MAH Final Report 5

MATA ANANDAMAYEE HOSPITAL,
VARANASI
CURRENT STATUS & WAY FORWARD
SHREE SHREE MA ANANDAMAYEE ASHRAM, DELHI

JANUARY 2019
MATA ANANDAMAYEE HOSPITAL, VARANASI
CURRENT STATUS &WAY FORWARD
Prepared by
SHREE SHREE MA ANANDAMAYEE ASHRAM, DELHI
January, 2019
1
Contents
Executive Summary............................................................................................................................9
Introduction .................................................................................................................................... 10
Mata Anandamayee Hospital – Current Status& Way Forward .......................................................... 12
A. Out Patients Department (OPD) .................................................................................................. 12
1. Introduction ........................................................................................................................ 12
2. Registration of Patients....................................................................................................... 12
3. Health Card by NGO ............................................................................................................ 14
4. Working of the Out-Patient Department (OPD) ................................................................. 15
B. In-Patient Department (IPD) ........................................................................................................ 26
C. General Observations on OPD & IPD ........................................................................................... 28
D. Operation Theatre ........................................................................................................................ 29
E. Emergency Service ....................................................................................................................... 31
F. Thalassemia Day Care Centre ....................................................................................................... 31
G. Pathology Lab ............................................................................................................................... 31
H. X-Ray Centre ................................................................................................................................. 32
I. Other Services (Refraction, Ultrasound, ECG and Physio-therapy) ............................................. 33
J. Canteen ........................................................................................................................................ 34
K. Pharmacies ................................................................................................................................... 34
L. Homeopathic Charitable Dispensary............................................................................................ 35
M. Publicity ........................................................................................................................................ 35
N. Purchase Procedure ..................................................................................................................... 35
O. Financial Management ................................................................................................................. 36
P. Manpower and Pay & Allowances ............................................................................................... 44
Q. Welfare Allowances...................................................................................................................... 45
R. General Administration ................................................................................................................ 45
S. Parking Facility ............................................................................................................................. 47
T. Security arrangement................................................................................................................... 47
U. Fire and Safety.............................................................................................................................. 48
2
V. Computerisation and MIS Reporting............................................................................................ 48
W. Annual Report .............................................................................................................................. 49
Summary of Recommendations ........................................................................................................ 50
A. Management Structure ................................................................................................................ 50
B. Building and other Infrastructure................................................................................................. 50
C. Out Patient Department .............................................................................................................. 50
D. InPatient Department (IPD).......................................................................................................... 51
E. Operation Theatre (OT) ................................................................................................................ 51
F. Emergency Services ...................................................................................................................... 51
G. Special Programmes ..................................................................................................................... 51
H. Pathology, Radiology (X-Ray, ECG & USG) ................................................................................... 51
I. Canteen ........................................................................................................................................ 52
J. Pharmacies& Homeopathic Dispensary ....................................................................................... 52
K. Publicity ........................................................................................................................................ 52
L. Purchase Procedure ..................................................................................................................... 52
M. Contracts ...................................................................................................................................... 52
N. Financial Management ................................................................................................................. 53
O. Manpower and Pay & Allowances ............................................................................................... 53
P. Welfare Allowances...................................................................................................................... 53
Q. Donation ....................................................................................................................................... 53
R. Parking Facility ............................................................................................................................. 53
S. Security Arrangement .................................................................................................................. 53
T. Fire & Safety ................................................................................................................................. 53
U. Electricity Audit ............................................................................................................................ 54
V. Auditor.......................................................................................................................................... 54
W. Computerisation and MIS Reporting............................................................................................ 54
Bibliography .................................................................................................................................... 55
Annexure 1:List of Personnel as on 26th November 2018, Ma Anandamayee Hospital, Varanasi…………56
3
1. Entrance to the Hospital
2. Patients seek Ma's Blessings for quick recovery
4
3. Entrance – Needs sprucing 4. Registration Counter
5. Doctor in OPD examining patient 6. Ophthalmic Unit – Unusable machines
7. Dental Department – Needs upgradation 8. Physio-Therapy Department
5
9. Operation Theatre – Poor facilities 10. Laparoscopic Operation in progress
11. Male Ward – No patient 12. Special Ward – No patient
13. Private Ward – Waiting for more patients 14. Private Ward
6
15. Pathology Lab – Tests mostly outsourced 16. Spectacle Shop - Redundant
17. Dirty entry 18. Terrace - Dump yard
19. Distribution box – Potential danger 20. Generator Shed – Place for drying clothes
7
21. Jan Aushudhi Kendra 22. Medlife – Private shop for branded medicine
23. Health Card – Not serving purpose 24. Canteen – Poor state
25. Staff quarters – Need better outlook

26. Parking – In a mess
8
Executive Summary
01. The hospital, despite being at the heart of Varanasi City and having a glorious past.is running
into a loss of about Rs 12 lakh per year over a revenue of Rupees one crore for the last two years. The
current state of affairs is mainly due to lack of effective management. No systems and procedure are in
place for ensuring economy and efficiency in expenditure. The hospital is over-staffed with utterly low
pay structure. There is no punctuality, no discipline in administration. The hospital precincts are shabbily
maintained, toilets are filthy, OPD ill-equipped and IPD mosquito infested with broken glass panes and
open entry/exit points.
02. As stated by all the doctors interviewed, nobody from the management takes round of the
hospital and there is none to look after the day to day functions of the hospital. The situation in OPD and
IPD leaves much to be desired. Most of the Senior Doctors (including Surgeons) are quite old in age and
have crossed their prime, as a result, they are not able to attract patients. Many of them are not in a
position to undertake surgery. The junior doctors are usually fresh from the university, who are still
trying to establish themselves.
03. The IPD is supervised by three Bachelor of Ayurveda, Medicine and Surgery (BAMS) doctors.
There is only one trained nurse and a few untrained nurses. The quality of services provided by them is
far from adequate. As a result, the patients as well as the doctors in OPD are reluctant to recommend
admission. Consequently, the IPD remains without patients almost throughout the year.
04. Procurement of medicines and equipment, printing & stationery, repair & maintenance worth
more than Rs 40 lakh per year are being raised and executed by two individuals without any tendering.
There is no system in place for independent scrutiny. One of them is a Contractor, who should not have
been involved in the procurement process. In many cases, material is directly supplied to the
departments without initially entering in the stock register.
05. Major contracts, worth lakhs of Rupees are being permitted to be run by the same contractors,
even long years after their expiry without formal extension or tendering. For instance, the contract for
running Pathology Centre, which generates receipt of more than Rs 20 lakh per year, had expired in July
2017 is still being permitted to run without renewal. Similarly, the contract for running the X-Ray Centre
generating more than Rs 12 lakh per year had expired in June, 2015 and has still not been renewed.
Some of the contracts appeared to be undervalued resulting in loss of revenue to the hospital.
06. There is a strong need for electrical audit as the total expenditure towards Electricity Charges
and running generators including maintenance was as high as Rs 19.06 lakh in 2016-17, when the OPD is
run mainly between 10 AM to 1 PM. In addition, fire and safety measures in place are utterly inadequate
to mitigate any disaster.
07. The Auditors, M/S M. B. Gabhawala & Co., Varanasi have been carrying out audit of the
accounts of the hospital, formore than a decade and in the Audit Reports provided to the team do not
contain and audit observation despite many apparent irregularities. There is no internal auditor either to
carry out internal audit of the expenditure.
08. The dire state of affairs prevailing in the hospital calls for immediate remedial measures.
Requisite recommendations in this regard have been duly incorporated at the end of this report.
9
Introduction
Established in 1968, Mata Anandamayee Hospital on the bank of River Ganga is one of the major charity
hospitals in the sacred city of Varanasi in Uttar Pradesh, India, engaged in providing subsidised
healthcare facilities to the weaker sections of the society, irrespective of caste, creed or religion. This
hospital is owned by Shree Shree Ma Anandamayee Sangha, with headquarters at Kankhal, Haridwar, in
Uttarakhand.
For the last fifty years, the hospital has been providing healthcare to more than 70,000 patients per year
in its OPD covering Medicine, Gynae, Surgical, Cardiology, Urology, Ophthalmic, ENT, Pediatrics,
Neurology, Dental, Orthopedics, X- ray, Skin, Ayurvedic and also Physio Therapy. The hospital also has
facility for in-house treatment.
The hospital was formally inaugurated by the then Prime Minister Smt. Indira Gandhi in presence of Ma
Anandamayee on 26th Dec. 1968. During the inauguration ceremony, Shree Ma gave the direction to
carry on --
ROGRUPI JANA JANARDAN SEVA

(Service to the Diseased Humanity as Service to God)
However, over the last couple of years, the image of the hospital has deteriorated considerably. The
Income and Expenditure Accounts of the hospital for the preceding three years reveal a loss of Rs 11.99
lakh and Rs 6.29 lakh during 2017-18 and 2016-17 respectively as against a surplus of Rs 1.47 lakh during
2015-16.
This startling revelation, coupled with the deteriorating image of the hospital, regarding its quality of
services made the management to sit up and make an attempt take cognizance of deficiencies in the
running of the hospital and identify remedial measures that could be initiated to stem the current trend
and bring the hospital back to its past glory.
Accordingly, a team comprising of Shri Sandeep Dutta (Gobluda), Shri Chinmoy Chakravorty, Shri Tarun
Krishna Majumdar and Shri Roma Prosad Chatterjee was deputed to conduct a study of the functioning
of the hospital and submit appropriate recommendations for its revival for consideration of the
management. An amount of Rupees one lakh was sanctioned by the Management for meeting expenses
towards travel and other ancillary expenditure of the team.
The team visited the hospital from 25th November to 5th December 2018 and undertook an in-depth
study of the organizational and financial aspects of the functioning of the hospital.
The following modes were adopted for the study:
a. Focused discussion with Swami Deveshanandaji

b. Group discussion with important stakeholders
c. One to one discussion with almost all the Department heads in OPD
10
d. Interview with important stakeholders including selected Contractors
e. Discussion with few eminent doctors in Varanasi
f. Review of (a) Cost Audit Report for the Period 1st April to 30th September 2015 (b) Gap
Analysis Report of Mata Anandamayee Hospital, Varanasi prepared by Architect D. S.
Bhui of Cosmic Design Pvt Ltd., Lucknow.
11
Mata Anandamayee Hospital – Current Status& Way Forward
A. Out Patients Department (OPD)
1. Introduction
01. The following departments in OPD are functioning in the hospital:
i. Medicine ix. Dental
ii. Gynecological x. Orthopedics
iii. Surgical xi. Radiology (X- ray and USG)
iv. Cardiology xii. Dermatology
v. Urology xiii. Endocrinology
vi. Ophthalmic xiv. Ayurvedic (Ksharsutra)
vii. ENT xv. Pathology and
viii. Pediatrics xvi. Physio Therapy.
2. Registration of Patients
02. Every person, desirous of consulting doctor or obtaining medical service, is required to
first register at the Registration Counter in the Hospital by paying Rs 20/- valid for a period
of one week following which fresh Registration Charge is to be paid. On Registration, the
Counter Clerk gives a computer-generated print-out of a blank prescription form citing
name of the patient, doctor to be consulted and validity of the registration.
03. The number of patients registered for availing services in the OPD during last three
calendar years 2015, 2016 and 2017 are given below:
2015: 63,855
2016: 73,572
2017: 72,724
04. Distribution of Registered Patientsinthe hospital by Departments in the Calendar Year
2015, 2016 and 2017 is given below.
12
Number of patients registered in MAH by Departments
- Calendar Year 2015, 2016 and 2017
Number of registered patients

