KUWAIT MEDICAL CENTRE

Location
The Proposed Medical Centre is located in northern region of Pakistan
namely Gilgit-Baltistan.

Located in the high peaks of Karakorum and

Himalayas range, it has remained cut off from the outside world for centuries
till the construction of KKH. This highway passes through a winding route
along Indus river in one of the most difficult and inhospitable terrain. The
highway goes straight to the Chinese border Khanjrab Pass. At 30 KM short of
Gilgit it branches off with the Indus river to east to Siachin and two districts
of Ghanchey and Skardu. The region has international borders with Chinese
region of Xinjiang, Wakhan corridor of Afghanistan and an active control line
with India India held Kashmir.
Geopolitical Importance
The location of this area has a geopolitical importance as it provides
future commercial corridor for China that connects to Gawader port through
road network of the country. Once made operational this will facilitate the
transportation of the Chinese products of the entire western provinces to the
international market that is not only economical in terms of transportation
cost but also has the added advantage of time saving. The proposed highway
to Tajkistan by crossing the Wakhan corridor the area will also open to the
region for trade and commerce Asian countries to the rest of the world.
The control line along the Chinese glacier and Kargil poses a constant
threat of conflict with India. The losses are caused to both sides more due to
the weather than any clashes. If the situation settles down and the land if
route to Kargil is opened it will set off an immense activity in the tourism
industry as the tourists visiting these areas to see mountainous range in this
entire region will have a very convenient route of traveling through Pakistan
to an India destination and also from India to Pakistan and to their
destination. This economic activity will bring prosperity to the area.

This area has also huge natural resources of minerals that include
copper, gold, marble, granite and semi-precious stones as well as potential
of about 50-70 thousands MGW of hydro power energy. The government of
Pakistan is already working on mega hydro power projects of Bhasha, Bunji
and Astore.

This has attracted the international attention of the investors

and also the other countries due to its natural resources and its strategic
location.
History and the People
Gilgit-Baltistan consisted of small states and principalities under the
suzerainty of Dogra rule of Kashmir in 1947. In that year historic
developments were taking place in British India and the Muslims wanted a
separate homeland. The local population which is 100% Muslims also seized
this opportunity and rose against the repressive Dogra rule and after a long
struggle of almost more than a year with very limited resources liberated the
entire area and declared its independence and later on joined Pakistan. The
area technically is still part of State of Jammu and Kashmir and is considered
as a disputed territory and has no representation in the Pakistan Parliament.
The Government of Pakistan however has the de facto authority for the area
and in the year 2009 promulgated a Self Governance Order for the area that
now has a Chief Minister selected by the Gilgit-Baltistan directly elected
Legislative Assembly. There has been substantial enhancement in the powers
of the local Government structure. The future of the area is linked with the UN
Resolution for holding free and fair plebiscite of the entire state of Jammu and
Kashmir. This has not happened and the people are now demanding the
merger of the region as a province with Pakistan.
Ethnically the people of Baltistan are a mix of Tibetant descent of
Mongols and Arians while the districts of Gilgit population are Arians. Multiple
languages that include Balti, Shina, Brushiski and Wakhi are spoken in the
area. The total population based on 1998 census with annual growth 3.2% is

now ____. The entire population is Muslim with all the sects i.e. Sunni, Shia,
Ismaili, Ahle Hadis and Noor Bakhshia.
The region has a stunning landscape with very good weather in
summers and abundance of fruits but due to scarcity of cultivable land and
has remaineds cut off from the rest of the world due to the towering
mountains around it, the population has for decades lived on subsistence
farming. The ravages of harsh winters add to their miseries and in the
absence of education and health facilities they have suffered for a very long
time. Even after independence in 1947 the area was neglected and had very
limited any facilities for education and health.
Marafie Foundation
The KKH however opened the area to the world in seventies. In the
year 1986 the members of the Marafie Foundation family visited Baltistan
and touched by the abject poverty and lack of health and education facilities
started its philanthropic work in Baltistan.

Its activities have now been

extended to districts of Astore and Gilgit. In order to serve the people a Trust
was created that works across the ethnic and religious divide for humanity at
large. Its vision is to work together for humanity. Its mission is to alleviate
poverty through investment in health, education and other community
support projects. It emphasis is on providing health facility and education and
targeting female population because the Foundation feels the healthy
mothers is essential for any successful community. The Marafie Foundation
Pakistan is governed by a Board of Trustees of the locals with representation
of Marafie family as Patron Trustees.

The Board lays down the policy

guidelines and identifies the sectors that need attention. First Chief Patron
Trustee Mr. Abdul Fateh Marafie realized the need to compliment and
supplement efforts of the other players in the field for providing health and
education services. He therefore initiated a very close working relationship
with the government and filled in the gaps that were impeding their efforts
due to shortage of resources. A very balanced and calibrated relationship
with the public sector was therefore built to obtain the optimum results from
limited resources. His novel approach produced impressive results and that

has brought about lasting positive change in the lives of people living in the
project area.

This change is now being extended to the rest of the region.

He was a pioneer of the Public-Private partnership concept for the first time in
Pakistan. Presently the present Chief is Abdul Ilah Marafie has consolidated
the achievements of the Foundation and has built solid relationships with all
the stakeholders. This with time has resulted in phenomenal development in
education and health sectors.
An over view of the achievements of the Marafie Foundation are given
in the slides.

