Chapter 2. Contents of the Project Chapter 2. Contents of the Project
2-1 Basic Concept of the Project
2-1-1 The Project and its Higher Objectives
“Health Sector Strategic Framework 1999-2004” is South Africa’s health sector development plan at national level. It emphasizes the need to
1) consolidate achievements in improving access to care and advancing equity, 2) deal decisively with the HIV/AIDS epidemic and its ramifications which threatens to undo our developmental gains 3) stabilise the hospital sector, and 4) adopt a multidimensional approach to ensure steady improvement in quality of care
In accordance with the Framework, the Limpopo DOHW make a strategic plan with a vision that “A caring and developmental health and welfare system which promotes well-being, self-reliance and humane society in which all people in the Limpopo province have access to affordable and good quality services”.
The Project is in accordance with “District Health Services” and “Provincial Hospital” plan raised in the
Strategic Plan for April 2003-March 2004 by the Limpopo DOHW and it can contribute to achievement of above goals.
The Limpopo DOHW attributes poor provision of health services and malfunctioning of hospital to its incomplete health system and they try to improve them by using the budget of “District Health Services” and
“Provincial Hospital”. They put more than half of the Limpopo DOHW’s budget to “District Health
Services”. Despite their effort, it is not easy to improve the whole health service provision system in the province. Thus the Limpopo DOHW has requested the Government of Japan for procurement of medical equipment and construction of clinics in the Greater Tzaneen SD where 3 tribes live together and where more delicate considerations in providing health services are needed.
This Project targets at improvement of primary and secondary health services through procurement of medical equipment and construction of clinics in the Greater Tzaneen SD (population of 380,000, data of 2002).
5 2-1-2 Basic Concept of the Project
The Project involves the following inputs to achieve the above mentioned goal.
Provision of equipment with Letaba regional hospital Provision of equipment with Dr. C. N. Phatudi district hospital Provision of 27 clinics Provision of equipment with 4 Health centres Provision of 4 V.P. shelters for mobile clinic
The Requested Japanese Assistance will include the following inputs.
Procurement of medical equipment to Letaba regional hospital Procurement of medical equipment to Dr. C. N. Phatudi district hospital Procurement of medical equipment to 24 clinics Construction and procurement of medical equipment to 3 clinics Procurement of medical equipment to 4 Health centres Procurement of vehicles for mobile clinic activities Construction of 4 V.P. shelters for mobile clinic Technical assistance by consultant (Instruction on Management Method of Equipment Maintenance) to Letaba hospital
6 2-2 Basic Design of the Requested Japanese Assistance
2-2-1 Design Policy
(1) Equipment Planing
1) Basic Policy a. Assistance to improve quality of health services of the lower income class
More than 200 thousand out of 380 thousand population of the Greater Tzaneen SD are either seasonal workers or the jobless and their family suffering poverty. Most of their diseases are the life-style related diseases, such as STD, hypertension, upper respiratory disease, mental disorder, diarrhea, HIV/AIDS, etc.
Each health facility in the project site offers their services practically free of charge.
The Requested Japanese Assistance shall aim at primary health facility (district hospital, health centre and clinic) and secondary health facility (regional hospital) which are responsible for health improvement of the people suffering poverty in the Greater Tzaneen SD.
b. Assistance to strengthen regional health and referral system
The Requested Japanese Assistance shall include assistance for revitalization of regional and referral system which is not functioning properly.
c. Scale of assistance according to the present staff allocation
In most of the facilities of the project site, as few as 70% against the staff allocation plan are filled. They always suffer shortage of personnel, which has caused delay in their activities.
Thus, the scale of the Requested Japanese Assistance shall be set up according to the present condition of staff allocation.
2) Equipment Policy a. Selection of equipment
① Regional / District Hospitals
They already have such basic equipment as stethoscope, blood pressure monitor. Even if they lack, they can
7 purchase them with their budget to be allocated as of the fiscal year 2003.
The equipment that are urgently needed due to breakdown or superannuation shall be excluded from the assistance and shall be procured by South African side. On the other hand, the equipment that need to be periodically renewed for their normal activity shall be examined on its validity and suitability according to their actual activities and availability of doctor, etc.
② 4 Health centres / 27 Clinics
Most of the facilities still use the basic equipment for nurse that were procured in 1994 to 97 at the opening of facility. Renewal has been delayed for a long time. The Limpopo DOHW is responsible for procurement of equipment but they are not able to allocate enough budget. Therefore, the basic equipment for nurse shall be examined under the Requested Japanese Assistance according to their activities, number of staff / patient, etc.
However, general furniture such as fan, refrigerator, bed, examination couch, etc. are overstocked in most of the facilities and shall not be examined. Incinerator shall not be examined either as it can cause environmental pollution by generating dioxin.
For the 3 clinics to be newly constructed, the existing equipment shall be transferred, as a rule, but for some old equipment, renewal plan shall be considered to make opening of the new facility smooth.
③ Mobile Clinic
Important part of the PHC in the Limpopo Province rely on mobile clinics. Their activities involve 1) medical examination and medication, 2) maternal examination, 3) vaccination, 4) child examination, 5) health promotion and 6) home based care. A vehicle with 3 to 6 health staffs visits 40 to 50 visiting points a month.
Examination for mobile clinic vehicle shall be based on the fact that most of the existing vehicles were procured before 1993, that they are not built for mobile clinic activity securing space for patient’s privacy, that the requested vehicles are exclusively built for mobile clinic activity and can not be used for other purposes, and that mobile clinics are the most familiar way for the people of low income level to get access to
8 medical services. Examination shall also be done to help improve their activity without requiring any modification on number of staff and of administrative budget. No equipment for visiting point of mobile clinic shall be examined.
Based on the policies discussed above, equipment planning under the Requested Japanese Assistance shall be done by following the principles below.
Table 2-1 Principle of Equipment Selection Included in the assistance Excluded from the assistance 1. Equipment that renew the old equipment 1. Equipment that are already or will be procured by the recipient side 2. Equipment of which shortage is a serious problem 2. Equipment whose requested quantity is more than necessary for normal activity 3. Equipment that is indispensable to activities of the 3. Equipment designed for purely academic purpose facility 4. Equipment that are easily managed and maintained 4. Equipment that require large amount of maintenance cost and can be substituted by other simple alternatives 5. Equipment with large beneficiary effects 5. Equipment with little beneficiary effects 6. Equipment with low cost effectiveness 6. Equipment with cost ineffectiveness 7. Equipment with usefulness 7. Equipment with little usefulness 8. Equipment requested for personal purposes 9. Common furniture, general office apparatus, consumables which do not influence activity of the facility
b. Specifications of equipment
In renewing equipment, specifications of equipment shall be equivalent to and based on those commonly used in the existing facilities. As the project facilities are either secondary or primary health facilities, highly sophisticated equipment shall be excluded.
c. Quantity of equipment
Shortage of doctor is one of the most serious problems for the project hospitals. Most of the hospitals are obliged to employ foreign doctors and sometimes professional nurses have to do what should be done by doctors, for example, delivery. Therefore, quantity of equipment shall be examined by confirming who will use the equipment. It shall also be based on the existing number of patient and their present workload.
d. Maintenance skill
9 It is difficult to observe an established equipment maintenance system in the project facilities. Equipment maintenance is done by outside agents. Therefore, the equipment that are easily managed and maintained shall be examined and those equipment that require periodical checkups, repair, replacement of spare parts, etc. shall be procured from the manufacturers that have distributors in South Africa.
e. Procurement of equipment
The equipment that do not require consumables or spare parts shall be the products of either South Africa or
Japan. For the equipment that require periodical replacement of spare parts or consumables and for the equipment that need to be taken care of by a professional maintenance staff, they shall be procured from the manufacturers with an agent in South Africa that can respond to those requirements. For those equipment, products from the third country shall be examined too.
f. Environment
With regard to installation of X-ray unit, suggestions shall be given concerning risk avoidance of radiation leak and its protection, for example.
Incinerator shall not be examined under the Requested Japanese Assistance as it can cause environmental pollution by generating dioxin.
(2) Building Design
1) Basic Policy on Building Design
Regarding clinics, they are the front line of primary healthcare and welfare services but the number of staff working there is limited. When planning them, which function well within the local healthcare service system, the relations between the clinics and higher level medical institutions should be taken into consideration. Idle and excessive space is to be eliminated for efficient facility with most suitable scale thereby minimizing the construction cost as well as running/maintenance cost. For example, a facility is to be planned by analyzing the user, staff and service flows in order to simplify the flow so that minimum
10 number of staff is required for running it.
Regarding V.P. shelter for mobile clinic, a waiting area for patients/residents and a parking space for a mobile clinic vehicle are to be included. Though the V.P. Shelter is of a simple structure, it should be made durable and not to be easily damaged.
Refer to Higher Level Institutions
VCT Vaccination General etc.
Obstetric
Mather&Child Care
Reception
The Pregnants Ready for Delivery
Out Patients
Fig. 2-1 Function of a Clinic
2) Policy for Functional Configuration a. Clinic
According to the Terms of Reference (TOR) regarding Capital Works Planning Programme issued by the
Limpopo DOHW, all clinics are to provide an obstetric function and 24-hour medical services as a goal.
Each clinic building is therefore required to have the functions shown in Table 2-2. A clinic building is also required to be easily expandable in order to cope with future population growth within its catchment area.
As a policy, therefore, this project will provide clinic facilities with obstetric function as well as general medical care and expandability. As provision of 24-hour medical services, however, largely depends on management/administration system of the facility, e.g., assigning enough number of nurses for carrying out two shifts and availability of staff quarters, therefore, it shall be excluded from the Japanese Assistance
11 .
Table 2-2 Rooms and Functions of a Clinic Health and Management No. L S Room Function 1 ● ● Office (Social) Inquire income level etc. of patients/residents before treatment 2 ● ● Office (Health) Check health conditions of patients, carry out vaccination etc. 3 ● Health Inspector Health Inspector’s office 4 ● Com Dev. Officer Com Dev. Officer’s office 5 ● ● Waiting Area1 Waiting room for 60 persons, health/ hygiene education etc. 6 ● Staff WC(M/F) 7 ● ● WC(M/F/Disabled) 8 ● ● Cleaners Cleaners’ room Maternity and Clinic 9 ● ● N. Station/Reception Reception after screening. 10 ● ● Records Medical record room 11 ● ● Waiting2 Waiting room: for 14 persons (L), 7 persons (S) 12 ● ● Consultation 1 VCT services, collecting specimen 13 ● ● Consultation 2 Counseling for contraception, Maternal & child health (S) 14 ● Consultation 3 Maternal & Child Health: Maternal & child health services including medical examination services for infants and prenatal women are provided 15 ● Consultation 4 General consultation 16 ● ● Treatment Treatment, injection, dressing 17 ● ● Pharmacy This room is for dispensing drugs to patients. Medicine store and dispensary 18 ● ● Store Store linen and medical equipment 19 ● ● First Stage First stage room for pregnant women 20 ● ● Labour Rm Normal case delivery services are provided by midwifes. Abnormal deliveries are not conducted in this facility. Prenatal women, who need Caesarean section, are referred to the hospital. 21 ● ● Post Natal This room accommodates postnatal women at least 6 hours. Baby bath is also installed in this room. 22 ● ● Sluice This room is to handle dirty items, e.g. linen, from the treatment room, delivery room, etc. 23 ● ● Laundry Laundry for linen, etc. 24 ● ● Kitchen 25 ● Nurse Restroom 26 ● ● Staff WC L: Large size clinic, S: Small size clinic
b. V.P. Shelter
According to the TOR issued by the DOHW, a V.P. Shelter is to have a designated parking for a mobile clinic vehicle and patients’ waiting area. The Limpopo DOHW has already planned and/or constructed permanent
V.P. Shelter structures, which can easily become a small size clinic building by remodeling and expanding, for the areas whose populations are predicted to be over 5,000 in the near future.
The requested Project sites are out of the area mentioned above and are not required to have the same kind of
12 structure that is expandable to become a small clinic building. In principle, a covered space for patients’ waiting area and a mobile clinic vehicle is to be made.
3) Determination of Floor Area a. Clinic
In South Africa, R158 Regulation prescribes medical/healthcare facilities and floor areas of required rooms need to follow this regulation. The TOR of the Limpopo DOHW, which is based on R158, stipulates the standard sizes of clinics based on their catchment area population. An area with population smaller than
5,000 is covered by mobile clinic service. An area with population between 5,000 and 20,000 is to have a small size clinic and an area with population greater than 20,000 a large size clinic. The standards for clinic facility are also stipulated that are to be followed when planning new clinics.
Since the facilities to be constructed under this project are to be used and managed by the Limpopo DOHW administration, the facilities need to adhere to the norms set by the Limpopo DOHW. Therefore, the size of the facilities shall be decided based on the TOR and to be the most appropriate by eliminating unnecessary area.
Medical room specifications and layouts issued by CSIR, which are commonly used for designing public health facilities, will also be used as a reference for planning (e.g. dimension of the rooms).
b. V.P. Shelter
As mentioned above, the V.P. Shelters of this project does not need to be the type that is expandable to a standard small size clinic. Therefore, a simple shelter with a wall on one side that will protect patients from rain and harsh sunlight while they wait and a parking space for a mobile clinic vehicle will be provided under this project.
13
4) Site Conditions a. Clinic
All three proposed sites for clinics are inclined with a minimum level difference of two meters within the sites.
Taking environmental impact into consideration, site layout and building plan should be made such that minimum land development is required. The volume of excess soil is to be minimized and used/disposed of within the site.
The site plans of the three clinics are shown below.
E FENCE FENC FENCE
51
6 CE FEN FE NCE
51 5
KERB
7 OLD ENTRANCE 51 514.982 515.267 RT ROAD 515.231 DI
515.368 E PPRRROOOJJJEEECCCTT SSIIITTTEE C N ELECTRIC POLE E D F A O R E 515.578 R C A N T E F 51 5 515.811 BOREHOLE 516.208
516.267 E C N E 516.303 F 516.579
5
16
62850 Y E
C 62750 Y 43150 X N 43150 X E F
516.925 517.204 N 517.219 ELECTRIC POLE E C N E E C F D A N O E R F
R A T
7 51
Fig. 2-2 Letsitele Clinic Site
The infrastructure such as electricity, water, telephone is available from the front street
14 ELECTRIC POLE SEPTIC TANK
7
2
5
0 590.719
N 0
Y ELECTRIC POLE 47800 X INSPECTION HOLES
WASHING LINE 591.924 591.491 591.400 591.092 HOUSE 589.088 589.473 590.469 HOUSE 592.172 589.742 TE 590.915 I 591.893 592.399 588.828 5S90.178 591.671 OPEN TESTPIT T 592.253 CT 591.604 588.562 JE 590.949 O TELEPHONE POLE 588.247 PR 587.443 PROJECT SITEWATERTANK 587.021 TREE CONCRETE 587.524 FOOTPATH
MANHOLE
OPEN TESTPIT WATERTANK
591.070 TOILETS 590.568 GUARDHOUSE GATE CLINIC
591.709
590.914 OP EN WATERTANK TE S TP I T
RAMP UP
590.908
DISUSED CONCRETE DAM
CONCRETE SLAB
90 5
7
2
4
0
0
Y 47900 X
Fig. 2-3 Mohlaba Clinic Site
Electricity and telephone are available. Water shall be provided by boring a new well or laying a new supply pipe from the nearby reservoir tank by South African side.
DIRT ROAD
FENCE
N 00 Y 00 7676000 0 Y 624.056
5710057 100 X X 75800 Y 57100 X
DIRT ROAD FENCE 624.765
625
625.341
FENCE 625.572
625.881
DIRT ROAD 626.338
FENCE PPRRROOOJJJEEECCCTT SSIIITTTEE 626.938
627.410 75800 Y 57200 X 627.895 DIRT ROAD 628.076 FENCE
628.481 628.704 628.839 FENCE 628.906 629.124
DIRT ROAD FENCE
PIPE CULVERT UNDER ROAD FENCE
Fig. 2-4 Maake Clinic Site
Electricity and telephone are available. Water shall be provided by laying a new
supply pipe from the water main approximately 500m away by South African side.
15 b. V.P. Shelter
It is mandatory that the set back distances from boundary lines required by law be kept when positioning V.P.
Shelters in the Project sites. The user access and vehicle flow to the shelter shall also be taken into consideration and if the size of the Project site is large enough, layout should be made to allow future expansion.
5) Natural Conditions
The Project sites belong to a tropical zone. The highest monthly average maximum and minimum temperatures are 27.8℃ and 18.4℃ respectively in January and the lowest monthly average max. and min. temperatures are 21.2℃ and 11.4℃ respectively in July. In principle, no heating device will be installed and natural ventilation is to be fully utilized. Ceiling fans are to be installed and insulation on roofs and outer walls is to be enhanced in order to obtain a comfortable indoor environment. However, an air conditioning unit will be installed in the pharmacy because the sites are situated within the heat zone, which has an average max temperature of more than 25℃ for over 10 days per year, defined by the Limpopo DOHW requiring installation of air conditioner.
Insect screen on windows will not be installed since malaria case is not common in Greater Tzaneen SD.
