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HUMAN RESOURCE MANUAL

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Policies/& Guidelines
Dear We are pleased to welcome you to the INDUS AFRICA (Unit of Indus Healthcare) family and would like to present to you the INDUS AFRICA Handbook. Whether you have been here for many years or just a few days, being part of INDUS AFRICA, provides us the privilege to contribute to the development of care of patients with full respect and love. The Employee Handbook is intended as a general guide to help new and existing employees better understand and adhere to organizations procedures and rules. It contains key policies, goals, benefits and other information concerning the hospital that all INDUS AFRICA team members should be aware of. The Handbook has been prepared with careful deliberation and reviewed by various team members. Invaluable suggestions and inputs have helped give shape to a document that is reflective of our values and goals. If you have a concern regarding this document, or would like to provide suggestions to improve the content, please write in at recruitment@indusafrica.com or hr@indusafrica.com contact Project Manager Mr. Sandeep Kapoor. Your suggestions will be given due considerations for the next version of the Manual. Regards, (HR Manager)

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INDEX SrNo Topic


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Organizational Structure Recruitment Procedure Job Specification Job Description Probation and Confirmation Training of employees Evacuation procedure in case of fire Formal Dress Code Confidentiality Working Hours and Holidays Remuneration ,Compensation and Benefits Leave policy Employee Performance and Appraisals Committee on employee grievances Addressing health needs of employees Disciplinary Action Termination Exit

Pg No

ANNEXURE Form on health checks

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HUMAN RESOURCE MANUAL


INDUS AFRICA Code of Conduct
At INDUS AFRICA, Employees are expected to maintain the highest standard of conduct at all times. Their personal appearance, their actions and the impressions they make both during and after office hours are important to their growth and to the enhancement of the reputation of self and the organization. It is therefore expected that they would conduct themselves as per the high standards expected by social and corporate patients as well as employees. Any lapse in this regard may call for disciplinary action as per the existing norms of the organization.

1. ORGANISATIONAL STRUCTURE
INDUS AFRICA strives at a responsive flat structure. Clearly defined roles and responsibilities within which position or role falls helps create the clarity required and unifies the organization by adopting a departmental format with hierarchical relationships between members so that corporate policy spreads throughout the company and moves in the same direction. Some of the positions at INDUS AFRICA are currently vacant. Therefore, there may be instances where one is called upon to wear multiple hats and fill in for multiple roles but the primary responsibilities remain those that one was inducted for. At different levels/grades the scope of responsibility will vary within the organization. At JUNIOR LEVELS, the job usually adds value to the present. Executive s at this level manage operations/ procedures/ practices to support services and functional areas. At SENIOR LEVELS, a job also adds values to the future. The impact of an incumbents contribution to overall organizational effectiveness, improvements and refinement of process is far more than at the junior levels. At this level, jobs contribute and participate in the strategy making process. At HIGHEST LEVELS, jobs will ensure continued viability/survival of organization for the future. The complexity of the job is reflected in the number of unpredictable variables to be handled. Salary and benefits are dependent on the level. Each level will have two implicit levels and movement from lower to higher level within a level would be based on number of years of relevant experience and performance and movement to another level would depend on a role change.

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5 ORGANISATIONAL CHART

CHAIRMAN

CFO Finance & Corporate Marketing

CEO Operations & Medical Affairs

Director Strategic Planning & Liasoning

Manager HR

Quality Manager / Director Operations

Accounts & Finance Assistant Manager

Unit Manager

Marketing Manager

IT

OT

ICU

Procurement Manager

Consultants

RMO

Nursing Suptd

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2. Recruitment Procedure
The Recruitment Procedure guidelines
Need based recruitment The number of staff members for every department is fixed. But in case of urgency ad-hoc additional recruitments may be done on recommendation of the Department Head and Team Leader. Strength of various departments at a given time DEPARTMENT NAME TOTAL EMPMLOYEES 1 53 1 3 1 2 1 1

HR Department
Consultants Director Operation Assistant Manager Marketing Manager Accountant Logistic Manager IT Manager

On the creation of a vacancy the Department Head instructs the HR department for the need to conduct interviews. Each function/business/practice head is responsible for its own manpower requirement and planning and should intimate corporate HR and (In case of Medical and Para-Medical) Medical Manager and Nursing Manager HR would help identify sources and could post the advertisement in recruitment websites, newspaper or use help of a placement agency. After the initial interview, candidates are short listed and sent to the concerned department head for the second level of interview. Final approval is then sought from the CFO/CEO/Chairman

Head- Leader requests Vacancy HR Manager for Vacancy

HR Manager Shortlists Candidates with Team Leader. as per Rules

Final Approval by CEOOperations

Interview by Department Head & Team Leader

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Our recruitment process endeavors to hire the best. Recruitment is done by employing the following methods in order of priority: o o o o Recommendations and referrals of Existing Staff/ Department Heads/Team Leaders/Doctors, Well Wishers. On-Line Resume Database like Monster.com Campus interviews at Nursing Colleges. Media Advertisements in VACANCY Columns

Candidates with minimum 3 years of experience with requisite work experience from related service Industry are recruited. Since, they are sans mindsets and can be easily indoctrinated and groomed through rigorous training, e.g. people from the hotel industry, who are expected to possess etiquettes in hospitality. Recruitment is done at all levels/positions depending on the need For eg., a nurse, works on an average between 265 to 290 days a year. Therefore, as a thumb rule, 30% of the total nurses required should be added to the figure, due to leave necessities, which are religious, and for ceremonies like marriage. At least 15% should be male nurses. While doing this exercise, it should be kept in mind that on an average, 6065% beds are occupied at any given point of time. A section of the nurses should periodically be withdrawn from their posts and subjected to class room training, purely to upgrade them. It is a pre-requisite, that all nurses have the basic knowledge of working on a computer, since modern HIS software calls for online entries at all levels and departments Total Nurses Average 40 Area ICU GW HDU Private Ward Ratio 1:1 1:6 1:3 1:4

4. Job Description
Job Description for following to be provided at the time of employment: A. Chairman Responsible for the overall functioning and administration of the HCO. The final authority in matters relating to Strategic Planning , Finance, Operations, etc The final authority in terms of grievance issues and disciplinary matters. Liasoning with Doctors, IMA and other Health Organizations.

