH:
Dr Umesh Phangshu Dr Karuna Hazarika:
:9954095705 9864018665
Udalguri: Jt. Director Jorhat MCH:
Dr. Bramha : Dr Ratna Talukder:
7002626787 9864015372
A1-15
NAME AND CONTACT DETAILS OF PRINCIPAL, MEDICAL COLLEGES AND HOSPITALS, ASSAM
Sl. Name of MCH Name of The Principal Mobile E-mail ID
No. Phone
(+91)
1 Assam Medical Dr. Sanjeeb Kakati 87230 51445 principalamch@rediffmail.com;
College & Hospital
superintendentamc@rediffmail.com
2 Guwahati Medical Dr. Achyut Baishya 99540 75427 gmch-asm@nic.in
College & Hospital
3 Silchar Medical Dr. Babul Bezbaruah 98640 66772 principlsmc@gmail.com

College & Hospital
4 FAA Medical Dr. Ramen Talukdar 9435973537 faamc.barpeta2010@gmail.com

College & Hospital
Barpeta
5 Tezpur Medical Dr. Karuna Hazarika 98640 18665 tmctezpur@gmail.com
College & Hospital
6 Jorhat Medical Dr. Ratna Talukder 98640 15372 jmc-asm@nic.in

College & Hospital
7 Diphu Medical Dr. Sumitra Hagjer 94351 44372 drsumitrahagjer123@gmail.com;

