Bhaktivedanta Hospital

Dr Sanjiv Gupta
drsanjivgupta.bvh@gmail.com
director@bvhnepal.org
 Bhaktivedanta Hospital – A Community Hospital for the poor

Contents
Community Hospital for the Poor...................................................................................................................2

1 Executive summary.........................................................................................................................................3

1.1 Problem......................................................................................................................................................3

1.2 Solution......................................................................................................................................................3

2 Statement of need...........................................................................................................................................5

2.1 Why build a hospital at Budhanilkantha?...........................................................................................5

2.2 Other examples........................................................................................................................................5

3 Project description..........................................................................................................................................7

3.1 Objectives..................................................................................................................................................7

3.2 Methods.....................................................................................................................................................7

4 Cost calculations..............................................................................................................................................9

4.1 Budget summary......................................................................................................................................9

4.2 Expenses....................................................................................................................................................9

4.3 Income......................................................................................................................................................11

4.4 Project expense budget......................................................................................................................12

5 Organizational Information.........................................................................................................................13

5.1 Rural Assistance Nepal (RAN).............................................................................................................13

5.2 Budhanilkantha Community Hospital Management Committee................................................13

5.3 RANNepal................................................................................................................................................13

6 Conclusion......................................................................................................................................................14

ANNEX - Costs and revenues........................................................................................................................15

Detailed breakdown of building costs and floor plans.............................................................................24

2
1 Executive summary
We are set to set up a 15-bed community hospital in Ward-5 of Budhanilkantha Municipality, to
provide access to medical services to this peri-urban community of Municipality.
The aim is to provide a comprehensive health program (preventive, curative, and rehabilitation),
aimed at reaching target groups, by improving the access to basic health services.
The focus of this program is to improve access to and affordability for medical and health care
services for underserved community as Janjati (Magar and Tharu people form a large group in
the surrounding area), disabled people, Dalits, Muslim and other marginalized people, women
and in people particular affected by conflict and all types of discrimination.

1.1 Problem
 There is a general absence of healthcare facilities in the area. Most hospitals and doctors are
located in the central city. The nearest (zonal) hospitals to Budhanilkantha is at 5 kilometres
distance from the proposed venue.
 Access to affordable health care services far exceeds the income of the majority of the
population in this area.
 Maternal health and infant mortality are major problems in this part of Kathmandu valley,
despite recent efforts for improvement.
 There are only big corporate hospitals and lacks good facility provider with subsidized rates.
Government Hospitals like Bir Hospitals & IOM are generally overcrowded, so underserved
community are also forced to mortgage their homes so as to receive treatment at private
hospitals.

1.2 Solution
A community hospital in Budhanilkantha will provide and ensure affordable access to healthcare
services for the poor communities in the surrounding areas.
Based on the vision of Dhulikhel Hospital in Kavre, the 15-bed community hospital should:
 provide emergency services, treatment of common diseases and injuries, maternal and peri-
natal healthcare, a 24 hour/day delivery service, emergency obstetric care, PNC services,
family planning service, immunization, tuberculosis control, child health services (including
oral health services, accident prevention and rehabilitation, post trauma problems,
operation services, chronic disease – diagnosis, control and referral, counselling and school
health program and preventive services) and outreach support such as seasonal RH camps
at a community level;
 be initially run by 2 doctors, and 3-4 nurses (Phase 1), a third doctor (Phase 2), and further
doctors and nurses in Phase 3;
 have an operating theatre and the capacity for surgery, specifically for emergency obstetrics
and gynecology; as well as a full range of simple procedures by phase 3.

1
Based on 2002 data, Rolpa had a doctor/patient ratio of 105, with Pyuthan, Dang and neighbouring Arghakhanchi
each at 42. The national average was 22.8, with an index of 3.9 for Kathmandu.
2
This compares with the 1,238 government hospital beds reported available in Kathmandu (2004). Just under a third
of all government hospital beds available in Nepal are located in the six government hospitals in Kathmandu.
3
These figures will have improved since the government’s recent incentive scheme paying mothers to give
birth at birthing centres.
  provide nurses’ training (Phase 2/3), primarily aimed at training nurses from rural areas to
provide primary healthcare services in local communities;
 ultimately provide support and outreach services to the surrounding area (Phase 3).
Funding is required for:
 Building the 15-bed hospital, including an operating theatre, maternity department, OPD
and laboratory. This is estimated to cost about 40 million NRs (£340,000 or 560,000 USD);
 Phase 1 – building a complete Out Patients’ Department (OPD), one ward and hospital
administration offices would cost around 15 million NRs (£130,000 or 214,000 USD)4;
 Phase 2 – adding the maternity services and a second ward is estimated to cost 11.4
million NRs (£100,000 or 164,000 USD);
 Phase 3 – emergency, operating theatres and two more wards will cost around 13
million NRs (£110,295 or 183,000 USD).
 Equipment including X-ray machine, lab equipment, ECG, ultrasound, full range of medical
equipment, furniture etc. is estimated to cost around 10 million NRs (£80,000 or 130,000
USD);
 Start-up capital to cover initial running costs at least for the first 12 months are estimated
to cost around about 6 million NRs (about £50,000 or 85,000 USD) or 495,000 NRs/month
(£4,300 or 7,000 USD).
The cost of running the hospital would be to a certain extent covered by charges made for
hospital services. A fund would be set up to subsidize/cover costs of medical treatment for the
poor and needy. Any surplus from revenues would be paid to this fund or used to develop the
hospital’s services. A number of organizations have already indicated that they could cover some
of the doctors’ and nurses’ salaries, as well as provide equipment.
Costs NRs GBP USD
1 OPD, lab, x-ray, USG etc., ward and office 14,972,125 129,993 213,888
2 Maternity, pre- and post- natal wards, ward 11,409,885 99,017 163,904
3 Operating theatres, pre-and post op wards, 12,729,690 110,295 182,572
Total for 15-bed hospital 39,111,700 339,305 560,314
Equipment and furniture etc. 9,050,971 8,704 129,300
Start-up capital running costs for the first 12 months 5,920,500 51,483 84,580
Total set up costs 54,083,171 469,492 774,194
As well as contributing the land, the surrounding VDCs (Village Development Committees) have
committed providing timber and the local community will provide local materials like sand and
stone, and labor. The value of this contribution has not been factored into the estimates but
could make up 25- 30% of the building costs, based on experience of building projects
elsewhere.
4
Exchange rates of 115NRs to £1 and 70NRs to $1 have been used as the approximate levels applicable in March 2011.
2 Statement of need
2.1 Why build a hospital at Budhanilkantha?
The districts of Rolpa, Pyuthan, Salyan, Kapilbastu, and Arghakhanchi are all in the bottom half of
Nepal’s Human Development Index rankings. 5 Over 1,326,355 people live in these hill districts,
with a further 462,380 living in Dang district (2008 Census Projected Report). Access to
healthcare facilities in these districts is limited. Other than the district hospitals and a few private
and NGO hospitals, there are just two Zonal hospitals at Butwal and Nepalgunj, a hundred and
one hundred and fifty kilometres to the east and to the west respectively.
Locating a community hospital at Budhanilkantha will provide maximum access to people living
in a large area, including Pyuthan, Rolpa, northern Dang and the neighbouring areas of
Arghakhanchi, Salyan and Kapilvastu.
Budhanilkantha is located in the northern side of Dang District, about 280km west of
Kathmandu in the Rapti Zone in the Mid-Western Region. It is a bazaar situated at the Terai/Hill
interface and is a junction on the east-west Mahendra Highway, where branch roads served by
scheduled buses go to Pyuthan and Rolpa districts. About 150km east of Nepalgunj and 100km
west of Butwal, it is between the Bheri Zonal Hospital in Nepalgunj (with 150 beds), and the
Lumbini Zonal Hospital (Butwal).
In the absence of comprehensive primary healthcare and hospitals, patients often travel long
distances, causing undue delay in obtaining proper medical treatment.
The Nepal Demographic and Health Survey of 2006 found significant improvements in health
outcomes despite the decade-long conflict. However, wide disparities persist in health outcome
indicators across different caste and ethnic groups and by gender. Among Dalit children, 95 out
of 1,000 do not survive to their fifth birthday (the corresponding figure for Newars is 43). Girls
still have a higher mortality rate than boys. The under-five mortality rate of Tarai/Madhesi caste
and ethnic groups is higher than that of the Hill/Mountain groups. Access to health care, along
with the nutritional status of children, tends to worsen among the excluded groups, resulting
into their low human development.
For the majority of people, healthcare services, even if available, are often out of the reach of
many of the poorer people. A community hospital would be able to help address this, by
providing affordable healthcare services to the poorer sections of society.
Outside of Kathmandu and the main cities, there are relatively few hospitals. For poorer people,
the need to travel and the cost this involves, put this beyond the reach of most. Budhanilkantha
is located about half way between the Zonal hospitals of Butwal and Nepalgunj, close to the hill
districts of Rolpa and Pyuthan in particular, as well as the surrounding districts of Salyan,
Arghakhanchi and Dang.