B. CFO Responsible for planning and implementing corporate marketing strategies Controls the accounts and Pay etc. Heads the cashless services of the HCO. Indus Healthcare, Human Resource Manual Page 7 of 31

8 Responsible for sanctioning procurement for non medical and medical equipment etc Responsible for and deals with the financial aspect of the functioning of HCO

C. COO Head and Reporting Authority for all team Leaders in the Hospital Viz Nursing Superintendent, Chief Medical Officer, HR Manager, Team LeaderFront Office, Team Leader Security & Maintenance. Procurement Manager reports to the COO. Approval of all misc and sundry expenses COO Office itself or a women appointed by COO shall be the Women welfare Volunteer who shall look after all women issues including any harassment or inequality. Resolving escalated issues relating to the Patient Care and service. Overlooking and ensuring all legal compliance including Medico legal Cases and Police liasoning. Approval for any Charitable and Social cases including Discounts on Services provided up to maximum of 20% in specified services.

D. Director Strategic Planning & Liasoning Responsible for the effective functioning of the ICU, OT and IT Responsible for formulating policies , planning strategies for the new projects of the organisation\ Liasoning and interaction for improving the image of the HCO Responsible for Quality Compliance and various departments of the organisation

E. Team Lead Quality Compliance Responsible for framing and formulating SOPs and policies on the basis of structured quality norms for different areas of functioning in the hospital. Implementation of the policies and ensuring quality compliance.

F. Medical Records Maintenance of medical records of patients.

G. Consultant Singularly responsible for his / her patients treatment, management and coordination. Responsible for calling/ collaborating with other specialty consultants in the best interest of the patient. Indus Healthcare, Human Resource Manual Page 8 of 31

To introduce himself with qualifications to the patient and use non technical language explaining the ailment and the likely course of treatment. To acquire various consents during the course of treatment, as and when required. Responsible for follow up care for his/her patients. Keeping the interest of the patient in mind the consultant can refer / guide the patient to another consultant / senior consultant and thus absolve himself /herself of the case. Implementation and maintenance of Policies related to Quality Systems (NABH Guidelines).
Independent Conduct of Surgery. Post Operative Personal Follow Up till patient Discharge. Daily Ward Round for all operated patients is mandatory. To work in an environment with no emergency access to Senior Surgeon and with limited access to ICU, medications, Blood and blood products. Each Doctor to conduct 2 teaching sessions /Interactive teaching for local citizen staff. To exhibit a cooperative attitude and to be a team player. Exhibiting respect and regard to African people and their sensibilities. The Doctor may also be required to travel to nearby places for meetings or Lectures and represent themselves on behalf of Indus Healthcare.

ADMISSION RIGHTS
1.0 Purpose

To ensure a standardized policy and procedure that guides the Admission Rights of Consultants/Doctors 2.0 Policy 1. The Admission Rights are given to Dr. Vikas Goyal starting from 16.08.2012. 2. The Admission Rights are applicable for the following facilities (Indus Healthcare): 3. Responsibility of the Hospital towards the Admission Rights Doctor and his patient: i) Quality Hospitalization for guests at par with the quality provided to all other Hospital guests. ii) Hospital services in accordance with Indus Quality Systems (IQS). iii) Emergency and resuscitation services and ICU back up for patients as and when required on 24X 7 basis. Indus Healthcare, Human Resource Manual Page 9 of 31

10 iv) Medical Officers, Anaesthetist, Physician, Surgeon Services as and when requested by the treating Consultant. v) To take the charges for hospitalization from the patient after cost counseling and written consent about tariffs has been taken from patient prior to hospitalization. vi) Timely remunerations are given to the Doctor. 4. Expectations from the Consultant/Doctor with Admission Rights to one or more Indus Hospitals.

2.4.1 General: It is mandatory for the Consultant/Doctor to provide a copy of their CV and Medical Council Registration Credentials for necessary records. The Management and the Human resource department must ensure that he\she has a valid degree to carry out the procedure for which he \she is admitting the patient. The copy of degree and the registration certificate has to be deposited at the account department with (Mr. Sandeep Kapoor) 1. For booking of the OT, the reception of the respective hospital must be contacted and informed by the concerned Doctor. 2. In case of routine admission, all patients must be assessed by the Consultant/Doctor within 4 hrs of admission into the hospital without any exception. This practice must be followed even if the patient is admitted at night. In case of emergencies the patient is to be seen by the Consultant immediately. 3. To provide ultimate patient care, the treating Consultant/Doctor can coordinate the patients care in a multi-disciplinary setting if required. 4. The Consultant/Doctor is required to visit the patient at least twice a day in normal circumstances and whenever called in case of emergencies. 5. The Consultant/Doctor is required to ensure self written legible visit notes in the progress sheets of the patient with the Date, Time of visit, Name and Signature of the Consultant. Asking a junior Doctor to write a nd sign on the Consultant/Doctors behalf is strongly discouraged. 6. Also Consultants must put down the notes for the same day with Time, Date and legible signature and name. Observations of previous visits are not to be inserted on a later-date. Indus Healthcare, Human Resource Manual Page 10 of 31

