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Projet d`Appui au Développement Local dans le Nord

1. Fire extinguisher holder one at driver s side and one in back compartment Inflow outflow fan fixed in roof for ventilation on compartment Sanitary system with 20 L clean water tank stowed under bench Portable stretcher spine board holding brackets Stretcher securing mechanism brackets One 12 volts DC outlet Siren and public address system at the driver s console 2 way intercom Rear projector loading light 55 W Flashing Light system dome beacon or bar type fixed on roof Patient side windows to have glazed opaque screen Logo of Cross and Crescent and labeling Ambulance and Wadi Khaled Social Services Center in English and Arabic in reflective adhesive material Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 115 of 127 Medical equipment and supplies e 2x2 Kg fire extinguishers e 2x E size aluminum oxygen cylinders with flow meter and mask e Immediate Emergency Response Care Pack professional trauma bag with supplies e Burns kit e Blankets e Retraining belts e Splints set 2 x 22 cm 2 x 45 cm and 2 x 90 cm e Resuscitation equipment including Ambubag laryngoscope ophthalmoscope and defibrillator e Flashing Light system dome or bar type fixed on roof e Patient side windows to have glazed opaque screen e Spine board with restraints e Foldable heavy duty and light weight cot type patient stretcher with body straps 12 cm thick mattress with
2. Kit d urgences et de secours ts lobed 50s 3 se 3E seze Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 7 of 127 1 INTRODUCTION Lebanon can strike many as a vibrant and modern country where the quality of life is of high standard sometimes rivaling that of the prosperous western countries Behind that facade lays a disturbing and bitter reality Outside Beirut and the largest towns Lebanon is truly a third world country Indeed its rural areas especially the remote villages are heavily neglected if not forgotten by the central government and its agencies It s only at the onset of political events that these areas are briefly remembered empty promises of development and would be prosperity pour in to attract support from the locals only to disappear after the events are over and done with The Northern Parts of the country Akkar Dannieh and Hermel constitute pockets of poverty that have attracted local ministries NGO s and World Financial institutions that performed numerous local evidence based needs assessments and studies to try to provide possible solutions to ongoing problems The needs are great and they involve all aspects of daily life There are shortcomings in governmental services basic utilities and infrastructure Power roads transportation water sewage waste management communications healthcare and health education social services education career advan
3. AL AMAYER MOSA PHC dut The population of Wadi Khaled was naturalized Lebanese in 1994 It is mainly composed of Arab Ashaer The Atik and Ghanem tribes spread across the Lebanese Syrian border Most of them are impoverished and rely on either agriculture or smuggling to survive Also most citizens of Wadi Khaled consider Syria as their second country mainly due to the porous geography with no true boundary relatives living in Syria cheaper living costs and most of all because Higher taxes in Lebanon and the lack of government assistance infrastructure and meaningful development As an example it is easier faster and cheaper for the Wadi Khaled inhabitants to the nearest Syrian town Homs and Tal Kalakh then to go to the closest Lebanese town Halba 45Km away for sourcing their basic needs foodstuffs building materials medical care medicine and fuel Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 14 of 127 However today with the ongoing crisis in Syria these activities are stopping because of the dangers involved Shooting bombardments and land mines It is affecting the supply of cheaper merchandise and commodities from Syria adding to the hardships of this deprived population The influx of Syrian refugees is also adding to this Burden Today they are desperately relying on any form of help that reaches them On the positive side there is hope that the new generations will
4. GFAA O A E INITIAL FEASIBILITY STUDY FOR THE EXTENSION OF HEALTH SERVICES IN WADI KHALED CLUSTERS ASSESS THE TECHNICAL FEASIBILITY OF THE HEALTH CARE CENTERS PROJECTS IN WADI KHALED CLUSTERS ADELNORD PROJECT DIN IAT SA Wadi Khaled N K X X T X Projet d Appui au D veloppement Local dans le Nord du Liban ADELNORD Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 1 of 127 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 2 of 127 TABLE OF CONTENTS Acronyms abbreviations and glossaries 1 WOON DU BWN m e 11 12 13 14 Introduction Mission Information And Objectives Methodology Overview background information Sites visited Evidence gathered from visits and meetings Health Situation and Indicators PEST analysis SWOT analysis Primary Healthcare minimum requirements design planning and operation a generic model Projects Feasibility Start up phase list of prioritized needs Recommendations Conclusion Appendix 1 Photographs from sites visited Appendix 2 Proposed layout for the ER at Al Hishi Makassed PHC Appendix 3 Generic room Layouts for PHC Appendix 4 Technical Specifications for proposed equipment start up phase References Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 4 7 Page 8 9 Page 9 12 Page
5. Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 18 of 127 6 1 4 Al Hishi Welfare Dispensary 15 02 2012 e Privately owned center e Claims to be a welfare center and charges basic fees for services e Center consists of a ground level floor with 5 rooms worn out Water seepage mildew and scraped paint e A pharmacy a dental clinic installed following our visit a laboratory and 2 examination clinics e Doctors come from nearby towns and from Syria most bring their own diagnostic equipment e Center front is a Pharmacy Store with groceries and drugs mostly from Syria e Nota serious Health Center but more a business 6 2 Wadi Khaled Eastern Cluster 6 2 1 Al Amayer Social Services Center e Owned funded and managed by the Ministry of Social Affairs MOSA e Managed by a MOSA appointed public official e Centrally located in the eastern cluster e Center is part Healthcare and part vocational Educational e Center consists of a ground level Building built in the 1960 s With a large yard surrounding it recently transformed as a playground for children and patients with DRC funding e Facilities are much below standard especially concerning the basic hygiene requirements The walls are cracked seeping water with heavy traces of mildew growth e Lack of a handicapped access ramp e A pharmacy a dental clinic a laboratory and 3 examination clinics e Health Services General Me
6. 3 000 00 MEO100 Syringe Pump 2 1 200 00 2 400 00 MEO101 Crash Cart with Defibrillator and all accessories 1 9000 00 9 000 00 ME0046 ECG 12 Channels 1 3500 00 3 500 00 ME9990 Bowl Stand Double SS 1 245 00 245 00 ME2022 Portable Transport ventilator 1 10 000 00 10 000 00 TOTAL 49 625 00 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 38 of 127 List ME 02 Minor Treatment and Procedure Room Item Reference Description Quantity Unit Toa Price Price ME0011 Oxygen Flow meter 0 15L Min 1 90 00 90 00 ME0010 Air Flow meter 1 90 00 90 00 ME1004 Operating Light Small Ceiling Mounted 1 5000 00 5 000 00 ME0060 Patient Monitor 1 5000 00 5 000 00 MF0100 Double Step Stool 1 75 00 75 00 MF0080 I V Stand Mobile 1 70 00 70 00 MF0010 Step On 12 to 15L waste bin with lid 1 20 00 20 00 ME0051 Patient Stretcher 1 2500 00 2 500 00 ME0070 Diagnostic Set 1 565 00 565 00 MF0020 SS Treatment and dressing cart 1 240 00 240 00 MF0011 Trolley Soiled Linen Single with Lid 1 170 00 170 00 ME0021 X Ray Viewer Single 1 130 00 130 00 ME0013 Suction pump electric 2 jars 1 1 500 00 1 500 00 MF0021 Kick bucket 1 140 00 140 00 ME2000 Electro Surgery Unit 1 6 000 00 6 000 00 MF0027 Mayo table 1 190 00 190 00 ME0100 Infusion Pump 1 1 500 00 1 500 00 ME0101 Syringe Pump 1 1 200 00 1 200 00
7. ME0046 Cast Cutter Plaster Saw 1 1 400 00 1 400 00 OE5654 Vacuum Cleaner wet dry 1 330 00 330 00 MF0022 Bowl Stand Double SS 1 245 00 245 00 MF0028 Plaster cart 1 475 00 475 00 TOTAL 26 930 00 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 39 of 127 List ME 03 Basic Clinical Laboratory equipment Item Reference Description Quantity ae ERE LBO100 ae Biochemistry analyzer Open 1 7 000 00 7 000 00 LBO101 E Hematology Analyzer 3 parts 1 10 000 00 10 000 00 LB0010 Centrifuge Bench top 2 2 200 00 4 400 00 LB0800 Routine Microscope 1 2 000 00 2 000 00 LB0102 Semi automated Coagulation analyzer 1 6 000 00 6 000 00 LB0105 Spectrophotometer 1 3 500 00 3500 00 LB0030 Incubator 1 1 500 00 1 500 00 LBO600 Pipettes set 5 2 800 00 1 600 00 MEO0650 Benchtop autoclave 30 L 1 5 000 00 5 000 00 LBOO20 Hot plate Stirrer 1 350 00 350 00 LBOO21 Water bath 10 L 1 800 00 800 00 LBOO040 Tube roller Mixer 1 600 00 600 00 LBOO41 Vortex Mixer 1 250 00 250 00 LB0042 Bunsen Burner 1 75 00 75 00 LB0343 Timer 1 75 00 75 00 LBO108 Manual differential counter 1 350 00 350 00 LAO001 Start up glassware and durable accessories 1 750 00 750 00 Start up Consumables accessories Syringes Slides LAO002 Petri dishes sample cups Blood
8. Minor Wound Management Strip Bandages 100 Knuckle Bandages 50 Fingertip Bandages 50 X Large Bandages 25 Cotton tipped Applicators packet 2 pack 5 Butterfly Wound Closure Strips 10 Sterile Wound Closure Strips cards 2 Moleskin 1 sheet of pieces 1 Antiseptic Wipes 100 Triple Antibiotic Ointment Packs 1 g 25 Hydrocortisone Cream packs 1 g 10 lodine Wipes 50 Sting Relief Pads 10 Tincture of Benzoin Swabsticks 2 Bandage Materials Non sterile 5 x 5 cm Gauze Pads 200 Sterile 5 x 5 cm Gauze Pads pack 2 pack 25 Bloodstopper style Compression Bandage 2 25 x 75 cm Multi Trauma Dressings 2 Feminine Napkins 4 5 cm Conforming Gauze Rolls non sterile 12 Sterile 10 cm Krinkle Gauze Rolls 4 Triangular Bandages with safety pins 12 Safety Pins 10 8 cm Elastic Bandages with Clips or Velcro 2 2 5 cm x 10 m Silk Style Cloth Tape 2 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 42 of 127 List ME 06 Immediate Emergency Response Care Pack cont Description Quantity Splinting 90 cm Padded Moldable Aluminum Splint Padded Moldable Finger Splints Cardboard Arm Splints Cardboard Leg Splints Adjustable Neck Collar Adult Adjustable Neck Collar Pediatric PiPIN ININI FR Burn Irrigation Antbacterial gel 10 x 20 cm Burn Dressing Antbacterial ge
9. MOSA have started and funded projects with the help of foreign donation and grants but never followed through for sustained outcomes The best example would be to compare the Al Hishi Makassed Managed PHC Owned by the MPH and the Al Amayer MOSA owned and managed PHC The first is the only descent center offering a good bundle of services and essential drugs for the needy population despite the many gaps The building is well maintained and is very clean Well as the Al Amayer PHC the building that was built in the 1960 s is in bad shape there are water leaks cracks in walls and structure beams and columns it is poorly equipped essential drugs supplies are not regular the MOSA sends what it has in its warehouses and most of the times the drugs sent do not respond to the needs of the population This is a typical example of government neglect Lacks of decent facilities most buildings are not well finished or maintained Total absence of hygiene Except for the Al Hishi PHC Except for the Al Hishi PHC all the other PHCs and dispensaries lack essential medical equipment for performing even basic laboratory tests etc Even more important there are just not enough trained and qualified doctors and medical staff to adequately serve this rural population Doctors from nearby towns mainly Halba and Qobaiyat are reluctant to travel to let alone live in impoverished remote areas Absence of any financial incentives to convince medical sta
10. Power crest factor Coagulation gt 8 Cut 1 Separate controls for cut coagulation and bipolar Adjustable homeostasis in cutting mode Foot switch amp switching handle in mono polar mode Foot switch control for bipolar mode Supplied with Double foot pedal cutting coagulation Patient plate with cord Foot control cutting amp coagulation handle 1 Set of electrodes ball knife needle Isolated bipolar forceps with cable Bipolar Foot Switch Manuals Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 105 of 127 e Power supply 220 240V 50 Hz MEOO060 PATIENT MONITOR A bedside vital signs monitor for adult and pediatric patients undergoing cardiac catheterization requiring special care under that environment The monitor shall have the following features and specifications e 10 inch display e Color LCD EL or TFT type display e Minimum resolution 800 x 600 pixels e Upto six waveforms e With networking capabilities via LAN network e Interface to connect to central station should be included e Preconfigured or Modular preferred e Must include the following parameters o ECG RESPIRATION N I B P Non Invasive Blood Pressure SpO2 Pulse Oximetry TEMPERATURE DUAL I B P Invasive Blood Pressure CARDIAC OUTPUT CAPNOGRAPHY CALCULATIONS amp ANALYSIS TRENDS O O OO Q Oo QO Q Oo e Graphical and tabular type e Memory Storage min 24 hours e Datainterva
11. Tube with automatic changeover e for small focus in fluoroscopy e Iris shutters for fluoroscopy automatically selectable e Fluoroscopic Patient Radiation Dose Display C arm Fully balanced system Height adjustable gt 50 cm motorized Horizontal movement 20 cm Scanning horizontal plane 20 e Carm rotation 180 C arm Angulations Orbital movement gt 200 e SID gt 95 cm I I TV system e 9in H R Image Intensifier with fiber optic coupling e l Magnification 9 in 7 in and 5 in fields e Image Rotation 360 e Circular Grid R 1 10 e High resolution Solid State Digital CCD camera e AGC Automatic Gain Control Display monitor e One 17 in H R monitor e AEC Automatic Brightness Control Digital processor e Multi Patient Date Base Solid state full frame memory for at least 16 images upgradeable Real time Digital Imaging processing for edge and Contrast enhancement Recursive Filtering for Noise Integration Last image hold Multi Patient Data Base Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 111 of 127 Fluoroscopy e Continuous Fluoroscopy e Pulsed Fluoroscopy e Snapshot e Subtracted Fluoroscopy Connectivity e Full DICOM Connectivity Package Accessories e Universal Rotatable Cassette holder for the Il e Set of 5 sterile covers for the C Arm Tank unit and the II tube e To come with operator s protective lead a
12. encourage more skilled people to work at skilled health and allied health professionals the PHCs Also raises motivation and trust e Cultural resistance to change amongst Hs local population e Sporadic government interest and e Collaboration between the 2 PHCs involvement due to unstable political e Better health education capability situation e Better women development and education e Local younger generation taking advantage of their naturalization and integrating into broad Lebanese society by seeking public jobs A move that will pay its dividends in the coming years OPORTUNITIES THREATS Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 28 of 127 10 PRIMARY HEALTHCARE FACILITY A GENERIC MODEL The concept of Primary health care PHC was put forward at Alma Ata international conference on primary health care in 1978 It was described as possibly the only alternative most likely to meet the health needs of the majority of the world s population It also became the core of the Health for All concept of the WHO Primary health care provides basic health care services and stresses prevention rather than cure These services should be available equitable accessible affordable and acceptable to the whole population Some PHCs due to local health needs provide essential ambulatory curative care In addition to health promotion and disease prevention services These
13. extra services include emergency care small procedures surgeries and mother and child services as ante and post natal care not involving surgeries like C section It may for this purpose have a few beds for observation or for awaiting transfer transportation to a higher level hospital It should also serves as a facility where patients can be counseled on family planning nutritional advice and health education The PHC s purpose is to become a place where ill people can bring all their medical problems whether they are clinical dietary or mental The PHC should function like hub that performs a sort of triage treating basic cases or else referring patients to the right specialist or to hospital It is usually the first contact patients and their communities have with the health system In addition to essential care the PHC can offer or fulfill any of these following components e Education about common health problems and what can be done to prevent and control them e Maternal and child health care including family planning e Promotion of proper nutrition e Immunization against major infectious diseases e Adequate supply of safe water e Basic sanitation e Prevention and control of locally endemic diseases e The proper treatment for common diseases and injuries e Follow up is another important function of PHCs after the initial treatment a patient can return for more check ups and advice Patient s records should be updated reg
14. following features and specifications Up to 19 parameters with 3 differentials WBC RBC HGB HCT PLT MCV MCH MCHC RDW MPV LYM 96 GRAN MONO Screened and programmable Through put 60 samples h Whole blood sample aspiration Diluents pack include Isonton Lyse Clenz and waste container Sample volume up to 100 ml from closed or open tube Possibility of micro sampling and sampling from prediluted sample Built in thermal printer LCD display External printer with color graph capability Automation of classical maneuvers Automatic dilution Automatic self check Automatic calibration Automatic rinse and clean after every sample Automatic cleansing of the probe Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 121 of 127 Tests management software Flag indicators for anomalies Storage capability of up to 10 000 patients Possibility to transfer information via RS232 port or memory card Alphanumeric keyboard Power supply 220 240V 50Hz LBO102 SEMI AUTOMATED COAGULATION ANALYZER Coagulation analyzer to perform a variety of tests to detect abnormalities in normal blood clotting to have the following features and specifications e Compact e User Friendly e 4 channel coagulation analyzer for analyzing up to 4 differential parameters simultaneously e Performs the following tests PT APTT Fog TT and all factor assays should be possible on the coagulation anal
15. for the extension of health services in Wadi Khaled clusters Page 122 of 127 e Multi language software e Power supply 220 240V 50 Hz LB8080 BIOSAFETY CABINET CLASS 2 SMALL To have the following features and specifications e Floor standing class 2 type A e For the safe handling of groups 1 2 and 3 pathogens e Compact single operator size width max 120 cm e Open fronted model e Steel construction with epoxy finish e Front viewing screen to be of toughened glass e Controls to be external e Controls to include on off fan switch on off light switch air velocity indicator power on lamp e Hazard alarm e Exhaust air to be 99 99 HEPA filtered prior to being discharged Air to be drawn through the filters by a fan mounted at the end of the ducting e Inward air velocity at front opening to be 0 75 m s e Two Ultra Violet lamps approx 30W e Provided with complete set of service fixtures e Dimensions approx 1400x 1200x 800 H W D e Power supply 220 240V 50 Hz LBOO41 VORTEX MIXER To have the following features and specifications e Variable speed control e Touch or continuous operation e Provided with standard rubber cup head for test tubes e Controllable speed up to approx 2000 RPM e Power supply 220 240V 50hz Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 123 of 127 LBO600 PIPETTES SET 5 To have the following features and specifications Set of 5 variable