2.2 Other examples

In particular, Dhulikhel Hospital in Kavre is a good example of a hospital strategically located to
serve the communities outside of the cities, run to help the poorer people and provide valuable
healthcare services not only within the hospital but through its many valuable outreach
programmes in the surrounding areas.
Tamakhosi Cooperative Hospital at Manthali, in Ramechapp District is another example of a
hospital serving the poorer people in a positive way, and also providing valuable outreach
services in the forms of camps to villages in the surrounding countryside. Savings credit schemes
in the district help to pay running costs of the hospital and women’s saving groups are creating
emergency medical funds, to ensure that poorer members of the community can obtain
affordable medical services when needed.
Rukum and Lamjung mission hospitals are being visited, as good examples of health facilities in
similar rural areas.
5
Districts of Nepal: Indicators of Development 2001: Update 2003 (2003), ICIMOD, Netherlands
Development Organisation (SNV); Central Bureau of Statistics (CBS): Rolpa (64), Pyuthan (50), Salyan (45),
Kapilbastu (54) and Arghakhanchi (42).
Asha Clinic, an NGO-run health facility in Pokhara serves as a very good example of an urban
clinic providing a wide range of services for the poor, who come from Pokhara and the
surrounding areas.
Patan Hospital provides comprehensive medical services to people from a wide range of
economic backgrounds, charging for private patient services which help to fund services for
poorer people.
Much useful information has been gathered from these hospitals as well as Gulmi District
Hospital to obtain background information and provide valuable ideas on best practices, lessons
learned and technical issues.
3 Project description
3.1 Objectives
The primary objective for creating a community hospital at Budhanilkantha, in Dang District, is to
work with the local community to provide affordable and accessible quality modern healthcare
facilities to the deprived people of communities in this Mid-Western region of Nepal.
 The community hospital will be an independent, non-profit organization run for, and by
the local community to provide quality health services.
 It aims to provide affordable and quality healthcare for all, in particular focusing on
deprived groups, marginalized people, women, and children.
 The hospital will improve access to hospital care services. It could have a potential
catchment area of around a million people from Pyuthan, Rolpa, Dang and the
neighbouring districts of Salyan, Kapilvastu and Arghakhanchi. About two million people
live in these districts.
 Strategically located about mid-way between Butwal and Nepalgunj (over 100 kilometres
from both cities), and at the junction between the districts of Pyuthan and Rolpa, this will
make access to hospital services easier from the surrounding hill districts.
 The hospital will provide outpatient and inpatient services, (general surgery, obstetrics
and gynecology, orthopedics, family planning and will include general ward and neonatal
care.
 Initially, a full OPD service will be provided, with one in-patients’ ward. Maternity
services, a further ward would follow, with emergency services, operating theatres and
two more wards being built to complete the hospital. It is anticipated that construction of
the hospital could start in September 2011 and that it should be complete within two
years.
 In phase 2/3, health training for nurses will be provided, with the prime objective to
improve the staffing at primary healthcare centres in the local rural and remote areas.

3.2 Methods
The community hospital will be managed by the local community, with the objective of offering
affordable access to medical care. The User Management Health Committee will help to
determine the running of the hospital in conjunction with donors, NGOs and other national and
international organisations.
Land has been provided in Budhanilkantha and construction will commence as soon as possible
subject to funding. At this stage, a provisional floor plan of the hospital has been drawn up and
engineers have estimated a tentative building cost.
Consultation with Habitat for Humanity, with architects and engineers is currently in progress, to
ensure that the building is appropriate (earthquake resistant, fully utilizing natural materials
available locally, use of sustainable energy - solar energy etc) and can be built in a cost effective
way.
3.2.1 Staffing/Administration
Rural Assistance Nepal (RAN) is providing management/administrative support for the set-up of
the hospital and Dr Kashim Shah is providing advice on medical requirements. A technical
overseer will be required for the construction work. Dhulikhel Hospital is assisting by providing
technical advice for the construction of the hospital.
RAN is responsible for fund-raising and administration of the project. Dr Kashim Shah and RAN
will be responsible for procurement, recruitment and management of the hospital.
3.2.2. Sustainability
To provide low cost hospital services, it cannot be expected to cover costs in a profitable
manner, even if the hospital is run efficiently and cost-effectively. It is aimed to cover costs as far
as possible, to rely on additional funds only for subsidizing services to the poor.
With this in mind, it is envisaged that those people able to afford to pay a modest and affordable
charge for services, should pay. Patients who are assessed to be unable to pay, should receive
treatment free or at a subsidized rate.
The hospital would aim to be as self-sufficient as possible, but it would also be proactive in
seeking funding to help the needy, and for outreach work that would start from Phase 3,
providing medical services in the more remote areas of the surrounding districts.
The new hospital will need to establish its reputation, but it is envisaged that within a short
period of time, patient volumes will necessitate recruitment of further staff.
To start with however, funding will need to be set aside to cover the start-up costs (staffing,
running costs etc.). There are indications from a number of NGOs that they would be willing to
cover some of the staff costs and to provide equipment, so it is envisaged that the running costs
of the hospital that need to be met from revenues will be considerably lower than detailed here.
A senior doctor (MBBS, MD qualified) will be available to commence from the end of the first
quarter of 2013, though other staff would to be recruited before this time. Locally available staff
resources have already been identified and there has been expression of interest from Patan
Hospital and Nick Simon Institute to send doctors and medical students to work at the hospital.
Staff incentives and staff retention polices will be high priority.
Staff recruitment and retention are seen as key to the success of this hospital. Based on the
model provided by Dhulikhel Hospital and lessons learned in other countries where staff
retention in remote areas is a problem, high priority is given to staff incentives. It is envisaged
that good HR policies: training incentives, good working conditions, performance-related
benefits, family support and other incentives can help attract the right people to work here.
While it is expected that many doctors will not want to stay in a remote hospital, far from
Kathmandu for very long, as long as retention policies can attract and keep staff for a minimum
of 2-3 years, this would be acceptable.
Following the model of Dhulikhel Hospital, it is envisaged that within a relatively short period of
time, the community hospital will be able to extend its services, establish outreach and support
to the rural areas and provide nurses’ training.
The community hospital will report to the Department of Health and is in the process of being
registered with the Ministry of Health in Kathmandu.
4 Cost calculations
4.1 Budget summary
A summary of estimated building, equipment costs for the hospital and nurses’ training school
below provides a tentative figure for the cost of setting up Budhanilkantha Community Hospital.
Costs NRs GBP USD
1 OPD, lab, x-ray, USG etc 11,056,320 96,142 159,144
Ward 1 3,046,365 26,291 43,520
Office 869,440 7,560 12,421
Sub-total (Phase 1) 14,972,125 129,993 213,888
2 Maternity, pre- and post- natal wards 8,363,520 72,726 120,384
Ward 2 3,046,365 26,291 43,520
Sub-total (Phase 2) 11,409,885 99,017 163,904
3 Operating theatres, pre-and post op wards, 4,926,240 42,837 70,908
Emergency 1,710,720 14,876 24,624
Wards 3 and 4 6,092,730 52,582 87,040
Sub-total (phase 3) 12,729,690 110,295 182,572
Total for 15-bed hospital 39,111,700 339,305 560,314
Equipment and furniture etc. 9,050,971 78,704 129,300
Start-up capital running costs for the first 12 months 5,920,500 51,483 84,580
Total set up costs 54,083,171 69,492 74,194

