MINISTRY OF HEALTH

Uganda Heart Institute Project

REVIEW OF ARCHITECTURAL AND ENGINEERING DESIGNS,

AND SUPERVISION OF CIVIL WORKS, MEDICAL EQUIPMENT
AND HOSPITAL FURNITURE EQUIPPING OF THE PROPOSED
250-BED FACILITY PROJECT.

Inception Report
24th September, 2021

by
 TABLE OF CONTENTS
ACRONYMS .................................................................................................................................................................. IV
EXECUTIVE SUMMARY.................................................................................................................................................. VI
1.0 INTRODUCTION ....................................................................................................................................................... 1
1.1 BACKGROUND TO THE INCEPTION REPORT (IR) ...................................................................................................................... 1
1.2 INCEPTION REPORT BASIS .................................................................................................................................................. 1
1.3 INCEPTION REPORT OBJECTIVES .......................................................................................................................................... 2
2.0 APPRECIATION OF THE PROJECT AND CONSULTANT’S ASSIGNMENT ....................................................................... 4
2.1 BACKGROUND ................................................................................................................................................................. 4
2.2 APPRECIATION OF THE CLIENT ............................................................................................................................................ 4
2.2.1 Cardiovascular Healthcare Status and UHI’s Statutory Mandate ....................................................................... 4
2.2.2 UHI Proposed Structure for Project ..................................................................................................................... 5
2.3 APPRECIATION OF THE CONSULTANT’S ASSIGNMENT............................................................................................................... 5
2.3.1 Clarifications on Scope ........................................................................................................................................ 5
2.3.2 Appreciation and Clarifications of the Project Objectives ................................................................................... 5
2.3.3 Appreciation of the Consultancy Objectives and Approach ................................................................................ 6
2.3.3.1 Key Consultant’s Design Stage Specific Responsibilities ................................................................................................ 6
2.3.3.2 Key Consultant’s Supervision Stage Specific Responsibilities ......................................................................................... 9
2.3.3.3 Oversee Equipment Handling- ..................................................................................................................................... 10
2.3.3.4 Samples of Equipment Check lists ................................................................................................................................ 12
2.3.3.5 Other Consultant’s Responsibilities ............................................................................................................................. 13
2.3.4 Comments on Personnel ................................................................................................................................... 15
2.3.5 Comments on Duration of the Project............................................................................................................... 15
2.3.6 Comments on Facilities and Documentation .................................................................................................... 15
2.4 EMERGING ISSUES AND RECOMMENDATIONS ...................................................................................................................... 16
2.4.1 Introduction ...................................................................................................................................................... 16
2.4.2 Key Emerging Issues .......................................................................................................................................... 16
2.4.2.1 New Site Master Planning ............................................................................................................................................ 17
2.4.2.2 Local Content Requirements ........................................................................................................................................ 17
3.0 NEEDS ASSESSMENT REPORT ................................................................................................................................. 19
3.1 BACKGROUND TO NEEDS ASSESSMENT REPORT (NAR) ......................................................................................................... 19
3.2 BRIEF OVERVIEW OF UGANDA HEART INSTITUTE (UHI) ......................................................................................................... 19
3.2.1 A Historical Perspective ..................................................................................................................................... 19
3.2.2 Current Operations and Services ....................................................................................................................... 20
3.2.3 UHI’s Current Structure ..................................................................................................................................... 20
3.3 THE NEEDS ASSESSMENT REPORT OUTLINE......................................................................................................................... 21
3.3.1 Introduction ...................................................................................................................................................... 21
3.3.2 Stakeholder Mapping (SM) ............................................................................................................................... 22
.3.3 Approach and Methodology ............................................................................................................................... 22
3.3.4 Needs Assessment (Prioritising the Gaps) ......................................................................................................... 22
3.3.5 Action Plan ........................................................................................................................................................ 23
3.4 STAKEHOLDER MAPPING AND ENGAGEMENTS APPROACH...................................................................................................... 23
3.4.1 Methods for Engaging Stakeholders ................................................................................................................. 23
3.4.1.1 Stakeholder Engagements-A Conceptual Approach..................................................................................................... 25
3.4.2 Categorisation of the Stakeholders ................................................................................................................... 25
3.4.2.1 Patients and Attendants/Family ................................................................................................................................... 25
3.4.2.2 Health Professionals, Insurance Providers ................................................................................................................... 25
3.4.2.3 “Expert Team” Review Meeting ................................................................................................................................... 25
4.0 LITERATURE REVIEW .............................................................................................................................................. 27
4.1 KEY REVIEW RESOURCES (FS) .......................................................................................................................................... 27
4.1.1 The Project Feasibility Study-(2018) .................................................................................................................. 27
4.1.2 Human Resource Development Plans and Manuals ......................................................................................... 27
4.1.3 Annual Financial and Medical Reports-(2019 to 2020) ..................................................................................... 27
 4.1.4 Review of Existing Facilities and Infrastructure ................................................................................................ 28
4.2 REVIEW OF THE PROJECT FEASIBILITY STUDY........................................................................................................................ 28
4.2.1 Objectives of the feasibility study ..................................................................................................................... 29
4.2.2 Project Rationale ............................................................................................................................................... 30
4.2.3 UHI Status at the Time of Conducting the FS .................................................................................................... 30
4.2.4 UHI Bed Capacity-2018 ..................................................................................................................................... 31
4.2.5 Inpatient Bed Occupancy Rate and Length of Stay ........................................................................................... 31
4.2.6 Space Shortage Impact ..................................................................................................................................... 31
4.2.7 Clinical Performance ......................................................................................................................................... 32
4.2.7 Equipment Capacity .......................................................................................................................................... 32
4.2.8 Relevance of the Project.................................................................................................................................... 33
4.2.9 Proposed Project Intervention ........................................................................................................................... 33
4.2.10 Demand Analysis for cardiovascular health care at UHI ................................................................................. 34
4.2.11 The Market Area ............................................................................................................................................. 35
4.2.12 Demographic Profile of the Project Catchment Area ...................................................................................... 35
4.3 VALIDATION AND UPDATING OF THE FEASIBILITY STUDY FINDINGS ........................................................................................... 36
5.0 REVISED PROJECT BRIEF AND SCOPING.................................................................................................................. 37
5.1 INTRODUCTION.............................................................................................................................................................. 37
5.2 PROJECT BRIEF AND SCOPING APPROACH ........................................................................................................................... 37
5.2.1 Infrastructure .................................................................................................................................................... 37
5.2.2 The Built Environment ....................................................................................................................................... 38
5.2.3 Medical Equipment ........................................................................................................................................... 39
5.2.4 Accessibility ....................................................................................................................................................... 39
5.2.5 Technology ........................................................................................................................................................ 40
5.3 CONCLUSION................................................................................................................................................................. 40
6.0 DESIGN REVIEW ..................................................................................................................................................... 41
6.1 BACKGROUND TO THE DESIGN REVIEW .............................................................................................................................. 41
6.2 RATIONALE ................................................................................................................................................................... 42
6.3 GENERAL DESIGN REVIEW OBJECTIVES ............................................................................................................................... 43
6.4 REVIEW OF ORIGINAL PROJECT BRIEF................................................................................................................................. 43
6.4.1 Design Review Scope ......................................................................................................................................... 43
6.4.2 Design Review Output ....................................................................................................................................... 43
6.4.3 Review Stages and Submission Requirements .................................................................................................. 44
6.4.4 Schematic Design Phase Part I .......................................................................................................................... 44
6.4.4.1 Schematic Design Phase Part I Documents .................................................................................................................. 44
6.4.5 Schematic Design Phase Part II ......................................................................................................................... 45
6.4.5.1 Schematic Design Phase Part II Documents: ................................................................................................................ 45
6.4.6 Preliminary/Design Development Stage ........................................................................................................... 48
6.4.6.1 Preliminary Design Stage Submission Requirements ................................................................................................... 48
7.0 METHODOLOGY AND APPROACH TO THE ASSIGNMENT ........................................................................................ 51
7.1 DESIGN APPROACH ........................................................................................................................................................ 51
7.1.1 Pre-Design Activities ......................................................................................................................................... 51
7.1.2 Design and Tender Stage .................................................................................................................................. 51
7.1.3 Construction Supervision and Contract Administration Stage .......................................................................... 53
7.1.3.1 Equipment Installation Supervision.............................................................................................................................. 53
7.1.3.2 Equipment and MEP/ICT Categorisation ...................................................................................................................... 54
7.1.3.2.1 Key Equipment ..................................................................................................................................................... 54
7.1.3.2.2 Normal MEP/ICT .................................................................................................................................................. 54
7.1.3.3 Specifications and Scoping-quantification and budgeting, .......................................................................................... 54
7.1.3.4 Equipment Procurement Plan-Sourcing, Shipping, Delivery ........................................................................................ 54
7.1.3.5 Equipment Installation Design Integration ................................................................................................................... 55
7.1.3.6 Pre-Installation Works .................................................................................................................................................. 56
7.1.3.7 Equipment Installation ................................................................................................................................................. 56
7.1.3.8 HVAC and Associated BMS Installations ....................................................................................................................... 56
7.1.3.9 Equipment testing, commissioning and training .......................................................................................................... 57
7.2 IMPLEMENTATION STRUCTURE AND CONTRACTOR’S RESOURCING ........................................................................................... 58
7.2.1 Implementation Structure ................................................................................................................................. 58

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 7.2.1.1 Implementation Structure-A Conceptual Approach ....................................................................................... 59
7.3 APT RESOURCING OF THE CONTRACTOR ............................................................................................................................. 60
7.4 DURATION, WORK-PLAN AND SCHEDULING ........................................................................................................................ 61
7.4.1 Overall Duration of the Project ......................................................................................................................... 61
7.4.2 Medical Equipment/Gases and HVAC Program ................................................................................................ 61
7.4.3 Consultant’s Work-flow Plan ............................................................................................................................. 62
7.4.3.1 Work-flow Plan-Stage-1- Design Review and Tender Action........................................................................................ 62
7.4.3.2 Work-flow Plan-Stage-2- Construction Supervision & Equipment Installation .............................................................. 63
7.4.3.3 Work-flow Plan-Stage-3- Defects Liability Period - (DLP) ............................................................................................... 64
7.4.4 Consultant’s Assignment Scheduling ................................................................................................................ 64
7.4.4.1 STAGE-1- Design Review and Tender Action ................................................................................................................. 65
7.4.4.3 STAGE-2- Construction Supervision and Equipment Installation ................................................................................ 67
7.5 PROJECT RISK ANALYSIS AND MITIGATION MEASURES .......................................................................................................... 70
7.5.1 Background ....................................................................................................................................................... 70
7.5.2 The Appropriate Construction Management Vs Risk Mitigation ...................................................................... 70
7.5.3 Risk Analysis and Mitigating Measures ............................................................................................................ 72
7.5.4 Risk Management Plan and Tracker ................................................................................................................... 74
8.0 REPORTING REQUIREMENTS ................................................................................................................................. 75
8.1 PRE-CONSTRUCTION REPORTING REQUIREMENTS ................................................................................................................ 75
8.2 CONSTRUCTION PHASE REPORTING REQUIREMENTS ............................................................................................................. 76
9.0 KEY DELIVERABLES AND WORK-PLAN .................................................................................................................... 77
9.1 KEY MILESTONES AND DELIVERABLES ................................................................................................................................. 77
9.2 PROJECT BRIEF AND SCOPING REPORT ............................................................................................................................... 78
9.2.1 Basis for the Project Brief and Scoping Report .................................................................................................. 78
9.2.1.1 Inception Report .......................................................................................................................................................... 78
9.2.1.2 A Needs Assessment Report ........................................................................................................................................ 78
9.2.1.3 Site Analysis Report ...................................................................................................................................................... 78
9.2.2 Objectives and Scope of the Assignment .......................................................................................................... 78
9.3. CODES OF PRACTICE, STANDARDS AND STATUTORY RESOURCES ............................................................................................. 80
9.3.1 Background ....................................................................................................................................................... 80
9.3.1.1 Selected Codes of Practice and Standards to Guide the Project .................................................................................. 80
9.3.1.1.1 General Codes and Regulations ........................................................................................................................... 80
9.3.1.1.2 Specific Codes and Standards .............................................................................................................................. 80

List of Figures:
Figure 1: Stakeholder Engagements-A Conceptual Approach ........................................... 25
Figure 2: UHI Annual Heart Disease Treatment (2012-17)................................................. 30
Figure 3: Percentage of Cases Handled Vs Turned Away-2018 ........................................ 32
Figure 4: Uganda’s Population Pyramid ............................................................................. 36
Figure 5: Implementation Structure .................................................................................... 58
Figure 6: Apt Contractor Resourcing Strategy-................................................................... 60
List of Tables:
Table 1: Equipment Requirements Check List .................................................................... 12
Table 2: Medical Gases Requirements Check List ............................................................. 12
Table 3: Emerging Issues and Anticipated Impact .................................................................... 16
Table 4: Iterative Intervention Design ................................................................................. 25
Table 5: Feasibility Study-Proposed Project Summary(2018)............................................. 29
Table 6: UHI Equipment stock-January 2018 ..................................................................... 33
Table 7: Overall Project Duration and Scheduling ................................................................... 61
Table 8 : Reporting Requirements-1- ...................................................................................... 75
Table 9 : Reporting Requirements-2- ...................................................................................... 76
Table 10 : Key Milestones and Deliverables ....................................................................... 77

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ACRONYMS
AEC Atomic Energy Council
AKUH Aga Khan University Hospital
BMS Building Management System (S)
BoQ Bills of Quantities
BP Blood Pressure
CAD Computer Aided Design
CCT Cold Chain Technician
CCU Coronary Care Unit
CoW Clerk of Works
CSSD Central Sterile and Supplies Department
CT Scan Computerized Axial Tomography Scan
CVD Cardio Vascular Disease
CVS Cardio Vascular System
DHO District Health Officer
DLP Defects Liability Period
ECG Electrocardiography
EHS Environment, Health and Safety
EIA Environmental Impact Assessment
EMP Environmental Management Plan
FS Feasibility Study
GIT Gastro Intestinal Tract
GoU Government of Uganda
HCFC Health Care Facility Code
HCU High Care Unit
HMIS Health Management Information System
HRH Human Resources for Health
HSSP Health Sector Strategic Plan
HVAC Heating, Ventilation and Air Conditioning
ICT Information, Communication and Technology
ICU Intensive Care Unit
IR Inception Report
IT Information Technology
JKCI Jakaya Kikwete Cardiac Institute
KCCA Kampala Capital City Authority
MDGs Millennium Development Goals
MEP Mechanical, Electrical and Plumbing
MGLSD Ministry of Gender, Labor and Social Development
MoFPED Ministry of Finance, Planning and Economic Development
MoH Ministry of Health

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MoJCA Ministry of Justice and Constitutional Affairs
MoWT Ministry of Works and Transport
MRI Magnetic Resonance Imaging
NAR Needs Assessment Report
NCD Non Communicable Disease
NDA National Drug Authority
NDP National Development Plan
NEMA National Environmental Management Authority
NFPA National Fire Protectional Associstion
NGO Non Government Organization
NHP National Health Policy
NW&SC National Water and Sewerage Corporation
OPD Out Patient Department
PBS Project, Brief and Scoping
PC Project Coordinator
PHC Primary Health Care
PHP Private Health Practitioners
PMP Project Management Plan
PMU Project Management Unit
PNFP Private Not for Profit
PPDA Public Procurement and Disposal of Public Assets
PPF Project Preparation Facility Fund
PSC Project Steering Committee
QAO Quality Assurance Officer
QS Quantity Surveyor
RAP Resettlement Action Plan
RFI Request For Information
RFP Request For Proposal
SPN Specific procurement Notice
UBOS Uganda Brewery of Statistics
UNBS Uganda National Bureau of Standards
URA Uganda Revenue Authority

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 EXECUTIVE SUMMARY
Cardiovascular healthcare (CVH) in Uganda started at Mulago Hospital in 1956 with the
first cardiac catheterization laboratory established in 1958. Though CVH advanced over
the years with open heart surgery being performed by 1969, the political crisis of the 1970s
hampered further growth. The primary challenge to the advancement of CVH has been
insufficient financing for improving and increasing the infrastructure and specialist
equipment needed for CVH demand in the country. In 1988, the Uganda Heart Institute
(UHI) became independent from Mulago Hospital and was established as a limited
company in 2001. In 2016, by an Act of Parliament, UHI was established as an autonomous
body. Much as these institutional reforms were a step in the right direction, they have been
insufficient in meeting the ever-increasing annual demands of CVH services in
Uganda, and in limiting the escalating capital outflow for treatment of citizens abroad;
annually spending staggering amounts of forex.

While addressing Parliament in 2018, the then Secretary to the Treasury was quoted in
The New Vision, saying that the government had spent US$123m (sh455b) on the
treatment of its employees in India alone that year in 2016. The Ugandan government
apparently sent 5,000 people for treatment in India in 2016.

In total, the article noted that the finance ministry confirmed that 8,200 persons applied for
medical visas at the Indian High Commission in Kampala in 2016. While in 2014, the
government is reported to have spent US$73m (sh270b) on treatment and $113m
(sh418b) on travel and upkeep for its patients abroad.

From the foregoing, it is evident that the government's expenditure on healthcare abroad
only covers the few high ranking privileged officials, and that even then, a good portion is
wasted on travel, upkeep and attendants’ expenses.

