Chapter 1 Background of the Project · 2010. 12. 15. · Dubai3 unit WHO Drinking water standard Japanese drinking water standard Temperature 14 19 22 22 22 ℃ - - Color Clear Clear

Chapter 1 Background of the Project

Preparatory Survey on the Project for Construction of Hospital for Communicable Disease in the Islamic Republic of Afghanistan

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Chapter 1 Background of the Project

1-1 Background of the Project

In accordance with current needs and challenges on the Health sector in Afghanistan, the Government of Afghanistan (GoA) has requested construction of the hospital for communicable disease (the Hospital) and the procurement of relevant medical equipment, which aim to promote controls against the 3 major communicable diseases: tuberculosis (TB), HIV/AIDS and malaria, and to enable intensive and isolated treatment and examination of severe malaria and respiratory infections such as multidrug-resistant tuberculosis (MDR-TB) and turbeculosis and HIV coinfection (TB/HIV).

The following contents were originally requested by GoA on June, 2008.

Table 1-1: Items of the Original Request by GoA Department/

Function Room/ Equipment Remarks

General One or Two-story building 2,500 ㎡

General Medical Services

• X-ray room • General Laboratory • Pathology laboratory • TB Culture room

―

Inpatient/ Wards • Patient room（Male/Female） • Isolated Patient room

(Male/Female)

40～50 beds Included above

Administration/ Services

• Offices/ rooms for administration and general services

Dining Hall (40)

Training • Training room • Library・Reference room

Medium room (40), Small room (10) Reference tables (24)

Facility

Utility & Others • Well • Water supply/drainage system

―

Inpatient/ Wards • Beds for patients • Curing equipment

―

General medical Services/ Diagnosis

• Digital X-ray machine • Equipment for general

bacteriology examination • Equipment for pathology

examination • Equipment for Culture • Auto-biochemical analyzer • Equipment for ELISA kit • CD4counter • Autoclave • Distilled water-making machine

etc

―


• Office furniture • Kitchen equipment • Laundry and lines

―

Equipment

Training • Training equipment ―

Source: Application form for Grant Aid made by GoA


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In addition to the above items, the following additional items wererequested by GoA at the beginning of discussion on the preparatory survey on March, 2010, which comprise an increase of each component of facility and equipment such as total number of beds, rooms and equipment.

Table 1-2: Items of the Additional Request by GoA Department/

Function Additional Room/ Equipment Additional Items

General Medical Services

• Outpatient Department HIV/AIDS, Malaria

Inpatient/ Wards ― Total 140 beds：TB (100), HIV/AIDS (20), Malaria (20)


• Nursery Infants under 7 years old,Kitchen/Toilet furnished

Facility

Utility & Others • Incinerator ― General medical Services/ Diagnosis

• Mobile X-ray machine • PCR • CT Scanner • Ultrasound Examination

machine • Ultraviolet Lumps

―

Equipment Administration/

Services • Ambulance • 4WD vehicles • Personal computer

―

Source: Prepared by the Survey team

Considering those additional items and based on current capacity of the infrastructure as well as operation and maintenance of hospitals in Afghanistan, which were observed throughout the field survey, technical discussion on the facility and equipment concluded the following components as the end results of requests by GoA. Official agreement with the components has been mutually confirmed on the Minutes of Discussions (M/D).

1-1-1 Facility Component

Construction site shall be located at the east lot in the compound of the National Tubeculosis Program (NTP). The facility shall be laid out with the zoning plans considering the traffic flow from the existing gate and inter-communication with the existing facility.

The facility comprises the following 5 core departments for defining required rooms.

• Inpatient Department (TB, HIV/AIDS, Malaria)

• Outpatient Department (HIV/AIDS, Malaria)

• General Medical Service Department (Laboratory unit, Radiography unit, Central Supply unit)

• Administration Department (Administration office, Doctor’s room, Conference room, Library, Mortuary, Nursery)

• Service Department (Kitchen, Dining room, Washing room, workshop)

The facility is a new construction of one-story hospital with consideration of future expansion for inpatient wards. The wards are to be thoroughly separated into two compartments: one for male and another for female, and are comprised of 80 beds in total,


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which are distributed to each ward as follows:

• TB Wards: 56 beds

• HIV/AIDS Wards: 12 beds

• Malaria Wards: 12 beds

1-1-2 Equipment Component

Medical equipment shall comply with the Essential Package for Health Services (EPHS). In consideration with required functions as the communicable disease hospital as well as operation and management with ease, minimum necessary and basic equipment is to be planned and designed which will render low cost as well as benefits by simple operation and maintenance.

Existing laboratory equipment at the National Tuberculosis Institute (NTI) for tuberculosis culture examination, CD4 counter machine which is expected to be furnished for the Antiretroviral treatment center (ARV center) in the National infectious disease hospital are subject to be transferred to the Hospital.

Basically, general office furniture and equipment consumable are not subject for grant aid cooperation with an exception, e.g. equipment indispensable and justifiable for required functions as the communicable disease hospital.

Based on above mentioned criteria and priority, details for equipment are to be evaluated.


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1-2 Natural Conditions

1-2-1 Geographical Features

Kabul City is situated at northeast mountainous area in Afghanistan and formed a basin with the Kabul River between mountains, which measures an altitude of about 1,800 m.

The project site is planned at land lot inside the NTP compound which is located 6 km away from the Darlaman road to south direction and measures around 31,000 m2. NTI and Tuberculosis Center have been established and in operation inside the compound. The land lot is mostly flat except for 600 m2 of green belt along the front road, which forms embankment with 50 cm of height.

At northside of the NTP compound, a hospital of the Ministry of Public Health (MoPH) and a building of the Ministry of Justice are constructed with some vacant plot of land, whereas a building of the National Malaria and Leishmaniasis Control Program (NMLCP) at eastside, some housing at westside and the front road of 12 m wide at southside are positioned in surrounding. The compound is firmly surrounded by the stone-masonry wall with barbed wire except for the boundary with NMLCP building at eastside where a simple earthen wall stands.

Through the field survey, the topographic survey was implemented in order to confirm the boundary line of land lots, to measure elevation and area, position of the existing facilities including supplementary buildings such as elevated tanks and pump house. As to implementation of the topographic survey, temporary benchmarks were set in the compound for reasons that no official benchmarks, no cadastral information and data are available.

T-WELL

TEMPRORY TOILET

G-ROOM

S-ROOMS-ROOM

FLAG POST

DAR-UL-AMAN POLY CLINIC

BUILDINGS

STAIR

CAR PARKING

ELECTRIC BOX

BOXELECTRIC

ELECTRIC BOX

BOXELECTRIC

ELECTRIC BOX

ELECTRIC BOX

TEMPR

OR

Y WALL

STONE WALL

STONE WALL

TEST-2

W-TAPE

EP

CAR PARKING

DAR-UL-AMAN POLY CLINIC

TECH

ING

RO

OM

W-TANK

WALL

S-ROOMS-ROOM

STOC

K RO

OM

STOC

K RO

OM

NATIONAL

TUBERCULOSIS

CONTROL PROGRAM

BOXELECTRIC

ELECTRIC BOX

Figure 1-1: Data of Topographic survey at the NTP compound

Source: implemented by the Survey team

1-2-2 Geological Features

Geological features of Kabul City belong to the stratum which is formed with layers of sediment from the Neogene to the Quaternary similar to the Kabul region.

N


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The plate loading test was implemented by loading 37.5 to 39.7 t/m2 in maximum to investigate the bearing capacity at 2 different points in the land lot for construction. Soil layer consist of non-bearing top soil of 20 cm thick and clayish silt starting 60 to 80 cm below the ground level or deeper. The test results that the clayish silt layer presents enough bearing capacity, which measures over 13.2 t/m2 for the Sample1 and 12.5 t/m2 for the sample 2, and that no pile foundations are to be required.

1-2-3 Well Water Conditions

(1) Hydrological features around site

It is thought that the Alabaman region where the project site exists is located in the plain ground between the major river (Kabul River) and Paghman Stream. As to the mountainous region, deposits of Pleistocene epoch - Holocene epoch composed of boulder, pebble, etc., and the amount of underground water in the aquifer is abundant.

Moreover, because the Dairyman region is the upstream side of the central part of Kabul, water quality in this region is more favorable than Kabul urban areas.

Figure 1-2: Hydrological Features at Kabul Basin

(2) Capacity and Water Quality of the Existing Well

• Amount of Possible Pumping in the Exiting Well

The pumping test (stage pumping test, continuous pumping test) was executed and the amount of a possible pumping was examined at the project site. The existing submerged pump was used for pumping. As a result of stage pumping test the limit pumping volume was 210 L/min, then the continuous pumping test was executed with 200 L/min. As a


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result, 2 hours after initiation of pumping, the lowered water level reached to a stationary level and the amount of lowered level was as little as 2.53 m. From the above results, even if it usually pumps in 200 L/min, the troubles such as withering of the well will not arise, so the continuous pumping of 200 L/min (=288 m3/day) is possible.

• Water Quality of the Existing Well

Simple tests such as Packing test and laboratory (Afghanistan & Dubai) test were executed. The results of these tests are shown in the following table. The metals such as iron and manganese are not contained in water samples. Neither viable bacteria nor E. coli bacteria are detected and because COD is also 0 mg/L, it is thought that this water is clean. Although the amount of the arsenic and the nitrite nitrogen exceed drinking water quality standards of Japan by the simple test and laboratory test in Afghanistan, they are all below the standard by the result by the laboratory in Dubai. The laboratory in Dubai has the best capacity to carry out water analysis and is the most reliable from the view point of facilities among them. Moreover the results of three samples have little dispersion. So the water is regarded to satisfy the quality standard. It is necessary to design facilities with considering that the water is hard water.

Table 1-3: Laboratory Test Results of Water Quality

ItemIn-situ

Simple testLab in

AfghanistanLab. InDubai1

Lab. InDubai2

Lab. InDubai3

unitWHO Drinkingwater standard

Japanesedrinking water

standard

Temperature 14 19 22 22 22 ℃ - -Color Clear Clear Clear Clear Clear - - -pH 7.3 7.6 7.3 7.3 7.2 - - 5.8 to8.6

Electric Conductivity - 101 1140 1190 1180 μS/cm - -Tubibidity - 0.5 - - - Degree Average１or less 2 or less

Standard Plate Count Bacteria 0 0 27 29 29 - - 100 or less/ml Fecal Coliform 0 0 Nil Nil Nil - - Not Detected

Total Disolved Solids - 354 615 645 640 mg/L 1000 or lessDisolved Oxigen 8 7 1.8 1.6 1.7 mg/L - -

Chemical Oxigen Demand 0 5 3.5 4.1 4 mg/L - -Biological Oxigen Demand - - <1 <1 <1 mg/L - -

Hardness 200 450 413 450 446 mg/L - -Alkarlinity - 0.5 348 363 367 mg/L - -

Oil Content - - N.D. N.D. N.D. mg/L - -Sodium - 76 58 55 59 mg/L 20 or less 200 or less

Potassium - 17 12 13 13 mg/L - -Magnecium - 230 56 62 61 mg/L - -

Calcium - 220 73 78 78 mg/L - -Chloride - - 53 55 55 mg/L - -Fluorides - 0.17 0.15 0.13 0.13 mg/L 1.5 or less 0.8 or lessCadmium - - <0.01 <0.01 <0.01 mg/L - -Iron, Total 0 0.01 0.03 0.11 0.08 mg/L 0.3 or less 0.3 or less

Lead - 0.005 0.01 0.01 0.01 mg/L 0.01 or less 0.01 or lessArsenic 0.3 0 <0.01 <0.01 <0.01 mg/L 0.01 or less 0.01 or less

Manganese 0 0.2 0.02 0.03 0.03 mg/L （0.5 or less） (0.01 or less)Chromium hexavalent 0 0.08 0.01 0.02 0.02 mg/L 0.05 or less 0.05 or less

Mercury - - <0.001 <0.001 <0.001 mg/L - -Ammonia-N 0.2 0.03 <0.1 <0.1 <0.1 mg/L - -Nitrite-N 10 0.04 <0.05 <0.05 <0.05 mg/L 3 or less 10 or lessNitrate-N 0.02 1 3 2.5 2.5 mg/L 50 or less 10 or lessNitrate - - 13 11 11 mg/L - -

Carbon dioxide - 125 - - - mg/L - -Carbonate - - Nil Nil Nil mg/L - -

Bicarbonate - 6145 425 444 448 mg/L - -Phosphate - 0.21 <0.1 <0.1 <0.1 mg/L - -

Sulfate - 10 118 135 133 mg/L 250 or less - Source: prepared by the Survey team


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(3) Hydrological Capacity of the Project site

The electric detection is executed in six places in the project site, and the geological feature is investigated (Line A, B, C by Local re-consignment, A, D, E, F by member). The result of the electric detection has adjusted to the result of the water level measurement of an existing well (vicinity of GL - 8 to 13 m). Moreover, it is the same aquifer up to over 50 or 60 m. So the water quality is expected to be similar to water from the established well in the project site.

