BACK GROUND AND PROJECT DESCRIPTION

PROJECT BACK GROUND

Before the most recent devastating war on/in Tigray, in 2015, the healthcare system included 39
hospitals (2 referral, 15 general, and 22 primaries), 204 health centers and 712 health posts.
Depicts the healthcare system in 2015 and 2020. The latest data on the health facilities are
reported on Tigray Region Health Bureau (TRHB)’s bulletien.

The war in Tigray Erupted on 4 November 2020 and its impact is still ongoing and will do so in
for the years to come as in any other war. The war, just in few weeks-months after its start it has
been causing huge loss of lives, displacements of health care workers and destruction of
healthcare facilities becoming some of the defining elements of the armed conflict, putting
millions of lives at risk. The war has led to a near-total collapse of the Tigray region’s healthcare
system, rendering 70–80% of healthcare facilities in the Tigray region dysfunctional (Gessessew
et al BMJ 2021). On the other hand, due to epidemiological transition which is taking place in
every part of the world, among all races, ethnic groups, and cultures there is a global rise Non
Communicable Diseases (NCDs. Most recent reports show that NCD and Injuries burden
accounted for more than 50% of the disease burden in Ethiopia. Of the Non Communicable
Disease, cardiovascular disorders (CVD) constituted 35% of the total NCDS in a National report
on Non Communicable and Injuries burden report in 2015 followed by Cancers (16%), Injuries
(17%), Digestive Diseases (9%) and other Non-Communicable Diseases (12%), Diabetes,
urogenital and other endocrine disorders (8%) among others.

Today cardiovascular disorders have become the most common causes of death globally
accounting for 30% of deaths worldwide, with 80% of the burden now occurring in developing
countries like Ethiopia. The vast majority of Cardiovascular diseases in Sub-saharan Africa are
due to Hypertensive Heart Disease (HHD), Cardiomyopathies (CMP), Rheumatic heart disease
(RHD), Ischemic heart Diseases (IHD) (Frontiers in Cardiovas Med 2022). The most important
risk factors for these disorders being Hypertension, diabetes, lipid abnormalities among others
like infectious causes which also contribute to many cardiac conditions in Ethiopia like
Rheumatic Heart Disease (RHD) as well as cardiomyopathies which are causing significant
morbidity and mortality in Ethiopia as leading cause of Heart failure.
Unfortunately, countries like Ethiopia are not yet equipped to deal with this condition, ie the fast
growing burden of Non Communicable Diseases like CVDs will take the lives of many bread
winning segment of the population for there are poorly equipped tertiary care centers in the
country and particularly in Tigray, including Mekelle city. A couple of private and non-profit
hospitals in the capital city at Addis Ababa are the only ones giving some cardiovascular services
in the country and similarly Ayder Referral Hospital also the only center which gives limited
services to the community of Tigray, Afar, some part of Amhara.

Cardiac surgery is badly needed to patients with RHD and other cardiac conditions and here in
Tigray there is no access to continuously functioning cardiac center, a bleak reality for region
with one of the highest prevalence of rheumatic heart disease, which is largely preventable and
often caused by non-treated throat infections. It is the leading causes of acquired heart disease
among children and young adults. At Tikur-Ambesa and Ayder specialized hospital, there is a
waiting list of over 8000 and 1500 patients in Addis Ababa and Mekelle Tigray respectively. The
poorest people in low- and middle-income countries are most affected.

In this Region, there is no specialized center which is capable of handling cardiac patients and
other cardiovascular complications; hence the demand of having a center is obvious. This profile
envisages the establishment of a specialized CARDIAC & MEDICAL center with a capacity
providing service more than 20 thousand peoples per annum with a capacity of 50 beds. It will
provide a broad range of medical services to a t r i s k cardiac and medical patients or the
general population.

RATIONALE OF THE PROJECT

The vast majority of heart failure causes in sub-Saharan Africa are due to non-ischemic causes;
with rheumatic heart disease (RHD), hypertensive heart disease (HHD), and cardiomyopathy
accounting for over 75% of cases. Epidemiological data on CVD disorders are generally scarce
in low-middle income countries, including Ethiopia. The Ethiopian government developed a
national NCD action plan and is conducting a NCD risk factor survey to assess baseline risk
factors. This initiative aims to achieve a 25 % reduction in the NCD related mortality by 2025, a
goal set by the Global NCD action plan.
The above facts clearly revealed the criticality of the problem in Africa including Ethiopia and
particularly Tigray region. This problem not only takes the life of the citizens but also their
families and the nation’s economy as it takes the breadwinning segment of a community by
taking lives prematurely.
Therefore, the rationale of the envisaged project is:-
 To save the life of the citizen
 To significantly reduce the foreign currency expatriation from the country due to
seeking the treatment abroad, as it takes long time to get the service locally.
 To generate foreign currency to the Country through rendering the service at least to
the neighboring countries.
 Transferring knowledge to the Ethiopian professionals in the field so that the
accessibility of the service to the cardiac patients and patients with related disrders
will increase.
 Contribute to the growth of the country through generating profit, foreign currency
and payment of various taxes to the government.

MISSION, VISION, CORE VALUES AND GOALS OF SALUTE

MISSIONS

The Salute Cardiac & Medical Center team are dedicated to providing the highest standard of
quality cardiac care to our patients with a professional compassionate approach. Salute Cardiac
& Medical Center privately owned and operated team specialists with a focus on ensuring
comprehensive range in cardiology, pulmonology, nephrology, pathology, endocrinology,
neurology to our community:

Our mission as a team is to offer quality health services by advancing modern health care
system to promote health of the general public.

• This will be achieved through ethically uncompromised and public interest-centered disease
prevention, health education and cost-effective treatment services on the major health issues of
our society with a focus in advanced cardiac and medical conditions.

• Contributing to the advancement of local health care services and clinical research
VISION
Our team in Salute aspires and strives to be one of the best in East Africa and leading in the
cardiovascular and medical services by delivering compassionate and up-to-date cardiac and
medical services to our community with commitment to deliver comprehensive quality patient
care.

VALUES
Our Core Values drive our operational excellence, collaborative and supportive culture and
ensure we deliver quality cardiac care with excellent customer service standards.

 Integrity - Salute Cardiac & Medical Center takes great pride in fostering an open and
supportive culture that inspires the team to work together in a collaborative environment.
Mutual respect within the organization ensures trust and honesty in delivering all facets
of Salute Cardiac & Medical Center operations and this ethical focus is translated
externally into how we treat our patients and deliver quality cardiac care consistently.

 Compassion - As a team at Salute Cardiac & Medical Center we respect every individual
and understand that each patient will have varying needs and that it is important to work
collaboratively and compassionately for the best outcome in every individual case. Our
patient’s health comes first and we work together in an open and supportive environment
to ensure there is a clear understanding of the care required and to demonstrate empathy
at all times to our patients and colleagues.

 Collaboration & Team work - Collaboration is at the heart of our organization. We

understand that the sum of many parts is greater than the individual and we work together
as a team to ensure we are delivering the highest standard of quality cardiac care to our
patients and their supporting health professionals. Teamwork is paramount to our culture
and we value open and transparent communication in all aspects of Salute Cardiac &
Medical Center operations. We believe that effectiveness & efficiency of a system is
solely built on the collective decision & team cohesiveness, & hence we work & decide
in teams to achieve common goals.

 While believing in team work we recognize and appreciate the contributions of individuals
in Salute health services
  Excellence - We maintain a focus on skill and knowledge combined with utilizing
contemporary medical technology to deliver excellence in cardiac care for our patients.
Our group of doctors aims to be the first choice in cardiac care through reputation,
professionalism and expertise. This high standard of care drives us every day and
underpins our operations and cultural environment to deliver optimal patient outcomes.

 Client oriented service: We are compassionate listeners and dedicated to patient care.
Beyond anything, the patient is our priority!