6) Building Code and Building Permit
South Africa has a well-established building code. According to the building code, details of every architectural plan are subject to official approval prior to the commencement of construction work. In implementing the Project, it is essential to comply with the local building code and to follow the appropriate procedures for obtaining the building permit. The building laws and regulations that are applicable to the
Project are as follows.
National Building Regulations and Building Standard Act 1997
R158 Regulations
Limpopo Province Department of Health and Welfare Terms of Reference
16 Major design and specification standards prescribed by the South Africa Bureau of Standards (SABS) are as follows.
Table 2-3 List of SABS’s Major Standards SABS 0400 The Application of the National Building Regulations SABS 0161-1980 The design of foundations for buildings SABS 0160-1989 The general procedures and loadings to be adopted in the design of buildings SABS 0100-1:1992 The structural use of concrete Part 1: Design SABS 0139-1981 The prevention, automatic detection, and extinguishing of fire in buildings SABS 0114-1:1996 Interior lighting Part 1: Artificial lighting of interiors SABS 241-1984 Water for domestic supplies SABS 543:1992 Fire hose reels (with hose) SABS 1128: Part I-1977 Fire fighting equipment Part I: Components of underground and above hydrant systems SABS 1253:1994 Fire-door and fire-shutters
For the urban planning-related regulations, the Project shall comply with the following regulations which are enforced by the Greater Tzaneen Municipality.
Table 2-4 Regulations Applicable to the Project Site Building type： Institution restricted to medical use Size restriction： Floor coverage: 60％、Floor area rate: 50％ Height restriction： Unrestricted Building lines： on street:7.5ｍ, side and rear spaces: 4.5m+（1.5ｍ× number of storey-1） Parking requirements： One per floor area 150 ㎡+one per two staff members
It is not necessary to obtain building permit from the local authority for this Project but the Limpopo DOHW shall notify the local authority regarding the Project prior to commencement of the construction work instead.
Therefore, after obtaining approval for detail design of the Project from the Limpopo DOHW, it shall submit a notification of the Project to the local authority. The following table gives an outline of the procedures.
Table 2-5 Outline of Procedures for Building Permit Authority： Tzaneen Municipality Submission timing： After approval to the Detail Design by DOHW
7) Local Construction Condition
South Africa outperforms other African countries in terms of the level of building technology and experience of construction work. South Africa also has its own building standards, which are based on the British
17 Standard. All major building materials are manufactured in compliance with the local standard and available in local market. Therefore, the application of Japanese standards for construction work is not effective for local construction. For this reason, local construction methods, which are considered highly reliable in compliance with the local building standard, should be used for construction.
8) Local Consultants and Contractors
In South Africa, local consultants and contractors have experience in construction of public health facilities, of which qualities are very high and technology used are sophisticated. Thus, their experience and construction technology are judged reliable to be utilised for the Project.
However, because financial stabilities and technical skills of local contractors are different substantially, it will be necessary to screen their capabilities by examining their financial records, experience, etc. in selecting local sub-contractors for the Project.
9) Grade of Facilities
The grade of equipment and finishing materials should be determined on the basis of other existing clinics, and the standards of health facilities in South Africa. Centralised air-conditioning system, which requires high-level maintenance and management capabilities and high operation costs, are not considered to this
Project. For selection of building materials, priority should be given to durable and locally common materials in terms of reducing the maintenance and management cost.
10) Maintenance and Management
As qualified engineers will not be assigned to the new clinics, attention should be given to selection of equipment and materials in terms of required technical skills for operation and maintenance. When selecting equipment, especially the ones which need regular maintenance, the specification of the item shall not be of high quality so that the running/maintenance cost will not be burden to the clinic. The degree of ease for obtaining consumables and spare parts should be of the priority of selection.
18 11) Construction Schedule
It must be considered in the construction scheduling that in South Africa the construction industry is under vacation from December 15 to January 10. Easter season in April also is a common vacation period. Thus, during these periods, no progress will be expected in any construction work in principle.
Since the climatic condition around the Project site is fairly mild, it is not necessary to consider seasonal variations in the progress of construction except for the rainy season between October and March. To avoid negative effect of heavy rainfall, neither earthwork nor roofing work should be carried out during this period.
19 2-2-2 Basic Plan
2-2-2-1 Equipment Plan
(1) Overall Plan
The Requested Japanese Assistance covers equipment provision for 1 regional hospital, 1 district hospital, 4 health centres, 27 clinics, 3 of which are to be newly constructed. It also includes vehicles for mobile clinic activity and construction of V.P. shelters.
Table 2-6 shows overall plan and outline of the equipment planning of the assistance by each sector.
Table 2-6 Overall Plan（Outline of equipment planning） Project Facility Sector Outline of equipment planning Letaba Regional Emergency OPD Most of equipment are already provided. Instrument set for treatment Hospital (4 sets) shall be replaced. OPD 1 Blood pressure monitor shall be provided to reduce the screening time. Instruments need to be replaced. 2 old Dental unit s shall be renewed to support the activity of 2 dentists and 3 assistants. Specialized OPD 1 ECG, 1 Ultrasonic nebulizer, and 2 Instrument set for treatment shall be replaced. As there is no ophthalmologis, only Traial lens set shall be provided. Gynecology 1 Cardiotokograp, 4 Instrument set for delivery and 2 Instrument set /Obstetrics for Obstetric/Gynecology examination shall be to renewed or replaced to promote safer delivery. Pediatrics 1 Infant warmer, 1 Neonatal monitor and 1 Phototherapy unit shall be replaced and renewed to support neonatal care. Theatre Most of equipment are already provided. Instrument sets shall be replaced. CSSD 1 old High pressure steam sterilizer shall be replaced. ICU 4 Infusion pumps to be provided for 8 bed ICU Radiology 1 old X-ray unit shall be renewed. Fluoroscopic function shall be needed. Laboratory No equipment shall be provided. Physiotherapy No equipment shall be provided. Laundry No equipment shall be provided for the possibility of outsourcing to a private company can not be eliminated. Dr. C. N. Phatudi Emergency OPD 1 Emergency cart, 1 Defibrillator, 1 Pulsoxymetre, 1 Operation light, District Hospital mobile, 2 Instrument set for treatment, 2 Laryngoscope sets shall be provided to strengthen the function of OPD. OPD 1 ECG, 1 Blood pressure monitor shall be provided to strengthen the screening function. 1 old Ultrasound unit shall be renewed to improve the antenatal check. Gynecology 1 Cardiotokograph, 1 Instrument set for delivery shall be provided to /Obstetrics ensure safe delivery. Pediatrics 1 Infant warmer, 1 Neonatal monitor, 1 Phototherapy unit shall be provided. Provision of ventilator would be excessive. Theatre Instrument set for general surgery, appendectomy and caesarian section shall be provided. 1 Infusion set shall be provided in the recovery room. CSSD, Lab, Eye Excluded from the project for such reasons as no more equipment clinic, Physiotherapy, necessary, it is an independent unit from the hospital, no specialists Laundry available, etc. Dental 1 Dental unit and 2 Instrument set for dental shall be renewed. 4 Health Centres Equipment planning shall be based on size of the population, number of patient and staff, conditions of equipment and facilities, etc. The equipment that has never been used before (ECG, for example) or that has already been procured (Infant warmer, Oxygen generator) shall not be considered. Incinerator shall not be considered for it can emit harmful products into the environment.
20 24 Clinics Equipment planning shall be based on size of the population, number of patient and staff, conditions of equipment and facilities, etc. The equipment that has never been used before (ECG, for example) or that has already been procured (Infant warmer, Oxygen generator) shall not be considered. 3 clinics that has no power supply shall no be provided with the equipment that require electricity. 3 Clinics to be 1 Delivery bed, 2 Dressing trolley, 4 Examination lamp, 3 Medicine constructed cabinet and 1 Suction unit shall be provided as well as other clinic equipment. Mobile Clinic 5 Vehicle for mobile clinic shall be provided to strengthen the activity in the area where poverty prevails. 3 of the requested vehicles shall not be considered for they are used in a private farm.
(2) Examination of the Requested Equipment
Based on the policies mentioned so far, appropriateness and necessity for the requested equipment were examined as follows. Appendices 6 “Examination of the Requested Equipment” shows the results of the examination by equipment.
Classifications The requested equipment are classified as follows. Renewal : Equipment to be renewed New equipment : Equipment new to the facility and to be newly procured Replenishment : Equipment to be replenished in quantity for the existing equipment
Criteria A. Purpose ○ : Basic equipment compatible with the activities of the facility × : Equipment not compatible with the activities of the facility, can be replaced by another simple equipment B. Necessity ○ : Equipment necessary for the basic activities of the facility as the existing equipment has become too old or out of order × : Equipment not necessary because of its cost-ineffectiveness and limited beneficiary group, furniture not essential for the activities of the facility, office apparatus, inexpensive equipment procurable in South Africa and small articles C. Technical Level ○ : Equipment compatible with the technical level of the facility × : Equipment that require higher level of technique than expected from the facility D. Administration Cost ○ : Equipment that can be maintained by the facility, that the manufactures can offer the after sale services and that the consumables / spare parts are procurable × : Equipment difficult to be maintained by the facility, that the manufactures can not offer
21 the after sale services and that the consumables / spare parts are not procurable E. Maintenance Cost ○ : Equipment whose maintenance cost is negligible or bearable by the facility × : Equipment whose maintenance cost is not negligible or not bearable by the facility F. Quantity ○ : Equipment whose requested quantity and allocation plan are judged appropriate by the contents of activities, number of patient and staff △ : Equipment whose requested quantity and allocation plan are judged inappropriate or needed to be adjusted by the contents of activities, number of patient and staff G. Overall Decision ○ : Equipment judged appropriate and included in The Project × : Equipment judged inappropriate and excluded from The Project
(3) Equipment Planning
1) Letaba Hospital a. Emergency OPD
Emergency OPD has just opened recently and major equipment are already provided. 6 beds are separated by curtain and the equipment can be shared by each section. Only Instrument set for treatment (4 sets) that are lacking shall be provided under the Requested Japanese Assistance.
b. OPD ① Specialised OPD
Specialised OPD (Internal medicine, Surgery, Orthopedics, Pediatrics, Obstetrics and Gynecology ,
Ophthalmology) has not opened yet. Basic equipment such as stethoscope, blood pressure machine, etc.) will be purchased by the hospital. The Requested Japanese Assistance shall cover such equipment as ECG
(1), Ultrasonic nebuliser (1), Instrument set for treatment (2) in the Surgery and Orthopedics section. For
Ophthalmology section where no specialists are available, Trial lens set (1) shall be provided.
② OPD (existing)
The existing OPD will be used as a screening section and consultation section for out patients even after the
Specialised OPD opens. As basic equipment are already provided, the Requested Japanese Assistance shall provide Blood pressure monitor (2) to strengthen screening function and reduce the waiting time of patient.
22 Instrument set for treatment, Dressing trolley and Instrument cabinet shall be provided in each 4
Consultation room.
There are 3 dental units and 2 compressors in Dental section, which are all old. The Requested Japanese
Assistance shall cover Dental unit (2) including compressors.
c. Obstetrics and Gynecology
Obstetrics and Gynecology Department has 4 delivery rooms and major equipment are already provided.
2,232 delivery are performed in 2002, of which 362 are caesarian section. The Requested Japanese
Assistance focuses on obstetrics and shall provide Cardiotocograph (1) to promote safer delivery.
d. Pediatrics
Pediatrics Department covers from neonates to 14-year-old child. Neonates are treated in this department after treated in the Neonatal Ward. There are quite a few pregnant women with some complication in this secondary hospital and there were as many as 390 cases of premature birth (weight less than 2,500g) in 2002.
The department is divided between Neonatal Ward (6 incubators) and NICU (1 infant warmer). There are enough number of infant warmer so it is not included in the Requested Japanese Assistance. There are 1 infant warmer, 1 neonatal monitor, 1 pulse oxymetre in NICU but they are not enough in number.
Thus 1 Infant Warmer and 1 Neonatal Monitor shall be added in the NICU under the Requested Japanese
Assistance. 2 Ultrasonic nebulisers shall be provided to fight against infantile asthma.
e. Theatre
3 out of 4 operation theatres are not used due to breakdown of air conditioner. All the 4 rooms are basically equipped with operation table, operation light, patient monitor, anesthesia machine and ventilator, defibrillator, etc. Under the Requested Japanese Assistance, Operation Instrument Set that are lacking in number
(Appendectomy, Finger Bone, Gastrectomy, Hand Surgery, Nephrectomy, Cholecystomy Prostatectomy,
Caesarian Section and General Surgery) shall be renewed. Instrument Set for Biopsy shall also be provided based on the number of operation performed.
23 f. CSSD
In this newly built CSSD, there are 3 high pressure steam sterilisers that were transferred from an old facility,
2 of which are out of order. The hospital has requested the Limpopo DOHW for renewal because breakdown of the last one can stop all the hospital function. But renewal schedule is not yet fixed.
If all the 4 machines do work, the number of operation per year (1,298 in 2002) could double or triple (about
3,000). Therefore, on condition that the Limpopo DOHW shall renew one of them, the Japan side shall provide another one.
g. ICU
8 bed-ICU is equipped with 8 ICU beds, 8 ventilators, 8 patient monitors, 1 blood gas analyzer. 4 Infusion
Pumps against 8 beds shall be provided for medication to serious patients under the Requested Japanese
Assistance.
h. Radiology Department
The department has 2 x-ray units, one of which is so old (1986) that it often malfunctions and maintenance cost is so high. Both units do not have fluoroscopic function to capture gastrointestinal images. Therefore, under the Requested Japanese Assistance, 1 X-ray Apparatus, basic screening unit shall replace the old one and fluoroscopic examination shall become possible.
i. Physiotherapy Department
Physiotherapy (Rehabilitation) Department is well equipped with basic equipment for exercise and occupational therapy. Therefore, despite of its importance in rehabilitation of patients after orthopedic surgery, this department shall be excluded from the Requested Japanese Assistance.
j. Laboratory
Presently the Laboratory Department is administered by National Health Laboratory Service (NHLS). The hospital does not own or control any part of the department. Therefore, it shall be excluded from the
Requested Japanese Assistance.
24 k. Laundry
Laundry equipment (washer, extractor, dryer) are very old. But the hospital plans to consign the laundry to outside supplier. Therefore, it shall be excluded from the Requested Japanese Assistance.
2) Dr. C. N. Phatudi a. Emergency OPD
Emergency OPD has a treatment room and ICU but does not function properly due to shortage of equipment.
Under the Requested Japanese Assistance, 1 Defibrillator, 1 Pulse Oxymetre, 1 Operation Light, mobile with battery back up and 2 Instrument Sets for Treatment shall be provided to help treat emergency patients.
b. OPD
OPD is always crowded with patients and it needs to strengthen its screening function. Under the Requested
Japanese Assistance, 1 Blood Pressure Monitor shall be provided to reduce the screening time of patients.
1 Ultrasound Scanner and 1 ECG shall also be provided to strengthen its examination function.
c. Obstetrics and Gynecology
2 Delivery rooms are almost equipped with basic equipment. But there are no equipment to see the condition of a fetus and judgement of emergency cases. Therefore, under the Requested Japanese Assistance, 2
Doppler Fetal Detector and 1 Cardiotocograph shall be provided to promote safer delivery.
d. Pediatrics
Enough number of infant incubators are already provided. 1 Infant Warmer, 1 Neonatal Monitor and 1
Phototherapy Unit shall be provided under the Requested Japanese Assistance.
e. Theatre
2 operation theatres are well equipped with necessary equipment. Operation Instrument Sets that are lacking (Appendectomy, Caesarean Section and Genaral Surgery) shall be supplemented. As there is no ICU in a disctrict hospital, 1 Infusion Pump shall be provided in the Recovery room.
25 f. CSSD
One of the 2 high pressure steam sterilizers is out of order but is still able to be used after repair. Therefore,
CSSD shall be excluded from the Requested Japanese Assistance.
g. Radiology Department
There is 1 x-ray unit, 1 mobile x-ray machine and 1 automatic film developer, all of which are new. There is no need to renew them.
h. Dental Department
Both of 2 dental units are very old and one of them is beyond repair. Therefore, the worse one shall be replaced by the Requested Japanese Assistance to assist their activities.
i. Laboratory, Ophthalmology, Physiotherapy, Laundry
These departments shall be excluded from the Requested Japanese Assistance since, as in the case in Letaba
Hospital, they are administered by a different body, there are no specialists, etc.
3) Health Centre/Clinic
The Requested Japanese Assistance shall assist their activities and improve the quality of services through renewal and provision of basic medical equipment used by nurses.
a. Blood Pressure Monitor
Each facility except 3 clinics which have no power supply shall be supplied with 1 Blood Pressure Monitor.
It is expected that this equipment will reduce the time and workload of staff for patient screening.
b. Autoclave (table top)
Health centres and some of the clinics have one or two autoclaves but many of them are out of order. They know the importance of sterilization but they use some disinfecting case filled with solution. Supply of sterilized instruments from higher health facilities has already stopped.
Therefore, all the health centre and clinics except 3 clinics that have no power supply shall be supplied with 1
Autoclave, table top under the Requested Japanese Assistance.