It should also be emphasised that treatment abroad is not sustainable even for the
privileged, and pauses challenge for reviewing such patients, and as is usually the case,
many cannot afford the would-be frequent return visits required for such reviews and thus
end resorting to the locally available deficient solutions.

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Accordingly, through Vision 2040, the Third National Development Plan 2020/21 – 24/25
and the Manifesto of the National Resistance Movement, the Government of Uganda
committed to establishing a centre of excellence for cancer, renal and CVH for the provision
of affordable healthcare services to the nation and the region at large. In 2018, having
identified the need for public investment in the provision of CVH services, the Ministry of
Finance, Planning and Economic Development commissioned a feasibility study to
determine the need for and the viability of a state-of-the-art facility that can accommodate
the provision of a wide range of; CVH services, training, and research programs. Through
the Ministry of Health, the construction and equipping of a modern 250-bed state-of-the-
art facility project was identified. The facility was to be sited on a 2.5-acre piece of land in
Mulago, earlier secured in 2012. In 2020, by Presidential Directive, this has since been
revised to a 10-acre piece of land on the slopes of Naguru hill for which a master plan shall
be developed following necessary engineering studies.

The feasibility study was conducted and among the key recommendations were the
provision of a facility that meets the best interests of patients, staff, and the wider
community at national, regional, and international levels in the provision of CVH services,
training, and research programs. The consultant was to conduct a detailed needs
assessment during the development of the brief and assist UHI in all processes of the
project. To that end, the consultant assembled an eminent team of consultants with the
requisite training and relevant experiences; many of whom also boast of a long and cordial
working professional relationship spanning over a decade.

The Terms of Reference for the Consultant spelt out the need for implementing the project
to the highest possible standard and to ensure that it meets international accreditation, for
the provision of CVH services, training, and research programs. The design and
construction of the facility were to be done with very good workmanship, high quality of
construction and, importantly, to be completed on schedule, and within budget. The
objectives for the Consultant are to be achieved through the submission and approval of
the following major documentation:

a) Inception Report; this report is to be submitted to the Ministry of Health and will
streamline the project objectives and ensure unity of purpose, giving clarity and guidance
to all project stakeholders.

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b) Needs Assessment Report; this report will be prepared following close engagements
with the staff of UHI. This crucial exercise is to be done through a detailed and broad
consultative approach, focusing on ascertaining UHI’s treating, teaching and research
requirements.

c) Review Report of existing Designs, Specifications and Bills-of-Quantities; this report

shall constitute the Consultant’s detailed design review along with the technical
specifications and Bill-of-Quantities. The key documents for review under this section shall
include architectural and engineering drawings and designs as well as the accompanying
design narratives. Additionally, the Consultant shall examine the specified medical
equipment and furniture for their appropriateness, completeness, availability, and
affordability, noting any deficiencies and/or over-specificationth to better guide the re-
designing of the revised project.

d) Comprehensive and Responsive Project Brief and Scoping (PB&S) Report; the PB&S
report shall be used as a guide for the new approved designs.

e) New and approved Designs, Specifications and Bills-of-Quantities; these documents

shall include new and approved architectural and engineering designs, specifications for
medical equipment and furniture, and the processes for supervision of the works and
installation of equipment and furniture.

The Consultant shall seek all the necessary statutory approvals and clearances from
Ministries, Departments and Agencies, including municipal authorities and institutions such
as the International Atomic Energy Council. The Consultant hopes to complete their
services within 42-calendar months from the date of contract signature. This period for
consultancy services includes the; supervision and monitoring of the Defects Liability
Period, the requisite training of staff and installation of equipment and furniture.

In the bid to seeing to it that the project is well managed, an implementing structure has
been proposed. The project shall be overseen by a Project Steering Committee (PSC) with
representation from key Ministries, Departments and Agencies and shall be chaired by the
Permanent Secretary (PS) Ministry of Health (MoH). This in turn shall be represented by
the Project Coordinator (PS) at the institutional level working closely with the Executive
Director and the top management of UHI for the day-to-day management of the project.

viii
It is the sincere hope, commitment and aspiration of all involved to deliver this project within
time, budget and at the desired quality and standard; thus reversing the trends of capital
and associated brain-drain the country has grappled with for long; offer affordable and
sustainable CVH services to the nationals and the region at large thereby tapping into the
medical tourism market as a beneficiary instead, while on the other hand offering affordable
specialised CVH training and research.

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1.0 INTRODUCTION

1.1 Background to the Inception Report (IR)

This Inception Report (IR) is the very initial startup deliverable, that will include but not limited to, the
reviewing and streamlining of the objectives, terms of reference (ToRs) and scope of the assignment
for “the Review of Architectural, Engineering Design and Supervision of the Civil Works,
Medical Equipment and Hospital/Office Furniture Equipping of the Proposed 250 Beds
Facility Project for Uganda Heart Institute (UHI)-(the Client);” to be carried out by Altido
HealthCare Consulting LLP, Pan Modern Consult Ltd. & Joadah Consult Ltd-(the Consultant).

1.2 Inception Report Basis

The IR is a vital deliverable; it ensures that both the Client and Consultant have the same understanding
and expectations of the project requirements and projected deliverables from the onset.

In addition, coming after some time since the initiation of the project under review, the IR also seeks to
identify any changes and gaps that might have cropped up since, so as to capture them at the earliest.

In addition, the IR shall contain a work plan indicating the different phases of the project; their respective
timings, key deliverables and milestones. A workflow chart along with timelines has been added for
easy demonstration of the proposed scheduling of works. Other provisions of the IR shall include:
methods, codes of practice, quality and standards of work and outputs, as well as projected resources
as expected of the Consultant for the successful delivery of the project.

In essence, the IR is a compilation of the project requirements and an agreement between the
Consultant and Client of the Hows, by Whom, When and of What should be done in order to
successfully deliver the project. As such, it acts as a Check List (CL) during the project implementation,
and as a template for the Final Report(FR) at the completion of the project.

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1.3 Inception Report Objectives
The overall objective of this IR is to harmonise the Client’s expectations with the Consultant’s
understanding and appreciation of the project at the onset. Accordingly, the IR seeks to clarify, refine
and/or improve where necessary:
i) Objectives and Terms of Reference (ToRs) of the assignment so as to capture any
changes and ensure an updated Project Brief;
ii) Methodologies and approach to delivering the project; highlighting the processes and
procedures, as well as describing methods for executing the assignment including
information gathering as well as its evaluation and analysis;
iii) Projected resources-anticipating and spelling out the required resources of personnel,
finances and equipment, for both the Consultant and the eventual Contractor;
iv) Timelines and a work-plan/workflow giving a logical sequencing and scheduling of
works,
v) A well-thought-out project implementation and reporting structure, to ensure due
supervision and monitoring of the project, and the;
vi) Reporting requirements; what reports, when and in what format and numbers they should
be submitted;
vii) Deliverables and outputs, timed milestones and benchmarks to help measure and
monitor progress, to provide guidance for timely interventions and correction where
necessary.

Finally, the IR outlines:

viii) Potential risks that may be encountered, and the mitigating measures proffered;
ix) A schedule of the project requirements and commensurate procurement schedule
and cash flow projections and planning, in line with the works program, as well as
x) key codes of practice and standards, and references to be employed in the guidance of
the project, along with the
xi) Quality assurance and EHS measures and plans that shall be needed, among others.

Ideally, the IR, demonstrates the Consultant’s understanding of the nature, scope and timelines of the
assignment; and shall serve as the assignment scoping document, and as a guide and check to ensure
effective and efficient delivery of the project.

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As such, the IR has been prepared as the first deliverable of the assignment, and is be based on, but
not limited to, the following sources of information:
 Request for Proposal (RFP) documents and ToRs;
 The project feasibility study of 2018;
 Discussion during Project Startup Meeting;
 Discussion during the inception review meetings;
 Discussions and interviews with the UHI’s executives, management and stakeholders;
 Discussions and interviews with MoH, key ministries, departments and agencies;
 Case studies, and site visits and surveys;
 Experience of Consultant’s team of experts dealing with similar projects;
 Review of relevant project documents and sources of relevant project information:
o Original Project Brief;
o The Project Feasibility Study Report;
o Existing Drawings, Specifications and BoQs;
o UHI Mandate, the UHI Act and other relevant statutes;
o UHI human resource plans and manuals;
o other relevant documents such as annual reports and manuals;
o Meetings and interviews with UHI’s staff and key stakeholders.

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2.0 APPRECIATION OF THE PROJECT AND
CONSULTANT’S ASSIGNMENT

2.1 Background
This section gives an outline of a demonstration of the Consultant’s appreciation of the
project; among which, its objectives, scope and the required methods and approaches for
the project’s successful delivery. In addition, the Consultant’s understanding of the Client’s
mandate and limitations, as well as analysing the opportunities and constraints thereof; and
to align these aspects with the proposed project’s objectives and the terms of reference
(ToRs).

Notwithstanding, detailed analysis and presentation of the project requirements shall be

provided in the Needs Assessment Report(NAR).

2.2 Appreciation of the Client

2.2.1 Cardiovascular Healthcare Status and UHI’s Statutory Mandate

Heart care in Uganda started at Mulago Hospital in 1956 with the first cardiac catheterisation
laboratory established in 1958. Though open heart surgery was being performed by 1969,
the political crisis of the 1970s hampered heart care. The current UHI has undergone
institutional changes like being independent in 1988, limited company in 2001 and the UHI
Act, 2016. The above evolution though has not been supported by investment in
infrastructure and equipment and UHI has not kept pace with the rate of increase
of cardiovascular diseases. Own space is increasingly very limited, and in some
cases borrowed or even improvised.

Accordingly, Uganda’s cardiovascular healthcare has faced a series of challenges: there

are acute deficiencies in infrastructure, the required specialised equipment is insufficient or
lacking, while funding is not enough compared to the demand for services. However, the
Government of Uganda has committed to establishing cardiovascular care as one of the
health care centres of excellence, others being cancer and renal care.

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To this effect, a Feasibility Study (FS), to determine the need for and viability of a state-of-
the-art facility that can accommodate a wide range of cardiovascular treatment, training and
research activities and programs, was commissioned and subsequently cleared by the
government through the Ministry of Finance, Planning and Economic (MoFPED-UG) in
2018. Even then, the proposed facility has been in discussion for a while. In 2012, following
a needs assessment, UHI sought land and undertook conceptual facility design and site
planning. The FS explored in more detail the above needs and plans.

2.2.2 UHI Proposed Structure for Project

Given the drastic change from approximately 30 to 50 beds to a 250-bed capacity facility,
it is apparent that UHI’s structure shall significantly change. The Consultant shall duly
analyse the new structure at the time of needs assessment and project brief
development, to informing the new designs.

2.3 Appreciation of the Consultant’s Assignment

(Clarifications on Scope, Objectives and ToRs )
2.3.1 Clarifications on Scope

2.3.2 Appreciation and Clarifications of the Project Objectives

The consultant has noted and appreciates the project’s primary objective of providing a
modern, state of the art facility of 250-bed capacity along with high-end treatment, training
and research facilities, as well as other requisite supportive amenities such as a doctors’
mess, a kitchen and dining, laundry and bio-waste handling provisions etc.; as shall be
refined during the detailed needs assessment and during project brief development
exercises.

It is further noted that the client desires a facility in the best interest of the patients, staff and
wider community at national, regional and international levels that shall be used to treat
cardiovascular diseases and also support the teaching and related research.

Accordingly, the consultant is fully cognisant of the importance and urgency attached to this
project; and has assembled an eminent team of consultants with the requisite training and

5
relevant experiences; many of whom also boast of a long and cordial working professional
relationship spanning over a decade.

In addition, the Consultant notes the ToR’s strict requirement to ensure that the project is
implemented with a high standard to meet international accreditation, for cardiovascular care
and treatment and able to support related specialized teaching and research; with very good
workmanship, standard and quality of construction, on schedule, and within the budget, in
accordance with approved specifications, designs and drawings.

2.3.3 Appreciation of the Consultancy Objectives and Approach

The primary objective of the consultancy is to carry out a comprehensive review and updating
of the project’s existing architectural, and engineering designs and drawing along with the
specifications, BoQs and medical equipment and medical/office furniture thereof, including
the eventual supervision of the civil works and equipping of the proposed 250-bed facility for
Uganda Heart Institute.

This objective of the consultancy services have been divided into two stages namely:
1-design and 2-supervision stages, and shall be achieved through various activities.

2.3.3.1 Key Consultant’s Design Stage Specific Responsibilities

1) Prepare an Inception Report (IR), as proposed in our bid this IR shall streamline the
objectives and have a meeting of minds and give clarity at an early start, so as to guide
the project well.

2) Prepare Needs Assessment Report (NAR)- to this end, the Consultant shall work closely
with the UHI counterpart staff, particularly for from surgery, the in and out-patient, bio-
medical, anaesthesia and perfusion, nuclear medicine, laboratory, nursing departments,
among others.

The exercise, through a detailed and broad consultative approach, shall focus on
interrogating UHI’s treating, teaching and research requirements for space and medical
equipment as well as medical and office furniture including HVAC and Medical gases. The
exercise shall largely be guided by the views/interviews and records on key UHI staff (medical
and non-medical), patients, visitors, etc.

Also to be engaged and/or consulted at this stage are other stakeholders, such as
lecturers/professors and students, and those on fellowship to ascertain the teaching and
research requirements.

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3) Conduct a review of existing designs, specifications and BoQs-
The Consultant noted and shall conduct a detailed design review along with the specifications
and BoQ, in the bid to identify any gaps, or positives, to enhance the revised designs.

Key documents for review under this section shall include architectural, structural and
MEP/HVAC drawings and designs as well as the accompanying design narratives.

In addition, the Consultant shall examine the specified medical equipment and furniture for
their appropriateness, completeness, availability, and affordability; noting any deficiencies
and/or over-specifications so as to better guide the re-designing and specifications of the
revised project.

Following the preparation of an IR, conducting of a comprehensive NAR through assessment

of the existing designs and infrastructure, as well as related documents, the Consultant shall
be in position to empirically establish the Client’s needs and thus develop;

4) Conduct a detailed site analysis of the new site

The initial site was 2.5 acres serviced with only one main road, and thus limited layout and
design options as well as straightforward access.
On the other hand, the new site is substantially larger, measuring approximately 10 acres
and with two access options.

As such the Consultant shall conduct a detailed site analysis on the new site and, given its
size, produce its overall master planning to guide future expansions and growth of the
institution.

In the bid to ably guide the various aspects of design and to meet statutory requirements and
approvals, a number of respective studies and investigations shall be conducted namely:
i) Cadastral / Topographical Survey;
ii) ii)- EIA and Social Impact Survey and Report;
iii) iii)- Traffic Study and Survey Report;
iv) iv)-Geotechnical Investigations
v) v)-Wind Studies-(Direction/Speeds)
vi) vi)-Site Analysis-Orientation/Accessibility/Services/Context.

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It suffices to note that a comprehensive Site Analysis Report shall be one of the key
deliverables that shall guide the new designs.

5) Prepare a responsive project brief and scoping (PB&S)

The so-developed PB&S shall be signed off and be used as a guide for the new designs.
It is thus hoped that the PB&S shall better guide the new designs; giving a responsive
design, in addition to eliminating any previous omissions.

6) Production of new designs, specifications and BoQs,

The Consultant is then expected to revise the designs as per the new Project Brief and
Scoping(PB&S) and revised specifications; and to deliver the project within time, budget
and to the expected standard and quality, as well as ensure observance of all guiding laws
and statutes.

The revised specifications shall also include updated medical equipment, and medical/office
furniture, medical gases, HVAC and related supporting BMS systems.

In addition, the Consultant shall ensure that the designs are responsive to appropriate codes
of practice and standards.

As indicated above, given the relocating of the project to a larger site, the consultant shall in
this case also be required to prepare a master plan for the new site; clearly indicating the
project area and future developments.

In which case, master planning options shall be presented to the client and the preferred
option carried forward for detailing in the subsequent design stages.

The key designs and drawings expected under this section are; architectural, structural,
MEP/ICT designs. Other designs will include; interior and landscape designs and drawings.

Also key under this section are the medical equipment, medical gases and HVAC installation
designs and drawings. These shall require to be well harmonised and integrated with the
said architectural and engineering designs and drawings mentioned above.

To this end, given the centrality and importance of the equipment and attendant installations,
the consultant has called out the equipment aspect of the project and proposed a detailed
approach of how it will be managed.

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7) Participate in Tender Action
The consultant shall at this stage participate in two broad aspects:
1) Prepare comprehensive, accurate and well-checked tender documents;
2) Participate in the selection of the contractor; particularly in ensuring that the bidders
understand the project by responding to any queries and clarifications to ensure
responsive and accurate bids.

8) Seek and follow-up statutory approvals/permits and clearances

The Consultant notes this requirement and shall ensure that all statutory approvals and
clearances are obtained; particularly from NEMA, KCCA, the Atomic Energy
Council(AEC), as well as the Ministry of Gender, Labor and Social Development
(MoGLSD), etc

In addition, the Consultant shall ensure that the appointed Contractor also heeds to this
requirement during construction; among which ensure the contractor obtains the following
permits and clearances:
 KCCA Job Card,
 Excavation, and
 Site hoarding permits,
 Approved dumping sites,
 Work permits for foreign staff etc.