16. help to improve the situation in that area in the years to come Today more and more are getting educated many are working or seeking employment in the public sector mainly in education and in the armed forces This integration into the Lebanese society will perhaps encourage the central government to put into action the many studies and strategies done for this area mainly by creating career opportunities through development and infrastructure and encourage these promising cadres to return to their towns and villages Many NGO s and private benefactors have tried to alleviate the situation by satisfying some needs here and there through limited but useful grants and donations but the main effort remains the government responsibility Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 15 of 127 5 SITES VISITED A Wadi Khaled Western Cluster e Al Rami Dispensary 15 02 2012 e Al Hishi Makassed Primary Health Center 15 02 2012 e Meeting with Mqaible Municipality and Mukhtars 15 02 2012 e El Hishi Welfare Dispensary 15 02 2012 B Wadi Khaled Eastern Cluster e Al Amayer Social Services Center MOSA 16 02 2012 e Karha Social Services Center 16 02 2012 e Meeting with Al Mounseh Municipality Mukhtars and Stakeholders 16 02 2012 C Area major Hospital e Al Yousef Hospital Halba 22 02 2012 e Halba Governmental Hospital 22 02 2012 e Rahal Hospital Sheikh Mohamed Halba 22 02 2012 e Sayde
17. lt AWOLO83 lHd S3 ldWVS Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 86 of 127 370 0 ANHOLIVHOS8VT Initial feasibility study for the extension of health services in Wadi Khaled clusters 0 Occ 007 Page 87 of 127 0 08 120 0 N N U z m Z O w o 2 c O Z N z O O 390 0 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 88 of 127 0 02r LL LABOR amp DELIVERY ROOM Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 89 of 127 400 0 A e e Sz o 2m p lt T wo gt c w NO Jg lt A E o I 177 3 207 8 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 90 of 127 APPENDIX 4 TECHNICAL SPECIFICATIONS FOR SELECTED MEDICAL EQUIPMENT General Guidelines The Wadi Khaled PHCs identified in this study to receive the ADELNORD grant shall be provided with state of the art equipment Therefore the present specifications and layout drawings shall be interpreted as guidelines for type and quality of the equipment required The specification texts are brief and therefore covering a wide range of equipment types and ancillaries In some cases specific figures and limits have been given Such information should be co
18. or his local dealer will validate the site before the installation For electrical installations 2 international codes are useful the NFPA NEC and the IEC 60364 For HVAC the most reliable is ASHRAE and NHS HTM 2025 The basic infrastructures of the facilities include e Clean and potable water supply e Treated water supply for medical equipment use e Uninterrupted power supply for sensitive medical equipment and conservation equipment e Stable power current and voltage supply to avoid damage to expensive and sensitive medical equipment e Proper HVAC design for climate control that respect the minimum requirements of ASHRAE s healthcare facilities guidelines e Special care should be given to humidity control that is very harmful to electronics and also can lead to growth mildew fungus and other microorganisms in the facility affecting the health of both the patients and the staff Another issue that should be addressed is the respect of Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 32 of 127 pressure gradients in the flow of air especially in critical areas like surgery and delivery rooms to avoid cross contaminations in the facility e The use of finishing materials that don t favor microorganisms growth and are easy to clean and maintain like ceramic tiles groove less and laser cut vinyl flooring antibacterial and low VOC wall paints e Have adequate numbers of electrical
19. or shared It can also serve for the education and development of staff Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 44 of 127 For community Education IT technology is not a problem for the younger generations as they are exposed to itin schools and universities but can be a challenge for most adult inhabitants who are not highly educated and most only speak Arabic So educating and training these people on the use of computers A wide range of Arabic software is available is important To this end IT can be a bridge to help them to cross gradually to the modern era of computer and internet technologies as they are trained and gain confidence IT will enhance their awareness on prevention alternative medicines life improvement methods sanitation management of chronic diseases maternal and child health including family planning the importance of safe water and information about appropriate treatment of common diseases injuries and immunization against major infectious diseases and also for fun IT would be an important mean to break the vicious cycle of underdevelopment and the fear of change 14 CONCLUSION Health is a fundamental human right and should be available to all people regardless of gender color social class ethnicity and age Healthcare should be delivered through medical technology that is accessible affordable feasible and culturally acceptable to the community A skilled
20. outlets distributed in the facility and proper lighting design especially in work areas e Have a good signage system bilingual Arabic French or English to direct patients and visitors to their right destination e Good drainage and waste collection areas Designate areas for the collection of medical waste general storage for supplies and equipment in addition to a storing area cabinet for hazardous materials shall be clearly labeled e Handling and disposal of waste including bio wastes e Fire safety system and equipment e T infrastructure with Ethernet cabling and outlets CAT 6 are amply distributed across the facility for easy technology integration and communication via internet e Segregated departments and areas Administrative public emergency care inpatient care outpatient care utilities and storage e Additional infrastructure facilities may be added for special tasks as and when needed 11 PROJECTS FEASIBILITY There is no doubt that this neglected area needs to have at least a couple of descent and up to standards Primary Healthcare Centers to serve the routine health needs of the population For this purpose these centers have to be readied and equipped for such tasks The amount available to fund this mission through the EU ADELNORD program is small compared to the actual needs But it can start to improve the present situation and possibly serve as a pilot project for other funds and donations The importa
21. to various film sensitivity Power supply 220 240V 50 60 Hz Both items are to be delivered with all necessary accessories and manuals Dark room accessories Cassettes Cassettes with rare earth screens window type for day light identification e 5 x 18cmx24cm e 5 x 24cmx30cm e 5 x 30cmx40cm e 5 x 35cmx35cm e 5 x 35cmx43cm Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 113 of 127 Accessories Safe light for dark room incl of filter set e Screen cleaner e Clip R L AP PA Working table made from chrome nickel steel 1200x600mm ME0191 PANORAMIC X RAY Panoramic dental imaging unit to have the following features and specifications Generator High frequency Converter type Micro Processor controlled Automatic mains voltage compensation Up to 80 kV Up to 14 ma Automatic kV rise for spine density compensation Pre programmed and manual technique Automatic mains compensation X Ray tube Single tank type Single focus Stand Suitable for standing and sitting patients Vertical movement of the imaging system from 95 cm to 180 cm fully counterbalanced Motorised positioning device with light indication for optimum positioning Flat metal cassette 15 x 30 cm with rare earth screens Computer controlled multi projection modes fe Standard projection o Children projection o Orthogonality projection o TMJ bi axi
22. volume micropipettes Single hand operation thumb action Light weight and air tight design Piston controlled pipeting Separate tip ejector button Pre calibrated with calibration certificate Set to include the following sizes o to10yl o to25yl o to100ul o 100to 250 pl o 250 to 1000 ul Approx dosage precision of the above capacities respectively 1 596 196 0 896 0 696 0 596 Color coded for easy size identification Accessories to include pipette rack box of tips 1000 disposable for each specified size OE5654 VACUUM CLEANER WET DRY Wet dry pick up Tank capacity 15 25 liters Motor power 1000 1200 watts Complete tool sets for dry and wet cleaning Hose vacuum 2 3 m Power cable min 15m Power supply 220 240V 50 Hz MF0011 TROLLEY SOILED LINEN SINGLE WITH LID Ring Circular design Ring diameter 60 cm Durable Tubular steel construction With stable M shape base Chrome lid pedal activated Capacity up to 120 liters Mobile on heavy duty castors 4 with brake Comes with compatible hamper bag washable Can also accept commercially available plastic bags MF0010 STEP ON 15 L WASTE BIN WITH LID Initial feasibility study for the extension of health services in Wadi Khaled clusters Made of durable PVC Washable Page 124 of 127 e Capacity 15 liters e Strong pedal mechanism activates opening and closing of lid e Lid attached by heavy duty hinges MF0100 DOUBLE STEP STOO
23. washable cover in floor fasteners e Portable vital signs monitor NIBP SPO2 Temp e Manual sphygmomanometer e Removable and washable tray made from durable materials e Battery powered ME7676 DENTAL UNIT COMPLETE Complete dental treatment unit to have the following features and specifications e Dental chair O Section with removable articulated head rest Adjustable position hand rests Hydraulic operation with back tilt and height adjustment Upholstered in impermeable washable material with chair mounted cuspidor Dental light chair mounted Luminous intensity adjustable 8 to 40 Klux Removable and washable light handles Floor control with presets of dental chair movements Q Q9 7 0 9 5 9 iO e Cart dental surgeon o Chair mounted with floor fed services o Instruments console to include Two air turbines One normal one with micro head 1 micro motor hand piece with spray High speed with contra angle 1 micro motor hand piece Low speed with contra angle 1straight hand piece Ultrasonic descaler Chip blower in 1 Syringe heated mayo tray top Integral air pressure gauge Water coolant adjustment foot control Dentist s tool panel can be supplied as an integral part of the dental chair Foot control for dentist s tools to be incorporated Qo Qo Q0 Q9 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 116 of 127 e Cart Assistant
24. workforce of well trained physicians nurses allied health professionals and support staff in adequate numbers must be at hand at the local PHCs to be able to serve the health needs of the locals The health services should be tailored to life patterns of the population their real needs and help to manage the most occurring diseases They should also be scalable to adapt to future changes The community must get more involved in the planning and implementation of their health care system Developing communication channels between the population and the health professionals about the community s needs to help find the best and cost effective solutions to the many problems From that collaborative effort a check list of problems and prioritized needs can be drawn which can be fulfilled one by one as soon as resources and funds are available This collaboration can be facilitated by the creation of steering committees and by the support of local government and NGOs Follow up and accountability sessions are needed to monitor the progress of improvement projects International studies have shown that It easier and more affordable to access primary care which can significantly reduce the pressure on public hospital system and significantly improve the health of the population The money saved from avoiding unnecessary hospitalizations is invested on preventive health new health technologies IT technologies staff development and health education They a
25. 0 degrees Vertical displacement 2 225 cm Longitudinal displacement gt 270 cm Electromagnetic brakes Manual collimator X Ray Tube rotation 2 120 degrees Manual collimator e Bucky unit including Grid ratio 12 1 lonization chamber for automatic dose control Suitable for cassettes from 13 X 18 up to 35 X 43 cm X Ray Generator e Computer controlled e High frequency converter type e Minimum nominal rating 50 kW 600 mA 125 kV e Automatic mains correction e Automatic exposure control digitally controlled e APR Anatomic Programs e Safety system for X Ray Tube heat and Overload e Digital display for all exposure parameters X Ray Tube e Speed 3000 rpm e Focal spot 0 6 1 3 mm e 17 50 kW nominal power rating e 150kV Wall Bucky stand e Counterbalanced vertical displacement including o Grid ratio 12 1 o lonization chamber for automatic dose control o Suitable for cassettes from 13 X 18 up to 35 X 43 cm Accessories e Ratchet Compressor e Lateral Cassette Holder Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 109 of 127 Installation of unit is to be included Supplier must provide all MEP requirements and shop drawings prior to install Radiation protection Screen 200 x 220cm with side wings Description Floor mounted 2mm lead screen in laminated faced boards 200 x 220cm with one lead glass window of 60cm W x 80cm having 2mm lead equivalent in t
26. 00 examination clinic See List ME 05 MEO0180 Portable Ultrasound unit 1 32 000 00 32 000 00 ME7676 Dental unit complete with Intra Oral Xray 12 000 00 12 000 00 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 37 of 127 25 000 00 25 000 00 TABLE MENO2 PRIORITIZED NEEDS FOR AL AMAYER PHC 6 000 00 Personal Computer with Display UPS and Printer p EE Total in US Dollars Total Price USD 6 000 00 1 000 00 382 430 00 List ME 01 Trauma amp Resuscitation room Item Reference Description Quantity ee Toral rice MEO011 Oxygen Flow meter 0 15L Min 1 90 00 90 00 MEO0010 Air Flow meter 1 90 00 90 00 ME1004 Operating Light Small Ceiling Mounted 1 5000 00 5 000 00 MEO0060 Patient Monitor 1 5000 00 5 000 00 MF0100 Double Step Stool 1 75 00 75 00 MF0080 I V Stand Mobile 2 70 00 140 00 MF0010 Step On 12 to 15L waste bin with lid 2 20 00 40 00 MEO0051 Trauma Stretcher 1 6500 00 6 500 00 MEO0070 Patient Stretcher 2 900 00 1 800 00 MF0020 Diagnostic Set 1 565 00 565 00 MF0011 SS Treatment and dressing cart 1 240 00 240 00 MEO0021 Trolley Soiled Linen Single with Lid 1 170 00 170 00 MEO0021 X Ray Viewer Single 1 130 00 130 00 MEO0013 Suction pump electric 2 jars 1 1 500 00 1 500 00 ME2000 Kick bucket 1 140 00 140 00 MF0027 Infusion Pump 2 1 500 00
27. 12 Page 13 15 Page 16 Page 16 23 Page 24 26 Page 27 Page 28 Page 29 33 Page 33 35 Page 36 43 Page 44 45 Page 45 Page 46 65 Page 66 70 Page 71 90 Page 91 126 Page 127 Page 3 of 127 ACRONYMS ABBREVIATIONS amp GLOSSARIES Association for the Advancement of Medical AAMI instrumentation NEC National Electric Code ADA Americans with Disabilities Act 1990 NFPA National Fire Protection Association o m ee aga Het staan for ug ASHE The American Society for Healthcare Engineering B Uninterruptible power systems Standard ASHRAE c Remigeration and Air a Medical Device Software Standard AUB American University of Beirut IMA Islamic Medical Association AusHFG The Australasian Health Facility Guidelines IMC International Medical Corps BDN Basic Development Needs IOM Institute of Medicine CBI Community Based Initiatives ISO International Organization for Standardization CBR Community Based Rehabilitation KFAED Kuwait Fund for Arab Economic Development CCA Common Country Assessment MD Medical Doctor CDR Council for development and reconstruction MEP Mechanical Electrical amp Plumbing works DDS Doctor of Dental Surgery MOPH Ministry of Public Health EC European Commission MOSA Ministry of Social Affairs EML Essential Medications List MSF Medecins Sans Frontieres EMRO Eastern Mediterranean Regional Office WHO NHS National Health Servi
28. 4 of 127 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 55 of 127 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 56 of 127 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 57 of 127 Al Amayer MOSA Center mah P ar D Oy Dij Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 58 of 127 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 59 of 127 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 60 of 127 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 61 of 127 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 62 of 127 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 63 of 127 Karha MOSA Social Services Center Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 64 of 127 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 65 of 127 Appendix 2 Proposed Layout Plans for the new Emergency department at Al Hishi Makassed PHC EMERGENCY ROOM LAYOUT Initial feasibility study for the extension of health services in Wadi Khaled c
29. L e Tubular mild steel construction e Steps are made of mild steel sheets lined with non slip tread e Electrically welded joints e Chrome finish e Extra wide and deep steps e Rubber feet for extra stability e Load capacity 2200 Kg MF0028 PLASTER CART This mobile cart plaster is made of durable high quality SS and includes 5 Drawers of approx 150 mm height 1 Drawer of approx 300 mm height Work top of chrome nickel steel with run around profiled edge 1 Extension plate approx 500 mm folding down type 1 Holder with removable plaster bowl approx 30 x 320 x 200 mm Complete with one large cast spreader and one small cast spreader Dimensions Approx 900 x 600 x 800 mm MF0022 BOWL STAND DOUBLE SS Unit made durable high quality SS with e Two detachable SS bowls e Supported on four large swivel anti static wheels 50 mm dia e Bowl diameter 300 mm approx e Stand height approx 800 mm MF0020 SS TREATMENT AND DRESSING CART Mobile cart mounted on 4 swivel castors with bumper protectors and 2 with brakes Made from high quality durable SS 1 upper shelf with up stand on 3 sides With 1 drawer approx 20 cm high Under shelf with up stands on 4 sides Dimensions approximately 1100 x 600 x 700mm HxWXxL MF0027 MAYO TABLE This Mayo table is made frame and table durable high quality SS with a hydraulic height adjustment supported on three antista
30. L for Specialty tests Dental services fees range from 5 000 00 L L for routine procedures to 25 000 00L L For oral surgery Drugs are sold at 2596 to 5096 of initial cost Prices are set by the foundation Wadi Kahled patients unable to get drugs from the local PHCs come to this center to obtain them They care for 60 patients per day Most cases treated Orthopedics General medicine amp Pediatrics Ob Gyn Cardiac ENT Pulmonary amp Chronic diseases 6 3 6 Meeting with Dr Beri El Assaad A practicing physician in Wadi Khaled Has similar concerns to those identified by the Municipality chiefs Stakeholders and Mukhtars Thinks that the Al Amayer MOSA social services center should be strengthened because of its central position in Wadi Khaled region Thinks that the central government should get more involved in the area and improve the infrastructure Water electricity public works and sanitation He proposes to create a local Ambulance and Rescue unit to serve the area and take care of the operation and maintenance of the vehicles So they are exclusively used to transport patients and not to be used for smuggling Need for an X ray machine and Ultrasound unit He believes that the area needs a better equipped clinical laboratory to be run and managed by the MOSA who in turn takes care of its operation and maintenance He identifies the most occurring diseases and health conditions as follows Infectious diseases due to se
31. LABO106 ELISA WASHER amp READER ELISA reader and washer for detection of immune responses Antigens and Antibody testing to have the following features and specifications e The apparatus shall read plates with 24 48 and 96 holes e Micro Elisa reader shall be capable of reading at various modes e The apparatus shall be capable of formula and cut off arrangement e The linear measurement interval and resolution of the apparatus shall be 0 3 00 absorbent unit A and 0 001 A respectively e The apparatus shall contain filters with the standard interval of 405 630 mm and such intervals may be increased up to 340 700 mm when required e The apparatus shall be capable of reading the result of 92 holes in a maximum duration of 2 minutes and have the results written Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 118 of 127 e The apparatus shall be micro processor controlled and have a RS232 outlet a kinetic ELISA program shall be provided with the apparatus e A continuous power source capable of feeding the reader and washer up to one hour shall be provided together with the apparatus e ELISA washer which shall be provided with the apparatus must have the following specifications e tshould be fully automatic e It should be capable of washing microplates with 16 holes e It should have more than 20 different washing programs e It should be capable of making double aspiration botto
