1) INTRODUCTION:
Bhimber
is 7th District of Azad Jammu & Kashmir and established in December 1995. It
is situated on South East side of Azad Jammu & Kashmir. It consists of three
Sub Division: -
1. Bhimber
2. Barnala
3. Samahni
Subdivision
Barnala and Samahni are situated over line of control (more than 70 KM in length). Sub
Division Bhimber is not situated over Line of Control but whole of the District is in the range of medium artillery and worst
affected by Indian shelling in recent years.
This District
consists of three legislative units, one municipal Committee and 18 Union Councils with total population of 3,63,420 (three
lac sixty three thousand four hundred twenty only), 95% of which is Rural and only 5% urban population. Total area of the District is approx. 1516 sq. Km.
"He who saved
a life saved the Mankind - (Al-Quran ) "
There can
be no second opinion to the fact that better health facilities are a fundamental requirement of mankind. Undoable the Government, at its own level and private sector as well has been endeavoring hard in this
sector and special attention is being paid to
excel the
establishment of various health units. The fact is that still a lot is yet to
be done in this sector for which government encourages the private sector. NGOs
and other agencies to participate either individually or in collaboration with the Government.
One such example is the construction of a 50-bed hospital at Dera, Tehsil Barnala, District Bhimber and Azad Kashmir. For which Kashmir Welfare and Research Trust has planned to collect funds on charity
basis. The charity “Kashmir Welfare And Research Trust” or there
representatives will monitor the utilization of funds. The hospital shall be
equipped with all necessary medical and other equipments.
Barnala, where hospital
is to be built is a Sub Division of District. Bhimber and is situated near the control line.
By virtue of its location it has been the most affected area due to very less health facilities as a remote area (refer
location map attached). There is another fact due to the Indian shelling in the recent years before ceasefire on LOC. The
hospital apart from facilitating the medical assistance to the patients shall also provide treatment to the injured.
This Preliminary
Feasibility Report provides the merits and other benefits of establishing the planned hospital at Dera, Tehsil Barnala, District
Bhimber, and Azad Kashmir.
2)
AVERAGE ANNUAL GROWTH RATE AND EXISTING FACILITIES IN THE DISTRICT AND AT BARNALA;
2.1 Average Annual Growth Rate;
District
Bhimber spread over an area of approximately 1516 sq. Km. had a population of 2,97,336 (two lac ninety seven thousand three
hundred thirty six) in the year 1998. The break up of this in the rural and urban
area is given below;
District
Bhimber
Population
Rural Areas
2,81,381
Urban Areas
15,955
Total
2,97,336
The Rural
and Urban Population as per 1981 census was 1,87,666 and 7,343 respectively. The
comparison of both the census shows that there had been an Annual Average Growth rate of 2.41% per year in the rural areas
and 4.67% in the urban areas, which yields an overall Annual Average Growth Rate of 2.51%.
The comparison is given below;
Annual Average Growth Rate (AAGR)
District Bhimber
Population
|
|
AAGR (%) |
1981 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
2004 |
2005 |
2006 |
|
|
187666 |
281381 |
288162 |
295107 |
302219 |
309503 |
316962 |
324600 |
332423 |
340435 |
2.41 |
|
7343 |
15955 |
16700 |
17480 |
18296 |
19150 |
20044 |
20980 |
21960 |
22985 |
4.67 |
|
195009 |
297336 |
304862 |
312587 |
320515 |
328653 |
337006 |
345580 |
354383 |
363420 |
2.51 |
Overall
annual average growth rate is 2.51 (as refer table in attachment.)
Applying the above estimated growth rate the estimated growth rate the estimated population now would be around 3,63,420.
2.2) THE EXISTING FACILITIES;
The present
facilities for this population in the district and for the injured from the Line of Control are given below;
* District Head Quarter Hospital
(DHQH)-----------------------------------01
* Rural Health Centre (RHC)
----------------------------------- 03
* Basic Health Units (BHU)
-----------------------------------25
* Civil Dispensary (CD)
----------------------------------- 13
* First Aid Post (FAP)
----------------------------------- 19
* Mother & Child Health Centre (MCHC) ---------------------------------14
* Tuberculosis/ Leprosy Center
----------------------------------- 06
* Expanded Program in Immunization (EPI) ------------------------------
31
The population
of Tehsil Barnala according to 1997 was 104301 (refer table in attachment), which if increased at a growth rate of 2.51% would
be around 121000 at present for which there exist the following facilities;
* Basic Health Unit at Der, Kanjloor, Kot Jamel, Kherowal ---------------
07
Banian, Patni and Maloot.