2.3.3.2 Key Consultant’s Supervision Stage Specific Responsibilities

1) Supervision of the construction works and equipment installation:

This shall include post design activities covering supervision of works and equipment
installation and monitoring the defects liability period (DLP).

The construction supervision aspect requires the consultant to deliver the project to
specification and standard, within time and budget to the client’s approval.

2) Ensure the use of right materials, methods and expertise;

The consultant is enjoined and shall ensure value for money and see to it that the project
is delivered at the right quality and standard.

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3) Cost and time control
Relatedly, the consultant is also expected to monitor and control project costs and time
to avoid cost overruns and delays.

Details of this requirement are contained in the consultant’s methodology ahead.

4) Plan and oversee the testing, training and commissioning of all key installations
By practical completion, the consultant is expected to ensure that the buildings are ready
for occupancy, and with minimal or no defects or snags. In which case the buildings shall
be fit for occupancy and in a position to obtain an Occupation Permit.

As such, the consultant shall ensure that the building is well supervised to meet the required
codes, standards and regulations, as well as key installations having been tested,
commissioned and certified as required.

Accordingly, in addition to the Occupation Permit, the following key requirements shall be
observed by the Practical Completion Stage:;

1- As-built Drawings
2- Operational Manuals, Warrants & Guarantees
3- MEP/ICT Installations Testing/Training/Commissioning and Certification
Report: -Fire Detection/Fighting
-Lifts
-HVAC/BMS
4- Medical Equipment Testing/Training/Commissioning and Certification Report
5- Practical Completion Certification

5) Monitoring the DLP.

Upon attaining of practical completion, the consultant shall proceed to monitor the
defects liability period and ensure that by the time the project reaches Final Completion
all snags and defects are corrected.

2.3.3.3 Oversee Equipment Handling-

(Specification, Procurement and Installation)

This being a major, sensitive and critical component to the project, medical equipment,
including medical furniture, medical gases, HVAC and attendant BMS, simply referred to as
“equipment”, has been called out for emphasis and close supervision.

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In the bid to ensure that the “equipment” aspect is appropriately specified, accurately
designed for, the pre-installation works and eventual installation well supervised, the
Consultant shall develop respective comprehensive checklists to help adequately assess the
equipment requirements at all stages. Accordingly, the Consultant has identified six critical
stages to guide this aspect, namely:
1- Specification, quantification and costing; at the needs assessment and project brief
development, the Consultant shall work closely with the Client and relevant
agencies to ensure the required equipment is adequately and accurately specified.
2- Equipment layout and installation design/drawings; ensure accurate harmonization
and integration of equipment requirements and specifications with the architectural
and engineering designs and drawings.
3- Sourcing, procurement and delivery; Upon approval of what equipment to procure,
the Consultant working with the Contractor and Client, shall ensure that a detailed
equipment procurement schedule is prepared and signed off.
The procurement schedule shall guarantee spec, quantity, the right source and cost,
as well as timely delivery of the equipment.
4- Pre-installation works supervision; this stage shall see to it that the equipment
installation designs and drawings referred to above are implemented so that the
equipment environs and services meet the various equipment manufacturer’s
specifications.
The Consultancy team has a bio-medical engineer and a certified HVAC expert and
has provided for a specific Clerk of Works (CoW), in addition to the one for civil
works, for the day-to-day management of this aspect.
5- Installation works; If the above, particularly 2 and 4; the equipment installation
designs and execution of equipment pre-installation works are well guided and
managed, this stage shall be more of a “plug-and-play”. As such, in ensuring this
stage, the Consultant shall lay emphasis on stages 2 to 4 above.
6- Testing and commissioning, which shall also include the training of the end-users.
Stage 6 is elaborately explained in the Consultant’s methodology.
The stage is aimed at, among others, confirmation of accurate installation for
supplier’s warrant qualification purposes, certification of key equipment and
installation for acceptable safe usage, and skills and knowledge transfer.

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 2.3.3.4 Samples of Equipment Check lists

Table 1: Equipment Requirements Check List

1.0-Equipment Description:
2.0-Location: 2.1-Department: 2.3-Floor:
3.0-Weight 6.0-MEP/ICT Provision Requirements:
4.0-l x w x h 6.1-Water Supply Cold hot deionized

5.0-Mounting 6.2-Power Connection Single Phase Three Phase backup

Floor Worktop 6.3-Drainage Applicable N/A Maybe

Applicable N/A Maybe
Wall Ceiling 6.4-ICT Connectivity

Discharge Emissions/Radiation 1- Effluent 1-

If “YES” list the discharges Yes: No: 2- Yes: No: 2-

Table 2: Medical Gases Requirements Check List

(Medical Oxygen/Medical Air 4 & 7bar /CO2 /Nitrous Oxide /Vacuum, Others)
1.0-Medical Gas Description:
2.0-Location: 2.1-Department(s): 2.3-Floor(s):
3.0-Weight 6.0-MEP/ICT Provision Requirements:
4.0-l x w x h 6.1-Water Supply Cold hot deionized

5.0-Mounting 6.2-Power Connection -1-Phase -3-Phase backup

Floor Worktop 6.3-Drainage Applicable N/A Maybe
Wall Ceiling 6.4-ICT Connectivity Applicable N/A Maybe

Emissions 1- Effluent 1-
Discharge If “YES” list the discharges
2- 2-
Type of Installation: Gas Plant Manfold system Cryogenic Tank Other
Pipe Work Size Connection Accessories

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2.3.3.5 Other Consultant’s Responsibilities

Notwithstanding, from the foregoing, it will be noticed that the roles of the consultant, from
inception to design and completion of the project are numerous and diverse.

Accordingly, listed below, but not limited to, is an attempt to expound on the responsibilities
above:
o The Consultant shall be in charge of, and responsible for the design outcomes, and
coordination, integration and harmonisation of the different design aspects, to
ensure that the drawings are well correlated and synched, i.e. “talk-to-each-other”,
so as to avoid variations and undue changes during implementation.
o It is at this stage that the Consultant shall ensure that the equipment manufacturer’s
specifications -space requirements, power rating, water and drainage, etc., are well
harmonised and integrated at the design stage with the Architectural, Structural and
MEP/HVAC Designs and Drawings
o Ensure functionality of the designs and the ensuing buildings – i.e. provision of the
right and appropriate spaces commensurate to the planned uses and activities e.g.
accessibly to peoples with disabilities in wheelchairs and of bulky and sensitive
equipment both at installation, maintenance and replacement-(entrances/openings,
width, height, and turning angles); or adequate space for equipment and working
room etc.
o Relatedly, the Consultant shall pay attention to appropriate designs for safe
environs; say where radioactive emissions are anticipated such as x-ray, MIR and
CT-Scan machine rooms, and other nuclear medicine spaces etc., through the
provision of right sized and appropriate building envelop such as concrete grade for
walls, floor and ceiling, or rated doors and viewing glasses/windows.
o Guarantee structural Integrity of the buildings, by ensuring that the building firmly
and safely supports itself, the projected users and functions, and the equipment
thereat by designing the structure of the building-foundations and columns bases,
columns and beams, roof trusses etc. the meet the design loads and geotechnical
characteristics of the soils.
o Ensure sustainable designs and buildings for cost-effective running and
maintenance of the facility; the Consultant shall give due consideration to the
appropriateness-durability, serviceability, of materials specified, and running costs
of systems and installations; e.g. incorporation of solar lighting and heating;

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o Design and provide appropriate services to the buildings; water (cold and hot)
supply, lighting, electrical supply including both single and three-phase
requirements for heavy medical, medical gas plants, HVAC, laundry and kitchen
equipment as shall be guided by the Needs Assessment. Also to be considered
under this requirement is the aspect of appropriate stormwater runoff channelling.
o Being a hospital facility, the Consultant shall take due care to allow for and ensure
safe on-site handling and decontamination of hazardous bio-medical waste before
onward discharge into the public sewer through the use of decontamination
chambers, autoclaving, and/or incineration.
o Supervise and monitor Contractor's progress and workmanships, and ensure timely
reporting of works progress to the Client noting any delays, causes and remedial
measures;
o Timely reporting on various aspects and progress of the project; i.e.
1-Monthly progress reports, which shall state progress-current and projected, as
well as anticipated challenges and recommendations;
2-Quarterly Financial Appraisals, indicating financial performance vs budget, cash
flows and payment details to the contractor;
3-Variations and change orders, for which prior approval shall be required;
4-Contractor’s personnel and equipment levels vs contract requirements;
5-Reporting on statutory requirements; especially on KCCA and NEMA.
o Cause the Contractor to perform tests on materials, as and when required, to satisfy
their suitability for use in the works at the laboratory registered and approved by
Ministry of Works and Transport to ensure observance of quality and standards at
all times;
o Verify the amount of work done-quantity, quality, cost and payments due, under
each milestone and check the Contractor's payment requests before submitting to
the Client for approval and release of payments and ensure cost and budget
effectiveness;
o Issue timely valuation of works and Interim Payment Certificates, Practical,
substantial and final works completion Certificates in accordance to the works
remuneration accrued upon the achievement and issuance of each certificate in
accordance with agreement frameworks.
o With the approval of the Client, prepare and issue variation orders where required;
o Develop and document a risk management framework for the project to identify and
manage risks associated with the project. The Consultant shall keep track of an

14
 exhaustive risk register that will cover all aspects of risks that may potentially impact
project cost, completion time, quality of the final product etc.
o Similarly, the Consultant shall manage safety, social, and environmental-related
issues during the construction cooperating with the Employer.
o In doing all the above, the Consultant shall hold regular meetings with the Contractor
to review project progress, technical issues, and measures to achieve the targeted
cost, quality and schedule control.
o Ultimately, review and approve as-built drawings and the operation and
maintenance manuals (O&M) prepared by the Contractor for use by Client in the
operation and maintenance of the facility at practical handover;
o Prepare a "Completion Report" for the works under the contract, including a final
closing account.

2.3.4 Comments on Personnel

The Consultant has taken note of the Key Personnel requirements and largely agrees with
the same however, the following modifications are proposed:
Client’s Counter Staff: The Consultant has proposed a select UHI staff with whom they shall
closely work from bio-medical, anaesthesia and perfusion, nuclear medicine, surgery,
laboratory, nursing departments, etc. at the Needs Assessment stage and Project Brief
development stages to identify and specify the project requirements; including various space
provisions, medical equipment, medical gases as well as medical/office furniture etc., and to
refine the project ToRs and scope.

2.3.5 Comments on Duration of the Project

The Consultant has noted the 150 man-months for the entire duration of the project to
cover Needs Assessment and Tender stage, construction and equipment installation, and
the defects liability period monitoring, and contends that, although we have complied with
this provision, the time has been found to be inadequate by close to 20-30%; and that is if
all the time frames are strictly adhered to.
As such, from the Activity Schedule, it will be noted that the time allocation has been so
stressed.

2.3.6 Comments on Facilities and Documentation

These have been noted and found adequate for the assignment.

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2.4 Emerging Issues and Recommendations
2.4.1 Introduction

Given the time-lapse since the existing designs in 2012, and the feasibility study in 2018,
new issues and understanding have since cropped up. Also, there are considerations that
may not have been initially taken into account.

Among them, but not limited to, the Consultant has identified some new developments and
trends that may have an impact on the project designs and outcomes.

2.4.2 Key Emerging Issues

The table and the narrative below, highlight some of the anticipated emerging issues and
proffers possible solutions for consideration at the design stage, among which:
Table 3: Emerging Issues and Anticipated Impact

Item Description Possible impact on the Design

 -Provision of an Isolation ward/ICU within?
 New Bio-safety/bio-security requirements
1. The Covid-19 Pandemic-2020
 Stay-home workers?
 Space-Wards/Office designs?

 Telemedicine?
2. eHealth Strategy 2017 – 2021
 Online teaching and research tools?

 New specifications for medical equipment?

3. Advances in Technology/ICT  Building Management Systems(BMS)

 Paper-less operations trend?

 LEED certification?
 Design Standards/Approaches?
 Solar Energy-back-up power/emergency
4. Sustainability and Greening of Buildings
lighting/water heating?
 Materials-Internal/External finishes-Floors, walls,
ceiling?

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  Design/Equipment Specifications, and quality and
5. Accreditation/Medical Tourism
standards of work?

 Site is much more than needed for the project under

Change of Project site from Mulago (2.5
6. consideration; shall thus require master planning for
acres) to Naguru (10 acres)
coordination with future growth and development.

 Identify potential areas for skills, knowledge and

7. Local Content Act technology transfer, carefully identify local talent to
understudy the expatriates.

2.4.2.1 New Site Master Planning

The Consultant notes that the originally proposed project site of 2.5 acres located
within Mulago Hospital Complex has been exchanged with another site at Naguru
hill measuring 10 acres. Given the size, it is apparent that a master plan to guide
its orderly development shall be required. In this regard options for the master
planning shall be developed and the preferred option shall inform the subsequent
design stages.

It suffices to note that a detailed site analysis indicating the shape, topography and
cadastral, accessibility and context or neighbourhood including orientations, area
wind study conditions-speeds and direction shall be assessed to guide the designs.

2.4.2.2 Local Content Requirements

The requirement for local content has been noted, and the Consultant fully agrees with this
provision.

To this extent, the Consultant has singled out key aspects of the project including:
1-HVAC,
2-Medical-Equipment,
3-Medical Gases, which fields are not fully developed and/or there are not many well-
experienced experts, and provided local expertise to understudy the international
experts on the team for skills and knowledge transfer.

17
Accordingly, the consultancy team has well-experienced persons for bio-medical engineering,
HVAC installation and hospital planning who shall offer the skills and knowledge. As noted in
the proposed methodology, the testing and commissioning of HVAC, is required to be
incorporated at the design stage, as such Fredrik G. Snyman has been brought on board to
work under Gregers Chalker, the HVAC expert.

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3.0 NEEDS ASSESSMENT REPORT

3.1 Background to Needs Assessment Report (NAR)

It suffices to note that a detailed Needs Assessment Report (NAR) shall be prepared and presented
separately after wide consultations and stakeholder engagements. As such Section-3- of this Inception
Report (IR) only gives an outline of the intended NAR as provided hereinbelow.

The Consultant will engage key stakeholders, with a view of establishing the project requirements
and legal framework governing the project.

The expected stakeholders to be engaged shall include, but not limited to; UHI top management and
departments including health professionals and administration staff, Ministry of Health, and other
relevant ministries and departments, patients.

The Consultant will engage these stakeholders through one-on-one interviews or focus group
discussions online or through physical meetings. Detailed questionnaires for requesting for
information will be sent to the target parties by data clerks, who will be given prior training.
Followup will be undertaken in cases where information is not provided, data is incomplete, or the
information is incomprehensible.

3.2 Brief Overview of Uganda Heart Institute (UHI)

3.2.1 A Historical Perspective

UHI started as a simple cardiac clinic at Mulago Hospital in 1958 and transitioned from a clinic
to a fully-fledged facility, established as an autonomous body by an Act of Parliament (The
Uganda Heart Institute ACT, 2016). UHI currently has a Board membership of nine(09) and
Top Management of Five (5) members.

Uganda Heart Institute handles over 20,000 patients annually. comprehensively handle over
95% of the adult cases and 85% of the cases among children in Uganda. Therefore, among
the things Uganda Heart Institute needs now to fulfil its mandate, is more working space.

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3.2.2 Current Operations and Services

UHI provides In-Patient, Out-Patient and Diagnostic services.

 In-patient services run for 24 hours for Children and Adults’ admissions
encompassing both medical and surgical conditions. Its units include: Coronary Care
Unit, Cardiac Critical Care, Cardiac Ambulance Service. The average length of stay on
the ward is 5 days.
 The Out-patient Department receives and oversees medical care of on average -100
patients per day, offering services in medical procedures/tests catering for Rheumatic
Heart Disease, Paediatrics, Heart failure, Arrhythmia and Pacing,
Hypertension/Ischemia, Cardiomyopathies, Surgery (Adult and Paediatric).
 Diagnostic services provided by UHI include: ECG (Electrocardiography), ECHO
(Echocardiography), Stress Test, Cardiac Catheterisation Service, Pacemaker
Programming, Clinical Laboratory.

The Uganda Heart Institute also boasts in providing for Research and Training:
 Research with focus on Epidemiology of cardiovascular diseases, Prevention,
diagnosis, and treatment of cardiovascular diseases, Natural history, clinical profiles
as well as clinical outcomes of cardiovascular diseases, Healthcare systems in the
delivery of cardiovascular services, Disparities in the prevention, diagnosis or
treatment of cardiovascular diseases, Capacity building.
 Training in Adult Cardiology, Paediatric Cardiology, Cardiac Surgery, Cardiac
Anaesthesia, Critical Care and Cardiac Nursing is also among its priorities.

3.2.3 UHI’s Current Structure

Currently, UHI is composed of eight(8) Divisions namely:
1. The Adult Cardiovascular Surgery Division
2. Paediatric Cardiology Division
3. Paediatric Cardiac Surgery Division
4. Cardiac Critical Care Division
5. Adult Cardiology Division
6. Nursing Division
7. Allied and Therapeutics Division
8. Corporate Services Division

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3.3 The Needs Assessment Report Outline
(i)- Introduction
(ii)-Stakeholder Mapping
(iii)- Approach and Methodology
(iv)- Needs Assessment (Prioritising the Gaps)
(v)- Action Plan

3.3.1 Introduction

The Introduction Section of the NAR shall highlight a brief background of UHI; its mandate, structure
and operations, while enumerating its accomplishments and achievements as regards cardiovascular
disease treatment and management in Uganda and the region at large.

