OBSERVATION ON MASS SUBMISSION ON

Revised Programming Report for

SAMAJIK HEALTH COMPLEX

on 18.05.2020
 PART-B

POINTS THAT NEED TO DISCUSS WITH

ADVISORY COMMITTEE

Page 1 of 17
 1. Comments from Grameen

Comments by
Page MASS/ CHAI
Grameen (for
no. of Page Key Comments Grameen’s
SL.NO. Review Particulars consideration
MASS Content Observation
only not
report
bindings)

In page 65,
Daybeds Surgery: The 171 bed
45 (including counts had
Ophthalmology included
We noticed a discrepancy beds 20); but in those in the
in Day bed count. Here page 67, Daybeds departments Grameen’s
(Page 65), Day bed is Surgery: 25 mentioned
feedback is
shown in the surgery as well as
ready
department, Medicine & OPD. The
1.12 # 65 (Referred to
ICU and OB-GYN Please note that bed total day
department respectively quantity for beds will be Bed
(45+53+36) which is total Emergency changed Distribution
134 nos. instead of 171 Department will based on the Sheet)
(Ref page 68) not be additional
considered in the feedback
total bed given by
estimation for Kishwar
the hospital.

2. Grameen Comments

Comments by
Grameen (for
SL. Page no. of Review MASS/ CHAI Grameen’s
Page Key Content consideration
NO. MASS report Particulars Comments Observation
only not
bindings).

2.3 # Key Departmental In the page # For Noted - MASS Need to

70,80,81,112 Adjacencies; Main Lobby; 70, Radiology Consideration will refine this discuss about
Outpatient department diagram and departmental
should be departmental adjacencies
nearest/ and
adjacent to ER programmatic
department adjacencies
which is not desired
shown in the during

Page 2 of 17
 Comments by
Grameen (for
SL. Page no. of Review MASS/ CHAI Grameen’s
Page Key Content consideration
NO. MASS report Particulars Comments Observation
only not
bindings).

Concept
diagram.
Design Phase

Depending on For
the Consideration
completion MASS will
Alternatively,
timeline of incorporate
you may use
the feasibility as much as It is under
health bulletin
study, which possible. process and
Limitations and of DGHS 2018
2.4 # 141 observations What is the will let be
Considerations or 2019 for
and analyses expected known soon.
rapid
can inform completion
assessment or
programming date?
same
and concept experience
design? from the other
studies.

3.Observations by Grameen

Page
SL. Grameen comments
no. of Page Key Recommended MASS/ CHAI Grameen’s
(for the considerations
NO. MASS Content Particulars Comments Observation
only not Bindings)
report

Please follow
recommendation of
Among the three BMDC in general with Grameen’s
criteria, Medical some special inclusions feedback is
College Hospital as per internationally Noted - BMDC ready
Bed Count requirements need to tested and
3.2 # 68 requirements (Referred to
Comparison be considered – as it is recommended shall be met. Bed
a teaching hospital. suggestions
Distribution
Ref: Pls see Bed Sheet)
allocation table in
below. (Point 4.1)

Page 3 of 17
 Page
SL. Grameen comments
no. of Page Key Recommended MASS/ CHAI Grameen’s
(for the considerations
NO. MASS Content Particulars Comments Observation
only not Bindings)
report

Followings are
preferable- Grameen’s
● Decentralized feedback is
These are precedence ready
Staff Support
Hospital of other international Noted with
3.6 # 73 Spaces (Referred to
Precedents Hospitals. May be agreement
Manpower
● Integrated considered.
Sheet)
Patients’ Attendant
Space in Wards (if
space permits). ??

Need to
discuss the
following:
On #78, option A is  Oxygen
The Modular Ward -
preferred. supply &
Option A is preferable
A Modular as it allows better suction
3.9 # 78 Noted facility will
Ward visibility from nurse
Every bed in ward
station and without be
should have central preferred
balcony.
oxygen supply and for every
suction facilities. bed or
alternative
bed?
3.15 # 91 Intensive Care The Internal Medicine In 500 bed hospital, at Final bed Grameen’s
ICU bed is preferred to least 20% ICU bed is allocation and feedback is
as per bed allocation required. distribution to be ready
table. confirmed by
Except PED & CARDIAC (Referred to
Grameen and
Ref: Bed allocation (CCU) all other ICU can Bed
MASS
Table stated below. be centralized. Distribution
Sheet)
Some standard
internationally
recommended guideline
for allocation would be
preferable.
Need clarification from
MASS for having only 20
ICU beds. Standard
Guideline to be

