Shalamar Institute of Health Sciences Past, Present and Future

FINAL

ABSTRACT

This document presents a brief profile of Shalamar Institute of Health Sciences and its subsidiary organizations. The brief also includes some prospective areas for fund raising.

SIHS – Past, Present and Future

TABLE OF CONTENTS

LIST OF FIGURES 3

LIST OF ABBREVIATIONS 4

EXECUTIVE SUMMARY 5

WHO WE ARE 6

OUR FOUNDERS 6

OUR GOVERNANCE STRUCTURE 7

OUR FUNDING 7

OUR FACILITIES 11 SHALAMAR HOSPITAL 11 SERVICES PROVIDED BY SHALAMAR HOSPITAL 13 SHALAMAR NURSING COLLEGE 15 SHALAMAR MEDICAL AND DENTAL COLLEGE 16

WHAT SETS US APART? 17 CAREFULLY SELECTED GEOGRAPHICAL FOCUS 17 HIGHLY QUALIFIED HUMAN RESOURCE 18 ENVIRONMENTAL RESPONSIVENESS 18 STRATEGIC PARTNERSHIPS 18 STATE-OF-THE-ART INFRASTRUCTURE 18 INTEGRATED APPROACH 19

OUR STRATEGY 21 KEY STRATEGY PILLARS 22 PATIENT-CENTRIC HEALTHCARE SERVICES 22 24-HOURS HIGHLY RESPONSIVE EMERGENCY AND TRAUMA CARE 22 COMMUNITY OUTREACH 22 POOL OF CAPABLE HUMAN RESOURCE 22 SOCIAL RESPONSIBILITY 22 OUR CORE VALUES 23 OUR STRATEGIC ACTION PLAN 2010-15 23

CONCLUSION 24

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LIST OF FIGURES

Figure 1: SH Yearly Financial Snapshot 1988-2010 ...... 8 Figure 2: SIHS Donations Over the Years ...... 9 Figure 3: SIHS – Journey Through the Years ...... 10 Figure 4: Hospital Admissions 2006-2010 ...... 13 Figure 5: Patients Inflow 2006-2010 ...... 14 Figure 6: Use of Diagnostic Services 2006-2010 ...... 14 Figure 7: Patients Check-ups 2006-2010 ...... 15 Figure 8: SIHS Strategic Framework ...... 21 Figure 9: SIHS – The Way Forward; 2010-2015 ...... 23

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LIST OF ABBREVIATIONS

BHT Businessmen Hospital Trust

CCU Coronary Care Unit

CT Scan Computed Axial Tomography Scan

ENT Ear, nose and throat

HOC House of Charity

ICU Intensive Care Unit

MBBS Bachelor of Medicine and Bachelor of Surgery

MRI Magnetic Resonance Imaging

OB/GYNE Obstetrics and Gynecology

OPD Outpatients Department

PKR Pakistani Rupees

PMDC Pakistan Medial and Dental Council

SNC Shalamar Nursing College

SIHS Shalamar Institute of Health Sciences

SH Shalamar Hospital

SMDC Shalamar Medical and Dental College

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EXECUTIVE SUMMARY

Shalamar Institute of Health Sciences (SIHS) is an umbrella organization for Shalamar Hospital (SH), Shalamar College Of Nursing (SNC) and Shalamar Medical and Dental College (SMDC). SIHS is undertaking various activities for healthcare service delivery to the disadvantaged communities and provision of quality health education in Lahore. Shalamar Hospital, with its outpatient facilities and the 24-hours emergency department is the primary source of free and subsidized medical treatment to hundreds of thousands of patients of northern Lahore and beyond. While providing the best healthcare facilities to its patients, Shalamar Hospital is positioned to set highest standards of personalized, specialized, accessible and cost-effective medical care to provide benchmarks for other healthcare facilities of Pakistan. Shalamar Nursing College fulfills the vacuum of trained and qualified paramedical staff through pre-service training of nurses, not only for Shalamar Hospital but also for other healthcare institutions, whereas Shalamar Medical and Dental College, a recent addition to the SIHS institutions, aims at extending the same spirit a step further by producing quality medical professionals.

Some of the dimensions that set SIHS apart from other philanthropic institutions, are a carefully selected geographical focus, highly qualified human resource, environmental responsiveness, strategic partnerships, state-of-the-art infrastructure, integrated approach and the focus on excellence.

SIHS aims to serve the disadvantaged community of northern Lahore by providing quality medical treatment and developing healthcare capacity in the society through education in the field of medical and health sciences. In order to realize this vision, SIHS has developed a comprehensive strategy and an action plan for the next five years. SIHS’s strategy revolves around five key pillars – Availability of 24-hours highly responsive emergency and trauma care; Provision of patient-centric healthcare services; Outreaching community for provision of primary healthcare services; Developing a pool of capable human resource; and Undertaking credible initiatives to demonstrate social responsibility. SIHS intends to realize its vision, while working around these strategic pillars and adhering to the core values of promoting local philanthropy; ensuring sustainability; adopting patient-centric services and continuously improving quality. The strategy has been translated into a five-year action plan. SIHS is now looking for funding sources to implement this action plan.