The section shall also give an overview of Non-Communicable Disease(NCD) and related care in
Uganda with specific reference to cardiovascular diseases, and finally the rationale and justification of
the NAR and its objectives.
 About UHI and its mandate
 Overview of Non-Communicable Diseases and related care in Uganda with specific reference to
cardiovascular diseases
 Justification and rationale for the needs assessment. This will expound on the need to reconcile
the existing (old) project needs/proposals with the current contexts. These will include but are not
limited to the new site, current trends in NCDs, externalities such as COVID-19 and rapid
technological advancement.
 Objectives of the needs assessment
o Understand the project objectives;
o Undertake a Situational Analysis to get a grasp on what is already available.
o Identify any gaps(missing) requirements and any latent(un-utilised) capacity.
o Draw an action plan and strategies to fill those gaps

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3.3.2 Stakeholder Mapping (SM)
 Being cardinal to this exercise, SM is a process of identifying and categorising key stakeholders
involved in achieving the objectives of the NAR, the details thereof have been detailed above.

.3.3 Approach and Methodology

 This section will present an overview of the approach to the assessment. The assessment is
envisaged to cover two major aspects; that is, resources (human and financial) and infrastructure.

This will entail

 A review of existing, latent (existing but not utilised) capacities and Infrastructure. This is
envisaged to be undertaken through;
o Review of existing project proposals and related documents
o Review of the existing infrastructure
o Stakeholder Engagement and consultation
 Methodology- Data Collection and Analysis will combine both qualitative and quantitative
approaches. The qualitative assessment will mostly entail document review and Key Informant
Interviews.
 This will be complemented by a quantitative Cost-Benefit Analysis of the main action to be
undertaken – using the Benefit-Cost Ratio approach.
 Data analysis will be undertaken using Atlas.ti (qualitative data) and STATA/SPSS (quantitative
data).

3.3.4 Needs Assessment (Prioritising the Gaps)

 While several gaps are likely to be identified, not all can be addressed within the available resource
envelope.
 We, therefore, have to collectively (in consultation with UHI) draw up a scale/list of preference
given the available resources.
 The resultant scale of preference will later inform the detailed design of the project

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3.3.5 Action Plan
 Once the gaps and the corresponding needs have been identified, we will collectively agree on
the actions to be taken.
 The resultant action plan shall highlight the needs to be met through the detailed design
 The action plan will also highlight actions to deal with needs deemed not to be of immediate priority
given the available resources.

3.4 Stakeholder Mapping and Engagements Approach

Stakeholder engagement is emerging as a vital tool for clinician investigators, hospital designers and
planners alike to learn from patients, families, and health professionals to better design and implement
interventions that are responsive to patient and family needs and preferences.

The Consultant proposes an “Expert Team” composed of two(2) recovered/patients, two(2) UHI
representatives and two(3) from the consultant’s team to refine the information so gained from the
parents and health professionals.

3.4.1 Methods for Engaging Stakeholders

Over the next two-month period (September to October 2021), our study team shall engage patients,
attendants/families and health professionals involved in the care of persons with cardiovascular
diseases; who have been treated both at UHI and selected and renown abroad facilities in Kenya,
South Africa and India; two from each country.

The key experts on the consultant’s team shall detail the methods, interview tools, and analysis
plans, and highlight how we used this information to inform our interventions.

Our engagement approach shall consist of three approaches to provide input to the team regarding
engagement, as outlined below:

The engagements shall consist of one-on-one interviews from both the outpatient and inpatient stay
experiences. For inpatient stakeholders, interviews shall be at the bedside on the inpatient unit, while
for the outpatient, this will be done at the outpatient clinic, so as to avoid asking participants to come
back to the hospital after discharge for an interview or focus group.

23
Thirty (30) interviews shall be conducted with a semistructured interview guide, and the interviews
shall be recorded, transcribed and subsequently analysed by using a content analysis approach.

The consultant shall rely on UHI to identify participants who have been treated abroad.

24
 3.4.1.1 Stakeholder Engagements-A Conceptual Approach

Initial/Test Interactions
Test Questioneer (10 Participants) Test Outcomes

Refined Refined Outcomes

Questionee
Refined/Final Interactions
(30 Participants)

Figure 1: Stakeholder Engagements-A Conceptual Approach

Table 4: Iterative Intervention Design

Target Group Description of Engagements Talking Points

Patients In-Patients -One-on-one talks with in/out-patients -Improving quality of
Out-Patients -Meeting with caretakers and family, services and facilities
Caretakers and Family -Online Interviews -Affordability of
Health Professionals (Doctors, -One-on-one talks HP heartcare services
Personnel Nurses, etc.) -ditto other HP on the wards/on-duty
-Meeting with heads of divisions
-Focus group discussions
Insurance providers -Meeting with Key

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3.4.2 Categorisation of the Stakeholders

3.4.2.1 Patients and Attendants/Family

This shall constitute the in and out-patients at UHI, and those who have been treated abroad but
have their reviews at UHI.

3.4.2.2 Health Professionals, Insurance Providers

Health professionals and insurers engagements shall consist of both one-on-one interviews as well
as focus groups discussions.

Due to Covid-19 restrictions; on the basis of convenience, certain health professional groups and
cardiovascular physicians (inpatient and outpatient), interviews shall be conducted online; where
face-to-face encounters are not possible.

Again, interviews and focus groups discussions shall be conducted with a semi-structured interview
guide that shall be adapted with our experience from previous interactions, and these interviews
shall be recorded and transcribed and subsequently analysed by using content analysis or
descriptive thematic analysis.

3.4.2.3 “Expert Team” Review Meeting

A single or two face-to-face meetings shall be conducted at UHI to share our findings with a select
team of doctors and invite their feedback. This stakeholder engagement shall be used to provide
further patient perspective and validation on the findings that shall have been previously gathered
from the first 10 of the targeted 30 patient/attendants/family, health professionals and insurers
engagements. After this meeting, we hope that we shall continue to engage the other stakeholders
with a better focus.

In our engagement plan, we shall use two (2) key strategies: purposeful inclusion of diverse health
care professionals and method flexibility. The consultant, with guidance from UHI, shall identify the
key patient, health professional and insurer stakeholders. Although engaging patients shall be
central to our effort, we also shall seek to engage other key stakeholders, including physicians,
nurses, educators, and insurance payers. To expedite and successfully gather feedback from these

25
groups, we shall be flexible in our research approach. For this reason, while some interviews shall
be conducted as one-on-one, others shall be online focus groups engagements.

26
4.0 LITERATURE REVIEW

4.1 Key Review Resources (FS)

4.1.1 The Project Feasibility Study-(2018)

The FS shall be one of the key resource documents. Prepared only 3 years ago, the study
was based on wide consultations specifically for the project under study and cleared by
MoFPED in the same year.

4.1.2 Human Resource Development Plans and Manuals

The Consultant has been informed that a new structure to match the proposed 250-bed
capacity development is in its final stages of approval; this will be key to informing the
development of the new Project Brief and scoping of the project; particularly as regards space
requirements.

The Consultant notes that the structure has changed from 7 divisions to 12 departments with
20 divisions, while the number of staff has increased to 436 from a mere 200 approved by
government.

It goes without saying, that with improved facilities, staff numbers and better remuneration,
the demand for services will soar. The document will be analysed in more detail at the needs
assessment level.

4.1.3 Annual Financial and Medical Reports-(2019 to 2020)

Equally important for the literature review exercise, are the financial and medical annual
reports; these shall be key in assessing effective demand for UHI’s services and also point to
any gaps and deficiencies that shall require closing under the new designs.

27
4.1.4 Review of Existing Facilities and Infrastructure

Under the needs assessment exercise mentioned above; the Consultant shall conduct a wide
inspection of the existing facilities, infrastructure and equipment, hold interviews with the end-
users at the different UHI divisions while analyzing the spaces and the services thereat-MEP,
HVAC, ICT and BMS platforms, radiation-emission protection/shielding, etc.; with the view of
identifying both the existing positives and negatives, as well as deficiencies in the current
setup so as to better guide the review of the existing designs.

Together with other findings from the needs assessment exercise, the Consultant is confident
that an informed and improved Project Brief shall emerge, and thus a responsive design.

4.2 Review of the Project Feasibility Study

The feasibility study for the project was completed in May 2018; in reviewing it, the Consult is
fully aware that some aspects of it; particularly data, may have changed. However, given that
it is only two to three years since, a quick check indicated that most aspects of the feasibility
study are still valid.

Moreover, from the feasibility study’s project data excerpt below: Table-1-, it is confirmed that
most of the project data is still valid.

Notwithstanding, where there is a significant change, such parameters shall be ably verified
and updated during the needs assessment exercise; especially if such a parameter shall
inform the revised Project Brief.

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 Table 5: Feasibility Study-Proposed Project Summary(2018)

Project Aspect
Sector Health
Vote 115 – Uganda Heart Institute
Vote Function Heart Services
Vote Function Code 08 58
Project Title Proposed UHI Project
Project Duration 5 Years
Project Start Date 2019
Project End Date 2024
Estimated Project Cost US$ 73M
Implementing Agency Uganda Heart Institute
Project Location Mulago III
Funding Source Government of Uganda
Officer Responsible The Executive Director, Uganda Heart Institute
Address: P.O. Box , Kampala, Uganda
Tel: +256 (0)417 720 350
Mobile: +256 (0)772 402 340
E-mail:[email protected]
Date of Submission 20/05/2018
Source: UHI Feasibility Study Report-2018

4.2.1 Objectives of the feasibility study

The main objective of the feasibility study was to determine the viability of establishing a state-
of-the-art UHI. The specific objectives of the study included:

(i) To assess the extent of cardiovascular disease in Uganda and the region;
(ii) To establish the demand for cardiovascular services in the country and the region;
(iii) To identify and appraise (financial, economic, social and environmental) the best
project implementation alternative for establishing the state-of-the-art Uganda
Heart Institute;
(iv) To undertake a risk analysis of the project and identify mitigation measures;
(v) To carry out a stakeholder analysis from the point of view of economic, social and
health benefits and the role of different actors

29
4.2.2 Project Rationale

The rationale for the project, therefore, emanated from the need for the following:

a) To boost accessibility to cardiovascular healthcare by developing facilities equipped

with modern equipment, a conducive environment and motivated staff that will
diagnose and address the growing heart–related complications and act as an
inevitable catalyst to the transformation of regional healthcare standards.
b) To develop additional trained and experienced personnel and meet the growing need
for cardiovascular services nationally and regionally.
c) To support research aimed at expanding and sharing knowledge about the
magnitude, diagnosis and management of heart diseases.
d) To curb the increasing number of patients referred or seeking treatment abroad and
thus save foreign exchange which was estimated at US$ 5,610,029 for a period of 5
years excluding self-sponsored patients who did not apply for referral through the
Medical Board. Expanded UHI facilities will also earn foreign exchange by attracting
foreign patients.

4.2.3 UHI Status at the Time of Conducting the FS

The mandate to treat all cardiovascular diseases throughout Uganda was and is still born by
UHI. The number of patients accessing CVD care at UHI had grown to its limit given the space
and equipment constraints.

Figure 2: UHI Annual Heart Disease Treatment (2012-17)

Patients

17109 16072
13561 12949
12184

2012/13 2013/14 2014/15 2015/16 2016/17

Year

Source: UHI Feasibility Study Report-2018

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4.2.4 UHI Bed Capacity-2018

The bed capacity is critical to the operation of UHI. At the time, there was a total of 21 beds
at UHI of which 13 were general care beds, 4 intensive care unit beds, 4 critical care beds
and there were no high dependence unit beds. While the different categories of beds were
being utilised during different levels of patient recovery; the CCU beds were limited to patients
immediately after the catheterisation labs and theatres from which they are transferred to ICU
beds and then to general beds before discharge. Inadequacy of any type of bed would
automatically halt operations of the laboratory and theatre which not only rendered staff idle
but could also increase fatalities for patients in critical conditions. The situation was worsened
by the fact that female and male adult patients and children were sharing the in-patient ward.

4.2.5 Inpatient Bed Occupancy Rate and Length of Stay

The occupancy rate of beds was over 100% with many patients not admitted. After performing
a cardiovascular procedure, patients would be transferred to the ICU where they spent 3 to 5
days depending on the procedure; after which they are transferred to the HCU for up to three
days and then to the general (medical, paediatric or surgical) bed for a period of up to seven
days. Any delay especially in the ICU meant other operations cannot be handled due to lack
of space. Some patients were being discharged earlier due to impending transfer of others in
a more critical condition even when they would ordinarily stay.

4.2.6 Space Shortage Impact

UHI operations were scattered in four different locations; moreover temporary rented spaces.
The outpatient department occupied Mwanamugimu space, the main block occupied a
Mulago Hospital Annex–at the time under renovations. Stores were being housed in an
improvised stack of containers adjacent to the parking yard, while the responsible
Procurement Section was in a makeshift structure curved from a Mulago hospital staircase.

Operating in multiple locations duplicated equipment and human resources requirements.

Necessitating moving specialists, patients, facilities and test samples/results to-and-fro, and
between locations escalated UHI’s running cost. Also renovating the borrowed space was
expensive, and the approval and decision processes unnecessarily long and cumbersome.

31
4.2.7 Clinical Performance

Though the number of procedures handled had grown consistently, the then level of facilities
was not sufficient to keep pace with demand for services. The patient waiting list and backlog
had become unsustainable. The facility was booked till December 2018. Recurrent
interventions push the backlog further. As a result, a number of patients were unfortunately
being turned away forcing even the less able to seek treatment abroad or risk loss of life.
Figure 3: Percentage of Cases Handled Vs Turned Away-2018

Holter
Stress ECG
Echo
Resting ECG
OPD Consultation
Surgery for Tumors & Cancers of Heart
A-V fistula creation in End Stage Kidney Disease
Endovascular Aortic Aneurysm Repair
Open Aortic Aneurysm Repair
Peadiatric Catheterisation
Peadiatric Surgery
Left Ventricular Aneurysm Repair
Coronary Bypass Grafting
Valve Repair & Replacement

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Done Turned Away

Source: UHI Feasibility Study Report-2018

4.2.7 Equipment Capacity

At the time, UHI had acute challenges with regard to both space and equipment needed to
effectively deal with the rising number of patients suffering from heart diseases.

32
 Table 6: UHI Equipment stock-January 2018

Item/infrastructure Available
1-Cardiac Life 1*
Number
2-Intensive Care 1*
Support
3-Cardiac 1
Unit
4-Theatres 1
Catheterisation
5-General Labs 1*
Labs
6-Radiology Unit 0
7-Pharmacy 1*
8-Coronary Care 1*
9-Office space 30-40%
Units
10-Stores 1*
* Improvised and inadequate

These infrastructural challenges have resulted in congestion and constrained the institute’s
ability to effectively treat patients; with highly trained doctors attending to patients from
improvised containers as a coping mechanism.

4.2.8 Relevance of the Project

The Government of Uganda regards Health as a fundamental human right and a prerequisite
for socio-economic stability and sustainable development. The goal of the Ministry of Health
through the National Health Policy II (NHPII) is to improve population health and well-being,
reducing health inequalities, and ensuring a citizen-centred health system that is universal,
equitable, sustainable and of high quality by addressing the human resource gaps and related
service delivery challenges among others. The proposed project was a government priority
in line with broader development objectives and plans.

4.2.9 Proposed Project Intervention

The project was envisaged to transform cardiovascular healthcare by providing a quality and
secure layout and space built to ensure patient satisfaction, employee work environment,
well-being and motivation, citizen patronage, research and continuous improvement. The
project was be realised as a modern emergency and outpatient centre with capacity and
facilities like:
 Emergency admittance for grave conditions and care facilities for intensive care and
emergency cases including catheterisation procedure rooms, emergency X-Ray and

33
 CT Scans, recovery rooms with adequate number of beds and cabinets for
cardiovascular care staff;
 Two (2) operating theatres properly fitted to meet the needs for a wide range of
surgical interventions for cardiovascular and thorax interventions and connected with
appropriate sterilisation meeting the needs of the facility and with appropriate sections
and modern technology, and in close proximity to histology, blood bank and
laboratories sections;
 Two (2) catheterisation laboratories
 250-bed including 20 critical care unit beds, 144 general hospital beds and caretaker
beds; This will increase the number of bed days to 73,000 and sufficient capacity to
handle 7,300 patients (excluding critical care and intensive care beds and assuming
10 days length of stay and continuous admission).
 With the project, each specialist will provide training to two fellowship students and
two cardiac nursing students in addition to space and facilities dedicated to research.

4.2.10 Demand Analysis for cardiovascular health care at UHI

Demand and Supply interaction in CVS:

The law of demand applies to the cardiovascular health care market: as the price of health
care increases, demand reduces. Demand for health care is relatively inelastic. A sick person
requiring care will purchase services at almost any price. The risks associated with CVDs
have the power to alter patients’ priorities. Patients with limited income will trade-off spending
on other products or dispose of items of value to spend on healthcare.