S.
Department Variation
No. 2015 2016 2017
2015-16 2016-17
Total: 63,855 73,572 72,724 15.2 (1.2)
1 Medicine 12,281 11,428 11,364 (6.9) (0.6)
2 Surgical 8,418 4,378 3,657 (48.0) (16.5)
3 Eye 2,436 1,927 2,337 (20.9) 21.3
4 Gynecology 10,534 10,887 10,028 3.4 (7.9)
5 ENT 3,827 4,296 3,953 12.3 (8.0)
6 Dental 10,510 10,499 10,478 (0.1) (0.2)
7 Pediatrics 1,588 2,172 1,309 36.8 (39.7)
8 Orthopedic 2,232 1,466 3,100 (34.3) 111.5
9 Cardiology 2,190 284 341 (87.0) 20.1
10 Laparoscopy 287 306 N. A. 6.6 ..
11 Skin 531 640 813 20.5 27.0
12 Urology 185 119 85 (35.7) (28.6)
13 Khar-sutra 381 - - .. ..
14 Diabetic Clinic 3,443 4,080 5,657 18.5 38.7
15 Rheumatic diseases 449 684 481 52.3 (29.7)
16 DOTs 55 87 92 58.2 5.7
17 Ayurvedic 902 633 114 (29.8) (82.0)
18 Physio-therapy 3,606 3,366 2,905 (6.7) (13.7)
19 Repeat Patients 16,320 16,010 .. (1.9)
Note: Number of Repeat Patients in 2015 is included in the figures for respective departments
05. It is pertinent to note from the above that there is a decline in the total number of
patients registered in 2017 compared to 2016. Significant decline in patient registration
has been recorded in case of consultation in such departments as Ayurvedic (-82.0%),
Pediatrics (-9.7%) and Rheumatic diseases (-29.7%).
06. Receipts from OPD Registration in last three financial years are as follows:
Amount
Variation (in
S. No. Financial Year Collected (in
%)
Rs)
1 2015-16 966,850
2 2016-17 966,500 0.04
3 2017-18 900,880 -6.79
13
Recommendations:
i. As a large number of poor patients, that is those belonging to BPL category,

visit the OPD for treatment, it is recommended that the Registration Fee
charged from them may be reduced to Rs 10/- only. At present a large
number of poor patients prefer to visit other charitable hospitals (e.g. R. K.
Mission, Marwari Hospital) where they only pay Rs 10 for registration. This is
likely to result in increase in number of patients visiting the hospital.
ii. In addition, the validity of the registration for non-BPL patients may be
reduced to only 3 days in place of seven days.
3. Health Card by NGO
07. Every patient is required to separately obtain a Health Card showing the identity of the
patient issued by the hospital by paying a one-time fee of Rs 30/-. In addition to the
Registration ID Number, this card shows the photograph of the patient as well as her/his
name, address, blood group, age and mobile number.
08. The hospital has made arrangements by outsourcing the work of preparing the card by
engaging a private agency (MedLife), who incidentally also run the pharmacy located
within the premises of the hospital. The hospital supplies the material for preparing plastic
card and the print cartridges, costing about Rs 15/-, to the agency for preparing the card.
The patient is required to present the card every time she/he visits the hospital for
availing the services. In addition, a patient has to pay Rs 20/- as Registration Fee every
time - valid for seven days. The hospital gives three medicines prescribed by the
consulting doctor free of charge against each registration.
09. In addition, MedLife has also donated a few desktop computers and a software for use in
the registration of patients. They also assist the hospital in maintenance of these
computers.
10. The hospital could not produce any document outlining the purpose of the Health Card. It
was gathered from interviews that the Health Cards were introduced only about three
years back in order to facilitate registration of patients and in identifying the patient. The
other unstated reason could be to prepare a database of information on disease and
treatment and also track their visits to the hospital. Whenever a person visits the hospital,
showing the Health Card Number is mandatory. As a result, it is possible to study the
progress of health and study disease pattern. The other purpose is to use the Health Card
for providing services at a discount of 10% - a fact which could not be verified.
11. It was learnt that the intended purpose, perhaps, was to develop a minimum sample of 1
lakh card holders to study and derive acceptable results. However, over a period of time,
this has caused resentment among the poor patients visiting the hospital, who find it
difficult to pay this amount. They prefer to visit other charitable hospitals (like, R K
14
Mission or Marwari Hospital), where such payment for Health Card is not required. The
progress of the scheme does not seem to have achieved the objective as the number of
Health Cards issued so far was only about 21, 250 (as on 27 November 2018).
Recommendations:
i. In view of large-scale resentment among the patients to pay an additional
amount of Rs 30/- for obtaining the Health Card, it is recommended that the
practice of issuing Health Card may be discontinued. This matter was also
supported by the doctors interviewed.
ii. The hospital may instead introduce the facility to track a patient, if need be,
by name and/or mobile number as like in other hospitals using the
computer for registration.
4. Working of the Out-Patient Department (OPD)
12. With a view to assess the current status of functioning of the various departments and to
identify reasons responsible for theirdecline, if any, information was collected fromeach
Department separately. Suggestions were also sought from the senior doctors in the
Departments regarding ways to improve the working.
13. The OPD is served by 40 doctors for consultation, who are mostly available from 9 AM to 2
PM on week days as per schedule prepared by the hospital. A few doctors are also
available for consultation in the afternoon.
14. The following list shows the availability of doctors for consultation by number of hours
andDepartment in a week:
No. of hours Dr J K Agrawal 2

Department/Name of Doctor available per Endocrinology 6
week Dr Sujit Bhattacharya 6
ENT 14
Ayurved 22 Dr K K Singh 6
Dr Rajesh Srivastava 12 Dr M M Gupta 3
Dr Sanjay Nathani 2 Dr R G Tandon 5
Dr Santanu Mishra 4 Eye 8
Dr V D Dwivedi 4 Dr P K Rai 6
Cardiology 1 Dr R M Bajpai 2
Dr P N Sonami 1 Gynecology 15
Dental 29 Dr Alka Bhandari 4
Dr Farhana Durrani 6 Dr P V Tiwari 8
Dr Pankaj Pandey 8 Dr Sangita Roy 3
Dr Shubha Choudhury 3 Kharsutra 4
Dr Vivek Gautam 12 Dr M Sahu 2
Diabetes 2 Dr Raman Singh 2
15
Medicine 49 Physiotherapy 1
Dr A K Dev 13 Dr D V Mishra 1
Dr Ravi Ranjan 6 Dermatology 8
Dr Ravindra Agarwal 6 Dr M K Jaiswal 4
Dr S K Dixit 12 Dr Neha Sah 4
Dr S N Pandey 6 Surgery 21
Dr S. H. Srivastava 6 Dr B N S Bhatnagar 2
Ortho 11 Dr N N Khanna 6
Dr A K Sinha 6 Dr O P Singh 13
Dr Amit Kr Gupta 5 Urology 5
Pediatric 11 Dr Chaitanya Sah 4
Dr K C Barnawal 2 Dr K Pandey 1
Dr Kailash Singh 5
Dr S N Tripathi 4 Grand Total 207
15. In order to find out the condition of facilities available at important selected departments,
focused interviews were held with senior doctors. The purpose was to collect information
on facilities and infrastructure available for consultation, number of patients visiting the
Department for consultation currently and also in the past. They were requested to
comment on the declining number of patients visiting the hospital and to make
suggestions for improvement in the situation. They were also requested to suggest list of
new equipment required for use. As a result, a huge array of information was collected
from the doctors which provide a meaningful insight on the working condition of the
hospital and suggestions for improvement.
16. The doctors are paid a token honorarium as conveyance charges varying from Rs 750 to Rs
2500 per month for their 2 to 3 hours services, as the case may be. In addition, they are
also paid 30% of the charges received by the hospital for surgery and 30% as doctors'
share for pathological and other tests referred by them.
A. MedicineDepartment
Current status:
17. Of the total number of patients examined at this OPD and in the absence of proper
statistics, the senior doctor in this department was consulted and he opined that about
one-third of the patients belong to BPL category.
18. According to a senior doctor, even a decade back the MAH used to be the best charitable
hospital in Varanasi, with large number of patients visiting for consultation and treatment.
In 2003, when he joined MAH as a consulting doctor, he used to examine about 15,000
patients in a year, which has today declined to about half that level. There were many
reputed doctors who came forward to be associated with the hospital to serve the poor as
directed by Ma Anandamayee. The fact that the charges were bare minimum, facilities
good and the doctors highly reputed, contributed to its popularity.
16
19. Remuneration: Each doctor in this department is paid on a monthly basis a fixed
Honorarium (Conveyance Allowance) of Rs 1000 per month, 30% share of pathology tests
and 40% share of X-Ray charges on patients referred.
20. The Medicine Department is facing problems in supervision and management due to the
absence of MBBS Doctors.This particularly affects post-operative care in the In-Patient
Department (IPD).Some of the other issues highlighted by the doctors are:
i. Proper emergency drug kit, supply of oxygen and other equipment are not
stated to be available in OPD.
ii. Due to absence of poor infrastructure available at In-patient Department (e.g.,

dirty toilet, lack of wash basin, broken windows, etc.) the patients are reluctant
to get admitted. According to a senior doctor, only 3 to 5 patients were
recommended by him for admission out of nearly 500 patients examined in OPD
by him.
iii. The doctors were critical of the lack of cleanliness and hygiene in the hospital
premises. They felt that maintaining cleanliness is extremely important for
providing a healthy atmosphere helpful to recovery.
iv. The main reason for this reluctance in advising patients for admission is due to
non-availability of appropriate facilities at the In-Patient Department in MAH.
The condition of the beds, mattresses, linen are not good and need
replacement. There is no Nursing Station with adequate number of trained
nursesand support staff. The condition of the toilet for use by in-patients are
dirty resulting in unhygienic condition. Lack of adequate number of patients is
resulting in poor maintenance, which in turn is affecting the number of patients
admitted.
Recommendations:
i. One senior consultant may be appointed to head the Medicine Department.
Due to absence of a senior Doctor, the IPD is not able to provide proper care to
inpatients.
ii. Immediate steps should be taken to provide good and caring environment in the
IPD with trained nursing and service staff.
iii. The basic infrastructure in IPD should be immediately improved providing good
and clean beds for patients. There should be regular arrangements for cleaning
the floor with disinfectants, washing the linen and availability of basic medical
kits.
iv. Specific steps may be taken to clean the hospital premises on a regular basis.
17
v. The hospital may consider increasing the number of free medical camps for
health check-up.
vi. Procurement of new equipment like Nebulizers (costing Rs 1,500 each),

Emergency Drug Kit (Rs 300) and Oxygen cylinders (Rs 1500 each) for use at the
Medicine OPD.
vii. Formation of Joint Committee of Doctors to effectively administer all the

Departments in OPD by involving senior doctors.
B. Eye Department
Current status
21. The eye department is located in two small rooms at the OPD. There are two doctors who
visit the department. One of the rooms is used for examination of the patients and the
other as refraction room.
22. There are three consulting doctors available on different week days for examining the
patients and provide treatment.
23. The work of eye testing as prescribed by the doctors, has been outsourced to a technician
(contractor).
24. The equipment for testing eye (refractometer) is not working properly and needs
replacement. The eye testing drum is damaged, many of the lenses in Trial Box are full of
scratches and there is shortage of furniture in the room.
25. The technician,who tests the eye and uses the refractometer, is not an employee of the
hospital. He provides his services free in lieu of permission to set up a shop for selling
spectacles within the premises. He uses his personal equipment (Keratometre) for eye
testing.
26. As per the Contract signed, the owner of the Spectacle Shop will pay a rent of Rs 3000 per
month for first six months and, thereafter, the rent will be enhanced to Rs 4000 pm.
However, it may be pointed out that the Contract had expired on 10.07.2015 and the
application for its renewal is still pending. The hospital has received only Rs 25,000 as rent
in the last Financial Year 2017-18.
27. In the absence of adequate facilities, major eye surgeries are diverted to other
hospitals,which are properly equipped and only minor operations are conducted in the
hospitals.
28. There is a dearth of proper equipment in the Eye Department.The Slit Lamps procured a
few years back are not in working condition.
29. The number of patients examined by the doctor interviewed is only 10 in a day. In the
past, the number used to be substantially higher.
18
30. The hospital organises one Eye Camp within the hospital premises every year to treat
patients.
Recommendations:
i. The Eye Department should have sufficient space to allow doctors to examine
the patients and also to move freely for using different equipment.
ii. The costly equipment available in the Ophthalmic Department for use by the
doctors may either be repaired or replaced for use.
iii. Proper Eye-OT should be set up with facilities for carrying out all types of eye
operations backed by qualified eye surgeons.
iv. The department has proposed procurement of the following new equipment:
a. Auto Refracto Keratometre

b. Trial Box
c. Distance vision drum with remote
d. Slit lamp
e. Chair Unit
f. Digital Tonometre
v. The present system of providing free service by the Ophthalmic Technician in
lieu of allowing him to run the Spectacle Shop may be dispensed with.
vi. The Spectacle Shop covering an area of 10 x 10 feet may be used for some
better purpose.
vii. Instead of only one Eye Camp in a year, the hospital should organise more eye
camps. Adequate publicity should be made well in advance for the purpose.
C. Surgery Department
Current status
31. There are four surgeons in this Department to carry out general and laparoscopic surgery.
32. Dr M. M. Khanna, Senior Surgeon for General Surgery had joined MAH in 1993, when
about 70 to 80 patients were examined by him per day, out of which about 5 patients
were operated upon. Currently the number of patients consulting him has dwindled to
only 15 to 20 per day, out of which ultimately only 5 or 6 patients per month are operated
upon.The main reason for this drastic reduction in number of patients opting for
operation is ascribed to lack of facilities for post-surgical treatment in the IPD including
absence of a senior doctor in the Medicine Department.In spite of these shortcomings,
the Department is still functioning even with reduced number of patients, mainly due to
19
the name and fame of Dr M. M. Khanna. In fact, he had suggested approaching Dr K. K.
Tripathi, retired Professor of BHU and Dr Rana Gopal Singh for the Medicine Department
in the hospital.
33. The Laparoscopic surgery is conducted by an experienced surgeon - Dr O. P. Singh. The

