KHYBER MEDICAL INSTITUTE
PESHAWAR PAKISTAN
(KMC, KCD & KTH)
BUSINESS PLAN
Planning & Development Cell
2010-2014
Business Plan, Khyber Teaching Hospital Peshawar
Table of Contents
ACRONYMS ........................................................................................................................................................ 4
EDITORIAL BOARD ......................................................................................... ERROR! BOOKMARK NOT DEFINED.
MESSAGE FROM THE CEO .................................................................................................................................. 6
EXECUTIVE SUMMARY ....................................................................................................................................... 7
FACILITIES OFFERED ......................................................................................................................................... 11
BASELINE DATA 2008 .......................................................................................................................................... 12
BASELINE DATA 2009 .......................................................................................................................................... 13
COMPARISON OF 2008-2009............................................................................................................................... 14
TOP TEN DISEASES ................................................................................................................................................... 15
BASIC MINIMUM SERVICES OFFERED ............................................................................................................... 16
THE MANAGEMENT SUMMARY ....................................................................................................................... 17
COMPOSITION OF THE MANAGEMENT COUNCIL: ........................................................................................................... 17
ORGANOGRAM ....................................................................................................................................................... 18
FINANCIAL PLANNING ...................................................................................................................................... 20
SITUATIONAL ANALYSIS ............................................................................................................................................. 20
FINANCIAL ANALYSIS ................................................................................................................................................. 20
PROJECTED RECURRING BUDGET ( 2010-11 TO 2014-15) FOR KHYBER TEACHING HOSPITAL ............................................... 24
PROJECTED RECURRING BUDGET ( 2010-11 TO 2014-15) FOR KHYBER MEDICAL COLLEGE.................................................. 24
PROJECTED RECURRING BUDGET ( 2010-11 TO 2014-15) FOR KHYBER COLLEGE OF DENTISTRY ........................................... 24
A. KHYBER TEACHING HOSPITAL PESHAWAR ................................................................................................................. 25
B. KHYBER MEDICAL COLLEGE PESHAWAR.................................................................................................................... 26
C. KHYBER COLLEGE OF DENTISTRY PESHAWAR ............................................................................................................. 26
CONSTRAINS .................................................................................................................................................... 27
ADMINISTRATIVE ISSUES ............................................................................................................................................ 27
FINANCIAL ISSUES .................................................................................................................................................... 27
CONSTRAINS IN ACHIEVING FULL BENEFITS OF AUTONOMY ............................................................................................... 27
PROPOSALS ...................................................................................................................................................... 29
ADMINISTRATIVE PROPOSAL....................................................................................................................................... 29
FINANCIAL PROPOSALS ............................................................................................................................................. 29
ANNEX I ................................................................................................................................................................. 31
LOGFRAME .......................................................................................................................................................... 31
ANNEX II ................................................................................................................................................................ 37
ANNEX III ............................................................................................................................................................... 38
ANNEX IV .............................................................................................................................................................. 39
KHYBER MEDICAL COLLEGE FIVE YEARS PROSPECTIVE PLAN FROM 2010-14 .................................................... 39
IMPROVEMENT OF EXISTING FACILITIES OF ........................................................................................................ 39
PURCHASE OF EQUIPMENTS ............................................................................................................................ 39
IMPROVEMENT OF RESIDENTAL FACILITIES FOR STAFF AND STUDENTS. ..................................................... 39
IMPROVEMENT OF LIBRARY FACILITY ............................................................................................................. 39
FURNITURE ........................................................................................................................................................ 39
IMPROVEMENT OF SLRC SECTION .................................................................................................................... 39
IMPORVEMENT OF MORTURY / FORENSIC MEDICNE...................................................................................... 39
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IMPROVEMENT OF MORTUARY. ...................................................................................................................... 40
IMPROVEMENT OF SECURITY MEASURERS. .................................................................................................... 40
ASSURANCE OF ELECTRIC AND GAS SUPPLY TO THE COLLEGE HOSTELS. ..................................................... 40
PROVISION OF AN AMBULANCE FOR NIGHT DUTY TO RESIDENCE STUDENTS. ............................................ 40
IMPROVEMENT OF FACILITIES IN THE COLLEGE LIBRARY. ............................................................................. 40
PURCHASE OF CHEMICALS ............................................................................................................................... 40
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ACRONYMS
KTH
KMC
KCD
IMC
KP
OPD
FCPS
IT
PMRC
CENNA
ICU
DATC
BOR
ALOS
A&E
MRI
CT SCAN
ECG
MAW
MBW
MCW
M DW
MEW
SAW
SBW
SCW
SDW
GAW
GBW
GCW
ENT-A
ENT-B
ETT
CVA
DNS
CAD
TB
COPD
HTN
UTI
ESRD
PCR
HbsAg
CCU
SICU
Khyber Teaching Hospital
Khyber Medical College
Khyber College of Dentistry
Institutional Management Council
Khyber Pakhtunkhwa
Out Patient Department
Fellowship of the College of Physicians and Surgeons
Information Technology
Pakistan Medical Research Council
Name of the famous scientist” Ibn-e-Cenna”
Intensive Care Unit
Drug Addicts Treatment centre
Bed Occupancy Rate
Average Length Stay
Accident and Emergency
Magnetic resonance imaging
X-ray computed tomography
Electrocardiography
Medical A Ward
Medical B Ward
Medical C Ward
Medical D Ward
Medical E Ward
Surgical A Ward
Surgical B Ward
Surgical C Ward
Surgical D Ward
Gynecological A Ward
Gynecological B Ward
Gynecological C Ward
Ear-Nose-Thought A Ward
Ear-Nose-Thought B Ward
Endo tracheal tube
Cerebero Vascular Disease
Deviated Nasal Septum
Coronary artery disease
Tuberculoses
Chronic obstructive pulmonary disease
Hypertension
Urinary tract infection
End-stage renal disease
polymerase chain reaction
Hepatitis B surface Antigen
Cardiac Care Unit
Surgical Intensive Care Unit
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NICU
PICU
ERP
SOP
Etc
IPSAS
TORS
PC-2
ADP
FD
HR
DOH
FATA
PAC
I/C
HMIS
PRO
P&D
C&W
PC-1
TMOS
CPSP
PGMI
CE
FHT
Jr. Reg.
ICD-10
GFR
Rs.
