Setting up of Super-specialty /

Multi-specialty Hospital

Medical Health and Family Welfare

Government of Uttarakhand
Contents

Advantage India
Uttarakhand – Key Credentials
Project Concept – Overview and Expectations
Project Information – Location and Infrastructure
Project Concept- Role of Private Party
Project Information - Manpower
Project Financials
Ease of doing business
Investor Facilitation
Indicative Project Structure and Approvals
Policies, Schemes & Incentives
Key Contacts

Page 2 26 September
2018
Advantage India (1/2)

INDIAN HEALTHCARE ECOSYSTEM

► The Indian healthcare market is expected to increase three fold to USD 133.44 billion by
2022.
► India is experiencing 22-25 % growth in medical tourism and the industry is expected to
double its size from present (April 2017) USD 3 billion to USD 6 billion by 2018. This is
proved by the fact that medical tourist arrivals in India increased to 1.07 million in January
2018 from 0.98 million in January 2017. *
► Indian Hospital Industry constitutes 80% of the total healthcare sector which is observing
great demand with relaxed FDI rules and insurance coverage.*
► The Diagnostics industry in India is currently valued at USD 4 bn. The share of organized
sector is almost 25% in this segment (15% in labs and 10% in radiology).*
► Medical tourist arrivals in India increased by over 50% to 200,000 in 2016 from 130,000 in
2015 **
► Up to 100% FDI is allowed in the healthcare sector

EMERGING SEGMENTS IN HEALTHCARE SECTOR

Medical Equipment Medical Medical

Telemedicine Diagnostics
and Supplies tourism insurance

KEY GOVERNMENT INITIATIVES

State telemedicine
Relaxed FDI norms for the
Ayushman Bharat Network
healthcare sector

National Nutrition
Pradhan Mantri Surakshit Biomedical Equipment Management Mission with budget
Matritva Abhiyan and Maintenance Program (BMMP) of USD 1.4 billion

Page 3 26 September * IBEF - https://www.ibef.org/industry/healthcare-

2018
india.aspx.
Advantage India (2/2)

GROWTH DRIVERS

Ø The Government of India aims to increase the total health

expenditure to 2.5 per cent of Gross Domestic Product (GDP) by
Favorable 2025 from the current 1.15 per cent.
Demographics
Ø Rising population and increasing per capital income would lead
to an increase in the requirement of healthcare services

► As per Public Health Foundation of India (PHFI), traditional

diseases in India are being replaced by lifestyle related
Growth in lifestyle
diseases
Diseases
► High blood pressure, stroke, diabetes, diseases associated with
smoking and drinking are mainly lifestyle diseases

► As per Euro-monitor, between 2015-2030 period, the Indian

median income per household is expected to increase by 89.8%
Rising healthcare
consumption by to reach USD 10,073 (in constant 2014 prices) by 2030
middle class ► Rise in income coupled with lifestyle diseases would lead to
increasing consumption of healthcare services

► The insurance industry intends to increase penetration levels

to 5% by the year 2020*
► With about 360 m policies which are expected to grow at a
CAGR of 12-15% over the next five years, India has the largest
Growing life insurance sector*
penetration of
health insurance ► Uttarakhand in particular has been focusing on an assurance
led model to increase the purchasing power of the population
for health related services

► As per World Health Organisation, the total expenditure on

healthcare in India is about 4.1% of GDP, in which government
Private Equity in contribution is less than 1% of GDP
Indian Healthcare
► Also the 12th Plan has envisaged rise in healthcare
Sector
expenditure to about 2.5% of GDP by the end of 2017 ,
apparently the private sector investment is going to play a
major role#

Page 4 26 September *Invest India

2018 # IBEF website
Uttarakhand –
Key Credentials
UTTARAKHAND STATE HEALTHCARE OVERVIEW

Uttarakhand state State has

has One + Crore increasing Uttarakhand has
population growing penetration of untapped potential
at the rate of 1.99 insurance of Medical tourism
percent coverage

State has invested

in good Uttarakhand State
infrastructure and favours and
has favourable promotes PPP
policies

DEVELOPMENTS IN UTTARAKHAND HEALTHCARE SECTOR

► The state of Uttarakhand was formed on 9th November 2000 as the 27th State of India,
when it was carved out of northern Uttar Pradesh. Located at the foothills of the
Himalayan mountain ranges, it is largely a hilly State, having international boundaries
with China (Tibet) in the north and Nepal in the east.