Health spending is an Investment and everyone prefers being healthy to being sick. The
demand for health care is in part an expression of this preference. Money spent on being
healthy today averts lost days at work and is a benefit for future work and wages. This is a
cost not only to the individual but also to society as a whole: the economy’s population is
producing less output. If one is in poor health, they risk losing wages for the days when the
patient cannot come to work.

Studies of demand for health care in developing countries find price elasticity to be less than
1.0 in absolute value (implying that demand changes less than proportionately to price). Price
elasticity for outpatient are as well as prenatal, well-baby, and immunisation services at values
very close to zero implying that fees would not discourage access to care.

34
This analysis assumed UHI prices reflect the value patients attach to services since they can’t
pay for services whose prices exceed their value. Current prices charged by UHI have been
stable for a long period and are low compared to those charged by competitors in the region
and abroad.

4.2.11 The Market Area

The market area for the proposed facility was categorized as primary and secondary. The
study considered Uganda as the primary market due to the lack of a facility offering similar
CV services. In recognition that healthcare patterns are not reflective of political boundaries,
the study acknowledges that facilities and services offered in neighbouring countries attract
Ugandan residents. Correspondingly, the proposed project will draw patients from outside
Uganda.

The secondary market area has been defined as the Great Lakes region including countries
like D.R. Congo, South Sudan, Burundi, Rwanda, Kenya, Tanzania and Somalia. This area
has been defined based on the historical UHI patient information and a CV market survey in
the area. The existence of CV healthcare facilities in this area is acknowledged though they
do not match the scope of the proposed project.

4.2.12 Demographic Profile of the Project Catchment Area

Access to cardiovascular services is influenced by many factors, including demographic

characteristics, the most influential of which are exposure to risk factors, age, income and
education. Future trends will be influenced by changes in the profile of the area. The ease of
movement of people across borders in the region is expected to impact demand. The growing
number of foreigners will boost the demand for specialised healthcare services and medical
tourism. Uganda’s population is estimated at 41m (UBOS) which at a growth rate of 3.2% per
year is expected to top 53.7 million by the year 2025 growing to 81.4 million by 2040. This will
increase the number of people exposed to cardiovascular risk factors. Investment in health
care projects to address the foreseeable challenges is inevitable. The project is also expected
to tap into the regional market.

35
 Figure 4: Uganda’s Population Pyramid

Uganda’s population pyramid and the improving life expectancy calls for evolving
interventions addressing the needs of a growing number of persons aged 55 years. Life
expectancy is steadily improving to the projected 80 years by 2040, the birthrate is high
leading to an increasing need for paediatric interventions and there is growing exposure to
CVD risk factors. Investment in the health sector is of utmost importance.

4.3 Validation and Updating of the Feasibility Study Findings

The feasibility study findings shall be validated and updated through the needs assessment
exercise and upon which, the outcome shall form part of the key basis for the revised Project
Brief.

36
5.0 REVISED PROJECT BRIEF AND SCOPING

5.1 Introduction

It suffices to note that a comprehensive and detailed Project Brief and project scoping is one
of the key deliverables that shall be produced after the needs assessment exercise.
Nonetheless, this section of the IR highlights the general focus and direction the brief shall
take.

5.2 Project Brief and Scoping Approach

5.2.1 Infrastructure

Given the gaps identified in the feasibility study, the consultant shall focus on the
infrastructure workstream of the proposed UHI state-of-the-art hospital project; work with the
Client, the Project Coordinator and key stakeholders and end-users, to seek their
perspectives on the desirable built environment and specific elements of healthcare
infrastructure, including architecture, design, commissioning a new hospital, sustainability
and information technology, to meet both the national and international standards.

Broadly, hospital infrastructure includes the built environment and supporting elements:
equipment, access, information technology (IT), systems and processes, sustainability
initiatives and staff.

The infrastructure must integrate the hospital, as the centre for outpatient, acute and inpatient
care, into the broader health care system, and should facilitate the seven aspects of quality
healthcare: (i)-patient experience, (ii)-effectiveness, (iii)-efficiency, (iv)-timeliness, (v)-safety,
(vi)-equity and (vii)-sustainability.

Overall, these interwoven facets shall enable patients to move seamlessly, with their privacy
and dignity maintained at all times, from initial referral through local hospitals to specialist
tertiary centres and discharge to appropriate care (home, care home, or community hospital
with intermediate care), whatever the age, disorder or social circumstances of the patient.

Accordingly, infrastructure is a key pillar supporting the fundamental aim of promoting

improved standards of care and wellbeing for all patients, together with a good experience of
the health care system. In parallel, the healthcare system and staff must support effective

37
health promotion, prevention and self-care of the whole population. In addition, a secondary
aim must be to improve the wellbeing of staff, as this is integrally related to ensuring improved
care for patients.

5.2.2 The Built Environment

Hospitals should ideally be integrated into the broader community, wherever possible, to
promote accessibility to-and-fro, as well as within, societal ‘buy-in’ and well-being. There
should be easy access, ample car parking and accessible public transport facilities and clear
signage within the hospital and hospital grounds to ensure patients and families can easily
navigate all hospital services.

The new hospital buildings shall be constructed to a high standard, reflecting certain principles
in their design, specifical flexibility of usage of space to keep services adaptable and revenue
costs down. Wards and patient areas shall have well-lit waiting spaces, with good views
wherever possible, to promote a patient-friendly and healing environment. In addition, there
shall be adequate space between beds for procedures, clinical activities and infection control.
The Consultant shall balance between co-location of related services to enhance efficiency
and timeliness of services, and total separation and zoning of others such as access routes
for staff, patients and the public to hosptital wards and services.

A range of amenities, such as a choice of food, shops, a restaurant, postage, IT facilities,

telephone, TV/radio access and chaplains, improve patient and staff wellbeing, while regular
childcare services support seven-day staff working. Importantly, neither patients nor services
should be constrained by the physical environment, but the environment should be configured
to be fit-for-purpose, with a high degree of cleanliness, and should be sufficiently flexible to
serve all patients, including both the physically and mentally disabled.

Buildings shall require to be reconfiguration to promote seamless and efficient healthcare,

with specific services in specific sites; for example, acute care services on one site, with
intermediate community care, outpatients, rehabilitation, integrated therapy and social
services, together with daycare and hospice care, on another. Such provision across the
whole healthcare pathway should be supported by integrated medical, nursing and multi-
professional healthcare services.

38
5.2.3 Medical Equipment

A comprehensive, corporate approach to managing medical equipment, overseen by a

responsible expert, ensures that appropriate medical equipment is available and fit-for-
purpose, as required for the delivery of high-quality clinical services. This requires scrutiny of
every element of the life cycle of a device from the specification of requirements, through
evaluation of competing products, decontamination, procurement, installation,
commissioning, training, maintenance and quality assurance to disposal and funded plans for
equipment replacement. In addition, the responsible expert should evaluate and introduce
appropriate new technologies and ensure that requirements for medical equipment are
factored into service development proposals. The management of risks associated with
medical equipment, including responding to adverse incidents, should also be undertaken
within a corporate framework.

Accordingly, the Consultant has, under the proposed methodology, given an elaborate
process and procedure to ensure that the right equipment is specified and procured, as well
as guaranteeing its proper installation, and provided for its testing, commissioning and training
of the end-users.

5.2.4 Accessibility

The term ‘access’ here refers to patient access to all healthcare services, including
emergency health support, physical access to healthcare facilities and all relevant hospital
information, including clinical service statistics, in electronic, written or audio formats.

Access to information shall be recognised as an effective way in which to promote both patient
and staff wellbeing. There shall be equity of access irrespective of age, gender, ethnicity, and
disability. The design shall provide for flexibility of all aspects of access that is required to
ensure the optimal provision of services.

Information to be provided shall include clinic times, appointment arrangements allowing

linked appointments across different disciplines/levels of healthcare, named doctors in clinics,
the nature and role of multidisciplinary teams, transport facilities and costs. Patient-centered
services benefit from easy access to information shall cover investigations, treatments and
medicines, together with healthcare education advice providing both prevention and self-care

39
information. Good housekeeping information may relate to visiting hours, shops (goods and
opening hours), religious contacts/services, telephone arrangements and, for inpatients,
hospital activities, such as exhibitions, music, and radio and television programs.

5.2.5 Technology

Accordingly, fully integrated information technology systems shall support the delivery of
information to ensure patients, carers and health professionals can access information they
need, when they need it. In addition, technology could support improved healthcare efficiency
both in outreach provision of care and by reducing travel and healthcare visits and in inpatient
provision. For instance, all or a few beds may have televisions with clinical information and
data displayed for the clinician and health promotion messages displayed to the patient.
Hospital efficiencies could be achieved by supplying multiple terminals around the hospital,
allowing real-time access to an interactive database of inpatient admission and discharge
information, with referral details, patient information and location (kept up-to-date), the name,
grade and contact details of the doctors, the time of medical assessment, and details of
investigations (including outstanding results) and speciality reviews. This should also include
a capacity and activity management system, linked to the wider health and social care
providers and personal communication devices detailing contact details to each member of
the clinical team in each shift.

5.3 Conclusion
Thus, multiple infrastructure systems, processes and personnel arrangements are key to any
hospital project aims and objectives, underpinning a new approach to healthcare that will
ensure efficiency, cost reduction, sustainability and a reduced carbon footprint, and most
importantly improved patient care.

This approach shall be duly employed to guide the delivery of the project.

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6.0 DESIGN REVIEW

6.1 Background to the Design Review

The review and evaluation shall check whether existing designs, in part or as a whole, were designed
properly or not and if they will fail in practical situations. The review will follow a structured agenda that
includes a brief overview, background, the design review, feedback gathering, and prioritizing the next
steps.

According to the existing drawings, the project has four core elements namely: i)-the Clinical/ Nutrition,
ii)-Research and Training, ii)-the Doctors’ Mess, and the iv)-Administrative, Maintenance and
SupportiveAmenities elements; each of which plays a distinct but complementary role in fulfilling UHI’s
mandate.

The four elements are further subdivided into different core sections that hold and support
different functions as indicated below:

 Clinical/Nutrition:
o Out-Patients-Waiting,
o Diagnostic-Laboratory, x-ray, radiology,
o In-Patients-wards, ICUs, duty stations/rooms,
o Theatres,
o Pharmacy/Stores,
o Mortuary, etc.
 Research and Training:
o Lecture halls,
o Teaching laboratories, etc.
o Doctors’ Mess:
o Key staff/ students’ accommodation, etc.
 Support and Maintenance Amenities elements:
o Offices/
o Board/meeting rooms
o Stores,
o Dining/kitchen,
o Laundry,
o Equipment/maintenance rooms, etc.

41
Following, understanding UHI’s institutional setup is key to tackling space and facilities
requirements, and layout for efficient and functional running.

Thus the Consultant shall develop a comprehensive and accurate space schedule which
recognizes the importance of each element, department, and section to guide space
allocation and facilities provision.

6.2 Rationale
This Design Review is intended to address any gaps that may have occurred at the initial
design stages, or due to changes and new understanding that has emerged since 2012 when
the designs were first made; so as to assist the project to achieve design excellence–
functionally, economically, and technologically in the most cost-effective and sustainable
manner.
The design review shall also address legal aspects that may have been missed, or as new
provisions.

In undertaking this exercise, the Consultant’s team shall promote and encourage design
quality, by acting as an enabler of design quality and enhanced value outcomes through
discussing design‐related issues with the Client, end-users and key stakeholders.

In this bid, the Consultant also intends to conduct case studies at Jakaya Kikwete Cardiac
Institute (JKCI) in Tanzania, and Aga Khan University Hospital (AKUH) in Kenya among
others.

The purpose of this section is to provide details regarding design submissions at each stage
of the design review process. The intent of the section is to clarify what is expected at each
stage of the Design Review Process. Doing so will not only ensure a step-by-step
comprehensive approach, it will also provide a benchmark throughout the design review
process.

Thus the section shall be used in determining schedules for the revised designs, and It shall
be used throughout the design process as a guide for preparing each submission. Each
submission will be evaluated for ‘completeness’ prior to being signoff. The result of this effort
shall be a consistent design approach.

42
6.3 General Design Review Objectives
The General Design Review Objectives are to produce designs that:
 Satisfy the spatial, and functional needs of the users as per the revised Project
Brief;
 Designs are specifically for the actual climate and other physical parameters of the
new site;
 Sustainable and structural sound, and for the minimum capital cost consistent with
lowest life cycle costs; and
 Meet all applicable codes, regulations and standards
.
The design review shall be focused on outcomes for people:
evaluating how the buildings shall/can better meet the needs of the users and staff using it,
and of anyone who is affected by it. Design quality is an essential component of the creation
of sustainable places.

The design review shall aim at improving quality: It shall constructively seek to raise the
quality of all buildings by providing better quality design solutions.

6.4 Review of Original Project Brief

A Project Brief is a document which outlines project requirements for the client and
departments, that establishes a basis (functional, spatial, and technical criteria) for evaluating
design solutions/alternatives, and serves as reference document for design consultants, for
post-occupancy evaluations.

6.4.1 Design Review Scope

"Design" in this regard encompasses a number of activities within the fields of Architecture
and Engineering. During the design phase of any project several documents are usually
produced, each with a specific scope and objective. The scope of this Design Review and the
resulting report shall be guided by the Terms of Reference and other listed documents.

6.4.2 Design Review Output

The output of the Design Review shall be a formal report. The report shall be cumulative and
document the full history of the project, and contain findings and the related responses from
the Consultant. Significant design decisions shall be recorded, while specific design elements

43
that require additional research, such as the proposed use of new materials, technologies or
methods that have not been proven, shall be documented in detail with specific
recommendations. The intent is to provide the Project Team with the information that it
requires to make design-related decisions in a timely fashion to move the project forward.

6.4.3 Review Stages and Submission Requirements

The design process shall be divided into three stages, such that each stage culminates in a
distinct product requiring reviews and approval. The three stages are:

1. Schematic Design Phase I & II;

2. Detailed or Design Development Phase;
3. Construction Document Phase

6.4.4 Schematic Design Phase Part I

In this stage, the consultant shall demonstrate practical and imaginative responses to the
revised project brief. Give alternatives for the new site, functional layouts, building sections,
and elevations shall be developed considering the objectives, assumptions and criteria in the
brief and the governing codes and regulations. The alternatives shall be presented, reviewed
and evaluated by the Client. The most cost-effective and technically appropriate alternative
is then selected for further development and refining.

6.4.4.1 Schematic Design Phase Part I Documents

Drawings:

 Site plan alternatives

 Floor plan alternatives
 Building section alternatives
 Elevation alternatives

Report/Written Information:

A formal report shall be prepared indicating:

 Adequacy of site, preliminary layout alternatives/options;

 Foundation/structural alternatives;
 Plumbing system alternatives.
 Plumbing, drainage and ventilation system alternatives.

44
  Power system alternatives (i.e. phase/loads/back-up power).
 Lighting system alternatives.
 Other electrical systems alternatives.
 A summary table or listing of applicable code and regulatory requirements.
 Preliminary cost estimate information to guide the project budget

6.4.5 Schematic Design Phase Part II

Based on the preferred alternatives established within Part I above the consultant shall
prepare detailed schematic design documents, consisting of drawings and other documents
illustrating the general scope, scale and relationship of the project components. Designs
produced will be conceptual in character, indicating the proposed plan form, site plan and
appearance of the facility with relation to orientation, topography, adjacent land use and
utilities, as well as a general approach to structural, mechanical and electrical systems.
Furthermore, the consultant shall outline major mechanical, electrical, structural and
architectural sub-systems to demonstrate that the preferred alternative can be implemented,
that it represents the best solution to the requirements of the Project Brief, and that it complies
with all governing codes and regulations.

Schematic Design Phase Part II Review:

These shall be reviewed to assess the suitability of the schematic alternative in meeting the
requirements of the Project Brief, the Client’s aspirations, and budget objectives.
Architectural, Mechanical and Electrical systems will be outlined in greater detail to clearly
reveal project design direction, cost implications and how the building systems are integrated.

At this stage, the Consultant shall also give a detailed layout of the medical equipment and
medical furniture as well as office furniture layout, and ensure they are well harmonized with
other designs and well provided for as regards their weight/load, building envelope and
MEP/HVAC requirements.

6.4.5.1 Schematic Design Phase Part II Documents:

Drawings:
 Location and site plan
 Schematic floor plans
 Preliminary equipment and furniture layouts

45
  Schematic cross sections
 Typical envelope assembly (roof, walls, and floor)
 Building elevations
 Structural plans
 Plumbing, heating and ventilation plan(s),
 Electrical and lighting plan(s)

Design Report/Written Information:

 Changes to any pre-design information prepared for the consultant and agreed to
at the previous reviews shall be documented and incorporated into the Schematic
Design.
 The Occupancy Classification as approved by the fire department is to be stated.
 A summary table or listing of applicable code requirements and proposed
responses.
 Description of any design "features" or important site conditions that may not be
apparent from the drawings alone.
 The rationale behind any important design decisions that may assist in explaining
choices, which may not appear to be appropriate.
 Summary of floor areas compared to program areas.
 Foundation/structural system description.
 Identify areas where the design provides for substantiation and costing.