32. ORIES Trolley resuscitation emergency with shelf support bracket arm extension shelf for defibrillator 4 drawer units drip stand with hook Accessories for Crash Cart suitable for adults paediatrics and infants ECG electrodes single use 5O packs ECG cables External Defibrillation electrodes Adult and pediatric Internal defibrillation paddles Stethoscope Adult amp Pediatric Laryngoscope Adult amp Pediatric Sphygmomanometer complete aneroid type Disposable tongue depressor Penlight Resuscitation bag accessories in container 1 Adult 1 Pediatric 1 Infant Complete sets of NASO amp ORO pharyngeal instruments Foot electric or ventury operated suction system and tubing O2 cylinder manifold with reducing valves with Regulator amp Humidifier Small O2 demand valve patient tubing amp 3 size facemasks Scissors Paddle GEL ECG electrode GEL Backboard for cardiac use solid At least 4 electrical outlets for ancillary equipment Defibrillator Features Lightweight easy to operate defibrillator with ECG monitor and min 2 channels recorder for internal and external defibrillation semi automatic and manual mode alarms audible and visual Built in rechargeable batteries suitable for 2 hours of continous operation or 50 chocs at 360 joules and charger Synchronized and non synchronized operation Delivered energy maximum at 360 joules limited to 50 joules for internal defibrillation Charging ti
33. SED PHC Cont SS DAS Unit Price Total Price Priority Item Reference Description of Need Quantity USD USD Immediate Emergency Response Care 30 ME3535 Pack for mobile dispensary See List ME 1 1 200 00 1 200 00 06 31 MEOO066 Defibrillator and resuscitation equipment 1 8 000 00 8 000 00 for mobile dispensary 32 ME2020 Dialysis Machine with therapy chair 20 000 00 80 000 00 33 0E1701 aa eat mene espe ROVE 12 000 00 12 000 00 Po Total in US Dollars 557 255 00 TABLE MENO2 PRIORITIZED NEEDS FOR AL AMAYER PHC Priority Item Reference Description of Need Quantity in E E Renovation of building Fixing of cracks New paint job for the whole center with Anti Bacterial paint Waterproofing of building roof Procurement of new pharmacy casework 1 7 000 00 7 000 00 Basic Clinical Laboratory equipment See List ME 03 1 62 000 00 62 000 00 Equipment and furniture for a Minor treatment room with plaster sink See 26 930 00 26 930 00 List ME 02 With Medical Gases Cylinders with 1 1 500 00 1 500 00 regulators Lump Sum ME9988 Ambulance fully equipped 1 50 000 00 50 000 00 MEO065 Crash Cart with Defibrillator and all 1 9 000 00 9 000 00 accessories Immediate Emergency Response Care Pack for mobile dispensary See List ME 1 200 00 1 200 00 06 Essential furniture for examinations clinic See List ME 04 3 150 00 6 300 00 Essential furniture for Ob Gyn 1 3 500 00 3 500
34. Spirometer Spirom tre HS role c Portable Portable Jl se Osece Ultrasound unit Appareil d chographie BIG Ae se sone Dialysis machine Appareil de dialyse rein artificiel BIST He Sloe Therapy Th rapie zdl RO reverse osmosis treatment Syst me de traitement de l eau par a ibi Bons inverse P gogrog ote 5 UPS uninterruptible power supply Alimentation lectrique secourue Gale cgo Mle dala sje Power generator Groupe lectrog ne ely XJ se Calibration Calibration 5 xr Air handling unit Groupe de traitement de l air el pisc Ole dx 5 EIISA reader and washer HEAR ig ladila xgll BIE 5 ec Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 6 of 127 ENGLISH FRANCAIS SHE Description Description gia s Operating light Scialytique Bgl hole de aae Flow meter D bitm tre exl scie Suction regulator R gulateur d aspiration Ji sS dean Diagnostic set Otoscope amp Trousse pour diagnostique Otoscope et 3 og diay lo Haqupag ioe iad Ophtalmoscope ophtalmoscope ODS lag Stained SoC DIRE Chariot de soins et de pansements JY scie FE sdb BURY co st dressing cart J3oa laos X ray viewer N gatoscope Bas ys a las Suction pump Pompe d aspiration lev Film processor D veloppeur de film radiographique E RII soa xu cole Ventilator respirator Ventilateur respirateur Ela al iple e Bench top Paillasse B3 e Immediate Emergency Response Care Pack
35. al failure Congenital First Cousins marriages highly frequent in this tribal society Living and dietary habits Substance and smoke abuse and essential nutrients deficiencies like folic acid in pregnant women Infection during pregnancy e Causes can include infant mortality birth defects learning difficulties sensory and motor functions problems and metabolic disorders e Cases of epilepsy and convulsions High Birthing rate Early pre arranged marriages Akkar has the highest birthrate in the country approximately 10 annual increase Absence of family planning sexual education and social orientation Dominance of Arab tribal culture Ashaer that influences social behavior and life style e Population increase in poverty area e More children diseases e Additional family charges feeding clothing e Burden on healthcare facilities Miscellaneous Lack of sanitation and hygiene Living conditions amp Overcrowding Sharing of beds covers and clothing Psychosocial Stress factors and genetic factors e Lice infection e Snake Bites e Dermatologic disorders e Neurological problems e Psychiatric cases Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 25 of 127 There are other factors affecting the poor healthcare delivery in that area mainly Absence of government initiatives Even though both the MPH and the
36. al feasibility of the health care centres projects cited above and proposed for co financing in the ADELNORD community development component The requested tasks will be 1 Analysis of the technical feasibility of the proposed projects including cost estimates project design and preliminary bill of quantities 2 Elaboration of technical specifications of proposed equipment respecting EU procurement rules 2 3 2 Tasksand Activities The expert will work under the direct responsibility of the Community Development Manager of ESFD and will closely collaborate with the permanent experts of ESFD and the Technical Assistance to ADELNORD Duties of the Expert shall include the following tasks On basis of discussions with the ESFD and the Technical Assistance of ADELNORD provide within two days after the start up of the mission a timetable agenda and methodology of study activities to be carried out during the mission Conduct field visits to the project region discuss with the project staff the project ideas and the general layout of the proposed projects Assess the regional health care services coverage as well as the actual needs Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 10 of 127 Assess the existing health care centers in the project clusters from the managerial aspect their performance and service provision e Where the proposed projects consist in establishing a new heal
37. al projection Tele Radiography Cephalostat suitable for flat cassettes18 x 24 cm S I D 150 cm Exposure time from 0 16 sec to 2 5 sec Standard cassettes 18 x 24 cm with rare earth screens Power supply 220 240V 50 60 Hz Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 114 of 127 ME9988 AMBULANCE To have the following features and specifications Vehicle and chassis Interior Exterior Van suitable to be converted to an ambulance Long body approx 5 m High internal roof approx 2 3 m Width approx 2 m Body paint white With all round windows Motor engine 4 cylinders 16 valves approx 2 5 L 4 wheel ABS Fuel injection Power steering Manual transmission 5 speeds Runs on unleaded gasoline Isolated wooden floor marine plywood grade Floor covered with washable non slip materials Interior walls to be covered with ABS plastic panels Partition between driver and care sides to be a sliding window middle center Small medication and instruments cabinet with shelves made from high quality laminated plywood and Plexiglas sliding doors A bench with back rest for 2 EMTs to the right of the patient area with storage compartment under lid Upholstered foam mattress with washable cover Seat belts for each EMT 2 Oxygen cylinders E size holder Fluorescent Lighting fixtures on the ceiling Serum hanger above patient side facing EMTs bench
38. ammable channel selection e 12 leads pick up Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 99 of 127 e Paper size A4 The ECG shall include at a minimum the following information on each record e The recording date and time e The sensitivity setting e The chart speed e The leads being recorded The ECG shall include the following visual indicators e Battery status e Loose electrode contact e System status e The ECG shall be capable of operating on either rechargeable battery or line power e The ECG shall measure all basic axes and durations including RR PQ QT ATC P QRS T and HR e The ECG shall identify arrhythmias e Electrical Safety e Calibration test should be in each starting cycle e The ECG shall come complete with patient leads electrodes and 1 gel bottle amp 1 box of A 4 paper e Power supply 220 240V 50 60 Hz MEO021 X RAY FILM VIEWER SINGLE To have the following features and specifications Single screen viewer Dimmable x ray illumination Wall mounted Controls in one row at bottom of viewer Housing made of enamel painted steel sheet Viewer face made of durable translucent plastic With Film gripper Dimensions approx 510 mm x 115 mm x 370 mm H x D x W Power supply 220 240V 50 60 Hz MEO0068 SPOT CHECK MONITOR PULSE SPO2 NIBP TEMP Compact size vital signs monitor designed to be used on adult pediatric and neo
39. and Al Amayer on which they rely for their routine healthcare needs Some go to Al Rama Dispensary when new batch of Syrian Medications arrive o Procurement of an ambulance and vehicles to transport the corpses of the deceased Creation of vocational and career improvement centers o Socio Economic development O Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 20 of 127 6 3 Visit to area major health care facilities and meetings with health care providers 6 3 1 Al Yousef Hospital Halba e Privately owned e Managed by Dr Saoud el Yousef e Best equipped hospital in the region Fully equipped imaging dept e Offers a large variety of medical services e Most cases treated Common to all Akkar Trauma General medicine amp Pediatrics Ob Gyn Dialysis Cardiac Chronic diseases and Gun shot wounds 6 3 2 Halba Governmental Hospital e Owned by the MPH e Managed by Mr Hussein el Masri e Built in 2001 and opened in 2006 e Even though it was well equipped this hospital offers limited medical services Building is run down and needs renovation e Most machines including medical equipment are out of service due to no maintenance and lack of funds to fix them e Most cases treated Trauma General medicine amp Pediatrics Ob Gyn And Cardiac 6 3 3 Rahal Hospital Sheikh Mohamed Halba e Privately owned e Managed by Rana El Ahdab Health and Safety Officer e Fairly equip
40. and sonography test OOo0000 See Appendix 1 for photographs of center 6 2 2 Karha Social Services Center Satellite facility to Al Amayer e Owned by MOSA under the authority of the Al Amayer Center e sasmall Health Post small Dispensary e Center consists of a ground level Building with 4 rooms 2 clinics and a small pharmacy and a small waiting hall e Charges basic fees for services as set by the MSA e Building in poor shape needs some renovation and new casework e Services General Medicine Ob Gyn Pediatrics and Cardiac e Visiting doctors are contracted by MSA e Distributes medications and drugs when available from MSA They are free when available e Number of patients per day up to 20 more when new supplies of drugs are available e Needs Procurement of a 6 KVA Electrical Generator ECG Dental Clinic Portable Ultrasound unit Ambulance to be shared with Al Amayer New clinic furniture Small autoclave And Van for transporting corpses See Appendix 1 for photographs of center O O O OO0O0O0OO 6 2 3 Meeting with Eastern Cluster Municipality Chief Stakeholders and Mukhtars e Meeting at Al Mounseh Municipality premises e Discussed major concerns for the region as follows o Health awareness o Absence of basic utilities and services Water treatment and supply power sewage and garbage disposal o Better health services needed Most in favor of consolidating El Hishi Makassed PHC
41. are protected To reach these results the Program runs two main components e The Agricultural Infrastructures component that realizes infrastructure investments in the agricultural development and in the sustainable management of natural resources and The Community Development component that carries out community development projects in close partnership with the Municipalities Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 9 of 127 2 2 Context of the mission The preparation of grant projects under the community development component of the program has reached a stage of identifying potential projects to be subject of ADELNORD financing In order to be able to finally select or deselect the actual priority projects in each cluster of villages feasibility studies have to be carried out for setting the basis for deciding on the technical financial and social feasibility of these projects Among the identified projects in the target area of Wadi Khaled Mashta Hassan Mashta Hammoud Chadra Ouweinat there are some focussing on assisting and equipping health care centres in particular In Wadi Khaled cluster of villages n Mashta Hassan cluster of villages In Dannieh cluster of villages 2 3 Requested services 2 3 1 Objectives and responsibilities The primary objective of the expert s mission is to identify the content of the proposed projects and to assess the technic
42. ce UK ENT Otolaryngology NCD Non Communicable Disease ESFD Economic amp Social Fund for Development NGO Non Governmental Organization EU European Union OPEC Organization of the Petroleum Exporting Countries FFM Facult Fran aise de M decine OPHT Ophthalmology FGI Facilities Guidelines Institute PH Public Health FM Family Medicine PHC Primary Healthcare Center FPH Faculty of Public Health PPM Planned Preventive Maintenance GP General Practitioner SS Stainless Steel HFA Health for All WHO Concept TA Target Area HIT Health Information Technologies UL Universit Libanaise Lebanese University NEU ee Tae p EM HQ Headquarter UOB University of Balamand HRD Human Resource Development USAID PORE Agency for International HTM Health Technical Memorandum USJ Universit St Joseph HVAC Heating Ventilation and Air Conditioning VHA Veterans Health Administration US IDB Islamic Development Bank WB World Bank IEC M Eedrotecnnical Commission WBDG Whole Building Design Guide IEC ee 60601 Medical Electrical Equipment Standard WHO World Health Organization WHE Al Waleed bin Talal Humanitarian Foundation Lebanon Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 4 of 127 ENGLISH FRENCH ARABIC GLOSSARY ENGLISH FRANCAIS SHE Description Description bps s Waiting Multipurpose Salle d attente Polyvalente JON eaoat dilap g agg ela Toilet Public Toil
43. cement and orientation work opportunities through economic development both public and private They require major interventions and investments from the central government foreign governments help packages Financial institutions grants the continuous assistance of non profit local and international organizations benefactors contributions and the empowerment of local municipalities through decentralization to have the funds and authority to undertake and complete pressing local projects In 1998 the MOPH launched ambitious projects in health reform namely the Carte Sanitaire System and the hospital accreditation system The CDR has been active in the healthcare area building and equipping public hospitals and healthcare centers all over the Lebanese territory It has received donation and funding from various countries and organizations like the IDB WB WHF OPEC KFAED the Italian government and the Saudi Government However when the projects are handed over to the end users they face numerous problems mainly in staffing and funding In the area off Akkar there are only 2 public health centers a 75 beds hospital in Halba and a PHC in Akkar el Aatiqa These two centers are not enough to respond to local populations needs in Akkar and especially to those living in the remote parts When looking at various socio economic and development indicators we can see the WADI KHALED region in AKKAR Northern Lebanon is the poorest and most under
44. collection tubes 1 750 00 750 00 needles swabs Lump Sum LB8080 Biosafety cabinet Class Il small 1 8 000 00 8 000 00 LFOOO1 Laboratory Casework and Sanitary works Lump sum 1 9 000 00 9 000 00 TOTAL 62 000 00 List ME 04 Essential furniture for examination clinic Item Reference Description Quantity ve E ME1005 Exam light wall mounted 1 500 00 500 00 MF0100 Double Step Stool 1 75 00 75 00 MF0010 Step On 12 to 15L waste bin with lid 1 20 00 20 00 MF0900 Fixed Height 2 sections exam couch 1 800 00 800 00 MEO0070 Diagnostic Set 1 565 00 565 00 ME0073 Sphygmomanometer 1 50 00 50 00 MF0020 SS Treatment and dressing cart 1 240 00 240 00 MF0011 Trolley Soiled Linen Single with Lid 1 170 00 170 00 MEO0021 X Ray Viewer Single 1 130 00 130 00 MEO0700 Patient scale with rod 1 250 00 250 00 MEO0701 Pediatric scale 1 350 00 350 0 TOTAL 3 150 00 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 40 of 127 List ME 05 Essential furniture for Ob Gyn examination clinic Item Reference Description Quantity An A ME1005 Exam light wall mounted 1 500 00 500 00 MF0100 Double Step Stool 1 75 00 75 00 MF0010 Step On 12 to 15L waste bin with lid 1 20 00 20 00 MF0901 Manual Ob Gyn Examination table 1 1500 00 1 500 00 MEO0070 Diagnostic Se
45. d height measurement Capacity up to 200kg in 100g increments Telescopic height measurement rod range approx 800 2000mm in 1mm increments Non slip platform cover ME0073 SPHYGMOMANOMETER Aneroid sphygmomanometer mounted on mobile stand with 5 swivel caster base for stability Measurement range 0 300mm Hg Stand adjustable height range 350mm With the following attachments Velcro cuff 14 x 54cm with latex bag Bulb with valve Stethoscope Adult Pediatric Accessory basket Should include adult and pediatric cuffs and bellows ME0013 SUCTION PUMP ELECTRIC 2 JARS To have the following features and specifications Totally enclosed oil free vacuum pump supported on base with four anti static swivel castors and braking system Foot pedal operated On indicator light Protection against accidental aspiration of fluids inside the pump Vacuum range 0 675 mm Hg approx Vacuum gauge Integrated suction regulator Suction capacity approx 50 L min Bacterial filter at the entrance of the apparatus Carrying handle 2 x 4L graduated suction jars with overload cut out and overflow protection Comes with all necessary tubing and connectors All parts in contact with bio secretion are Autoclavable Power supply 220 240V 50 Hz Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 104 of 127 ME1004 OPERATING LIGHT CEILING MOUNTED Cei
46. developed part of the country The area is divided into two clusters Eastern and Western with a registered population of about 39638 inhabitants 31114 are resident during the summer season The population of this region only recently in 1994 acquired the Lebanese Nationality Despite this fact and due to the lack of governmental assistance and because of tribal belongingness and inter marriages the impoverished inhabitants consider Syria to be their second home and rely on cross border trade legal and illegal with the bordering Syrian towns namely Homs and Tal Kalakh to fulfill their basic needs including the purchase of foodstuffs building materials healthcare medicine and fuel The escalating strife in Syria has halted many of these activities also many Syrian refugees have come to Wadi Khaled to seek refuge with relatives on the Lebanese side They are now relying on the Lebanese market to meet these needs at a higher premium adding to their burden The European Union in collaboration with ESFD through the CDR initiated a program Appui au D veloppement Local dans le Nord du Liban ADELNORD to assess primary needs for development in this target area The program targets three essential components Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 8 of 127 e Infrastructures e Community development e Environmental The following is an initial feasibility study of the needs and possible