A-Line D-Line E-Line F-Line 100Ω

40Ω

10.6Ω

0m0.6m

9.3m

7.6Ω

24m

60m

280Ω

40Ω

22Ω

0m1.6m

11m

10Ω

26m

60m

33Ω

20Ω

0m

8m

12Ω

27m

60m

40Ω

30Ω

0m

10m

20Ω

60m

A-Line B-Line C-Line

Figure 1-3: Result of Electric Exploration: Vertical Distribution of Resistivity

Source: prepared by the Survey team


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(4) Fluctuation of Groundwater

Water level data logging device had been installed in the existing well since March 25th until August 7th to gain the data of daily fluctuation. The result is shown in below Figure.

Figure 1-4: Water Level Fluctuation in the existing well（3/25～8/7）

Water level depressions are observed twice or three times a day in the figure indicates

usual water supply to existing facility along the statement of a person responsible for operating the pump. The equivalent water level is relatively stable until the end of May. However, the level began to decrease apparently after that, and reached at about 1.5 m lower on August 7th than the start day, March 25th, probably due to the effect of dry season opening since May. About 3 m (=1.5 m×2) depletion will be expected at the end of dry season, November, with considering the measuring end date as a half of dry season. There seems to be few impacts by 3 m annual fluctuation on pumping rate of existing well and water supply plan due to the fact that the exisiting well enables to mitigate the fluctuation by having 58 m of depth.

1-2-4 Meteorological Conditions

The climate of Kabul is classified as steppe semi-arid climate area and average precipitation is 176 mm in 2009. As Kabul is located at highland of 1,800 m above sea level, the temperature gap in day and night is remarkable. Annual temperature range is also large with minimum monthly average temperature of - 1 ℃ in January and the maximum 27 ℃ in July. The maximum temperature was 39 ℃ and the minimum was - 25 ℃ in last 50 years from 1958 to 2008. It snows in the winter season when 40% of annual precipitation is concentrated.

The average minimum temperature and the maximum temperature as well as precipitation in 2008 are indicated in the table below. It observes the temperature daily fall below freezing point during 3 months in winter (December to February). Average relative

8

9

10

11

12

13

14

3/25

4/1

4/8

4/15

4/22

4/29

5/6

5/13

5/20

5/27

6/3

6/10

6/17

6/24

7/1

7/8

7/15

7/22

7/29

8/5

年月日時

井戸

内水

位　

（G

L-ｍ

）W

ater

Lev

el in

the

wel

l

Time


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humidity in the evening (17:00) measures 52% in January, and 25% in June, whereas average in the daytime measures 10% in summer, which enables to provide comfortable atmosphere in shade.

Predominant wind direction is from the northwest from October to March, and from the north from April to September. Sandstorms occur a few times during the dry season from June to October.

Table 1-4: Meteorological data in Kabul City in 2008 Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Av.Max.Temperature 2.3 7.8 20.0 19.6 28.1 33.6 34.4 33.2 29.1 22.8 17.5 12.6Av.Max.Temperature -7.8 -5.1 5.2 7.3 12.3 17.1 18.2 17.5 12.3 7.7 1.0 -1.7Av.Temperature -1.4 0.3 12.6 13.9 21.1 26.5 27.1 25.3 20.3 11.4 8.3 4.6Precipitation [ｍｍ] 42.9 21.0 1.6 77.1 17.1 0.0 6.6 0.0 0.0 1.5 0.0 8.2

Source: Kabul Meteorological Observatory

1-3 Environmental Concerns

In the Project, there will be no significant intervention against natural environment due to the fact that the new construction of the Hospital is to be implemented inside the land lot where has already been developed for the existing medical and research facilities. Consequently, no large-scale land preparation is required. It is essential for planning that local building codes in terms of “Building-Land ratio”, “Wall setback line” etc. are to be complied in order for effective usage of land lot and city-scope. Sewage water will be treated by natural processes in the septic tanks and percolated into the ground through soak beds inside the project site, so that inland water will not be affected by discharged water. Building itself forms one-story and pitched roofing in harmonization with the external appearance of the existing facilities.

In the Project, there will be no needs for resettlement, and no influences on well water supply in the neighborhood due to the fact that the existing well is to be utilized by securing sufficient hydrological capacity in the project site, which the Survey team technically confirmed through the field survey.

Accordingly, it is understood that there will be no critical impacts against surrounding environment and regional communities, and that the Project is categorized in rank C of JICA environmental category based on “JICA Guidelines for Environmental and Social Considerations”.

Chapter 2 Contents of the Project


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Chapter 2 Contents of the Project

2-1 Basic Concept of the Project

2-1-1 Overall Goal and Project Objectives

GoA announced “Afghanistan’s Millenium Development Goals (MDGs)” in 2005 and appointed major targets of health sector to aim to prevent tuberculosis, HIV/AIDS, malaria and other diseases from spreading.

GoA formulated in May 2005 “National Health Strategy 2005-2009” as their mid-term policy and strategy for the health sector in order to strengthen the Ministry of Public Health (MoPH)’s organizational capabilities, and simultaneously to prioritize consistent dissemination of the Basic Package of Health Services (BPHS) and EPHS, which are specified in 2002 for improving health cares.

GoA is giving priority to maternal and child health through the establishment of communicable disease measures, such as integrating its NTP into BPHS and EPHS. Besides, harmonization and integration with international standards such as “Directly Observed Treatment with Short-Course Chemotherapy (DOTS)” are to be commenced as part of BPHS.

The Project is to address driving those superior policy and strategy forward by promoting communicable disease countermeasures, and aimed for following purposes:

• “Cooperate with the implevement of examination and treatment services for MDR-TB, TB/HIV, and severe malaria”

• “Cooperate with the development of national standard laboratory capabilities focusing on the 3 major communicable diseases in Afghanistan”

Under the Afghanistan’s health sector policy, The roles of the Project are to deliver proper medical services and technologies, throughout constructing the hospital and providing medical equipment, against the 3 major diseases, especially severe respiratory infections such as MDR-TB, TB/HIV.

2-1-2 Outline of the Project

The “Communicable Disease Hospital in Afghanistan” is operated to comprehensively manage measures to tackle the 3 major communicable diseases. This is done via the Hospital’s preliminary work group composed of MoPH, NTP, National AIDS control Program (NACP), and NMLCP, who closely collaborate to pursue the above measures. For the formulation and implementation of hospital operations and management plans (range and content of services, hospital management provisions and guidelines) and plans relating to the deployment of backbone staff and staff training, the principal government office, MoPH will prepare the basics of EPHS and then provide assistance for calculated budget and personnel.

Further, considering that the ARV Center of the National Infectious Disease Hospital and the laboratory for tuberculosis culture examination of NTI will work together with the newly-constructed hospital for communicable diseases, it is planned that transfers of function (including the new procurement and relocation of some equipment) will be carried out by GoA.

Direct benefits of the Project are that the intense and isolated treatment of severe malaria


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and respiratory infections, which is currently insufficient; will be provided to Kabul province residents. Further, the capabilities of national standard laboratories will be strengthened, and examination and research systems to tackle the 3 major communicable diseases will be organized. This will indirectly help the Afghan people by enabling communicable disease controls to be promoted in Afghanistan. As the development of a referral system based on the BPHS and EPHS will continue to advance in the future, this hospital will develop its role as a referral hospital and increasingly benefit the people of Afghanistan.

The grant aid cooperation, which includes procurements of the required equipment and construction of a new hospital for communicable diseases within the NTP compound in the Dalraman district, will provide the following functions:

• Examination, hospital admission, and treatment for patients suffering from multidrug resistant tuberculosis, TB/HIV, and severe malaria;

• Establishment of a national standard for laboratory services targeting the 3 major communicable diseases; and

• Development as the top-referral hospital as part of communicable disease controls of Afghanistan in collaboration with the NTP, NACP, and NMLCP.

The following indicates project components for Japanese assistance.

Facility construction which comprises:

• Inpatient Department (TB Wards, HIV/AIDS Wards, Malaria Wards)

• Outpatient Department (OPD for HIV/AIDS, OPD for Malaria)

• General Medical Service Department (Laboratory Unit, Radiology Unit, Central Supply Unit)

• Administration Department

• Service Department

• Common spaces and Others

Building systems which comprise:

• Power Supply System (Transformer, Main cable, Generators, Lighting and Outlets)

• Mechanical and Plumbing Installation (Water/ Hot water Supply, Sanitary fixtures, Wastewater sewage, Septic tanks, LPG facility)

• Heating, Ventilation and air-conditioning System

• Telecommunication System (Interphone, Nurse call, Public address facilities)

• Fire Fighting System (Fire extinguisher, Fire alarm, Lightning protection)

Equipment which are to be furnished for:

• Inpatient Department (Patient rooms, Nurse stations, Day rooms)

• Outpatient Department (Consultation room, Dressing room, Pharmacy, Staff rooms)

• General Medical Service Department (Laboratory: Biochemical/ Bacteriological/ TB culture/ DST (Drug Susceptibility Test)/ Medium Culture, Sterilization room, X-ray room, Central supply room)

• Administration Department (Doctors’ room, Administration office, Conference


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rooms, Library, Watchman room, Mortuary, Nursery)

• Service Department (Washing room, kitchen/ Dining room, Workshop)

Others:

• Courtyards, Courtyard roads, Exterior lightings, Lawn faucets

• Relocation of: existing container storage/ existing water supply pipes/ existing parking canopy/ pump room

• Reconnection of power supply line

Details of project components are summarized on the following table.

Table 2-1: Summary of Project Components (Building) Department Rooms Floor Area

TB wards Patient room, Toilet, Shower room, Nurse station, Staff room, Day room, Prayer room

1,728.9 ㎡

Malaria wards Patient room, Toilet, Shower room 323.6 ㎡Inpatient Department

HIV/AIDS wards

Patient room, Toilet, Shower room, Nurse station, Staff room, Day room, Prayer room

710.4 ㎡

Outpatient Department Reception, Waiting room, Consultation room for HIV/AIDS, Dressing room, Consultation room for Malaria, Pharmacy

397.1 ㎡

Laboratory Biochemical, Bacteriological laboratory, TB culture room, DST, Culture medium room, Sterilizing room

355.5 ㎡

Radiography Digital X-ray room, Control room, Reception, Staff room, Waiting room, File storage room

286.2 ㎡

General Medical Service Department

Central Supply Dirty linen room, Sterilizing room 54.7 ㎡

Administration Department

Doctors' room, Nap room, Administration office, Staff restroom, Private offices, Drug storage, Toilet, Conference rooms, Library, Watchman room, Mortuary (morgue), Nursery

803.2 ㎡

Services Department Washing room, Linen room, Kitchen, Dining room, Workshop

308.7 ㎡

Common space Warehouse, Stove warehouse, Corridors, Electrical room, Power generator, Water receiver tank, Elevated water tank

359.1 ㎡

Total Floor Area 5,327.4 ㎡

Source: prepared by Study team


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Table 2-2: Summary of Project Components (Equipment) Department Equipment Q’ty Description

Radiography

Digital X-Ray Machine

1 lot Used for general X-ray and fluoroscopy. By selecting a digital X-ray, it enables to contributes on minimizing maintenance costs as well as environmental impacts.