Page 4 of 17
 Page
SL. Grameen comments
no. of Page Key Recommended MASS/ CHAI Grameen’s
(for the considerations
NO. MASS Content Particulars Comments Observation
only not Bindings)
report

followed.
The standalone IVF
center under Maternal
Health & Center of
Excellence is needed to
consider. Noted - We will
integrate a
standalone IVF Need to
Questions: center and will discuss
This is high demand for aim to position it about the
To help us size the Infertility Center (IVF)
3.19. # 107 OB-GYN to be accessible questions
facility please identify:
IVF Center is needed. from both the
--# of OTs/procedure
OPD & IPD.
rooms for egg
Please see
collection and embryo
questions to the
transfer (1-2)
left.
--# of consult rooms (2-
4)
--# of patient recovery
beds (2-4)

Page 5 of 17
 Need to
discuss the
following:
As per Dr.
Need clarification
Rahman:
Geriatric care or
Bariatric surgery? The
Preference not to Geriatric
include Geriatric Care by The program was care is also
considering Bangladesh written for required for
will it be Geriatric Care
in place of Bariatric context, so it may keep Bariatric surgery old person
3.20. # 118 Out-Patient Care? the same as mentioned and will be like old
in the submitted report. changed to fall home .This
under General type of care
● Bariatric surgery as Surgery OPD is already
part of General
surgery should be available in
kept Bangladesh

The shared offices for

the following services Need to check: if we can
are needed to manage in-house or Dept. of Laundry
consider- outside the building but was considered
inside the campus. part of Need to
● 4/5 staff under Housekeeping
Shared Office of discuss
3.24 #134 Support Laundry dept. (12 ppl) - confirm
Ancillary Services
● 4/5 staff under if adequate.
should be designed
Waste Shared office is
based on number of
Management added for Waste
people
dept. Mgmt. Depts.

Page 6 of 17
Others Requirement by Grameen Stakeholders which is needed to include in the submitted report:

1. The Comparison Chart between the proposed programming for Samajik Health Complex (SHC) by MASS and
the Preliminary Functional Requirements which was previously sent to MASS by Grameen. This requirement
has already been requested to MASS during their visit in Dhaka on 09 February to 17 February, 2020.
MASS Comment: This shall be added to the Bed Count Comparison chart on pages 66-68 of the Programming
Report for review by Grameen. The aim is to reconcile these different requirements to reach a final bed count.
Grameen’s Feedback: Referred to Bed Distribution Sheet

2. The Staff Strength for both department wise and ancillary functions of the Medical College & Hospital including
the Nursing Strength are needed to be mentioned in the programming report of SHC project. This requirement
was included in the Preliminary Functional Requirements of the project which was sent previously to MASS by
Grameen.
MASS Comment: This will be added to the Programming Report from the Preliminary Functional Requirements
Grameen’s Feedback: Referred to Manpower Sheet

4. Bed Allocation Table

4.1 : Estimated Bed Allocation Table:

UPDATED DISTRIBUTION PER KISHWAR’S EMAIL - MAY 8, 2020
Grameen’s Feedback: Referred to Bed Distribution Sheet

4.1 : Estimated Bed Allocation Table:

Page 7 of 17
 Number of Dept wise
beds bed Min Bed Distribution
Bed Types With Remarks Grameen’s Observation
Samajik compliance Details
(proposed) BMDC
Standard 145 1. Medicine: Medicine Subspecialty:
Bed General ward:55
Cardiology
(WARD)
Internal Medicine
2. General Surgery
Gastroenterology
General Surgery
Pulmonary/Respiratory
Wards 60
Medicine
Endocrinology/
3. OBS & GYN
Diabetology
General ward 30
Neurology
Nephrology
Dermatology
Psychiatry
Oncology/Hepatology
Infectious Disease

Surgery Subspecialty:
General Surgery
Pediatric surgery
Orthopedics
Oncology
Urology
Neurosurgery
Plastic and Burn
ENT
Ophthalmology
Trauma

Recommendation: 60%
bed shall be allocated for
male and 40% bed for
female patients in wards.

Pediatric 55 Med 36, Ped Surgery 10 single room facility is

Ward 10, Others 9 (special recommended for high
cases) income patients

Semi 70 Med 15, Surgery 25,

Private/ OBS GYN 30
 
Shared
Superior
Single 80 Med 20, Surgery 15,
Private/ OBS GYN 25, Ped 20 High demand for middle
Superior (including 10 ped income patients
surgery)

Page 8 of 17
 Number of Dept wise
beds bed Min Bed Distribution
Bed Types With Remarks Grameen’s Observation
Samajik compliance Details
(proposed) BMDC
Deluxe 40 Med 15, Surgery 10, High Demand for upper
OBS GYN 15 middle-income patients

