GENERAL HOSPITAL OF 250 BEDS
[EIRI/EDPR/4654] J.C.: 2871BDT
The Constitution of the People's Republic of Bangladesh establishes the role of the State in ‘planned economic growth’ and ‘improvement in the material and cultural standard of living of the people’. The government is responsible to its citizens for their basic needs, for example, ‘food, clothing, shelter, education and medical care’ (article 15(a)). Article 18(1) of the constitution establishes that the State shall have regard to ‘raising the level of nutrition and the improvement of public health’ (article 18(1)).
Geographic context
Bangladesh covers 147 570 square kilometres, and is densely populated with approximately 1 286 people per square kilometre. It is the world’s seventh most climate risk-affected country, with 185 extreme events recorded and 0.38 fatalities per 100 000 inhabitants between 2000 and 2019. According to a 2022 World Bank report, climate-related cyclones, flooding, drought, change of disease patterns and loss of agricultural lands threaten communities causing disproportional damage and disrupting lives and livelihoods. Floods have caused severe economic impacts in Bangladesh, while cyclones are responsible for the highest number of deaths. Heat stress, river and coastal flooding and landslides are predicted to increase between 2041 and 2060 with devastating effects even under low-emission scenarios.
COST ESTIMATION
Land & Building (8092 sq.mt.) BDT 34.46 Cr
Plant & Machinery BDT 40.00 Cr
Working Capital for 2 Months BDT 1.34 Cr
Total Capital Investment BDT 78.81 Cr
Rate of Return 3%
Break Even Point 93%
CONTENTS
INTRODUCTION
GEOGRAPHIC CONTEXT
DEMOGRAPHIC CONTEXT
ECONOMIC CONTEXT
VULNERABLE GROUPS
OVERVIEW
FIGURE 1: ORGANOGRAM OF THE MOHFW, 2020
ADMINISTRATIVE STRUCTURE
TABLE 1: ADMINISTRATIVE UNITS OF BANGLADESH
TABLE 2: THE FOUR TIERS OF THE ESSENTIAL HEALTH SERVICE PACKAGE, ADAPTED FROM MOHFW'S HEALTH NUTRITION POPULATION SECTOR STRATEGIC INVESTMENT PLAN (HNPSIP)
PUBLIC SECTOR
URBAN HEALTH SERVICES – PRIMARY CARE
RURAL HEALTH SERVICES – PRIMARY CARE
TABLE 3: PRIMARY HEALTHCARE FACILITIES RUN BY THE DGHS, ADAPTED FROM MOHFW, HEALTH BULLETIN 2020 (DECEMBER)
SECONDARY CARE
TERTIARY CARE
PRIVATE SECTOR
HEALTHCARE RESOURCES
PHARMACEUTICAL SECTOR
PATIENT PATHWAYS
THE MOST IMPORTANT STATISTICS
ECONOMIC FACTORS
HEALTH SERVICES PROVIDED BY THE STATE/PUBLIC AUTHORITIES
FIGURE 3: CURRENT HEALTH EXPENDITURE PER CAPITA (CURRENT USD) - BANGLADESH
FIGURE 4: SHOWS PER CAPITA SPENDING AS A PERCENTAGE OF GROSS DOMESTIC PRODUCTS (GDP). THIS HAS RISEN GRADUALLY FROM 2.11 % IN 2000 TO 2.63 % IN 2020.
FIGURE 4: CURRENT HEALTH EXPENDITURE AS A PERCENTAGE OF GROSS DOMESTIC PRODUCTS (GDP)
RISK-POOLING MECHANISMS
COMMUNITY-BASED HEALTH INSURANCE SCHEMES
PRIVATE INSURANCE COMPANIES
TABLE 4: PERCENTAGE OF GROSS PREMIUM IN LIFE INSURANCE (2015 TO 2019)
OUT-OF-POCKET HEALTH EXPENDITURE
FIGURE 5: HOUSEHOLD OUT-OF-POCKET PAYMENT AS A PERCENTAGE OF CURRENT HEALTH EXPENDITURE
FIGURE 5: USES CURRENT HEALTH EXPENDITURE (CHE) TO SHOW THAT OOPS HAVE INCREASED SINCE 2000 AND THAT THEY HAVE BEEN ABOVE 70 % OF CHE SINCE 2014.
FIGURE 6: SHOWS A STEADY INCREASE IN THE MONEY PAID BY EACH HOUSEHOLD RISING TO A HIGH OF USD 37.49 [EUR 34] IN 2020.