4.2 Expenses
4.2.1Cost of hospital building
The total cost of building the hospital has been estimated at about 40 million NRs (£340,000 or
560,000 USD), based on floor plan drawings and calculating the building materials needed to
build the rooms needed for the hospital. (See Annex for detailed estimates).
By constructing the hospital in three phrases, the following estimates for each stage of building are:
Phase Costs NRs GBP USD
1 OPD, lab, x-ray, USG etc., Ward 1, offices 14,972,125 129,993 213,888
2 Maternity, pre- and post- natal wards, Ward 2 11,409,885 99,017 163,904
3 Operating theatres, pre-and post op wards, 12,729,690 110,295 182,572
emergency, Wards 3 and 4
Total for 15-bed hospital 39,111,700 339,305 560,314
This does not include staff accommodation, nurses’ training school buildings, or the value of the
local community’s contribution of local materials and labour, which could reduce costs by 25-30
percent.6
4.2.2Cost of equipment
The cost of equipment has also been divided into the departments.
Department NRs GBP USD
Emergency Services 367,815 3,198 5,255
OPD/In-patient 771,677 6,710 11,024
Laboratory 1,992,303 17,324 28,461
Operating theatre 1,469,565 12,779 20,994
6
Some areas of the hospital buildings could be built using cost-effective methods as recommended by
Habitat for Humanity, which would reduce the cost of construction. These are being looked into to
determine how appropriate they would be for such areas as staff accommodation, office rooms, patients’
waiting areas, pharmacy, and canteen.
 Minor OT 438,779 3,815 6,268
Radiology 1,864,500 124,300 26,636
Gynecology/maternity 439,062 3,818 6,272
Admin 246,114 2,140 3,516
Other fixed costs (generator, solar, air-conditioning) 1,461,156 12,706 20,874
Total 9,050,971 78,704 129,300
The total cost of equipment is estimated to be around 9 million rupees (130,000 USD). 7 Support
from individual donors, organizations and charities will be sought to provide equipment and
furniture.
4.2.3Cost of staff
Initially, in Phases 1-2, at least two MBBS qualified doctors would run OPD and the total staff
cost is estimated to be about 370,000Rs per month (£3,300 or 5,200 USD). By Phase 3, by
which time emergency, operating theatres and all four wards will have been completed, there
would be at least three doctors, including an MD GP doctor running the hospital, bringing bring
the total staff cost to about 444,500 NRs per month (£3,865 or 6,700 USD).
NRs GBP USD
Phase 1-2: (OPD, maternity, 2 wards) – inc 2 doctors 369,500 3,213 5,279
Phase 3: (OPD, maternity, OT, emergency, 4 wards) – 444,500 3,863 6,707
including additional MD doctor
A one month Dashain discretionary bonus would be paid based on staff performance. Income
from establishing the nurses’ training school would help fund salaries, though some NGOs have
already indicated that they are willing to help pay staff costs.
4.2.4Day-to-day running costs
Service NRs/month GBP USD
(approx)
Electricity 8,000 70 114
Water (no cost) - -
Telephone/internet 10,000 87 143
Fuel for back-up generator8 6,000 52 86
Supplies for X-ray/lab 25,000 217 357
Ambulance fuel and maintenance (x2) 17,000 148 243
Total 66,000 574 943
Running costs like electricity, fuel, communications etc. are estimated at 66,000 NRs (£574 or
943 USD). Including staff costs, the total monthly running costs of the hospital in Phase 1-2
would be 435,500 NRs (£4,250 or 6,222 USD); and by Phase 3, 510,500 NRs (£4,902 or 7,650
USD).
4.2.5Staff quarters
Accommodation would be needed for doctors/senior staff, with further accommodation planned
for up to eight nursing staff, providing communal kitchens and bathrooms. Habitat for Humanity
suggest that it would cost around 600,000 NRs (£5240 or 8,500 USD) for a large three-bedroom
apartment, and for a two bedroom apartment, about 460,000 NRs (£4000 or $6,600) to provide
good quality accommodation made from local materials. A four-person nurses’ apartment is
estimated to cost about 518,700 NRs (£4510 or $7,410). Eventually, at least four apartments
would be needed, plus nurses’ accommodation for at least eight nurses (total for staff
accommodation would be around 3 million NRs (£30,000 or 43,000 USD).

7
Nick Simon Institute is verifying the cost of equipment and it is anticipated that this figure is a little high.
A couple of NGOs have already indicated that they would be willing to donate equipment too.
8
At Gulmi, about 10,000NRs of fuel is used a month. Budhanilkantha does not have significant powercuts
like in Kathmandu and use of back-up solar lighting will avoid the need for the long continuous use of a
generator.
4.2.6Patents’ party accommodation
Eventually, it would be expected to build some accommodation for patients’ parties that could
be used by those unable to make alternative arrangements. It is suggested that a Habitat for
Humanity dormitory with three rooms accommodating up to four persons would cost around
500,000 NRs (£4,300 or $7,000).
4.2.7Nurses’ Training School (Phase 2)
As soon as the hospital is running, it is planned to add the nurses’ training school costing around
3 million NRs (£26,000 or 42,000 USD). Discussion with Habitat for Humanity suggests the cost
of construction of classrooms and accommodation for students could be a fraction of this
however, using local materials like adobe, bamboo and innovative building methods used by
them. (These figures are not being included with the hospital building costs for the time being).
Buildings and furniture NRs GBP USD (approx)
Classroom 2 324,720 2,824 4,639
Conference room (to seat 80) 1 546,480 4,752 7,807
Hostel (to accommodate 60) 2,000,000 17,391 28,571
Seat/desks 80 80,000 696 1,143
Total 2,951,200 25,663 42,160