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WHO WE ARE

SIHS aims to serve the disadvantaged community of northern Lahore by providing quality medical treatment and developing healthcare capacity in the society through education in the field of medical and health sciences.

Shalamar Institute of Health Sciences is instituted by Businessmen Hospital Trust, which is involved in various activities of healthcare and health education. The main institutions run by BHT include Shalamar Hospital (SH), Shalamar Nursing College (SNC) and Shalamar Medical and Dental College (SMDC). All the institutions run under the umbrella of SIHS and are fully aligned with the organizational vision and have significant synergies. Shalamar hospital is the primary source of free and subsidized medical treatment to hundreds of thousands of patients of northern Lahore and beyond. The seamless operations allow maximum number of patients to benefit from the services of the hospital, outpatient facilities and the 24-hours emergency facility. In order to provide quality treatment and round the clock service to hospital patients, trained and qualified paramedical staff is a critical pre-requisite. Shalamar Nursing College fulfills this vacuum through pre-service training of nurses, not only for Shalamar hospital but also for other healthcare institutions. SMDC, a recent addition to the SIHS institutions, aims at extending the same spirit a step further by producing quality medical professionals. The state-of-the- art infrastructure and outstanding faculty of SMDC are likely to ensure unparalleled quality in the institution.

While providing the best healthcare facilities to its patients, Shalamar Hospital Trust is positioned to set highest standards of personalized, specialized, accessible and cost- effective medical care to provide benchmarks for other healthcare facilities of Pakistan. The Shalamar Medical and Dental College along with Shalamar Nursing College are striving to produce quality healthcare human resource for Punjab, with the broader aim of creating sufficient capacity to maintain Shalamar Hospital’s standards as well as to create similar other facilities providing seamless healthcare to disadvantaged communities.

OUR FOUNDERS

Businessmen Hospital Trust was the result of collective efforts of a number of notable major businessmen of Pakistan. The trust was initiated because of the perceived corporate social responsibility vacuum in the policies of the local corporations. Chaudhry Nazar Mohammad, the co-founder of Servis Industries, was one of the pioneers of BHT, who, along with some other leading members of Lahore Chamber of Commerce and Industry, contributed a sum of

Page 6 | 29 SIHS – Past, Present and Future five million rupees for developing a state-of-the-art well-equipped hospital for the citizens of northern Lahore. Prof. Mohammad Akhtar Khan has been the moving spirit behind conception, planning and execution of various initiatives undertaken by BHT, since its inception. Syed Babar Ali, one of the most notable businessmen and philanthropists of Pakistan has also been instrumental in the establishment of SIHS and its various subsidiary organizations.

Ch. Nazar Mohammad (Late) Prof.Mohammad Akhtar Khan Syed Babar Ali

OUR GOVERNANCE STRUCTURE

Business Hospital Trust has been registered under the Trust Act, 1882. The organization was registered on 27th May, 1974 in Lahore1.The Trust is governed by a seven-member body headed by Chaudhry Ahmad Saeed, a leading businessman of Lahore. The trust employs more than 1000 people. The three institutions run by BHT – SH, SMDC and SNC – are collectively known as SIHS.

OUR FUNDING

All the funding of SIHS has been mobilized locally, mostly from generous contributions of philanthropists and some grants from the government. These contributions have been instrumental in the expansion of Shalamar Hospital and establishment of SNC and SMDC. However, even with the current volume of donations at more than PKR 70 million per annum, the SIHS institutions still fall short of funding to meet recurrent expenditures and undertake expansions to cater to the ever increasing inflow of patients.

SIHS and in particular SH has been focusing on revenue generation from those patients who can afford, to ensure sustainability of its activities and the annual receipts of SH now exceed PKR 300 million. However, due to heavy inflow of deserving patients, the

1 Registration No. 12631

Page 7 | 29 SIHS – Past, Present and Future operational shortfall has been on the rise over the past few years. The shortfall in 2010 was close to PKR 100 million. SIHS has been quite successful in mobilizing donations, thanks to its large pool of local philanthropists and business houses. In 2010, due to locally raised donations and government grants, the shortfall was squeezed to a mere PKR 25 million.

Figure 1: SH Yearly Financial Snapshot 1988-2010

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Figure 2: SIHS Donations over the Years

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Figure 3: SIHS – Journey through the Years

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OUR FACILITIES

Shalamar Hospital

The Businessmen Hospital Trust established Shalamar Hospital in 1982 as a not- for- profit Hospital to cater the needs of patients belonging to the lower income population of Lahore, a historic city with over 8 million population. With the sustained efforts of the Board of Trustees and the Management of Hospital, Shalamar Hospital has grown to 350 beds and is now amongst major health care providers in Lahore.

