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BUKOBA DISTRICT- KAGERA REGION

TANZANIA

A Framework Paper for Maruku

Dispensary Pediatric Ward Project

(DRAFT)

August 2017

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Acronym and Abbreviations

ABAC AHEAD Inc. Bukoba Advisory Committee

ADAC AHEAD Inc. Dar es Salaam Advisory Committee

AHEAD Adventures in Health, Education and Agricultural Development

BDC Bukoba District Council

BOQ Bill of Quantities

COI Clinical Officer In-charge

DMO District Medical Officer

DPC Deputy Project Coordinator

FBOs Faith Based Organizations

MDGC Maruku Dispensary Governance Committee

MHC Maruku Health Centre

MOU Memorandum of Understanding

NA Native Authority

NGOs Non-Governmental Organizations

PC Project Coordinator

PHC Population and Housing Census

PIP Project Implementation Plan

PTA Project Technical Advisor

TDHS Tanzania Demographic and Health Survey

USA United States of America

WDC Ward Development Committee

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FRAMEWORK PAPER FOR MARUKU DISPENSARY PEDIATRIC WARD PROJECT

1. Introduction

The framework paper is intended to provide the guiding principles, including the course of action,

plans and strategies which will inform the construction of the pediatric ward at Maruku Dispensary

in Bukoba district, Kagera region in Tanzania. The paper outlines the: (i) background and context

of the project, including the demographic characteristics of the project area; (ii) description of the

project; (iii) project financing; (iv) management structure; (v) project implementation plan; (vi)

finance disbursement plan; and working relationship with local government structures, including

the dispensary management committee.

2. Background and context

Maruku dispensary is a community health service facility located in Bukoba District Council.

According to the recent past population and housing census which was conducted in 2012, Bukoba

District Council (BDC) had a population of 289,697, consisting of 141,142 males (48.7 percent)

and 148,555 females (51.3 percent). The average household size stood at 4.4. Taking into account

Tanzania’s annual population growth rate of 3.2 percent, the population of the district is currently

projected to be 328,773 (160,180 males and 168,593 females)1. The district has 29 wards,

including Maruku and Kanyangereko which are served by Maruku dispensary. According to the

2012 Population and Housing Census (PHC), Maruku ward had 9,202 people (4,443 Male and

4759 female) and Kanyangereko ward had 10,166 people (5093 male and 5073 female), making a

total of 19, 368 people in the two wards receiving services from Maruku dispensary. The

dispensary also offers medical care services to some patients from Ijuganyondo ward which is in

Bukoba Municipal Council.

Maruku dispensary was established after the end of the Second World War in 1950. It was initially

managed and providing services under the auspices of the Native Authority (NA) which was

established by the British colonial administration in 1926. The local-cum-traditional chief was in-

charge of the day-to-day functioning of the dispensary. Currently, on average, about 70 people are

served by the dispensary daily, making a total of about 2000 patients per month from both Maruku

and Kanyangereko wards in Bukoba district council as well as to some people from Ijuganyondo

ward in Bukoba Municipal Council.

The 2015-16 statistical data by Tanzania Demographic and Health Survey reveals alarming

indicators in respect of the state of children health in various areas in Tanzania, including Maruku

ward. The neonatal and infant mortality rate are 25 and 43 deaths per 1000 live births, respectively.

Under five mortality rate is 67 births per 1000 live births. Moreover, anecdotal evidence reveals

that children born to mothers with no or little education are more likely to die before their fifth

birthday than those with secondary or higher education. The obtaining trends in childhood

mortality is shown in Figure 1.

1 Official projection by Tanzania Demographic and Health Surveys (TDHS) based on 2012 Population and Housing Census.

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Figure 1.

Source: Tanzania Demographic and Health Survey

Under five mortality is dramatically higher among children born less than two years after a

previous birth (112 deaths per 1,000).

Figure 2.

Source: Tanzania Demographic and Health Survey

For children born two or more years after a previous birth, under-5 mortality rate is less than 70

deaths per 1,000 live births for each interval. Overall, in Tanzania, 19 percent of children are born

less than two years after their siblings as Figure 2 shows. The statistical information in Figure 1

and 2 also reveal the state of children health in Bukoba district Council, including Maruku and

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Kanyangereko wards. The envisaged construction of the pediatric ward will significantly help to

improve the health of children, including a reduction in death rates.

3. Description of the project

The project is intended to construct a pediatric ward as part of the most essential facilities at

Maruku dispensary. The ward will have a number of facilities, including: (i) large patient rooms;

(ii) small patient rooms; (iii) Doctor’s room; (iv) treatment room; (v) bathroom; (vi) waiting room;

(vii) storage rooms; (viii) Nurses station; (ix) kitchen; and (x) cleaning room.