 Handle each individuals with respect and dignity

 Uncompromised high quality health service and professionals: we promote quality

service & make our clients confident on us & let them value quality. we promote quality
medical and cardiovascular health care and attract competent professionals to our team

 Staff professionalism: Salute by no means compromises the professional component of its

health services for material benefits. We provide impersonalized services. Our integrity
and ethics will never be compromised

 Being involved in the search for the solutions of our nearby community’s problems
through research, public health education, delivering consultancy services & Donations

 Introducing new technologies & create innovative ideas in the ways to solve health
challenges of the community we serve.

 We create a dynamic and innovative organization

GOALS:
 Providing efficient & effective ( quality ) health service with minimum cost; at the same
time maintaining high ethical standards

 Continue as competent organization by establishing new clinical services

 Establishing strong partnership with regional, national & international Health service
institutions
  Being a center of excellence in providing up-to-date preventive, diagnostic and curative
medical and cardiovascular services to our community in Mekelle, Tigray, Ethiopia
and the other eastern Africa region

SERVICES
The proposed project is for setting up specialized hospital focused in handling advanced cardiac
problems in the region and other medical conditions particularly cardiology, radiology,
pulmonology, nephrology, endocrinology and neurology. This center would be focused on
cardiac and Medical service catering both to inpatient as well as outpatient service. The hospital
in patient facilities would include a 50-bed in-patient department with a fully functional
operation room capable of conducting various types of cardiac surgeries and other surgeries. The
outpatient facilities would include outpatient examination rooms, diagnostic rooms including a
central Laboratory, Cardiac Imaging, and radiology.

There are at least three major new things that our hospital will introduce as a brand new service
to Tigray and Mekelle Surgery, cardiac Catheterization Laboratory (Cath Lab) and Cardiac
Coronary CT Angiography (cardiac CT). Cardiac CT and Cardiac MRI are changing the ways of
modern CVDs treatment and helped modernize treatment of heart failure patients globally and
this services are currently only available in a single center in Addis Ababa in the nation. It is
important to note that SALUTE has been the only center until today (in the whote north Ethiopia
and Tigray) and is the first to introduce up to date cardiac diagnostic facilities like Ambulatory
Blood Pressure measurement and Exercise stress ECG with Defibrillator among pthers used to
treat Hypertension, diagnose Ischemic Heart Disease early. Salute has been the first private
sector to introduce echocardiographic evaluation in private sector too. In the Cath Lab, we also
plan to do PCI (Percutaneous coronary Intervention), Pacemaker Implantations, Implantable
Cardioverter Defibrilators (ICDs), Valvuloplasties and heart defect closure for children with
congenital heart defects. The Hospital will also have a modern and well equipped medical
Intensive care unit (MICU, coronary Care Units as well as surgical Intensive care units. The
equipments in the intensive care units will include: Mechanical ventilators, Central monitors
with arterial Blood pressure monitors, Defibrillators, Perfussers, ICU beds among others. The
ICU will be used to take care of acutely and severely ill patients, acute Myocardial
Infarctions/heart attack/, and post complicated surgery cases.

It is worth noting that the most common cardiovascular problem in our setting is Rheumatic
Heart Disease (RHD) . A considerable number of these RHD patients will obviously have
concomitant Atrial Fibrillation or stroke and some have received mechanical valve replacement
at a cost of up to 600,000.00 Ethiopian Birr (~$11,000) for a single valve or by the support of
nongovernmental organizations (international or local). Patients with RHD need follow up and
those operated also need need warfarin and INR monitoring; otherwise they will be at risk of
thromboembolic or bleeding complications.

So with understanding of this critical gap the promoter of this envisaged project to establish a
specialized hospital with special focus in cardiac and other related medical facilities based on
the study total investment requirement is estimated at about birr 145.5 million, out of which
Birr 75.4million is for medical equipment.

In the Cath Lab, in addition to the above life saving procedures, we also plan to do another
important life saving device based treatment to the heart like Pacemaker Implantations and
Implantable Cardioverter Defibrilators (ICDs) for patients whose heart rates go below 40Beats
permute due to heart Block and for patients arrhythmia and advanced heart failure after
Myocardial Infarction/heart attack/. We also plan to do Valvuloplasties for Rheumatic Heart
Disease with mitral stenosis and heart defect closure for children with congenital heart defects.

The Hospital will also have a modern and well equipped medical Intensive care unit (MICU,
coronary Care Units as well as surgical Intensive care units. The equipment’s in the intensive
care units will include: Mechanical ventilators, Central monitors with arterial Blood pressure
monitors, Defibrillators, Perfussers, ICU beds among others. The ICU will be used to take care
of acutely and severely ill patients, acute Myocardial Infarctions/heart attack/, and post
complicated surgery cases.

We also envision to have a well-equipped Pulmonology unit equipped with modern spirometry
and Bronchoscopies in addition to others and will be lead by a pulmonologist and critical care
specialist. In our nephrology department run by a nephrologist, we will introduce dialysis
services too by creating special agreement with a company capable of continoussly providing the
consumables for dialysis.

The Center will also provide general therapeutic, diagnostic care, counseling and rehabilitation
services. However, area of excellence or specialization of the hospitals will be cardiovascular
and related disorders in neurology, nephrology, and pulmonology, hence; the Center performs
most types of examinations and treatments within this field. Accordingly, the types of service
provided by the envisaged centre includes but not limited to the following;

 Coronary Angiography
 PCI (Percutaneous Coronary Intervention)
 Permanent Pacemaker (PPMK) implantation
 Lung function test (Spirometry)
 Trans-Esophageal Echcardiography (TEE)
 Stress ECG and Stress Echocardiography
 Implantable Cardioverter Defibrillator (ICD) Implantation
 ICD function test
 Pacemaker Function test
 Tilt table test
 24 hour Blood Pressure monitor (Holter BP test)
 24 hour Heart Rhythm test (R-test)
 ECG with interpretation
 ECG, consultation
 Phlebotomy
 Defibrillation with Cardioversion
 Catheterization (Urinary track)
 Emergency care
 Laboratory Services
 X-Ray service
 Ultrasound
The priority services areas of the envisaged hospital are;

 Cardiology
 Surgical services
 Intensive care services
 Emergency services
 Medical imaging and
 Rehabilitation

MANAGEMENT AND ORGANIZATION

The envisaged specialized hospital will continue to focus on improvising and widening cardiac
services with strong foundation of internal medicine practice alongside critically linked
professions like Endocrinology and Metabolism, Pulmonary and Critical Care Medicine,
Neurology, Nephrology as well as other subspecialties of internal medicine. Our center currently
involves 2 cardiologists, 1 Internist, 1 nephrologist, 1 pulmonary and critical care specialist, 1
pathologist, 1 Radiologist on permanent and spare time bases, most of them have more than 5
years of experience in teaching internal medicine and their respective subspecialties.

Owing to the human resource development scheme of the Ministry of Health of The Federal
Democratic Republic of Ethiopia and the dedicated work of our medical schools in the country
there is a remarkable increase in the intake of physicians for specialty training with decent
number of specialists being offered with subspecialty placements?

