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 _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 2 Business Plan, Khyber Teaching Hospital Peshawar 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 _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 3 Business Plan, Khyber Teaching Hospital Peshawar 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 _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 4 Business Plan, Khyber Teaching Hospital Peshawar 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 _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 5 Business Plan, Khyber Teaching Hospital Peshawar 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 _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 6 Business Plan, Khyber Teaching Hospital Peshawar 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. _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 7 Business Plan, Khyber Teaching Hospital Peshawar 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 _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 8 Business Plan, Khyber Teaching Hospital Peshawar 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. _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 9 Business Plan, Khyber Teaching Hospital Peshawar 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) _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 10 Business Plan, Khyber Teaching Hospital Peshawar 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 _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 11 Business Plan, Khyber Teaching Hospital Peshawar 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 _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 12 Business Plan, Khyber Teaching Hospital Peshawar 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 _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 13 Business Plan, Khyber Teaching Hospital Peshawar 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 _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 14 Business Plan, Khyber Teaching Hospital Peshawar 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 _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 15 Business Plan, Khyber Teaching Hospital Peshawar 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. _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 16 Business Plan, Khyber Teaching Hospital Peshawar 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. _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 17 Business Plan, Khyber Teaching Hospital Peshawar ORGANOGRAM Management council KTH/KMC/KCD Chief Executive Principal KMC Principal KCD Medical Superintendent _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 18 Business Plan, Khyber Teaching Hospital Peshawar Finance Office Following is the organization Chart of the Directorate of Finance Director Finance KTH & Allied institutions Finance & Account officer Audit officer _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 19 Business Plan, Khyber Teaching Hospital Peshawar 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 _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 20 Business Plan, Khyber Teaching Hospital Peshawar 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. _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 21 Business Plan, Khyber Teaching Hospital Peshawar 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. _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 22 Business Plan, Khyber Teaching Hospital Peshawar 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: _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 23 Business Plan, Khyber Teaching Hospital Peshawar 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/- _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 24 Business Plan, Khyber Teaching Hospital Peshawar 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 _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 25 Business Plan, Khyber Teaching Hospital Peshawar 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. _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 26 Business Plan, Khyber Teaching Hospital Peshawar 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. _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 27 Business Plan, Khyber Teaching Hospital Peshawar 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. _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 28 Business Plan, Khyber Teaching Hospital Peshawar 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. _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 29 Business Plan, Khyber Teaching Hospital Peshawar 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. _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 30 Business Plan, Khyber Teaching Hospital Peshawar 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 _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 31 Business Plan, Khyber Teaching Hospital Peshawar 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 _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 32 Business Plan, Khyber Teaching Hospital Peshawar 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. _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 33 Business Plan, Khyber Teaching Hospital Peshawar 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 _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 34 Business Plan, Khyber Teaching Hospital Peshawar 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 _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 35 Business Plan, Khyber Teaching Hospital Peshawar 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 _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 36 Business Plan, Khyber Teaching Hospital Peshawar 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 _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 37 Business Plan, Khyber Teaching Hospital Peshawar 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 _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 38 Business Plan, Khyber Teaching Hospital Peshawar 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 _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 39 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. _____________________________________________________________________________________________________________ Business Plan 2010-2014 P&D Cell 40