26 c. Glucose Meter
Each facility shall be supplied with 1 Glucose Meter to fight against one of the most prevailing diseases in the Greater Tzaneen SD, hypertension and diabetes.
d. Hemoglobin Meter
Each facility shall be supplied with 1 Hemoglobin Meter. Antenatal examination is a main activity of health centres / clinics. Among them blood hemoglobin test is one of the most important tests for pregnant women.
e. Infant Warmer
Mgodeni Grace (476 delivery per year, 2002) and Nkowankowa (156) Health Centres which exceed by far the other 2 health centres in the number of delivery shall be supplied with 1 Infant Warmer
f. Stethoscope
Most of their stethoscopes are too old or out of order. Each facility shall be supplied with this most basic examination tool as many as the number of the professional nurse.
g. Oxygen Generator
All of the facilities are supplied with oxygen cylinder so it shall be excluded from the Requested Japanese
Assistance.
4) Mobile Clinic a. Vehicle for Mobile Clinic
5 Vehicles for Mobile Clinic shall be renewed to assist the most effective medical services for the people living in a remote area. The vehicle shall be designed to secure the privacy of patients and shall be 4WD type to enable them to run under the bad weather in a bad road. Other 3 vehicles requested are considered to be used in private farms and therefore they are excluded from the Requested Japanese Assistance.
b. Audiomenter
Each vehicle for Mobile Clinic shall be equipped with 1 Audiometer to screen the patient with hearing disorder.
27 2-2-2-2 Construction Plan
(1) General Scheme
The target facilities to be built under this Project are three clinics at Letsitele, Mohlaba and Maake and four
V.P. Shelters at Burgersdorp, Khujwana, Mogoloboto-2 and Pharare, all of which are located within the
Greater Tzaneen SD (NP333, Population: 380,000) of Mopani district (DC33) in Limpopo province.
The population within the catchment area, number of staff, activities being carried out at the three clinics are shown below.
Table 2-7 Catchment Area Population, Staff, Activities of the Clinics Activiities Utility Number of Staff （2002,01～12） Distance Referring Patients HC Clinic from the Hospital Area Area Woking Hospital Guards PN EN Hours ENA, Water Aux.A Population Population supply supply Catchment Annual Under 5 /Cleaner /Cleaner Drainage Drainage Electricity Electricity Gen.Assit
Letsitele 25km ○ ○ ○ 12,530 4 1 1 1 (2) 9 18,182 3,367 HC ○ × ○ Mohlaba Dr. CN 20km * 18,890 2 2 2 2 2 9 18,877 4,930 Nkowankowa Phatudi
Maake 7km ○ ×* × 10,285 3 4 0 2 2 9 13,114 3,606 HC Shiluvana Shiluvana ○：Good、△：Difficulty、×：No service、*: well water Legend （ ）Guards at Letsitele to be provided after completion of the construction
The populations of catchment areas of all three clinics are between 5,000 to 20,000 as shown in the table above. Therefore, the appropriate size for all three clinics is the small size clinic according to the TOR set by the Limpopo DOHW. The building and site plans should be made such that future expansion is possible.
Water supply to the sites at Mohlaba and Maake must be secured by the Government of South Africa before the completion of the construction of the buildings.
A V.P. Shelter shall have a roof and a concrete floor for patients waiting area and a parking area for a mobile clinic vehicle as indicated in the policy.
28 (2) Site Plan
The site plans for the clinics and V.P. Shelters are as follows.
1) Letsitele Clinic (Fig. 2-5)
Of the two streets that the project site is on, the one that is already paved and water and electricity mains are available is the most suitable to provide entrance to the site. The main gate is to be located around the middle of the site slightly off the existing borehole, which provide water to the community. The site will be zoned for clinic area and staff quarters area placing clinic building with sufficient area for future expansion on the north side and staff quarters, which shall be built by the South African side, on the south side of the plot.
Sewage shall be treated in a septic tank and sent to French drains whose location shall be the furthest from the two existing boreholes. The Project site is inclined towards the west and the drainage plan should be made accordingly, e.g. the elevated water tanks to be placed in the east and sewage drain towards the west.
END 516.305
FNC 515.565 FEN C E TREE N CE 515.653 FE
FEN END CE 516.80 2 TRFNEEC RD 51515.15.19396 516.609
TREE SE PT IC T ANK 515.272
TREE 51 515.309 6 TREE 515.365 RD 516.746
TPUT 515.56 3 SS 515.366 SS N CE TPUT515.439 FE FE 515.412 N C E SS 515.233 RD 516.35 9 RD FNC 516.570 FR EN CH DRAIN 516.45 5
TPUT STOP 516.569 516.762 SS SS NE W CFNC 514.617514.47 6 SS 516.645 SS SS WA TER 516.539 515.61 3 516.253 ENTR RD TA NK 516.728 ENTR 516.745 SS 51EN6.9TR61 514.37 4 SS SS ENTR 516.803 515.192 515.226 516.715 ENTR KER B OLD ENT RANC E 516.795 NE W RD RD ENTR 516.925 516.989 516.819 WA TER 51 7 ENTR EN51TR6.722 516.702 RD TA NK 516.746 TPUT SS SS 515.333 515.70 4 SS ENTR 514.982 SS HE AL TH CLINIC 516.459 ENTR516.30 8 515.636 516.808 RD 516.883 ENTR ENTR 516.8516.72197 RD 516.07 8 SS 515.267 SS SS SS SS RD 514.742 515.264 515.48 3 516.492 516.813 SS SS SS 515.165 514.587 515.20 1 SS SS SS SS 515.031 515.150 514.83 9 514.938 CFNC FNC SS SS 516.773 517.262 TREE SS 515.09 1 SS 515.57 3 SS 514.624 SS SS 514.914 515.231 515.86 5 FNC SS 514.821 514.849 517.79 1 514.795 SS . FNC 514.762 RD RAMP 518.385 517.167 515.161 SS RD SS 514.774 516.40 8 SS 514.731 RD 514.698 515.257 SS 515.368 RD Clinic 514.736 RD 514.853 SS 516.568 EPOLE 516.988 SS E ELE CTRI C PO LE 515.356 C TPUT N FNC SS 516.675 E 517.006 514.56 7 F
SS 515.183
SS TPUT D 515.578 515.806 A O R FNC 516.757 R A E T C N E F
SS
514.931 RD SS TREEPA RKING 516.860 SS 515.608 SS 515.989 515.363 515.811
DB TREE SS 517.034 515.103 515.33 2 DB 517.035 FNC BOR EHOL E 517.083
POMP 516.666 SS 516.208 POMP N 0 R T H 516.760 SS SS 515.543 515.697 SS ST AF515.4 F28 HO USI NG
POMP TREE TPUT PA RK IN G 516.779 515.459 515.494
GT 516.928
SS 516.67 2
TREE 516.410 SS 515.785 E SS SS NE W C 515.706 516.44 2 N E EN TR AN CE F SS 516.303 GU AR D
GT HO US E 517.276 SS 516.579 62850 Y 62850 Y 62750 Staff QuartersSS 516.209 GT TREE 516.979 515.921 GT 517.276
SS
515.97951
6
E C 43150 X N 43150 X N E F TREE 517.148
SS SS STAFF HOUSING516.283 516.745 SS SS 516.516 516.233 TPUT 516.480 Gate RD 516.925
FNC
516.853
SS 516.494
EPOLE FNC 517.219 517.204 SS 516.562 ELE CTRI C PO LE
E GT C 516.949 N E F
E TREE TREE C 517.285 516.744 N E F
GT 517.190
GT 516.92 9
GT 517.310
GT GT 517.314 517.029
GT 7 517.356 FNC 51 517.011
RD 517.042
Fig. 2-5 Letsitele Clinic Site Plan
2) Mohlaba Clinic (Fig. 2-6)
The existing gate and the guardhouse will be utilized as they are. The new clinic building, for which the area needed for future expansion is secured, is to be placed towards the west side of the Project site. Enough
29 distance between the new clinic building and the existing large tree is kept so that the effect of the construction work on the tree will be minimized. Since there are already two staff quarters within the plot, no extra space for construction of future staff quarters is kept aside. Electricity is available from the nearby power line. Water needs to be supplied to the Project site by boring a new well or laying a new supply pipe from the nearby reservoir tank by South African side. The Project site is inclined towards the west. The design of water supply and drainage system will take advantage of this site condition, e.g. new elevated water tanks will be placed in the northeast side behind the existing staff quarters and sewage to be drained towards the west through a septic tank and to French drains.
FNC 592.067
EXISTING ELE C TR I C P O LE SEPTIC TANK
EPOL E 591.96 4 FNC 592.157
STANK FNC 590.68 8 590.474 S 591.318 S 592.87 2 STANK MHOL E 590.719 591.89 2 TREE
725 0 0 Y 590.50 5 MHOLE MHOL E TREE 591.307 591.02 3STANK 592.846 59 0 MHOLE 590.995 S 591.297 S 592.302 593.73 1
STANK S E LE C TR I C P O LE 590.843 593.154 S S 589.610 590.345 INS P EC T IO N HO LE S S 47800 X DI S US ED S 592.790 591. 841 S WLYN 591.37 8 WATERKRIB 591.20 1 EPOLE S 589.161 591.245 WA T ER SS WLYN NE W 588.428 590.797 TAP CFNC 591.302 TA P SS SS SS 589.043 588.459 SS588.633 588.796 WA T E R 588.19 4 SS WASHING LINE TA NK 588.563 TREE 589.290 SS S HOUSE2 KRIP 589.012 591.399 591.924 KRIP 588.452 NE W NE W 588.580 ANKE R KRIP 589. 454 Exist.Bldg. KRIP 588.558 DRN WA TE R SS SS 588.705 SE PT IC T ANK SS 591.64 9 588.36 1 588.553 SS 588.989 HOUSE2 SS SS SS SS588.46 6 TREE HOUS E1 591.491 DRA IN SS588.51 4 588.83 6 588.20 6 588.41 4 591.54 0 591.400 SS588.328 SS NE W TA N K SS SS 588.144 589.41 0 SS 587.66 5 588.20 1 SS SS 587.52 9 SS 588.765 SS 588.43 0 588.74 3 HE AL TH C LIN IC 587.42 5 SS HOUSE1 SS SS SS 589.036 591.092 587.12 7SS 587.855 588.561 587.465 SS TPUT SS 588.63 3 FR EN CH D RAI N 589.012 EX IS TI NG SS 587.68 7 TREE SS 589.473 587.02 1 SS 588.567 TPUT TREE 587.63 3 SS 589.88 0 SS HO US E 592.172 588.36 7 589. 187 SS E X IS TI N G SS588.913 SS TPUT SS588.745 588.49 5 588.20 8 589.072 HO US E TPUT HOUSE2 FNC 588.28 8 591.893 592. 399 SS 588.47 7 HOUSE2 OP EN TE STP I T HOUSE1 591.671 HOUS2 E 591.04 6 591.715 TREE TREE 592.253 RA M P 592.009 TREE SS 592.TP59 0OLE TREE SS588.38 9 592.083 587.407 SS 588.723 SS HOUS E1 SS SS SS 588.562 SSSS 589.274 FOOTP591. 536 SS587.37 0 587.92 7 588.64 1 589.2589.4364 0 SS SS Clinic 591.436FOOT P 587.260 588.589.108 935 591. 455 TREE SS SS WTAN KHOUS1 E 591.87 9 586.56 7 SS 589.247 591.97 2591.07 3 SS SS SS 588.945 TE L EPH O NE P O LE 587.118 587.431 SS 588.47 2 SS 587.49 7 58SS8.893 589.79 0 TPUT 587.443 SS FOOTPFOOT P SS SS 589.39 1 591.408591.49 4 586.558 589.296 WLYN S 592.059 591.483 SS SS FNC 586.73 3 587.21 0 589.604 S 591.47 6 S SS 589.866 CON CRET E TREE 587.570 SS SS S 587.524 SS 589.384 EXISTING FOO TPAT H S 585.882 SS SS 589.589.1 04038 FOOTPFOOT P 592.34 0 SS586.230 589.301 591.342591.22 4 TPOLE 585.938 WATER ANKER 592.601 592.402 S TPUT TREE TANKS 585.795 SS SS SS SS 589.065 590.24 0 591.223 S 586.172 587.095 588.614 589.88 0 591.531 S 591.14 7 SS S 587.52 4 585.06 7 SS WAS HING LIN E SS 587.52 6 S FOOTPFOOT P 586.192 SS 589.97 9 591.359251.79 3 586.830 MHOLE MA N H OL E S SS SS MHOLE 591.431 585.77 8 586.042 587.787 SS S S 590.692 S 587.68 7 SS TPUT 590.149 590.566 590.65 6 585.785 SS 587.10 2 588.30 1 590.22 9 MANH OLE S 58SS6.82 6 SS 590. 655 S 592.085 S 586.305 587.855 TPUT S 591.727 WLYN 585.14 9 588.28 1 S 590.8S 33 TREE 590.587 S 592.274 590.02 3 591.077 590.81 7S 591.37 3 WTANK S 590.56 7 591.534 S SS OPE N TE STPI T SS SS 590.33 3 S FOOTP 586.267 586.13 3 589.58 39.93 34 6 S 591.317 591.286FOOTP EXISTING WATERTANK S SS TPUT SS SS SS S 590. 670 591.300 586.078 586.942 588.83 0 589.069 589. 334 589.162 589. 863 WTAN K FNC TPUT SS S ATEBUI 591.25 5 TE L EP HO NE 592.446 S SS 587.38 9 588.367 590.020 590.589 BUIL C 586.162 S 587.90 3 SS S POLE 591.13 5TEL TOILT E 586.419 SS 587.88 3 590.611 590.576 591.48 5 592.78 1 587.011 SS SS ATCFEBUNCI DRA IN TOILET 586.494 588.38 0 590.3633 5 S 592.127 S FOOTP DRN 592.022 586.321 SS SS S FOOTP 591.278 591.625 587.37 7 587.00 5 TREE S 590.31 5 591.167 S SS 588.69 7 589.881 TOILET TREE 586.397 587.301 SS SS SS S TEL Exist.BldgTAP 592.215 586.062 587.477 588.55 1 587.85 8 590.258 590.537 BUIL C DRN WAT ER S S TPUT SS 591.70 0 591.7BU84ILC 592.024 TOILET 586.652 SS 587.76 5 587.83 5 SS 591.810 592.112 586.05 5 S 586.63 7 588.028 BUIL C TAP TO I LE TS S 586.92 7 SS SS SS ATEBUI 591. 670 58S 6.97 6 SS 587.476 588.104 EX I S TI N G 590.484 590.568 586.581 587.629 SS SS SS S 587.00 7 587.839 58SS9.748 SS 586.622 S SS SS589. 562 CNC F GU A R DH590.2 O53 US E BUILC MA N HOL E 586.745 587.634 589.27 4 589.859SS 591.925 SS 589.56 9 SS GATEP MHOL E TOILET 587.82 8 589.965 590.518 591.21 9 592.171 SS SS GA T E S S 589. 445 SS 589.23 7 EX IS TI NG S 586.793 587.424 589.76 4 SS EL E CTR I CA L S 586.87 5 SS SS SS SS 590.244 586.043 S S 589.042 SS589.512 589.591 589.744 586.339 586.33 9 589.602 SS CL I N IC BO X TOILET S S SS 589. 966 592.157 586.845 587.374 587.820 SS GATE P DBOX CFNC SS SS SS 590.185 590.23 5 591.805 592.33 6 S S 587.522 587.78 9 SS 589. 432 SS BUILC S 586.691 587.199 SS 588.212 SS 589.45 9 591.709 586.618 S 587.609 SS TREE SS 589.56 5 586.99 8 SS SS 588.42 5 SS 589.597 SS 589. 521 S S S 587.384 SS SS SS 588.37 2 588.880 589. 668 586.270 586.437 586.76 6 S SS 588.54 3 588.85 1588.30 1 SS TREE S 587.307 587.669 SS TPIT SS 590.32 4 586.254 S 586.689 588.97 4 SS 589.06 2 SS 589.09 6 P A RK IN G S 586.70 7 588.703 TSTAND 586.85 6 589.690 TSTAND 592.014 S S TPIT BUIL C 591. 993 586.696 S 586.83 7 589.148 590.914 587.56 0 SS S S SS SS TSTAND 586.403 S 586.02 8 S 587.59 4 589.751 590.462 TSTAND 592.422 587.00 1 587.209 O SS 592.425 TPIT P E 589. 714 SS 589.215 N SS 588.86 9 T E EXI STIN G 588.863 S T SS S SS P I 589.907 RAMP S 586.99 8 S TREE 588.110 T 591.87 1 WAT E RT A NK 587.52 1 58S 7.340 588.123 TREE SS SS RAMP 587.39 3 588.841 589.907 590.59 0 591.031 S FNC 586.49 9 TPIT TPIT 591.69 3 S SS Gate589.665 589. 817 SS S S 587.69 2 S SS58 SS8.068 590.096 587.06 3586.00 9 587.572 587.3258 67.01 7 SS SS TPIT SS SS 589.272 589.591 589.52 8 587.65 9 588.945
SS TREE 589.62 9 SS 586.506 SS 590. 546 RA M P UP 589.114 SS SS SS 589.979 590.610 S 589. 763 SS SS SS SS SS 587.675 SS 589.98 8 SS 590.67 5 590.399 586.92 7 SS 590.032 590.138 D IS U SE D BO R HO LE 590.002 S S S SS S 586.99 9 S 587.255587.570 588.96 0 SS 589.326 SS TREE 587.75 4 587.384 S 588.24 2TPUT SS SS 589.30 6 PHUIS A ND PU M P HO U SE SS 586.661 587.55 5 588.196 589.556 589.95 3 589.879 590.213 TREE CFNC 588.25 1 SS 590.08 9 S SS 589.541 587.490 SS SS SS 589.059 PHUIS PHUIS SS S SS587.41 8 588.59 4 588.45 7 589.804 589.936 590.10 4 SS 587.033 588.94 1 SS DAM 590.806 S SS DAM 589.32 6 587.514 588.511588.706 SS 589.19 6 SS 589.547 SS SS 588.90 0 589.620 589.954 DAM SS SS DAM 589.612 SS SS 590.756 590.04 7 589.645 590.039 590.556 SS SS SSSS S TREE 588.077 588.97 3 588.589.094 819 SS 587.01 7 588.239 SS 590.668 S SS 588.686 DIS USED CON CRET E 587.09 6 588.19 4 SS SS 589.068 SS 590.282 SS 590. 038 588.77 5 SS DA M SS S SS 589.409 SS 587.256 587.96 5 588.698 589.48 7 CONC SS TREE 590.10 2 588.895 589.907 SS SS 590.92 2 SS SS 589.06479 CONC590.040 588.300 CONC 590. 218 C ON C RE T E S L AB TPUT SS 590.169 SS 588.60 3 SS 588.99 9 CONC 589.991 588.522 590.70 1 SS 587.885 SS SS CONC SS SS 588.987 589.193 590.173 589.905 SS 588.757 590.24 4
0 SS 9 590.40 0 5 N TREE 587.04 4 SS SS 589.66 2 587.97 6
SS 588.860
SS 588.030
TPUT 588.57 6 SS 588.785
SS 588.26 7
SS 587.776
SS 588.661 7 240 0 Y
4 790 0 X SS 588.100
SS 588.330
Fig. 2-6 Mohlaba Clinic Site Plan
3) Maake Clinic (Fig. 2-7)
The main approach is to be on the south side front street from which electricity, water and telephone lines will be connected. The clinic building is to be placed in the front and the area for staff quarters at the back, the northeast side, of the plot. Electricity is available from the power line on the front street. Water is not readily available and need to be brought to the site from the water main, which is approximately 500m away, by South African side. The Project site is inclined towards the northeast and the design of water supply and drainage system is to be made utilizing the site condition. New elevated water tanks are to be placed in the
30 south of the plot near the front street and sewage to be drained towards the north through a septic tank and to
French drain.