4.3 Income
Based on the monthly income earned at Gulmi Distirct Hospital, it is estimated that the
community hospital would be able to earn about 500,000 NRs (£4,350 or 7,140 USD) per month,
assuming an average of 100 patients a day, and based on the government level of charges.
However, it is being recommended that a careful balance of charges needs to be set, where
those who can afford to pay, would pay slightly more than the government charge, thus
subsidizing those who would not be able to afford treatment.
In Phase 2, commencement of the nurses’ training school would bring in income that would pay
for more doctors and nurses. This does not take into account assistance with staff salaries from
outside organizations. (See Annex for further details.)
4.3.1Chargeable services
Charge description NRs / month USD
OPD tickets (including emergency) 41,500 593
Procedures (x-ray, USG, ECG, delivery, appendisectomy, hydrocele, 270,500 3,864
lipoma excision, plaster for fracture, hernia, c-section)
Laboratory testing (electrolyte, blood, liver function, blood sugar/ 142,250 2,032
diabetes, cardiac enzyme, endoscopy, other)
In-patient (bed charge, cabin) 29,000 414
Ambulance 11,000 157
Total per month 494,250 7,061
4.3.2Phase 2 nurses’ training school
Assuming forty students per batch training as ANM or CMAs with 25% of places non-paying,
income from the nurses’ training school would be as follows:
Fees No Charge NRs income USD
NRs
Registration fee (pro-rata’d over 12 months) 30 13,000 32,500 464
Monthly tuition fee 30 1,300 39,000 557
Total for year 1 71,500 1,021
From year 2, 6 months of second year monthly 30 1,300 19,500 279
fees
Total from year 2 90,000 1,280
The nurses’ hostel would also generate income, covering its running costs (electricity, internet,
wear and tear on furnishings etc.).
Training Health Assistants and Staff Nurses requires a 50-bed hospital, but Budhanilkantha
Community is being registered as such, so could provide training to this level. This would earn
the hospital a higher level of income.
4.3.3Other sources of income
Land surrounding the hospital could be cultivated, providing food for staff and patients that is
charged for at a minimal cost. It is envisaged that landless workers from the nearby Dalit
settlement could cultivate land in exchange for half the produce grown, sharing the crops with
the hospital.

4.4 Project expense budget

Costs involved in the set up of the hospital will include personnel and non-personnel costs, but
administrative costs will be negligible, as Rural Assistance Nepal (RAN) operates on a non-
overhead basis, with fixed costs covered by the Project Manager, i.e. salary, office,
communications etc. Technical advice is being offered to the project on a no-charge basis. A
building overseer and skilled labour will be needed however, but the local community will be able
to contribute unskilled labour needed for construction.
4.4.1Personnel costs
Architect – Deepak KC (donating his services)
Engineer/building surveyor – costings, advice – Ramash Adhikari (donating his services)
Building overseer - ?
Skilled builders/carpenters - ?
Unskilled – local labour -
donated
Project management – RAN (donated services)
4.4.2 Non-personnel costs
Travel expenses to and from Budhanilkantha, for architect/engineer/overseer; meetings etc.
5 Organizational Information
5.1 Rural Assistance Nepal (RAN)
Rural Assistance Nepal (RAN) was set up in June 2008 to help advance education and to assist in
the provision of healthcare in the rural areas of Nepal. Donors from around the world support
the salaries of teachers at government schools, and nurses at a healthpost. As well as salaries,
land was purchased for building more classrooms, school libraries have been set up in two
schools, and science and other materials have been provided for two schools in villages in
Dolakha and Solukhumbu. The charity was registered with the UK Charity Commission in June
2008 (Reg No 1124311) to formalise the work that had started in 2006 with support to teachers’
salaries first at Garimudi Secondary School and then Deusa Secondary School in April 2007.
Project Adviser, Marianne Heredge, comes from a management consultancy background, first in
local government services in the UK, and then moving to the financial sector in the City of
London. As well as an MBA, she has an MSc in Development Studies from Birkbeck College
(University of London), where her research was focused on mountain development in Nepal. She
has lived in Nepal since 2005, running Rural Assistance Nepal (RAN), a UK registered charity,
also working for the Mountain Forum Secretariat and ICIMOD.
Marianne Heredge runs RAN on a voluntary basis from Kathmandu. Two other trustees,
Christine Miller and Kate Miller (no relation to each other), assist from the UK, running the RAN
charity finances and providing annual financial reports to the UK Charity Commission. RAN has a
charity bank account set up with HSBC in Rickmansworth, Hertfordshire.
Project Director, Dr Kashim Shah, comes from Pyuthan District and lived in Budhanilkantha for
some time. He trained first as a Health Assistant (1993-96), when he worked in the far western
region of Nepal, then as a doctor at Teaching Hospital (1998-2004). Currently working as an MD
for the Nick Simon Institute, he has worked as a Health Programme Coordinator for Medical
Relief International (Merlin), and Field Medical Officer for Medical Aid Committee (CAM), French
INGO. He has a wide range of experience both in the practical examination and provision of day
to day medical treatment and emergency opera- tions, to training paramedics and assessing
training requirements, organizing medical camps, organizing various programmes and advising on
procurement of medical equipment and drugs.
Qualified as an MD (General Practice in 2010 from the Nepal Academy of Medical
Sciences, he qualified as a doctor from Tribhuvan University (MBBS) in 2004.
5.2 Budhanilkantha Community Hospital Management Committee
Following an initial meeting in Budhanilkantha with over 20 members of the local community in
January 2011, including representatives from the community forest management committee,
drinking water manager committee and youth organization, a hospital user management
committee is being formed to represent the local community, including a minimum of 30 percent
representation by women, and representatives from the traditionally marginalized Tharu, Magar,
Dalit, and Moslem communities. The first meeting of this committee will occur in February 2011.
This committee will be responsible for the provision of labour and local supply of raw materials
for hospital construction, as well as day-to-day management issues once the hospital is
established.
On 16 February 2011, 15 representatives from the community were nominated and met for the
first Budhanilkantha Hospital Management Committee. Of the 15, six members are women
(40%) and there are representatives from the Dalit, Moslem, Tharu, Magar and Brahmin/Chhetri
community, across the political and religious spectrum.

5.3 RANNepal
RANNepal is a Nepali NGO being set up and to be registered with the Social Welfare Council
(SWC), that will be partnered with Rural Assistance Nepal for the establishment of the hospital
and other work undertaken by the UK charity. Dr Kashim Shah is the director of RANNepal.
6 Conclusion
Subject to available funding, work can commence in the autumn of 2011, following the
monsoon. This should commence with the construction of the OPD rooms, one ward, and the
hospital administration offices. It is anticipated that OPD services should be able to commence
by the end of the first quarter of 2012 by the latest.
Construction should then continue with Phase 2, to build the maternity department (including
delivery room, pre- and post- natal wards, wash areas, sterilisation etc.) and a further ward. This
would lead into Phase 3 when the operating theatre (minor and major), pre- and post op wards,
emergency and further two wards would be completed. It is estimated, subject to funds being
available, that this work should be completed within two years of starting, to finish by the end of
2013.
Whilst much of the day to day running costs of the hospital would be met from income
generated from patient registrations and chargeable services, income generated by the nurses’
training school and proactive work to fund-raise will be necessary to raise funds for charitable
support for poor patients, for extending medical services, providing support to healthposts in the
surrounding hill districts, and for training and work with community groups on healthcare and
preventative medical services.
Every opportunity for income generation within the hospital will also be explored, such as
growing vegetables in the surrounding hospital grounds, ambulance transport services, private
patient services, training and others means to enable the hospital to provide medical services to
those who are genuinely in need.
It is anticipated that the hospital will work very closely with the local communities that it serves,
in seeking ways to provide better quality and level of healthcare, awareness and to seek ways to
provide insurance/saving schemes making medical services more accessible to everyone,
including the poorest.
A community hospital at Budhanilkantha, this will introduce more accessible medical services to
the poor people of the mid-western region of Nepal that are critically important for improving
current health conditions. This will include a large number of people from the poorly served hill
districts of Pyuthan and Rolpa, as well as a very large surrounding area in Dang, and parts of the
Arghakhachi, Salyan, and Kapilvastu districts of Lumbini Zone. 9
On 18 March, 2011, Dr Kashim and Shah met with the Ministry of Health to start the
registration of the hospital. In April 2011, a visit to Budhanilkantha is being made with a civil
engineer, to measure and register the land needed for the hospital.
9
Thanks go to the support and technical advice from doctors and staff at the Dhulikhel Community
Hospital, Kavre, Tamakoshi Cooperative Hospital, Ramachapp, Gulmi District Hospital, Gulmi, Community
Action Nepal (CAN), Kathmandu, Stupa Hospital, Kathmandu, the Nick Simon Institute, Patan Hospital,
Kathmandu, Habitat for Humanity, as well as Humans in Crisis, and the community of Budhanilkantha.
ANNEX
Costs
and
Revenue
s
Costs and revenues
A breakdown of costs and income is given. The hospital is divided into the main departments of
OPD, emergency, maternity, OT, in-patient wards, lab/radiology/tests, with accommodation for
dental services, a pharmacy and canteen. In the second phase, buildings for the nurses’ training
school and hostel are needed. Staff accommodation is calculated separately.
A summary of estimated building, equipment costs for the hospital and nurses’ training school
below provides a tentative figure for the cost of setting up Budhanilkantha Community Hospital.
Construction of parts of the hospital buildings with the assistance of Habitat for Humanity will
reduce costs.