Mechanical and Electrical Information (and Drawings) required as part of Design

Submissions:

 Preliminary design calculations for the ventilation/HVAC rates and requirements,

fuel/water tanks, bio-medical effluent decontamination/holding tanks etc.
o Provide separate floor plans for each floor,
o Provide preliminary layouts of mechanical room(s) indicating all equipment to
correct scale.
o Provide information and description of major equipment and components to be
used in the building.
o Include the location of main electrical service equipment and existing or
proposed utility power locations (site plan).
o Provide separate electrical drawings for each floor, including proposed lighting
and power layout.

46
 o Description of existing and/or proposed electrical systems and sub-systems:

- Distribution
- Voice & Data
- Security
- Operation & Maintenance Considerations
- Specialized Electrical Systems
- Generator
– Lighting
- Public Address
- Music Systems
- Fire fighting
- Power
- Television
-Exit & Emergency

Preliminary Code Analysis

A preliminary code analysis to be provided. The code analysis shall identify the following:

 A list of applicable Codes and Standards

 A Building Description including:
o Major Occupancies
o Building Area
o Building Classification
 Major Fire Protection and Life Safety Requirements including:
o Building Construction
o Spatial Separation and Limiting Distance
o Fire Separations
o Egress and Exiting
o Occupant Load and Exit Capacity
o Location of Exits
o Water Supply
o Sprinkler Systems
o Fire Detection and Alarm System
o Fire Department Access
o Barrier Free Requirements

47
 Additional Reports and Studies that Shall be Required

1.0 EIA & Social Impact Survey & Report

2.0 Cadastral / Topographical Survey
3.0 Geotechn ical Survey
4.0 Traffic Study & Survey
5.0 Area Wind Studies-Direction/Speeds
6.0 Site Analysis-Orientation/Sun Direction, Accessibility, Services and Context

6.4.6 Preliminary/Design Development Stage

At the Preliminary Design Stage, or Design Development Stage, the consultant shall prepare
drawings based upon the selected schematic design alternative, in order to determine more
precise aspects of planning, appearance and construction. These documents shall illustrate
and define the design concept in terms of site, plan form, character, materials, and the
systems for structural, mechanical and electrical.

The drawings and preliminary specifications produced during this phase shall be based on
the selected and approved schematic design alternative and typically will be of sufficient detail
to allow for client reviews. Site plans, floor plans, elevations, representative sections,
drawings outlining the mechanical and electrical systems, as well as a description of all the
critical components of the building technology, materials, and equipment are presented.

These documents will not, however, be sufficient to enable construction nor tendering of the
project. Also, the interior and exterior color schemes are addressed along with the use of
natural and artificial lighting and acoustical treatments.

6.4.6.1 Preliminary Design Stage Submission Requirements

The purpose of this stage is to finalize design related issues, technical criteria, technical
performance objectives, and budget forecasts so that the contract documents can be
prepared. The Design Development submission must fully convey the design intent.

Drawings:

 Site plan
 Floor Plan
 Foundation plan/floor framing plan

48
  Roof framing plan
 Building cross sections
 Roof, wall, floor sections
 Color Boards (at least 2 alternatives)
 Mechanical site plans
 Plumbing/heating/ventilation plan(s)
 Electrical site plan
 Power/other electrical system plan(s)
 Lighting plan
 Medical Equipment, Medical Furniture and Office Furniture layout

Schedules and Design Reports

 Preliminary door and window schedules

 Preliminary hardware schedules
 Preliminary sign schedule
 Interior elevation details
 Furniture layout
 Preliminary finish schedule
 Exterior elevations
 Mechanical/electrical room plan detail
 Piping and/or system schematics
 Electrical details- Main distribution single line diagram
 Medical Equipment Layout and Fixture mounting details(s)
 Record of any revisions or clarifications to the project requirements made since the
previous review.
 A summary table or listing of applicable code requirements and proposed responses
(reaffirmed or revised based on previous submission).
 Description of any design "features" or important site conditions (reaffirmed or revised
based on previous submission).
 The rationale behind any important design decisions (reaffirmed or revised based on
previous submission).
 Summary of floor areas compared to program areas.
 Structural calculations and assumptions used to calculate structural elements, and
both floor and roof loading.

49
 Mechanical and Electrical Information narratives, (and drawings) required as part of Design
Submissions:
o Indicate all plumbing fixtures, floor drains, plumbing and waste piping on floor plans.
o Provide structural support details for all domestic/fire water and sewage storage tanks,
if applicable.
o Provide fire protection system detail, including level of coverage, type and zoning.
Indicate hose reels and hand held fire extinguisher locations.
o Provide HVAC system layouts including: system schematics, sequence of operation,
single line main, and branch duct runs, terminal devices, fire dampers, and accessories.
o Provide equipment schedules on a dedicated mechanical drawing to include: all
mechanical components such as boilers, pumps, coils, heaters, fans, tanks, control
valves, diffusers, grilles, terminal heat transfer units, and other accessories. The
schedule is to include information on equipment identification, model, size, flow,
pressure, voltage, CV, capacity, and other remarks.
o Provide building management and control system schematics including system types,
layouts, and sequence operation. Include a description of the mechanical alarm system.
o Provide legible Product Data sheets on all major mechanical components.
o Provide in the specification, detailed information of products intended for use including
manufacturer, model numbers, type, style, phase, voltage, capacity for equipment
components specified in the project.
o Provide legible Product Data sheets on all major electrical components, and fixtures
(Catalogue cuts are acceptable with visible indication of proposed product). Provide
Main Distribution single line diagram.
o Provide drawings of power, lighting and other electrical system locations with proposed
device zoning, circuit number, panel designation, for:

Power - Lighting - Switching - Security - Other - Fire Alarm

 Provide complete electrical room details with equipment layout.

 Provide fixture-mounting details, if unusual.
 Provide service and feeder calculations, c/w lighting and power demands.
 Demand factors for existing or proposed buildings.
 Panel & Motor schedules.
 An outline of specifications.

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7.0 METHODOLOGY AND APPROACH TO THE
ASSIGNMENT
7.1 Design Approach
The consultancy assignment has been divided into three stages:
1-Pre-design,
2-Design and Tender Action,
3-Construction Supervision and DLP.

7.1.1 Pre-Design Activities

1-Pre-design Stage: include activities that precede the actual designing work.
The stage determines the information needed to begin the design and the construction of the
project, i.e.
 Project Goals and Scope
 Project Brief
o Scope analysis
o Specifications and Standard of work
o Codes
 Site and Analysis
o Surveys, Geo technical investigations,
o Local area planning/zoning regulations
 Project Budgeting
o Finance sourcing and planning
 Preliminary Project Schedule
This stage shall be covered along with the Needs Assessment exercise.

7.1.2 Design and Tender Stage

2-Design Stage; this shall include three distinct phases:

2.1- Schematic Design Phase: is the first phase of design; dealing general design concepts
and alternatives or options, but not getting into deep detail. This stage helps to figure out
more or less how the building will look and operate, and the zoning.

51
 This stage has been further subdivided into part-1 and part-2; part-1 shall deal with the
master planning, or land-use planning, options. While 2 shall deal with the schematic
design for the prefered option.

2.2- Design Development Phase

At this stage the architectural designs and drawings are with more specificity and detail; allowing
for other engineering designs and drawings to commence, i.e. structural, MEP/ICT, HVAC/AC
systems, energy analysis and any other project-specific systems.

It is at this stage that the Consultant plans to:

i)- Apply for KCCA approval as a means of saving time; given the delays associated with these
approvals. The Consultant, in the same vine, shall seek for a presentation to KCCA to clear
any quarries before the formal application.
ii)-It is also at this point that the equipment installation requirements shall be introduced. Early
start on the harmonisation and integration of the equipment specifics shall ensure that the
required equipment pre-installation works are well provided for in the designs without
abortive design works in subsequent design phases.

At the end of the design development phase, a good deal of product selection and systems
design shall have progressed. The phase shall also cover interior and exterior designs of the
buildings; thus making it possible for;

iii)-Preliminary cost estimates will be produced at this point.

2.3 Construction and Tender Documents Phase:

During this phase, the consultancy team shall finalise all the technical and engineering
designs including structural engineering and detailing, MEP/ICT, HVAC/AC systems, and all
products and materials selected and scheduled. The construction documents and drawings
shall be separated for each work type.

The phase allows for more refined project cost estimates, and the other engineering designs
and drawings required by KCCA-Structural and MEP.

52
 2.4 Tender Action Phase:
The Consultant shall offer assistance to the Client as and when called upon; particularly
participating at the pre-bid meeting(s), and attending to quarries by bidders.

7.1.3 Construction Supervision and Contract Administration Stage

This shall involve routine inspections and monitoring of works in the bid to guide the Contractor
to deliver the project in time, within budget and specifications as well as meeting the required
standard and regulations. The stage shall also cover monitoring of the DLP as well.
The Consultant shall be available to answer queries and provide additional information to issues
that arise.

A more detailed explanation of the Consultant’s responsibility has been provided under Section
2.0; Sub-Section 2.3- Appreciating the Consultant’s Assignment.

7.1.3.1 Equipment Installation Supervision

As pointed out earlier, the Consultant has proposed to handle the equipment aspect of the
project under the following thematic specialities:
1- Medical Equipment,
2- Medical Furniture
3- Medical Gases,
4- HVAC, and the attendant
5- BMS.

This is intended to help focus and give clarity to each speciality’s requirements and to guide
the harmonization and integration with the architectural and engineering designs.

In addition to the categorization of equipment as indicated above; the Consultant has broken
down the equipment requirements in a well sequenced 7-step process to help manage the
task as well as ensure that the distinct aspects associated with equipment specification,
procurement and installation are well coordinated and managed.

The 7-step process is as follows:

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7.1.3.2 Equipment and MEP/ICT Categorisation

7.1.3.2.1 Key Equipment

As explained above, in the bid to ably handle this aspect, the equipment and furniture have
been divided into four broad categories:
1-Medical Equipment-
This is further subdivided depending on sizes (l x w x h), weight, emissions (x-rays),
MEP/ICT (power rating, drainage/effluent, water supply-cold/hot/denoised, internet
connectivity) requirements;
2-Medical Gases;
3-Medical and Office Furniture;
4-HVAC Installations-for specialized spaces such as theatres and BSL3 laboratories;
5-Attendant BMS for monitoring specialized installations.

7.1.3.2.2 Normal MEP/ICT

It suffices to note that the Consultant is aware of the normal MEP installations such as lifts,
fire detection/fighting, AC/Ventilation, solar-based systems and other backup power, etc.
These shall follow the same rigorous specification, procurement, installation supervision and
commissioning processes.

7.1.3.3 Specifications and Scoping-quantification and budgeting,

The Consultant/bio-Medical engineer shall work closely with the UHI counterpart staff from
bio-medical, surgery, anaesthesia, laboratory, nuclear medicine etc. during the Needs
Assessment stage to identify and specify appropriate medical equipment, medical gases and
medical furniture etc.

7.1.3.4 Equipment Procurement Plan-Sourcing, Shipping, Delivery

Subsequently, the Consultant shall work with the Contractor to prepare a detailed equipment
procurement plan; to see to it that the right equipment is ordered and procured on time and
within budget.

This procurement plan shall be in sync with the building works and aligned with the
Contractor’s cash-flow projections, to avoid undue time losses whether in delays for the
works, or late, or wrong procurement of the equipment.

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The procurement plan shall lay emphasis on the following, among others;

i)-Agreed equipment standards, specifications and budget;

ii)-Prior signing off of a comprehensive equipment list as a key submittal, as informed by the
Need Assessment Report and the Project Brief,
iii)- Timely placement of the equipment order(s) as guided by the manufacturer’s timelines.
The consultant proposes that this is done not later than four to six months upon
commencement of the project to ensure timely delivery;

7.1.3.5 Equipment Installation Design Integration

Harmonisation and correlation with architectural and engineering designs.

This stage commences right at the start of the Design Review process; to ensure that
equipment requirements are well assessed and provided for at the design stage, by
correlating the architectural, structural and MEP designs and drawings with the equipment
manufacturers’ layouts and specific requirements.

This then shall guide the pre-installation works to ensure that the equipment is well provided
for.

Harmonisation and integration of equipment layouts with architectural and engineering

drawings is key to ensuring ample space for the equipment as well as safe and recommended
working room, and to meeting the required standards. Equally important is passage provision
especially for bulky and delicate equipment, as well as appropriate environs for specialized
equipment such as x-ray.

In addition to space sizes, heights of rooms and doors/openings, and corridor width and
turnings; other requirements shall include: appropriate power rating and stability, water
supply(cold, hot and or distilled and drainage, HVAC provision, x-ray screening at walls, doors
and viewing windows, etc.

Ease of accessibility addresses unique and at times delicate space requirements for medical
equipment, but is also meant to cater for future maintenance and replacement requirements.

55
7.1.3.6 Pre-Installation Works

Equipment-related pre-installation works is a very critical stage; this shall be well supervised
and managed to ensure there are no abortive works as a result of unwanted changes; first by
ensuring that the equipment is well specified and well-integrated in the architectural and
engineering designs with all the requirements checked and signed off.
Secondly, a dedicated CoW in-charge of MEP/HVAC working together with the CoW for
building works, and in close collaboration with the consulting team, shall be enjoined see to it
that the called out works associated with equipment pre-installation works are given due
attention on a day-to-day basis and regularly reported on including timely highlighting any
discrepancies for timely intervention.

7.1.3.7 Equipment Installation

Satisfactory installation of the equipment shall be dependent on satisfactory execution of the

equipment related pre-installation works, which in turn is dependent on suitable equipment
layout and MEP/HVAC services.

7.1.3.8 HVAC and Associated BMS Installations

Like for the medical equipment, the HVAC designs and installations shall also follow a strict
step-by-step process to ensure a responsive HVAC system installation

1■ pre-design 2 ■ design
3■ construction 4 ■ acceptance 5■ post-acceptance
HVAC systems shall be energy efficient, satisfy stringent indoor air quality and comfort
expectations, and still be designed and constructed within tight budgets. System designs
meeting these demands typically have many components, sub-systems, and controls.
Ineffective communication and coordination between designers and contractors, and among
contractors, can produce HVAC systems with installation deficiencies that do not perform
properly. Without verification of the correct interaction and operation of all systems and
components, system performance as specified and intended is unlikely to occur.
Commissioning is a systematic process that addresses these issues. It facilitates and ensures
the required communication, coordination, testing, and verification, and results in the delivery
of a building whose HVAC systems perform as intended. Effective HVAC commissioning is
an intentional, visible, cooperative and proactive process. It includes design review,
installation verification, proper system start-ups, functional performance tests, operations and

56
maintenance (O&M) training, and complete documentation of the HVAC systems. It assists
in the coordination of construction schedules and sequences to facilitate an efficient
construction process and challenges systems to perform as designed under all specified
modes of operation.

The Consultant has assembled a team with the requisite expertise and experience to mitigate
against these risks.

7.1.3.9 Equipment testing, commissioning and training

It is important to note that, although this aspect is usually thought of as coming at the end of
a project; equipment and HVAC installations require that the testing and commissioning
aspects are well decided, enumerated, and even the would-be commissioning expert
identified and brought on board at the onset; these requirements shall be handled by the
respective experts on the consultancy team.

Thus for the best possible results, the equipment and HVAC commissioning should, and shall,
be given due consideration at all phases of the design and construction process.
Suffices to note that the testing, training and commissioning, shall be guided by the
manufacturers’ Operation and Maintenance Manuals.

The Consultant shall also ensure that manufacturers’ test and commissioning before
shipment of all supplies to provide a fit-for-use certificate and pre-shipment inspection and
indemnify the Client, as well as meet the national PVOC regulations.

57
7.2 Implementation Structure and Contractor’s Resourcing
To streamline the reporting requirement and hierarchy, and given the various stakeholders;
there is a proposed project structure. The proposed project implementation arrangement has
been portrayed by the illustration given below.

7.2.1 Implementation Structure

Accordingly, a Project Steering Committee (PSC) composed of representatives from key

ministries and relevant departments and ostensibly chaired by the Permanent Secretary(PS)
of Ministry of Health(MoH) at the pinnacle for the overall oversight has been proposed.

The PSCV shall be represented by the Project Coordinator who shall work closely with the
Executive Director-UHI and the top management to oversee the Consultant on a day-to-day
basis to provide general direction and strategic guidance of the project.

For effectiveness and better management, the Project Steering Committee (PSC) shall be
divided into two sub-committees:
i)-Civil and Building works and Quality Controls, and
ii)- Finance sub-committees

The PSC, represented by the PC, will oversee the Consultant, along with the ED and top
management of UHI to support and supervise the implementation of the project and
coordination of the various aspects of the project. The PC will provide:
o Close support to the Client for all aspects of the project implementation
(including coordination and any contributions required );
o Monitoring and quality control of both the processes and construction works;
o Lead coordination with relevant government ministries, departments and agencies where
required.