Suite 5  5 bed Under

medicine
HDU 10 Under medicine
CCU 20 Cardiology
(Cardiac Under Medicine
Care Unit)
CT ICU, CT 10 CTVS/ Cardio Thoracic
HDU
Under Surgery
(Cardio
Thoracic)
Surgical 10 Surgery
Under Surgery
ICU
Medical 10 Medicine and OBS
Under surgery
ICU GYN
Neonatal 10 Pediatric
 
ICU
Neuro ICU 10 Neurology/ Neuro
Surgery
Gen/ped 10 Pediatric/ Pediatric
 Under Surgery
ICU Surgery
KTU 6 Urology
(Kidney TP  Under Surgery
Unit)
LABOR 15 OBS & GYN
ROOM  
(SB)
LDR 5 OBS & GYN
(Deluxe  
room)
LDR 9 OBS & GYN
 
(standard)
 
Total Bed 520  

Page 9 of 17
 SL Specialty Compliance Allocation
Medicine: 186 (including CCU 186 (including
and Pediatrics) pediatrics)
OBD GYN 129 129
Gen Surgery 197 196
Pediatric special case 9

Note: We tried to accommodate the bed allocation as per compliance of three broad category; medicine,
Obs-Gyn and Surgery.

Day-care:

Day-care beds area for the following Specialty/ Allied Department:

Gastroenterology (Endoscopy): 20 beds

Nephrology (Dialysis): 20 beds

Ophthalmology: 20 beds
Oncology: 10 beds
General Day care: 10 beds (it is better to have 10 beds for day care for other clinical dept)

Note: Emergency and day care beds will not be counted as regular bed. These are all transient bed. Therefore,
these beds will not be counted under 500 regular (overnight) bed count.

MASS/CHAI Interpretation of revised table from May 8 is shown below. Programming will reflect similar bed
allocation. Revised day beds will be updated in the OPD section.

Grameen’s Feedback: Referred to Bed Distribution Sheet

Page 10 of 17
 5 Feedback only on MASS’s Inquiry

Page
MASS’s Inquiry to Remarks by
no of Page Key MASS/ CHAI Grameeen’s
SL.NO. Grameen & Clinical Grameen &
MASS Content Comments Observation
Advisors Clinical Advisors
report

● In these tertiary
care hospitals
at least 20 %
bed should ICU
bed.
This includes Medical
ICU, Surgical
ICU, Neuro ICU,
CT ICU, CCU,
Pediatrics and
neonatal ICU.
● Separate ICU
for Gyn and
OBS is not ICU beds updated Grameen’s
h) MASS asked for
necessary as per Grameen feedback is
the total number of
this patient can recommendations ready
ICU beds
be treated in
Hospital- (Referred to
5.2 # 92 Ref: Bed Allocation SICU.
Intensive Care table (Point 4.1) ● ICU beds can be Bed
● Dedicated Distribution
found in ICU
ICU for burn Sheet)
section and in
patient should be
pediatric section
in plan.
20% was
mentioned, 100
ICU Beds should
be okay

Preferably, 20-
25% of the total
number of beds.
This is as per min.
international
standards

Page 11 of 17
 Page
MASS’s Inquiry to Remarks by
no of Page Key MASS/ CHAI Grameeen’s
SL.NO. Grameen & Clinical Grameen &
MASS Content Comments Observation
Advisors Clinical Advisors
report

Bed allocation is Grameen’s

MASS asked for noted from table feedback is
confirmation on: 4.1 ready
i) How many of the
(Referred to
general surgery beds
Bed
should be ward,
Distribution
twin-share or single
Sheet)
cabins?

● Private Beds
Hospital- should be on
5.4 # 98 one Floor, but
Surgery easier to have Grameen’s
Sub Specialty feedback is
ii) Should the other beds in one area ready
surgery wards have of that Floor, (Referred to
dedicated private then specialized Bed
cabins? nurses etc. can Distribution
attend to Sheet)
patients properly
● Would
appreciate Floor
Plan

MASS asked for Additional

physician’s input to recommendations
determine if this from Grameen Grameen’s
type of OT can be welcomed during feedback is
housed here (in Concept Design ready
Hospital- cardiology (Referred to
5.5 # 100
Cardiology department) or if a Bed
full OT in the OT Distribution
complex is needed Sheet)
for minimally
invasive surgery
procedures?

5.7 # 112 Hospital- MASS asked for 10 Endocrinology Endocrinology and Grameen’s
sufficient data on & 10 Diabetology Diabetology beds feedback is
Out-patient
volume to estimate day beds are not will be removed ready
number of OPD actually required. from programming
(Referred to
consultation and These 20 beds Bed
procedure rooms can be Distribution

Page 12 of 17
 Page
MASS’s Inquiry to Remarks by
no of Page Key MASS/ CHAI Grameeen’s
SL.NO. Grameen & Clinical Grameen &
MASS Content Comments Observation
Advisors Clinical Advisors
report

transferred to
Sheet)
Dialysis unit.