College & Hospital
principaldiphu1@gmail.com
A1-16
Annex II Important Modules in the National Health Mission
The following important modules are developed under GOI/NHM guidelines and in use. (there are several
other modules for use in NHM related activities)
Sl Important modules in NHM Access to
DHS/DFW/DME
1 Swasthya Sewa Dapoon Yes
1 (a) HR – MIS Yes
1 (b) Inventory Management Yes
1 (c) Civil Works Monitoring System Yes
1 (d) Maternal Death Reporting System Yes
1 (e) Child Death Reporting and Review System Yes
1 (f) ASHA Payment and Performance Monitoring System Yes
1 (g) Wage Compensation Scheme for pregnant women of tea gardens Yes
1 (h) HWC-CHO Performance Monitoring System Yes
1 (i) VHND (Village Health & Nutrition Day) Monitoring System Yes
3 Government of India Portals
3 (a) RCH portal Yes
3 (b) Health Management Information Management System (HMIS) Yes
3 (c) AB-HWC Portal Yes
3 (d) NIN Portal At present only with
NHM
3 (e) IHIP – IDSP Yes
3 (f) Nikshya – NTEP Yes
3 (g) e-Hospital
3 (h) DVDMS – CDAC
4 Other Portal
4 (a) 24 X 7 Command and Control Centre Yes
4 (b) Bio medical equipment maintenance program Yes
4 (c) 108 – Emergency Referral Transport System Yes
4 (d) Chief Minister’s Free Diagnostic Service – X-Ray Services Yes
4 (e) Chief Minister’s Free Diagnostic Service – CT Scan Services Yes
4 (f) Chief Minister’s Free Diagnostic Service – Laboratory Services Yes
A2-1
Annex III NHM - MIS PLAN 2021-22
よ
合 GUIDELINESFORIMPLEMENTATIONOFH
MIS,RCHPORTAL/MCTS ド
び
ANDM&EACTIVITIESFORTHEFINANCIALYEAR2021-22
Index
S
I Content PageNo
1 P
ref
ace 3-7
2 Summaryofa
llo
cat
ionfort
heyear2021・22 8
3 GeneralG
uid
eli
nes 9
A Gui
delinesforTra
ini
ngcumr β ＆MCTS
eνiewmeetingforH M 10-14
atDis
tri
ctlevel
B G
u i
deline
sforTr
ain
ingcumreviewmeetingforHMIS& MCTS 15-21
。tBlockle
vel
C G
uidel
ine
sforM obil
itySupportforHMIS& MCTSatD
ist
ric
t 22-25
l
eve
lfortheyear2021・22
D G
uid
eli
nesforP
rin
tin
gofHMISFormats 26-28
E G
uid
eli
nesforo
per
ati
ona
lco
stforHMIS&MCTS 29-35
F G
uid
eli
nesforo
per
ati
ona
lco
stforAN
MOL 36-37
G G
uid
eli
nesforimplementationofe
-Ho
spi
tals
olu
tio
n 38・4
1
d
N
ati
ona
lHe
alt
hMi
ssi
on,Assam P
age2
dy
A
／
u
A3-1
GUIDELINESFORIMPLEMENTATIONOFH
MIS,RCHPORTAL/MCTS 色
れ
~
ANDM&EACTIVITIESFORTHEFINANCIALYEAR2021・2
2
P
ref
ace
:
N
ati
ona
lHe
alt
hPo
liy2017emphasizet
c oensured
ist
ric
t-l
eve
lel
ect
ron
icdatabase
o
fin
for
mat
ionon h
eal
thsystemcomponents.S
tat
ePP2
I 0
21-
22ofAssamfocusedon
b
uil
din
gel
ect
ron
icdatabaseofa
l
lhe
alt
hprogrammes.However,theremays
lig
htchanges
i
nthes
tra
teg
iesa
fte
rimplementationo
fNa
tio
nalD
igi
talH
eal
thM
iss
ionwhichw
il
lbe
communicatedonduecourseo
fti
me.
F
oll
owi
nga
cti
vit
iesa
rep
rio
rit
ize
dinthef
ina
nci
alyear2
021
-22
:
1
. H
eal
thManagementInformationSystem(
HMI
S):
N
ati
ona
lHe
alt
hMi
ssi
on,Assam hasimplemented HMISsystemi
ntheS
tat
efrom
2
008
-09.100%f a
cil
itywisedatai
suplo
adin
geverymonthintheHM15WebP o
rta
l.
Intheyear2020-21,States
hif
tedtonewHMISP or
talprovidedbyN
ation
alHe
alt
h
M
iss
ion
,Assam.
HMISdatai
swidelyusedf
orp
lan
nin
g,programmeimplementationandm
oni
tor
ing
&reviewpurposes.Dis
tri
ctw
ise
,h e
althblockwiseandf a
cil
itywiseana
lysisofHMISdata
i
scar
riedouta tStat
eHQandthea nal
ysisrepo
rtissharedwitha l
lst
akeholde
rsforta
king
c
orr
ectivemeasures.HMISdataisalsousedduringpreparatio
no fDi
stri
ctHealt
hActio
n
P
lanandS
tat
ePI
P.Reviewmeetinga
tSt
atel
eve
l,d
ist
ric
tle
velandb
loc
kle
vela
rebased
on HMISd
ata
.Intheyear2
021
-22
,iti
sproposedt
oco
nti
nue useo
fHMISdataf
or
p
lan
nin
g,programmeimplementationandm
oni
tor
ingp
urp
ose
s.
F
oll
owi
ngp
rio
rit
yac
tiv
iti
esa
reproposedi
nthef
ina
nci
alyear2
021
-22
:
i
) ntheyear2
I 021
-22
,iti
sproposedt
oensureu
plo
adi
n f100%f
go aci
lit
ywisedatai
n
theHMISP
ort
al.Timelyu
plo
adi
ngo
fda
ilyr
epo
rt, monthlys
erv
iced
eli
ver
yda
ta,
monthlyi
nfr
ast
ruc
tur
edataandd
ist
ric
tHQformats
hal
lbep
rio
rit
yinthef
ina
nci
al
year2
021
-22
.
i
i
) ThoughnewHMISpo仕 a n2
limplementedi 0
20-
21,propert
rai
nin
gupt
ope
rip
her
y
l
eve
lco
uldnotbecompletedduet
ore
str
ict
ion
sofc
ovi
dpandemic.O
rie
nta
tio
non
monthlyi
nfr
ast
ruc
tur
eformats
hal
lbeconductedt
oensuredataq
ual
ity
.Intheyear
2021-
22,i
tisproposedtopro
video
rie
ntati
onofa
l
ldatahan
dle
rs.
i
i
i) Focusonda
t aqu
alityis
sue
swil
lbepri
ori
tize
din2
021
-22.
i
v) Asperd
eci
sio
ntakenbyGovernmento
fIn
dia
,nowR
ura
lHe
alt
hSt
ati
sti
csw
illbe
p
ubl
ish
edbased ondatauploadedi
nth
eIn
fra
str
uct
ureand HRformato
fHMIS.
S
pec
ialf
ocu
ssh
allbeg
ive
nonthed
ataq
ual
ityo
fIn
fra
str
uct
ureandHRrepo同
．
v
) Withano
bje
cti
vet
oimproved
ataq
ual
ityi
nHMlSandRCHP
ort
al,mandatorydata
v
ali
dat
ionsystemunderN
ati
ona
lHe
alt
hMi
ssi
on,Assamw
illcontinuei
ntheS
tat
e.
N
ati
ona
lHe
alt
hMi
ssi
on,Assam Page3
；
ルf
パt
ヤ十
l U
A3-2
付
﹀
MIS,RCHPORTAL/MCTS
事
A
lld
atapersonsa
tSt
ate
,Di
str
ictandB
loc
kwi
llv
is
ita
tle
ast10f
aci
lit
iespermonth
t
ova
lid
ated
atauploadedi
nth
eHMISwebp
ort
al.
v
i) P
eri
odi
cre
vie
wofHMISdataelementsl
ink
edw
ithS
tat
eHe
alt
hIn
dexo
fNI
TIAayog,
SDGI
ndi
cat
ors
,Ru
ralH
eal
thS
tat
ist
ics
,Di
str
ictH
osp
ita
lRa
nki
ng,PHCG
rad
ing
,CHC
G
rad
ing
,SDCHGradings
hal
lbeundertakena
tSt
ateandD
ist
ric
tle
vel
.Th
isw
illbe
anotherf
ocu
sar
eaf
ort
hef
ina
nci
aly
ear2021・2
2.
2
. RCHPo同a
l,ANMOL,K
ilk
ariandMobileAcademy:
S
tat
ehasa
lsoimplementedReproductive& C
hil
dHe
alt
h(RCH}P
ort
alaugmented
v
ers
io fMother& C
no hil
dTr
ack
ingSystem(MCTS)i
nth
eSt
ate
.St
ateh
astakens
pec
ial
f
ocu
sfo
rti
mel
yupdatingo
fdatai
ntheRCHandu
til
iza
tio
nofd
ata
.Ve
rif
ica
tio
nofWork
p
lanw
ithRCHR
egi
ste
rand byv
isi
tin
ghouseof2 pregnantwomen/motherhasbeen
mademandatoryf
ora
llmonitoringo
ffi
cia
ls.
Fromthemontho
fNovember2018,RCHP
ort
alhasbeenimplementedi
ntheS
tat
e.
F
oll
owi
nga
cti
vit
iesa
rep
rio
rit
ize
dinthef
ina
nci
alyear2021-22:
i
) I
nthe FY2
021
-22
,iti
senvisagedt
oro
lloutRCH P
ort
alwith 100%coverageo
f
日igi
bleC
ouple,PregnantWomenandCh
ildr
en.
i
i
) Re
gularupdatingofs erv
icede
liv
erydata and u
til
iza
tio
nofwork-plan s
hal
l be
f
ocu
sareaf
or2021
・22f
orRCHP
ort
al.
i
i
i) ANMOL(ANM o
nli
ne)T
abl
etbasedv
ers
iono
fRCH P
ort
al has beens
tar
tedi
n7
a
spi
rat
ion
ald
ist
ric
tso
ftheS
tat
e.ANMOLw
illber
oll
edouti
nal
lSubC
ent
reso
fth
e
S
tat
eal
ongw
ithNCDa
ppl
ica
tio
n.
i
v) Implementationofv
ers
ion2
.0o
fRCHR
egi
ste
rdevelopedbyM
ini
str
yofH
eal
th&
F
ami
lyW
elf
are
, Governmento
fIn
diaw
ill be another major f
ocu
sar
eaf
orthe
f
ina
nci
alyear2021-22.T
rai
nin
gofANMandf
iel
dle
vels
taf
fwi
llbecompletedw
ith
in
znd qua同e
rofthef
ina
nci
alyear2
021
-22
.Tr
ain
ingo
fANMsonthenewRCHR
egi
ste
r
w
illbetakenupd
uri
ngB
loc
kle
velt
rai
nin
gs.
v
) F
or smooth implementation o
f RCH R
egi
ste
r2.
0,i
tis proposed t
opr
ovi
de
"
Ins
tru
cti
onManualf
orANMsonRCHR
egi
ste
r2.
0”t
oal
lANMsi
nthef
ina
nci
al
y
ear2
021
-22
.In
str
uct
ionmanuals
hal
lbemadea
vai
lab
lewitha
llANMsandf
iel
d
l
eve
lst
affa
fte
rthef
ina
lve
rsi
ono
fin
str
uct
ionmanualr
ece
ive
dfromGovernmento
f
I
ndi
a.O
rie
nta
tio
n onthe i
nst
ruc
tio
n manual i
sal
so proposed t
o be c
arr
iedout
d
uri
ngmonthlyb
loc
kle
velr
evi
ewmeetingcumt
rai
nin
gs.
v
i) F
oll
ow up o
f pregnant women and c
hil
drn through ”
e Assam E
arl
y Childhood
DevelopmentC
allCentre"w
illbecontinuedi
n20
21-
22.Assam MCTSC
allCentre
d
N
ati
ona
lHe
alt
hMi
ssi
on,Assam Page4
dv
／
ho
A3-3
W
﹁ UV
／
︶
MIS,RCHPORTAL/MCTS
V
司
ANDM&EA CT
IVITIE
SFORTHEFINANCIALYEAR2021・22
wasmadee
sta
bli
shdon1
e stA
prl2
i 0
13.AssamMCTSC
allCentrewasupgradedt
o
Assam E
arl
yChildhood DevelopmentC
allCentreon 1
stJanuary2020toprovide
s
erv
ice
stot
he pregnant women and c
hil
dre
nas per g
uid
eli
nesc
irc
ula
ted by
Governmento
fIn
dia
.
v
ii
) V
eri
fic
ati
onandv
ali
dat
ionofphonen
u!'
"be
rofANMandASHAw
illbefocused
a
reai
nthef
ina
nci
alyear2
021
-22
.
v
ii
i)K
ilk
ari and Mobile Academys
erv
ice
sofM
ini
str
yofH
eal
th& F
ami
lyW
elf
are
,
Governmento
fIn
diahasbeenr
oll
edouti
ntheS
tat
e ntheyear2021
.I ・22
,iti
s
proposed t
ofo
cus on awareness a
cti
vit
ies on K
ilk
ari and Mobile Academy.
Awarenessi
sproposedt
obec
arr
iedouti
nthemonthlyb
loc
kle
velreviewmeeting
cumt
ra川n
i gsandb
loc
k/s
ect
ora
lle
velASHAm
eet
ing
s.Emphasizew
illbeg
ive
nto
c
apt
urec
orr
ect phone number o
f pregnant women. Pregnant women w
ill be
informedabouttheK
ilk
arimessagesa
tthetimeo
fre
gis
tra
tio
nofANCt
oav
ailf
ul
l
b
ene
fitofthes
erv
ice
.
3
. D
ist
ric
tVaccineD
ist
rib
uti
onManagementSystem(DVDMS):
S
tat
e has a
lre
adys
tar
ted the p
roc
esso
f implementation o
f "Drugs Vaccine
D
ist
rib
uti
o ”
n Management System (DVDMS） developed by ’
℃en
tre f
or
DevelopmentofAdvanceComputing(
C-D
AC)
" underM
ini
str
yofE
lec
tro
nic
sand
I
nfo
rma
tio
nTechnology(
Mei
tY)
.Inthey
ear2021・22i
tisproposedt
oro
lloutthe
DVDMSsystemupt
oHe
alh&WellnessC
t ent
res
.
4
. e
-Ho
spi
tals
olu
tio
n:
P
roc
essf
orimplementationo
fe-
Hos
pit
als
olu
tio
nofNICi
n25D
ist
ric
tHo
spi
taland
MedicalUnito
fAssamSec
ret
ari
athasbeensta
rte
d.
Inthef i
nan
cilyear2
a 0
21-22,i
tisproposedtoimplemente
-Ho
spi
tals
olu
tio
nin3
newD
ist
ric
tHo
spi
tal
satM
aju
li,H
oja
iandCharaideod
ist
ric
ts.
ntheyear 2021
I ・22
,iti
s proposed theO
per
ati
ona
lco
sto
fe-
Hos
pit
als
olu
tio
n
i
ncl
udi
ngI
nte
rne
tco
nne
cti
vit
y,AMC,Maintenance,O
ffi
ceConsumablese
tc.f
or29
H
osp
ita
ls(
26e
xis
tin
g+3new).
Implementationo
f"MeraA
spa
taa
l"a
ppl
ica
tio
nisanotherp
rio
rit
yar
eaf
ortheFY
2021・2
2.
N
ati
ona
lHe
alt
hMi
ssi
on,Assam Page5
も：}J.11-·~ ψ A3-4
仰し
GUIDELINESFORIMPLEMENTATIONOFHMIS,RCHPORTAL/MCTS
’ ANDM&EACTIVITIESFORTHEFINANCIALYEAR2021・22
5
. Implementationofe-Governancei
nit
iat
ive
sofGovernmentofI
ndi
a:
i
) NINPo同a
lhasbeenimplementedi
ntheS
tat
eal
lph
ysi
calp
ubl
ich
eal
thf
aci
lit
iesh
as
beenv
eri
fie
dandc
onf
irm
ed.I
nthef
ina
nci
alyear2
021
-22
,iti
sproposedt
ofo
cuson
100%updatingo
fda
t ntheNINpo同a
ai l.
i
i
) D
ail
yandmonthlyr
epo
rti
n ntheAB-HWCPo同a
gi lsh
allbecontinuedi
nthef
ina
nci
al
year2021・2
2.
i
i
i} S
tat
e has a
lso developed one i
n-h
ous
e web a
ppl
ica
tin "CHO・HWC P
o ort
al’
F t
o
monitorPerformanceBasedI
nce
nti
veo
fHe
alt
hWellnessCentreteams.Thesystem
i
s proposed t
o be continued i
n the f
ina
nci
al year 2021・22 f
or monitoring and
paymento
fteambasedi
nce
nti
veo
fHWCteami
ncl
udi
ngCommunityH
eal
thO
ffi
cer
,
i
v) I
tis proposed t
o continue the other e
xis
tin
gon
lin
e systems l
ikeo
nli
ne SNCU
m
oni
tor
ings
yst
em, PMSMAP
ort
al, NCDP
ort
al,MCDSRs
oft
war
e underSUMAN
i
nit
iat
ive
s,RBSKPo内a
l,DBTP
ort
al,F
P-L
MIS
,et
c.
6
. SwasthyaSewaDapoon-I
nte
gra
tedMISGISSystem:
S
tat
ehasa
lsoimplemented”
SwasthyaSewaDapoon-I
nte
gra
tedMISG
ISSystem”
whichhasbeendevelopedu
sin
gopensourcetechnologybyu
sin
gin
-ho
usec
apa
cit
y
o
f NHM, Assam. Important modules l
ik W件 MlSぺ
e’ ”Inventory Management
ぺ
System＂ASHAPaymentandPerformanceMonitoringSystemぺ
， Mate「『、 alDeath
Reporting Systemぺ＂Ir】f
ar 「
t Death Rep
】。ting Systemぺ
ぺ
Monitoring System， CHO-HWC Performance Monitoring System＂
，
”Civil Works
MonitoringSystem＂
，
” WageCompensationSchemeforPregnantWomenofTea
Gardens"e
tc.havebeenimplemented.
・M
HR ISsystemhasbeenf
ull
yimplementedi
ntheS
tat
eand HRdataupdatedf
or
bothreg
ula
randemployeesunderNHM. Now,a
l
lt r
ansf
er,posti
ng,re
leaseand
joi
nin
gofal
lemployees(
bot
hR e
gula
randNHM)a redonethroughtheonl
ineHR-
MISsystemo
nly
.Pa
y-s
lipo
fNHMemployeesgeneratedthrought
hissystemo
nly
and100%s
ala
rypaymenti
smadethroughPFMSu
sin
gtheHR-MISs
yst
em.
S
imi
lar
ly, 100% paymento
fASHA i
nce
nti
ve made through "ASHA Payment and
．
PerformanceMonitoringSystem”
A
llthesea pp
lic
ationsareproposedt
obecontinuedi
nthef
ina
nci
alyear2
021
-22
.
7
. e
-Pr
ast
uti-S
tan
dar
diz
ati
onofNHM,Assamw
ebs
ite
:
Websiteo
fHe
alh& F
t ami
lyWelfareDepartmentandi
tsc
ons
tit
uen
tor
gan
iza
tio
ns
d
i
ncl
udi
ng NHM, Assam has been developed and hosted under e
-Pr
ast
uti
N
ati
ona
lHe
alt
hMi
ssi
on,Assam Page6
d
v
／AV
A3-5
九い︶
:G
t UIDELINESFORIMPLEMENTATIONOFH
MIS
,RCHPORTAL/MCTS
S
tan
dar
diz
ati
ono
fwebsitea
sperg
uid
eli
nesc
irc
ula
tedbyWebDevelopmentTeam
o
fNI
C ntheyear2021・2
.I 2,i
tisproposedt
ore
gul
arl
yupdatethewebsitea
spere
-
P
ras
tut
igu
ide
lin
es.
8
. C
apa
cit
yBu
ild
ingonHMISandRCHPo同a
l:
F
oll
owi
ngc
apa
cit
ybu
ild
ingworkshopsa
reproposedi
nthef
ina
nci
aly
ear2
021
-22
:
i
) S
tat
ele
vel workshop c
ove
rig HMIS, RCH Po同a
n l, ANMOL and other I
T
i
nit
iat
ive
s
i
i
) D
ist
ric
tle
velq
uar
ter
ly review meeting cum t
rai
nin
gco
ver
ing HMIS, RCH
P
ort
al,ANMOLandotherI
Tin
iti
ati
ves
i
i
i) B
loc
kle
velmonthlyreviewmeetingcumt
rai
nin
g
9
. C
apa
cit
yBu
ild
ingonAdvanceDataA
nal
ysi
s-Newproposali
nco
lla
bor
ati
onwith
UNICEFandWHO:
I
n the y
ear2
021
-22
,iti
s proposed t
oor
gan
izet
rai
nin
g programme o
f
advance d
ataa
nal
ysi
sfo
rSt
ate
,Di
str
ict and B
loc
kle
vel data managers i
n
c
oll
abo
rat
ionwithUNICEFandWHO.
Thet
rai
nin
gisproposedt
obeconducti
nvi
rtu
alp
lat
for
m.Resourceperson
fromUNICEFandWHOw
illp
rov
idethet
rai
nin
g.
N
ati
ona
lHe
alt
hMi
ssi
on,Assam Page7
仇
JY
八守
Jy
A3-6
、
t
Summaryofa
llo
cat
ionf
ortheyear2021-22:
Fundallo
catio
nfo
r
New ApprovedBudget ResponsibleOff
ice
rofthe Fundal
locat
ionfor
D
ist
ric
tandBlockle
vel
FMR 2021・22 acti
vit
y Stat
eleve
lacti
vit
y
A
cti
vity/
Sub-
A c
tivity a
cti
vit
y
(
a sper
Fin
.
RoP, Budget At At Fi
n.
(
inclu
dingP Mact
ivi
ties
) Quantity/ AtS
tate Q
u an
tity/ a
llocat
ion Q
uanti
ty/
2021- (Rs. DPMU BPMU allo
cati
on
Target HQlev
el Target (Rs.in Ta
rget
22
) Lakhs) lev
el lev
el (
Rs.inla
kh)
l
akh)
T
a b
let
s:softwaref
orimplementation Manager-
6
.1.
2.S
.2 10714 257.140 DDM BDM 7955 190.
920 2759 66.
220
ofANMOL MIS
9
.5.
26.
1
T
raini
ngcumreviewmeetingf
& MCTSatS
tat
eL ev
el
orHMIS
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MIS
『
・
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710 。 0.
000
9
.5.
26.
2
T
raini
ngcumreviewmeetingf
& MCTSatD
ist
ric
tLevel
orHMIS
132 72.420
Manager-
MIS
DDM 。 0.000 132 72.420
9
.5.
26.
3
T
raini
ngcumreviewmeetingf
orHMIS
1836 101.070
Manager-
DDM 。 101.070
A3-7
BDM 0.000 1836