11 7. In case of Telephonic Instructions the same instructions can be recorded in the file by the Junior Doctor/Nursing Staff, read back to the Consultant/Doctor and signed by the Consultant within 24 Hours. 8. It is the responsibility of the consultant to come to the hospital whenever called by the resident, though for routine procedures the hospital appointed resident \ senior resident \ full time anesthetist will also see them. 9. The Consultant/ Doctor must adhere to Hospital Quality Systems in Clinical Care, a briefing for which would be made by the Hospital Quality Manager or Infection Control Nurse before you admit your first patient. 10. If a consultant is unable to attend to a particular patient (e.g. a new admission) then he/she should express the inability to do the same and the management reserves the right to transfer the treatment of the patient to another consultant. 11. The patient's condition must be clearly explained by the Consultant to the relatives and in case of an unfortunate event of death of the patient the Consultant is required to be present in order to explain the situation to the patient's relatives and declare the death of the patient to the relatives. 12. In case of an unexpected turn towards adverse treatment outcome or to avoid such sentinel events, the hospital reserves the right to seek a second opinion or involve a critical care specialist for the benefit of the patient. 13. As per the Law, the Hospital is equally liable towards the patient even if the patient has been brought in contact with the hospital so lely because of admitting doctors efforts. Therefore as we share this responsibility with the admitting doctor we remain observant but non-interfering with the treatment but reserve the right to actively participate in patient care and appoint a case manager for such a patient and seek your cooperation whenever such support has to be used to save a patient from an adverse outcome for the benefit of all concerned. 14. In case a Consultants patient file is taken up for Medical Audit, the Consultant must be informed of the same and may choose to be in attendance at the Medical Audit committee Meeting as an invitee to give his/her inputs. 15. The admitted patients files and treatment shall form a part of the hospital record and can be subject to analysis including Medical Audit. As part of Indus Quality Systems a peer review medical audit committee is in place. It would be appreciated if the concerned Consultant can attend the medical audit committee whenever his/her old/current patient file is selected for review. All findings of the Medical Audit Committee report are open only to Doctors Peer Groups within the Indus Healthcare, Human Resource Manual Page 11 of 31

12 hospital and remedial action of Medical Audit committee is binding on all in the hospital. In cases of gross neglect and medical blunders penal action may include but is not limited to cancellation of Admission Rights. 16. Adherence to Hospital Formulary for medication prescription: The Medications and surgical being prescribed have to be in accordance with Hospital Formulary which has been prepared after due diligence and in consultation with Doctors at Indus. Preference is given to prescriptions with Generic names. Brand names to be avoided as far as possible. If you wish to add any new brand to the Hospital formulary you would have to give it in writing a motivation and reasons for the same which shall be considered at the biannual formulary review. 17. In this world of spurious medicines in the market, patients are strongly encouraged to use exclusively the hospital Pharmacy. We do not guarantee the originality of any medication purchased from any other chemist. 18. No cash whatsoever can be taken in the hospital from any patient. Kindly abide by the rules and maintain the decorum.

2.4.2 Financial: 1. The Consultants/ Doctors/Management staff should submit the valid PAN card copy (with Mr. Sandeep Kapoor in Office). 2. The rate of With Holding Tax is currently 10% which can vary from time to time depending on government directions of Botswana. 3. The approximate tariffs/Cost of the treatment/procedure/ admission are to be explained to the patient by the treating Consultant and written consent for the same must be taken by the same or with by the IPD manager as per the Consultants instructions. 4. The anesthetists are available full time and outside anesthetist are not allowed to perform any cases except for cardiac surgery.

H. Medical Officers: CHIEF MEDICAL OFFICER (Indoor and ICU Services) & Assistant Chief medical Officer (ACMO) ACMO shall assist CMO in conducting the duties and officiate as CMO in his/her absence. Indus Healthcare, Human Resource Manual Page 12 of 31

13 Organize the paper work and continuously document task completion and necessary Patient data through the day. Organize the Medical Officers duties in a proper manner. Check that the best medical care is provided to the patients by the Medical Officers in coordination with Nursing Staff. Liaise with Specialist and Consultants in association with Medical Manager and Operations Manager for smooth Coordination of multi-modality and multiconsultant care to achieving desired treatment outcomes. To monitor Quality of Patient Care and Patient Satisfaction with Physician care and give feedbacks to management for continual improvement. Be the nodal person with Management and Treating Consultants in Managing Sentinel Events and situations. In addition to medical duties Ensure Patient and attendant worries and queries are courteously addressed by the Medical Officers. Teach the Para-Medical and Medical staff in-service through training programs. To mentor the Medical Officers for their future Career and personal growth in the Organization To maintain the monthly record register of the Medical Officers Co-Operate with the Medical Officers, Nursing Staff. Counseling and Constructively Mentor if any problem or mistake done by the Medical Officer or Nursing staff. Lead by Example. Educate client, families and communities as well as health team members. Promote health and prevent disease. Compromises work creatively and openly to find the solutions that most fully satisfies all important goals and concerns to be achieved. Think out-of-the-Box for achieving best medical outcomes with limited recourses for achieving high efficiency and cost effective cures. To supervise a number of departments and work closely with the administration team of the organization. Implementation and maintenance of Policies related to Quality Systems(NABH Guidelines)

I. HR Manager: To define Organizational Structure. Recruitment (Hiring to Firing) in consultation with the Management. Probation and confirmation. Confidentiality. Working Hours and Holidays. Leave Policy. Performance Appraisal coordination in association with department heads.. Rewards for outstanding individual/group. Termination of services Relieving Formalities. To check discipline in all departments. Indus Healthcare, Human Resource Manual Page 13 of 31

14 Handle grievances among employees. Conduct training programmes. Maintain personal/ individual records. All Documentation and Work related to Quality Systems(NABH Guidelines)

J. Food & Beverage Manager: Is responsible for provision of timely, Healthy, tasty Diet to Patients through the appointed catering contractor. To plan the dietary requirements according to patients need/ disease in consultation with Treating Doctors and Nursing staff. Counsel and Communicate with the Patient and their relatives for dietary decisions affecting a change in their lifestyle. Attend to any complaints about the Patient Diet provided by the Catering Vendor and monitor the Quality of Services of the Catering Vendor. Recommend Penal action where deemed necessary. To make adjustments in diets according to the disease and the liking/disliking of the patients. Recommend a dietary chart to the patient after consulting the treating physician. Food to be given to the patients only after checking it. Implementation of Quality Policies and all Work related to Quality Systems(NABH Guidelines)