Salute Cardiac Hospital will have one medical director who over sees the core strategic issues of
the center and one General Manager who manages the supportive facilities of the Hospital.
Beside to this there are five department heads as depicted in the under below organizational
structure chart

MANAGEMENT PROFILE
Dr Abraha Hailu is the owner and Medical Director of salute cardiac specialized Hospital .He
studied his undergraduate (Medicine) and post graduate in internal medicine in Addis Ababa
University and graduated in Doctor of Medicine /MD/ in 2005 with Distinction. He has been
serving his country as a staff of Mekelle University College of Health Sciences for the last 18
years since 2005. He did his Specialty training again in Addis Ababa University and awarded his
specialty in Internal Medicine in 2010. For further sub-specialty he went abroad /Rome, Italy /
first for three months (December 2013-March 2014) and later certified in the sub-specialty of
cardiology in san Camillo Forlanini Hospital in Rome in the year 2014-2015.
Dr Abraha has been engaged and has been involved in the establishment of the first cardiology
unit in Tigray/Ayder in 2011 after his return from his speciality training in internal medicine did
lead the establishment of the first Public Cardiac Catheterization Laboratory (Cath Lab) in
Ethiopia in Ayder Hospital in Tigray in 2015 with his team from Mekelle University after his
return from his cardiology training in Italy. Dr Abraha has has been the first to do independent
local operator of both Coronary angiography and Percutaneous coronary Interventions (PCI) as
well as Permanent Pacemaker Implantations as as of April 2016.

After the war, again Dr Abraha Hailu has been to Germany for two months for a course in a
complex Cardiovascular Interventions in Cardiac Catheterization Laboratory, cardiac
pacemakers and Intensive care of cardiac patients in Klinikum Memmingen and he is back to
serve his his country again hoping that the government will support his endeavors to improve the
cardiovascular care of patients in Ethiopia and Tigray. .

The promoter of the project, in addition to his own expertise and experience, he has a group of
professionals with specialized knowledge (specialists and sub specialists) who are committed /
determined to deliver specialized medical and cardiac services in a team with organized plans put
through plausible /practical organizational plans.

Currently The prompter provides his valuable medical service in his own Business organization
namely Salute Cardiac Specialty center. Dr Abraha started his service in speciality clinic in
iternal medicine and cardiology since 6 years ago at Mekelle city in Hawelti sub city,
Adishimdihun. Since its establishement, Salute clinic started involving other professionals in the
clinic including Pathology, radiology, Minor Surgery, Pulmonology, Nephrology, and infectious
diseases care among others.

Recently SALUTE has expanded its services and from a specialty clinic, it has grown to
SALUTE INTERNAL MEDICINE SPECIALITY CENTER and added services of inpatient
beds with 11 beds in addition to emergency services with defibrillators among others. Hence,
SALUTE has been providing valuable services and has been a referral center to the community
of Tigray at large, Afar and some of Amhara region (Sekota) of course before the devastating
war. Salute is committed to continue its services at a higher level post war. Dtails of the
promoter profiles attached in the Annex part of the proposal .
The owner has been offering his service to his community for a relatively longer period in the
past years in governmental service by providing his best experience in clinical service and
teaching both undergraduate and postgraduate students in internal medicine and he has been
playing a leading role in the establishment of the Ayder Hospital cardiology and other services in
addition to his private practice and other businesses. He has accumulated sufficient knowledge
and skill in running business firms. Moreover, he has good academic background and is
professionally qualified in the field of health in general and cardiology in particular. Because of
this, he understood deeply about the long standing gap of Cradiovascular and medical care
genrally in Ethiopia and particularly in Tigray

In addition the management role, since the health sector business wise which demands specialty
on its process the role of expertise is critical. With understanding of this fact salute specialized
cardiac Hospital assigned a high level specialist for currently ongoing medical services.

Table : list of specialities

Name Profession Remark

Dr Abraha Hailu Internist, interventional Teaches at School of Medicine, College

cardiologist of Heath Science, Mekelle University

Dr Hailay Gebremeskel Internist Teaches at School of Medicine, College

of Heath Science, Mekelle University

Dr Hagos Kahsay Internist, non Teaches at School of Medicine, College

interventional cardiologist of Heath Science, Mekelle University

Dr Meskelu Kidu Internist, Nephrologist Teaches at School of Medicine, College

of Heath Science, Mekelle University

Dr Yirga Kidanu Radiologist Teaches at School of Medicine, College

of Heath Science, Mekelle University

Dr Kibrom Gebreselassie Internist, pulmonary & Teaches at School of Medicine, College

critical care specialist of Heath Science, Mekelle University
Dr Sara Kiros Pathologist Teaches at School of Medicine, College
of Heath Science, Mekelle University

Dr Marta Yemane Pediatrician inlined in Teaches at School of Medicine, College

cardiology and trained in of Heath Science, Mekelle University
Echocardiography

SALUTE SPECIALITY Center is highly privileged to affiliate the above named accomplished
physicians. These senior physicians are involved in attending patients and doing procedures
pertaining to their respective areas of expertise. The outcome this esteemed physicians’ profile
our center has been so successful in attending huge number of patients and doing so many
diagnostic procedures in a relatively short period (more than 50,000 patient visits so far. The
center is engages medical residents from School of Medicine, College of Heath Science,
Mekelle University and during their spare time where they enjoy the privilege creating academic
sessions with above named teachers. Furthermore, the center serves as a hub for future
cardiovascular nurses who would continue their carriers in the care of patients with diverse
cardiac conditions.

SALUTE Cardiac and Medical Center has a solid foundation and considerable cardiac patients’
pool spanning the entire Tigray and northern Amhara, and Afar. The acquired skills and the
academic competence of each professional working at the center is also indisputably excellent.
This is a big asset whose contribution to the envisaged tertiary cardiology care, teaching and
medical tourism to Tigray will be significant. The various cardiac services underway and those
due to start will continue to be focuses of the center while closely tied medical activities such as
Internal Medicine, Endocrinology and Metabolism, Nephrology, Neurology/psychiatry,
Pulmonology and other divisions will also be pillars within the center.

Address of salute cardiac center

MARKET AND DEMAND ANALYSIS OF THE PROJECT
.

Health sector analysis

According to the MOH the number of health facilities shows an increasing trend. During the
period 2009 – 2014 the following trends can be observed; The number of hospitals increased by
an average growth rate of 14.47% and the hospital population ratio decreased from 1: 543,964 to
1:341,197, The number of health centers increased by an average growth rate 11.13%, and the
health centers population ratio decreased from 1: 35,045 to 1:25,118, and The number of health
post increased by an average growth rate of 19.50%, and the health post population ratio
decreased from 1: 10,482 to 1:5,476

However, even though number of health facilities has shown an increasing trend, the health
infrastructure in Ethiopia is still below the standards established by the Ministry of Health. In
Ethiopia the only specialized cardiac hospitals are Addis Cardiac Hospital, Children’s Heart
Fund of Ethiopia and International Cardio Vascular Medical Centre SC.

The situation in Tigray with regards to treatment of cardiovascular disease (CVD) is even worse
as there is no specialized cardiac hospital.

Therefore, it can be concluded that considering the population of the nation the capacity of the
existing number of specialized cardiac hospitals in Ethiopia is not sufficient and even
nonexistent in Mekelle city/Tigray which indicates the market potential for a new entrant.

Over view of Prevalence of Cardiovascular Disease

Global Trend
CVDs almost doubled over three decades from 271 million in 1990 to 523 million in 2019, and
the number of CVD related deaths increased from 12.1 million to 18.6 million in the same period
as per the 2019 global burden of diseases (GBD) study report. Cardiovascular Diseases (CVDs)
are the leading causes of morbidity and mortality globally with above 70% deaths occurring in
low and middle income nations (Keates AK et al, Cardiovascular disease in Africa :
epidemiological profile and challenges. Nat Publ Gr. 2017;14). Currently, CVD had become the
leading cause of death globally with 80% of the burden being in the developing world. Other
causes of death, such as injuries, respiratory infections, nutritional deficiencies, and HIV/AIDS,
collectively still play a predominant role in certain regions, but even in those areas CVD is now a
significant cause of mortality. The origins of common CVDs in SSA have been reported to be
either of infectious ones like in rheumatic heart disease, HIV & other viral cardiomyopathies,
pericarditis, corpulmonale (post pulmonary tuberculosis) among others or non-communicable
ones including hypertensive heart disease, ischemic heart disease, stroke or peripheral arterial
disease among others The most common causes of CVD morbidity and mortality are:

 Ischemic heart disease (IHD)

 Stroke
 Rheumatic Heart Disease
 Cardiomyopathy
 Congestive heart failure (CHF)
 Hyper tension.