47. dicine Ob Gyn Dentistry Cardiac and Pediatrics e Charges basic fees for services as set by the MOSA e Laboratory tests are sent to Al Hishi PHC or Local Hospitals e Serviced by 6 local doctors contracted by MOSA e Distributes medications and drugs when available from MOSA They are free when available e Medications when available are dispensed only to patients with prescription or doctor ordinance e The majority of the equipment is old but in passable condition e They have a pharmaceutical refrigerator dental chair ultrasound unit and ECG e Receive occasional donations from NGO s UNDP DRC USAID and UNICEF e Number of patients per day up to 50 more when new supplies of drugs are available e Needs o Renovation of facility and water proofing of walls and roof o Inspection of facility by structural engineer for building stability major cracks in columns and beams o Procurement of new pharmacy casework o Panoramic X ray o Routine X ray o Film processor o Portable Ultrasound unit o New basic Lab equipment o Bench top autoclaves Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 19 of 127 New dental chair Minor treatment room with Resuscitation equipment Photocopier General utility transport van Fully equipped ambulance And power generator The center has received a Cardiac Ultrasound It charges a basic fee of 15 000 00 L L for a consultation
48. duty frame die cast metal e Anti Mold design and finishing e Min quadruple revolving objective nose piece turret 360 rotation Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 117 of 127 e Smooth ball bearing mechanism e Stage with rack and pinion e Tension adjustment mechanism e 45 or 30 inclined body e Spring loaded clips to hold slides e Slide guard system e Min 12x 12 cm mechanical stage with drive controller e X Y coaxial controls Illumination e Min Long life 12 V 20 W Halogen Bulb e Min 1 25 ABBE condenser e Adjustable height condenser with mounts for bright field phase contrasts and dark field e ris diaphragm e Filters All necessary filters for routine work e Fixed intensity illuminator e Easy lamp replacement Focusing e Fine and Coarse focusing e Focusing knob on each side Optics e Twin eye pieces 10 X with 20mm FOV and 22mm eye relief e Color coded Plan achromatic DIN type or equivalent objectives Magnification 4 X 10 X amp 40 X Magnification 100 X oil immersion e Objectives interchangeable Can fit other type of objectives e Infinity corrected optics Digital specifications e Configured to connect to digital camera or video camera via adapters not included Accessories e Comes with power cord Carrying case Antistatic pad dust cover spare halogen light bulb oil bottle amp cleaning kit e User manual e Power supply 220 240V 50Hz
49. e alarms audible and visual Built in rechargeable batteries suitable for 2 hours of continous operation or 50 chocs at 360 joules and charger Synchronized and non synchronized operation Delivered energy maximum at 360 joules limited to 50 joules for internal defibrillation Charging time less than 6 seconds Display of selected stored and delivered energy Non invasive fixed override or on demand pacer modes possibilities ECG acquisition via Paddles and patient cable with adjustable alarm limits and min 6 leads selection Display CRT LCD or EL has ECG Alarm messages sensitivity lead alarm limits heart rate and defibrillated energy large screen Defibrillation modes External defibrillation via paddles Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 94 of 127 e External defibrillation via adhesive pads e Semi automated defibrillation with voice controls e Delivery to include the standard set of accessories for the complete proper function of the unit including pacing electrodes e Option SPO monitoring e Power supply 220 240V 50 60 Hz Instruments e CG electrodes single use 50 packs e ECG cables e External Defibrillation electrodes Adult and pediatric e Internal defibrillation paddles e Stethoscope Adult amp Pediatric e Laryngoscope Adult amp Pediatric e Sphygmomanometer complete aneroid type e Disposable tongue depressor e Penlight e Resuscitat
50. e digital Spirometer to have the following features and specifications Lightweight handheld Spirometer Runs mains power supply or rechargeable battery Measures the following parameters Basic VC FVC FEVI FEVI 96 FEF25 7596 PEF Comparison of Measured Versus Predicted Results Flow detection principle Pneumo tachograph Volume and flow to be specified Range for children and adults with impaired airways LCD display of parameters and graphs Connects to PC via USB or RS232 ports Comes with analysis software compatible with Windows OS To be delivered with 100 Disposable Pneumotachs and mouthpieces Comes with carrying pouch Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 101 of 127 MEO046 CAST CUTTER PLASTER SAW To have the following features and specifications Oscillating frequency 1400 cycles min Motor construction double insulated Radio interference suppression Motor protection automatic overload cut out manual reset Maximum depth of cut with 80 mm blade 25 mm Length of power cord 5 meters e Noise level 75 db Comes with the following accessories Blade 80 mm diameter Socket head screw key e Spanner e Power supply 220 240V 50 Hz MEO100 INFUSION PUMP General purpose infusion pump to have the following features and specifications e Compact size e User friendly e Case made of high quality material resis
51. ept different kind of tubes 7ml 10ml 15ml etc e Power supply 220 240V 50Hz Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 120 of 127 LBO100 SEMI AUTOMATED CLINICAL ANALYZER Semi automated Clinical Analyzer for small labs to have the following features and specifications Compact size User Interface 12 5cm Touch Screen or integrated alpha numeric keyboard Reaction Volume 200p per minute Data Display Reaction Curve QC Record Parameter Setting Reproducibility Less Than 0 005 Abs CV Less Than 0 396 Cross Contamination Less Than 196 Peltier Controlled Temperature RT 25 C 30 C 37 C Optional Disposable Cuvette Monochromatic amp Biochromatic Measurement Measurement Procedures Absorbance Double Wavelength Endpoint Enzymatic Enzymatic Standard Multi standards Kinetic Nephelometry Sample Blank Two points Wavelength Range 300 800nm Standard Preset 340 365 415 520 545 630nm Light Source Halogen Lamp 6V 10W Absorbance Range 0 3 2 5 Abs Flow Cell 301 size Ceramic Body Quartz Glass Window Flow Cell Reaction Volume 200 3000y per tes Storage Capacity gt 100 Test Parameters 1060 Test Results 31 Days QC Results Data Output 320x240 dpi LCD Graphics Touch Screen 40mm High Speed Built in Thermal Matrix Printer RS232 Power supply 220 240V 50Hz LBO101 FULLY AUTOMATED HEMATOLOGY ANALYZER 3 PARTS DIFFERENTIAL To have the
52. ette Publique Js dale oe Toilet Staff Toilette Personnel Oba ale re Toilet Patient Toilette Malade G2 plale oe Nurse Station Poste d infirmi res J ea o2 eal ol oe Clean Utility room Salle de services propres sibada SR GE Dirty Utility room Salle de services sales stud ae SE Resuscitation room Salle de r animation ile wha ge Consultation Examination room Salle de consultation et d examen arcs c Ligue Treatment Dressing Injection room Salle de traitement de pansement et d injection Odes YeomdgU BSE Minor procedures room surgeries Salle de petites proc dures chirurgies jd welts Odsal Je Ua Ge Delivery room Salle d accouchement VU stadog Laundry room Buanderie Blanchisserie AIT e We Linen room Salle de linge propre SHV ale se Laboratory Laboratoire seul X ray imaging room Salle de radiologie Fox J sod m d X ray machine Appareil rayons X BE BN sonic Fluoroscopy Fluoroscopie Jes IGS Ji bay Mobile Mobile Oi swan Electronic patient monitoring Surveillance lectronique des patients cp A Grape D Bede Patient monitor Moniteur de patient i sca led Ub de Jc ox9eud Spot check Contr le surveillance sur place Fed GHG doe Holter monitor Moniteur Holter odhil ede XJ Slog Oral care Soins bucco dentaires asd Ua Dental unit Unit de soins dentaires dudik NE Go od lee Dental clinic Cabinet dentaire Oli Bg Mosis oo Salle de la
53. expensive drugs from the influx of Syrian refugees Lebanese market e Area typical neglected by the central e Also illegal cross border trade was a major government source of revenue for the area Today it is e Absence of infrastructure and almost halted development projects e Crisis in Syria and the arrival of refugees e Politicians only interested in the area have added to their burden during election periods e Ability to pay for basic needs and healthcare e NGOs and welfare organizations are very services has greatly diminished active in the area e Ability to pay for transportation costs because of high fuel prices is also greatly affected Rely on unsafe motorcycle commuting e Relying on help from foreign governments local government world organizations and NGOs to fulfill essential needs e Typical Arab Ashaer tribal community e Except for household appliances few e Predominately Sunnite and conservative computers and cellular phones technology is e Rely on agriculture and smuggling for very basic earning revenue e Most cars are old and most rely on basic e Populations especially the youth are Chinese made motorcycles for getting better educated and are slowly transportation integrating in Lebanese society e Electrical power is severely rationed in this e Younger generations are migrating and area People rely on generators if they can immigrating seeking better fortune in afford the fuel urban areas or other cou
54. f grey and the scan converter will be 512 x 512 x 6 bits e Shall have at least 8 independent TGC controls plus general gain and dynamic gain adjustments e 8 Post processing programs e Additional display functions shall include at least 4 circumference or area calculations gestational and Obstetric reports velocity volume and heart rate calculations e Power supply 220 240V 50 Hz and battery ME0199 FILM PROCESSOR DARK ROOM ACCESSORIES Automatic x ray film processor that provides fully processed dry ready to read X ray films to have the following features and specifications Processor Specifications Capacity per hour approx 150 films in various sizes Processing time 90 seconds 10 x 10cm up to 35 x 43cm film sizes Operation with ambient incoming water temperature Built in automatic stand by control to save power water and reduce processor wear Developer temperature control Automatic replenishment of fixer and developer to maintain high quality processed films Replenishment tanks for fixer and developer Floor standing Power supply 220 240V 50 60 Hz Identification camera Specifications Identification camera for recording hospital data patient data and date in full room light Camera should be suitable for normal window type cassettes Built in digital display should simultaneously indicate the date of identification The intensity of the exposing light in the camera should be adjustable
55. feasibility study for the extension of health services in Wadi Khaled clusters Page 45 of 127 Appendix 1 Site visits photographs Al Rama Dispensary Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 46 of 127 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 47 of 127 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 48 of 127 4 15 02 2012 and liter on the fioor Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 49 of 127 Shonating Oust from cnumbiiag wail paint inside suteciove chamber Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 50 of 127 Al Hishi Makassed PHC 9 wT iS Bates b Rohe Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 51 of 127 15 02 2012 m Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 52 of 127 BhotoeseAldishi Makassed PHC Xrayemachine with wall bucky Photo 8 Al Hishi Makassed PHC Automated Hematology analyzer with blood tube raller uio AN i Melee File a o Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 53 of 127 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 5
56. ff to work in rural areas Some Syrian doctors and medical staff unlicensed to perform in Lebanon used to practice in some PHCs before the start of the crisis in Syria The result of non functioning PHCs has been that in many cases diseases are not diagnosed in their early stages nor treated The rural population has to often travel through tough road conditions to urban area hospitals to seek proper medical care Shy efforts in implementing health awareness and education leading to better family planning hygiene sanitation better nutrition management of chronic diseases and prevention of communicable diseases Lack of local community involvement Community involvement is a process in which individuals and or families assume responsibility for their own health and develop the capacity to contribute the acquired skills to the community development as a whole Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 26 of 127 8 PEST ANALYSIS POLITICAL ECONOMIC e Population became naturalized Lebansese e Poverty stricken area citizens in 1994 e Population relied on neighboring Syrian e Many Consider Syria to be their second towns for sourcing their basic needs at much homeland cheaper rates e Strife in Syria is affecting the Wadi Khaled e Cheaper medications from Syria were very area common before the crisis Now they have to e Worldwide interest in the area following buy much more
57. g unit for humidity control for 1 15 000 00 15 000 00 ER department MEO0650 Benchtop autoclave 30 L 6 500 00 13 000 00 PEO100 Power Generator 40 KVA 1 15 000 00 15 000 00 PEO200 UPS 40 KVA 1 25 000 00 25 000 00 Calibration and renovation of electrical cables wiring ME0645 Steam sterilizer 200 L 30 000 00 30 000 00 ME0635 Table top washer disinfector 50L 8 500 00 8 500 00 MEO0655 Ultrasonic washer 20 L 2 500 00 2 500 00 LBO106 ELISA washer amp Reader 10 000 00 10 000 00 Water purification system RO for sterilizer 7 500 00 7 500 00 6 000 00 6 000 00 OE1700 7 500 00 7 500 00 LBO102 Semi Automatic coagulation analyzer 6 000 00 6 000 00 LB8080 Biosafety cabinet Class II small 8 000 00 8 000 00 MEO066 Holter 4 parameters 10 000 00 10 000 00 MEO0067 ECG 12 Channels 4 000 00 4 000 00 ME1288 Tympanometer 5 000 00 5 000 00 MEO068 Spot Check monitor NIBP SPO2 TEMP 3 500 00 3 500 00 ME1213 Audiometer 4 500 00 4 500 00 ME0196 Fluoroscopy X ray C Arm 95 000 00 95 000 00 MEO0051 Trauma stretcher 6 500 00 6 500 00 LBO800 Routine Microscope 2 000 00 2 000 00 LBOO30 Incubator 1 500 00 1 500 00 MEO0192 Mobile X ray unit 21 000 00 21 000 00 MEO0180 Portable Ultrasound unit 32 000 00 32 000 00 ME0191 Panoramic X ray 22 000 00 22 000 00 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 36 of 127 AL HISHI MAKAS
58. gainst residues Integrated detergent dispenser All high quality and durable SS construction Chamber volume approx 50 L If no integral printer unit must be delivered with external compatible printer Power supply 220 240V 50Hz Installation of unit to be included Supplier to provide all MEP requirements and shop drawings prior to install To be delivered with all accessories necessary for normal and safe operation ME0645 STEAM STERILIZER 250L Steam sterilizer system to have the following features and specifications Single door Pre vacuum type Fully automatic microprocessor controlled Comes with preset cycles protocols User programmed protocols capability Preset cycles should include for porous loads heat sensitive materials liquids open instruments and glassware flash cycle disinfection and chamber leak test Uses mechanical air evacuation for high volume sterilization Operating pressure up to 33 psi Operating temperature up to 137 C Gauges for pressure and temperatures 250 L internal chamber Constructed from heavy duty high grade stainless steel Pneumatic vertical sliding door Compressed air 5 6 bar Built in recorder printer for daily cycle number chamber pressure temperature date and sterilization time Unit to have an integrated steam generator Alarms for pressure drop leaks door open and other malfunctions Power supply 380V 50Hz 3 phase installation Installation of uni
59. he top center with one angled 2mm lead wing ME0192 MOBILE X RAY UNIT To have the following features and specifications Generator e High frequency converter type e Micro processor controlled e Automatic mains voltage compensation e 3to20 kW nominal output e Upto 110 kV max e Upto 300 ma e Timer 0 003 to 5 0 s e Digital display of exposure parameters e Mains supply 220 volt 50 Hz X Ray Tube e Single tank type e Single focus e Fixed anode e Light beam collimator with halogen lamp and measuring tape Stand e Articulated counterbalanced type column e Parking position for the articulated arm for transport e Base height to be specified e Maximum height for transport to be specified e Maximum width for transport to be specified e Weight to be specified e Radiation protected cassette compartment for up to 5 cassettes 36 cm x 43 cm e To come with operator s protective lead apron e Power supply 220 240V 50 Hz Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 110 of 127 MEO0196 FLUOROSCOPY RAY C ARM To have the following features and specifications X ray generator e X Ray Generator DC Converter Constant Potential e Radiography 20 mA 110 kV e Fluoroscopy 0 10 mA to 7 0 mA 110 kV e Fluoroscopy Modes high definition continuous and pulsed e Automatic manual density control via kV and of mA e lt 0 6 1 4 mm focal spot X Ray
60. ies Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 30 of 127 e A mobile x ray unit with protective wear and film processing e Aportable ultrasound unit with universal Ob Gyn and Vascular apabilities e General diagnostic equipment Exam light Otoscope ophthalmoscope Sphygmomanometer stethoscope and thermometer a scale and an ECG e And finally medical gases supply by cylinders Commonly it is run by paramedical staff with doctors on scheduled visits The team includes at least a registered nurse a midwife a medical assistant and two or three auxiliary staff The typical catchment area would be a population of up 10 000 people depending on the geographic factors A more advanced specialized PHC would have in addition to the above e A routine x ray room with wall bucky e A panoramic x ray e Ascreening mammography unit e A diagnostic eye clinic e An ENT clinic e Amore advanced lab with additional immunology testing e A cardiology clinic with Holter monitoring e Apulmonology clinic with Spirometry e Amental health clinic e A physical therapy unit e An advanced ultrasound unit with universal Ob Gyn and Vascular and cardiac capabilities e Atrauma resuscitation room e A minor surgery room e A delivery suite excluding surgery C Section e Anursery e An observation ward for at least 4 male and 4 female patients e All the ancillary facilities Co
61. ion bag accessories in container 1 Adult 1 Pediatric 1 Infant e Complete sets of NASO amp ORO pharyngeal instruments e Foot electric or ventury operated suction system and tubing e 02 cylinder manifold with reducing valves with Regulator amp Humidifier Small e O2demand valve patient tubing amp 3 size facemasks e Scissors e Paddle GEL e ECG electrode GEL ME0655 ULTRASONIC WASHER 20 L Bench top unit Used to clean metal plastic and ceramic dental parts In hard to reach places User friendly Variable cleaning frequency 30 to 60 KHz e Average power 80 Kw Includes cycle timer Integrated thermostat controlled heater Heavy duty construction Stainless steel cleaning tank e Tank comes with strainer net e Tank capacity approx 20 L 1 Operation Manual Power supply 220 240V 50Hz ME0635 TABLE TOP WASHER DISINFECTOR 50 L Bench top unit Instruments washer and disinfector Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 95 of 127 User friendly Preset and user programmed washing cycles LCD display of parameters RS 232 or USB output connection for printing results Built in steam condenser Built in dryer Fast washing pumps with high flow rate High pressure for efficient spraying Washing and Disinfection temperatures up to 93 C Internal water filtering system to guard a
62. ion of health services in Wadi Khaled clusters Page 77 of 127 JSINITO NA9 SOnRIL31SSO INOOY AON39 H3JW3 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 78 of 127 M JSINITO DYLVIGAd 0 06 JINITD oviduvo Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 79 of 127 420 0 N e eo EES GUIIZAERUEGURCU EES Ra a n IE 1 AWa X AWa X T 1 al B 0 N HE 8 o CH ii WOOM 3H L GNnO3SV TIV NOLLO3 LOHd NOILLVIQVM QV37 ww 2 d o z 3 M m z z E 8 8 4004 peusiuy e oqy um OFZ OL dn SIWYYH4 HOOG NV SHOOG ONIGNIONI Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 80 of 127 SNILIVM 400 0 0 00 WTS O NISSJJOYd S3AIHONV Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 82 of 127 AOVWHVHd Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 83 of 127 ALUFTLLO ALYIG ALILA NV3 12 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 84 of 127 9M SLN3ILVd 9M 318lISS322V GAddVSIGNVH WOON WHOLINVP Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 85 of 127 S3 ldAVS U I p m v O O