Neonatal intensive-care unit
Pediatric intensive-care unit
Endoscopic Retrograde Pancreatography
Standard Operating Procedures
Et cetera
International Public Sector Accounting Standards
Terms of Reference
Planning Construction Phase 2
Annual Development Plan
Finance Department
Human Resources
Department of Health
Federally Administrated Tribal Area
Public Accounts committee
In-Charge
Health Information Management System
Personnel Relation Officer
Planning and Development
Construction and Works
Planning Construction Phase 1
Trainee Medical Officer
College of Physicians & Surgeons Pakistan
Post Graduate Medical Institute
Chief Executive Officer
Female Health Technician
Junior Registrar
International Statistical Classification of Diseases and Related Health Problems
10th Revision
Glomerular filtration rate
Rupees
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MESSAGE FROM THE CEO
First of all I would like to recognize the people whose help and collaboration was essential in
producing this business plan. These include:
 Teaching Staff of KMC, KCD & KTH
 Administration of the Khyber Teaching Hospital Peshawar
 The Institutional Management Committee (IMC)
 The Secretary of Health KPK, Dr. Sohail Khan
 Minister of Health, Dr. Zahir Shah
This is the first business plan of its kind, ever produced together by Khyber Teaching Hospital
(KTH), Khyber Medical College (KMC) and Khyber College of Dentistry (KCD). As one could
imagine, the task was daunting. Nonetheless, a serious effort has been made to lay a solid
foundation, keeping in mind the past and present institutional circumstances, leveraging
potential opportunities, while addressing the future needs.
Pakistan and particularly KPK, including tribal areas, is going through major social upheaval
due to terrorism. This business plan has also looked at the implications of the present turmoil.
The plan attempts to deal with the challenges emerging from these circumstances on the
functioning of the KTH, KMC and KCD and the services it provides.
You’ll find this document to be a stepping stone towards strengthening the existing
capabilities & services and building new ones.
Regards,
Dr. Mohammad Zafar
Chief Executive KTH
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EXECUTIVE SUMMARY
Health department is the second largest department of KP after education. Its health
department caters, not only to the needs of people of the province, but also to that of
millions of afghan refugees and adjacent tribal areas. KP is the third most densely populated
province of the country. It has a total area of 74,521 square kilometers. Peshawar, a city of
over 2.5 million citizens, is situated in the Western part of the country and close to historical
and famous Khyber Pass.
Khyber Teaching Hospital (KTH) Peshawar has been providing tertiary health care delivery and
teaching facilities to local population in KPK ever since 1976. established over a covered area
of 962,000 square feet on busy Jamrud Road, this 1202 bed hospital caters for the health
requirements through OPD, Casualty, indoor facilities and Evening OPD of over 739500
patients (in the Year 2007) (approx) an year.
The hospital management has submitted a business plan 2009-14 for government’s approval,
which is intended to make the services, rendered by Khyber Teaching Hospital and its sister
institutions more responsive, effective and cost efficient. The plan extends over 5 years and
envisions ensuring:
Financial discipline overt this time frame.
The standard of Medical Education and health care services to be brought at par with
international standards and norms.
Efforts towards implementation of clinical and performance audit system based on
organizational centered performance standards and patient care quality standards. This will
allow protecting rights of the clients and safeguarding the interests of the staff.
We are excited and hopeful that the successful implementation of this business plan by KTH
and associated institutions, will lead them to serve as a role model and a leader in exemplary
provision of patient care, quality medical education and research based services to the target
population. Additionally, the business plan over time will provide the essential lessons learnt
and baseline information for the next 5 Year plan.
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INSTITUTIONAL SUMMARY
Khyber Medical Institution consists of Khyber Medical College, Khyber Teaching Hospital,
Khyber College of Dentistry and Nursing School. Khyber Medical College is situated at the
doorstep of University of Peshawar, at the site of ancient Buddhist Academy. In 1954 the
Governor General of Pakistan Mr.Ghulam Muhammad laid the foundation stone of KMC. It
started functioning as Peshawar University’s faculty of medicine in 1955 with enrolment of 55
students
Since its inception the college has developed tremendously. It has been under the
administrative control of Health Department after parting way from Peshawar University in
1975. Later in 1999, The college and the affiliated Khyber teaching hospital was given
administrative and financial autonomy by the Government of KPK and is working under the
institutional management committee, headed by Chief Executive Khyber teaching hospital.
Khyber Medical College pioneered medical education in KPK and has gained the status of a
prestigious medical institution at both national and international level. a
Khyber Medical College enrolls 275 students yearly and over 8000 have graduated since its
establishment. Besides undergraduate medical education, it offers M. Phil in all basic medical
sciences, FCPS Training in clinical as well as basic medical sciences, and minor diplomas in
many specialties.
To keep pace with the changing trends in education and to further enhance the capacity of
the medical students and medical graduates, the college has a well-established Medical
Education Department. The medical education department of the college arranges courses,
workshops, symposia and seminars for the students, faculty members and other hospital staff
members.
An IT based “Learning Resource Center” has been setup within college which also provides
facilities of internet to the undergraduate students. To aid the learning resources, the College
has a well-established library consisting of lending services, a reference section and a
periodicals section. The library is well furnished, air-conditioned and offers large collections of
books and periodicals to meet the teachers and students requirements. “CENNA”, the official
annual magazine of KMC is rightly regarded as an outstanding magazine of its kind.
The KMC houses the Pakistan Medical Research Council (PMRC), a well-equipped center
where research facilities are provided in all disciplines of medical sciences.
The College is on the WHO list of recognized medical institutions in the world and is affiliated
with the Khyber Medical University. The college is recognized and regulated by PMDC. The
College of Physicians and surgeons of Pakistan, Royal colleges in UK and the Medical licensing
authority of the United States embrace the KMC graduates whole heartedly and recognize its
status.
Adjacent to the College, are Khyber College of Dentistry and Institute of Radiotherapy and
Nuclear Medicine (IRNUM), providing training facilities to the students of Khyber Medical
College in the respective disciplines.
In order to provide dental health facilities to the people of this region, it was
considered necessary to set up a teaching dental department at Khyber Medical College
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Peshawar. The idea to start a dental department came from late Dr. Hassan Raza Shah, the
then Principal of the, Montmorency College of Dentistry Lahore. It was gladly accepted;
appreciated and very much encouraged by the General Muhammad Akram, the then Principal
of Khyber Medical College and Mr. Muhammad Ali, the then Vice Chancellor of the University
of Peshawar. The Department of Dentistry was formally declared open by the then Minister
for Health Begum Mahmuda Salim on 12th October 1964.