Safety Cabinet 1 set Used for containment of pathogens to prevent from leaking to laboratory technician side.

Distilled Water-making Machine

1 set Used for making distilled water. Laboratory

Examination Tables 6 sets Used for clinical examination in a laboratory.

General Medical Service Department

Central Supply Automatic Autoclave

2 sets Used for high-pressure sterilization of instruments, linens and other items.

Outpatient Department Electrocardiograph 4 sets Used for measuring and analyzing

electrical signals generated by beating heart.

Iron machine 2 sets Used for smoothing the shrink of the linens and uniforms.

Washing machine 2 sets Used for washing laundry. Services Department Dehydrator 2 sets Used for spin-drying laundry after

washing.

Administration Department Corpse refrigerator 1 set Used for preserve the dead body in

a mortuary. Source: prepared by the Study team


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2-2 Outline Design of the Japanese Assistance

2-2-1 Design Policy

(1) Basic Policies

1) Scope of the Assistance and Scale of the Facilities

The Japanese assistance is directed toward construction of hospital for communicable disease in Darlaman, Kabul City and to furnish necessary equipment in order for the 3 major diseases to be treated intensively and isolatedly through strengthened lab-facility as the National standard laboratory.

2) Basic Policies for the Facility Design

• Hospital building is to be distributed at the east land lot in the project site which measures approximately 8,000 m2 and locates at the NTP compound. Site layout planning is to take into account close linkage with the existing Tuberculosis Center facility and its OPD operation.

• In compliance with the Afghanistan building codes, the building-to-land ratio, set back distance from boundary lines and designated road alignments, in case that urban development plan exists for the Darlaman district, is to be duly considered into land use and site layout planning.

• One-story building is to be selected based on the fact findings on existing hospitals in terms of current status of technical maintenance and provision of infrastructure for mechanical lifts. One-story building enables to simplify traffic lines for patients among 3 target diseases due to the fact that no vertical flow planning is required.

• Harmonization with the existing building, peripheral environments and landscape is essential to be considered into architectural design.

• Future development and advance of medical healthcare for communicable diseases in Afghanistan as well as future upsurge of local medical needs are to be duly considered into facility planning and building systems planning.

• It is essential that facility planning allows sufficient sunlight and natural ventilation into the facilities, and that prevention against hospital acquired infection is properly considered.

• Grounded on current constraints and requirements for security and safety measures in Afghanistan, mitigation and minimization of security risks shall be essential for project implementation. Determination of facility scale and structure type, and selection of construction methods, materials and construction plans are to be considered into the facility planning to shorten construction period adapted to natural conditions in severe winter as well as local practices for construction business.

• Under close connection with JICA technical assistance project, the transfer and relocation of existing lab-equipment at TB culture in NTP are to be considered into facility planning properly coordinating with equipment planning.


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3) Basic Policies for the Equipment Design

• Based on required functions as well as operation and management plan for communicable diseases hospitals, necessary and basic equipment are to be planned and designed which will render low cost of maintenance, management and operation, as well as simple maintenance and management.

• Conventional equipment is to be basically out of scope for procurement, but it is necessary to prepare a plan for ordering a part of equipment with special necessities.

• Consumables used for medical equipment are subject to each standard manufacturer which is different; therefore, it is necessary to consider adding terms when selecting an agent at Afghanistan or surrounding countries so that GoA can easily buy the consumables.

• As disputes and conflicts often break out in Afghanistan, it is essential to manage supply and stock for consumables. Considering necessary time in order for the management plan of consumables to be properly prepared by GoA as well as lead time to deliver consumables after procurement of equipment, initial provision of consumables is to be considered for enough volume for 6 months usage in order to avoid shortage of consumables.

(2) Policy toward Natural Conditions

• Cooling system is to be applied for selected areas such as general medical service department and part of administration department.

• Based on results of the hydrological investigation for allowable flow of ground water as well as quality examination, water supply system for the Hospital is to consider existing well, which is simultaneously usable both for existing NTP facility and the Hospital.

• Japanese structural design code and standards are to be applied for the seismic force and study of the Project.

(3) Policy toward Socioeconomic Conditions

• Islamic religious as well as cultural contexts in Afghanistan are to be properly considered into the facility planning and the architectural design.

• Based on particular constraints on security and safety in Afghanistan, temporary construction plans as well as safety and security plan are to be well-examined.

(4) Policy toward Local Construction Industries and Particular Business Conditions

• It is common that not Russian building codes but particular building codes of the donor countries and/or International Building Code (IBC) are applied for those construction projects implemented by USAID, IOM and other donors. Under these circumstances, the Project is to be complied with Japanese building codes as well as Japanese structural design standards. In addition, technical verification based on facility standards of the WHO and IBC will be considered in case necessary.

• After the design review and approval by the construction department of MoPH, MoPH shall apply and obtain design approval from the Ministry of Urban Development and Housing (MoUD) in order to implement the Project.


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(5) Policy toward Employing Local Contractors and Consultants

• Although there are many traders who call themselves building contractors, approximately 20 years of conflict has had a large impact on the social infrastructure, and there are currently few traders with construction experience. Due to a lack of confidence in the technical capabilities, experience and organizational skill of local construction companies, it is suggested that the addition of Japanese and third country engineers to the Japanese construction company staff assignment plan would be appropriate.

• While it would be possible to acquire common laborers locally, skilled workers such as formwork and joinery carpenters, reinforcement placer, steel welders, roofers, plasterers, interior finishers, and electricians will undoubtedly be scarce and also technically limited. At each critical point of the various stages of construction, careful consideration should be given to devising a construction and equipment installation labor plan based on the technical guidance and management of engineers dispatched from Japan or a third country.

(6) Policy toward Management and Maintenance Capability

• After thoroughly reviewing the rather limited maintenance capabilities possessed by Afghan parties, designs shall consider the specifications and quality of facilities and equipment to ensure that functions required from a hospital for communicable diseases, and hospital operation and management based on those functions, can be easily and smoothly implemented.

• The design of the required rooms’ scale (area calculations) shall be based on organization plans and staff assignment conforming to EPHS criteria.

(7) Policy toward Setting of Grades for Facilities and Equipment

• Facility grades are set according to EPHS Specialized Hospital categories, and appropriate and effective specifications and quality are required for this facility considering its status as a top referral hospital in Afghanistan for 3 major communicable diseases, as well as being a healthcare facility funded by grant aid.

• In addition, it is also essential to set scales and specifications based on the hospital operation and management abilities of the Afghan parties, that is to say, securing finance, budget measures, staff assignment and technical levels needed to operate and maintain facilities and equipment.

• It is a basic principle of this plan that once this hospital has adequately fulfilled its functions as a hospital for communicable diseases, advanced medical equipment shall not be employed as equipment. It is also proposed as a basic requirement that the grade of building equipmenthall possess low age degradation specifications and quality, enabling it to be maintained in Afghanistan.

(8) Policy toward Methods of Construction, Procurement and Construction Period

• Based on the natural and social conditions of Afghanistan, a thorough work schedule shall be set to enable the adequate selection of employed specifications, materials, and construction methods.

• It is estimated that the Exchange of Notes (E/N) will be entered into in December 2010, as a single year project. Assuming that field surveys, detailed designs and tender document creation will take approximately 4.5 months, tender document


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approval and MoUD design review will take approximately 1 month; tender and contract finalization will take approximately 3 months; and the work period will run for 15 months. Work will get underway in October 2011, and be completed by the end of December 2012.


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2-2-2 Basic Plan

(1) Land Use Planning and Site Layout Planning

1) Land Use Plan

NTP Compound measures 31,875 m2 of area. Taking into account the outpatient department of the existing Tuberculosis Center, the approach to be taken in developing the entire plan, which carefully considered the mutual cooperation with the existing facilities, will be to work out a unified exterior of the building and blocks by eyeing sharing the existing security gate and relocation of the existing garage.

In addition, the use of the premises will satisfy the area-based building regulations of the Construction Law of Afghanistan, i.e., a building coverage of 30% or smaller (22.9%) and a setback line of 10 m from the wall. As further information, since the road in front of the facilities was confirmed as non-city plan designated, the setback will be also planned as 10 m away from the edge of the road. Incidentally, it is estimated that the floor area can be expanded by 2,260 m2 by maximizing the upper limit of the 30% building coverage.

Figure 2-1: Land Use Plan and Site Plan

2) Facility Layout Plan

There is no slope in the premises. All the buildings are to be one-story high (except for a Tower building) and will be built 10 m away from the north, east and south boundaries to the adjacent lands. The facilities are constructed of seven buildings in seven blocks respectively following the zoning by hospital function and hospital infection prevention. As for the layout, the main hospital building is to be connected by aisles and lobbies to the other buildings respectively.

Site area Floor area existing building

Project Floor area

Building to Land Ratio (BLR)

Expandable area（BLR=30%）

31,875 ㎡ 1,932 ㎡ 5,371 ㎡ 22.9 % 2,260 ㎡

Setback Line

Setback Line

Setback Line

Adjacent Land

Adjacent Land

Front road

HIV/AIDS, Malaria Patients Access Flow

Main Gate

TB Referred Patient Access Flow


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① Tuberculosis wards (4-bed room for Male patients)

② Tuberculosis wards (4-bed room for Female patients)

③ Tuberculosis wards (1-bed room for Male/Female patient)

④ Malaria, HIV/AIDS wards (Male/Female patients), Outpatient Dept., General Medical Service Dept., Administration Dept., Service Dept.

⑤ General Medical Service Dept. (Laboratory)

⑥ Tower (Elevated water tank), Electrical room, and Power generator room, etc.

⑦ Nursery

Figure 2-2: Facility Layout Plan

The ward block plan will be made as follows: The Tuberculosis Ward will be built in order to make the patients’ rooms open to south; the HIV/AIDS Ward and Malaria Ward will stand in the north side to have more patient privacy. The entire facilities including these wards will be connected via the Central Administration Department, Central Examination Department and Service Department.

The Outpatient Department will be positioned in consideration of the approach from the existing gate and roads in the premises and visibility. In addition, since only special medical staff members have access to the laboratory room, the block plan will be made to isolate the laboratory unit from other blocks and face three sides of the unit to outside in view of the bio-hazard.

For the Tuberculosis, HIV/AIDS and Malaria Wards, the respective flow plans in the premises will be made to reserve spaces for extensions including the future expansion of

⑦Nursery

①TB wards (4-bed male)

②TB wards(4-bed female) ③TB wards (1-bed male/female)

⑤Laboratory

④HIV/AIDS wards

④Outpatient dept.

④General Medical Service, Service dept

④Administration dept.

④Malaria wards ⑥Tower, Ele. Room etc.

Future Expansion

Future Expansion

Future Expansion

HIV/AIDS, Malaria Patients Access

TB Referred Patients Access

Staff Access


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the entire facilities. As WHO expects that the number of MDR-TB, HIV/AIDS patients will increase, the block plans for the Tuberculosis and HIV/AIDS Wards will be made to realize a considerable number of extensions of these wards. The individual directions and spaces for the extensions are shown in the above figure.

The 10-m setback space from the site boundary wall will be used for the layout of the break tank, clarification tank/osmotic cell and drying yard works.