Shalamar Hospital is exclusively catering to the 2.5 million residents of northern Lahore. The northern part of Lahore includes localities such as Mughalpura, Baghbanpura, Harbanspura, Tajpura, Tajbagh, Manavan, Batapur, Pakistan Mint, Dharampura, Garhi Sahu, Shalamar town, Angori Bagh, Wapda Colony, G.T. Road, Darogawala, Misri Shah, Chamra Mandi, U.E.T, Momanpura, Mehmood Booti, Shad Bagh, Ghoray Shah, Rizwan Gardens, Jallo Town, Wagah and Railway Colony. Much of the population living in these localities belongs to lower socio-economic strata of society and cannot afford expensive or fully paid medical treatment. Most of these localities are underdeveloped in terms of infrastructure and presence of basic health facilities. The hygiene conditions are poor, owing to rapidly deteriorating sanitation facilities and tremendous increase in population, resulting in sporadic outbursts of common diseases such as Dengue Fever, tuberculosis, hepatitis, gastroenteritis, etc.

Shalamar Hospital is an impressive health care facility over 18 acres. With 350 beds, it ranks amongst the largest private trust hospitals in Punjab and is widely recognized for the excellence in healthcare. The hospital supports the community through various collaborative projects like Waste Management Program and free treatment for congenitally deformed and burnt children. The medical staff members represent a wide range of specialists with many physicians being widely recognized in their fields. The hospital is providing a comprehensive range of safe and reliable, acute and specialized services to a population of more than 2.5 million people residing in northern Lahore & its outskirts. From six specialties originally, now the hospital provides a complete range of consultation, diagnosis and treatment services for almost all medical and surgical specialties through its hospital based clinical services and community based outreach program. These services are provided free of cost to the non-affording patients. At Shalamar Hospital, every fifth patient is non-affording and our aim is to provide treatment to any patient who walks through the door notwithstanding his or her ability to pay.

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Designed by a team of experienced Australian For setting up a medical facility like architects, the SH complex is a reflection of the Shalamar, selection of location is the first 70s, with a rectangular design. The wide and foremost priority. During the survey an corridors have windows on both sides so that air 18-acre public land owned by Pakistan Railways near Mughalpura, Lahore was can ventilate naturally throughout the hospital, found best considering the requirement of which reduces odor and provides sufficient community and situation of location. After natural light inside the hospital. hectic efforts and persuasion the land was donated in the name of the hospital by the Ministry of Railways. The hospital was Shalamar Hospital serves its patients through a named the Businessmen Hospital Trust, number of general medicine and surgical which was later changed to Shalamar departments. The general medicine and allied Hospital for being in the vicinity of the historical Shalamar Gardens constructed by departments include General Medicine, Chest Mughal Emperor Shah Jahan in 1642. Medicine, Gastroenterology, Diabetes and Endocrinology, Cardiology, Neurology, Nephrology, Dermatology, Paeds Medicine and Psychiatry, whereas the surgery departments include General Surgery, Orthopedic Surgery, Plastic Surgery, Neuro Surgery, Paeds Surgery, Anesthesia, ENT, Ophthalmology, Gynae and Obstetrics, Dentistry and Urology.

Although our Cardiac Care Unit is not functioning as a full-service cardiac department, its adherence to quality and care has been its hallmark. This department also has highly trained staff and two very experienced cardiologists.

The Radiology Department is another prime example of quality. It offers comprehensive, cutting edge diagnostic technology services that provide the physician with the required information for timely medical intervention. Services are provided in an environment that is warm and friendly and provides procedure areas that are discreet and private. The department has experienced staff of trained and qualified radiologists and technologists. With C.T. Scans, X-Rays, Ultrasound, and many other diagnostic procedures, it is ensured that the disease is detected at the earliest so that appropriate treatment can be given.

The state-of-the-art Dialysis Ward has fulfilled a long felt need, as there was no proper dialysis facility in northern Lahore. Initially the Dialysis Ward had 10 beds with three dialysis machines, but through generous contributions from its donors, the ward now has 20 beds and 19 dialysis machines.

Established in 1982, the Peadiatrics Department has three full time consultants, one visiting consultant and a team of trained doctors and nurses. The department functions 24 hours a day. The Pediatric Department is well equipped with ventilators, incubators, phototherapy units, radiant warmer, cardiac monitor, oxygen saturation monitor and CPAP. More severe cases of burns and abnormalities of children are referred to the United States through collaboration with House of Charity, Houston, Texas.

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The Pathology Department was upgraded and given a brand new image with upgraded services and advanced equipment.