FNC626.1 S 47 626.415 625S .790 626DRD.09 624S .765 626.2DRD95
S 626.052
624S .65 626.2S 4 625S .616 DRD 626.38 626DRD.438 FENCE 626.1S 46 626.4S 50
S 626GAT.9E 12 625.554 S S 625.375 S 626.1S 74 625.987 S 626.548 626DRD.602 625.693 626GAT.9E 57 626DRD.704 625S .341 TPIT 626S .015 626.358 S S 625.29 S 625.878 DIRT R OAD 626.342 S 625TPI.9T 02 S 625.953 625S .905 625.169
624.8S 87 626S .720 FRE NCH DRAIN 626.5S 12 624.9S 96 FENCE 626DRD.796 FENCE 625.9S 79 627DRD.04 S S 625S .154 S 625.5723 626.273 S S 625.90813 626.581 626.1S 61
625.9S 53 TPIT S 626S .687 626.171 FENCE 625.680 FNC 626S .323 S 627.723 DRD SEPT IC T ANK S TPIT 625.525 627.0S 09 627.164 627DRD.35 626.238 626.17 S 625.8S 81 S S 625.306 625.4186 S 626S .7578 625.518 626S .498 S 626.456 S 627.473 625.5S 82 626.3S 5 S 627DRD.46 625.792 627DRD.596 S S 625.5S 95 627.414 626.338 S 625.5756 625S .850
FNC 628.087 S 626S .097 626.054 FENCE STAFFHOU S ING DRD 627.7S 87 627.860 625.6S 43 DRD 627.894 626S .474
627.5S 60 FNC Staff Quarters 627.591 FNC 628.326 628.907 626.3S 83 627.1S 48 625.9S 18 626.6S 04 629.9. 10 626.1S 73 FENCE S 628.029 628FNC.785 Clinic S TPIT FENCE 626.181 S DRD DRDS DIRT ROADS 626.938 626.709 628.184628628.0.085 82 628.197 S 626.5S 28 628.491 S 628S .254 STAFF HOUSI NG 626.381 628CFN.6C 31 628.4S 70 628CFN.6C 17 628.0S 140 627TRE.1E 56 S DRD SSS628S .792 628.162809S .287 628.237 628DRD.302 628.886 628S .907 S 628S .036 626.2652 L 628.6S 08 627.4S 10 628S 629.7DR .092 67 629.3S 67S S DR 628.747 629.565 628.38 628.956 628S .248 628S .580 628.5S 32 628S .241 S RC 628.4S 58 628.583 629.081 S PAR KING 627S .247 626.421 629.1S 15 628.5S 25 628R .764 S S S 629.286 629.171 628.57
629S .562 S 628S .60 FENCE 626.959 628EP .526 629.5FNC13 GUAR D S 628.514 HOUS E S 628.7S 86 628.076 627.1S 25 DR PARK ING 628.794 628.5DR 1 MAIN RL S CFNC 628.743 ENTR ANCE 627.703 629.241 628.2S 9 628.9RC 26 S FENCE WAT ER 627.106 TANK WAT ER FENCE S R 628.51 TANK S 628.828 627.763
628S .772 EP DIRT ROAD S 628.935 S 627.060 FNC 628.479 629.423 628RL .723 S Gate 628.481 627.6S 84 628RC .889 CFNC 628.979 FENCE S R 628.52 627.1S 45 N 628.706 628S .706 DR 628.704 EP DR 628.876 628RL .440 628.616 627.7S 36 FNC 628.2S 45 629.353 S S 628.745 RC 627.534 628.839 SS 627.689627.782 FENCE 628HOO.7P 59 628R .638 628S .40
CFNC 628S .589 628.961 628.9S 06 627S .879 627S .758 DR RL 628.379 629S .045 628.553 S 628.25 627.8S 93 RC FNC 628.732 629.124
Fig. 2-7 Maake Clinic Site Plan
4) Burgersdorp V.P. Shelter (Fig. 2-8)
The Project site is sandwiched between a soccer ground and a street and another side is on a school and the other on a open land. There are an old filled in well and a tree in the middle of the plot. The plot has just enough area to build a 10m x 10m shelter after subtracting necessary set back distances from the front street, boundary lines and the tree.
SOCCER GROUND 37027.3
Boundary Line
4
5
0
0
VP SHE LTER Lin e 12700 ce 1 ry Li ne 24200 SCHOOL Fe n 4. 1 6 1 2 Bou n d a 2
1 Well Boundary Exi sti ng 1 1 7 . 3 8010 7500
Ex is t i n g Po le (400V) Boundary Li ne
4500 0 450 10000 22450 4500
36950
57000 14600
BURGERSDORP
Fig. 2-8 Approximate Site Plan of Burgersdorp
31 5) Khujwana V.P. Shelter (Fig. 2-9)
This Project site is on 13.5m wide street, generally flat and a three cable power line (33kVA) runs above the site. The land area is large enough to build a 10m x 10m shelter, which accommodates patients’ waiting area and a parking bay, after subtracting necessary set-back distances from the boundary lines, the front street and the power line.
48400
Boundary Line FENC E 4500
E x is ti n g T oil e t (t o be re m o ved by SA) (950×750） 20000 Li n e
10000 VP SHELTER FENC E Bou nd ar y 26000 43300 43300 Stor m Water Res erve 7250 EXISTING SCHOOL BLDG. 10000 ECE FENC
Power line (33kva) ry Line ry Bounda 12800
SEWER FENCE Bou nd ar y Line Ga te
12200 4600 7500 4000 32400 4500 13500 KHUJWANA
Fig. 2-9 Approximate Site Plan of Khujwana
6) Mogoloboto-2 V.P. Shelter (Fig. 2-10)
The Project site is on two streets and there is a level difference of about 1.5m between the back of the plot and the front street. There are two big trees within the site. The site is large enough to build a 10m x 10m shelter after subtracting necessary set-back distances from the boundary lines and avoiding the big trees.
32 10400 63900
7500 10000 4500
Boundary Line
Exi sti ngFence 4500
23000 14000 Line Line Fence
FENCE VP SHELTER 10000 Exi sting 29500 Boundary Boundary 28600 2500 13900 7500
Boundary Line
Ga te FENCE Existi ng Gate
7500 4000 4000 19700
63900 11000
MOGOLOBOTO-2
Fig. 2-10 Approximate Site Plan of Mogoloboto-2
7) Pharare V.P. Shelter (Fig. 2-11)
The Project site faces two streets and shares boundary with a school. There is a tree within the plot. The plot is large enough to build a 10m x 10m shelter after subtracting necessary set-back distances from the streets, the boundary lines and avoiding the tree.
SCHOOL 50000
8000 10000
ExistingFence
Boundary Line 4500 4500 11300
10000 VP SHELTER
9 .
4
6 17000 0 Line Line 9
2 FENCE 29000 Boundary Boundary FENCE 7500 Ga te
Boundary Line FENC E 16740 4000
53000
PHARARE
Fig. 2-11 Approximate Site Plan of Pharare
8) J.B. village V.P. Shelter (Fig. 2-12)
In depth examination of site conditions after returning to Japan revealed that the proposed site had a build-able area of only 0.5m x 2.0m after subtracting necessary set back distances from the boundary lines.
It is, therefore, not possible to build a shelter on this site and hence the Project for this site is to be cancelled.
33 Toilet
Boundary Line 4500
Possible area for building 2000 14000
Shelter Boundary Line Boundary Line 7500
Boundary Line 7500 500 4500
12500
Fig.2-12 Approximate Site Plan of J.B. Village
(3) Architectural Plan
1) Function Layout a. Clinic
Function layout of a clinic can be divided into two parts, a health & welfare, administration block and a maternity & medical services block. Two covered corridors connect the two blocks providing ventilation and natural light into the corresponding rooms. There will be an entrance for maternity area on one of the covered corridors so that the pregnant women do not have to go through the general entrance and waiting hall. The fig. 2-13 shows a function layout of a clinic.
General Entrance
Health&Welfare, Adm. Health&Welfare, Waiting area, screening, Future income level survey, Adm. Block Expansion immunization, health/hygiene education takes place
Pregnant women’s Maternity direct access to Entrance corridor corridor Covered Covered the maternity area Covered
Medical, Maternal&Child ＊ Expandable to cope with Maternity Care Maternity& an increase of Normal delivery General Future Medical Block catchment services. consultation & Expansion treatment, area contraceptive, VCT, population in etc. the future
Fig. 2-13 Function Layout Diagram b. V.P. Shelter
Function layout of a V.P. Shelter consists of a patients’ waiting area and a parking bay for a mobile clinic vehicle. The shelter can also be used as a meeting hall when it is not used for mobile clinic.
34
Patients/Residents
Patients/ Waiting Parking Residents Area
Patients/Resident Mobile Clinic Vehicle
Fig.2-14 Function Layout Diagram of a V.P.Shelter
2) Floor Areas of Essential Rooms
Floor areas of the essential rooms mentioned in the Planning Principle are determined and shown in Table 2-8.
Table 2-8 Area Table for a Small Clinic Planned Bases for Area Determination Dept. Room Area SA 2 Note (m ) Standard Area
Office (Social) 12.41 14.00 Work space for 2～3 staff with document shelves Office (Health) 12.41 14.00 Work space for 2～3 staff with document shelves Waiting Area-1 79.05 87.00 Waiting area for 60 persons Toilet (F) 8.23 9.20 Toilet: 2, Washbasin: 2 Toilet (M) 6.68 6.85 Toilet: 1, Urinal: 1, Washbasin: 1 Toilet(Disabled) 3.65 3.60 Toilet: 1, Washbasin: 1, Handrail
Health Welfare Health Cleaners Rm 4.10 5.00 Storage for cleaning equipment、Slop hopper Nurse sta. & 10.56 14.00 Nurses’ working space and reception reception Records Rm 2.82 2.91 Medical record storage Waiting Area-2 10.11 10.15 Waiting area for 7 patients Consultaion-1 10.80 13.50 Exam. Table: 1, Desk:1, Chair:3, Washbasin:1, Shelf :1 Consultation-2 10.49 13.50 Ditto Treatment 9.86 13.50 Exam Table:1, Trolley:1, Chair:3, Washbasin:1, Shelf:1 Pharmacy 11.15 12.50 Medicine cabinet, Counter Storage 7.93 8.00 Linen & equipment store First Stage 22.04 27.00 SA standards: 2 beds, Washbasin:1, w/ Shower Rm Shower:1, Toilet:1, Washibasin:1 OB & & Clinic OB Labour Ward 16.16 15.00 Labour table:1, Washbasin:1, Cabinets:1 etc. Post Natal Ward 32.43 32.50 SA standards: 3 beds, Washbasin:1 w/ Bath Baby bath:1, Bath tab:1, Washbasin:1,. Toilet:1 Sluice 5.13 5.00 Bedpan & wash up sink :1, Bedpan & bottle racks Laundry 7.66 8.00 Wash sink: 1, Washing machine:1, Dryer:1, Worktable Kitchen 6.51 9.00 Sink:1, Range:1, Shelf, Refreglator:1 Toilet (Staff) 2.60 2.50 Toilet:1, Washbasin:1 Common Corridors 74.75 82.00 25％ of the total of rooms above 2 Total 367.56 Based on S.A. standard: 408.71m
35 3) V.P. Shelter
Standard waiting area for 60 persons mentioned in the above table and a parking space for a mobile clinic vehicle ((3m x 5.5m) are added. The required area for the Shelter is as follows.
Waiting area 87 m2 + Parking area 16.5 m2 ＝ 103.5 m2 ≒ 100 m2
4) Section Plan
In the cross-sectional plan, consideration should be given to natural ventilation, natural lighting, and protection against direct sunshine and rainwater into the building. The roof and outer walls are to be well insulated so that indoor environment of the building can be as comfortable as possible without air-conditioning, e.g. the roofs are to be pitched roof in order to provide ventilated attic and outer walls to be cavity walls. The windows are to have depth to let the natural light in while cutting off direct sunlight into the room and to eliminate water penetration. The ceiling height is to be decided to provide sufficient air volume for providing comfortable indoor environment and other factors such as economical and ease of maintenance.
(4) Structural Plan
1) Foundation
According to the soil survey and plate loading test conducted in April 2003, the soil conditions of three project sites for clinics are as follows.
a. Letsitele Clinic
The upper soil layer (0.2～0.5m) consists of a dark red to brown stiff to very stiff sandy clay. This overlies a very stiff slickensided sandy clay down to a depth of approximately 1.6m. All materials are considered potentially medium in expansiveness with an allowable bearing pressure of 200kPa. The clinic building to be built under this project is a single story structure. Therefore, it is appropriate to adopt reinforced concrete
36 strip foundations with reinforced concrete foundation beams at the average depth of about 1.35m.
Considering the potential medium expansiveness of the soil, concrete aprons of 1.5m width is to be provided all around the building in order to reduce effects of the surface water seepage to the foundation level.
b. Mohlaba Clinic
The top 0.3 to 0.6 m consists of a dark brown stiff sandy clay overlying stiff to very stiff highly decomposed granite up to a depth of approximately 2.0m. Both these soils exhibit potential medium heave characteristics and allowable ground bearing pressure at this level is 275kPa. Considering the structure being a single story it is appropriate to adopt reinforced concrete strip foundations with reinforced concrete foundation beams at the average depth of about 1.65m. 1.5m wide concrete aprons are to be provided all around the building in order to reduce effects of surface water seepage to the foundation level.
c. Maake Clinic
The material on this site up to a depth of 2.5m is consistently a sandy clay to a clayey sand with medium to high potential expansiveness with an allowable bearing capacity of 200kPa. The clinic building to be built under this project is a single story structure. Therefore, it is appropriate to adopt reinforced concrete strip foundations with reinforced concrete foundation beams at the average depth of about 1.3m. Considering the potential medium expansiveness of the soil, concrete aprons of 1.5m width is to be provided all around the building in order to reduce effects of the surface water seepage to the foundation level.
d. V.P. Shelter
The V.P. Shelter consists of a light structure, e.g.; a concrete floor and columns, and a wooden truss roof.
Therefore, it is appropriate to adopt individual footings.
2) Super Structure a. Clinic
37 In South Africa, a typical superstructure of low-rise building is brick masonry wall. In the area around the
Project sites, the most common superstructure with heat insulation and effective waterproofing is cavity brick masonry wall. The roof trusses are usually fixed to concrete lintels above the brick walls, or fixed directly onto the tops of brick walls. As for this Project, concrete posts and girders are to be constructed prior to the brick masonry works. The roof trusses can then be installed onto the concrete girders prior to brick masonry work. This method enables to start the roofing work without waiting for completion of the brick masonry works, and to continue the brick works and the interior finishing work without much influence of rain, which ensures control of the construction schedule. Furthermore, it will be possible to prevent the damaging or staining of the face brick walls caused by concrete casting. The same super structure system is to be applied to all three clinics.
b. V.P. Shelter
The structure of V.P. Shelters will be a combination of RC foundation/columns and wooden truss roof.