The first batch graduated in 1968 while Pakistan Medical and Dental Council accorded
permanent recognition to BDS degree in its session held in Dacca (Bangladesh), the capital of
the then East Pakistan in November 1968.
From the modest start, it has grown to become a fully developed teaching institute
with modern Oral and Dental Hospital, housing operation theatres and Wards in its new
building complex, which was opened on 9th September 1978.
The annual intake of students has gone up gradually from 14 in 1964 to 50. So far
more than 600 dental graduates have qualified from the institute. Nearly 300 patients receive
daily dental treatment of various natures. This includes highly specialized treatment
modalities like orthodontic appliances, treatment for oro-facial pain, facial injuries, oral
cancer and fixed and removable prostheses of various kinds. Three new blocks housing the
Department of Orthodontia, Prosthetic and Conservation added in 1992. After the completion
of Basic Science Block it was upgraded to the status of the College by the then Chief Minster
Mr. Aftab Ahmad Khan Sherpao who made this announcement while presiding over the
inaugural function of the Silver Jubilee of the Department of Dentistry.
Khyber College of Dentistry is located within the University Campus and adjacent to Khyber
Medical College.
Khyber Teaching Hospital was established in 1976 which is attached to the Khyber Medical
College for teaching/training purposes. It is a 1224-bedded hospital, which has sophisticated
equipment.
Under Khyber Pakhtunkhwa Medical Institutions Reforms Act 1999, autonomous status was
accorded to Lady Reading Hospital (LRH) Peshawar, Khyber Teaching Hospital (KTH)
Peshawar, Hayatabad Medical Complex (HMC) Peshawar and Ayub Teaching Hospital (ATH)
Abbottabad. These institutions compile their accounts departmentally. The North-West
Frontier Province Medical Health Institutions and Regulation of Health-Care Services
Ordinance, 2002 replaced the Reforms Act 1999, giving full financial autonomy to these
institutions.
Director Finance compiles accounts and pre-audits payments. Hospital is mainly dependent
upon grant in aid from the Government of KPK including its own generated receipts. Originally
it had been envisaged that it will generate funds and will become self sustaining entity,
however the said objective could not be realized for the reason that this will lead to
privatization and will have negative political fall out.
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VISION
To become a role model & leader in patient Care, medical education, research and
community interaction.
CORE VALUES /GUIDING PRINCIPLES






Ethics
Quality
Equity
Access
Relevance
Affordability
MISSION
We are an equal opportunity employer and provider with no discrimination on the basis of
gender, cast, religion, disability and social status. We are committed to the provision of
accessible, affordable and quality health care services along with human resource
development based on good governance and optimal utilization of resources in a sustainable
manner. We continuously search for better, through the process of continuous education,
research and evidence based practice in accordance with international standards.
AIMS/GOALS




Improvement of patient safety, quality of health care and client satisfaction in next five
years.
Provision of relevant training and education to staff and students as per International
standards in context of local needs.
Provision of equal opportunities and enabling environment for research facilitation
leading to evidence based practice.
Ensuring good governance, transparency, accountability and efficient use of resources
through better management
(Note: - Target/Activities along with status and output indicators are annexed)
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SERVICES
FACILITIES OFFERED
1. General Medicine
2. General Surgery
3. Gynecology & Obstetrics
4. Pediatric Surgery
5. Pediatrics (Child Health care)
6. Nursery
7. Special care baby unit
8. Neonatal ICU
9. Medical ICU
10. Surgical ICU
11. Cardiology ward & Cardiac Care Unit
12. Accident & Emergency Services
13. Ear, Nose and Throat (Oto-Rhino-Laryngology)
14. Eye (Ophthalmology)
15. Pulmonology (Chest)
16. Nephrology (Kidney)
17. Pathology (Laboratory diagnostic services)
18. Radiology (X-Ray, Ultrasound, CT Scan and MRI)
19. Psychiatry
20. Dermatology (Skin)
21. Burns and Plastic Surgery
22. Orthopedics & Trauma
23. Physiotherapy
24. Endoscope Suite for Gastroenterology patients
25. Pharmacy
26. Dental Care
27. DATC
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HOSPITAL DATA PERFORMANCE & WORKLOAD
BASELINE DATA 2008
Total OPD Patients 430313
10
9
8
7
6
5
4
3
2
1
0
3
2
Patients waiting time
after Feb. 2009
Patient waiting time
before Feb. 2009
Total Indoor Patients
BOR ----- 66%
ALOS --- 5 days
65565
Patient data catagory wise
1000000
Total Patients A&E
Total Surgeries
Total Lab. Investigations
Total MRI
10000
CT Scan
1000
Total ECT
489
39053
933
5253
777
1448
24639
110197
9612
7091
825704
10
Total Ultra Sounds
18135
100
Total X-Rays
380690
No-Patinet
100000
Total Endoscopies
Total Dialysis
1
Total Echos
No of Patient
Total ECGs
Catagory
Total ETTs
 Patient waiting time: Registration counter → MO General OPD→ Specialist OPD→OUT
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BASELINE DATA 2009
2009 Patient Data
416029
10000000
100000
No of Patie nt
1000
10
0.1
386466 65572
65%
S1
Tot al OPD
pat ient
Tot al A & E
Pat ient s
Tot al Indoor
Pat ient s
Bed Occupancy
Rat e
Catagory
Patient waiting time reduced to 1hr 15 minutes
A.L.O.S (Unit Wise)
ALOS Data Table
12
11
M AW
M BW
M CW
10
M D/E WARD
8
8
PSYCHIATRY