► Uttarakhand has a population of 1.01 crore and a majority of them reside in rural areas..
Currently having 2336 CHC/FRU, PHC and SC; state has shortfall of around 300 health
centres. Apart from this uphill also face shortage of physicians and paramedical staff.

► The State has been facing crunch of physicians and allied resources related to healthcare
since its inception and is attempting to fill the gaps through the public service
commission, contractual employees and recruitment through walking interviews. There is
urgent need to cater the unmet demand in the state that can be met through engaging
private partners in the state for the innovations in integrated delivery systems.

Page 5 26 September
2018
Project Overview and Expectations

Background, Project Structure and Land Availability

Ø Government of Uttarakhand is inviting private partners to set up multi-specialty and super-
speciality hospitals in the State at Haridwar, Dehradun and Pantnagar.

Ø The private player would be required to design, finance, construct, equip the hospital wit
h necessary medical & non medical infrastructure. They will also be responsible for operations of
the hospitals.

Ø Government of Uttarakhand will support in providing land through public and private partners
subject to availability in desired area. State will also facilitating policy related incentives and
fast clearances/approvals through single window system.

Project Facets

► Hospital is expected to be developed as per Indian Public Health Standards and minimum
Standards laid down by the National Accreditation Board for Hospitals & Healthcare Providers
(NABH)

► It is envisioned to provide health care facilities in selected disciplines

► The broad scope of work is to develop a two hundred and fifty (250) bedded Hospital. The
hospital may be developed in a phased manner as agreed in the Concession Agreement

► The scope includes deployment of adequate number and mix of qualified clinical and non-clinical
staff for operation and management of the hospital and providing the health care services

Key Private Players in Uttarakhand

All India Institute of Medical

Max Super Speciality Hospitals
Sciences

Fortis Escorts Hospital Himalayan Hospitals

Kailash Hospitals Pvt. Ltd Synergy Hospitals

Shri Mahant Indresh Hospital CMI Hospitals

Page 6 26 September
2018
Project Information - Location and
Infrastructure
Location – Multiple Locations across Uttarakhand

Areas proposed for hospital with good

infrastructure, resources and
increasing demand for healthcare

Connectivity

Ø Haridwar and Dehradun city has a railway station which is well connected to
major cities including Mumbai, Delhi, Hyderabad and Bangalore.

Ø Rudrapur has its own railway station connected through train with major cities
like Kashipur, Lucknow, Moradabad, Dehradun and Delhi

Ø State has two domestic airport; Jolly Grant and Pant Nagar connected with
Mumbai, Delhi and Lucknow.
Ø Haridwar – Nearest airport is Jolly Grant (30 Km)
Ø Dehradun is well connected with all major cities of the state and nearby states;
nearest airport is Jolly Grant (30 Km)
Ø Rudrapur – Nearest airport is Pantnagar ( 16 Km)

Ø Uttarakhand is well connected to all major locations of India and it offers good
connectivity among the state with state highways.
Ø Dehradun, Haridwar and Pant-nagar are well connected to National Capital and
nearby big cities

Page 7 26 September
2018
Project Concept
Role of Private Party

The private party is expected to construct, equip, staff and

Construction of ►
operate the core and support facilities at the Hospital and get
facility all the relevant approvals

The private partner is expected to construct a two hundred

250 bedded ►
and fifty (250) bedded hospital as per the IPHS and the
hospital minimum standard laid down by the NABH

► Out of the two hundred and fifty (250) beds, at least one
hundred and twenty five (125) beds may be reserved for
Super speciality in relation to cardiology and cardiac surgery
Super specialty and same number of beds maybe require to start operation of
the other Super Speciality department(as identified by the
Medical Council of India)

► All associated clinical and non-clinical services including

Medical pathology laboratories, emergency units, diagnostics centre,
infrastructure radiology, pharmacy, kitchen, etc. to support the proposed
hospital