3) Roof Structure
In consideration of construction cost, the structure of the roof frame that supports the roofing materials should be wooden truss, which is widely used in the construction of public medical facilities in South Africa. The same super structure system is to be applied to all three clinics.
4) Structural Design Load
The structural live load for this project is shown in Table 2-9 in accordance with "SABS 0160-1989 The general procedures and loadings to be adopted in the design of buildings".
38
Table 2-9 Structural Live Loads Rooms Live Load （kN/m2） Intensive Load Consultation, Treatment, 2.5 9.0kN per 0.75m x 0.75m Office First Stage, Post Natal Ward 1.5 1.5kN per 0.1m x 0.1m Store 5.0 5.0kN per 0.1m x 0.1m Toilet, Kitchen 3.0 3.0kN per 0.1m x 0.1m Entrance/waiting hall, 3.0 3.0kN per 0.1m x 0.1m Corridor
5) Reinforced Concrete
The value of strength of concrete is to be determined in accordance with "SABS 0100-1:1992 The structural use of concrete Part 1: Design." The details of the standard are identical with those of "BS 8110: Structural use of concrete Part 1: Code of practice for design and construction." Thus this standard is sufficient to be applied to this Project.
With respect to reinforcing bars, in South Africa, high-tension steel with a tensile strength of 450Mpa is used widely for main reinforcement and soft steel with a tensile strength of 250Mpa is used widely for other reinforcing bars. Thus the strength and quality of the locally manufactured steel is sufficient to be used as construction material.
(5) Electrical Facility Plan
1） Power Reception Plan
Low voltage power supply (3Φ4W－400/230V) will be the intake power at all three (Letsitele, Mohlaba, and
Maake) clinics. A main distribution board will be installed near the connection point at each clinic.
Installation of the first stage power line up to the main distribution board is to be carried out by the South
African side.
2） Main Feeder
Distribution panel boards and power control panels are to be installed where necessary. In principle, the main line feeder system should consist of cable trays and cables installed above ceiling.
39 Work to be carried out by S.A. Work to be carried out by Japan
T/R
Main Distrib ution Bd.
400/230v Power supply to the facility
Boundary Line
Fig. 2-15 Electrical System Diagram
3） Lighting Fixtures / Socket outlets
Fluorescent lamps will mainly be used for their long lives and operation costs. In the consultation room and other medical rooms, suspended ceiling lamps for medical use are also to be installed. The target intensity of illumination for each of the main rooms is as shown below.
Table 2-10 Target Illumination Rooms Illumination (lx) Consultation, Treatment, Delivery, First 500～300 Stage, Pharmacy Nurse Station, Post Natal Ward, Office 350～250 Reception, Waiting, Pharmacy, Sluice, 250～100 Laundry, Medical Record Corridor, General Store 150～100
Receptacles shall comply with SABS and of standard type. Outdoor lights will be installed for crime prevention.
40 4） Telephone System
One telephone will be installed.
(6) Air Conditioning / Ventilation System
1) Air Conditioning System
According to the standards set by the Limpopo DOHW, all three Project sites for clinics are within the area requiring air conditioning. However, in order to minimize the running cost only the pharmacy will be air conditioned. In consideration of operation and ease of maintenance a split-type air conditioning unit, of which both the indoor and outdoor units will be wall-mounted, is to be installed.
Air-conditioned Room Rooms with Air-conditioning unit Pharmacy
2) Ventilation System
Natural airflow will be the basis for ventilation system of the building. Natural ventilation fans should be installed in the rooms which require exhaust odor / heat.
Ceiling fans shall be installed in the rooms listed below.
Rooms with Ceiling Fan Rooms with Ceiling Fan Consultation room, Treatment room, Labour ward, First stage, Post natal ward, Office, Waiting
(7) Plumbing and Sanitary System Plan
1) Water Supply System
A service pipe of size about 40A will be connected to the water main/source provided by South African side at all three clinics.
Number of people Staff members:6 （120 L/day･person） Visitors: approx.120（10 L/ day･person） Daily water requirement = 1,920 L/day（≒2m3/day）
5days equivalent: 2m3/day x 5days = 10m3 = 5m3 tank x 2 Nos.
41 Daily water requirement is calculated above and it is required to provide five day supply in the elevated water tank according to the standards of the Limpopo DOHW. Therefore, two 5m3 elevated water tanks will be installed.
Work to be carried out by S.A. Work to be carried out by Japan
Elevat ed Water Tank
Clinic
Septic Tank
French Drain Boundary
Fig. 2-16 Water Supply & Sewage System
2) Hot Water Supply System
Hot water will be supplied centrally by installing an electric geyser in accordance with the standards of the
Limpopo DOHW.
3) Drainage and Vent System
Soil water from the toilets and other waste water will be disposed separately within the site. The soil water will first be sent to a septic tank for treatment and then be sent to French drain. General waste water will directly be sent to the other French drain within the site.
Storm water will be lead so that it can naturally be absorbed within the site and excessive water will be drained away.
42 4) Medical Gas
Medical gas in the clinics are handled individually by providing a gas cylinder to where necessary.
Therefore, no medical gas piping will be installed within the building.
5) Sanitary Fixtures
Western-style stools, urinals, washbowls, bathtub and sinks will be installed. Faucets for both cold and hot water will be long lever type except for the toilets. A special double sink, combination of a slop sink for washing urine glass and a regular sink, will be installed in the sluice.
6) Fire Fighting System
Fire fighting utilities in compliance with the National Building Regulations should be installed. Hose reels and fire extinguishers are required for the clinics according to the regulations. The hose reels will directly be connected to the water supply pipe from the elevated water tank. No special water pump will be provided for hose reel.
(8) Materials and Construction Methods
Methods of construction and building materials will be decided by examining the surrounding climatic conditions, functional requirements, available construction period, construction cost, quantity of supply, and the maintenance and management cost.
1) Exterior Finishing Materials
The following table shows the main exterior finishing materials and rationale for their selection.
43 Table 2-11 Exterior Finishes Part Finish Remarks The most reliable water proofing material available locally Corrugated galvanized with cost effectiveness in the area where no chloride erosion Roof steel sheet need to be considered. Also, compared to the roof tiles, the lightness of the material will result less structural cost. Highly durable and free of maintenance. Since re-painting or Exterior Wall Face Brick repair work for cracks are not necessary, maintenance cost can be reduced. Reliable compared to steel sash, in terms of corrosion and Windows Aluminum Sash water resistance. * The finish for V.P. Shelter will basically be the same as the clinics except for not having windows
2) Interior Finishing Materials
The following table shows main interior finishing materials and rationale for their selection.
Table 2-12 Interior Finishes of Clinics
Room Floor Wall Ceiling Remarks Consultation, Seamless Treatment, Paint on plaster Paint on water resistant vinyl sheet Hygienic and durable First stage, Labour screed fiber cement board flooring ward Paint of plaster Waiting area, Covered Colour Paint on water resistant screed/fair face Durable and economical corridor Hardener fiber cement board brick Toilet, Shower Rm., Ceramic Ceramic wall Paint on water resistant Water resistant and Sluice floor tiles tiles fiber cement board easily cleanable
Table 2-13 Interior Finishes of V.P. Shelters
Room Floor Wall Ceiling Remarks Steel Face brick/ Waiting area, car parking troweled Exposed insulation board Durable and economical partially plastered concrete
44 2-2-3 Basic Design Drawings (1) Equipment Plan X-ray apparatus (Letaba) High pressure steam sterilizer (Letaba) Dental unit (Letaba) Dental unit (Dr.CN Phatudi)
(2) Building Plan The following drawings are attached. 1) Letsitele Clinic and Maake Clinic Site Plan (Letsitele Clinic) Site Plan (Maake Clinic) Plan (Common) Elevation (Common) Section (Common)
2) Mohlaba Clinic Site Plan Plan Elevation Section
3) V.P. Shelters Site Plan (Burgersdorp, Khujwana, Mogoloboto-2, Pharare) Plan, Section Elevation
45 5344
Existing Cable Trench
Existing Cable Duct On Walls 1600
R/F Table 3871 Stand Bucky
To be replaced by Japan Entry 5955 Local Controler 1449
14 70
CH=3,287
Main Control Unit 1824
Control Room
Pass Box Outlet New Electric Distribution Board (3φ 380v) 1m
Letaba Regional Hospital X-ray apparatus, basic screening unit (H-L-F-02)
46 1000 1390 600 1390 600 1390 1238
To be replaced Japan
New Electric Distribution Board
3445 Sterilizer Back yard for Autoclave
CH = 2924
Outside Fence
Switch 5808 Water Cock 7608 1m Floor Drain Cleaner Cap
Letaba Regional Hospital High pressure steam sterilizer (H-L-H-01)
To be replaced by Japan CH=3,026 Work Top 808 1060
Existing Floor Channel Covered × with Wooden Panel W Sinc Compresser Room 2682 3777 350
Compresser Compresser 1230
1244 830 1470 830 1905 830 882
2174 2184 2591 Outlet 1m Letaba Regional Hospital Dental unit (H-L-C-06)
47 5832.5 2247
To be replaced by Japan
Drain pipe
Drain 2800
Compressor
Existing Air Compress or CH=2,767
Drain Pipe Outlet Existing Distribution Board 1m Dr.CN Phatudi District Hospital Dental unit（H-P-C-01）
48 49 SITE PLAN RD 516.935 FNC
517.262
7
1
RD 5 516.989 FNC 517.179 KERB RD 516.746 ELECTRIC POLE RD 516.925 FNC 517.167 N 0 R TH N 0 R RD 516.609 43150 X 43150 RD 516.883
FNC
517.006
E
C
N
E EPOLE F 516.988 RD 516.745 RD
RD 516.570
STOP 516.746 516.762 62750 Y 62750 ENTR 516.803 ENTR 516.961 RD RD RD DB 516.840 516.807 516.813 517.034 ENTR DB 516.795 ENTR FNC 516.819 517.035 517.083 ENTR 516.830 CFNC 516.645 ENTR ENTR 516.728 516.808 ENTR .
516.797 ENTR
516.715
ENTR 518.385 516.821
E
C
N
E D
F
ENTR A
516.722
ENTR O
516.702 R
CFNC 516.773
R A T END 516.280 RD END 516.860 516.305 GT ELECTRIC POLE 517.276
OLD ENTRANCE
E C
N GT SS
E 517.276 516.492 F FNC GT 516.545 TPUT 516.928 516.569 SCALE = 1:500 SCALE FNC SS 516.757 SS 516.539 516.459 TPUT 516.675 SS 516.568
E NEW NEW TREE 517.148
C TANK TANK GT N WATER WATER 516.979 E
F
FNC
517.204 E
C
N E F EPOLE 517.219 SS 516.253 POMP 516.760 POMP 516.779 NEW RD TREE 517.285 516.925 GT POMP 516.666 517.190 ENTRANCE GT 517.310
GT
517.314
E
C GT N
E 517.356 F GT 516.949
516 GT 516.992 GUARD HOUSE FNC GT 516.853 517.029 RAMP BOREHOLE TREE 516.410 SS 516.579 SS 516.745
E
E RD SS C
NC N 517.042 516.303
E FE F SS 516.516 HEALTH CLINIC SS 516.267 TPUT
516.480
7
1 5 FNC TREE 516.744 PARKING 517.011 SS 516.562 SS 516.494 TREE 515.653 SS 516.208 PARKING TPUT SS 515.806 TREE 516.283 515.989 SS 515.636
E SS 516.244 C
N
E
F STAFF HOUSING SS 515.586 SS 515.811 SS 516.233 SS 515.439 SEPTIC TANK SS TPUT 515.412 516.209 FNC 515.565 SS 515.361 LETSITELE CLINIC LETSITELE SS 515.697 SS 515.470 SS 515.578
SS 516 515.785
SS
E 515.979
C
N E SS
SS F SS 515.348 SS 515.357 TPUT 515.150 515.333 515.366 SS 515.608 FRENCH DRAIN SS 515.368 SS 515.226 SS SS TREE SS 515.921 SS 515.543 515.231 515.264 515.031 SS 515.706 SS SS 515.109 TPUT 515.356 514.938 SS SS TREE FNC 515.196 515.356 515.193 515.165 TREE 515.272 SS RD RD 515.267 515.257 SS 515.161 515.233 SS 515.363 SS SS 514.914 515.120 TREE 515.309 TPUT 515.494 SS 514.849 SS 43150 X 43150 TREE 515.365 515.428 SS 515.192 STAFF HOUSING SS 515.183
TREE 515.459 SS Y 62850 514.821 SS 514.983 SS 514.982 SS
515.233
E C
SS N
5 514.774
1 E 5
RD F 514.853 SS 514.731 SS 514.795 RD SS 514.736 514.931 TREE 515.103
5 1
SS 5 514.742 SS 514.647 OF THE HEALTH FACILITIES OF THE HEALTH FACILITIES SS 514.617 SS 514.698 SS 514.762 SS THE REPUBLIC OF SOUTH AFRICA OF SOUTH THE REPUBLIC 514.756 SS 514.587 TREE 514.624 SS 514.437 IN THE LIMPOPO PROVINCE IN IN PROVINCE LIMPOPO IN THE THE PROJECT FOR IMPROVEMENT IMPROVEMENT FOR PROJECT THE SS FNC 626.147 626.415
SS DRD 625.790 626.099 SS DRD 624.765 626.295
SS 626.052
SS 624.655
S 626.244 SS 625.616 DRD 626.388DRD 626.438
S FENCE S 626.146 626.450
GATE S 626.912 625.554
S 625.375 S S 625.987 SS 626.174 SS 626.548 DRD 625.693 626.602 GATE DRD S 626.957 626.704 625.341 S TPIT 626.015 626.358 S 625.299 S 625.878 S 626.342 S TPIT DIRT ROAD 625.953 S 625.902 S 625.905 625.169 S 624.887 S 626.720 FRENCH DRAIN N 0 R T H S S DRD 626.512 S 624.996 FENCE 626.796 FENCE DRD 625.979 S 627.044 SSS 625.154 S 625.573625.572 626.273 S S 625.913625.908 626.581 S 626.161
S 625.953
TPIT S S 626.171 625.680 626.687 FENCE S FNC 626.323 627.723 S DRD SEPTIC TANK S 625.525 SS 627.164 626.238 TPIT 627.009 DRD 626.177 S 627.355 625.306 S SSS 625.881 625.418625.416 S S 625.518 626.758 626.757626.755S 626.498 S 626.456 S 627.473 S S 625.582 626.355