The ward will consist of single or double occupancy patient room spacious enough to

accommodate … children and their parents or careers. The ward will provide hospitalized children

a dedicated space for care. . Each room will comply with guidelines for prevention of nosocomial

infection and will be large enough to accommodate parents and care takers who may choose to

stay with their children. The parents, father or mother will be encouraged to stay overnight with

their children, particularly the under-5. The rooms will be furnished with an adjustable bed and

necessary medical equipment, including age-appropriate furniture. There will be space or area set

aside for play, entertainment, education and other child- life activities designed in manner that

takes into account the safety and well-being of children under 12 years. The ward’s architectural

design is appended to this framework as Annex I. The cost for the construction of the pediatric

ward, including the Bill Of Quantities (BOQ) was prepared in 2015. Since then there has been

fluctuations in prices and the value of the Tanzanian currency has slightly declined. Moreover, the

decision to use local competent technicians under the supervision of a competent Civil Engineer,

will significantly, reduce some of the construction cost. The Table below shows the estimated

construction cost at current (2017) prices.

4. Construction cost estimates

S/No. Description Total

Tsh USD

1. Earth work: site clearance and excarvation of

the foundation trench

8,347,128 3,795

2. Foundation construction work: walling with

natural hard stones

19,441,568 9,721

3. Walling work including materials 20,865,420 9,485

4. Roofing work including materials 26, 619,300 12,100

5 Doors (frames, grills and shutters) and

steel/aluminium windows, including grills

29,229,250 13,286

6. Finishing; painting, ceiling works, electrical

installation

33,427,000 15,194

7. Sanitary appliances, toilets,water tank, septic

tank and soakage pit, including materials

19,905,600 9,048

8 Subtotal (a) 131,215,966 72,629

9. Labour charges cost and supervision [30% of

subtotal (a)]

39,364,789.8 17,893

10 Supervision [10% of subtotal (a)] 13,121,597 5,965

11 Subtotal (b) 183,702,353 96,487

12 Contingency 5% 9,185,118 4,175

13 GRAND TOTAL 192,887,471 100,662

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5. Equipment Cost (Indicative)

The project will include procurement of all essential equipment required for a fully functioning

pediatric ward, including but not limited to the following: (i) treatment room for patient assessment

and treatment procedures; (ii) covered electrical outlets, appropriate window locks and door

latches; (iii) air, Oxygen suction equipment and electrical outlets at each bed, with access to the

dispensary emergency power system; (iv) cribs equipped with safe overhead restraints; (v) self-

inflating bag-valve resuscitators; (vi) oxygen source and masks; (vii) nasal cannula; (viii) nebulizer

for inhalation treatments; (ix) oral airways; (x) IV access catheters and IV stand; (xi) intra-osseous

needles; (xii) pediatric beds, mattress and beddings; (xiii) Pediatric bedside cabinets; (xiv)

examination tables; (xv) toddler scales; (xvi) friendly blood pressure monitors; (xviii)

infantometers/baby thermometers; (xix) pediatric emergency medical carts (xx) pediatric

orthotics; and (xxi) office chairs and tables

In summary the required equipment and estimated cost are shown in the Table below.

Equipment Units Cost Total cost

Tsh USD Tsh USD

Surgical and medical

equipment

1 44,000,000 20,000 44,000,000 20,000

Pediatric EKG machine 1 33,000,000 15,000 33,000,000 15,000

Surgical sets 2 7,700,000 3,500 15,400,000 7,000

Bed frame,matress 24 220,000 100 5,280,000 2,400

Bedside cabinets 24 52,800 50 2,640,000 1,200

IV stands 24 52,800 50 2,640,000 1,200

Chairs 24 52,800 50 2,640,000 1,200

Office desks 5 231,000 105 1,155,000 525

Pediatric blood pressure cuff 24 44,000 20 1,056,000 480

Pediatric oxygen masks 10 88,000 40 880,000 400

Office chairs 5 143,000 65 715,000 325

Equipment cart 1 550,000 250 550,000 250

Total equipment cost 109,956,000 49,980

Contingency (5%) 5,497,800 2,499

Grand total 115,453,800 52,479

6. Project objectives

The projects has a number of objectives, the main ones being to: i. reduce childhood mortality such as neonatal illness, pneumonia, diarrhoea, fever,

mainly malaria, meningitis and septicaemia, severe acute malnutrition and HIV/AIDS;

ii. create appropriate supportive care and monitoring of patients in the ward; iii. improve the quality of care for severely ill or sick children; iv. provide admitted children a dedicated space for professional care in a friendly and

supportive environment; v. establish a patient centred and family friendly environment for admitted children;