Costs NRs GBP USD

1 OPD, lab, x-ray, USG etc 11,056,320 96,142 159,144
Ward 1 3,046,365 26,291 43,520
Office 869,440 7,560 12,421
Sub-total (Phase 1) 14,972,125 129,993 213,888
2 Maternity, pre- and post- natal wards 8,363,520 72,726 120,384
Ward 2 3,046,365 26,291 43,520
Sub-total (Phase 2) 11,409,885 99,017 163,904
3 Operating theatres, pre-and post op wards, 4,926,240 42,837 70,908
Emergency 1,710,720 14,876 24,624
Wards 3 and 4 6,092,730 52,582 87,040
Sub-total (phase 3) 12,729,690 110,295 182,572
15-bed hospital 39,111,700 339,305 560,314
Equipment: x-ray machine, lab equipment, USG, 9,050,971 78,704 129,300
medical equipment, furniture etc.
Start-up capital running costs for the first 12 months 5,920,500 51,483 84,580
4 Nurses’ training school
Total set up costs 54,083,171 469,492 774,194

Hospital building
The total cost of building the hospital has been estimated at 40 million NRs (£339,305 or
$560,314), based on floor plan drawings and calculating the building materials needed to build
the rooms needed for the hospital.
By constructing the hospital in three phrases, the following estimates for each stages of building are:
Phase Costs NRs GBP USD
1 OPD, lab, x-ray, USG etc., Ward 1, offices 14,972,125 129,993 213,888
2 Maternity, pre- and post- natal wards, Ward 2 11,409,885 99,017 163,904
3 Operating theatres, pre-and post op wards, 12,729,690 110,295 182,572
emergency, Wards 3 and 4
15-bed hospital 39,111,700 339,305 560,314
This is a tentative figure at this stage, and it is anticipated that the cost can be reduced by
utilizing local materials, local labour and cost-effective building resources such as those
recommended by Habitat for Humanity and other such organizations. Some areas of the hospital
buildings could be built using cost- effective methods as recommended by Habitat for Humanity,
which would reduce the cost of construction. For example, the patients’ waiting areas, pharmacy,
canteen, and wards could be built using such construction techniques.
Nurses’ Training School (Phase 2)
As soon as the hospital is running, it is planned to add the nurses’ training school costing around
3 million NRs (£26,000 or 42,000 USD). Discussion with Habitat for Humanity suggests the cost
of construction of classrooms and accommodation for students could be a fraction of this
however, using local materials like adobe, bamboo and innovative building methods used by
them.
Buildings and furniture NRs GBP USD
(approx)
Classroom 2 324,720 2,824 4,639
Conference room (to seat 80) 1 546,480 4,752 7,807
Hostel (to accommodate 60) 2,000,000 17,391 28,571
Seat/desks 80 80,000 696 1,143
Total 2,951,200 25,663 42,160

Staff quarters
Accommodation would be needed for doctors/senior staff, with further accommodation planned
for up to eight nursing staff, providing communal kitchens and bathrooms. Habitat for Humanity
suggest that it would cost around 600,000 NRs (£5240 or 8,500 USD) for a large three-bedroom
apartment, and for a two bedroom apartment, about 460,000 NRs (£4000 or $6,600) to provide
good quality accommodation made from local materials. A four-person nurses’ apartment is
estimated to cost about 518,700 NRs (£4510 or $7,410). Eventually, at least four apartments
would be needed, plus nurses’ accommodation for at least eight nurses (total for staff
accommodation would be around 3 million NRs (£30,000 or 43,000 USD).
Patents’ party accommodation
Eventually, it would be expected to build some accommodation for patients’ parties that could
be used by those unable to make alternative arrangements. It is suggested that a Habitat for
Humanity dormitory with three rooms accommodating up to four persons would cost around
500,000 NRs (£4,300 or $7,000).

Equipment
The cost of equipment has also been divided into the departments, with further distinctions
made between the main and minor operating theatre, and the laboratory and radiology areas.