CHILDREN A
CHILDREN B
NURSERY
SAW
No of days
6
5
5
4
4
5
4
4 4
SBW
5
SCW
4 4
3
4 4 4
3
4 4
3
SDW
GAW
GBW
GCW
2
ENT A
ENT B
EYE A
0
EYE B
Unit
ORTHOPEDIC
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Patient Data Catagory wise 2009
1000000
To tal No o f M ajo r Surgeries Do ne
To tal No o f M ino r Surgeries Do ne
To tal No o f M RI Do ne
To tal No o f CT scan Do ne
To tal No o f X-Rays Do ne
10000
To tal No o f Ultra so und Do ne
To tal No o f ECG Do ne
1000
To tal No o f Dialysis Do ne
To tal No o f Endo sco pies Do ne
100
467
36
67
627
484
754
6457
41350
To tal No o f ‘ ECT Do ne
30417
125994
10361
4825
10036
10
To tal No o f ETT Do ne
19055
No of patient
100000
To tal No o f Ho lter Do ne
To tal No o f A B P Do ne
To tal No o f Echo Do ne
1
Catagory
COMPARISON OF 2008-2009
777
754
489
484
933
467
Total Endoscopies
Total ETTs
Total Echos
5253
6457
Total Dialysis
39053
41350
Total ECGs
1448
627
Total ECT
24639
30417
Total Ultra Sounds
110197
125994
Total X-Rays
9612
10361
4825
7091
Total MRI
CT Scan
18135
19055
1000000
100000
10000
No of patient
1000
100
10
1
Total Surgeries
Comparison of 2008-2009
progress
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Top Ten Diseases
Top 10 Diseases Unit Wise
S-No
Medical
Surgical
Gynae & Obs
Pediatric
ENT
1
Malaria
Acute Appendicitis
Eclampsia
Diarrhea
Ch.SOM
2
Enteric Fever
Cholelithiasis
PPH
Pneumonia
Ch. Tonsilitis
3
D. Mellitus
Hernias
Pregnancy &
Diabetes
Malnutrition
DNS
4
Hypertension
Obst. Jaundice
Pregnancy & Anemia
Tuberculosis
Epistaxis
5
G. Enteritis
Enlarged Prostate
Mismanagement Of
labor
Acute
Respiratory
Failure
Voice Change
6
CVA
Hemorrhoids
Abortion
Measles
Dysphagia
7
Meningitis
Intestinal
Obstruction
Malaria
Sinusitis
8
Hepatitis B&C
Breast lumps
Gynecological
Cancers
Enteric Fever
Foreign Bodies
9
Gastric ulcer
Diabetic Foot
Fibroids & Ovarian
Cysts
Nutritional
Anemia
Goitre
10
Liver Cirrhosis
Renal colic
Ectopic Pregnancy
Meningitis
Top 10 Diseases Unit wise
S.NO
Eye
Cardiology
Nephrology
Pulmonology
Psychiatry
1
Catract
CAD
Diabetic
Nephropathy
TB
Unipolar Depression
2
Ch. Dacrocystitis
Rh. Heart Disease
Hypertensive
Nephropathy
Br. Asthma
Bipolar Depression
3
Conjuctivitis
Congestive
Cardiomypathies
Acute
glumonephropathy
COPD
Generalised Anxiety
Disorder
4
Keratitis
HTN
Calculus diseases
Pneumonia
Conversion Disorder
5
Refractive Errors
Cong. Heart
Diseases
Obst. Nephropathies
Lung Abscess
Szp
6
Diabetic
Retinopathy
Tachy Arrhythmias
Metabolic Disorder
Bronchogenic
Ca
Somat. Disorder
7
Hypertensive
Retinopathy
Brady Arrhythmias
UTIs
Bronchiestasis
Acute Psychosis
8
Squint
Cor pulmonal
ESRD
Interstitial lung
Diseases
Personality Disorder
9
Ptosis
Pericardial Disease
Infection Associated
& ESRD
Pneumotherax
Drug Abuse.
10
Glaucoma
Nephrotic Syndromes
Pleural Effusion
Epilepsy
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BASIC MINIMUM SERVICES OFFERED
1. All clients to be given free of cost access to the services including free consultation
services. All in door patients in the general wards will be provided free diagnostic
services except MRI, CT scan , PCR, HbsAg, Anti HCV-ab and certain other specialized
services as reflected in user charges list
2. Patients in the high dependency units like ICU, CCI, SICU, NICU, Nursery, PICU will be
provided free medicines and surgical disposals for 72 hours along with free diagnostic
services except MRI, CT Scan, PCR (Cost/patient/72 hrs. copy annexed).
3. In case of burns patients and terrorist/ bomb blast victims will be given full free
Medical treatment including surgical disposals and all diagnostic services.
4. In case of all emergencies, patients admitted through casualty will be provided free
treatment for 24 hours under ERP.
5. Implants will be provided only to bomb blast victims.
6. Zakat patients will be given free treatment as per existing policy (The SOPs regarding
the use of Zakat funds is attached as annex).
7. All anesthesia medicines (Halothane, Pentothal) will be given free to all in door
patients.
8. 70% sutures (catgut etc) will be provided free to all indoor patients.
9. 60% of the total cost of dialysis will be born by the hospital, while 40% cost of dialysis
will be born by the patient except under Baitulmall, Zakat, TLW and Entitlement.
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THE MANAGEMENT SUMMARY
The management of the affairs of medical institutions has been vested in the Institutional
Management Council. The management Council comprises of a total of ten members with
Chief Executive as its Chairman.
COMPOSITION OF THE MANAGEMENT COUNCIL:
1. The Chief Executive of the
Chairman
Medical institution (KTH/KMC/KCD)
2. Principal Khyber Medical
Member
College
3. Principal of the Khyber College of
Member
Dentistry
4. The Medical Superintendent
Member
of the Khyber Teaching Hospital
5. The Director of Finance
Member
KTH/KMC/KCD.
6. Five Non-official members
Member
nominated by Government.
The representatives from Departments of Health, Finance & Establishment are co-opted
member with no voting power.
Sub committees have been constituted with approval of Management Council for the
discharge of functions as assigned to them.
These are as follows.
a. Academic, Research and Publication Committee.
b. Technical Advisory & Finance Committee
c. Procurement Committee
d. Inspection Committee
e. Selection & Promotion Committee
f. Performance review & Clinical Audit Committee
g. Accommodation Committee
h. Monitoring & Evaluation Committee
i. Death Review Committee
The Chief Executive of the KTH/KMC/KCD has been entrusted the task of performing the
administrative and financial functions under the Health and Medical Institutions Reform Act
1999 called as Autonomy Act.