* Civil Dispensary at Nali, Mera Jattan, Channeer & Sardari. --------------
04
* First Aid Point at Kadhala, Haji Pura, Pantra, Baboot, Glota, -------------08
Abowala, Chandni Chowk and Thub.
* Rural Health Centre at Barnala -------------------------------------------------01
The Basic
Health Units of East border includes Banian,Kot Jamel and Kherowal can take care of area of
Watala up to Iftikhar Abad. These Basic Health Units are serving well the injured in emergency from Iftikhar Abad,Chumb,
Munawar, Dewa and Watala border, the villages located near Line of control (L.O.C).
The Basic Health Unit of north border is only Nali. Basic Health Unit
Nali is located in remote and difficult travel area. The Nali BHU is serving basic health facilities more than ten villages
on the north border of L.O.C. The patients from these villages cannot be shifted to R.H.C Barnala. As such B.H.U at Kherowal and Nali are justified as in emergency the injured and patients from these BHUs
can be shifted to Mirpur and Gujrat (Pakistan). Unlike Kot Jamel and Barnala
the injured and patients from Ghakrai, Patian, Jhang, Baliwal, Moil, Patni and Sardari by virtue of its location cannot be
shifted to Mirpur in case of emergency, as they have to be transported a long distance along the Line Of Control where there
is all the time a danger of sporadic Indian shelling. Refer attachment for road
connection of Barnala RHC to with other towns. Refer attachment for road connection
of Barnala with other towns.
3)
MAJOR HEALTH PROBLEMS IN THE PROJECT AREA;
There are
following major health problems, which shall be addressed in the proposed hospital;
* Infectious Diseases and Diarrhea
* Worm Infestation
* Malnutrition
* Inadequate facility to the injured from LOC
* Inadequate and inefficient health services on LOC
* Inadequate health facility for mother and childcare
* Inadequate and inefficient maternity services
The proposed
hospital at Dera, Tehsil: Barnala, District. Bhimber shall be a step towards improving the health facilities to the people
of Tehsil Barnala and people from the area of influence of this hospital, which extends from Gujrat border on the East, West
and North villages on L.O.C. Presently the patients are given basic treatment
at RHC Barnala, whereas more serious patients and injured are required to be moved to Mirpur, which is risky and inconvenient
for the patient / injured and its caretakers.
The proposed
hospital shall provide better treatment and other facilities to the residents of Tehsil Barnala and adjoining areas at their
doorsteps.
4) OBJECTIVES OF THE PROJECTS;
The main
objectives of the project are as follows;
I.
To efficiently provide better treatment
and health facilities to the residences of Tehsil Barnala and adjoining area of District. Gujrat, Pakistan.
II.
To provide efficient and quick treatment
to the wounded from line of control and its adjoin areas of District Gujrat.
III.
To provide at the doorstep of residents
of the area more efficient and better Maternity Facilities.
IV.
To provide more efficient Mother &
Child Health Care.
V.
To help bring down the Infant Mortality
Rate (IMR), the present estimate of which is 86/1000 children.
VI.
Similarly to help bring down the Maternal
Mortality Rate (MMR) the present estimate of which is 5/1000 Births.
VII.
To promote better health education
and on job training to the paramedical staff.
VIII. To promote family planning concept in the area.
IX.
To provide better, efficient and regular
Vaccination to the children.
5) THE PROJECT COST;
The hospital
building as per the specifications shall be adequate to accommodate all treatment and other facilities required for a 50-bed
hospital.
In general the hospital building shall comprise of;
* Patient’s wards adequate to accommodate 50 beds along with affiliated facilities.
* Fully equipped operation theatre.
* Fully equipped labour room.