S DRD 625.792 627.466 DRD 627.596 S S S 627.414 626.338 625.595 S 625.567625.575 SS 625.850
FNC 628.087 S S 626.054 626.097 FENCE STAFF HOUSING SS DRD 627.860 S 627.787 625.643 DRD 627.894 S 626.474 S 627.560S FNC 627.591 628.326 FNC S 628.907 S S 625.918 626.383 627.148 S 626.604 . 629.910 S 626.173 FENCE SS 628.029 FNC 628.785 S TPIT 626.181 626.938 FENCE S DRD DIRT ROAD 626.709 628.184 DRDS S 628.085628.082 628.197 S S 626.528 628.491 S SS STAFF HOUSING 626.381 CFNC 628.254 628.631 SS CFNC 628.470 628.617 SS 628.014628.004 TREE 627.156
SS DRD SS 628.109SS 628.237 DRD SS 628.792 628.287 628.302 628.886 SS S 628.907 SS 626.262S 628.036 626.265 L SS S SS629.067 SS 628.608 627.410 628.792DR 629.367SS 628.747 629.565 SS DR 628.388 628.956 SS 628.248 SS 628.580 SS SS 628.241 628.532 SS SS RC 628.458 628.583 629.081 S S 626.421 PARKING 627.247 SS SS 629.115 628.525 RR 628.764 SS S SS 629.286 629.171 628.577
S 629.562 S SS FENCE 626.959 628.600 EP FNC 628.526 629.513 GUARD S 628.514 HOUSE S S S 628.786 628.076 627.125 DR 628.794 PARKING DR 628.511 MAIN RL S 628.743 627.703 CFNC ENTRANCE 629.241
S RC 628.299 628.926 S FENCE WATER 627.106 TANK WATER FENCE S 628.511 RR TANK S 628.828 627.763
S 628.772 EP DIRT ROAD 628.935 S S 627.060 628.479 FNC RL 629.423 628.723 S 628.481 S RC 627.684 628.889 CFNC 628.979 FENCE S 628.522 S RR S 627.145 628.706 628.706 DR 628.704 DR EP 628.440 628.876 RL 628.616 S 627.736 S FNC 628.245 629.353 S S 627.534 628.745 RC 628.839
S S 627.689627.782 FENCE HOOP RR S 628.759 628.638 628.400 S 628.589 CFNC S S 628.961 S 628.906 627.879 627.758 DR 628.379 RL S 628.553 629.045 S 628.255 S 627.893 50 RC 628.732 FNC 629.124 THE PROJECT FOR IMPROVEMENT OF THE HEALTH FACILITIES IN THE LIMPOPO PROVINCE IN THE REPUBLIC OF SOUTH AFRICA MAAKE CLINIC SCALE = 1:500 SITE PLAN 21295
2820 2740 2575 2910 1700 2070 1910 4570 0 3 8 3 5735 5 0 9 1
FHR 0 3 8 3 3830 WM
DR 0 7 2 25715 7 7270 0 9 7 1 4060 0 8 9 1 0 1 0 8120 1 0 2 0 2 4060 0 2 3 1 0 9 6
3080 1845 5280 1845 3220
FLOOR PLAN ROOF PLAN
51
THE PROJECT FOR IMPROVEMENT OF THE HEALTH FACILITIES IN THE LIMPOPO PROVINCE IN THE REPUBLIC OF SOUTH AFRICA LETSITELE CLINIC / MAAKE CLINIC SCALE = 1:200 FLOOR PLAN / ROOF PLAN EAST ELEVATION
WEST ELEVATION
NORTH ELEVATION
SOUTH ELEVATION
52
THE PROJECT FOR IMPROVEMENT OF THE HEALTH FACILITIES IN THE LIMPOPO PROVINCE IN THE REPUBLIC OF SOUTH AFRICA LETSITELE CLINIC / MAAKE CLINIC SCALE = 1:100 ELEVATION IN THE LIMPOPO PROVINCE IN THE PROJECT FOR IMPROVEMENT GL FL
300 4947 THE REPUBLIC OF SOUTH AFRICA OF THE HEALTH FACILITIES 8120 ROOFPITCH = 22.5 DEGREES WAITING AREA 1
2975 LETSITELE CLINIC /MAAKE CLINIC 7270 STATION ROOFPITCH = 22.5 DEGREES PASSAGE 2 9565 SCALE = 1:100 CONSUL. 2
2975
300 5246 GL FL SECTION 53 FNC 592.067
EXISTING ELECTRIC POLE SEPTIC TANK
EPOLE 591.496 FNC 592.157
STANK FNC 590.868 590.474 S 591.318 S 592.287 STANK MHOLE 590.719 591.289 TREE
72500 Y 590.550 MHOLE MHOLE TREE 591.307 591.302STANK 592.846 590 MHOLE 590.995 S 591.297 S 592.302 593.173 S STANK 593.154 ELECTRIC POLE 590.843 S S 589.610 590.345 INSPECTION HOLES S 47800 X DISUSED S 592.790 591.841 S WLYN 591.837 WATERKRIB 591.120 EPOLE S 589.161 591.245 WATER SS WLYN NEW 588.428 590.797 TAP TAP SS CFNC 591.302 SS SS 588.796589.043 WATER 588.459 SS588.633 SS 588.419 588.563 WASHING LINE TANK TREE SS 589.290 KRIP 589.012 S HOUSE2 KRIP 588.452 591.399 591.924 NEW 588.580 NEW ANKER KRIP 589.454 KRIP 588.558 DRN SS 588.705 SEPTIC TANK 591.964 WATER SS 588.553 SS HOUSE2 588.136 SS SS 588.989 SS SS SS588.646 TREE 591.491 SS 588.451 588.683 588.620 588.441 591.054 HOUSE1 DRAIN TANK SS588.328 SS NEW 591.400 SS SS 588.144 589.041 SS 587.566 588.120 SS 587.952 SS SS 588.765 HEALTH CLINIC SS 588.043 588.374 587.542 SS HOUSE1 SS 589.036 591.092 587.712 SS SS SS 587.855 588.561 587.465 SS FRENCH DRAIN TPUT EXISTING SS 588.363 589.012 TREE SS 587.768 589.473 587.102 SS SS 588.567 TPUT HOUSE TREE 587.363 SS 589.088 SS 589.187 592.172 588.736 SS EXISTING SS588.913 SS TPUT SS 588.745 588.549 588.820 589.072 HOUSE HOUSE2 FNC TPUT 591.893 592.399 588.828 SS HOUSE2 588.747 OPEN TESTPIT HOUSE1 591.671 HOUSE2 591.604 591.715 TREE RAMP TREE 592.253 592.009 TREE SS 592.059TPOLE TREE 588.938 592.083 587.407 SS SS SS 588.723 SS HOUSE1 SS SS 588.562 SSSS SS 589.274 FOOTP 591.536 SS587.037 587.792 588.164 589.243589.064 SS 591.436FOOTP 587.260 588.908589.135 591.455 TREE SS SS WTANK HOUSE1 591.987 586.756 SS 589.247 591.297591.307 SS SS SS 588.945 TELEPHONE POLE 587.118 587.431 SS 588.247 SS 587.749 SS588.893 TPUT 589.079 587.443 SS FOOTPFOOTP SS 591.408591.449 586.558 SS 589.139 WLYN 589.296 S 592.059 591.483 SS SS FNC 586.373 587.021 589.604 S S 591.647 SS 589.866 CONCRETE TREE 587.570 SS SS S 587.524 SS 589.384 EXISTING FOOTPATH S 589.040589.138 FOOTP 592.034 585.882 SS SS SS 591.342FOOTP TPOLE 585.938586.230 589.301 WATER 591.422 592.601 ANKER S TREE 592.402 585.795 SS SS SS TPUT 590.024 TANKS S 587.095 SS 589.065 591.223 591.531 586.172 588.614 589.088 S SS 591.714 S 587.452 585.706 SS SS 587.652 FOOTP WASHING LINE 586.192 S 591.325FOOTP SS 589.997 591.379 586.830 MHOLE MANHOLE SS SS MHOLE S 587.787 SS S S 590.692 591.431 585.877 586.042 587.768 590.566 S SS TPUT 590.149 590.665 585.785 SS 587.210 588.130 590.922 MANHOLE S 586.682SS SS S 592.085 S TPUT S 590.655 WLYN 586.305 587.855 588.128 590.833 591.727 585.914 S S TREE 590.587 S 592.274 590.302S 591.077 590.781S 591.337 WTANK 590.756 SS SS 590.333 S 591.534 S OPEN TESTPIT SS589.634 591.317 FOOTPFOOTP 586.267 586.313 TPUT SS 589.393 S 591.286591.300 EXISTING WATERTANK S SS 588.083 SS SS 589.162 S 590.670 586.078 586.942 SS 589.069 589.334 589.863 S WTANK FNC TPUT ATEBUI 591.525 S SS 587.938 588.367 590.020 590.589 BUILC TELEPHONE 592.446 586.162 587.390 591.513 TOILET S SS SS S POLE TEL 592.178 586.419 587.388 590.611 590.576 591.548 587.011 SS SS ATEBUICFNC DRAIN 586.494 588.038 590.533590.536 S TOILET S FOOTP DRN 592.022 592.127 586.321 SS SS S FOOTP 591.278 591.625 587.737 587.500 TREE S 590.531 591.167 S SS SS 588.769 589.881 TOILET 586.397 587.301 SS SS S TEL 592.215 TREE 587.477 588.155 590.258 BUILC TAP WATER 586.062 S 587.885 590.537 591.070 DRNBUILC 592.024 TOILET 586.652S TPUT SS 591.784591.810 SS 587.576 587.583 592.112 586.505 S 586.763 SS BUILC TAP TOILETS S SS 588.028 591.670 586.792 587.476 SS SS ATEBUI 586.697S SS SS 588.104 EXISTING 590.484 590.568 586.581 587.629 587.700 SS SSSS SS S 587.839 SS 589.562589.748 590.253 BUILC MANHOLE 586.622 S SS CFNC GUARDHOUSE 589.427 589.859SS 591.925 586.745 SS 587.634 GATEP 589.956 SS 590.518 MHOLE TOILET 587.882 589.965 591.921 592.171 SS SS GATE S S 589.445 SS 589.723 EXISTING S 586.793 589.476 SS ELECTRICAL 586.587 587.424 SS SS SS 590.244 S 589.042 589.512 SS 586.043 S S SS 589.591 589.744 586.339 586.933 589.602 SS CLINIC BOX TOILET S S 589.966 592.157 586.845 587.374 SS GATEP DBOX SS587.820 SS SS 590.523 591.805 CFNC S SS 590.185 592.633 S 587.522 587.978 SS 589.432 SS BUILC S 586.691 587.199 SS 588.212 SS 589.945 591.709 586.618 S 587.609 SS TREE SS 589.556 586.899 SS SS 588.542 SS 589.597 SS 589.521 S S S 587.384 SS SS SS 588.237 588.880 586.270 586.437 SS 588.354 588.185588.130 589.668 586.676 S S SS TREE 587.307 587.669 SS SS TPIT SS 590.432 PARKING 586.254 S 586.689 588.497 589.206 589.609 S 586.770 588.703 SS TSTAND 586.685 589.690 TSTAND 592.014 S TPIT BUILC 591.993 586.696 S 589.148 S 586.783 590.914 587.056 S SS SS TSTAND SS S S 587.459 589.751 590.462 592.422 586.403 S 586.802587.209 TSTAND 587.100 O SS 592.425 TPIT PE 589.714 589.215 N SS SS TE 588.863 588.986 S EXISTING S SS TP SS 586.899 I 589.907 RAMP S S TREE 588.110 T 591.187 587.152 587.340S 588.123 TREE SS SS RAMP WATERTANK 587.339 588.841 589.907 590.059 591.031 S FNC 586.949 TPIT TPIT 591.369 S SS 589.817 SS S S S SS588.068 589.665 590.096 586.900587.269 587.572 SS 587.701 SS 587.306 587.632 SS 589.591 TPIT SS SS 589.272 589.852 587.965 588.945
SS TREE 589.962 SS 586.506 SS 590.546 RAMP UP 589.114 SS SS SS 589.979 590.610 S 589.763 SS SS SS SS 587.675 SS SS 589.898 SS 590.567 590.399 586.792 590.032 590.138 DISUSED BORHOLE 590.002 S S SS SS 587.255 S 588.096 589.326 SS S 586.999 S 587.570 SS S TPUT SS 589.630 PHUIS SS TREE 587.475 587.384 587.555 588.224588.196 SS 589.879 AND PUMPHOUSE 586.661 589.556 589.395 590.213 CFNC TREE SS 590.908 S 588.125 SS 589.541 587.490 SS SS 589.059 SS S 587.841 SS PHUIS PHUIS SS 587.033 SS 588.459 588.745 589.804 589.936 590.410 588.194 DAM 590.806 S SS SS DAM 589.632 587.514 588.511 588.706 589.619 SS SS SS 588.090 589.547 589.620 SS DAM 589.954 589.612 SS SS DAM SS SS 590.756 590.704 589.645 590.039 590.556 SS SS SS S TREE SS 589.019 587.701 588.077 588.397 588.894 SS 588.239 SS 590.668 S SS 588.686 SS DISUSED CONCRETE 587.609 588.419 SS 589.068 SS 590.282 SS DAM 590.038 SS S 588.577 SS 587.256 587.596 SS 589.409 SS 588.698 589.748 TREE CONC SS SS 590.210 588.895 SS 589.907 SS 590.292 CONC SS SS 589.064589.079 590.040 588.300 CONC 590.218 CONCRETE SLAB SS 590.169 SS TPUT SS CONC 589.991 588.360 588.522 588.999 590.170 N SS SS CONC 0 587.885 SS 590.173 SS R 588.987 589.193 589.905 T H SS SS 588.757 590.424
0 SS 9 590.040 5
TREE 587.404 SS SS 587.697 589.266
SS 588.860
SS 588.030 TPUT 588.657 SS 588.785 SS 588.726
SS 587.776
SS 588.661 72400 Y
47900 X SS 588.100
SS 588.330
54 THE PROJECT FOR IMPROVEMENT OF THE HEALTH FACILITIES IN THE LIMPOPO PROVINCE IN THE REPUBLIC OF SOUTH AFRICA MOHLABA CLINIC SCALE = 1:500 SITE PLAN 21295
4570 1910 2070 1700 2910 2575 2740 2820
SHELVING
BATHRM 1 0 3
STORE TREATMENT CONSUL. 2 CONSUL. 1 8 SHELVING 3 DUCT KITCHEN PHARMACY 5735 STAFF 5
POST NATAL 0
PASSAGE 2 9 1
FHR
FIRST STAGE BATHRM 2 0 AREA 3
LABOUR LAUNDRY STATION 8 3
3830 WAITING SLUICE WM RECORDS
DR SHOWER SHELVING
MATERNITY 0 WALKWAY WALKWAY 7 RAMP 2
ENTRANCE 25715 7 7270 COVERED COVERED 0
DISABLED 9 7 1
HEALTH 4060 0 8
MALE 9 1 0 1
WAITING AREA 1 0 8120 1
FEMALE 0 2 0 2 SOCIAL FHR 4060 0
CLEANER 2 3 1 0 9 6
MAIN ENTRANCE MAIN ENTRANCE
RAMP RAMP
3220 1845 5280 1845 3080
FLOOR PLAN ROOF PLAN
55
THE PROJECT FOR IMPROVEMENT OF THE HEALTH FACILITIES IN THE LIMPOPO PROVINCE IN THE REPUBLIC OF SOUTH AFRICA MOHLABA CLINIC SCALE = 1:200 FLOOR PLAN / ROOF PLAN WEST ELEVATION
EAST ELEVATION
NORTH ELEVATION
SOUTH ELEVATION
56 THE PROJECT FOR IMPROVEMENT OF THE HEALTH FACILITIES IN THE LIMPOPO PROVINCE IN THE REPUBLIC OF SOUTH AFRICA MOHLABA CLINIC SCALE = 1:100 ELEVATION IN THE LIMPOPO PROVINCE IN THE PROJECT FOR IMPROVEMENT GL FL
300 5246 THE REPUBLIC OF SOUTH AFRICA
2975 OF THE HEALTH FACILITIES CONSUL. 2 PASSAGE 2 9565 ROOFPITCH = 22.5 DEGREES STATION MOHLABA CLINIC 7270 ROOFPITCH = 22.5 DEGREES
2975 WAITING AREA 1 8120 SCALE = 1:100
300 4947 GL FL SECTION 57 POSSIBLE AREA FOR BUILDING 48400
Boundary Line FENCE 4500
Existing Toilet (to be removed by SA) (950×750） SCHOOL 50000 20000
8000 10000
Existing Fence
10000 VP SHELTER
Boundary Line FENCE Boundary Line 26000 4500 4500 11300 43300 43300
Storm Water Reserve VP SHELTER 7250 EXISTING SCHOOL BLDG. 10000 10000 FENCE
Power line (33kva)
9 .
4
6 17000
0
9
2 FENCE 29000 Boundary Line Boundary Line FENCE Boundary Line 12800
7500 SEWER FENCE Gate Boundary Line Gate Boundary Line
FENCE 16740 4000 12200 4600 7500 4000 32400 4500
53000 13500 PHARARE KHUJWANA
10400 63900
7500 10000 4500 SOCCER GROUND 37027.3
Boundary Line Boundary Line
Existing Fence
4
5 4500
0 0 23000 14000
12700 VP SHELTER Fence 24200 SCHOOL Fence 21614.1
10000 VP SHELTER 2 Boundary Line
1 Well Boundary Line Existing Existing
1 FENCE 1 7 .
3 Existing Boundary Line Boundary Line 29500 28600 8010 7500 4500 Existing Pole (400V) Boundary Line 13900 4500 0 450 10000 22450 4500 7500 36950
Boundary Line 57000 Gate FENCE Existing Gate 14600
7500 4000 4000 19700
11000 63900
BURGERSDORP MOGOLOBOTO-2
58 THE PROJECT FOR IMPROVEMENT OF THE HEALTH FACILITIES IN THE LIMPOPO PROVINCE IN THE REPUBLIC OF SOUTH AFRICA VISITING POINT SHELTER SCALE = 1:500 SITE PLAN KHUJWANA PHARARE 2100 2100 BURGERSDORP 5050 (MOGOLOBOTO-2) 1000 6295 1500 PARKING 2975
FL ▼GL±0 ▼GL±0 300
PARKING 5000
1500 10000 1500
SECTION 10000
WAITING AREA 5000 MOGOLOBOTO-2
FL=GL+300 1000
GL+150 1500 6295
PARKING 2975
6000 FL ▼GL±0 ▼GL±0 DI TCH 300 1500 10000 1500 EXISTING GROUND LEVEL
1500 10000 1500 FLOOR PLAN
5050 SECTION
59
THE PROJECT FOR IMPROVEMENT OF THE HEALTH FACILITIES FLOOR PLAN / SECTION IN THE LIMPOPO PROVINCE IN THE REPUBLIC OF SOUTH AFRICA VISITING POINT SHELTER SCALE = 1:100 25° 6295 6295
PARKING WAITING AREA WAITING AREA 2975 2975
FL FL ▼GL ▼GL 300 300
10000 10000
60
THE PROJECT FOR IMPROVEMENT OF THE HEALTH FACILITIES IN THE LIMPOPO PROVINCE IN THE REPUBLIC OF SOUTH AFRICA VISITING POINT SHELTER SCALE = 1:100 ELEVATION
2-2-4 Implementation Plan
2-2-4-1 Implementation Policy
The Requested Japanese Assistance shall be executed in accordance with the framework of Japan’s grant aid scheme. After conclusion of the exchange of notes regarding the Project between the two governments, the
Project will officially be commenced.