CVD In Africa
In Sub-Saharan Africa (SSA), CVDs accounted for 38.5% of deaths due to Non Communicable
Diseases as per the report in GBD 2013 study and is expected to surpass Communicable related
deaths by 2035. Hypertension with hypertensive heart disease, stroke, cardiomyopathies and
rheumatic heart disease and Ischemic heart disease has been the most prevalent causes of CVD
deaths in Africa. (Ntusi NA etal, Epidemiology of heart failure in sub-Saharan Africa. Expert
Rev Cardiovasc Ther. 2009).

Rheumatic heart disease is the most important form of acquired CVD in children and adolescents
in Africa. Several studies show a 15–30 per 1,000 population rheumatic heart disease. The
impact of this disease on patients, families, health system and society is very high. Of the 39
million people currently affected by rheumatic fever or rheumatic heart disease, two thirds are
children between 5 and 15 years of age. There are around 400,000 deaths each year, with 2
million people requiring repeated hospitalization and 1 million likely to require surgery in the
next 5 to 20 years.

The Case of Ethiopia

Ethiopia has a weak health information systems like vital statistics registration. In terms of
information on the CVD epidemic, the overall magnitude of the burden of CVD would be clearer
and possibly greater if data from the community level were added. Unfortunately, as a result of
the weaknesses of the health information system as a whole, population-based data on CVD
morbidity, mortality, risk factors and their determinants remain very scanty.

However, some studies show that heart diseases are prevalent among Ethiopian children.
Congenital Heart Diseases occur as much as they do elsewhere, the incidence of which is
believed to be between 6 and 8 per 1000 live births. Rheumatic Heart Diseases are in particular
the commonest among Ethiopian children, a case which is true in other underdeveloped
countries. Studies showed that 15% of the 4 million children between the ages of 5-15 years are
at risk of developing streptococcus throat infection on the average twice in one year. Thus, in
Ethiopia, with 3% attack rate of rheumatic fever about 120,000 children are estimated to develop
rheumatic fever every year.

Moreover, analysis of mortality and risk factor patterns and the socio-economic situation at the
present time in Ethiopia provide important information related to the burden of disease, risk
factors and determinants. According to a report by Fikru Tesfaye, Peter Byass and Stig Wall “
Population based prevalence of high blood pressure among adults in Addis Ababa: uncovering a
silent epidemic” which is conducted based on the WHO’s STEP approach is based on
community evaluation of risk factors revealed widespread prevalence of various risk factors of
cardiovascular diseases among adults in Addis Ababa.

More recently, WHO STEPS Survey reports or verbal autopsy based community studies which
address CVD prevalence and CVD related deaths show the increasing prevalence of CVDs in
Ethiopia. These relatively recent studies report rheumatic heart disease, cardiomyopathies,
hypertension and related disorders like hypertensive heart diseases, strokes and ischemic heart
disease to be the dominant forms of adult CVDs in Ethiopia. Studies done in 1970 - 1990’s in
Ethiopia showed CVDs constituting 4-13% of medical admissions to hospitals in Addis Ababa
(25) (26).

The case of Tigray

Similarly there are no community based studies on the prevalence of CVDs in Tigray except for
the STEPS surevey which also included Tigray as mentioned above. There has been recent
hospital based studies showing the patterns of intensive care and hospital admisions. A study on
patterns of medical ICU admission showed that CVDs were the leading causes of admissions to
Ayder referral hospital (Kibreab G et al Ethiop Med J, 2018, Vol. 56, No. 1). A recent study
done in 2017-2018 in adult medical ward and intensive care admissions to Ayder referral
Hoaspital in Tigray show that Cardiovascular disorders constituted 54% of the Non
communicable disease admissions and the most common cardiovascular diseases were
rhueumatic heart disease, cardiomopathies, Ischemic heart disease, corpulmonale, degenerative
valve diseases and Hypertensive heart disease (Abraha H et al International Journal of General
Medicine, , 243-257, DOI: 10.2147/IJGM.S385578.

The emergence of increased CVDs in Tigray has not been accompanied by corresponding
adjustments in health service structures and human resources. Current health care systems were
developed to provide acute, episodic care; they are inadequately designed and resourced to care
for people with chronic conditions such as CVD.

There has been no specialized cardiac hospital yet in Mekelle/Tigray. Additionaly, the recent war
has also led to the collapse of the different health institutions and therefore, there is a large
market potential for a hospital that specializes in cardiovascular disease in Addis Ababa.

The proposed project is for setting up a a specialized hospital. This hospital would be a focused
on cardiac and Medical service catering both to ipatient and out patient services. The hospital
inpatient facilities would include a 100-bed inpatient department with a fully equipped and
functional Intensive care unit/coronary care unit dedicated to severely ill patients and patients
with heart attack/Acute Coronary syndrome/.
Salute will also introduce the First Private Cath Lab in Northern Ethiopia/Tigray. It will also
introduce an advanced diagnostic facility in cardiology including Cardiac CT. We also envision
on having an operation theater for cardiac and general surgery with two OR tables and a recovery
room equipped with machines for emediate post operative care. It is estimated that the new
center will have the physical capacity to perform 100 Cardiac CT, 300 surgeries, 200 coronary
angiographies, 150 pacemakers, 50 Implantable cardioverter defibrillator implantations and 360
dialysis each year once it goes functional. Thus is a unique project for our community as we are
creating an entire regional Cardiac and medical therapeutic solution.

AGGREGATE DEMAND AND SUPPLY

Tigray National Regional State is the fourth largest regional state with 5% of the size of Ethiopia
population. Nonetheless, it is influenced by the limited network of health care facilities. These
health care facilities include 40 hospitals, 224 functional health center, and 742 functional health
posts. In the region, there is shortage of the human resource available for health cares across all
professions (TRHB, 2023). () These are the facilities which were functional before the war and
even before the war they were not fully equipped and not prepared cardiac and medical patients
to even those in stable condition let alone to take care of those with advanced cardiac problems
and hence the need to have centers equipped with materials and professionals ready to handle
such patients.

The estimated population of Tigray region is in 2017 was 5.5 million of which 20% lives in the
urban area while the remaining 80% resides in the rural part (TNRS, BoFED, 2017). () In other
words, the region is the fourth largest populous region in Ethiopia.

Among other things, growing population has stretched the existing public health care system in
the Tigray region where the bed (hospital and health care) to population ratio had stood at 1:9000
in 2014/15 despite an increase in the number of beds in comparison to the preceding year. This
has given rise to high demand of private sector health care facilities to complement its public
sector counterpart. However, available report divulges that there were 309 private clinics in the
region of which only 16 were higher clinics. Except to the 2 private hospitals which were both
based in Mekelle few years ago. More recently and after the war, the hospitals in the region have
 gone severely dysfunctional with poor equipment’s and highly affected by staff attrition and they
have little to offer to the community. On the other hand there are some private hospitals
providing basic service but none of them have even the basic cardiac services required by the
standards. Salute aspires to fill these gaps particularly in cardiac and medical services in our
community by adding values of care like surgery, cardiac catheterization laboratory and better
diagnostic tools in the field of cardiology and internal medicine.

In general, the foregoing presentation pointed out the presence of huge gap in demand and
supply due to the high growth in demand with relatively meager growth in the supply of health
care, cardiology in this case.