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ORGANOGRAM
Management council
KTH/KMC/KCD
Chief Executive
Principal KMC
Principal KCD
Medical
Superintendent
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Finance Office
Following is the organization Chart of the Directorate of Finance
Director Finance
KTH & Allied
institutions
Finance & Account
officer
Audit officer
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FINANCIAL PLANNING
SITUATIONAL ANALYSIS
Though the institute is working hard on improving its services, still there are areas which
have many lacunas. Conditions of the laboratories are not satisfactory. Most staff
members are not clear about autonomy. The hospital has 35 years old building which
needs repair; many pipelines are leaked and needs immediate attention. Relationship
between management and senior professors needs much clarity; for example, the chief
executive and a professor are of same grade, so it is very difficult to implement new
procedures. Professors have a powerful lobby. Unions of all sorts from peons to senior
doctors are in place, they work as pressure groups and many times management fails to
implement new reforms.
When the present management took over in the year 2009, steps were taken to bring
financial discipline and enhance accountability/transparency. Internal audit has been
upgraded and its quarterly report is being regularly submitted to M.C. Record
maintenance has been improved upon. File system has been introduced and efforts have
been made to implement rules and regulations. Perhaps due to this reason the numbers
of audit paras have tremendously declined. Role of technical committee has been
enhanced and experts from other bodies, such as University of Engineering and
Technology, have been involved. Commitment accounting and Asset accounting as per
International Public Sector Accounting Standards (IPSAS) is being introduced. Efforts are
being made to frame institutional by laws and regulations under overall policy of the
Government and existing rules of business. The process of recruitment and promotion has
been streamlined and is based on merit and transparency. Rules for clinical audit and
accounting will be made through hiring of consultants by February 2010.
T.O.Rs of the Consultants; 1. Formulating rules/procedures for Internal Audit
2. Making Accounting manual as per International Accounting Standards.
3. Estimating Assets of the Teaching Hospital & Associated Institutions.
FINANCIAL ANALYSIS
Though there is a gradual rise in the grant in aid given by the Government over a period of
time (Table1), but as is obvious from the given data, the increase is mainly in salary and
utility component and not other sub-heads which directly affect the services rendered to
the patients. Over a period of time, the number of patients has increased tremendously
(Table 2), but there is no matching increase in the budget allocation for drugs, diagnostic
services, infection control and other patient safety measures. Similarly due to low funding,
resources are not available to launch initiatives which could complement and improve
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quality assurance system and human resource development in accordance with the needs
of organization.
1000000
800000
600000
400000
200000
0
2006
2007
2008
2009
Table 1
600000000
500000000
400000000
300000000
200000000
100000000
0
2006
2007
2008
2009
Table 2
In contrast to increase in number of patients, there has been little increase in overall
budget. This has ensured status quo, as new projects could not be initiated with static
budget. Inflation has nullified any increase in the budget, very little is left for medicines,
chemicals, equipment, repair and machinery. Budget is ‘incremental based’ as in most of
the public sector; even there has been just nominal increase in the budget as is shown by
Table 3; Huge operating expenses leave very little for development works .No free
treatment can be provided with current budget. For free medicines to be given an
additional annual fund of at least Rupees 200 million is needed.
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600000000
500000000
400000000
Salary
Utilities
Total
300000000
200000000
100000000
0
2005
2007
2008
2009
Table 3
If salary remains same; of which there is little probability, then the current expenditure
may increase as below in table 4. Budget for the year 2010-11 will be Rs.799488290, if
the service delivery is desired to be the same.
800000000
700000000
600000000
500000000
400000000
300000000
200000000
100000000
0
2008-09
2009-10
2010-11
Table 4
Further, releases by the finance must be made at the beginning of financial year. At
present quarterly release are made which is main hurdle in proper planning. If budget
is released at appropriate timing then planning could be made and management may
be able to spend it in the areas where it is needed. This is the true spirit of autonomy
which is still awaited.
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Cost per patient has increased as shown below in table 5;
2006
2007
2008
2009
377147400/736672
429757660/787850
488506270/827463
537028000/885606
Rs. 512.per person
Rs. 545.per person
Rs. 590.per person
Rs. 606 .per person
Increase
Rs. 33
Rs. 45
Rs. 16
Table 5.
The budget for the previous three financial years i.e. 2006-07 to 2008-09 was:
Institution
Budget for 2008-09 Budget for 2007-08 Budget for 2006-07
KTH
448919000/434431928
32530118/KMC
277,151444/167,237,350/162,911,372/KCD
55,19300/26,503,870/21,411,100/-
The current/recurring expenditure of all three institutions, Khyber Teaching Hospital, Khyber
Medical College and Khyber College of Dentistry, will increase by 10% due to annual
increments of the employees, promotions, pension payments and crease in salaries and
allowances by government. Based on this 10% increase the estimated budget for the next
five years is projected below taking in to account that salary and tariff rate for utilities will
remain constant:
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PROJECTED RECURRING BUDGET ( 2010-11 TO 2014-15) FOR KHYBER TEACHING HOSPITAL
Serial no.
01
02
03
03
04
05
Financial year
2009-10
2010-11
2011-12
2012-13
2013-14
2014-15
Estimated Budget
774,280,000
799,488,290
879,437,119
963,380,831
1,060,118,914
1,166,130,805
PROJECTED RECURRING BUDGET ( 2010-11 TO 2014-15) FOR KHYBER MEDICAL COLLEGE
Serial No
Financial Year
Estimated budget
1
2
3
4
5
2009-10
2010-11
2011-12
2012-13
2013-14
198,128,920.00
217,941,812.00
239,735,993.20
263,709,592.52
290,080,551.77
6
2014-15
319,088,606.95/-
PROJECTED RECURRING BUDGET ( 2010-11 TO 2014-15) FOR KHYBER COLLEGE OF DENTISTRY
Serial no.
01
02
03
03
04
Financial year
2009-10
2010-11
2011-12
2012-13
2013-14
Estimated Budget
59,878,700/65866570/72453227/79698549/87668403/-
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PROPOSED DEVELOPMENTAL ACTIVITIES AND BUDGET
A. KHYBER TEACHING HOSPITAL PESHAWAR
Serial No.
1.
2.
3.
Project name
Repair &
Revamping of
drainage &
sewage system
of the main
hospital and
residential area
*
PC-2 for hiring of
consultant
Establishment of
a purpose built A
& E department
Total
Budget
50.