K. Accounts/HR Department: i. Telecaller: a. b. c. d. e. f. To collect data of discharged patients. Maintain database of discharged patient on the computer. A follow up call to patients for their feedback. Documentation of feedback in the database. Resolve patients problem if any during the call. To fix a re-appointment of the patient if he/ she so desires with a specific doctor. g. To ensure satisfaction of the patient. h. Greetings to be sent to all ex-patients on every occasion or festivals i. Humane attitude to be shown to all patients especially for Cancer patients. j. Feedback to be sent the MD of hospital. k. Implementation of Quality Policies and all Work related to Quality Systems(NABH Guidelines)

L. IT Manager: Look after IT related all works and problems. Check out problems related to networking. Indus Healthcare, Human Resource Manual Page 14 of 31

15 Maintain servers and update it on time. Make software for various departments to resolve problems in future. Main software is HIS(Hospital Information System) Coordinating Printing and Posting Work related to Hospital Magzine. Implementation of Quality Policies and all Work related to Quality Systems(NABH Guidelines)

M. Procurement Manager: Procurement of all medical / non medical requirements of the hospital Monitor the Contractor Services and the Services Quality (Ambulance, Laundry, Housekeeping etc). Coordinate between Team Leaders (Estate and Maintenance, Housekeeping, NS, CMO etc.) for smooth inter-departmental coordination within the hospital. Solve queries of patients and any escalations. Implementation of Quality Policies and all Work related to Quality Systems(NABH Guidelines)

N. LEGAL DEPARTMENT:

Recruitment and Retention of Staff: The biggest challenge continues to be the recruitment and retention of the appropriate skilled human resources required for district hospital service delivery. Issues around foreign qualified doctors, national and international migration of health professionals and poor morale all impact on this. Education and Training of Personnel: Changes in undergraduate and postgraduate training of doctors, and the new two year internship, hold out hope for improved medical staffing in district hospitals in the future. Examples and issues around the skills mix required for district hospitals are discussed. Human Resource issues impact on quality of care. New quality of care initiatives are supported by increased community involvement. Quality compliance as per policies of Indus Hospital

5. Probation and Confirmation


Effectiveness of a new joiner in an organization is not only the function of skill that is tested at the recruitment/selection stage; it is strongly dependent on the ability of the new joiner to function within the environment of our organization. A period of probation is set aside to allow the organization to asses this fit. Thus all new employees would be placed on probation for a period of Six months. A review of the employees performance will be done at the end of the

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Seventh or Eighth month and communication regarding his confirmation or extension of probation shall be made in writing. During the probation period if indications are that the employee is clearly not a good fit with the organization or his performance is not in sync with organizational interests, a decision to terminate his services (not to confirm his services) could be taken after the CEO, Corporate HR and function head have discussed the issue and only two months salary will be paid.

6. Training of employees
A Buddy System is in place, wherein an old and experienced employee shoulders the responsibility of familiarizing the new joinee with the norms, rules and regulations, culture and work ethics of the organisation. Induction manual with general guidelines is maintained by HR department to orient the employee towards the organizations goals, the job responsibility as well as responsibilities towards safety and risk management. Details of training sessions attended by the medical professionals and nursing staff, other than those conducted by the Indus hospital; have to be handed over to the HR department. These details will be filed in the respective personal files. Training registers are also maintained by the HR department which logs in the details of the training programs conducted by the Hospital, the number of people trained and a brief on the training program. Format as under--Sr Date of No Training Subject Name and details of Trainer Names of people attending Signatures Feedback- FeedbackTrainer Employees

Training Sessions are also conducted in matters of Medical and General Brief about Africa. Medical Details session will be given by Dr. SPS Bedi for Two Hours. General Brief about Africa session will be given by Dr. Vandana Sharma.

7. Formal Dress Code


INDUS Africa follows a formal dress code for all Business Hours Monday To Friday. And Casual Dress Code for working Hours on weekends.

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Dress Code Monday to Friday All Clinical Staff as well as Management staff to be Formally Dressed. All Clinical Staff to ensure that they wear their Apron on all days. Wearing a neck tie is optional. All to wear formal shoes. No open shoes, sneakers or sandals are allowed. Wearing of denims is not permitted on weekdays. Dress Code Weekends On weekends, all staff can wear informal clothes to work including business casuals. All clothes being worn by the individual should be respectful of the work environment and appropriate. No shorts, No open shoes allowed on casual days. Please Note All Doctors and clinical staff have to arrange own Apron / White Coat / Lab Coats and ensure that it is washed, clean and ironed on all days. All Employees involved in client interaction and at public events are especially required to be dressed in business formals as their appearance reflects the INDUS Hospitals brand. All Employees have to maintain basic hygiene and be neat and clean at all times. They should ensure that there is no untoward body odor besides that they should be neatly groomed. For all Hindu and Clean Shaven Men, should be neatly groomed and shaved and for all Sikh men should have their beard neatly groomed and sport a Turban.

8. Confidentiality
All Employees of Indus Hospital are bound by the Confidentiality Principles implying that employees will not and cannot divulge or utilize, except in the furtherance of the organizations business, any confidential or proprietary information that comes to their knowledge in their course of their employment with the organization. The responsibility for keeping such information confidential applies not to the period of employment but also thereafter. INDUS HOSPITAL legal cell would require employees to sign non-disclosure documents from time to time as warranted by the organization needs. As a condition of employment, employees are requested to consider work done and information received during the course of employment as confidential. In case of a breach to the said contract, relevant legal provisions will be strictly applied. NON DISCLOSURE/CODE OF CONDUCT/CONFIDENTIALITY details listed in the Induction Manual.