Department NRs GBP USD

Emergency Services 367,815 3,198 5,255
OPD/In-patient 771,677 6,710 11,024
Laboratory 1,992,303 17,324 28,461
Operating theatre 1,469,565 12,779 20,994
Minor OT 438,779 3,815 6,268
Radiology 1,864,500 124,300 26,636
Gynecology/maternity 439,062 3,818 6,272
Admin 246,114 2,140 3,516
Other fixed costs (generator, solar, air-conditioning) 1,461,156 12,706 20,874
Total 9,050,971 78,704 129,300
The total cost of equipment is estimated to be around 9 million NRs (£79,000 or 130,000 USD).
Support from individual donors, organizations and charities will be sought to provide equipment
and furniture. The radiology department and laboratory are each estimated to need nearly 2
million NRs to equip (£17,000 or 29,000USD), with the most expensive pieces of equipment
including the ultrasound machine, blood cell counter and anesthesia machine.
Detailed breakdown of the costs for each department
OPD and in-patient services
Equipment NRs No NRs cost USD
Examination bed (inc mattress) 6,500 4 26,000 371
Hospital bed fowler 15,000 2 30,000 429
Hospital semi-bed fowler 12,000 3 36,000 514
Hospital plain bed 8,000 15 120,000 1,714
Bedside locker 2,800 15 42,000 600
Mattress 4,000 15 60,000 857
Pillow 400 15 6,000 86
IV stand 2,300 10 23,000 329
Bed side-screen 3,800 8 30,400 434
Foot step 2,500 10 25,000 357
Revolving stool 2,500 10 25,000 357
Mayos instrument trolley 7,500 4 30,000 429
Instrument trolley 8,000 4 32,000 457
Overbed table 7,500 4 30,000 429
Dressing trolley 5,200 4 20,800 297
Medicine trolley 3,200 1 3,200 46
Soiled linen trolley 7,000 4 28,000 400
X-ray view box 2,500 4 10,000 143
Surgical instruments and suture 25,000 2 50,000 714
Other misc 25,000 2 50,000 714
Ambo bag 850 1 850 12
ENT set 850 1 850 12
Baby weight scale 2,150 1 2,150 31
Weighing machine 1,650 1 1,650 24
682,900 9,756
VAT 13% 88,777 1,268
TOTAL 771,677 11,024
Emergency services
Equipment NRs No NRs cost USD
Examination bed (inc mattress) 9,000 2 18,000 257
Treatment bed semi fowler 10,000 2 20,000 286
Observation (plain bed) 9,000 2 18,000 257
Suction machine 12,500 1 12,500 179
Suture set 1,650 2 3,300 47
Ambu bag with laryngoscope 5,000 1 5,000 71
Oxygen cylinder 10,000 3 30,000 429
ECG machine 70,000 1 70,000 1,000
Pulseoxymeter 16,500 1 16,500 236
BP set 1,650 2 3,300 47
IV stand 2,300 4 9,200 131
ENT set 5,000 2 10,000 143
Cart trolley for medicine 32,000 1 32,000 457
Trachostomy set 5,000 1 5,000 71
Nebulizer 4,000 2 8,000 114
Wheel chair 6,500 1 6,500 93
Trolley 10,500 1 10,500 150
Foot step 2,500 2 5,000 71
Duch can set 500 2 1,000 14
Foot suction machine 10,000 1 10,000 143
Patient transfer trolley 25,000 1 25,000 357
Stretcher 1,750 2 3,500 50
Dressing drum 1,250 1 1,250 18
Dressing set 670 1 670 10
Foreign body removal set 1,280 1 1,280 18
325,500 4,650
VAT 13% 42,315 605
TOTAL 367,815 5,255
Operating theatre
Equipment NRs No NRs cost USD
OT light - major, heavy 150,000 1 150,000 2,143
OT light - light, moveable LED 45,000 1 45,000 643
Suction machine (high vacuum) 35,000 2 70,000 1,000
OT table - heavy, hydraulic 200,000 1 200,000 2,857
Medicine trolley 9,500 1 9,500 136
Defribulator 250,000 1 250,000 3,571
Oxygen cylinder 15,000 3 45,000 643
Oxygen trolley 5,000 2 10,000 143
Autoclave (horizontal 12x20" high) 21,000 1 21,000 300
Monitor 200,000 1 200,000 2,857
Surgical instruments 75,000 2 150,000 2,143
Other misc consumerables 100,000 1 100,000 1,429
Misc accessories 50,000 1 50,000 714
1,300,500 18,579
VAT 13% 169,065 2,415
TOTAL 1,469,565 20,994
Minor procedures operating theatre
Equipment NRs No NRs cost USD
OT light - light, moveable LED 45,000 1 45,000 643
Suction machine (high vacuum) 10,800 1 10,800 154
OT table 33,500 1 33,500 479
Medicine trolley 9,500 1 9,500 136
Oxygen cylinder 15,000 3 45,000 643
Oxygen trolley 5,000 2 10,000 143
Autoclave (horizontal 12x12" high) 9,500 1 9,500 136
Surgical instruments 75,000 1 75,000 1,071
Other misc consumerables 100,000 1 100,000 1,429
Misc accessories 50,000 1 50,000 714
 388,300 5,547
VAT 13% 50,479 721
TOTAL 438,779 6,268
Maternity services
Equipment NRs No NRs cost USD
Labour table 70,000 1 70,000 1,000
Suction machine 35,000 1 35,000 500
Vacuum extractor set 9,000 2 18,000 257
Dilator and Curreters set 5,000 2 10,000 143
Baby cradle 10,000 2 20,000 286
Infant cot 10,000 2 20,000 286
Baby bassinet 10,000 1 10,000 143
Gyne exam table 9,500 2 19,000 271
Misc instruments/accessories 25,000 2 50,000 714
Hospital plain bed (pre/post-delivery) 8,000 6 48,000 686
Bedside locker 6,000 6 36,000 514
Mattress 4,000 6 24,000 343
Bed side screen 3,800 4 15,200 217
Revolving stool 2,800 4 11,200 160
Baby weight scale 2,150 1 2,150 31
388,550 5,551
VAT 13% 50,512 722
TOTAL 439,062 6,272
Radiology
Equipment NRs No NRs cost USD
X-ray machine (portable 400MA) 400,000 1 400,00 5,714
0
Ultrasound 6600 Plus (Mindray, China) 550,000 1 550,00 7,857
0
Autoprocessor 600,000 1 600,00 8,571
0
Computer, other accessories 100,000 1 100,00 1,429
0
1,650,00 23,571
0
VAT 13% 214,50 3,064
0
TOTAL 1,864,50 26,636
0
Laboratory
Equipment NRs No NRs cost USD
Microscope (Human, Germany 90,000 1 90,000 1,286
binocular)
Semi-auto analyzer (Human, Germany) 275,000 1 275,000 3,929
Incubator (14x14x14 Aluminum 20,000 1 20,000 286
chamber)
Digital weighing machine (Adam, USA) 12,000 1 12,000 171
Electrolyte analyzer (Human, Germany) 275,000 1 275,000 3,929
Blood cell counter (Humacount 30TS) 550,000 1 550,000 7,857
Centrifuge machine (8 tubes, Reml) 12,000 2 24,000 343
Glucometer 3,100 1 3,100 44
Colorimeter digital EI 15,000 1 15,000 214
Hot air oven (14x14x14 aluminum 20,000 1 20,000 286
chamber)
Autoclave 12x15 portable with drum 15,000 1 15,000 214
Refrigerator (double door 220 litres) 25,000 1 25,000 357
Counting chamber (Germany) 2,000 1 2,000 29
DC counter 5 keys 1,500 1 1,500 21
Computer + printer 60,000 1 60,000 857
Micropipette 5,000 10 50,000 714
Glassware, chemicals 250,000 1 250,000 3,571
UPS 1 KVA online 70,000 1 70,000 1,000
Needle destroyer 5,500 1 5,500 79
1,763,100 25,187
VAT 13% 229,203 3,274
TOTAL 1,992,303 28,461
Administration offices
Equipment NRs No NRs cost USD
Bed (doctors’ rest room) 2,000 1 2,000 29
Armchair 3,000 5 15,000 214
Desk 3,500 4 14,000 200
Office chair 2,000 4 8,000 114
Chair 800 6 4,800 69
Table 2,000 3 6,000 86
Bookshelf 3,000 3 9,000 129
Kitchen stove 3,000 1 3,000 43
Filing cabinet 3,000 3 9,000 129
Computer 45,000 3 135,000 1,929
Printer 12,000 1 12,000 171
217,800 3,111
VAT 13% 28,314 404
TOTAL 246,114 3,516
Other fixed equipment costs
Equipment NRs GBP USD
Back-up generator 200,000 1,739 2,857
Solar back-up lighting 637,241 5,541 9,103
Solar vaccine refrigerator/backup 377,245 3,280 5,389
Solar water heating (1,000 litres) 186,670 1,623 2,667
Air conditioning/heating for OT 60,000 522 857
Total 1,461,156 12,706 20,874
These equipment costs are probably estimated a little high and confirmation from Nick Simon
Institute will give a more accurate figure.
Running costs
Staff salaries (cost per month)
Phase 1-2: OPD, maternity, 2 NRs/mon No NRs/mon GBP USD/mon
wards
MBBS doctor 50,000 2 100,000 1,428
Senior nurse 20,000 1 20,000 286
Health Assistant (HA) 20,000 2 40,000 571
Nurse (ANM) 10,000 6 60,000 857
 ANM (FP/ANC) 10,000 1 10,000 143
Paramedic (DOTS/HIV) 10,000 1 10,000 143
Lab technician 15,000 1 15,000 214
Lab assistant 10,000 1 10,000 143
X-ray technician 10,000 1 10,000 143
OPD registration clerk 4,500 1 4,500 64
Reception clerk 4,500 1 4,500 64
Cashier 6,000 1 6,000 86
Manager 40,000 1 40,000 571
Admin – finance 10,000 1 10,000 143
Guard 5,000 2 10,000 143
Driver 6,000 1 6,000 86
Cleaner 4,500 3 13,500 193
Total 369,500 3,213 5,279