number of operations conducted currently is quite low due to lack of proper facilities and
unhygienic condition prevailing in the IPD,shortage and poor quality of nursing staff and
absence of round-the-clock MBBS Residential Doctor. About 8 to 10 laparoscopic
operations are conducted every month by Dr O.P. Singh and Dr Raman Singh.
34. Dr M. Sahoo, Ayurveda Department, visits the hospital once a week. He examines only 15
patients each time for the treatment of piles, fistula, etc. Large number of patients have to
wait for weeks to consult him. He conducts anorectal operations on 50-60 patients every
month at the hospital.
35. The hospital charges a standard package of Rs 12,000/ for every surgery. Based on
doctors' advice, the poorer patients are charged Rs 500 to Rs 12,000 for each operation,
with permission by Swamiji.
36. It may be pertinent to mention that most of the equipment required are available for
general and laparoscopic surgery, though provision of additional latest equipment will
surely help. For providing nursing support, when required, trained nurses and anesthetist
are requisitioned from private nursing services (e.g., Santushti).
Recommendations:
i. As Dr Khanna, in charge of general Surgery, is about 83 years old, it will be in the

interest of the hospital to induct another sufficiently senior surgeon so as to
maintain continuity in future.
ii. As advised by Dr Khanna, it would be beneficial for the hospital to engage the
services of an experienced nephrologist with facilities for dialysis as there is
strong demand for this service in the hospital.
iii. Services of a senior doctor in the Medicine Department is also essential for post-
operative care.
iv. The In-Patient Department (IPD) will have to be properly strengthened to

provide appropriate post-surgery care.
D. Gynecology Department
Current status:
37. The Gynecology Department is one of the important Departments with over 10,000
patients visiting it in 2017. There are four Consultants who provide the services of
examining the patients and offering medical advice. Unlike in the past, the hospital does
not have arrangement for delivery. Shree Shree Ma Anandamayee had specifically
20
forbidden the introduction and continuation of maternity facilities. Instead, the Doctors
are available for prenatal and postnatal care.
38. Experienced doctors, viz, Dr P V Tiwari, Dr Alka Bhandari and Dr Sangita Roy are available
for consultation. Special mention may be made of Dr Tewari, who is 81 years old,
providing yeomen services and treating patients on three days a week. It is her experience
and reputation which bring patients from far and near.
39. Like all other doctors in the hospital, the doctors in this department are paid a
Conveyance Allowance, share of pathology, X-Ray, ECG or USG charges. It was learnt that
Dr Tewari does not accept any share of pathology and other lab charges.
Recommendations:
i. In view of the advance age of Dr Tewari, efforts should be made to persuade

young senior doctors to join the hospital for the benefit of large number of
patients, mostly from the poor strata.
ii. Vacant time slots in the Department may be judiciously utilised by appointing
additional Doctors.
E. Urology Department
Current status
40. The Urology Department is a small unit in the hospital where two consultants share the
responsibility of examining patients.
41. Dr K Pandey attends the OPD only on Tuesdays (11 AM to 12 PM) and Dr Chaitanya Sah on
Mondays (12 to 2 PM) and Wednesdays(12 to 2 PM). Dr Sah examines about 4 to 5
patients per day and, if necessary, also operates on them.
Recommendations:
i. The Urology Department should be strengthened by procuring necessary
equipment including facility for dialysis along with the services of a
nephrologist.
ii. Adequate publicity should be made to inform the public about the availability of
services being provided by Urology Department.
iii. A free camp may also be organised once a year for poor patients, which in turn
will provide some publicity.
F. Dental Department
Current status
42. The Dental Department comprises of one examination room and a separate small waiting
area for the patients.There are four Doctors in the department to examine the patients
21
and also undertake minor surgery.About 25 to 30 patients visit the OPD for dental check-
up every day.
43. Most of the basic necessary equipment is available for day to day examination and
treatment. However, the condition of the dentist's chairs and other furniture is poor.
Proper cleanliness is also not maintained.
Recommendations:
i. The following equipment and other accessories may be procured on an urgent
basis:
a. Endodontics for RCT (Root Canal Treatment).
b. LED Light
c. Extraction equipment
d. Sterilizer
e. Dentist's Chair
f. New chairs
g. Composite Filling Material
G. Orthopedic Department
Current status
44. The Ortho Department in the hospital has two Consultants - Dr A. K. Sinha and Dr A. K.
Gupta.
45. Over the years, the number of patients for treatment has declined substantially as
currently only 10 to 15 patients visit the department for treatment every day, out of which
5 to 6 are new.
46. The patients prefer to visit SSPG Hospital and BHU as they get free treatment there.
Besides, as was learnt from the doctors, they are also reluctant to pay for the Health Card
as required in the hospital. The charges for plastering and few other procedures are also
high in comparison to other charity hospitals. The patients also do not get all the free
medicines as per practice in the hospital.
47. Costly new equipment, like, C-Arm machine used for surgical, orthopedic and fluoroscopic
inter operative imaging and C-Arm Table are lying unused due to absence of trained
doctors.
Recommendations:
22
i. The Ortho Department may be strengthened by recruiting one senior
Orthopedic Surgeon for consultation and carrying out operations, which will
generate more revenue.
ii. Free medicines should also be provided to the patients, like in a few other
departments.
H. Dermatology Department
Current status
48. The Skin Department is a small unit in the hospital where two consultants share the
responsibility of examining patients.
49. Dr M. K. Jaiswal attends the OPD only on Tuesday (10 AM to 12 PM) and Dr Sneha Sah on
Monday (12 to 2 PM) and Wednesday (12 to 2 PM). Dr Neha has joined the hospital only
in May 2018.Dr Neha examines about 8 to 15 patients per day and advises treatment.
50. She suggested that facility may be introduced in pathology lab for KOH test required for
skin examination. Besides, free camp should also be organised with adequate advance
publicity.
51. She was particularly critical about the poor cleanliness in her OPD and suggested regular
cleaning.
Recommendations:
i. The advice of the Consulting Doctor for KOH test and holding camp may be
implemented.
ii. Adequate publicity should be undertaken by the hospital on the availability of
senior experienced doctors for consultation.
I. ENT Department
Current status
52. The Department is located in one room of the OPD with three doctors (Dr R. G. Tandon, Dr
M. M. Gupta and Dr K. K. Singh)sharing the room. They are reputed,experienced and have
been with the hospital for many years. They have all retired from service and offer free
services to MAH. In compensation, they are paid Conveyance Allowance, Share of
Laboratory and X-Ray Charges received from patients.
53. The Department has a collection of basic equipment for examining the patients.These are
very old and require replacement.
54. Dr Tandon suggested that the following equipment may be considered for purchase:
a. Audiometer
b. OPD Microscope
23
c. Suction Machine
d. Otoscope
55. In 2017, about 7,000 patients visited the ENT department for treatment. When Dr Tandon
joined the hospital in 2000, he used to examine about 90 patients per day, which has now
dwindled to only 10 to 12 patients a day. Lack of proper facilities in comparison to other
charitable hospitals is one important reason for this decline. Besides, the doctors opined
that the introduction of Health Card with no apparent benefit to the patient is also
considered a deterrent. In comparison, the Registration Fee in R K Mission is only Rs 10/-
per visit and the facilities are better.
56. The hospital provides free treatment to Sadhus, Blind and other poor patients with
approval of the Swamiji in each case.
57. Dr Tandon prescribes both generic and branded medicines for treatment to avoid
repeated interactions. The generic medicines are purchased from the Jan Aushudhi
counter in the hospital.
58. Dr Tandon used to operate 2 to 3 patients in a month in the past.He has offered his
services 5 days a week inplace of 3 days now.
59. He is paid Rs 750/ as Conveyance Allowance and share of laboratory charges he refers for
pathology tests.
60. In spite of inadequate facilities, he prefers to work in this hospital out of profound
devotion and respect to Ma. He feels that patients treated in this hospital get the divine
blessing of Ma, which definitely contributes to the recovery of patients.
Recommendations:
i. The advice of the Consulting Doctor to purchase equipment may be considered
favourably.
ii. New young doctors may also be persuaded to join the department.
iii. Adequate publicity should be undertaken by the hospital on the availability of
senior experienced doctors for consultation.
J. Utilization of OPD Rooms
Current status
61. In all, there are 20 rooms in the hospital located in the basement of the Hospital Building.
These rooms are allotted to the respective departments for consultation and minor
procedures.
62. To find if the rooms are utilised optimally, occupancy of the rooms by consulting doctors
was plotted by time slots for each week day.
24
63. There are 8 Time Slots of one-hour duration each from 9 AM to 5 PM every day.
Considering the fact that the OPD runs on all week days, except Sunday, in all the 20
rooms, there will be in all 960 Time Slots available in a week.
64. Out of the 960 time slots from 9 AM to 5 PM six days of the week, at present only 207
slots are used by respective doctors for examining patients (see Table below). The
utilization rate per week is 22% only.
65. As the OPD now runs mainly between 9 AM to 2 PM, 185 time slots out of total 600 slots
(or 31%) are used. On the other hand, from 2 PM to 5 PM, only 22 (6%) slots out of 360
slots are used.
66. The following table will illustrate the point further:
Number of rooms in OPD used by time slots

Time Slot (AM/PM) Monday Tuesday Wednesday Thursday Friday Saturday Total
9-10 4 2 3 1 2 1 13
10-11 12 6 11 5 10 7 51
11-12 11 10 11 11 9 9 61
12-1 8 6 8 7 3 6 38
1-2 4 4 6 3 2 3 22
2-3 1 2 2 1 1 2 9
3-4 2 1 1 1 1 1 7
4-5 3 1 1 1 6
Occupancy (Total) 45 31 43 30 29 29 207
9 AM to 2 PM 39 28 39 27 26 26 185
2 PM to 5 PM 6 3 4 3 3 3 22
% Occupancy 28.1 19.4 26.9 18.8 18.1 18.1 21.6
Total Time Slots

160 160 160 160 160 160 160
67. The table above clearly brings out the under-utilization of OPD Rooms in the Hospital and,
at the same time, points out scope for improvement.
Recommendations:
i. In view of the gross underutilization of the rooms available in the OPD, the
following steps may be considered:
a. Efforts may be made to invite new doctors to join the panel of
consulting doctors at the OPD so that the available
infrastructure could be used more judiciously.
b. While searching for new doctors, emphasis may be given to

those departments which lack sufficient number of doctors. For
25
instance, at present only one doctor is available for one hour in
a week in Cardiology, Diabetes (2 hours in a week),
Physiotherapy (1 hour a week) and Urology (5 hours a week).
There is also further scope for extending the consulting facilities
in ENT (presently 14 hours a week), Orthopedic (presently 11
hours a week) to help the poor patients.
c. In addition, for better utilization of the facilities in the afternoon

or evening hours (4 PM to 7 PM), the hospital may consider
introducing Special Paid OPD facilities by setting up a special
block in the existing OPD building with proper amenities for the
use of paying patients.
d. The consultation fee in the proposed Paid OPD may be fixed

suitably to meet the cost of introducing a Private OPD with
adequate facilities to the patients, including, better waiting
area, TV facility, snack bar etc. All ancillary facilities, like
Pathology Lab, X-Ray, USG Centre, ECG, etc., should run
concurrently.
B. In-Patient Department (IPD)
Current status
68. The Hospital has facility for in-patient treatment for surgery and other treatments.
69. Set up in 1995, the hospital has 50 beds for use by patients admitted as per the following
details:
a. General Ward – Charges: Rs 100 per day
b. Special Ward:
 Cabins - AC Rooms – Charges per day: Rs 600 Double occupancy, Rs 800

for single occupancy
 Cabins - Non-AC Rooms – Charges per day: Rs 400 per bed
70. The Room Rates were revised about 4 to 5 years back. The hospital provides free bed to
Sadhus (Ashram) in Special Ward and to other Sadhus in General Ward. Free beds are also
given to financially poor patients.
71. There are three Resident Doctors (BAMS – Bachelor of Ayurveda, Medicine and Surgery)
available for providing medical care and supervision in General, Special Wards and Cabins
in the hospital.
72. In addition, other staff, comprising of one trained female Nurse, two male untrained
nurses, two ward boys and one ward master are available in the IPD. The hospital
requisitions the services of additional nurses and support staff from outside whenever
situation demands.
26
73. The hospital maintains three-shift care, where they allot nurses and other ward personnel
for these shifts. (7 AM to 2 PM, 2 PM to 8 PM and 8 PM to 7 AM).Each shift has at least
one female Nurse/Untrained Nurse on duty).
74. The general condition of the Wards is very poor except the Special Ward which are
comparatively cleaner and have AC facility. There is additional space/bed for attendants.
During inspection of the rooms, it was noticed that most of the beds were vacant.
75. The IPD maintains stock of emergency drugs but for usual requirement the patient has to
purchase other requirements from the market.
76. The number of patients treated in the IPD in the years 2015, 2016 & 2017 were as follows:
Number of Patents treated at the In-Patient Department 2015, 2016 & 2017
Diseases 2015 2016 2017
Total: 1877 1903 1613