► Accommodation should be provided for the clinical and non-

Accommodation clinical staff as well as for the attendants of the patients

► Pharmacy, ATMs, car parking, telephone booths, e-suvidha

counter / jan suvidha Kendra etc may be permitted with
Support services prior approval in accordance with the provisions of the
Concession. In addition, restaurants, and canteens may be
allowed

Page 8 26 September
2018
Project Information – Manpower

Indicative Manpower Requirement for 250-Bedded Hospital

Indicative Minimum Manpower Requirement

Sl. No. Specialists For 250 bedded
1 Medical Specialist 3
2 Surgeon 3
3 Obstetrician & Gynaecologist 4
4 Paediatrician 4
5 Anaesthetist 3
6 Ophthalmologist 2
7 Orthopaedic Surgeon 2
8 Radiologist 2
9 Pathologist 3
10 ENT Specialist 2
11 Dentist 2
12 Medical Officer 15
13 Dermatologist 1
14 Psychiatrist 1
15 Microbiologist 1
16 AYUSH Doctors 1
17 Visiting Doctors (for major operations) 5
18 Nurses & paramedical 201
19 Administrative Staff 21
TOTAL 276

Source: Indian public health standards, guidelines for district hospitals, revised 2012

Page 9 26 September
2018
Project Financials

Indicative cost of setting up of a new super-specialty hospital#

Area in sq.
Description of Work Rate INR crore
meter

Land cost would vary depending on the size and location of the site. Approximate land
requirement for the project would be around 10 acre

Civil Works:
Area requirement for 250 bedded hospital, minimum
required area per bed (1,076 sq ft. per bed for all
hospitals)* Therefore built up area requirement is
25,000 sq meter 25000 25000 62.5
Rate @ INR 25,000/ sq meter,
(Escalated rate for Hospital, RCC framed structure
upto 6 storeys from INR 23,500/ sqm *

Plant & Machinery/ Engineering Services 24.0

Medical Equipment 26.0

Medical & Non Medical Furniture, Signage etc. 5.0

Ambulance & Automobiles 0.6

Site Development 40460 1200 4.8

Total 122.9

Contingency @ 10% 12.2

Total Project Cost 135.1

Estimated annual Human resource cost 11.06

Number of Beds 250

No of OPD Rooms 15

Number of Operation Theatres Minor: 3 Major: 6

Estimated Project Cost ~146.5 crore

Note: Above cost is indicative and may vary subject to the scale and facilities in the Project.

Page
Page 12
10 26 September Source: * http://dda.org.in/planning/docs/13_Social_Infrastructure.pdf
2018 • PWD, Govt. of India
# Excluding cost involved in land arrangements (purchase/lease/rent etc.)
Ease of Doing Business

EASE OF DOING BUSINESS

Under the ‘Ease of Doing Business’ initiative, the State has implemented a web based Single
Window Clearance System - www.investuttarakhand.com, allowing investors to avail the
necessary State Government approvals to establish and start their business operations
through a single platform without any physical touch point with the approving / licensing
authority.

150 100 50
+ + +
40+

Regulatory Timelines notified New Standard New Online

Reforms under Uttarakhand Operating Systems Developed
Undertaken Enterprises Single Procedures drafted
Window Facilitation for Departmental
& Clearance Act services
2012