PROJECTED DEMAND
According Mekelle structural plan the demand of Health institution showing increasing rate
statues Mekelle population projected to be 663,349 in 2024 . accordingly the city expects to
have additional privately owned 27 Health centers and 9 hospitals in the coming year. The
detailed are described in the under below table:

Table 1: Health institutions projection

Health system Standard # of Projected popn Additional (new or

organization requirements existing size in 2023/4 upgrading by faire
health (663,349) distribution per sub - cities)
institutions
Primary health 1 HC: 25,000 9 HCs 27 HCs are 18 HCs
care unit (health population size required
centers)
Primary hospital
1 PH: 80,000 4 private 9 PHs 5 primary hospitals by sub-
popn size PHs cities
(approximate)
Source MSP(2015)

According the above table there is a backlog for about 720,000 populations in Mekelle city , The
structural plan insisted the establishment of 9 primary Hospitals. When you come to proposed
project ,The major target market for the proposed facility consists of mainly middle and high
income families of Mekelle city where the facility is going to be established and people residing
in adjacent areas of Mekelle as well as we aspire to be referral centers for cardiology,
pulmonology, nephrology and other internal medicine fields for patients from all parts of Tigray,
population from the surrounding regions of Afar, Northern Amahara regions.

Being conservative in projection, it is assumed that 20% of the population in the town where the
facility is to be established, other Major T towns of the region and 30% of the Targeted
population also will form part of neighboring Regions Mainly Amhara and Afar . Since health
care is generally considered as necessity service, and the participation of the private sector in the
business is at its infant stage (about 8%), the above assumption can be considered as a bit
conservative. The major town that can attract good proportion of target customers are mainly
Mekelle and the major cities of Tigray . Accordingly, the following table constructs the
estimated target customers from Tigray region for the facilities that would be established in
Mekelle

Table 1: Projected Demand for Private Hospital.

Year Total Population in cities

2023 1738377.062 347,675.41

2024 1783574.866 356,714.97

2025 1829947.812 365,989.56

2026 1877526.455 375,505.29

2027 1926342.143 385,268.43

2028 1976427.039 395,285.41

2029 2027814.142 405,562.83

2030 2080537.31 416,107.46

2031 2134631.28 426,926.26

2032 2190131.693 438,026.34

The above table points out that the estimated potential customers are about 347.6 thousands in
2023 and 438.5 thousands in 2032. However, it is impossible to exactly identify how many of
these target customers actually visit the envisaged facility. Because, some of them may visit the
service repeatedly while others may not visit at all in a given year. Thus, it is assumed that about
25% of the target customers pay a visit once in a year for some kind of medical treatment
purpose. Accordingly, the effective demand would be 87 thousands per year in 2023 and 110
thousands in 2032. Besides to this it is estimated that from neighbouring regions basically
Amhara and Afar equal to 30 % of the target customers of Tigray Region will visit salute cardial
center. This will result the effective demand to be 113,100 patients in 2023 and 143.000 in 2032

In projecting the future effective demand for the service it is assumed that a 3% growth will take
place in the future in line with the population growth rate. Thus, the forecasted demand growth
will be as detailed in table 2 below.

Table2: projected demand for Cardiac and Medical center

Year Total Population in cities Target

customers
for special
medical
service

2023 1738377.062 86,918.85

2024 1783574.866 89,178.74

2025 1829947.812 91,497.39

2026 1877526.455 93,876.32

2027 1926342.143 96,317.11

2028 1976427.039 98,821.35

2029 2027814.142 101,390.71

2030 2080537.31 104,026.87

2031 2134631.28 106,731.56

2032 2190131.693 109,506.58

The above table informs that for a plant that would resume operation after two years (in
2009/10), expected demand for the center will be 91.4 thousand in 2025.

Accordingly, based on the market assessment and the required physical and human resource the
annual service plan of the envisaged centre is shown below;

Number of
Sr. patients
No. Service ( annual)

1 Inpatients

Diagnosis and treatment

1.1 including 2,580

Surgery including cardiac

1.2 surgeries 400

2 Outpatients

2.1 Diagnosis and treatment 13,020

3 Emergency 1,076

4 Rehabilitation 3,000
 Total 20,948

PRICING
The payment made by patients depends on the type of treatment they would obtain. In this regard
the following fee is set in accordance to the service.

Table 3: Payment to Service Received.

Item Description of Service Reason for Average Fee (Br)

Payment

Nephrology Dialysis 3000

Total 24,000

Consultation and
diagnostic (of MD)

Consultation

General Practitioner Consultation 300

Specialist Consultation 700

Diagnostic center

Ultra Sound Ultrasound 400

Doppler Ultrasound Ultrasound 800

Echocardiography Echocardiography 1000

X-Ray X Ray 700

ECG ECG 400

 Treadmil Exercise ECG Stress test 2000

Stress Echocardiography Stress echo 3000

Transesophageal
echocardiography
TEE echo 2500
Troponin
Cardiac marker 800
Other blood chemistry tests
See annex

Urine Test Test 100

Total 2700

CAPACITY
Based on the projected demand and the planned size of the service, the envisaged center is set to
provide treatment for 400 patients per day of which 100 are inpatients (given service in the
hospital admitted as an emergency, in ICU or wards) while 300 are out patients (ou patient
department/OPD).

Accordingly, the envisaged specialized hospital assumes that to accommodate a minimum of

27,660 beneficiaries annually in different service packages. The table below describes the
estimated service packages.

Table 4: Capacity estimation

capacity estimation

Income Category Number of beneficiaries

Cardiac Surgery 100

Coronary angiography 300

PCI 50

General Surgery 1830

1830
Pulmonology and nephrology

consultation 12,000

lab and Diagnostic 12,000

Total 27,660

SERVICE DELIVERY PROGRAM

The program is scheduled based on the consideration that the envisaged center will work 365
days in a year with 24 hours per day program as we will take care of emergency, Intensive care,
acute coronary syndrome care in the emergency and the cardiac catheterization lab as well as in
inpatient on a continuous 24/7 working hour basis. During the first year of operation the center
will operate at 80 percent capacity and then it grows to 90 percent in the 2 nd year. The capacity of
the center will grow to 100 percent in the other services starting from the 3 rd year. This
consideration is developed based on the assumption that awareness to the service would develop
increasingly throughout the region.

TECHNICAL FEASIBILITY

LOCATION AND SITE

The appropriate locations for the envisaged project in view of the availability of infrastructure,
professional staffs as well as market for the service would be in the city center of Mekelle. The
project demands 6000 square meter of land from the concerned government body which is
planned for the establishment of the specialized hospital in CARDIAC & MEDICAL services in
Mekelle, the capital city of Tigray regional state and serves communities in the city, and around
Tigray as well as neighboring regions.

CIVIL ENGINEERING COST

The total site area for the envisaged specialized hospital is estimated to be 6,000m 2 where
3,000m2 is allocated to the building, while the remaining space is left for Greenery space,parking
and related activities. The rooms to be constructed shall be splinted into various departments and
sections as detailed below. The average cost of the Building is estimated Birr 1100.00 per Square
meter for building and Birr 2000 per square meter for land escaping so the total investment cost
estimated to be Birr 41,000,000.00. The details the physical plaining and program development
attached in the annex part of the project proposal

MACHINERY AND EQUIPMENT

The machineries and equipment required for proposed specialized hospital is detailed in table 6
below:

Table 6; Medical equipments other machinery

Description U Qty U/C Cost(Birr)