Diseases of Gastro-Intestinal System 287 291 240
Diseases of Liver & Biliary System 109 119 114
Diseases of Uro-Genital System 30 30 23
Diseases of Ano-Rectal Disease 31 11 4
Gynaecological Diseases 74 63 65
Eye 86 91 106
ENT 3 1 2
Diseases of Bones/Joints 14 29 15
Diseases of Chest & Respiratory System 102 103 118
Diseases of Cardio - Vascular System 30 23 22
Diseases of C. N. S. 14 10 10
Diseases of Endocrine System 39 32 38
Diseases of Malignari (Cancer) 47 32 17
Abscess / Ulcer / Gangrene 12 8 12
Thalassemia 883 941 758
Miscellaneous 116 119 69
77. It is very disheartening to note that a 50-bed fully operational hospital could not find even
five in-patients per day for treatment. In fact, as per Annual Report for the year 2017-18,
the total number of In-patents treated was only 1,613 in the entire calendar year 2017,
(that is, 134 in a month or less than five patients per day). The number of patients treated
in IPD was 1,877 in 2015 and 1,903 in 2016.
27
78. This was also furthedr corroborated by the fact, during the ten-day stay, the Team found
the wards completely empty except for two or three patients. As a result, the hospital is
continuously witnessing huge loss as it has no alternative but to maintain the entire
infrastructure, and pay for Doctors on duty, Nurses and other staff, hospital supply and
consumables, the staff responsible for cleaning, the electricity charges, etc.
79. Except persons suffering diseases of Gastro-Intestinal System, Liver & Biliary System and
Chest & Respiratory System, the number of in-patients are low. Absence of senior
surgeons in the hospital in these fields could be the reason behind the low admissions in
the IPD. The main reason, many doctors felt, is the poor quality of services provided at the
IPD.
Recommendations:
i. Concerted effort should be made to obtain the services of MBBS Doctors in the
IPD.
ii. Special attention may be paid to obtain the services of a senior doctor in
Medicine to ensure proper post-operative care.
iii. The above steps will also increase the flow of patients in the OPD.
iv. Once the proper services/facilities are in place in the IPD, the doctors in the OPD
should be requested to refer patients for admission, a step currently avoided by
many doctors.
v. The basic infrastructure of the IPD must be improved for providing secure
environment to the patients. These include:
a. Fixing broken glass panes, cleaning toilets, providing drinking water
facilities as also clean mattresses and linens, door closers and glass
panels at the entry and exit gates to prevent entry of mosquitoes.
b. Regular cleaning and fumigation of the IPD.

c. Improving Nursing Stations in each floor
d. Provision of emergency drugs and injection should also be made

available.
C. General Observations on OPD & IPD
80. Every department in OPD has one or two Senior Doctors and Junior Doctors. The Senior
Doctors (including Surgeons) are quite aged and had crossed their prime long back. As a
result, patients are not attractedto them.
81. The IPD is supervised by three BAMS Doctors – one in each shift for treatment. There is
only one trained Nurse and a few untrained nurses. The quality of services provided by
them is far from adequate. As a result, the patients as well as the doctors in OPD, except
for one or two doctors, are quite reluctant to recommend admission as they cannot
28
assure post-operative after care. Consequently, the IPD remains without patients
throughout the year. In fact, most of the doctors prefer to recommend admission in other
charitable hospitals (like Rama Krishna Hospital and Marwari Hospital) where the services
are far better. Most of the doctors interviewed, except those who are very old, also are
attached to these two hospitals or have their own clinics.
82. Combination of the above two factors is primarily responsible for the declining attendance
in the hospital.
83. Another aspect relates to the payments made to the Doctors. As per the practice in the
hospital, the doctors are entitled to Honorarium in the form of Conveyance Allowance
(ranging from Rs 750/- to Rs 2000/- per month) and 30% of the receipts on laboratory
tests, (including X-Ray, USG, or ECG) of patients referred. The doctors who undertake
surgery are also entitled to 30% of the receipts. Usually, it is the commission part, which
forms the major componentof the monthly payment currently. There is, therefore, a
tendency to recommend pathological and other tests to patients, whether necessary or
not.
D. Operation Theatre
Current status
84. The Operation Theatre in the hospital is located on the first floor providing adequate
facilities for various major and minor operations. These include General Surgery,
Gynecological Surgery, ENT Surgery, Urology Surgery, Orthopedic Surgery, Eye Surgery,
Plastic/Reconstructive Surgery and Dental Surgery.
85. There is adequate staff available for duty in OT on a regular basis and also on call from
outside. Supply of oxygen cylinders, various consumables and emergency medicines is also
stated to be satisfactory.
86. According to the Doctors Interviewed, the OT has adequate equipment for conducting the
operations. However, they strongly advocated for a new Modular OT.The success of the
OT will rest on the availability of the suitable post-operative facility and a regular ICU.
87. The following table will help understand the type of operations undertaken at OT during
last three years.
Table: Number of Operations Performed in 2015, 2016 & 2017
S. No. Type 2015 2016 2017

A Major Operations 152 140 175
i General Surgery 90 100 143
ii Gynecological Surgery 53 30 32
iii ENT Surgery 3 2 0
iv Urology Surgery 6 5 0
v Orthopedic Surgery 0 3 0
B Moderate Operations 194 211 215
29
ii Plastic/Reconstructive Surgery 9 0 1
iii Eye Surgery 92 117 126
C Minor Operations 2070 1821 1578
ii Gynecological Surgery 178 172 92
iii Urological Surgery 10 10 33
iv Plastic/Cosmetic Surgery 9 0 0
v Orthopedic/Cosmetic Surgery 44 54 47
vi ENT Surgery 58 54 29
vii Dental Surgery 1193 1268 1166
D General Surgery 635 2181 768
i Major 90 140 104
ii Moderate 277 220 281
iii Minor 268 1821 383
88. The Surgeons advocated purchase of the following new equipment for use in the OT:
a. Two ventilators, full set bed, automatic pump
b. Suction machine
c. 3 - Chip Laparoscopic machine
89. The hospital is planning to set up a Modular OT by converting one of the two OTs available
now. They are also planning to set up HDU (High Dependence Unit), like ICU, for patients'
care after operation.
90. The Hospital has a Rate List for different types of operations. All the patients for surgery
have to get admitted in the hospital, pay admission charge, two days room rent and the
cost of the operations. The Sannyasis from Ma's Ashram are not required to pay any
charges, though Sadhus from other orders are required to pay part of the cost. Poor
patients are also exempted from any payment, if recommended by the doctor and
approved by Swamiji. Due to poor financial condition of the patients, doctors do not
recommend revision of rates.
91. The hospital hosts Special camp for free treatment of Hernia and Hydrocele every year,
which are sponsored by donors. This year,one camp is proposed to be held from 15
December to 31 January, 2019. The hospital also organises Eye Camp in December every
year, in which all the expenses,including cost of lens and medicine,are paid by donors,.
Recommendations:
i. New and latest equipment for surgery may be purchased for use in OT, as in
other charitable hospitals in the vicinity. This will instill confidence among
patients leading to increase in their number.
30
ii. Efforts may be made to obtain the services of Senior Surgeons to undertake
operations.
E. Emergency Service
92. The hospital does not operate any Emergency Service, which is an essential feature of
most hospitals. The reason for not operating Emergency Services are as follows:
i. Non- availability of sufficient number of doctors round-the-clock
ii. Absence of an Intensive Care Unit
iii. Absence of senior doctors in Medicine for post-operative care in IPD.
iv. Non-availability of support staff, like Trained Nurse, Untrained Nurse, Ward Boy,
and others for in-patient care.
F. Thalassemia Day Care Centre
Current status
93. The Centre is run by the Thalassemia Welfare Society for the last 15 years with active
support of the local doctors and other staff of the hospital. The Thalassemia society makes
all the arrangements for transfusion of blood. IMA supplies blood free of cost.
94. There are 150 Registered patients in the hospital who are treated for Thalassemia once a
month free of cost.About 70 to 80 patients are currently provided with blood transfusion
every month. On an average, about 800 cases of treatment are handled by the hospital in
a year.
Recommendations:
i. Status quo may be maintained.
G. Pathology Lab
Current status
95. The hospital used to operate a Pathology Lab for conducting tests as recommended by the
Doctors. About three years back, the services were outsourced to an individualcontractor.
No tendering procedure was adopted for appointing the Service Provider.As per the
Contract, the receipts on this count are shared at the ratio of 30%: 40% : 30% among
Doctors, Contractor and the Hospital respectively. The validity of the contract has already
expired in July, 2017.
96. The Contractor is allowed to use the entire existing infrastructure of the hospital, including
rooms, equipment, electricity, generator back-up, cleaning facility, etc, free of cost. Two
employees, who were serving in the Pathology Lab run by the hospital, were continued to
work with the contractor meeting half their salary.
31
97. The Pathology Lab at the hospital collects the sample/specimen from the patients and
conducts the basic tests. For advanced teststhe work is outsourced to a well-known
Diagnostic Lab by the Contractor.
98. The financials for the last three years are as follows:
S. Pathology - Income, Expenditure &

2015-16 2016-17 2017-18
No. Shares
Pathology:
A. As per Auditor's Report:
1 Receipt: Pathology (from OPD + IPD) 2,040,230 2,059,460 2,044,500

2 Expenditure: Doctors & Contractor's 1,403,094 1,419,306 1,417,025
Share)
3 % Expenditure (item 2 above) over 68.8 68.9 69.3
Income
B. Estimated Shares:
Doctors (30% of Receipts) 612,069 617,838 613,350
Contractor (40%of Receipts) 816,092 823,784 817,800
Hospital (30% of Receipts) 612,069 617,838 613,350
Recommendations:
i. Please refer Item 23 of the Recommendations at the end of the report.
H. X-Ray Centre
Current status
99. The hospital operates an X-Ray Centre in a separate building near the main gate away
from the main OPD. This work has been outsourced to a contractor, who has appointed a
technician for taking the X-Ray. There is a doctor (job outsourced) to examine the X-Ray
plates and provide report.
100. As per the Contract, the receipts from this head are shared at the ratio of 30% : 40% : 30%
among Doctors, Contractor and the Hospital respectively. The validity of the contract has
already expired on 30th June 2015. Although the Contractor had requested for an
extension for another five years, no formal renewal of the Contract has been made so far.
101. The financials for the last three years are as follows:
S.
X-Ray - Income, Expenditure & Shares 2015-16 2016-17 2017-18
No.
32
X-Ray:
1 X-Ray (from OPD + IPD) 1,213,840 1,222,005 1,119,805
2 Expenditure: Doctors & Contractor's N. A. 840,111 764,428
Share
3 % Expenditure over Income N. A. 68.7 68.3
B. Estimated Shares:
1 Doctors (30% of Receipts) 364,152 366,602 335,942
2 Contractor (40% of Receipts) 485,536 488,802 447,922
3 Hospital (30% of Receipts) 364,152 366,602 335,942
Recommendations:

I. Other Services (Refraction, Ultrasound, ECG and Physio-therapy)
Current status
102. In addition to Pathology and X-Ray Centre, the hospital has outsourced the above-
mentioned services to various contractors. All of them use the hospital premises,
equipment and all other infrastructure facilities without any payment to the hospital.
S. Other Lab Services - Income,