63. ipment by means of UPS uninterrupted electric power And also power generators powerful enough to sustain the needs of each center Train paramedics and nursing staff to handle essential primary care Train staff and technicians on the proper use of new equipment Train and empower the staff at the PHCs to spread awareness on some of these issues build trust within the community and to take a holistic approach to health care Educate patients and their relatives on health issues sanitation hygiene and diseases management and prevention With the help of NGOs and Benefactors Encourage community involvement by conveying the message that the PHCs are here to serve them and to help them reduce the impact of their illnesses and injuries Focus on women and youth associations Organize cultural events and educational self help programs Take advantage of supported and experience from international agencies like EU USAID UNDP World Bank IDB and WHO and the various NGOs Have long term vested interest in seeing this project succeed This will encourage more development programs The objectives and outcomes of the program should be sustainable and yield long term improvements in rural healthcare Encourage decentralization by empowering the municipalities and officials in assessing their needs and developing their capacities for better service delivery at the local level Establish new municipalities with more authority in Wadi Khaled I
64. ith regulators which require floor space in already small areas e Al Makassed recently purchased for the center a fully equipped ambulance some new equipment and accessories e They also have a mobile dispensary that goes to more remote areas to offer basic health services including vaccinations This vehicle is in passable shape and can be up hauled with some modern equipment Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 17 of 127 e Number of patients per day 60 and up to 150 when new supplies of drugs are available e Needs prioritized Small water treatment plant RO De lonized water EMG EEG neurological analyzer Spirometry device And Audiometer See Appendix 1 for photographs of center o Procurement of Electrical Generator and UPS system o Panoramic X ray o New trauma and resuscitation ER with all necessary equipment and furnishings o Asmall CSSD sterilization with autoclave and washer o 2bench top autoclaves o Additional new Lab equipment o Fluoroscopy X ray system o Dialysis o Portable Ultrasound unit with 4D capability o Mammography O O O O 6 1 3 Meeting at with Western Cluster Municipality Chief Stakeholders and Mukhtars e Meeting at Al Makassed PHC e Discussed major concerns and needs for the region o Health Awareness o Better health services needed Most in favor of consolidating Al Hishi Makassed PHC o The major di
65. l 20 seconds e Adjustable vertical scaling when using graphical trends o OTHER FEATURES e User friendly interface knob controlled e Audible and visual alarms for faults and limits breach e Power supply 220 240V 50 Hz e Complies with IEC 60601 1 o ACCESSORIES For proper operation each monitor should be delivered complete with e ECG cable 5 leads e Two Temperature probes rectal with covers e SaO sensors with one extension cable one reusable adult and pediatric e NIBP cuffs 1 pediatric 1 medium and 1 large e Spare rechargeable battery e All necessary probes and accessories for modules e User Manual e All necessary cables and attachment accessories e Wall mounting set Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 106 of 127 e Invasive pressure cables transducers and transducer holders to be supplied as well as the 10 ea disposable kits e Cardiac output cables to be supplied as well as 5 catheters MEO0070 DIAGNOSTIC SET Portable set of high quality diagnostic instruments e A Battery operated universal rechargeable handle e Stainless steel body construction light weight e Halogen light source e Otoscope Throat illuminator screw on Head Ophthalmoscope screw on head Nasal Illuminator screw on head To be offered with spare bulbs and case Other heads can be fitted if needed Multi purpose stethoscope with case or pouch Percussion Hammer Buck Tourniquet S
66. l 10 x 10 cm Burn Dressing 20cc Irrigation Syringe 60cc Irrigation Syringe Sterile Water pouches Di rFPIrPINniIN Eye Care 4x8 cm Sterile Eye Pads B 0 25 L Eye Wash 0 5 L Eye Wash Over the Counter Medications Glucose Servings Ammonia Inhalants Aspirin bottle 81 mg dosage Comfort and Care Items Emergency Foil Blankets Reusable washable Blanket Chemical Cold Packs Kold Pak 10 Chemical Dry Heat Packs 10 Emergency Whistles Instructional and Organizational Materials First Aid Manual Kit Contents sheet Patient Information Field Notes Pad with Pencil Other informational handouts for shelters and large events packet Rl RP I RP PR Rolling Duffel bag 90 cm rolling sturdy duffel fabric bag with 2 outside pockets carry handles retractable hand truck frame system and removable shoulder strap 1 TOTAL SET 1 200 00 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 43 of 127 13 RECOMMENDATIONS Steps in the process of enhancing the capabilities of the PHCs To furbish or refurbish the existing PHCs land building equipment and supplies already set up by the government The furnishing will be simple comfortable and durable Available on the Lebanese market with after sales support Provide stable electrical power for sensitive equ
67. l beds electro surgery systems and defibrillators and Medical Imaging amp Diagnostic Equipment i e radiology endoscopy ultrasound shall fully comply with their respective ANSI AAMI IEC EN 60601 series of directives and ANSI AAMI IEC EN 62304 or equivalent regulation used in country of origin and shall be CE marked a certificate from original manufacturer must be provided Medical furniture i e SS furniture desks cabinets tables chairs shall be brand new durable quality and from reputable manufacturers local or foreign All Manufacturers should be ISO 9001 2008 classified The bidder shall provide each item in the specifications as complete fully functional units with all ancillaries and accessories necessary for normal and safe use The bidders are due to inform adequately on all relevant specifications and performances of the offered equipment even though such information has not been required in detail in the present specifications Such detailed specifications should be the original manufacturer s specifications and supported by the manufacturer s original technical data sheets Transcription of the specifications in the tender documents will not be accepted The bidder may be required to provide additional clarification and supporting documentation about his specifications The bidder shall in detail describe procedures for maintenance and the current updating of major equipment and systems The bidder shall
68. ling mounted OR light system for minor surgical procedures System comprises a main light Must have the following features and specifications Free and unhindered rotation around central axle and joints Fully balanced spring controlled system Easy maneuverability and positioning via headlight integrated handle Adjustable focusing with the handle Handle easily removable and sterilisable Multi bulbs or single bulb with automatic switch over emergency bulb system IR filtration system Light illumination Min 80K Lux Color rendering index from Ra 93 to Ra 96 Color temperature from 3300 K to 4300 K Low wattage light source Max 150 W halogen 70W Gas discharge Long life light source Approx 1000 h halogen 5000h Gas discharge Light field diameter Approx 15 25 cm Working distance Approx 70 140 cm Depth of working area with focus Min 50 cm Maximum temperature increase at surgeon s head 2 C Hermetically closed cupola to allow disinfection and cleaning Easy and quick bulb replacement Integrated light intensity dimmer control in light head To be delivered with all necessary accessories and cables including transformer anchorage plate and bolts Must comply with IEC 60601 2 41 ME2000 ELECTROSURGICAL UNIT Universal electro surgical unit for general surgery Suitable for mono polar bipolar applications and underwater cutting Cutting 300 W Coagulation 200 W Bipolar 35 W 20 ohm
69. lso recognized that primary health cannot be improved by just concentrating on the health sector indeed other sectors are equally important in promoting the health and self reliance of communities These sectors include agriculture education communications public works rural development industry and community organizations Intersectoral collaboration is a critical success factor in the delivery of good healthcare Government and local authorities have a fundamental responsibility for the health of their citizens They need to elaborate working strategies based on successful pilot projects in other regions or countries They can also seek the help of experienced NGOs and Public Health schools that have conducted many studies and have access to a vast database of information and statistics There are four major universities AUB LU USJ and UOB in Lebanon that have public health faculties and am sure they would be keen in landing a hand to the concerned ministries to help their underprivileged countrymen Further study need to investigate the capacity of the poor population to pay for services and how it will impact their quality of life In any case if fees are charged the money generated should be re injected into the local system not collected by government to ensure self reliance and progress Sustainable primary health care be achieved gradually by the implementation of adequate health and social policies strategies and measures Initial
70. lusters Page 66 of 127 EMERGENCY ROOM DIMENSIONS Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 67 of 127 MED GASES RAMP 7 IN STEEL HOUSING Initial feasibility study for the extension of health services in Wadi Khaled clusters Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 69 of 127 ABOVE SINK amp TABLE CABINETS STERILIZATION PASS THROUGH Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 70 of 127 ENDIX 3 GENERIC ROOM LAYOUTS FOR PHC B RA 27 Yy MACY Ys ORA o A 77 A yy Yes 5 GROU Ye I igs 7 PRIMARY HEALTH CENTER TYPICAL ONE FLOOR TYPE TYPICAL TWO STORIES TYPE PRIMARY HEALTH CENTER s ENV zz SER by o gt T Sg 7 h CHNICAL A o B a SOM L NN NE P zu mo Ru NN NN 3 SS ES NS T ES NS IET TE zou SET c c ed NS 2 A 2 p NN NV E i t NY Y Qui 8 PRIMARY HEALTH CENTER TYPICAL SEGREGATED TYPE WOON SNIL33W 391440 YyOLDANIG Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 75 of 127 491440 lan LNAILVd TWOIdAL Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 76 of 127 JINITD TVH3N39 JSINITO TV LN3G Initial feasibility study for the extens
71. m washing and agitating e The volumes of the washing and agitating bottles shall be at least 2 L e The volume of hole washing should be adjustable for required quantity e It should be capable of performing cross aspiration e The flow rate of the washing solution should be adjustable e tshould have agitating and non contamination programs e The following items shall be provided with the apparatus e Inner pressure and vacuum pumps e Washing agitating and waste bottles e Maintenance kit and extra fuse e Power supply 220 240V 50 Hz LB0030 INCUBATOR To have the following features and specifications e Capacity approx 200 liters e Chemical and moisture resistant chamber e Digital electronic control continuously displaying chamber e Temperature e Capable of operating in the temperature range ambient 5 C to 70 C e Fitted with inner glass door e Fitted with a circulating fan e Temperature fluctuation at 37 C lt 0 5 C e Temperature Control at 37 C lt 0 2 C e Over Temperature safety cut out e Supplied with a minimum of 4 shelves e Power supply 220 240V 50Hz LBOO20 HOT PLATE STIRRER To have the following features and specifications e Ceramic top e Chemicals resistant and easy to clean e Holds loads up to 10 L e Microprocessor controlled operations e LCD display for parameters e Control knobs for speed and temperature Initial feasibility study for the exten
72. mation through direct observation taking notes and photographs and by discussing with health centers staff and municipal chiefs Mukhtars and local stakeholders about the actual health conditions and needs During each visit was accompanied by the TA teams of the ESFD and GFA Meeting with health officials from the major hospitals in the nearby towns Kobayat and Halba to collect some feedback about their knowledge about the health conditions in Wadi Khaled region Meeting with the Head of Al Makassed Health Care Bureau Write a preliminary report about the general findings Prepare a complete technical study based on the evidence gathered To facilitate the mission and to standardize the type of data assembled a questionnaire reference guide was prepared and used during the site visits and meetings the questions concentrated on Demographics Health conditions epidemiology Healthcare services accessible in the area Costs of health services Health awareness education Availability of skilled human resources Environmental constraints Availability of infrastructure and governmental support Needs Improvement recommendations and expectations as seen by the locals Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 12 of 127 4 OVERVIEW BACKGROUND INFORMATION The Wadi Khaled region is located in Akkar in Northern Lebanon at its north eastern tip It has a registered po
73. me less than 6 seconds Display of selected stored and delivered energy Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 93 of 127 Non invasive fixed override or on demand pacer modes possibilities ECG acquisition via Paddles and patient cable with adjustable alarm limits and min 6 leads selection Display CRT LCD or EL has ECG Alarm messages sensitivity lead alarm limits heart rate and defibrillated energy large screen Defibrillation modes External defibrillation via paddles External defibrillation via adhesive pads Semi automated defibrillation with voice controls Delivery to include the standard set of accessories for the complete proper function of the unit including pacing electrodes Option SPO monitoring Power supply 220 240V 50 60 Hz Accessories Percussion Hammer Buck Percussion Hammer Babinsky Ophthalmoscope Otoscope Desk Top Tourniquet Strap Nasal Speculum Adult Nasal Speculum Pediatric Measuring Tap 2m Steel Rule 30cm Tuning Fork Set of 4 Pinwheel Wartenberg Forceps Magill Adult Forceps Magill Child Forceps Straight Scissors Lister Bandage Scissors Universal Bandage MEO0066 DEFIBRILLATOR AND RESCUCITATION EQUIPMENT FOR MOBILE DISPENSARY Defibrillator Features Lightweight easy to operate defibrillator with ECG monitor and min 2 channels recorder for internal and external defibrillation semi automatic and manual mod
74. ment e Health services offered General Medicine Ob Gyn and normal delivery Pediatrics Cardiac ENT Ophthalmic psychiatry Dentistry Laboratory and Radiology e Visiting doctors are all from the surrounding areas All Lebanese e Distributes medications and drugs supplied by the MOPH and the YMCA which are free and others bought by Al Makassed are sold at cost price e Opens every day 7 7 e They have collaborations with nearby hospitals Al Salam Kobayat Al Yousef Halba and Halba Govt Hospital for acute cases However not to be renewed this year e The center is equipped with adequate equipment in some departments They are maintained by suppliers and biomedical technicians from AL Makassed e The Lab is the best in the area Can be improved with the addition of few modern machines to complete the testing services e They have a routine X ray machine a Dental chair with intra oral X ray an Ultrasound and EKG e The meeting room in the basement was designed to become an emergency room e Across the hallway they have a steam sterilizer autoclave installed next to a boiler in the mechanical room The place is inappropriate for sterilizing instruments There is also a foul smell sewage inside the area due to bad drainage system needs to be evaluated by a Mechanical engineer or expert plumber e They lack medical gases installations especially in patient rooms and procedural areas They rely on cylinders w
75. ml hr in 0 1 ml hr increments e Volume limit O 1ml to 0 5ml in O 1ml increments e Audible and visual alarm for e Fluid depletion infusion near end infusion end high pressure occlusion system malfunction syringe unlocked plunger disengaged low battery mains failure purge mode KVO mode e Built in charger and rechargeable battery 4 6 hr capacity e lock function to prevent accidental changes of flow rates e Light weight e Rail pole clamp e Power supply 220 240V 50 Hz ME1005 EXAMINATION LIGHT WALL MOUNTED General purpose examination light to have the following features and specifications e Compact size light head e Wall mounted on heavy duty mechanism e On Off switch e Light source Tungsten halogen not less than 50watt e Parabolic reflector and heat absorbing filter e Built in transformer and control elements e Double jointed arm Swivel Radius approx 100 cm e Maneuverable by means of a sterilisable handle e Height Movement approx 80 cm e Lamp head adjustable horizontally and vertically e Illumination Intensity 220 KLUX e To include all necessary mounting material for wall installation e Must comply with IEC 60601 2 41 directives or equivalent e Power supply 220 240V 50 Hz Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 103 of 127 MEO0700 PATIENT SCALE WITH ROD Mechanical beam type Heavy duty beam For patient weighing an
76. mmonly it is run by one senior duty doctor assisted by resident and paramedical staff with other doctors on call and scheduled visits The team includes at least 3 registered nurses a midwife 4 medical assistants and three auxiliary staff The typical catchment area would be a population of up 20 000 people depending on the geographic factors Typical building layout Depending on local building regulations urbanism laws and the characteristics of the site chosen for constructing a PHC the architect and civil engineer will design a building that accommodates the project concept needs specified in a space program based on a medical program and facilities guidelines The size of the land will also influence the shape of the building whether it will be a one floor or multiple floors facility There are lots of models to go by but the most practical are e The one story most accessible to people with disabilities and requires no lifts to be integrated However it requires a larger land area Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 31 of 127 e The two stories or more model gives flexibility in both the number of services that can be accommodated and segregates care administrative and utilities areas Requires at least one lift preferably a patient lift to provide accessibility to the upper floors Works best for smaller land areas e Both models can be either an island type internal topol
77. mples sec channel for recording and storage e 1000 sec channel for VLP e Compatible PC software e Should be supplied with a latest technology PC with Colour Ink Jet Printer amp UPS ME1288 TYMPANOMETER Screening diagnostic Tympanometer performs automatic impedance measurements for middle ear evaluations To have the following features and specifications Tympanometry mode Reflex mode IPSI Frequencies IPSI Intensities on off ratio rise fall time Contra Intensities Pressure Reflex decay mode Reflex Frequencies Contra Intensities Pressure Test Time 500 1000 2000 amp 4000 Hz 2 70 105 dB HL 105 dB HL max at 4000 Hz Minimum 70 dB Approx 10 msec Approx 60 110 dBHL Automatically set to peak value on tympanogram 500 1000 2000 4000 Hz 2 70 120 dBHL 115 dB HL max at 4000 Hz Automatically set to peak value on tympanogram 13 seconds 10 seconds auto tone present Eustachian tube function mode Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 98 of 127 Pressure Range 300 to 400 daPa mm H20 Accuracy 10 or 4 10 daPa whichever is greater Standard accessories Display Printer Probes Power Port LCD type graphical display shows graph of tympanogram peak compliance peak pressure canal volume gradient reflex graph and conclusion Integrated thermal printer Regular probe High tone frequency Compatible Ear tip