The Out Patient Department (OPD) provides consultation to about 1,000 walk-in patients every day. The number of patients coming for consultation and diagnosis makes it one of the busiest hospitals amongst private sector healthcare institutions in Lahore. Services Provided by Shalamar Hospital

Besides outpatient and emergency healthcare, the hospital is also offering a number of other diagnostic and treatment facilities. Over the past five years, more than 100,000 patients have been admitted to Shalamar Hospital, whereas more than 350,000 patients benefit from the hospital every year. The use of diagnostic services such as x-rays, ultrasound, CT Scan and pathological laboratory tests as well as patients services in the areas of dialysis, dental, dermatology, physiotherpay and antenatal have also been on the rise over the last five years.

Figure 4: Hospital Admissions 2006-2010

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Figure 5: Patients Inflow 2006-2010

Figure 6: Use of Diagnostic Services 2006-2010

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Figure 7: Patients Check-ups 2006-2010

Shalamar Nursing College

The Shalamar Nursing College is the first private institute in Lahore to offer a bachelor degree in nursing. Staffed by skilled professionals, the college offers a modern auditorium, spacious classrooms, chemistry and computer laboratory and a hostel for female students.

In Pakistan, there is an acute shortage of nursing professionals – the result of lack of quality training facilities and difficult working environment. According to Pakistan Economic Survey, 2008-09 there are only 65,387 registered nurses for a population of 170 million people, translating into a ratio of less than 4 nurses (and midwives) per 10,000 population. As a mainly female profession, nursing ranks lower in status than medicine. To keep up with the health and Nursing demands of the country, Shalamar Hospital College of Nursing is doing its part to help to meet the tremendous nursing shortage in the country.

The four-year B.Sc. nursing program started in January 2006 and the first batch has already graduated. It provides the educational depth and breadth that is needed by the nursing students to step confidently into healthcare work or advanced study. Since January 2005, the college is providing educational services to all members of society on not-for-profit basis. As the College is affiliated with Shalamar Hospital, it has all the teaching and clinical facilities available for the students. The college offers two types of bachelor programs to its students. The 4-years B.Sc. Nursing is offered to male and female students, having minimum qualification of Intermediate certificate in Pre-Medical. This four-year course gives the students an in-depth learning of both theoretical and clinical practices of learning. On the other hand, the 2-year B.Sc. Nursing is offered to nurses and midwives with diploma training and registration from PNC. Both degrees are recognized under Pakistan Nursing Council and University of Health Sciences.

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Conducive Learning Environment: The classrooms at Shalamar Nursing College are equipped with projectors and multimedia facilities, to facilitate students in learning with the help of international videos and pictorial presentations. There is a separate auditorium and conference room equipped with multi-media and projectors as well. The laboratories are equipped with the latest models of multi-purpose teaching manikins for students to learn good nursing skills. Shalamar Hospital is also housing a state-of-the-art laboratory that is enabling the nursing students to enhance their learning. Each member of Shalamar Hospital College of Nursing faculty has an advanced degree in nursing. The professional and qualified faculty also plays a major role in enriching the academic experience of the students.

Hands On Experience: The nursing students utilize the facilities of the 35-bed Shalamar Hospital during their clinical practicum. The students gain exposure to ICU, CCU, OB/GYNE, Operation Theatre (General), OB/GYNE Theatre, Dialysis Unit and many other areas. Shalamar Hospital has an ongoing community outreach program that gives another unique dimension to students’ learning. Shalamar Medical and Dental College

The project of Shalamar Medical & Dental College commenced in the year 2007. With the most modern & contemporary building design, Shalamar Medical & Dental College is going to serve as an emblem for medical education in Pakistan in the 21st century.

Having the capacity to cater to 750 students, the custom made building provides all the necessary spaces required to ensure an ideal learning environment with lecture theaters, laboratories, library, museum, dissection hall, auditorium and cafeteria. Apart from providing audio-visual aid for educational purposes, the building also provides physical, mental & aural comfort through controlled temperature and humidity.

The SMDC is providing the finest medical education of international standard and recognition and is currently offering M.B.B.S degree program. The teaching method is formulated around “Problem-Based Learning” in tutorial groups of students, supervised by highly qualified staff. The college is recognized by PMDC and Ministry of Health. All academic and non-academic facilities of the campus including classrooms, laboratories, library, administrative facilities and extracurricular facilities comply with international standards and the 350-beds Shalamar Hospital is attached with the college for clinical training. The college has a robust communications network, with intranet connections and wireless network, providing access not only to the college resources but also to international journals. The college is affiliated

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with the University of Health Sciences for its supervision and conduct of examinations. PMDC offers scholarships to promising students on a need-cum-merit basis.

WHAT SETS US APART?

Although a number of philanthropic institutions are working in Punjab for providing healthcare services, the SIHS institutions enjoy a unique position in many better ways. Some of the dimensions that set us apart from other organizations, include a carefully selected geographical focus, highly qualified human resource, environmental responsiveness, strategic partnerships, state-of-the-art infrastructure, integrated approach and the focus on excellence.