In addition, it is planned to undertake the following parts of the construction work:

・ Relocation and restoration of the existing container warehouses during and after the construction period

・ Removal of the existing garage and building a new garage

・ Relocation and restoration of the existing pump room during and after the construction work


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(2) Architectural Planning

1) Components of the Facility

The component of the facilities and the rooms for each unit are planned as follows:

Table 2-3: List of Departments and Rooms Departments Rooms

Inpatient Department Tuberculosis Wards Patient room (20 rooms, 56 beds), Toilet, Shower room

Nurse station Staff room Day room, prayer room

Malaria Wards Ward (6 rooms, 12 beds), Toilet, Shower room HIV/AIDS Wards Ward (6 rooms, 12 beds), Toilet, Shower room

Nurse station Staff room Day room, Prayer room Outpatient Department Reception, Waiting room Consultation room (2 rooms), Dressing room Pharmacy Toilet General Medical Service Department

Laboratory Unit Biochemical, Bacteriological laboratory TB culture room, DST (multidrug-resistant TB) Culture medium room

Sterilizing room Radiography Unit Digital X-ray room, Control room

Reception, Staff room Waiting room File storage room

Central Supply Unit Dirty linen room Sterilizing room Administration Department Doctors' room, Nap room Administration office, Staff restroom Private offices Drug storage Toilet Conference rooms Library Watchman room Mortuary (morgue) Nursery Services Department Washing room, Linen room Kitchen Dining room Workshop Common space Warehouse, Stove warehouse Corridors Electrical room, Power generator, Water receiver tank,

Elevated water tank


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2) Facility Capacity Planning

The respective scales of departments and necessary rooms will be decided in line with the medical contexts and needs for communicable diseases, and the operation and management for the hospital in Afghanistan. The operation and management structures are required to be in conformance with the equipment according to the number of beds and the proposed staffing plan based on the personnel arrangement and the number of personnel as specified in EPHS of Afghanistan.

○ Inpatient Department

• Tuberculosis Wards

The main functions of the Tuberculosis Ward include inpatient treatment for MDR-TB and TB/HIV patients. Since no statistical data regarding TB/HIV patients are available, WHO’s estimations will be taken as conditions for the necessary number of beds, including the number of MDR-TB patients as 600 per year (nationwide), 100 per year in (Kabul) and a 6-month treatment period. As further information, the ratio of women tends to be high among general tuberculosis patients; however, there are not any data of the ratio between men and women among MDR-TB patients. Thus, the number of beds for men and women is planned on a one-on-one basis.

• HIV/AIDS Wards

According to the 2007 WHO Report, it is estimated that the number of HIV/AIDS patients will increase to 1,500 to 2,000. In the neighboring countries (Iran and Pakistan), the HIV/AIDS patients are increasing within the border areas, and the number of referred patients. The public medical data is not available until the results of the Integrated Biological and Behavioral Surveillance (IBBS) (March 2010) become available. However, 556 patients are registered nationwide so far, of which 51 are the patients of the Kabul ARV Treatment Center (in National Infectious Diseases Hospital). Due to the shortage of the facilities, all of them are outpatients.

Under the circumstances and taking into account the relocation of the functions of the Center to the Hospital, the HIV/AIDS Ward is planned with the minimum number of six beds in total, four beds in one room and one bed each in two isolation rooms respectively for men and women.

• Malaria Wards

The Malaria Ward intends inpatient treatment of severe malaria patients. It is not quite often but Kabul has had severe malaria patients sometimes, although the state is a low malaria risk area. The table below shows the trend in the number of malaria patients in Kabul over the recent five years. There are not available medical data such as severe malaria patients, the number of inpatients and the period of hospitalization.

Table 2-4: Number of Malaria Patients in Last 5 Years Year No. of

examinations Pf No. Py No. No. of beds Total

Patients 2004 1,006 4 188 1,006 1,1982005 1,995 3 84 4,206 4,2932006 3,760 13 355 8,916 9,2842007 3,924 81 385 14,150 14,6162008 16,198 344 3,459 8,070 11,873

Source: NMLCP

Taking into account that severe malaria patients will be referred to the Hospital from the National Infectious Disease Hospital and the hospitals in Kabul provice, the Malaria Ward


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is planned with the minimum number of six beds in total, four beds in one room and one bed each in two isolation rooms respectively for men and women.

Based on the above study, the configuration of the hospital ward and the planned beds will be as follows. And the following also show the possible number of beds for the future extension:

• Tuberculosis wards：4-bed room (12), 1-bed room (8)

Total=56 beds (male 28/ female 28); future expansion: 48 beds

• HIV/AIDS wards： 4-bed room (2), 1-bed room (4)


• Malaria wards： 4-bed room (2), 1-bed room (4)


Incidentally, two nurse stations are planned. The Tuberculosis Ward will have one nurse-unit, and the HIV/AIDS, Malaria Wards will also have one nurse-unit. The number of nurses will be 11 and 8 respectively, in accordance with the EPHS. Based on the staffing plan, the scales of the individual rooms will be decided.

○ Outpatient Department

Taking into account that the ARV Center and the functions of the malaria examination will be relocated to the Hospital, the Outpatient Department for HIV/AIDS and Malaria is planned. As further information, tuberculosis outpatients will continue to be treated at the existing clinic.

Since there are not any available medical data regarding the number of HIV/AIDS/Malaria outpatients, it is planned to create one treatment room and two examination rooms per special treatment (one room for men and one room for women)

○ General Medical Service Department

As for the General Medical Service Department for the Laboratory and Radiology units, the scale of necessary rooms will be decided based on the sizes and the number of planned equipment, and the layout and the operation of such equipment.

In particular, the scale of Laboratory unit is planned by considering the consistency with the activities and the plans in the JICA Tuberculosis Control Project Phase 2.

○ Administration Department and Service Department

The rooms for Administration Department and Service Department are planned based on the operation and management organization of the Hospital. Based on the staffing plan in accordance with EPHS, the respective scales of the individual rooms will be decided by taking the number of users shown in the table below into account.

The Kitchen is estimated to have capabilities to provide about 250 meals for 100 employees and 140 inpatients when the number of beds will be increased.

Table 2-5: Expected No. of Administration Dept. and Services Dept. Users Administration Dept. Services Dept.

Rooms Planned staff Rooms Planned Staff

Doctors’ room and nap room 8 Dining room 40Private offices (5 rooms) 1 per office Kitchen 3Pharmacy 2 Washing room 2


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Administration office and Staff room

8 Workshop 2

Large conference room 20 Small conference room 10 Library 10 Reception 1 Watchman room 1

3) Preventive Measures against Hospital-Acquired Infection

• Tuberculosis Wards

In Tuberculosis Ward, there will be a lobby, or receiving area, right after the door before the ward, where people will be sterilized by ultraviolet lamps to prevent infection from the patients being transferred from outside to the ward and from the ward to other facilities. Each private isolation room will have an anterior room equipped with ultraviolet lamps to prevent the infection to the general patients’ rooms. In the anterior room, toilets and showers will be installed. The isolation room is planned with a space and power supply to install the negative pressure equipment.

• Laboratory

As for the laboratory unit for bacteria analysis, the bacteria specimens will be confiscated in the cabinet by carrying out examinations within the BSL (Biosafety Level) IIB class safety cabinet to prevent the bacteria from leaking out of the cabinet to the laboratory unit as an infection source. An anterior room with ultraviolet lamps will be created at the entrance to the laboratory unit; those entering will have to wear a protective gown and shoe cover to prevent infection.

• Dirty linens

Contaminated beddings will be boiled for sterilization (3-minute boiling at 65 deg. C will destroy tuberculosis bacteria). Then, they will be washed and dried, and further exposed to natural light for ultraviolet sterilization.

4) Floor Planning

○ Inpatient Department

• Patient room

Single-bed room and multiple-beds room are to be planned. The multiple rooms will have four beds in accordance with the bed arrangement standards of WHO.

The rooms with one bed will be isolation rooms in the Tuberculosis Ward. Basically, these rooms will be assigned to patients who are strongly infectious. In the HIV/AIDS and Malaria wards, severe to serious state of patients will be assigned. TB/HIV patients will be treated in the Tuberculosis Ward first.

The measurement of the room having one bed will be 6.0 m x 3.0 m. The anterior room will be created, equipped with shower facilities and a small kitchenette. The room measurement having four beds will be 6.0 m x 6.0 m.


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Figure 2-3: Floor Plan for Patient Room

Tuberculosis Wards

Tuberculosis Ward will be a balcony access type. It will have a total of 28 beds: six rooms having four beds each and four isolation rooms having one bed each. The Ward will be separated for men and women. A courtyard will be created between the two buildings to enable both buildings to actively take in natural ventilation and natural light.

The Tuberculosis Ward is planned to be built at the south side of the premises and the rooms will face south. In the ward, one nurse unit will be organized, and the nurse station, examination and treatment rooms will be built.

The space for future extension is planned for another 24 beds separate for men and women buildings (6 rooms having 4 beds). It will include the future plan to increase the number of beds to 104.

Figure 2-4: Floor Plan for TB Wards

HIV/AIDS Wards, Malaria Wards, Outpatient Department

The HIV/AIDS and Malaria Wards will be constructed of one room having four beds and

4-beds room 1-bed room

4-bed rooms Male wards24beds

4-bed rooms Female wards24beds 1-bed rooms Male wards4beds 1-bed rooms Female wards4beds

Nurse station

Consultation, Dressing room

Dayroom

Courtyard Courtyard

Entrance

TB Referred Patients Access

Enlace Wards – Nurse station


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two rooms having one bed each. In the center of the ward, toilet, sanitary room and shower rooms are laid out. The wards are the middle-aisle type; therefore, the courtyards will be created to ensure natural ventilation and natural lighting. To secure the space for the future extension of the HIV/AIDS Ward because of its high incidence, the HIV/AIDS Ward will be built in the west side of the existing well and the Malaria Ward in the east side.

In the ward, one nurse unit will be organized, and the nurse station, examination and treatment rooms will be built.

Figure 2-5: Floor Plan for HIV/AIDS, Malaria Wards, Outpatient Department


Laboratory Unit

To avoid the spread of tuberculosis bacteria in the facilities, and to move in and maintain the equipment, three sides of the unit will face outside. The Laboratory unit will be constructed with rooms that include a reception area, staff room, biochemical laboratory, general bacteria laboratory, TB incubation room, DST (Drug Susceptibility Test) laboratory, culture media room and sterilization room. A space is prepared for the future pathology laboratory in the part of the biochemical laboratory.

Enlace Wards – Nurse station

Service Flow

Courtyard

Courtyard

Courtyard

HIV/AIDS Male wards 6 beds

Nurse station



Dayroom

Dayroom

Malaria Female wards 6 beds Malaria Male wards 6 beds

HIV/AIDS Female wards 6 beds

Pharmacy

Wating room

HIV/AIDS, Malaria Patients Access


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Figure 2-6: Floor Plan for Laboratory Unit

Radiography Unit

The Radiography unit is planned to be equipped with Digital X-ray, Control and Staff Rooms. In the planning, a space will be considered to install a CT scanner and ultrasound scanning equipment in the future.

Figure 2-7: Floor Plan for Radiography Unit

Ante room

Biochemical

Bacteriological

Sterilizing room TB Culture

DST Culture Medium

Staff room

Control room

CT room

BFS room

Waiting room

X-ray room


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Central Supply room

Used medical instruments will be transferred to the Dirty Linen room. These will then be transferred from the counter to the sterilization room where two autoclaves are installed and sterilized. They will be assembled on the work table, and stored on shelves. They will be removed to the hospital ward via the Pass Boxes which are classified by ward and outpatient department.

Figure 2-8: Floor Plan for Central Supply Unit

○ Service Department

Kitchen

Referring to the cases of other hospitals, the kitchen is planned including the equipment layout and facilities plans. The kitchenette will be constructed to serve two lanes.

Dining room

The dining room will have 40 seats for the staff members, and the space which enables them to have meals by two shifts.