9. RESTRAINT OF TRADE
a. The Parties hereto acknowledge that [1. the Employer at considerable expense secured the opportunity to conduct business in Botswana and [2. considerable further expense has been incurred by the Employer to relocate and employ the Employee and [3. that the Employer stands to suffer considerable loss and inconvenience in the event of the Employee breaching the conditions of this agreement and [4. in order to protect the interests of the Employer, the following restraint of trade has been necessitate.

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b. During the currency of this agreement (hereinafter referred to as the restraint period), the employee or his family members may not engage in any work of any description whatsoever, and in particular hereby undertakes that he will not, either alone or jointly or together with any other person:i. during any part of the restraint period be interested or engaged in any capacity whatsoever, including, but without prejudice to the generality of the aforegoing, as trustee, proprietor, shareholder, member, manager, director, adviser, consultant, partner, employee, financier or agent in or for any person which is directly or indirectly engaged, interested or concerned in a competitive activity in the territory; ii. during any part of the restraint period and thereafter, to the extent that the same are protected by law, disclose any trade secretes and/or confidential information of the business other than to persons connected with the business and who are required to know such secretes or to have such confidential information. Trade secrets and confidential information shall include (but not be limited to) all and whatever information relating to the business and their suppliers and customers which is not readily available in the ordinary course of business to their competitors. c. The Employee acknowledges and agrees that: i. the restraints imposed upon him in terms of this agreement (interpreted initially in their widest sense as provided in clause 3.3) are reasonable as to subject matter, period and territorial limitation and are no more than reasonably necessarily required by the Employer to maintain the goodwill of, and its legitimate business interests in respect of, the business; ii. the provisions of clauses 2 and 3.1 shall be construed as imposing separate, severable and independent restraints in respect of: 1. the Employee in favour of 2. each of the months falling within the restraint period; 3. each magisterial district falling within the territory; 4. each activity falling within the ambit of a competitive activity; 5. each capacity in relation to a competitive activity which the Employee is prohibited from holding in terms of this agreement; d. the restraints set out in clause 2 shall initially be given the widest possible interpretation and no restraint or combination of restraints shall be limited by reference to or inference from any other restraint or combination of restraints, provided however that the invalidity or unenforceability of any one or combination of restraints referred to in clause 2 (including the restraints interpreted in their

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widest cumulative sense as aforesaid) shall not affect the validity or enforceability of any of the other restraints referred to in clause 2 or another combination of such restraints. e. No restraints referred to in this agreement shall apply to any direct or indirect shareholding by the Employee in any company listed on a recognized Stock Exchange where the aggregate direct and indirect holdings of the covenantor, his spouse and descendants does not exceed 5% (five per centum) of any class of that listed companys issued share capital and the interest of such persons in that company is solely that of a shareholder. f. The Employee undertakes that neither he nor any person in or by which he is directly or indirectly interested or employed will during the restraint period and whether for reward or not, directly or indirectly: i. encourage or entice or incite or persuade or induce any employee of the business to terminate his employment with the business; or ii. furnish any information or advice to any employee then employed by the business or to any prospective employer of such employee or use any other means which are directly or indirectly designed, or in the ordinary course of events calculated, to result in any such employee terminating his employment with the business and/or becoming employed by or, directly or indirectly, in any way interested in or associated with any other person, or attempt to do so. g. The above restraints shall endure also in favour of the successors-in-title of the term successor-in-title shall mean any person who: i. acquires the business; or ii. acquires the goodwill of the business of; or iii. becomes the beneficial owner of such goodwill through his shareholding in any company; or iv. has acquired by cession the right to enforce the restraints embodied herein. h. The employees spouse may not be engaged in any gainful employment by anybody or be a director, associate, partner, professional assistant or shareholder in any establishment of any description whatsoever without the prior written consent of the employer. i. The employees other family members/dependents or any friends who would be staying with him as a family may not be engaged in any gainful employment by anybody or be a director, associate, partner, professional assistant or shareholder in any establishment of any description whatsoever without the prior written and

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explicit consent of the employer Indus Healthcare (Pty) ltd in Botswana and Indus Healthcare (India). j. In the event of the employee unilaterally deciding to leave the employment and staying on in Botswana and/or taking up employment with another employer either part-time and full-time or starting their own business/company/private-practice: In the event of any of this the employee agrees to reimburse the employer the sum of an amount equal to 24 months Salary and in additional to this 24 months salary, 1 million Botswana pula, as part compensation for the financial loss resulting to employer from such act and to cover some of the expenses incurred on the employee in confidence of their allegiance of their contract and the damages incurred in such an action.

k. At the expiry of this agreement or early termination thereof for any reason whatsoever, the employee agrees to return to India and may not engage in any medical practice in Botswana or any countries in the SADC (Southern African Development Community). The current members of SADC are Angola, Botswana, Democratic Republic of Congo (DRC), Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Swaziland, United Republic of Tanzania, Zambia and Zimbabwe. and Southern African Customs Union(SACU)region for a period of 5 years from such expiry or early termination of this agreement.

10.

Working Hours and Holidays

Working hours and In-Time Being on Time is a value and an important work ethic at INDUS Africa. Starting on time is based on the premise that employees need to work together within specified working hours which is core hours for business needs. Employees are expected to be present during the core working time, which is between 07:30am to 4:30pm on all days Monday to Saturday, expect those working on a shift system. Such employees function on the Roster system In-time at all offices of INDUS Africa is 07:30am and working hours are from 07:30am to 4:30pm and shift wise for nursing staff and doctors. You are advised to plan your arrival time at the office. However given the exigencies of heavy traffic and other unanticipated reasons, a grace of thirty minutes (07:30am) will be allowed for three days in a month. After the three days of grace reporting have lapsed in the same month, reporting to work after 07:30am will be considered a half-day and accordingly deductions will be done from the annual assigned leaves. A non-entry on any date shall be treated as Leave and shall be debited from an employees current account of earned leaves. In case of nil leave balance, the same would be deducted from the employees pay. On the days the employee is attending office, she/he is required to sign in his/her time office. Out Time is defined as 4.30pm on all working days except for those working in shifts. All employees would be required to sign out in the time office.