78. mprove the infrastructure namely roads waste management and disposal and most important sewage treatment Create more local economic development to keep people from migration and to attract people to come live and work in the area especially professionals Doctors scientists engineers technicians Introduce information technologies IT Experience shows that the ability to acquire and use information is fundamental to the successful implementation of primary health care There are two facets to information technology in primary healthcare One is concerned with diagnosis and medical care and the other with the education and enlightenment of the rural population especially among the adults For care appropriate application of information technology in primary health care will extend traditional diagnosis and patient management beyond the PHC walls With a computer and an IP camera and a descent internet connection starting with an investment as low as 1000 S for a basic teleconferencing solution health professionals can seek help and second opinions for colleagues in larger institutions on clinical cases for this an HD Pan Tilt Zoom IP camera is needed costing an average 2500S or look up solutions or get information from the web They can also get informed and educated on new trends and technologies Also most modern equipments come with a digital interface and management software that can be connected to a computer and the data either saved
79. n and other Eastern European Ex Soviet Bloc universities but they are competent given their exposure and hands on experience The center has 8 patient rooms but lack any medical gases infrastructure It is mandatory to have medical gases services for any inpatient care Relying on cylinders is not cost efficient on the long run and poses logistical problems They also take up space in already small rooms During our conversation with the center s director Mr Khaled Al Mostapha he expressed wishes to have a surgical operations department especially for Cesarean Section This is not feasible at this stage because with any surgical facility we need to design a special patient a staff flow with clean restricted areas sterilization facilities recovery and intensive care in case of complications all requiring at least a 120 m area and a budget of approximately 200 000 00 This PHC is too small to accommodate such facilities He also asked for a Dialysis center By MPH standards a Dialysis center proper has to have a minimum of 8 care stations with all auxiliary facilities This would require an area at least 230 m and a budget of 225 000 00 This type of care requires a specialized medical and paramedical staff not readily available in this area We believe we should concentrate on essential life saving treatment and minor procedures by building a decent well equipped emergency department with a trauma resuscitation and minor procedure rooms
80. natal patients for intra hospital fast monitoring This preconfigured monitor shall have the following features and specifications Display e LED or TFT type display e Numerical Values Parameters monitored NIBP Pulse SPO2 and Temperature N I B P Non Invasive Blood Pressure e Oscillometric method e Cuff pressure display e Cuff size adult pediatric neonate e Quick connect hose connection is recommended Pulse Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 100 of 127 e 30to 250 bpm SpO2 Pulse Oximetry e Disconnect amp failure detection e Disposable and reusable probe possibility Temperature Alarms e One input e Selectable scale C or F e Range C 15 to 45 e Range F 59 to 113 e Audible and visual for malfunction and errors e Over pressure protection Data output e Via Ethernet cable Battery Long life Lithium lon battery or equivalent Power requirements Power supply 220 240V 50 60 Hz Accessories For proper operation each monitor should be delivered complete with One Temperature probe rectal with cover SpO sensors with one extension cable one reusable adult amp pediatric Wrap sensor for neonates NIBP cuffs 1 infant 1 pediatric 1 medium and 1 large adult Spare rechargeable battery User Manual All necessary cables and attachment accessories Compatible trolley with basket ME1277 SPIROMETER Portabl
81. nce of such development missions is to help create projects or consolidate existing one to become sustainable and self sufficient However given the evidence this will be hard to achieve especially that these institutions are welfare type charging no or basic fees for services and medications It is most likely that they will rely on Ministries funding NGOs and Charitable organizations Like Al Makassed donations to sustain their operations As mentioned previously the funds allocated for this mission have to be used for agricultural type development projects and Healthcare improvement The amount available for each cluster is 200 000 00 that s 266 000 00 at 1 1 33 If we split the amount then we can appropriate 133 000 00 for healthcare projects in each cluster For this money to have a positive impact on the situation we chose the following centers 1 The Al Hishi Makassed PHC is our first choice to receive this money to complement its already existing portfolio of medical equipment Table MEN 01 describes by order of priorities the pressing needs for this healthcare center The amount allocated will have a better impact in such a facility where we can eliminate some of the gaps like planning and installing a modern emergency department Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 33 of 127 The Al Hishi Makassed PHC is a relatively new building built in 2003 and its owned by the Minis
82. nit Automatic power cut off in case of low water level Power supply 220 240V 50 Hz MEO066 HOLTER SYSTEM To have the following features and specifications e Should be a PC based software compatible with windows OS e 3Channel Arrhythmia analysis e Full disclosure of ECG with different color coding for VE SVE amp PAUSES Hourly count menu Page scan Mega scan Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 97 of 127 e Minimum of 20 Templates editing to analyze VE SVE V RUN SV RUN PAUSE ST etc e Atrial fibrillation and Flutter analysis e Heart Rate Variability HRV Time Domain 3D frequency Domain Lorenz Point e care plot e Pace Maker auto detection and analysis e Possible to have a unique 12 lead analysis with FCG CAD gram e 12 Lead ST scan e QT analysis with validation e Vector cardiography e TWave Alternans analysis e To print ECG strips from any part of Holter recording e Dedicated software capable of analyzing data from 3 Channel digital recorders e Memory card slot type to be specified e Color Printing Recorders with following Configuration e 3 Channel Digital recorder with removable storage media e Memory card capacity 1 GBx 1 e 7 Lead cablex1 e Recorder should be compatible with alkaline and rechargeable batteries e Digital recorder should have a minimum of 512 samples sec channel for pacemaker e Spike detection and at least 128 sa
83. nsidered as guidelines The equipment and supplies offered shall be brand new premium quality and from reputable manufacturers whose experience in the healthcare field has exceeded a Ten Years period It shall be of EC origin and make and should meet European Union directive standards should be CE marked The Client may reject any equipment which has not been field proven has no installed base and no recognized references Bidders that have no local references yet should submit a reference list of projects completed in the Middle East and Levant region preferably This list must be recent and certified by the original manufacturer Reconditioned or refurbished equipments are not acceptable The supplier warrants that the offered goods are new unused of the most recent or current models and those incorporate all recent improvements in design and materials The supplier also warrants that all goods shall have no defect arising from design material and workmanship of from any act or omission of the supplier The above mentioned statement shall be proven by original certificates from manufacturers The supplier must be well established locally with proven after sales service record for more than 10 years and warrants that he will keep in stock spare parts for the purchased equipment for at least 7 years All Life Support Medical Equipment i e surgical equipment anesthesia machines ventilators infusion equipment patient monitors electrica
84. ntries e The best PHC in the area the Al Hishi e Some resistance to women education and Makassed hospital is also basically equipped empowerment compared to other PHCs in the country but e Pre arranged marriages and First cousins is fairly better than the rest of Wadi Khaled marriages are frequent e High birthrates e Inadequate health education and family planning e Bad living conditions e Bad living habits mainly sanitation nutrition and smoking SOCIO CULTURAL TECHNOLOGICAL Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 27 of 127 9 SWOTANALYSIS STRENGHTS WEAKNESSES e Identification of 2 prospect sites for the e Both centers lack basic emergency services assistance grant e Al Hishi PHC requires calibration of its e The Al Hishi PHC has an acceptable electrical network unstable electrical infrastructure and can quickly make use of current can damage expensive medical the needed equipment to be supplied by equipment It also lacks proper HVAC the grant installations especially in critical areas where e Al Amayer needs some overhauling but is humidity control is needed also a viable candidate for the assistance e Al Amayer shows signs of water damage and grant Once completed it can also make cracks in the walls and in some parts of the quick use of the equipment that will be structure Need overhauling before new supplied
85. o Mobile with wall or floor fed services with saliva ejector hose o High volume evacuator o ini1Syringe o Mayo tray o Assistant s tool panel can be supplied as an integral part of the dental chair e Suction unit e Air compressor quiet e Dental surgeon s stool e Assistant stool e Power supply 220 240V 50 60 Hz All hand pieces and compatible burs shall be stainless steel heavy duty ergonomically designed and fully autoclavable They will be chosen by dental staff during purchase All pre installation civil electrical and electromechanical works should be included Dental X ray Unit Wall Mounted Dental X Ray apparatus for intra oral radiography to have the following features and specifications e Wall mounted on counterbalanced articulated arm e Microprocessor controlled e With preprogrammed exposure parameters e with digital display of settings System Specification e Single tank type e Tube head rotation o 270 swing in the vertical plane o 360 continuous rotation e Fixed rating 65 kV 7 5 mA e 2 mm AL equivalent inherent filtration e Open ended lead lined cone o 20cmlong o 6cm diameter e Electronic timer 80 to 2500 ms e Automatic power compensation e Power supply 220 240V 50 Hz LBO800 ROUTINE MICROSCOPE A professional binocular analog compound light microscope digital ready for general medical laboratory applications to have the following features and specifications Body e Heavy
86. oard pad x1 e Restraint straps one set per trolley e X Ray cassette film tray slide and holder MEO0051 PATIENT STRETCHER e For general patient transport e Heavy duty steel construction e Fixed height trolley e Dimensions approx 200 x 75 x 75cm LxHxW e Mounted on 4 large swivel castors 2 with brakes and steering e Radio translucent mattress platform e With adjustable backrest e 02 cylinder holder e 5cm conductive mattress with washable cover e Length collapsible patient safety side rails e 4Acorner bumpers and IV pole holders e Facility for drainage bag and IV rod storage e Large weight capacity Complete with e Vrod e Storage basket e Patient restraint straps MEO0011 OXYGEN FLOWMETER 0 15L MIN e To fit oxygen cylinder Incorporating reducing valve cylinder content gauge e Flowmeter graduated in liters per minute at 1 liter intervals e Adjustable flow ranges 0 15 L min e With adaptor to fit humidifier and detachable Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 108 of 127 e Autoclavable humidifier Complete with spanner ME0190 ROUTINE RADIOGRAPHY X RAY SYSTEM A radiographic floating table for general purpose radiography to have the following features and specification Table e Bucky table e Floating tabletop with electromagnetic brakes e Integrated X Ray tube column Rotation around the vertical axis 9
87. ogy or a segregated internal topology Both should be designed around patient flow concept e All PHC facilities should incorporate accessible pathways and WCs for people with disabilities according to ADA guidelines Refer to appendix 3 for generic room layouts and their preferred dimensions Typical infrastructure and site requirements The patient visitors and staff flow need to be well thought during the design phase Cross circulation hinders the care effort There should be specific areas for waiting and only patients and concerned staff will use the care areas there should be a separate entrance for medical staff into the facility typically from the ER side Minimum space requirements as described in well elaborated healthcare facilities design guidelines like the AIA FGI the AusHFG the UK HTM and VHA WBDG need to be implemented in order to assure smooth flow of patients and staff and also ideal working conditions for staff and comfortable space for patients For medical equipment to function properly and for health staff to perform their tasks effectively a suitable infrastructure must be provided Manufacturers of medical equipment can provide a list of MEP requirements where they apply needed for the proper operation of their equipment Based on these requirements each site that will receive this equipment will have to be readied according to these MEP requirements Typically and engineer or technician from the manufacturer
88. onfiguration of a PHC is as follows e Adirector s office with meeting room and private WC e An assistance small office with a back room for document copying and filling e An accountant and collection officer office e Amain reception and information desk at the entrance e A waiting hall with male and female public toilets preferably accessible to disabled people otherwise provision for on Handicapped WC must be made e Aramp As per ADA guidelines should also be constructed to facilitate access to the facility e Acombined emergencies and minor procedure room with essential life support equipment e There should be at least two multipurpose consultation and exam room adequately equipped e One Obstetrics and gynecology consultation and exam room adequately equipped e One dental clinic with intra oral x ray and film developing apparatus e One area for blood and sample taking for laboratory e Basic laboratory with biochemistry hematology coagulation and bacteriology testing e A pharmacy with secure storage cabinets and cold storage equipment e One washing disinfecting room and a flash sterilization room totally segregated e Aclean utility a dirty utility a linen store and a pantry e Astaff area with lounge WC and pantry e Atleast one janitor room for housekeeping purposes e A patient records room with a computer with large storage and ample filling space e Anequipment store and a general purpose store for suppl
89. ped hospital Well equipped imaging dept e Offers a large variety of medical services e Most cases treated Trauma General medicine amp Pediatrics Ob Gyn Dialysis Cardiac Chronic diseases And Gun shot wounds 6 3 4 Saydet al Salam Hospital Qobaiyat e Privately owned by the Antonins Maronite Order e Managed by Sister Marie Edouard Daccache e Due to lack of funds the hospital is relying on old equipment but in good shape They buy new equipment only on needs basis e Fairly equipped hospital Fairly equipped imaging dept e Offers a large variety of medical services e Most cases treated Trauma General medicine amp Pediatrics Ob Gyn Dialysis Cardiac Pulmonary Chronic diseases And Gastric diseases 6 3 5 Al Hariri Foundation Dispensary Al Bireh e Privately owned and managed by Hariri Foundation e Has a nursing team on duty e Provides primary health care services and some sub specialties like Cardiology and orthopedics Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 21 of 127 Implements a Nationwide Health card system enabling patients to receive care at any Hariri Foundation facility where the patient s records can be easily accessed for continuation of care Fairly equipped center But lacks X ray imaging Has a social counseling office The center is well maintained and clean Charges basic fees for services 5 000 00 L L for routine exams 8 000 00 L
90. pron e Power supply 220 240V 50 Hz ME0180 PORTABLE ULTRASOUND UNIT Portable general purpose ultrasound system which can support applications such as Abdominal Obstetrics Gynecology small parts endocavity to the following features and specifications e User interface Keyboard key panel trackball e 2 probe selector amp one for pencil probe and support the following probes Convex linear sector endo cavity and pencil probe e A12 video monitor that shall have adjustable height swivel and twist movements e Power system e B W and color printer and DVD e Compatible Cart The following specifications should be included e DICOM compatible e Application Abdominal OB GYN breast small parts endocavity e Imaging modes B mode M mode BM mode e Doppler imaging modes PWD Pulsed Wave Doppler CWD Continuous Wave Doppler CDI Color Doppler Imaging Doppler Color Flow mapping CFM or power Doppler imaging e Display function Cine loop playback mode covering several seconds as well as freeze frame capability depth change and zoom magnification e Analysis package including but not limited to OB GYN scanning e Image storage Built in HDD USB memory DVD CD e With the following multi frequency or broadband probes Convex probe Linear probe Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 112 of 127 Endo vaginal probe Pencil probe e Display at least 64 shades o
91. pulation of around 39638 inhabitants its resident population during the summer reaches 31114 inhabitants The region is culturally rich due to the confessional variety of the population belonging to a Sunnite majority Alawites 6000 and Shiites 1500 living in the village of Karha The total area of Wadi Khaled is around 40 Km with hills overlooking the Syrian regions of Homs and the Tal Kalakh It borders Syria to east and north naturally separated by the Nahr el Kabir Big River to the west it borders the village of Mashta Hammoud and to the South the villages of Jabal Akroum Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 13 of 127 The climate in Wadi Khaled is cold in the winter hot in the summer and pleasant in spring and autumn however the region is very humid all year long It is divided into 2 clusters Eastern and Western with a total of 18 villages led by the Mqaible municipality for the western cluster and by the Al Mounseh municipality for the eastern cluster The Eastern Cluster with 9 villages Al Mounseh Has a municipality Al Amayer Rajem Issa Rajem Khalaf Al Kalkha Rajem Bayt Hussein Karha Hnaider Al Amriye Kanissa and Al Majdel Al Msaed The Western Cluster with 9 towns and villages Al Mqaible Has a municipality Khat el Petrol Bani Sakher Karm Zebdine Al Fared Al Hishi Al Awadeh Al Rama and Jourmanaya Syria AL HISHI A ranas MAKASSED PHC AL YER
92. re a must SIMV Mode e No Ventilation Mode for battery charging during storage e Airway pressure meter should be integrated e Controls o PEEP O to 20 cm H20 Volume 50 to 2800 ml Pressure Limit Adjustable from 10 to 100 cmH20 Flow Adjustable from 20 to 110 Ipm nominal Rate Breaths Per Min Adjustable from 1 to 50 in one breath increments Sensitivity Adjustable from 10 to 10 cm H20 nominal o FiO2 e Built in Air compressor to deliver room air which can be enriched with oxygen through a hose connection and a built in blender e Battery Sealed rechargeable type with a capacity at least 2 hours Battery charge level indicator Oo Q O Q9 cO Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 92 of 127 should be available e Safeguards and Alarms o Low Battery Audible and visual alarm o Power Switchover AC to DC switchover with pulsing audible alarm o Ventilator Malfunction Constant audible alarm with flashing alarm lights o Alarms for Apnea High low respiratory rate High Low minute volume High pressure PEEP drop if the breathing circuit is disconnected and flow resistance is encountered e The ventilator should be delivered with e Three Patient tubing circuit Re useable e Side rail bracket e Three section patient circuit support Arm e Rigid cover for the control panel e Power supply 220 240V 50 60 Hz MEO0065 CRASH CART WITH DEFIBRILLATOR AND ACCESS