FIGURE 6: HOUSEHOLD OUT-OF-POCKET PAYMENT IN CURRENT USD PER CAPITA
TABLE 5: COST BURDEN ACROSS SOCIOECONOMIC GROUPS FROM A HOUSEHOLD SURVEY IN DHAKA URBAN AREA
COST OF CONSULTATIONS
COST OF MEDICATION
PROJECT LOCATION
SERVICES
INTRODUCTION
DRIVERS OF GROWTH
DEMOGRAPHIC, EPIDEMIOLOGICAL AND HEALTH TRANSITIONS
WHAT LICENSE REQUIRED TO OPEN A HOSPITAL AND THEIR PROCEDURE
NECESSARY LICENSES REQUIRED OPENING A HOSPITAL
REGISTRATION OF HOSPITAL
LAND AND CONSTRUCTION
ELECTRICITY AND WATER
SEWAGE
BIOMEDICAL WASTE
FIRE AND HEALTH LICENSE
REGULATIONS RELATING TO EMPLOYMENT OF STAFF
SIGN BOARDS
FOOD MANUFACTURING LICENSE FOR OPERATING A KITCHEN
PERMIT TO STORE LPG CYLINDER
PHARMACY REGISTRATION FOR MEDICAL SHOP
TRADEMARK REGISTRATION
VEHICLE REGISTRATION FOR AMBULANCES
ARMS LICENSES UNDER ARMS ACT
WASTE DISPOSAL
PLANNING THE HOSPITAL INFRASTRUCTURE
ONE MUST TAKE CARE OF THESE THINGS;
THE OTHER IMPORTANT LICENSE REQUIRED IS:
LIST OF 250-300 BED HOSPITAL IN BANGLADESH
BRIEF DESCRIPTION OF SOME COMMON HOSPITAL EQUIPMENTS
1. DRESSING DRUM
2. SURGICAL TRAY
3. CATHETHER TRAY
4. SYRINGE CASE
5. ANIMA POT
6. BOWEL
7. BED POT (LATRINE)
8. URINAL POT
9. KIDNEY TRAY
10. SPIT-ON
11. ELECTRICAL STERILIZER
BUILDING CONSTRUCTION & FURNISHING OF HOSPITAL
1. CARDIOLOGY
2. E.N.T.
3. MATERNITY
4. EYE SECTION
5. CHILDREN WARD
6. LABORATORY
7. X-RAY ROOM & ECG CLINIC
8. PHYSICIAN
GENERAL HEALTH AMENITIES
DRUG SITUATIONS
LISTED BELOW ARE THE DESIRED FEATURES OF AUTOMATED BIOCHEMICAL ANALYZERS.
MODERN MEDICAL EQUIPMENT
COMPUTER TOPOGRAPHY
ULTRASOUND
CATHETERS IN INTERVANTIONAL PROCEDURES ARE MAINLY USED FOR:
CONSUMABLE STORES
UTILITIES & OVERHEADS
1. POWER/LIGHT CONSUMPTION:-
2. WATER:-
HOSPITAL/MEDICAL EQUIPMENTS AND SUPPLIERS
MACHINERY & EQUIPMENT SUPPLIERS
X-RAY ACCESSORIES
AIR CONDITIONING & REFRIGERATION UNITS
IMPORTED PLANT & MACHINERY SUPPLIERS
LIST OF CONSULTANT FOR SETTING UP HOSPTAL
LIST OF NABET ACCREDITED HOSPITAL & HEALTHCARE CONSULTANT (NABH STANDARD)
HOSPITAL/MEDICAL EQUIPMENTS AND SUPPLIERS
PROPOSED MINIMUM STANDARDS FOR PRIVATE HOSPITAL
UP-TO 250 BEDDED UNIT PROVIDING (MEDICAL/SURGICAL/MATERNITY SERVICES ETC.)
BASIC FUNCTIONS PROVIDED BY A HOSPITAL
HUMAN RESOURCE REQUIREMENT
QUALIFICATIONS
AVAILABILITY OF PERSONNEL:
MINIMUM REQUIREMENT OF PERSONNEL:
DUTY MEDICAL OFFICER
NURSING STAFF:
NURSING AIDS:
PARAMEDICAL STAFF:
ENGINEERING STAFF:
ADMINISTRATIVE AND ANCILLARY STAFF
INSTRUMENTS AND EQUIPMENT
ENTRANCE ZONE
RECEPTION AND REGISTRATION WITH CASHIER
WAITING AREA
AMBULATORY ZONE
A. NURSING
B. TREATMENT/DRESSING ROOM AND INJECTION ROOM
C. EXAMINATION AND CONSULTATION ROOMS (OPDS) AND CASUALTY
D. PHARMACY
DIAGNOSTIC ZONE (OPTIONAL)
PATHOLOGY
RADIOLOGY (OPTIONAL)
INTERMEDIATE ZONE
A. WARDS
B. NURSING STATION
C. TREATMENT ROOM
D. TROLLEY BAY
E. WARD STORE
OPERATION THEATRE
INSTRUMENTS FOR GENERAL SURGERY & (MATERNITY) OBSTETRICS/GYNAECOLOGY
OPERATION THEATRE
EQUIPMENT FOR SURGERY AND OBSTETRICS/GYN
DELIVERY SUITE: EQUIPMENT & INSTRUMENTS (FOR MATERNITY HOMES ONLY)
A. EXAMINATION AND PREPARATION
B. LABOUR ROOM
C. DELIVERY ROOMS
EQUIPMENT FOR SERVICE ZONE
LAUNDRY
GENERATOR
MINIMAL FUNCTIONAL AND SPACE REQUIREMENTS
ENTRANCE ZONE
AMBULATORY ZONE
DIAGNOSTIC ZONE (OPTIONAL)
THIS ZONE SHOULD IDEALLY BE INTERPOSED BETWEEN OPD AND IPD.