Washing room

The washing room is planned by taking into account the work flow and space for medical instrument sterilization (boiling), and linen washing and drying. In addition, the space for ironing and sewing of beddings is planned. The drying place is planned in the vacant space in the east side (the area 10-meter setback).

Workshop

The workshop will have work tables and tools to repair equipment and cabinets to store parts.

Sterilizing room

Dirty lines


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Figure 2-9: Floor Plan for Service Department

○ Administration Department

Administration Office

The Administration Department is planned with the offices for Director, Head of Doctors, Head of Nurses and Curative Chief, and back offices for eight staff members. The Doctors Room is planned with the common room and the changing room for doctors and napping beds for night shift doctors.

Library

Books are stored and maintained by individual doctors so far, and the total number of books they have is unknown. The number of reference and reading seats is planned by estimating appropriate number of users based on the number of staff members including doctors, laboratory engineers and administration personnel.

Watchman room

Watchman room will be created to monitor and keep watch over the hospital. One guard per room will engage in the security of the facilities for 24 hours. The watchman room will be built at the entrance for patients and near the outpatient department. If emergency alarms are installed, the terminals of the alarm system will be set in the guard’s rooms.

Workshop

Washing room

Linens

Kitchen Dining room Drying space

Kitchen Receiving

Courtyard

OPD, Wards

General Medical Dept., Laboratory

Wards, Service Dept.

Service Flow


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Figure 2-10: Floor Plan for Administration Department

Mortuary

According to the EPHS, a mortuary will be created. It is planned in a place in the Tuberculosis Ward, out of sight of patients and visitors, and where it is easy to remove and take out bodies.

Figure 2-11: Floor Plan for Mortuary

Nursery

Following the practices in Afghanistan, the day care center is planned to care patients’ and employees’ children. Nursery will be built separately from the hospital facilities,

Mortuary

Courtyard Library

Doctors’ room Administration office

Nap room (Staff room)

Watchman room Conference room

Conference room

Director

Head of nurse

Head of doctors

Curative chief

Staff Entrance

OPD Wards

Service Dept General Medical Dept

Service Flow


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which will be constructed of dining room, nap room and play room.

Figure 2-12: Floor Plan for Nursery

5) Required Floor Area

Assuming the total area will be approximately 5,327.4㎡ (incl. Nursery), the area of each unit is planned as follows.

Table 2-6: Floor Area of Each Department Department Area (m2)

Total Floor Area 5，327.4Inpatient Department 2,762.9Outpatient Department 397.1General Medical Service Department 696.4Administration Department 803.2Service Department 308.7Common space, Tower 359.1

The areas of each department’s main rooms are proposed as follows.

Table 2-7: Floor Area of Rooms Department Rooms Area (m2)

Inpatient Dept. 2,762.9 TB wards Incl. corridor 1,728.9

Anteroom 35.1 Patient room (4-bed room) (male/female) 454.8 Patient room (1-bed room) (male/female) 152 Nurse station 36.3 Consultation room (male/female) 39.1 Dressing room 18.2 Staff room (male/female) 37.8 Day room 72.8 Prayer room 15.6 Toilet and Sluice room (male/female) 75.8 Shower room (male/female) 75.8

Play room

Kitchen

Staff room


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Malaria wards Incl. corridor 323.6 Patient room (4-bed room) (male/female) 75.8 Patient room (1-bed room) (male/female) 79.2

Toilet and Sluice room (male/female) 40.8 Day room 41.1

HIV/AIDS wards Incl. corridor 710.4 Patient room (4-bed room) (male/female) 75.8 Patient room (1-bed room) (male/female) 79.2

Nurse station 34.3 Toilet and Sluice room (male/female) 40.8

Day room 40.3 Prayer room 30.1 Staff room (male/female) 41.4Outpatient Dept. Incl. corridor 397.1 Waiting room 182.1 Consultation room (male/female) (4 rooms) 76.7 Dressing room (2 rooms) 36.6 Pharmacy 21.7 Toilet 43.1General Medical Service Dept. 696.4

Laboratory Unit 355.5 Biochemical laboratory 302.9 Bacteriological laboratory Incl. in above

Tuberculosis Culture room Incl. in above DST (multidrug-resistant TB laboratory) Incl. in above Culture medium room Incl. in above Sterilizing room Incl. in above Anteroom 21.4 Reception 13.4 Staff room 17.8Radiography Unit Incl. corridor 286.2

Digital X-ray room 33.8 Control room 7.8 Staff room 21.4 Waiting room 70.6 File storage room 5.3

Central Supply Unit Incl. corridor 54.7 Dirty linen room 12.9

Sterilizing room 17.2Administration Dept. Incl. corridor 803.2 Doctors' room, nap room 88.1 Administration office 39.1 Staff room 29.0 Office of the Hospital Director and secretary 60.2 Office of the Head of Doctors 18.2 Office of the Curative Chief 18.2 Office of the Head of Nurses 18.2 Reception 12.9 Drug storage 13.9 Toilet (male/female) 27.2 Large conference room 54.4 Small conference room 22.5 Library 46.4 Watchman room 11.8 Mortuary (morgue) in TB ward 19.9 Nursery (separate building) 151.4


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Services Dept. 308.7 Washing room 55.6 Linen room 10.1 Kitchen (incl. office and pantry) 111.9 Dining room 78.5 Workshop 28.3 Common space, Others 359.1 Stove warehouse 80.1 Warehouse Incl. in each unit Corridors Incl. in each unit Electrical room, Power generator room 80.1 Tower (warehouse and elevated water tank) 198.9

6) Elevation and Sectional Planning

Elevation Plan

Kabul, located at 1,800 m above sea level, is irradiated with strong sunshine throughout the seasons. For the countermeasures for the sunlight to protect the openings of individual hospital ward, shading walls will be put up on the front of the exterior to help weaken the direct sunlight. The sunshade wall will be built with perforated bricks on the RC columns and beams, and aluminum louvers will be attached on the upper part.

Figure 2-13: Elevation of Sun-Shading Wall（TB wards South）

Cross-Section Plan

For the roof, the terrace roof should be avoided; gable roof made of metal steel plates will be employed to ensure high water proof and durability. The pitch of roof is planned at 2.5/10 to 3/10 in consideration of fallen snow.

Since Kabul has a severe drop in temperature during mid winter (the average temperature is 4.83 ℃ from December to February), the roof slab is built to make the space between the metal roof and the attic as an air chamber, in order to lighten impact on room temperatures during winter and summer. Under the current condition that negative pressure is not properly set, the patients’ rooms are zoned by structure, whereby it is expected to help hospital infection prevention. The space is also used for facility piping and wiring, and to install the negative pressure duct for the patients’ rooms in the Tuberculosis Ward for the future.


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Courtyards will be created in the hospital ward to actively take natural ventilation and natural light via the aisles and the openings of the rooms.

The patients’ rooms are planned to have a ceiling to improve the heat insulation of the rooms during the winter and the amenity. In addition, the exterior of the patients’ rooms will be covered with sunshade walls to mitigate direct sunlight into the rooms.

The space under the floor around the water section will be a pit. By planning the ground floor level at around GL + 0.40 m, the space under the floor will ensure the necessary height for facility construction and maintenance.

Figure 2-14: Cross-Section Planning

7) Structural Planning

Basic Policy

The planned facilities are constructed of two buildings of Tuberculosis Ward: one building for HIV/AIDS/Malaria Wards, Outpatient Department, Administration Department and Service Department, and one building for Central Examination Department (Examination Department) and Tower (electric power room, elevated storage tank and warehouse). Each building and aisle will be connected with expansion joints.

The basic grids for the square building structure will be 6.0 x 6.0 from the perspective of economy. For the structure type and frame construction, the reinforced concrete rahmen method will be employed. For the exterior walls and partitions in the building, the local brick masonry construction will be employed.

The roof will be built by putting iron roof framing and metal steel roof plates on the concrete roof slab (flat). The hospital ward roof plane is 8.30 m at the highest point and the tower will be 18.2 m high.

Foundation Type

The plate bearing test was conducted at two places in the planned site for the construction. Based on the result, the long-term allowable bearing capacity of soil shall be 13.0 t/m2 (=130 kN/m2). The level to place the plates was set at a depth of 1.50 m from the current ground level for the test.

The foundation will be the non-pile foundation. Since the surface soils are uneven and a sufficient bearing capacity of soil can not be expected, the supporting layer is set at GL-1.50 m. As further information, the freezing depth is estimated at GL-0.80 m from the

Corridor

Sunlight

Patient room Corridor

Patient room Courtyard Natural vent.

Natural vent.

Natural vent.


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local climate data and the existing embedded pipes. In conclusion, freezing damage should not be a concern.

For the construction method for the foundation, the matt footing will be employed because it is expected to shorten the construction period most in consideration of the timing of the midwinter (when the concrete construction is impossible) during the total estimated construction period and construction procedures, and thereby, the foundation is planned to reduce the foundation girder volume as much as possible.

For the ground floor, the dirt floor slab will be employed for the general part of the building, and for the water section a structural slab with a pit under the floor (the effective height under the floor is 1.10 m).

Figure 2-15: Floor Type on 1st FL: Pit floor for piping

Figure 2-16: Floor Type on 1st FL: Slab-on- Grade

• Structural Design Conditions

The structure design for the planned facilities will be calculated for the cross-section areas by the stress analysis on the frames and allowable unit stress method as employed in Japan in principle. Non-design force and load will be decided by considering the climate conditions and earthquake loads in the region and Japanese structural design standards.

For the allowable unit stress of materials, the values specified in the Japanese structural design standards will be employed in principle.

• Live Loads

The live loads are determined as shown in the table below by referring to the Japanese Building Standards Acts and Enforcement Orders:

Corridor Toilet, Sluice room

Slab on glade Slab

Soill fill Pit

Mat Foundation

Slab on glade Corridor Patient room

Soill fill Soill fill

Slab on glade

Mat Foundation


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Table 2-8: Live Loads Live loads [N/ m2] Room

Floor slab and beam

Structure frame

Seismic force calculation

Roof 900 100 100Inpatient Dept. 1800 1300 600Waiting room 2900 1800 800Outpatient and General Medical Service Dept.

2900 1800 800

Administration and Services Dept.

2900 1800 800

Elec. room and Power generator room

4900 3900 2900

NOTE: The heavy-duty equipment will be studied separately.

• Seismic Loads The seismic load for Kabul City in Afghanistan as calculated in accordance with the

old Russian construction standards is set at the seismic intensity level 8. The level is used in CIS countries including current Russia and Eastern European countries (one to 12: the levels are corresponding to the seismic acceleration from 100 to 200 gal). This is corresponding to the Meteorological Agency Seismic Intensity Scale of 5 lower to 6 lower (a frequency of one second). According to the International Building Code (IBC), the city of Kabul belongs to the Zone-D, where the Richter Magnitude Scale∗ 7 is generally used for the calculation of the seismic load.

The seismic horizontal force will be calculated in accordance with the Japanese Construction Standards Acts by taking the above into account.

• Wind Loads

The wind load will be calculated by the Japanese Construction Standards Acts. The basic wind velocity is set at V0 = 30.0 m/s (inland: roughness index III) in accordance with the climate data (year-round wind direction and velocity).

• Snow Loads

The snow load will be calculated by the Japanese Construction Standards Acts and set at 1,000 N/m2 (Snowfall: H=50cm, Specific gravity: 20 N/m2･cm)

• Structural Material

Concrete： Design standard strength at Fc = 24 N/mm2

Quality standard strength at Fc = 27 N/mm2

Re-bar： SD345 (D19 or greater) or the equivalent or greater

SD295 (D16 or lower) or the equivalent or greater

Structural Steel： SS400, SSC400 or the equivalent or greater

∗ Richter magnitude scale: known as the local magnitude (ML) scale, assigns a single number to quantify the amount of seismic energy released by an earthquake


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(3) Utility and Building Systems Planning

1) Mechanical and Plumbing Installation

• Water Supply System

The water supply facilities plan for the Hospital is to store water in the newly-installed water tank received from the existing water well, and pump it up to the elevated water tank with the lifting pump. It will then be fed to all locations by gravity method. The water tank and elevated water tank will be made of FRP (Fiber Reinfirced Plastics), and it is expected that the capacity of the water tank will be the equivalent of one day’s used water. However, it is assumed that mineral water will be arranged separately for drinking water.