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Emergency duties all Clinical staff attending to emergency duty is also required to sign in and sign out respectively if they are attending to a call after hospital hours. A finger scanning Machine will be used to Capture all In-time and Out-Time for All Employees. Marking your attendance is mandatory. If anyone missing either of their attendance will be treated as Leave Without Pay. Public Holidays: All employees would be entitled to ten public holidays in a calendar year. Corporate HR would make the calendar of approved holiday/gazetted holidays / restricted holidays along with the time of entry in the Attendance Register available at the office reception. As Hospital is a 24 Hour and 7 days a week facility no provision is made for regular Public Holidays. All festivals are celebrated as a family in the Hospital and Staff take turns in taking Off on Public Holidays e g Christian Employees may get their Off adjusted to include Christmas and so on. No Indian Holidays will be given in Africa. Selected Public Holidays according to Botswana may have a Half Day or Early Off as decided by management without affecting the Patient Care Excellence. All Clinical Staff will be on emergency call on all Sundays and Public Holidays Privilege Leave: Consultants - will become eligible to take leave after Every Six Months. 7 Days holiday will be given to meet your family in India & for this ticket will be provided by the company. Salary for the

month you are on Holiday will be credited to your account on your return and resuming your respective duties
. Sick Leave: you are allowed 7 leaves in the entire calendar year as sick leave. Casual Leave: you are allowed 7 casual leaves in a calendar year Special Note: All Clinical staff will be on emergency duty even on days of sick leave / casual leaves and Public Holidays

11.

Leave & Transfer Policy

Leave and holidays


Leave policy - You will be entitled to leave, holidays and other service benefits as per the rules of

the management as framed from time to time and applicable to the managerial cadre employees in the office/establishment/department in which you are for the time being posted.

Leave without pay up to one week as authorized by management for special cases as sickness etc. Leave application to be attached. Person name mention on leave form is must.

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Transfer Policy The organization will transfer any consultant from one place to another for according to the need and requirement of the project.

12.

Employee Performance and Appraisals

As a philosophy each employee is expected to set challenging target and take up the task to achieve them. Self development is Key Result Area (KRA) at INDUS AFRICA. Manager will provide the support to the employee under his/her supervision to achieve his/her targets and initiatives. Each employee is to discuss with his/her Manager and clearly spell out and document the job responsibilities and related key Result Area (KRA) for the appraisal to be meaningful Employees are advised to seek clarity on their roles. It is as much the responsibility of the employees as the manager to establish clear goals of performance. In case of any performance problems, the managers may ask the employee to show cause.

Rewards for Group Performance


In order to recognize outstanding group performance, reward can be declared by the organization at any point of time. These rewards are for special occasions and achievements and are given over and above the variable pay of the employee(s). The Manager in consultation with corporate HR can recommend and declare such rewards. Those employees who are regular and punctual will get reward. Fringe benefits will be given for good performance. Monthly Reward to Selected Best Hospital according the performances of the consultants of those hospitals.

Performance Management System and Career Development


The Performance Management System (PMS) provides for performance review, identifying career goals, and training and development need. The objective of PMS at INDUS AFRICA is to facilitate concept productivity and an individual performance with that of her/his business/department/region and also with that of the organization as a whole. Further, with increasing seniority in the organization, the weight age for performance evaluation would move towards business/function/regions and organization performance. The appraisals will be conducted by the department head and the CFO/CEO/Chairman.

13.

Remuneration, Compensation and Benefits

Remuneration: salaries, allowances etc are dependent on the level of the employee. Each

level will have two implicit levels and movement from lower to higher level within a level would be based on number of years of relevant experience and performance and movement to another level would depend on a role change. Indus Healthcare, Human Resource Manual Page 22 of 31

23 Employees will be paid by the company monthly on 7th day of every month. The salary is deemed to accrue from day to day. The pay cycle runs from the 1st to the last day of every month. Any employee, who joins on or after the 25th of any month, will be paid the salary arrears of that particular month with the following months salary. For all Consultants salary has been divided into two parts. 75% of your salary will be treated as taxable salary and balance 25% of your salary will be per diem and paid according to your clinical performance. Besides this to encourage best practices, we will run a contest in-between all hospitals in Africa, to encourage best practices in Healthcare and the winning team will be suitable rewarded on a weekly, monthly basis.
Compensation The companys remuneration policy is to be fair, equitable and transparent. It would be competitive to attract and retain the best talent in the industry. Income Tax Payment of personal income tax is strictly a personal issue, which the company is not involved in. The only relation the company has is regarding the deduction of and payment of tax on behalf of the employee to the Indian tax authority / Botswana Tax Authority, for salaries & benefits paid by the company to the employee. (Tax Deduction at Source) Income tax will be deducted in accordance with the income Tax Act & Rules as are in force from time to time. The onus of tax planning is on the employee. Income tax recoveries for employees are made every month based on the best estimates of tax payable during the year on salaries and perquisites, if any, and on the basis of information provided by employees regarding their tax relief investments. It is essential that employees provide the investments details as this would from the basis of the Tax Deductible at source (TDS) Computation. The new employee will also need to provide the details of taxable income from the previous employer. This can be done through a copy of the Form 16 issued by the previous company or a salary certificate giving the details of the taxable income. If the employee stay in Africa less than 6 months than he has to pay his taxes according to the India Tax Law. But if the employee stay more than six months in Africa then he has not pay any taxes in india. Tax has been deducting from the salary of the employee every month according to the income tax law of Africa.