& MCTSatB
lockLev
el MIS
1
2.9
.1 P
rin
tin
gofHMISFormats 2897952 28.980
Manager-
MIS
DDM BDM 。 0.000 2897952 28.980
12.
9.4
Any Other (P
rin
tingo fIns
tru
ctio
n
12500 12.500
Manager-
12500 12.500 。 0.
000
1
4.2
.2
ManualsofRCHReg
Implementationo
i
ste
rve
fDVDMS
r
sion2.
0)
1 68.470
MIS
1 68.
470 。 0.
000
Manager-
1
6.3
.2 M
obi
lit 代 f
ysuppo orHMISandMCTS 4080 50.
520 DDM BDM 120 3.000 3960 47.
520
MIS
Operat
i o
nalc o
stforHMIS& MCTS
(i
nc
l.Internetcon
nect
ivity;AMCof Manager-
1
6.3.
3 34 464.000 DDM BDM 1 398.150 33 65.
850
Laptop,pri
nter
s,computers,U
PS; MIS
Mobilereimbursement)
16.
3.S C
allCentre(Capex/Opex) 1 456.000
Manager-
MIS
1 456.000 。 0.
000
Implementationo
fHo
spi
tal Manager-
1
7.6 29 102.340 HA 3 33.300 26 69.040
ManagementSystem MIS
TOTAL: 2927280 1618.150 20582 1167.050 451.100
NationalHealthMission,Assam Page8
ミ
（
〆 GUIDELINESFORIMPLEM凹 TATIONOFH
MIS,RCHPORTAL/MCTSQ
_1
'1
苛
G) Guidelines for implementation of e-Hospital Solution (Hospital Management