CRITICAL ZONE
OPERATING SUITE
BASIC DESIGN STANDARDS
MINIMUM SPACE REQUIREMENTS
A. PROTECTIVE ZONE
B. CLEAN ZONE
C. ASEPTIC ZONE
INTERMEDIATE ZONE
SERVICE ZONE
BUILDING ENGINEERING ENVIRONMENTAL STANDARDS
1. CATION
2. CEILINGS
3. FLOOR HEIGHT
4. FLOORS AND WALLS
5. DOORS:
6. WINDOWS
7. CORRIDOR
8. WATER SUPPLY, PLUMBING AND OTHER PIPING SYSTEMS
FOR MORE THAN 50 BEDS
FOR LESS THAN 100 BEDS
OXYGEN CYLINDERS
9. ELECTRICAL STANDARDS
10. ACCESS ROUTES TO VARIOUS FACILITIES OF THE NURSING HOME:
11. COMMUNICATION SYSTEM
12. FIRE-FIGHTING SYSTEM
13. VENTILATION REQUIREMENTS FOR AREAS AFFECTING PATIENT CARE IN NURSING HOMES
14. REQUIREMENTS FOR SANITARY FITMENTS IN NURSING HOMES FOR PATIENTS
INPATIENT WARDS AND NURSING UNITS
OUTPATIENT BLOCK
THE RADIOLOGY DEPARTMENT MUST HAVE FOLLOWING SPECIAL TOILET FACILITIES IN CASE IT CARRIES OUT PROCEDURES LIKE IVP.
PROJECT PLANT LOCATION FACTORS
PRIMARY FACTORS
1. RAW-MATERIAL SUPPLY:
2. MARKETS:
3. POWER AND FUEL SUPPLY:
4. WATER SUPPLY:
5. CLIMATE:
SPECIFIC FACTORS
6. TRANSPORTATION:
7. WASTE DISPOSAL:
8. LABOR:
9. REGULATORY LAWS:
10. TAXES:
11. SITE CHARACTERISTICS:
12. COMMUNITY FACTORS:
13. VULNERABILITY TO WARTIME ATTACK:
14. FLOOD AND FIRE CONTROL:
PLANNING OF EACH FLOORS ARE AS FOLLOWS
EXPLANATION OF TERMS USED IN THE PROJECT REPORT
1. DEPRECIATION:
2. FIXED ASSETS:
3. WORKING CAPITAL:
4. BREAK-EVEN POINT:
5. OTHER FIXED EXPENSES:
6. MARGIN MONEY:
7. TERM LOANS:
8. TOTAL LOAD:
9. LAND AREA/MAN POWER RATIO:
ENVIRONMENTAL MANAGEMENT PLAN
AIR ENVIRONMENT
NOISE ENVIORNMENT
SOLID WASTE MANAGEMENT
OPERATION PHASE
WATER MANAGEMENT (SOURCE & SUPPLY OF WATER)
SEWERAGE
SCHEME OF SEWAGE TREATMENT PLANT:
TREATMENT PROCESS:
THE PROCESS FOR SEWAGE TREATMENT PLANT BASED ON MBBR TECHNOLOGY
SCHEMATIC REPRESENTATION OF STP BASED ON MBBR TECHNOLOGY
BENEFITS OF USING MBBR TECHNOLOGY
PROCESS FLOW DIAGRAM FOR ETP
THE HOSPITAL AND LABORATORY WASTE WATER WILL BE TREATED IN 170 KLD ETP.
