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46457 Public Disclosure Authorized PublicWBI DEVELOPMENTSTUDIES Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Facilities in Developing Countries inDeveloping Facilities Establishing Private Health Care Health Establishing Private a guide for medical entrepreneurs a guide for Seung-Hee Nah andEgbe MD Seung-Hee Nah Osifo-Dawodu, Establishing Private Health Care Facilities in Developing Countries WBI DEVELOPMENT STUDIES Establishing Private Health Care Facilities in Developing Countries a guide for medical entrepreneurs Seung-Hee Nah and Egbe Osifo-Dawodu, MD Th e World Bank Washington, D.C. © 2007 The International Bank for Reconstruction and Development/The World Bank 1818 H Street, NW Washington, DC 20433 Telephone: 202-473-1000 Internet: www.worldbank.org E-mail: [email protected] All rights reserved First printing June 2007 1 2 3 4 10 09 08 07 This volume is a product of the staff of the International Bank for Reconstruction and Development/The World Bank. The findings, interpretations, and conclusions expressed in this paper do not necessarily reflect the views of the Executive Directors of The World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgement on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Rights and Permissions The material in this publication is copyrighted. Copying and/or transmitting portions or all of this work without permission may be a violation of applicable law. The International Bank for Reconstruction and Development/The World Bank encourages dissemination of its work and will normally grant permission to reproduce portions of the work promptly. For permission to photocopy or reprint any part of this work, please send a request with complete information to the Copyright Clearance Center Inc., 222 Rosewood Drive, Danvers, MA 01923, USA; telephone: 978-750-8400; fax: 978-750-4470; Internet: www.copyright.com. All other queries on rights and licenses, including subsidiary rights, should be addressed to the Office of the Publisher, The World Bank, 1818 H Street, NW, Washington, DC 20433, USA; fax: 202-522-2422; e-mail: [email protected]. Library of Congress Cataloging-in-Publication Data Nah, Seung-Hee Establishing private health care facilities in developing countries : a guide for medical entrepreneurs / Seung-Hee Nah, Dr. Egbe Osifo-Dawodu. p. cm. ISBN-13: 978-0-8213-6947-0 ISBN-10: 0-8213-6947-4 ISBN-10: 0-8213-6948-2 (electronic) 1. Health facilities--Developing countries--Planning. 2. Health facilities--Developing countries-- Design and construction. I. Osifo-Dawodu, Egbe, 1965- II. Title. RA395.D44N34 2007 362.109172’4--dc22 2006103080 Cover and publication design: James E. Quigley, World Bank Institute. Cover photos: Alan Gignoux (Lebanese hospital); Yosef Hadar (Brazilian researcher); John Isaac (Indian surgeon); Eric Miller (Mozambique doctor and mother); and Dr. Jean-Marcel Guillon (Franco-Vietnamese Hospital, Ho Chi Minh City). Contents Foreword . .ix Acknowledgments . .xi Abbreviations . xiii Chapter 1: Introduction . 1 So You Want to Build a Hospital? . 1 Recent Trends in Health Care . 3 Overview of Health Care Facilities . 6 Chapter 2: Project Concept and Mission Statement . 13 The Whats and Whys of Your Project . 13 Project Concept . 13 Mission Statement . 15 Project Management . 16 Chapter 3: The Prefeasibility Analysis . 19 Better to Stop Now than Fail Later . 19 Conducting the Prefeasibility Analysis . 20 Key Questions . 20 Risk Assessment and Management . 25 Chapter 4: The Feasibility Analysis . 29 Finding and Clearing a Path to Success . 29 Conducting the Feasibility Analysis . 30 Nonfi nancial Analysis . 31 Financial Analysis: No Margin, No Mission . 52 Will Your Hospital Be Viable? . 65 A Note on the Business Plan . 66 v vi Establishing Private Health Care Facilities in Developing Countries Chapter 5: Obtaining Financing . 67 Keeping Your Fuel Tank Filled . 67 Keys to Success in Obtaining Financing . 68 How to Look for Financing . 70 Types of Financing . 73 Structure of Financing . 76 Chapter 6: Marketing Your Facility . 83 If You Build It, Make Sure They Come . 83 Developing and Refi ning Your Marketing Strategy . 84 Building and Maintaining the Hospital’s Reputation . 91 Chapter 7: Facility Planning and Design . 95 Time to Start Drawings . 95 The Facility Design and Planning Team . 96 Space and Functional Programming . 102 Conceptual (Preliminary) Design . 103 Schematic Design . 103 Consider Future Expansion . 105 Cost Projections . 105 Chapter 8: Major Medical Equipment . 107 Not Everyone Needs an MRI . 107 A Systematic Approach . 108 Selection Criteria . 108 Procurement . 116 Delivery and Installation . 120 Training . 121 Maintenance and Insurance . 122 Chapter 9: Facility Construction . 123 As Planned, on Time, and on Budget . 123 Planning for Construction . 123 Construction Assignment . 129 Construction Documentation and Construction Contract . 130 Insurance Requirements . 132 Time to Break Ground . 133 Chapter 10: Facility Opening . 135 Preparing for the Big Day . 135 Staffi ng . 136 Documentation of Operating Policies and Procedures . 137 Building Commissioning . 138 Medical Equipment . 139 IT System . 139 Operating Licenses and Permits . 140 Minor Equipment and Supplies . 140 Insurance . 141 Contents vii The “Hotel Management” . 142 Training and Support System for Troubleshooting . 143 Dry Runs . 143 Opening Day Preparations . 144 Appendix A: Sample Timeline for Building a Health Care Facility. 147 Appendix B: Millennium Development Goals . 151 Appendix C: Types of Public–Private Partnerships . 153 Appendix D: Health Status Indicators . 155 Appendix E: Health Facility and Hospital Development . 157 Appendix F: Evaluating.

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