Current water supply for the existing facilities is untreated raw water received from the existing water well. The raw water has a high degree of hardness. In addition to a high hardness content, it is easy for scale to build up within drainage piping and the (high) water piping system is prone to blockages due to scale (calcium salt crystal). Buildup of scale was also observed on electrical water heating apparatus of laboratories in existing facilities.

As a solution, softening apparatus can be attached, but it is not certain whether local staff would be able to maintain such apparatus appropriately, so it is proposed not to install it as part of the building equipment plan.

The maximum daily water supply amount for the Hospital is calculated below;

・ Calculation of daily water supply amount according to apparatus

If it is used twice an hour Use time is 10 hours Daily water supply volume will be 20.23 m3/day → 20 m3/day

・ Calculation of daily water supply amount according to staff

If 1 inpatient uses 100 L/day 1 worker uses 50 L/day Daily water supply volume will be 18.78 m3/day → 20 m3/day

・ Calculation per bed (200 L)

200 L x facility scale (80 to 140 beds) = 16,000 to 30,000 L/day → 16 to 30 m3 Based on the three calculations given above, daily water supply amount is set at 20 m3/day.

The water tank will be an above-ground type from the hygienic viewpoint, and it will be a 2-tank type enabling easy periodic cleaning of the tank interior. Using FRP sandwich panels as the material is being considered. It is planned that the same specifications and materials will be used for elevated water tanks to prevent freezing.

・ Water tank capacity: approx. 1 day’s worth - 34 m3 (20 m3 + 14 m3 : existing facilities’ capacity = 34 m3 )

・ Elevated water tank capacity: approx. half of 1 day’s use - 10 ㎥


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• Wastewater Sewerage Systems

Taking into account maintenance aspects following work completion, the drainage system will be divided into 3 systems consisting of effluent, gray water and laboratory system water. It is proposed that drainage from these systems will be passed through the observation pit and then finally deposited and decomposed by the septic tank and soaked into the ground using a soak pit.

In the case of chemicals used in the laboratory classroom, a request has been made to the NTP to ensure that they are drained using an outside effluent treatment device, and that all efforts will be made to individually recover undiluted solutions.

In addition, rainwater drainage from the buildings of the planned premises will be collected in the gutters and then soaked into the ground via street gutters built around the perimeter of the buildings.

The drainage volume is virtually the same as the water supply, estimated at 16 m3 / day (1 day’s worth of drainage – 20 m3 x 0.8). Water supply plans for the Hospital are to store water received from the water well (planned as a result of a groundwater survey) in the water tank installed in the Hospital, pump it up to the elevated water tank via the lifting pump, and then supply it to each location using the gravity method. The water tank and elevated water tank will be made of FRP, and it is expected that the capacity of the water tank will be approximately half of the daily used water volume. However, it is assumed that mineral water will be arranged separately for drinking water.

• Sanitary Fixtures

Based on discussions with NTP and W/G, it is planned that a local type toilet basin will be used for patients, and a western-style toilet basin will be used for some staff considering the sanitary aspects of the medical facilities and ease of use for outpatients.

However, the water supply system to the lavatory basins will use well water and employ a “low-tank system”, which is a versatile local system that takes into consideration maintenance aspects and water-saving.

• Hot Water Supply System

In principle, the local hot water supply system will be used, and hot water storage type electrical water heaters will be installed in rooms to supply hot water. In the kitchen and washing room, which will use large quantities of hot water, a large hot water storage type water heater or multiple apparatus is planned.

Easy maintenance and cost-cutting are key focus of this plan, and it was found that replacing some broken electrical water heater parts locally could be done simply and at little cost. Accordingly, a parts exchange policy will be adopted to counter the effect of hard water on electrical water heaters.

• LPG Facility

As the fuel for gas apparatus installed in the kitchen, it is proposed that easily-obtainable and low cost propane gas equipment will be used.

Gas piping is planned for the 1st floor kitchen in consideration of its workability and usability. In addition, propane gas cylinders will be placed outside for safety reasons.

Further, in the case of gas equipment used for laboratory Bunsen burners, gas faucets will


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not be fastened to laboratory benches to ensure safe handling of Bunsen burners, and agreement has been obtained with NTP to prepare propane gas cylinders so they can be used in a timely fashion.

• Fire Fighting Facility

While this is not currently mandated equipment that must be installed in Afghanistan, there are plans to install fire extinguishers, which enable to bring the fire under control at an early stage and not to require technically complicated maintenances.

In addition, in this hospital where there will be many physically weak patients, early response to a fire is very important. Therefore, plans will be made to ensure that patients are alerted and evacuated smoothly by installing fire alarm apparatus and broadcasting equipment.

2) Heating, Ventilation and Air-Conditioning Systems

• Cooling Systems

Kabul has a continental highland climate. Throughout the year, rain is scarce and during the winter period there is only a tiny amount of rain and snowfall. Temperature differences are extremely large. While the temperature can exceed 40°C in the summer, temperatures can drop to as low as -15 °C in the winter. Despite such conditions, based on the status of use of existing buildings and discussions with NTP and W/G, there are plans to expertly construct facilities so they are not over-reliant on machines (solar shields and natural ventilation, etc.).

However, to accommodate the hospital’s peculiarities, separate systems utilizing a split air conditioner (heat pump type) that is energy-efficient and easy to maintain and operate are planned only for rooms that need to block outside air to conserve precision equipment and maintain the indoor environment (X-ray rooms, rooms performing same operation, pharmacy, laboratory-related rooms, etc.).

A power supply box or power outlets may be installed sometime in the future to enable negative-pressure equipment to be installed in wards.

• Heating Systems

Based on local conditions and examples of other hospitals in Kabul, it is essential to consider heating equipment with low running costs that is easy to maintain locally.

As a heating method, oil stoves (chimney type) that are used for various purposes locally and are easy to maintain and operate will be mainly used, followed by oil-filled electric panel heaters.

• Ventilation Systems

The basic plan is to use natural ventilation for ventilating equipment. However, ventilating fans are planned for kitchens with cooking apparatus, control booths not facing outside, and the X-ray room, which cannot have windows.

3) Power Supply Systems

• Power and Transformer Facility

To enable power distribution in the Hospital, a transformer (step down from 15KV→ 420V/240V) and an incoming panel shall be installed, and there will be a low-pressure


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three-phase four-wire system in facility rooms with a 420V/240V charge.

• Power Generator

It was discovered from interviews with NTP, W/G and MoPH (Construction Dept.) that the power supply situation in Kabul has improved, but power supply is still unstable with problems such as power failures and voltage fluctuation.

Results of voltage and frequency measurement taken by this survey at existing facilities showed that voltage fluctuation is a maximum of 4.2% within 10%; and frequency fluctuation is a maximum of 2.8% within 5%. It is considered that this level of fluctuation will normally have little influence on equipment, but repeated power loss and recovery will have an impact on the longevity of such equipment.

電圧測定　3月24日　9：00～15：00 （1秒間隔）

225

230

235

240

245

250

9:00 10:00 11:00 12:00 13:00 14:00 15:00

時間

電圧

　（V

)

0V

246.8V

241.7V

233.4V 233.4V 233.3V

平均236.8V　(0Vは含まず）

4.2%

Figure 2-17: Voltage Fluctuation Experienced at NTI

周波数測定　3月25日　8:23～15：00　（1秒間隔）

48

48.5

49

49.5

50

50.5

51

51.5

52

8:15 9:15 10:15 11:15 12:15 13:15 14:15

時間

周波

数　

（H

z)

51.39 Hz

51.23Hz

49.35 Hz49.19 Hz

0Hz (約3分間）

2.8%

Figure 2-18: Frequency Fluctuation Experienced at NTP Facility

However, even with this level of voltage and frequency fluctuation, medical equipment with computing functions is sensitive to voltage fluctuations and instantaneous power failure, so CVCF installation or uninterruptible power supply (UPS) should be considered separately by the equipment plan. Further, power failure during a medical procedure or a laboratory test could seriously impact medical activities, so it is assessed that installing an emergency power generator is required.

Time

Time

Volta

ge (V

) Fr

eque

ncy (

Hz)

( in 3 minutes)

AV.236.8V


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For the purposes of this plan, power generator capacity is expected to be approximately 30% of the maximum demand power load (240KVA*). There are plans to use a low-noise diesel generator due to its long-time operation capabilities and also to prevent noise disturbance. Power generator capacity estimates are as follows.

* Power generator capacity estimate

Electric light socket load 40w/ｍ2 x 5,000ｍ2 x 0.5 (demand factor) = 100 kw

Heater load 60 kw

Medical equipment load 70 kw

Sanitary equipment 10 kw

Total 240 kw

Therefore, in the case of power generator capacity, it is proposed that the maximum demand power load will be 240 kw x 30% ＝ 80 KVA.

Transformer capacity is proposed to be 300 KVA considering that X-ray apparatus requires 50 KVA.

• Main Cables

Primary power equipment transmits power from the incoming panel using a three-phase four-wire system 420V/240V, 50Hz; divides systems according to load application and facility type; and delivers power to the necessary rooms via a host of distribution panels. Primary power capacity is set to ensure that the appropriate voltage drop and allowed current value are satisfied in line with equipment capacity. As a rule, the cable rack method is used as the wiring method inside the shaft. Apart from that, pipe and wire are used.

• Lighting and Outlets

This plan considers the use of fluorescent lights as the main type of lighting for all rooms, the entrance hall and corridors for maintenance and running cost reasons.

Illuminance criteria (general illuminance) shall conform to average illuminance as specified in JIS (Z9110). This is detailed in the table shown below. Light blinking shall be set in principle for each room, and the blinking circuit shall be divided to ensure that blinking is possible per required plot.

Figure 2-9: Intensity of Illumination [lx] Name of main rooms

Designed

illuminance (general lighting)

lx

JIS illuminance criteria

(general lighting) lx

Remarks

Patient room 200 200～100

Dressing room 300 750～300

Pharmacy 300 750～300

X-ray room 200 200～100

Office 300 500～200

Conference room 300 500～200

Dining room 300 500～200

Toilet 100 150～75

Corridor 100 100～50


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The circuit is partitioned and installed to handle power socket equipment including general sockets, electrical heater sockets, medical equipment power sockets, and kitchen equipment power sockets. In particular, plans will ensure that the brightness of the X-ray can be adjusted. Power is distributed to electric light and socket circuits with single phase two wire 220V. There are plans to install exit sign lighting and emergency lighting in the evacuation route and stairway area as necessary.

• Cable piping for information network

This plan is considering only handling sockets for wireless LAN equipment and pneumatic piping from the concrete base of the parabola antenna (the parabola antenna will be built by the other party) to the receiver so that a network can be built within the facility that will one day have Internet access capability.

• Interphone / Nurse Call System

Installing an intercom is being considered to facilitate internal communications within the facility and support medical activities in the hospital. Rooms targeted to be installed with this system are laboratory-related rooms, the nurses’ station and administration-related rooms.

In addition, there are plans to install a nurse call system to enable calls from the ward to the nurses’ station as well as a toilet emergency call to support patient emergency response.

• Public-Address System

Public-address equipment in this hospital shall be provided to enable emergency calls and communication between staff members. Making a broadcast to alert all facilities simultaneously of a fire enables physically weak patients who are unable to evacuate speedily to obtain information about the fire instantaneously. Since this greatly aids early evacuation, it will be considered via a domestic analysis.