Phase 3 – MD doctor NRs/mon No NRs/mon GBP USD/mon

MD GP doctor 75,000 1 75,000 1,428
Total 444,500 3,865 6,707
In Phase 1-2, the total staff cost is estimated to be about 370,000Rs per month (£3,300 or 5,200
USD). By Phase 3, there would be an MD GP doctor, bringing bring the total staff cost to about
444,500 NRs per month (£3,865 or 6,700 USD). A one month Dashain discretionary bonus
would be paid based on staff performance. Income from establishing the nurses’ training school
would fund the second doctor’s salary, though indications are that some of the staff salaries
might be paid by an NGO.
Services (cost per month)
Service NRs/month GBP USD
(approx)
Electricity 8,000 533 114
Water (no cost) - -
Telephone/internet 10,000 87 143
Fuel for back-up generator10 6,000 52 86
Supplies for X-ray/lab 25,000 217 357
Ambulance fuel and maintenance (x2) 17,000 148 243
Total 66,000 1,037 943
Day to day expenses such as electricity, fuel, communications etc. are estimated at around
66,000 NRs or just less than 1,000 USD a month.
Including staff costs, the total monthly running costs of the hospital in Phase 1-2 would be
435,500 NRs (£4,250 or 6,222 USD); and by Phase 3, 510,500 NRs (£4,902 or 7,650 USD).

Revenues
Based on Gulmi District Hospital’s monthly income, it is estimated the community hospital would
earn about 500,000 NRs (£4,350 or 7,140 USD) per month, assuming an average of 100 patients
a day, and based on the government level of charges.
A careful balance of charges needs to be set, where those who can afford to pay, would pay
slightly more than the government charge, thus subsidizing those who would not be able to
afford treatment.
In Phase 2, commencement of the nurses’ training school would bring an income that would pay
for more staff. (This does not take into account assistance with staff salaries from outside
organizations.)
Summary of revenues from chargeable services/month
10
At Gulmi, about 10,000NRs of fuel is used a month. Budhanilkantha does not have significant powercuts
and back-up solar lighting will avoid the need for the long continuous use of a generator.
 Chargeable services NRs revenue/ Cost USD
month
OPD tickets (including emergency) 41,500 593
Procedures (x-ray, USG, ECG, delivery, appendisectomy, 270,500 3,864
hernia, hydrocele, lipoma excision, plaster for fracture, c-
section)
Laboratory testing (electrolyte, blood, liver function, blood 142,250 2,032
sugar/diabetes, cardiac enzyme, endoscopy, other)
In-patient (bed charge, cabin) 29,000 414
Ambulance 11,000 157
Total per month 494,250 7,061
OPD tickets: Assuming 100 patients a day, 15NRs/ticket would provide 1,500NRs/day to the
hospital, or 37,500NRs/month, with additional income generated from emergency tickets. A
further 29,000NRs would be earned based on 80% bed occupancy from in-patients.
Based on the numbers of patients visiting the local sub-healthpost just eight kilometres away at
Bangeswal, where 20-80 patients visit each day, it is estimated 25-30% of these patients should
be seeing a doctor; in additional to the size of the catchment area; and looking at daily patient
numbers at Gulmi District Hospital, which now receives over 100 patients a day, peaking to 200-
400 during the summer months. It is believed that within a short time there will be at least this
number of patients, given the range and quality of services that will be available here.
Procedures: These would include x-ray, USG, deliveries, operations like c-sections, hernia, etc.
Laboratory tests: These include a range of tests, endoscopy, liver function, diabetes, blood tests etc.
In-patient bed charges: (ward and cabin charges). Volumes are based on Gulmi District Hospital’s
statistics, which are expected to be less than potential earnings from Budhanilkantha’s
catchment area.
Ambulance services: Budhanilkantha VDC is finalizing the purchase of an ambulance to serve the
community, with an offer from the British Gurkha’s Association in Budhanilkantha to provide a
second ambulance. Charges are expected to cover fuel, wear and tear, and a driver’s salary. Fixed
rates could be set for local, non- hill and hill journeys, with special allowance for those who
cannot afford to pay. Gulmi District Hospital’s ambulance earns about 20,000Rs a month, with
8,500Rs used for fuel and maintenance. A further 6,000Rs a month would be needed to pay the
driver (providing 5,500Rs surplus a month). With two ambulances it is estimated that income
might be at least 11,000Rs a month.
Breakdown of chargeable services
Charge description Item NRS Est no/mon NRS /mon Cost USD
Tickets
OPD ticket 15.00 2,500 37,500 535
Emergency ticket 20.00 200 4,000 57
Subtotal 41,500 592
Procedures
X-Ray 100.00 400 40,000 571
USG 400.00 300 120,000 1,714
ECG 150.00 50 7,500 107
Delivery 1,000.00 50 50,000 714
Appendisectomy 3,000.00 2 6,000 85
Hydrocele 1,500.00 2 3,000 42
Lipoma excision 200.00 10 2,000 28
Plaster for fracture 200.00 15 3,000 42
Hernia 3,000.00 3 9,000 128
C-Section 5,000.00 6 30,000 428
Subtotal 270,500 3,864
Laboratory testing
Electrolyte test 150.00 200 30,000 428
Blood culture 60.00 200 12,000 171
Liver function test 450.00 5 2,250 32
Random blood sugar, post 1,000.00 3 3,000 42
prandial sugar, HBAC
Cardiac enzyme 1,000.00 5 5,000 71
Endoscopy 1,000.00 50 50,000 714
Other Var Var 40,000 571
Subtotal 142,250 2,032
In-Patient
Bed charge 75.00 360 27,000 385
Cabin charge 200.00 10 2,000 28
Subtotal 29,000.00 414
Ambulance
Ambulance x 2 11,000 157
Total, per month 494,250 7,061
Total, per year 5,931,000 82,842.86

Nurses’ training school (Phase 2)

Assuming forty students per batch, training as ANM or CMAs (18 months theoretical training,
plus three months practical experience), and making 25% of places non-paying, then income
from the nurses’ training school would be as follows:
Charges No Charge NRs income USD
NRs
Registration fee (pro-rata’d over 12 months) 30 13,000 32,500 464
Monthly tuition fee 30 1,300 39,000 557
Total for year 1 71,500 1,021
From year 2, 6 months of second year monthly 30 1,300 19,500 279
fees
Total from year 2 90,000 1,280
The nurses’ hostel could also generate a small income, covering its running costs of electricity,
internet, wear and tear on furnishings, etc.
Other sources of income
Land surrounding the hospital could be cultivated, providing food for staff and patients that is
charged for at a minimal cost. It is envisaged that landless workers from the nearby Dalit
settlement could cultivate land in exchange for half the produce grown, sharing the crops with
the hospital.

Detailed breakdown of building costs and floor plans

Various configurations could be used, but given that land is available, and the high seismic risk in
the area, a single storey construction is recommended.
Setting out as a 15 bed hospital, it is anticipated that this will expand quite rapidly. Therefore,
four wards that have the capacity for more beds will enable increase to 25 beds without further
construction. It is being recommended that further wards are planned for in the original design,
so that when they are needed, they can be located where they are needed.
At this stage, the design is very tentative and open to further discussion and refinement.
However, it provides a guide as to the services that would be included and gives an idea of the
extent of construction that will be required.
 Community Hospital for the Poor
Example A

The estimates for construction are based on a costing of 3,960 NRs per square foot, which
includes VAT and 10% contingency and isused by the government for this type of construction.
(Habitat for Humanity’s estimates are a similar amount but per square metre). This works out at
£34 and 57 USD per square foot respectively.