93. rence on Primary Health Care declaration 1978 e The World Health Report 2008 Primary Health Care now more than ever World Health Report WHO 2008 e Primary Health Care Theory and Practice ABC Trisha Greenhalgh BMJ Book 2007 e Primary Care Centers Second Edition A Guide to Health Care Design Geoffrey Purves 2009 e Oxford American Handbook of Ophthalmology James Tsai et al 2010 e Oxford American Handbook of Infectious Diseases Aimee Zaas et al 2011 e Epidemiology Key to Prevention Klaus Krickeberg Springer 2012 e Epidemiology A Very Short Introduction Rodolfo Saracci Oxford University Press 2010 e JCI Accreditation Standards for Primary Care Centers JCI 2008 e Primary Health Care Centers Functional Description Planning of Equipment and Renewable Resources UNICEF 2004 e Essential Medications List EML WHO Model List 17 edition 2011 e List of Essential Drugs for Primary Care in Lebanon B R Saab et al Lebanese Medical Journal 2001 Volume 49 5 273 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 127 of 127
94. s e Shortage of essential medical equipment and instruments e Essential drugs and medical supplies are not supplied on a continuous basis e Shortage of skilled professionals and workers and inadequate recruitment strategies e Poor skills and knowledge of local PHC workers leading to inappropriate diagnosis and treatment of illnesses contributing to higher morbidity and mortality levels in patients Local staff at many centers utilize medical procedures and medical technology inappropriately to deal with basic health problems this due to lack of manpower training and development e Poor job descriptions and authorities delegation e Lackof motivation and incentives e Migration and immigration of educated youth and professionals to urban areas or abroad seeking better fortune and career opportunities e Absence of communication channels between providers and individuals community leads to mistrust e Bypassing Unsatisfied patients will prefer to go to a specialist or larger hospital for treatment even at higher costs if they deem that the local PHC is poorly managed and equipped e Lack of continuous commitment from individuals communities and governments Typical Configurations of a PHC There are 2 interesting models for a PHC that would best fulfill the needs of primary care the first being a basic one with essential diagnostic services and minor emergencies and the second a larger PHC with specialized care The most basic c
95. s and equipment from UNICEF DRC and UNDP The new projects included the creation of a children playground the supply of medical equipment most recent was a Cardiac Ultrasound system The Center collaborates with Al Hishi Makassed PHC for laboratory tests The Makassed center sends its mobile dispensary daily to the Al Amayer center to collect samples For this center we propose to create a small emergency small procedures room a new basic lab new pharmacy casework renovate the building and create a handicapped access ramp and supply an ambulance If MOSA can fund the renovation of the building then we can use the money to supply more medical equipment as listed in Table MEN 02 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 35 of 127 12 START UP PHASE LIST OF PRIORITIZED NEEDS The following tables list the prioritized needs for each PHC with their estimated costs in US dollars TABLE MENO1 PRIORITIZED NEEDS FOR AL HISHI MAKASSED PHC Priority Item Reference Description of Need Quantity a Ea ced Equipment and furniture for a trauma and icis 1 49 625 00 49 625 00 resuscitation room See List ME 01 i Equipment and furniture for a Minor treatment room with plaster sink See List 26 930 00 26 930 00 ME 02 Ramp for the Supply of medical gases from cylinders with valves and regulators N20 Oxygen Medical Compressed air 4 bar For Emergency Department Air Handlin
96. saged health care centres projects The management and the field staff of the Community Development component dispose of an adequate basis for evaluating the technical feasibility of the proposed health care centres projects 2 3 4 Deliverables e After two days from the start of the mission Work Plan and activity schedule as well as methodology to be followed during the mission The expert will be required to produce one technical feasibility report per project comprising at least of the following elements e A presentation and evaluation of the conditions prevailing in the regional health care sectors of the cluster and in relation to the envisaged projects e Onthe basis of the analysis of the prevailing conditions the expert elaborates on the specific objective and the results of each envisaged project Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 11 of 127 On the basis of the current situation the expert elaborates the definition of each project comprising of content of project choice of technology and equipment preliminary design preliminary cost estimates preliminary O amp M costs estimates implementation calendar log frame Technical specifications of the envisaged equipment respecting EU procurement rules A synoptic project fiche 3 METHODOLOGY A time table was set for this intervention Starting with the field visit of each cluster of villages to gather infor
97. seases and health problems in their towns Diabetes Cardiac Digestive tract Kidney disorders Dermatological and trauma mainly from motorcycle accidents and sometimes from gunshot wounds o Absence of basic utilities and services Water treatment and supply power sewage and garbage disposal o They have 2 old power generators 1 at 120 KVA and 1 at 13 KVA but since the troubles begun across the border they cannot get cheaper fuel and now at local prices it s costing them 2000S per month to run They are both worn out and consume more fuel o They took the initiative to write letters to politicians NGOs Governments demanding help for their region but so far without any successful outcomes No potable water Local water sources are heavily contaminated Water treatment softening of hard water High CaCO3 content Garbage Trash is disposed of at all side roads on river banks and ravines Many of the sick and injured from the Local population are being transported to nearby hospitals using damaged and traitorous roads Many get there in worst shape then what they started with o Education literacy improved from 1096 to 90 96 since they became naturalized in 1994 mainly amongst the younger generations They however lack career orientation for specializations that are useful for their livelihood and region o Some are already enrolled or seeking employment as civil servants mainly in the military and security forces O OO 0
98. set 220 230 volts AC 50 60 Hz RS 232C To be delivered with Carrying case manual calibration cavity tools compatible thermal paper ME1213 AUDIOMETER Microprocessor controlled unit for air and bone conduction and speech threshold testing with digital display Speech tests to include ABLB automatic threshold HW Bekesey Langenbeck SISI Stanger binaural pure tone stimulation Screen audiometer with air and bone conduction Automatic semi automatic and manual modes Channels 2 separate and identical channels Frequency range 250 to 8000Hz Bone Frequency range 125 to 8000Hz Air Attenuator range 10 to 120 dB air 10 to 80 dB bone in 1 or 5 dB steps Masking noise narrow band white noise Attenuator accuracy within 3dB of indicated level Frequency accuracy lt 1 To include automatic validity check Printer for Printout of audiometric test results External inputs CD Tape Microphones Outputs phones bone conductor insert phones special phones and free field loudspeakers Accessories head phones TDH 39 bone conductor built in charger and battery angiogram pad earphones and carrying case Power supply 220 240V 50 60 Hz MEO0067 ECG 12 CHANNELS To have the following features and specifications e Manual and automatic operation e 3 6 12 channels print out e mobile trolley mounted e 3 selectable sensitivity levels e Speeds 5 10 25 and 50 mm sec e Progr
99. sion of health services in Wadi Khaled clusters Page 119 of 127 Speed stirrer from O to 2000 rpm Regulated temperature up to 4502C Plate size approx 20 x 20 cm Delivered with temperature probe probe holder retort rod and stir bar Power supply 220 240V 50Hz LBOO21 WATER BATH 10L To have the following features and specifications General purpose laboratory water bath High grade stainless steel chamber and perforated stainless steel sample tray Seamless contraction to guard against leaks Poly carbonate see through removable cover Integrated power stirrer for bath uniformity Digital temperature display Low liquid level over temperature safety cut out device Tank capacity 20 25L Temperature range 5oC above ambient 1000C Uniformity 0 1 C at 37 C Power supply 220 240V 50Hz To be delivered with necessary accessories Safety features to be specified LBOO10 CENTRIFUGE BENCH TOP To have the following features and specifications Up to 6000 rpm Digital and programmable Built in timer up to 60 min Swing out rotor can accept 2 ml to 100 ml test tubes Open door indicator Imbalance cut off Speed and time display Power supply 220 240V 50Hz LBOO40 TUBE ROLLER MIXER For smooth mixing of specimen for uniform suspension to have the following features and specifications e Adjustable speed 2 60 rpm e Mixing by rotation e Adjustable mixing platform e 16 tubes capacity e Acc
100. solutions for the furbishing of primary healthcare centers in each of the clusters under the community development component 2 MISSION INFORMATION AND OBJECTIVE 2 1 Information on the Program The program Appui au D veloppement Local dans le Nord du Liban ADELNORD finds its justification in the existence of strong inequalities what concerns economic and social development The general objective of the program is threefold To contribute to the national unity and to the improvement of living conditions of the people of Lebanon through valuation of the potentialities of the region that suffers a lack of development To contribute to a national land use strategy and To contribute to the improvement of environmental protection The specific objective of the program shows the participative approach with local communities in sustainable management of agricultural and natural resources The program principles underline the sustainability of the economic activities oriented to local development in harmony with the natural environment Three results are formulated for the program Administrations local communities private sector and civil society are mobilised around sustainable land development strategies Agriculture is diversified productivity and efficiency are improved Use of Good Agricultural Practices GAP is systematized and employment in the agricultural sector is maintained and increased Mountain ecosystems
101. specify in detail the training component included in his offer which shall cover all necessary training and education of relevant staff for safe and competent handling of major equipment and systems The Medical Equipment Supplier shall adhere to the specifications and other documents within the tender which consist of 1 100 scale layouts for equipment room by room listings department listing and general bill of quantities Tender documents shall complement each other for information purposes and the contractor shall not discard any of the enclosed documents Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 91 of 127 All dimensions contained within the specifications are approximate and shall not be taken literally except in the event of Supplier s equipment surpassing the specified dimensions then an exercise from his part shall be carried out to ensure proper space clearances within any particular room for his proposed equipment Power ratings as shown in documents are indicative except voltage and frequency ratings Any brand name mentioned in the specifications shall be used for analogy purposes rather than selection Similar product shall be acceptable Supplier has to ensure proper coordination with all other Contractors particularly those pertaining to civil electrical medical gas and electromechanical works Supplier has to verify all his equipment dimensions according to available architec
102. stormy weather it was evident that the waterproofing has failed This center is owned and managed by MOSA The appointed official is Mr Ahmed Khalaf The center serves as healthcare social and educational vocational center The Center offers few medical consultation services General pediatric Ob Gyn Cardiac and Chronic Diseases management and dental practice It is served by This center employs local doctors 6 doctors and staff contracted by MOSA Again most these doctors graduated from Russian and other Eastern European Ex Soviet Bloc universities but they are competent given their exposure and hands on experience The center charges basic fees for its services as set by MOSA A sign with prices is posted The Pharmacy is less than basic as the MOSA only sends medications that are available at its central warehouse not fulfilling the real needs in medication for the population Some of these drugs are not used and are thrown out after a while The MPH stopped sending drugs since MOSA assumed management of its centers Patients are either sent to other facilities to get their prescribed drugs This center also manages a small satellite dispensary in the remote village of Karha that is very basically equipped with 2 clinics and a very small pharmacy Both centers serve a population of about 20000 inhabitants The Center s operations costs are paid for by the MOSA depending on availability of funds The center has received donation
103. t 1 565 00 565 00 ME0073 Sphygmomanometer 1 50 00 50 00 MF0020 SS Treatment and dressing cart 1 240 00 240 00 MF0011 Trolley Soiled Linen Single with Lid 1 170 00 170 00 MEO0021 X Ray Viewer Single 1 130 00 130 00 MEO700 Patient scale with rod 1 250 00 250 00 TOTAL 3 500 00 List ME 06 Immediate Emergency Response Care Pack ITEM ME3535 Description Quantity CPR and Airway Module CPR Faceshield 1 Pocket Style CPR Mask 1 Berman Oral Airway Set 1 Disposable Bag Valve Mask Adult 2 Disposable Bag Valve Mask Pediatric 1 Manual Suction Unit 1 Medical Instruments Tools 2 7 L Medical oxygen cylinder including valve and regulator filled 1 Manual Blood Pressure Cuff and monitor adult 1 Stethoscope Dual head 1 Penlight Otoscope 1 Aluminum Penlight reusable 1 Flash light 1 Digital Hypo Hyper thermometer 85 110 degrees 1 Large EMT Shears 2 Small EMT Shears 2 Lister Bandage Scissors 1 Splinter Forceps w magnifier 1 Ring Cutter 1 Kelly Forceps 1 Eye Magnet Loop 1 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 41 of 127 List ME 06 Immediate Emergency Response Care Pack cont Description Quantity Brass Window Punch 1 Nursing Apron Organizer Pack 1 Infectious Control Nitrile Exam Gloves 100 Latex Exam Gloves 100 Antimicrobial Wipes 100 Mask Faceshield Combos 5 Spill Clean up Kit 1 Infectious Control Bags 5
104. t al Salam Hospital Qobaiyat 22 02 2012 D Al Makassed Hospital Beirut Meeting with Mrs Reem Rabah Head of Makassed Health Bureau E Al Hariri Foundation Dispensary in Al Bireh 7 03 2012 F Meeting with two Physicians from the region Dr Beri El Assaad and Dr Mostapha AI Ali 7 03 2012 6 EVIDENCE GATHERED FROM SITES AND MEETINGS 6 1 Wadi Khaled Western Cluster 6 1 1 Al Rama Dispensary e Privately owned center e Center consists of a ground level floor with 5 rooms A pharmacy a dental clinic a laboratory and 2 examination clinics e Services General Medicine Ob Gyn Dentistry Laboratory and Pediatrics e Claims to be a welfare center and charges basic fees for services 10000 L L for routine and Ob Gyn examination and 10000 to 20000 L L for Laboratory tests e Usually employs unlicensed in Lebanon Syrian doctors and medical staff Now being replaced by Local doctors due to the absence of the Syrian doctors because of ongoing crisis across the border e Distributes medications and drugs bought and or smuggled from Syria Events in Syria are preventing regular supply of these medications hence the stocks are being depleted and need to be replenished locally at higher prices e Medications are dispensed to patients without any prescription or doctor ordinance The pharmacy is managed by a Syrian pharmacist e Facilities are much below standard especially concerning the basic hygiene requirements The walls are cracked mold
105. t to be included Supplier to provide all MEP requirements and shop drawings prior to install To include SS enclosure and side access panels Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 96 of 127 To be delivered with all accessories necessary for normal and safe operation MEO0650 BENCHTOP AUTOCALVE 30 L Used for the sterilization of instruments to have the following features and specifications Bench mounted model Front loading Door locks during operations Will not open until chamber has cooled down and has depressurized Override device for safe door release Inner chamber constructed of high grade stainless steel Chamber volume approx 30 L Microprocessor controlled operations Built in water pump and steam generator Maximum Heater wattage 15 Kw Temperature range up to max 134 C Over temperature alarm and Cut off device Automatic drying cycle Digital or LCD display Integrated data printer Accepts wide range of racks and accessories Power supply 220 240V 50 Hz OE1700 WATER DI RO UNIT FOR STERILIZER USE Combined Reverse osmosis Deionization unit for automatic production of ultra pure water Capacity of 10 15 liters per hour Fully automatic system Wall hanged system One RO processing unit One Di processing unit with Di water dispenser 60 L tank with RO water dispenser Sequence as follows Feed water to RO unit RO to 60 L tank Tank to Di u
106. tant to impact e Dedicated patient set to ensure high accuracy in drug administration e Main and battery operation e LCD display for infusion parameters e Rate 1 999 ml hr in 1ml increments e Volume infused 0 9999ml e KVO off 5ml hr e Selectable occlusion pressure e Airin line detection e Free flow protection e Rate volume and volume time programming e Bolus capability 200ml hr e Secondary infusion capability e Battery life 8 hrs at 125ml hr when fully charged e Panel lock e rate cannot be changed in run mode e Alarms for e Low battery e open door e Malfunction e Upstream downstream occlusion e Airin line e Set miss loading or bad set e Power supply 220 240V 50 Hz Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 102 of 127 MEO101 SYRINGE PUMP Syringe pump for intravenous injection therapy to have the following features and specifications e Accuracy to be better than 2 e Universal pump to accommodate syringes from all major manufacturers e Membrane or soft touch control key pad e User friendly e Large LCD display of chosen parameters e Display of infusion rate infused volume volume remaining pressure level on bar graph and syringe size e Prime rate approx 100ml hr 500ml hr to a max of 2ml e Bolus rate up to 1200ml hr with a 50 ml syringe e Adjustable occlusion pressure approx 250 600mmHg e Infusion rate O 1ml to 600
107. th care centre the expert will diagnose the place where the centre is to be hosted and report on its viability as a suitable place from the health and technical aspects dentify together with the key stakeholders appropriate medical equipment needed dentify accompanying measures if deemed necessary for a coherent project Conduct technical feasibility studies for identified projects including justification and choice of equipment design performance and economic viability Elaborate the technical specifications and cost estimates for the identified equipment The expert will ensure to the maximum possible extent an active participation of the beneficiaries during the definition of the projects The elaboration of the technical options is to be based primarily on existing information and data as well as on experience gathered on similar projects supplementary data collection will be restricted to those to be obtained through interviews with key and resource persons through existing data collected during the CD component s diagnostic phase through existing studies of the same region if applicable complementary data collection such as socio economic surveys or similar are not foreseen the mission will base its findings on the data to be reasonably obtained within the limited time frame given 2 3 3 Expected Results The following results are expected from the mission The concerned Municipalities have a clear vision of the envi