Income Tax Slabs of Botswana:

A tax year runs from 1st July to 30th June of the succeeding year An ITW8 certificate should be filled out for each employee who earns a salary that is above P3000 per month or P36, 000 per annum. The employer should then give two copies to the employee without fail.
PAYMENTS MADE ANNUALLY in BWP (Botswana Pula) Taxable income Tax Nil 0 36 000 0 + 5% of the excess over P36 000 36 001 72 000

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72 001 - 108000 108 001 -144 000

144 000 and above

1800 + 12.5% of excess over P72 ()()() 6 300 + 1 8.7%. Of excess over P108 000 13 050 + 25%of excess over P144 000

Table applies to resident individuals. Who have been in Botswana over a period of 183 days

Monthly Components Bank Account Organization will open an Account for all employees in Bank of Baroda, Botswana after the arrival to Botswana. Accommodation All employees in Botswana will be provided with company provided accommodation. All flats / houses will be furnished with basic furnishings as appended: 1. 2. 3. 4. 5. One Bed (queen size) + Mattress + 2 Pillows. One Hot Plate in Kitchen One Fridge One Microwave One Fan / room

In case consultant / clinical staff wants to arrange their own house/flat on Rent, the following HRA will be payable per person: (please note no furnishings will be provided for) For Gabarone Town: BWP 2500 For Francistown: BWP 2000 For all Other towns: BWP 1500 BWP=Botswana Pula No HRA will be payable if the employee stays in Company provided accommodation. All other consumables like sheets, pillow-covers, utensils etc, will have to be borne by the employee. All Water & Electricity bill charges will be borne by the employee. All Staff have to ensure maintenance of the furnishings given and any breakage will be debited from the employees compensation / salary Conveyance & Travelling All Local travel made for personal purpose will be arranged by consultant himself, though hospital can help you for travel in first few days. A Return Air ticket will be provided to all consultants to be able to return home every 6 months for a period of 7 days and the cost of date change of ticket is to be borne by the employee. Any Excess Luggage while travelling too and from India will be paid by the employee by his own.

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Medical Benefit All Consultants and Management staff will be insured for Accident and Death Policy will give to each and every employee. In cases of eventualities like death or serious injury, the employee will be evacuated to India. Other Benefits Sickness Benefit (SB) 1. Extended sickness Benefit (ESB): during his /her course of work in Africa, if an employee falls sick, then relevant treatment then the medical treatment in the hospital will be provided. 2. Enhanced Sickness Benefit: In case the employee is sick under emergency conditions, he/she will be evacuated to india for treatment in india. Funeral Expenses In case of the death of an employee in Africa due to any reason, the organization will bear the cost of moving the dead body of the employee from Africa to India. The employees body will be handed over to his next of kin to perform the last rites. The last rite expnses will not be borne by the organization. (c)Maternity benefits No Maternity Benefit will be provided. Any employee has to declare the same before leaving from India (d)Dependent Benefits No employee will be provided any dependent benefits and will have to bear all such expenses on his own. Food and Recreation Benefits On reaching Botswana, the initial stay and food will be borne by Indus, after moving the employee to his respective place of posting, the employee has to bear his own food and recreation costs. Besides the same, Indus will assist the consultant to settle down and also provide from where he can purchase his day to day needs. In case of any non-availibility of goods that a consultant requires, the same will be provided to him on payment terms. . All Employee accommodation will be arranged by the organization. Details are mentioned above under accommodation category. Mobile Reimbursement

No Consultant will receive any mobile reimbursement.

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Conveyance and Travelling In todays world every rupee saved is a rupee earned. Managing costs is very critical to every business and therefore the rules and regulations given below are an attempt to save on our costs which are mounting by the day and at the same time ensure comfortable conveyance / travel to the Employee. This will also help in the smooth passing of all conveyance / travel vouchers that are submitted to accounts. Also the formats given herein are as per the information that is required by accounts /copy of expense detail with bills should be submitted to in accounts and hence will also help in effective compliance of systems which accounts department is working towards. Local Conveyance 1. Whenever an consultant is going out of office for an official visit he / she must enter the name of the client he / she are visiting in the movement register and submit out gate pass that must be approved by respective head of department and submit at the security gate. 2. Please make it a point to tell your department heads/team mates where you are going and where you can be contacted and when you expect to be back so that they can reach you. 3. The monthly Expense Details for each person will be sent to Accounts department on 7th of every month and Then conveyance reimbursed on 20th of every month. 4. No reimbursement shall be made if the claims are not made for the respective Month in question. 5. Reimbursements will be made by the concerned person. If a person is not available, the amount in question will be given to the team mate and they will sign on your behalf. 6. Reimbursement for Hotel / Guest House stays according to the Management decision. 7. Whenever two employees go out together only one of them should claim the conveyance and it should be decided who is claiming that conveyance. 8. Also if they are coming back separately then on returning back they must claim for the respective conveyance amounts. 9. Please note that this facility is for claiming a weeks expenditure alone. The onus for ensuring that the expense claims are not duplicated purely lie with the Employee. 10. In case Fixed conveyance paid to employees in salary for local marketing as well other purpose then they were not supposed to submit bills for that and it will be mentioned in there appointment letter. Mileage Claim Consultants are authorized to use their own two wheelers / cars for official work. And the claim for the same will be decided by the management from time to time depending on the nature of work and distance to be travelled. In such cases the consultant has to maintain a logbook for the kilometers traveled along with the client name, organization, destination and purpose of travel.

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For consultants travelling from home to work and back in place of posting will not be reimbursed a mileage claim. Here again the frequency of reimbursement is Monthly. Outstation Travel for Official Purposes Consultants will need to travel on occasions to treat the sick to remote areas or even stand up for sick colleagues in other locations for which travelling is a must. For the same, the consultant will have to inform Admin Head about the travel plans wherein they will have to give the name of the client, the location, the travel dates, travel reason. You can get the format of the same from HR. Entertainment Expenditure Policy All Consultants will need to take approval from Administrative Heads for any Entertainment expenditure. We have given the following indicative slabs for entertainment expenses according to client type. There would be some exceptions to this rule for a few very important and profit generating clients. Employees are required to submit their hard copies with expense detail every month of incurring such expenses after getting the necessary signatures from their respective Department Heads. It will not be considered next month. Failure to do so within the time period would lead to disqualification of the expenses. The expenses will be reimbursed once a month on the designated day by the accounts department through the admin person.