HASSLE FREE SETUP AND OPERATIONS IN THE STATE

Online Single Window System for Auto Renewal of Consent to

all required approvals Establish, Consent to Operate

Self / Third party certification in

Single Point Sectoral
lieu of departmental inspections
Clearances

Investment facilitation centre to I Single Integrated Return for all

handhold investors labour laws

Objective Criteria for land Use of modern SCADA System to

allotment ensure reliable supply of electricity

Geographic Information System Commercial Court set up in

of all land banks Dehradun with entire state
jurisdiction

Page 11 26 September
2018
 Investor Facilitation

INVESTOR FACILITATION
► The Government of Uttarakhand has laid huge emphasis on business facilitation by creating
an enabling environment for industries to set up and start their operations in the State
► The State government houses a dedicated ‘Investment Promotion & Facilitation Centre
(IPFC)’ which acts as a centralized one-stop-shop for the investors / businesses and
provides complete handholding support in a structured, focused and comprehensive manner.
IFC will focus on investment promotion, facilitation, direct engagement and consultation
with investors / Stakeholders and ensures investment realization and sustainable
industrialization in the state
► ‘Uttarakhand Right to Service Act, 2011’ & ‘The Uttarakhand Enterprises Single Window
Facilitation and Clearance Act, 2012’ were enacted to provide necessary time bound
licenses, permissions and approvals for the setting up of commercial establishments in the
state. The State has ensured robust legal resolution mechanisms to ensure time bound
delivery of government services with more than 100 investor related services already
notified under both the acts separately and is in the process of adding more such services of
multiple sectors shortly

CREDITED BY INDUSTRY ASSOCIATIONS

NCAER Assessment based on Uttarakhand has emerged as

Story of `Make in
“Perception of good business the top state in the country
Uttarakhand` which
climate” ranks Uttarakhand as in terms of growth in the
started in 2003 is a
the Least Corrupt state in India industry and service sectors
classic example of what
NCAER N-SIPI Index Survey ; in the last ten years.
manufacturing can deliver
to a region`s economy in Five states – Uttarakhand, Uttarakhand has also figured
terms of both economic Gujarat, Assam, Andhra as the second best
growth and employment Pradesh and Himachal Pradesh – performing state in terms of
generation had more than 90% respondents project implementation,
say they faced no problem in improving investment
-CII Report `Making getting land scenario in the state
Uttarakhand Competitive,
June 2016’

CII NCAER ASSOCHAM

Page 12 26 September
2018
Indicative Project Approvals (1/3)

INDICATIVE LIST OF CLEARANCES

Authority/ Agency/ Office/ Department
Sr. No. Name of Service
officer granting approval

Department of Medical health and family

1 Land allotment
welfare (Govt. of Uttarakhand)

Application for new connection LT / HT

2 Uttarakhand Power Corporation Limited
line – non domestic / industrial

3 Uttarakhand Jal Sansthan

Application for Water Connection

4 Application for building plan approval State Industrial Development Authority

Application for Completion cum

5 State Industrial Development Authority
Occupancy Certificate

Consent to Establish under Water

Uttarakhand Environment Protection and
6 (Prevention and Control of Pollution)
Pollution Control Board
Act, 1974
Consent to Establish under Air
Uttarakhand Environment Protection and
7 (Prevention and Control of Pollution)
Pollution Control Board
Act, 1981
Consolidated Consent & Authorization
under Water Act, 1974, Air Act, 1981 &
Uttarakhand Environment Protection and
8 Authorization under The Hazardous and
Pollution Control Board
Other Wastes (Management and
Transboundary Movement) Rules, 2016
Application for Pre-Establishment Fire
9 NOC Uttarakhand Fire and Emergency Services
(National Building Code, 2005)

Page 13 26 September
2018
Indicative Project Approvals (2/3)

INDICATIVE LIST OF CLEARANCES

Authority/ Agency/ Office/

Sr. No. Name of Service
Department officer granting approval

Application for Pre-Operational Fire NOC Uttarakhand Fire and Emergency

10
(National Building Code, 2005) Services

11 Site Plan Approval under Factories Act, 1948 Department of Labour

Registration of Factories under Factories Act,

12 Department of Labour
1948

Registration under Uttarakhand Dookan Aur

13 Department of Labour
Vanijya Adhisthan Adhiniyam, 1962

License under Contract Labour Act,

14 Department of Labour
(Regulation and Abolition),1970

Registration under GST (Uttarakhand Goods

15 Department of Commercial Tax
and Services Tax Rules, 2017)

HEALTHCARE SPECIFIC APPROVALS

National Accreditation Board for

16 NABH Accreditation
Hospitals and healthcare providers

Public Health and Family Welfare

17 Registration for Nursing College Department

18 Registration for Paramedical College Paramedical Council of India

19 Registration for medical college Medical Council of India

Atomic Energy Regulatory Board

Registration for radiology
20 Approval

Page 14 26 September
2018
Indicative Project Approvals (2/2)