OPD, lab, tests, reception

OPD, lab, tests, reception Sq m Sq ft NRS GBP USD
OPD rooms (5) 60 640 2,534,400 22,03 36,480
8
OPD - tests/lab/etc 170 1,77 7,013,160 60,98 100,947
1 4
Reception/store/dental 53 381 1,508,760 13,12 21,717
0
TOTAL 282 2,79 11,056,320 96,14 159,144
2 2
OPD m m sq m sq ft NRs GBP USD
OPD room 1 3.5 3.4 11.9 128 506,880 4,408 7,296
OPD room 2 3.5 3.4 11.9 128 506,880 4,408 7,296
OPD room 3 3.5 3.4 11.9 128 506,880 4,408 7,296
OPD room 4 3.5 3.4 11.9 128 506,880 4,408 7,296
25
 Community Hospital for the Poor
OPD room 5 3.5 3.4 11.9 128 506,880 4,408 7,296
TOTAL 59.5 640 2,534,400 22,03 36,480
8

26
 VCT room 3.5 3.4 11.9 128 506,880 4,408 7,296
DOTS room 3.5 3.4 11.9 128 506,880 4,408 7,296
Counselling room 3.5 3.4 11.9 128 506,880 4,408 7,296
ANC 3.5 4 14 128 506,880 4,408 7,296
USG 3.5 4.5 15.75 151 597,960 5,200 8,607
Sample collection room 3.5 3.4 11.9 128 506,880 4,408 7,296
Blood store 3.5 2 7 75 297,000 2,583 4,275
Lab 3.5 8 28 301 1,191,960 10,36 17,157
5
Endoscopy 3.5 4.5 15.75 151 597,960 5,200 8,607
X-ray 3.5 4 14 151 597,960 5,200 8,607
Dressing/injections 3.5 4 14 151 597,960 5,200 8,607
FP immunisation 3.5 4 14 151 597,960 5,200 8,607
TOTAL 170.1 1771 7,013,160 60,98 100,947
4
Registration/cash 3.5 2.5 8.75 108 427,680 3,719 $6,156
Store 3.5 5.5 19.25 108 427,680 3,719 $6,156
Dental room 4.5 5.5 24.75 165 653,400 5,682 $9,405
52.75 381 1,508,760 13,12 $21,717
0
Configuration A Configuration B

OT, maternity and in-patients' wards

OT m m Sq m Sq ft NRs GBP USD
Operating theatre 5.5 8.0 44.0 474.0 1,877,040 16,322 27,018
Minor OT 5.5 4.0 22.0 237.0 938,520 8,161 13,509
Pre-op ward 5.5 4.0 22.0 237.0 938,520 8,161 13,509
Post-op ward 5.5 5.0 27.5 296.0 1,172,160 10,193 16,872
TOTAL 115.5 1,244 4,926,240 42,837 70,908
Maternity m m Sq m Sq ft NRs GBP USD
Sterilization/store 5.5 3.0 16.5 178.0 704,880 6,129 10,146
Scrub/change room 6.0 3.5 21.0 226.0 894,960 7,782 12,882
Delivery room 8.0 4.5 36.0 388.0 1,536,480 13,361 22,116
Counselling room 3.5 3.4 11.9 128.0 506,880 4,408 7,296
Exam room 3.5 3.4 11.9 128.0 506,880 4,408 7,296
WC/bathroom 3.0 2.0 6.0 65.0 257,400 2,238 3,705
 Post-delivery ward 5.0 5.0 25.0 269.0 1,065,240 9,263 15,333
Pre-delivery ward 5.0 5.0 25.0 269.0 1,065,240 9,263 15,333
WC/bathroom 3.0 2.0 6.0 65.0 257,400 2,238 3,705
Doctor's room 5.5 3.5 19.3 208.0 823,680 7,162 11,856
Nurses' station 5.0 3.5 17.5 188.0 744,480 6,474 10,716
TOTAL 196.1 2,112 8,363,520 72,726 120,384
In-patients - wards m m Sq m Sq ft NRs GBP USD
Private room 1 5.5 4.5 24.8 267.0 1,057,320 9,194 15,219
Private room 2 5.5 4.5 24.8 267.0 1,057,320 9,194 15,219
Ward 1 (6 bed) 9.0 6.5 58.5 630.0 2,494,800 21,694 35,910
Ward 2 (6 bed) 9.0 6.5 58.5 630.0 2,494,800 21,694 35,910
Ward 3 (6 bed) 9.0 6.5 58.5 630.0 2,494,800 21,694 35,910
Ward 4 (6 bed) 9.0 6.5 58.5 630.0 2,494,800 21,694 35,910
TOTAL 283.5 3,054.0 12,093,84 105,164 174,078
0

Emergency
m m Sq m Sq ft NRs GBP USD
Emergency waiting area 5 3 15 49 194,040 1,687 2,793
Emergency ward (2 beds) 5 4 20 66 261,360 2,273 3,762
Observation room (2 beds) inc wc 5 6 30 98 388,080 3,375 5,586
Emergency treatment room 1 bed 5 4 20 66 261,360 2,273 3,762
Emergency nurses' station 4 3 12 130 514,800 4,477 7,410
Wash area 2 2 4 13 51,480 448 741
Toilet 2 1.5 3 10 39,600 344 570
TOTAL 104 432 1,710,72 14,876 24,624
0
Hospital administration
m m Sq m Sq ft NRs GBP USD
Staff room 4 7 28 92 364,320 3,168 5,244
Kitchen 4 3 12 39 154,440 1,343 2,223
Admin office 4 8 32 105 415,800 3,616 5,985
Library/computer room 4 6 24 79 312,840 2,720 4,503
Doctors' rest room 4 6 24 79 312,840 2,720 4,503
Director's office 4 4 16 52 205,920 1,791 2,964
Hospital manager's office 4 4 16 52 205,920 1,791 2,964
Meeting room 4 4 16 52 205,920 1,791 2,964
Store 2 2 4 13 51,480 448 741
Staff toilet 2 2 4 13 51,480 448 741
TOTAL 176 576 2,280,96 19,834 32,832
0

Habitat for Humanity estimates 869,440 NRs (£12,421 or $7,560) for a similar office building.

Habitat for Humanity estimates

Staff quarters
3 bedroom apartment m m Sq m NRs GBP USD
Living room 4 7 28
Bedroom 1 4 5 20
Bedroom 2 4 4 16
Bedroom 3 4 4 16
Bathroom 4 3 12
Kitchen 4 3 12
Dining room 4 3 12
Store 3 2 6
Total 122
30% for circulation 36.6
TOTAL 158.6 602,680 5,241 8,610
2 bedroom apartment m m Sq m NRs GBP USD
Living room 4 7 28
Bedroom 1 4 5 20
Bedroom 2 4 4 16
Bathroom 4 3 12
Kitchen 4 3 12
Store 3 2 6
Total 94
30% for circulation 28.2
TOTAL 122.2 464,360 4,038 6,634
Nurses' accommodation m m Sq m NRs GBP USD
Living room 4 5 20
Bedroom 1 4 3.5 14
Bedroom 2 4 3.5 14
Bedroom 3 4 3.5 14
Bedroom 4 4 3.5 14
Bathroom 3 3 9
Kitchen/dining room 4 5 20
Total 105
30% for circulation 31.5
TOTAL 136.5 518,700 4,510 7,410
Patients' party dormitory (dormitory for 12
persons) m m Sq m NRs GBP USD
Kitchen/dining room 4 5 20
bathroom 3 3 9
Dormitory 1 4 6 24
Dormitory 2 4 6 24
Dormitory 3 4 6 24
Total 101
30% for circulation 30.3
TOTAL 131.3 498,940 4,339 7,128
 Community Hospital for the Poor
Three bedroom apartment Two bedroom apartment

Nurse’s accommodation Patient’s party dormitory

30