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. 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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.