INDICATIVE LIST OF CLEARANCES

Authority/ Agency/ Office/

Sr. No. Name of Service
Department officer granting approval

21 Retail/Bulk Drug License (Pharmacy) Food and Drug Administration

License for Operation & Renewal of Blood Bank Food and Drug Administration and CLAA
22
under Drugs and Cosmetics Act, 1940 (Delhi)

Registration for Opening a drug store in hospitals

23 Food and Drug Administration
(both outdoor and indoor pharmacy)

Registration with third party for bio medical waste

24 PHFW & PCB
management

License for Operation of Blood Bank under Drugs Food and Drug Administration and CLAA
25
and Cosmetics Act, 1940 (Delhi)

Narcotics Drugs and Psychotropic Substances

26 Food and Drug Administration
License and Act

Drug License for setting up a pharmacy in state and

27 renewal (by state drug standard control Food and Drug Administration
organization) Both retail and wholesale

Health-care Establishment (as defined in BMW

28 Department of Health
Rules) waste water > 100 KLD or having incinerator

Health care Establishment (as defined in BMW rules)

29 waste water <100 KL per day without and without Department of Health
incinerator

Public Health and Family Welfare

30 Registration of Nursing Home/
Department

Page 15 26 September
2018
Policies, Schemes & Incentives (1/5)
Mega Industrial and
Investment Policy 2015

01
Policies
&
Incentives
Available for
Investors
MSME Policy
2015
Industrial Development Scheme 2017

Financial Incentives available

Interest Capital
Subsidy Subsidy

Stamp
Duty
Subsidy

Page 16 26 September
2018
 Policies, Schemes & Incentives (2/5)

Industrial Development Scheme 2017

Central Central capital investment incentive for access to credit @ 30% of the
Capital investment in plant and machinery with an upper limit of INR 5.00 crore
Investment

Central
Comprehensive Reimbursement of 100% insurance premium on insurance of building and
Insurance Plant & Machinery for a maximum period of 5 years from the date of
Incentive commencement of commercial production/ operation

Note: Units which have commenced production on or after 01st of April, 2017 will be allowed
to register with DIPP on or before 30th of September, 2018

Detailed central schemes and policies are available at http://dipp.nic.in/whats-new/brief-north-

east-industrial-development-scheme-neids-2017

Page 17 26 September
2018
Policies, Schemes & Incentives (3/5)

MSME Policy 2015

► Healthcare Sector is covered under MSME industrial policy

► Hospitals are eligible for electricity tariff on industrial rate

Categorization of regions for the purpose of quantum of incentives

Category Included Region

Whole Districts of Pithoragrah, Uttarkashi, Chamoli, Champawat,

Category A
Rudraprayag and Bageshwar
► Whole District of Almora
► All hilly development blocks of District Pauri Garhwal, Tehri
Category B Garhwal (Excluding regions under category B+)
► All hilly development blocks of District Nainital and Dehradun
(Excluding regions under category B+)

► Kotdwar, Sigaddi and adjoining plain regions of Dugadda

development block of district Pauri Garhwal
► Dhalwala, Muni Ki Reti, Tapovan and adjoining plain regions of
Category B+
Fakot development block of District Tehri Garhwal
► Kotabagh development block of District Nainital
► Plain regions of Kalsi development block of District Dehradun

► Regions located above 650 mtrs from sea level in Raipur,

Sahaspur, Vikasnagar and Doiwala development blocks of District
Category C
Dehradun
► Ramnagar and Haldwani development blocks of District Nainital
► Whole Districts of Haridwar and UdhamSingh Nagar
Category D ► Remaining area of District Dehradun and Nainital (which are not
included in category ‘B’, ‘B+’ and ‘C’)

Detailed central schemes and policies are available at https://www.doiuk.org/policies.php

Page 18 26 September
2018
 Policies, Schemes & Incentives (4/5)

MSME Policy 2015

Category A: Category A: % of Annual Turnover (Per

Transport Subsidy
Capital Subsidy
Interest Subsidy

10%(Max 8 lacs) 40%(Max 40 lacs) year/ unit) or Inbound/

Category B, B+: Category B, B+: Outbound Logistics Cost
8% (Max 6 lacs) 35% (Max 35 lacs) whichever is less