• Automatic Fire Alarm System

Broadcasting equipment is considered to be extremely important because it will promptly alert patients of a fire enabling them to be evacuated speedily before the fire spreads.

To combine with equipment that take into consideration systems in this country, and is easy to maintain and handle, fire alarm equipment content will be considered via a domestic analysis.

• Lightning Arrester and Grounding

Because lightning often strikes Kabul, lightning rod equipment is needed - especially at a medical facility with many physically weak people. Equipment to prepare for all accidents, avoid substantial damage and protect buildings as a whole will be considered via a domestic analysis.


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(4) Procurement Planning and Selection of Construction Materials

Construction materials in Afghanistan are mostly imported from neighboring countries such as Pakistan, Iran and Central Asia, which are both quantitatively and qualitatively quite limited.

Shortening construction periods, durability and easy maintenances of materials are to be considered into selection of the materials and facility design, which shall comply with severe natural conditions, particular conditions of procurement in Afghanistan and facility requirements as a hospital.

The following table indicates applicable finishing materials and methods in comparison with the locally conventional practices.

Table 2-10: Finishing Materials and Methods Items Conventional Practice Applicable Material and

Methods Remarks

Roofing Concrete flat roof slab

Aluminzinc metal sheet with Steel roofing structures

Japanese product

Wall Brick masonry wall Paint on cement mortar plastering

Brick masonry wall with air space insulation Paint on mortar plastering

Exterior finish Floor Local stone

Local stone

Floor Terrazzo Terrazzo tile Ceramic tile

Elastic resin flooring Dust-proofing paint flooring Ceramic tile

Japanese product Japanese product Japanese product

Wall Ceramic tile on cement mortar topping

Ceramic tile on cement mortar topping

Japanese product

－ Stretcher guard-railing Wheel chairs guard-railing

Japanese product Japanese product

Ceiling T-Suspension ceiling＋plaster boards Paint on concrete slab ceiling

T-Suspension ceiling＋plaster boards Paint on concrete slab ceiling

Interior finish Door & Window

Plastic resin sash Wooden sash Double glass w/air space

Aluminum sash Steel sash Double glass w/air space

Japanese product Japanese product Japanese product


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(5) Well Water Facility

1） Capacity and Daily Operation of Existing Well

According to the site investigation as well as hearing to the administrative staff of NTI, the parameter of the existing well is as follows.

･ Well diameter: φ300 mm

･ Depth of well: 58 m

･ Model of submerged pump: Made of MASTRA R95-DF-24, 2850 RPM, 4 kW, Q=6-8-10 m3/h, H=130-107-80 m

･ Depth of submerged pump: 58 m

Results of a pumping test conducted at the site showed that the existing water well can secure a continuous pump displacement of 200 L/min, enough to adequately cover the total amount used (20 m3 + 14 m3 = 34 m3) by the current Tuberculosis Center and the Hospital. The water was also found to be of good quality (albeit a little hard).

With regard to the status of operation, the water well is operated manually 2 to 3 times a day, and water is stored in the inside water tank (4.2 kL). From there the water is supplied to the elevated water tank (6 kL + 1.2 kL) until it is full. Supplying water to the inside of buildings originally made use of a pressure tank, but it is currently broken so it is cannot be used.

2） Basic Policy for Well Water Facility

While the capacity (intake capacity and water quality) of the existing water well is not under question, operation of the well is heavily reliant on the working schedule of the person in charge. When used at the Hospital, a water tank for communal use will be provided near to the well to remove the influence of the existing facilities’ operation and management methods. This will enable operation and management of the water from the water tank stage onwards to be clearly shared with the Tuberculosis Center.

A mechanism enabling water from the communal water tank to be supplied to the new and old facilities separately by water pump will be used. In addition, the well pump will be controlled in response to the water level of the communal water tank. To conserve the quality of water, the water tank is structured to seal-up, preventing the water from being contaminated with dirt.

To prevent freezing during the winter, protection with an interior or cold protection sheet is under consideration. In addition, it is unclear when the well was cleaned, so it would be desirable to clean it once during the work period.


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3） Migration of Existing Water Supply Piping

Supplying water from the existing water well to the Tuberculosis Center is carried out via VU50 underground pipe located around 0.5 m to 1 m underground. Because the laid area is within the grounds of the Hospital, and also because there is a fear of damage caused by the passing of construction vehicles including heavy machinery, underground pipes will be relocated along the northern side of the site to avoid the above-mentioned damage.

Figure 2-19: Route and Layout of Existing Piping for Migration

4） Specification of Existing Well and Pumps

Water well specifications are as follows: radius - φ300 mm; depth – 58m; submersible pump model – MASTRA R95-DF-24, 2850RPM, 4kW, Q=6-8-10 m3/h, H=130-107-80 m. Because it is unclear how many years the current submersible pump has been used, replacing it with a new pump would be desirable.

5） Specification of New Pumps

Assuming that the total use amount for the old and new facilities is a maximum of approximately 60 m3 / day and that the pump will be in operation for approximately 8 hours a day, a pump that can secure a minimum pump head of 60 m and pump displacement of 12.5 L/min is required. The pump installation place shall be 50 – 55 m away considering the buildup of gravel in the bottom of the well.

Existing supply piping

Route of diversion


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(6) Equipment Planning

1) Plan for installation of equipment at divisions and rooms

○ Inpatient and Outpatient Department

• Patient room

A plan is prepared for equipping 80 beds for adults, 80 tables near beds and 80 tables on beds corresponding with the number of rooms in construction design. In addition, a plan is prepared for equipping 10 beds for child patients and 10 beds for whoever takes care of the child patients, in consideration of the habits and customs of Afghanistan.

• Nurse station

Nurse station has 3 main types, namely, nurse station for tuberculosis, nurse station for HIV/AIDS and nurse station for malaria. In each type of nurse station, it is divided in area for male patients and area for female patients. Thus, it is planned to equip each one with 6 sets for each type of equipment such as sphygmomanometer (for taking blood pressure), auscultator (stethoscope), treating equipment set, scrap boxes, pedal type of medical waste case, injection needle tank, humidifier, sliding seat (for adults). In addition, due to the fact that the quantity of child patients in nurse station for malaria is predicted to increase, it is scheduled to equip 10 beds and 2 sliding seats (small type) for children.

・ Thermometer A plan is prepared to equip each nurse station with 5 thermometers; total number is 30 pieces. Because thermometers could easily break, it is suggested to use electronic thermometers.

・ Stretcher It is intended to provide one stretcher for tuberculosis nurse station; other remaining nurse stations share one stretcher.

・ Rack for water and medicine transfusion Each area of nurse station has 3 pieces and total number is 18 pieces.

・ Oxygen measuring instrument Because there are 10 single rooms, each room will have one oxygen measuring instrument; total number is 10. In addition to equipping tuberculosis nurse station with one instrument, HIV/AIDS nurse station and malaria nurse station share one instrument. Total number is 12 instruments.

・ Cardiography equipment Tuberculosis nurse station will be equipped with one unit, while HIV/AIDS nurse station and malaria nurse station will share one unit.

• Consultation room

Necessary basic equipment are examination table, light, light box and ECG etc.

Common examination table light is halogen type; however, halogen lamp is expensive and standard of each maker is different. On the other hand, although a light bulb’s lighting is rather weak, it is still selected because it is cheaper and readily available at electric utility shops in Afghanistan.

Necessity of refrigerator is not high, so it is ranked as priority C. In addition, although an spirometer is mainly used in treatment of multidrug-resistance tuberculosis patient, its necessity is low and embouchure, which is put into mouth, is a consumable because it is used only once for one patient. Accordingly, it will cost about ¥400,000 for a year’s


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supply; therefore, it is listed as priority C from viewpoint of cost effectiveness.

● Dressing room

Because there are 3 dressing rooms, it is necessary to equip each room with a treatment table, a seat for treatment, a sterilization box for hot water, and a rack for water transfusion. Treatment tool kit will be considered based on how long each treatment lasts. And as a dressing room, frequency of usage is high; thus, it is needed to prepare a plan for equipping 3 sets for nurse station. Total number needed is 9 sets.

● Staff room for night shift nurse

・ Bed for night shift nurse In the Project, it is assumed there will be two shifts per day. A bed for nurses is especially important to have in nurse’s station, and so it is estimated that each male nurse room and female nurse room with have 2 beds each.

● Pharmacy

A plan is prepared to supply the Pharmacy with 1 medicine storage refrigerator, 2 medicine cupboards with opening and closing leaves and 2 racks for storage of medicines for preservation. These equipment are very important for arrangement and preservation of medicines of the pharmaceutical division; therefore, its necessity is high.


● Radiography Unit

・ Digital X-Ray equipment This is an indispensable equipment for hospitals in the treatment of communicable diseases, mainly tuberculosis. Digital X-ray equipment has higher accuracy than X-ray film processing equipment; furthermore, there is no need for films and developers, thereby saving cost. And because developers are not used, there is no environmental issue involved. Thus, it is very appropriate for current situation in Afghanistan. It is planned to import one unit of this type of equipment for the Project.

・X ray aprons The Project is to supply 2 X-ray aprons for X-ray technician and the person going along with child patient (if necessary).

● Laboratory Unit (Biochemical laboratory)

It is planned to supply this division with basic equipment such as four laboratory tables, an electronic balance, an haemoglobinometer, a spectrophotometer, a centrifugal machine and a microscope for check-up of malarial bacteria. Cold storage for keeping medicines of NTP and Counter CD4 are planned to be purchased, and national communicable diseases hospital will be transferred to the Project.

● Laboratory Unit (TB culture room)

A plan is prepared to equip it with a laboratory table; other equipment such as incubator, refrigerator for preservation of medicines, and safety cabinet will be moved from room for culture of tuberculosis bacteria of NTP.

● Laboratory Unit (Bacteriological laboratory)

A plan is prepared for equipping it with an incubator required for common culture, a CO2 incubator, and a refrigerator for medicine preservation. In addition, one laboratory table will be moved from room for culture of tuberculosis bacteria of NTP.


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● Laboratory Unit （Culture Medium room)

Washing table and solvent hardener available in NTP will be moved.

● Laboratory Unit （DST: MDR-TB laboratory)

A plan is prepared for equipping it with a laboratory table and a safety cabinet.

● Laboratory Unit （Sterilizing room)

Move two autoclaves and two dry heat sterilizers required for sterilization room of examination room of NTP. It is to prepare a plan for supplying two basins for medical waste and a rack for laboratory. In addition, it is necessary to provide a distilled water making machine for sterilization room at all examination divisions. • Central Supply Unit

・ Autoclaves There is no surgical room in this plan, but such things as treatment tools, injection needle, and gloves need to be sterilized; it is not necessary for autoclaves to have great capacity but planning for two smallest types is better than being equipped with a medium type. The reason is that autoclaves have their features of sterilization in hospital; they must be available in operational status. In case one autoclave is out of order and being repaired, the other one can be used to sterilize.

・ Cust Cust is a tool used for handling objects to be sterilized inside autoclave. This is an equipment required for sterilization by autoclave. It is assumed that one set is medium sized and one is small sized; it is planned to purchase 10 sets for 2 automatic autoclaves.

・ Operating table used in sterilizing room Used for handling and arranging instruments which have been sterilized. It is estimated to be equipped with one set.

○ Service Department

● Kitchen

This is the functional division required in hospital. It is divided into two types: one used for patients and the other for staff of the Hospital. Thus, it is needed to prepare a plan for two ovens for cooking, two gas cookers, five shelves for cooking tools, one refrigerator for food preservation and two tables for processing and slicing food and two trolleys for supplying food and delivering food to patient rooms.

● Dining room

It is to plan to equip 9 eating tables (a table for four people) and 36 seats for staff members of the Hospital.