M
FC LC TC

Medical head lights psc 2 77,687.55 100,993.81 54,381.28 155,375.10

Microscope “ 2 51,791.70 67,329.21 36,254.19 103,583.40

Scales and Weights “ 5 5,179.17 16,832.30 9,063.55 25,895.85

EKG “ 2 276,222.44 359,089.17 193,355.71 552,444.88

Electro cautery “ 2 51,791.70 67,329.21 36,254.19 103,583.40

Exam lights “ 2 25,895.85 33,664.60 18,127.09 51,791.70

Autoclaves “ 3 103,583.40 201,987.62 108,762.56 310,750.20

Diagnostic
Equipment “ 2 103,583.40 134,658.41 72,508.38 207,166.80

Exam Head lights “ 2 51,791.70 67,329.21 36,254.19 103,583.40

Exam Lights “ 2 25,895.85 33,664.60 18,127.09 51,791.70

Patient
Transport/cart/ “ 3 5,179.17 10,099.38 5,438.13 15,537.51

Laboratory
anesthesia “ 3 86,345.26 168,373.26 90,662.53 259,035.78

Autoclaves “ 2 155,375.09 201,987.62 108,762.56 310,750.18

Respiratory
Ventilators “ 5 67,329.21 218,819.92 117,826.11 336,646.05

Diagnostic monitors “ 3 207,166.79 403,975.24 217,525.13 621,500.37

Medical Lighting “ 2 103,583.40 134,658.41 72,508.38 207,166.80

Cautery “ 3 51,791.70 100,993.81 54,381.28 155,375.10

Lab microscope “ 3 51,791.70 100,993.81 54,381.28 155,375.10

Defibrillators “ 2 129,479.24 168,323.02 90,635.47 258,958.48

Warmers “ 2 86,345.26 112,248.84 60,441.68 172,690.52

Centrifuges “ 2 207,166.79 269,316.83 145,016.75 414,333.58

Patient Circuit “ 2 51,791.70 67,329.21 36,254.19 103,583.40

Anesthesia Supplies “ 2 34,553.57 44,919.64 24,187.50 69,107.14

Cattery Supplies “ 2 17,264.41 22,443.74 12,085.09 34,528.82

Anesthesia
Equipment “ 2 86,345.26 112,248.84 60,441.68 172,690.52

Autoclaves “ 2 155,375.09 201,987.62 108,762.56 310,750.18

Respiratory
Ventilators “ 2 103,583.40 134,658.41 72,508.38 207,166.80

Vaporizers and
Accessories “ 2 51,791.70 67,329.21 36,254.19 103,583.40

Vital signs Monitor “ 2 41,433.36 53,863.37 29,003.35 82,866.72

Surgical Lights “ 2 155,375.09 201,987.62 108,762.56 310,750.18

Head lights and Light

sources “ 2 55,270.24 71,851.32 38,689.17 110,540.48

Patient Transport “ 2 6,906.08 8,977.90 4,834.25 13,812.16

Defbriliators “ 2 63,935.85 83,116.60 44,755.09 127,871.70

Cautery “ 2 76,722.83 99,739.68 53,705.98 153,445.66

Multi Parameter
Monitors “ 2 690,556.48 897,723.43 483,389.54 1,381,112.96

Medical Stretcher “ 2 34,553.57 44,919.64 24,187.50 69,107.14

AED “ 2 86,345.26 112,248.84 60,441.68 172,690.52

Cardiac Monitor “ 2 517,916.98 673,292.07 362,541.88 1,035,833.96

Cardiac Ultra sound

machine “ 2 6,184,083.29 8,039,308.28 4,328,858.31 12,368,166.58

Vascular ultra sound

Machine “ 2 431,598.00 561,077.39 302,118.60 863,196.00

EKG Machine “ 5 276,223.83 897,727.45 483,391.70 1,381,119.15

Automated External
Defibrillators “ 5 172,639.20 561,077.39 302,118.60 863,196.00

Heart Lung By pass “ 5 69,055.80 224,431.36 120,847.66 345,279.00

Stress Test System “ 5 86,319.54 280,538.50 151,059.19 431,597.70

Infusion Pumps “ 5 34,538.11 112,248.84 60,441.68 172,690.55

X-ray digital “ 1 9,276,124.94 6,029,481.21 3,246,643.73 9,276,124.94

Estress
test/ESG/treadmill “ 1 3,092,041.65 2,009,827.07 1,082,214.58 3,092,041.65

Cat-Lab/C-alm/
machin “ 1 9,276,124.94 6,029,481.21 3,246,643.73 9,276,124.94

Chemistry machine “ 1 1,546,020.82 1,004,913.54 541,107.29 1,546,020.82

48,648,334.97
 Table 8:Other Auxiliary furniture’s and equipment’s and facilities

Laundry Machine “ 1 517,916.98 336,646.03 181,270.9 517,916.98

4

Generetor “ 1 989,453.33 643,144.66 346,308.6 989,453.33

6

Photocopy “ 8 154,602.08 803,930.83 432,885.8 1,236,816.6

3 6

Computer “ 45 40,196.54 1,175,748.8 633,095.5 1,808,844.3

4 3 6

Printer “ 38 26,282.35 649,174.14 349,555.3 998,729.45

1

fax “ 6 2,473.63 9,647.17 5,194.63 14,841.80

Telephon bax “ 4 10,822.15 28,137.58 15,151.00 43,288.58

Binder “ 8 1,855.22 9,647.17 5,194.63 14,841.80

Kitchen Equipment “ 1 92,761.25 60,294.81 32,466.44 92,761.25

& Furniture

Wheel Chairs “ 2 10,358.34 13,465.84 7,250.84 20,716.68

Hospital beds “ 2 10,358.34 13,465.84 7,250.84 20,716.68

Operating room “ 2 10,358.34 13,465.84 7,250.84 20,716.68

Table

Lab Tables “ 2 20,716.68 26,931.68 14,501.68 41,433.36

Exam tables “ 2 6,215.00 8,079.50 4,350.50 12,430.01

Medical Furniture “ 3 6,905.56 13,465.84 7,250.84 20,716.68

Table “ 55 23,190.31 829,053.67 446,413.5 1,275,467.1

 1 8

Chair “ 106 7,730.10 532,604.17 286,786.8 819,391.04

6

Shelfs “ 52 20,098.27 679,321.55 365,788.5 1,045,110.0

3 8

Hospital Beds “ 100 3,710.45 241,179.25 129,865.7 371,045.00

5

Total 9,365,237.5
8

Table 9: Vehicles

Ambulance Vehicle “ 1 6,184,083.2 4,019,654.1 2,164,429.1 6,184,083.29

9 4 5

Dauble cup Toyota “ 1 4,638,062.4 3,014,740.6 1,623,321.8 4,638,062.47

7 1 6

Total 10,822,145.7
6

The Machinery and equipment and Vehicles requirement and the associated cost for the
envisaged project are Birr 95,599,193.88 and 10,822,145.76 respectively as shown in the above
tables7- 9 here above

AVAILABILITY AND SOURCE OF MATERIALS AND CONSUMABLES:

Most of the materials to be used in the hospital shall be purchased from firms supplying imported
items from abroad. The major items include: Cardiac Surgery sets with Cardiopulmonary bypass
machine, Cardiac Catheterization Laboratory Machine (Cath Lab Machine) with its consumables
like cardiac catheters and pacemakers, stents, laboratory reagents, dressing materials, grip,
Echocardiography and doppler ultrasound and x-ray machines, etc.