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vi. create specific space for parent-rooming-in with her or his child in a hospital environment.

vii. contribute significantly to the process of transforming Maruku Dispensary into Maruku Health Centre (MHC)

7. Project outputs/deliverables On successful completion, the project is expected to deliver the following outputs and outcomes: i. a fully functioning paediatric ward delivering quality health services to the

people of Maruku and Kanyangereko wards in Bukoba District Council as well as villages in the vicinity of the two wards;

ii. a well-equipped paediatric ward meeting the basic national and international standards; and

iii. reduced children mortality rate in Maruku and Kanyangereko wards and Bukoba district.

8. Project finance/budget The total cost of the project is estimated at Tsh 308,341,271 (USD 153,141), consisting of monetary (cash) and in-kind contributions from community members-cum-beneficiaries. The in-kind contribution includes, community land on which construction of the ward will be undertaken, time input fee for the project coordinator, Assistant Coordinator and supervisors, tangible contribution in respect of construction materials, voluntary security services at construction site; etc. Monetary contributions will come from voluntary contribution by community members, monetary donations from the American people through AHEAD, Inc. The money from contribution in cash will spent on construction materials, water tank, labor charges, transportation of construction materials, and procurement of all essential equipment and materials required for a full-functioning pediatric ward. Specifically, the project finance/budget is summarized below.

Cost item Tshs USD

Construction of the pediatric ward 192,887,471 100,662

Medical equipment and furniture 115,453,800 52,479

Total 308,341,271 153,141

Exchange rate estimates USD 1.00 = Tsh. 2,200 The money generated through donations and cash contributions will be deposited into THE AHEAD, Inc. Bukoba Account whose Bank details are as follows: Account Number: 31810014237, Account Name: AHEAD, Inc. Kanda ya Bukoba; Name of the Bank: National Microfinance Bank, Jamhuri Road, Bukoba, Tel. +255 28 2250154.

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9. Project Management

The project management function will be basically undertaken on voluntary basis. The Bukoba and Dar es Salaam based AHEAD Inc. Advisory Committees under the leadership of the Chairman, Mr. Jovin Kangimba (retired public servant and experienced professional Accountant), will be responsible for providing overall leadership and guidance in respect of all activities pertaining to the project implementation arrangements. The Advisory Committee will, furthermore, appoint a Project Coordinator (PC) and the Deputy Project Coordinator (DPC) to undertake the day-to-day project management activities. Both of them will directly report to the Advisory Committee chairman, and compile periodic/regular reports for the Advisory Committee members based in Bukoba and Dar es Salaam for their discussion and approval before the same are submitted to AHEAD, Inc. headquarters in the US. Moreover, the AHEAD, Inc. Bukoba Advisory Committee (ABAC) will appoint a Project Technical Advisor (PTA) to oversee the ward construction works. The advisor will be expected to work on voluntary basis, devoting considerable time to supervise the construction and offer expert advice to the local technicians who will be carrying out the real construction tasks at the site. The Project Technical Advisor, will be an individual with competencies and proven sound experience in civil engineering, preferable a recognized and registered civil engineer who is willing to offer services voluntarily. The Project Technical Advisor will report directly to the Project Coordinator/Deputy Project Coordinator and maintain a dotted line communication with the Advisory Committee Chairman. The Project Coordinator and his/her deputy in consultation with the Project Technical Advisor will through open transparent and competitive mechanisms based on merit principles select a team of competent and experienced local technicians to undertake the construction works at different phases. The team will be approved by the AHEAD, Inc. Bukoba Advisory Committee in consultation with Dar es Salaam based members. Overall the project implementation arrangement will use a “phasing model”, each phase with specific construction activities and funding/cost requirements. The project will be implemented in nine mutually supporting phases as follows:

Phase Main Activities

Phase One Preparations and clearance of the construction site

Phase Two Construction of the Foundation

Phase Three Brick walling

Phase Four Roofing

Phase Five Fixing door frames and grills and doors

Phase Six Fixing window frames/ grills and steel or aluminium windows

Phase Seven Electric installation and plumbering works for water service

Phase Eight Finishing works: plastering, flooring (tiles), ceiling and painting

Phase Nine Procuremt of ward materials, furnishing and installation of medical equipment

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10. Financial Approvals

The moneys set aside for the construction of the ward will be managed in a manner that guarantees accountability, transparency and value for money, in accordance with AHEAD, Inc. financial management regulations. Specifically:

i. Expenditure will be approved by the Chairman-AHEAD, Inc. Bukoba Advisory Committee (ABAC) on behalf of the Committee;

ii. Three quotations/proforma invoices will be required and decision for procurement of required items will be made on the three price quotations received from prospective suppliers;

iii. Financial reports will be prepared and presented by the Project Coordinator/Deputy Project Coordinator