ETP DESIGN
TREATED EFFLUENT CHARACTERISTICS
WATER CONSERVATION & AUGMENTATION
RAINWATER HARVESTING TABLE:
RAINWATER HARVESTING CALCULATIONS
BLOCK DIAGRAM FOR PROPOSED RAIN WATER HARVESTING/AQUIFER RECHARGING SYSTEM
SCHEMATIC REPRESENTATION OF THE RAINWATER HARVESTING SYSTEM
SOLID WASTE MANAGEMENT
SOLID WASTE GENERATION
TABLE: TOTAL SW GENERATION FROM THE PROPOSED PROJECT
NO OF TRANSIT CENTERS:-
COMPOST FORMATION POTENTIAL OF THE PROJECT
COMPOST GENERATION POTENTIAL OF THE PROJECT (CHEN, 2016)
TENTATIVE DETAILS OF ORGANIC WASTE CONVERTOR:
STANDARD OPERATING PROCEDURE OF ORGANIC WASTE CONVERTER:
TABLE: HOSPITAL AND BIOMEDICAL WASTE GENERATION FROM BEDDED AREA (MINISTRY OF HEALTH AND FAMILY WELFARE; PANDIT ET AL 2006)
SEGREGATION OF BIOMEDICAL WASTE AND ITS STORAGE:-
BIOMEDICAL WASTE CATEGORIZATION
BMW WILL BE SEGREGATED AND COLLECTED AND THEN WILL BE HANDED OVER TO A UPPCB APPROVED BMW VENDOR.
AIR POLLUTION CONTROL:
STACK HEIGHT CALCULATIONS
LANDSCAPING & HORTICULTURE
SHRUBS/HERBS TO BE PLANTED
PROJECT LOCATION
IMPLEMENTATION SCHEDULE
PROJECT IMPLEMENTATION WILL TAKE A PERIOD OF 18 MONTHS
LIST PLANT & MACHINERY
DEPARTMENT OF NEPHROLOGY
DEPARTMENT OF CARDIOLOGY
DEPARTMENT OF UROLOGY
DEPARTMENT OF ORTHOPAEDICS
DEPARTMENT OF NEUROSURGERY
MAJOR LIST OF EQUIPMENTS
DEPARTMENT OF NEPHROLOGY
MAJOR EQUIPMENTS
DIALYSIS MACHINE
MICROSCOPE
DEPARTMENT OF CARDIOLOGY
MAJOR EQUIPMENTS/INSTRUMENTS
ECHO CARDIOGRAPHY MACHINES
TMT WIPRO GE MACHINE
TWO FLAT PANEL CATH LABS
ST. JUDE EP SYSTEM
HOLTER MONITOR – ECG
AMBULATORY BP
CX 50
TILT TABLE
DEPARTMENT OF UROLOGY
MAJOR EQUIPMENTS
DA VINCI ROBOT
MODULAR OPERATION THEATRES
DORNIER COMPACT SIGMA LITHOTRIPSY MACHINE
MEDISON ULTRASOUND MACHINE
RIGISCAN PLUS
MMS URODYANAMICS MACHINE
ENDO UROLOGY INSTRUMENTS
100 WATT HOLMIUM LASER
A MOBILE C-ARM IS A MEDICAL IMAGING DEVICE
DEPARTMENT OF ORTHOPAEDICS
MAJOR EQUIPMENTS
ARTHROPLASTY
ARTHROSCOPY SET
INTERLOCK NAIL
ARTHROSCOPY TROLLEY
DEPARTMENT OF NEUROSURGERY
MAJOR EQUIPMENTS
MEDTRONIC 58 NAVIGATION SYSTEMS (FULLY LOADED CRENIAL AND SANAL OPTICAL AND ELECTROMAGNETIC SYSTEM)
DEDICATED CUSA (CAUITRON ULTRASONIC SURGICAL ASPIRATDR)
MEDTRONICS HIGH SPEED DRILL SYSTEM
WELL EQUIPPED OPERATION THEATER WITH INTEGRATED WORKSTATION (MICROSCOPE, ENDOSCOPE AND NAVIGATION SYSTEM)
DEDICATION WELL EQUIPPED NEUROSURGICAL ICU
MICROSCOPE:- FIRST FULLY LOADED ROBOTIC 3D MICROSCOPE WITH 30 EXOSCOPE AND ENDOSCOPE
SPECIFICATIONS OF STANDARD LIST OF MEDICAL EQUIPMENT
LIST OF USEFUL LINKS
APPENDIX – A:
01. PLANT ECONOMICS
02. LAND & BUILDING
03. PLANT AND MACHINERY
04. OTHER FIXED ASSESTS
05. FIXED CAPITAL
06. RAW MATERIAL
07. SALARY AND WAGES
08. UTILITIES AND OVERHEADS
09. TOTAL WORKING CAPITAL
10. TOTAL CAPITAL INVESTMENT
11. COST OF PRODUCTION
12. TURN OVER/ANNUM
13. BREAK EVEN POINT
14. RESOURCES FOR FINANCE
15. INSTALMENT PAYABLE IN 5 YEARS
16. DEPRECIATION CHART FOR 5 YEARS
17. PROFIT ANALYSIS FOR 5 YEARS
18. PROJECTED BALANCE SHEET FOR (5 YEARS)