ANNUAL REQUIREMENT AND COST OF MATERIALS AND UTILITIES ,

CONSUMABLES
The annual material and utility requirement and the associated cost for the envisaged plant is Birr
3,324,235 as shown in table 10 here under

Table 10: Material and CONSUMABLES Requirement

S Description UM QT unit Cost in Birr) Total

r Y cost in
cost FC LC
Birr

1 Adrenalin Injection Pac 15 8,800 85,800 46,200 132,000

k

2 Aminophyllin Injection Pac 10 15,100 98,150 52,850 151,000

k

3 Oxytocin Injection Pac 10 15,970 103,850 55,895 159,700

k

4 Ergometrin Injection Pac 7.5 21,720 105,885 57,015 162,900

k

5 Hydro cortisone sodium Pac 4 46,750 121,850 65,450 187,000

succinct k

6 Vitamin K injection Pac 4 30,340 78,884 42,476 121,360

k

7 Hyoid Hydro bride Pac 7.5 20,120 98,085 52,815 150,900

injection k

8 Lidocaine Hydrochloride Pac 4 27,880 72,488 39,032 111,520

 injection k

9 Tetanus anti-toxin Injection Pac 2.5 43,740 71,077.5 38,273 109,350

(TAT) k

1 Diclofenac Injection Pac 2.5 63,420 103,057.5 55,493 158,550

0 k

1 40% Dextrose Pac 5 247,86 805,545 433,755 1,239,30

1 k 0 0

1 Intravemous fluids ( different Pac 4 81,470 211,822 114,058 325,880

2 types) k

1 Alcohol Solution (79%) Pac 10 2,190 14,235 7,665 21,900

3 k

1 Savlon Chlor- hex cotrimidde Pac 15 1,490 14,527.5 7,823 22,350

4 k

1 Plaster Rol 10 1,100 7,150.0 3,850 11,000

5 l

1 Roll bandage different Pac 15 2,190 21,352.50 11,497.5 32,850

6 k 0

1 Elastic bandage Pac 5 8,750 28,437.50 15,312.5 43,750

7 k 0

1 Dispsyringe needle (different) Pac 25 3,290 53,462.50 28,787.5 82,250

8 k 0

1 Cotton Pac 15 150 1,462.50 787.5 2,250

9 k

2 Pethidine Injection Pac 2.5 39,370 63,976.25 34,448.7 98,425

0 k 5
 Grand Total 2,161,097. 1,163,48 3,324,23
75 2 5

Add Cardiac Surgery and Cath alb Consumables as a table:

Table 11:

UTILITIES
The major utilities required by the cardiac center l are electricity and water. The required
quantity of these utilities and corresponding cost are indicated Table

Table 12: Annual Utilities Requirements and Cost.

S.n Utility UM Qty Cost in Birr Remarks

1 Electricity kWh 200,000 98,650.00
2 Water m3 10,000 32,500.00
3 Total 131,150.00
HUMAN RESOURCE PLANING
SALUTE SPECIALITY Center is highly committed to assign a highly specialized physicians.
These senior physicians are involved in attending patients and doing procedures pertaining to
their respective areas of expertise. The outcome this esteemed physicians’ profile our center has
been so successful in attending huge number of patients and doing so many diagnostic
procedures in a relatively short period (more than 50,000 patient visits so far. The center is
engages medical residents from School of Medicine, College of Heath Science, Mekelle
University and during their spare time where they enjoy the privilege creating academic sessions
with above named teachers. Furthermore, the center serves as a hub for future cardiovascular
nurses who would continue their carriers in the care of patients with diverse cardiac conditions.

SALUTE Cardiac and Medical Center has a solid foundation and considerable cardiac patients’
pool spanning the entire Tigray and northern Amhara, and Afra. The acquired skills and the
academic competence of each professional working at the center is also indisputably excellent.
This is a big asset whose contribution to the envisaged tertiary cardiology care, teaching and
medical tourism to Tigray will be significant. The various cardiac services underway and those
due to start will continue to be focuses of the center while closely tied medical activities such as
Internal Medicine, Endocrinology and Metabolism, Nephrology, Neurology/psychiatry,
Pulmonology and other divisions will also be pillars within the center.

Resource
allocation
Division Remark
(%)

1 Cardiology 40 Prevailing huge manpower & institutional

potential

2 Cardiothoracic Surgery 20 Essential for complete care to the limit

3 Internal Medicine 20 Foundation of all medical subspecialties

4 General Surgery 5 Essential to manage for complete management of

complications in cardiothoracic surgery

5 Endocrinology & 5 Closely tied to cardiology, no success without

Metabolism good management of metabolism

6 Nephrology 5 Closely related & essential for complete care of

complications in cardiology & cardiac surgery

7 Neurology & 5 Often appear as complications requiring

Neuropsychiatry thoughtful neurology management
HUMAN RESOURCE
The list of required manpower for the envisaged plant is stated in table 6 below

Table 12: Human Resource Requirement

S/ Description Qt Monthly Total Annual Salary

N y Salary M/salary

1 Medical Director 1 11,037.00 30,037.00 132,444.00

2 Cardiologist 2 64,037.00 128,148.00 529,776.00

3 Cardiac Surgeon 2 64,037.00 128,074.00 264,888.00

4 General Practioner 1 22,037.00 44,074.00 264,888.00

5 Internist 2 50,037.00 100,370.00 1,324,440.00

6 Radiologist 2 50,037.00 110,074.00 264,888.00

7 Nephrologist 2 64,037.00 64,074.00 264,888.00

8 pulmonologist 1 64,037.00 64,074.00 264,888.00

9 Matron 1 11,037.00 11,037.00 132,444.00

10 Nurse 15 3,653.00 54,795.00 657,540.00

11 Health Assist 6 2,998.00 17,988.00 215,856.00

13 X-ray – Technician 3 3,653.00 10,959.00 131,508.00

14 Asst X-ray 2 2,998.00 5,996.00 71,952.00

15 Lab technician 4 2,998.00 11,992.00 143,904.00

16 Card room Staff 3 2,998.00 8,994.00 107,928.00

17 Asst Lab technician 2 2,998.00 5,996.00 71,952.00

18 Clinical social worker 1 3,653.00 3,653.00 43,836.00

19 Laboratory Techno-gist 1 3,653.00 3,653.00 43,836.00

20 Pharmacist 4 3,653.00 30,306.00 87,672.00

Supporting power - -

21 G/manager 1 26,680.00 26,680.00 164,160.00

22 HR personnel 1 16,662.00 32,662.00 55,944.00

23 Files &Documentation 1 2,404.00 2,404.00 28,848.00

keeper

24 Office 1 2,404.00 2,404.00 28,848.00

Administration/Secretariat

25 Administration&finance 1 6,809.00 6,809.00 81,708.00

head

26 Property Administration 1 5,304.00 5,304.00 63,648.00

exp.

27 Store Keeper 1 2,748.00 2,748.00 32,976.00

28 Purchaser officer 1 4,662.00 4,662.00 55,944.00

29 Procurement expert 1 7,304.00 7,304.00 63,648.00

30 Accountant 1 5,304.00 5,304.00 63,648.00

31 Finance officer 1 4,662.00 4,662.00 55,944.00

32 Main Casher 1 2,748.00 2,748.00 32,976.00

33 Daily cashier 1 2,748.00 2,748.00 32,976.00

34 Electrician 1 2,748.00 2,748.00 32,976.00

35 Drivers 2 1,828.00 3,656.00 43,872.00

36 Cooker 5 1,370.00 6,850.00 82,200.00

37 Laundry man 2 1,370.00 2,740.00 32,880.00

38 Janitors/Cleaners 8 1,370.00 10,960.00 131,520.00

39 Tailors 1 1,828.00 1,828.00 21,936.00

40 Kitchen supporters/wood/ 3 1,182.00 3,546.00 42,552.00

41 Gardener 1 1,182.00 1,182.00 14,184.00

42 Guards 8 2,500 10,960.00 131,520.00

43 Priest 1 1,182.00 1,182.00 14,184.00

44 Sub-Total 538,344.00 6,460,128.00

45 Pension contribution 710,614.08

Total budget 113 7,170,742.08

The envisaged plant creates 113 job opportunity and about Birr 7.17 million of income. Most of
the medical doctors stated in the above table will be recruited on a half day (i.e., 4 hours/day)
basis so as to attract those well-known personnel working in the public hospitals and private
clinics. Nurses can be recruited from the hospitals and clinics operating in the region. Moreover,
the private colleagues engaged in medical trainings in the region are also good sources of nurses
and pharmacists. The support staffs for the envisaged services shall be recruited from the specific
towns where the cardiac center is to about to be start function.