11. Collaboration with Maruku Dispensary Governing Committee (MDGC)

The government of the United Republic of Tanzania requires all dispensaries to establish a democratically elected committee, consisting of eight members representing: (i) health service providers from the private sector; (ii) Non-Governmental Organizations (NGOs) or Faith Based Organizations (FBOs); (iii) Ward Development Committee (WDC); (iv) Village Council; (v) Clinical Officer In-charge (COI) of the dispensary; and three people representing health service users in the locality. The dispensary governance committee has a number of responsibilities, the major ones being to:

i. manage the finances allocated to the dispensary under the custodian of the clinical officer in-charge;

ii. approve the expenditure for medicine and related equipment and materials; iii. advice the local district council on human resource management matters,

including recruitment, in-service training, staff development and motivation; iv. ensure the availability of the necessary drugs and infrastructure required for the

smooth functioning of the dispensary; v. approve the dispensary strategic plans;

vi. ensure the service users and stake holders get quality services vii. mobilize resources from different stakeholders and donors required for effective

functioning of the dispensary Taking into account the preceding context, AHEAD, Inc. Bukoba Advisory Committee (ABAC) will create good working climate and relationship with Maruku Dispensary Governance Committee (MDGC) and through it will consequently, establish healthy working relationship with the district council authority, including the office of Bukoba District Medical Officer (DMO). In light of the preceding context:

i. A Memorandum of Understanding (MoU) will be drawn and signed by both the parties in the construction of paediatric ward partnership, specifying the boundaries, duties and responsibilities of each party (ABAC and MDGC);

ii. The Chairman of MDGC or his/her representative will be invited to attend meetings of ABAC;

iii. MDGC will be advised and encouraged to mobilise resources (cash and in-kind contribution) from the community, including in-kind contribution for the ward in

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order to augment resources which will be made available for the project from AHEAD, Inc.; and

iv. Information on the project implementation progress will be shared between ABAC and MDGC.

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12. Project Implementation Plan (PIP)

Activities 2017 2018 2019 Sep Oct No Dec Jan Feb Mar Apr Ma Jun Jul Au Sep Oct No Dec Jan Feb Mar

Preparation and site clearing

Construction of the Foundation

Brick walling

Roofing

Cnstruction of water tank

Fixing door frames, grills and doors

Fixing window frames, grills and steel/aluminium windows

Electric installation and plumbing works

Finishing works: plastering, flooring (tiles), ceiling and painting

Procuremt of ward materials, furnishing and installation of medical equipment

,

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If all the required financial resources are disbursed for the implementation of project activities on time, and if the construction materials are procured on time; and if all the required pediatric ward equipment are procure on time, it is possible to have a full-functioning ward by December, 2018.

13. Finance disbursement plan It is proposed that the disbursement of money for the implementation of the project activities reflect the project implementation phases, each with specific requirement after the approval of AHEAD, Inc. Bukoba Advisory Committee (ABAC) and AHEAD, Inc. Head Office in USA. The proposed disbursement plan is as follows: Phases Activity Estimates Proposed

disbursement date Tsh USD

Phase One Earth work: site clearance and

excarvation of the foundation

trench

8,347,128 3,795 August 2017

Phase Two Foundation construction work:

walling with natural hard stones

19,441,568 9,721 September 2017

Phase Three

Walling work including materials

20,865,420 9,485 October 2017

Phase Four Roofing work including materials

26, 619,300 12,100 February 2018

Phase Five Doors (frames, grills and shutters)

and steel/aluminium windows,

including grills

29,229,250 13,286 February, 2018

Phase Six Finishing; painting, ceiling works,

electrical installation

33,427,000 15,194

March 2018

Phase Seven Sanitary appliances, toilets,water

tank, septic tank and soakage pit,

including materials

19,905,600 9,048 June 2018

Sub-total (a) 131,215,966 72,629

Phase Eight Procuremt of ward materials, furnishing and installation of medical equipment

109,956,000 49,980 October 2018

Sub-total (b) 109,956,000 49,980 9. Labour charges cost and

supervision [30% of sub-total (a)]

39,364,790 17,893 To be spread in each phase

10 Supervision [10% of sub-total (a)] 13,121,597 5,965

To be spread in each phase

11 Sub-total (c) 293,658,353 146,467 12 Contingency 5% of sub-total (c) 14,682,918 6,674 13 GRAND TOTAL 308,341,271 153,141