This procedure will be followed by conclusion of a consultant agreement and preparation of detail design / tender documents. Tendering of construction contractor (hereinafter referred to as “the Contractor”) and equipment supply contractor (hereinafter referred to as “the Supplier) will be held thereafter. The Contractor and the Supplier selected through the tenders shall then execute both construction work and equipment supply and installation work.
During the detail design stage the Consultant and the persons concerned in South Africa will study construction schedule of the Project and have discussions to ensure smooth implementation of works undertaken by the both Governments. The scope of works undertaken by South Africa shall be completed prior to procurement of equipment and construction of the new buildings.
(1) Implementing Organisation
1) South African side
The implementing agency of this Project is the Limpopo DOHW. The Limpopo DOHW formed a committee for implementation of the Project. The members of the committee are as follows.
♦ Dr. M. Nkadimeng （Senior General Manager, Health Care Services Branch） ♦ Mr. Mpho Mofokeng （Chief Financial Officer, Financial Management Branch） ♦ Dr. P.N.Kgaphaola （General Manager, District Health Services） ♦ Mr. Anton van Geffen （General Manager, Financial Management Chief Directorate） ♦ Mr. Jimmy Ledwaba （Senior Manager, Devolution Support Directorate） PIC ♦ Ms. Mantji Mahlo （Senior Manager, Integrated Primary Health Care） ♦ Dr. ETC Moloko （Senior Manager, District Hospital Services）
61 ♦ Mr. Frans Faul （Manager, Physical Resource Management Sub-directorate, Strategic Management and Planning） ♦ Mr. Manasseh Khosa （Deputy Manager, Physical Resource Management Sub-directorate）
2) Consultant
Immediately after the Notes regarding the Project are exchanged between the two governments, the
Government of South Africa will conclude a consultant agreement with a selected Japanese consultant in accordance with the Grant Aid scheme of the Government of Japan. The agreement will become effective upon verification by the Government of Japan. The consultant will carry out the following services in compliance with the provisions of the consultant agreement.
Detail Design: Preparation of the detail design documents including specifications and other technical documents Assistance of Tendering: Assistance of tendering to select the Contractor and the Supplier, and concluding the contract. Supervision: Supervision of construction work and equipment work including installation and instruction for operation and maintenance
In Detail Design stage, the Consultant will prepare tender documents including detailed specifications and drawings of construction work and equipment work based on the Basic Design, and tender instructions and condition of the contract.
In Tendering stage, the Consultant will provide the tendering services, e.g. public notice of tender, receipt of applications, pre-qualification, distribution of tender documents, tender opening, evaluation of the tender results. Furthermore, the Consultant will assist on concluding the contract between the Government of
Republic of South Africa and the Contractor and the Supplier, and report to the Government of Japan.
In Supervision stage, the Consultant will ensure that construction work and equipment work will be carried out fairly in accordance with the contract documents as well as instructions, advice and coordination, for implementation of the Project. The supervision service includes the followings:
62 a. Coordination, instructions and advice to the Contractor and the Supplier
The Consultant will examine the construction schedule, construction plan, the building materials procurement plan and the equipment procurement / installation plan, and shall coordinate, give instructions and advices to the Contractor and the Supplier.
b. Examination and approval of working drawings of the construction work
The Consultant will examine, instruct and approve the shop drawings and other relevant documents submitted by the Contractor.
c. Confirmation and approval of building materials and equipment
The Consultant will confirm and approve the building materials and equipment proposed by the Contractor and the Supplier in compliance with the contract documents.
d. Factory inspection
The Consultant shall inspect, if necessary, the building materials and equipment at the manufacturers’ factories to ensure the quality and performance.
e. Reporting progress of work
The Consultant shall grasp the actual conditions of the construction sites and progress, and report them to both the governments of South Africa and Japan.
f. Completion inspection and commissioning test
Upon completion of the construction work and the equipment work, the consultant will conduct a final inspection and commissioning tests of the completed facilities and installed equipment to ensure that all the works are completed in compliance with the contract documents, and will submit the completion certificates to the Government of South Africa.
63 g. Training for operation of the equipment
Some equipment included in the Project will require expertise on operation and maintenance. Therefore, the persons in charge of operation of the equipment will be required to receive on-site training by the Supplier during the installation / adjustment / test-run period. The Consultant shall give instructions and advice regarding the training programme.
3) The Contractor and the Supplier
The Contractor will carry out construction work and the Supplier will procure, supply and install medical equipment in accordance with the contract documents and give instruction for operation and maintenance of the equipment. The Supplier will also ensure after-sale services for getting technical assistance and procuring spare parts and consumables for the major equipment within the guarantee period from local suppliers.
4) JICA
In order for the Project to be implemented in accordance with Japan’s Grant Aid scheme, the Grant Aid department of JICA will guide the Consultant as well as the Supplier. JICA will hold meetings with concerned parties for advancement of the Project when necessary.
2-2-4-2 Implementation Conditions
(1) Construction Work
1) Condition of the Local Construction Industry
There are in principle no major differences in terms of construction practices between South Africa and Japan.
However, since the scope of local contractors' operations and responsibilities differ widely from those of
Japanese contractors’, careful attention should be paid to the local method of determining the construction period and so on. In South Africa, the range of consultants' services in construction project is broad, including preparation of working drawings and reinforcement-bar schedule, as well as a heavy responsibility for
64 warranty against defects. If a building is not constructed strictly with the design drawings, the architect in charge must rectify such defect at their own expense, and the contractor will not be held responsible for such defect. Therefore, in South Africa, architects are insured for architectural design insurance according to the size of the project.
It should be noted that in South Africa the amount of gross profit included in the unit cost of construction is by far lower in Japan due to the difference in terms of scope of work and responsibility.
2) Building Regulations and Permit Procedure
In South Africa, there are regulations on facility planning and construction. Furthermore, Building materials and machinery equipment should also comply with the relevant industrial standards and regulations in South
Africa.
Prior to commencement of the construction work of this Project, it is not necessary to obtain building permit from the local authority but the Limpopo DOHW shall submit a notification of the Project to the local authority instead. Upon the completion of detail design, all the relevant documents for construction of the
Project shall be submitted to the Limpopo DOHW for its approval. The Limpopo DOHW shall submit the notification to the local authority thereafter.
(2) Equipment Procurement
1) Supervision of Equipment Installation
Installation work and training of the procured equipment will be done during the operation period of the existing facilities. Therefore, schedule of installation work and training must be controlled through close communication between South African side and the consultant not to hinder the activities of facilities.
2) Dispatch of Engineer
Engineers shall be dispatched from the manufacturers or distributors of equipment under the Requested
Japanese Assistance. They shall give instruction to facility staff as to handling, operation, daily maintenance,
65 etc. so that the equipment may be used properly and effectively.
2-2-4-3 Scope of Works
(1) Scope of Works (Equipment Procurement & Installation)
1) Work under Japan’s Grant Aid
Procurement, transportation, loading and unloading of the equipment to the Project site
Installation and test operation of the equipment
Explanation, operation and maintenance training for the equipment
2) Work under the Government of South Africa
Relocation, removal of existing equipment where new equipment will be installed
Provision of space for temporary storage within the Project site
Provision of access way for transportation of the equipment
Provision of water supply (with bulbs), drainage (with end caps), power supply (with receptacles,
breakers), medical gas supply, reinforcement of foundations, and so on, which is necessary prior to the
equipment installation
(2) Scope of Works (Construction Work)
1) Work under Japan’s Grant Aid a. Facility construction
Construction of the buildings described in the Basic Design Study report
Electrical, mechanical, plumbing and sanitary ware installation works
Water service piping, electric cabling and drainage work within the Project sites
Installation, removal of temporary fence and temporary buildings such as warehouse for construction
Payments for electricity, water and telephone used for construction
66 b. Other relevant work
Inland transportation of materials and equipment to the Project site
2) Work under the Government of South Africa a. Site and exterior works
Securing the sites for the Project
Removing existing structures, trees and any other obstacles work from the Project sites and levelling
Landscaping work such as planting, gardening and pavement
Construction of other necessary structures such as a guardhouse and generator room at each Project site
Construction of boundary fences and gates
b. Infrastructure
Low voltage electricity supply to the sites
Installation of telephone lines with enough capacity up to the Main Distribution Frame in the buildings
Provision of water supply, which includes construction of a new bore well, up to the boundary line of the
Project sites
c. Preparatory work
Provision of sites for temporary construction site office, workshops and material storage
Connection of temporary supply line of electricity, telephone, and water
2-2-4-4 Consultant Supervision
(1) Supervision Policy on Procurement and Construction
In accordance with the scheme of Japan’s Grand Aid, the consultant will organize the Project working team to ensure smooth implementation of the Project based on the policy of the basic design. The supervision policy on procurement and construction are as stated below.
67
To keep close communication with the persons in charge of the Project of both the governments to ensure
completion of construction of the buildings and procurement of equipment without delay
To promptly give proper advices and instructions with justice to the Supplier and the Contractor
To give proper advices and instructions concerning installation and operation of equipment after
handover
To confirm completion of equipment installation and construction of the buildings in compliance with
conditions of the contract, to attend handover of equipment and the buildings, and to conclude the
consulting services with approval of South African side
(2) Supervision Plan on Procurement and Construction
Judging from the scale of the Project, it is advisable that, in carrying out the aforementioned tasks, the consultant should dispatch one engineer to South Africa throughout the term of works. The Consultant shall also dispatch necessary consultants/engineers to the site at relevant occasions for inspection, instruction and coordination, and at the same time assign necessary engineers in Japan to establish a communication and support system. The consultant shall report the progress of the works, payment procedures, completion of construction of the facilities and installation of the equipment, and any other relevant matters to the concerned officers of the Japanese Government.
2-2-4-5 Quality Control Plan
Construction supervision under this Project is to be conducted in compliance with the following criteria in order to achieve the designated quality of construction work. These criteria are based on relevant standards of South Africa or Japan.
68 Table 2-14 Criteria for Quality Control Typical criteria for quality control Remarks Items Target value Testing method Earth work Inclination Within accepted range Slant gauge, observation The consultant will instruct Accuracy of floor the Contractor to submit level +0～-5cm Levelling, observation the Summary of Height of foundation construction techniques Height of levelling +0～-3cm As above which include types of concrete inspection, target value, ±1cm As above contents of inspection, method of testing, curing, construction, and check prior to construction. Re-bar work Minimum concrete Sides not in contact with Observation, measurement As above covering thickness the earth 30m/m Sides in contact with the earth: Foundation 60m/m Others 40m/m Processing Tolerable size: precision Stirrup / hoop ±5m/m Others ±10m/m Tensile strength 3 pieces taken from 1 lot Tested at factory at the at site (1lot= 20 tons for presence of consultant each diameter) Concrete work Compressive Planned strength over 3 samples x 3 types for every As above (Freshly mixed strength 210kg/cm2 batch as well as every 150 concrete) m3 (tested at site at the presence of consultant) Slump level 15cm±2.5cm Once for every batch as well as every 150 m3 (tested at site at the presence of consultant) Chloride level Under 0.3kg/m3 As above Masonry work Compressive 40～70kg/cm2 Tested at manufacture at the As above strength presence of consultant Other materials Observation (cement, re-bars) Plaster work Material, storage As above Paint work construction, Roof waterproofing compound, finishing work thickness, curing, Doors / windows precision Plumbing work Water supply pipe Air pressure test Tested at the presence of As above Sewage pipe Water filling test consultant Electrical work Electrical cabling Insulation resistance test As above As above Performance test
2-2-4-6 Procurement Plan
(1) Procurement of Equipment
1) Procurement of Equipment
Equipment procured shall be the product of either Japan or South Africa. The both governments may
however allow procurement of the third country products considering competitiveness of price, ease of
maintenance and other criteria below.
The manufacturer has (a) local distributor(s) for maintenance in South Africa Spare parts and consumables are available locally
69 The equipment that are widely used in South Africa The equipment that are procured within the E/N period
The equipment that contain the possibility of third country origin are as follows.
Table 2-15 Equipment that contain the possibility of third country origin Equipment Country Infant Warmer EU X-ray Apparatus, basic screening unit EU Audiometer US Glucose Meter US High Pressure Steam Sterilizer EU Defibrillator EU Neonatal Monitor EU Diagnostic Set US ECG（6ch） Switzerland Pulse Oxymeter EU Peak Flow Meter US Bilirubin Meter US Cardiotocograph EU Hemoglobin Meter EU Autoclave EU
2) Transportation Plan a. Packing
Japan and the third country procured equipment shall be packed in wooden case and carried in a 20ft. container to avoid robbery during marine transportation.
b. Route ① Japanese Products and Third Country Products (for existing facilities)
Shipped from Japanese and third country port to Durban port by sea, sorted out at a warehouse near Durban port, then transported to each facility by truck.
② South African Products (for existing facilities)
Sorted out at a warehouse near Durban port, then transported to each facility by truck.
The equipment for the 3 new clinics shall be transported to a warehouse at Van Velden Hospital to be kept until construction work is finished. Installation of those equipment shall be controlled according to the progress of the construction work.
70 c. Vehicle Vehicle for Mobile Clinic shall be handed over at each site.
(2) Procurement of Building Materials
All of the major building materials are produced and available in South Africa. Some of the primary parts of industrial products, such as generators, are imported, but it is possible to procure those products in local market through local distributors. Most of the major building materials are locally available or available in
Polokwane, which is about 2 hours drive from the sites. Therefore, no problem will be expected regarding the procurement of repair parts and maintenance of equipment after completion of the Project.
Table 2-16 indicates origins of materials/equipment for building, electrical, plumbing and mechanical work and locations from where they can be procured.
Table 2-16 Procurement Plan of Building Materials/Equipment Material / Equipment Country Area Remarks Cement South Africa All areas Local products Sand / Gravel South Africa All areas Local products Re-bar South Africa All areas Local products Form South Africa All areas Local products Aluminium South Africa Building Building Polokwane, Johannesberg Local products windows Steel doors South Africa Polokwane, Johannesberg Local products South Africa Local products, Imported (Locally Hardware Polokwane, Johannesberg procured） South Africa Tzaneen, Polokwane, Face brick Local products Johannesberg Floor tiles South Africa Tzaneen, Polokwane Local products South Africa Tzaneen, Polokwane, Paint Local products Johannesberg South Africa Local products, Locally assembled Distribution panel Johannesberg
Electrical Electrical with imported parts South Africa Local products, Locally assembled Lighting fixture Polokwane, Johannesberg with imported parts Electric cable South Africa Polokwane, Johannesberg Local products cover (PVC pipe) Electric wire, cable South Africa Polokwane, Johannesberg Local products
Mechanical Mechanical Air-conditioning South Africa Local products, Locally assembled Polokwane, Johannesberg unit with imported parts South Africa Ventilation fan Polokwane, Johannesberg Local products
Sanitary Sanitary South Africa Tzaneen, Polokwane, Local products, Imported (Locally Sanitary fittings Johannesberg procured) South Africa Tzaneen, Polokwane, PVC pipe Local products Johannesberg
71 2-2-4-7 Implementation Schedule
When the Notes regarding implementation of the Project are exchanged between the Government of South
Africa and the Government of Japan the work shown in Table 2-17 shall be executed accordingly.
Table 2-17 Implementation Schedule 1 2 3 4 5
Tender Doc. Preparation
Approval of tender Doc.
PQ and tender preparation Detail Design
Supply Contract (5.0 Months) 1 2 3 4 5 6 7 8 9 10 11
Manufacturing
Transportation Equipment Equipment Installation
Preparation / Temporary work
Excavation / Foundation Work
Wall and Roof construction Implementation/Procurement Construction Construction
Finishing, Electric, Mechanical, Plumbing, Sanitary and Exterior work （1.1 Months） 1 2 3 4 5 6 7 Technical Assistance （6.5 Months） Work in Japan Work in South Africa or third Country
(1) Detail Design
After conclusion of consultant agreement with the Limpopo DOHW, the consultant shall start preparing detail design drawings for construction work, equipment specifications and tender documents in accordance with the
Basic Design Study Report. In the meantime the consultant shall also obtain approval for those documents from the South African side.
(2) Tender
The Supplier and the Contractor for implementation of the Project shall be selected through open tender.
Tendering procedure shall start from a public announcement, pre-qualification, explanation and distribution of tender documents, questions and answers, submission of tender, tender evaluation and conclusion of supply
72 contract and construction contract. The South African side shall take the necessary measures to obtain land permission, building permit, working visa, etc. prior to the commencement of the works. The consultant shall assist these procedures.
(3) Construction Work and Equipment Work
Judging from the functions of the facility, scale of the project, technique required and the local conditions of construction industry, the overall project implementation period for both the construction work and equipment work will be 11 months if construction materials are procured without delay.
73 2-3 Obligations of the Recipient Country
The following tasks for the Project shall be carried out by the South African side within the stipulated period.