Million
2010-11
2011-12
2012-13
2013-14
25Million
25Million
-
-
Rs.2.00
Million
2.million
-
-
-
998
Million
94.512Million
178.847million 178.848
Million
(Capital cost
175.9)
+(370.991
Revenue cost)
Total
545.991Million
4.
Female doctor’s
Hostel
21.19
Million
5Million
16.19Million
-
-
5.
Construction of
Doctor’s Hostel
60
Million
30Million
30Million
-
-
45
Million
20Million
25Million
-
-
Renovation and
132
revamping of
Million
Ground floor
(OPD block)
* Submitted for approval.
** Submitted for approval.
66Million
66Million
-
-
**
6.
7.
Clinical &
Performance
Audit and HMIS
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B. KHYBER MEDICAL COLLEGE PESHAWAR
Total
Project name
2009-10
2010-11
2011-12
Improvement/ Capital cost
Rehabilitation
of KMC
Peshawar.
ADP NO. 158
Revenue Cost
Code 90336
50.
Million
100Million
80Million
230Million
50
Million
15
Million
18.075Million
00.00
068.075Million
118.075
80.90
298.975
Total
The development work in KMC includes up gradation of library, mortuary, Construction of
accommodation for staff and students, purchase of chemicals and books.
C. KHYBER COLLEGE OF DENTISTRY PESHAWAR
Serial No. Project name
Budget
1
New department
of Oral &
Maxillofacial
Surgery
2
Repair and
renovation of KCD
2010-11
2011-12
2012-13
2013-14
75.557Million 25Million
25Million
25.557Million -
54.725Million 27Million
27.725Million -
-
The development work in KCD include construction of new Oral and maxillofacial surgery
block, repair & renovation of the KCD, Research & development cell and construction of a
new cafeteria.
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CONSTRAINS
ADMINISTRATIVE ISSUES
1. Civil servants (teaching staffs that have not opted for absorption are under the control of
provincial government.
2. All general cadre doctors and majority of paramedics and nurses are under the control of
the government.
3. Contrary to rules posting/transfer of the staff is done instead of deputation
4. Lack of clarity regarding autonomy on part of majority of the hospital staff including MC
members and even at the government level leading to management and legal issues.
5. Lack of uniformity autonomous institutions in delivery of various functions e.g.
implementation of user charges, scoring criteria in selection process etc.
6. Non Representation of health finance and establishment department as members of MC
leading to delay in certain decisions where their concurrence is required as per autonomy
rules/delegation of powers.
1.
2.
3.
4.
5.
6.
7.
8.
1.
2.
3.
4.
5.
6.
7.
FINANCIAL ISSUES
Limited revenue generation under the government policy.
Annual grant in aid provided by the government is not need based and realistic.
Free treatment for entitled patients and subsidized rates for poor is a burden on budget.
Ratio between establishment and non establishment is not realistic.
Utility charges consume a big chunk of non salary component. Hardly 10% budget is
available for patient care.
Unrealistic target given by FD which is deducted at the beginning of the year.
The training cost of medical institutions is met from hospital budget.
The expected receipts are deducted at source in the start of financial year without taking
in to account:
a. The actual realize over the period of one year.
b. 40% receipts constitute staff share which is deducted at the cost of institution budget.
CONSTRAINS IN ACHIEVING FULL BENEFITS OF AUTONOMY
Most of the budget is committed to salaries and utilities.
The government financial procedures are still applied and audit focuses on procedures not
outcomes.
Accounting procedures for autonomous institution still not developed.
No incentives to make efficiency savings / increasing own receipts.
Current user fee do not cover even marginal cost
Lack of clarity about HR planning, development and deployment.
Wrong number, wrong skills, wrong discipline.
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8. Confusion about relationship between academic and non academic manager.
9. Public sector emphasis on seniority and non competence for promotion / posting.
10. Frequent posting / transfer of staff without consultation.
11. Absence of patient referral system.
12. Over burdens the teaching hospitals.
13. Hospital provides poor value of money.
14. Private practice widely remains unregulated.
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PROPOSALS
ADMINISTRATIVE PROPOSAL
1. The existing legislation is self explanatory and does not need any change except
reconstitution of MC by inclusion of representative from DOH, Finance and establishment
department as members.
2. Early finalization and approval of draft rules based on ordinance 2002.
3. Posting of the staff to the autonomous institutions on deputations bases without
allowance (as practice in FATA).
4. Teaching staff who are civil servant should be made transferable to other teaching
hospital in the province( on analogy of Punjab)
5. Bringing uniformity in selection/scoring criteria and certain other functions spelled out in
the 1999 Act. And ordinance 2002.
FINANCIAL PROPOSALS
1. The institution shall retain receipts from various fees levied by the Government or
institution to meet the recurring and development expenditure (section 15 of the
Ordinance 2002).
2. Grant in Aid is to be calculated on mutually agreed TORs/Criteria and be fixed with in built
provision for inflation, increase in salary/utility charges by government keeping salary and
utility component as per actual.
3. In order to provide the minimum services already mentioned previously in this document,
the following criteria may be considered:
 Bed Strength
 Bed occupancy rage.
 Average length of stay of patients.
The following scheme of cost per patient must be kept in mind:
4. Cost per emergency case received in casualty required special enhanced rates. On the
average red category care in casualty, ICU, CCU and Labor room costs around Rs 18000 to
Rs 25000/ per patient per 72 hours.
5. Number of beds reserved for patients receiving specialized treatment e.g. burn, trauma,
swine flu etc costs on the average Rs 1000/ per patient per day.
6. Number of training facilities for under graduate in the hospital e.g. House officers and
students.
7. Number of post graduate training facilities and cost per number of post-graduate student.
8. Uniform user charges to be agreed and implemented in all medical institutions as
proposed by PAC.
9. The share formula for clinical staff needs revision in consultation of all stack holders.
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10. Non representation of health, finance and establishment department as members of
MC leading to delay in certain decisions where their concurrence is to delay in certain
decision where their concurrence is required as per autonomy rules/delegation of
powers. Most of the budget is committed to salary. Funds are released to the hospital
quarterly.
11. Financial procedures of the government are applied wherein focus is on rules rather
than outcomes.
12. Current fees do not cover even marginal cost. Management of the hospital can not
enhance fees without the approval of the government.