Carefully Selected Geographical Focus The SIHS institutions, especially Shalamar Hospital, are catering to the population of northern Lahore, which has limited access to public tertiary healthcare services. The population in the area exceeds the whopping 2.5 million figure and the high population density takes a toll on the overall living conditions. Most of the localities have poor hygienic conditions, resulting in high incidence of diseases and epidemics. Shalamar Hospital has therefore filled in a critical vacuum by providing access to quality healthcare services to local community. Moreover, the establishment of Nursing College and Shalamar Medical and Dental College further highlight the SIHS’s focus on the up-gradation of the northern Lahore region, as an important part of the Lahore metropolitan.

The following table compares the availability of doctors, nurses and hospital beds with the average figures for Lahore, Punjab, Pakistan and some other countries. It is quite evident from these figures that Northern Lahore lack far behind in the availability of basic healthcare infrastructure and there is a great room for expansion. For instance, in order to bring the number of hospital beds at par with rest of Lahore, at least 2,400 beds need to be added in this area. Similarly, in order to bring the number of physicians and nurses (and midwives) merely close to Punjab’s average, at least 900 new physicians/doctors and 700 new nurses (or midwives) need to be brought in this area2.

2 The area would of course a lot more doctors, physicians and nurses in order to bring this area at par with the rest of Lahore.

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Indicators Japan India Iran Pakistan Punjab Lahore Northern Lahore3 Hospital Beds (per 139 9 14 6 4.2 15.27 5.58 10,000 population) Physicians (per 21 6 9 8 6.08 NA 2.30 10,000 population) Nurses and 95 13 14 4 4.67 NA 1.74 Midwives (per 10,000 population)

Highly Qualified Human Resource The SIHS boasts having some of the highly qualified human resource, including 42 full-time consultants/specialists, 24 part-time consultants/specialists and more than 800 support and allied staff members. Most of these staff members, especially the consultants/specialists and faculty members of SMDC are accomplished professionals with impeccable credentials in their fields of practice. Moreover the establishment of School of Nursing, which was a result of the perceived need for quality paramedical staff, is a glaring example of SIHS’s commitment to quality.

Environmental Responsiveness SIHS is an environmentally responsible organization, which ensures a hygienic environment for its patients. The cleanliness is ensured through regular orientation and training of staff. In year 2000, the Shalamar Hospital has initiated a project for hospital waste disposal, by installing an incinerator with a capacity of 1,600 kg per shift. The incinerator is being used to dispose off biomedical waste, not only from Shalamar Hospital but also from more than 220 other hospitals, laboratories and pharmaceutical companies located in and around Lahore.

Strategic Partnerships SIHS believes in forging strategic partnerships with complementing organizations and leveraging the combined resources to realize its vision. SIHS, for instance, has international liaison with the House of Charity (HOC), USA since 1997 for provision of free surgical treatment of burnt and congenitally abnormal children from around the country. Through this partnership, children with deformities are sent to USA for free surgical treatment. Hundreds of children have so far benefited from this program.

State-of-the-art Infrastructure The SIHS institutions enjoy having state-of-the-art infrastructure. The Shalamar Hospital has a well-equipped Dialysis Ward, which is the second largest dialysis facility in Lahore.

3 The data for Northern Lahore is based upon the findings of a survey covering 23 hospitals in Northern Lahore, catering to a population of 2.5 million people approximately. The number of physicians within these facilities (289) only result in a ratio of 1.15 physicians per 10,000 population, however, as there are a number of private practicing physicians working in this area as well, this ratio has been assumed to be doubled, which is still considerably less than even the comparable figures.

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Similarly, the Shalamar OPD is one of the largest outpatient facilities in Pakistan catering to more than a thousand walk-in patients on a daily basis. The ISO-certified Accidents and Emergency Department is fully functional with adequate capacity to respond effectively and efficiently to various types of medical and surgical emergencies.

Integrated Approach The SIHS’s holistic and integrated approach not only focuses on provision of tertiary healthcare services but also encompasses strategic interventions to strengthen the healthcare sector in general. The establishment of Nursing College addresses the gap in availability of quality paramedical staff, whereas the Medical and Dental College aims to set new benchmarks in quality medical education. Moreover, the hospital waste management initiative underscores the focus on allied healthcare management issues. The SIHS also has initiated community outreach programs through mobile dispensaries to provide basic healthcare services to the doorstep of disadvantaged communities.