Figure 5: Implementation Structure

58
 7.2.1.1 Implementation Structure-A Conceptual Approach

Support Staff Key Personnel

Architect/Team Leader Patrick Rubongoya ICT Specialist Vincent Okwija
Hospital Expert/Planner Rajesh Dahol Quantity Surveyor Muhumuza John K.
Structural Engineer Caleb Tugumisirize Environmental Specialist Vivian Chambo
Electrical Engineer Stephen Kagwamu Social SafeguardsSpecialist Gerald Ahabwe
Mechanical Engineer Musubire Vincent CoW-1- Building Works Same Kaboga
BioMedical Expert Claudio I. Meirovich CoW-2- MEP/Medical Equip. Eugenio Okello
HVAC Specialist Gregers Chalker

CoW-1- CoW-2-
Building Works MEP/HVAC/Euipment

Domestic Nominated Listed

59
Figure 6: Apt Contractor Resourcing Strategy-
A conceptual approach

7.3 Apt Resourcing of the Contractor

The performance of the Contractor, and subcontractors, shall depend on their experience
and how well they are resourced:
1.) Man-key personnel, engineers, foremen, artisans and labourers;
2.) Materials-timely procured and meeting specifications and to approval;
3.) Machinery- including tools and equipment/formwork/scaffolding
4.) Money-contractor’s own funds and lines of credit, and cash flow planning along
with timely and acceptable progress and certification of payments
5.) Methods-standard methods of work, experience and expertise.

Accordingly, the Consultant shall ensure that through proper project-(designs, drawings,
narratives/computations and specifications) and contract–(form of tender and form of

60
contract) documents, as well as a rigorous tendering processes, that an appropriately
well-resourced Contractor is appointed. And that coupled with close and strict supervision
and monitoring of works, the successful Contractor delivers the project timely, within
budget and according to specifications and standards.

7.4 Duration, Work-plan and Scheduling

7.4.1 Overall Duration of the Project

At tender, the project was largely divided into four broad stages over a period of 42 months as
per table below:
Table 7: Overall Project Duration and Scheduling

7.4.2 Medical Equipment/Gases and HVAC Program

At close scrutiny, the two stages of construction supervision and equipment installation (-medical
equipment/furniture, medical gases and HVAC including the attendant BMS components) have
been merged into 24 months; with the equipment aspects broken into six distinct and manageable
components for close monitoring and better management of the overall project timelines. The
installation, pre-installation works and actual installation is now spread over the entire period,
while the specification and equipment installation design aspects have now been shifted to the
first 6 months of Stage-1-Design Review and Tender Action. .

61
 7.4.3 Consultant’s Work-flow Plan

7.4.3.1 Work-flow Plan-Stage-1- Design Review and Tender Action

1.1- Inception Report 1.2- Needs Assessment Report

1.3.1 EIA & Social Impact Survey & Report

1.3.2 Cadastral / Topographical Survey
1.3- Site Studies and 1.3.3 Geotechnical Survey
Surveys 1.3.4 Traffic Study & Survey
1.3.5 Area Wind Studies-Direction/Speeds.
1.3.6 Site Analysis-Orientation/AccessibilityServices/Context

1.4.1 Project Brief (i) Schedules (ii) Codes of Practice/Standards

1.4.2 Architectural & Engineering Designs & Drawings
1.4- Design Review
1.4.3 Medical Equipment, Medical Gases, HVAC and BMS Specifications
Report 1.4.4 Specifications & BOQs
1.4.5 Form of Tender & Form of Contract
1.5- Project Brief and Scoping
1.5.1 Design Codes & 1.5.2 Specifications/Alternatives/Costing 1.5.3 Specifications/Alternatives/Costing
Standards Medical Equipment & Furniture Finishes/Fittings/Fixtures

1.6- PART-I-Schematic Designs (Giving Alternatives)

1.6- PART-II-Schematic Designs (Detailing Preferred Option)
1.6.3 Statutory Approvals
1.6.1 Draft -1-
1.6.2 Draft-1- Layout 1-Client
Design Report/Project
Medical Equipment & Furniture 2-KCCA
Estimate
3- MGLSD

1.7- Preliminary Design Report

1.7.1 Architectural and 1.7.2 Final Draft Layout 1.7.3 Value Engineering
Engineering Designs/Narratives Medical Equipment & Furniture Specifications/BoQs/Project Estimate

1.8- Detailed Design

1.8.1 Architectural and
1.8.2 Final Draft Layout 1.8.3 Value Engineering
Engineering
Medical Equipment & Furniture Specifications/BoQs/Project Estimate
Designs/Narratives

1.9- Final Detailed Design Report/Tender Documents

1.9.1 Architectural and
1.9.2 Final Draft Layout 1.9.3 Specifications/BoQs/Project Budget
Engineering
Medical Equipment & Furniture
Designs/Narratives

1.10.1 Tender Advertisement

1.10.2 Pre-Tender Meeting/Responses to Contractors’ Queries
1.10.3 Closing of Tender
1.10- Tender Action 1.10.4 Tender Opening
1.10.5 Tender Evaluation Process
1.10.6 Tender Award
1.10.7 Contract Formalization-(No-Objections and Clearances)

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7.4.3.2 Work-flow Plan-Stage-2- Construction Supervision & Equipment Installation

1-Performance Guarantee
2.1 Contractor’s Legal 2-Insurance Bonds-(workers, works/equipment covers)
Requirements 3-Advance Payment Guarantee
4-International staff Work-Permits & Clearances
2.2 Site Handover “Limited Notice to Proceed”

2.3 Kick-Start Meeting & Scheduling of Works/sign off

2.4 Contractor’s Mobilization

KCCA Job card & Permits Equipment/Tools & Site planning & Site
Personnel
(Site Hoarding, Excavation, Dumping, etc.) machinery Structures

2.5 Quality Assurance and EHS/Risk Management Measures Meeting

2.5.3. Supervision
2.5.1. Method Statements 5.5.2. Progress and Monitoring Trackers
Scheduling
(i). Method Statements, (i). Program/Progress Tracker (i)-Site Meetings and
(ii). Codes & Standards Inspections Scheduling
(iii). Standard Formats (ii). Procurement/Cash-flow Projections Tracker
(iii). Submittals/Samples Tracker
(iv. Materials Tests/Certifications Tracker
(v). Request for Information Tracker
(vi). EHS Management Plan and Tracker
(vii). Risk Management Plan and Tracker
2.6 Equipment Procurement Plan
Confirm Specification/Sourcing Procurement Plan Budgeting & Ordering of Equipment

(i). Day-to-Day Supervision by CoWs/Weekly Reports

2.3 Construction Supervision & (ii). Monthly Meetings & Inspections/Reports
Monitoring-Civil Works (iii). Quality Control & Quality Assurance
2.8 Medical Equip. & Medical Gases, MEP/ICT and HVAC/BMS
Supervision and Monitoring
2.8.1- Pre-Installation Works Monitoring: –
(i)-Space/Passage Requirements-Rooms/Corridor Sizing;
(ii) Equipment Loads Requirements- Affected Structural Elements Sizing-Slabs/Walls/Ceiling
(iii)-Emissions/X-rays Screening
(iv)-Ducting and Piping Provisions
(v)-Power/Water/Drainage Supply Requirements Provisions, ,
2.8.2- Equipment/MEP-HVAC/BMS Installation Supervision and Monitoring

2.8.3- Testing, Training and Commissioning 2.8.4- Accreditation

2.11 Progress Monitoring and Tracking

(i) Program/progress
(ii) Procurement/cash-flow projections
(iii) Submittals/samples approval register
(iv) Materials tests/certifications
(v) Request for Information
(vi) EHS Management plan
(vii) Risk Management Plan
2.10 Progress Reporting Certification of Works
(i) Site Meetings & Monthly (ii) Quarterly Financial (iii) Measurement of Works &
Reports Appraisals/Reports Certification
Final Inspection & Snagging
Testing, Training & Commissioning
Practical Completion & Handover

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7.4.3.3 Work-flow Plan-Stage-3- Defects Liability Period - (DLP)

3.1 Initial Snags Correction Scheduling &

Monitoring

3.2 Quarterly Snags Correction Monitoring & Reporting

3.3 Consultants & Client’s Meetings

3.4 Final Accounts & Retention Release

3.5 Final Completion Closing out Report & Approval

7.4.4 Consultant’s Assignment Scheduling

64
 7.4.4.1 STAGE-1- Design Review and Tender Action
Year 2021 2022
STAGE-1- Activity Schedule Month August September October November December January
Week
(06 Calendar Months) Duration 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
(Months)
1.0 MOBILISATION
1.0.1 Offices Setup and Local Staff Mobilisation 0.25
1.0.2 International Staff 0.5
Deliverable-1.0- CONSULTANTS FULLY MOBILIZED
1.1 INCEPTION REPORT(IR)
1.1.1 First Draft/Final Draft Inception Report 1.00
1.1.2 Presentation & Receiving Client’s Comments 0.25
1.1.3 Incorporation of Comments and Final IR Drafting 0.25
DELIVERABLE-1.1-Final Inception Report
1.2 NEEDS ASSESSMENT REPORT(NAR)
1.2.1 Literature Review: 0.75
-UHI Proposed Project Feasibility Study-(2018) 0.25
-Revised Human Resource Plan 0.25
-Management Reports-(2019,20 & 21) 0.50
Existing Designs and Equipment Review: 0.75
-Drawings/Designs & Narratives 0.50
-BoQs & Specifications 0.75
-Codes of Practice and Standards 0.25
-Medical Equipment, Medical/Office Furniture Review 0.25
1.2.2 Stakeholder Engagements 2.00
1.2.3 Review of Existing Equipment and Infrastructure 0.75
1.2.4 Presentation & Receiving Client’s Comments 0.50
1.2.5 Incorporation of Comments and Final NAR Drafting 0.50
DELIVERABLE-1.2 Needs Assessment Report
1.3 SITE STUDIES AND SURVEYS
1.3.1 Cadastral / Topographical Survey 1.00
1.3.2 EIA and Social Impact Survey and Report 1.00
1.3.3 Traffic Study and Survey Report 1.00
1.3.4 Geotechnical Investigations 1.00
1.3.5 Wind Studies-(Direction/Speeds) 0.50
1.3.6 Site Analysis-Orientation/Accessibility/Services/Context 1.50
DELIVERABLE-1.4 Site Analysis Report
1.4 PROJECT BRIEF AND SCOPING (PB&S)
1.4.1 Revised Design Codes & Standards 1.00
1.4.2 Revised Specifications 1.00
1.4.3 Civil Works Scoping 1.00
1.4.4 MEP Requirements and Scoping 1.00
1.4.5 Medical Equipment & Furniture Specifications & Listing 1.00
1.4.6 Medical Gases Specifications 1.00
1.4.7 HVAC/BMS Specifications & Requirements 0.50
1.4.8 Finishes/Fittings/Fixtures Specifications 0.50
1.4.9 Equipment Environs Design & Provision-Power Rating 0.50
1.4.10 Presentation & Receiving Client’s Comments 0.25
1.4.11 Incorporation of Comments and Final PB&S Drafting 0.25
DELIVERABLE-1-4- Project Brief & Scoping

65
 7.4.4.2 STAGE-1- Design Review and Tender Action cont’d
Year 2021 2022
Month August September October November December January
STAGE-1- Activity Schedule cont’d Week
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Duration
(Months)
1.5 PART-1- SCHEMATIC DESIGNS (Master Plan Options)
1.5.1 Master Planning & Massing Options 1.5
1.5.2 Presentation & Receiving Client’s Comments 0.25
1.5.3 Incorporation of Client’s Comments 0.50
DELIVERABLE-1.5 - Preferred Master Plan Option
1.6 PART-2- SCHEMATIC DESIGNS (Preferred Option)
1.6.1 Detailing Preferred Option-( Massing and Layouts) 1.5
1.6.2 Presentation & Receiving Client’s Comments 025
1.6.3 Incorporation of Client’s Comments 0.25
DELIVERABLE-1.6- Final Schematic Designs
1.7 PRELIMINARY DESIGN AND TENDER DOCUMENTS
1.7.1 Architectural Designs 1.50
1.7.2 Structural Designs 1.0
1.7.3 MEP Designs 1.0
1.7.4 Medical Equipment Layout Designs & Dwgs 1.0
1.7.5 Medical/Office Furniture Layout Designs & Dwgs 1.0
1.7.6 HVAC Layout Designs & Dwgs 1.0
1.7.7 BoQs 3.0
1.7.8 Preliminary Engineer’s Estimate 1.0
1.7.9 Presentation & Receiving Client’s Comments 1.0
1.7.10 Incorporation of Client’s Comments 1.0
DELIVERABLE-1.7.1- Preliminary Design Report and Tender Documents
DELIVERABLE-1.7.2- Statutory Approvals Application
1.8 DETAILED DESIGN and DESIGN NARRATIVES
1.8.1 Architectural Designs/Narratives 1.5
1.8.2 Structural Designs/Narratives 1.0
1.8.3 MEP Designs/Narratives 1.0
1.8.4 Medical Equipment Layout Designs & Dwgs 1.0
1.8.5 Medical/Office Furniture Layout Designs & Dwgs 1.0
18.6 HVAC Layout Designs & Dwgs 1.0
1.8.7 BoQs 2.0
1.8.8 Value Engineering/Final Engineer’s Estimate 2.0
DELIVERABLE-1.8- Detailed Design and Engineer’s Estimate
1.9 TENDER ACTION
1.9.1 Tender Advertisement 1.0
1.9.2 Pre-Tender Meeting 0.5
1.9.3 Closing of Tender 0.75
1.9.4 Tender Opening/Evaluation Commencement 3.0
NB. Although KCCA approval application and Tender Action commence in Stage-1-; they are planned be completed first quarter of Stage-2-:
(i)-Tender Action shall overflow approx. 2 to 3 months into the Construction Phase
(ii)-KCCA approvals may take 2 to 3 months

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 Year 2022 2023
Month Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul
STAGE-1- Activity Schedule cont’d Week
(overflow in first quarter of Stage-2-) 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9
Duration 6 8 0 2 4 6 8 0 2 4 6 8 0 2 4 6 8 0 2 4 6 8 0 2 4 6 8 0 2 4 6 8 0 2 4 6
(Months)
1.9 TENDER ACTION -
1.9.5 Tender Evaluation Process Continued 1.5
1.9.6 Best Evaluated Bidder/Award 0.25
1.9.7 No-Objections/Clearances-( Contractor Appointment) 0.5
Deliverable-11- PROCUREMENT OF CONTRACTOR

7.4.4.3 STAGE-2- Construction Supervision and Equipment Installation

Year 2022 2023

STAGE-2- Activity Schedule Month Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul
(24 Calendar Months) Duration 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9
(Months) 6 8 0 2 4 6 8 0 2 4 6 8 0 2 4 6 8 0 2 4 6 8 0 2 4 6 8 0 2 4 6 8 0 2 4 6
2.1 CONTRACTOR'S LEGAL REQUIREMENTS
2.1.1 Performance Guarantee 1.0
2.1.2 Insurance Bonds (All-Workers Compensation, etc.) 1.0
2.1.3 Advance Payment Guarantee 1.0
DELIVERABLE-2.1- Contractor's Legal Requirements
2.2 SITE HANDOVER / GROUND BREAKING
2.2.1 Limited Notice to Proceed 1.0
DELIVERABLE-2.2- Site Handover/Ground Breaking
2.3 CONTRACTOR'S MOBILIZATION
2.3.1 Personnel-(CVs of Key Personnel and Work Permits) 1.0
2.3.2 Permits-(Job Card/hoarding/excavations/dumping etc.) 1.0
2.3.3 Scaffolding/Formwork/Tools, Equipment & Machinery 1.0
2.3.4 Site Planning & Site Structures 1.0
DELIVERABLE-2.3- Contractor Mobilised/Setting-Out
2.4 KICK START MEETING & SCHEDULING OF WORKS
2.4.1 Programming for Works 0.50
2.4.2 Procurement Plan- Civil Works / MEP 0.50
2.4.3 Procurement Plan Equipment/Furniture 0.50
2.4.4 Cash Flow Projection 0.50
2.4.5 Quality Assurance & EHS Measures 0.50
-Method Statements/Standard Forms 0.50
-Submittals and Samples Approval Processes 0.50
-Risk Management Plan 0.50
-Environment, Health, and Safety (EHS) Plan 0.50
DELIVERABLE-2.4.1- Scheduling of Works
DELIVERABLE-2.4.2- Quality Assurance and EHS Plan

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 7.4.4.4 STAGE-2- Construction Supervision and Equipment Installation cont’d
Year 2022 2023
STAGE-2- Activity Schedule Month Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul
Duration 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9
(Months) 6 8 0 2 4 6 8 0 2 4 6 8 0 2 4 6 8 0 2 4 6 8 0 2 4 6 8 0 2 4 6 8 0 2 4 6
2.5 CONSTRUCTION SUPERVISION & MONITORING
2.5.1 Site/Consultants Meetings & Monthly Reports monthly
2.5.2 Quarterly Financial Appraisals/Reports quarterly
2.5.3 Measurement of Works & Certification quarterly
2.5.4 Key Tracking and Monitoring Documents
-Overall Works Program Quarterly Reviews
-Procurement Schedule Tracker
-Submittals and Samples Tracker
quarterly
-Request for Information Tracker
-Risk Management Plan Quarterly Reviews
-Quality Assurance & EHS Quarterly Reviews
2.5.5 Medical Equipment/HVAC Pre-Installation Works Monthly
DELIVERABLE-2.5.1- Monthly/Quarterly Progress Reports
DELIVERABLE-2.5.2- Quality Assurance and EHS Reports
2.6 EQUIPMENT & HVAC INSTALLATION
2.6.1 Medical Equipment Installation
2.6.2 HVAC Installation Monthly
2.6.3 BMS Installation
DELIVERABLE-2.4- Equipment & HVAC Installation Reports
2.7 FINAL INSPECTION & SNAGGING
2.7.1 Final Inspection and Snagging
Monthly
2.7.2 Correction of Minor Defects
DELIVERABLE-2.7- Final Inspection
& Snagging Report
2.8 COMMISSIONING, TESTING & TRAINING
2.8.1 MEP Commissioning & Testing
2.8.2 Medical Equipment Commissioning, Testing & Training 2.0
2.8.3 HVAC Commissioning, Testing & Training
DELIVERABLE-2.8- Testing, Commissioning & Training
2.9 PRACTICAL COMPLETION & HANDOVER
2.9.1 1- As-built Drawings
2.9.2 2- Operational Manuals, Warrants & Guarantees
2.9.3 3- MEP Installation Certification
2.9.4 4- HVAC Installation Certification
2.9.5 5- Medical Equipment Installation Certification 2.0
2.9.6 6- Fire Fighting Installation Certification
2.9.7 7- Lift Installation Certification
2.9.8 8- Occupation Permit
2.9.9 9- Practical Completion Certification
DELIVERABLE-2.9- Practical Completion Certificate/Handover

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7.4.4.5 STAGE-3- Defects Liability Period (DLP)
Year 2023 2024
A S O N D J F M A M J J
Month u e c o e a e a p a u u
g p t v c n b r r y n l
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
9
Week 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4
8
0 2 4 6 8 0 2 4 6 8 0 2 4 6 8 0 2 4 6 8 0 2 4
DLP Monitoring Scheduling
Stage-3- 3.1
Activity Schedule
(12 Calendar Months) Quarterly DLP Monitoring, Correction and Reporting
3.2

Consultants and Client's Meetings

3.3

Final Accounts and Retention Release

3.4

Final Completion Closing out Report and Approval

3.5

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 7.5 Project Risk Analysis and Mitigation Measures
7.5.1 Background

As noted earlier, the project is expected to be delivered with very high specifications in line
with the national and international standards, in addition to being able to meet international
healthcare accreditation requirements. The project also has stringent timelines and budget.