SystemofN IC):
e
-Ho
spi
tals
olu
tio
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sbe
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implementedi
nal
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str
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osp
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nito
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AssamS
ecr
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I
n theyear 2
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-22
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spi
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olu
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nin 3 new D
ist
ric
t
H
osp
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lsa
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oja
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har
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oll
owi
ngmodulesa
rec
urr
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ala
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i
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ill
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adi
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lin
ic
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iet
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toe&Pharmacy
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i
x) OTManagement.
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. One-timec
ost(Onlyf
orD
ist
ric
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spi
tala
tHo
jaiandM
aju
li)
:
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akh
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orimplementationo
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ist
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aju
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rin
ter
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shm
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ter
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ect
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tc.
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ithP
rin
terandUPScanbeprocuredf
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ist
ric
t
h
osp
ita
l.
c
) Anamounto
fRs
.6.00l
akh
searmarkedf
orprocuremento
f10numberso
fComputer
s
etswithP
rin
terandUPS.
d
} The a
llo
tme
nto
fthe Desktop ComputerandUPSalongwith P
rin
tercan bedone
p
rio
rit
ywisedependingonnumbero
fBe
ds,OPDl
oad
s,I
PDl
oad
s,numbero
fNu
rsi
ng
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tat
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/Warde
tc.
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rin
terandUPSprovidedf
orimplementationo
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Hos
pit
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nshould
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nst
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edi
nther
esp
ect
ivel
oca
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nsl
ikeOPDR
egi
str
ati
onC
oun
ter
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egi
str
ati
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C
oun
ter
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egi
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ter
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bor
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tor
e,D
isp
ens
ingRoom,e
tc.
f
) I
nte
rne
tco
nne
cti
vit
yshouldbee
sta
bli
she
dina
llcomputers.D
ist
ric
tHo
spi
talmayt
ake
I
nte
rne
tCo
nne
cti
vit
yofanymode based on f
eas
ibi
lit
y/a
vai
lab
ili
tyi
nthe l
oca
tio
n
w
ith
inthebudgetl
imi
t.
g
) I
tissuggestedt
obuyDataCard(
Don
gle
)wi
thminimum1yearwarrantyt
oovercome
thei
ssu
eofLAN(
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alAreaNetwork)C
onn
ect
ivi
tγa
tDi
str
ictH
osp
ita
l.Dongleshould
workf
ora
llI
nte
rne
tSe
rvi
ceP
rov
ide
r.Based on a
vai
lab
ili
ty and f
eas
ibi
lit
yofthe
N
ati
ona
lHealthM
iss
ion
,Assam Pag
e38
政〆 A3-8
v
／
b
手t
内ν
．
I
nte
rne
tco
nne
cti
vit
y/bandwidth c
onn
ect
ion (4G SIM)tobetakenfrom I
nte
rne
t
S
erv
iceP
rov
ide
r.TheSIMconnectionshouldbeonp
re-
pai
dba
siss
oth
ati
tco
uldbe
easyt
ochanges
erv
icep
rov
ide
rift
her
eisanyC
onn
ect
ivi
tyi
ssu
e.
h
) Fund a
llo
cat
ionf
orD
ist
ric
tHo
spi
tala
tCharaideos
hal
lbecommunicated a
fte
rth
e
D
ist
ric
tHo
spi
tali
smadef
unc
tio
nal
.
2
. OperationalC
ost
:
a
) O
per
ati
ona
lco
stf
orimplementationo
fe-
Hos
pit
als
olu
tio
nhasbeenearmarkedf
or
eachh
osp
ita
lbasedonOPD,I
PDl
oado
fthef
aci
lit
y.
b
) Monthlyc
osto
fIn
ter
netc
onn
ect
ivi
ty,andothero
per
ati
ona
lco
sti
ncl
udi
ngc
osto
f
p
ape
r,tonner/c
art
rid
ge,e
tc.maybei
ncu
rre
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hisheadf
orimplementationo
fe-
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pitalsolu
tio
n.
c
) Maintenanceofcomputer,p
rin
tere
tc.maya
lsobei
ncu
rre
dfromt
hish
ead
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isw
ill
bea
ppl
ica
blef
ori
tem
sno
tunderw
arr
ant
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d
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tat
uso
f warranty p
eri
odo
fth
eit
ems should be a
sse
sse
dbe
for
ein
cur
rin
g
e
xpe
ndi
tur
e.I
nca
seo
fit
emsa
reunderwarrantyp
eri
od,thesames
hou
ldber
ect
ifi
ed
throught
her
esp
ect
ivev
end
ors
. 270numberso
fDesktopComputer,P
rin
terandUPS
p
rov
ide
dfromNHMS
tat
eHQi
nthef
ina
nci
alyear2020-21a
reunderwarrantyp
eri
od.
D
eta
ilso
fSe
rvi
ceSupportf
orDesktopComputer,P
rin
terandUPS:
Item Make/ModelNo ContactNumberf

orsuppo同
Desktop ACER VERITON Nameo ftheOEM:M/sAcerI ndiaPvt
.Ltd
.
Compute「 M4660G ToolFreeNo:1800116677
ptLevel:
(
3ye
ars
Name:S itaSitaraman
w
arr
ant
y)
MobileNo:033-44272400
E-ma
il:sita.sitaraman@acer.com
2ndLeve
l:
Name:D e
bjyotiS a
n yal
MobileNo:09836466415
E-ma
il:d ebiy
:oti.sany:al@
acer
.com
3rdLev
el:
Name:PraveenB isht
MobileNo:09910100474
E-ma
il:Praveen.bisht@acer.com
Nameo ftheS up
plier:M/sE aster
nTechnology
Group
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lution＠旧 hoo.com
etgr.se
rvice15盆gmail.com
N
ati
ona
lHealthM
iss
ion
,Assam Page39
A3-9
‘
、
Item Make/ModelNo ContactNumberf