13. Frequent posting/transfer of staff without consultation.
14. Public sector emphasis on seniority and no competence for promotion/posting.
15. Confusion about relationship between academic and nonacademic management.
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ANNEX I
LOGFRAME
S≠
1.1a
1.1b
1.2
1.2a
Activities
Goal 1: Improvement of patient
safety, quality of health care and
client satisfaction in next five
years.
To develop treatment protocols
and guidelines for elective and
emergency management in
different disciplines by July 2010
Executed by
Respective
In process
teams led by
Prof I/C or
Head of Dept
Reduction of
mortality/morbidity
Availability of relevant need base
staff by proper Rota system.
To establish quality assurance
system in the hospital by 2012
Hospital
In progress
management
Hospital
management
Duty Rota available and
notified. 95% staff available
Development and approval and
start of implementation of quality
standards by end of 2010
Clinical audit
committee
Respective
I/C
Hospital staff
& Consultant
Committee notified
and functional
Availability of approved
standards
In progress
HMIS functional & Clinical
audit system in Place and
functional
All
concerned
Committee notified
and functional
Quarterly reports available
Head of
respective
departments
& team
PRO/
Hospital
In progress
SOPs available and
practiced
To be done
Available
Hospital
Client complaint
system installed
Reduce waiting time in
specialist and general OPD.
1.2a ( i )
Establishment of Clinical Audit &
performance system based on
HMIS/HR (Cost 45million)
1.2a ( ii ) Establishment of Quality standard
unit.
1.2b
Conduct clinical audit and
performance appraisal of relevant
activities on quarterly basis
1.2c
Development and compliance
with SOPs in identified areas by
June 30 2010.
1.3
1.4
1.4a
Preparation and notification of
Job description of Key hospital
staff by 30th March 2010
To ensure client satisfaction
Conduction of client satisfaction
surveys on quarterly basis
Status
Out put indicator
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1.4b
To readdress client complaints
1.5
Expansion and strengthening of
existing services in phase manner
by 2013
1.5a
1.5b
To improve existing A & E services
with development of SOPs and
provision of specialized services
by July 30 2010
( Cost 3 million)
1.5c
1.5d
Hospital
Work in Progress
management
% of clients satisfied
Percentage of complaints
from the clients redressed
Hospital,
DOH and C&
W
PC 1 submitted
through P&D to
DOH, approval
awaited
Patients utilizing the new
improved services
To construct new A & E block
including other
specialties/services with 400 bed
capacity and state of the art
services by 2013 (Cost 1000
Million)
Hospital,
DOH and C&
W
PC 1 submitted
through P&D to
DOH, approval
awaited
Construction work completed
and patients start using
services
Revamping, renovation of OPD
and laundry services by July 2011
Cost 132 Million
Hospital,
DOH,
C&W
PC 1 submitted
through P&D to
DOH, approval
awaited
Up gradation and strengthening of Hospital
Part of umbrella PC
existing diagnostic services,
management 1 of DOH
sterilization, lifts etc by July 2011
, DOH and
C&W
Health care providers and
clients start using the
renovated OPD facilities and
other services
1.5f
Up gradation of Endoscope suite
Approval pending
Improved endoscope services
1.5g
Up gradation of services and
Hospital
improvement of patient care (Cost management
180 Million)
and Clinical
staff
Proposal submitted
to DOH for funding
under up gradation
of DHQs project
Services up graded and
patient care improved.
1.5h
Improvement of existing facilities
including academic, diagnostic
and other facilities in KMC Cost
300 (Details of projects attached
as annex )
30th March 2010
will be functional
Issuance of administrative
approval and start of work.
1.5e
KMC, DOH,
C&W
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1.5i
(i)
(ii)
(iii)
Goal 2.
2.1
2.2
2.3
2.3a
2.4
Improvement and expansion of
services/facilities in KCD (Details
annexed ), these include:
New department of Oral &
Maxillofacial surgery in KCD (Cost
Rs. 755.57 millions)
Repair and renovation of old
building of KCD (Cost 2253
million)
Establishment of R & D cell in KCD
Provision of relevant training and
education to staff and students as
per international standards in
context of local needs.
Training need assessment of staff
(Teaching staff, Nurses,
Paramedics, management staff)
Availability of full faculty for
nursing education and medical
education
Assessment of post graduation
trainings (TMOs), Survey
Study designed and survey
conducted by June 30, 2010
Launching of performance
appraisal system for Trainees and
supervisors in teaching hospital
(CPSP guidelines)
2.5
Staff development through the
process of continuous medical
education
2.6
Up gradation of information
resource center in the institute.
Streamlining TMOs training
through better
coordination/Management of
affairs
2.7
KCD, DOH,
C&W/
PBMC
Hospital in
conjunction
with PGMI
KMC, KCD &
Hospital
June 2010
Patients start using the
facilities
June 2010
Availability of completion
report
June 2010
Availability of completion
report
June 2010
Availability of completion
report
Performance
appraisal of
Trainees is being
done. Regarding
supervisors it will
be done in due
course of time
Already in practice
for medics
Availability of performance
reports
Number of CPSP and other
seminars done for medics.
Skills and knowledge
development of other staff
members.
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2.7a
2.7b
Goal 3.
3.1
Creation of Director and Deputy
director academic positions and
its office
Delegation of requisite powers to
Dir academics by Dean PGMI
Provision of equal opportunities
and enabling environment for
research facilitation leading to
evidence based practice
Development of conducive
environment to bring in the
culture of research
IMC & PGMI
Accomplished
Both directors working
IMC & PGMI
Accomplished
Powers being exercised
Director
academics &
staff of KTH
Continuously
practiced, being
part of selection
and promotion
Availability of research papers
Quarterly magazine being
published
Goal 4.Ensuring good governance,
transparency, accountability and
efficient use of resources through
better management
4.1
To improve the Hospital
performance in terms of services
(continuous process)
Hospital
Partially achieved,
management activities in
progress
BOR, ALOS, CPP/D/B
% of complication of
anesthesia, % of Transfusion
reaction reduced
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4.2
To ensure Better Human resource Hospital
management
management
4.3
Recruitment of staff during the
year 2009
Principal
KMC, KCD,
CE KTH &
IMC
4.4
Development and implementation IT
of Hospital MIS , ICD 10 by March consultants
2010 (cost 45 million)
& hospital
management
1. Staff attrition rate in last
one year
2. Staff turn over rate in the
last one year
3. Percent of staff provided
with approved job
descriptions
4. Percent of doctors whose
performance for the last
year has been evaluated
5. Percent of staff which
received relevant training in
the last one year
6. Percent of postings and
transfers in the last six
months
7. Percent of posts that
remained vacant for six
months or more during the
last year

90% of Jr. Reg.
and Sr. Reg.
recruited and
have started
working.