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SHALAMAR HOSPITAL WASTE MANAGEMENT

The Shalamar Hospital Waste Management project was initiated with the objective of stopping recycling and reuse of clinical waste such as syringes and other disposables. The recycling of clinical waste results in spread of typhoid, Hepatitis B, C,HIV and epidemics. In addition to this, many health care providers and diagnostic centers throw contagious waste on the roadside or in municipality containers. To overcome the menace of hospital waste disposal in Lahore, a non- profit company was registered in June 2000 for the proper handling of the Hospital Waste. The project was first of its kind in Pakistan. Under its supervision two incinerators each are having the capacity of 1600 Kgs/Shift have been installed at the two hospitals i.e. Shalamar and United Christian Hospital. These incinerators were donated by the Government of Netherlands. Custom made collection vehicles have also been provided to collect the bio medical waste from the health care providers and pharmaceutical companies who have been registered as members of the user club. A nominal fee is charged to all the members to cover the cost of the collection and incineration of the biomedical waste. Currently, 220 Hospitals, Labs and Pharmaceuticals companies including 10 Government Hospitals are using this facility. The company has successfully completed five years of biomedical waste disposal services.

The main aims of the Hospital Waste Management Company are to reduce the recyclable infectious clinical waste; and educate medical and non- medical professionals in proper biomedical waste management. About 200 Training Workshops and Lectures have been delivered to develop understanding on the hazards of hospital waste in approximately 15,000 health related professionals. Following areas are focused while conducting such courses.

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OUR STRATEGY

SIHS aims to serve the disadvantaged community of northern Lahore by providing quality medical treatment and developing healthcare capacity in the society through education in the field of medical and health sciences. In order to realize this vision, SIHS has developed a comprehensive strategy and an action plan for the next five years.

SIHS’s strategy revolves around five key pillars – Availability of 24-hours highly responsive emergency and trauma care; Provision of patient-centric healthcare services; Outreaching community for provision of primary healthcare services; Developing a pool of capable human resource; and Undertaking credible initiatives to demonstrate social responsibility. SIHS intends to realize its vision, while working around these strategic pillars and adhering to the core values of promoting local philanthropy; ensuring sustainability; adopting patient- centric services and continuously improving quality. The strategy has been translated into a five-year action plan.

Figure 8: SIHS Strategic Framework

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KEY STRATEGY PILLARS

Patient-Centric Healthcare Services SIHS through Shalamar Hospital is aiming to provide a wide range of healthcare services to the community of Northern Lahore. While currently, the SH already has a range of departments providing a wide array of medial services, catering to both admitted and outdoor patients, there is still a need for improvement in the provision of these services as well as for introduction of new services. Moreover, SIHS believes in focusing these services on the patients, understanding their needs in a better way and improving its services to better serve their needs.

24-hours Highly Responsive Emergency and Trauma Care Shalamar Hospital is one of the very few major hospitals in Northern Lahore and the only key facility in the vicinity. Therefore, SH’s Emergency Department plays a critical role in serving the patients in critical medical or surgical conditions, round the clock. However, owing to its location and subsidized/free services for the needy, there is a mounting pressure on the department, with a dire need for expansion and improvement in services.

Community Outreach Northern Lahore has various localities with population belonging to low income levels. The low-income levels not only result in lack of affordability for quality medical services but also indirectly result in limited awareness about seeking such services. In order to provide better access to community to such services, SH is not only providing free/subsidized services to a number of patients but has also undertaken initiatives for community outreach such as the mobile dispensary program and a network of diagnostic laboratory collection centers. SIHS believes that there is a great need to strengthen its community outreach initiatives to further deepen its access, thereby spreading the benefits if its services.

Pool of Capable Human Resource In order to provide quality medical and emergency services, well-trained healthcare professionals play a key role. SIHS has therefore embarked on its mission to develop capabilities to produce such human resource not only for its own facilities but also for the healthcare market in general. SNC and SMDC are two key facets of this approach to train quality doctors and nurses. Moreover, in order to run a full-scale hospital, such institutions provide a strategic fit, providing research, teaching and practice opportunities to qualified professionals.

Social Responsibility SIHS stands tall as evidence of the success of local philanthropy and generosity of local business community. Social responsibility therefore has become the cornerstone of SIHS’s philosophy. This responsibility so far translated into a number of initiatives such as the waste management program, the provision of free and subsidized treatment to needy patients, ensuring a hygienic environment for its patients, etc. SIHS aims to demonstrate this spirit of social and environmental responsibility in all its future endeavors.

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OUR CORE VALUES

SIHS believes in core values of ensuring sustainability of its initiatives, continually improving quality of its services, retaining its focus on the end users (i.e., patients) and promoting local philanthropy. Through our journey, SIHS has held closely to these values and it aims to demonstrate these values across all its future endeavors. OUR STRATEGIC ACTION PLAN 2010-15 In order to implement its strategy, SIHS has also come up with a concrete action plan for the next 5 years, to undertake a host of initiatives under each strategic pillar. The appended strategy matrix presents SIHS’s action plan.