Health Facilities Available in the Region

The entire region has a total ______ hospital and _______ dispensaries.
All these facilities are in public sector with the exception of some areas in
and Ghizer where Aga Khan Health Support Program has provided medical
facilities of _______ hospitals and _________ dispensaries/MCH Centres.
The health facilities available in the public sector available to the
common man, is faced with the endemic problems of resource constraints
resulting in shortage of medical supplies and medical equipment. Moreover
there is acute shortage of specialists particularly the female gynecologists.
This has father aggravated the situation for the female population who are
traditionally neglected.
Marafie Foundation has been supporting these facilities by providing
medical supplies, budgetary support and purchase of equipment.
The problems of the health sector are summarized below:Financial Constraints
The local Government of Gilgit Baltistan has very limited budget and
out of this allocation it is not possible for it to meet the financial requirement
of these hospitals with the result there is always a shortage of medical

supplies, staff particularly for Maintenance/cleanliness and availability of

required specialists particularly the female Gynecologists.
Poor Quality of Services
This resulted in poor quality of services for treatment of the patients.
Absence of any credible and quality diagnostic facilities
Quality-Diagnostic Services are just not available as the hospitals do
not have necessary equipment nor the consumable goods/kit required for
running such facilities.

Non-availability of female gynecologist

Due to non-availability of female doctors and nurses staff the female
population suffered most with very high rate of mortality during child birth
and of the infants.
Absence of specialist
Since there are no specialists in some of the important disciplines,
serious medical cases go unattended like plastic surgery and pediatrics and
cancer.
Kuwait Medical Centre
In order to address these problems and fill a serious gap in the health
services structure in Baltistan and also in the entire region including 4
districts of Gilgit, Marafie Foundation has taken up construction of State of
the Art Hospital of 300 bed hospital with all the required facilities. This was
necessary because the existing facilities are insufficient with serious
inadequacy in the health services as well as quality of services available.
In order to integrate public sector and forge public-private partnership
we approached the government of Gilgit-Baltistan. After a lot of persuasion

the local government has provided a piece of land at a central location in

Skardu town measuring about 30,000 square meters free of cost. The market
value of this land is Rs.100 million.
After taking over the possession of the land Marafie Foundation has
completed the following steps:i)

Detailed topographic survey of the land.

ii)

Preparation of a master plan by engaging a professional

company of Architects.

iii)

Extensive consultation with a team of doctors who provide

voluntary services to the Marafie Foundation.

iv)

Appointment of a doctor as consultant to coordinate with the

architects.
In the first phase of this project the main block and the services

building with wards for 100 patients and the essential residential
accommodation for the members of the staff will be taken in hand and
completed within three years.

The main block has the State of the Art diagnostic facilities that
broadly include radiology, blood bank and laboratory. The hospital in
addition to the indoor treatment of the patients will provide the quality
and credible diagnostic facilities which are practically not available in
the entire region.
Staffing
There will be a permanent staff of the doctors and specialists
who will be dealing with cases of gynecology, pediatrics, medical
specialists

and

general

surgeons.

For

other

specialties

regular

specialists will come in rotation from Lahore and Islamabad for ten
months except for two winter months i.e. December and January. The
treatment by the doctors coming on rotation will be holding medical

camps and will provide the much needed treatment in high specialties
at the door steps of the people of the region.
Area to be served
The catchment area for the population will not be confined to
the Baltistan but also be available to the other four districts of Gilgit as
upcoming up-gradation and improvement of the road of Skardu the
journey to Skardu by road will be only three hours.

It will save the

people of the entire region from traveling to Islamabad from far flung
cities for treatment. Even now in medical camps of high specialties the
patients from Gilgit and Chilas are being treated.
Governance
The

hospital

will

be

run

under

the

Management

Board

comprising the following:i)

Chairman and four members to be nominated by the

Marafie Foundation.

ii)

Four members to be nominated by the Government of

Gilgit-Baltistan by designation.

iii)

Two members to be nominated for fixed period from the

civil society by consensus between both the stakeholders
i.e. Marafie Foundation and Gilgit-Baltistan government.

This Board will oversee the working of this hospital, lay down the
broad policy guidelines, approve the budget, appoint the auditors and
approve the annual audit report by external auditors.
Management of the hospital and arrangement of the funding
would however be the sole responsibility of the Marafie Foundation through
this Board.
Sustainability

The challenge for this hospital is to sustain the operation and ensure
quality services to the population of the entire region who are faced with
common problems of lack of facilities in the health sector and travelling to
Islamabad is difficult and very expensive.
In order to sustain it regular flow of income need to be ensured and
matched with the requirement of free treatment to the poorest of the poor
through cross subsidy.
In order to generate the resources the following frame work has been
determined:i)

The patients visiting the hospital will make full payment of the
charges to be determined by the Management Board keeping in
view the actual cost and minor addition of some profit for cross
subsidy for the poor.

ii)

The hospital will also seek donations from philanthropists and

funding from Zakat and Baitul Mal.

iii)
iv)

Government grants.
Budget allocation for hospital will however be ensured by the
Management Board. Even the poorest of the poor will make
payment for the treatment. Marafie Foundation will however
fund the treatment charges from the profit of the hospital and
donation/allocation from other sources. This will be done through
an independent committee outside the management structure
of the hospital.

Financial Layout for 1st phase

The first phase will that include the full facilities of diagnostic,
operation theatres, emergency, physicians block, ancillary services and

residential accommodation for the essential staff with 100 beds ward will cost
approximately US $ 7 million.
The cost of equipment including transportation and ancillary services
will be US $ 300 million. Operational expenses for one year will be US $
500,000.
Source of Funding for the project

Present donors will continue their support for the project.

Seek donation from multinational and other business entities as part of

their corporate social responsibility.

Seek support from the donors who are investing in the NGO sector in
Pakistan.

Government grants and funding support.

Equipment from international donors (DRI). They have already

committed the provisions of hospital beds and instruments

New donors from Kuwait.