 95% nursing
staff working,
5% under
training.
 95% IT
Positions filled.
 100% FHT
positions
vacant as they
are still under
training.
HMIS software
developed and
pilot tested
Presence of a computerized
database working
satisfactorily
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4.5
a.
b.
To improve financial
management through financial
discipline though;
Implemented and
regular follow up
done
Number of Audit paras
Institutional
management
Implemented, staff
on board and
internal audit being
done regularly in
addition to pre
audit
Availability of internal audit
reports
(Note: TORs have been
advertised to get services of
consultant firms to develop
balance sheet, income
statement, liquidity ratios and
others. All these will be
available by the end of March
2010)
Enforcement of GFR and
procurement rules
Enforcement of proper inspection
procedures
c.
4.5
Enforcement of proper file work
Introduction and implementation
of internal audit system in
addition to pre audit to ensure
financial discipline.
4.6
To generate additional
Funds through;
Increase in User charges
a.
Finance &
Est. section
of institution
b.
Voluntary institutional private
practice
c.
Use of 3 canals of vacant land for
commercial purpose
Approval of
Implemented
IMC available (25% increase done
against the
previous ceiling)
Proposal
Will be in place by
Approved by the end of June
IMC
2010
Proposal
The land is under
Approved by litigation.
IMC
Negotiations being
done.
Implementation by
end of 2010
% increase in revenue
Clinics within hospital
functional
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ANNEX II
Sanctioned post
Senior R
BPS-18
Junior R
BPS-17
SMO
BPS-18
33
35
60
Chief
Pharmacist
BPS-18
01
04
01
Posting/Transfer
by Dec’ 08
Retired by Dec ‘08
Resigns by 08
Vacant Posts by
Dec’ 2008
Resigns by Dec’ 09
Retired by Dec’ 09
Transfers by Dec’
09
Filled up posts by
Dec’ 09
≠of vacant posts
Medical
Officer
BPS- 17
58
01
Head Nurse
BPS-17
32
02
24
03
05
01
58
24
03
60
01
58
00
00
00
00
02
02
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ANNEX III
Cost/patient/day; Cost/procedure and cost/patient for 72 hours in Burn
unit, Medical ICU, CCU and Surgical ICU
Cost/patient/day and per year
S.#
Dept
01
Surgical &
Allied
Medical &
Allied
02
Total # of
admitted
patients in
2009
31627
Cost per
pt. per
day
Total
Cost/patient
Total cost/year
1500
Average
length of
stay of a
patient
5days
7500/-
237202500/-
24837
1200
5 days
6000/-
149022000/-
Total ≠ of
Surgical
procedure
s/yr
Cost/pro
cedure/
patient
Total cost/
year
29091
3000 PKR
87273000
Total cost/procedure
03
Dept/unit
Surgical & Allied Units
combined
------
------
Cost/patient/72 hours in CCU, ICU, & SICU in PKR.
04
Unit/department
SICU,
MICU
CCU
Burn Unit
Total
Number
of
patients/y
ear
506
617
2500
221
Cost/pati
ent/day
Cost/patient/day
Cost/patient/72h
rs
6500
5000
1796
4000
3289000
3085000
4490000
884000
9867000
9255000
13470000
2652000
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ANNEX IV
KHYBER MEDICAL COLLEGE FIVE YEARS PROSPECTIVE PLAN FROM 2010-14
IMPROVEMENT OF EXISTING FACILITIES OF
PURCHASE OF EQUIPMENTS
COST: Rs.50 millions
The Laboratories facilities and its teaching media is up to the standard and by virtue of
this it is a recognized and registered Institution on country as well as International
level. For the coming five years we will be in need of new equipments of about 50
millions to feed our students in accordance to the standard and updated education
level.
IMPROVEMENT OF RESIDENTAL FACILITIES FOR STAFF AND STUDENTS.
The existing facilities are very short and we are facing hardship in providing residential
facilities to students specially the female students whose strength is increasing every
year. For the time being we have four residential hostels on the University Campus (03
for boys and one for girls). To improve this facility either a fresh hostel will be
constructed for female students in the year 2013.
IMPROVEMENT OF LIBRARY FACILITY
Due to the recent improvement in the science and skill we will have to update our
library for providing better facility to our students. For the coming next five years we
will be in need of Rs. 30 million for purchase of books to improve our library up to the
modern status. Library will be computerized, connected to world class international
libraries. Target date 2011.
FURNITURE
To improve our lecture theaters, library and Dinning Halls in hostels we will be
required about 15 millions rupees for improve our existing facilities.
IMPROVEMENT OF SLRC SECTION
The present SLRC Section is providing learning facilities to students which need further
extension and modification. For this purpose an amount of Rs. 30 million will be
required during the next five years for purchase of equipments.
IMPORVEMENT OF MORTURY / FORENSIC MEDICNE
For improvement of existing facilities and keeping in view the present law and
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Business Plan 2010-2014
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Business Plan, Khyber Teaching Hospital Peshawar
IMPROVEMENT OF MORTUARY.
Due to the current law and order situation the available facilities in Mortuary in
Department of Forensic Medicine requires improvement for which at least 10. millions
may be provided on emergency basis.
IMPROVEMENT OF SECURITY MEASURERS.
For improvement of the college and hostels security proper weapons are
provided.2010.
ASSURANCE OF ELECTRIC AND GAS SUPPLY TO THE COLLEGE HOSTELS.
Efforts may be made to assure gas and electric supply to the college hostels specially
to avoid discontentment amongst the students.
PROVISION OF AN AMBULANCE FOR NIGHT DUTY TO RESIDENCE STUDENTS.
To meet the emergency needs of the residence students an Ambulance may be
provided to the college.
IMPROVEMENT OF FACILITIES IN THE COLLEGE LIBRARY.
An amount of Rs. 10 millions may be provided for purchase of books and furniture etc
for the college library.
PURCHASE OF CHEMICALS
An amount of Rs. 05 millions may be provided for purchase of chemical to over come
constrains.
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