orsuppo同
UPS Make:zebronic Nameo ft
heOEM:M/sZ ebron
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ndi
aPv
tlt
d.
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ftheS
upp
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ast
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or the C
ont
actNo:97060
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att
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ear
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tQ:
r.s
e『vice1S@gmail.com
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ter Lexmark, Nameo
ftheOEM:M/sLexmarkI
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ateL
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ted
.
w
arr
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Name:Ms.S
hib
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/Mr.Perumal
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exs
upp
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spi
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com
,
pe
rum
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@in
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com
2
ndL
eve
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Name:M仁川jayakumarS
rin
iva
san
E
-ma
il:v
iia
Ya.
sri
niv
asa
n@l
exm
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3
rdL
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Name:Mr.R
aje
shOnkar
ιmail:raiesh.onkar@lexmark.com
Nameo
ftheS
upp
lie
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nte
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ContactNo:96780
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-ma
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sch
and
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3 F
ina
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) A
llf
ina
nci
alnormss
hou
ldbef
oll
owe
d.
b
) D
ist
ric
twised
eta
ilfundbreakupmaybeseena
tAnnexure-G
c
) Theexpenditureshouldbebookedundertheheadofaccount(FMRCode:FMR
code17.6-ImplementationofH
osp
ita
lManagementSystem)
d
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ota
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hou
ldnotexceedamounta
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cat
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orthef
ina
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ear
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e
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ela
tedt
oM/sLuminouslnfowaysP
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td.(empaneledvendoro
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s
hal
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tat
eHQ.D
ist
ric
tshouldn
otmakeanypaymentt
oM/s
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td. However, concerned Superintendent/ Deputy
Superintendents
hal
lpr
ovi
dethec
ert
ifi
cat
efo
rcompletiono
fworkandg
o-l
iveo
fe-
H
osp
ita
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lut
ion
.
山﹀
N
ati
ona
lHealthM
iss
ion
,Assam Page40
A3-10
竺
（L
MIS,RCHPORτAL/MCTS
Annexure-G
Fundbreakupf
orimplementationofe
-Ho
spi
talS
olu
tio
n(H
osp
ita
lManagementSystemO・
fNI
C)
FMRCode:FMRcode17.6-ImplementationofH
osp
ita
lManagementSystem
Amount.all
ocate
df ortheFY
S
I D
ist
ric
t NameoftheD
ist
ric
tHo
spi
tal
202122(
・ Rs
.I nLakhs)
1 Baksa D
r.R
aviBaroC
ivi
lHo
spi
tal 1.
250
2 Barpeta BarpetaCi
vilHo
s p
ital 2.150
3 Bongaigaon BongaigaonCi
vilHos
pita
l 1.250
4 cachar S.M.DevC
ivi
lHosp
ita
l 1.250
5 Chirang JSBCI
VILH
ospit
al 0.500
6 Darrang MangaldaiC
ivi
lHo
spi
tal 4.850
7 Dhemaji DhemajiCiv
ilHospi
tal 1.850
8 Dhubri DhubriCi
vilHosp
ital 4.850
9 DimaHasao HaflongC
ivilH
ospital 0.930
10 Goalpara 200BeddedC
ivi
lHos
pit
al 3.000
SwahidKushalKonwarC i
vil
11 Golaghat 3.500
Hospital
12 H
ailak
and
i S.K.RoyCiv
ilH o
spi
tal 1.850
13 H
oja
i Dist
rictHospi
tal,Hoj
ai 7.900
14 Kamrup(M) MedicalU
nit
,AssamS
ecr
eta
ria
t 0.300
15 Kamrup(M) Dis
tric
tH o
spitalSonapur 1.600
16 Kamrup( R} TRBC i
vilHos
pital 0.930
17 Karimganj KarimganjCi
vilHosp
ital 3.000
18 Kokrajhar RNBCHKokrajhar 1.650
19 M
aju
li D
ist
ric
tHo
spo
tal
,Ma
jul
i 7.900
20 Morigaon MorigaonC
ivi
lHo
spi
tal 3.000
21 Nagaon BPC
ivi
lHospital+MCHwing 4.100
22 Nalbari SMKC i
vilH
ospital 2.300
23 Sivasagar SivasagarC
ivi
lH o
spital 2.300
24 Sonitpur KanaklataCi
vilHospi
tal 2.900
25 Tinsukia LGBC iv
ilHospi
tal 3.000
26 Udalguri UDALGURIC I
VILHOSPITAL 0.930
27 StateHQ 33.302
_
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Page41
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A3-11
Annex IV Hospital Management Information System (HMIS) vendors
sample list
Sr
Provider Name of HIS Nodal Person Coverage
No.
Mr Naveen Kumar, STD NIC
Mob: 9811348896 605 Health Facilities -
1 NIC eHospital Email: naveenkumar@nic.in Onboarded
Mr Praveen Srivastava
Mob -9811622408 122 Health Facilities and
2 CDAC eSushrut Email: pksrivastava@cdac.in Railways hospitals
Mr Kanaiyalal Kotak 36 Health Facilities in

Mob – 9033729382 Gujarat
HIS
3 TCS Email: kanaiyalal.kotak@yahoo.com
307 Health Facilities in
Tamil Nadu
OASYS Mr Kumariselvan
5 Health Facilities in
4 Cybernetics Pvt HIS Mob – 8939879061
Tamil Nadu
Ltd Email: Kumariselvan.b@oasys.co
HIS Safdurjung Hospital and

Manorama Mr Ashvini Vipul Danigond
(Safdurjung 399 Health Facilities in
5 Infosolutions Mob- 9689891799
Hosp) Mumbai
Pvt. Ltd Email: ashvini@manoramasoft.com
& Mumbai
United Health
Dr Bhavnish 56 Health Facilities in
6 (Optum Global eUpchar
Mob - 8872681448 Haryana
Solution Ltd)
Mr Manoj Kumar
JK Technosoft Mob - 9650333503 224 Health Facilities in
7 HIS
Limited Email: manoj.kumar@jktech.com Kerala
A4-1
Annex V National Health Digital Mission
The National Digital Health Mission (NDHM), is a Government of India initiative, aimed at developing the
backbone for a unified digital health infrastructure. Among other objectives, NDHM seeks to bridge the
gap amongst multiple stakeholders that are a part of the healthcare ecosystem.
A Unique Health ID will be provided to every citizen which will contain details of their diseases, diagnoses,
report, medication etc., in a common database through a single ID. This will essentially be a digitised
version of all their health records. This digital database will be linked to the registry of doctors and health
facilities across the country.
Digital data/records will help medical college professors conduct/public quality research articles, secure
funding from national bodies and improve their professional knowledge through submission of research
papers in national and international conferences.
The benefits for registering in NDHM
a. The implementation of NDHM is expected to significantly improve the efficiency, effectiveness, and
transparency of health service delivery overall.
b. Patients will be able to securely store and access their medical records (such as prescriptions, diagnostic
reports, and discharge summaries), and share them with health care providers to ensure appropriate
treatment and follow-up.
Who can enroll on NDHM
Currently it is rolled out in six Union Territories only i.e., Andaman & Nicobar Islands, Chandigarh, Dadra
& Nagar Haveli and Daman & Diu, Ladakh, Lakshadweep and Puducherry. We are working on rolling this
out nationally.
Participating in NDHM is completely voluntary. There is no fee for registration in the NDHM systems.
Safety and secure on NDHM Systems

NDHM does not store any of your health records. Your health records are stored with healthcare
information providers as per their retention policies and are shared over the NDHM network with
encryption mechanisms only after your express consent.
Anonymous records can be used by the government to make data driven public policy decisions. However,
no individual’s information and health data shall be shared without their consent.
Records will be shared with the doctor or health facility only after patient consent. In patient consent one can
customize and edit the permissions in terms of duration, type of records visible.
A5-1
The user will have the option to deactivate/reactivate/delete the health ID/PHR address
NDHM Health Records