108. thy diet with High Frequency of Diabetes excessive energy food intake like fats Cardio Vascular problems carbohydrates and sugars Respiratory and Cancer e Physical inactivity Chronic Diseases e Heavy tobacco use e Living conditions e Psychosocial Stress factors and genetic factors Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 24 of 127 CONDITION CAUSE EFFECT Gastric Intestinal Digestive Bad hygiene and sanitation Hand sanitation and baby bottle sterilization Waste and sewage pollutants contaminating water source underground Mainly due to unregulated digging of water wells and septic sewage tanks Also the proliferation of garbage and waste dumps on river banks and on road sides Bad food stuff and preparation Food poisoning Humid and wet climate Contact with infected people High levels of harmful microorganisms like E coli and Coliforms in water Main problems encountered are e Gastroenteritis and Dysentery mainly in children e Sometimes there are outbreaks of Typhoid e Food poisoning by salmonella and other microorganisms Renal Disorders Chronic diseases mainly diabetes and hypertension Urinary tract obstruction Untreated Calcareous Hard water quality to some extent Smoking and eating habits especially with obese people Traumatic injury Renal diseases ranging from kidney stones to total ren
109. tic swivel castors of 50 mm diameter Table top 700 x 500 mm Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 125 of 127 MFO080 I V STAND MOBILE Constructed from high quality and durable SS Shaft mounted on 5 star castor pedestal frame 2 hooks model height adjustable Swivel castors to be electrically conductive MF0901 MANUAL OB GYN EXAMINATION TABLE To have the following features and specifications Three sectioned Heavy duty constructed examination table Tubular steel frame chrome plated or with epoxy finish Back rest adjustable by means of tooth rack or other suitable mechanism Upholstered with washable vinyl cover Built in examination paper roll holder at head of table Fold down and removable leg section Two height adjustable leg supports with positioning clamps Comes with compatible SS collector bowl on swinging support and retractable beneath the table surface Dimensions approx 190 x 65 x 80 cm LxWxH MF0021 KICK BUCKET To have the following features and specifications Made from durable SS Removable seamless bucket pail with handle Carriage ring mounted on four anti static swivel castors Bucket capacity approx 10 L Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 126 of 127 REFERENCES e Oxford American Handbook of Clinical Medicine John A Flynn 2007 e The Alma Ata International Confe
110. tion measures will help improve health conditions in the area e Provide more training to local healthcare workers to better serve the region e He identifies the most occurring diseases and health conditions as follows o Infectious diseases due to severe pollution of the water sources and bad sanitation Gastric and abdominal disorders Birthing Dermatological disorders Chronic diseases o And Respiratory diseases e For him the priority is to address the pollution problems and increase health awareness especially among women O OO 0 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 23 of 127 7 HEALTH SITUATION AND INDICATORS Wadi Khaled except for the presence of one acceptable Primary Healthcare Center The Makssed PHC in Al Hishi medical services are much below standard in terms of essential primary care To better address the needs in terms of medical equipment needed to complement what is already available we relied on site visits to evaluate the condition of the healthcare buildings and the medical equipment used We also used the information obtained by the local healthcare providers and from feedback from the Akkar area hospitals treating patients from the valley The following table shows the cause and effect of the most common medical conditions in this rural region CONDITION CAUSE EFFECT e Use of low quality Chinese motorbikes Road accidents ranging from
111. tiste Ole izloge 5 cd Clinical psychologist Psychologue clinicien Logo i Lad Chronic diseases Maladies chroniques bale o3 el Diabetes Diab tes c 0S a0 o2 A Trauma Traumatologie dale lcaldla s bu s my holes aU Hypertension Hypertension art rielle eval ex UE oa Hematology H matologie eur sexJleUgE Bacteriology Bact riologies e dae Jide Microbiology Microbiologie 8 eg edlel zdIl ade Immunology Immunologie 5e lad eg Biochemistry Biochimie e ele dd Analyzer Analyseur gle eee Crash cart Chariot d urgences 8 Sat SI 5l sb GE Patient stretcher Brancard malade G49 d r IV stand Porte s rum d cal aUelc Syringe pump Pousse seringues Gl oM OG jh amp Infusion pump Pompe a perfusion Compte goutes c dos Slee Autoclave Sterilizer Autoclave St rilisateur Je tb dS x Washer disinfector Laveur D sinfecteur 3 ale 5 sull x slc igre Slee Ultrasonic washer D graisseur ultrasonique Baral le susto Water purification system Systeme d puration des eaux lsd Jo do xs jlog Coagulation analyzer homeostasis Analyseur de coagulation d h mostase ext oed Semiautomatic Semi automatique sida gl ei Biological safety cabinet Poste de s curit microbiologique Sg s slap Awe sis Wg di Microscope Microscope Yee Incubator Incubateur Be Swale Tympanometer Tympanom tre odil dS Gag sje g Audiometer Audiom tre Feed oac g
112. trap Percussion Hammer Measuring Tap 2M Steel Rule 30cm Tuning Forks Set of 4 Pinwheel Penlight Tympanic digital thermometer in C To be delivered with good quality carrying bag MEO701 PEDIATRIC SCALE e Digital scale e With clear LCD display e Measurements in Kg and Pounds e Suitable for infants and toddlers weighing e Capacity up to 50 Kg MEO050 TRAUMA STRETCHER To have the following features and specifications e Full length radiolucent sleep surface e with integral restraint holders and transport handles e 12cm mattress pad with durable and washable cover e Large conductive casters e Stainless steel collapsible side rails e SSIV pole e Minimum 4 infusion support sockets e Storage basket Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 107 of 127 e Full perimeter bumper system e Quick activated trendelenburg reverse trendelenburg e drainage bag holders e Hydraulic hi lo foot control on both sides e Hydraulic height adjustment approx 60 to 100cm e Head and foot pan covers e Cantilever arm design mechanism with central brake and steering at the head and foot end e Oxygen tank holder with protective skid plate e Large patient weight capacity Approximate Dimensions Sleep surface 70cm x 200cm Overall length 215cm Each stretcher to include the following attachments e Oxygen tank x1 size F and holder e Arm b
113. try of Public health who gave its management to the Makassed Welfare Organization Despite being well managed by both and energetic director and by the Makassed organization the center has a monthly loss of approximately 14 000 00 yet it continues to provide valuable health services to the community and today to the Syrian refugees fleeing the strife in their country 2000 cases treated since March 2011 Normally at least 5096 of the local inhabitants come to benefit from this PHC s health services On an ordinary day they open 7 7 they would serve 60 patients per day and up to 150 on special occasions Most services are free once the patient registers at the center with an initial fee of L L 18 000 00 Medications are procured from the YMCA and the IMC and are charged a basic fee of L L 2 000 00 The Makassed also supplies them with medication not available from the NGOs these are sold at cost prices The Center maintains a computerized patient records system that is updated regularly It is relatively well equipped with A basic laboratory dental clinic routine X ray machine Film developing Ob Gyn clinic and services including normal delivery General medicine Pediatrics Cardiology Gastroenterology Ophthalmology ENT and recently Psychiatry The originally designated Emergency room area was never equipped and operated and now is used as a meeting room The center employs local doctors and staff Most doctors graduated from Russia
114. tural drawings and present his shop drawings with all the necessary required pre installation civil electric medical gas and electromechanical works The Supplier should be responsible to connecting his equipment to the closest services outlets as available in the Hospital Any works required by these connections should be included in the price of the equipment Upon termination and acceptance of any of his works the supplier should be responsible for restoring and properly finishing the Site paint plaster tiling etc In case old or surplus equipment belonging to the Hospital are present on the Site the supplier should be responsible where required for uninstalling this equipment packing them appropriately against humidity temperature and shock and storing them in a storage place provided by the Hospital This task should be coordinated with the Hospital administration The successful bidder should submit shop drawings for all items with samples of material for Consultant approval TECHNICAL SPECIFICATIONS ME2022 PORTABLE TRANSPORT VENTILATOR Transport ventilator designed to replace manual ventilation in an emergency or transport situation inside and outside the hospital to have the following features and specifications e Small and lightweight e Easily mounted e Microprocessor controlled e Volume ventilator e Modes of Operation Control Mode Assist Control Mode Pressure support and flow triggering a
115. ularly and kept safe for easy retrieval Today s information technology advances allow for greater data manipulation and safe storage This collected data can serve as indicators of the health situation of the TA e Invest in women education particularly in health and hygiene This measure of empowering local women can have a very positive impact on the community health service in a number of ways e They are the household caretakers and have influence in the decision making e Training women to become both care givers and health educators e Improving their own health also improves that of their families e Raisestheir self esteem by placing them in positions of responsibility The issue of sustainability is principal to ensure that the center will be able to function even after benefactors funding has stopped The caretakers must elaborate strategies that will be in form of partnerships with the local communities welfare organizations NGOs foreign donations or help packages and when possible governmental assistance by concerned ministries Charging basic fees for services must be carefully planned and implemented to avoid alienation of the poor Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 29 of 127 Many factors affect the quality and efficiency of primary health care services The main ones are e Shortage of funds needed to buy equipment supplies and make improvements in existing facilitie
116. under the grant equipment can be installed This can be time e With the supply of well equipped consuming The facility also lacks a ramp for ambulances a greater number of people disabled people accessibility which needs to can be reached for health care be constructed e AkHishi PHC owns a mobile dispensary and e Al Amayer also relies principally on funding is getting a brand new Ambulance from AI and supply of drugs and medical supplies Makassed Foundation from the MOSA The frequency of these e Both are strategically located and if they supplies is not regular and most of the time are adequately equipped they can better they receive medications that do not serve the primary healthcare needs of this respond to the real needs of the population TA e Have 2 well equipped PHCs e Financial sustainability questionable without e Serve the community of the 2 clusters with government and NGO support better primary care e Local population ability and willingness to e Pilot project that can bring on other pay basic fees for services contributions if successful e Bypassing of the PHC system e Project involves community contribution a e Crisis in Syria still escalating more refugees step forward in community involvement are arriving adding to the burden e New equipment involves new training for e Migration of educated and skilled local health workers youth e New technologies could attract or e Ability to recruit and retain the services of
117. vage et de d sinfection sacs dec iy Packing and Assembly room Salle d emballage et de confection c Es Jom Sterilization room Salle de St rilisation e Gg E Eye examination clinic Clinique d ophtalmologie Ost Jah ita ENT clinic Cabinet ORL Bears OF ci Gb sale Mental Health clinic Cabinet sant mentale p He Ode code Mammography Mammographie cox so Panoramic x ray imaging Imagerie panoramique rayons X BEN dca y soa Pharmacy Pharmacie Bed Phlebotomy room Salle de pr l vement sanguin ad Ste SE Defibrillator D fibrillateur able is ed ane lec ECG Diagnostic ECG de diagnostique I GE LES c Stress Test unit Unite d preuve d effort avec ECG UB Bccre r0 Siar ile General Practitioner M decin G n raliste Bale broa da Cardiologist Cardiologue didla jel cada Pulmonologist Pneumologue l ouem cada Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 5 of 127 ENGLISH FRANCAIS SHE Description Description C s Pediatrician P diatre Juby cd Gynecologist Obstetrician Gyn cologue et obst tricien YQ sea ts load da Ophthalmologist Ophtalmologue Os cda ENT doctor M decin en ORL 8 coc o3 c i eda Psychiatrist Psychiatre Quia da Urologist Urologue 8 sad se cas Gastroenterologist Gastroent rologue goce Sieg eda Family physician M decin de famille 8 gla da Dentist Dental surgeon Dentiste Chirurgien den
118. vere pollution of the water sources and bad sanitation Gastric and abdominal disorders Dermatological disorders Neurological problems mainly due to trauma Chronic diseases Respiratory diseases o And Allergies related disorders Disabled people are cared for by Arc En Ciel out of Halba No special care for the Elderly they are treated as normal adult patients For him the priority is to address the pollution problem caused by waste water and garbage littering the area They are the primary cause of serious health problems and the high incidence of the Rotavirus oO0O000 0 Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 22 of 127 6 3 7 Meeting with Dr Mostapha AI Ali e A practicing physician in Wadi Khaled e Has similar concerns to those identified by the Municipality chiefs Stakeholders and Mukhtars e Thinks that the Al Amayer MOSA social services center is inefficient today could be strengthened because of its central position in Wadi Khaled region but prefers that the Al Hishi Makassed PHC is better fit to serve the primary health needs of the area and should be improved e He thinks that improving the infrastructure Water electricity public works and sanitation can help alleviate some of the burdens of the local population e He strongly believes that women are the key to successful primary health since she is the household main caretaker Educating them in preventive and sanita
119. with their auxiliary facilities Clean and dirty utility flash sterilization Specialized care should be referred to close by hospitals able to cope with the demand The center in collaboration with Al Makassed and Social groups holds regular health awareness sessions to educate the community 2 Our second choice despite the terrible condition of parts of the building is the Al Amayer Ministry of Social Affairs Development Services center The main reason for our choice is that one of the conditions of granting the funds would be to have an actual facility to equip Other reasons include its strategic location central to most villages in the eastern cluster and the nice enclave in which the center stands You will see from the photographs taken during the site visits the awful condition the building is in despite efforts from both the director and his staff to do the best with what little they have Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 34 of 127 Surprisingly some of the rooms especially the ones used as clinics are slightly in better shape than the remainder of the building The building was built and inaugurated in 1966 Since then this building was neglected until recently when an attempt at halting water leaks through the roof has not worked The waterproofing project was funded S 16 000 00 and contracted to a local engineer by the MOSA At the time of our visit and following 2 days of
120. without any protections minor to major injuries e Use of badly maintained old cars with used leading to fatalities up tires Adding burden on local e Dreadful road conditions without night healthcare facilities with lighting scarce resources unable to Trauma f e Total disregard to safety regulation speed cope with such cases and absence of law enforcement Tough logistics in e Gunshot wounds during hunting or transporting casualties to smuggling nearby hospitals in Qobaiyat e Work and home related accidents 25 km and Halba 40 km away High incidence of respiratory e Indoors smoking by adults and diseases mainly with teenagers or exposure to heavy children amounts of secondhand smoke and Bronchitis viral and bacterial pollution origins Bronchiolitis viral origin most common in e Exposure to certain gases or fumes with a children during winter and inadequate ventilation early lt olinel and Preumonis Respiratory e High humidity climate VER Rudi ve CIEE re d ki bacterial origin can be fatal qemen ary Fa ing Sobia and cooking Chronic Obstructive diseases Methods using diesel fuel wood and sh i Chronic Bronchitis Asthma nowadays used rubber tires and Emphysema e Lack of health hygiene and preventive i Require prompt medical care methods education and after care management e Exposure to the elements without proper insulation or clothing e Eating habits including unheal
121. y and there are traces of fungus growth e In some parts of the centers there is evidence of rodent infestation presence of droppings on some of the medical equipment this is probably due to the presence of garbage dumps all around the center e The majority of the equipment is old and in bad shape signs of rust and heavy dust build up Initial feasibility study for the extension of health services in Wadi Khaled clusters Page 16 of 127 e Dental chair is leaking and is practically unusable e Autoclaves are rusty e Lab is very basic with heavily abused equipment and dirty e Number of patients per day 30 up to 50 more when new supplies of drugs are available e Needs o Renovation of facility o Procurement of Panoramic X ray o Portable Ultrasound unit o New Lab equipment o Refrigerator for Pharmacy See Appendix 1 for photographs of center 6 1 2 Wadi Khaled Primary Healthcare Center a k a Al Hishi Makassed PHC e Built in 2003 by local initiative with the help of USAID and the MOPH e Owned by MOPH and managed in collaboration with Al Makassed Welfare Organization Beirut e Charges basic fees for services e Center consists of a three stories building Basement Ground Floor and First Floor e Center Managed by Mr Khaled Moustafa an ex school principal e M Building in relatively good shape and is well maintained despite minor problems e Overall hygiene conditions are passable and there can be room for improve
122. yzer e Coagulation tests to monitor the effects of drugs such as heparin oral anticoagulants and thrombolytic and antiplatelet agents as well as the effects of blood component therapy e It should have the facility to store at least 4 reagents on board e t should do automatic mixing of the cuvette after the addition of the reagent with automatic sensing of the reagent addition e It should be able to store standard curve with maximum points in it memory e The analyzer should have a built in display and a built in graphic printer e RS232connection e Automatically calculates results related to the stored calibration curves with the corresponding units activity and international normalized ratio INR e Power supply 220 240V 50 Hz LBO105 SPECTROPHOTOMETER For various routine clinical tests to have the following features and specifications e Bandwidth nominal 5 nm e Wavelength range 300 1000 nm approx e Wavelength accuracy 2 nm e Scanning wavelength resolution 2 nm e Photometric accuracy 1 at 1A e Sample compartment with cell holder accommodating 6 positions e Compartment temperature range 15 50 9 C e Automatic wavelength setting e Automatic filter selection e Reads Absorbency transmission factor values and concentration e Controlled by built in microprocessor e Data input via integrated keyboard e Large LCD display e RS 232Cinterface and port for printer Initial feasibility study

Projet d`Appui au Développement Local dans le Nord

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Projet d`Appui au D&eacute;veloppement Local dans le Nord

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Projet d`Appui au Développement Local dans le Nord