Figure 9: SIHS – The Way Forward; 2010-2015

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CONCLUSION

SIHS is well positioned to serve the disadvantaged community of northern Lahore through its various initiatives for providing quality medical treatment and developing healthcare capacity in the society through education in the field of medical and health sciences. SIHS has ambitious expansion plans to further its scope of activities to benefit a larger chunk of community. These plans have been developed under a well though out and coherent strategy, as explained earlier. While working on strengthening its own systems and capabilities, SIHS is now looking for funding sources to implement its action plan for the next five years, to transform this strategy into concrete initiatives on ground.

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SIHS – STRATEGIC ACTION PLAN 2010-15

Strategic Pillar Key Initiatives Funding Needs Potential Impact Availability of 24-hours 1. Up-gradation of Accidents and Emergency Department & OPD: The PKR 60 Million Treatment of 500,000 highly responsive Shalamar Hospital is planning to upgrade its Accidents and Emergency & patients per annum, emergency and trauma General OPD Department to further enhance the capability of handling including 140,000 care different emergency situations and needy patients. patients free of cost

Total Funding Availability of state-of- Requirement: PKR 60 the-art trauma Million (USD 0.69 management and Million4) emergency & OPD services in a radius of 15 kilometers in a highly dense populated community Provision of patient- 2. Systems Strengthening through a Robust Management Information PKR 41 Million Better patient care centric healthcare System: SIHS is considering deployment of a state-of-the-art management through maintaining the services information system, not only for better internal management but also for record of patients’ managing an up-to-date patient record database. The solution is including medical and visits history; Total Funding hardware software and IT personnel are estimated to cost. Operational cost Requirement: PKR 647 reduction, process Million (USD 7.44 improvement and efficient Million) management; Reducing response time.

3. Expansion of Hospital for Additional 150 Beds Unit: Shalamar hospital is PKR 255 Million Addition of 150 beds, currently a 350-bed facility. Out of these 350 beds, 100 beds have been resulting in 16,000 exclusively dedicated for providing free-of-cost treatment to deserving additional patients treated patients. However, these 100 beds are not sufficient to provide treatment to a per annum. 100 additional community of 3 million people. Shalamar Hospital is planning to expand the beds, dedicated for free hospital capacity by another 150 beds to cater to the heavy inflow of patients’ treatment to needy admissions as well as to comply with the requirements of Pakistan Medical and patients, resulting in Dental Council. Out of these 150 beds, additional 100 beds will be dedicated 7,000 free patients treated for free treatment of poor and needy patients (PKR 225 Million). Moreover up per annum. gradation of 100 existing free beds of general ward .(PKR 30 Million)

4 Exchange Rate: 1 USD = PKR 87

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Treatment of 36,000 4. Strengthening of Ophthalmology Unit: The Shalamar Hospital is planning PKR 30 Million additional patients per to establish a new ophthalmology unit, to more effectively address eye-related annum for eye-related problems of the patients. Furthermore, the SH is also planning to procure problems, including additional equipment to strengthen its services. 29,000 additional OPD visits per year. Treatment of 23,000 additional patients per annum, free of cost, for eye-related problems

2,000 surgeries 5. Establishment of Neurosurgical Operation Theater: Currently the PKR 75 Million (neurosurgeries) per problems related to neurosurgery can only be effectively dealt with at the annum, including 500 General Hospital Lahore, which is the only facility of this kind in Punjab. To surgeries free of cost; make these services more easily accessible and to share the burden of patients, Availability of state-of- the Shalamar Hospital is considering establishment of a new neurosurgical the-art neurosurgery operation theater. operation theater in a radius of 15 kilometers in a highly dense populated community;

15,000 additional walk in 6. Establishment of Cardiac Operation Theater: The residents of northern PKR 44 Million patients treated per annum Lahore need an economical medical facility to provide affordable cardiac for cardiac problems treatment, which calls for establishment of a new cardiac operation theater at including 3,750 patients Shalamar Hospital. free of cost, and 1000 surgeries per annum with 200 free of cost treatments.

7. Strengthening Gynecology Department: Shalamar Hospital is planning to PKR 45 Million 70,000 additional walk in strengthen its Gynecological Department to more effectively manage the gynae patients treated per annum patients through establishment of a gynae operation (PKR 30 Million) theater for gynae problems, along with reallocation of admin block (PKR 15 Million) including 14,000 patients free of cost.