(1) Equipment Work
To relocate and/or remove existing equipment and prepare the place where new equipment will be
installed
To provide space for temporary storage within the Project site
To provide access way for transportation of the equipment
To provide water supply (with bulbs), drainage (with end caps), power supply (with receptacles,
breakers), medical gas supply, reinforcement of foundations, and so on, which is necessary prior to
equipment installation
(2) Construction Work
1) Site and Exterior Work
To secure land necessary for the Project
To remove existing structures, trees and any other obstacles from the Project sites and to level the land
To undertake incidental outdoor works, such as gardening and paving
To construct a guardhouse and a generator room
To construct fence around the site and a gate
2) Infrastructure
To bring electricity up to the boundaries of the three clinic sites
To bring telephone line up to the boundaries of the three clinic sites
To provide water supply, including provision of a new bore well, up to the boundaries of the 3 clinic sites
74 3) Preparation for Construction
To provide sites for temporary office, workshop and warehouse
To provide temporary connection line of electricity, telephone, water supply
(3) Others
To obtain the building permits for all the clinics and shelters
To bear commissions, namely advising commissions of an Authorisation to Pay (A/P) and payment
commissions, to a Japanese bank for the banking services based upon the Banking Arrangement (B/A)
To ensure prompt unloading and customs clearance of the products purchased under the Japan's Grant Aid
at ports of disembarkation
To exempt Japanese nationals from customs duties, internal taxes and fiscal levies which may be imposed
in South Africa with respect to the supply of the products and services under the verified contracts
To accord Japanese nationals whose services may be required in connection with the supply of the
products and services under the verified contracts such facilities as may be necessary for their entry into
South Africa and stay therein for the performance of their work
To provide necessary permissions, licenses, and other authorisation for implementing the Project, if
necessary
To bear all the expenses, other than those covered by the Japan's Grant Aid, necessary for the Project
75 2-4 Project Operation Plan
2-4-1 Project Team in Limpopo DOHW and Maintenance System
As described in 2-2-4, the implementing organization is the Limpopo DOHW, in which a project team consisting of nine members headed by Mr. J. Ledwaba, Senior Manager, Devolution Support Directorate, DHS
Chief Directorate, has been formed. In Limpopo DOHW, Physical Resource Management Sub-directorate,
Strategic Management and Planning Directorate, Strategic Management Services Branch is in charge of construction, facility and installed equipment. In DHS Chief directorate, Regional Hospital Division,
District Hospital Division and District Health Division are in charge of other medical equipment at each level.
As of the organizational change in 2003, actual management of maintenance is done by each hospital and district health office (for Health Centres and Clinics). Therefore, the Limpopo DOHW only gives advice to each facility on budget allocation, administration of maintenance, etc.
2-4-2 Project Implementation Structure of the Medical Facilities
The facilities to be constructed under this Project will be operated by the existing operation and management structure. The equipment to be supplied under this Project is basically replacement of the existing ones and the specifications and quantities of the equipment plan are made based on the existing manpower of each facility. Therefore no problem is foreseen for operation and management of the new facilities and equipment.
Letsitele clinic, which is being operated within several rented rooms and does not have any guards at present, will need to hire two guards upon completion of the Project. Though this will be an increase in staff number, it will not be a problem because this is the usual number of guards for a clinic.
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2-5 Estimated Project Cost
2-5-1 Estimated Project Cost
Estimated project cost required for realization of the Project under the conditions described in (3) Conditions of Estimation is Japanese Yen 521 million. (Japan’s Grant Aid:476 million, South African side:45 million).
(1) Project Cost borne by Japan
The Project cost borne by Japan is shown in Table 2-18.
Table 2-18 Project Cost borne by Japan Item Amount (JY1,000) 1 Equipment Procurement 191,400 a. Letaba Regional Hospital 78,800 b. Dr. CN Phatudi Hospital 32,000 c. Health Centres 11,500 d. Clinics 42,400 e. Vehicles for Mobile Clinic 26,700 2 Construction Work 179,600 a. Clinic (3 sites) 162,800 ①Letuitele Clinic 54,600 ②Mohlaba Clinic 54,400 ③Maake Clinic 53,800 b. Visiting Point Shelter (4 sites) 16,800 Burgersdop, Khujwana, Mogoloboto, Pharare 3 Design and Supervision 105,400 Grand Total 476,400
This cost estimation is provisional and would further be examined by the Government of Japan for the approval of the Grant
(2) Project Cost borne by South Africa
The Project cost borne by Japan is shown in Table 2-19
Table 2-19 Project Cost borne by South Africa Category Total (ZAR 1000) 1 Removal of existing equipment 8 2 Preparation work 7 3 Electricity and water supply and telephone connection cost 673 4 Guardhouse for clinics 266 5 Fences and gates for clinics 99 6 VAT (14%) 1,719 7 Commission on Authorization to Pay (A/P) 35 Grand Total 2,807
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1) Breakdown of Removal of existing equipment Equipment removed Hospital Total (ZAR) X-ray apparatus Letaba 4,941 High pressure steam sterilizer Letaba 1,005 Dental unit Letaba 1,005 DR.CN Phatudi 924 Total (ZAR) 7,875
2) Breakdown of Preparation work Equipment installed Hospital Construction Total (ZAR) X-ray apparatus, basic Letaba Distribution boad 1,161 screening unit High pressure steam Letaba Water supply 1,224 sterilizer Dental unit Letaba Plumbing 924 DR.CN Phatudi Plumbing, water supply, 3,210 drainage Total 6,519
3) VAT = ZAR 1,719,000 1. VAT on consultant fee Approximately 25 % of consultant fee including hotel, car, etc. ￥117,000,000. X0.25X0.14＝￥4,095,000．（ZAR253,000）
2. VAT on procurement of equipment Approximately 20% of equipment cost procured in South Africa ¥192,000,000.X0.2X0.14=¥5,376,000．(ZAR332,000)
3. VAT on construction cost Approximately 100 % of Direct Expenses of construction work ¥131,000,000.X0.14＝¥18,340,000．（ZAR1,134,000）
4) Commission on authorization to pay (A/P) = ZAR 35,000 Fund from the Japanese Government will be transferred to an account of National Department of Health after Banking Arrangement (B/A). The 0.1 % commission will be charged on consultant fee, equipment procurement and construction.
1. Commission on consultant fee ¥5,000＋¥117,000,000X0.001=¥122,000．（ZAR7,000）
2. Commission on equipment procurement ¥5,000＋¥192,000,000X0.001=¥197,000．（ZAR12,000）
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3. Commission on construction ¥5,000＋¥247,000,000X0.001=¥252,000．（ZAR16,000R）
(3) Conditions of Estimation
Estimation date ： June, 2003
Exchange rate ：US$1＝JY120.35
1Rand＝JY16.17（Based on TTS for the last 6 months）
Construction period ： 1 phase in the 1 fiscal year. The period of detail design, equipment
procurement and construction work are as shown in Table 2-16.
2-5-2 Operation and Maintenance Costs
(1) Equipment
The budget for equipment operation and maintenance are allocated from “Programme 8, Health Facilities
Management” drafted by the Limpopo DOHW, as follow.
Table 2-20Maintenance Budget (ZAR)
Fiscal Year 2002 2003 Facility Letaba Facility 551,046 360,000 Equipment 322,363 500,000 Dr. C. N. Phatudi Facility 406,676 260,000 Equipment 237,906 242,754 Health Centre/Clinics Facility n.a. 1,095,000 in Mopani District Equipment n.a. 339,856 Maintenance budget Facility 21,999,932 22,027,300 all province Equipment 12,000,000 14,972,700 Program Total* 217,574,000 190,210,000 Souce : Limpopo DOHW and Mopani District Office * Figure of 2002 corresponds to Programme 6 Health Science and Training and 2003 to Programme 8 Management
Table 2-21shows an estimation of annual costs of operation and maintenance including consumables, spare parts and maintenance contract necessary for implementation of the Project.
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Table 2-21 Operation and Maintenance Costs of Each Facility (ZAR)
Maintenance Consumables/ Contract Spare Parts Facility Total Total Total All Facilities Total(ZAR) 83,547 798,267 881,814 ital Hosp Letaba 67,904 71,117 139,020 Dr. C.N.Phatudi 15,644 78,856 94,500
Centres Mgodeni Grace 0 42,278 42,278 Health Nkowankowa 0 42,278 42,278 Shilvane 0 37,751 37,751 Julesburg 0 37,751 37,751 Makgope 0 17,052 17,052 Mamitwa 0 17,052 17,052 Nyavana 0 17,052 17,052 Mokgwathi 0 17,052 17,052 Ramotshinyadi 0 17,052 17,052 Ooghoek 0 17,052 17,052 Dr.Hugo Nkabinde 0 17,052 17,052 Letsitele 0 19,433 19,433 Mohlaba 0 19,433 19,433 Khujwana 0 17,052 17,052 Dan 0 17,052 17,052
Clinics Mariveni 0 17,052 17,052 Tzaneen 0 37,751 37,751 Motupa 0 17,052 17,052 Morapalala 0 17,052 17,052 Madumane 0 17,052 17,052 Morutji 0 17,052 17,052 Carlotta 0 17,052 17,052 Tours 0 17,052 17,052 Mogapeng 0 17,052 17,052 Zangoma 0 17,052 17,052 Jamela 0 17,052 17,052 Mogoboya 0 17,052 17,052 Maake 0 19,433 19,433 Lenyenye 0 17,052 17,052 Lephephane 0 17,052 17,052 Moime 0 17,052 17,052
Those 2 tables above indicate that the operation and maintenance costs borne by each facility will be within their budget of FY 2003. Percentage of the operation and maintenance costs over the budget is as follow.
Letaba Regional Hospital 27.8%
Dr. CN Phatudi District Hospital 38.9%
Health Centres and Clinics 45.1%
(2) Facility
The present operation and maintenance of the clinics in Limpopo province are managed by the sub district
80 offices in charge of each clinic. The expenditures are divided only into personnel expenditure and others.
The other expenditures are disbursed as they occur and no statistical data on each clinic have been prepared.
The operation and maintenance cost of the three clinics at Letsitele, Mohlaba and Maake after completion of the Project is determined as follows.
・ Personnel expenditure There will be no increase in number of staff at Mohlaba and Maake clinics after completion of the Project because the clinics will be run by the same number of staff. Letsitele clinic on the other hand will have an increase of personnel expenses for security guards who need to be newly hired because there are no guards stationed at the moment since the present operation is carried out in a rented place within a store complex. 4 security guards (2 shifts) x Rd.4,850/person･month = Rd.19,400/month ・ Administrative, stores and livestock, and equipment expenditure This expenditure will be the same as the present one. ・ Expenditure on heat, electricity and water An estimated cost on heat, electricity and water is Rd.8,500/month per clinic. Because the present expenditure is unknown, this whole amount is indicated as an increase for the sake of calculation. ・ Maintenance cost of each clinic According to the DOHW, maintenance cost is to be calculated as 3％ of the construction cost (net building cost) per year which is about Rd.4,500/month per clinic. For the same reason as heat, electricity and water cost, this whole amount is indicated as an increase.
Based on the above conditions, an expected increase in operation and maintenance cost of the clinics per month are calculated as follows.
Table 2-22 Expected Increase in Operation % Maintenance Cost (ZAR) Administrative, Stores, Heat, Electricity, Name Personnel Maintenance Total Increase livestock, and Equipment and Water Letsitele 19,400 No change 8,500 4,500 32,400 Mohlaba No change No change 8,500 4,500 13,000 Maake No change No change 8,500 4,500 13,000
81 2-6 Other Relevant Issues (Technical Assistance by Consultant)
(1) Background
All the equipment in the health facilities under the Limpopo province are divided into 2 categories, the
equipment that require installation work such as X-ray unit, Steam sterilizer, Operation light, etc. and the
equipment other than that. The former is administered by Physical Resource Management Sub-directorate,
Strategic Management and Planning Directorate, Strategic Management Services Branch of the Limpopo
DOHW. Each facility requests the Sub-directorate for repair or checkups and then the Sub-directorate
requests the agents or distributor of the manufacturers to dispatch the engineer to each facility.
Other basic equipment are administered by each relevant section of the Limpopo DOHW or
district/sub-district health office. When requested by a facility, the section places an order for repair to
agents.
Having no budget or staff for maintenance of their own, the health facilities depend for equipment
maintenance on the relevant section of Limpopo DOHW, which can respond only within the budget.
The largest problem that Limpopo DOHW has faced is the situation where no unified responsible agents
for equipment maintenance exist in either the Limpopo DOHW or health facilities.
To cope with the situation, the Limpopo DOHW, as of 2003, decided to transfer all the responsibility for
equipment maintenance to regional and district hospital and allocate the budget for equipment maintenance
within the discretion of them.
Even Letaba Regional Hospital, the only hospital where specialized doctors are stationed, does not have a
system of medical equipment maintenance. They only have a list of equipment in Finance, Procurement
and IT Management Section.
So Letaba Hospital decided to establish a system of medical equipment in Finance, Procurement and IT
Management Section to make the best use of the budget. They started with sending a manager of the
above section to the counterpart training for medical equipment organized by JICA and wishes that the
manager will play an important role in establishing a new Equipment Management Section. During the
Explanation of Draft Report, the study team confirmed that a Medical Equipment Management section
82 would be established under Subdirectorate: Technical Support Services (headed by Mr. Banda).
Under the circumstances in which need for establishing an Equipment Management Section and a system
of management of their own, Letaba hospital requested the Basic Design study team for Technical
Assistance by Consultant on instruction of computerized equipment management as a soft component of
the Project.
(2) Purpose
To establish a medical equipment management system designed for effective use of budget and for making
the best use of equipment.
(3) Outputs
1) To be able to grasp the situation of medical equipment based on the ledger for equipment management
2) To be able to grasp the annual cost for maintenance
(4) Activities
First phase: Completion of equipment management ledger and centralised management of equipment
1) Assist establishment of an Equipment Management Section in Letaba Hospital headed by Mr. Derrick
Baloyi, who should have finished the counter part training for equipment management by JICA
2) Assist to extract the data of medical equipment from the list of equipment used by Mr. Baloyi and
then define the name of equipment.
3) Discuss necessary item to be used in the computerized ledger and assist to make a formula for the
ledger. Also assist data input.
4) Discuss the method of requesting quotation and assist to make slips for repair. Assist to establish a
system for storing and supplying spare parts and consumables.
5) Assist to pick the equipment that need spare parts, consumables, periodical checkups and
maintenance contract from the ledger.
After the First phase, the trainee should be able to complete the equipment management ledger. Then the
83 trainee requests quotation for spare parts, consumables, periodical checkups and maintenance contract to manufacturers or agents.
Second phase: Making an annual maintenance budget
1) Assist to check the quotation from manufacturers or agents.
2) Assist to request additional quotation, if necessary.
3) Discuss the possibility of outsourcing of maintenance contract (what equipment and how)
4) Assist to classify the data of annual maintenance cost, spare parts, consumables and outsourced
maintenance contract. Also assist to input the data of collected quotation.
5) Assist to establish an annual maintenance budget, calculate the cost of outsourced maintenance
contract and draft a policy for allocation of maintenance budget.
(5) Inputs
Management Method of Equipment
1 Japanese Consultant x 3.5 months (0.34M/M in Japan, 3.16M/M in South Africa)
First phase, 1.5 months (0.17M/M in Japan, 1.33M/M in South Africa)
Second phase, 2.0 months (0.17M/M in Japan, 1.83M/M in South Africa)
A Japanese consultant shall be dispatched twice for assistance of the above activities.
The first stage shall start immediately after installation of equipment under the project.
The second stage shall start after completion of construction work under the project.
The Japanese consultant shall have wide knowledge of medical equipment and be able to instruct on management of spare parts and consumables. He/she also shall have at least 12 years of experience including an experience of equivalent technical assistance.
84
Table 2-23 Activities of Technical Assistance
Japan South Africa Limpopo Consultant Letaba Hospital DOHW In Japan In South Africa Activities (Day, MM) （Day, MM) Maker / Medical Physical Japanese Material CEO, Agent Equipment Resource Consultant Management Manager Management Management
Work in Japan (sort out equipment, etc) 3 ○ Assistance in establishment of an Equipment 2 ○○ ○○ 1 Management Section Assist to extract data and define the equipment 9 ○○ ○ ○ 2 title Discuss the necessary item for ledger and make 12 ○○ ○ ○ 3 formula. Assist for data input 5 ○○ First phase Assist for method of requesting repair and for 4 10 ○○ ○○ ○ making slips Assist to pick the equipment for requesting 5 2 ○○ ○ quotation Work in Japan (organize data, etc) 2 ○ 5 days 40 days First phase Total 0.17MM 1.33MM
Collection of quotation and data input by trainee ○○ (for 3 months)
Work in Japan (sort out spare parts, 3 ○ consumables, etc) 1 Check the quotation 10 ○○ 2 Assist for additional quotation, in necessary 3 ○○ ○ 3 Assist for outsourced maintenance contract. 7 ○○ ○ ○ Assist to classify the collected data 15 ○○ 4
Second phase Assist for data input 5 ○○
5 Assist to establish an annual maintenance budget 15 ○○ ○○ ○
Work in Japan (report to JICA, etc) 2 ○ 5 days 55 days Second phase Total 0.17MM 1.83MM
(6) Final Documents
1) Equipment Maintenance Ledger
2) Slips for equipment repair and spare parts/consumables
3) Annual Maintenance Plan (Draft)
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