All OPD Consultation rooms

will be changed
Consultation room
from 7 to 5. The
shall have exam
Child Development
facility with bed.
Center will be
● 5 Consultation moved to OPD.
Rooms are okay
● Conversion to
surgery is very
low
● Would
For Pediatric: recommend a
MASS asked for Child Grameen’s
additional Development feedback is
estimations to Center in that ready
Hospital- determine how Floor, with (Referred to
5.8 # 114
Out-patient many of these enough space Bed
patients will require for Special Child Distribution
surgery consults Development Sheet)
versus general Pediatrician,
consults. Psychologist
(specially
trained, and a
therapist-also
specially
trained).
● With a
Dedicated
Manager
● Floor space will
need to be
specified
5.11 # 117 Hospital- For Internal 5 consultants’ Programming will Grameen’s
Medicine: room, 2 Nursing be changed to the feedback is
Out-patient
MASS asked for assessment room recommended ready
confirmation on the 1 Isolation room rooms
(Referred to
number of

Page 13 of 17
 Page
MASS’s Inquiry to Remarks by
no of Page Key MASS/ CHAI Grameeen’s
SL.NO. Grameen & Clinical Grameen &
MASS Content Comments Observation
Advisors Clinical Advisors
report

2 procedure room Bed

consultations Distribution
1 store room
and procedure Sheet)
rooms required. Avg patient: 120-
125 per day
5 consultants’
room, 2
Endoscopy unit, 1
For anesthetist room,
Gastroenterology: 1 nursing Grameen’s
MASS asked assessment room feedback is
confirmation on ready
2 Colonoscopy unit Programming will
preference for
1 Report writing be changed to the (Referred to
flexible
room recommended Bed
procedure rooms for
1 ERCP+Fibroscan rooms Distribution
all procedure or if
room Sheet)
each procedure type
*Need endoscopy
needs a dedicated
day care facility
room?
with 20 beds.
Avg patient: 120-
150 per day.
For Positron Info not available -
Emission Noted -
MASS shall seek Need to
Tomography (PET): Recommendation
Hospital- recommendation of discuss
MASS asked for of medical
5.16 # 123 Imaging & medical
confirmation on professionals to be
Diagnostics professionals
What is the ratio of followed
uptake rooms to PET
imaging rooms?
5.27 # 176 Medical Office: Yes, It is required Noted and updated
College- MASS asked for in the programming
Need to
Academic clarification: report. Note: This
discuss
Surgery i) Will a space is not
Department departmental required by BMDC
meeting room for Standards therefore
the staff be for space efficiency
required? purposes it may be
removed during the
design and
recommend staff to
use the common

Page 14 of 17
 Page
MASS’s Inquiry to Remarks by
no of Page Key MASS/ CHAI Grameeen’s
SL.NO. Grameen & Clinical Grameen &
MASS Content Comments Observation
Advisors Clinical Advisors
report

room.

6 FEASIBILITY STUDY recommended by MASS

6.2.The appropriate number deliveries and corresponding OT needs in OBS-GYN department of the hospital . (page
#109)

● 10 Deliveries /per day

● 2 Labor OTs
● Gynae OT may be a common OT

No. of deliveries would again be dependent on a detailed healthcare demographic study. Yet we may have to
dedicate approx. 2 OTs for OBS-GYN other than the labour rooms.

MASS’s programming will reflect a change from 7 dedicated OBS-GYN OTs to 3 OTs total. We will dedicate 2 labor
OTs for OBS-GYN. Of those 2 dedicated OB OTs, one will be septic. 1 GYN OT will be dedicated to the department but
can serve as a general OT and be flexible for OB, GYN, and other surgeries.

Grameen’s Feedback: Referred to Bed Distribution Sheet

8.OTHERS RECOMMENDATION for MASS to Design

● The actual area required by a hospital bed is 2m 2. However, the area required for each bed in a ward, where space
must be allowed for nursing and general circulation, amounts to about 6 m 2. For each nursing unit of 20-30 beds,
other facilities such as toilets, shower, pantry, duty room, examination room, storage and utilities must be
included, thus, bringing the total floor area per bed required in the inpatient department to 8 m 2 When other
essentials for inpatients are added, such as outpatient department, laboratory, imaging and support services ,
kitchen, laundry, CSSD, stores are taken into consideration the total floor area required per bed increases to
approximately 70 m2 . These figures vary according to the site and the facilities provided. Staff housing is not
considered on the above figures. (should follow Indian guideline 100m2)

Page 15 of 17
 Need to discuss to confirm the required area for hospital bed.

Noted with agreement - an average of 100m2 per bed has been assumed for the overall hospital facility.

Page 16 of 17