NDHM Health Records is a Personal Health Record application through which patients can maintain and
manage their health information (and that of others for whom they are authorized) in a private, secure, and
confidential environment.
The Personal Health Record (PHR) will be a longitudinal record for each individual on the system,
comprising all health data, lab reports, treatment details, discharge summaries etc. related to one episode
or a set of episodes, across one or multiple facilities.
The benefits of registering on PHR

 Real-time, Patient-centered, Aggregated Health Records across the facilities, viewing key health
information e.g. history, diagnoses, medications, immunization dates, allergies, radiology images, and
lab and test results.
 Makes health information available instantly, "whenever and wherever it is needed" and bring together
in one place everything about a patient's health
 Interoperable, Sharable, Patient-centered record of key health information for Health Records
Exchange between Organizations /Care Providers.
 Ensures efficient Continuity of Care to the Citizens
 Promote Digital capturing of all patient data, using EMRs
 Access Patient data from anywhere
 Achieve operational efficiencies
 Improve Clinical decision making
 Increasing practice efficiencies and cost savings
 Reduce patient waiting time
 Reduced medical errors through better access to patient data
 Improved patient health/quality of care through better disease management and patient education.
User can add their health records on the application. Health records can also be stored in health lockers,
which are integrated with NDHM. As of now there are no health lockers but going forward there will be
multiple health lockers (public and private players)
The data will be stored on a cloud and as the patient will be the owner of all the data, he/she will have all
the rights to manage it. The health lockers integrated with NDHM can also be used for keeping the health
records secure in the lockers and the number of integrated health lockers will keep increasing enabling more
options for the users.
For patients who have not yet created health ID/PHR address can get their health record linked to their
mobile number and can fetch all the linked health records at once, by installing the NDHM health records
application.
A5-2
Also, there are two types of records linking
 HIP (Facility initiated linking)- Once an Individual visits the hospital and creates Health ID. Post
individual’s one time consent, the facility will link health records with Health ID. SMS is sent to user
with an option to download the NDHM health records from google play store and view the records.
 Individual initiated linking through the NDHM health records mobile app.
Health Facility Registry
The Health Facility Registry (HFR) is a comprehensive repository of health facilities of the nation across
different systems of medicine. It includes both public and private health facilities including hospitals, clinics,
diagnostic laboratories and imaging centres, pharmacies, etc. Enrolling in the Health Facility Registry will
enable them to get connected to India’s digital health ecosystem
Enrollment in the Health Facility Registry
The Health Facility Registry is open to registration of all health facilities in India providing healthcare
services across both modern and traditional systems of medicine such as Modern Medicine (Allopathy),
Dentistry, Physiotherapy, Ayurveda, Unani, Siddha, Homeopathy and Sowa-Rigpa systems of medicine.
Applications for enrolment in the registry will be verified by the appropriate officials, and once the facility
details have been verified, approval will be given before they are visible to the public.
Healthcare Professional ID to register in the Health Facility Registry
The Healthcare Professional ID is an authentication mechanism that allows users to access various
applications in the NDHM, without having the need to enter user credentials at multiple places. It essentially
ensures that no unauthorized person can access the health facility details.
Benefits of registering in Health Facility Registry
Healthcare Professionals enrolling in HPR will have access to several benefits. Some envisaged benefits
are covered below and more such benefits will be added over time as adoption of the NDHM ecosystem
increases.
 Online presence and discoverability: facilities can share about their specialties available and services
offered, address, contact details and geo-location enabling easier access for individuals
 Building trust and reputation: Listing on national platform of verified health facilities
 Ease of doing business: Paperless registration and renewal of licenses, ease in empanelment with
insurance agencies, TPAs
 Digital Health Records: Consented access to electronic medical records with seamless retrieval
 Ability to go paperless through e-signature on diagnostic reports, discharge summaries, prescriptions
etc.
 Telemedicine: Eligible healthcare facilities can treat individuals remotely through telemedicine
A5-3
Enrolment in Health Facility Registry is voluntary. However, government health facilities would be
required to enroll in the Health Facility Registry, where the respective state/UT government participating
in the NDHM requires them to do so..
National Health Authority (NHA) is implementing the National Digital Health Mission (NDHM). NDHM
focuses on developing the technological backbone for India's digital ecosystem. Health Facility Registry is
a key building block of NDHM under the purview of NHA.
The Health Facility Registry shall act as a single source of truth for all health facilities in the country.
Falsification of information or misuse of account shall carry stringent penalties. Further, these health
facilities will also need to abide by the rules of conduct placed by various services they are utilizing through
the registry.
Information, Education and Communication (IEC) campaigns are being designed and rolled out by NHA
in conjunction with the concerned authorities at the state and national level. Integrations with existing
digital applications managed by various entities will be used to accelerate adoption.
The main aim of the NDHM initiative is to enable the facilities to be part of a national platform. Additional
functionalities will be released in subsequent stages and made available to all facilities equally. In case
specific additional functionality is sought, please contact the technical team for support.
There is a functionality within the Health Facility Registry that will allow facilities to link to healthcare
professionals working with them. The declaration of association can be initiated by either the doctor or the
facility and needs to be approved by the other side.
EMR solution is a digital version of a patient's chart and it contains the patient's medical treatment history
from a health facility. EMR Solution can be used within a health facility such as hospital/clinic/diagnostic
centre to support patient diagnosis and treatment. The application allows doctors to record clinical
information specific to each facility.
NDHM EMR solution is intended to be used as reference application for the HRPs and HIPs to provide
them a 'framework' to digitize patient clinical records and enable sharing these records across the care
spectrum, while integrating their HRPs with NDHM Ecosystem.
This solution is built very specifically to provide EMR functionalities only as a reference model in order to
achieve consent-based Health Record Exchange under the NDHM Ecosystem. Integrators can download
the Source Codes provided by the NDHM to their EMR applications.
Refer URL: https://emr.ndhm.gov.in/
A5-4
Annex VI Visit to Tripura National Information Centre (NIC) and study of
eHospital
Introduction:
e-Hospital solution developed by National Informatics Centre (NIC) is being implemented in the existing
District Hospitals of the State of Assam. Ministry of Health & Family Welfare, Government of India
accorded approval for implementation of eHospital solution in 25 District Hospitals and Medical Unit of
Assam Secretariat in the earlier year. At present 15 DHs are using eHospital solution. Training for
remaining hospitals going on with the help of empanelled vendor of NIC. Further, in the RoP 2021-22,
approval for implementation of eHospital solution 3 new District Hospitals namely at Majuli (100 bedded),
Hojai (200 bedded) and Charaideo (100 bedded) received. Further, MoHFW have approved implementation
of e-Hospital solution in 4 District Hospitals namely South Salmara Mankachar, Biswanath, West Karbi
Anglong and Bajali under ECRP-II. Implementation of e-Hospital solution in all District Hospitals have
been approved by Government of India which need to be completed within the financial year 2021-22.
Further, Health System Strengthening Project, JICA is being prepared by Health & Family Welfare
Department, Government of Assam. Implementation of robust Hospital Management Information System
in the Medical College & Hospitals, District Hospitals and other hospitals to be taken up under this project
is one of the main objective of the project.
Government of India is in the process to nationwide rollout of National Digital Health Mission (NDHM)
and implementation of Hospital Management Information System in all hospitals is essential to create
Health Id for all and access health record through NDHM ecosystem.
e-Hospital solution has been developed by National Informatics Centre (NIC), Tripura.
To understand the detail concept of the e-Hospital solution and feasibility to implement the same in the
Medical Colleges of the State, the visit to NIC Tripura was carried out by the following team members:
1. Dr. Ranganayakulu Bodavala, Consultant, JICA project
2. Sri Rahul Dev Chakraborty, State MIS Manager, National Health Mission, Assam
Key persons interacted during the visit:

Following key persons were interacted during the visit:
1. Shri Chayan Kanti Dhar, Scientist-G, State Informatics Officer (SIO), National Informatics Centre
(NIC), Tripura
2. Shri Nilkamal Dey Purkayastha, Scientist-C, National Informatics Centre (NIC), Tripura
3. Shri Rudra Pratap Bhattacharjee, Modulist, National Informatics Centre (NIC), Tripura
A6-1
A. Meeting with Shri Chayan Kanti Dhar, Scientist-G, State Informatics Officer (SIO), National
Informatics Centre (NIC), Tripura on 15th September 2021
 Small briefing meeting with Shri Chayan Kanti Dhar, Scientist-G, State Informatics Officer (SIO),
National Informatics Centre (NIC), Tripura and Shri Nilkamal Dey Purkayastha, Scientist-C, National
Informatics Centre (NIC), Tripura was held.
 It was a very fruitful discussion and SIO, NIC, Tripura briefly described how the e-Hospital project
started in Tripura and subsequently rolled out in all parts of the Country.
 The project was initially started in Government Medical College of Tripura and subsequently rolled
out in other hospitals.
 More than 600 hospitals in the Country are using e-Hospital solution including big hospitals like
AIIMS Delhi, KGMU Lucknow, Dr. Ram Manohar Lohia Hospital Delhi, Lady Hardinge Medical
College Delhi, AIIMS Rishikesh, AIIMS Bhupal etc.
 He also informed that, e-Hospital solution has been implemented in other Countries like Gana.
 Integration of e-Hospital with Lab Analyzers is another big achievement.
 The e-Hospital application has also adopted various health vocabulary standards recommended by
Ministry of Health & Family Welfare like ICD10 & SNOMED-CT in various modules. Clinicians and
care providers can enter ICD10/SNOMED-CT codification into the clinical data so that the EHR
generated is more meaningful and reduces the variability in the way data are captured, encoded and
used for clinical care of patients and research.
 e-Hospital solution is compliance to EHR standard.
 E-Hospital is a “Software as a Service (SaS) cloud based solution.
 E-Hospital solution is also integrated with National Digital Health Mission (NDHM).
 SIO, NIC, Tripura provided the following suggestions during implementation of e-Hospital solution:
 All modules of the e-Hospital solution should be implemented to get the actual benefit of the system.
By implementing only 2/3 modules like OPD, IPD and Billing will not serve the purpose.
 Small Programme Management Unit (PMU) should be constituted to run the programme.
B. Demonstration of e-Hospital solution by Shri Nilkamal Dey Purkayastha, Scientist-C, National

Informatics Centre (NIC), Tripura and his team on 15th September 2021:
 Detailed demonstration on the e-Hospital solution was provided.
 Following modules of e-Hospital solution are now available on cloud:
 Patient Registration (OPD & Emergency)
 IPD (Admission, Discharge & Transfer)
 Billing
 Lab Information System (LIS)
 Radiology Information System (RIS)
 Clinics
 Store & Pharmacy
 Dietary
A6-2
 Laundry and OT Management
 Online Registration System (ORS)
 eBloodBank
 Key points noted during the demonstration:
 OPD Registration slip are template based. It can be configured for each hospital based on need. It
is a good feature which may solve the issue of prescription audit currently faced by District
Hospitals of the State.
 e-Blood Bank module is also available in e-Hospital. The matter to be discuss whether State have
to adopt eRaktkosh of CDAC or e-BloodBank of NIC under e-Hospital.
 Telemedicine services is integrated with e-Hospital. It is informed that, advanced technology is
used which is better than eSanjeevani of CDAC.
 Online Registration System (ORS) is integrated with e-Hospital. It is a very nice feature and can
be very helpful for crowd management and hassle free service to citizen.
 New National Health Id can be generated as per NDHM framework.
 Health Id can be generated from NDHM as well as from e-Hospital solution.
 Health Id can be linked with Aadhar as well as can be generated without Aadhar.
 Option to validate Health Id during registration.
 If a patient doesn’t bring Health Id, then Health Id can be retrieved using mobile based OTP
verification.
 QR code based Health Id is printed in the OPD slip.
 Bar code and QR code based Id is printed in the OPD slip. Just by using Bar code scanner or QR
code scanner, patient can be tracked in other section of the hospital which minimizes data entry and
also reduces error.
 Option to configure billing type for BPL, APL etc. Rates for various services can also be configured
for each hospital separately.
 During registration, operator can search availability of Doctor and assign a Doctor for each patient.
 Option is provided to capture the status of COVID vaccination of the patient during OPD
registration.
 Clinic module is very user friendly. Separate template can be prepared for Doctor/ Hospital as per
need. It is very helpful to capture detail information of each patient for specialized services like
Oncology, Cardiology etc. as per need. Open EHR platform is used for creation of the template.
Templates can be created by Doctors with working computer knowledge just selecting the criteria
and functions. It is just like creation of web form.
 Drop down menu option is provided for entry. Drop down list automatically filtered based on
characters typed in the box.
 Doctor can see the rate of tests during advice for test. He can orient the patient about the cost of the
test.
 Doctor can issue special instruction to Laboratory / Technician in the advice to test.
 Comprehensive Oncology module with complete work flow is available under e-Hospital solution.
 Que management is also available in the e-Hospital solution.
A6-3
 Discussion on implementation level points:
 24 X 7 support system is available. District NIC can directly contact NIC, Tripura for any technical
issue.
 Implementation of e-Hospital has three options:
a) Cloud based: There is no need for internal server. Entire database will be stored in cloud. But,
need Internet connectivity at each computer.
b) Local Server based: Data will be stored in the local server of the hospital. No need for Internet
connectivity at each computer. But, LAN is required to connect all computers.
c) Hybrid Model: Initially data will be stored in the local server and can be synchronized with
the central server using scheduler. Local server and LAN is required. No need to provide
Internet connectivity at each computer, but local server need Internet connectivity.
d) Bar code scanner and bar code printer is required. Bar code scanner should be made available
in each counter for smooth patient flow. Bar code should be used everywhere including OPD
counter, Laboratory etc.
Photo: Presentation and Demonstration on e-Hospital solution by Shri Nilkamal Dey Purkayastha,
Scientist-C, NIC, Tripura
C. Tripura Medical College and Dr. BRAM Teaching Hospital visited on 16th September 2021:
 E-Hospital solution is implemented with Local Server. Two servers are used one for Database and the
other for hosting the application. All computers are connected through LAN. Dedicated server room.
 System support team is in-position to provide technical support.
 e-Hospital solution is implemented in OPD Registration counter, IPD registration counter, Billing
counter, Wards and Laboratories. Store module is also implemented.
 Computers are not available in Doctors’ room and Clinic module is not implemented.
A6-4
 Separate counter for follow up visit.
 On an average 2 minutes take to register one patient including collection of user charge of Rs. 20/-.
For follow up patient less than 1 minute is taken.
 Important feedback of users:
 Good IT system is need for faster registration. Sometimes keyboard or printers are not working. In
case of small issue with IT hardware, it hampered the process of registration. One of the user give
one example. One key of the keyboard was not working. It results all patient containing character
of the faulty key was missing in the OPD registration slip. It hampered overall implementation till
replacement with the new keyboard. It is a very good lesson and we have to prepare plan to avoid
such issues.
e-Hospital Modules OPD Registration Counter
OPD Registration Counter OPD Registration Counter
A6-5
OPD Registration Counter Computer used in Indoor Ward
Server Room Server Room
D. Atal Bihari Vajpayee Regional Cancer Centre, Agartala visited on 16th September 2021:
 Comprehensive Oncology module with complete patient flow implemented in the hospital.
 Tele-consultation system integrated with e-Hospital and used for patient follow up and consultation.
 Option to send prescription through email. Option for digital signature of prescription.
 Patient can share Blood test report through email also. Schedule for Chemo is fixed based on medical
records.
 Teleconsultation helped to reduce the number of visits by patients.
Front view Registration Counter
A6-6
Teleconsultation Centre Teleconsultation Centre
E. Agartala Government Medical College & Govind Ballabh Pant Hospital:
 e-Hospital solution is implemented in all the counters in the hospital.
 Laboratory Information System (LIS) module of e-Hospital is integrated with the Lab Analyzers
Registration Counter Lab Requisition Counter
A6-7
Annex VII List of Interviewees for ICT Survey Visit
Sr. No Name Organization Designation