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8. Modernization of Equipment for Effective Patient Treatment: The Shalamar Hospital is also seeking funding for the procurement of the following equipment to strengthen its various departments: PKR 70 Million 1,825 MRIs done per  MRI Equipment: Currently the SH has no MRI facility, which is a annum, including 365 critical requirement for any tertiary healthcare facility. The lack MRIs free of cost. of MRI equipment seriously undermines the Radiology Section’s diagnostic capability. Currently Shalamar Hospital, on an average, is referring 5-6 patients to other hospitals for MRI on daily basis. The equipment, once installed, is expected to benefit more than 2000 patients annually and would provide the first facility of its kind in the vicinity. This hospital has already allocated space for setting up this facility. PKR 65 Million 570additional patients  Cath Laboratory Equipment: Currently there is not a single treated per annum, Cath Lab facility in the area surrounding Shalamar Hospital. The including 114 patients incidence of cardiac diseases is on the rise, resulting in free of cost. increasing inflow of cardiac patients. However, in the absence of any such facility, no complicated procedure can be performed on these patients. Currently, on an average, the hospital is referring 3-4 patients to different hospitals for cardiac treatment on a daily basis. The proposed Cath Lab is likely to benefit more than

1500 patients annually. PKR 12 Million 37,440additional patients

treated per annum,  Orthopedics Equipment including 8,640 patients

free of cost. PKR 10 Million

 Up gradation of Existing Operation Theaters

Outreaching 9. Scaling Up Mobile Dispensaries Initiative: Shalamar Hospital is PKR 25 Million Availability of quality

Page 27 | 29 SIHS – Past, Present and Future community for undertaking a community outreach program through a mobile dispensary unit. diagnostic services in 12 provision of primary The SH is planning to add another 10 mobile dispensary units to further disadvantaged urban healthcare services strengthen its outreach program 10 Mercedes Ambulance communities and outskirts of Lahore; Total Funding Requirement: PKR 25 Providing basic medical Million (USD 0.28 care to 250,000additional Million) deserving patients per annum, through 10 new mobile dispensary units, free of cost Developing a pool of 11. Expanding Medical and Dental College: The SIHS has already PKR 362 Million Producing 100additional capable human established a state-of-the-art building for SMDC, however, the project still doctors per annum and 50 resource needs substantial capital funding for initiating the dental college. dentists per annum; The projected funding requirements include developing a girl’s hostel for 150 Increase in female Total Funding students (PKR 111 Million) and establishing a dental college for 50 students participation in SMDC’s Requirement: PKR (PKR 251 million). oncoming class by 70%, 1,184 Million (USD resulting in 70 additional 13.60 Million) 12. Operational Cash Subsidy for SMDC: SMDC has started its operations PKR 822 Million female doctors and 35 and currently the annual operational loss stands around PKR 117 million, female dentists entering however, in 5 years, this loss is expected to come down to merely PKR 21 the market per annum. million per annum (for funding scholarships for qualified and needy students). In addition, the accumulated liabilities for SMDC till the end of FY 09-10 amount to PKR 212 million, which have so far been funded through commercial and supplier credit. In order to sustain itself through the initial years of its operations, SMDC needs a one-time cash subsidy of PKR 610 million to cover these losses. (The ongoing loss to fund scholarships after 5 years is proposed to be bridged through an endowment fund; See Para 14).

Undertaking credible 13. Up-gradation of Hospital Waste Management Unit: Shalamar Hospital PKR 200 Million Efficient disposal of 600 initiatives to is providing the waste management facility to approximately 220 medical tones of additional demonstrate social facilities, pharmaceutical companies and small medical complexes for their hospital and medical responsibility bio-medical waste. The equipment is almost 10 years old and needs up- waste per annum for the gradation. Moreover, the increasing load also calls for its capacity next 5 years. Total Funding enhancement. The project therefore requires refurbishing of the existing unit ad Requirement: PKR installation of an additional unit. 1,023 Million (USD 11.76 Million) 14. Establishment of Endowment Fund to Support Free/Subsidized PKR 823 Million6 Continued provision of Treatment and Other Initiatives by SIHS: SIHS and in particular SH has free/subsidized services to been focusing on revenue generation from those patients who can afford, to 500,000 deserving

6 This amount has been calculated, using an expected interest rate of 11% for an annual perpetuity of PKR 90.5 million.

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ensure sustainability of its activities and the annual receipts of SH now exceed patients per annum; PKR 300 million. However, due to heavy inflow of deserving patients, the Sustained focus of SMDC operational shortfall has been on the rise over the past few years. The shortfall on quality of incoming in 2010 was close to PKR 110 million. SIHS has been quite successful in students, irrespective of mobilizing donations, thanks to its large pool of local philanthropists and their capacity to pay and business houses. In 2010, due to locally raised donations and government provision of quality grants, the shortfall was squeezed to a mere PKR 25 million. On an average, medical education to this gap for SH is expected to stand around PKR 160 million per annum5. The community. consolidated average operational loss per annum for SIHS is expected to be around PKR 181 million, including PKR 160 million for SH and PKR 21 million for SMDC.

SIHS plans to raise annual donations to pick up 50% of this operational loss, which would amount to PKR 90.5 million. For remaining PKR 90.5 million, SIHS is now looking for establishing an endowment fund to sustainably bridge this gap and meet its recurrent expenditures.

Total PKR 2939.9 Million US $ 33.78 Million

5 The loss is expected to increase substantially from FY 2011-12 due to addition of 150 beds.

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