14.

Committee for Employee Grievances

SOP for Employee Grievance The hospital has a Grievance Committee in place. The members of the Committee are the Assistant Manager, Unit Manager, HOD Operations, and the CEO the hierarchy of lodging the complaint being in that order. The employee grievances and redressal action is documented in an EMPLOYEE GRIEVANCE AND REDRESSAL REGISTER with a format as under--Sr Date of Name of No Complaint Employee Nature of Complaint Complaint against Steps taken to resolve issue

When an employee has a grievance against any other employee or any practice in the hospital he can file a complaint in the register which is maintained by the Assistant manager. The Assistant Manager then forwards the same to the Unit Manager and Unit Manager forward to department head, which if unresolved is escalated to the CEO/CFO and finally to the Chairperson. Indus Healthcare, Human Resource Manual Page 27 of 31

28 In case the complaint is against the department Head, the matter is directly escalated to the CEO/CFO. If the employee performs well in this project then the organization give the opportunity to that employee to join Indus India.

15.

Addressing Health Needs of employees

A form consisting of medical tests to be conducted for very employee at the time of employment. Employees and doctors who are in close contact with patient or radiation are regularly examined and all the results are documented/ TLD Batch worn and dose monitored and all the results are documented. The Radiation Safety in the Radiation Oncology Department is monitored by a Level 3 Radiation Safety Officer as per Atomic Energy Regulatory Board (A.E.R.B Norms)
16. Disciplinary

Action

Disciplinary action taken by dept heads commensurate with the mistake in consultation with CEO, Ops. Three warning system is followed, after which the issue is escalated to the next level. Final authority of disciplinary action is with the Chairman. First is the oral warning from the Head, Second warning the deduction of salary & third warning is termination. Any disciplinary action taken against any employee is documented in his personal files. Appeals against the disciplinary action can be made to appellate authority who is the Chairperson of the organisation

17.

Termination

The employee may be terminated on a Notice of One Month from the employers side. The organization may terminate the employment contract with an employee by giving notice as per terms of appointment or pay salary in lieu thereof. In case of proven misconduct, the company reserves its right not to give notice or pay in lieu thereof. An employee may also be terminated after being asked to show cause for non performance. Two show causes notices related to performance or indiscipline will put an employee on notice. Legal action will be taken by the organization if the employee misbehaves & misconduct in Botswana after given the three warning.

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Any full and final settlement figure due to the employee will be paid when the employee returns to his home country.

18.

Exit

An employee who wishes to resign from the service of the company will be required to give the notice of at least 2 months resignation as per terms of appointment or subsequent thereof. This would be required to be in writing to their head of department and a copy to corporate HR. This period is normally for two months. When an employee resigns, it will be the prerogative of the organization to decide upon the duration of the notice period to be served though it has been defined at a minimum of 2 months. An employee may be asked to leave at short or immediate notice. If the employee desires to be relieved earlier than the notice period, management at its sole discretion may decide to waive the notice period or pay in lieu of. Any employee unable to serve the required period may be required to pay in lieu of a Minimum of 2 months gross salary An employee is not allowed to take any leave during notice period and cannot adjust accumulated leave against notice period. An employee who is under notice period loses all terminal benefits. However, if any fixed or mid-term performance bonuses are due before his/her last date, the same shall be paid. In case of a delay in the conduct of the annual review up to 30 days, any performancelinked incentives due within the notice period will not be applicable. No retrospective review and prorated payment will be made. When an employee resigns, his pay for the period of two notice months will be withheld in order to calculate outstanding if any and the same shall be disbursed with full and final settlement when he/she returns back to their home country. In case an employee decides to resign before completing 3 months on the job, all costs incurred towards processing and visa charges, will be debited to the employees account. While serving the notice period, the employee can be transferred to any locations the employer deems fit without any notice, wherever the employees specialty is required. The employee in consultation with is employer will confirm his/her air-ticket to return back to home country and employee will have to bear the cost of the same and will be adjusted to his full and final settlement.

On Exit the clause section on 'Limitation of trade' in the MoU applies and this is mutually agreed. Even if the emoployee resign without completion of the contract.

Relieving Formalities Every employee leaving the organization is expected to aid smooth transitioning / handover / knowledge transfer to an identified individual by documenting all data and handing over all knowledge objects. Ensuring a full and comprehensive handover, which is properly documented, is the employees responsibility. The knowledge objects include, but are not restricted to, all visiting cards, proposals and documents relevant to the area of work. An employee should ensure the signing off of any official collateral like books, laptop and IT equipment that may be issued in his name. Any loans and advances taken by the employee will need to be cleared and settled before the relieving date.

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The full and final settlement is contingent of all dues being cleared and the handover being satisfactory. The employee should get the necessary sign offs from all relevant stakeholders on the severance form which can be taken from the HR. Once signed off, the finance department would make the full and final settlement within three weeks of the relieving.

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ANNEXURE
S. No PATIENTS DETAILS NAME: AGE: SEX: HEIGHT: WEIGHT: BP: PULSE: MEDICAL HISTORY H\O DIABETES H\O ASTHMA H\O HYPERTENSION EYE VISION EYE SIGHT: COLOR VISION: DEPTH PERCEPTION MEDICAL EXAMINATION FORM

TEST REPORTS X-RAY: ECG: LAB: Blood-(Hb,TLC/DLC,).Urine R For Medical Employees: HCV,HIV,HBV

Any other chronic illness: Hepatitis C/Hepatitis B/ HIV

PHYSICAL EXAMINATION Chest: CVS: Abdominal Examination: CNS: Check for presence of Hernia: Check or Hearing Loss: Reports Medical Officer

Signature

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