2015-16 2016-17 2017-18
No. Expenditure & Shares

Income:
1 Refraction 55,224 33,700 26,520
2 Ultrasound 33,920 209,140 182,175
3 ECG 54,730 54,716 62,470
4 Physio-therapy 173,590 228,105 210,550
B. Expenditure
1 Refraction N.A. 18,010 13,430
2 Ultrasound N.A. 201,540 222,520$
3 ECG N.A. 17,350 19,300
4 Physio-therapy N.A. 127,022 117,490
Note: $: Taken from the Auditors Report, the figures could not be verified
Recommendations:
33
J. Canteen
Current status
103. The hospital has outsourced the provision of running a Canteen to a Contractor who
supplies food to inpatients, and the visitors who stay at the Guest House run by the
Ashram. In addition, staff and other visitors also partake meals at the Canteen as per rates
decided by the Contractor himself.
104. As per the Contract, which expired on 30 November, 2018 and is yet to be renewed, the
Contractor is required to pay Rs 1500/- per month as rent to the hospital. However, as it
appears from the Auditor's Report (2017-18), the Contractor has paid rent @ Rs 1000 only
per month.
Recommendations:
i. The outlook of the Canteen needs drastic improvement.
ii. Rent of Rs 1500/- as per the Contract may be collected with retrospective effect.
K. Pharmacies
Current status
105. At present, two pharmacies are allowed to function from the hospital premises to meet
the need of the patients. These are: Medlife International Pvt Ltd for branded medicines
and Jan Aushudhi Kendra for generic medicines.
106. Medlife International: As per the contract with Medlife, valid till 31st December, 2020, the
company is required to pay Rs 10,000/- per month as rent for the 468 sq. ft. of space
occupied by it. They offer a discount of 15% to 20% on all branded medicines sold to
hospital patients, though the volume of sale is low. It was learnt that the Company uses
the premises primarily as hub for distribution of medicines for orders which it receives
from clients online. The company is providing free service for preparing the Health Card to
the patients on behalf of the hospital at the time of registration (see para 3 for
details).They have also provided a few Desktop Computers to the hospital for use in
registration, invoice generation and maintenance of account along with a basic software
used in this process.
107. Jan Aushudhi Kendra (JAK)is run by the hospital directly since 2016-17,when it was set-up
pursuant to GOI policy for providing generic medicines at lower price. Three employees of
the hospital, including a Pharmacist, are posted at the Centre to run it on a daily basis.
108. The medicines available at the Kendra are generic in nature and are purchased from Local
Wholesalers by the hospital. The medicines are provided free of cost to registered OPD
patients and also to patients during Free Camps.
34
109. The margin for sale of these low-cost medicines is minimal and, as such, profitability for
operating the Kendra is an issue. In fact, Rama Krishna Mission Hospital at Varanasi has
already closed down it's JAK.
Recommendations:
i. As the Medlife runs a commercial service using the space provided by the
hospital, they should be charged at current commercial rate as rent in place of
Rs 10,000/- per month being charged now.
ii. Doctors may be advised to mention the name of the generic drug along with
branded medicines when they write prescriptions to enable the patients to
purchase medicines as per their choice.
iii. Jan Aushudhi Kendra should be allowed to be continued to function irrespective

of marginal loss or profit as it provides an opportunity to the poor patients to
purchase low cost medicines.
L. Homeopathic Charitable Dispensary
Current status
110. The Dispensary, established in 1952, is providing yeomen service to the old and the poor.
In 2017, as per Annual Report, 18,479 patients visited the Dispensary. The patients are
charged Rs 10 each by way of registration and are given medicines free of cost. On an
average, 50-60 patients visit the dispensary daily.
111. It was learnt that the cost of medicines distributed to patients in a month is about Rs
40,000/- while the receipts on account of registration fee is only about Rs 18,000/- per
month. As the dispensary is running at a loss, there is a move to close it, a view not shared
by most stakeholders.
Recommendations:
i. As Homeopathic Dispensary is used by a large number of old and poor patients,

the hospital should make concerted efforts to raise revenue through donations.
M. Publicity
112. The general public does not seem to be aware about all the departments functioning in
the OPD, except Medicine, Gynecological, Dental and Surgery. Suitable publicity measures
may be initiated to popularize other departments as well.
N. Purchase Procedure
113. It seems the hospital does not have any system of floating tender for purchase of
stores/equipment. The administration places order for purchases of store/equipment,
irrespective of value, directly on the supplierwith the approval of Swamiji. The goods are
35
then supplied to the user department directly without physical verification by the Store
Department.
114. For making payment, the delegation of financial power was stated to be as follows:
Up to Rs 1 lakh Swamiji
Rs 1 lakh to Rs 5 lakh Local Managing Committee
Above Rs 5 lakh Sangha HQ, Kankhal
115. It may be worthwhile to enquire whether the abovementioned delegation of financial
powers are being strictly enforced, particularly in case of high value contracts, e.g., for
Pathology Lab, X-Ray, etc.
116. Purchase Order, Stock Register, Issue Register: The hospital maintains stock and issue
register. However, standard procedures in this regard do not appear to have been
followed in some cases.
O. Financial Management
Current status
117. Financial control is an extremely important tool for disciplined management planning in
any organisation. One of the means of exercising financial control is preparation of an
annual budget, which is a quantitative expression of a plan of action.
118. The hospital did not seem to have adopted this practice, which helps in establishment of
quantifiable and verifiable objectives, measurement of performance and noting of
variance, if any, and taking appropriate remedial and timely action.
119. An effort has been made in the succeeding paragraphs to analyse the trend of income and
expenditure of the hospital during the last three financial years 2015-16, 2016-17 & 2017-
18. This will give a fair idea of the sad state of financial affairs to which the hospital has
been reduced.
Income Statement for last three financial years (2015-16, 2016-2017 & 2018) (In Rupees)
Variation Variation
S. (2015-16 (2016-17
Broad Head of Income 2015-16 2016-17 2017-18
No. and 2016- and 2017-
17) in % 18) in %
Total: 10,689,094 11,471,474 11,891,672 7.3 3.7

Total (As per Audit
Report)
1 By Government Grant 800,000 800,000 800,000 - -

Donations &
2 2,546,413 1,850,929 2,675,925 (27.3) 44.6
Contributions
3 Outdoor receipts 4,892,094 5,184,745 4,911,115 6.0 (5.3)
36
3 (i) Jan Aushudhi 368,079 1,022,566 954,898
3 (ii) Health Card by NGO 89,960 NA 159,394
4 Indoor receipts 1,625,420 2,116,555 1,882,580 30.2 (11.1)
5 Other receipts 793,298 1,477,946 1,596,754 86.3 8.0
6 Bank Interest (2 FDs only) 31,869 41,299 25,298 29.6 (38.7)
120. It will be seen that, although the hospital is able to generate or collect more than about Rs
1 crore every year, the pace of growth does not seem to be satisfactory. In fact, there has
been a decline in the growth of total income over the last three financial years (from 7.3%
to 3.7%).
121. The broad heads of Income are discussed in the following:
a. Government Grant: The hospital receives an annual grant of Rs 8 lakh

from the UP Government, though efforts are underway to increase the
quantum since last few years. The matter needs to be pursued
vigourously with the State Government.
b. Donations & Contributions: About Rs 27 lakh was collected as Donations
& Contributions in 2017-18. This has been a substantial improvement
over Rs 19 lakh received in the previous year. In 2017-18, the major
donors were:
i. Sandoz Private Limited, Mumbai: Rs 19.4 lakh for Rural Health
Services
ii. Jalan Sewa Trust, Varanasi: Rs 7.5 lakh for repair and
maintenance
iii. Consumer on-line Foundation, New Delhi: Rs 4.96 lakh for free
medicines
iv. Dr. Rajendra Kumar, Jaipur: Rs 1.32 lakh as general donation.

v. Shri D. Mukhopadhyay, Hooghly, West Bengal: Rs 1 lakh for
repair and maintenance.
vi. Shri Praful D. Seth, New Delhi: Rs 1.0 lakh for sewerage system
122. A comparison of major donations (above Rs 1 lakh) received in last three financial years
shows that there were 10 such donors (max Rs 3 lakh) in 2015-16, 9 donors (max 1.55
lakh) in 2016-17 and only 6 donors (max Rs 19.40 lakh) in 2017-18. It seems there was lack
of efforts in raising donation for this charitable hospital and also pursuing the existing
donors to continue donations.
123. There is a need to continuously develop relationship with major donors without which it
will not be possible to continue the activities meant for the poor. Regular liaison should be
maintained with them, acknowledgement of receipts sent and details of utilization
provided. Every effort should be made to involve the major donors or prospective major
37
donors to continue their relationship with the functioning of the hospital and its
programmes.
124. A database of all donors across the country should be prepared to maintain liaison
acknowledging their donations and utilization of the funds received from them.
125. Outdoor Receipts: The total receipts collected from OPD in 2017-18 was about Rs 49 lakh
in comparison to Rs 52 lakh in 2016-17.
Outdoor Receipts in last three financial years (2015-16, 2016-2017 &2017-2018)

Variation Variation
(2015-16 (2016-17
S. Item of Outdoor
2015-16 2016-17 2017-18 and and
No. Receipts
2016-17) 2017-18)
in % in %
Outdoor Receipt -
Total 4,892,094 5,184,745 4,911,115 6.0 (5.3)
1 Registration Outdoor 966,850 966,500 900,880 (0.0) (6.8)
2 X-Ray OPD 1,200,490 1,202,015 1,105,390 0.1 (8.0)

3 Pathology OPD 1,981,310 2,022,250 1,989,550 2.1 (1.6)
4 Surgery OPD 132,870 99,745 107,330 (24.9) 7.6
5 Physio Therapy OPD 173,590 228,105 210,550 31.4 (7.7)
6 Dental OPD 271,315 350,770 317,365 29.3 (9.5)
7 Other OPD 165,669 315,360 280,050 90.4 (11.2)
126. Outdoor Receipts of Rs 49.11 lakh has been the most important source of revenue for the
hospital in 2017-18 as in past two financial years. They constituted 45% of the total funds
received.
127. The components of the Outdoor Receipts, as given above,are discussed hereunder:
a. Registration Outdoor: Each patient is charged Rs 20/ towards

registration, valid for 7 days.
b. In addition, the hospital also charges one-time fee of Rs 30/- extra for
preparing a Health Card being used mainly as ID. As shown above, there
has been a decline against this head over the past three years. The main
reason for the decline, as could be gathered through discussions, were
as follows:
i. Poor patients are preferring to visit R K Mission Hospital

where the Registration Fee is only Rs 10/-.
ii. The practice of giving three medicine free has been

mostly withdrawn.
38
iii. The patients are quite reluctant to pay the additional
charge of Rs 30/- for the Health Card.
c. X-Ray /Pathology OPD: As per contract, 40% of the total receipts on

these counts are payable to the Contractor providing these services.
Remaining 60% is distributed equallybetween the hospital and the
doctors.
d. It is important to point out that the Annual Reports for the last three
years do not include the Income and Expenditure Statement for the
hospital. The figures quoted above are taken from the Auditor's Report
for the three years made available.
e. An analysis of the income and expenditure of the services outsourced to

contractors are given below:
i. X-Ray OPD: In 2017-18, Rs 11,05,390/- was received as receipt

on this head. Out of this, Rs 7,64,428/- (i.e., about 70%) was
paid out as Doctor's Share (30% or Rs 3,31,614/-) and
Contractor's share (40% or Rs 4,42,152/-).
ii. Pathology: In 2017-18, the total receipt on this count has been
Rs 19,89,550/- against an expenditure of Rs 14,17,025/-. In
other words, the hospital received Rs 5,96,614/- (i.e., 30%),
Doctor Rs 5,96,614/- (i.e., 30%) and the Contractor Rs
7,95,820/- (i.e., 40%). It is learnt that most of the tests got
carried by an outside Diagnostic Lab.
f. It implies that if the hospital takes upon itself the responsibility of

providing the radiological, pathological and other such services in-house
than out sourcing to contractors, the entire loss suffered by the hospital
(i.e., about Rs 11 lakh) in a year can be conveniently wiped out.
128. Indoor Receipts:Details of the Indoor Receipts as per Auditor's Reports are as follows:
Indoor Receipts in last three financial years (2015-16, 2016-2017 & 2018)
Variation Variation
(2015-16 (2016-17
S.
Item of Indoor Receipts 2015-16 2016-17 2017-18 and and
No.
2016-17) 2017-18)
in % in %
Indoor Receipt - Total 1,625,420 2,116,555 1,882,580 30.2 (11.1)
1 Registration/Admission 115,305 134,160 138,000 16.4 2.9
2 Indoor/Cabin 647,220 683,400 622,100 5.6 (9.0)
3 Surgery 712,675 1,196,185 997,700 67.8 (16.6)
4 Oxygen Gas 10,000 8,350 8,900 (16.5) 6.6
5 Other Receipts 140,220 94,460 115,880 (32.6) 22.7
39
129. There has been a perceptible decline in Indoor Receipts in 2017-18 over 2016-17. This
could be due to decline in number of in-patients for the following reasons:
a. Absence of ICU and trained nurses to provide proper medical care to the
inpatients.
b. Unhygienic condition prevailing in the IPD, which is detrimental to proper