Given the importance, urgency and budgets restrictions associated with the project, it is
imperative that the project is proficiently managed; strictly observing the timelines, budget
and quality of work at all times.

To this end, given the consultant team’s experience, with a carefully selected Contractor;
with requisite experience, expertise, and one who is well resourced, the Consultant is
capable of putting in place appropriate management systems to ensure the Contractor
performs to deliver the project as envisaged.

7.5.2 The Appropriate Construction Management Vs Risk Mitigation

What constitutes “appropriate management systems”?

The main objectives of appropriate construction management are:
 To schedule and coordinate all design and construction processes to ensure a
productive and safe work environment.
 To make sure the project is completed on time and on budget with the right amount
of tools, equipment, and materials.
 To ensure that the project is delivered at the desired standard and specifications,
and meets the applicable codes of practice and standards as well as the governing
laws and regulations.

Generally speaking, construction management major responsibilities fall into 7 categories:

i)- Project Management Planning,

ii)- Cost Management,
iii)- Time Management,

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 iv)- Quality Management,
v)- Contract Administration,
vii)- Safety Management, and
vii)- Observance of Professionalism.

From the Needs Assessment and the ensuing project brief, the Consultant shall prepare a
comprehensive construction management plan consisting of documents that shall clearly
define the requirements of the project, indicating the activities, resources, schedule and
budget.

The plan shall be one of the key deliverables created during the construction planning
process and shall include the following:

 A written document that outlines the expected methodologies and approach

 Drawings, specifications, BoQs and design narratives/computations;
o Well harmonised and integrated designs and drawings including
o Architectural and Engineering-(structural, MEP/ICT, HVAC,) drawings-
o Equipment & Furniture layouts and their installation designs and
drawings,
o 3Ds, photographs, and other images that illustrate the design;
 A work breakdown structure that identifies all the activities and resources that
make up the project,
o A construction project schedule that organizes all the project activities
on a timeline,
o A commensurate and detailed procurement schedule, along with
o Supporting cash-flow projections and plans.
 The construction project management structure indicating participants and
stakeholders, as well as reporting requirements and their timelines.

Creating this construction plan is of crucial importance, given the size and complexity of
the project; and given that proper and thorough construction planning greatly increases
the likelihood of a successful project.

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The plan shall be comprehensive and detailed, to minimise any issues likely to arise
during the execution. At a high level, the construction plan shall serve as a durable
document that will guide the project from an idea to completion.

7.5.3 Risk Analysis and Mitigating Measures

Notwithstanding the appropriateness of the construction management systems put in

place, all projects are associated with risk.

In the construction perspective, risks are generally considered as incidences that

influence the principal objectives of time, cost, quality, or environmental and safety of
persons, works or equipment. As such the construction industry is said to be exposed to
greater risk in comparison with other industries.
Risk management shall be tailored toward “analysing”, “identifying” and “responding” to
risk factors in order to achieve the project goals. The Consultant notes that It is not
possible to manage all the risks in a construction project.

However, it is important to focus on the vital risks; with the aim of maximizing the chances
and the impact of positive events while minimizing the probability and the impact of
negative events, in order to meet the project objectives.

Broadly, the associated risks fall under four categories:

 The Inexperience of the contractor,
 Poor costing and budgeting,
 Poor planning and operations,
 Hazards

Accordingly, the Consultant foresees the following risks:

1. Unknown site conditions

2. Cost/budget overruns and variations

3. Contractor Delays
4. Significant increase in materials prices

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 5. Contractor inexperience/poor resourcing

6. Delayed statutory approvals.

7. Safety hazards and accidents

8. Loss/theft, damage of materials and equipment

9. Scope Creep

10. Issues with subcontractors and suppliers

11. Client delays

12. Act of God-force majeure

The consultant, in mitigating the highlighted risks, shall work with the Contractor to devise
a detailed risk management plan and tracker, that shall be monitored and updated
accordingly from time to time.

The consultant is confident that he has assembled an experienced team and; shall work
towards ensuring a robust contractor-selection process so as to lead to a well experienced
and well-resourced contractor as the surest way of mitigating against most of the risks.

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 7.5.4 Risk Management Plan and Tracker
ID Date Risk description Likelihood Impact if Severity Owner Mitigating action Contingent action Progress on actions Status Remarks
raised of the risk the risk Rating Person Actions to mitigate the Action to be taken if the
occurring occurs based on who will risk e.g. reduce the risk happens.
impact & manage likelihood.
likelihood. the risk.

1 30/08/2021 Ununknown site Medium High High Contractor Conduct comprehensive Halt works, secure the Open
conditions-poor site survey and site and re-examine the
soils, underground geotechnical possibility of a
services etc. investigations and ensure redesign/diversion
well engineered and
checked foundation
designs
2 [enter Cost/budget Low High High Consultant Define the scope in detail Document assumptions Design workshops Open
date] overruns and via design workshops with made and associated scheduled.
variations input from subject matter risks. Request high risk
experts. items that are ill-defined
are removed from
scope.
3 [enter Contractor Delays Low Medium Medium Project Hold scheduling Share the plan and go Workshops scheduled. Open
date] Manager workshops with the through upcoming tasks
project team so they at each weekly project
understand the plan and progress meeting.
likelihood of missed tasks
is reduced.

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 8.0 REPORTING REQUIREMENTS
8.1 Pre-Construction Reporting Requirements
Table 8 : Reporting Requirements-1-

ITEM REPORT/DOCUMENT TITLE Month No. NO. OF Remarks

COPIES
1. Monthly Progress Report
-Physical vs Financial Progress
-Quality Control/Assurance
-Works Measurements/Interim Payments
-Validity of Contractor’s Securities/Bonds
2. Quarterly Report
-Financial Appraisal/Cash-Flow Projects
-Stage Progess Report 3Hard copies
M7-M30 and
3. HSE Monthly Report
1soft copy
4. Practical Completion Report
-As-Built Drawings/Manuals/Warrants
-Occupation Permit
-Testing, Training and Commissioning Report
-Penultimate Certificate
5 Final Completion Report
-Final Accounts

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 8.2 Construction Phase Reporting Requirements
Table 9 : Reporting Requirements-2-

ITEM REPORT/DOCUMENT TITLE Month No. NO. OF COPIES Remarks

1. Draft Inception report M1

Final Inception report: M2
2. Needs Assessment Report M2

3. Site Surveys Report and Master Plan Options M2

4. Design Review Report M2
3Hard copies and
5 Scheme Design Report. M3 1soft copy
6. Submission/Approval Drawings to KCCA M4

7. Draft Detailed Design Report, Bills of Quantities and Tender M4

Documents
8. Final Detailed Design Report, Bills of Quantities and M5
Tender Documents

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 9.0 KEY DELIVERABLES AND WORK-PLAN

9.1 Key Milestones and Deliverables

The Consultant has taken note of all major deliverables and milestones per stage as per the
table below:

Table 10 : Key Milestones and Deliverables

Duration
No. Deliverable (Months) Remark
Due Date
Deliverables and Key Milestones Stage-1- Design Review And Tender Action
1.0 Consultants Mobilized 0.50 15/08/21
1.1 Final Inception Report 1.50 30/09/21
1.2 Needs Assessment Report 2.00 07/10/21
1.4 Site Analysis Report 3.00 07/11/21
1.5 Project Brief & Scoping 1.25 22/10/21
1.6 Preferred Master Plan Option 2.00 30/10/21
1.7 Final Schematic Designs 1.50 30/10/21
1.8.1 Preliminary Design Report &Tender Documents 3.00 15/12/21
1.8.2 Statutory Approvals Application 3.00 15/12/21
1.9 Detailed Design and Engineer’s Estimate 2.75 31/01/22
1.10 Procurement of Contractor 5.75 30/04/22
Deliverables and Key Milestones Stage-2- Construction Supervision & Equipment Installation
2.1 Contractor's Legal Requirements 1.00 31/05/22
2.2 Site Handover/Ground Breaking 1.00 31/05/22
2.3 Contractor Mobilised / Setting-Out 1.00 31/05/22
2.4.1 Scheduling of Works 0.50 15/05/22
2.4.2 Quality Assurance and EHS Plan 0.50 15/05/22
2.5.1 Monthly/Quarterly Progress Reports
2.5.2 Quality Assurance and EHS Reports
2.6 Equipment & HVAC Installation Reports 4.00 31/03/23
2.7 Final Inspection & Snagging Report 2.00 31/07/23
2.8 Testing, Commissioning & Training 5.00 15/07/23
2.9 Practical Completion Certificate/Handover 6.50 31/07/23
Deliverables and Key Milestones Stage-3- Defects Liability Period Monitoring
3.1 DLP Monitoring Scheduling
3.2 Quarterly DLP Monitoring, Correction & Reporting
3.3 Consultants and Client's Meetings
3.4 Final Accounts and Retention Release 31/07/24
3.5 Final Completion Closing out Report & Approval 31/07/24

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9.2 Project Brief and Scoping Report
9.2.1 Basis for the Project Brief and Scoping Report

9.2.1.1 Inception Report

9.2.1.2 A Needs Assessment Report
9.2.1.3 Site Analysis Report

The Inception, Needs Assessment and Site Analysis Reports form the basis of the Project Brief and
Scoping. The details of these reports are captured in Chapters 1, 3 and 8. As observed, these
reports are key precursor deliverables, that shall be used to inform the Project Brief and the scoping
of the revised project.

Following, the Consultant will prepare a project scoping report basing on the collected
information from the existing project documents-drawings, designs and narratives, and from
the needs assessment report mentioned above.

9.2.2 Objectives and Scope of the Assignment

The objective of the assignment is four-fold:

(1) To conduct a comprehensive Needs Assessment through wide consultations so as to develop a
detailed Project Brief to guide the project designs and implementation;

(2) Conduct a detailed review of existing designs-architectural and engineering (structural/MEP/ICT

and HVAC), specifications and BoQs, as well as medical equipment and medical/office furniture
specifications and costing; and prepare new designs, specifications and costing as per the new
Project Brief and budget;

(3) Effectively and efficiently supervise the construction and equipping, including procurement and
installation, of the proposed 250-Bed Facility for Uganda Heart Institute project;

(4) Plan and implement a comprehensive testing, training and commissioning program for various
aspects of the project, particularly the clinical and surgery sections and the specialised medical
equipment thereat to meet international standards and accreditation.

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The assignment will be carried out within the following scope:
1) Conduct wide consultations with key stakeholders to come up with a comprehensive Needs
Assessment, identifying gaps and mitigating measures in the existing designs and facilities, to
guide the development of the new Project Brief and the eventual designs;

This aspect shall also provide for coming up with a comprehensive and updated listing of medical
equipment and medical/office furniture along with installation and testing and commissioning
requirements.

2) Develop designs and drawings as per the ensuing Project Brief, and as per national and international
codes, statutes and standards, as well as the approval thereof.

3) Working with the successful Contractor to devise and come up with:

i)-A works program and scheduling (timelines and logical sequencing of works and tasks),
ii)-Appropriate Methods of execution (experience and expertise),
iii)-Projection and ensuring the deployment of the right resources at all times (Men,
Machinery, Money & Materials,) to meet the project timelines, budget and
specifications(quality and standards);

4) Effectively and efficiently supervise and monitor the construction to ensure the project meets the
specifications/standards and quality, the applying codes and regulations, timelines as well as within
budget.
As such, through regular meetings and inspections, closely monitor the works program; constantly
reviewing and updating it accordingly, to address any lags, along with the attendant procurement
schedules and cash projection and planning to ensure the project is not derailed.

5) Prepare and submit in time, monthly and quarterly reports, minutes and briefings to the client and/or
stakeholders on the progress of works, including but not limited to, measurement of works, change
orders/variations, payments certificates, etc,

Details of meeting this objective and scope of the assignment are provided in the attached description
of services and workflow provided by the Consultant.

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9.3. Codes of Practice, Standards and Statutory Resources
9.3.1 Background

A code is a set of rules and specifications for the correct methods and materials used in a
certain product, building or process. Codes can be developed and approved by governments
or professional bodies and can carry the force of law. The main purpose of codes is to protect
the public by setting up the minimum acceptable level of safety for buildings, products and
processes.

A technical standard, on the other hand, is an established norm or requirement. It is usually

a formal document that establishes uniform engineering or technical criteria, methods,
processes and practices. Standards allow for interchangeability of parts, system
interoperability, and they ensure quality, reliability and safety.

The reviewed existing project documents-drawings, specifications, BoQs are silent about
the various codes and standards previously employed. To help on the improvement of the
project delivery; a list of codes and standards for the different aspects of the project have
been highlighted, discussed and signed off as one of the key guides and checks for the
project delivery.

9.3.1.1 Selected Codes of Practice and Standards to Guide the Project

9.3.1.1.1 General Codes and Regulations

The Building Control Regulations, 2020

The National Building Code, 2019
The Building Control Act, 2013
Health Care Facilities Code Handbook-Eleventh Edition

9.3.1.1.2 Specific Codes and Standards

Architecture
o Neufert Architect's Architects' Data-5th Edition
o National Physical Planning Standards & Guidelines

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Civil/Structural Engineering
o BS 8004:1986: Code of practice for Foundations
o BS 8110: Part 1: 1997: Structural Use of Concrete
o BS 5950: Part 1: 2000: Structural use of steel
o BS 5268:2002:Structural use of timber
o BS 5628:1992:Structural use of Masonry
o BS 6399: Part 1: 1996: Loading for buildings, Dead & Imposed loads
o BS 6399-2:1997 Loading for buildings: Code of practice for wind loads
o Euro code 8:Design provisions for earthquake resistance of structures

Electrical Engineering
o Code for Electrical installations In Building (Draft) MoWT
o The Electrical Engineering Handbook

Mechanical Engineering/HVAC
o The National Building (Standards for Mechanical Installations) Code-2019,
o Mark's Standard Handbook for Mechanical Engineer,
o Specialised Ventilation for Healthcare Buildings (United Kingdom).

Biomedical Engineering
o National Medical equipment Policy MoH 2009,
o Guidelines on Registration of Surgical Instruments and Appliances-NDA,
o NFPA 99 - Health Care Facilities Code-2018,
o Quality practices in basic biomedical research-Handbook 2006.

Quantity Surveying
o Standard Method of Measuring Building Work for Africa 2015 – First Edition.
o RICS; Quantity Surveying and Construction Standards
o Standard Methods of measurement of building works for East African; 1970,

ICT Installations
o Information and communication Technology (ICT) Standards and Guidelines; 2018,
o NITA-U Standards Catalogue 2017
Environmental and Social Impact Works
o Integrated Environmental Assessment and Audit Experts-NEMA

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o A Guide to the Environment Impact Assessment Process In Uganda-2001.
o The National Environment (Waste Management) Regulations-1999
o The National Environment (Standards for Discharge of Effluent Regulations-1999
o National Environment (Noise Standards & Control) Regulations-2003
o The Public Health (Building) Rules SI 281-1

Clerk of Works

The project provides for 2 Clerks of Works, one for the building and civil works and the second
for MEP/HVAC and equipment installation due to the complexity of the project and to ensure
that the building works are well harmonized and integrated with the equipment installation
requirements.

Although these have no specific codes of practice, they shall be guided by the consultant team
on how to enforce the different requirements.

82