1 Dr. Ramen Talukdar Fakhruddin Ali Ahmed Medical Principle and
College and Hospital, Barpeta Superintendent
2 Dr. Uddip Talukdar Fakhruddin Ali Ahmed Medical Dy. Superintendent
College and Hospital, Barpeta
3 Dr. Sanjay Bhattacharya Fakhruddin Ali Ahmed Medical Dy. Superintendent
College and Hospital, Barpeta
4 Prof.(Dr) Karuna Hazarika Tezpur Medical College and Hospital Principle and
Superintendent
5 Dr. Benudhar Nadh Tezpur Medical College and Hospital Head community
medicine and incharge
- HIS
6 Dr. Madhab Ch. Rajbangshi Tezpur Medical College and Hospital Medical
Superintendent
7 Dr. Tanvira Tezpur Medical College and Hospital Dy. Superintendent
8 Sr. Manager AMTRON, Guwahati Head – Hospital
information system
9 Dr. Subash CH. Sarma Ravi Baro Baksa civil hospital Superintendent
10 Administrator
11 Dr. Dr. Kalita SMK Civil Hospital, Nalbari Superintendent
12 Dr. Nabadeep Sarma Nalbari civil hospital Administrator
13 Mr. Karuna Brahmma NHM – Baksa District Program
Manager, NHM
14 Dr. Mubidur Rahman Baksa Joint director
15 Dr.Kavita Chowdhury NIC Guwahati SPD

16 Chandan Luminous info way private limited System Analyst (now
moved to other dept)
17 Rahul Chakravarty NHM – MIS CELL
18 Pragati NHM – MIS CELL
19 Kamal NHM – MIS CELL
20 Dr. Rathindra. Bhuyan Directorate of health services Director
21 Dr. Lal Sim Joint Director
22 Dr. Anup Kumar Barman Directorate of Medical education Director
23 Dr. Sarma Directorate of Medical education Joint Director
24 Sumana das Study team
25 Dipon Ghosh Study team
26 Nivedita Paul Study team
27 Prabhal Ghosh Study team
A7-1
Appendix VIII: Record of Public Consultation (interview to community representatives)
No. Results
1 <Profile of interviewee> Gender: Male, Profession: lawyer, Age:80’s
<Comments to the proposed project> Date of Interview: 4-Jan-2022
− There is no objection as the upgradation of the existing hospital to SSH would benefit the
general citizens(poor people) and thus it will be welcomed by the public.
− Local public is sensitive towards the name of the Old Hospital [Jananayak Deveshwar Sharma
Civil Hospital] 1, which is proposed to be demolished. Thus, keeping the sentiments of the
locals the name of the new SSH to be constructed at the same location is preferred to keep the
same name.
− Already railway over bridge is being constructed in the vicinity and that is to benefit the local
citizens in easing out the traffic flow in the area thus impact on traffic during construction of the
hospital would not be a major issue.
− Since the new hospital building would be constructed at the same place after demolition of the
existing old building thus there would not be any major change in the landscape.
− There is no major env or social issue expected still the proposed grievance mechanism is a
welcome measure.
− During demolition of the existing old building as well as during construction hospital need to
take up measures to avoid any inconvenience to the hospitalised patients.
2 <Profile of interviewee> Gender: Female, Profession: Professor, Age: middle
general citizens and thus it is welcomed by the public.
− Noise pollution to be addressed during the construction phase to avoid inconvenience to the
patients in the existing new hospital building within the same campus
− Since the new hospital building would be constructed at the same place after demolition of the
existing old building thus there would not be any major change in the landscape apart from
additional floors, and the positive impacts of the hospital are much more than any landscape
aspect.
3 <Profile of interviewee> Gender: Male, Profession: Civil Service, Age: 50’s
− The super specialty hospital at JMCH campus would definitely be welcomed by all the sections
of society.
− The proposed double storey basement parking would definitely help in vehicular/traffic
management within and outside the campus.
− In built sewage treatment plant/ waste disposal system would help in waste management in the
hospital/JMCH campus.
− Water quality of the area is not very good in the area so provision should be made for setting up
water purification systems to provide safe drinking water to the patients/staff in the new facility.
− Solar panels may be installed so that alternate/eco-friendly back up power system can be made.
4 <Profile of interviewee> Gender: Male, Profession: Environmentalist, Age: 50’s

− There is no objection from the local community as the upgradation of the existing hospital to
SSH would benefit the general citizens and thus it is welcomed by the public.
A8-1
No. Results
− Since the new hospital building would be constructed at the same campus after demolition of
the existing old building thus there would not be any major change in the landscape apart from
additional floors, and the positive impacts of the hospital are much more than any landscape
aspect.
− Traffic would not be an issue as mostly the construction would be taking place within the
campus, moreover it is not like construction of road/over bridge/flyover where there is
significant impact on the traffic movement.
− It is suggested that Plantation within the Hospital premises should be done as part of
landscaping that would enhance the local environment and ambience as well.
5 <Profile of interviewee> Gender: Male, Profession: Civil Service, Age: 40’s
general citizens and thus it is welcomed by the public.
A8-2

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Government of Assam,

Health and Family Welfare Department

Preparatory Survey for

Japan International Cooperation Agency (JICA)

Koei Research & Consulting Inc.

Abbreviations and Acronyms

O&M Operation and Maintenance

Preparatory Survey for

Background of the Survey......................................................................................................... 1-1

7.6 Operation and Maintenance of Medical Equipment ......................................................................... 7-6

Table 3-16 Excerpts from Building Construction By-laws ....................................................................... 3-18

Libraries, Hostel, Smart Classrooms - Component 8................................................................ 7-6

Background of the Survey

1.1 Background of the Project and Purpose of the Survey

Background of the Project

 Inadequate and/or aging facilities / equipment / management system, paper-based medical

Source: JICA Survey Team

Purpose of the Survey

1.2 Outline of the Project

Objectives of the Project

Outline of the Project

(1) Strengthening medical institutions (facilities, equipment)

The target survey area is Assam State, India.

Responsible Ministry / Implementing Agency

Government of Assam, Health and Family Welfare Department (HFWD)

Appropriateness of the Project

2.1 Healthcare Sector

Major Policies on Healthcare Sector in India and Assam

Table 2-1 Priorities of the National Health Policy 2017

Table 2-2 Targets of the National Health Plan 2017 and

Table 2-3 Progress in Health Sector Priority Actions in Assam

Table 2-4 Priorities of Health and Family Welfare Department of Assam

Table 2-5 Roles of Federal, State, and District Health Authorities

Branches Composition of the State Health Mission

Relevant Development Plans and Donors’ Activities

Health Conditions and Disease Burden in Assam

Source: [Health Data, 2017]

Source: [Health Data, 2017]

Table 2-7 Infant and Maternal Deaths in Districts in Assam (2016)

Source: [Google, 2021]

Major measures undertaken by GOA were as follows [Gov of Assam, 2021]:

Medical Services and Referral System in Assam

DME, HFWD Assam Cancer Care Foundation

31 – 100 beds CT (28) X-ray (130)

Source: [CDDEP, 2020] [Unique Identification of India, 2020]

Table 2-8 Health Facilities in Districts in Assam (2019)

Darrang 1 0 7 33 176 0.69

Dhubri 1 1 6 35 187 0.29

Karbi Anglong 1 0 0 6 24 104 0.64

Hailakandi 1 0 4 13 107 0.57

PPP in Health Sector

Table 2-9 Chief Minister’s Free Diagnostic Services Programme

Table 2-10 Assam Cancer Centre

Patient Satisfaction and Care Seeking Behaviour

86% 88% 90% 92% 94% 96% 98% 100%

Rs.0 - Rs.250,000 Rs.250,001 - Rs. 500,000 Rs.500,001 - Rs. 750,000

Source: JICA Survey Team

0% 20% 40% 60% 80% 100%

Source: JICA Survey Team