* Casualty / Emergency ward
* Doctor’s Rooms
* Paramedical Staff Rooms
* Out Patient Ward
* Reception and other Services area etc.
The building
as per requirements shall cover an area around 30,000 sq. ft. Excluding ancillary buildings (Staff quarters etc.), which shall
cover approximate estimated cost of the building and other affiliated structures is computed as follows;
* Cost of main hospital building @ Rs.1500 per sq. ft.
= Rs. 45,000,000
* Cost of ancillary building @ Rs. 1100.00 per sq. ft.
= Rs. 7,700,000
* Cost of Parking lot (taken as Lump Sum)
= Rs. 1,300,000
* Cost of Furniture and Equipment (taken as Lump Sum)
= Rs. 6,000,000
* Cost of External Services
= Rs. 2,000,000
* Cost of Ambulances
= Rs. 10,000,000
* Contingencies (taken as 5% of above cost)
= Rs. 3,600,000
* Total Approximate Estimated Cost = Rs. 75,600,000
6) ANNUAL RECURRING COST;
The annual
recurring cost is the expense required to meet with the maintenance of building, hospital equipment, furniture etc. that cannot
be calculated more accurately at this stage. However an approximately estimated requirement of annual recurring cost for first
five years would be as under,
* First year after construction
= Nil (contractor’s liability)
* Second year after construction
= Rs. 1800,000
* Third year after construction
= Rs. 1800,000
* Fourth year after construction
= Rs. 1800,000
* Fifth year after construction
= Rs. 2,500,000
The building
will have to be maintained properly for a longer service life otherwise the level of serviceability of the building shall
keep on deteriorating and ultimately shall result in shorter service life and more recurrent cost.
7) OPERATION OF THE HOSPITAL BUILDING;
The proposed
hospital as earlier stated in this report shall be a Charity based hospital, as such, the following is proposed;
·
The hospital building completed, equipped,
and furnished can be donated to the Government of Azad Jammu & Kashmir for operation and bear the future maintenance.
·
It is normally seen that procurement of adequate
funds for the maintenance of the building is difficult exercise and most inadequate funds are provided considering this to
be a low priority requirement, which results in perpetual deferment of important maintenance works in the building. To lesson the burden of the government and to meet with the balance requirement to ensure sufficiency of
funds it is suggested to levy a nominal fee of Rs. 10.00 (Ten only) per patient
per visit which will result in generation of estimated additional revenue of around Rs.
540,000.00 per year during first five years. This additional revenue can
help in meeting any shortfall in the funds for maintenance released every year by the government.
·
Cost of medicines, Syringes, Bandages etc.
shall be met out by the government.
8) GENERAL REQUIREMENT OF THE STAFF;
Generally the following is proposed to require;
* Doctors (Male) 04
* Doctors (Female)
02
* Nurses
(Female)
08
* Room
Boys
12
* Sweepers
04
* Other
Staff
As per requirement
The above
strength may vary with the actual requirement at the time when the hospital is put to operation.
9) PROJECT VIABILITY;
The hospital
as stated earlier shall be a charity Hospital thus bears very high moral values, which cannot be measured by any Empirical
Formula. The building, if regularly maintained, shall last for along time and the people shall reap the benefits of the hospital
for years to come? It will be a boon not only for the present generation, rather,
also for the generation to come. The construction of the hospital, as compared
to the direct benefits is justified. These benefits for the Donor to satisfy
his donation are detailed as below;
·
Direct benefits to the National Exchequer
for the first year of Hospital operation due to Donor` act of Charity;
i.
Estimated saving in maintenance cost
to be incurred Rs. 360,000 by the Govt. due to proposed registration token fee of Rs. 10.00 per person per visit.
ii.
Estimated saving in transportation
of serious patients Rs. 740,000 required to be shifted to Mirpur.
·
Indirect benefits of the hospital to the
residents of Barnala due to Donor’s act of Charity.
i.
Construction of hospital shall provide
better health and treatment facilities to the residents of Barnala and adjoining areas at their doorsteps.
ii.
Hospital shall provide efficient treatment
to the serious patients / injured from LOC who
otherwise are shifted to Mirpur for treatment thus reducing the risk for their lives.
iii.