medical care. The Wards are infested with mosquitoes, have open windows
with no glass panes in some cases, dirty toilets as also soiled beds and linens
for use.
130. Other Receipts:The hospital also received about Rs 16 lakh in 2017-18 from rent, sale of
Jan Aushudhi medicines and issue of Health Cards as shown below:
Other Receipts in last three financial years 2015-16, 2016-17 & 2017-18
Variation Variation
(2015-16 (2016-17
S.
Item of Other Receipts 2015-16 2016-17 2017-18 and and
No.
2016-17) 2017-18)
in % in %
Other Receipt - Total 793,298 1,477,946 1,596,754 86.3 8.0
1 Rent from UCO Bank 71,409 60,423 119,473 (15.4) 97.7
2 Jan Aushudhi Kendra Receipts 368,079 1,022,666 954,898 177.8 (6.6)
3 Rent from Canteen 13,000 12,000 12,000 (7.7) -
4 Health Card by NGO 89,960 - 159,394 (100.0)
5 Rent from Medlife 10,000 120,000 120,000 1,100.0 -
6 Rent from Post Office 45,900 39,000 33,000 (15.0) (15.4)
7 Rent from Eye Dept Shop 45,900 20,000 25,000 (56.4) 25.0
8 Other 220,459 264,280 292,462 19.9 10.7
131. Of particular concern is the fact that the rents collected from UCO Bank (Rs 10,000 pm),
Canteen (Rs 1,000 pm), Medlife (Rs 10,000 pm), Post Office (about Rs 3000 pm) and Eye
Dept Shop (Rs 2000 pm) are quite low. The space used by MedLife is mainly for
commercial purposes and should definitely fetch higher rent.
132. It may be pertinent to point out that the management has rented out a complete floor to
Government of India for setting up a Pharmco-Vigilance Office & a Drug Controller's Office
in 2017. Unfortunately, the hospital has not received any rent on this count since the
office was inaugurated. During discussion with Swamiji, it was assured that there are some
issues regarding finalisation of rent which is expected to be resolved soon.
133. It may be useful to consider terminating the arrangements for renting out space to
outsiders and instead plan alternate use for earning revenue commensurate with the
space rented out as the total rent collected does not exceed Rs 3 lakh in a year (i.e., about
Rs 26,000 per month).
40
134. Expenditure: Given in the following is a table showing the total expenditure in last three
years and also expenditure on some selected important items:
Expenditure Statement for last three financial years (2015-16, 2016-2017 & 2017-18) (In Rupees)
Variation
Variation
(2016-17
S. (2015-16
Broad Head of Expenditure 2015-16 2016-17 2017-18 and
No. and 2016-
2017-18)
17) in %
in %
Total 10,689,093 11,471,486 11,891,673 7.3 3.7
(Total - As per Audit Report) 10,689,094 11,471,474 11,891,673 7.3 3.7
1 Pay & Allowance 4,712,570 5,537,483 5,538,441 17.5 0.0
2 Medical expenses 640,157 575,596 1,205,430 (10.1) 109.4

2 (i) Purchase of medicines 270,477 54,179 1,109,763 310.3 1,948.3
2 (ii) Minor Instruments and 116,556 231,852 73,581 98.9 (68.3)
accessories
2 (iii) Other 253,124 289,565 22,086 (419) (1,771)
3 Other expenses 1,680,640 1,811,263 3,530,559 7.8 94.9
3 (i) Jan Aushadhi 192,743 984,421 9,245 410.7 (99.1)
3 (ii) Repair & Maintenance 1,260,862 546,319 2,344,739 (56.7) 329.2
3 (iii) Govt. Grant Expenses - - 800,422
3 (iv) Other 227,035 280,523 376,153 23.6 34.1
4 Indirect expenses (Pathology 1,403,094 1,419,308 1,417,025 1.2 (0.2)
Lab Share)
5 Admin expenses 2,105,241 2,757,629 1,400,060 31.0 (49.2)
5 (i) Electricity charges 961,456 1,019,449 98,140* 6.0 (90.4)
5 (ii) Printing & Stationery 157,020 145,243 131,063 (7.5) (9.8)
5 (iii) Generator-Op & 466,348 887,096 252,114 90.2 (71.6)
Maintenance
5 (iv) Campus & Hospital cleaning 108,775 367,250 564,268 237.6 53.6
charges
5(iii) Other expenses 411,642 338,591 354,475 (17.7) 4.7
6 Excess of income over 147,391 (629,793) (1,199,842) (527.3) 90.5
expenditure (transferred to
HQ)
Note: '*' Excludes Rs 8,00,422 for Electricity Charges booked separately under Government Grant
Expenses
135. It will be seen from the above that more than Rs one crore is being spent by the hospital
on various accounts. Observations on some of the major items of expenditure are as
follows:
41
a. Purchase of medicines: The amount spent on purchase of medicine in
2015-2016 was Rs 2.70 lakh. In 2016-17 it got reduced to only 0.54 lakh.
However, in 2017-18, the amount leaped to Rs 11.09 lakh.The rationale
behind such a wide fluctuation could not be fathomed out and needs
further examination.
b. Repair and maintenance: In the preceding three years, about Rs 42 lakh

has been spent on this item, for which specific details were not made
available. It requires detailed scrutiny as to how such a staggering
amount has been spent and what procedure was followed in this
regard.
c. Electricity Charges: The hospital paid about Rs 10 lakh every year

towards electricity charges. This appears to be very high, especially in
view of the fact that, the hospital does not have to operate any lift and
other major equipment. It requires to be looked into if there is any
pilferage of electricity by conducting an audit of electricity
consumption.
d. Generator Operation & maintenance: In last three years, a staggering Rs
16 lakh was spent on this item. On enquiry it was learnt that besides
normal repair and maintenance, the sum also includes expenditure
towards purchase of diesel required to run the generator. Taking into
account both the Electricity Charges and the expenses on account of
running generators, the total amountof about Rs 46 lakh seems to be
unbelievably high and requires further examination, particularly keeping
in view the fact that the OPD is run mainly between 10 AM to 1 PM.
e. Campus & Hospital cleaning: The expenditure on this item rose to Rs

5.64 lakh in 2017-18 as compared to Rs 1.08 lakh in 2015-16. This five-
fold increase in cleaning charges cannot be justified in view of the
extremely unhygienic condition prevailing in the entire hospital
premises. The matter requires detailed examination with reference to
the contract signed for this purpose with the outsourced agency.
f. Excess of expenditure over income: As per the Auditor's Report,

whereas the hospital could save Rs 1.47 lakh in 2015-16 after meeting
all expenditures, it incurred a loss of Rs 6.29 lakh in 2016-17 and Rs
11.99 lakh in 2017-18.
Recommendations:
i. The hospital management should prepare a realistic budget of Income and

Expenditure, based on 2017-18 actuals. This will also be helpful in monitoring
42
achievements vis-à-vis targets for reviewing performances and submitting MIS
Reports.
ii. Based on last year's (2017-18) actuals, the following steps may be taken to
increase revenue and decrease expenditure to realise an overall revenue of
about Rs 30 lakh, which will not only wipe-out the overall deficit but also leave a
surplus of Rs 18 lakh in the Financial Tear 2019-20:
a. Expenditure: Overall reduction of expenditure by Rs 14.44 lakh as shown

below resulting in saving:
 5% reduction in expenditure (saving Rs 6.54 lakh)
 25% reduction in expenditure towards Repair and Maintenance

(saving Rs 5.86 lakh)
 25% reduction in expenditure towards 'Generator Operation &

Maintenance' (saving Rs 0.63 lakh)
 25% reduction in expenditure towards 'Campus & Hospital cleaning

charges' (saving Rs 1.41 lakh)
b. Income: Overall increase of Income by Rs 15.63 lakh generating additional
revenue as per detail shown below:
 5% increase in Total Income (adding Rs 5.94 lakh)
 Realizing pending rent from Canteen (adding Rs 0.06 lakh)
 Realizing pending rent from Spectacle Shop (adding Rs 0.23 lakh)
 Realizing pending rent from Post Office (adding Rs 0.03 lakh)
 Realizing pending rent from Central Drug Office (adding Rs 0.96 lakh)
 Additional revenue by annulling all Outsourced Contracts (adding Rs

10.00 lakh)
 Total abolition of Income from Health Card (loss of Rs 1.59 lakh)
iii. The above estimation does not include income or expenditure towards new
constructions, purchase of equipment and other initiatives proposed to be
undertaken.
iv. In view of the unreasonably high expenditure in some activities, like repair and
maintenances, generator operations and maintenances, Campus& Hospital
cleaning charges, etc., it is recommended that a forensic audit of the entire
account for last three financial years may be undertaken.
43
v. For ensuring proper financial control and management, appointment of an
Internal Auditor is recommended.
vi. There is a need to continuously develop relationship with major donors for
which a separate department be formed be immediately to solicit donations on
a regular basis.
vii. Utilisation Certificate should also be given to all major donors (above Rupees
Fifty Thousand) conveying details of expenditure incurred on the items for
which the donation was received.
P. Manpower and Pay & Allowances
Current status:
136. In all, the hospital employs 66 persons in different capacities, out of which 26 employees
are Permanent,38 employees are Casual and 2 are Daily Workers.
137. A statement containing details of Salary/Wage of each Permanent /Casual employee is

placed at Annexure 1. The Monthly/Annual expenditure on Pay and Allowances are
summarised in the following table:
Table showing Pay & Allowances of employees in the hospital (as on 26 November 2018)
Type of No. of Pay (in Rs) Allowances (in Rs)# Total (in Rs)#
Employees employees
Monthly Annual Monthly Annual Monthly Annual
Permanent 26 108,405 1,300,860 6,350 76,200 114,755 1,377,060

Casual* 38 125,275 1,503,300 5,500 66,000 130,775 1,569,300
- -
Total: 64 233,680 2,804,160 11,850 142,200 245,530 2,946,360
*-Excludes Conveyance allowances/Honorarium paid to doctors and wages paid to the 2 Daily Wage
Workers
Current status
138. An amount of Rs 29.46 lakh is paid towards pay and allowances of the employees in a
year.
139. The number of permanent/casual employees is very high in relation to the actual
workload in the hospital, which essentially runs between 10 AM to 2 PM.
140. There is a high degree of resentment among the employees for the meagre pay and
allowances they are receiving over many years, some of whom have not been granted
annual increments.
44
141. Allowances ranging from Rs 100 to Rs 2000 per month are paid to selected permanent and
casual employees.
142. In addition, residential quarters located within the premises of the hospital are also
provided to 12 permanent employees and 8 casual employees.
143. Electricity Charges for 50 units in a month are provided free of cost to the employees
having residential quarters.
144. There does not seem to be any policy regarding fixation of pay, allowances as also
allotment of quarters.
145. There is substantial room for streamlining the workload of the employees taking into
account, inter alia, the optimum number of employees required to run the hospital,
organisation structure and department-wise allocation of work.
Recommendations:
i. The Pay & Allowances of the staff may be suitably enhanced, subject to
rationalization of manpower, if necessary.
Q. Welfare Allowances
Current status:
146. The hospital has paid Welfare Allowance to the tune of Rs 12.71 lakh during 2015-16, Rs
14.41 lakh during 2016-17 and Rs 14.68 lakh during 2017-18, the total of which works out
to a staggering amount of Rs 41.80 lakh. The details of these payments were not provided.
Recommendations:
i. The quanta and beneficiaries of Welfare Allowance may be identified and the
policy in this regard reviewed.
R. General Administration
Current status:
147. Hospital administration is a subject in itself and any person at the helm of affairs of a
hospital and those assisting him must have some qualification/experience in hospital
management. Unfortunately, in the case of this hospital, there is no qualified person
responsible for day to day administration. All the functions of the hospital are being run
completely on ad-hoc basis without any control/supervision on a periodical basis. This has
resulted in considerable amount of inefficiency in terms of punctuality, manpower
utilization, general cleanliness, upkeep of the OPD and IPD, purchase and maintenance of
essential equipment, etc.
148. The overall supervision and administration of the hospital currently is under the charge of
Swamiji. He is assisted by one experienced Accounts Officer looking after all establishment
45
matters including purchases. In addition, one contractor of the hospital, also plays an
important role in the day to day activities of the hospital.
Recommendations:
i. There is an urgent need of putting in place a formal organizational structure