● Washing room

Like the kitchen, this is a functional division required for the Hospital. Special attention is paid to planning for a special facility as a hospital specializing in treating communicable diseases, so devices for heating water used for killing tuberculosis bacteria are ranked as high priority. In addition, there is a type of machine which combines washing and dehydrating, but such combination will easily cause damage for the machine. It is necessary to prepare a plan for equipping the wash room with a washing machine and a dehydrator.


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Furthermore, specification of washing machine and dehydrator should be very high and advanced in order not to worry about its failures, and its usage and operation should be easy. Equipment for washing room includes two washing machines, two dehydrators, one hot water supply tank for tuberculosis bacteria sterilizer, one iron for patient bed linens, one iron for white clothes/uniforms of doctors and nurses (common type used for family), one operating table for laundry, one laundry table, three laundry carts, one sewing machine for repairing linens, and one table for the sewing machine.

○ Administration Department

● Administration office

・ Desktop Computer The office is planned to have one desktop computer for keeping medical records required for management work of the Hospital and another one for accounting and HR staff use.

● Instruction table (anteroom)

・ Seats for patients to use while waiting

Because there are four consultation rooms, there will be two benches for patients’ use per consultation room; the total is 8 benches.

● Nap room

・ Bed for night shift doctors

Seat for use by night shift doctors is necessary. It is required to prepare a plan for equipping the dispensary with one seat.

● Conference room (large）

As the main coference room in the Hospital, it is necessary to prepare large size room with furnishing one data projector, a screen for data projector, a white board, microphone system (simple one), and a light box (table type) for each large meeting room.

● Conference room (small)

This small meeting room is to be equipped with one white board.

○ Other rooms

• Mortuary

・ Corpse refrigerator According to EPHS standard of Afghanistan, corpse refrigerator is required for mortuary; furthermore, in case a patient from a remote locality dies in hot period of summer, it takes a few days for patient’s family to come to hospital to receive corpse, thus necessity for corpse refrigerator is very high. It is necessary to plan for equipping one refrigerator for one corpse.

• Workshop

It is necessary to have an operating table and seat for Engineer. This is necessary equipment for maintenance division of the Hospital. It is scheduled to equip an operating table for workshop and two seats for this table.


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2） Machines and Equipment to be transferred

There are some machines and equipment which need to be transferred from room for culture of tuberculosis bacteria of NTP and national communicable diseases hospital to the Project. Detailed list of machines and equipment to be moved is as follows.

Table 2-11: List of Equipment to be transferred and relocated Current base of

equipment Name of part of equipment to be

moved Name of equipment Qty.

Refrigerator for medicine preservation

1

Incubator 3


1

refrigerated centrifuge 1

Room for culture of tuberculosis

bacteria

Safety cabinet 2

Laboratory table 1 Common culture room Centrifugal machine 1

Cleaning table 1 Solvent room

Solvent hardener 1

NTP


1

National infectious

diseases hospital

Testing division

Medical laboratory

Biochemnical testing room CD4 table 1

3) Main specification of equipment

Main specification of equipment in this plan is as follows.

Table 2-12: Main specifications of Equipment Name of equipment Main specification

PC for hospital management division

OS: Windows 7, Language：Thailand, English, Software: Word, Excel; Monochrome laser printer

Light box Table type, cliff three films type

Washing machine Capacity: 30kg, three-phase circuit power supplies

Dehydrator Capacity: 30kg

Bed (for adults) One manual crank type, (The backrest is upper and lower), bed with side rail, caster addition, mattress addition

Cabinet near bed Size : (W)500 x (D)500 x (H)700mm

Bed (for children) Size : (W)1400 x (D)800 x (H)1200mm, caster addition, mattress addition

Table on bed Size : (W)1280 x (D)400 x (H) 650-950mm, caster lock function addition, 2 legs type.

blood pressure meter mercury type, measurement range: 0-300mmHg

Clinical thermometer Electronic clinical thermometer


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Scales (for adults) Analog type and the maximum measurement weight: 100kg

Scales (for baby) The maximum measurement capacity: 20kg, measurement precision: 50g

IV stand Made of stainless steel

Medicine cupboard Size : (W)1200 x (D)400 x (H)2400mm

Apparatus cupboard Size : (W)1200 x (D)450 x (H)1800mm

Bed, Urinal, suspender set Bed 10, Urinal 10, suspender set 1

Oxygen saturation level meter Portable type

Electrocardiograph 3 channels, With analytical function

Portable suck machine With cart

Oxygen cylinder With movable cart

Examination table Size : (W)750 x (D)1800 x (H)700mm

Medical examination light Light bulb type

Digital X Ray machine Generator: 80KW, TV camera: One million pixels CCD, monitors: 18"LCD, Radiation protection apron

Laboratory table Size : (W)1500 x (L)4350mm, a shelf in the center of the laboratory table, addition sinks in both sides of the laboratory table, the faucet is 3 three-pronged , built-in the power supply outlet.

Automatic autoclave for laboratory

With dry function, Capacity : 50L

Distilled water-making machine

Capacity: 20L/hour, with prefilter, three-phase circuit power supplies

Ultrasonic washer Table type, 5.5L, Timer ：0-99 second

Electronic balance

Measurement precision：0.1g, The maximum measurement capacity ：200g

Dry heat sterilizer 160L, Natural convection method, independent over prevention machine attachment

ESR rack Rack material: plastic, Rack capacity: 10 pipets, Pipet materials: glass

Haemoglobinometer Measurement range：0-25g/dL

Spectrophotometer Range of measurement wave length: 340-999 nm,

Width of wavelength: 8 nm, sample quantity: 1mL, Optical accuracy: 1%, display: LED

Centrifugal machine Swing rotor, size of test tube: 5 cc

Safety cabinet BSL-IIB class, with exhaust duct

Incubator

150L, air jacket nature convection method, temperature adjustment accuracy ±0.2℃,independent over prevention machine attachment

Automatic autoclave Capacity: 120L, electric steam generator, with prefilter

Equipment repair table Size : (W)1200 x (L)1800mm

Corpse refrigerator Temperature: 0℃ ～ 10℃, Size : (W)950 x (D)2300 x (H)1600mm, Front opening and closing type


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2-43

4) List of Equipment

Equipment to be furnished for the Project are listed on the following table.

Table 2-13: List of Equipment

Consultaton roomDressing roomX-ray roomBiochemistry roomCulture room for TBBacteria test roomCulture roomDrug testing roomSterilizing room for Lab.W

ardPharmacySterilizing roomAdministrative UnitReception (waiting hall)Doctor's roomNight duty roomLaundryKitchenDiningConference room 1Conference room 2W

ork ShopKitchen for NurseryMortuary

1 Digital X-ray System set 1 12 X-ray viewer, stand type units 2 1 13 X-ray viewer, table type units 6 64 X-ray Protection Apron set set 1 15 Electrocardiogram units 4 2 26 Pulse Oxymeter units 12 127 Examination Lamp units 6 68 Scale for Adult units 6 69 Scale for Infant unit 1 1

10 Portable Aspirator units 10 1011 Sphygmomanometer units 6 612 Stethoscope units 6 613 Thermometer units 30 3014 IV stand units 21 3 1815 Stretcher on wheels units 2 216 Wheel chairs for adult units 6 617 Wheel chairs for child units 2 218 Oxygen Syrinder units 10 1019 Oxygen Syrinder Cart units 10 1020 Oxygen Flow Meter and Humidifier units 6 621 Dressing set sets 33 12 9 1222 Dressing Trolley units 3 323 Sharp container units 12 1224 Safety Cabinet unit 1 125 Autoclave units 2 226 Cast set units 10 1027 Boiling Sterilizar units 3 328 Water purification system unit 1 129 Special Table for Laboratory set units 6 4 1 130 Experimental Table unit 1 131 Laboratory Counter A units 2 232 Laboratory Counter B unit 1 133 Sink units 2 234 Spectrophotometer unit 1 135 Balance unit 1 136 Centrifuge unit 1 137 CO2 Incubator unit 1 1

CodeNo.

Allocation

Unit Q'tyName of Equipment


FINAL REPORT

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38 Incubator unit 1 139 ESR rack unit 1 140 Hemogrobin meter unit 1 141 Microscope unit 1 142 Microscope for Mararia unit 1 143 Ultrasonic Cleaner unit 1 144 Refridgerator A units 2 1 145 Refridgerator B units 3 1 246 Bed for adult units 80 8047 Bed for child sets 10 1048 Bed for night duty unit 1 149 Bed for nurse night duty units 4 450 Bed for family of child units 10 1051 Bed side table units 80 8052 Over bed Table units 80 8053 Bedpan, Urinal and Rack set sets 2 254 Cabinet for Equipment units 8 6 255 Cabinet for Medicine units 4 2 256 Pedal Waste Bin units 6 657 Examination Table units 6 658 Dressing Table units 3 359 Desk for X-ray room unit 1 160 Desk for Consultation room units 6 661 Chair for Consultation room units 6 662 Chair for Dressing room units 3 363 Chair for Patient units 6 664 Chair for Dining units 36 3665 Chairs (long) for Waiting hall units 8 866 Chair for Dirty area Table units 2 267 Chair for Sterilizing room units 2 268 Chair for Work Shop units 2 269 Chair for X-ray room unit 1 170 Chair for Special Table units 14 8 2 2 271 Chair for Laboratory Counter units 8 4 2 272 Chair for Iron Table unit 1 173 Chair for Laundry Working Table units 4 474 Chair for Sewing Table unit 1 175 Iron Machine for Hospital Clothing units 2 276 Iron Machine for Patients Sheets unit 1 177 Iron Table unit 1 178 Washing Machine units 2 279 Extractor Machine units 2 280 Laundry Cart units 3 381 Sewing Machine unit 1 182 Cooking Oven units 2 283 Cooking stove units 4 484 Refridgerator unit 1 185 Serving Wagon units 2 286 Mortuary Refridgerator unit 1 187 Shelf for Laboratory room units 3 2 188 Shelf for Pharmacy units 2 289 Shelf for Sterilizing room units 2 290 Shelf for Work Shop unit 1 1

CodeNo.

Allocation



FINAL REPORT

2-45




91 Shelf for X-ray room unit 1 192 Shelf for Kitchen units 6 5 193 Working Table for Kitchen units 3 2 194 Working Table for Laundry units 2 295 Working Table for Sewing Machine unit 1 196 Working Table for Dirty area unit 1 197 Working Table for Sterilizing room unit 1 198 Working Table for Work Shop unit 1 199 Table for Dining units 9 9100 Data Projector unit 1 1101 Screen for Data Projector unit 1 1102 Mike & Speaker System unit 1 1103 Desk top PC units 2 2104 Printer units 2 2105 White Board units 2 1 1

CodeNo.

Allocation


5) Countermeasure for voltage change, power cut-off and quality of water

• Handling voltage change

In order to protect medical equipment sensitive to power fluctuations, they are to be equipped with AVR (Automatic Voltage Regulator); for such special equipment as spectrophotometer, haemoglobinometer, drug cabinet and centrifugal machine, these will be provided with a special countermeasure for voltage fluctuation.

• Handling power outage

In order to prevent data loss due to regular power cuts, PCs of management division and control panel division of automatic autoclaves, etc. will be supplied with UPS (Uninterruptible Power Supply) units.

• Handling hard water

Because water used is hard water, it is to further install soft water making machine at automatic autoclave and prefilter at distilled water making machine so as to protect equipment.

• Quantity of consumables need to be ordered in advance

As disputes often occur in Afghanistan, management of consumables after import of equipment should be on rotation; it is necessary to identify how long is delivery from the date of purchase order to prepare a plan for provision of consumables used within 6 months so as to avoid lack of consumables.

Documents

Chapter 1 Background of the Project · 2010. 12. 15. · Dubai3 unit WHO Drinking water standard Japanese drinking water standard Temperature 14 19 22 22 22 ℃ - - Color Clear Clear