General Hospital of 250 Beds

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)