Category C: Category C: 30% (Max Category A: 7%

6% (Max 4 lacs) 30 lacs) Category B: 5%
Category D: 15% (Max Category B+: 5% (Max 5
Category D:
15 lacs) lacs)
5% (Max 3 lacs) *Per year/ unit

Category A: Category A:
SGST Concession*

Power Bill Rebate

100% for the first 5 Sanctioned Load upto 100
yrs and 90% KVA: 100% for 5 yrs and
Stamp Duty

thereafter 75% thereafter; If

Category A, B, B+, C: 100% Load>100 KVA: 60%
Category B, B+: Category B, B+:
Category D: 50%
100% for the first 5 Sanctioned Load upto 100
KVA: 100% for 5 yrs and
yrs and 75%
60% thereafter; If
thereafter Load>100 KVA: 50%

*The SGST after adjustment of ITC on sale of finished product (B2C) will be reimbursed from the date of commencement of
production of the unit
Internet Charges

Mandi Charges

Category A, B:
Excise Duty

75% reimbursement on
50% Reimbursement Category A, B: State Excise Duty,
on internet usage 100% exemption on Additional Excise Duty,
charges for all Mandi charges Bottling fees and other
categories charges as under State
Excise Policy

Reimbursement of cost incurred for carrying out standardization and quality certification of products by accredited
institutions at national and international level by means of ISI marking, registration of copyright, trade marking etc.
- 75% (maximum Rs. 1 lacs)

Detailed central schemes and policies are available at https://www.doiuk.org/policies.php

Page 19 26 September
2018
 Policies, Schemes & Incentives (5/5)
Mega Industrial and Investment Policy 2015

Healthcare related activities are included in the policy

SGST after adjustment of ITC on sale of finished product (B2C) will be reimbursed

Categorization of industries for the purpose of quantum of incentives

Category Units Included

Large Projects Investments of INR 50 Cr.to 75 Cr.

Mega Projects Investments of INR 75 Cr.to 200 Cr.

Ultra Mega Projects Investments above INR 200 Cr.

Coverage:
New & Existing Projects undergoing expansion (falling within notified Industrial Estates / declared
non-agriculture land under section 143: Large projects (50 Cr to 75 Cr), Mega Projects (75 Cr to
200 Cr), Ultra Mega Projects (Above 200 Cr)
SGST Concession*

7% for 5 years
Stamp Duty
Interest
Subsidy

Investment – Interest
Large – 25L Max
Large: 30%
50% Exemption
Mega – 35L Max Mega / Ultra Mega: 50%
Ultra Mega – 50L Max

*The SGST after adjustment of ITC on sale of finished product (B2C) will be reimbursed from the date of commencement of
production of the unit

Extra Employment Land Registration Land Rates

ETP Subsidy Power Assistance
Subsidy Fees Rebate
Rebate of 15%,
@ 500 P.M. per 25% and 30% on
Male Land Rebate of 1/-
SIIDCUL
30% (up to 50 lacs) registration fee per unit on the
prevailing land
@700 P.M. per @1/- per 1000/- power bill and
rate for Large,
Female 100% rebate on
Mega and Ultra
electric duty for
Mega Projects
7 years
respectively

Detailed central schemes and policies are available at https://www.doiuk.org/policies.php

Page 20 26 September
2018
Key Contacts

Uttarakhand Medical Health and Family Welfare

Address Health Directorate, Danda Lokhand P.O. Gujrara,

Sahastradhara Road, Dehradun, Uttarakhand
Website https://www.ukhfws.org

Email ID dghealth.uttarakhand@gmail.com / apd.ukhsdp@gmail.com

Phone 0135-2608646

Investment Facilitation Centre

Address Directorate of Industries

Industrial Area, Patel Nagar, Dehradun, Uttarakhand
Website www.investuttarakhand.com

Email ID ifc.uttarakhand@gmail.com

Toll Free 18002701213

Disclaimer: This project profile is based on preliminary study to facilitate prospective

entrepreneurs to assess a prima facie scope. It is, however, advisable to get a detailed
feasibility study prepared before taking a final investment decision