with allocation of specific duties and responsibilities, with a strong and
dedicated Administrator at the helm.
A. Building and other Infrastructure
Current status
149. As stated earlier, the hospital precincts are shabbily maintained, toilets are filthy, OPD ill-
equipped and IPD mosquito infested with broken glass panes and open entry/exit points.
150. The hospital requires extensive repairs and renovations for optimum use of space to
provide better environment and quality of service.
Recommendations
i. A detailed development plan for repair and renovation may be prpared and
executed, which should include provision for:
a. Prevention of water logging in the OPD basement areas, etc.
b. Urgent facelift by colour washing the outer and inner walls, removing
the ugly and unnecessary structures, proper landscaping in the open
spaces, providing space for flower beds and greenery.
c. Creating more space for use by OPD as many of the Departments in OPD
are seriously short of space.
d. Construction of a Private OPD with latest infrastructural facilities in the

hospital block.
e. Renovating of the rooms in both the OPD and IPD with beautiful
interiors and new furniture.
f. Proper landscaping including aesthetically relaying the open space near

the Main Gate up to the main building.
g. Development of parking area near the main entrance and also in front
of the staff quarters
ii. In addition to above, taking advantage of location of the hospital on the main
road, it may be seriously considered if it would be beneficial to shift the X-Ray
and USG Units on the left of the main entrance to the main building and
redeveloping the entire block for commercial purposes for generating additional
revenue.
46
S. Parking Facility
Current status:
151. The hospital management has outsourced the work of maintaining parking facility to two
separate contractors – one for Day Parking and the other for Night Parking. As per the
Contract in place, the contract for Day Parking yields Rs 50,000/- per year. For Night
Parking, no particular amount has been fixed in the contract and it has been stated that
the revenue collected will be shared between the Hospital and the Contractor in the ratio
of 70% and 30%.
152. When the team first visited the hospital, the members were shocked to find large number
of Cars, SUVs, Bikes parked within the hospital premises both during Day and Night period
at every conceivable place. Even a school bus was found to be parked after school hours.
When the team started enquiring about it, especially with reference to the revenue
received, there was visible reduction in the number of vehicles parked.
153. It is likely that the hospital premises is used as a parking space not only by the visitors but
also by many others who are residing nearby as finding space for parking is difficult in
Varanasi. A few hotels nearby, it seems, are also taking full advantage in connivance with
the Contractors and a few others.
154. Following are the parking charges for different category of vehicles:
Rates:
 Bike (Rs 10 per day, Monthly rate: Rs 300 per month)
 Car (Rs 30 per day, Monthly rate: Rs 1200 for hatchback & Rs 1500 for
Sedan/SUV).
155. Donation for Parking received by the hospital in last three financial years were: Rs 1.69
lakh in 2017-18, Rs 1.78 lakh in 2016-17 and Rs 0.82 lakh in 2015-16. The receipt from
parking appears to be significantly low and there is scope for improvement.
Recommendations:
i. A specific Parking Policy with rates of different categories of vehicles and

duration of parking may be formulated and implemented in-house to
substantially enhance revenue generation. Suitable parking space may be
identified and renovated for the purpose.
T. Security arrangement
Current status:
156. At present the security arrangement in place is inadequate. Only two or three security
guards are assigned the duty. There is no security guard at the main entrance of the
hospital. As a result, even outsiders are free to enter the premises and park their vehicles
freely. The situation turns worse in the evening/night when the free space in the premises
47
is overcrowded with cars and motorcycles for night parking. This poses a serious security
hazard to the hospital.
157. The CCTV coverage of the key areas is inadequate.
Recommendations:
i. There is an urgent need to enforce strict security in the hospital on 24 X 7 basis

(3 shift duty).
ii. The provision of CCTV must be reviewed to identify the blind spots to ensure
safety and security.
U. Fire and Safety
Current status
158. Sufficient attention has not been paid to this important aspect as no Fire and Safety Audit
seems to have been undertaken.
159. In all there are only fourteen Fire Extinguishers installed in the hospital at different
places/floors. The capacities of Fire Extinguishers vary from 4 kg to 5 kg. These are in
working condition and are regularly refueled. It may however be pointed out that, the
hospital has not obtained fire and safety clearance from statutory bodies required in a
hospital. In the unfortunate event of fire accident, the hospital authority may face fine
and/or imprisonment as per law.
Recommendations:
i. A Fire and Safety Audit may be got carried out by the statutory authority at the
earliest and their recommendations implemented.
V. Computerisation and MIS Reporting
Current status
160. Every hospital usually uses a digital Hospital Information System to manage the varied
activities. Instead, except Registration Section, most of the activities are recorded in
registers and sometimes are not updated or reconciled. The Registration Section has three
stand alone computers and uses a registration software developed by ACE Software
services (www.acesoft.co.in) which, at the moment, seems to be a basic software for this
purpose. The software is used to register each patient, generating receipts and for
preparing consolidated statement.
Recommendation:
i. The hospital requires a functional HIS software to track transaction/activities in

all the respective departments as shown below:
a) Patient Care: Registration, Appointments, In-patient management,
Billing and Pharmacy
48
b) Clinical support: Laboratory, Operation Theatre, Blood Bank, CSSD,
Medical Records, Radiology
c) Administration: Stores, Personnel, Payroll, Finance and Accounting,

Duty Roster, MIS, Sec & Administration
d) Ancillary: Housekeeping and Laundry, Diet & Kitchen, Equipment

Maintenance, File Management, and other functions.
ii. For developing, the HIS, steps should be taken to identify and outsource the
work to develop a robust system for use by users in different Departments.
Priority of developing different modules to manage the activities of different
departments may be categorised in a phased manner.
iii. Each department should be provided with desk top computers and
interconnected using Local Area Network (LAN). The list of persons authorized
tokey-in information may be identified and given a User ID and Password. The
LAN should be connected to a server and a back-up server to protect the
information.
iv. It is also important to provide key information in the form of MIS to important
management officials on the web using internet.
W. Annual Report
161. The Annual Report of any society is a document which provides a snapshot of the working
of the society, plans and programmes and about its financial health. The Annual Reports
published by the MAH lack these necessary details.
162. Annual Reports of the hospital for the last three years do not provide the Annual Income
and Expenditure Statementsand Auditor's Reports. The Balance Sheet given in the Annual
Reports do not provide sufficient information on the financial health of the hospital.
163. It may be appropriate to mention here that the Auditor's Reports for the last three
financial years 2015-16 to 2017-18, copies of which were made available, do not have any
observation on the different items of income and expenditure undertaken by the hospital.
It is merely stated therein that the observations made by the Auditors were satisfactorily
explained and consequently stand resolved.
164. The management may consider changing the Auditor at regular intervals to bring forward
new ideas for better management.
49
Summary of Recommendations
A. Management Structure
01. The administration of the ashram and the hospital must be separated - while the
ashram may be administered by an ascetic member, the Administrator of the hospital
should be a non-ascetic person, if necessary, by paying suitable remuneration. [Refer p.
53]
02. The Administrator may be assisted by three functional heads in charge of (a) Finance
&Accounts, (b) Contracts & Procurement and (c) Pubic Relation &Redressal of
Grievances.
03. The Administrator should get Annual Budget prepared and fix quarterly targets of
achievements, both in financial and physical terms.
04. The Administrator should take a quarterly review of work done by all the functional
heads on a regular basis with reference to the targets fixed, identify the deficiencies and
take appropriate remedial measures.
05. The Administrator should also submit an MIS Report to the Headquarters at Kankhal and
to Delhi Ashram on quarterly basis.
B. Building and other Infrastructure
06. Urgent steps may be taken to repair and renovate the hospital premises.[Refer pp. 54-
55]
C. Out Patient Department
07. Registration Fee may be reduced from Rs 20 to Rs 10.[Refer p.21]

08. Validity of registration for patients may be reduced to 3 days in place of seven
days.[Refer p. 21]
09. Health Card including levy of Rs 30/- may be dispensed with.[Refer p. 22]
10. Additional Senior and Junior Consultants in Medicine, Cardiology, Orthopedic,
Gynecology, Ophthalmic, ENT and other departments should be appointed.[Refer p. 24]
11. List of equipment for respective OPD Departments may be procured and supplied
urgently. [Refer pp. 24-32]
12. The weekly schedule for consultation may be revised by extending the availability of the
existing doctors and also by appointing new doctors.[Refer p. 33]
13. Reputed doctors in Varanasi may be contacted and persuaded to join the hospital. They
may be adjusted in the vacant time slots available. [Refer p. 33]
50
14. Special Paid OPD may be introduced in the evening shift (4 PM to 7 PM) to augment
revenue.[Refer p. 33]
15. A Committee of Senior Doctors may be constituted to effectively administer the

Departments in OPD. They may meet once a month and devise ways and means to
improve the services.[Refer p. 25]
D. InPatient Department (IPD)
16. Regular MBBS Shift Doctors and suitable number of trained nursesas also service staff
may be immediately provided. [Refer p. 35]
17. The basic infrastructure of the IPD may be improved for providing secure environment
to the patients. [Refer p. 36]
E. Operation Theatre (OT)
18. New and latest equipment for surgery may be purchased for use in OT, subject to
recommendations in this regard by group of doctors as mentioned at item 15
above.[Refer p. 38]
19. Senior Surgeons in the field of Orthopedic and ENT may be recruited as the surgeons in
service are quite old and are reluctant to perform operations. [Refer p. 38]
F. Emergency Services
20. The Emergency Service, though necessary, may not be introduced at present till the
basic standard of the hospital comes up to the expected level. [Refer pp. 38-39]
G. Special Programmes
21. In addition to running Thalassemia Day Care Centre with support from IMA and Blood
Bank and organising one Free Eye Camp every year, steps should be taken to host
additional free medical camps (e.g., for treatment of diabetes, general medicine,
gynecology, etc.) for poor patients.
22. The hospital may consider hosting free medical camps for health checkup. Like other
camps organised by the hospital, the patients may be given free medicine.
H. Pathology, Radiology (X-Ray, ECG & USG)
23. The following three options could be considered to increase hospital's revenue:
a. To dispense with outsourcing of these functions and carry them out in-house.
51
b. To reduce the Contractor's share from 40% to 20% and correspondingly increase
the hospital's share from 30% to 50%.
c. To completely outsource the services to Diagnostic Centres after ensuring that

the hospital receives more revenue than at present
I. Canteen
24. The outlook of the Canteen needs drastic improvement. [Refer p. 42]
25. Arrear in payment of rent from the Contractor should be realised immediately.
J. Pharmacies& Homeopathic Dispensary
26. The contract with Medlife maynot be renewed and the space utilised by them may be
more gainfully used for the treatment of patients in the OPD.
27. The doctors may be advised to write the name of the branded medicines as well as the
generic medicines in the prescription. [Refer p. 43]
28. Special donations may be raised to run Jan Aushudhi Kendra and Homeopathic
Dispensary even if they are not able to generate profit.Services of both may continue
despite losses.[Refer p. 43]
K. Publicity
29. Suitable publicity measures may be initiated to advocate availability of all the
departments of the hospital. [Refer p. 43]
L. Purchase Procedure
30. The existing delegation of financial powers for all Contracts and Purchases, as
mentioned below, may be continued:
 Up to Rs 1 lakh – By the Administrator

 Rs 1 lakh to Rs 5 lakh – By Local Managing Committee
 Above Rs 5 lakh – By Sangha HQ, Kankhal
31. The Sangha Management may decide about the tendering procedure.
M. Contracts
32. All the contracts, which have already expired and are without renewal, may be
regularized by submitting to the competent authorities mentioned above with adequate
reasons for delay.
52
N. Financial Management
33. The system of budgeting with verifiable targets of achievement on a quarterly and
annual basis may be introduced immediately and performance reviewed. [Refer pp. 50-
52]
O. Manpower and Pay & Allowances
34. The Pay & Allowances of the staff may be suitably enhanced, subject to rationalization
of manpower, if necessary.[Refer p. 53]
P. Welfare Allowances
35. The quanta and beneficiaries of Welfare Allowance may be identified and the policy in
this regard reviewed.[Refer p. 53]
Q. Donation
36. All major donations (above Rs 50,000) may be duly acknowledged and utilisation
certificate furnished to the donors. The major donors should be invited to attend all
major functions of the Ashram and hospital. A database of all donors across the country
should be prepared to maintain liaison acknowledging their donations and utilization of
the fund received from them.[Refer p. 52]
R. Parking Facility
37. A specific Car Parking Policy with rates of different categories of vehicles and duration of
parking may be formulated and implemented in-house to substantially enhance revenue
generation. Suitable parking space may be identified and renovated for the purpose.
[Refer p. 55]
S. Security Arrangement
38. Management may decide on the number of security staff required including provision of
a Supervisor to enforce optimum security in the hospital on 24 X 7 basis (3 shift duty).
39. Adequate number of CCTVs may installed for full coverage to monitor safety and
security.[Refer p. 56]
T. Fire & Safety
40. A Fire & Safety Audit may be got carried out by the statutory authority at the earliest
and their recommendations implemented. [Refer p.56]
53
U. Electricity Audit
41. An audit of electricity consumption may be undertaken to identify pilferage, if any, and
reduce the unwarranted consumption. The audit may also cover the unusually high
expenditure on Operation of Generators and their maintenance. [Refer p. 50]
V. Auditor
42. A forensic audit of the entire account for last three financial years may be undertaken.
43. An internal auditor may be immediately appointed to carry out internal audit at regular
interval.
44. The management may consider changing the Auditor at regular intervals to bring
forward new ideas for better management.[Refer p. 58]
W. Computerisation and MIS Reporting
45. A functional HIS (Hospital Information System) software may be introduced to track
transaction/activities in all the respective departments. [Refer p. 57]
______________
54
Bibliography
1. Annual Report – 2014-15 : Mata Anandamayee Hospital, Shivala, Varanasi – 221001
5. Annual Report of the General Secretary for the financial year ended on 31st March, 2014 : Shree
Shree Anandamayee Sangha, Kankhal, Haridwar
6. Annual Report of the General Secretary for the financial year ended on 31st March, 2015 : Shree
Shree Anandamayee Sangha, Kankhal, Haridwar
7. Joshi, D. C. & Joshi, Mamta; Hospital Administration, 2009.
55
Annexure -1
Ma Anandamayee Hospital, Varanasi

List of Personnel as on 26th November 2018
S. Education Permanent/ Date of Salary/ Allowance

Name Designation Sex Age
No. Qualification Casual Joining Wage + Quarter
1 Dr P K Mishra RMO M 25.4.63 BAMS P 1.9.2002 8,850.00 150 + Qrt.