Hospital shall ensure efficient and
better maternity services, thereby reducing the rate of Infant Mortality and Maternal Mortality.
iv.
Hospital shall cause awareness amongst
the people of the area about family planning and consequently of a better living.
v.
The project shall create jobs for
the residents of Tehsil Barnala during construction and after it is put to
operation.
vi.
It shall help in propagating the Health
Education as provision in made for that. (See Art. 4)
vii.
It will be an efficient Vaccination
Centre for the children in the area.
Above mentioned
are the major indirect benefits of the hospital that cannot be measured in Financial Terms by any of the Empirical formula,
however the cause is of immense moral value.
Looking
into the Geographical and strategically position of Tehsil Barnala also the constraints of existing RHC to handle serious
cases due to inadequate health and treatment facilities, which has been discussed in detail in this report, it is concluded
that the proposed Hospital is more viably required as Tehsil Barnala.
The construction
of the hospital as stated above shall remain viable provided an assurance by the government is given for better hospital goverance
timely provision of maintenance, operation and other funds for smooth running of this proposed Charity hospital at Dera, Tehsil
Barnala, District. Bhimber, Azad Jammu & Kashmir.
Rural & Urban Population
Of District Bhimber
Azad Jammu & Kashmir
Year 1981 & 1998 Census
District
Bhimber |
1998 Censes |
1981
Population |
Male |
Female |
Total |
Rural |
140264 |
141117 |
281381 |
187666 |
Urban |
8241 |
7714 |
15955 |
7343 |
Total |
148505 |
148831 |
297336 |
195009 |
TABLE-1 DISTRICT WISE POPULATION BY SEX AND RURUAL / URBAN
1998 CENSUS -AZAD KASHMIR, PAKISTAN.
Area /
District |
Households |
Male |
Female |
Both Sexes |
1981 Population |
1981-1998 Avg.Annual Growth Rate % |
Azad Kashmir |
Rural |
363310 |
1273736 |
1282734 |
2556470 |
1822067 |
2.01 |
Urban |
51810 |
189335 |
169762 |
359097 |
161398 |
4.81 |
Total |
415120 |
1463071 |
1452496 |
2915567 |
1983465 |
2.29 |
District
Muzaffarabad |
Rural |
89304 |
318780 |
306639 |
625419 |
419323 |
2.38 |
Urban |
14988 |
54071 |
44930 |
99001 |
46780 |
4.51 |
Total |
104292 |
372851 |
351569 |
724420 |
466103 |
2.63 |
District
Bagh |
Rural |
50243 |
187241 |
185832 |
373073 |
275832 |
1.79 |
Urban |
3032 |
11374 |
10596 |
21970 |
5275 |
8.75 |
Total |
53275 |
198615 |
196428 |
395043 |
281107 |
2.02 |
District
Poonch |
Rural |
48349 |
177015 |
174361 |
351376 |
265999 |
1.65 |
Urban |
6915 |
26213 |
25165 |
51378 |
15763 |
7.19 |
Total |
55264 |
203228 |
199526 |
402754 |
281762 |
202 |
District
Sundhonti |
Rural |
28947 |
95379 |
105172 |
200551 |
160140 |
1.33 |
Urban |
1976 |
6996 |
6824 |
13820 |
|
|
Total |
30923 |
102375 |
111996 |
214371 |
160140 |
1.73 |
District
Mirpur |
Rural |
33053 |
106354 |
105193 |
211547 |
164126 |
1.50 |
Urban |
16657 |
58622 |
53306 |
111928 |
70458 |
2.76 |
Total |
49710 |
164976 |
158499 |
323475 |
234584 |
1.91 |
District
Bhimber |
Rural |
41571 |
140264 |
141117 |
281381 |
187666 |
2.41 |
Urban |
2328 |
8241 |
7714 |
15955 |
7343 |
4.67 |
Total |
43899 |
148505 |
148831 |
297336 |
195009 |
2.51 |
District
Kotli |
Rural |
71843 |
248703 |
264420 |
513123 |
348981 |
2.29 |
Urban |
5914 |
23818 |
21227 |
45045 |
15779 |
6.36 |
Total |
77757 |
272521 |
285647 |
558168 |
364760 |
2.53 |
|