TRAINING REQUIREMENT
As most of the professional staffs are experienced in their profession, the center as such do not
require to train these staff at the startup phase. However, whenever new technologies and
machines are introduced, concerned professionals will be trained with regard to the technology
and trouble shooting. Professionals will be required to fulfill the national requirements to
practice and get uptodate trainings in the field as much as possible with the available
technologies online and in person trainings
FINANCIAL ANALYSIS

UNDERLYING ASSUMPTION

The financial analysis of our hospitalwould be based on the data provided in the preceding
chapters and the following assumptions.

A. Construction and Finance

Construction period 3 year

Source of finance 30% equity and 70% loan

Tax holidays 2 years

Bank interest rate 12%

Discount for cash flow 18%

Value of land Based on lease rate of TNRS

Spare Parts, Repair & Maintenance 3% of fixed investment

Overhead costs 15% of sales Revenue

B. Depreciation

Building 5%

Machinery and equipment 10%

Office furniture 10%

Vehicles 20%

Pre-production (amortization) 20%

INVESTMENT
The total investment cost of the project including working capital is estimated at Birr 145.2
million as shown in table 7 below. The Owner shall contribute 30% (Birr 43.5 million) of the
finance in the form of equity while the remaining 70% ( Birr 101.6 million) is to be financed by
bank loan.

Table 13: Total initial investment

Items L.C F.C Total

Land 381,660 381,660

Building and civil works 15,015,0 27,885,000. 42,900,00

00 00 0

Office equipment 9,365,23 9,365,238

8

Vehicles 10,822,1 10,822,14

46 6

Specialized Hospital machinery & 75,411,811 75,411,81

equipment 1

Total fixed investment cost 35,584,0 103,296,81 138,880,8

43 1 54

Pre-production capital expenditure* 1,242,21 1,242,215

5

Total initial investment 36,826,2 103,296,81 140,123,0

58 1 69

Working capital at full capacity 5,116,92 0 5,116,921

1
Total 41,943,1 103,296,81 145,239,9
79 1 89

*Pre-production capital expenditure includes - all expenses for pre-investment studies,

consultancy fee during construction and expenses for company‘s establishment, project
administration expenses, commission expenses, preproduction marketing and interest expenses
during construction.

The foreign component of the project accounts for 52% of the total investment cost.

SALES REVENUES FORECASTING

The project is expected to generate revenues from 10 % of customers seeking service in private
owned specialized hospital and the revenue expects to increase by 10% annualy with different
service capacity and initial commencement of production with 85% capacity. Revenues at
different capacity utilization levels are presented below

Table 14: sales for casting

Income category Sales Volume

Cardiac Surgery

Cardiac Catheterization

Pacemakers

General Surgery 21,959,373.74

Pulmonology and Nephrology 13,175,624.25

consultation 9,600,000.00

lab and Diagnostic 28,800,000.00

Total revenue 73,534,997.99

PRODUCTION COSTS
The total production cost at full capacity operation is estimated at Birr 30.6 million as detailed in
table 8 below.

Table 15: Production Cost

Items Cost

Raw materials 3,324,235

Utilities 131,150

Wages and Salaries 7,170,742

Spares and Maintenance 4,886,418

direct costs 15,512,545

Depreciation 13,925,134

Financial costs 1,167,194

Total Production Cost 30,604,873

FINANCIAL EVALUATION

PROFITABILITY
According to the projected income statement attached in the annex part (see annex 1) the project
will generate profit beginning from the first year of operation. Ratios such as the percentage of
net profit to total sales and return on total investment are an average of 39% and 24% in the
project implementation period. Furthermore, the income statement and other profitability
indicators show that the project is viable.
BREAKEVEN ANALYSIS
The breakeven point of the project is estimated by using income statement projection.

Accordingly, the project will break even at 9% of capacity utilization.

PAYBACK PERIOD
Investment cost and income statement projection are used in estimating the project payback
period. The projects will payback fully the initial investment less working capital in 4 years.

INTERNAL RATE OF RETURN AND NET PRESENT VALUE

Based on cash flow statement described in the annex part, the calculated IRR of the project is
21% and the net present value at 18 % discount is Birr 14,682,959.73

Table16 ; cash flow statement

values years

initial investment
(145,239,989.40)

Return from first year

36,395,119.01

Return from second year

42,562,233.28

Return from the third year

34,542,241.28

Return from the fourth year

34,542,241.28

R
34,542,241.28 eturn from the fifth year

Retu
34,542,241.28 rn from the sixth year

Retur
34,542,241.28 n from the seventh year
 Retur
34,542,241.28 n from the eighth year

34,542,241.28 Return from the ninth year

Retur
34,542,241.28 n from the tenth year

NPV 14,682,959.73

IRR 21%

Sensitivity Analysis

The envisaged specialized Hospital is profitable even with considerable cost increment. That is
the specialized Hospital maintains to be profitable starting from the first year when 10 % cost
increment takes place in the sector.

ECONOMIC AND SOCIAL BENEFIT AND JUSTIFICATION

Expected Contribution of Project to Economic Development treated with the contribution in
GDP, employment, tax to Government, its contribution in saving the hard currency of the
country and stimulating factor to other sectors. Many of our patients go abroad for advanced
cardiovascular care due to lack of such ervices in Tigray.

Implementing this investment project has a long lasting impact on the socio-economic conditions
of the local, regional and national communities. The expected contribution of the project to
economic development is briefly described as follows.

GROSS VALUE ADDED (GVA) TO GDP

The GVA, also known as the localized gross domestic product (GDP), is a measure of the
value of goods and services produced in an area, industry or sector of the economy. It takes
into account the following:

• Net profits;
 • Depreciation; and

• Salaries and wages.

The GVA is an indication of the economic activity that can take place in a certain geographical
area, brought about by the establishment or operation of a venture. GVA is calculated by
adding the average annual net profit, depreciation and salary spend. The GVA for this project
is expected to be average at ETB 55,487,404.30 per annual and a total of birr 554,874,042.97
during its life time.

EMPLOYMENT
Based on the number of people needed to operate the operations, management and support
staff, the project could yield 113 direct job opportunities. In addition, the impact multiplier for
jobs in the medical sector is 1.3 – therefore, in addition to the direct jobs created, this project
could contribute to the livelihoods of 339 people.

TAX TO THE GOVERNMENT

The project is profitable since the beginning period, accordingly it will generate a tax revenue
at average birr 11,843,054.15 per annum and a total of birr 118,430,541.53 during 10 years
time.

CONTRIBUTION TO HARD CURRENCY

The envisaged project is totally characterized with nature of a broad sabroad medical service
substitution industries and 50 % of its services has vital role in saving US dollar a total of us
dollar 3,416,300.79 in its project during 10 years .

STIMULATE OTHER SECTORS OF THE ECONOMY

Investment projects on health sectors are well known for their role in stimulating other
economic sectors. Hence, the Cardiac and medical hospital will contribute significantly to
boosting Medical Tourism, healthy Food and beverage as well as boost the development of
pharmaceutical industries locally and internationally. No doubt, these sectors will contribute to
solve the growing unemployment status of the generations to come.
SOCIAL RESPONSIBILITY
The envisaged project is planning to allot 10% of its net income to social health development
of Tigray and its surrounding area. Accordingly, the project is expected to contribute at
average Birr 3,552,952.83 per annual for health service facility sponsorship for low income
part of the community.

PROJECT IMPLEMENTATION SCHEDULE

The promoter will implement the project on the basis of the planned activity schedule and the
detail timeline is shown in table 17 below.

Table. Project Implementation Action Plan

Project Implementation Schedule

S. Year 2024 Year 2025

N Activity 1 1 1 1 1 1
4 5 6 7 8 9 1 2 3 4 5 6
0 1 2 0 1 2

Loan processing &

1
sanction

Machinery and
2
Equipment
 Importation of Raw
3
Materials

Procurement of
4
Vehicles & Furniture

5 Machinery Erection

Manpower
6 Recruitment and
Training

Test-Run and
7
Commissioning

Commercial ization
8
the service