2 Dr Vikas Dixit RMO M 4.6.77 BAMS p 2.9.2002 7,350.00 150 + Qrt.
3 Dr Dinesh Singh RMO M 28.12.70 BAMS p 1.12.2003 6,450.00 150 + Qrt.
Sri Shambhu Nath
4 Chakraborty A.O. M 6.3.64 M.A. p 1.7.1991 8,800.00 250 + Qrt
Higher
5 Ashish Mukherjee Office Asstt. M 1.3.65 Secondary p 1.1.1989 3,925.00 Qrt.
Computer
6 Alok Ranjan Choudhury Operator M 15.8.62 B. Com P 2.1.2001 4,400.00 300
7 Sharad Kr. Srivastava Office Asstt. M 16.4.74 B.Sc. P 1.7.2008 3,795.00
Ward Shift
8 Alok Kr. Basak Incharge M 10.5.64 High School P 1.6.1984 3,625.00 500
9 Bijay Sengupta Electrician M 2.6.63 High School P 1.7.1997 3,650.00
10 Nandulal OPD Asstt. M 7.1.73 VIII P 1.6.1993 3,020.00 400 + Qrt
11 Smt. Sumitra Devi Ward Dai F 1.1.72 Nil P 1.1.1996 2,865.00 500 + Qrt
12 Smt. Sakina Bano Safaikarmi F 10.5.75 Nil P 1.2.2000 2,910.00 100 + Qrt
13 Archana Choudhury Ward Asst. F 4.7.64 Inter P 21.1.2002 2,895.00 500 + Qrt
14 Basanti Devi Ward Atten F 4.7.72 Nil P 5.9.2002 2,845.00 500
15 Mukesh Kr. Ward Asst. M 12.7.79 Inter P 2.7.1999 3,490.00 500 + Qrt
16 Ashok Kr. Pharmacist M 11.1.79 B.Sc.Pharma P 1.11.2004 6,050.00 Qrt.
56
Annexure -1


17 Smt. Kala Trivedi Ward Atten F 1.9.69 Nil P 5.8.2002 2,895.00

18 Shakuntala Pandey Ward Asst. F 4.1.69 High School P 19.7.2004 3,000.00 500 + Qrt
19 Gayatri Nandi Regd. Clark F 9.11.72 B.A. P 9.2.2008 3,350.00 250 + 100
20 Som Nath Dutta X-Ray Asst M 30.11.91 B.A. P 1.8.2011 3,490.00
21 Sumita Sarkar Regd. Clark F 15.3.69 High School P 9.2.2012 3,100.00 500
22 Soni Kr. Electrician M 12.12.83 Nil P 1.5.2012 3,100.00 Qrt.
23 Amita Neogy Regd. Clark F 7.12.70 B.A. P 1.6.2012 3,100.00 500
24 Sharawani Chatterjee Regd. Clark F 13.6.68 B.A. P 10.7.2012 3,100.00 500 + Qrt
25 Siddharath Sengupta O.T. Asst. M 7.6.78 High School P 1.9.2013 2,750.00
26 Ajeet Kr. Rao Driver M 26.12.85 VIII P 6.6.2016 5,600.00 Qrt.
Asst.
27 Santosh Kr. Srivastava Accountant M 5.7.61 Graduate Casual 1.1.2018 4,000.00
28 Jharna Nandi OPD Atten F 26.9.69 Inter Casual 31.10.2013 2,000.00
29 Ajay Sahani OPD Atten M 14.3.87 B.A. Casual 31.10.2013 2,000.00
Ward Shift
30 Pramod Kr. Mishra Incharge M 6.1.72 Inter Casual 1.2.1992 3,475.00 500
31 Saurabh Singh Mali M Nil Casual 16.3.2013 1,900.00
32 Avinash Singh OPD Atten M 2.7.95 High School Casual 19.8.2013 2,000.00
33 Jaldhar Dasgupta OPD Atten M 14.10.87 Inter Casual 1.5.1980 2,790.00
34 Kailash Prasad S. Guard M 10.10.55 Inter Casual 1.5.1980 2,790.00
57
Annexure -1


35 P N Rai OT Tech. M Nursing Tra Casual 14.5.2005 4,400.00

36 Lallu Ram Lab Asst M 23.9.43 Admission Casual 29.10.2004 2,600.00
37 H K Pal Store Inch. M 1.7.52 B.A. Casual 1.8.2005 2,650.00
38 D D Mathur Dispen. Asst M 15.12.47 Inter Casual 29.11.2004 2,500.00
39 S N Das OPD Atten M 28.5.51 6 th Casual 14.1.2008 2,400.00
Asst. Ward
40 P. R Singh incharge M 4.4.83 High School Casual 1.2.1981 3,300.00 500 + Qrt
41 Aruna Chakraborty OPD Atten F 72 Years 5 the Casual 7.4.1996 2,200.00
42 Ram Charan Mali M 26.7.49 3 rd Casual 7.10.1993 2,200.00
43 Md. Ali Khan OT Tech. M 70 Years AGU Casual 1.12.1994 4,100.00 Qrt.
44 P R Pandey Ward Master M Housing Casual 10,000.00 2000
45 Girdhari OPD Atten M 14.7.58 High School Casual 2.9.1979 2,970.00
46 Tanmoy Majumder M Casual 1.10.2018 6,000.00 Qrt.
47 Surendra Kr. Singh USG Asst M 5.7.54 B.A. Casual 12.9.2015 1,700.00
48 Rahul Sahani OPD Atten M 2.6.95 Inter Casual 29.10.2015 2,000.00
49 Kishan Sahani OPD Atten M 20.6.95 Inter Casual 29.10.2015 2,000.00
50 S N Roy Electrician M 15.6.64 High School Casual 15.2.2017 4,500.00 Qrt.
1000 +
51 Sunita Singh Ward Nurse F GNM Casual 5,600.00 Qrt
52 Kakuli Bhattacharya Ward Asst. F 22.10.71 Inter Casual 4.4.2016 3,600.00 500
58
Annexure -1


53 Manoj Kr. Pandey Ward Atten M 38 Years Inter Casual 1.6.2017 3,800.00 500
54 Jitendra Kr. Mishra Ward Asst. M 4.7.59 B.A. Casual 2.4.2017 4,300.00 500
55 Sarita F Casual 60/- Per day Qrt.
56 Kalawati Devi Ward Dai F Casual 7.12.2012 80/- Per day Qrt.
57 Ajay Kr. Srivastava OPD Atten M 10 th Pass Casual 3.2.2018 1,500.00
58 Ram Raj Singh PRO M 29.6.57 B.Sc. MRH Casual 1.4.2018 4,000.00
59 Dasarath Gupta S. Guard M Nil Casual 4,000.00 Qrt.
60 Dinesh Lal Srivastava S. Guard M Nil Casual 4,000.00
61 Rajeev Ranjan Singh M Casual 5,000.00
62 Navanish Pathak OPD Atten M Nil Casual 1,000.00
63 Mritunjoy Ojha Pujari M 1971 Nil Casual 1.1.2014 1,000.00 Qrt.
64 Akash Mishra Ward Asst. M GNM Casual 11.11.2018 3,000.00
65 Manta Km. Ward Asst. F Inter Casual 1.11.2018 4,000.00
66 Soni Kr. Safaikarmi M Casual 1.10.2018 4,000.00
59

MAH Final Report 5

Enviado por

Dados do documento

Descrição original:

Título original

Direitos autorais

Formatos disponíveis

Compartilhar este documento

Compartilhar ou incorporar documento

Opções de compartilhamento

Você considera este documento útil?

Este conteúdo é inapropriado?

Direitos autorais:

Formatos disponíveis

MAH Final Report 5

Enviado por

Direitos autorais:

Formatos disponíveis

MATA ANANDAMAYEE HOSPITAL,

SHREE SHREE MA ANANDAMAYEE ASHRAM, DELHI

Annexure 1:List of Personnel as on 26th November 2018, Ma Anandamayee Hospital, Varanasi…………56

2. Patients seek Ma's Blessings for quick recovery

5. Doctor in OPD examining patient 6. Ophthalmic Unit – Unusable machines

7. Dental Department – Needs upgradation 8. Physio-Therapy Department

11. Male Ward – No patient 12. Special Ward – No patient

17. Dirty entry 18. Terrace - Dump yard

25. Staff quarters – Need better outlook

ROGRUPI JANA JANARDAN SEVA

The following modes were adopted for the study:

a. Focused discussion with Swami Deveshanandaji

A. Out Patients Department (OPD)

01. The following departments in OPD are functioning in the hospital:

i. Medicine ix. Dental

ii. Gynecological x. Orthopedics

iii. Surgical xi. Radiology (X- ray and USG)

iv. Cardiology xii. Dermatology

v. Urology xiii. Endocrinology

vi. Ophthalmic xiv. Ayurvedic (Ksharsutra)

vii. ENT xv. Pathology and

viii. Pediatrics xvi. Physio Therapy.

Number of registered patients

i. As a large number of poor patients, that is those belonging to BPL category,

3. Health Card by NGO

4. Working of the Out-Patient Department (OPD)

No. of hours Dr J K Agrawal 2

ii. Due to absence of poor infrastructure available at In-patient Department (e.g.,

vi. Procurement of new equipment like Nebulizers (costing Rs 1,500 each),

vii. Formation of Joint Committee of Doctors to effectively administer all the

a. Auto Refracto Keratometre

33. The Laparoscopic surgery is conducted by an experienced surgeon - Dr O. P. Singh. The

i. As Dr Khanna, in charge of general Surgery, is about 83 years old, it will be in the

iv. The In-Patient Department (IPD) will have to be properly strengthened to

i. In view of the advance age of Dr Tewari, efforts should be made to persuade

a. Endodontics for RCT (Root Canal Treatment).

g. Composite Filling Material

J. Utilization of OPD Rooms

66. The following table will illustrate the point further:

Number of rooms in OPD used by time slots

% Occupancy 28.1 19.4 26.9 18.8 18.1 18.1 21.6

Total Time Slots

b. While searching for new doctors, emphasis may be given to

c. In addition, for better utilization of the facilities in the afternoon

d. The consultation fee in the proposed Paid OPD may be fixed

B. In-Patient Department (IPD)

a. General Ward – Charges: Rs 100 per day

 Cabins - AC Rooms – Charges per day: Rs 600 Double occupancy, Rs 800

Diseases 2015 2016 2017

Total: 1877 1903 1613

b. Regular cleaning and fumigation of the IPD.

d. Provision of emergency drugs and injection should also be made

Table: Number of Operations Performed in 2015, 2016 & 2017

S. No. Type 2015 2016 2017

a. Two ventilators, full set bed, automatic pump

i. Non- availability of sufficient number of doctors round-the-clock

ii. Absence of an Intensive Care Unit

iii. Absence of senior doctors in Medicine for post-operative care in IPD.

F. Thalassemia Day Care Centre

S. Pathology - Income, Expenditure &

1 Receipt: Pathology (from OPD + IPD) 2,040,230 2,059,460 2,044,500

i. Please refer Item 23 of the Recommendations at the end of the report.